Pagets disease has been well known disease in western countries, but it is extremely rare in orient and no case has been reported in Korea yet. It is a chronic osseous disease affecting middle and late life, characterized by progressive skeletal deformities which consist of excessive resorption and abnormal regeneration. We experienced a case of Paget's disease in a 57-year old man with involvement of pelvis, femur and skull, and confirmed with open biopsy.
Biopsy ; Congenital Abnormalities ; Femur ; Korea ; Pelvis ; Regeneration ; Skull

p53 is the most frequently mutated gene in female breast cancer tissues and the prognosis of breast cancer could be changed by mutation of the gene. This study was performed to examine risk factors for breast cancer subtypes classified by p53 mutation and to investigate the roles of p53 gene mutation in carcinogenesis of breast cancer. The study subjects were 81 breast cancer patients and 121 controls who were matched to cases 1:1 or 1:2 by age, residence, education level and menopausal status. All the subjects were interviewed by a well-trained nurse with standardized questionnaire on reproductive factors, and were asked to fill the self-administrative food frequency and 24 hour recall questionnaires. p53 gene mutation in the cancer tissue was screened using polymerase chain reaction (PCR)-single strand conformational polymorphism (SSCP) method. Mutation type was identified by direct sequencing of the exon of which mobility shift was observed in SSCP analysis. Mutations were detected in p53 gene of 25 breast cancer tissues. By direct sequencing, base substitutions were found in 20 cancer tissues (10 transition and 10 transversion), and frame shift mutations in 5 (4 insertions and 1 deletion). For the whole cases and controls, risk of breast cancer incidence decreased when the parity increased, and increased when intake amount of total calory, fat, or protein increased. Fat and protein were statistically significant risk factors for breast cancer with p53 mutation. For breast cancer without p53 mutation, protein intake was the only significant dietary factor. These results suggests that causes of p53 positive breast cancer would be different from those of p53 negative cancer, and that dietary factors or related hormonal factors induce mutation of p53, which may be the first step of breast cancer development or a promoter following some unidentified genetic mutations.
Breast Neoplasms* ; Breast* ; Carcinogenesis ; Case-Control Studies* ; Education ; Exons ; Female ; Frameshift Mutation ; Genes, p53 ; Humans ; Incidence ; Parity ; Polymerase Chain Reaction ; Polymorphism, Single-Stranded Conformational ; Prognosis ; Surveys and Questionnaires ; Risk Factors*

Purpose: Early diagnosis and treatment are essential features to save the kidney in patients with an acute renal infarction. To reduce the delay in diagnosis, the clinical features and treatments of an acute renal infarction were evaluated. Materials and Methods: The medical records of 19 patients (14 men and 5 women) diagnosed with an acute renal infarction were retrospectively analyzed. Symptoms, findings of a cardiologic evaluation, laboratory findings, presumptive diagnosis and treatments were evaluated. Results: All patients complained of flank or abdominal pain. Fifty-three percent of the patients had a history of cardiovascular disease and 37% had no history of specific illnesses. The level of serum LDH was markedly elevated in all patients that performed the test. Initially, only 4 patients were diagnosed as acute renal infarction. In the others, the presumptive diagnoses were urinary stone, acute abdomen, aortic dissection and so forth. Seven patients were managed with conservative care due to the delay in diagnosis or poor general condition. Nine patients were managed with systemic anticoagulation and 3 with intra-arterial thrombolytic therapy. Conclusions: An acute renal infarction must be considered as one of the presumptive diagnoses in patients presenting with flank or abdominal pain and a history of cardiovascular diseases. Prompt CT scanning and testing of the serum LDH level will help in the accurate and immediate diagnosis of an acute renal infarction.
Abdomen, Acute ; Abdominal Pain ; Cardiovascular Diseases ; Diagnosis ; Early Diagnosis ; Humans ; Infarction* ; Kidney ; Male ; Medical Records ; Retrospective Studies ; Thrombolytic Therapy ; Tomography, X-Ray Computed ; Urinary Calculi

On histological examination, an epidermolytic hyperkeratosis was observed adjacent to follicular papules on the back of a 53-year-old man. It has been reported that incidental epidermolytic hyperkeratosis occur either within various lesion (epidermal neoplasm, melanocytic neoplasm, scars, and inflammatory conditions) or in the normal skin adjacent to the lesion. This patient participated in the Vietnam War for 2 years, and had had contact with defoliants. He was treated for multiple peripheral neuropathies and cerebral infarcts. In keratinocytes, 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD; Agent Orange) contained in defoliating agents is associated with altered patterns of keratinocyte differentiation. So, as a cause of incidental epidermolytic hyperkeratosis, defoliant contact could be suspected.
Cicatrix ; Humans ; Hyperkeratosis, Epidermolytic* ; Keratinocytes ; Middle Aged ; Peripheral Nervous System Diseases ; Skin* ; Tetrachlorodibenzodioxin ; Veterans* ; Vietnam*

No abstract available.

