Cholangiocarcinoma has been associated with various fibrocystic diseases of liver and biliary tract, but cholangiocarcinoma in polycystic liver disease (PLD) was extremely rare. It was reported that the prognosis of cholangiocarcinoma associated PLD was very poor and distant metastases were common. We report a rare case of intrahepatic cholangiocarcinoma associated with PLD in 58- year- old female who presented vague abdominal pain. She had also polycystic kidneys with normal renal function. MRI showed well demonstrated tumor with central scar and a adjacent large cyst in the left lobe of the liver. She underwent extended left lobectomy. On microscopic examination, the tumor was moderately differentiated cholangiocarcinoma having abundant fibrous stroma and necrosis and the adjacent cyst showed focal in situ carcinomatous changes in the lining epithelium.
Abdominal Pain ; Biliary Tract ; Cholangiocarcinoma* ; Cicatrix ; Epithelium ; Female ; Humans ; Liver Diseases* ; Liver* ; Magnetic Resonance Imaging ; Necrosis ; Neoplasm Metastasis ; Polycystic Kidney Diseases ; Prognosis ; Cholangiocarcinoma

PURPOSE: To evaluate the parameters of optic nerve head (ONH) and retinal nerve fiber layer (RNFL) in patients with large cup/disc ratio (CDR) and normal neuroretinal rim configuration who have normal perimetry (physiologic large cups, LC) and to compare these parameters with those of the normal and early glaucoma patients. METHODS: Using Heidelberg retinal tomography (HRT) and optical coherence tomography (OCT), 30 patients with LC, 29 normal subjects, and 31 early glaucoma patients were examined. One eye from each subject was randomly selected. RESULTS: Significant differences between LC and glaucomatous eyes (GE) were found in parameters indicating loss of nerve fibers, such as rim area, rim volume, and mean RNFL thickness. However, there was no difference between LC and normal eyes (NE) in RNFL thickness, rim area, and rim volume. LC was able to be defined as a normal central excavation with a large disc and large CDR with a normal rim area. CONCLUSIONS: HRT ONH parameters and RNFL thickness obtained with OCT may be useful for differentiating between glaucoma and LC eyes.
Retina/*pathology ; Optic Disk/*pathology ; Nerve Fibers/*pathology ; Middle Aged ; Humans ; Glaucoma/*pathology ; Adult ; Adolescent

PURPOSE: To investigate the surgical results of repeated trabeculectomy in primary congenital glaucoma. METHODS: The authors retrospectively reviewed the data of 16 patients (23 eyes) who underwent two or more trabeculectomies with or without mitomycin C for primary congenital glaucoma between 1990 and 2004. Surgical success rate and postoperative complications were assessed. The relationship between the use of mitomycin C and the surgical outcomes was also studied. RESULTS: Among the 23 eyes, 10 had a history of previously failed goniotomy or trabeculotomy and 6 eyes had undergone trabeculectomy more than 3 times. The overall success rate of repeated trabeculectomy was 63.9% and the success rate of the 14 eyes operated on with mitomycin C was not higher than that of the 9 eyes that did not receive mitomycin C (p=0.166). Two eyes were reported to have postoperative hypotony and there was one case of endophthalmitis after trabeculectomy; however, the use of mitomycin C did not increase the overall rate of surgical complication (p=1.00). CONCLUSIONS: Repeated trabeculectomy can be considered as a procedure to treat primary congenital glaucoma, particularly in severe cases of congenital glaucoma.
Endophthalmitis ; Glaucoma* ; Humans ; Mitomycin ; Postoperative Complications ; Retrospective Studies ; Trabeculectomy*

