No abstract available.
Risk Factors*

Parosteal lipoma is a rare and generally asymptomatic benign tumor of mature adipose tissue that is located in direct apposition to the external surface of the bone. These tumors are occasionally associated with reactive changes in the underlying bone. The reactive bone formation is generally restricted to the base of the tumor, that is, near the periosteum. We recently experienced a case of parosteal lipoma in the proximal femur, which displayed exuberant bone and cartilage formation, and this led us to a misdiagnosis of chondroblastic osteosarcoma on the initial biopsy. We report here on this case with a special emphasis on making the differential diagnosis from osteosarcoma.
Adipose Tissue ; Biopsy ; Cartilage ; Chondrocytes ; Diagnosis, Differential ; Diagnostic Errors ; Femur* ; Lipoma* ; Osteogenesis ; Osteosarcoma ; Osteosarcoma, Juxtacortical ; Periosteum

BACKGROUND: To describe factors affecting the prognosis after operation for recurrent intermittent exotropia (X[T]) in children. METHODS: Clinical records of 50 patients who underwent operation for recurrent X(T) by a single surgeon were reviewed. The age at diagnosis of X(T), and first and second operations, deviation angle at distance and near, surgical method, concurrent vertical strabismus, stereoacuity, and Worth's Four Dot (W4D) examination before reoperation were analyzed, along with the postoperative deviation angle. A successful surgical outcome was defined as orthophoria, esodeviation ≤ 5 prism diopters, or exodeviation ≤ 10 prism diopters at distance. RESULTS: Among the 50 recurrent exotropes who underwent surgery and were followed up for more than 1 year postoperatively, 13 showed recurrent exotropia and 1 showed consecutive esotropia. The mean age at reoperation was 8.49 ± 2.19 years, and the mean duration of postoperative follow-up was 27.78 ± 12.02 months. Good near fusion before reoperation was a significant factor in the success of surgery (P = 0.006). Smaller postoperative deviation angle measured immediately and 2 months after surgery were related to smaller final deviation angle (P = 0.027 and P = 0.022, respectively). CONCLUSION: Peripheral suppression lowers the success rate of operation for recurrent X(T) in children. Overcorrection rather than orthotropia should be the target of immediate postoperative deviation angle. Peripheral suppression status and immediate and 2-month postoperative deviation angle may be important clues for predicting the final result of operation for recurrent X(T).
Child ; Diagnosis ; Esotropia ; Exotropia ; Follow-Up Studies ; Humans ; Methods ; Prognosis ; Reoperation ; Strabismus

Post-transplant lymphoproliferative disorder (PTLD) following solid organ transplantation is an important form of post-transplant malignancy. PTLD is typically associated with Epstein-Barr virus (EBV) and occurs in the setting of immunosuppression resulting in a deficiency of EBV-specific cytotoxic T lymphocytes. PTLD encompasses heterogeneous lymphoproliferative diseases, from polyclonal proliferation resembling infectious mononucleosis to aggressive monomorphic proliferation such as diffuse large B-cell lymphoma. Clinically, PTLD is usually manifested as lymph nodal mass or extranodal mass of solid organs such as liver, transplanted kidney, tonsil, bone marrow or spleen. The authors experienced very rare case of PTLD manifested as a single mass in a native kidney. According to a review of the literature, this is a rare case of PTLD which developed in a native kidney after kidney transplantation. Initially under the impression of renal cell carcinoma, unilateral nephrectomy of the native kidney had performed, and after confirmed as PTLD by histologic diagnosis the patient had treated with reduction of immunosuppressants and chemotheraphy for PTLD, and eventually has got in complete remission.
Bone Marrow ; Carcinoma, Renal Cell ; Herpesvirus 4, Human ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Infectious Mononucleosis ; Kidney ; Kidney Transplantation ; Liver ; Lymphoma, B-Cell ; Lymphoproliferative Disorders ; Nephrectomy ; Organ Transplantation ; Palatine Tonsil ; Spleen ; T-Lymphocytes, Cytotoxic ; Transplants

Gastric metastasis from breast cancer is rare and only six cases have been reported in Korea. Colon metastasis is more rare than gastric metastasis. We report a 63-year-old woman with gastric and colon metastases of invasive lobular carcinoma of breast. She was diagnosed as right breast cancer, received right modified radical mastectomy 10 years ago and has been treated with chemotherapy and hormone therapy. Investigating for melena and a small caliber of stool, we found gastric and colon metastases. The diagnosis of metastatic breast cancer was made through gross pathologic and immunohistochemistry staining. We report a case with gastric and colon metastases from breast cancer and a review of the associated six case reports in Korea.
Breast ; Breast Neoplasms* ; Carcinoma, Lobular ; Colon* ; Diagnosis ; Drug Therapy ; Female ; Humans ; Immunohistochemistry ; Korea ; Mastectomy, Modified Radical ; Melena ; Middle Aged ; Neoplasm Metastasis* ; Stomach*

