No abstract available.
Bone Density* ; Hyperparathyroidism, Primary*

No abstract available.
Gonadotropin-Releasing Hormone* ; Puberty, Precocious*

The surgery of large cerebral arteriovenous malformation(AVM) may be complicated by the potential for serious brain swelling and hemorrhage during operation and/or postoperative period due to "normal perfusion pressure breadthrough(NPPB)". The authors present two cases of successful management of large AVM which anticipated the development of 'NPPB' using hypotension and preoperative embolization. The one case admitted with intraventricular hemorrhage and intracerebral hematoma due to rupture of large occipital AVM. We managed him with one-stage resection, followed by postoperative hypotension successfully. The another case was interesting. He had the history of intracranial hemorrhage about 13 years ago. We treated him conservatively at that time. He also had the another attack of intracranial hemorrhage in 1979. We performed angiography which revealed large AVM around trigon of left lateral ventricle. He also had another one time of intracranial hemorrhage in 1985. In 1986, We decided to treat him surgically and repeated angiography which showed enlarged AVM compare to size of AVM in previous angiogram of 1979 definitely. We embolized this lesion with Ivalon(R)(polyvinyl alcohol) and confirmed decreased size of AVM. During waiting the surgical resection, another intracranial hemorrhage occurred and recovered without surgical management. In May 1987, we decided to do operation and performed preoperative angiography, which showed reenlarged of previous embolic obliterated AVM. We resected that AVM successfully and discharged him without any aggravation of previous neurological signs. The pathologic findings of resected embolized AVM revealed infiltration of neurtrophils within vessel walls and foreign body material, surrounded by multinucleated foreign body giant cells, epitheloid cells in the vessel lumen. We reviewed the literature and discussed the enlargement of AVM, the treatment of large AVM, especially in point of view about 'NPPB' and pathologic findings of embolized AVM with Ivalon(R)(polyvinyl alcohol).
Angiography ; Brain Edema ; Foreign Bodies ; Giant Cells, Foreign-Body ; Hematoma ; Hemorrhage ; Hypotension ; Intracranial Arteriovenous Malformations* ; Intracranial Hemorrhages ; Lateral Ventricles ; Perfusion ; Postoperative Period ; Rupture

Insulinoma is clinically characterized by fasting hypoglycemia, various neuropsychiatric symptoms, and these caused by secondary to hypoglycemia.Of patients with insulinoma, 80 percent have single benign tumors, 11 percent have multiple benign tumors, 6 percent have single malignant tumors, and the remainder have multiple malignant tumors or islet hyperplasia according to Service's statement.A 42 year-old male chemical engineer who had insulinoma associated with regional lymph node metastasis has been successfully performed with curative resection and consecutive postoperative therapy with streptozotocin.He entered to this hospital because of frequent occasion of bizarre behavior and language, transient unconsiousness and syncopal episode, and sweating associated with hypoglycemia especially in night four months prior to addmission in November 1992. Those symptoms and hypoglycemia were controlled by intravenous glucose injection and/or oral feeding of glucose riched stuffs.No physical abnormalities were found except neuropsychiatric symptoms. On admission the fasting blood glucose level was 10 mg/dl, plasma immunoreactive plasma insulin level was 125.23 uU/ml, and plasma C-peptide level was 10.24 ng/ml, respectively.Abdominal CT was suggestive of retroperitoneal tumor just behind the pancreas. Selective celiac axis angiography demonstrated hypervascular mass supplied by dorsal pancreatic artery which was compatible with insulinoma. Surgical intervention including distal pancreatectomy, as well as splenectomy and parital omental resection were performed successfully. Consecutive postoperative treatment of streptozotocin was done without any side effects.His condition is very good and enjoyed his life with full activity to date.
Angiography ; Arteries ; Blood Glucose ; C-Peptide ; Fasting ; Glucose ; Humans ; Hyperplasia ; Hypoglycemia ; Insulin ; Insulinoma ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Pancreas ; Pancreatectomy ; Plasma ; Splenectomy ; Streptozocin ; Sweat ; Sweating ; Syncope

