Pseudotumor cerebri is a condition of obscure etiology characterized by headache, papilledema and raised intracranial pressure in the absence of a space-occupying lesion. We have experienced a case of pseudotumor cerebral complicated by acute frontal sinusitis associated with mild intracranial meningeal inflammation. We have checked the intracranial pressure through serial lumbar puncture before and after medication and conservative management. Symptom were resolved gradually upon lowering the intracranial pressure by serial lumbar puncture and conservative management. So we report a case with brief review of the literature.
Frontal Sinus* ; Frontal Sinusitis* ; Headache ; Inflammation ; Intracranial Pressure ; Papilledema ; Pseudotumor Cerebri* ; Spinal Puncture

Phase and Amplitude Image were developed to overcome the subjective nature of interpretation for cinematic endless loop display of radionuclide gated blood pool scan. To evaluate the usefulness of color coded phase image in coronary artery disease, we conducted a clinical study with coronary angiography and phase image in 23 patients, and compared the results of those studies. 1) The results of coronary angiography revealed normal coronary artery in 6, 1 vessel disease in 11, 2 vessel disease in 4, and 3 vessel disease in 2 patients. 2) Color-coded Phase Image revealed abnormal phase area in 2/2(100%) of 3 vessel disease patients and in 3/4(75%) of 2 vessel disease patients, in 5/11(45%) of 1 vessel disease patients, and only 1/6(16%) of normal coronary artery. 3) Among the patients who disclosed abnormal phase image, 5 patients of 2-or3-vessl disease revealed abnormal phase through whole left ventricular area, but 3 patients with right coronary artery lesion and 2 patients with left antrior descending artery lesion showed localized abnormal phase area, infero-apical and anterior portion respectively, which were in accord with each coronary lesion. We concluded that the phase image may be useful in evaluation of the regional wall motion abnormalities in the patients of coronary artery disease. Further studies seem to be neccessary to clarify the sensitivity and specificity of the phase image in the each disease entity group.
Arteries ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Humans ; Sensitivity and Specificity

OBJECTIVE: The purpose of this study was to evaluate the clinical usefulness of CD44v6 in patients with histologically confirmed endometrial cancer. METHODS: Immunohistochemistry was used to determine the expression of CD44v6 in 39 hysterectomy specimens with the diagnosis of endometrial cancer. RESULTS: CD44v6 expression was detected in 8 specimens with no myometrial invasion of endometrial cancer, one specimen with <50% myometrial invasion, and none with >50% myometrial invasion. There was a significant association between CD44v6 expression and no myometrial invasion of endometrial cancer. There was a statistically significant association between CD44v6 expression and lymph node metastasis, lymphovascular involvement. And all cases of CD44v6 expression were FIGO stage I with histological grade 1 or 2. CD44v6 expression was statistically related with estrogen receptor expression. Although statistical significance was not revealed, it was likely that CD44v6 expression was related with progesterone receptor expression with positive predictive value of 6/9 (66.7%). CONCLUSION: Significant relationships between myometrial invasion, lymph node metastasis, lymphovascular involvement, surgical stage and expression of estrogen receptor and CD44v6 expression suggest that CD44v6 expression could be a good prognostic factor. CD44v6 expression may have potential clinical usefulness if this expression is demonstrated in a further study with prehysterectomy sampling specimens containing endometrial cancer.
Diagnosis ; Endometrial Neoplasms* ; Estrogens ; Female ; Humans ; Hysterectomy ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Receptors, Progesterone

Background: The predictors of poor prognosis in patients with coronavirus disease 2019 (COVID-19) using computed tomography (CT) have not been investigated in a large cohort.Therefore, the purpose of this study was to investigate the adverse initial CT features to predict poor prognosis in COVID-19. Methods: From February to April 2020, 281 COVID-19 patients who underwent CT at the time of admission were included. We divided the patients into the severe and non-severe disease groups. The severe group included patients with severe pneumonia or critical events.Intensive care unit admission or death were the critical events in this study. We compared the clinical and CT findings between the severe and non-severe groups and investigated the prognostic factors and critical events of the severe group using the regression analysis. Results: Among the 281 patients, 36 (12.8%) patients were in the severe group and 245 (87.2%) patients were in the non-severe group. Critical events occurred in 10 patients (3.6%).In the severe group, patients showed significantly more pneumonia with consolidation, crazy-paving appearance, pleural effusion, and higher CT scores than those in the non-severe group (all, p < 0.05). In the multivariate regression, pleural effusion (odds ratio [OR], 8.96;95% confidence interval [CI], 1.81–44.42; p = 0.007), CT score > 5 (OR, 3.70; 95% CI, 1.44– 9.53; p = 0.007), old age (> 77 years, OR, 9.96; 95% CI, 3.78–26.28; p < 0.001), and elevated C-reactive protein (OR, 4.15; 95% CI, 1.62–10.6; p = 0.003) were significant prognostic factors of severe disease. CT score > 5 (OR, 7.29; 95% CI, 1.37–38.68; p = 0.020), pleural effusion (OR, 5.67; 95% CI, 1.04–30.8; p = 0.045) and old age (OR, 8.6; 95% CI, 1.80–41.0; p = 0.007) were also significant predictors of critical events. Conclusion Pleural effusion and the extent of pneumonia on initial CT scans are associated with poor prognosis in patients with COVID-19.

