Peliosis hepatis is characterized by the presence in the liver of blood-filled cavities, which may or may not be lined with sinusoidal cells. The individual cysts or cavities usually do not exceed several centimeters in diameter. The cysts are typically continuous with adjacent, more normal sinusoids, and they sometimes can be seen in continuity with hepatic venous tributaries. The lesion is usually diagnosed by gross or microscopic examination. When suspected, it can be diagnosed by percutaneous liver biopsy. In the past, peliosis hepatis is primarily associated with wasting diseases, such as tuberculosis, malignancy, and chronic suppurative infection. However, recently peliosis hepatis is seen most commonly in association with the administration of anabolic steroids or HIV infection. We report a case of peliosis hepatis that is diagnosed by peritoneoscopic live biopsy and not associated with known disease.
Biopsy* ; HIV Infections ; Laparoscopy ; Liver* ; Peliosis Hepatis* ; Steroids ; Tuberculosis ; Wasting Syndrome

BACKGROUND: The incidence of mycoplasmal pneumonia is predominantly at childhood and early adulthood, but in adults, its incidence is low and its symptoms and physical findings are nonspecific. The definite diagnosis of M. pneumoniae pneumonia can be made by sputum culture, but requires several weeks for positive results, and the early diagnosis must initially be based on the serologic tests and appropriate clinical findings. Thus, we evaluated the clinical aspects of M. pneumoniae pneumonia in the adults patients. METHOD: Among the admitted patients due to pneumonia, the definite diagnosis is anti-M. pneumoniae antibody titer of > 1:40 and a single cold agglutinin titer of > 1:64. The presumptive diagnosis is anti-M. pneumoniae antibody titer of > 1:40 or a single cold agglutinin titer of > 1:64 and the clinical characteristics or chest X-ray findings are compatible with M. pneumoniae pneumonia. We studied the age and sex distribution, seasonal distribution, clinical symptoms, physical findings, serologic test, chest X-ray findings, treatment and its progression. RESULTS: 1) The age distribution was even and the ratio of male to female was 1:1. 2) The monthly distribution was most common in January(16.7%) and the seasonal distribution in autumn and winter(autumn: 30%, winter: 33.3%). 3) The cold agglutinin titers were higher than 1:64 in 12 cases(40%), and reached the peak level around 2 weeks from onset and antimycoplasma antibody titers were higher than 1:160 in 5 cases(16.7%). 4) On the chest X-ray, pulmonary infiltration was noted in 28 cases(93.3%) among 30 cases and right lower lobe involvement was the most common(33.3%) and both lower lobe involvement was noted in 7 cases(23.3%). 5) The mean treatment duration was most common(33.3%) in 1 week to 2 weeks after admission and 26 cases(86.7%) were improved within 4 weeks. 6) On admission, there was fever(> or =38.9degreesC) in 17 cases(56.7%), and the fever subsided in 12 cases(70%) within 3 days after treatment using erythromycin. CONCLUSION: The mycoplasmal pneumonia in adults shows milder clinical patterns than that in childhood and can be completely recovered without complication by early diagnosis and treatment.
Adult* ; Age Distribution ; Diagnosis ; Early Diagnosis ; Erythromycin ; Female ; Fever ; Hospital Distribution Systems ; Humans ; Incidence ; Male ; Pneumonia* ; Seasons ; Serologic Tests ; Sex Distribution ; Sputum ; Thorax

PURPOSE: The easy recognition and characterization of a discrete or fixed subaortic ridge by echocardiography provides a method for prospective study of the coexistence of ventricular septal defect (VSD) and subaortic ridge. In the presence of a VSD, a subaortic ridge may be clinically silent, but the obstruction can progress if the VSD is surgically or spontaneously closed. This study was carried out to test the hypothesis that the presence of a subaortic ridge associated with a VSD is related abnormal shunt flow through the septal defect. METHODS: Serial two-dimensional echocardiographic diagnosis of the coexistence of VSD and subaortic ridge was done prospectively in 271 patients. The VSD was morphologically characterized as perimembranous, muscular, or subarterial according to the components of its borders. Also, defect size of the VSD was characterized. The presence of septal malalignment was established when the outlet septum was deviated anteriorly or posteriorly. The subaortic ridge was recognized when an echo-bright localized protusion into the left ventricular outflow tract extending from the margin of the septal defect. RESULTS: The prevalence of a subaortic ridge was 8.86% (24/271). The mean age of patients at the initial detection of a subaortic ridge was 11.3+/-9.8 months. Among the 24 patients with a subaortic ridge 14 patients (p<0.01) had more than moderate defect in size of VSD. 16 patients (16/24) had malalignment VSD (p<0.01). A subaortic ridge was found in 20 (9.9%) patients with perimembranous VSD, 4 (8.3%) with subarterial VSD. CONCLUSIONS: The presence of a subaortic ridge associated with a VSD is related to a more than moderate sized defect and/or a malaligned ventricular septum. It is possible that the increased turbulence adjustance to the area of the VSD could favor the development of an abnormal fibrous tissue below the aortic valve.
Aortic Valve ; Diagnosis ; Echocardiography* ; Heart Septal Defects, Ventricular* ; Humans ; Prevalence ; Ventricular Septum

