The lacrimal fossa can be invovled by a wide specturm of orbital pathology. The correct diagnosis is importantto avoid unnecessary procedure and to do appropriate management. 14 patients with mass lesions in the lacrimalfossa were evaluated with CT and clinical findings. The results were as follows: 1. Final diagnosis of 14 caseswith lacrimal fossa tumors was pleomorphic adenoma in 3 cases, adenoid cystic carcinoma in 1 case, pseudotumor incases, lymphoma in 2 cases, neurofibroma in 1 case, chloroma in 1 case and metastatic adenocarcinoma in 1 case. 2.The duration of symptoms of pleumorphic adenoma was more than 1 year and characteristic CT findings were globularmasses with pressure erosion of the adjacent bone. Patient wih adenoid cystic carcinoma had a short history ofsymptoms. CT showed a fusiform mass but intracranial extension with frank destruction of sphenoid bone. 3.Patients wtih pseudotumor and lymphoma had symptoms for less than 1 year. The CT findings were ill-definedinfiltrative patterns with scleral thickening and the differential diagnosis of them was difficult. 4. The marginsof neurofibroma and chloroma were well defined while that of the metastatic adenocarcinoma was ill-defined. 5. Thedegree and the extent of the contrast enhancement gave no benefit in the differential diagnosis of each diseaseentities and even of the benign and malignant lesions.
Adenocarcinoma ; Adenoma ; Adenoma, Pleomorphic ; Carcinoma, Adenoid Cystic ; Diagnosis ; Diagnosis, Differential ; Humans ; Lymphoma ; Neurofibroma ; Orbit ; Pathology ; Sarcoma, Myeloid ; Sphenoid Bone ; Unnecessary Procedures

BACKGROUND: As the pleural inflammation progresses, exudative pleural fluid becomes loculated rapidly with pleural thickening. Complete drainage is important 13 prevent pleural fibrosis, entrapment and depression of lung function Intrapleural urokinase instillation therapy has been advocated as a method to facilitate drainage of gelatinous pleural fluid and to allow enzymatic debriment of pleural surface. This study was designed to investigate the Predictors of effeotiveness of intrapleural urokinase in treatment of loculated pleural effusion METHOD: Thirty-five patients received a single radiographically guided pig-tail catheter ranging in size from 10 to 12 French Twenty-two patients had tuberculous pleural effusions, and 13 had non-tuberculous postpneumonic empyemas. A total of 240,000 units of urokinase was dissolved in 240 ml of normal saline and the aliquots of 80mL was instilled into the pleura1 cavity via pig-tail catheter per every 8hr. Effectiveness of intrapleural urokinase instillation therapy was assessed by biochemical markers, ultrasonography, and technical details. A greater than 50% improvement on follow-up chest radiographs was defined as success group. RESULT: Twenty-seven of 35 (77.1%) patients had successful outcome to urokinase instillation therapy. Duration of symptoms before admission was shorter in sucess group (11.8α6.9day) than in failure group (26.62α16.5day) (P<0.05). Amount of drained fluid during urokinsse therapy was larger in success group (917.1α392.7ml) than in failure group (613.8α259.7ml) (P<0.05). Pleural fluid glucose was higher in success group (89.7 α35.9mg/dl) than in failure group (41.2α47.1mg/dl) (P<0.05). Pleural fluid LDH was lower in success group (878.4α654.31U/L) than in failure group (2711.1α973.1IU/L) (P<0.05). Honeycomb septated pattern on chest ultrasonography was observed in six of eight failure group, but none of success group(P<0.05). CONCLUSION: Longer duration of symptoms before admission smaller amount of drained fluid during urokinase therapy, lower glucose value, higher LDH value in pleural fluid examination and honeycomb septation pattern on chest ultrasonography were predictors for failure group of intrapleural urokinase instillation therapy.
Biomarkers ; Catheters ; Depression ; Drainage ; Empyema ; Fibrosis ; Follow-Up Studies ; Gelatin ; Glucose ; Humans ; Inflammation ; Lung ; Pleural Effusion* ; Radiography, Thoracic ; Thorax ; Ultrasonography ; Urokinase-Type Plasminogen Activator*

