A hepatoblastoma is the most common liver tumor in children between 6 months to 3 years of age. It is a rare malignancy of the liver with an incidence of 0.7 to 1 case per 1 million children under 15 years of age in Western countries. Males are more affected. Patients usually have normal liver function test, but have high serum levels of alpha-fetoprotein (AFP), which is a sensitive diagnostic marker. They usually present with abdominal distension or an asymptomatic abdominal mass. Rarely, patients with a hepatoblastoma show an acute abdominal emergency which is not typical for the disease process. The management of a ruptured hepatocellular carcinoma provides guidance for diagnosis and treatment of a hepatoblastoma because the incidence of hepatoblastoma is low. We report a child who presented abdominal pain and distension with the diagnosis of a ruptured hepatoblastoma.
Abdomen, Acute* ; Abdominal Pain ; alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Child* ; Diagnosis ; Emergencies ; Hepatoblastoma* ; Humans ; Incidence ; Liver ; Liver Function Tests ; Male

Acute renal infarction is an uncommon disease which is often delayed or missed due to its rarity and unspecific clinical presentations. Most patients have an underlying disease or embolic event that can be detected easily by history and physical examination. The frequently noted symptoms include flank, abdominal, and back pain, as well as nausea. The pain is usually acute, severe, and sharp in nature without radiation. The most sensitive laboratory test is lactate dehydrogenase. Angiography, renal scintigraphy, IVP (intravenous pyelography), sonography and, CT (computed tomography) can be used in diagnosing renal infarction. However, CT is more preferred for the diagnosis of renal infarction because it has the advantages of easy accessability and noninvasiveness. Once diagnosed, conservative treatment with intra-arterial infusion of thrombolytics or heparin appears to be the most favorable modality. We report a 82-year-old male with asynchronous bilateral renal infarctions associated with atrial fibrillation and coronary artery disease. His clinical status improved during admission without any events.
Aged, 80 and over ; Angiography ; Atrial Fibrillation* ; Back Pain ; Coronary Artery Disease ; Diagnosis ; Heparin ; Humans ; Infarction* ; Infusions, Intra-Arterial ; Korea* ; L-Lactate Dehydrogenase ; Male ; Nausea ; Physical Examination ; Radionuclide Imaging

BACKGROUND/AIMS: Gastric variceal bleeding is a severe complication of cirrhosis, and it has a high mortality rate. This study was conducted to evaluate the efficacy of n-butyl-2-cyanoacrylate injection therapy for patients suffering with gastric variceal bleeding. METHODS: A total of 86 patients diagnosed with gastric variceal bleeding underwent endoscopic n-butyl-2-cyanoacrylate (Histoacryl(R)) injection therapy at our department between April, 2002 and July, 2005, with a mean follow-up period of 44 weeks (range: 2 to 136 weeks). The initial hemostasis rate and the rebleeding rate of endoscopic sclerotherapy were analyzed. Also, the cumulative survival rate was analyzed according to the status of hepatocellular carcinoma and hyponatremia, the MELD score, the Child-Pugh score and the amount of injected Histoacryl(R). RESULTS: The initial hemostasis rate of Histoacryl(R) injection therapy was 93% and the 1 month rebleeding rate was 16.1%. The total number of session for treating the initial hemostasis was 1.2+/-0.4 and the total volume of Histoacryl(R) was 2.7+/-1.2 mL. The cumulative rebleeding-free rates for the patients treated by the Histoacryl(R) injection method at 1 month, 12 months and 34 months period were 95.1%, 83.2% and 74%, respectively. The cumulative survival rates were 78.3% at 1 month, 61.9% at 12 months and 54.6% at 34 months, respectively. No thromboembolic phenomenon occurred. According to the Cox's proportional hazards analysis, only the MELD score (<15) was an independent predicting factor for survival of the patients with gastric variceal bleeding. CONCLUSIONS: Endoscopic sclerotherapy using n-butyl-2-cyanoacrylate was a safe and effective hemostatic method for patients with gastric variceal bleeding. Also, the MELD score (<15) contributed to predicting survival of the patients with gastric variceal bleeding.
Adult ; Aged ; Aged, 80 and over ; Enbucrilate/*analogs & derivatives/therapeutic use ; Esophageal and Gastric Varices/*therapy ; Female ; Gastrointestinal Hemorrhage/mortality/*therapy ; Hemostasis, Endoscopic ; Humans ; Male ; Middle Aged ; *Sclerotherapy ; Survival Rate ; Treatment Outcome

