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

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 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

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

BACKGROUND: The pathogenesis of silicosis has been focused on the interaction between alveolar macrophages and silica particle. Although fibrosis in silicosis has been studied extensively, the mechanism is still not fully understood. There is increasing evidence that monokines and arachidonic acid metabolites produced by macrophage are involved in pathogenesis of silicosis. Recently, it was reported that prostaglandin E2 produced from macrophage counteracts the stimulatory effects of other monokines on fibroblast proliferation or collagen production. Until now, it was remained uncertain by which mechanism silica particle may activate alveolar macrophage to an enhanced release of prostaglandin E2. METHODS: In order to investigate the relationship between the activity of alveolar macrophage and the production of PGE2 from activated alveolar macrophage, the authors measured hydrogen peroxide and PGE2 from alveolar macrophages activated by silica in vitro and from alveolar macrophages in the silicotic nodules from rat. Experimental silicosis was induced by intratracheal infusion of silica(SiO2) suspended in saline (50 mg/ml) in Sprague-Dawley rats. RESULTS: 1) The silicotic nodules with fibrosis were seen from the sections of rat lung at 60 days after intratracheal injection with 50 mg aqueous suspension of silica. 2) In vitro, silica caused the dose dependent increase of hydrogen peroxide(p<0.05) and PGE2(p>0.05) release from alveolar macrophages. Alveolar macrophages from rats with silicotic nodules released more hydrogen peroxide and PGE2 than those of control group(p<0.05). CONCLUSION: These results suggest that silica particle could activate macrophage directly and enhanced the release of PGE2 and hydrogen peroxide from the alveolar macrophage.
Animals ; Arachidonic Acid ; Collagen ; Dinoprostone* ; Fibroblasts ; Fibrosis ; Hydrogen ; Hydrogen Peroxide ; Lung ; Macrophages ; Macrophages, Alveolar* ; Monokines ; Rats ; Rats, Sprague-Dawley ; Silicon Dioxide* ; Silicosis

This study aimed to investigate the independent and interactive influences of apolipoprotein E (APOE) epsilon4 and beta-amyloid (Abeta) on multiple cognitive domains in a large group of cognitively normal (CN) individuals and patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD). Participants were included if clinical and cognitive assessments, amyloid imaging, and APOE genotype were all available from the Alzheimer's Disease Neuroimaging Initiative database (CN = 324, MCI = 502, AD = 182). Individuals with one or two copies of epsilon4 were designated as APOE epsilon4 carriers (epsilon4+); individuals with no epsilon4 were designated as APOE epsilon4 non-carriers (epsilon4-). Based on mean florbetapir standard uptake value ratios, participants were classified as Abeta burden-positive (Abeta+) or Abeta burden-negative (Abeta-). In MCI, APOE epsilon4 effects were predominantly observed on frontal executive function, with epsilon4+ participants exhibiting poorer performances; Abeta positivity had no influence on this effect. Abeta effects were observed on global cognition, memory, and visuospatial ability, with Abeta+ participants exhibiting poorer performances. Measures of frontal executive function were not influenced by Abeta. Interactive effects of APOE epsilon4+ and Abeta were observed on global cognition and verbal recognition memory. Abeta, not APOE epsilon4+, influenced clinical severity and functional status. The influences of APOE epsilon4+ and Abeta on cognitive function were minimal in CN and AD. In conclusion, we provide further evidence of both independent and interactive influences of APOE epsilon4+ and Abeta on cognitive function in MCI, with APOE epsilon4+ and Abeta showing dissociable effects on executive and non-executive functions, respectively.
Aged ; Aged, 80 and over ; Alzheimer Disease/genetics/pathology ; Amyloid beta-Peptides/*metabolism ; Aniline Compounds/chemistry ; Apolipoprotein E4/*genetics ; Brain/radiography ; Cognition ; Databases, Factual ; Demography ; Ethylene Glycols/chemistry ; Female ; Genotype ; Humans ; Male ; Mild Cognitive Impairment/genetics/*pathology ; Positron-Emission Tomography

BACKGROUND: The prognosis of syncope is related to the severity of the underlying disease, including cerebral disease, rather than of the syncope itself. The aim of this study was to identify the clinical factors related to the cerebral comorbidity confirmed on brain imaging of syncope patients. METHODS: We retrospectively reviewed the medical records of patients who were diagnosed as syncope and underwent brain magnetic resonance [MR] imaging between January 2011 and December 2014. An abnormal MR lesion was defined as the presence of one or more of the following: (1) ischemic lesion, (2) major cerebral artery occlusion or stenosis over 50%, (3) cerebral aneurysm or vascular abnormalities, and (4) other traumatic or parenchymal lesion. The findings of electroencephalography and clinical factors that might be related to abnormal lesions in brain MR images were investigated. RESULTS: Of 347 (mean age 50.5 years, 48.1% females) patients, abnormal imaging findings were observed in 48 (13.8%). The clinical factors related to abnormal findings were age, hypertension, diabetes mellitus, and coronary artery disease. Independent factors for an abnormal MR lesion were age (odds ratio=1.05, 95% confidence interval [CI] 1.03-1.08, p <0.001) and hypertension (odds ratio=2.73, 95% CI 1.34-5.60, p=0.006). Abnormal electroencephalography findings were noted in 52 (20.3%) of 256 investigated patients. Generalized or focal slowing was observed more frequently in elderly patients (p<0.001) and in the presence of abnormal brain MR lesions (p=0.013). CONCLUSIONS: In syncope patients with hypertension or who are elderly, a brain MR image may be helpful for detecting comorbid brain lesions.
Aged ; Brain ; Cerebral Arteries ; Comorbidity ; Constriction, Pathologic ; Coronary Artery Disease ; Diabetes Mellitus ; Electroencephalography ; Humans ; Hypertension ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Medical Records ; Neuroimaging ; Prognosis ; Retrospective Studies ; Syncope*