Primary trabecular carcinoid of the ovary is very rare and less than 30 cases have been reported. Herein is reported a primary trabecular carcinoid of the ovary which contained an epidermoid cyst in a 80-year-old woman. Gross examination showed 12 x 11 x 7 cm- sized mass in the right ovary. On cut-surface, the mass was composed of multilocular cyst containing serous and keratinized material and of 5 x 3.5 cm-sized solid area with extensive necrosis and hemorrhage. Microscopic examination revealed that the tumor cells are almost arranged in trabeculae and focally in insular pattern. Also, the tumor contained an epidermoid cyst but not other teratomatous elements. Tumor cells were immunoreactive for cytokeratin, neuron specific enolase (NSE) and chromogranin. Electron microscopic tindings revealed characteristic, round-shaped neurosecretory granules and perinuclear microfilaments.
Actin Cytoskeleton ; Aged, 80 and over ; Carcinoid Tumor* ; Epidermal Cyst ; Female ; Hemorrhage ; Humans ; Keratins ; Necrosis ; Ovary* ; Phosphopyruvate Hydratase

PURPOSE: To present our operative experiences with carpometacarpal (CMC) injuries, excluding thumb. MATERIALS AND METHODS: Thirty four fracture and dislocations of CMC joint excluding thumb were reviewed retrospectively. Emphases were placed on injury mechanisms, anatomical location, times between diagnosis and surgery, treatment and complications. RESULTS: The average age of patients was 31.5 years. 19 cases of axial loading by blow as an injury mechanism. The 5th CMC joint was found to be the most frequently involved single joint (18 cases of 34 cases). Dorsal dislocation of CMC joints was present in 12 cases. Comminution of the carpal or metacarpal bone was present in 18 cases. The average time to surgery was 6 days. Twenty-seven cases were operated upon by closed reduction and percutaneous pinning. Seven cases were treated by open reduction and internal fixation. In the last follow up period, a clinically full hand function was restored in 31 cases. Intermittent pain was present in 6 cases in which there was grip weakness in 4 cases and limitation of motion in 3 cases. However, all cases were able to activities of daily living. CONCLUSION: We obtained good outcomes in CMC joint injuries through the accurate diagnosis and proper operative treatment.
Activities of Daily Living ; Carpometacarpal Joints* ; Diagnosis ; Dislocations ; Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Joints ; Retrospective Studies ; Thumb

Diagnosis of an adrenal tumor without typical clinical signs related to hyperadrenocorticism and elevated alkaline phosphatase is challenging. This report describes a sex hormone-secreting adrenal tumor in a 10-year-old castrated male Shih Tzu evaluated through repetitive ultrasonographic examination. An adrenocorticotropic hormone stimulation test revealed elevated concentrations of androstenedione and 17-hydroxyprogesterone but a normal cortisol concentration. A mass was surgically excised and adenoma was diagnosed histopathologically. In the present case, adrenal tumor was strongly suspected based on a gradual increase in adrenal size and a change from peanut shape to an irregular mass on repetitive ultrasonography. Repetitive ultrasonographic examination of the adrenal gland is recommended when an abnormal ultrasonographic appearance of adrenal gland is identified, even in an asymptomatic dog.
17-alpha-Hydroxyprogesterone ; Adenoma* ; Adrenal Gland Neoplasms ; Adrenal Glands ; Adrenocortical Hyperfunction ; Adrenocorticotropic Hormone ; Alkaline Phosphatase ; Androstenedione ; Animals ; Arachis ; Child ; Diagnosis ; Diagnostic Imaging ; Dogs ; Humans ; Hydrocortisone ; Male ; Ultrasonography

BACKGROUND AND OBJECTIVE: Hunter syndrome(mucopolysaccharidosis (MPS) type II) is a genetic, metabolic disease of excessive mucopolysaccharide storage leading to mental and skeletal abnormalities, distinctive facial features, hearing loss, and airway problems. Its eventual lethal outcome results from cardiac failure and progressive obstruction of the airway. We tried to outline the otolaryngologic manifestations and management of patients based on the results of our study and review of the relevant literature. MATERIALS AND METHODS: Nine patients with Hunter syndrome were included in this study. Every patient was interviewed for the evaluation of any abnormality in the head and neck region, intelligence and language. Audio tests, temporal bone CT, and plain films of cervical spine were also performed. RESULTS: Upper airway obstruction occurred in most of patients, and necessitated tonsillectomy and adenoidectomy in 4 patients. Tracheal narrowing occurred in 3 patients. Otitis media with effusion, hearing loss and thickening of the external auditory canal and tympanic membrane were commonly observed in patients, and ventilation tubes were inserted in 4 patients. Mental retardation was more profound in the severe type Hunter syndrome, but speech function was disordered in both severe and mild type. CONCLUSION: Accurate evaluation and management of airway obstruction is needed to prevent lethal airway problems. Aggressive audio and otological managements, including the management of otitis media, hearing aids and speech therapy are required to enhance communicative development and improve their quality of life.
Adenoidectomy ; Airway Obstruction ; Ear Canal ; Head ; Hearing Aids ; Hearing Loss ; Heart Failure ; Humans ; Intellectual Disability ; Intelligence ; Metabolic Diseases ; Mucopolysaccharidosis II* ; Neck ; Otitis Media ; Otitis Media with Effusion ; Quality of Life ; Speech Therapy ; Spine ; Temporal Bone ; Tonsillectomy ; Tympanic Membrane ; Ventilation