No abstract available.
Pleural Effusion*

Although varying types of cystic lesion, true to false, in the spinal cord have been described, spinal enterogenous cyst is a rare condition. It is considered as a result of congenital remnant of primitive foregut. The authors experienced a case of a spinal enterogenous cyst in the intradural space along the fouth, fifth and sixth cervical spine, occurred in a twenty-seven years old male patient. The cyst was composed of hyalinized fibrous wall with single layered lining epithelium, such as simple non-ciliated cuboidal epithelium or ciliated tall columnar epithelium with focal mucinous columnar epithelium.
Male ; Humans ; Cysts

PURPOSE: The measurement of serum thyroglobulin (Tg) of papillary thyroid carcinoma patients, 12 months after total thyroidectomy and radioactive iodine (RAI) ablation following thyroxine hormone withdrawal (T4-off Tg) or recombinant human thyroid-stimulating hormone stimulation (rhTSH-Tg), is standard method for monitoring disease status. The aim of this study was to find predictive factors for detectable T4-off Tg during follow-up. METHODS: A retrospective review was conducted of 329 patients who underwent total thyroidectomy and RAI ablation between October 2008 and August 2012. Subjects were assigned to high (>1 ng/mL, n = 53) and low (≤1 ng/mL, n = 276) groups, based on T4-off Tg measured 12 months postoperatively. Demographic and clinicopathological characteristics at diagnosis and follow-up were compared between the 2 groups. RESULTS: The low and high T4-off Tg groups differed with respect to tumor size, preoperative Tg, ablative Tg, cervical lymph node metastasis, thyroglobulinemia out of proportion to results of diagnostic whole body scan, and American Thyroid Association 3-level stratification and restratification. Multivariate analysis confirmed that ablative Tg > 1.0 ng/mL (odds ratio [OR], 10.801; P = 0.001), more than 5 cervical lymph node metastasis (OR, 6.491; P = 0.003), and thyroglobulinemia out of proportion (OR, 9.221; P = 0.000) were risk factors. CONCLUSION: Ablative Tg >1.0 ng/mL, more than 5 cervical lymph node metastasis, and thyroglobulinemia out of proportion were independent factors for T4-off Tg >1 ng/mL 12 months postoperative. In low-risk patients without these risk factors, the possible omission of Tg measurements could be considered during follow-up.
Diagnosis ; Follow-Up Studies ; Humans ; Iodine* ; Lymph Nodes ; Methods ; Multivariate Analysis ; Neoplasm Metastasis ; Retrospective Studies ; Risk Factors* ; Thyroglobulin* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyrotropin ; Thyroxine ; Whole Body Imaging

Since 1982, many countries have reported outbreaks or sporadic cases by enterohemorrhagic Escherichia coli (E. coli) serogroup strains, mainly E. coli O157 : H7. Hemorrhagic E. coli induces hemolytic uremic syndrome (HUS) in 10 to 15% of cases in infants and young chilidren. HUS is a clinical syndrome of hemolytic anemia, acute renal failure, and thrombocytopenia. We experienced a case of E. coli O8 as the causative organism of hemorrhagic colitis and hemolytic uremic syndrome in 16 year-old man. Hemorrhagic colitis was diagnosed by the sigmoidoscopy and E. coli O8 was identified in the stool culture. Hemolytic uremic syndrome was clinically diagnosed. A conservative management including total parenteral nutrition, plasma exchange transfusion, hemodialysis and continuous arteriovenous hemofiltration with dialysis resulted in a complete recovery of the patient. We herein report this manifestations of E. coli O8 and discuss the therapeutic issues related to hemorrhagic colitis and hemolytic uremic syndrome.
Acute Kidney Injury ; Adolescent ; Anemia, Hemolytic ; Colitis ; Dialysis ; Disease Outbreaks ; Enterohemorrhagic Escherichia coli ; Escherichia coli* ; Escherichia* ; Hemofiltration ; Hemolytic-Uremic Syndrome* ; Humans ; Infant ; Parenteral Nutrition, Total ; Plasma Exchange ; Renal Dialysis ; Sigmoidoscopy ; Thrombocytopenia

