No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*

A wide variety of cancers metastasize to the ovaries. In a majority of instances the primary site is the gastrointestinal tract, breast, or other gynecologic organs. The best known tumor of this type is signet-ring cell adenocarcinoma. The gallbladder and bile duct are rare sources of these metastases. The authors have had an experience of a case that was presented of Krukenberg tumor metastatic from the gallbladder and report the case with brief review of literature.
Adenocarcinoma ; Bile Ducts ; Breast ; Female ; Gallbladder* ; Gastrointestinal Tract ; Krukenberg Tumor* ; Neoplasm Metastasis* ; Ovary

In the present study, we investigated the differences in the levels of expression of virulence factors between blood isolates of Candida albicans and commensal strain isolated from the oral cavities of health volunteers, and correlations between virulence factors. Blood isolates of 33 and commenal isolates of 71 were characterized by putative virulence factors such as proteinase production (PROT), an ability to adhere to epithelial cells (ADH), cell surface hydrophobicity (CSH), phospholipase production (PLASE), and hyphal transition (GERM). In PROT, ADH, CSH, and PLASE, the means of expression of blood isolates were higher compared with those of commensal isolates, however statistical significance was only shown in CSH (p=0.036). On the contrary, mean expression of GERM of blood isolates was lower than that of commensal isolates. Of relationships between virulence factors, although a negative correlation of PROT with CSH was obtained, the correlation was relatively low (r=-0.316, p=0.001). These results suggest that higher expression of CSH is a more distinguishing character in virulent blood isolates of C. albicans and that the expression of virulence factors are independent.
Candida albicans* ; Candida* ; Epithelial Cells ; Healthy Volunteers* ; Hydrophobic and Hydrophilic Interactions ; Phospholipases ; Virulence Factors ; Virulence* ; Volunteers

Cerebral palsy is a non-progressive cerebral sensori-motor defect, acquired either prenatally or in an early life and evolves over the first few years. Until recently many people believed that asphyxia at birth was a major cause of cerebral palsy and that the prevention of asphyxia at birth by improving perinatal care would reduce the number of cerebral palsy children. However the incidence of cerebral palsy in children has remained steady or ever risen slightly. The real cause of cerebral palsy is still unbaron to us. This analysis was undertaken to determine the clinical features of cerebral palsy in Korea by the retrospective study of 98 children. Over a half of infants with cerebral palsy (64.2%) was recognized by parents before 1 year of corrected age, and their chief complaints were delayed developments or equinus foot deformities. The most common type of cerebral palsy was spastic type (64.2%) which was followed by athetoid (10.5%), ataxia and hypotonia types (4.2% each). The mixed type was 19.4% Among 98 cerebral palsies, the preterm infants were 42.9% and the infants with low birth weight were 41.4%. The cerebral palsies with low birth weight and preterm infants were more likely to have spastic diplegia. The most frequent abnormal primitive reflex was absent protective extension(78.3%). No significant associations of the type of cerebral palsy with primitive reflexes were found. An increased risk of cerebral palsy with increased maternal age was not observed in this study. Of 55 MRI findings, no abnormalities were seen in 27.2%, periventricular leukomalacias in 34.5%, brain atrophies in 21.8%, cerebral infarcts in 10.9%, intracerebral hemorrhage in 3.6%, and delayed myelinations in 1.8%. The periventricular leukomalacias were associated with the preterm infants in 63.2%.
Asphyxia ; Ataxia ; Atrophy ; Brain ; Cerebral Hemorrhage ; Cerebral Palsy* ; Child ; Foot Deformities ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Korea ; Leukomalacia, Periventricular ; Magnetic Resonance Imaging ; Maternal Age ; Muscle Hypotonia ; Muscle Spasticity ; Myelin Sheath ; Paralysis ; Parents ; Parturition ; Perinatal Care ; Reflex ; Retrospective Studies

