Spontaneous testicular hemorrhagic necrosis is a rare disease usually associated with testicular torsion. Partially involved and suspicious testis tumor cases are also defined from orchiectomy specimens. Herein, a spontaneous hemorrhagic necrosis, without any testicular torsion, but with involvement of the whole testicle and epididymis, is reported. A 21 year old patient, who presented with a painless left testicular enlargement of several days duration was believed, based on physical examination, ultrasonography and elevation of serum LDH, to have a testicular tumor. Diagnosis was made only after radical orchiectomy and histopathological examination.
Diagnosis ; Epididymis ; Hemorrhage ; Humans ; Male ; Necrosis* ; Orchiectomy ; Physical Examination ; Rare Diseases ; Spermatic Cord Torsion ; Testis* ; Ultrasonography ; Young Adult

OBJECTIVE: Brain-derived neurotrophic factor (BDNF) is a neurotrophin that is widely expressed in the mammalian brain and acts to regulate neuronal survival and influence cognitive processes. The present study measured serum BDNF levels to investigate the associations of the BDNF Val66Met and 5-hydroxytryptamine transporter linked promoter region (5-HTTLPR) polymorphisms with cognitive function in elderly Korean individuals. METHODS: Over 60 years, a total of 834 subjects were recruited for the present study. The subjects were classified into groups based on the degree of cognitive impairment (age-associated cognitive decline, mild cognitive impairment, and Alzheimer's disease) and compared with normal controls in terms of a neuropsychological assessment and a clinical evaluation. RESULTS: Of the initial 834 study participants, 165 (59 controls and 106 subjects with cognitive impairments) completed the study. There was a significant increase in serum BDNF levels in subjects with cognitive impairments relative to the control group and the BDNF Val66Met polymorphism was significantly associated with cognitive function but not serum BDNF levels. The 5-HTTLPR polymorphism did not have any associations with cognitive impairment or serum BDNF levels. CONCLUSION: The present findings suggest that BDNF may play a role in the pathophysiology of cognitive impairment and the BDNF Val66Met polymorphism may be an important factor in the susceptibility to these age-related deficits.
Aged* ; Brain ; Brain-Derived Neurotrophic Factor* ; Cognition ; Dementia ; Humans ; Mild Cognitive Impairment ; Neurons ; Polymorphism, Genetic ; Promoter Regions, Genetic ; Serotonin

BACKGROUND: In 1951, Ardran reported that metastatic bone lesions could be detectable on plain radiography with 30% to 50% of decalcification. Authors performed experimental study for minimum level of decalcification to detect the osteolytic bone metastasis of long bone with recent technique of radiographs. METHODS: One pair of fibula and humerus from two cadavers was cut into specimen 1 inch in length. Distal half of specimen was dipped into hydrochloride (HCl) with 15 min interval. All 16 specimens were checked by film-type radiography (FR), computed radiography (CR), digital radiography (DR). To exclude inter-observer's variance, 3 radiologists evaluated images. Calcium amount before and after decalcification was measured and expressed in percentage of decalcification. RESULTS: Osteolytic changes were detectable with 11% to 16% of decalcification for fibula and 3% to 8% for humerus on plain radiography with FR, CR, and DR. CONCLUSIONS: Our study showed that minimum of 3% and maximum of 16% of decalcification is necessary when osteolytic metastatic bone lesions of long bone could be detected on plain radiography.
Cadaver ; Calcium ; Decalcification Technique ; Fibula ; Humerus ; Neoplasm Metastasis* ; Osteolysis ; Radiographic Image Enhancement ; Radiography*

An important challenge in Parkinson’s disease (PD) based neuroscience and neuroimaging is mapping the neuronal connectivity of the basal ganglia to understand how the disease affects brain circuitry. However, a majority of diffusion tractography studies have shown difficulties in revealing connections between distant anatomic brain regions and visualizing basal ganglia connectome. In this current study, we investigated the differences in basal ganglia connectivity between 6-OHDA induced ex-vivo PD mouse model and normal ex-vivo mouse model by using diffusion tensor imaging tractography from diffusion-weighted images obtained with a high resolution 9.4 T MR scanner. Connectivity pattern of the basal ganglia were compared between five 6-OHDA and five control ex-vivo mouse brains using results of probabilistic tractography generated with PROBTRACKX. When compared with control mouse, 6-OHDA mouse showed significant enhancements to motor territory-related subthalamopallidal and pallido-subthalamic connectivity. Multi-fiber tractography combined with diffusion MRI data has the potential to help recognize the abnormalities found in connectivity of psychiatric and neurologic disease models.