A conference was convened by the Korean Diabetes Association and the Korean Endocrine Society on September 7, 2009 to discuss and organize the results of research on intensive glucose control for the prevention of cardiovascular disease in patients with type 2 diabetes. Professor Kyung Soo Park led the conference, and Professors Kwang Won Kim and Ho Young Son acted as chairmen. Professors Doo Man Kim, Tae Sun Park, and Bong Soo Cha reported on intensive glucose control and diabetic complications, including the UK Prospective Diabetes Study (UKPDS), Diabetes Control and Complication Trial (DCCT) research results, the recently published Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE), and Veterans Affairs Diabetes Trial (VADT) research, as well as meta-analyses. Professor Jeong-Taek Woo reported on the manuscript written by the committee for the Korean Diabetes Association which dealt with the treatment of diabetes mellitus. Professors Kyung Soo Ko, Joong Yeol Park, Hyun Shik Son, Moon-Kyu Lee, Dong-Won Byun, and Yoon-Sok Chung participated in the discussion and collected information for the manuscript from all of the participants. The aim of the debate was to determine how to establish target goals for intensive glucose control and how to individualize those goals. The participants concluded that there was no need to modify the recommendation of maintaining an HbA1c under 6.5%, the current blood glucose treatment goal that is recommended by the Korean Diabetes Association. In addition, individual target goals for glucose control were recommended depending on the situation of each patient. We report on the consensus statement from the meeting.
Blood Glucose ; Cardiovascular Diseases ; Consensus ; Diabetes Complications ; Diabetes Mellitus ; Drug Combinations ; Gliclazide ; Glucose ; Humans ; Indapamide ; Perindopril ; Solar System ; Veterans

A conference was convened by the Korean Diabetes Association and the Korean Endocrine Society on September 7, 2009 to discuss and organize the results of research on intensive glucose control for the prevention of cardiovascular disease in patients with type 2 diabetes. Professor Kyung Soo Park led the conference, and Professors Kwang Won Kim and Ho Young Son acted as chairmen. Professors Doo Man Kim, Tae Sun Park, and Bong Soo Cha reported on intensive glucose control and diabetic complications, including the UK Prospective Diabetes Study (UKPDS), Diabetes Control and Complication Trial (DCCT) research results, the recently published Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE), and Veterans Affairs Diabetes Trial (VADT) research, as well as meta-analyses. Professor Jeong-Taek Woo reported on the manuscript written by the committee for the Korean Diabetes Association which dealt with the treatment of diabetes mellitus. Professors Kyung Soo Ko, Joong Yeol Park, Hyun Shik Son, Moon-Kyu Lee, Dong-Won Byun, and Yoon-Sok Chung participated in the discussion and collected information for the manuscript from all of the participants. The aim of the debate was to determine how to establish target goals for intensive glucose control and how to individualize those goals. The participants concluded that there was no need to modify the recommendation of maintaining an HbA1c under 6.5%, the current blood glucose treatment goal that is recommended by the Korean Diabetes Association. In addition, individual target goals for glucose control were recommended depending on the situation of each patient. We report on the consensus statement from the meeting.
Blood Glucose ; Cardiovascular Diseases ; Consensus ; Diabetes Complications ; Diabetes Mellitus ; Drug Combinations ; Gliclazide ; Glucose ; Humans ; Indapamide ; Perindopril ; Solar System ; Veterans

