Pharmacologic therapy is still the primary management for epilpsy; however, surgical treatment is a reasonable therapeutic option for patients suffering from medically intractable seizures, especially temporal lobe epilepsy having a documented unilateral epileptogenic area. Thirty nine patients with pharmaco-resistant complex partial seizures underwent anterior temporal lobectomy and hippocampectomy in 38 cases and frontal cortisectomy in one case. On pathological examination, hippocampal sclerosis was a predominent pathologic finding and was identified in 18 cases. Other non-neoplastic lesions consisted of 5 cases of vascular lesions(2 cavernous angiomas, 2 arteriovenous malformations and 1 angiomatosis), 3 cases of fibrous nodule, 2 cases of cicatrical changes of cerebral cortex, and 1 case of parasitic infection. Neoplasms including two cases of oligodendroglioma and one case of anaplastic astrocytoma were also noted. In seven cases, there was no detectable lesion on gross and microscopic examination. On post-operative follow-up, seizures were completely terminated in most cases(31 cases, 79%). The rest of the patients also displayed marked alleviation of symptoms. The seizures tended to recur more aften among the patients with neoplasm or no pathologically detectable lesion. In order to detect any minute pathological lesion, thorough gross and microcsopic examinations are considered to be essential.

We report a rare case of carcinosarcoma arising in the stomach. The tumor is presented in the posterior wall of the gastric lower body and antrum of a 56-year-old man. Grossly the tumor has polypoid appearance with diffuse surface ulceration and measures 5.5 cm in diameter. The tumor is accompanied with three separate well differentiated early gastric adenocarcinomas (two EGC type IIc & IIa). Microscopically, the tumor consists of moderately well differentiated adenocarcinoma in the periphery, and lobulated sarcomatous areas in the center, which shows chondroid differentiation. Transitional areas between adenocarcinoma and chondrosarcoma are evident. Immunohistochemical studies show positivity for cytokeratin and carcinoembryonic antigen in the epithelial component, and for vimentin and S-100 in the sarcomatous component. The transitional areas are positive in carcinoembryonic antigen, vimentin, S-100, and cytokeratin. The tumor extended to the subserosa and showed metastasis of only adenocarcinomatous component in six out of 47 dissected perigastric lymph nodes.
Adenocarcinoma ; Carcinoembryonic Antigen ; Carcinosarcoma* ; Chondrosarcoma ; Humans ; Keratins ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis ; Stomach* ; Ulcer ; Vimentin

This report presents an unusual case of primary malignant melanoma in the midesophagus. The patient was a 36-year-old woman presenting with dysphagia and odynophagia. The resected esophagus and proximal stomach showed a dark purple large polypoid mass, measuring 6.0 3.3 2.0 cm, with a diffuse tan pigmentation of surrounding mucosa in the mid-esophagus and two small daughter nodules, up to 1.2 0.3 cm, in the lower esophagus near the gastro-esophageal junction. A microscopic examination revealed a malignant melanoma of epithelioid cell type confined to mucosa and submucosa with a diffuse melanosis. Cytoplasmic immunoreactivity for HMB 45 and S-100 protein were noted. An electron microscopic examination revealed large, loosely cohesive variable shaped cells with a few cytoplasmic premelanosomes.
Adult ; Cytoplasm ; Deglutition Disorders ; Epithelioid Cells ; Esophagus* ; Female ; Humans ; Melanoma* ; Melanosis ; Mucous Membrane ; Nuclear Family ; Pigmentation ; S100 Proteins ; Stomach ; Triacetoneamine-N-Oxyl

Fibroepithelial polyps of the ureter are usually acquired rather than congenital. Most polyps are hamartomatous growths which tend to arise in the proximal portion of the left ureter. Most patients exibit either hematuria or persistent flank pain secondary to partial ureteral obstruction. Because of false positivity of urine cytology, as well as intravenous pyelogram, the correct diagnosis is confused with malignancy. Herein we report four cases of ureteral fibroepithelial polyp, which are associated with stones resulting in partial obstruction of the ureter. One of the four cases is associated with nephrogenic adenoma in the lamina propria of the adjacent ureter. The following report describes clinicopathologic findings of fibroepithelial polyp with review of literatures.
Adenoma

