Bilateral nonfunctioning adrenal cortical carcinoma is an extremely rare disease with poor prognosis. We report a case of asynchronous bilateral nonfunctioning adrenal cotical carcinoma. The patient was a 55 year-old man who had complained of discomfort in the right upper quadrant and flank area. There was no endocrinological abnomaliries. Abdominal CT revealed about 9.5 x 7.0 cm sized right adrenal mass. Under the impression of nonfunctioning adrenal cortical carcinorna, right radical adrenalectomy was performed. After 1 year from operation, 5.0 x 7.0 x 6.0 cm sized new mass was detected in the left adrenal gland with metastasis to the peritoneum.
Adrenal Glands ; Adrenalectomy ; Adrenocortical Carcinoma* ; Humans ; Middle Aged ; Neoplasm Metastasis ; Peritoneum ; Prognosis ; Rare Diseases ; Tomography, X-Ray Computed

Coincidental occurrence of the renal cell carcinoma and renal angiomyolipoma in the same kidney is exceedingly rare, and it is usually presented as separated masses or nodules in cage of its occurrence. However, our case which has occurred in a 37-year-old-man without any stigmata of tuberous sclerosis is different because the angiomyolipoma and renal cell carcinoma are admixed in the same mass. To our knowledge, only 2 cases or combination of this tumors have been reported previously.
Angiomyolipoma* ; Carcinoma, Renal Cell* ; Christianity ; Kidney* ; Tuberous Sclerosis

Urethral foreign body extended to bladder and scrotum is very rare. We report a case of urethral perforation by plastic tube extended to bladder and scrotum with brief review of literature.
Foreign Bodies* ; Plastics ; Scrotum ; Urethra ; Urinary Bladder

PURPOSE: The present study investigates the onset and frequency of increased intraocular pressure (IOP) after injections of intravitreal Bevacizumab, Triamcinolone, and a combination of both drugs. METHODS: Patients were classified into three groups: Bevacizumab group (group A), Triamcinolone group (group B), and combined drug group (group C), irrespective of the underlying causes. The IOP was measured 30 minutes prior to followed by one day, one week, one month, two months, three months, six months, and one year after injection. The measured IOP at each time point was compared with the pre-injection IOP and the differences in IOP among the three groups were statistically analyzed. The relationships between various factors possible of increasing IOP were also analyzed. RESULTS: A total of 259 subjects were enrolled in the present study. An IOP increase of more than 5 mm Hg was observed in 25 eyes (15%) in group A, 34 eyes (40%) in group B, and 40 eyes (50%) in group C. There was no statistically significant mean IOP change after injection in group A, but in groups B and C there was an increase in mean IOP up until two and three months after injection, respectively. However, eyes in group A with a history of glaucoma showed statistically significant increases in IOP. CONCLUSIONS: The onsets and frequencies of increased IOP were different with the different drugs. Proper follow-up for increased IOP after injection is necessary based on the type of drug used.
Antibodies, Monoclonal, Humanized ; Eye ; Follow-Up Studies ; Glaucoma ; Humans ; Intraocular Pressure ; Intravitreal Injections ; Triamcinolone ; Bevacizumab

The influence of hemostatic materials in split thickness calvarial bone defects was evaluated in 24 white rabbit models. The rabbits were divided in 4 groups. In the group A, Surgicel(R) was inserted into the 2x2cm sized left calvarial defects. In the group B, Gelfoam(R) was inserted and in group C, Bonewax(R) was inserted and in group D, Collagen bloc was inserted. The contralateral side underwent sham operation as the control group. After 4 and 8 weeks, radiological findings, histopathological findings and immunohistopathological findings were studied to find development of trabeculae, appearance of osteoblast, calcification and increased expression of TGF-beta. As a result, osteoid and osteoblast were richly found in Surgicel(R), Gelfoam(R), Collagen bloc inserted groups. In Bonewax(R) inserted group, bone regeneration was delayed and foreign body reaction was seen in 4 weeks and it reduced in 8 weeks. The TGF-beta was darkly stained in periosteum, connective tissue and periphery of bone defect. From this result it would be concluded as follows. Surgicel(R), Gelfoam(R) and Collagen bloc effects positively on bone healing with marked increasing of osteoid, osteoblasts and rapid bone remodeling. Bonewax(R) prolongs bone healing with increasing foreign body reaction. Bone regeneration was confirmed with increased expression of TGF-beta in Surgicel(R), Gelform(R) and Collagen bloc applied groups especially in periosteum and ends of bone defects. It suggests that bone regeneration was originated from these areas.
Bone Regeneration ; Bone Remodeling ; Collagen ; Connective Tissue ; Foreign-Body Reaction ; Osteoblasts ; Osteogenesis* ; Periosteum ; Rabbits ; Transforming Growth Factor beta

