BACKGROUND: Hyperleukocytic acute myelogenous leukemia (H-AML) is a relatively rare disease found in adults and it should have different characteristics from those of non-hyperleukocytic acute myelogenous leukemia (non-H-AML). We analyzed adult patients with H-AML whose peripheral WBC count was over 100, 000/ L, and compared laboratory and clinical findings of H-AML with those of non-H-AML cases. METHODS: This study included 19 patients with H-AML who were diagnosed between July 1994 and February 2001 at Chonnam University Hospital. The laboratory data, including peripheral blood smear, bone marrow study, immunophenotyping and cytogenetic study, were reviewed and the clinical out-comes of the patients were assessed. The results were compared with those of 127 non-H-AML cases. RESULTS: Of all adult AML cases, 13.1% (19/146) were H-AML. In H-AML, the subtypes were in the order of M5 (36.8%), M4 (21.1%) and M2 (21.1%), while in non-H-AML were in the order of M2 (40.9%), M3 (28.3%) and M4 (11.0%), respectively. HLA-DR and CD14 were more frequent in H-AML than in non-H-AML (83.3% vs. 47.2%, P=0.005; and 23.5% vs. 56.4%, P=0.042; respectively). H-AML had a tendency for low complete remission and short overall survival. Disease-free survival of H-AML was significantly shorter than that for the non-H-AML (6.0 vs 22.1 months, P=0.006). CONCLUSIONS: It suggests that hyperleukocytosis could be a predictor of unfavorable clinical out-comes and survival in acute myelogenous leukemia.
Adult ; Bone Marrow ; Cytogenetics ; Disease-Free Survival ; HLA-DR Antigens ; Humans ; Immunophenotyping ; Jeollanam-do ; Leukemia, Myeloid, Acute* ; Rare Diseases

A sesamoid bone can occasionally be found under the interphalangeal joint of the hallux. These had anatomical variants and usually remain asymptomatic, it is uncommon for symptomatic cases of painful plantar keratoses or irreducible dislocation of interphalangeal joint of the hallux with incarcerated sesamoid. While the latter has a few cases, the former has not reported in Korea. We experienced a rare case of intractable plantar keratoses due to interphalangeal sesamoid bone of the hallux which may reqire excision.
Dislocations ; Hallux ; Joints ; Keratosis ; Korea ; Sesamoid Bones

Pulmonary alveolar proteinosis is characterized by the remittent or progressive accumulation of lipid-rich proteinaceous material within the alveolar sacs in the absence of inflammatory response. Whole-lung lavage is the only consistent treatment for pulmonary alveolar proteinosis. We have utilized whole-lung lavage for the successful treatment of a 62 year-old female patient with pulmonary alveolar proteinosis. There was no persistent complication during the procedure and the postanesthetic recovery except temporary fever and hypoxic event. The patient was symptomatically, physiologically, and radiologically improved within days after the procedures.
Female ; Fever ; Humans ; Middle Aged ; Pulmonary Alveolar Proteinosis* ; Therapeutic Irrigation*

The mission of psychiatric practice is rangesing from alleviating the distress and impairment caused by psychiatric disorders to promoting a state of well-being in order to cope with the normal stresses of life and for to improvement of social functioning. Various factors, including social changes in general and the change of Psychiatry is are grounded in clinical neuroscience and public health. The authors are to review the determinants of changes in clinical practice of psychiatry and to review plausible areas of new clinical practice in psychiatryic both from both a clinical neuroscience and a public health perspective.
Humans ; Missions and Missionaries ; Neurosciences ; Public Health ; Social Change

Spontaneous dissection of the anterior cerebral artery is an unusual cause of subarachnoid hemorrhage. We present a case of a dissecting aneurysm of the anterior cerebral artery presenting with subarachnoid hemorrhage. A 51-year-old woman presented to our hospital with severe headache. Neurological examination demonstrated neck stiffness, decreased visual acuity of the left eye, and left ankle weakness. Computed tomographic scans showed subarachnoid hemorrhage. The initial cerebral angiogram demonstrated a slightly narrowed caliber and mild poststenotic dilation of the right A1 segment. A second cerebral angiogram 14 days later revealed no change in the focal narrowing of the proximal A1 segment but marked progression of the dilatation of the distal A1 segment. Right pterional craniotomy was performed. A sausage-like dilation of the right A1 segment was found with no definite mural hematoma. This abnormal right A1 segment was wrapped with a Sundt clip. A postoperative computed tomographic scan revealed infarction of the right head of the caudate nucleus and the anterior limb of the right internal capsule. If a dissecting aneurysm is suspected, serial angiographic studies should be performed because of the possibility of dynamic changes over a short period.
Aneurysm, Dissecting* ; Ankle ; Anterior Cerebral Artery* ; Caudate Nucleus ; Craniotomy ; Dilatation ; Extremities ; Female ; Head ; Headache ; Hematoma ; Humans ; Infarction ; Internal Capsule ; Middle Aged ; Neck ; Neurologic Examination ; Subarachnoid Hemorrhage ; Visual Acuity