A seventyone-year-old male presented with sudden epigastric pain followed by jaundice and intermittent right upper abdominal pain. He was diagnosed as hepatocellular carcinoma 7 years ago, and has been treated with transarterial chemoembolization, percuaneous ethanol injection and segmentectomy. On admission, the level of serum bilirubin, amylase and lipase were 8.7 mg/dL, 560 IU/L, and 13,297 IU/L, respectively. Stool occult blood test was positive. Abdominal computed tomography revealed newly-appeared intraductal soft tissue mass with ductal dilatation. Endoscopic retrograde cholangiography demonstrated filling defects in the common hepatic and distal common bile duct (CBD). Endoscopic sphincterotomy was performed and the clots in the distal CBD were removed. An intraductal stent was inserted at the common hepatic duct. The obstructive jaundice and pancreatitis were resolved. Our case suggests that intraductal hepatocellular carcinoma may induce hemobilia as a possible cause of acute pancreatitis.
Abdominal Pain ; Amylases ; Bilirubin ; Carcinoma, Hepatocellular* ; Cholangiography ; Common Bile Duct ; Dilatation ; Ethanol ; Hemobilia* ; Hepatic Duct, Common ; Humans ; Jaundice ; Jaundice, Obstructive ; Lipase ; Male ; Mastectomy, Segmental ; Occult Blood ; Pancreatitis ; Sphincterotomy, Endoscopic ; Stents

BACKGROUND: Remifentanil infusion is commonly used for general anesthesia but reflex cough can occur after an intravenous (IV) infusion. This study was designed to examine the effect of IV-dexamethasone on remifentanil-induced cough (RIC). METHODS: One hundred thirty patients scheduled for elective surgery were randomly assigned into two groups that received by either 2 ml of IV 0.9% saline (Group C, n = 68) or 10 mg of dexamethasone (Group D, n = 62) 5 min before administration of remifentanil at a target effect-site concentration of 5 ng/ml. The incidence and severity of coughs of each patient were recorded. RESULTS: The overall incidence of cough was 6.5% (4/62 patients) in Group D and 26.5% (18/68 patients) in the Group C (P = 0.002). The severity of cough observed was significantly different by dexamethasone pretreatment (P = 0.02) but there were no significant hemodynamic changes. CONCLUSIONS: Pretreatment with dexamethasone after IV administration was effective in suppressing the reflex cough induced by remifentanil infusion.
Anesthesia, General ; Cough ; Dexamethasone ; Hemodynamics ; Humans ; Incidence ; Piperidines ; Reflex

PURPOSE: Pseudomembranous colitis (PMC) occurs rarely in children, but its incidences are increasing due to frequent antibiotic use. We investigated the incidence and clinical characteristics of PMC accompanied by bacterial enteritis-like symptoms in children. METHODS: Between November 2003 and July 2007 at the Department of Pediatrics, Dongsan Medical Center, we analyzed the medical records of consecutive patients who received antibiotics in the past 1 month, developed bacterial enteritis-like symptoms, and were diagnosed with PMC based on sigmoidoscopy examination and histological findings. RESULTS: Among 22 patients who underwent sigmoidoscopy and biopsy examinations, 11 (50%) were diagnosed with PMC. These 11 patients were aged 2 months-12 years, among whom 5 patients (45.5%) were less than 1 year old. The clinical symptoms were bloody diarrhea (28.6%), abdominal pain or colic (28.6%), watery or mucoid diarrhea (23.8%), vomiting (9.5%), and fever (9.5%). The antibiotics used were penicillins (55.6%), macrolides (27.8%), cephalosporins (11.1%), and aminoglycosides (5.6%). The period of antibiotic use was 3-14 days. The interval between the initial antibiotic exposure and the onset of symptoms was 5-21 days. The results of stool examination of all patients were negative for Clostridium difficile toxin A. Patient distribution according to the degree of PMC was as follows: grade I, 18.2% (2 cases); grade II, 27.3% (3); grade III, 36.4% (4); and grade IV, 18.2% (2). PMC did not recur in any case. CONCLUSION: PMC is not a rare disease in children. If pediatric patients receiving antibiotics manifest symptoms like bacterial enteritis, PMC should be suspected. Endoscopy and biopsy should be applied as aggressive diagnostic approaches to detect this condition.
Abdominal Pain ; Aged ; Aminoglycosides ; Anti-Bacterial Agents ; Bacterial Toxins ; Biopsy ; Cephalosporins ; Child ; Clostridium difficile ; Colic ; Diarrhea ; Endoscopy ; Enteritis ; Enterocolitis, Pseudomembranous ; Enterotoxins ; Fever ; Humans ; Incidence ; Korea ; Macrolides ; Medical Records ; Pediatrics ; Penicillins ; Rare Diseases ; Sigmoidoscopy ; Vomiting