Radiofrequency ablation (RFA), a local ablative modality, is gaining acceptance for the treatment of liver malignancies. Despite a relatively low complication rate, tumor seeding resulting from RFA in hepatocellular carcinoma (HCC) treatment can occur. A 44-year-old woman was diagnosed with HCC. Spiral computed tomography (CT) revealed a 2.3 × 2.0-cm mass in the S5 segment, which was treated with RFA on May, 2005. Follow-up imaging, performed at 6-month intervals after RFA, showed complete tumor necrosis. In October 2009, CT revealed a heterogeneous mass, 5.7 cm in diameter, in the right ovary. Since the lesion was limited to the right ovary without evidence of spread, bilateral salpingo-oophorectomy was performed. Histopathology indicated that the metastatic spread from the HCC to the ovary was positive for hepatocyte-specific antigen on immunohistochemistry. The ovary is a rare site for HCC metastasis. Moreover, needle tract implantation of HCC in the ovary is very rare.
Adult ; Carcinoma, Hepatocellular* ; Catheter Ablation* ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Liver ; Necrosis ; Needles ; Neoplasm Metastasis ; Neoplasm Seeding ; Ovary* ; Tomography, Spiral Computed

The authors analyzed 105 cases of spinal cord tumor in regarding to the age, sex, location and distribution, clinical presentation and postoperative outcome. They were confirmed by pathologic study at the Kyung Hee Medical Cented from 1981 to 1991. The incidence of spinal cord tumors was slightly predominant in males. The most commom tumor was neurogenic tumor. The neurogenic tumor composed 43.8%(46 cases), and the rests were meningioma 15.2%(16 case), metstasis 10.5%(11 cases) and others. The tumor were located most frequently in the thoracic area(31.4%) and in the intradural extramedullary space(56.1%). Most common initial symptom of spinal cord tumors were pain and it's mean duration was 8.3 month. The patients were assigned to one of four groups according to their neurologic deficit. About 66.6%(70 cases) of the patients were included in Groups I and II(mild neurologic deficit), and others were classified in Groups III and IV(significant to severe neurologic deficit). Complete tumor removal was achieved in 70.4%(4 cases) of the patients, and subtotal removal was performed in 26.7%(28 cases), and biopsy was performed in 2.9%(3 cases). Among the 105 patients, the postoperative outcomes on dischage were recovery in 36 cases(34.3%), improved in 45 cases(42.9%), stationary state in 12 cases(11.4%), and progression in 12 cases(11.4%).
Biopsy ; Hospital Distribution Systems ; Humans ; Incidence ; Male ; Meningioma ; Neurologic Manifestations ; Spinal Cord Neoplasms ; Spinal Cord*

PURPOSE: The aims of this study were to define the necessity and effectiveness of patient safety education during surgical clerkship to develop competency for managing and preventing medical errors. METHODS: Fifty 3rd-year students participated in the patient safety education program during a 4-week surgical clerkship. The students were divided into 4 groups: control group, pretest-only group, education-only group, and pretest and education group. Students were assessed using short essays and an oral exam for reasoning skills, clinical performance exams for patient education and communication skills, and multisource feedback and direct observation of error reporting for real-world problem-solving skills. The results were analyzed with SPSS 14.0K. The reliability (Cronbach alpha) of the entire assessment was 0.893. RESULTS: There was no difference in scores between early and late clerkship groups. Reasoning skills were improved by the pretest. Reasoning, patient education, and error reporting skills were much more developed by patient safety education. Real-world error identification, reporting, and communication did not change after the 4-week course. CONCLUSIONS: Patient safety education during surgical clerkship is necessary and effective. Error prevention and competency management in the real world should developed.
Clinical Clerkship ; Clinical Competence ; Humans ; Medical Errors ; Patient Education as Topic ; Patient Safety ; Safety Management

BACKGROUND: The purpose of this study was to assess the optimal time interval between rocuronium pretreatment and succinylcholine for prevention of the rise in serum potassium and creatine kinase concentrations and the increased incidence of fasciculations and myalgia following succinylcholine administration. METHODS: We have studied 60 patients undergoing a minor elective surgery, in a prospective double blinded method. Three groups of 20 patients each were pretreated with saline 2 ml (Group C), 0.05 mg/kg rocuronium one min before (Group R1) or 3 min before (Group R3) 1.5 mg/kg succinylcholine administration. Serum potassium and creatine kinase were respectively measured 5 min after succinylcholine and 24 h after the operation. Fasciculations and myalgia on postoperative day 1 and day 2 were evaluated. RESULTS: The increase in the serum potassium concentration was not attenuated in any group. The increase in creatine kinase concentration, the incidence of fasciculations and the incidence of myalgia on postoperative day 1 and day 2 were highest in Group C; however, there was no difference between the Group R1 and R3. CONCLUSIONS: Either a 1 min or 3 min pretreatment time interval of the rocuronium has a similar effect on the prevention of the rise in serum potassium and creatine kinase concentrations and an increased incidence of fasciculations and myalgia following succinylcholine administration.
Creatine Kinase ; Fasciculation* ; Humans ; Incidence ; Myalgia* ; Potassium ; Prospective Studies ; Succinylcholine*

Two patients with basilar bifurcation aneurysm were treated by different approach, low lying posteriorly projecting aneurysm was clipped with subtemporal approach and high bifurcated basilar bifurcation aneurysm with multiplicity approached through pterional method. The author reviewed literature concerning the approaches of basilar bifurcation aneurysm.
Aneurysm* ; Deception ; Humans