PURPOSE: The purpose of this study was to evaluate the impact of the use of external radiation therapy (ERT) in terms of survival and compliance in patients with anaplastic thyroid carcinoma. MATERIALS AND METHODS: The medical records of 17 patients with anaplastic thyroid carcinoma treated with ERT between 1993 and 2002 were retrospectively reviewed. ERT was administered after surgery in 14 patients and after a biopsy in three patients. Among the 14 patients who had undergone surgery, nine underwent a curative resection and five underwent a palliative resection. Six patients had associated well-differentiated thyroid carcinomas and 14 patients were diagnosed with a tumor size exceeding 5 cm. The radiation dose ranged from 6~70 Gy (median dose, 37.5 Gy). Eleven patients completed the planned course of ERT, whereas six patients did not. The follow-up period ranged from 1~104 months (median, 5 months; mean, 20 months). RESULTS: Five patients started the ERT without the presence of a gross mass and all of the patients completed ERT without a re-growth of tumor. Twelve patients (four patients after a curative resection, five patients after a palliative resection and three patients after a biopsy) started ERT with a gross mass present and only six patients were able to complete the planned course of ERT. Among the six patients who completed ERT, two patients showed a marked regression of the tumor mass, whereas two patients showed slight regression and two patients showed no response. The median survival was five months (range, 1~104 months) and the mean survival was 21 months. The overall survival was 41% at 1-year, 24% at 2-years and 12% at 5-years. Significant prognostic factors included the number of primary tumors present, tumor size, whether surgery was performed and completion of ERT as planned. Long-term survivors showed a tendency of having smaller sized initial tumors and smaller sized pre-ERT tumors than the short-term survivors. CONCLUSION: This study suggests that patients with a small initial tumor (< or =5 cm), which was treated by surgery (curative resection or palliative resection) before ERT, and without rapid re-growth of the mass seen at the surgical site at the beginning of the ERT course, would be the best candidates for postoperative ERT. In contrast, patients with a large initial tumor (>5 cm) and did not undergo surgery before ERT or that rapid re-growth of the mass was observed at the surgical site are likely to have a short survival time, along with the interruption of ERT. In these cases, the role of ERT is very limited and the omission of ERT could be considered.
Biopsy

The number of women undergoing breast augmentation surgery with a prosthesis for cosmetic purposes or reconstruction after a mastectomy is steadily increasing.Hematoma is one of complications associated with breast augmentation surgery.It usually occurs early in the postoperative period. It rarely occurs late (after six months). However, chronic hematomas after prosthesis removal have not yet been reported in the radiological literature. We present a case of unilateral chronic organizing hematoma that developed late and grew persistently over long period after breast explantation, mimicking a soft tissue tumor of the chest wall clinically. Meanwhile, characteristic magnetic resonance imaging features of heterogeneous signal intensities on T1-weighted and T2-weighted images and dark signal intensity with a persistent enhancement of the peripheral wall of the lesion were found. These can be used for a differential diagnosis.

We report a case of laparoendoscopic single-site surgery (LESS) for a symptomatic left seminal vesicular cyst and ipsilateral renal agenesis. A 49-year-old man presented with a 1-year history of severe irritation upon voiding and intractable, recurrent hematospermia. A computed tomography scan showed a 68x41x38 mm sized left seminal vesicular cyst with ipsilateral renal agenesis. LESS was performed successfully to treat the seminal vesicle cyst. The total operative time was 125 minutes, and blood loss was minimal. The patient was discharged from the hospital on the second postoperative day.
Congenital Abnormalities ; Hemospermia ; Humans ; Kidney ; Kidney Diseases ; Laparoscopy ; Middle Aged ; Operative Time ; Seminal Vesicles ; Surgical Procedures, Minimally Invasive

