Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease of probable autoimmune etiology. The MR images of patients with clinically suspected ADEM were retrospectively reviewed. The clinical symptoms occurred 5 days to 1 month after viral upper respiratory infection (4) and Coxsakie viral infection(1). The symptoms had begun with fever(3), headache(3), sore throat(1), and drowsy mental state (1), which progressed with monophasic course to altered mental change(2), extremity weakness(2), seizure(1) and/or cerebellary symptom(I) MRI findings of ADEM showed patchy(4), nonhemorrhagic(5), asymmetric(5) high signal intensity lesions on T2-weighted images. The number of the lesions was mostly multiple(4). The lesions mainly involved the brain stem(3) and subcortical white matter(3). Follow-up MR images of 13 days to 20 days after high dose steroid therapy showed marked improvement in two of three, which well correlated with clinical manifestations. MR findin of multiple, patchy, nonhemorrhagic and asymmetric lesions in subcortical white matter and brain stem on T2-weighted images seem to be characteristic features of ADEM, but nonspecific. Therefore, clinical correlation is required in evaluating ADEM.
Brain ; Brain Stem ; Demyelinating Diseases ; Encephalomyelitis, Acute Disseminated ; Extremities ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Retrospective Studies ; White Matter

PURPOSE: To understand the various clinical and radiological features of ectopic thyroid. MATERIALS AND METHODS: This study involved nine ectopic thyroid cases (M:F=2:7; age range, 2-57 years) confirmed by RI thyroidscan between 1993 and 1997. We analyzed one neck ultrasonogram, five CT scans, three MR images, nine Tc-99mthyroid scans, and classified the ectopic thyroid by the basis of these findings. Hormonal abnormalities andsymptoms were evaluated on the basis of medical records. RESULTS: The status of nine patients was found to beeuthyroid (n=6), hypothyroid (n=2) or hyperthyroid (n=1). Among the nine, the ectopic thyroid was lingual (n=6),sublingual (n=3) or thyroglossal (n=1); one patient had both the lingual and sublingual types. Ectopic thyroid wasseen as a well-defined round mass, homogeneously enhanced on CT scan, homogeneously hyperechogenic onultrasonogram and of intermediate signal intense on MRI. All cases showed ectopic radioactivity uptake on Tc-99mthyroid scan. In eight patients, ectopic thyroid was the only hormone-producing thyroid tissue; one had bothnormal thyroid and ectopic thyroid tissue in a thyroglossal duct cyst. Among the six cases of euthyroidism,ectopic thyroid patients with the lingual type complained of throat discomfort. Those with the sublingual typecomplained of palpable neck mass, and preoperative evaluation of thyroglossal duct cyst showed that this wasectopic thyroid. CONCLUSION: Understanding the various clinical and radiologic features of ectopic thyroid canhelp accurate diagnosis and prevent unnecessary surgery or other procedure.
Diagnosis ; Humans ; Magnetic Resonance Imaging ; Medical Records ; Neck ; Pharynx ; Radioactivity ; Thyroglossal Cyst ; Thyroid Dysgenesis* ; Thyroid Gland ; Tomography, X-Ray Computed ; Ultrasonography ; Unnecessary Procedures

