A 49-year-old woman visited the clinic because of acute hepatitis and acute kidney injury with decreased urine output presenting microscopic hematuria and proteinuria. An abdominal computed tomography revealed a localized, hypoattenuated lesion in a hepatic lateral segment, and kidney biopsy showed oxalate crystal deposition with tubular necrosis. In addition, the patient's 24-hour urinary excretion of oxalate was increased. Her kidney and liver injury improved after sessions of hemodialysis, and urinary oxalate excretion was normalized. Major mutations in primary hyperoxaluria have not been proven. A full sequencing of target genes may be helpful to diagnose a rare form of primary hyperoxaluria.
Acute Kidney Injury ; Biopsy ; Female ; Hematuria ; Hepatitis ; Humans ; Hyperoxaluria* ; Hyperoxaluria, Primary ; Kidney* ; Liver* ; Middle Aged ; Necrosis ; Proteinuria ; Renal Dialysis

PURPOSE: The wedge filter is the most commonly used beam modifying device during radiation therapy. Recently dynamic wedge technique is available through the computer controlled asymmetric collimator, independent jaw. But dosimetric characteristics of dynamic wedge technique is not well know. Therefore we evluate dosimetric characteristics of dynamic wedge compared to conventional fixed wedge. MATERIALS AND METHODS: We evaluated dosimetric characteristics of dynamic wedge and fixed wedge by ion chamber, film dosimetry and TLD in phantoms such as water, polystyrene and average breast phantom. Six MV x-ray was used in 15X15 cm field with 15,30 and 45 degree wedge of dynamic/fixed wedge system. Dosimetric characteristics are interpreted by wellhofer Dosimetrie system WP700/WP700i and contralateral breast dose(CBD) with tangential technique was confirmed by TLD. RESULTS: 1) Percent depth dose through the dynamic wedge technique in tissue equivalent phantom was similar to open field irradiation and there was no beam hardening effect compared to fixed wedge technique. 2) Isodose line composing wedge angle of dynamic wedge is more straight than hard wedge. And dynamic wedge technique was able to make any wedge angle on any depth and field size. 3) The contralateral breast dose in primary breast irradiation was reduced by dynamic wedge technique compared to fixed wedge. When the dynamic wedge technique was applied, the scatter dose was similar to that of open field irradiation. CONCLUSION: The dynamic wedge technique was superior to fixed wedge technique in dosimetric characteristics and may be more useful in the future.
Breast ; Film Dosimetry ; Jaw ; Polystyrenes ; Water

Riedel's thyroiditis (RT) is a rare chronic inflammatory disease of the thyroid gland. It is characterized by a fibroinflammatory process that partially destroys the gland and extends into adjacent neck structures. Its clinical manifestation can mask an accompanying thyroid neoplasm and can mimic invasive thyroid carcinoma. Therefore, diagnosis can be difficult prior to surgical removal of the thyroid, and histopathologic examination of the thyroid is necessary for a definite diagnosis. The concurrent presence of RT and other thyroid diseases has been reported. However, to our knowledge, the association of RT with acute suppurative thyroiditis and micropapillary carcinoma has not been reported. We report a rare case of concurrent RT, acute suppurative thyroiditis, and micropapillary carcinoma in a 48-year-old patient.
Anti-Bacterial Agents/therapeutic use ; Biopsy ; Carcinoma/*complications/diagnosis/therapy ; Female ; Hashimoto Disease/*complications/diagnosis/therapy ; Hormone Replacement Therapy ; Humans ; Lymph Node Excision ; Middle Aged ; Thyroid Neoplasms/*complications/diagnosis/therapy ; Thyroidectomy ; Thyroiditis/*complications/diagnosis/therapy ; Thyroiditis, Suppurative/*complications/diagnosis/therapy ; Thyroxine/therapeutic use ; Tomography, X-Ray Computed ; Treatment Outcome

PURPOSE: Three-dimensional radiation dosimetry using magnetic resonance imaging of polymer gel was recently introduced. This dosimetry system is based on radiation induced chain polymerization of acrylic monomers in a muscle equivalent gel and provide accurate 3 dimensional dose distribution. We planned this study to evaluate the clinical value of this 3-dimensional dosimetry. MATERIALS AND METHODS: The polymer gel poured into a cylindrical glass flask and a spherical glass flask. The cylindrical test tubes were for dose response evaluation and the spherical flasks, which is comparable to the human head, were for isodose curves. T2 maps from MR images were calculated using software, IDL. Dose distributions have been displayed for dosimetry. The same spherical flask of gel and the same irradiation technique was used for film and TLD dosimetry and compared with each other. RESULTS: The R2 of the gel respond linearly with radiation doses in the range of 2 to 15 Gy. The repeated dosimetry of spherical gel showed the same isodose curves. These isodose curves were identical to dose distributions from treatment planning system especially high dose range. In addition, the gel dosimetry system showed comparable or superior results with the film and TLD dosimetry. CONCLUSION: The 3-dimensional dosimetry for conformal radiation therapy using MRI of polymer gel showed stable and accurate results. Although more studies are needed for convenient clinical application, it appears to be a useful tool for conformal radiation therapy.
Glass ; Head ; Humans ; Magnetic Resonance Imaging* ; Polymerization ; Polymers* ; Radiometry ; Radiotherapy, Conformal