Aneurysm of the pulmonary artery is a rare entity. Aneurysm of the peripheral artery are even less common. An 14-year-old girl was admitted for the evaluation of cardiac murmur. There was a variable grade 2/6 systolic murmur along the left sternal border. The chest x-ray showed a round mass in the right perihilar region. Echocardiogram demonstrated a small muscular ventricular septal defect with mild tricuspid regurgitation. The pulmonary arterial pressures were normal at cardiac catheterization, but pulmonary angiography indicated an aneurysm of the intrapulmonary portion of the right pulmonary artery. Surgical intervention was advised. However, the patient discharged againt operative plan. The literature on this entity is reviewed, and the diagnosis and etiology are discussed.
Adolescent ; Aneurysm* ; Angiography ; Arterial Pressure ; Arteries ; Cardiac Catheterization ; Cardiac Catheters ; Diagnosis ; Female ; Heart Murmurs ; Heart Septal Defects, Ventricular ; Humans ; Hypertension, Pulmonary* ; Pulmonary Artery* ; Systolic Murmurs ; Thorax ; Tricuspid Valve Insufficiency

Wiskott-Aldrich syndrome(WAS) is an X-linked recessive immunodeficiency characterized by thrombocytopenia with small platelet volume, eczema, and recurrent infections, and is also characterized by increased incidence of auto immune diseases and malignancies. The phenotype observed in this syndrome is caused by mutation in the Wiskott-Aldrich syndrome protein(WASP) gene localized to the proximal short arm of the X chromosome and recently isolated through positional cloning. The gene encodes a 502 amino acid protein, which contains 12 exons and spans 9 kb of genomic DNA. The function of the encoded protein is not well understood. The clinical diagnosis of WAS can be difficult and is usually confirmed by the detection of WASP gene mutations and the expression of WSAP in patient blood sample using genetic analysis. We reported a case of a 13-month old boy with WAS who was identified with the novel mutation in exon 2 of WASP gene by direct sequencing and the complete absence of WASP expression by immunoblotting.
Arm ; Blood Platelets ; Clone Cells ; Cloning, Organism ; Diagnosis ; DNA ; Eczema ; Exons* ; Humans ; Immune System Diseases ; Immunoblotting ; Incidence ; Infant ; Male ; Phenotype ; Thrombocytopenia ; Wasps* ; Wiskott-Aldrich Syndrome* ; X Chromosome

The development of myolysis has allowed number of gynecologic surgeons to treat myoma instead of hysterectomy or myomectomy. However not long time has passed since this operation started, little studies were conducted on this complication and side effect. Especially, there are not enough studies about complication and prognosis related pregnancy after myolysis. One of these complications, uterine rupture during pregnancy is not frequent, but fatal condition to both mother and fetus. We report a case of uterine rupture that occurred in early second-trimester who had been myolysis 22 months before pregnancy.
Fetus ; Humans ; Hysterectomy ; Mothers ; Myoma ; Pregnancy ; Prognosis ; Uterine Rupture

PURPOSE: To assess the tumor response, sphincter preservation, acute toxicity and survival with preoperative concurrent chemoradiation in locally advanced rectal cancer. MATERIALS AND METHODS: Fifty-four patients were treated with preoperative chemoradiaton for tumor downstaging and sphincter preservation. Radiation was delivered to whole pelvis to 45 Gy followed by a boost 5.4 Gy to primary tumor site. Chemotherapy consists of concurrent 2 cycles of 5-fluorouracil (500 mg/m2/day) and leucovorin (20 mg/m2/day). Surgery was performed approximately 6 weeks after treatment. RESULTS: Median follow-up period and rate were 48 months and 98%, respectively. The downstaging including primary tumor and lymph node occurred in 64%. Three of 53 patients (6%) had pathologic complete response. The resectability of tumor was 98%. A sphincter preservation was possible in 61%. Three patients developed grade 4 hematologic toxicity. Grade 3 skin erythema and diarrhea were 24% and 18%, respectively. The 5-year survival and local disease-free survival were 62% and 89%, respectively. Local failure and distant metastasis rate were 9% and 35%, respectively. CONCLUSION: Preoperative chemoradiation affords considerable downstaging with acceptable acute toxicity and postoperative morbidity. Also sphincter preservation is feasible by improved downstaging of tumor. This treatment could be improved local control of tumor, and may have a potential for long-term survival.
Diarrhea ; Disease-Free Survival ; Drug Therapy ; Erythema ; Fluorouracil ; Follow-Up Studies ; Humans ; Leucovorin ; Lymph Nodes ; Neoplasm Metastasis ; Pelvis ; Rectal Neoplasms* ; Skin

No abstract available.
Craniocerebral Trauma* ; Head* ; Humans ; Tomography, Emission-Computed, Single-Photon*

Despite advancements in treating ruptured cerebral aneurysms, an aneurysmal subarachnoid hemorrhage (aSAH) is still a grave cerebrovascular disease associated with a high rate of morbidity and mortality. Based on the literature published to date, worldwide academic and governmental committees have developed clinical practice guidelines (CPGs) to propose standards for disease management in order to achieve the best treatment outcomes for aSAHs. In 2013, the Korean Society of Cerebrovascular Surgeons issued a Korean version of the CPGs for aSAHs. The group researched all articles and major foreign CPGs published in English until December 2015 using several search engines. Based on these articles, levels of evidence and grades of recommendations were determined by our society as well as by other related Quality Control Committees from neurointervention, neurology and rehabilitation medicine. The Korean version of the CPGs for aSAHs includes risk factors, diagnosis, initial management, medical and surgical management to prevent rebleeding, management of delayed cerebral ischemia and vasospasm, treatment of hydrocephalus, treatment of medical complications and early rehabilitation. The CPGs are not the absolute standard but are the present reference as the evidence is still incomplete, each environment of clinical practice is different, and there is a high probability of variation in the current recommendations. The CPGs will be useful in the fields of clinical practice and research.
Aneurysm ; Brain Ischemia ; Cerebrovascular Disorders ; Diagnosis ; Disease Management ; Hydrocephalus ; Intracranial Aneurysm ; Mortality ; Neurology ; Quality Control ; Rehabilitation ; Risk Factors ; Search Engine ; Subarachnoid Hemorrhage ; Surgeons