The nutritional and health status of low-income alone-living elderly(ALE) was assessed in relation to the activity of daily living (ADL) and nutritional risk factors. One hundred and eighty five ALE over 65 years old, living in the Sungnam area, were interviewed in their homes through questionnaires. The results were as follows : 63.6% of the subjects considered themselves in poor the health and only 4.3% of them considered thermselves healthy. 89.7% of the subjects answered that they were suffering from illness and 29.7% were taking medication. The ADL was assessed through 10 checklist items and the average score of the ADL was 84.78+/-11.11(maximum :100) The nutritional risk index(NRI) was evaluated by 12 risk factors and the average score of the NRI was 4.43+/-1.38 (maximum: 12) The scores of the ADL were positively correlated with the scored of the instrumental activities of daily living (IADL)(r=0.7523, p<0.001) and negatively correlated with NRI(r=-0.2694, p<0.001) When subjects were divided into nutritionally high risk group(HNARI: NRI> or =5) and nutritionally low risk group(LNRI :NRI<5) according to the USA screening basis, 48.9% of the subjects belonged to the HNRI, But 16.9% of the HNRI and 34.4% of the LNRI belonged to the fourth quartile(Q/sub 0.75) of the ADL, the distribution of which showed significant differences(p<0.05) We suggest that the application of the ADL as a screening tool for nutrition intervention programs for the elderly. Oncemore, further research is needed to develop appropriate checklist items for the ADL and NRI along with the screening basis for the NRI to diagnose the adverse nutritional status of the Korean elderly.
Activities of Daily Living ; Aged* ; Checklist ; Gyeonggi-do ; Humans ; Mass Screening ; Nutritional Status* ; Risk Factors ; Surveys and Questionnaires

PURPOSE: To evaluate CT findings of normal anatomic alteration after neck dissection. MATERIALS AND METHODS: The postoperative CT findings were retrospectively reviewed in 40 patients with neck dissection, comparing to preoperative CT. There were 28 patients with radical neck dissection and 12 patients with modified radical neck dissection or selective neck dissection. In addition to the neck dissection, 10 patients had undergone pectoralis major myocutaneous flap reconstruction, 20 patients taken laryngectomy, and 25 patients treated with radiotherapy. RESULTS: The typical CT findings of radical neck dissection were non-visualization of internal jugular vein and sternocleidomastoid muscle(28/28), ipsilateral neck flattening(26/28), and trapezius muscular atrophy(12/28). The other non-specific findings were tissue plane eftacement, subcutaneous reticular pattern, platysma muscle thickening, and adjacent soft tissue contrast enhancement which was the only evidence of previous operation in the cases of modified radical neck dissection or selective neck dissection. Reconstruction with myocutaneous flap was shown as ipsilateral bulk of fat and muscle(10/10). In cases with radiation therapy there was much increased density of submandibular gland(12/25). 15 patients showed recurrence on follow up CT scan, including regional metastasis in 10, stomal recurrence in two, and residual mass at primary site in three patients. CONCLUSION: CT is useful in evaluation of patients with neck dissection and in whom postoperative change impese diagnostic problem.
Follow-Up Studies ; Humans ; Jugular Veins ; Laryngectomy ; Myocutaneous Flap ; Neck Dissection* ; Neck* ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Retrospective Studies ; Superficial Back Muscles ; Tomography, X-Ray Computed