BACKGROUND: We analyzed thyroid hormone values in brain death patients to determine the need for thyroid hormone replacement therapy. METHODS: We analyzed 111 brain death donors (77 males and 34 females, mean age, 41.1 years (range; 8 months -72 years) in Ajou University Hospital from 2000 to 2010. RESULTS: The mean values of thyroid hormones were T3; 72.5 ng/dl (normal range [NR] 60-181 ng/dl), T4; 5.0 microg/dl (NR 4.5-10.9 microg/dl), free T4 1.0 ng/dl (NR 0.8-1.5 ng/dl), and TSH 1.5 microIU/ml (NR 0.35-5.5 microIU/ml), respectively. However, the values of T4 (correlation coefficient -0.264, p = 0.005), free T4 (correlation coefficient -0.305, p = 0.001) and TSH (correlation -0.206, p = 0.031) significantly decreased based on the increase of interval from the brain death-inducing event to the evaluation time (hereafter, interval). The patients with greater than 8 days of interval (N = 30) showed significantly low thyroid hormone values compared to patients with less than 8 days of interval (N = 81); T3 (70.3 ng/dl vs. 77.0 ng/dl, p = 0.242), T4 (4.7 ng/dl vs. 5.3 ng/dl, p = 0.015), free T4 (0.8 ng/dl vs. 1.2 ng/dl, p = 0.006) and TSH (1.0 microIU/ml vs. 2.0 microIU/ml, p = 0.000), respectively. CONCLUSIONS: As the intervals from the brain death-inducing events increased, all thyroid hormone values of brain death donors except T3 significantly decreased. Therefore, we recommend that careful consideration should be given to the interval from brain death-inducing event for the evaluation of thyroid hormone status of brain death patients.
Brain ; Brain Death ; Female ; Humans ; Male ; Thyroid Gland ; Thyroid Hormones ; Tissue Donors

Occurrence of primary cardiac tumors is rare in all age groups; occurrence is observed in 0.05% of routine postmortem examinations. A 15-year-old Korean female transported by 119 rescue presented with common clinical findings for acute stroke. Brain imaging included computed tomography; magnetic resonance imaging was performed in the emergency department. Findings on brain imaging were compatible with acute cerebral infarction of the territory of the right middle cerebral artery. The patient was treated with reperfusion therapy with IV tissue plasminogen activator and cerebral artery stenting. Echocardiography was performed in the emergency department in order to determine the cause of acute cerebral infarction. We experienced a case of pediatric cardiac myxoma presenting as an acute stroke in the emergency department, which was confirmed by imaging study and biopsy; therefore, we report on it here along with a review of the literature.
Adolescent ; Autopsy ; Cerebral Arteries ; Cerebral Infarction ; Echocardiography ; Emergencies ; Female ; Heart Neoplasms ; Humans ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Myxoma ; Neuroimaging ; Reperfusion ; Stents ; Stroke ; Tissue Plasminogen Activator

OBJECTIVE: During the follow-up period of extrahepatic malignancy, one may encounter a solitary hepatic metastasis on CT scan which may be difficult to differentiate from hepatic abscess in an ambiguous clinical setting. It was our intention to copmare the radiological similarities and differences between two disease entities from which differentiation can be attempted. MATERIALS AND METHODS: Thirty-six cases of solitary heaptic meastesis and 23 cases of liver abscess were included in this study. Two radiologists interpreted the CT without knowledge of the clinical informations. CT pattern was categorized and the frequency of various findings were compared between the two groups. CT findings of the mass were analysed in misinterpreted cases. RESULTS: Without the clinical informations, the diagnostic accuracy of the mass was 72-76% without pattern analysis. Homogeneous masses were seen in both groups, but all masses larger than 4cm were metastases. In heterogeneous masses, metatases more frequently accompanied high attenuation in central or peripheral portion of the mass and showed thick intermediate zone, Irregular trabecular pattern or septations were more frequently observed in abscesses. Biliary dilatation or stone, pleural effusion, air in mass or biliary tree were more frequently seen in abscesses. The false diagnosis was encountered most frequently when the mass possessed any of the followings; homogeneous attenuation, mosaic pattern in the mass with inhomogeneous attenuation and thin intermediate attenuation area. CONCLUSION: Pattern analysis of the various CT character will be helpful to differentiate hepatic abscess and solitary hepatic metastasis in the equivocal clinical settings. However, similar pattern can be seen in both entities ;in this cases, corrdination of CT pattern and secondary findings is needed for better differentiation.
Abscess ; Biliary Tract ; Diagnosis ; Dilatation ; Follow-Up Studies ; Intention ; Liver Abscess* ; Neoplasm Metastasis ; Pleural Effusion ; Tomography, X-Ray Computed