Backgrounds: Diabetes insipidus(DI) is a clinical syndrome characterized by excretion of copious volumes of dilute urine combined with persistent intake of abnormally large quantities of fluid. Central DI, caused by lack of antidiuretic hormone(ADH), most often results from lesions in the hypothalamic-neurohypophyseal axis. Magnetic resonance(MR) imaging is particularly useful in documenting the presence of a structural lesion, as opposed to assigning a diagnosis of idiopathic DI for which only symptomatic therapy is prescribed. Recently, several reports have described a specific MR finding in central DI, that is absence of normal posterior pituitary bright spot(PPBS). Methods: We retrospectivesly studied the clinical and MR findings in 25 patients with central DI, diagnosed by warter deprivation test. Results: 1) The subjects included 17 males and 8 females, between the ages of 2 and 58 years. 2) 24-hour urine volumes were 2,340~13,750 mL, and mean urine osmolarity was 147.7±65.8 mOsm/kg. The 23 subjects diagnosed complete central DI by warter deprivation test. 3) We found that the most common cause of cntral DI was infiltrative lesions of hypothalmic-neurohypophyseal axis(60%). Germ cell tumor was the single leading cause in present study, accounting for 36% of cases. The other causes were found, including pituitary apoplexy, meningitis, and trauma. Idiopathic central DI accounted for 20% of all cases. 4) Growth hormone deficiency was the most common accompanying anterior pituitary deficit, and panhypopituitarism was found in 7 cases, Hyperprolactinernia was seen in 6 cases. 5) In all patients, PPBS on Tl weighted MR images were not observed. A thickened pituitary stalk was seen in 15 cases(9 patients with germ cell tumor, 3 patients with histiocytosis X, 1 patient with tuberculosis, 2 patients with unknown origin). Conclusion: In our results, the most common causes of central DI was suprasellar infiltrative lesions. MR is currently the imaging methods of choice in the evaulation of dysfunction of the hypothalamic-neurohypophyseal system in patients with central DI. A specific MR finding, that is loss of normal PPBS allows a confirmative diagnosis of central DI.
Diagnosis ; Female ; Growth Hormone ; Histiocytosis, Langerhans-Cell ; Humans ; Male ; Meningitis ; Neoplasms, Germ Cell and Embryonal ; Osmolar Concentration ; Pituitary Apoplexy ; Pituitary Gland ; Tuberculosis

BACKGROUNDS/AIMS: For patients with acute cholecystitis, conversion from laparoscopic cholecystectomy to open surgery is not uncommon due to possibilities of serious hemorrhage at the liver bed and bile duct injury. Recent studies reported successful laparoscopic subtotal cholecystectomy for acute cholecystitis. The purpose of this study was to determine the efficacy and feasibility of such an operation based on the experience of surgeons at our facility. METHODS: In this study, we enrolled 144 patients who had received either laparoscopic subtotal cholecystectomy (LSC), laparoscopic cholecystectomy (LC), or open cholecystectomy (OC) for acute cholecystitis from January 2004 to December 2009 at the Department of Surgery of our hospital. Their symptoms, signs, operative findings, pathologic results and postoperative results were compared and analyzed. RESULTS: There were 26 patients in the LSC group 80 in the LC group and 38 in the OC group. There were no differences in mean age, sex, and symptoms of acute cholecystitis. The LSC group showed higher CRP levels (p<0.001) and a higher grade according to the Tokyo criteria (p=0.001). The mean operative time was 115.6 minutes and mean blood loss was 158.9 ml without intra-operative or postoperative transfusion. There weren't any bile duct injuries during the operation. No group suffered bile leakage. Drains were removed 3.3 days after the operation in the LC group, the shortest time compared to the other groups (p<0.001). LC and LSC groups demonstrated shorter postoperative hospital days and time to diet resumption than the OC group (p<0.001). CONCLUSIONS: LSC appears to be a safe and effective treatment in cases of severe acute cholecystitis that require consideration of conversion to open surgery.
Bile ; Bile Ducts ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis, Acute ; Conversion to Open Surgery ; Diet ; Hemorrhage ; Humans ; Liver ; Operative Time ; Tokyo

Molecular investigations have provided evidence of the involvement of multiple genetic alterations in gastric carcinogenesis. Regarding the clinical, epidemiological and genetic aspects, well and poorly differentiated gastric adenocarcinoma exhibit some differences.(1) PURPOSE: To examine the gene expression profile of stomach cancer and evaluate the differentially expressed genes between intestinal and diffuse cancer type. METHODS: Five intestinal and 5 diffuse type gastric cancer tissues and their matched normal mucosa were obtained from patients who underwent a gastrectomy. The mRNAs frome these tissues were extracted, reverse transcribed with simultaneous Cy3 and Cy5 labeling, and hybridized with the MAGIC(TM) microarray (Korean 4.6k chip). The chip was scanned using Generation III, image analysis with Imagine 5.0 and data analysis with Arraytool, R, and SAM. RESULTS: Twelve and 15 genes were found to be up- and down-regulated genes in the intestinal type, whereas these figures were 25 and 4 genes in the diffuse type, respectively. With the intestinal and diffuse type, 2 and 9, 10 and 4 exhibites up- and down-regulation greater than 2 fold, respectively. In the intestinal type genes, up-regulation was associated with metabolism, cell growth and cell communication; whereas, down-regulation was associated with metabolism and mainly unclassified functions. In the diffuse type genes, up-regulation was associated with metabolism, cell growth, cell communication and drug resistance, ; whereas, down-regulation was associated with metabolism and cell growth. Non-hierarchical clustering of the genes revealed two expression profiles, which can be used to classify the above 10 samples into two exactly distinct types. CONCLUSION: The analysis of the intestinal and diffuse gastric cancers using the cDNA microarray showed distinct gene expression profiles, consistent with their different histological and clinical features.
Adenocarcinoma ; Carcinogenesis ; Cell Communication ; DNA, Complementary* ; Down-Regulation ; Drug Resistance ; Gastrectomy ; Gene Expression* ; Humans ; Metabolism ; Mucous Membrane ; Oligonucleotide Array Sequence Analysis* ; RNA, Messenger ; Statistics as Topic ; Stomach Neoplasms* ; Transcriptome ; Up-Regulation

