Choriocarcinoma of the gastrointestinal tract is rare. Among them, that of the stomach is the most common. Six cases of choriocarcinoma of the colon were found in the review of the literature. All of these previously reported cases had multiple metastatic foci in the liver, lung, lymph nodes and the prognosis seemed to be very poor. Therefore we think that choriocarcinoma of the colon should be distinguished from conventional adenocarcinoma. A 66-year old female patient, described in this case, was operated on under the impression she was suffering from acute appendicitis. The resected ascending colon revealed extensive hemorrhagic necrosis and perforation with fibrous adhesion in the cecum. On the cut section, the mural tumorous thickening was not definite. Histologically, the tumor showed a focus of typical adenocarcinoma arising from glandular epithelial cells, which were transformed into highly anaplastic tumor cells. There were frequent vascular invasions of tumor cells, similar to syncytiotrophoblasts. In the immunohistochemical stains, both glandular and highly anaplastic tumor cells reacted with cytokeratin. The glandular cells were also reactive for carcinoembryonic antigen (CEA) and anaplastic tumor cells for human chorionic gonadotrophin (hCG). This is the first report of choriocarcinoma of the colon in Korea. We describe this case with a review of the literature.
Adenocarcinoma ; Aged ; Appendicitis ; Carcinoembryonic Antigen ; Cecum ; Choriocarcinoma* ; Chorion ; Colon* ; Colon, Ascending ; Coloring Agents ; Epithelial Cells ; Female ; Gastrointestinal Tract ; Humans ; Keratins ; Korea ; Liver ; Lung ; Lymph Nodes ; Necrosis ; Pregnancy ; Prognosis ; Stomach ; Trophoblasts

Pharmacologic therapy is still the primary management for epilpsy; however, surgical treatment is a reasonable therapeutic option for patients suffering from medically intractable seizures, especially temporal lobe epilepsy having a documented unilateral epileptogenic area. Thirty nine patients with pharmaco-resistant complex partial seizures underwent anterior temporal lobectomy and hippocampectomy in 38 cases and frontal cortisectomy in one case. On pathological examination, hippocampal sclerosis was a predominent pathologic finding and was identified in 18 cases. Other non-neoplastic lesions consisted of 5 cases of vascular lesions(2 cavernous angiomas, 2 arteriovenous malformations and 1 angiomatosis), 3 cases of fibrous nodule, 2 cases of cicatrical changes of cerebral cortex, and 1 case of parasitic infection. Neoplasms including two cases of oligodendroglioma and one case of anaplastic astrocytoma were also noted. In seven cases, there was no detectable lesion on gross and microscopic examination. On post-operative follow-up, seizures were completely terminated in most cases(31 cases, 79%). The rest of the patients also displayed marked alleviation of symptoms. The seizures tended to recur more aften among the patients with neoplasm or no pathologically detectable lesion. In order to detect any minute pathological lesion, thorough gross and microcsopic examinations are considered to be essential.

Adenomatoid tumors are well-recognized neoplasms generally to be of mesothelial derivation. We experienced a case of an adenomatoid tumor of the tail of the epididymis in a 56-year-old male. Grossly the tumor was firm and whitish gray, and microscopically it consisted of glandular, cord-like, microcystic structures which were lined by flattened endothelial like to plump cuboidal cells. Immunohistochemical stains whowed positivity for keratin and negativity for facter VIII related antigen and carcinoembryonic antigen. Ultrastructually, there was many long microvilli projecting into the glandular lumina and intracytoplasmic luminal spaces, desmosomes, and prominent cytoplasmic tonofilaments. Those findings strongly support the mesothelial origin of the adenomatoid tumor especially in the glandular type. It also lead us to suggest that the term adenomatoid tumor should be remain in use for light microscopic diagnosis, and that the term adenomatoid mesothelioma should be applied when the mesothelial nature of an adenomatoid tumor is proven by electron microscopy and immunohistochemical stains.