STUDY DESIGN: Retrospective patient data collection and investigator survey. PURPOSE: To investigate patterns of opioid treatment for pain caused by spinal disorders in Korea. OVERVIEW OF LITERATURE: Opioid analgesic prescription and adequacy of consumption measures in Korea have markedly increased in the past decade, suggesting changing patterns in pain management practice; however, there is lack of integrated data specific to Korean population. METHODS: Patient data were collected from medical records at 34 university hospitals in Korea. Outpatients receiving opioids for pain caused by spinal disorders were included in the study. Treatment patterns, including opioid types, doses, treatment duration, outcomes, and adverse drug reactions (ADRs), were evaluated. Investigators were interviewed on their perceptions of opioid use for spinal disorders. RESULTS: Among 2,468 analyzed cases, spinal stenosis (42.8%) was the most common presentation, followed by disc herniation (24.2%) and vertebral fracture (17.5%). In addition, a greater proportion of patients experienced severe pain (73.9%) rather than moderate (19.9%) or mild (0.7%) pain. Oxycodone (51.9%) and fentanyl (50.8%) were the most frequently prescribed opioids; most patients were prescribed relatively low doses. The median duration of opioid treatment was 84 days. Pain relief was superior in patients with longer treatment duration (≥2 months) or with nociceptive pain than in those with shorter treatment duration or with neuropathic or mixed-type pain. ADRs were observed in 8.6% of cases. According to the investigators' survey, "excellent analgesic effect" was a perceived advantage of opioids, while safety concerns were a disadvantage. CONCLUSIONS: Opioid usage patterns in patients with spinal disorders are in alignment with international guidelines for spinal pain management. Future prospective studies may address the suitability of opioids for spinal pain treatment by using appropriate objective measurement tools.
Analgesics, Opioid ; Chronic Pain ; Data Collection ; Drug-Related Side Effects and Adverse Reactions ; Fentanyl ; Hospitals, University ; Humans ; Korea* ; Medical Records ; Nociceptive Pain ; Outpatients ; Oxycodone ; Pain Management ; Prescriptions ; Prospective Studies ; Research Personnel ; Retrospective Studies* ; Spinal Diseases ; Spinal Stenosis ; Spine

Breast cancer is a common malignancy in women and frequently metastasizes to various organs such as liver, lung, brain, bone and so on. But metastasis to gastrointestinal tract is rare. We describe a 73-year-old woman with small intestinal metastasis of breast cancer. She was diagnosed as right breast cancer in stage I, received modified radical mastectomy 6 years ago and had been followed up without any evidence of residual disease. During investigation for lower abdominal pain and weight loss of 9 kg, we found a small bowel mass. The histology of the tissue taken from small bowel mass was adenocarcinoma, poorly differentiated. The immunohistochemical stain of this specimen showed 75% positivity of estrogen receptor and 90% positivity of progesterone receptor. This is a case of small bowel metastasis from breast cancer and we report this case with a review of literatures.
Adenocarcinoma/*secondary ; Aged ; Breast Neoplasms/*pathology ; English Abstract ; Female ; Humans ; Intestinal Neoplasms/diagnosis/*secondary ; Intestine, Small

The gastric pedicle is commonly used for the reconstruction following the resection of esophageal cancer. We recently experienced a case in which gastric ulcer occurred eighteen months postoperatively. A 60 year-old man complaining of chest pain, dry cough, mild fever and chills was admitted to the emergency room. The patient had a history of esophagectomy and esophagogastrostomy because of esophageal cancer. Chest X-ray and CT scan showed pneumopericardium. Upper GI contrast study showed a fistulous tract between the stomach pedicle and the pericardium. Upper GI endoscopy showed beating heart through the fistulous opening. The patient expired with sepsis on the twenty second days after an emergent operation. Gastropericardial fistula caused by a peptic ulcer perforation after the esophgectomy and esophagogastrostomy operation is a very rare complication and brings a fatal result. Early detection using the chest radiography, electrocardiogram, echocardiography, upper GI study and physical examination, and an immediate treatment are therefore mandatory.
Chest Pain ; Chills ; Cough ; Echocardiography ; Electrocardiography ; Emergency Service, Hospital ; Endoscopy ; Esophageal Neoplasms* ; Esophagectomy* ; Fever ; Fistula* ; Heart ; Humans ; Middle Aged ; Peptic Ulcer Perforation ; Pericardium ; Physical Examination ; Pneumopericardium ; Radiography ; Sepsis ; Stomach ; Stomach Ulcer ; Thorax ; Tomography, X-Ray Computed

Spontaneous regression may occur in malignancies such as hypernephroma, neuroblastoma, malignant melanoma, choriocarcinoma, and bladder tumor, but yet it is extremely rare in carcinoma of the stomach. So far, 19 cases have been reported in the English literature and the mechanisms underlying this intriguing phenomenon remain unknown. A 48-year-old man with histologically-verified advanced gastric carcinoma had received no treatment since its diagnosis. However, gastric carcinoma was no longer detectable by endoscopy and histology after 4 years. Thus, we report a case of spontaneous regression of carcinoma of the stomach with a brief review of relevant literatures.
Carcinoma, Renal Cell ; Choriocarcinoma ; Diagnosis ; Endoscopy ; Female ; Humans ; Melanoma ; Middle Aged ; Neuroblastoma ; Pregnancy ; Stomach ; Stomach Neoplasms* ; Urinary Bladder Neoplasms