A pseudo-Cushing's state can be defined as some or all of the clinical features of Cushing's syndrome together with some evidence for hypercortisolism. It may be related to depression, alcohol abuse and obesity. Its manifestation may be transient and resolved with abstinence from causing factors. We report a case of a 70-year-old woman with unilateral nonfunctioning adrenal adenoma and geriatric depressive disorder, which diagnosed by Geriatric Depression Scale (GDS). She showed clinical and/or biochemical features of Cushing's syndrome. Low dose and high dose dexamethasone suppression tests were not identical to those in ACTH independent Cushing's syndrome. Few cases of pseudo-Cushing's syndrome were reported previously in Korea but there was no report about pseudo-Cushing's syndrome combined with nonfunctional adrenal adenoma.
Adenoma* ; Adrenal Glands ; Adrenocorticotropic Hormone ; Aged ; Alcoholism ; Cushing Syndrome ; Depression ; Depressive Disorder ; Dexamethasone ; Female ; Humans ; Korea ; Obesity

The antisynthetase syndrome is characterized by anti-Jo-1 antibody production, interstitial lung disease, inflammatory muscle disease, and, in many cases, fever, polyarthritis, Raynaud's phenomenon, and mechanic's hands. Joint signs and symptoms occur in up to 90% of patients with antisynthetase syndrome, occasionally as the initial manifestations. Although visual inspection of the hands shows changes that are highly suggestive of rheumatoid arthritis, notable differences exist. Antisynthetase syndrome is a predominantly nonerosive arthropathy with subluxations of the distal interphalangeal joints. It manifests as overlap syndrome with other connective tissue diseases. However, overlap syndrome of antisynthetase syndrome and rheumatoid arthritis is rare. We treated a 51-year-old male patient with overlap syndrome of antisynthetase syndrome and rheumatoid arthritis, and report the case with a review of the literature.
Antibodies, Antinuclear ; Antibody Formation ; Arthritis ; Arthritis, Rheumatoid ; Connective Tissue Diseases ; Fever ; Hand ; Humans ; Joints ; Lung Diseases, Interstitial ; Male ; Middle Aged ; Myositis ; Polymyositis

Dermatomyositis is a rare inflammatory myopathy with characteristic skin manifestations and accompanied by muscular weakness. Vesicle formation in dermatomyositis is rare. We report a case of dermatomyositis associated with ovarian cancer in a 62-year-old woman who had vesicles and bullae on her arms. She had erythema and edema on the face, chest, abdomen, and shoulder for 2 months. Diagnosis of dermatomyositis was established by clinical manifestations, muscle enzyme elevation, and a characteristic electromyogram. She was successfully treated with cyclosporin and high doses of steroids.
Abdomen ; Arm ; Blister ; Cyclosporine ; Dermatomyositis ; Edema ; Erythema ; Female ; Humans ; Middle Aged ; Muscle Weakness ; Muscles ; Myositis ; Ovarian Neoplasms ; Shoulder ; Skin Manifestations ; Steroids ; Thorax

PURPOSE: To evaluate the short-term results of two-staged delayed minimal invasive plate osteosynthesis in high-energy intraarticular fractures of the distal tibia. MATERIALS AND METHODS: Thirteen patients, who underwent two-staged delayed minimal invasive plate osteosynthesis for intraarticular fractures of the distal tibia between January 2002 and July 2004, were followed for more than one year. The mean interval time between first stage and second stage of the procedures was 28.6 days (range, 14~34 days). By Ruedi-Allgower classification, there were two cases in type I, three cases in type II, and eight cases in type III. There were six cases in type B and seven cases in type C patients according to AO/OTA classification. Radiographs were graded by the criteria of Burwell and Charnley and ankle functions were graded by the criteria of Mast and Teipner. Union time and postoperative complications were also analysed. RESULTS: Average union time was 16.9 weeks (range, 14~20 weeks) in twelve of the thirteen fractures, but there was one fracture resulting in soft tissue complication and infected nonunion. At the latest follow-up, review of the radiographic results showed that ten cases of fractures (77%) achieved an anatomic reduction, two cases (15%) achieved fair reduction and one case (8%) achieved a poor reduction. And clinical functional assessment showed that nine cases (69%) were good results, three cases were (23%) fair results and one case (8%) was poor result. CONCLUSION: Two-staged delayed minimal invasive plate osteosynthesis is an excellent option for the treatment of high-energy intraarticular fractures of the distal tibia.
Ankle ; Classification ; Follow-Up Studies ; Humans ; Intra-Articular Fractures* ; Postoperative Complications ; Tibia*