BACKGROUND: To investigate the changes of cross sectional area (CSA) in paraspinal muscles upon magnetic resonance imaging (MRI) and bone mineral density (BMD) in postmenopausal osteoporotic spinal compression fractures. METHODS: We reviewed 81 postmenopausal women with osteoporosis, who had underwent MRI examination. The patients were divided into 51 patients who had osteoporotic spinal compression fractures (group I), and 30 patients who without fractures (group II). Group I were subdivided into IA and IB, based on whether they were younger (IA) of older (IB) than 70 years of age. We additionally measured body mass index and BMD. The CSA of multifidus, erector spinae, paraspinal muscles, psoas major (PT), and intervertebral (IV) discs were measured. The degree of fatty atrophy was estimated using three grades. RESULTS: The BMD and T-score of group I were significantly lower than those of group II. The CSA of erector spinae, paraspinal muscles, and PT in the group I was significantly smaller than that of group II. The CSA of paraspinal muscles in group IB were significantly smaller than those of group IA. The CSA of erector spinae, mutifidus, and PT in group IB were smaller than those of group IA, but the difference was not statistically significant. Group 1 exhibited greater fat infiltration in the paraspinal muscle than group II. CONCLUSIONS: Postmenopausal osteoporotic spinal compression fracture is associated with profound changes of the lumbar paraspinal muscle, reduction of CSA, increased CSA of IV disc, and increased intramuscular fat infiltration.
Atrophy ; Body Mass Index ; Bone Density ; Female ; Fractures, Compression* ; Humans ; Magnetic Resonance Imaging* ; Magnetics* ; Magnets* ; Muscles* ; Osteoporosis ; Postmenopause ; Psoas Muscles

In this paper, the ACKNOWLEDGMENT was given incorrectly.

Holoprosencephaly is a rare malformation complex or development defect including different degrees of incomplete cleavages of the embryonic prosencephalon and varying degrees of the midface defects, resulting from the defect of prechordal mesoderm, migrating forward into the area anterior to the notochord during the third week of fetal development. Early antenatal diagnosis of holoprosencephaly is important to find out its severity, to predict its prognosis, and to determine proper management according to its prognosis and severity. The possibility of early antenatal diagnosis of holoprosencephaly by ultrasound has been suggested, but occasionally missed and rarely confirmed. We present one case of lobar holoprosencephaly, diagnosed postnatally and one case of alobar holoprosencephaly, diagnosed antenatally in our hospitals.
Fetal Development ; Holoprosencephaly* ; Mesoderm ; Notochord ; Prenatal Diagnosis ; Prognosis ; Prosencephalon ; Ultrasonography

We report here on a case of persistent proatlantal artery type I with the absence of the right vertebral artery's first, second and third segments. This rare anomaly was accidentally encountered when performing angiography in a patient with a ruptured aneurysm of the left anterior choroidal artery and an unruptured aneurysm of the right anterior choroidal artery. Both aneurysms were clipped via craniotomy. The angiography showed that the right proatlantal artery type I arose from the right internal carotid artery at the C2 level. The proatlantal artery joined the horizontal portion of the right vertebral artery. The absence of the right vertebral artery's first, second and third segments and a hypoplastic left vertebral artery were demonstrated. The anomalous artery was thought to have been unrelated to rupture of the aneurysm. We also reviewed the previous Korean reports about a persistent proatlantal artery, and we discuss the potential clinical implications of this anomalous vessel.
Aneurysm ; Aneurysm, Ruptured ; Angiography ; Arteries ; Carotid Artery, Internal ; Choroid ; Craniotomy ; Glycosaminoglycans ; Humans ; Rupture ; Vertebral Artery

BACKGROUND/AIMS: The study proposed to evaluate the efficacy of anticancer drugs of intraarterial chemoinfusion and investigate prognostic factors influencing survival. METHODS: A total of 127 patients diagnosed as having advanced hepatocellular carcinoma(HCC) of same stage (TNM stage IVa) from 1996 to 1998 were examined. Two intraarterial infusion chemotherapeutic regimens were employed: Adriamycin(Group I) and Cisplatin(Group II). RESULTS: Overall survival was significantly diffrent(10.0 vs 5.7months) and favored Group I. By the univariate analysis, significant prognostic factors included: age, portal vein thrombosis(PVT), size(>5cm) and type of tumor, response rate (size & -fetoprotein) at 3 months after therapy, level of albumin, alkaline phosphatase, and total bilirubin. After repeated therapy, Group I showed better survival (14.0 vs 7.9 months), but there was no statistical difference in survival rate between two groups in the case of large size, PVT, and diffuse type. CONCLUSION: Group I showed better survival than Group II in advanced HCC of TNM stage IVa. But, considering prognostic factors, there was no significant difference in survival rate between two groups except small size or nodular type of HCC. TNM classification of stage IVa should be reconsidered to include prognostic factors influencing survival rate such as PVT, size and type of HCC.
Alkaline Phosphatase ; Bilirubin ; Carcinoma, Hepatocellular* ; Classification ; Humans ; Infusions, Intra-Arterial ; Neoplasm Staging ; Portal Vein ; Psychotherapy, Group ; Survival Rate ; Treatment Outcome*