Radial tunnel syndrome is a rare disorder and it's symptoms sometimes so closely overlap those lateral epicondylitis, causing difficulties to differentiate. A 39-year-old man was presented who had a 2.5-year history of right elbow and forearm pain which was unseccesfully treated as 'tennis elbow'. Clinically, severe tender point over the forearm was relieved after a local anesthetic injection. Axial STIR(short tau inversion recovery) image showed high signal intensity at the origin of the extensor carpi radialis brevis, which was so minimal that it was not comparable to clinical symptoms. But radial nerve was revealed normal. So we decided that the symptoms were caused not by lateral epicondylitis but rather by radial tunnel sybdrome and an operation was performed. In the operative field, the most proximal part of the superficial head of the supinator muscle was tendinous and formed a fibrous arch, which was resected. After the operation, the right arm pain was relieved. This is a case diagnosed as lateral epicondylitis which showed no improvement under conservative treatment, but improved after a local anesthetic injection on the tender point. When a case with no correlations between lateral epicondylitis degree in MRI and clinical symptoms, one should take the possibility of radial tunnel syndrome into consideration.
Adult ; Arm ; Elbow ; Forearm ; Head ; Humans ; Magnetic Resonance Imaging ; Radial Nerve

No abstract available.
Aneurysm* ; Carotid Arteries* ; Neurofibromatoses ; Vertebral Artery*

BACKGROUND: In recent years, knowledge of bacterial resistance to antimicobials has expanded in important ways. Availability of an increasing number of antibiotics allows more precise individualization of resistance phenotypes and recording susceptibility results as patterns or phenotypes is valuable for both surveillance and patient care. If the patterns of resistance to panels of related antimicrobials are considered the underlying mechanisms can often be inferred. And the inferred mechanisms make the clinician to be advised to use alternative treatment. Interpretation of resistance phenotypes is based on the comparison of clinical isolates with prototype susceptible bacteria belonging to the same species. But interpretative reading of antimicrobial susceptibility tests requires an immense knowledge of antibiotics. Such interpretative reading is best achieved by computerized expert systems. METHODS: The authors attempt to determine phenotypes for the clinically isolated strains for each class of drugs tested by the Vitek 2 systemTM(bioMerieux, Marcy I'Etoile, France) using the Advanced Expert SystemTM(AES, bioMerieux, Marcy I'Etoile, France). A total of 91, 107, 89, 65, 251, 113, 47, 33, 23, 122 and 110 isolates of Staphylococcus aureus, coagulase negative staphylococci, Enterococcus faecalis, Enterococcus facium, Escherichia coli, Klebsiella pneumoniae, Serratia marcescens, Enterobacter cloacae, Enterobacter aerogenes, Pseudomonas aeruginosae and Acinetobacter baumannii, were examined respectively. RESULTS: Biological correction based on the phenotype was recommended from 2.2% of E. faecalis to 46.8% of S. marcescens and therapeutic correction, from 7.3% of A. baumannii to 60.9% of E. aerogenes. A total of 25, 26, 18, 19, 22, 22, 15, 15, 17, 19, 19 phenotypes of S. aureus, coagulase negative staphylococci, E. faecalis, E. facium, E. coli, K. pneumoniae, S. marcescens, E. cloacae, E. aerogenes, P. aeruginosa and A. baumannii, were detected respectively. Association of resistance mechanism from S. aureus, coagulase negative staphylococci, E. coli, K. pneumoniae, S. marcescens, show 10, 11, 6, 4 and 3 pairs from resistant phenotypes, respectively. CONCLUSION: Vitek AES potentially provides a tool to assist the development of antimicrobial susceptibility interpretation in the clinical microbiology laboratory. The inferred mechanisms make the clinician to be advised to use alternative treatment.
Acinetobacter baumannii ; Anti-Bacterial Agents ; Bacteria ; Cloaca ; Coagulase ; Enterobacter aerogenes ; Enterobacter cloacae ; Enterococcus ; Enterococcus faecalis ; Escherichia coli ; Expert Systems ; Klebsiella pneumoniae ; Patient Care ; Phenotype* ; Pneumonia ; Pseudomonas aeruginosa ; Serratia marcescens ; Staphylococcus aureus