To evaluate the intractability of partial epileptic patients by variables, the author studied 113 patients (uncontrolled: 45, controlled: 68) who were admitted to the Department of Neurology, College of Medicine, Yeungnam University from January, 1991 to August, 1993. The results were as follows. The items related to complex partial seizures, multiple seizure types and a histories of status epilepticus or clusters of seizures were significantly associated with drug-refractoriness (p<0.01). A high frequency of seizures before evaluation was associated with a poor outcome(p<0.01). The presences of known etiology of seizures, neurologic abnormalities and psychiatric disturbance were associated with limited treatment responses(p<0.01, p<0.05, p<0.01). An abnormal EEG findings such as background slowing, focal slowing, epileptiform discharges or secondarily bilateral synchrony were statistically significant (p<0.01). Age at onset, sex, distribution of epileptic foci, duration of seizure before evaluation, family history and abnormal neuroradiologic findings were not statistically significant. By these results, it was suggested that having at least four factors of the above variables were associated with limited treatment response.
Electroencephalography ; Epilepsies, Partial* ; Humans ; Neurology ; Risk Factors ; Seizures ; Status Epilepticus

PURPOSE: This study was to investigate the effects of problem solving group counseling on the index of obesity and health habits for obese children. METHOD: Forty seven obese children participated in the study(Exp.=22, Cont.=25). Children were recruited from the forth and fifth grade withhigher than 20% of the obesity degree. The problem solving counseling lasted for 10 weeks. In order to evaluate the effects of counseling, physical characteristics and health habits were measured three times; pretest, posttest, and at 10 weeks follow-up. The obtained data was analyzed by Chi-squared-test, t-test, and repeated measures ANOVA, using the SPSS WIN 10.0program. RESULT: Problem solving group counseling was effective on the physical characteristics(BMI, obesity degree, body fat ratio, waist measurement) and health habits over time. Children in the experimental group controlled their body weight better and reported lower scores in the index of obesity than children in the control group at 10 weeks follow-up. CONCLUSION: This counseling program helped obese children modify their health habits so that they could decrease their scores in the obesity index. It can be concluded that problem-solving counseling enhanced problem-solving abilities of obese children, which could help modify their ordinary health habits.
Child ; *Counseling ; Female ; *Health Behavior ; Humans ; Male ; Obesity/*nursing ; *Weight Loss

A rare case of hepatic metastasis with a choriocarcinomatous component from a composite adenocarcinoma and choriocarcinoma of the sigmoid colon in a 60-year-old man is reported. The hepatic metastasis displayed choriocarcinoma with extensive hemorrhagic necrosis. The tumor cells were poorly differentiated with scattered foci of bizzare syncytiotrophoblastic cells. Retrospective examination of the previous colonic carcinoma proved that the tumor was composed of two distinctive elements. One was a moderately well differentiated adenocarcinoma located in mucosa and submucosa. The other was a deep seated and undifferentiated carcinoma which was made up of hyperchromatic bizzare cells with syncytiotrophoblastic cells. There were transitional foci from adenocarcinoma to undifferentiated carcinoma with trophoblastic cells. Immunohistochemical staining showed beta-hCG expression in the undifferentiated cells of both the primary and the metastatic tumors. Implications for the possible origin and cause of tumor cell heterogeneity are briefly discussed.
Adenocarcinoma* ; Carcinoma ; Choriocarcinoma* ; Colon ; Colon, Sigmoid* ; Female ; Humans ; Middle Aged ; Mucous Membrane ; Necrosis ; Neoplasm Metastasis* ; Population Characteristics ; Pregnancy ; Retrospective Studies ; Trophoblasts

Teratocarcinoma is a form of mixed germ cell tumor composed of a mixture of teratoma and embryonal carcinoma. It is rarely found in the brain, but when present it is most commonly found in the pineal region. We investigated a case of primary teratocarcinoma in the pineal region. The patient was a 10 year old boy who had suffered from a bitemporal headache for one month. Brain CT and MRI revealed a rather well defined ovoid heterogenous mass in the pineal gland region, measuring 4.3 x 3.8 x 3.0 cm in size. Microscopically the tumor contained areas of immature teratoma and embryonal carcinoma. Immunohistochemical staining revealed positive reactions for cytokeratin, epithelial membrane antigen, carcinoembryonic antigen, and alpha-fetoprotein in the embryonal carcinoma component.