OBJECTIVE: We developed a Clinical Document Architecture(CDA) Generator module based on CDA standard for the interchange of radiological reports. METHODS: This paper describes CDA standard, the template of radiological report, CDA Generator module, and the Web-form report using an Extensible Stylesheet Language(XSL) style-sheet. And the CDA Generator module is integrated into a existing Picture Archiving Communication System(PACS) Viewer. RESULTS: Radiological reports based on CDA standard are used to interchange between different health institutions, and also presented in an Extensible Markup Language (XML) compatible web browser. CONCLUSION: The proposed module and concept in this paper may be a utility in improving health care delivery and can also be used to integrate with other Digital Imaging and Communication in Medicine(DICOM) Structured Report (SR) compliant PACS systems.
Delivery of Health Care ; Web Browser

PURPOSE: The purpose of this study was to determine the effect of dehydroepiandrosterone (DHEA) on recovery of muscle atrophy induced by Parkinson's disease. METHODS: The rat model was established by direct injection of 6-hydroxydopamine (6-OHDA, 20 microg) into the left striatum using stereotaxic surgery. Rats were divided into two groups; the Parkinson's disease group with vehicle treatment (Vehicle; n=12) or DHEA treatment group (DHEA; n=22). DHEA or vehicle was administrated intraperitoneally daily at a dose of 0.34 mmol/kg for 21 days. At 22-days after DHEA treatment, soleus, plantaris, and striatum were dissected. RESULTS: The DHEA group showed significant increase (p<.01) in the number of tyrosine hydroxylase (TH) positive neurons in the lesioned side substantia nigra compared to the vehicle group. Weights and Type I fiber cross-sectional areas of the contralateral soleus of the DHEA group were significantly greater than those of the vehicle group (p=.02, p=.00). Moreover, extracellular signal-regulated kinase (ERK) phosphorylation significantly decreased in the lesioned striatum, but was recovered with DHEA and also in the contralateral soleus muscle, Akt and ERK phosphorylation recovered significantly and the expression level of myosin heavy chain also recovered by DHEA treatment. CONCLUSION: Our results suggest that DHEA treatment recovers Parkinson's disease induced contralateral soleus muscle atrophy through Akt and ERK phosphorylation.
Animals ; Corpus Striatum/drug effects/metabolism ; Dehydroepiandrosterone/*pharmacology/therapeutic use ; Extracellular Signal-Regulated MAP Kinases/metabolism ; Male ; Muscle Fibers, Slow-Twitch/drug effects ; Muscle, Skeletal/drug effects/metabolism ; Muscular Atrophy/drug therapy/*etiology/*pathology ; Myosins/metabolism ; Neurons/drug effects/enzymology ; Oxidopamine/toxicity ; Parkinson Disease, Secondary/*chemically induced/*complications ; Phosphorylation ; Proto-Oncogene Proteins c-akt/metabolism ; Rats ; Rats, Sprague-Dawley ; Tyrosine 3-Monooxygenase/metabolism

This study was to determine the effect of exercise on the recovery of dopaminergic neuron loss and muscle atrophy in 6-OHDA-induced hemi Parkinson's disease model. Exercise was loaded twice per day for 30 minutes each time, at 5 days after 6-OHDA lesioning and continued for 16 days using a treadmill. Exercise significantly increased the number of tyrosine hydroxylase positive neuron in the lesioned substantia nigra and the expression level of tyrosine hydroxylase in the striatum compared with the control group. To examine which signaling pathways may be involved in the exercise, the phosphorylation of GSK3beta and ERK were observed in the striatum. In the control group, basal level of GSK3beta phosphorylation was less than in both striatum, but exercise increased it. ERK phosphorylation decreased in the lesioned striatum, but exercise recovered it. These findings suggest that exercise inactivates GSK3beta by phosphorylation which may be involved in the neuroprotective effect of exercise on the 6-OHDA-induced cell death. In the exercise group, weight, and Type I and II fiber cross-sectional area of the contralateral soleus significantly recovered and expression of myosin heavy chain and Akt and ERK phosphorylation significantly increased by exercise. These results suggest that exercise recovers Parkinson's disease induced dopaminergic neuron loss and contralateral soleus muscle atrophy.
Animals ; Atrophy ; Cell Death ; Dopaminergic Neurons ; Glycogen Synthase Kinase 3 ; Muscle, Skeletal ; Muscles ; Muscular Atrophy ; Myosin Heavy Chains ; Neurons ; Neuroprotective Agents ; Oxidopamine ; Parkinson Disease ; Phosphorylation ; Rats ; Substantia Nigra ; Tyrosine 3-Monooxygenase