The fibromatosis is a broad group of benign fibrous tissue proliferations of similar microscopic appearance that are intermediate in their biological behavior between benign fibrous lesions and fibrosarcoma. Although various series have been reported of abdominal wall and extra-abdominal desmoid tumors, intra-abdominal desoids are extremely rare. We experienced a case with mesenteric fibroma-tosis occuring in a 30 year-old male. He was admitted to the Kangbuk Samsung hospital complaining of right lower quadrant abdominal mass and abdominal bloating sense. Utrasonography and computed tomography of the abdomen showed a solid mass in the left abdomen surrounded by loops of small bowel. At explorative laparotomy, there was a hard, well circumscribed round mass (25 X 15 X 12 cm) in the mesentery of the terminal ilem. After the tumor was dissected from the retro-peritoneum and surrounding tissues, segmental re- section of ileum with end-to-end anastomosis was performed. On the histopathologic examination, it was confirmed as mesenteric fibromatosis. A brief review of the literature on mesentery fibromatosis was done.
Abdomen ; Abdominal Wall ; Adult ; Fibroma* ; Fibromatosis, Aggressive ; Fibrosarcoma ; Humans ; Ileum ; Laparotomy ; Male ; Mesentery

PURPOSE: Recent studies indicate that Fas and Fas Ligand (Fas-L) are implicated in autoimmune endocrine diseases and tumors of the thyroid. In this study we tried to elucidate the expression stati of Fas and Fas-L in some kinds of thyroid neoplasms, and their relationships with 4 prognostic factors in papillary thyroid cancer (i.e., size, lymph node metastasis, capsule invasion, age). METHODS: 66 cases of thyroid neoplasm including 45 cases of papillary cancer (PTC), 3 of a follicular cancer (FTC), 1 of a poorly differentiated cancer (PDC), 1 of a undifferentiated cancer (UC), 7 of follicular adenoma (FA), and 9 of nodular hyperplasia (NH) were examined, and estimated as negative, weak positive and strong positive about the Fas and Fas-L expression by the immunohistochemical staining intensities. We then collected and compared the differrences between benign and malignant tumors. The expressions of Fas and Fas-L in papillary thyroid cancers were evaluated relating to the differences in the prognostic factors (i.e., the size, lymph node status, capsule invasion, and age of the patients). RESULTS: Malignant thyroid tumors revealed stronger staining intensity than benign neoplasms. In papillary thyroid cancers, Fas-L staining intensities were significantly stronger in the cases with perithyroidal lymph node metastasis, or in those of 45 years old or over than in those with no lymph node metastasis, or younger than 45 years. CONCLUSION: Both Fas and Fas-L are implicated in thyroid tumorigenesis and revealed stronger staining intensities in malignant than benign tumors, and the Fas-L staining intensities may have some prognostic implications at least in papillary thyroid cancers.
Adenoma ; Carcinogenesis ; Endocrine System Diseases ; Fas Ligand Protein* ; Humans ; Hyperplasia ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis ; Thyroid Gland* ; Thyroid Neoplasms*

Although most persons infected with Helicobacter pylori harbor a single strain of the organism, multiple strain colonization in the same patient is also occasionally reported in developed countries. The aims of this study were to determine the prevalence of multiple strain colonization in Korean patients and to detect the cagA, iceA1, and babA status of H. pylori isolated from the antrum and body of the stomach. H. pylori was obtained from 35 patients from the antrum and body of the stomach. The genomic diversity of H. pylori was determined by random amplified polymorphic DNA analysis. The status of cagA, iceA1, and babA genes of H. pylori was assessed by polymerase chain reaction with appropriate primers. Clearly different diversity patterns were identified among the isolates from 35 individual patients. Eighteen (51.4%) patients had a single strain of H. pylori. Eight (22.9%) and nine (25.7%) patients had subtypically (one or two bands difference) and typically (clearly different pattern) different strains of H. pylori in the antrum and body, respectively. Among the 70 isolates of H. pylori from 35 patients, the positive rates of 349-bp and 208-bp cagA gene fragments and the iceA1 gene were 68/70 (97.1%), 68/70 (97.1%), and 58/70 (82.9%), respectively. However, the babA gene was found in 22/66 cases (31.4%). In five out of 18 patients with a single strain, the genetic status of cagA, iceA1, and babA varied between the isolates from the antrum and the body. In 8/17 patients with subtypically or typically different strains, the gene status differed between antrum and body isolates. The prevalence of co-colonization with typically or subtypically different strains is high in Korea, and sub-clones with different pathogenic gene status exist within strains of identical RAPD patterns.
Colon ; Developed Countries ; DNA ; Helicobacter pylori* ; Helicobacter* ; Humans ; Korea ; Polymerase Chain Reaction ; Prevalence ; Pyloric Antrum* ; Stomach