Signet ring cell carcinoma of lung is an unique variant of mucin producing adenocarcinoma which is characterized by abundant intracellular mucin accumulation. Only a few cases of primary signet ring cell carcinoma of lung have been reported in the world wide literature. And we have, recently experienced one case of primary signet ring cell carcinoma of lung. A 55 years old man was evaluated for paralysis of lower extremities and was found to have lung cancer in the left upper and lower lobe with pleural, multiple spinal, bone and liver metastases. Signet ring tumor cells were revealed by cytologic examination of pleural fluids. And there were no evidence of signet ring cell carcinoma of other organs. Primary signet ring cell carcinoma of lung seems to have an aggressive behavior and therapeutic modalities could be different from those for signet ring cell carcinomas from other organs. Therefore it is important to separate primary signet ring cell adenocarcinoma of lung from metastatic tumors.
Adenocarcinoma ; Carcinoma, Signet Ring Cell* ; Humans ; Liver ; Lower Extremity ; Lung Neoplasms ; Lung* ; Middle Aged ; Mucins ; Neoplasm Metastasis* ; Paralysis

Microscopic polyangiitis is a systemic small-vessel vasculitis that is primarily associated with necrotizing glomerulonephritis and pulmonary capillaritis. Lung involvement is characterized by a diffuse alveolar hemorrhage. However, rarely central nervous system involvement has been reported to be occurred with the microscopic polyangiitis. Relapse of microscopic polyangiitis are reported to be more frequent than those of polyarteritis nodosa, often after a reduction or discontinuation of the therapy. We would like to report two patients with microscopic polyangiitis. One presented with clinical manifestations of both lung and central nervous system involvements and the other was a case of recurrence during steroid tapering following the steroid pulse therapy.
Antibodies, Antineutrophil Cytoplasmic ; Central Nervous System ; Glomerulonephritis ; Hemorrhage ; Humans ; Lung ; Microscopic Polyangiitis* ; Polyarteritis Nodosa ; Recurrence ; Vasculitis ; Vasculitis, Central Nervous System

Objective: We investigated the prevalence of pneumonia in novel coronavirus disease 2019 (COVID-19) patients using chest radiographs to identify the characteristics of those with initially negative chest radiographs, who were positive for pneumonia on follow-up. Materials and Methods: Retrospective cohort data of 236 COVID-19 patients were reviewed. Chest radiography was performed on admission, with serial radiographs obtained until discharge. The ‘positive conversion group’ was defined as patients whose initial chest radiographs were negative but were positive for pneumonia during follow-up. Patients with initially positive chest radiographs were defined as the ‘initial pneumonia group.’ Patients with negative initial and follow-up chest radiographs were defined as the ‘non-pneumonia group.’ Clinical and laboratory findings were compared between groups, and predictors of positive conversion were investigated. Results: Among 236 patients, 108 (45.8%) were in the non-pneumonia group, 69 (29.2%) were in the initial pneumonia group, and 59 (25%) were in the positive conversion group. The patients in the ‘initial pneumonia group’ and ‘positive conversion group’ were older, had higher C-reactive protein (CRP) and lactate dehydrogenase levels, and lower absolute lymphocyte counts than those in the ‘non-pneumonia group’ (all p < 0.001). Among patients with negative initial chest radiographs, age ≥ 45 years (odds ratio [OR]: 3.93, 95% confidence interval [CI]: 1.76–8.75, p = 0.001), absolute lymphocyte count < 1500 cells/µL (OR: 2.25, 95% CI: 1.03–4.89,p = 0.041), and CRP > 0.5 mg/dL (OR: 3.91, 95% CI: 1.54–9.91, p = 0.004) were independent predictors for future development of pneumonia. Conclusion More than a half of COVID-19 patients initially had normal chest radiographs; however, elderly patients (≥ 45 years of age) with abnormal laboratory findings (elevated CRP and low absolute lymphocyte counts) developed pneumonia on follow-up radiographs.