Primary sclerosing cholangitis is a chronic disease of unknown cause, characterized by inflammation and fibrosis of the biliary tree with diffuse multifocal stricture formation. With increasing knowledge of primary sclerosing cholangitis, it is now recognized that in the setting of inflammatory bowel disease, cholangiocarcinoma is a complication of primary sclerosing cholangitis. We recently experienced a case of 41 year old female patient who had Crohns disease associated with primary sclerosing cholangitis and cholangioearcinoma. We report a case of primary sclerosing cholangitis with cholangiocarcinoma with literature review.
Adult ; Biliary Tract* ; Cholangiocarcinoma* ; Cholangitis, Sclerosing* ; Chronic Disease ; Constriction, Pathologic ; Crohn Disease ; Female ; Fibrosis ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Pancreas*

Diabetic neuropathy is an axonal degenerative disease characterized by progressive axonal atrophy and reduced axonal transport. We were interested in the potential neuroprotective effects of nerve growth factor against diabetic neuropathies. To this aim we studied the effect of nerve growth factor on satellite cells, which might play a trophic role toward the related neuron, of the dorsal root ganglion in the streptozotocin-induced diabetic rats by electron in microscope . Diabetes was induced in rats by the streptozotocin. And recombinant human NGF was administrated everyday for 10 consecutive weeks. The results obtained are as follows : 1.In the diabetic induced group, the satellite cells revealed irregular nuclei.The neuron-satellite cell interface was more irregular and plicated than that of control. Large vacuoles and dense bodies were observed and no defects were in the ribosomes and rough endoplasmic reticulum. In the vacuoles, medium electron dense, fiber -like materials were occasionally observed. 2. In the experimental group of diabetic rats treated with NGF for 10 weeks, nucleus was round and the neuron-satellite interface was more regular. Vacuoles and dense bodies were less seen than diabetic rats. In the cytoplasm, many microtubules were observed. In these studies, we considered that streptozotocin induces changes of the satellite cell structure and NGF might improve cellular changes of the satellite cell exposed with streptozotocin.
Animals ; Atrophy ; Axonal Transport ; Axons ; Cytoplasm ; Diabetic Neuropathies ; Endoplasmic Reticulum, Rough ; Ganglia* ; Ganglia, Spinal ; Humans ; Microtubules ; Nerve Growth Factor* ; Neurons ; Neuroprotective Agents ; Rats* ; Ribosomes ; Streptozocin ; Vacuoles

Carcinoma of the fallopian tube accounts for less than 1% of all cancers of the female genital tract. The histology and behavior of fallopian tube cancer are simillar to ovarian cancer; thus evaluation and treatment are also essentially the same. Unlike ovarian cancer, fallopian tube cancer begins in a hollow viscus, and early lesions may be less likely to be associated with extensive intraperitoneal carcinoma. Two postmenopausal women presented with a pelvic mass. Pathologic examination of the resected specimens revealed primary adenocarcinoma of the fallopian tube. We have experienced two cases of fallopian tube cancer and reported with brief review of literature
Adenocarcinoma ; Fallopian Tube Neoplasms ; Fallopian Tubes* ; Female ; Humans ; Ovarian Neoplasms

PURPOSE: The detection of epileptogenic lesion plays an important role in the management of patients with partial epilepsy. Although the development of MRI improved the examination of cerebral hemispheres greatly, many patients with neocortical temporal lobe epilepsy (TLE) or extratemporal lobe epilepsy (extra-TLE) still show no lesion in conventional two-dimensional (2D) images. To increase the yield of MRI in those patients, we performed three-dimensional (3D) surface-projection rendering (SPR) of the cerebral hemispheres. METHODS: Conventional 2D MRI (T1, T2, FLAIR, thin slice SPGR) and 3D SPR were performed in 24 patients with neocortical TLE and extra-TLE, and 20 normal subjects. Sulcogyral patterns were evaluated blindly to clinical information. The locations of the epileptogenic zone, ictal onset zone (IOZ) and irritative zone (IRZ) were determined by intracranial EEG monitoring and epilepsy surgery. RESULTS: The 2D MRI identified epileptogenic lesions in five of the 10 neocortical TLE (50%) and five of the 14 extra-TLE (35.7%). 3D SPR revealed abnormal sulcogyral patterns in 9 of the 10 neocortical TLE (90%) and 9 of the 14 extra-TLE (64.3%). Cortical deformation zones with sulcogyral anomalies included the whole area of IOZ in 10 (55.5%) and IRZ in 6 (33.3%), overlapped with IOZ in 7 (38.9%) and IRZ in 11 (61.1%), were connected to IOZ in 1 (5.6%) and IRZ in 1 (5.6%). CONCLUSION: 3D SPR of volumetric MRI data can detect epileptogenic structural lesions of neocortical epilepsy that are not visible in the conventional 2D images.
Brain* ; Cerebrum ; Electroencephalography ; Epilepsies, Partial ; Epilepsy* ; Epilepsy, Temporal Lobe ; Humans ; Magnetic Resonance Imaging*

