Hyperreactio luteinalis(HL)referes to moderate to marked cystic bilateral enlargement of ovaries due to benign theca lutein cysts, usually related to hydatidiform mole or choriocarcinoma. After its first description by Berger in 1938, almost 53 cases of HL unassociated with trophoblastic disease have been reported in the literature. We encountered one such case in a 34 years old female which was incidentally diagnosed during cesarean section at term.
Adult ; Cesarean Section ; Choriocarcinoma ; Female ; Humans ; Hydatidiform Mole ; Lutein ; Ovary ; Pregnancy ; Trophoblasts

PURPOSE: To compare the surgical outcomes of laparoscopic total gastrectomy between elderly and non-elderly patients. MATERIALS AND METHODS: Between 2008 and 2015, a total of 273 patients undergoing laparoscopic total gastrectomy for gastric carcinoma were divided into two age groups: elderly (> or =70 years, n=71) vs. non-elderly (<70 years, n=172). Postoperative outcomes, including length of hospital stay, morbidity, and mortality were compared between the groups. RESULTS: The elderly group showed a significantly higher rate of comorbidities and American Society of Anesthesiologists scores than those in the non-elderly group. No significant differences were found with respect to lymphadenectomy or combined organ resection between the groups. After surgery, the elderly group showed a significantly higher incidence of grade III and above complications than the non-elderly group (15.5% vs. 4.1%, P=0.003). Among the complications, anastomosis leakage was significantly more common in the elderly group (9.9% vs. 2.9%, P=0.044). Univariate and multivariate analyses showed that old age (> or =70 years) was an independent risk factor (odds ratio=4.42, 95% confidence interval=1.50~13.01) for postoperative complications of grade III and above. CONCLUSIONS: Elderly patients are more vulnerable to grade III and above complications after laparoscopic total gastrectomy than non-elderly patients. Great care should be taken to prevent and monitor the development of anastomosis leakage in elderly patients after laparoscopic total gastrectomy.
Aged* ; Comorbidity ; Gastrectomy* ; Humans ; Incidence ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Mortality ; Multivariate Analysis ; Postoperative Complications ; Retrospective Studies* ; Risk Factors ; Stomach Neoplasms

BACKGROUND: Needle biopsy and fine needle aspiration cytology (FNAC) play an important role in the differential diagnosis of a palpable breast mass because of simplicity and cost effectiveness. The purpose of this study is to evaluate the role of needle biopsy and FNAC in the differentiation of a palpable breast mass by comparing their results with those of definite tissue diagnosis in our hospital. METHODS: This study included 74 patients who visited Chungbuk National University Hospital for a palpable breast mass from January 1997 to July 1998. Clinical diagnoses were made by history taking, physical examination, ultrasonography. Then, gun-biopsy and fine needle aspiration were done at the same time. Final diagnoses were obtained by an open biopsy or a mastectomy. RESULTS: Clinical diagnosis was highly sensitive in differentiation of malignant from benign disease (diagnostic sensitivity: 100%, specificity: 80.9%, accuracy: 87.8%). A diagnostic specimen was obtained on the first attempt in 87.8% of the fine needle aspirations and in 93.2% of the needle biopsies. Definite diagnoses, such as benign or malignant, were possible in 90.5% of the fine needle aspirations and in 97.3% of the needle biopsies. Considering these cases only, FNAC and needle bopsy were highly specific diagnostic tools for detection of malignant disease (In FNAC: diagnostic sensitivity: 85.7%, specificity: 100%, accuracy: 95.5%; In needle biopsy: diagnostic sensitivity: 88%, specificity: 100%, accuracy: 95.8%). The results of FNAC and the needle biopsy were identical in 87.8% of the cases. Two malignant cases were diagnosed as benign in both FNAC and needle biopsy. CONCLUSIONS: FNAC and needle biopsy showed high diagnostic accuracy. Thus, these procedures can be useful tools in differentiating between a benign or a malignant palpable breast mass before establishing a treatment strategy.
Aspirations (Psychology) ; Biopsy ; Biopsy, Fine-Needle* ; Biopsy, Needle* ; Breast* ; Chungcheongbuk-do ; Cost-Benefit Analysis ; Diagnosis* ; Diagnosis, Differential ; Humans ; Mastectomy ; Needles* ; Physical Examination ; Sensitivity and Specificity ; Ultrasonography