PURPOSE: To describe the clinical course of congenital aniridia and to evaluate prognostic factors for visual outcome after long-term follow-up. METHODS: The medical records of 120 eyes from 60 patients with congenital aniridia were retrospectively reviewed. The prevalence and clinical course of ophthalmic characteristics, systemic disease, refractive errors, and visual acuity were assessed. Prognostic factors for final visual outcomes were analyzed. RESULTS: Aniridic keratopathy developed in 82 (69%) of 119 eyes. Macular hypoplasia was observed in 70 eyes of 35 patients (91%). Cataract was observed in 63 of 120 eyes (53%). Nystagmus was present in 41 patients (68% of 60 patients) at the initial visit but decreased in five patients (8% of 60 patients). Ocular hypertension was detected in 19 eyes (20% of 93 eyes), six (32% of 19 eyes) of which developed secondarily after cataract surgery. The mean changes in spherical equivalent and astigmatism during the follow-up period were -1.10 and 1.53 diopter, respectively. The mean final visual acuity was 1.028 logarithm of minimal angle of resolution. Nystagmus and ocular hypertension were identified as prognostic factors for poor visual outcome. CONCLUSIONS: Identification of nystagmus and ocular hypertension was important to predict final visual outcome. Based on the high rate of secondary ocular hypertension after cataract surgery, careful management is needed.
Adolescent ; Adult ; Aniridia/*diagnosis/physiopathology ; Cataract/diagnosis ; Child ; Child, Preschool ; Corneal Diseases/diagnosis ; Eye Abnormalities/diagnosis ; Eye Diseases/*diagnosis/physiopathology ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Nystagmus, Pathologic/diagnosis ; Ocular Hypertension/diagnosis ; Prognosis ; Retina/abnormalities ; Retrospective Studies ; Visual Acuity/*physiology ; Young Adult

PURPOSE: To report clinical characteristics of optic neuritis (ON) in Koreans >50 years of age. METHODS: A retrospective chart review was performed on patients with ON between January 2000 and December 2009. We obtained the best-corrected visual acuity (BCVA), Goldmann perimetry, relative afferent pupillary defect (RAPD), and color function tests as well as brain magnetic resonance imaging (MRI) findings in patients who were in the acute stage of the disorder. RESULTS: Nine eyes in eight patients were included. The mean age of patients at presentation was 60.5 years (range, 53 to 71 years). Six patients were female, and two were male. There was one patient with bilateral ON. The mean BCVA at presentation was 20 / 400 (no light perception-20 / 70). Eight eyes (89%) complained of pain with eye movement. Six eyes (66%) had disc edema. Central scotoma was the most common field defect. All eyes had color abnormalities. Five eyes in four patients showed abnormalities of the involved optic nerves on MRI. The patients were followed for a mean of 11.3 months (range, 2 to 34 months). All of the patients recovered to a BCVA of 20 / 40 or better within 2 months. On the last follow-up, the mean BCVA was 20 / 20 (20 / 40 to 20 / 16). Four eyes showed remnant central scotoma. One eye had remnant RAPD, and two eyes had mild color abnormalities. CONCLUSIONS: Although ON is uncommon in elderly patients, it can develop in patients >50 years of age, and clinical features of optic neuritis in elderly patients are similar to those of younger patients.
Acute Disease ; Age Distribution ; Aged ; Asian Continental Ancestry Group/*statistics & numerical data ; Color Vision ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Optic Neuritis/*ethnology/*pathology ; Optic Neuropathy, Ischemic/ethnology/pathology ; Pupil Disorders/ethnology/pathology ; Republic of Korea/epidemiology ; Retrospective Studies ; Scotoma/ethnology/pathology ; Visual Acuity