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis. There are no generally accepted diagnostic criteria for PsA. Indeed, the diagnosis of this inflammatory arthritis is made by exclusion of other possible diseases and based upon immunologic, radiologic, and clinical features which are consistent with the diagnosis. Inflammatory arthritis in a patient with psoriasis can be an important clue for the diagnosis of PsA, but the possibility for diagnosis of other inflammatory arthritides ever remains. Herein we report a case of a female patient who was not diagnosed with PsA, but with rheumatoid arthritis, even though she had psoriasis.
Adult ; Arthritis/classification/*diagnosis/*immunology ; Arthritis, Psoriatic/classification/*diagnosis/*immunology ; Bone and Bones/radiography/radionuclide imaging ; Diagnosis, Differential ; Female ; Humans ; Skin/pathology

Diabetic ketoacidosis is an acute complication of diabetic mellitus. The most common triggering factors are infection, insulin therapy omission and the onset of the disease, but if these are excluded, other less frequent etiologic factors must be ruled out. We report a case of 22-year-old woman with Graves' disease presented as diabetic ketoacidosis. She was diagnosed type 1 diabetes mellitus at 13 years old and continually has been treated with insulin therapy until now. She typically showed tachycardia at rest in spite of correction of metabolic acidosis. Hyperthyroidism worsens glycemic control in diabetic patients and may precipitate diabetic ketoacidosis. Hyperthyroidism always should be investigated in diabetic patients presenting diabetic ketoacidosis without obvious triggering factors.
Acidosis ; Adolescent ; Diabetes Mellitus, Type 1 ; Diabetic Ketoacidosis* ; Female ; Graves Disease ; Humans ; Hyperthyroidism* ; Insulin ; Ketosis ; Tachycardia ; Young Adult

Wegener's granulomatosis is a multisystem necrotizing vasculitis that primarily involves the upper and lower respiratory tract and kidneys but can affect almost any organ, including the central nervous system. Cerebral infarction and intracerebral hemorrhage are rare neurologic complications of Wegener's granulomatosis. We report on a 52-year-old male patient with Wegener's granulomatosis presenting with a cerebral infarction and subsequent intracerebral hemorrhage. He was successfully treated with high dose corticosteroid and cyclophosphamide.
Central Nervous System ; Cerebral Hemorrhage ; Cerebral Infarction ; Cyclophosphamide ; Humans ; Kidney ; Male ; Middle Aged ; Respiratory System ; Vasculitis ; Wegener Granulomatosis

