The incidence of colorectal cancer has been increased gradually and it was about 6.9% of all malignancies in Korea. Early diagnosis was recognized as the most important factor influencing the prognosis of colorectal cancer and the incidence of early colorectal cancer was increasing. Thus great change was observed in the treatment of early colorectal cancer, endoscopic therapy as well as curative surgical resection is being accepted. We report a case of effective and safe endoscopic therapy for early rectal cancer in 5S-year-old male patient. He presented with rectal prolapse and bleeding of a year's duration. A large polypoid mass with fine nodular surface and thick, short stalk was seen in the rectum at 4cm above the anal verge during flexible sigmoidoscopy. After the histologic examination of specimen obtained by bite biopsy, CT scan of pelvic cavity and ultrasonogram of abdomen, the tumor was removed safe and completely by 2 sessions of piecemeal polypectomies and strip biopsy. He has been well without symptoms and signs of recurrence of rectal cancer for 20 months.
Abdomen ; Biopsy* ; Colorectal Neoplasms ; Early Diagnosis ; Hemorrhage ; Humans ; Incidence ; Korea ; Male ; Prognosis ; Rectal Neoplasms* ; Rectal Prolapse ; Rectum ; Recurrence ; Sigmoidoscopy ; Tomography, X-Ray Computed ; Ultrasonography

Cerebral venous sinus thrombosis (CVST) following a closed head injury in pediatric patients is a rare condition, and an early spontaneous recanalization of this condition is extremely rare. A 10-year-old boy was admitted with a mild, intermittent headache and nausea five days after a bicycle accident. The brain computed tomography showed an epidural hematoma at the right occipital area with pneumocephalus due to a fracture of the occipital skull bone. The brain magnetic resonance imaging and the magnetic resonance venography demonstrated a flow signal loss from the right sigmoid sinus to the right jugular vein. The diagnosis was sigmoid sinus thrombosis, so close observations were selected as a treatment for the patient because of his gradually improving symptoms; however, he complained of vomiting 14 days the after conservative treatment. The patient was readmitted for a further examination of his symptoms. The laboratory and the gastroenterological examinations were normal. Due to concern regarding the worsening of the sigmoid sinus thrombosis, the brain magnetic resonance venography was rechecked and it revealed the recanalization of the venous flow in the sigmoid sinus and in the jugular vein.
Brain ; Child ; Colon, Sigmoid* ; Craniocerebral Trauma ; Diagnosis ; Head Injuries, Closed* ; Headache ; Hematoma ; Humans ; Jugular Veins ; Magnetic Resonance Imaging ; Male ; Nausea ; Phlebography ; Pneumocephalus ; Sinus Thrombosis, Intracranial* ; Skull ; Vomiting

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) generally involves a single semicircular canal (single canal BPPV) but it has been reported that more than one semicircular canal on either the same or the opposite side can be involved in 6.8-20% of the cases (multiple canal BPPV). In this study, the clinical characteristics of multiple canal BPPV were analyzed and compared to those of single canal BPPV. MATERIALS AND METHODS: Retrospective analysis was performed on 1054 consecutive patients diagnosed with BPPV. Multiple canal BPPV was diagnosed when the combination of typical nystagmus was provoked by the Dix-Hallpike and supine head roll tests. Canalith repositioning maneuver was performed sequentially starting with the semicircular canal causing more severe nystagmus or symptoms. Clinical characteristics and the treatment course were statistically compared between single canal BPPV and multiple canal BPPV. RESULTS: Among the 1054 patients, single canal BPPV was diagnosed in 1005 patients (95.4%) while multiple canal BPPV was diagnosed in 49 patients (4.6%). BPPV involving semicircular canals on the same side was more common (79.6%) than BPPV with bilateral involvement. The most common combination of the involved canals was ipsilateral posterior and horizontal semicircular canals (63.3%). Multiple canal BPPV was significantly more associated with underlying otologic diseases, especially labyrinthitis. Multiple canal BPPV required more treatment sessions and longer duration of treatment to achieve resolution of nystagmus and symptoms. CONCLUSIONS: As all cases of multiple canal BPPV were treated successfully although a longer duration of treatment and more treatment sessions were required compared to single canal BPPV, the results of our study could aid in making an accurate diagnosis and providing appropriate treatment of multiple canal BPPV.
Diagnosis ; Ear Diseases ; Ear, Inner ; Head ; Humans ; Labyrinthitis ; Retrospective Studies ; Semicircular Canals* ; Vertigo*

