A 48-year-old woman was admitted to our hospital with a palpable mass in her lower abdomen. A left ovarian, cystic mass containing multiple mobile globules was seen on CT and MR images. The outer portion of the globules showed fat components on CT and fat-saturated T1-weighted MR images. Ultrasonography showed multiple echogenic, mobile globules with some sound attenuation and hyperechoic lines and dots within the cystic mass, which corresponded with the presence of lipid globules and hair shafts of ovarian mature cystic teratoma, respectively.
Abdomen ; Female ; Hair ; Humans ; Middle Aged ; Ovary ; Teratoma* ; Ultrasonography

BACKGROUND: Keloids and hypertrophic scars are benign growths of dermal collagen that usually cause major physical, psychological, and cosmetic problems. Numerous treatment modalities have been used to treat keloids and hypertrophic scars, but the optimal treatment has not been established. OBJECTIVE: The purpose of this study is to investigate whether bleomycin intralesional injection has an therapeutic effect on both keloids and hypertrophic scars. METHODS: Thirteen patients with keloids or hypertrophic scars were administered with intralesional injection of bleomycin (1.5 IU/ml). Scar height was measured, and scar pliability and erythema were scored at baseline and then monthly during the treatment and follow-up period. Patient's self-assessments of subjective symptoms (pruritus and pain) were also scored. Pre- and post-treatment mean values for scar height, scar pliability, erythema, pruritus and pain were statistically compared. RESULTS: The clinical response was positive in all cases: highly significant flattening in one case, significant flattening in one case, moderate flattening in five cases and minimal flattening in six cases. The mean scores for pruritus and pain also improved. The observed side-effects were hyperpigmentation (two cases), hypopigmentation (one case) and skin infection (one case). No exacerbation was noted during follow-up period of 4 months. CONCLUSION: Bleomycin intralesional injecton may be one of the effective and safe method of treating keloids and hypertrophic scars.
Bleomycin ; Cicatrix ; Cicatrix, Hypertrophic ; Collagen ; Cosmetics ; Erythema ; Follow-Up Studies ; Humans ; Hyperpigmentation ; Hypopigmentation ; Injections, Intralesional ; Keloid ; Pliability ; Pruritus ; Self-Assessment ; Skin

PURPOSE: To determine the diagnostic performance of contrast-enhanced multidetector CT (MDCT) and the Alvarado score for acute appendicitis. MATERIALS AND METHODS: MDCT and determination of the Alvarado score were prospectively performed in 282 patients with 146 pathologically proven cases of acute appendicitis and 136 pathologically proven or clinically diagnosed cases of non-acute appendicitis. To compare the diagnostic performance of MDCT and the Alvarado score, the patients were subdivided according to age and sex, and receiver operating characteristics (ROC) analysis and Spearman rank correlation were performed. RESULTS: ROC analysis revealed that the optimal cut off value of the CT appendicitis grades was 2 in all patients, resulting in a sensitivity of 96.6% and a specificity of 94.9%. The optimal cut off values of the Alvarado score was different according to age and sex, resulting in a sensitivity of 85.6% and a specificity of 48.5%. There was a significant correlation between the CT appendicitis grades and the surgical-pathological grades (r=0.496, p<.0001). However, no significant correlation was observed between the Alvarado score and the surgical-pathological grades. CONCLUSION: Contrast-enhanced MDCT has a higher diagnostic accuracy and significant correlation with pathological findings than those of the Alvarado score in patients with acute appendicitis.
Acute Disease ; Appendicitis* ; Humans ; Prospective Studies* ; ROC Curve ; Sensitivity and Specificity

Gastric teratomas are extremely rare neoplasms and almost exclusively benign. They occur predominantly in males and generally present as a palpable abdominal mass. To our knowledge, only one adult case has been described in the Korean literature. We report a case in which an immature gastric teratoma in a 3-month-old boy was revealed by CT and US.
Case Report ; Human ; Infant ; Male ; Stomach Neoplasms/*epidemiology/radiography/ultrasonography ; Teratoma/*epidemiology/radiography/ultrasonography ; Tomography, X-Ray Computed