STUDY DESIGN: Prospective study. OBJECTIVES: To assess the correlation between symptom improvement and spinal canal dimensions in patients who underwent selective nerve root block for lumbar spinal stenosis. SUMMARY OF LITERATURE REVIEW: When the canal size is relatively small, the pressure on the nerve root increases. Decompressive surgery relieves more pain in such patients. MATERIALS AND METHODS: From July 2009 to March 2011, 141 patients received selective nerve root block for 1-level central lumbar spinal stenosis in our hospital. We evaluated the patients using a visual analog scale (VAS) before the procedure and 1 hour, 1 month, and 3 months following the procedure. We measured the spinal canal using magnetic resonance imaging. RESULTS: There was no significant correlation between spinal canal dimensions and the pre-procedure VAS. We divided the patients into 3 groups using the average and the standard deviation of the patients' spinal canal dimensions (<73.1 mm², 73.1-172.5 mm², >172.5 mm²) (p<0.01). One hour after the procedure, the VAS scores changed by 1.43±1.8, 1.62±1.7, and 1.53±1.5, respectively, with no significant differences among the 3 groups. However there were significant differences in the VAS changes 1 month and 3 months following the procedure, with results of 2.39±1.7 and 1.39±1.5, 4.65±2.1 and 4.28±2.3, and 4.97±2.2 and 6.83±1.9 (p<0.01), respectively. CONCLUSIONS: The smaller the area of the spinal canal, the less likely symptoms were to improve after selective nerve root block. The results of this study will help predict the effects of selective nerve root block in spinal stenosis patients.
Humans ; Lumbosacral Region ; Magnetic Resonance Imaging ; Nerve Block ; Prospective Studies ; Spinal Canal* ; Spinal Stenosis* ; Visual Analog Scale

PURPOSE: Because the breast cancer is one of the major causes of mortality among women, it is important to identify modifiable risk factors for this disease. Some reported that overweight/obesity is a risk factor for breast cancer, but the results are not consistent. Human breast cancer has different characteristics according to the status of menopause (premenopause and postmenopause). For the premenopaused women, the majority of the relevant prospective studies support an inverse relationship between body mass index and the development of breast cancer. In contrast, for the postmenopaused women, a positive relationship between body mass index and development of breast cancer has been reported in only half of prospective studies on this topic. This study was undertaken to determine the role of body size and body mass index by status of menopause in development of breast cancer in Korea using retrospective case-control study. MATERIALS AND METHODS: The breast cancer cases (n=683) and controls (n=501) were recruited from January 1993 to April 1998 at the Asan Medical Center. The authors collected information on demographic, reproductive and anthropometric characteristics by interviews. Quetelets index was calculated using height and weight. Multiple logistic regression was done to estimate adjusted odds ratios (ORs) by menopausal status, controlling age, age at first full-tenn pregnancy, age at menarche, number of parity, family history of breast cancer. RESULTS: Overall, there was a moderate, but significant association between obesity and breast cancer. Among premenopausal women, in comparison with women whose weights were less than 50 kg, the ORs for the upper quintile group of weight was 1.71 (95% confidence interval (CI), 1.01~2.89). The heaviest premenopausal women had a higher risk (OR=1.16, 95% CI, 1.05~1.29, P=0.005). The adjusted OR for the highest quintile of BMI relative to the lowest was 2.02 (95% CI, 1.18~3.45). Higher body mass index was significantly associated with increased risk of premenopausal breast cancer (OR=1.08, 95% CI, 1.02~1.15, P=0.006). Among postmenopausal women, higher body mass index and weight were associated with increased risk of breast cancer. In comparison with women whose weights were less than 50 kg, the OR for the upper quintile group of weight was 2.08 (95% CI, 1.064.08). The adjusted OR for the highest quintile of BMI relative to the lowest was 2.02 (95% CI, 1.02~4.01). CONCLUSION: Our findings suggest that overweight/obesity may play an important role in the incidence of premenopausal and postmenopausal breast cancer in Korea.
Body Mass Index* ; Body Size* ; Breast Neoplasms* ; Breast* ; Case-Control Studies ; Chungcheongnam-do ; Female ; Humans ; Incidence ; Korea* ; Logistic Models ; Menarche ; Menopause ; Mortality ; Obesity ; Odds Ratio ; Parity ; Pregnancy ; Retrospective Studies ; Risk Factors ; Weights and Measures