The authors analysed 2,653 cases of transthoracic fine needle aspiration cytology of the lung to evaluate the diagnostic accuracy and its limitation. A comparison was made between the original cytologic and the final histologic diagnoses on 1,149 cases from 1,074 patients. A diagnosis of malignancy was established in 38.3% benign in 48.1%, atypical lesion in 2.3%, and inadequate one in 11.9% of the cases. Statistical data on cytologic diagnoses were as follows; specificity 98.9%: sensitivity of procedure, 76.8%: sensitivity of diagnosis, 95.5%: false positive 5 cases: false negative 18 cases: predictive value for malignancy, 98.8%: predictive value for benign lesion, 79.5%: overall diagnostic efficiency, 87.5%: typing accuracy in malignant tumor, 80%.
Biopsy, Fine-Needle ; Diagnosis ; Diarrhea* ; Hemolytic-Uremic Syndrome* ; Humans ; Lung ; Sensitivity and Specificity

Smith-Lemli-Opitz syndrome (SLOS) is a rare, autosomal recessive disease caused by an inborn error in cholesterol synthesis. Patients with this disease suffer from multiple malformations due to reduced activity of 7-dehydrocholesterol reductase (DHCR7), which increases 7-dehydrocholesterol (7DHC) and 8-dehydrocholesterol (8DHC) concentrations and decreases cholesterol concentration in body fluids and tissue. The SLOS phenotypic spectrum ranges from a mild disorder with behavioral and learning problems to a lethal disease characterized by multiple malformations. Here, we describe a newborn male with ambiguous genitalia who was diagnosed to have type II SLOS during the neonatal period. A clinical examination revealed low levels of unconjugated estriol in the maternal serum, and a variety of fetal ultrasound anomalies, including prenatal growth retardation. After birth, the infant was diagnosed to have congenital heart disease (Tetralogy of Fallot with severe pulmonary artery stenosis), cleft lip and palate, micrognathia, postaxial polydactyly, ambiguous genitalia, and cataracts. Clinical investigation revealed extremely low plasma cholesterol levels and the presence of mutation (homozygote of p.Arg352Gln) in the DHCR7 gene. The patient underwent palliative heart surgery (to widen the pulmonary artery) and received intravenous lipid supplementation. Cholesterol levels increased slightly, but not to normal values. The patient died from cardiopulmonary failure and sepsis 72 days after birth. This report provides the first description of a Korean patient with SLOS confirmed by verification of DHCR7 gene mutation and illustrates the need for early recognition and appropriate diagnosis of this disease.
Body Fluids ; Cataract ; Cholestadienols ; Cholesterol ; Cleft Lip ; Dehydrocholesterols ; Disorders of Sex Development ; Estriol ; Heart Diseases ; Humans ; Infant ; Infant, Newborn ; Learning ; Male ; Oxidoreductases ; Oxidoreductases Acting on CH-CH Group Donors ; Palate ; Parturition ; Plasma ; Polydactyly ; Pulmonary Artery ; Reference Values ; Sepsis ; Smith-Lemli-Opitz Syndrome ; Thoracic Surgery

BACKGROUND: Rocuronium administration is associated with a severe burning pain during injection in 50-80% patients. The purpose of this study was to evaluate mixtures of saline, lidocaine, sodium bicarbonate (NaHCO3) and lidocaine-NaHCO3 with rocuronium to reduce injection pain and withdrawal movement. METHODS: One hundred and twenty patients were randomly assigned to one of four groups in a double blinded, prospective study; Group S (0.9% normal saline 5 ml mixed with rocuronium 50 mg/5 ml, n = 30), Group L (2% lidocaine 5 ml mixed with rocuronium 50 mg/5 ml, n = 30), Group B (8.4% NaHCO3 5 ml mixed with rocuronium 50 mg/5 ml, n = 30) and Group LB (4% lidocaine 2.5 ml and 8.4% NaHCO3 2.5 ml mixed with rocuronium 50 mg/5 ml, n = 30). After all patients had received an intubating dose (0.6 mg/kg) of premixed rocuronium over 5 seconds, we investigated the incidence and severity of pain and withdrawal movement. We measured the onset and duration of muscle relaxation using train-of-four (TOF) and the pH values and osmolalities of each mixture. RESULTS: The incidence and severity of pain during injection were significantly reduced in Groups B and LB compared with Group S. The withdrawal movement was observed 8 patients (26.7%) in Group S, but in no patient in Groups B or LB. No significant difference in the incidence of pain or withdrawal response was observed between Groups S and L. CONCLUSIONS: We conclude that premixed NaHCO3 with rocuronium is effective at reducing injection pain and withdrawal movement whereas the addition of lidocaine has little effect.
Burns ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Lidocaine* ; Muscle Relaxation ; Osmolar Concentration ; Prospective Studies ; Sodium Bicarbonate

