Large cell neuroendocrine carcinoma (LCNEC) of the lung is a newly recognized entity of pulmonary neuroendocrine carcinoma. Histologically, it is very difficult to differentiate LCNEC from other pulmonary carcinomas and the prognosis is significantly poor. The cutaneous metastasis of LCNEC of the lung shares some features with Merkel cell carcinoma of the skin in light microscopy and yet it is negatively stained with cytokeratin 20. We report a case of cutaneous metastasis of LCNEC of the lung, previously misdiagnosed as squamous cell carcinoma. Our patient showed a poor response to the chemotherapy and also revealed a brain metastasis on follow-up brain CT scan.
Brain ; Carcinoma, Merkel Cell* ; Carcinoma, Neuroendocrine* ; Carcinoma, Squamous Cell ; Drug Therapy ; Follow-Up Studies ; Humans ; Keratin-20 ; Lung* ; Microscopy ; Neoplasm Metastasis ; Prognosis ; Skin ; Tomography, X-Ray Computed

The ankle is an important joint supporting the entire musculoskeletal system during standing and walking. Current opinion has emphasized necessity of anatomical reduction and rigid internal fixation for a displaced or unstable fracture of the ankle. The purpose of this study was to evaluate the correlation of the adequate surgical operative methods and postoperative care with prognosis. The authors analysed 104 cases of ankle fracture, treated operatively in Department of Orthopedic Surgery of Dae-Han Hospital from January 1991 to December 1994, followed up more than one year. The results were as follows: 1. According to the classification of Lauge-Hansen and Danis-Weber, the most common type was supination-external rotation and type B, respectively. 2. The most common cause of injury was slip down and the others were traffic accident, fall down and direct trauma. 3. According to the criteria of Meyer, the result of treatment was good or excellent in 94 cases (90.4%) radiologically and in 91 cases (87.5%) clinically. 4. The complications were 5 cases of traumatic arthritis, 3 cases of malunion, 2 cases of non-union and 1 case of infection. 5. The early ROM exercise after accurate reduction and rigid internal fixation was very important in treatment of fracture of the ankle.
Accidents, Traffic ; Ankle Fractures ; Ankle* ; Arthritis ; Classification ; Joints ; Musculoskeletal System ; Orthopedics ; Postoperative Care ; Prognosis ; Walking

Sometimes it is not easy to make the diagnosis of myasthenia gravis (MG). The aim of our study was to understand the diagnostic sensitivities of tensilon, repetitive nerve stimulation (RNS), single fiber EMG (SFEMG) tests, acetylcholine receptor (AChR) antibodies (Ab), and to know their comparative significances for making diagnosis of MG. Those tests were safely completed in 40 myasthenia gravis, which consisted of 17 ocular, 21 generalized, 1 acute severe, 1 late severe MG. In all 40 subjects at least one of the tests was abnormal. The positive rates of tensilon, RNS tests, SFEMG, AChR Ab were 92.5%, 65.0%, 90.0%, and 82.5% respectively. The sensitivities of each tests were high in severe MG group, compared with those in mild MG group, because the positive rates were decreased from 100.0% to 89.2% in tensilon tests, from 83.3% to 57.1% in RNS test, from 100.0% to 89.2% in SFEMG tests and 91.7% to 78.6% in AChR Ab test. The positive results of RNS test was increased from 32.5% on abductor digiti quinti (ADQ) to 65.0% on orbicularis oculi (OOC). Among 3 cases with negative tensilon test, the RNS test in 1 case, the SFEMG tests were positive in all 3 cases, and the AChR Ab assay 1case. Among 3 cases with negative SFEMG, the tensilon tests were positive in 3 all cases, the RNS test in 1case and the AChR Ab assay in 1 cases. Among 5 cases, with negative RNS teses and negative AChR Ab assay, the tensilon tesrs wre positive in 3 cases and the SFEMG tests in 3 cases. Therefore we conclude that tensilon and SFEMG tests were more sensitive than RNS tests and AChR Ab assay. SFEMG test would be indicated to diagnose MG, especially in those mild MG cases with negative stensilon test. Also AChR Ab assay could improve diagnostic yields.
Acetylcholine ; Antibodies ; Diagnosis ; Edrophonium ; Myasthenia Gravis*

OBJECTIVE AND METHODS: To determine correlations among ambulatory renin activity, ambulatory blood pressure and microalbumin excretion rate, 66 Korean essential hypertensives were studied after 4 week wash-out period. The ambulatory blood pressure was monitored every 30 minutes and mean BP were calculated automatically. Urinary microalbumin excretion rate(UAER) and ambulatory plasma renin activity(aPRA) collected at mid-day were measured by radioimmunoassays. Subjectives were divided into 2 groups by aPRA value(2ng/ml/hr). RESULT: 14 cases were high renin group and 52 cases low renin group. The mean BP were 148.83/94.69mmHg in low renin group, and 146.57/98.07mmHg in high-renin group without difference. UAER were not different also between both groups. 23.07%(4/14) of non-dippers were included in high renin group and 25.58%(12/52) in low renin group without statistical difference. The aPRA was significantly related to UAER and systolic and diastolic mean blood pressure. Also UAER was related significantly to day mean blood pressures. CONCLUSION: Thus aPRA is thought to be a meaningful indicator to predict hypertensive renal target organ damage as well as blood pressure measured with 24-hr ABPM.
Blood Pressure* ; Hypertension* ; Plasma* ; Radioimmunoassay ; Renin*