There are no reports regarding pneumomediastinum caused by thoracic epidural block complications. We believe that it is possible to experience an occurrence of pneumomediastinum caused by air in the epidural space after performing a thoracic epidural block using the loss of resistance (LOR) technique with air. We report a witnessed case where pneumomediastinum appeared after a thoracic epidural block. Pneumorrrhachis, paravertebral muscle emphysema, and pneumomediastinum were diagnosed by Positron Emission Tomography-Computed Tomography. Although extremely rare, pneumomediastinum can be caused by an epidural block using LOR technique with air. In order to avoid the above danger, the use of saline or very minimal amount of air is required during a careful LOR technique.
Electrons ; Emphysema ; Epidural Space ; Injections, Epidural ; Mediastinal Emphysema ; Muscles ; Wit and Humor as Topic

PURPOSE: Leber's hereditary optic neuropathy (LHON) is caused by point mutations in mitochondrial DNA. The authors report a case of a middle-aged man with genetically confirmed LHON, combined with bilateral normal tension glaucoma (NTG). CASE SUMMARY: A 48-year-old man presented with complaints of decreased visual acuity in his left eye. His corrected visual acuity was 20/16 in the right eye and 20/63 in the left eye. The fundus photographs revealed a bilateral, superotemporal and inferotemporal retinal nerve fiber layer defect, corresponding to his visual field defect. The patient was diagnosed with bilateral NTG. After 2 months, the patient's corrected visual acuity in the left eye worsened to counting fingers and a central visual field defect was noticed in the Humphrey visual field test in the left eye. At 4 months after the initial visit, his corrected visual acuity in the right eye became 20/100, and the Goldmann visual field test demonstrated cecocentral scotoma. The fundus photographs showed a papillomacular bundle defect in his left eye. At 7 months after the initial visit, his visual acuity was hand movement in the right eye and a finger count in the left eye. A series of LHON gene mutation tests revealed a 11778 mitochondrial gene mutation, and the patient was diagnosed with LHON. CONCLUSIONS: Proper diagnosis of LHON might be disturbed by atypical manifestation of other optic nerve diseases, such as glaucoma. Therefore, suspecting LHON and checking for gene mutations as part of the work-up in patients with bilateral optic neuropathy is critical.
DNA, Mitochondrial ; Eye ; Fingers ; Genes, Mitochondrial ; Glaucoma ; Hand ; Humans ; Low Tension Glaucoma ; Middle Aged ; Nerve Fibers ; Optic Atrophy, Hereditary, Leber ; Optic Nerve Diseases ; Point Mutation ; Retinaldehyde ; Scotoma ; Visual Acuity ; Visual Field Tests ; Visual Fields

PURPOSE: To report a case of bilateral Coats' disease. CASE SUMMARY: A 19-month-old boy presented with esodeviation of his eyes, which started 5 months prior. A fundus exam showed total bullous exudative retinal detachment with retinal vascular telangiectasia in the right eye and localized exudative retinal detachment with vascular telangiectasia at the inferior periphery in the right eye. Fluorescein angiogram of the left eye showed retinal telangiectatic vessels, avascular area and fluorescein leakeage from telangiectatic vessels. The patient received external drainage of subretinal fluid and intravitreal air injection of the right eye and Argon LASER photocoagulation and cryotheraphy of the left eye. A cytologic exam of the subretinal fluid drained from the right eye showed no malignant cells. Forty-four months after the operation, his best corrected visual acuity was no light perception in the right eye and 0.4 in the left eye. Both fundi were flat and stable. No complications, such as glaucoma, recurred retinal detachment, or pain, occurred. CONCLUSIONS: Coats' disease rarely occurs bilaterally and can be involved asymmetrically. The disease presents more severely when bilateral and can progress after long-term observation. Proper treatment and long-term follow-up of both eyes are necessary to prevent visual loss and preserve eyes.
Argon ; Drainage ; Esotropia ; Eye ; Fluorescein ; Follow-Up Studies ; Glaucoma ; Humans ; Infant ; Light ; Light Coagulation ; Retinal Detachment ; Retinaldehyde ; Subretinal Fluid ; Telangiectasis ; Visual Acuity