Here, we present a case of anaplastic giant cell ependymoma (GCE) occurring in a 15-year-old woman. Squash smear slides for intraoperative frozen section diagnosis revealed oval to round cell clusters with a papillary structure in a fibrillary background. This was occasionally accompanied by the presence of bizarre pleomorphic giant cells with hyperchromatic nuclei and prominent intranuclear inclusions. These intranuclear inclusions were a key clue to diagnosis of ependymoma. Histologic analysis revealed features of a high-grade tumor with perivascular pseudorosettes and bizarre pleomorphic giant cells, which established the diagnosis of GCE. We performed a review of literatures about the cytologic features of GCE, including our case, thus proposing that intraoperative frozen diagnosis of GCE would be established by squash smear preparations featuring the mitosis and necrosis, as well as the high cellularity, and the presence of giant cells showing hyperchromatic nuclei with eosinophilic cytoplasm and intranuclear inclusions/pseudoinclusions.
Adolescent ; Cytoplasm ; Eosinophils ; Ependymoma ; Female ; Frozen Sections ; Giant Cells ; Humans ; Intranuclear Inclusion Bodies ; Mitosis ; Necrosis

No abstract available.
Edema* ; Humans ; Hydrops Fetalis* ; Infant, Newborn*

A 66-year-old male was admitted to the department of surgery, at the Presbyterian Medical Center due to right upper quadrant pain. Tumor marker studies reported CEA and CA19-9 elevation. Liver function test was normal. Ultrasonography and computed tomography showed a single infiltrative tumor in the left lobe of liver, multiple lymphadenopathies around the common hepatic duct and intrahepatic bile duct dilatation of the left lobe. The gallbladder was nonspecific. During laparotomy, we found an ill-marginated and infiltrative tumor in the left lobe of liver, multiple enlarged lymph nodes around the common hepatic duct and cystic duct, and mild thickening of the gallbladder fundus wall. Left hepatic lobectomy and cholecystectomy were performed. Pathologic findings revealed that the liver tumor was a moderated differentiated adenocarcinoma with extension to the pericystic and pericommon hepatic lymph nodes and focal adenocarcinoma in situ of gallbladder mucosal wall with clear cystic duct resection margin. We therefore report a rare case of synchronous double primary cancer of the intrahepatic bile duct and gallbladder.
Adenocarcinoma ; Aged ; Bile Ducts, Intrahepatic* ; Cholecystectomy ; Cystic Duct ; Dilatation ; Gallbladder* ; Hepatic Duct, Common ; Humans ; Laparotomy ; Liver ; Liver Function Tests ; Lymph Nodes ; Male ; Protestantism ; Ultrasonography

BACKGROUND/AIMS: Entecavir is a potent and selective guanosine analogue that has demonstrated a significant antiviral efficacy against hepatitis B virus (HBV). The aim of this study was to characterize the response to entecavir and to examine the factors affecting that response. METHODS: We administered 0.5 mg of entecavir once daily for more than 12 months to 114 naive chronic hepatitis B (CHB) patients. We measured the levels of liver enzymes, serological markers, and serum HBV DNA at 3-month interval. RESULTS: Normalization of serum alanine aminotransferase levels was observed in 68.5% (76/114), 74.6% (85/114), and 81.6% (62/76) of patients after 6, 12, and 24 months of therapy, respectively. HBV DNA levels of <50 copies/mL (as evaluated by polymerase chain reaction) were observed in 43.9% (50/114), 71.1% (81/114), and 85.5% (65/76) of patients after 6, 12, and 24 months, respectively. Viral breakthrough was not observed. The rates of HBeAg loss and seroconversion were 43.5% (27/62) and 14.5% (9/62), respectively, after 12 months of therapy, and 56.4% (22/39) and 15.4% (6/39) after 24 months. The independent factor associated with PCR negativity was early virologic response (EVR; HBV DNA <2,000 copies/mL after 3 months of therapy, P<0.001). The independent factors predicting HBeAg loss were found to be serum albumin levels (P=0.041) and EVR (P=0.005). CONCLUSIONS: Entecavir induced excellent biochemical and virologic responses in naive CHB patients. EVR was an independent factor for predicting HBV PCR negativity and HBeAg loss.
Adult ; Alanine Transaminase/blood ; Antiviral Agents/*therapeutic use ; Aspartate Aminotransferases/blood ; DNA, Viral/blood ; Female ; Guanine/*analogs & derivatives/therapeutic use ; Hepatitis B e Antigens/analysis ; Hepatitis B, Chronic/*drug therapy ; Humans ; Male ; Middle Aged ; Polymerase Chain Reaction ; Retrospective Studies ; Time Factors