Tarsal tunnel syndrome is an entrapment neuropathy of the posterior tibial nerve or its branches in the fibro-osseous tunnel beneath the flexor retinaculum. This pathology is associated with multiple etiologies, including trauma, space-occupying lesions, and impaired biomechanics. We report a case of tarsal tunnel syndrome associated with gout tophi in a patient with untreated gout along with a review of the relevant literature on tarsal tunnel syndrome.
Gout* ; Humans ; Pathology ; Tarsal Tunnel Syndrome* ; Tibial Nerve

OBJECTIVE: We attempted to confirm the effects of the combined treatment of medication and parent training on the behavioral problems of referred ADHD children, the maternal behavior, and the parenting stress of their mothers. METHODS: Twenty-four children between the ages of 5 to 11 and their mothers were selected as subjects from Child Psychiatric Clinics of Hanyang University Hospital. Three groups were organized : combined treatment group of medication and parent training(N=6) ; wating list group(N=6) ; and medication only group(N=6). Methylphenidate(0.5-0.7 mg/kg/day) was prescribed for children. Mothers of the combined treatment group of medication and parent training and the wating list group attended the parent training once a week for nine weeks and a booster session 4 weeks later. Treatment outcomes were evaluated by comparing both treatment groups at pre- and post-treatment using the various rating scales. Especially the combined treatment group was followed up after 6 months to evaluate the stability of treatment effects. RESULTS: This study showed greater effectiveness of the combined treatment of medication and parent training relative to the medication only in decreasing the overall behavioral problems of ADHD children and the parenting stress of mothers as well as in increasing the desirable maternal behavior. In addition, these improvements were maintained at 6 month follow-up. CONCLUSION: The combined treatment of medication and parent training facilitated the behavioral improvement of referred ADHD children in several aspects.
Child* ; Drug Therapy ; Follow-Up Studies ; Humans ; Maternal Behavior ; Mothers ; Parenting ; Parents* ; Weights and Measures

PURPOSE: An acute scrotum is a pathologic condition of the scrotum or intrascrotal contents that require emergency medical or surgical treatment. Because proper treatment and the outcomes are very important in reproduction, the records of patients who had acute scrotal diseases were reviewed for early and proper diagnosis and treatment. MATERIALS AND METHODS: The medical records of 313 patients with acute scrotal pain and swelling were retrospectively reviewed. The final diagnoses were made from the symptoms, a physical examination, the laboratory tests, a color Doppler ultrasound (US), and the surgical findings in cases that underwent surgery. Age, the presence of a urinary tract infection, an underlying disease, seasonal distributions, laterality and the accuracy of color Doppler US in acute epididymitis and testicular torsion were all analyzed. The missed cases of testicular torsion were also reviewed carefully. RESULTS: The most common disease of an acute scrotum was acute epididymitis in both adults and children. Urinary tract infections were not common in children with acute epididymitis. Testicular torsion occurred commonly in the left side, while acute epididymitis developed in same distributions. The mean age of an acute scrotum were 24.1 years; a testicular torsion was 16.0 years and an acute epididymitis was 25.4 years. The color Doppler US demonstrated a 82.5% sensitivity, a 100% specificity, a 100% positive predictive value and a 97.5% negative predictive value for testicular torsion. CONCLUSIONS: Acute epididymitis is also common in children. Although color Doppler US is useful in a differential diagnosis of an acute scrotum, a careful physical examination and follow up of the patient status are important to reduce the incidence of a misdiagnosis.
Adult ; Child ; Diagnosis ; Diagnosis, Differential* ; Diagnostic Errors ; Emergencies ; Epididymitis* ; Humans ; Incidence ; Male ; Medical Records ; Physical Examination ; Reproduction ; Retrospective Studies ; Scrotum* ; Seasons ; Sensitivity and Specificity ; Spermatic Cord Torsion* ; Ultrasonography ; Ultrasonography, Doppler, Color ; Urinary Tract Infections