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

OBJECTIVE: During the transition to menopause, various symptoms including vasomotor symptoms and depressed mood lead to low quality of life. We investigated the effect of low-dose venlafaxine hydrochloride extended release on depressed mood and vasomotor symptoms of perimenopausal women. METHODS: 33 perimenopausal women fulfilling Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria for a depressive episode were enrolled between January 2014 and May 2014. Subjects were prescribed 37.5 mg/day or 75 mg/day venlafaxine hydrochloride according to clinician's judgement, and the dosages were maintained for 8 weeks. Depressed mood and other psychological difficulties were evaluated by using Hamilton Rating Scale for Depression (HAMD), Hamilton Rating Scale for Anxiety (HAMA), Clinical Global Impression-Severity. Climacteric symptoms including vasomotor symptoms were evaluated by using Greene Climacteric Scale (GCS). For statistical analysis, paired t-test was used. RESULTS: Significant decreases in HAMD, HAMA, GCS scores were observed after 2 weeks of treatment and the trends continued until the end of the study. The scores of HAMD significantly decreased, 28 of them reached remission (HAMD < or =7). The scores on vasomotor symptoms of GCS after 8 week treatment significantly decreased compared to baseline (13.1+/-5.0, p<0.01). CONCLUSION: These results suggest that venlafaxine hydrochloride is effective and tolerable treatment option for vasomotor symptoms and depressed mood in perimenopausal women. To validate our results, furthur studies with double-blind, placebo controlled will be needed.
Anxiety ; Climacteric ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Humans ; Menopause ; Quality of Life ; Venlafaxine Hydrochloride

PURPOSE: To determine the intranasal causes of failed dacryocystorhinostomy (DCR) and the effects of transcanalicular diode laser-assisted revision surgery. METHODS: Twenty-four patients (29 eyes) who underwent revision surgery for a failed DCR at the Department of Ophthalmology, Ansan Hospital, Korea University between March 2009 and February 2011 were included in the present retrospective study. The intranasal causes of failed DCR, the time of symptoms such as epiphora and discharge after DCR, success rates of revision surgeries and follow-up periods were evaluated. RESULTS: Membranous obstruction was found in 25 eyes (86.2%) and was accompanied with granuloma in 10 eyes; these were the most common causes of failed DCR. The mean time for symptom development after DCR was 14.6 months, the success rate of the first revision surgery was 82.1% and good results were obtained in 5 eyes after the second revision surgery. Recurrence developed in 2 eyes, but symptoms improved after the lateral tarsal strip procedure. CONCLUSIONS: Membranous obstruction was the most common intranasal cause of failed DCR and transcanalicular diode laser-assisted revision surgery produced good results. Additionally, in patients with persistent epiphora following anatomically-patent revisional surgery, lacrimal pump failure due to lower eyelid laxity should be considered and corrected.
Dacryocystorhinostomy ; Eye ; Eyelids ; Follow-Up Studies ; Granuloma ; Humans ; Korea ; Lacrimal Apparatus Diseases ; Ophthalmology ; Recurrence ; Retrospective Studies

Depression is a common mental illness with a high lifetime prevalence rate in the general population. However, the pathophysiology of depression is still poorly understood. Recent studies showed that environmental factors can affect gene expression by modifying epigenetic factors. Early life stress (ELS) is likely a risk factor of lifetime vulnerability to stress and development of depression. ELS or stressful lifetime can induce changes in gene expression through epigenetic mechanism, such as DNA methylation or histone modification. In this article, recent researches on the epigenetic mechanisms of depression will be discussed.
Depression* ; DNA Methylation ; Epigenomics* ; Gene Expression ; Histones ; Prevalence ; Risk Factors ; Stress, Psychological