Mechanical obstruction of the common hepatic duct includes the following causes; choledocholithiasis, sclerosis, cholangitis, pancreatic carcinoma, cholangiocarcinoma, postoperative stricture, primary hepatic duct carcinoma, enlarged cystic duct lymph nodes, and metastatic nodal involvement of the porta hepatis. Partial mechanical obstruction of the common hepatic duct caused by impaction of stones and inflammation surrounding the vicinity of the neck of the gallbladder had been reported on the “syndrome del conducto hepatico” in 1948 by Mirizzi. Nowadays, this disease was named by Mirizzi syndrome. Mrizzi syndrome is a rare entity of common hepatic duct obstruction that results from an inflammatory response secondary to a gallstone impacted in the cystic duct or neck of the gallbladder. It results from an almost parallel course and low insertion of the cystic duct into the common hepatic duct. In a variant of Mirizzi's syndrome, the cause of the common hepatic duct obstruction was a primary cystic duct carcinoma rather than gallstone disease. A 71-year-old man was admitted with a four-day history of right upper quadrant abdominal pain. Past medical history was unremarkable. On physical examination, the patient had a temperature of 38℃, icteric sclera and right upper quadrant tenderness. Pertinent laboratory findings included WBC 18,000/cm3; albumin 2.6 g/dl (normal 0-1) with the direct bilirubin, 4.4 mg/dl (normal 0-0.4). Ultrasonography revealed a dilated extrahepatic biliary tree. ERCP showed that the superior margin was angular and more consistent with a calculus causing partial CHD obstruction (Mirizzi syndrome). At surgery a diseased gallbladder containing calculi was found. In addition, there was two calculi partially eroding through the proximal portion of the cystic duct and compressing the common hepatic duct. A cholecystectomy and excision of common bile duct was performed, with Roux-en-Y hepaticojejunostomy. The postoperative course was uneventful.
Abdominal Pain ; Aged ; Biliary Tract ; Bilirubin ; Calculi ; Cholangiocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystectomy ; Choledocholithiasis ; Common Bile Duct ; Constriction, Pathologic ; Cystic Duct ; Cytochrome P-450 CYP1A1 ; Gallbladder ; Gallstones ; Hepatic Duct, Common ; Humans ; Inflammation ; Jaundice, Obstructive ; Lymph Nodes ; Mirizzi Syndrome* ; Neck ; Physical Examination ; Sclera ; Sclerosis ; Ultrasonography

Takayasu's arteritis is a chronic inflammatory disease involving the aorta and the arteries arising from the aorta. The pulmonary arteries also may be involved. The inflammation leads to either stenosis and occlusion of the involved artery or formation of aneurysm or both. The arterial lesions can lead to secondary hypertension, retinopathy, cardiac involvement, cerebrovascular event. The course and prognosis of patients with Takayasu's arteritis shows wide variation. We experienced a case of rapid growing Takayasu's arteritis presenting as nausea and vomiting at emergency department, which was confirmed by computed tomography and angiography, so reported it with a review of literature.
Aneurysm ; Angiography ; Aorta ; Arteries ; Arteritis ; Constriction, Pathologic ; Emergencies ; Humans ; Hypertension ; Inflammation ; Nausea ; Prognosis ; Pulmonary Artery ; Takayasu Arteritis ; Vomiting

Opsoclonus is the involuntary, repetitive, rapid conjugate ocular movements occurring in all directions that are irregular in amplitude and frequency. The cause of opsoclonus are idiopathic, paraneoplastic or postinfectious. Opsoclonus of the postinfectious origin often accompanies other abnormal movements such as tremor, myoclonus and ataxia, and shows a relatively benign course with good response to steroid. Six patients who suffered from myalgia, chilling, fever, cough and generalized weakness fior one to two weeks prior to the admission, experienced visual disturbance, gait unsteadiness and clumsiness of the upper extremities,, Prominent opsoclonus, tremulous movements of trunk and limbs, and intermittent myoclonus were observed. These symptoms markedly improved several days following the use of ACTH or dexametasone.
Adrenocorticotropic Hormone ; Adult* ; Ataxia ; Cough ; Dyskinesias ; Extremities ; Fever ; Gait ; Humans ; Myalgia ; Myoclonus ; Ocular Motility Disorders* ; Tremor ; Upper Extremity