Klippel-Trenaunay syndrome is a rare congenital mesodermal abnormality characterized by varicose veins, cutaneous hemangiomas, soft tissue and bony hypertrophy of limb. Potential complications such as deep venous thrombosis and pulmonary thromboembolism have not been reported in Korea to date. We demonstrate the case of a 48-year-old woman with Klippel-Trenaunay syndrome with extensive varicose veins on right lower limb, hypertrophy of left big toe and basilar artery tip aneurysm, complicated with acute submassive pulmonary thromboembolism treated successfully with intravenous thrombolytic therapy.
Aneurysm ; Basilar Artery ; Extremities ; Female ; Heart Failure ; Hemangioma ; Humans ; Hypertrophy ; Intracranial Aneurysm ; Klippel-Trenaunay-Weber Syndrome* ; Korea ; Lower Extremity ; Mesoderm ; Middle Aged ; Pulmonary Embolism* ; Thrombolytic Therapy* ; Toes ; Varicose Veins ; Venous Thromboembolism ; Venous Thrombosis

Takotsubo cardiomyopathy (TC) is a transient form of acute heart failure that most often occurs in postmenopausal women, typically triggered by a preceding emotional or physical stressor. A 74-year-old woman who suffered from chronic psychiatric stress visited National Medical Center for dyspnea. Acute emotional or physical stress could not be identified despite careful history taking. An electrocardiogram showed diffuse T-wave inversions with prolonged QT interval, and the echocardiogram showed akinesia of mid and apical segments of the left ventricle with hyperkinesia at the base. There was no significant stenosis on coronary angiography. Differing from the typical case of TC, which follows acute stress triggers, our case indicates that underlying chronic psychiatric illness exacerbation can lead to TC. We suggest that cardiologists and psychiatrists be aware of this predisposition to TC, especially in the circumstances of acute heart failure.
Aged* ; Cardiomyopathies ; Constriction, Pathologic ; Coronary Angiography ; Depressive Disorder, Major* ; Dyspnea ; Electrocardiography ; Female ; Heart Failure ; Heart Ventricles ; Humans ; Hyperkinesis ; Psychiatry ; Takotsubo Cardiomyopathy*

Quetiapine is an atypical antipsychotic that is frequently used to manage delirium in geriatric patients. Acute pancreatitis associated with quetiapine has rarely been reported. A 70-year-old male presented with severe abdominal pain a few hours after taking a dose of quetiapine prescribed for delirium. Despite the lack of risk factors of pancreatitis in his medical history, the patient had a slight increase of serum lipase and amylase levels. His general condition improved on discontinuation of quetiapine. A month later, quetiapine was readministered for the recurrence of delirium. Subsequently, the patient developed the same symptom with a significant increase in serum pancreatic enzyme levels, confirming that quetiapine induced the pancreatitis. We reported the first case of quetiapine-induced pancreatitis in Korea, together with a review of the literature.
Abdominal Pain ; Aged* ; Amylases ; Delirium ; Humans ; Korea ; Lipase ; Male ; Pancreatitis* ; Recurrence ; Risk Factors ; Quetiapine Fumarate

The thyroid is resistant to infection due to its anatomical and physiological characteristics. We present a rare case of invasive liver abscess with metastatic thyroid abscess and endogenous endophthalmitis in a previously healthy 55-year-old female patient without diabetes or other medical illness. This report raises an important question of the virulence of Klebsiella pneumoniae as an increasingly common causative agent of liver abscess.
Abscess* ; Endophthalmitis* ; Female ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess* ; Liver* ; Middle Aged ; Thyroid Gland* ; Virulence

We report a case of a 73-year-old patient with a 17 year-history of well-controlled primary hypertension with a single antihypertensive drug, which became uncontrolled since 9 months ago when he started on oral carbamazepine (CBZ) therapy for syringomyelia. On admission, the patient had a blood pressure of 200-215/95-104mmHg despite an antihypertensive combination therapy with five different drugs. Further investigations ruled out secondary hypertension such as primary aldosteronism, pheochromocytoma and renal artery stenosis. After the discontinuation of CBZ, the blood pressure profile became significantly improved. The rechallenge with CBZ aggravated his blood pressure profile. Therefore, we considered that resistant hypertension was induced by the oral CBZ therapy.
Aged ; Antidepressive Agents, Tricyclic ; Blood Pressure ; Carbamazepine ; Humans ; Hyperaldosteronism ; Hypertension ; Pheochromocytoma ; Quaternary Ammonium Compounds ; Renal Artery Obstruction ; Syringomyelia

PURPOSE: This retrospective study was performed to investigate epidemiological characteristics in terms of the ageand the sex-specific incidences in patients with perforated or nonperforated appendicitis. METHOD: The study population comprised 314 patients who underwent appendectomies for suspected acute appendicitis between March 2002 and August 2003. This study used the student t-test, the coefficient of correlation, and the Cochran-Mantel-Haenszel Chi-square statistics. RESULTS: The incidence of nonperforated appendicitis was higher. Perforated appendicitis occurred at almost the same incidence in both sexes. However, the incidence of perforated appendicitis was high in small children and the elderly. The statistics of this study proved that the incidence of perforated appendicitis of the elderly was considerable. CONCLUSIONS: We suggest that the elderly need careful examination and rapid evaluation. Also, we suggest that since perforated appendicitis has a long duration of treatment, diagnostic accuracy is needed.
Aged ; Appendectomy ; Appendicitis* ; Child ; Humans ; Incidence* ; Retrospective Studies