Factor XI deficiency (Hemophilia C) is a very rare autosomal recessive bleeding disorder. Patients with factor XI deficiency do not typically show any spontaneous bleeding or specific symptoms. Sometimes those who have this disorder are identified during special situations such as trauma or surgery. Orthognathic surgery is particularly associated with a high bleeding risk. Therefore, great care must be taken when treating patients with bleeding disorders such as factor XI deficiency. There are a few reports that address the management of patients with bleeding disorders during orthognathic surgery. The current report describes a patient with factor XI deficiency who underwent Le Fort I osteotomy together with bilateral sagittal split osteotomy. The patient's condition was assessed using both rotation thromboelastometry (ROTEM™) and noninvasive measurements of total hemoglobin (SpHb) using Masimo Radical 7 (Masimo Co. CA, USA).
Anesthesia* ; Factor XI Deficiency* ; Factor XI* ; Hemorrhage ; Humans ; Orthognathic Surgery* ; Osteotomy ; Thrombelastography

Eighty-four patients with unresectable primary hepatocellular carcinoma due either to locally advanced lesion or to association with liver cirrhosis were treated with combined radiotherapy and hyperthermia from April 1988 to January 1991. Purpose of this study was to assess thermometry, response rate, toxicity, and survival in those patients. External radiotherapy was given with a total of 30.6 Gy/3.5 wks. Hyperthermia was given twice a week with a total of 6 treatment sessions using an 8 MHz radiofrequency capacitive type heating machine. Each hyperthermia session was started within 30 min following radiotherapy and continued for 30-60 min. Thermal data were analysed with maximum, minimum, and average temperatures of the tumors. Thermal mapping was also done. In thermometry results, maximum, minimum, and average temperatures of the tumors were 41.9 +/- 1.3 degrees C, 39.9 +/- 1.0 degrees C, and 40.8 +/- 0.9 degrees C, respectively. The fraction over 40 degrees C was 73 +/- 32% with a wide variation from 15% to 100%. Among 67 assessable patients, 27 patients showed tumor regression of more than 50% of the original tumor volume (40.3% response rate). Symptomatic improvement was observed in 78.6% of the patients. Acute toxicities during the treatment were mostly acceptable local pain (51.2%) and local fat necrosis (13.1%). The actuarial 1-year, 2-year, and 3-year survival rates were 44.8%, 19.7%, and 15.6%, respectively. Median survival was 6 months. In view of acceptable toxicities and the current rate of survival, further evaluation of combined treatment of radiotherapy and hyperthermia for unresectable hepatocellular carcinoma is warranted.
Carcinoma, Hepatocellular/radiotherapy/*therapy ; Combined Modality Therapy ; Female ; Human ; *Hyperthermia, Induced ; Liver Neoplasms/radiotherapy/*therapy ; Male ; Middle Age ; Remission Induction

Clonorchiasis is caused by a chronic infestation of liver flukes, Clonorchis sinensis, and these reside mainly in the medium- and small-sized intrahepatic bile ducts. Therefore, diffuse, uniform, minimal or mild dilatation of these bile ducts, particularly in the periphery, without dilatation of the extrahepatic bile duct is the typical finding on several imaging modalities. We report here on the CT findings of an unusual case of hepatic parasitic abscess that was caused by clonorchiasis; this malady mimicked cholangiocarcinoma, and there was no dilatation of the intrahepatic bile ducts.
Tomography, X-Ray Computed/*methods ; Middle Aged ; Male ; Liver Abscess/*parasitology/*radiography/surgery ; Humans ; Diagnosis, Differential ; Clonorchiasis/*radiography/surgery ; Animals

