BACKGROUND: Primary hepatocellular carcinoma(HCC) is the second cause of cancer death in our country. Hepatitis B virus(HBV) and hepatitis C virus(HCV) are important risk factors for hepatocellular carcinoma. The mechanism of HCC development and the epidemiology in HCV infected individuals are still unclear. In this study, we investigated the epidemiolgical and clinical features of HCC in relation to viral infection. METHODS: We reviewed the medical records of 160 HCC patients retrspectively who had been admitted to one University Hospital located in Seoul between January 1991 and December 1995. Among these patients, 113 patients were positive for HBsAg(B group), 24 for anti-HCV(C group). We compared epidemiological and clinical data between B group and C guoup. RESULTS: Anti-HCV positivity was significantly higher in HBsAg negative patients than in HBsAg positive patients(53.3:1.7%, p<0.01). The mean age of patients in B group was significantly lower than that in C group(52:62yr, p<0.01). In C group, the proportion of Child-Pugh class B and C was significantly larger than that of B group(35.4: 75.0%, p<0.01). In C group, the proportion of transfusion history was significantly larger than that in B group(4.4: 16.7%, p<0.05), and the proportion of drug abuse hestory was significantly larger than that in B group (31.0:62.5%, p<0.01). In C group, the albumin, cholesterol, Gamma-glutamyl transferase leves were significantly lower than those in B group. In B group, the proportion of metastasis was significantly larger than that in C group(31.9:4.2%, p<0.01). Alpha fetoprotein levels greater than 400ng/ml are much more prevalent in group B significantly(67:39.1%, p<0.05). No significant differences in cumulative survival rate(1yr, 2yr) and median survival time were observed between the two groups. CONCLUSIONS: We ascertain that the HBV and HCV are inportant factors in HCC. In epidemiology and clinical features of HCC, there were some difference between the HBsAg and anti HCV positive group. Therefore, on primary health care settings, it is necessary to test for hepatitis C as well as hepatitis B in order to prevent and manage HCC and chronic liver desease.
alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Cholesterol ; Epidemiology* ; Hepatitis B ; Hepatitis B Surface Antigens* ; Hepatitis C ; Humans ; Liver ; Medical Records ; Neoplasm Metastasis ; Primary Health Care ; Risk Factors ; Seoul ; Substance-Related Disorders ; Transferases

Primary leiomyosarcoma is a rare tumor of the ovary. We experienced a case of primary ovarian leiomyosarcoma in a 68 year old woman. Microscopically, the tumor was characterized by interlacing bundles of plump spindle cells that showed immunoreactivity for alpha-smooth muscle actin, pleomorphic multinucleated giant cells and an increased mitotic rate. Ultrastructural features included abundant smooth muscle type filaments and irregular bodies. Consequently, this case has led us to propose ultrastructural and immunohistochemical criteria for primary ovarian leiomyosarcoma.
Female ; Humans

No abstract available.
Cesarean Section* ; Female ; Pregnancy

Os subfibulare is a accessory bone arround the lateral maleolus, but it is different from many other accessory bones in foot and ankle in its development related to trauma and frequent symptoms of ankle instability. Accessory bone is a developmental anomaly which fails to unite to main secondary ossification center and usually asymptomatic. But os subfibulare is developed by recurrent ankle sprains in younger age or non-union of avulsion fracture of anterior talofibular ligament and causes instability of ankle. We experienced two cases of symptomatic os subfibulare in adolecents and report them with review of literatures.
Ankle ; Ankle Injuries ; Foot ; Ligaments

BACKGROUND AND PURPOSE: Sleep-disordered breathing (SDB) is suggested to be strongly associated with ischemic strokes. Risk factors, stroke subtypes, stroke lesion distribution, and the outcome of SDB in stroke patients remain unclear in Korea. METHODS: We prospectively studied 293 patients (159 men, 134 women; age 68.4+/-10.5) with acute ischemic stroke. Cardiovascular risk factors, stroke severity, sleep-related stroke onset, distribution of stroke lesions, and 3-month score on the modified Rankin Scale (mRS) were assessed. Stroke severity was assessed by the US National Institutes of Health Stroke Scale (NIHSS) and the mRS. The apnea-hypopnea index (AHI) was determined 6.3+/-2.2 days after stroke onset with the Apnea Link portable sleep apnea monitoring device. RESULTS: The prevalence of SDB (defined as an AHI of > or =10) was 63.1% (111 men, 74 women). Those in the SDB group were older, had higher NIHSS and mRS scores, greater bulbar weakness, and a higher incidence of sleep-associated stroke onset. Among risk-factor profiles, alcohol consumption and atrial fibrillation were significantly related to SDB. The stroke outcome was worse in patients with SDB than in those without SDB. The lesion location and specific stroke syndrome were not correlated with SDB. CONCLUSIONS: SDB is very common in acute cerebral infarction. Different risk-factor profiles and sleep-related stroke onsets suggest SDB as a cause of ischemic stroke. The higher NIHSS score and greater bulbar involvement in the SDB group seem to show the influence of ischemic stroke on the increased SDB prevalence.
Alcohol Drinking ; Aluminum Hydroxide ; Apnea ; Atrial Fibrillation ; Carbonates ; Cerebral Infarction ; Humans ; Incidence ; Male ; National Institutes of Health (U.S.) ; Prevalence ; Prospective Studies ; Risk Factors ; Sleep Apnea Syndromes ; Stroke