Splenic infarcts are comparatively less common lesions. Caused by the occlusion of the major splenic artery or any of its branches, they are almost always due to emboli that arise in the heart. The spleen, along with the kidneys and brain, ranks as one of the most frequent sites of localization of systemic emboli. Infarcts may be small or large, multiple or single, and sometimes involve the entire organ. Usually these infarcts are of the bland anemic type. Septic infarcts are found in vegetative endocarditis of the valves of the left side of the heart. Much less often, infarcts in the spleen are caused by local thromboses, especially in leukemia, myeloproliferative syndrome, sickle cell anemia, polyarteritis nodosa, Hodgkin's disease, and bacteremic diseases. We experienced a rather unusual splenic infarction due to lymphoma in a 80-year-old man.
Aged, 80 and over ; Anemia, Sickle Cell ; Brain ; Endocarditis ; Heart ; Hodgkin Disease ; Humans ; Kidney ; Leukemia ; Lymphoma ; Polyarteritis Nodosa ; Spleen ; Splenic Artery ; Splenic Infarction ; Thrombosis

PURPOSE: The natural history of renal transplant recipients with positive HBs Ag is still unclear and unpredictable. Liver-related morbidity and mortality after long-term immunosuppression need clinical challenges. We retrospectively investigated the clinical outcome of pre-transplant HBs Ag positive renal recipients in a single transplant center located in endemic area. METHODS: After excluding post-transplant de novo HBV infected, and peri-transplant anti-hepatitis C virus positive recipients, the clinical outcome of 1,816 recipients was examined by the nature of pre-transplant HBs Ag positivity. RESULTS: Pre-transplant HBs Ag positivity was documented in 61 recipients (M/F=47/14). During mean follow up of 71.61+/-54.14 months, 24 recipients died (6 by infection, 12 by hepatic failure, 2 by hepatocellular carcinoma, 2 by other malignancies, 1 by suicide, 1 by gastrointestinal bleeding). In 14 recipients (58.3%), death was related to liver-associated reasons. The 10-year patient survival rates in HBs Ag negative and positive groups were 90.0% and 62.6%, respectively (P<0.0001). The 10-year graft survival rates in HBs Ag negative and positive groups were 82.0% and 55.6%, respectively (P<0.0001). When pre-transplant HBV DNA viral load by PCR was positive or when the level of post-transplant HBV-DNA viral load flared up, we started lamivudine therapy since 1997. Seventeen recipients received daily 100 mg lamivudine. The mean duration of patients survival with (n=17) and without (n=44) lamivudine therapy was 104.3+/-45.6 and 59.0+/-51.2 months, respectively (P= 0.003). The 10-year patient survival rates in patients with and without lamivudine therapy were 80.7% and 55.4%, respectively (P=0.0698). CONCLUSION: Overall patient and graft survival in patients with positive pre-transplant HBs Ag was lower than negative recipients. Although, statistically not significant, lamivudine therapy showed a marginally positive impact on the survival of patients with pre-transplant positive HBs Ag.
Carcinoma, Hepatocellular ; DNA ; Follow-Up Studies ; Graft Survival ; Hepatitis B Surface Antigens* ; Hepatitis B* ; Hepatitis* ; Humans ; Immunosuppression ; Kidney Transplantation* ; Lamivudine ; Liver Failure ; Mortality ; Natural History ; Polymerase Chain Reaction ; Retrospective Studies ; Suicide ; Survival Rate ; Transplantation ; Viral Load

PURPOSE: The aims of this study were to review the result of kidney re-transplantation in comparison with first kidney transplantation, and to identify the prognostic factors affecting long-term outcome at a single center. METHODS: Between April 1979 and January 2006, the total number of renal allografts was 2,495. Among these, 159 cases received second (155 cases) or third (4 cases) transplantation. Demographic characteristics and clinical outcomes of both groups were compared. And we examined the risk factors affecting long-term outcome in re-transplantation recipients. RESULTS: The mean duration of previous graft survival in re-transplantation group was 86.1+/-51.4 (0~215) months. Major cause of the previous graft failure was chronic rejection (n=88, 55.3%). One-, 5-, and 10-year graft survivals of the re-transplantation group and the first transplantation group were 94.1%, 88.9%, 76.0% and 96.0%, 84.8%, 69.1%, respectively without significant difference (P=0.2203). In uni-variate survival analysis, acute rejection experienced group, elderly recipient more than 50 years old, and female gender group showed significant inferior graft survival rate compared to control group. Previous graft survival duration didn't cause significant graft survival difference. Multivariate survival analysis also confirmed that the episodes of acute rejection within 12 months after transplantation (P=0.035, Odd ratio= 2.514), elderly recipient more than 50 years old (P=0.002, odd ratio=3.734), and female gender (P=0.005, Odd ratio= 3.692) were statistically significant independent risk factors affecting graft survival in kidney re-transplantation. CONCLUSION: Long-term outcomes after kidney re-transplantation were not different from that of first kidney transplantation. Therefore, renal re-transplantation could be the treatment of choice even in recipients with previous failed renal allograft.
Aged ; Allografts ; Female ; Graft Survival ; Humans ; Kidney Transplantation ; Kidney* ; Middle Aged ; Risk Factors* ; Survival Rate ; Transplants