Multiple gastric caner, now considered to be a sort of multiple primary cancer by Moertel's classification, is a special type of cancer in which two or more tumor lesions arise independently from the stomach. Although its incidence is rare and it has never been reported in Korea yet, the report of multiple gastric cancer is increasing with lengthened life survival and improved diagnostic method. We recently experienced two cases of triple gastric cancer, the one in 53-years-old male who had well differentiated adenocarcinoma(EGC IIb+c) on antrum, poorly differentiated adenocarcinoma on cardia and moderately differentiated adenocarcinoma on mid-body, and the other in 65-years-old female who had two poorly differentiated adenocarcinoma on cardia and anterior wall of low body and moderately differentiated adenocarcinoma (EGCIIc) on posterior wall of low body. Triple gastric cancer is rare, so we reported 2 cases of triple gastric cancer.
Adenocarcinoma ; Cardia ; Classification ; Female ; Humans ; Incidence ; Korea ; Male ; Stomach ; Stomach Neoplasms*

Anticoagulation with heparin has been the standard management therapy of deep vein thrombosis during pregnancy. Pregnancy is generally considered as a contraindication for thrombolysis. However, anticoagulation therapy alone does not protect the limbs from post-thrombotic syndrome and venous valve insufficiency. Catheter-directed thrombolysis, combined with angioplasty and stenting, can remove the thrombus and restore patency of the veins, resulting in prevention of post-thrombotic syndrome and valve insufficiency. We report successful catheter-directed thrombolysis and stenting in two early gestation patients with a deep vein thrombosis of the left lower extremity.
Angioplasty ; Catheters ; Extremities ; Female ; Heparin ; Humans ; Lower Extremity ; Pregnancy ; Pregnancy Complications, Cardiovascular ; Pregnancy Trimester, First ; Stents ; Thrombosis ; Veins ; Venous Thrombosis ; Venous Valves

No abstract available.
Bone Density* ; Gonads*

PURPOSE: We wanted to evaluate the usefulness of MDCT for localizing a bleeding site and for helping make a decision on further management for acute intestinal bleeding. MATERIALS AND METHODS: We conducted a retrospective review of 17 consecutive patients who presented with acute intestinal bleeding and who also underwent MDCT before angiography or surgery. The sensitivity of MDCT for detecting acute intestinal bleeding was assessed and compared with that of conventional angiography. RESULTS: The sensitivity of MDCT for the detection of acute intestinal bleeding was 77% (13 of 17), whereas that of angiography was 46% (6 of 13). All the bleeding points that were subsequently detected on angiography were visualized on MDCT. In three cases, the bleeding focus was detected on MDCT and not on angiography. In four cases, both MDCT and angiogphy did not detect the bleeding focus; for one of these cases, CT during SMA angiography was performed and this detected the active bleeding site. CONCLUSION: In patients with acute intestinal bleeding, MDCT is a useful image modality to detect the bleeding site and to help decide on further management before performing angiography or surgery. When tumorous lesions are detected, invasive angiography can be omitted.
Angiography ; Hemorrhage* ; Humans ; Retrospective Studies

A pathologic splenic rupture is rare, occurring primarily in a spleen affected by infective, hematological, and neoplastic disease. To the best of our knowledge, no prior reports of a pathologic splenic rupture due to scrub typhus exist. Intrasplenic pseudoaneurysms and focal infarctions are visible on an initial CT scan. Moreover, the spontaneous splenic rupture occurred a week later. We report a case of nontraumatic-splenic rupture in a patient with scrub typhus.
Aneurysm, False ; Humans ; Infarction ; Rupture ; Scrub Typhus ; Spleen ; Splenic Rupture ; Typhus, Endemic Flea-Borne

There are many ways to evaluate the learning achievement of medical students. We are familiar with the problems related to the traditional laboratory course practical examinations of pathology and histology courses, which deal with morphology heavily. In order to overcome the limitations inherent to the traditional evaluation methods, we used Internet for the written and practical examinations for the pathology course. Two tests were conducted on the internet with thirty medical students. Each student used his/her personal computer, which was connected to Local Area Network(LAN), in the computer laboratory. The examinee entered the Pathology Department home page(address: http://ajoupath. ajou.ac.kr) and took their tests made up of descriptive and multiple choice questions including related gross and microscopic images. Common Gateway Interface(CGI) program of Perl language was used for automatic scoring and analysis of the multiple choice questions. The server computer in the Pathology Department scored the results instantaneously upon the answer selection and push down of the "send" button by the examinee. Furthermore, the computer program was capable of providing data regarding how many students got the correct answer and the degree of difficulty for each item. The students were requested to provide hand-written descriptions for the questions requiring descriptive answers, because of the technical limitation. We believe that the tests on the internet were performed successfully. The "dreadful" old fashioned examination using timer were no longer needed because high quality gross and microscopic images on the monitor were available for the examinee. We believe that the internet is very useful for the comprehensive evaluation of the medical students' learning achievement.
Education, Medical ; Humans ; Internet* ; Learning* ; Microcomputers ; Pathology ; Students, Medical

