A 21-year-old man presented with a 7 days history of fever. Careful clinical examination led to the discovery of left supraclavicular lymphadenopathy without hepatosplenomegaly. Serologic tests for Ebstein-Barr virus, HIV, hepatitis type B & C, syphilis and typhoid fever were negative. Blood, urine, and stool cultures yielded no growth. Histologically, the process mainly involved the connective tissue framework of the lymph node, sharing the features of inflammatory pseudotmor(IPT) of other organs: a storiform growth pattern, increased vascularity with associated vascular lesions, and a polymorphous inflammatory infiltrate in a collagen-rich stroma. Immunohistochemical study for spindle cells showed positive reaction for actin and vimentin but not for desmin, and lymphoid cells revealed polyclonality. Characteristics of mass formation, and the inflammatory nautre of the process enabled us adopt the term IPT which should be differentiated from hematolymphoid proliferative disorder or mesenchymal neoplasia.
Male ; Humans

We report the dynamic magnetic resonance imaging findings (MRI) of a metaplastic carcinoma of the breast. A 44-year-old woman presented with a 2-month history of a mass in the right breast. The tumor showed a central irregular necrosis that was depicted upon low signal intensity on a T1-weighted image and high signal intensity on a T2-weighted image. The periphery of the tumor showed strong enhancement on a contrast enhanced T1-weighted image. The time-signal intensity curve revealed an early strong contrast enhancement and a delayed washout pattern.
Adult ; Breast* ; Female ; Humans ; Magnetic Resonance Imaging ; Necrosis

BACKGROUND: Family physicians are interested in health promotion for maintaining one's sound health. But there is little information on what patients think about the practice of health promotion by family physicians. Therefore, we found out whether patients think that it is appropriate for family physicians to be concerned about problems relating to four health risk factors, and the patients' perception both of their own health problems and of the concern actually shown by their family physicians. METHODS: Patients who had visited our two family medicine offices from March to August 1998 was asked to complete a self administered questionnaire. Questions on attitudes to wards and perceptions of family physicians' interest in weight, smoking, drinking, and fitness problems were included. 586 questionnaires with adequate response were analyzed using chi square test and Mantel Haenszel's linear trend test. RESULTS: A total of 586 respondents consisted of 230 men and 356 women. Of the respondents, the proportion of people who thought that family physicians should be concerned about the health risk factors ranged from 83.6% in the case of smoking to 86.5% of fitness, but 76.6% thought their family physicians had in fact been interested in smoking and 72.2% thought so about fitness. There was a significant age group trend in the case of attitudes towards family physician concern for smoking with larger proportions of older patients (p<0.01). Significantly more women than men thought that their family physicians seemed interested in health risk factor with 62.2% to 70.0% in men and 78.6% to 80.9% in women (p<0.001). There were significant age group differences in proportions who thought that their family physicians seemed interested in weight (p<0.001), smoking (p<0.001), and drinking (p<0.05) problems except for fitness problem. 31.6% of the respondents thought that they had a weight problem, 20.5% smoking problem, 14.0% drinking problem, and 28.2% fitness problem. CONCLUSION: These results suggest that many patients thought that most of their family physicians seemed interested in health promotion, but felt the need that they should be come more interested.
Surveys and Questionnaires ; Drinking ; Female ; Health Promotion* ; Humans ; Male ; Physician's Role* ; Physicians, Family ; Risk Factors ; Smoke ; Smoking

BACKGROUND: To determine the relationship between nutrient intake and bone mineral density(BMD), we have investigated this issue by the use of a semiquantitative food-frequency questionnaire. METHODS: A total of 312 women aged 33-77 was divided into two groups, 187 premenopausal and 125 postmenopausal women. Dietary intake was assessed with a food-frequency questionnaire. DMD was assessed with dual-energy X-ray absorptiometry at the lumbar spine (lumbar vertebrae 2-4). Pearson correlation and partial correlation coefficients were calculated for each nutrient at the lumbar spine BMD. RESULTS: The mean age of the 312 participants was 48 years, and their mean body mass index (BMI) was 23.7+/-2.8 Kg/m2. Forty percent of the women were in postmenopausal state. The mean lumbar BMD was 1.117g/cm2. Age was negatively correlated with BMD in premenopausal and postmenopausal women, BMI was positively correlated with BMD in postmenopausal women, but smoking and exercise were not correlated with BMD. In premenopausal women, nutrient intakes were not associated with BMD. A significant association was found between intakes of fat, iron, vitamin A, vitamin C and BMD in postmenopausal women, but after adjusting for age, body mass index, energy intake, smoking, exercise, and use of hormone replacement therapy, there was no association. CONCLUSION: There was no significant association between nutrient intakes and BMD of the lumbar spine.
Absorptiometry, Photon ; Ascorbic Acid ; Body Mass Index ; Bone Density* ; Calcium ; Energy Intake ; Female ; Hormone Replacement Therapy ; Humans ; Iron ; Postmenopause ; Premenopause ; Smoke ; Smoking ; Spine ; Vitamin A ; Surveys and Questionnaires