PURPOSE: Studies to determine the relation between oxygen tension and outcome in cardiac arrest survivors treated with therapeutic hypothermia (TH) are lacking. We investigated the relation of time-weighted mean oxygen tension (TWMO2) and outcome in cardiac arrest survivors treated with TH. METHODS: This was a retrospective observational study including 177 out-of-hospital cardiac arrest (OHCA) survivors. The patients were divided into four categories according to quartile values of TWMO2. The primary outcome was neurologic outcome at discharge and the secondary outcome was all cause in-hospital mortality. We assessed neurologic outcome using the Cerebral Performance Categories (CPC) at hospital discharge. Neurologic outcome was dichotomised as either good neurologic outcome (CPC1 and CPC2) or poor neurologic outcome (CPC 3 to 5). The odds ratio with 95% confidence interval (CI) was estimated. RESULTS: The median value of PaO2 was 139(104.5-170.0) mmHg. Among a total of 1,239 PaO2 values, 22(1.8%) values were hypoxia (<60 mmHg) and 16(1.3%) values were hyperoxia (>300 mmHg). Results of univariate logistic regression analysis showed a significantly low odds ratio for poor neurologic outcome [0.353(95% CI, 0.133-0.938) and 0.321(95% CI, 0.121-0.850), respectively] and for in-hospital mortality [0.338(95% CI, 0.132-0.870) and 0.387(95% CI, 0.154-0.975), respectively] for the third quartile and the fourth quartile. However, results of multivariate logistic regression analysis showed no significant relation between TWMO2 and outcomes. CONCLUSION: In OHCA survivors treated with TH, time-weighted oxygen tension did not show an association with neurologic outcome and in-hospital mortality.
Anoxia ; Heart Arrest ; Hospital Mortality ; Humans ; Hyperoxia ; Hypothermia* ; Logistic Models ; Observational Study ; Odds Ratio ; Out-of-Hospital Cardiac Arrest* ; Oxygen* ; Retrospective Studies ; Survivors*

Sebaceous hyperplasia occurs on the face in persons over 40 years of age. Cyclosporine in dermatologic diseases can be used for the treatment of psoriasis, pyoderma gangrenosum, lichen planus, graft-versus-host disease, epidermolysis bullosa acquisita, Behcet's disease, and paraneoplastic pemphigus. etc. The side effects of cyclosporine in mucocutaneous tissue, were hypertrichosis, gingival hypertrophy, acneiform eruption, keratosis pilaris, flushing, angioedema, urticaria, and anaphylaxis have also been reported with the use of cyclosporine. Development of sebaceous hyperplasia is related to the process of dysplastic epithelial proliferation. We experienced a case of sebaceous hyperplasia in a renal transplant patient receiving cyclosporine. After carbon dioxide laser was done, lesions were cleared without any scar.
Acneiform Eruptions ; Anaphylaxis ; Angioedema ; Cicatrix ; Cyclosporine* ; Epidermolysis Bullosa Acquisita ; Flushing ; Gingival Hypertrophy ; Graft vs Host Disease ; Humans ; Hyperplasia* ; Hypertrichosis ; Keratosis ; Lasers, Gas ; Lichen Planus ; Pemphigus ; Psoriasis ; Pyoderma Gangrenosum ; Urticaria

Since anorexia nervosa is a multi-systemic disorder, as well as a psychiatric disorder, it needs a multidisciplinary approach. It causes many medical problems, including irregular menstruation, hematologic problems, decreased bone density, electrolyte imbalance, and dysrhythmias. Sometimes, this disorder also causes rare, unexpected complications, including abnormal air collections, such as pneumomediastinum, retropneumoperitoneum, or subcutaneous emphysema. The cause of these phenomena is unknown, although fragile parenchymal tissue that is disrupted easily when the local pressure is increased by coughing, vomiting, or defecation is a suggested cause. We experienced a case of anorexia nervosa complicated with abnormal air collections. After we excluded other possible causes, such as perforation of the gastrointestinal tract, and ordered the patient to undergo a short fast and inhale oxygen, the abnormal air collections resolved. We report this case because of its rarity and benign course.
Anorexia ; Anorexia Nervosa ; Bone Density ; Cough ; Defecation ; Female ; Gastrointestinal Tract ; Humans ; Mediastinal Emphysema ; Menstruation ; Oxygen ; Retropneumoperitoneum ; Subcutaneous Emphysema ; Vomiting

Ulcerative colitis is a diffuse inflammatory disease which is characterized by the vascular congestion and superficial ulcerations in the mucosal and the submucosal layers of the rectum and colon. Extraintestinal manifestations such as arthritis, skin lesion, hepatobiliary and ocular diseases occur in a large number of patients with ulcerative colitis, though gastrointestinal symptoms of mucous and bloody stool, diarrhea and abdominal pain are frequently presented. The association of ulcerative colitis and hepatobiliary disease has been frequently reported in the western countries since the first description by Thomas C.H. in 1874. Fatty degeneration, chronic active hepatitis, cirrhosis, primary sclerosing cholangitis and hepatobiliary carcinoma are included in this list of complications. In the case of hepatobiliary carcinoma, however, the histological diagnosis has almost invariably been cholangiocarcinoma. We report a case of clinical ulcerative colitis with coneurrent hepatocellular carcinoma confirmed by the histologic examination of biopsy specimen in a 49 year old man with the relevant literatures.
Abdominal Pain ; Arthritis ; Biopsy ; Carcinoma, Hepatocellular* ; Cholangiocarcinoma ; Cholangitis, Sclerosing ; Colitis, Ulcerative* ; Colon ; Diagnosis ; Diarrhea ; Estrogens, Conjugated (USP) ; Fibrosis ; Hepatitis, Chronic ; Humans ; Middle Aged ; Rectum ; Skin ; Ulcer*

