Primary small cell carcinoma of the prostate is a rare malignancy of unknown origin and with poor prognosis. We report a case occurring in a 74-year-old man. Radiologic findings showed that the prostate was markedly enlarged, with a lobulated contour and unclearly defined internal architecture. It was therefore impossible to distinguish it from prostatic adenocarcinoma, but the huge mass and normal range of serum tumor markers (prostate-specific antigen and prostate acid phosphatase) suggested small cell carcinoma of the prostate.
Adenocarcinoma ; Aged ; Carcinoma, Small Cell* ; Humans ; Prognosis ; Prostate* ; Reference Values ; Biomarkers, Tumor

PURPOSE: We previously reported that concurrent reactivation of latent Epstein-Barr virus (EBV) in children with hepatitis A virus (HAV) infection is common and EBV reactivation with HAV infection adversely affects the clinical features of hepatitis. However, the incidence of concurrent reactivation was not accurate because the detection of EBV reactivation was based on serologic methods. Therefore, we studied the effects of polymerase chain reaction (PCR)-proven EBV reactivation, thus a more precise concurrence, on acute HAV infection in children. METHODS: PCR were conducted in 34 patients, who had enrolled previous study and diagnosed with acute HAV infection between January 2008 and June 2010. Their medical records were reviewed. RESULTS: Among 34 patients with acute HAV infection, 12 patients (35.3%) had EBV reactivation which was proven using serologic and molecular biologic techniques. There were significant differences in the peak levels of AST and ALT between the reactivated and non-reactivated groups (p=0.001 and p<0.001, respectively). The duration of full recovery from hepatitis was more prolonged in the reactivated group (p<0.001). Clinical parameters, such as serum protein (p<0.001) and albumin concentrations (p<0.001), atypical lymphocyte count (p=0.001), prothrombin time-international normalized ratio (PT-INR, p<0.001), and splenomegaly (p<0.001), showed significant differences. The clinical features in the reactivated sub-group >10 years of age revealed more liver dysfunction compared to the non-reactivated sub-group. A comparison with a previous study was performed. CONCLUSION: PCR-proven reactivation of latent EBV in children with HAV infection is common and EBV reactivation with HAV infection adversely affects the clinical features of hepatitis, especially in older children.
Child ; Hepatitis ; Hepatitis A ; Hepatitis A virus ; Herpesvirus 4, Human ; Humans ; Incidence ; Liver Diseases ; Lymphocyte Count ; Medical Records ; Polymerase Chain Reaction ; Prothrombin ; Splenomegaly

PURPOSE: To evaluate the MR imaging of Mullerian duct anomalies (MDA) and analyze its diagnostic accuracy associated gynecologic diseases and effect on treatment plan. MATERIALS AND METHODS: Twelve patients with suspected MDA and three with incidentally-found MDA were included. Axial, sagittal and coronal images of T1-, FSET2- or T2-, proton density- and Gadolinium-enhanced T1-weighted images were obtained with 1.5T (n=13) and 0.5T (n=2) MR machines. On the basis of Buttram and Gibbons' classification, MR images were analyzed and classified as laparotomy (n=7), hysteroscopy (n=7), laparoscopy (n=3) or hystersalpingography (n=2). These were analyzed in terms of external contour of the uterus, intercornual distance, signal intensity of the uterus and septum, associated genitourinary diseases, and the influence of MR imaging on treatment plan. RESULTS: A total of 15 cases of MDA were accurately classified by MR imaging, as follows: didelphyses (n=6: 40%); ageneses (n=3: 20%); septate uteri (n=3: 20%); bicornuate uteri(n=2: 13%) and unicornuate uterus(n=1: 7%). In 14 cases (93%) findings corresponded with those of other examinations. The external contour of the uterus was banana-shaped in the didelphyc and unicornuate uterus, a fundal cleft in the bicornuate, and normal in the septate; intercornual distance was greater in didelphyc and bicornuate uteri. Except in three cases of agenesis, the signal intensity of the uterus was normal; in the septum, on T2WI, this was isosignal in the bicornuate uterus and low in the septate, as compared with that of the myometrium. In four of five cases, associated gynecologic diseases were found on MR imaging; in five cases (33%), there were associated urologic anomalies, and in six (40%), MR imaging influenced the treatment plan. CONCLUSION: MR imaging was valuable for the diagnosis of MDA and the determination of associated gynecologic diseases, and also influenced the treatment plan.
Animals ; Classification ; Diagnosis ; Female ; Genital Diseases, Female ; Humans ; Hysteroscopy ; Laparoscopy ; Laparotomy ; Magnetic Resonance Imaging* ; Mice ; Myometrium ; Protons ; Uterus