PURPOSE: The mortality of intestinal atresia has decreased remarkably owing to prenatal diagnosis, development of diagnosis method, neonatal intensive care, surgical technique, total parenteral nutrition and performing of early surgery. The clinical consideration of our experience about intestinal atresia would be helpful in the understanding of disease. METHODS: We reviewed the clinical presentation, hospital days, diagnosis method, surgical method, postoperative early complication and mortality based on medical records, retrospectively, in 32 cases of intestinal atresia encountered at Inha University Hospital between March 1997 and May 2009. RESULTS: The involved sites were; duodenum (n=11; 34.4%), jejunoileum (n=20; 62.5%), and colon (n=1; 3.1%). The mean postoperative fasting time was 6.38 days. The postoperative morbidity was 9.4% and mortality was 3.1%. CONCLUSION: Complete recovery from intestinal atresia can be insured by prompt diagnosis, early surgery and careful neonatal intensive care.
Colon ; Duodenum ; Early Diagnosis ; Fasting ; Infant, Newborn ; Intensive Care, Neonatal ; Intestinal Atresia ; Medical Records ; Parenteral Nutrition, Total ; Prenatal Diagnosis ; Retrospective Studies

PURPOSE: Pancreacticoduodenectomy is the procedure of choice for managing periampullary malignancy. But pancreatojejunostomy site leakage is a very critical complication because it is hard to prevent leakage. The aim of this study is to analyze the risk factors of pancreatic leakage after pancreaticoduodenectomy. METHODS: We retrospectively reviewed 172 consecutive patients who had received pancreaticoduodenectomy at Inha University Hospital between Apr. 1996 and Mar. 2006. We analyzed the pancreatic leakage rates according to the clinical characteristics, the pathologic and laboratory findings and the anastomosis methods. RESULTS: There were differences in the mean age and pathologic findings between the two groups. There were 115 (66.9%) patients older than 60 years, while the other 57 patients (33.1%) were younger than 60 years. The incidence of developing pancreatic fistula in patients older than 60 years was 21.7% (25/115) while this was 8.8% (5/57) for the younger patients, and the difference was significant (p=0.03). The patients with a dilated pancreatic duct showed a lower rate of esser post-operative pancreatic fistula than the patients with a non-dilated duct (p=0.001). Other factors, including the anastomosis method and the pathologic diagnosis, didn't show any statistical difference. According to the pathologic diagnosis, the patients with pancreatitis and stomach cancer revealed pancreatic fistula to a smaller extent; there were 6 cases (3.5%) of pancreatitis and 22(12.8%) of stomach cancer. Among the case with pancreatic fistula, there were 0 cases of pancreatitis and 2 cases (6,7%) of stomach cancer, but the difference was not statistically significant. CONCLUSION: Our study demonstrated that pancreatic fistula is related to age and a dilated pancreatic duct. Surgeon must take these risk factors into consideration when performing pancreaticoduodenectomy. We recommend surgeons to use skillful technique to prevent pancreatic fistula.
Diagnosis ; Humans ; Incidence ; Pancreatic Ducts ; Pancreatic Fistula* ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy ; Pancreatitis ; Retrospective Studies ; Risk Factors* ; Stomach Neoplasms