PURPOSE: To evaluate the changes of refraction and anterior chamber depth in pseudophakia with the single-piece intraocular lenses (IOLs) and the three-piece IOLs after cataract surgery. METHODS: This single-center prospective study comprised of 34 eyes in 27 cataract patients who underwent cataract surgery. Eighteen eyes of seventeen patients received the single-piece IOLs, and sixteen eyes of fifteen patients received the three-piece IOLs. At one day, one week, and six months after cataract surgery, the refraction, corneal thickness, and anterior chamber depth of both groups were measured and analyzed. RESULTS: The refraction after cataract surgery was not significantly different from the preoperative predictive refraction in both IOL groups. The corneal thickness increased significantly as compared with preoperative value at operative day in both groups. However, after 1 week postoperatively, there was no statistically significant difference between the preoperative and the postoperative corneal thickness. The anterior chamber depth of the single-piece IOL group decreased constantly, and the decrease was statistically significant at 6 months postoperatively. In the three-piece group the anterior chamber depth was stationary and there was no statistically significant change from 1 day postoperatively. CONCLUSIONS: There was remarkable difference of the changes of anterior chamber depth after cataract surgery between the single-piece and the three-piece IOL groups. In particular, the relative decrease of anterior chamber depth of the single-piece IOL group would affect the postoperative refractive errors.
Anterior Chamber* ; Cataract ; Humans ; Lenses, Intraocular* ; Prospective Studies ; Pseudophakia ; Refractive Errors

BACKGROUND: There are numerous therapeutic options for molluscum contagiosum (MC) and these may be broadly subdivided into surgical procedures (curettage, squezzing), chemical application (silver nitrate, cantharidin) and immunological therapies (imiquimod). However, in young children it is quite difficult to treat the condition due to pain associated with these procedures. Therefore, physicians need to consider more tolerable treatment options in pediatric patients. OBJECTIVE: We evaluated 20 children with MC for clinical effectiveness and side effects of imiquimod application. METHODS: Twenty children with MC were asked to apply 5% imiquimod cream three times per week at nights every other day for between 8~12 weeks. RESULTS: Nine of the 20 patients (45%) achieved complete clearance after a mean treatment period of 6.9 weeks. Partial clearance was observed in 10 patients (50%) and no response in 1 patient (5%). No patients dropped out due to adverse effects. Twelve children (60%) reported erythema and five children (25%) reported itching. CONCLUSION: Therapy with imiquimod cream was found to be effective, safe and painless in the treatment of MC in children. However, large-scale, double-blind, controlled prospective studies are needed to confirm the effectivenss of Imiquimod cream.
Child* ; Erythema ; Humans ; Molluscum Contagiosum* ; Pruritus

PURPOSE: The etiology of chronic nonbacterial prostatitis is unclear but it appears to be either an infectious disease caused by yet unidentified pathogens or a noninfectious form of inflammation. But, recent data showed that the chronic nonbacterial prostatitis is developed from abnormalities in autoimmunity. We examined the serum CD4, CD8, CD4/CD8 and CD16 levels in patients with chronic nonbacterial prostatitis and normal volunteers, so we tried to reveal their differences in both two groups and the relationship of its pathogenesis. MATERIALS AND METHODS: Between Aug. 1996 and Nov. 1996, we examined the serum level of CD4, CD8 and CD16 in patient with chronic nonbacterial prostatitis(n=20) and in normal patients including volunteers(n=16). RESULTS: The results showed decreased CD4, and increased CD8 which lead to decreased CD4/CD8 ratio and normal CD16 levels. CONCLUSIONS: We believe that our experimental data would show changes of T-cell subclones in chronic nonbacterial prostatitis patients and suggest the basic data in understanding the etiology of chronic nonbacterial prostatitis.
Autoimmunity ; Communicable Diseases ; Healthy Volunteers ; Humans ; Inflammation ; Prostatitis* ; T-Lymphocytes*

Ectopic openings of the common bile duct into the duodenal bulb, which are associated with biliary tract disease or recurrent/refractory duodenal ulcers, are rare. We report three such cases, all of which were documented with gastroscope, and two of which were managed with endoscopic retrograde cholangiopancreatography (ERCP) via gastroscope. We suggest that ERCP can be performed with gastroscope, since it may offer a better working position in certain cases.
Bile Ducts* ; Bile* ; Biliary Tract Diseases ; Cholangiopancreatography, Endoscopic Retrograde* ; Common Bile Duct ; Duodenal Ulcer ; Gastroscopes* ; Humans