Hepatic portal venous gas is a very rare radiologic sign which is characterized by gas accumulation in the portal venous circulation. Pneumatosis intestinalis is also very rare and is characterized by multiple air cysts in the serosal or submucosal layers of the gastrointestinal tract walls. These two findings are caused by various pathological conditions and can develop individually or simultaneously. The latter is clinically more significant because it is frequently related to bowel ischemia or necrosis, and represents a poor prognosis. However, prognosis is more influenced by the severity of underlying disease rather than hepatic portal venous gas or pneumatosis intestinalis itself. If bowel ischemia or necrosis is the primary cause, emergency operation is very important to improve patient's prognosis. Herein, we report a case of necrotizing colitis presenting as hepatic portal venous gas and pneumatosis intestinalis which was successfully managed by early surgery.
Colitis/complications/*diagnosis/surgery ; Humans ; Intestinal Perforation ; Male ; Middle Aged ; Necrosis ; Pneumatosis Cystoides Intestinalis/complications/*diagnosis ; Portal Vein ; Radiography, Abdominal ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Adipose tissue is an active endocrine organ that secretes various metabolically important substances including adipokines, which represent a link between insulin resistance and nonalcoholic steatohepatitis (NASH). The factors responsible for the progression from simple steatosis to steatohepatitis remain elusive, but adipokine imbalance may play a pivotal role. We evaluated the expressions of adipokines such as visfatin, adipocyte-fatty-acid-binding protein (A-FABP), and retinol-binding protein-4 (RBP-4) in serum and tissue. The aim was to discover whether these adipokines are potential predictors of NASH. METHODS: Polymerase chain reaction, quantification of mRNA, and Western blots encoding A-FABP, RBP-4, and visfatin were used to study tissue samples from the liver, and visceral and subcutaneous adipose tissue. The tissue samples were from biopsy specimens obtained from patients with proven NASH who were undergoing laparoscopic cholecystectomy due to gallbladder polyps. RESULTS: Patients were classified into two groups: NASH, n=10 and non-NASH, n=20 according to their nonalcoholic fatty liver disease Activity Score. Although serum A-FABP levels did not differ between the two groups, the expressions of A-FABP mRNA and protein in the visceral adipose tissue were significantly higher in NASH group than in non-NASH group (104.34 vs. 97.05, P<0.05, and 190.01 vs. 95.15, P<0.01, respectively). Furthermore, the A-FABP protein expression ratio between visceral adipose tissue and liver was higher in NASH group than in non-NASH group (4.38 vs. 1.64, P<0.05). CONCLUSIONS: NASH patients had higher levels of A-FABP expression in their visceral fat compared to non-NASH patients. This differential A-FABP expression may predispose patients to the progressive form of NASH.
Adipose Tissue/metabolism/pathology ; Adult ; Aged ; Fatty Acid-Binding Proteins/genetics/*metabolism ; Fatty Liver/metabolism/*pathology ; *Gene Expression Regulation ; Humans ; Intra-Abdominal Fat/*metabolism ; Liver/metabolism/pathology ; Middle Aged ; Nicotinamide Phosphoribosyltransferase/genetics/metabolism ; RNA, Messenger/metabolism ; Retinol-Binding Proteins, Plasma/genetics/metabolism

While leprosy is usually a chronic disease, leprosy reactions may lead to acute problems. These reactions most often occur after initiation of therapy, but can also develop before treatment. We report a case of leprosy type 1 reaction as the first manifestation of borderline tuberculoid leposy. The patient was a 71-year-old woman who had never received treatment for leprosy. She developed multiple erythematous, swollen lesions on has face, extremities and trunk within a few weeks and suffered from paresthesia, numbness and tenderness on those sites. General symptoms were accompanied by fever, malaise, fatigue and loss of appetite. Histological examination revealed multiple tuberculoid granulomas along with neurovascular bundles. A few acid-fast bacilli were detected on AFB stain. The disease was classified as borderline tuberculoid leprosy. The acute neuritis followed by skin lesions represented leprosy with type 1 reaction.
Aged ; Appetite ; Chronic Disease ; Extremities ; Fatigue ; Female ; Fever ; Granuloma ; Humans ; Hypesthesia ; Leprosy* ; Leprosy, Paucibacillary* ; Neuritis ; Paresthesia ; Skin