PURPOSE: To investigate the various ictal perfusion patterns and find the relationships between clinical factors and different perfusion patterns. MATERIALS AND METHODS: lnterictal and ictal SPECT and SPECT subtraction were performed in 61 patients with partial epilepsy. Bath positive images showing ictal hypoperfusion and negative images revealing ictal hypoperfusion were obtained by SPECT subtraction. The ictal perfusion patterns of subtracted SPECT were classified into focal hypoperfusion, hypoperfusion-plus, combined hypoperfusion-hypoperfusion, and focal hypoperfusion only. RESULTS: The concordance rates with epileptic focus were 91.8% in combined analysis of ictal hypoperfusion and hypoperfusion images of subtracted SPECT, 85.2% in hypoperfusion images only of subtracted SPECT, and 68.9% in conventional ictal SPECT analysis. Ictal hypoperfusion occurred less frequently in temporal lobe epilepsy (TLE) than extratemporal lobe epilepsy. Mesial temporal hypoperfusion alone was seen only in mesial TLE while lateral temporal hypoperfusion alone was observed only in neocortical TLE. Hippocampal sclerosis had much lower incidence of ictal hypoperfusion than any other pathology. Some patients showed ictal hypoperfusion at epileptic focus with ictal hypoperfusion in the neighboring brain regions where ictal discharges propagated. CONCLUSION: Hypoperfusion as well as hypoperfusion in ictal SPECT should be considered for localizing epileptic focus. Although the mechanisrn of ictal hypopertusion could be an intra-ictal early exhaustion of seizure focus or a steal phenomenon by the propagation of ictal discharges to adjacent brain areas, further study is needed to elucidate it.
Baths ; Brain ; Epilepsies, Partial* ; Epilepsy ; Epilepsy, Temporal Lobe ; Humans ; Incidence ; Pathology ; Perfusion* ; Sclerosis ; Seizures ; Tomography, Emission-Computed, Single-Photon*

The issues concerning the disability evaluating system in Korea are controversial to say the least. Evaluating systems are so complicated that they continually cause confusion to medical examiners even though they must evaluate patient's medical status accurately, objectively and reasonably to provide adequate compensation for patients. However, controlling associations or educating curricula for disability evaluation are not in place. This study investigates the impending problems of disability evaluation in Korea and discussed what should be done to improve the situations. Social environments, evaluating standards, examiners' capability and education are reviewed in an effort to present an adequate proposals to Korean medical examiners.
Compensation and Redress ; Coroners and Medical Examiners ; Curriculum ; Disability Evaluation ; Humans ; Hypogonadism ; Korea ; Mitochondrial Diseases ; Ophthalmoplegia ; Social Environment

PURPOSE: To report the distribution of ocular higher-order aberrations in candidates for refractive surgery measured by Zywave(R) II aberrometer. METHODS: The present study included 232 eyes of 116 subjects. Ocular aberration data were obtained by measurements per eye using Zywave(R) II aberrometer. The mean Zywave spherical equivalent (SE) and higher order aberrations (HOAs) calculated in the central 6-mm zone and expressed as root mean square (RMS) values were analyzed. Correlation analysis was performed to assess the association between ocular HOAs and gender, age, SE refractive error, or central corneal thickness (CCT) and investigate the aberration symmetry between right and left eyes. RESULTS: The average SE was-4.67 +/- 1.83 diopters (D). The mean RMS values of total HOA, 3rd, 4th or 5th summated HOAs, coma, trefoil and spherical aberration (SA) were 0.421 +/- 0.201 microm, 0.346 +/-0.206 microm, 0.202 +/- 0.105 microm, 0.087 +/- 0.048 microm, 0.241 +/- 0.172 microm, 0.225 +/- 0.154 microm and 0.136 +/- 0.102 microm, respectively. There was no significant differences of the mean total HOA, summated HOAs, coma, trefoil and SA between genders, age and refractive errors, but the 3rd order trefoil was strongly related with myopia (r = -0.900, p = 0.008). There was symmetry of ocular aberrations between both eyes and the ocular aberrations were not correlated with CCT. CONCLUSIONS: Herein, we report the normative distribution of ocular aberrations in the myopic Korean population measured by Zywave(R) II aberrometer. The 3rd order trefoil and myopia were correlated and mirror symmetry was observed between right and left eyes.
Aniline Compounds ; Coma ; Lotus ; Myopia ; Refractive Errors ; Refractive Surgical Procedures*