PURPOSE: We performed this study to evaluate the incidence and clinical significance of antiphospholipid antibodies (aPL Ab) in Korean children with Henoch-Schonlein purpura (HSP). METHODS: The medical records of 62 patients (31 boys and 31 girls) aged 6.0+/-3.1 (1-16) years with a clinical diagnosis of HSP based on the EULAR/PReS criteria were reviewed retrospectively. From the years 2007 to 2009, the sera from children with acute HSP were tested for aPL Ab such as LA, anti-cardiolipin antibody and anti-beta2 glycoprotein I antibody. RESULTS: LA was positive in 18 (29%) of the 62 patients with HSP and We divided the patients into the two groups LA positive group (N=18) and LA negative group (N=44). There were no significant differences between the two groups with regard to abdominal pain, arthralgia and renal involvement, but LA positive group had significantly higher C-reactive protein (4.3+/-7.2 mg/dL vs. 1.3+/-1.8 mg/dL, P=0.035), erythrocyte sedimentation rate (37.5+/-26.2 mm/hr vs. 25.1+/-22.6 mm/hr, P= 0.039), IgM (148.1+/-48.4 mg/dL vs. 114.9+/-41.5 mg/dL, P=0.024), C3 (143.1+/-21.9 mg/dL vs. 129.7+/-24.5 mg/dL, P=0.048) and C4 levels (30.9+/-6.3 mg/dL vs. 24.9+/-7.8 mg/dL, P=0.002) compared with LA negative group. CONCLUSION: We found that the incidence of positive aPL Ab tests was relatively higher in Korean children with HSP and the presence of aPL Ab was associated with acute inflammatory process of HSP. These results suggest that the aPL Ab are involved in the pathogenesis of HSP in children.
Abdominal Pain ; Aged ; Antibodies, Antiphospholipid ; Arthralgia ; Blood Sedimentation ; C-Reactive Protein ; Child ; Glycoproteins ; Humans ; Immunoglobulin M ; Incidence ; Lupus Coagulation Inhibitor ; Medical Records ; Purpura, Schoenlein-Henoch ; Retrospective Studies

Diabetic nephropathy is a common and serious complication in diabetic patients. Renal diseases other than diabetic nephropathy (non-diabetic nephropathy) can occur in diabetic patients with nephrosis. The presence of non-diabetic nephropathy is noted in type 2 diabetes patients, but no data exists for type 1 diabetes. In this report we describe the case of a 15-year-old girl with type 1 diabetes mellitus, who presented with an acute elevation of urinary microalbumin excretion, general edema, and liver enzyme elevation. She had shown microalbuminuria about 3 years earlier, as well as an uncontrolled hemoglobin A1c level, but she had no diabetic retinopathy and neuropathy. A renal biopsy was conducted, and she was diagnosed with primary focal segmental glomerulosclerosis. She was treated with corticosteroids and an angiotensin converting enzyme inhibitor.
Adolescent ; Adrenal Cortex Hormones ; Biopsy ; Diabetes Mellitus, Type 1 ; Diabetic Nephropathies ; Diabetic Retinopathy ; Edema ; Glomerulosclerosis, Focal Segmental ; Hemoglobins ; Humans ; Liver ; Nephrosis ; Peptidyl-Dipeptidase A

PURPOSE: Dickkopf-1 (DKK-1) is a Wnt/beta-catenin signaling pathway inhibitor. We investigated whether DKK-1 is related to progression in hepatocellular carcinoma (HCC) cells and HCC patients. MATERIALS AND METHODS: In vitro reverse-transcription polymerase chain reaction (RT-PCR), wound healing assays, invasion assays, and ELISAs of patient serum samples were employed. The diagnostic accuracy of the serum DKK-1 ELISA was assessed using receiver operating characteristic (ROC) curves and area under ROC (AUC) analyses. RESULTS: RT-PCR showed high DKK-1 expression in Hep3B and low in 293 cells. Similarly, the secreted DKK-1 concentration in the culture media was high in Hep3B and low in 293 cells. Wound healing and invasion assays using 293, Huh7, and Hep3B cells showed that DKK-1 overexpression promoted cell migration and invasion, whereas DKK-1 knock-down inhibited them. When serum DKK-1 levels were assessed in 370 participants (217 with HCC and 153 without), it was significantly higher in HCC patients than in control groups (median 1.48 ng/mL vs. 0.90 ng/mL, p<0.001). The optimum DKK-1 cutoff level was 1.01 ng/mL (AUC=0.829; sensitivity 90.7%; specificity 62.0%). Although DKK-1 had a higher AUC than alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) (AUC=0.829 vs. 0.794 and 0.815, respectively), they were statistically similar (all p>0.05). When three biomarkers were combined (DKK-1 plus AFP plus DCP), they showed significantly higher AUC (AUC=0.952) than single marker, DKK-1 plus AFP, or DKK-1 plus DCP (all p<0.001). CONCLUSION: DKK-1 might be a key regulator in HCC progression and a potential therapeutic target in HCC. Serum DKK-1 could complement the diagnostic accuracy of AFP and DCP.
Area Under Curve ; Biomarkers/blood/metabolism ; Biomarkers, Tumor/blood ; Carcinoma, Hepatocellular/blood/*diagnosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Intercellular Signaling Peptides and Proteins/*blood/*metabolism ; Liver Neoplasms/blood/*diagnosis ; Male ; Middle Aged ; Protein Precursors/blood/metabolism ; Prothrombin/metabolism ; ROC Curve ; Reverse Transcriptase Polymerase Chain Reaction/*methods ; Sensitivity and Specificity ; alpha-Fetoproteins/analysis/metabolism