A clinicopathological study based on stages, Gleason's method and srvival rates was carried out in 149 cases of prostatic carcinoma treated at Pusan National University Hospital and five participating hospitals. 1. The distribution of each stage was:17 (11.4%) in stage A, 37 (24.8%) in stage B, 22 (14.8%) in stage C, and 73 cases (49.0%) in stage D. Of Gleason's score between primary and secondary pattern, the uniform cases were in 32%, the cases of 1 step differences were in 59 %, the cases of 2 step differences were in 9%, and none in more than 2 step differences. 2. The score sum of Gleason's method was inclined to be higher as the stage became higher. 3. The survival rates were declining as stages excluding cases between stage A and B became higher. As the Gleason's score (primary and secondary pattern, Gleason's sum, Gleason's category) became higher, the survival rates tended to decline. 4. Comparing the death rates of our cases to that of VACURG study of USA and that of Harada of Japan according to Gleason's score, there were no statistical differences (a>0.05). The prognosis of prostatic carcinoma depends on the histological factor, which in dictates the significance of Gleason's method. Also the authors believe that a common ground of basis such as Gleason's method is useful in comparative studies.
Busan ; Japan ; Mortality ; Prognosis* ; Survival Rate

BACKGROUND/AIMS: In spite of the improvement of medical treatment for the peptic ulcer disease (PUD), PUD is still one of the common upper gastrointestinal diseases. The purpose of this study was to evaluate the risk factors and general characteristics of Korean patients diagnosed as PUD at a single third referral center. METHODS: A total of 310 patients, diagnosed as PUD through endoscopy during one year of 2007 at Seoul National University Bundang Hospital were, retrospectively, evaluated regarding age, gender, Helicobacter pylori (H. pylori) positivity, clinical manifestations, comorbidities and medications. In addition, PUD was analyzed in the aspect of ulcer location, type of visit, gastrointestinal bleeding, and age. RESULTS: The mean age was 61.5 years old (48.1% over 65) and 208 (66.7%) patients were men. The rate of H. pylori infection was 47.8%, and any ulcerogenic medication history such as antiplatelet agents and NSAIDs was found to be 21.0% (65 patients). The rate of idiopathic peptic ulcer without evidence of H. pylori and NSAIDs was found to be 40.6% (126 patients). Among 310 PUD patients, bleeding symptoms such as melena, hematemesis and hematochezia occurred in 110 patients (35.5%). CONCLUSIONS: PUD was more prevalent in the elderly patients and frequently associated with bleeding. Substantial proportion of PUD patients had neither H. pylori infection nor history of ulcerogenic medications, suggesting of increasing prevalence of idiopathic PUD.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Female ; Gastrointestinal Hemorrhage ; Gastroscopy ; Helicobacter Infections/complications/diagnosis ; Helicobacter pylori ; Hematemesis ; Humans ; Male ; Melena ; Middle Aged ; Peptic Ulcer/*diagnosis/drug therapy/epidemiology ; Platelet Aggregation Inhibitors/therapeutic use ; Prevalence ; Referral and Consultation ; Retrospective Studies ; Risk Factors ; Sex Factors

BACKGROUND/AIMS: Recent studies have shown that cyclooxygenase-2 (COX-2) may be involved in the process of invasion, growth and apoptosis in colorectal carcinoma and in the growth and tumorigenesis in familial adenomatous polyposis. This study was conducted to determine the significance of the expression of COX-2 in gastric and colorectal adenomas. METHODS: Forty-nine samples of gastric adenoma and fifty-seven samples of colorectal adenoma were obtained by endoscopic mucosal resection or polypectomy from 106 patients from January 2000 to July 2003. COX-2 expression was determined by immunohistochemistry. Correlation between COX-2 expression and several clinical factors were compared in each gastric and colorectal adenomas. RESULTS: The expression of COX-2 in epithelial cells was significantly higher in the group with large adenoma (>1 cm) compared with the group with small adenoma ( Adenoma/enzymology/*pathology ; Aged ; Colorectal Neoplasms/enzymology/*pathology ; English Abstract ; Female ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Prostaglandin-Endoperoxide Synthase/*analysis ; Stomach Neoplasms/enzymology/*pathology