Educational evironment and condition strongly influence the quality of graduate medical education. However, in Korea educational environment of in-hospital graduate medical education and training has not been explored in details. To evaluate current situation, we investigated 1,859 graduate trainees(residents) by self-administered questionnaire from May to July in 1996. Major findings of the survey were as follows; 1. Major providers of education were senior trainees(46.7%), compared with other sources of training such as self-study(22.9%) and staff trainers(14.5%). 2. At hospitals with less than or equal to 500 beds, formal educational programs for training were more poorly developed than hospitals with more than 500 beds. Among them, weakness in programs of case conference, staff lecture and training in affiliated hospitals was more remarkable. 3. At small hospitals with less than or equal to 500 beds, satisfaction level of trainees on their training were lower than that of trained at hospitals with more than 500beds. Research, conference, discussion with senior residents, and outpatient care were more dissatisfactory in particular. 4. Significant barriers to ideal training were work overload(57.2%) and shortage of educational programs(19.0%). Most of trainees are not satisfied with environment and condition of their training programs. To improve the quality of graduate medical education which is closely related with health care quality in the near future, general environment of education such as work load and educational programs has to be reoriented.
Ambulatory Care ; Education ; Education, Medical, Graduate* ; Korea ; Quality of Health Care ; Surveys and Questionnaires

A small-cell carcinoma of the gallbladder is an uncommon cancer with high malignancy potential. It is usually found in elderly women and is associated with cholelithiasis. These tumors show an aggres sive clinical course and death usually occurs within a few months after diagnosis. The diagnosis of a small-cell carcinoma should be based on cell morphology, histologic pattern, and immunohistochemical study. Correct diagnosis is important not only because these tumors give rise to endocrine syndrome but also because the chemotherapeutic approach to a small-cell carcinoma differs from that for an adeno carcinoma. We experienced a case of a small-cell carcinoma of the gallbladder in a 73-year-old woman with acute cholecystitis syndrome. She was treatment with a palliative cholecystectomy and chemotherapy with short-term excellent response. The literature on the subject is reviewed.
Aged ; Carcinoma, Small Cell* ; Cholecystectomy ; Cholecystitis, Acute ; Cholelithiasis ; Diagnosis ; Drug Therapy ; Female ; Gallbladder* ; Humans

BACKGROUND: Patients with liver injury can be managed by various techniques, including simple closure, electrocautery, hemostatic agent application, temporary packing, perihepatic drainage, and hepatic resection. Two different types of hepatic resections can be employed in selected and advanced hepatic injury; resectional debridement and anatomical hepatic resection. The aim of this study was to consider the role of hepatic resection in the management of severe liver trauma and to define the roles of the different types of resections. METHODS: Two hundred two patients with traumatic liver injury underwent surgical treatment from July 1989 to June 1998 at the Department of Surgery, Soonchunhyang University Chunan Hospital. From them, the records of forty-six patients who received hepatic resections in the same period were collected. Demographic, clinical, operative, and postoperative data were collected and analyzed. RESULTS: Among the patients with resectional management, the peak incidence was in the third and the fourth decades. The male-to-female ratio was 3.1:1. The most frequent injury mechanism was blunt trauma (95.7%). There was one postoperative death among the 8 anatomical resections (12.5%) and nine postoperative deaths among the 38 resectional debridements (24.4%). The overall mortality rate was 21.7%. There were no intraoperative deaths. Postoperative complications occurred in 11 patients (23.9%). CONCLUSIONS: Hepatic resection can play a major role in the management of hepatic trauma. It can be indicated in cases of deep laceration in the liver involving major vascular structures or the bile duct, extensive devitalization of the hepatic parenchyma, and hepatic venous bleeding. In selected cases, an anatomical resection can be successful by making a clear line of resection through anatomical planes away from any damaged parenchyma.
Bile Ducts ; Chungcheongnam-do ; Debridement ; Drainage ; Electrocoagulation ; Hemorrhage ; Humans ; Incidence ; Lacerations ; Liver* ; Mortality ; Postoperative Complications