Stickler syndrome is a progressive, hereditary disorder of connective tissue caused by mutations in different collagen genes. It is characterized by distinctive ocular, auditory, skeletal and oro-facial abnormalities and associated with long-term respiratory, nutritional, and developmental difficulties. Therefore, early detection and early treatment of Stickler syndrome is very important. We reported a case of Stickler syndrome in a newborn with family history and COL2A1 gene mutation.
Collagen ; Connective Tissue ; Humans ; Infant, Newborn*

MELAS (Mitochondrial Encephalomyopathy with Lactic acidosis, and Stroke-like episodes) is a major maternally inherited mitochondrial(mt) encephalopathy, a disease in which 80% of cases are associated with mtDNA point mutation (nt A3243G in tRNALeu(UUR)). We report a case of MELAS syndrome confirmed by typical clinical presentation, muscle biopsy, and molecular genetic diagnosis. A patient was 14-year-old male presenting repeated episode of right hemiparesis and visual field defect. He is exhibited a short stature with dull appearance. On neurologic examination, right homonymous hemianopsia, right hemiparesis, and right side hypesthesia are noted. Brain MRI showed multiple signal changes lesion in left thalamus, right occipital and both temporal regions. Level of lactic acid in serum and CSF was highly increased. Ragged red fibers were shown in the modified Gomori-Trichrome staining, and electromicroscopic finding showed on accumulation of variable sized mitochondrias and glycogen particles in some areas of subsarcolemmal and interfibrillar areas. The mitochondrial tRNALeu(UUR) 3243 A to G mutation was identified by PCR/restriction endonuclease and sequencing. The ratio of mutation in leukocytes of proband and proband's mother was 50% and 10%, respectively. We report a case of MELAS syndromes showing mitochondrial tRNALeu(UUR) 3243 A to G mutation.
Acidosis, Lactic ; Adolescent ; Biopsy ; Brain ; Diagnosis ; DNA, Mitochondrial* ; Glycogen ; Hemianopsia ; Humans ; Hypesthesia ; Lactic Acid ; Leukocytes ; Magnetic Resonance Imaging ; Male ; MELAS Syndrome* ; Mitochondria ; Molecular Biology ; Mothers ; Neurologic Examination ; Paresis ; Point Mutation* ; Thalamus ; Visual Fields

BACKGROUND: Adenocarcinoma of the esophagus has been reported to be increasing in incidence in a number of regions throughout the world, while the incidence of squamous cell carcinoma (SCCA) of the esophagus is mostly stable or decreasing. To evaluate the increasing tendency of adenocarcinoma of the esophagus. METHODS: we studied retrospectively the records of patients with histologically proven esophageal cancer between 1970 and 1999 at the Yonsei Medical Center. RESULTS: Total cases of esophageal cancer were 969 patients of which the cases of adenocarcinoma and SCCA were 27 patients and 918 patients, respectively. The ratio of esophageal adenocarcinoma to SCCA was 0.0375 in the 1970s, 0.0241 in the 1980s and 0.0292 in the 1990s. There was no statistical difference (p=0.811) in the ratios of adenocarcinoma of the esophagus between the three consecutive 10-year groups. CONCLUSION: In conclusion, unlike the US and other western countries, it seems that the ratio of esophageal adenocarcinoma compared to SCCA has not increased among patients with esophageal carcinoma at the Yonsei Medical Center.
Adenocarcinoma/*epidemiology ; Carcinoma, Squamous Cell/*epidemiology ; Chi-Square Distribution ; Esophageal Neoplasms/*epidemiology ; Human ; Korea/epidemiology ; Middle Age ; Prevalence ; Retrospective Studies

Weber-Christian disease is an inflammatory disease of subcutaneous fat tissue which is characterized by relapsing, febrile tender nodules and histologically lobular panniculitis. Many cases originally considered as examples of Weber-Christian disease were later found to be other diseases when lobular panniculitis was reclassified, and some authors believe that Weber-Christian disease should no longer be considered as a distinctive entity. However, there are still occasional cases which cannot be diagnosed as other specific diseases but have the characteristic manifestations of Weber-Christian disease, and they attest to the fact that Weber-Christian disease could be a distinctive disease entity. We report here a case of Weber-Christian disease in a 22-year-old female who was treated successfully with steroid pulse therapy.
Female ; Humans ; Panniculitis ; Panniculitis, Nodular Nonsuppurative* ; Subcutaneous Fat ; Young Adult