PURPOSE: Despite refinements in the surgical techniques for adult-to-adult living donor liver transplantation (ALDLT), biliary complications still remain the Achilles' heel of ALDLT. Moreover, there is no consensus for the ideal technique of biliary reconstruction to reduce the rate of complications to an acceptable range. We strove to collate the available data of the current surgical techniques for biliary reconstruction in ALDLT in Korea. METHODS: A questionnaire concerning the surgical techniques for biliary reconstruction was sent to 9 surgeons who performed biliary anastomosis in the major LDLT centers of Korea (the response rate was 100%). RESULTS: MR cholangiography (n=7) and/or intra-operative cholangiography (n=5) were routinely performed to evaluate the donor biliary anatomy. All the participants (n=9) preferred duct-to-duct anastomosis to hepatico-jejunostomy. Anastomosis was usually made on the whole layer (n=7 epithelium, n=2) of recipient's common hepatic duct under loupe magnification (n=8); only one center reconstructed the anastomosis on the 2nd order hepatic duct under view of a surgical microscope. There were various techniques for biliary reconstruction as follows: suture material (absorbable: n=5, non-absorbable: n=4), suture method (continuous: n=4, interrupted: n=3, mixed: n=3) and the use of a biliary stent (routine: n=3, sometimes: n=5, rare: n=1). Ductoplasty was performed on the back table (n=7) for the cases with a very close distance (<5 mm) between the bile ducts' openings, but each duct was separately anastomosed to the recipients' bile duct (n=8) or a roux-en-Y limb (n=1) was done in cases with a distance more than 10 mm. CONCLUSION: In 9 LDLT centers of Koreas, duct-to-duct was preferred; however, there was no unique consensus, among the major centers, for the biliary reconstruction techniques that might reduce complications.
Bile ; Bile Ducts ; Cholangiography ; Consensus ; Epithelium ; Extremities ; Heel ; Hepatic Duct, Common ; Humans ; Korea ; Liver ; Liver Transplantation ; Living Donors ; Stents ; Sutures ; Tissue Donors ; Surveys and Questionnaires

Photodynamic therapy is a promising modality for the palliation of advanced upper gastrointestinal cancer and for the eradication of early neoplastic and pre-neoplastic lesions. It is based on the combination of a photosensitizer that is selectively localized in the target tissue and illumination of the lesion with visible light, resulting in photodamage and subsequent cell death. For early esophageal cancer, esophagectomy has been a standard modality of curative intent. However, accumulated data supports the possibility of PDT replacing surgery as a curative modality. We experienced a case of early esophageal cancer that recurred after esophagectomy. The patient was successfully treated with photodynamic therapy using porfimer sodium as a photosensitizer.
Endoscopy, Gastrointestinal ; Esophageal Neoplasms/*drug therapy/pathology/surgery ; *Esophagectomy ; Humans ; Male ; Middle Aged ; *Photochemotherapy ; Photosensitizing Agents/administration & dosage/*therapeutic use

Retroperitoneal fibrosis (RPF) is a rare disease with unclear etiology, which is characterized by chronic non-specific inflammation of the retroperitoneum. This study was performed to investigate the clinical characteristics, laboratory findings, radiologic findings, treatment and outcome in Korean patients with RPF. We retrospectively reviewed medical records of 27 RPF patients who were admitted to Yonsei University Medical Center between 1998 and 2009. Twenty-two patients (81%) were male. The mean age at diagnosis was 56 yr. Nine patients had identifiable risk factors of RPF and three patients had combined autoimmune diseases. Acute phase reactants were elevated in most patients. Rheumatoid factor was positive in 3 of 16 patients (19%) and antinuclear antibody in 4 of 17 (24%). Five of 6 patients who were taken positron-emission tomography showed positive uptake. Glucocorticoids were used in 16 patients (59%) and four of them received combination therapy with azathioprine. After immunosuppressive treatment, the levels of acute phase reactants dropped, and the size of mass also decreased in most patients. In conclusion, the clinical characteristics of RPF in Korean patients are similar with other series except for higher proportion of male. Some patients with RPF have autoimmune features. The effect of immunosuppressive treatment on RPF is good.
Acute Disease ; Adult ; Aged ; Antibodies, Antinuclear/immunology/metabolism ; Azathioprine/therapeutic use ; Drug Therapy, Combination ; Female ; Glucocorticoids/therapeutic use ; Humans ; Immunosuppressive Agents/therapeutic use ; Male ; Middle Aged ; Positron-Emission Tomography ; Republic of Korea ; Retroperitoneal Fibrosis/*diagnosis/drug therapy/pathology ; Retrospective Studies ; Sex Factors ; Tomography, X-Ray Computed