An annular pancreas is a rare congenital variant of the pancreatic anatomy, which may cause symptoms of gastric outlet obstruction and recurrent pancreatitis, and is often hard to diagnose before operation. The case of an annular pancreas with intermittent abdominal pain in a 38-year-old alcoholic man is described. A duodenal obstruction with consecutive ulcers was the clinical manifestation in this patient. The annular pancreas was diagnosed by using hypertonic duodenography followed by pancreatic angiography. The duodenoscopy revealed stenosis of the pancreas. A duodeno-duodenostomy relieved the symptoms. The patient had an uneventful recovery following a operation.
Abdominal Pain ; Adult* ; Alcoholics ; Angiography ; Constriction, Pathologic ; Duodenal Obstruction ; Duodenoscopy ; Gastric Outlet Obstruction ; Humans ; Pancreas* ; Pancreatitis ; Ulcer

BACKGROUND: The treatment of intrahepatic stones is difficult because of frequent recurrence and residual stones. There are several suggested methods of treatment which include surgical bile-uct exploration with or without biliary drainage, an endoscopic procedure, transhepatic cholangiolithotomy, and hepatic resection. METHODS: We reviewed the therapeutic results in 96 patients who had hepatolithiasis and received surgery at Soon Chun Hyang University Chunan Hospital during the 10 years from June 1987 to June 1997. We divided them into 2 groups: one was the group of patients receiving a hepatic resection with or without a drainage procedure (resection group), and the other was the group of patients receiving only a T-ube choledochostomy or drainage procedure (nonresection group). RESULTS: The male-to-female ratio was 1:1.74, and the most prevalent age group was the 5th decade (31.3%). The most common symptoms were epigastric pain (61%) and RUQ pain (60%), and the locations of stones were the right intrahepatic duct in 10 cases (10.4%), the left intrahepatic duct in 47 cases (49%), and both intrahepatic duct in 39 cases (40.6%). Operative methods were a resection in 29 cases and a nonresection in 67 cases. The incidence of residual stones were 31.0% in the hepatic resection group and 68.6% in the nonresection group. The postoperative complication rate was 20.6% in hepatic resection group and 38.8% in the nonresection group, and the follow-p study showed the good results (Good & Fair) for 92.5% of the hepatic resection group and 66.7% of the nonresection group. CONCLUSION: The hepatic resection with or without drainage is an adequate treatment for hepatolithiasis. It can eradicate localized intrahepatic calculi, irreversible biliary stricture, an atrophied segment, and, possibly, an associated cholangiocarcinoma, with good results in clinical evaluation.
Calculi ; Cholangiocarcinoma ; Choledochostomy ; Chungcheongnam-do ; Constriction, Pathologic ; Drainage ; Humans ; Incidence ; Postoperative Complications ; Recurrence

Leiomyosarcoma of the intestine is an uncommon malignant tumor of the small and large bowels. It may metastasize mostly to the peritoneum, omentum and liver. We describe a case of a liver metastasis from ileal leiomyosarcoma which was treated by right hepatic lobectomy. Ultrasonography revealed multiple cysts in both lobes of liver and pelvic mass. Computerized tomography of the abdomen revealed that lobulated, marginated, low density mass was noted in ileal loop, and multiple, well-defined, low density masses were identified in both lobes of the liver. The patient underwent exploratory laparotomy and removal of the ileal leiomyosarcoma. One month later, the patient underwent a right hepatic lobectomy and removal of a cystic mass on the liver dome of the left lobe. The patient recovered and was discharged by postoperative day 24.
Abdomen ; Humans ; Intestines ; Laparotomy ; Leiomyosarcoma* ; Liver* ; Neoplasm Metastasis* ; Omentum ; Peritoneum ; Ultrasonography