The nephrotic syndrome that occurs in the absence of renal vein thrombosis, amyloidosis, neoplastic infiltration of the kidneys is an unusual but a well recognized paraneoplastic syndrome. The most frequently reported neoplasms associated with nephrotic syndrome are Hodgkin's disease and various carcinomas. The most common renal lesions are membranous glomerulonephritis(MGN) associated with carcinomas and minimal change lesions associated with Hodgkin's disease. Approximately 40% to 45% of patients clinically manifest the MGN symptoms prior to the diagnosis of the tumor, 40% simultaneously with the tumor and the remaining 15% to 20% following the tumor. Therefore, evaluating the underlying malignancy in patients with MGN is important. Here we report a patient with squamous cell lung cancer, which was detected 12 months after a MGN had been diagnosed, with a review of the relevant literature.
Amyloidosis ; Diagnosis ; Glomerulonephritis, Membranous* ; Hodgkin Disease ; Humans ; Kidney ; Lung Neoplasms* ; Lung* ; Nephrotic Syndrome ; Paraneoplastic Syndromes ; Renal Veins ; Thrombosis

BACKGROUND: Drowning represents the third most common cause of all accidental deaths worldwide. Although few studies of submersion injury were done in Korea, the subjects were mainly pediatric patients. The purpose of this study is to describe the clinical feature of submersion injury in adults. METHODS: The medical records of 31 patients with submersion injury who were >15 years of age and admitted to Kyungpook National University Hospital from July 1990 to March 2003 were retrospectively examined. RESULTS: The most common age-group, cause, and site of submersion accidents in adults were 15-24 years of age, inability to swim, and river followed by more than 65 years of age, drinking, and public bath respectively. The initial chest radiographs showed bilaterally and centrally predominant distribution of pulmonary edema at lung base in about 90% of patients with pulmonary edema represented by submersion injury but at only upper lung zone in 10%. Eventually, 25 patients (80.6%) survived without any neurologic deficit and 2 patients (6.5%) with significant neurologic deficit, and 4 patients (12.9%) died. Age, arterial gas oxygenation, and mental status among baseline variables showed significant difference for prognosis. CONCLUSIONS: More than 65 years of age, drinking, and occurrence in public bath were relatively important in submersion injury of adults, and the successful survival of 80.6% of patients suggests that cardiopulmonary resuscitation should be intensively done in even adults.
Adult* ; Baths ; Cardiopulmonary Resuscitation ; Drinking ; Drowning ; Gyeongsangbuk-do ; Humans ; Immersion* ; Korea ; Lung ; Medical Records ; Near Drowning ; Neurologic Manifestations ; Oxygen ; Prognosis ; Pulmonary Edema ; Radiography, Thoracic ; Retrospective Studies ; Rivers

BACKGROUND/AIMS: Minor disorders of peristalsis are esophageal motility disorders categorized by the Chicago Classification (CC), version 3.0, which was announced in 2014. This study evaluated the efficacy of anti-reflux therapy in patients with minor peristaltic disorders. METHODS: Patients with minor peristaltic disorders in accordance with CC v3.0 were included. We reviewed the medical records of patients with esophageal high-resolution manometry findings, and investigated the demographic and clinical information as well as the medical therapy. Thereafter, the response to treatment was assessed after at least 4 weeks of treatment. RESULTS: A total of 24 patients were identified as having minor disorders of peristalsis from January 2010 to December 2015. The mean follow-up period was 497 days, and there were 17 patients (70.8%) patients with ineffective esophageal motility. In terms of anti-reflux therapy, proton pump inhibitors (PPIs) with prokinetic agents and PPIs alone were prescribed in 19 patients (79.2%) and 5 patients (20.8%), respectively. When the rate of response to the treatment was assessed, the responders rate (complete+satisfactory [≥50%] responses) was 54.2% and the non-responders rate (partial [<50%]+refractory responses) was 45.8%. Patients in the responder group were younger than those in the non-responder group (p=0.020). Among them, 13 patients underwent 24-hour multichannel intraluminal impedance-pH, and 10 patients (76.9%) were pathologic gastroesophageal reflux. CONCLUSIONS: The majority of esophageal minor peristaltic disorders were accompanied by gastroesophageal reflux, and therefore, they might respond to acid inhibitor. Further well-designed, prospective studies are necessary to confirm the effect of anti-reflux therapy in these patients.
Classification ; Esophageal Motility Disorders ; Follow-Up Studies ; Gastroesophageal Reflux ; Humans ; Manometry* ; Medical Records ; Peristalsis* ; Prospective Studies ; Proton Pump Inhibitors ; Proton Therapy ; Treatment Outcome