OBJECTIVE: The study was to evaluate the biological significance of Ki-67 expression in common epithelial ovarian carcinomas. We investigated the correlation between Ki-67 expression and clinicopathological parameters. METHODS: One hundred patients with epithelial ovarian carcinomas stage I-IV treated at Department of Obstertrics and Gynecology, Korea University Hospital from January 1994 to December 2004 were used as study group. We determined expression of Ki-67 by immunohistochemistry using MIB-1 monoclonal antibody reactivity. RESULTS: Ki-67 overexpression was higher in high stage (III-IV) than low stage (I-II) (P<0.013). Ki-67 overexpression was higher in serous cystadenocarcinoma (76.3%) than mucinous cystadenocarcinoma (53.6%), endometrioid carcinoma (54.5%) and clear cell carcinoma (58.3%) but it was not statistically significant (P<0.191). Ki-67 expression was higher in high grade but it was not statistically significant (P<0.096). Ki-67 overexpression was not correlated with serum CA-125 level (P<0.172). Overall survival revealed significant survival difference between patients whose tumor showed Ki-67 overexpressions compared with remaining patients. CONCLUSIONS: Ki-67 overexpressions was a poor prognostic indicator in epithelial ovarian carcinomas.
Antibodies, Antinuclear ; Antibodies, Monoclonal ; Carcinoma, Endometrioid ; Cystadenocarcinoma, Mucinous ; Cystadenocarcinoma, Serous ; Female ; Gynecology ; Humans ; Immunohistochemistry ; Ki-67 Antigen ; Korea ; Ovary

PURPOSE: We evaluated the usefulness of 24 hour/3 hour radio-uptake ratio, lesion to non-lesion ratio, in differentiating bony metastases from acute (<2 months) and healing ( 2 months) fractures. MATERIALS AND METHODS: Sixty-three patients (age range: 26-81, 32 males, 31 females) having 90 lesions (30 bone metastases, 30 acute fractures, 30 healing fractures) were included. Bone scans were obtained 3 and 24 hours after administration of 740 MBq of 99mTc-MDP. The ratio of radio-uptake in the lesion to normal area was measured as 24/3 hour radio-uptake ratio ([lesion/non-lesion RUR at 24 hour]/[lesion/non-lesion RUR at 3 hour], 24/3 RUR) and analyzed clinical significance in differentiating bone metastases from acute or healing fractures. RESULTS: Mean 24/3 RUR were 1.22+/-0.18 for bone metastases, 1.25+/-0.14 for acute fractures, and 0.99+/-0.15 for healing fractures. 24/3 RUR values of bone metastases and acute fractures were not significantly different. But 24/3 RUR values of bone metastases and healing fractures, and those of acute and healing fractures were found to be significantly different (p<0.001). When 24/3 RUR of 1.0 was considered as the cut off point separating metastases from fracture, a sensitivity of 100% (30/30) was obtained. The specificity was 0% (0/30) in separating metastases from acute fractures, and 47% (14/30) in separating metastases from healing fractures. When 24/3 RUR of 1.2 was considered as the cut off point, sensitivity of 53% (16/30) in the diagnosis of bone metastasis, and specificity of 37% (11/30) in separating metastases from acute fractures, and 100% (30/30) in separating metastases from healing fractures were obtained. CONCLUSION: 24/3 RUR is useful in differentiating bone metastases from healing fractures, but not in differentiating bone metastases from acute fractures. A 24/3 RUR of less than 1.0 suggests healing fractures. A 24/3 RUR of more than 1.2 suggests bone metastases or acute fractures.
Diagnosis ; Humans ; Male ; Neoplasm Metastasis* ; Radionuclide Imaging* ; Sensitivity and Specificity ; Technetium Tc 99m Medronate

INTRODUCTIONThis study aimed to investigate differences in the complication rate and postoperative pain score between single and multilevel surgery performed on patients with obstructive sleep apnoea.

MATERIALS AND METHODSA retrospective analysis was performed on patients with obstructive sleep apnoea who underwent surgery in a tertiary referral centre over 3 years. Patients who underwent single-level nasal, palatal or tongue surgery were compared with patients who underwent concurrent multilevel surgery of 2 or 3 levels. Complications and the postoperative Visual Analogue Scale pain score were recorded and the outcomes between single and multilevel groups were compared.

RESULTSThe overall complication rate for patients was 12.6%, 6.7% if only patients requiring intervention were considered. The adjusted odds ratio (OR) for complication rate for patients undergoing multilevel surgery and single-level surgery was 2.76. It was statistically significant (=0.053) after adjusting for confounders. There was more pain in patients who underwent multilevel surgery than in the single-level surgery group.