Primary central nervous system atypical teratoid/rhabdoid tumors are rare and extremely aggressive malignancies of early childhood. These tumors are most common in infants less than 2 years of age. Diagnosis is based on distinctive light microscopic and immunohistochemical findings, coupled with a molecular genetic analysis. A histologic features of these tumors are epithelial and/or mesenchymal components in addition to rhabdoid, with or without neuroepithelial fields. The expression of the epithelial membrane antigen, vimentin, and the smooth muscle actin are characteristic of these tumors. Treatment includes surgery, chemotherapy, and radiotherapy. Prognosis is poor despite of an aggressive therapy. We report one case of an atypical teratoid/rhabdoid tumor in a young child. She is an 18 month-old-girl who presented with central type facial palsy. After extensive surgery she improved transiently but relapsed immediately. Her condition was not permitted to receive radiotherapy or chemotherapy. Thereafter, with phrenic nerve palsy, she suffered from recurrent episodes of pneumonia and respiratory difficulties. Finaly, she was expired three months after the diagnosis and treatment.
Actins ; Central Nervous System ; Cerebellum* ; Child ; Diagnosis ; Drug Therapy ; Facial Paralysis ; Humans ; Infant ; Molecular Biology ; Mucin-1 ; Muscle, Smooth ; Paralysis ; Phrenic Nerve ; Pneumonia ; Prognosis ; Radiotherapy ; Vimentin

Wilson s disease is an autosomal recessive disorder characterized by degenerative changes in the brain, liver, and cornea. Treatment includes D-penicillamine, trientine, and zinc sulfate. D-penicillamine has been used frequently as first line therapy for Wilson s disease. However, nephrotoxicity can occur after D-penicillamine treatment. Among them membranous glomerulopathy is the most common histological abnormality but minimal change lesions have also been reported. Nephrotic syndrome is a late complication of D-penicillamine treatment but very rarely can occur within 2 months after treatment of D-penicillamine. We report the early development of minimal change nephrotic syndrome in a 3-year-old girl with Wilson s disease 3 weeks after initiation of D-penicillamine.
Brain ; Child, Preschool ; Cornea ; Female ; Glomerulonephritis, Membranous ; Humans ; Liver ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Penicillamine* ; Trientine ; Zinc Sulfate

Ovarian myoma is a rare mesenchymal tumor, accounting for only 1% of benign ovarian neoplasm. These tumors only originate from smooth muscle on the walls of blood vessels in the cortical stroma, in the corpus luteum and in the ovarian ligaments at the point of attachment to the ovary. Most patients are asymptomatic and the tumors are usually found incidently during operations or at autopsies. Two cases of ovarian myoma experienced in our hospital recently are reported with a brief review of the literatures."
Autopsy ; Blood Vessels ; Corpus Luteum ; Female ; Humans ; Leiomyoma* ; Ligaments ; Muscle, Smooth ; Myoma ; Ovarian Neoplasms ; Ovary

PURPOSE: To evaluate the possibility of short-term dry eye model in rabbits by injection of concanavalin A (conA) to the lacrimal and haderian gland of rabbits. METHODS: We injected conA (10 mg/ml, 0.05 ml) to the lacrimal and haderian gland of rabbits twice to induce inflammation of lacrimal gland and compared with saline-injected control by lacrimal gland biopsy with H&E staining for identification of inflammation. The ratio of lacrimal secretion was evaluated by Schirmer test (preinjection vs. postinjection of conA) for 10 days and the number of goblet cells was counted in 10 consecutive high power field using impression cytology with PAS staining. The corneal & conjunctival apoptotic cell deaths were investigated with TUNEL staining 10 days after injection. RESULTS: Infiltration of inflammatory cells and destructed normal architecture of lacrimal gland was found only in conA injected group till 10 days. The Schirmer test showed marked reduction (0.56+/-0.26) by 5days after injection compared with control group (1.07+/-0.35) (p=0.02) and its significant difference was maintained till 10days. The number of goblet cell was 9.70+/-5.03/x200HPF, which was statistically significant decreased compared to control (47.50+/-17.13/x200HPF) at 10 days (p=0.00). Apoptotic cells were increased in injected eye (26.20+/-4.27) compared with those in control (16.60+/-2.70). CONCLUSIONS: Injection of conA to lacrimal glands in rabbit shows decrease of lacrimal secretion and similar cytological changes of the cornea and conjunctiva in human dry eye patients. It suggests its possible feasibility of short-term dry eye animal model for the 10 days.
Animals* ; Biopsy ; Cell Death ; Concanavalin A* ; Conjunctiva ; Cornea ; Goblet Cells ; Humans ; In Situ Nick-End Labeling ; Inflammation ; Lacrimal Apparatus ; Models, Animal* ; Rabbits