The majority of patients who was presented as severe mitral regurgitation can be managed with medical treatment. However, some cases of severe and acute mitral regurgitation need to rapid surgical intervention like as primary angioplasty for acute myocardial infarction. In this case, a patient with acute and severe mitral regurgitation presented as accelerating shortness of breath and impending multi-organ perfusion failure was dramatically recovered by rapid echocardiographic diagnosis and emergency valve replacement operation.
Angioplasty ; Diagnosis ; Dyspnea ; Echocardiography ; Emergencies* ; Humans ; Mitral Valve Insufficiency* ; Mitral Valve* ; Myocardial Infarction ; Perfusion*

The objective of this study was to investigate clinical and radiographic features and gender differences in Korean patients with adult-onset ankylosing spondylitis. Multicenter cross-sectional studies were conducted in the rheumatology clinics of 13 Korean tertiary referral hospitals. All patients had a confirmed diagnosis of ankylosing spondylitis according to the modified New York criteria. Clinical, laboratory, and radiographic features were evaluated and disease activities were assessed using the Bath ankylosing spondylitis disease activity index. Five hundred and five patients were recruited. The male to female ratio was 6.1:1. Average age at symptom onset was 25.4+/-8.9 yr and average disease duration was 9.6+/-6.8 yr. Males manifested symptoms at a significantly earlier age. HLA-B27 was more frequently positive in males. Hips were more commonly affected in males, and knees in females. When spinal mobility was measured using tragus-to-wall distance and the modified Schober's test, females had significantly better results. Radiographic spinal changes, including bamboo spine and syndesmophytes, were more common in males after adjustment of confounding factors. In conclusion, we observed significant gender differences in radiographic spinal involvement as well as other clinical manifestations among Korea patients with adult-onset ankylosing spondylitis. These findings may influence the timing of the diagnosis and the choice of treatment.
Adult ; Age of Onset ; *Asian Continental Ancestry Group ; Female ; HLA-B27 Antigen/diagnostic use ; Humans ; Joints/pathology ; Male ; Severity of Illness Index ; Spondylitis, Ankylosing/diagnosis/*pathology/*physiopathology/*radiography

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the efficacy of lacidipine in reducing blood pressure (BP) and to determine its effect on endothelial function in mild-to-moderate hypertensive patients with type 2 diabetes mellitus (DM). SUBJECTS AND METHODS: This was a prospective, multicenter, open-label, single-arm study, enrolling 290 patients with mild-to-moderate hypertension and type 2 DM. Patients were initially treated with 2 mg lacidipine orally once daily for 4 weeks, which was then increased as necessary every 4 weeks to a maximal dose of 6 mg daily. The primary endpoint was the mean change in systolic blood pressure (SBP) from baseline after 12 weeks of treatment. Secondary endpoints included mean changes in diastolic blood pressure (DBP), flow-mediated vasodilatation (FMD), and serum concentrations of biochemical markers such as high-sensitivity C-reactive protein (hs-CRP), monocyte chemo-attractant protein-1 (MCP-1), matrix metalloproteinase-9 (MMP-9), and plasminogen activator inhibitor-1 (PAI-1). RESULTS: Lacidipine treatment significantly reduced SBP by -13.4+/-13.0 mmHg (p<0.001) and DBP by -6.2+/-9.3 mmHg (p<0.001). Lacidipine treatment did not improve endothelial-dependent vasodilatation, despite significantly improved nitroglycerin-induced, endothelial-independent vasodilatation. MCP-1 levels significantly decreased from 283.66+/-110.08 pg/mL to 257.83+/-100.23 pg/mL (p<0.001); whereas there were no significant changes in the levels of hs-CRP, MMP-9, or PAI-1. CONCLUSION: Twelve weeks of treatment with lacidipine was effective and well tolerated in mild-to-moderate hypertensive patients with type 2 DM. In spite of inducing a significant reduction in MCP-1 levels, lacidipine did not improve endothelial function.
Biomarkers ; Blood Pressure ; C-Reactive Protein ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Dihydropyridines ; Endothelium ; Humans ; Hypertension ; Korea ; Matrix Metalloproteinase 9 ; Monocytes ; Plasminogen Activators ; Prospective Studies ; Vasodilation