Afferent loop syndrome is an uncommon complication which occurs in patients with Billroth II partial gastrectomy. Clinically, the diagnosis of afferent loop syndrome may be difficult to establish and thus, depends on the finding of computed tomography, abdominal ultrasound, barium studies and hepatobiliary scan. When the diagnosis is made, most of the cases are treated by surgical operation. We present a case of 67-year-old male patient with afferent loop syndrome associated with acute pancreatitis which was treated by endoscopic drainage procedure using a nasogastric tube.
Acute Disease ; Afferent Loop Syndrome/*diagnosis/etiology/*surgery ; Aged ; Drainage ; Endoscopy, Gastrointestinal ; Gastroenterostomy ; Hernia ; Humans ; *Intubation, Gastrointestinal/instrumentation ; Male ; Pancreatitis/complications/diagnosis/surgery ; Tomography, X-Ray Computed

PURPOSE: Altered mental status (AMS) is a collective phrase that describes an undifferentiated assortment of disorders of mentation including impaired cognition, attention, awareness, and level of consciousness. Although AMS is a common chief complaint and a frequent issue in the emergency department (ED), the clinical surveys of AMS have not been conducted in Korea. We analyzed the AMS patients on the clinical basis. METHODS: From march 2002 to may 2002, we had enrolled prospectively 256 adult patients who visited the ED of Sanggye Paik Hospital because of AMS. The patients accompanied by AMS clinically were included, excluding patients caused by trauma, cerebrovascular accident with alert mentality. The clinical records were reviewed to analyze the clinical features of AMS, 9 months after discharge from ED. RESULTS: AMS was found in 256 patients which comprised the 2.2% of the ED patients during the test period, and 112 patients were admitted. The most commonly encountered mental status was drowsiness(36.3%), and the overall mortality rate 10.2%. The AMS was caused by neurogenic, metabolic, alcohol-related, psychogenic disorders in frequency accounting for most of AMS etiologies. CONCLUSION: This survey shows that the incidence of AMS is 2.2%, old age increases the rate of admission, and the common etiologies are neurogenic, metabolic, alcohol-related disorders. It seems prudent to approach the patients with AMS on the basis of etiologies and age.
Adult ; Alcohol-Related Disorders ; Cerebrovascular Trauma ; Cognition ; Consciousness ; Delirium ; Emergency Service, Hospital ; Humans ; Incidence ; Korea ; Mortality ; Prospective Studies ; Seizures

OBJECTIVE: To evaluate the safety and clinical efficacy of transcatheter uterine artery embolization (UAE) for post-myomectomy hemorrhage. MATERIALS AND METHODS: We identified eight female patients (age ranged from 29 to 51 years and with a median age of 37) in two regional hospitals who suffered from post-myomectomy hemorrhage requiring UAE during the time period from 2004 to 2012. A retrospective review of the patients' clinical data, uterine artery angiographic findings, embolization details, and clinical outcomes was conducted. RESULTS: The pelvic angiography findings were as follows: hypervascular staining without bleeding focus (n = 5); active contrast extravasation from the uterine artery (n = 2); and pseudoaneurysm in the uterus (n = 1). Gelatin sponge particle was used in bilateral uterine arteries of all eight patients, acting as an empirical or therapeutic embolization agent for the various angiographic findings. N-butyl-2-cyanoacrylate was administered to the target bleeding uterine arteries in the two patients with active contrast extravasation. Technical and clinical success were achieved in all patients (100%) with bleeding cessation and no further related surgical intervention or embolization procedure was required for hemorrhage control. Uterine artery dissection occurred in one patient as a minor complication. Normal menstrual cycles were restored in all patients. CONCLUSION: Uterine artery embolization is a safe, minimally invasive, and effective management option for controlling post-myomectomy hemorrhage without the need for hysterectomy.
Adult ; Female ; Humans ; Hysterectomy ; Leiomyoma/blood supply/*surgery ; Middle Aged ; Postoperative Hemorrhage/*therapy ; Retrospective Studies ; Treatment Outcome ; Uterine Artery Embolization/adverse effects/*methods ; Uterine Neoplasms/blood supply/*surgery ; Uterus/blood supply/surgery

BACKGROUND: Mad1 protein is known to repress Myc target genes and antagonize Myc function. We underwent this study to investigate the clinical implication of Mad1 expression in human breast cancer. MATERIALS AND METHODS: We performed immunohistochemical assay for Mad1 protein together with Myc in human brest cancer, along with tissues from normal and benign diseases. The data from protein assay were merged with clinical and biologic parameters of the patients. RESULTS: Of 66 patients with invasive ductal cancer, Mad1 expression was detected in 22(33.3%). Intensity and area of Mad1 expression significantly decreased in DCIS and invasive cancers while high levels of Mad1 expression were persistent in benign breast lesions. Mad1 expression was significantly reduced in poorly differentiated tumors(P<0.001). Expression of Mad1 was not associated with tumor size, lymph node status, and stage of the disease. We could not observe any correlation between S-phase and expression status of Myc or Mad1. Mad1 expression was closely linked to differentiation of the cancer cells and inversely correlated with Myc expression(P=0.042). In survival analysis, Mad1 possessed a prognostic significance to predict recurrence of the disease but not overall survival after CMF chemotherapy. CONCLUSIONS: In human breast cancer cells, expression of Mad1 seems to be downregulated while expression of Myc is amplified. Altered expression of Mad1 may play a role in malignant transformation of human mammary epithelial cells and represent an aggressive phenotype in human breast cancer.
Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Drug Therapy ; Epithelial Cells ; Humans* ; Lymph Nodes ; Phenotype ; Prognosis ; Recurrence