No abstract available.
Child* ; Humans ; Melanoma*

Evoked potential studies including BAEP (Brainstem Auditory Evoked Potential), VEP (Visual Evoked Potential) and SEP (Somatosensory Evoked Potential-median nerve stimulated at wrist) were performed in 6 patients of wilson disease. Four patients with advanced neurological symptoms showed abnormal BAEP, revealing delayed latency for wave V, with prologation of interpeak latency between wave I and wave V, sepecially between III and V. However, two with only mild symptoms or without neurologic involvement showed normal BAEP. SEP and VEP studies were taken in 5 cases; SEP showed abnormal central conduction in one case and no cases were abnormal in VEP.
Evoked Potentials* ; Hepatolenticular Degeneration* ; Humans

BACKGROUND: Few studies have been done regarding the level of DHEA which is influenced by age, and their effect on cardiovascular disease and prevention of cancer. It is a well known fact that the level of DHEA is decreased with age and the aging is not a correctable risk factor for cardiovascular disease. The aim of this study was to identify plasma DHEA-S change by age and to find out if there was any correlation with serum DHEA-S and cardiovascular risk factors. METHODS: The author collected blood from 85 males and 80 females who had no particular disease history and no specific findings on physical examination. If there were any changes of DHEA according to age, we analyzed the correlation of DHEA with cardiovascular risk factors such as blood pressure, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein and obesity index (body mass index, waist/hip ratio). RESULTS: In both males and females, plasma DHEA-S level peaked at third dacades and the concentration of DHEA was significantly decreased according to aging (p<0.01). In males, DHEA-S showed no correlations with cardiovascular risk factors. In females, DHEA-S showed negative correlations with systolic blood pressure, diastolic blood pressure, total cholesterol, and low density lipoprotein. Also, high density lipoprotein positively correlated with DHEA-S. These correlations in female subjects, however, disappeared after multiple regression analysis. CONCLUSION: In both males and females, plasma DHEA-S was significantly decreased with advancing age. There was no significant correlation between DHEA-S and cardiovascular risk factors in both men and women.
Aging ; Blood Pressure ; Cardiovascular Diseases ; Cholesterol ; Dehydroepiandrosterone* ; Female ; Humans ; Lipoproteins ; Male ; Obesity ; Physical Examination ; Plasma* ; Risk Factors* ; Triglycerides

BACKGROUND: Although medical students' clinical competence should be assessed systematically and objectively, written exams or faculty's subjective methods were used in the past. We assessed the clinical competence of the family medicine clerkship students using the OSCE and evaluated the reliability and the validity of the OSCE. The purpose of this study was to find the logistic problems and the feasibility of the OSCE to an entire clerkship evaluation. METHODS: Twenty six volunteers took part in the OSCE. Ten, 5-minute long stations, were divided into 4 areas: 3 for history taking, 3 for physical exam, 3 for technical skill, and 1 for interview skill areas. RESULTS: Eleven students were examined on first session and 15 students on second session 4 weeks later. The mean OSCE score was 65.5 5.63. The reliability of the total stations was 0.615. The total OSCE score was not different by the sessions, but there was a significant difference in the two stations where the examiners had been changed. There were statistically significant correlations between the total OSCE score and the two previous written exams (r=0.56, 0.54, P<0.01). There was no significant logistic problem and the examinees showed positive responses to the OSCE. CONCLUSION: The OSCE was a useful tool for assessing the clinical competence of family medicine clerkship students. The reliability of the OSCE was moderate and in order to extend the OSCE to an entire clerkship evaluation, we need further study to acquire a higher reliability and validity.
Clinical Competence* ; Humans ; Reproducibility of Results ; Volunteers