Erythropoietic protoporphyria (EPP), caused by decreased activity of the enzyme ferrochelatase, is characterized clinically by burning photosensitivity beginning from childhood, and chemically by excessive amounts of red blood cell protoporphyrins. 1-10% of EPP patients develop potentially fatal protoporphyric hepatic failure. The diagnosis of EPP had been missed in many cases when traditional solvent extraction qualitative screening test was used for blood porphyrins, and use of fluorescence microscopy improved this problem. We report a case of EPP screened by fluorescence microscopy of erythrocytes in a 50-year-old man complaining of photosensitivity. We recommend fluorescence microscopy could be the screening test of choice for the detection of increased red blood cell porphyrins.
Burns ; Diagnosis ; Erythrocytes ; Ferrochelatase ; Fluorescence* ; Humans ; Liver Failure ; Mass Screening ; Microscopy, Fluorescence* ; Middle Aged ; Porphyrins ; Protoporphyria, Erythropoietic* ; Protoporphyrins

PURPOSE: Gastric adenocarcinoma is the most common malignant tumor in Korea and immunochemotherapy can be alternative method of the treatment for it. So we evaluated several immunologic markers, Major Histocomatibility (MHC) Antigen and Intercellular Adhesion Molecule (ICAM)-1 which play an important roles in cellular immune response of the host to the tumar cells, HLA-DR/DP antigens, one of the MHC class II which is expressed in various conditions, CD 68 antigen which are also important factor in immune response to the tumor cells. MATERIALS AND METHODS: We compared the expression of MHC class II (HLA-DR/DP) antigens, ICAM-1 and the number of tumor-infiltrating macrophages presenting CD68 antigen in formalin-fixed paraffin-embedded tissue sections of 95 gastric adenocarcinomas using immunohistochemistry. In addition to analyze the relationship between expression of these antigens in gastric adenocarcinoma, histolopathologic findings such as tumor invasion, regional lymph node metastasis and histologic differentiation are evaluated. RESULTS: The rate of HLA-DR/DP expression was 60% and strongly associated with tumor differentiation, invasion and regional lymph node metastasis. ICAM-1 was expressed in 15% and slightly increased in well-differentiated carcinoma. The lack of expression of ICAM-1 was observed in high invasive tumor (T 4). CD 68(+) macrophages counts were significantly increased in around the tumor cells, compared to normal epithelia. HLA-DR/DP expression and infiltrating CD 68(+) macrophage numbers were significantly associated (p<0.05), but there was no correlationship between ICAM-1 and CD 68(+) macrophage numbers. CONCLUSION: It was considered that enhanced expression of HLA-DR/DP antigens, ICAM-1 and CD68(+) macrophages in gastric adenocarcinomas may be an immunophenotypic deviation. HLA-DR/DP and CD68(+) macrophages infiltration showed correlationship with tumor invasion and regional lymph node metastasis, that they may be used as a prognostic factor of the tumor growth.
Adenocarcinoma* ; Biomarkers ; Immunity, Cellular ; Immunohistochemistry ; Intercellular Adhesion Molecule-1* ; Korea ; Lymph Nodes ; Macrophages* ; Neoplasm Metastasis

A giant colonic diverticulum is a rare complication of diverticulosis, and an inguinal hernia is a common diagnosis for patients presenting with a painful groin mass. A 52-year-old male presented to the emergency room with a 3-hour complaint of progressive, constant, right-groin pain with an inguinal mass. After manual reduction of the inguinal hernia, the patient complained of pain in the right upper quadrant. Operative findings showed a transverse colon diverticulitis without perforation. We report here that case of a transverse colon giant diverticulum presenting as an atypical incarcerated inguinal hernia.
Colon, Transverse* ; Diagnosis ; Diverticulitis* ; Diverticulum ; Diverticulum, Colon ; Emergency Service, Hospital ; Groin ; Hernia, Inguinal* ; Humans ; Male ; Middle Aged