We report here on a rare case of papillary and follicular carcinoma of the thyroid gland that developed in a 31 years old woman who was previously diagnosed with Hashimoto's thyroiditis. Her chief complaint was a palpable neck mass. The antimicrosomal and antithyroglobulin antibody levels were elevated. Ultrasonography of the left thyroid gland revealed a 2.5x2.0 cm sized thyroid nodule. Fine needle aspiration biopsy of the thyroid nodule was done and this was diagnosed as Hashimoto's thyroiditis. There was no evidence of thyroid cancer. After 1 year, thyroid ultrasonography and biopsy were repeated for examining an enlarged thyroid nodule. Total thyroidectomy was then performed. The histopathologic examination revealed that the right and left thyroid glands were in accordance with the diagnosis of papillary and follicular cancer, respectively. Until now, no known case of simultaneous papillary and follicular carcinoma in Hashimoto's thyroiditis has been reported. This case suggests that adequate follow up for Hashimoto's thyroiditis patients with thyroid nodule may help the early detection and management of thyroid cancer.
Adult ; Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Papillary ; Diagnosis ; Female ; Humans ; Neck ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy ; Thyroiditis* ; Ultrasonography

BACKGROUND: In this report, we present the annual data of the intensive care unit (ICU) module of the Korean Nosocomial Infections Surveillance System (KONIS) from July 2009 through June 2010. METHODS: We performed a prospective surveillance of nosocomial urinary tract infections (UTIs), bloodstream infections (BSIs), and pneumonia (PNEU) at 116 ICUs in 63 hospitals by using KONIS. Nosocomial infection (NI) rates were calculated as the number of infections per 1,000 patient-days or device-days. RESULTS: We identified 3,965 NIs during the study period: 2,156 cases of UTIs (2,119 were urinary catheter-associated), 1,110 cases of BSIs (948 were central line-associated), and 699 cases of PNEU (410 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTIs) was 4.75 cases per 1,000 device-days (95% confidence interval, 4.55-4.95), and urinary catheter utilization ratio was 0.86 (range, 0.859-0.861). The rate of central line-associated BSIs was 3.28 (range, 3.07-3.49), and the utilization ratio was 0.56 (range, 0.559-0.561). The rate of ventilator-associated PNEUs (VAPs) was 1.95 (range, 1.77-2.15), and the utilization ratio was 0.41 (range, 0.409-0.411). Although ventilator utilization ratio was lower in the hospitals with 400-699 beds than in the hospitals with 700-899 beds and more than 900 beds, the rate of VAPs were higher in the hospitals with 400-699 beds than in hospitals with 700-899 beds and more than 900 beds. The incidence of infections due to imipenem-resistant Acinetobacter baumannii increased from 43.6% to 82.5% since July 2006. CONCLUSION: The risk of acquiring VAP and CAUTI is highest in the ICUs of hospitals with 400-699 beds than that in hospitals with more beds. Imipenem-resistant A. baumannii was identified as an emerging gram-negative pathogen of nosocomial infections.
Acinetobacter baumannii ; Cross Infection ; Incidence ; Critical Care ; Intensive Care Units ; Pneumonia ; Urinary Catheters ; Urinary Tract Infections ; Ventilators, Mechanical

A mushroom bezoar is an unusual type of bezoar and a rare cause of small bowel obstruction, with the only cases being previously described in the foreign literature. Common sites of obstruction are the gastric outlet, the terminal ileum as well as segments of pre-existing gastrointestinal stenosis of various etiologies. Predisposing factors include a high fiber intake, inadequate chewing, gastric hyposecretion and hypomotility, and a previous gastrectomy and vagotomy. Computed tomography has the capability of directly showing the bezoar and displaying the resulting small bowel obstruction. We report a case of incomplete small bowel obstruction in a 38-year-old woman, caused by a mushroom bezoar in the terminal ileum.
Adult ; Agaricales* ; Bezoars* ; Causality ; Constriction, Pathologic ; Female ; Gastrectomy ; Humans ; Ileum ; Mastication ; Vagotomy