Warfarin is widely used for the prevention of cerebral infarction, especially in patients with atrial fibrillation or artificial valve. Although hemorrhagic problems are well known, skin necrosis is a rare complication. Failures of early diagnosis or management may lead to serious results. We report a case of skin necrosis induced by warfarin therapy.
Anticoagulants ; Atrial Fibrillation ; Cerebral Infarction ; Early Diagnosis ; Humans ; Necrosis ; Skin ; Warfarin

BACKGROUND: Arteriovenous malformations (AVMs) with vascular abnormalities, including aneurysms, have been reported frequently. However, the coexistence of AVM and unilateral moyamoya disease is rare. We report herein an AVM patient who presented with acute ischemic stroke with unilateral moyamoya disease and occlusion of the feeding artery. CASE REPORT: A-41-year old man was admitted with sudden dysarthria and facial palsy. Brain computed tomography and magnetic resonance imaging revealed an acute infarction adjacent to a large AVM in the right frontal lobe. Cerebral angiography revealed occlusions of the proximal right middle cerebral and proximal anterior cerebral arteries, which were the main feeders of the AVM. Innumerable telangiectatic moyamoya-type vessels between branches of the anterior cerebral artery and dilated lenticulostriate arteries on the occluded middle cerebral artery were detected. However, a nidus of the AVM was still opacified through the distal right callosomarginal artery, which was supplied by the remaining anterior cerebral artery and leptomeningeal collaterals from the posterior cerebral artery. CONCLUSIONS: While AVM accompanied by unilateral moyamoya disease is rare, our case suggests an association between these two dissimilar vascular diseases.
Aneurysm ; Anterior Cerebral Artery ; Arteries ; Arteriovenous Malformations ; Brain ; Cerebral Angiography ; Dysarthria ; Facial Paralysis ; Frontal Lobe ; Humans ; Infarction ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Moyamoya Disease ; Stroke ; Vascular Diseases

Malignancy-related cerebral embolism, which is generally attributed to hypercoagulability, is an uncommon cause of ischemic stroke. However, ischemic stroke developed with intracardiac extension of lung cancer has rarely been reported. We report a case of acute embolic stroke caused by pulmonary adenocarcinoma that invaded the right inferior pulmonary vein and extended into the left atrium. Microembolism developing as a result of lung cancer may have been the cause of stroke in this case.
Adenocarcinoma ; Cerebral Infarction ; Heart Atria ; Intracranial Embolism ; Lung Neoplasms ; Pulmonary Veins ; Stroke ; Thrombophilia

BACKGROUND: Most stroke patients are unable to receive thrombolytic therapy because they do not reach a hospital within 3 hours from symptom onset. The aim of this study was to determine the factors (including knowledge of stroke) that affect the admission delay. METHODS: From May 2007 to December 2007, consecutive ischemic stroke patients presenting within 3 days from symptom onset and their relatives were interviewed about their knowledge of the following aspects of stroke: stroke warning signs, thrombolytic therapy, the 3-hour time limit for admission delay, and use of emergency medical services. Clinical data of patients were collected from medical records. RESULTS: One hundred and fifty-three patients were finally included, 37 of which (24.2%) reached our hospital within 3 hours from symptom onset. In univariate and multivariate analyses, factors independently associated with an admission delay of less than 3 hours were age (odds ratio [OR]=0.95, 95% confidence interval [CI]=0.91.0.99; p=0.008), atrial fibrillation (OR=5.02, CI=1.35.18.70; p=0.016), NIHSS score at admission (OR=1.09, CI=1.01.1.18; p=0.028), and knowledge of the 3-hour time limit (OR=3.55, CI=1.45.8.72; p=0.006). In the patients with an NIHSS score of >4 points, knowledge of the 3-hour time limit was the only independent factor associated with an admission delay of less than 3 hours. This knowledge was significantly associated with graduation from high school (p=0.038). CONCLUSIONS: Knowledge of the 3-hour time limit was the only modifiable factor that influenced an admission delay of less than 3 hours. Therefore, educating the public about stroke, including about the 3-hour time limit, could increase the ability to apply thrombolysis to acute stroke patients.
Atrial Fibrillation ; Emergency Medical Services ; Humans ; Multivariate Analysis ; Stroke ; Thrombolytic Therapy

Acute optic neuropathy occurs commonly as a result of ischemia and inflammation, but paranasal sinus disease without infection is generally dismissed. We report a rare case of acute optic neuropathy caused by compression of a mucocele in an Onodi cell, which is an uncommon anatomical variation of the ethmoid sinus. The mucocele was confirmed by imaging and endoscopic sinus surgery. An Onodi-cell lesion should be considered in the differential diagnosis of acute optic neuropathy.
Diagnosis, Differential ; Ethmoid Sinus ; Inflammation ; Ischemia ; Mucocele ; Optic Nerve Diseases ; Paranasal Sinus Diseases