PURPOSE: The endoscopic management of a fully covered self-expandable metal stent (SEMS) has been suggested for the primary treatment of patients with anastomotic leaks after total gastrectomy. Embedded stents due to tissue ingrowth and migration are the main obstacles in endoscopic stent management. MATERIALS AND METHODS: The effectiveness and safety of endoscopic management were evaluated for anastomotic leaks when using a benign fully covered SEMS with an anchoring thread and thick silicone covering the membrane to prevent stent embedding and migration. We retrospectively reviewed the data of 14 consecutive patients with gastric cancer and anastomotic leaks after total gastrectomy treated from January 2009 to December 2016. RESULTS: The technical success rate of endoscopic stent replacement was 100%, and the rate of complete leaks closure was 85.7% (n=12). The mean size of leaks was 13.1 mm (range, 3–30 mm). The time interval from operation to stent replacement was 10.7 days (range, 3–35 days) and the interval from stent replacement to extraction was 32.3 days (range, 18–49 days). The complication rate was 14.1%, and included a single jejunal ulcer and delayed stricture at the site of leakage. No embedded stent or migration occurred. Two patients died due to progression of pneumonia and septic shock 2 weeks after stent replacement. CONCLUSIONS: A benign fully covered SEMS with an anchoring thread and thick membrane is an effective and safe stent in patients with anastomotic leaks after total gastrectomy. The novelty of this stent is that it provides complete prevention of stent migration and embedding, compared with conventional fully covered SEMS.
Anastomotic Leak* ; Constriction, Pathologic ; Gastrectomy* ; Humans ; Membranes* ; Pneumonia ; Retrospective Studies ; Self Expandable Metallic Stents ; Shock, Septic ; Silicon ; Silicones ; Stents* ; Stomach Neoplasms ; Ulcer

Adult onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology. AOSD is characterized by fever, arthralgia, salmon-colored skin rash, hepatosplenomegaly and its laboratory abnormalities include leukocytosis, elevated liver enzyme, negative autoantibody, and hyperferritinemia. The clinical course varied and severe complicated conditions, such as hemophagocytic syndrome, and disseminated intravascular coagulation, occurred occasionally. Such a complication is accompanied with hemolytic anemia and lead to be a fatal course. We report the first case of AOSD with hemolytic anemia, which improved with high dose steroid therapy.
Adult ; Anemia, Hemolytic ; Arthralgia ; Disseminated Intravascular Coagulation ; Exanthema ; Fever ; Humans ; Leukocytosis ; Liver ; Lymphohistiocytosis, Hemophagocytic ; Still's Disease, Adult-Onset

Adult onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology. AOSD is characterized by fever, arthralgia, salmon-colored skin rash, hepatosplenomegaly and its laboratory abnormalities include leukocytosis, elevated liver enzyme, negative autoantibody, and hyperferritinemia. The clinical course varied and severe complicated conditions, such as hemophagocytic syndrome, and disseminated intravascular coagulation, occurred occasionally. Such a complication is accompanied with hemolytic anemia and lead to be a fatal course. We report the first case of AOSD with hemolytic anemia, which improved with high dose steroid therapy.
Adult ; Anemia, Hemolytic ; Arthralgia ; Disseminated Intravascular Coagulation ; Exanthema ; Fever ; Humans ; Leukocytosis ; Liver ; Lymphohistiocytosis, Hemophagocytic ; Still's Disease, Adult-Onset

A 17-year-old girl presented with primary amenorrhea, short stature, and clitomegaly. Her karyotype showed Turner mosaicism of 45,X/46,XY,idic(Y)(q11.23)del(Y)(q11.23). Laparoscopic bilateral gonadectomy was performed and there was testicular tissue in left ovary.
Adolescent ; Amenorrhea ; Female ; Humans ; Karyotype ; Mosaicism ; Ovary ; Virilism