CONCLUSIONConcurrent multilevel surgery is a feasible option in patients with multilevel obstruction, especially if they are undergoing palate and tongue surgery, nose and palate surgery or nose and tongue surgery. There may be more complications, though it is not statistically significant. Further studies are required to investigate the differences between single-level nasal surgery and 3-level multilevel surgery. More patients undergoing multilevel surgery than single-level surgery experienced pain. Multilevel surgery patients should have their analgesia reviewed regularly and titrated accordingly.

Severe hyperammonemia can occur as a result of inherited or acquired liver enzyme defects in the urea cycle, among which ornithine transcarbamylase deficiency (OTCD) is the most common form. We report a very rare case of a 45-year-old Korean male who was admitted to the intensive care unit (ICU) due to severe septic shock with acute respiratory failure caused by Pneumocystis jiroveci pneumonia. During his ICU stay with ventilator care, the patient suffered from marked hyperammonemia (>1,700 µg/dL) with abrupt mental change leading to life-threatening cerebral edema. Despite every effort including continuous renal replacement therapy and use of a molecular adsorbent recirculating system (extracorporeal liver support-albumin dialysis) to lower his serum ammonia level, the patient was not recovered. The lethal hyperammonemia in the patient was later proven to be a manifestation of acquired liver enzyme defect known as OTCD, which is triggered by serious catabolic conditions, such as severe septic shock with acute respiratory failure.
Ammonia ; Brain Edema ; Humans ; Hyperammonemia* ; Intensive Care Units ; Liver ; Male ; Middle Aged ; Ornithine Carbamoyltransferase Deficiency Disease* ; Ornithine Carbamoyltransferase* ; Ornithine* ; Pneumocystis jirovecii ; Pneumonia ; Renal Replacement Therapy ; Respiratory Insufficiency ; Shock, Septic* ; Urea ; Ventilators, Mechanical

BACKGROUND: Despite many ongoing, prospective studies on the topic, sepsis still remains one of the main causes of death in hospital. The hormone insulin-like growth factor 1 (IGF-1) has a similar molecular structure to that of insulin. IGF-1 exerts anabolic effects and plays important roles in both normal physiology and pathologic processes. Previous studies have observed low serum IGF-1 level in patients with critical illnesses. Here, we evaluated changes in IGF-1 level based on survival of septic patients. METHODS: We evaluated 140 patients with sepsis and septic shock (21 with sepsis and 119 with septic shock) admitted to the intensive care unit of a university-affiliated hospital in Korea. Serum IGF-1 level was measured on days 0, 1, 3, and 7. Patients with liver disease were excluded from this study. All data were analyzed using SPSS version 20 (SPSS Inc., Chicago, IL, USA). RESULTS: Patients with septic shock had significantly lower serum IGF-1 level on days 1 and 3 than patients without septic shock (p = 0.002 and p = 0.007, respectively). Generally, there was a negative relationship between IGF-1 and serum cortisol levels; however, this relationship was only significant on day 3 (p = 0.029). Furthermore, renin showed significantly negative correlation with IGF-1 on day 3 (p = 0.038). IGF-1 level did not show significant difference between survivors and non-survivors. CONCLUSIONS: Our results showed that IGF-1 was associated with septic shock, and that the IGF-1 axis is severely disrupted in septic patients. Additionally, serum cortisol and renin levels were associated with IGF-1 level.
Anabolic Agents ; Cause of Death ; Critical Illness ; Humans ; Hydrocortisone ; Insulin ; Insulin-Like Growth Factor I ; Intensive Care Units ; Korea ; Liver Diseases ; Molecular Structure ; Pathologic Processes ; Physiology ; Prospective Studies ; Renin ; Sepsis* ; Shock, Septic* ; Survivors

PURPOSE: To demonstrate the mammographic and sonographic appearances of metaplastic carcinoma of the breast. MATERIALS AND METHODS: The mammographic and sonographic findings in eight female patients (aged: 28-78 years, mean: 50.3 years) with pathologically proven metaplastic cancer were analyzed retrospectively by three radiologists. We analyzed the size, density, shape, margin, associated architectural distortion, calcification in the mass and enlarged lymph node at the axilla, on the mammograms. We also analyzed the shape, margin and echogenicity of the lesions on the sonograms. RESULTS: On mammography, irregular (n=4), lobular (n=2) or oval (n=2) shaped high density masses were found. The margins of the masses were indistinct (n=4) or obscured (n=3). There were architectural distortions in three cases and pleomorphic calcifications in two cases. On sonography, irregular (n=5) or oval (n=3) shaped masses with microlobulated margins were found. The echopatterns of the masses were complex (n=5) or hypoechoic (n=3). CONCLUSION: The mammographic and sonographic findings of metaplastic carcinoma of the breast are nonspecific and similar to those of other forms of breast cancer. However, this type of tumor should be included in the differential diagnosis for breast masses which appear as an irregular or oval shape with a microlobulated margin and a complex or hypoechoic echopattern on sonography.
Axilla ; Breast Neoplasms ; Breast* ; Diagnosis, Differential ; Female ; Humans ; Lymph Nodes ; Mammography ; Retrospective Studies ; Ultrasonography*