PURPOSE: To evaluate morphological differences in proprioceptors in extraocular muscles between congenital exotropia, acquired exotropia and congenital nystagmus. METHODS: Nine medial recti including the myotendinous junction were resected using medial rectus resection in three congenital and five acquired exotropia patients. Two medial recti and two lateral recti were resected using the modified Kestenbaum procedure in two congenital nystagmus patients. The muscle tissues were examined under a light microscope following examination with a transmission electron microscope. RESULTS: In the congenital exotropia group, the electron microscopic findings showed degenerative changes in proprioceptors, such as decreased microtubules, axonal shrinkage and decreased myelin thickness. In the acquired exotropia group, the neural structures in the myotendinous junction were well maintained. There were no neural structures in the myotendinous junction in the congenital nystagmus group. CONCLUSIONS: Depending on the type of strabismus, there may be morphological differences in proprioceptors of extraocular muscles.
Axons ; Exotropia* ; Humans ; Microtubules ; Muscles* ; Myelin Sheath ; Nystagmus, Congenital* ; Strabismus

BACKGROUND: The clinical and electroencephalographic differentiation of the mesial temporal lobe epilepsy (MTLE) and neocortical temporal lobe epilepsy (NTLE) may have a practical value. Until now, a few comparative studies reported some relatively minor differences between the two groups. We investigated the clinical history, interictal and ictal electroencephalographic (EEG) patterns to differentiate NTLE from MTLE. METHODS: Twenty two patients with medically refractory MTLE and fourteen patients with isolated neocortical lesions were recruited. The interictal and ictal scalp EEG patterns were compared in terms of the interictal EEG distribution patterns of epileptiform discharges, focal slow waves (ipsilateral/contralateral refers to side of pathology), and the frequencies of ictal discharges on EEG at seizure onset. RESULTS: Interictal EEG patterns of epileptiform discharges and focal slow waves were recorded most often at the ipsilateral or bilateral sphenoidal electrodes in both groups without significant differences. Ictal EEG onset with rhythmic theta waves was significantly more frequent in MTLE (72.3%) than in NTLE (36.7%), but ictal EEG onset with rhythmic alpha waves and those with rhythmic beta waves were significantly more frequent in NTLE (33.3%, 20.0%, respectively) than in MTLE (10.8%, 1.2%, respectively). Initial ictal EEG patterns appeared more frequently at the sphenoidal electrodes in both groups (MTLE:73.5%, NTLE:60.0%). Initial ictal EEG patterns of the bilateral hemisphere, ipsilateral hemisphere or ipsilateral diffuse temporal area were seen only in NTLE (16.7%, 3.3%, 10% respectively), but not in MTLE. CONCLUSIONS: This study showed that the initial ictal patterns and the frequency of ictal onset were significantly different in MTLE and NTLE. These differences could give a practical help in diagnosing MTLE and NTLE.
Electrodes ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Humans ; Scalp* ; Seizures ; Temporal Lobe*

BACKGROUND: Recently elderly people have increased in Korea and increased demands of medical service. This study was carried out to identify diseases and health service utilization patterns of geriatric inpatients to provide better understanding and basis planning to meet the needs of expanding geriatric population. METHOD: We use data of `Patient Survey in Korea` in 1999 and analyzed characteristics of disease structure and utilization patterns of health care service of 54,013 cases of discharged patients aged 65 years or more. RESULT: The proportion of the elderly in total discharged patients is 14.7%. Male to female ratio is 1:1.3 and most common age group was between 65 and 69 years old. 84.2% of elderly patients were admitted at secondary or tertiary health care facilities. The most common disease in geriatric inpatients is malig- nancy in male and vascular disease in female. The average duration of hospitalization is 14.2 days. They stay longer than the nation wide average hospital length and stay longest when they are admitted by mental and behavioral disorders. CONCLUSION: Geriatric patients are admitted mostly with chronic degenerative diseases such as neoplasm and vascular disease. Elders prefer to be admitted to tertiary hospitals and oriental hospitals. They stay more in hospital.
Aged ; Delivery of Health Care ; Female ; Health Services* ; Hospitalization ; Humans ; Inpatients* ; Korea ; Male ; Tertiary Care Centers ; Vascular Diseases