Diabetic muscle infarction (DMI) is a rare complication of long-standing diabetes mellitus. The typical feature of DMI is abrupt onset of thigh pain, tenderness, and swelling and then spontaneous resolution over several months and frequent recurrence. Until 2004, a case of DMI has been reported among end-stage renal disease patients on dialysis in korea. Under-recognition or misdiagnosis (cellulitis, myositis, abscess, hemorrhage, and tumor) by physicians may contribute to the relative rarity of the diagnosis. We report a case of recurrent diabetic muscle infarction in a hemodialysis patient.
Abscess ; Diabetes Mellitus ; Diagnosis ; Diagnostic Errors ; Dialysis ; Hemorrhage ; Humans ; Infarction* ; Kidney Failure, Chronic ; Korea ; Myositis ; Recurrence ; Renal Dialysis* ; Thigh

BACKGROUND/AIMS: Endoscopic pancreatic ductal drainage may help alleviate the pain from chronic pancreatitis, but stricture dilatation may be technically difficult. Dilatation of high grade strictures of the pancreatic ducts with using dilating or balloon catheters may result in failure. We evaluated the efficacy of using the Soehendra stent retriever as a dilator. METHODS: Fourteen patients with pancreatic stricture had dilation performed with a Soehendra stent retriever. Each patient had sphincterotomy, guidewire placement and stent retriever dilatation. RESULTS: All procedures were successful and none of the patients had complications. Symptom relief was observed after dilation in all patients. There was no complication associated with the use of the stent retriever. None of the patients have relapsed for 6 months. CONCLUSIONS: The Soehendra stent retriever is safe and effective as a dilating device for the pancreatic strictures that are resistant to conventional dilation.
Catheters ; Constriction, Pathologic ; Dilatation* ; Drainage ; Humans ; Pancreatic Ducts* ; Pancreatitis, Chronic* ; Stents*

OBJECTIVE: The purpose of this study was to compare the survival of patients with pseudomyxoma peritonei (PMP) according to the modalities of treatment and find out the prognostic factors by evaluating clinical variables. METHODS: Thirty one patients were treated at Seoul National University Hospital between May 1995 and May 2005. The clinical data were collected retrospectively and all charts were reviewed. Kaplan-Meier survival analyses with low-rank test were performed for the comparison of survival according to clinical variables, and univariate and multivariate Cox regression analyses were performed for finding out the prognostic factors of PMP. RESULTS: The mean age at diagnosis was 60.9 years and the mean survival (MS) was 25 months. The recurrence rate was 46.7 % and the disease free survival (DFS) till recurrence was 22.6 months. The prognostic factors affecting DFS were histology, FIGO stage, ascites, CA 125, residual disease in 1st and last operations by univariate analyses, but only FIGO stage was the statistically significant prognostic factor by multivariate analysis. Surgical treatment combined with chemotherapy (intraperitoneal or adjuvant) improved MS more than surgical treatment alone by univariate analysis. CONCLUSION: FIGO stage is a prognostic factor that can predict the DFS in patients with PMP. Histology, CA 125, ascites, residual disease may be probably prognostic factors associated with DFS. Surgical treatment combined with chemotherapy is more effective than surgical treatment alone for the treatment of PMP.
Ascites ; Diagnosis ; Disease-Free Survival ; Drug Therapy* ; Humans ; Multivariate Analysis ; Pseudomyxoma Peritonei* ; Recurrence ; Retrospective Studies ; Seoul

OBJECTIVE: The purpose of this study was to compare the survival of patients with pseudomyxoma peritonei (PMP) according to the modalities of treatment and find out the prognostic factors by evaluating clinical variables. METHODS: Thirty one patients were treated at Seoul National University Hospital between May 1995 and May 2005. The clinical data were collected retrospectively and all charts were reviewed. Kaplan-Meier survival analyses with low-rank test were performed for the comparison of survival according to clinical variables, and univariate and multivariate Cox regression analyses were performed for finding out the prognostic factors of PMP. RESULTS: The mean age at diagnosis was 60.9 years and the mean survival (MS) was 25 months. The recurrence rate was 46.7 % and the disease free survival (DFS) till recurrence was 22.6 months. The prognostic factors affecting DFS were histology, FIGO stage, ascites, CA 125, residual disease in 1st and last operations by univariate analyses, but only FIGO stage was the statistically significant prognostic factor by multivariate analysis. Surgical treatment combined with chemotherapy (intraperitoneal or adjuvant) improved MS more than surgical treatment alone by univariate analysis. CONCLUSION: FIGO stage is a prognostic factor that can predict the DFS in patients with PMP. Histology, CA 125, ascites, residual disease may be probably prognostic factors associated with DFS. Surgical treatment combined with chemotherapy is more effective than surgical treatment alone for the treatment of PMP.
Ascites ; Diagnosis ; Disease-Free Survival ; Drug Therapy* ; Humans ; Multivariate Analysis ; Pseudomyxoma Peritonei* ; Recurrence ; Retrospective Studies ; Seoul