Hemorrhagic fever with renal syndrome is characterized clinically by the triad of fever, hemorrhage and renal failure. The hemorrhage in hemorrhagic fever with renal syndrome(HFRS) varies from transient petechial lesions to fulminant and massive bleeding. The latter can be an important cause of death in HFRS. We here report a case of massive perirenal hematoma in a patient with HFRS. A 17-year-old male was admited to our hospital presenting with fever, sore throat, nausea and oliuria. Computed tomography was performed at the 2nd day of hospitalization due to abruptly developing right flank pain and anemia and showed perirenal hematoma on the right kidney. He was diagnosed as HFRS and treated with hemodialysis, fluid infusion, and transfusion. There was no evidence of further blood loss at the 7th day of hospitalization. After conservative treatment, he recovered from HFRS.
Adolescent ; Anemia ; Cause of Death ; Fever ; Flank Pain ; Hematoma* ; Hemorrhage ; Hemorrhagic Fever with Renal Syndrome* ; Hospitalization ; Humans ; Kidney ; Male ; Nausea ; Pharyngitis ; Renal Dialysis ; Renal Insufficiency

OBJECTIVE: This study was to determine whether aquaporin-4, which plays role as a transcellular water channel, is expressed in human placenta, and to compare the degree of its expression between preeclamptic women and normal pregnant women. METHODS: Placentas were obtained from severely preeclamptic women and normal pregnant women who were delivered neonates by cesarean section before the onset of labor in the Chungbuk National University Hospital. Immunohistochemistry with aquaporin-4 antibody was performed using paraffin-embedded tissue section. Signal of aquaporin-4 expression was observed with light microscope. RESULTS: Immunohistochemistry demonstrated expression of aquaporin-4 in the placentas of both preeclamptic women and normal pregnant women. The degree of expression was not different in both group. CONCLUSION: Aquaporin-4 was expressed in the human placenta, but may not be related to the pathogenesis of preeclampsia.
Cesarean Section ; Chungcheongbuk-do ; Female ; Humans ; Immunohistochemistry ; Infant, Newborn ; Placenta* ; Pre-Eclampsia* ; Pregnancy ; Pregnant Women

PURPOSE: Defecography is a dynamic investigation which can influence clinical decision making in patients with pelvic outlet obstructive disease (POOD). The current study was designed to establish defecographic findings in patients with POOD. Specifically, we sought to assess the physiologic characteristics of categorized types by using anorectal physiologic tests. METHODS: One hundred seven patients (disease group; 45 men, 62 women) with POOD were retrospectively categorized as type I [non-relaxation of puborectalis (NRPR) only, n=19], type II [NRPR and rectocele, n=20], type III [NRPR, rectocele, and dynamic perineal descent (PD), n=17], type IV [deformed rectocele, mild-to-moderate fixed PD, and absence of NRPR, n=29], and type V [rectocele, severe fixed PD, and absence of NRPR, n=20] on the bases of defecographic findings. The ability to evacuate, the frequency/degree of intarectal intussusception (IRI), and the size of the rectocele were evaulated in these defecographic types of POOD. Age, duration of symptoms, and the physiologic findings of anal manometry and EMG/PNTML were compared for the five types. Eighteen healthy volunteers who had no defecation difficulty were used to estimate the normal findings of defecography. RESULTS: The age and the sex showed no significant differences among the types. The duration of symptoms was gradually lengthened from type I to V (P<0.01). The ability to evacuate in patients with POOD was significantly worse (failed to effectively evacuate) compared to that in the healthy volunteers (P<0.01). The frequency of IRI was increased more and more from type I to V (P<0.01). The size of the rectocele was significantly increased in types V compared to the other types (P<0.01). Manometric and neurologic findings, including EMG/PNTML, revealed no significant differences among the types. CONCLUSIONS: Even though there were no specific differences in the findings of the anal manometric and neurologic tests, the evacuation dynamics; were different in the five defecographic categories of patients with POOD. Specifically, these differences were relevants to the presence of NRPR, rectoceles, IRI, and perineal descent.
Decision Making ; Defecation ; Defecography ; Healthy Volunteers ; Humans ; Intussusception ; Male ; Manometry ; Neurologic Manifestations ; Rectocele ; Retrospective Studies

PURPOSE: This study was designed to evaluate the applicability and usefulness of emergency department (ED) syndromic surveillance using a computerized data source for highly contagious, public health related diseases such as conjunctivitis and meningitis. METHODS: Between Jan 1 2007 and Dec 31 2008 we conducted a retrospective, observational study through consecutive enrollment of individuals at a university hospital with an ED census of about 156,000. ED patient data were obtained from a computerized data system, the National Emergency Department Information System (NEDIS). Predefined symptoms including red eye, eye injection / discharge / itching, headache, nausea, vomiting and predefined signs such as fever comparable with conjunctivitis and meningitis and ED discharge diagnosis were used as data for syndromic surveillance. Data about spinal tapping were used for agreement analysis. RESULTS: We enrolled 714 patients for ED syndromic conjunctivitis and 1,889 for ED syndromic meningitis during the study period. A positive correlation was demonstrated between ED syndromic conjunctivitis data and national ophthalmologic sentinel survey data (Pearson correlation = 0.696; p<0.001). The agreement (kapha value) between ED syndromic meningitis using chief complaints and ED discharge diagnosis and ED syndromic meningitis using chief complaints and spinal tapping order was 0.665 (p<0.001). Real outbreaks were recognized 2 to 4 weeks early by both ED syndromic surveillance of conjunctivitis and meningitis. CONCLUSION: ED syndromic surveillance methods are applicable and useful for surveillance of conjunctivitis and meningitis. Further study is needed to clarify the effectiveness of ED syndromic surveillance and the likelihood of early recognition in highly contagious public health related diseases.
Censuses ; Conjunctivitis ; Information Storage and Retrieval ; Disease Outbreaks ; Emergencies ; Eye ; Fever ; Headache ; Humans ; Information Systems ; Keratoconjunctivitis ; Meningitis ; Nausea ; Nitriles ; Pruritus ; Public Health ; Pyrethrins ; Retrospective Studies ; Spinal Puncture ; Vomiting