OBJECTIVE: To evaluate sonographic findings and natural courses of fetal ovarian cysts. METHODS: Seven pregnant women (mean, 26 years old; 33 weeks of gestation) diagnosed with having fetal ovarian cysts were evaluated. All were followed-up more than once in utero. We analyzed the location, size, and characteristics (number of locules, thickness of wall/septa, internal echogenecity) of cysts. Internal echogenecity was categorized into 4 types (A=anechoic, B=fluid-fluid level, C=isoechoic portion, D=lace-like). Amount of amniotic fluid, fetal biometry, and other abnormalities were evaluated. RESULTS: In all cases, fetal ovarian cysts were located in lateral or anterior lower abdomen. At time of diagnosis, cysts were 4.2 cm in mean size, round and unilocular. Six cases were type A and the other was type B. On follow-up examination, type A cysts were disappeared (n=1), not changed (n=2), increased in size (n=1), or changed in internal echogenecity (n=2; type B and D). The case categorized into type B at the time of diagnosis was changed to type C later. The case categorized into type A at the time of diagnosis was changed to type B on the first follow-up, but changed to type C on the next examination. Finally, all fetal ovarian cysts were disappeared in utero (n=2) or postnatally (n=5). Fetal biometry and amniotic fluid amount were normal. In all cases, no other abnormalities were detected and full-termed healthy female babies were delivered. CONCLUSION: Fetal ovarian cysts may have various patterns of internal echogenecity although the most common pattern is unilocular anechoic. The size and pattern of internal echogenecity of the fetal ovarian cysts is changeable in utero, however all of them disappear spontaneously in utero or postnatally.
Abdomen ; Adult ; Amniotic Fluid ; Biometry ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Ovarian Cysts* ; Pregnant Women ; Prenatal Diagnosis ; Ultrasonography*

BACKGROUND: A predominant accumulation of adipose tissue in abdominal region confers increased risk of cardiovascular disease. The best technology available for measurement of regional fat distribution is computed tomography. However, computed tomography is limited its use for clinical purposes by cost. The aim of this study is to identify the best simple anthropometric index of abdominal visceral fat accumulation. METHODS: To quantify the relationship between anthropometric indices of abdominal obesity(waist circumference, waist to hip ratio, waist to height ratio, body mass index, abdominal sagittal diameter) and abdominal(total, visceral, subcutaneous) fat areas measured by computed tomography, correlation and multiple regression analyses have been conducted. RESULTS: No significant difference for waist circumference, body mass index and sagittal diameter between men and women have been found. Mean value of waist to hip ratio is larger in women, but waist to height ratio is larger in men. The mean abdominal total fat area and mean subcutaneous fat area are higher in women. Interestingly, men, despite lower total fat area, have higher mean abdominal visceral area. Thus, the mean visceral fat to subcutaneous fat ratio is much higher in men. Abdominal sagittal diameter shows the highest correlation(men: 0.69, women: 0.76) with abdominal visceral fat area in both genders. Stepwise regression analyses have been performed to determine the best simple anthropometric index of abdominal visceral fat accumulation. In men, the significant indices are abdominal sagittal diameter, body mass index, and waist to height ratio. In women, abdominal sagittal diameter is the only significant index. CONCLUSION: Abdominal sagittal diameter, in comparison with the waist circumference, waist to hip ratio, waist to height ratio and body mass index, is the best predictor of the amount of abdominal visceral fat.
Adipose Tissue ; Body Mass Index ; Cardiovascular Diseases ; Female ; Hip ; Humans ; Intra-Abdominal Fat* ; Male ; Obesity ; Subcutaneous Fat ; Waist Circumference ; Waist-Hip Ratio

Implantation of a pregnancy within the scar of previous cesarean section is the rarest form of ectopic pregnancy. If diagnosed early, treatment options are capable of preserving the uterus and subsequent fertility. However, delayed diagnosis and treatment can lead to uterine rupture, hemorrhage and maternal morbidity. We present two cases of ectopic pregnancy developing in the previous cesarean section scar in which successfully treated with dilatation and evacuation after vaginal misoprostol.
Cesarean Section* ; Cicatrix* ; Delayed Diagnosis ; Dilatation* ; Female ; Fertility ; Hemorrhage ; Misoprostol* ; Pregnancy ; Pregnancy, Ectopic* ; Uterine Rupture ; Uterus