BACKGROUND: The Cockcroft-Gault (CG) and the Modification of Diet in Renal Disease study (MDRD) equations are widely used to estimate glomerular filtration rate (GFR). We performed this study to estimate the prevalence of renal dysfunction using 2 equations in a large number of healthy adults, to compare the agreement of GFR classifications by two formulae, and to know serum creatinine concentrations equivalent to renal dysfunction. METHODS: Among the adults who underwent a health screening examination from April 2002 to March 2004, 12,276 healthy adults were selected. GFRs were calculated by CG and MDRD equations and classified as < 30, 30~59, 60~79, and >or= 80 mL/min/1.73 m2. Estimated GFR of < 60 mL/min/ 1.73 m2 was regarded as renal dysfunction. RESULTS: The increased prevalence of renal dysfunction with age, particularly in advancing age (>60 years), was consistent across the two formulae, but the absolute magnitude of the prevalence of renal dysfunction was more prominent on CG. There was weak agreement between GFR classifications by MDRD and CG. Correlation coefficients between serum creatinine and estimated GFR were significantly higher in MDRD than in CG. Serum creatinine concentrations equivalent to 60 mL/min/1.73 m2 using average body weight and height in each age group were lower when subjects were older and female. CONCLUSION: This study shows high prevalence of renal dysfunction after seventh decade in both sex. There is weak agreement between GFR classifications by MDRD and CG. Moreover, serum creatinine concentration equivalent to renal dysfucntion seems to be lower when subject is older and female.
Adult* ; Body Weight ; Classification ; Creatinine ; Cross-Sectional Studies ; Diet* ; Female ; Glomerular Filtration Rate* ; Humans ; Mass Screening ; Prevalence

Leriche syndrome is an aortoiliac occlusive disease. The aortoiliac junction is the most common sites of chronic obliterative atherosclerosis. Leriche syndrome has a variety of clinical symptoms attributed to the obstruction of the infrarenal aorta. Common clinical symptoms include thigh, hip, and buttock claudication as well as erectile impotence, usually in association with diminished femoral pulses. But acute anuric renal failure as first manifestation of Leriche syndrome is very uncommon. Contrast-enhanced 3D MRA appears to be well suited for assessment of patients with suspected Leriche syndrome. We report a 75-year-old man who presents anuria as first manifestation of Leriche syndrome.
Acute Kidney Injury ; Aged ; Anuria* ; Aorta ; Atherosclerosis ; Buttocks ; Erectile Dysfunction ; Hip ; Humans ; Leriche Syndrome* ; Male ; Renal Insufficiency ; Thigh

Intracranial epidermoid cysts usually show homogeneous hypodensity on CT scans, hypointensity on T1-weighted MR images and hyperintensity on T2-weighted MR images. Most of them arise in the cerebellopontine angle and parasellar areas. We report a case of middle cranial fossa epidermoid tumor with unusual image findings. The entire tumor mass showed inhomogeneous low density, without any enhancing solid portion on the CT scans. The lateral portion of the tumor showed homogeneous T1 low signal intensity and T2 high signal intensity. The medial portion of the tumor showed heterogeneous T1 and T2 intermediate to high signal intensity. On the gadolinium enhanced MR images, enhancement of the thickened dura was observed behind the tumor. Surgery and pathologic examination revealed the presence of an extradural epidermoid cyst.
Cerebellopontine Angle ; Cranial Fossa, Middle* ; Epidermal Cyst* ; Gadolinium ; Tomography, X-Ray Computed