BACKGROUND: Previous studies showed differences in healthcare utilization among insurance types. This study aimed to analyze the difference in healthcare utilization for percutaneous transluminal coronary angioplasty inpatients by insurance types after controlling factors affecting healthcare utilization using propensity score matching (PSM). METHODS: The 2011 national inpatient sample based on health insurance claims data was used for analysis. PSM was used to control factors influencing healthcare utilization except insurance types. Length of stay and total charges were used as healthcare utilization variables. Patients were divided into National Health Insurance (NHI) and Medical Aid (MA) patients. Factors representing inpatients (gender, age, admission sources, and Elixhauser comorbidity index) and hospitals (number of doctors, number of beds, and location of hospitals) were used as covariates in PSM. RESULTS: Tertiary hospitals didn't show significant difference in length of stay and total charges after PSM between two insurance types. However, MA patients showed significantly longer length of stay than that of NHI patients after PSM in general hospitals. Multivariate regression analysis provided that admission sources, Elixhauser comorbidity index, insurance types, number of doctors, and location of hospitals (province) had significant influences on the length of stay in general hospitals. CONCLUSION: Study results provided evidences that healthcare utilization was differed by insurance types in general hospitals. Health policy makers will need to prepare interventions to influence the healthcare utilization differences between insurance types.
Angioplasty, Balloon, Coronary* ; Comorbidity ; Delivery of Health Care* ; Health Policy ; Hospitals, General ; Humans ; Inpatients* ; Insurance* ; Insurance, Health ; Length of Stay ; National Health Programs ; Propensity Score* ; Regression Analysis ; Tertiary Care Centers

BACKGROUND AND OBJECTIVE: Transient global amnesia(TGA) is a neurological syndrome affecting preferentially middle-aged or elderly people and characterized by sudden onset of transient impairment of antegrade amnesia with variably retrograde amnesia. TGA was defined over 30 years ago, but the etiology remain unclear. Several mechanisms have been proposed, including arterial thromboembolic ischemic attacks in both posterior cerebral artery territories, epilepsy, and migraine. Although many studies have reported TGA, only a few reported cerebral perfusion studies using SPECT because of the brief duration of the episode. Technetium-99m-ethyl cysteinate dimmer(ECD) is superior to sensitivity of lesion detection and lesion to normal contrast, probably due to lower back diffusion from the brain to the blood and its excellent radiochemical stability. So we evaluate pathophysiologic mechanism of TGA by using 99mTC-ECD SPECT with or without acetazolamide(ACZ) stress. METHODS: We evaluated six patients with transient global amnesia, four women and two men, age ranges 56 to 78 years, mean 62.2 years. Measurements of CBF and vascular reserve using 99mTC-ECD with or without ACD stress were performed during or after TGA episode. RESULTS: One patient, who was evaluated in TGA episode showed that regional cerebral blood flow was decreased in both anteroinferior frontal, both temporal, right thalamus, both inferior parietal and left parietal region with impaired vascular reserve in left inferior temporal and right thalamus. Others, who were evaluated more than 6days in TGA episode showed that regional cerebral blood flow was decreased in left temporal (4), both temporal region (1), left thalamus (2) and both basal ganglia (1) with preserved vascular reserve except one, showed impaired vascular reserve in left thalamus. CONCLUSION: This result show that severe hypoperfusion of bilateral temporal region and impaired vascular reserve in left temporal region in TGA episode. Other patients who were recovered from TGA showed hypoperfusion of left temporal region and preserved vascular reserve. 99mTc-ECD with acetazolamide SEPCT that sensitively detects localized impaired cerebraovascular reserve should help elucidate these processes. But further study with more cases is necessary for evaluation of pathophysiology of TGA.
Acetazolamide ; Aged ; Amnesia ; Amnesia, Retrograde ; Amnesia, Transient Global* ; Basal Ganglia ; Brain ; Diffusion ; Epilepsy ; Female ; Humans ; Male ; Migraine Disorders ; Perfusion ; Posterior Cerebral Artery ; Rabeprazole ; Technetium* ; Thalamus ; Tomography, Emission-Computed, Single-Photon*

Thirty-nine patients with fixed drug eruption who visited the Department of Dermatology in National Medical Center from January 1g7g to December 1982 were selected. Among them, twentyseven patients performed skin biopsy and were evaluated histopathologically on the basis of duration. The results were as follows; ].In the early stage less than 1 week of duration, hydropic degeneration of basal cells, necrotic keratinocytes with eosinophilic cytoplasm and pknotic nucleus in the epidermis, and mixed cell infiltration with eosinophlis in the upper dermis were prominently. In the late stage more than 20 days of duration, acanthosis, an increased amount of melanin in the basal cell layer and presence of melanophages were found more prominent, however, hydropic degeneration of basal cells, papillary dermal ederna, inflammatory infiltration of mononuclear cells were found less prounced or absent.
Biopsy ; Cytoplasm ; Dermatology ; Dermis ; Drug Eruptions* ; Eosinophils ; Epidermis ; Humans ; Keratinocytes ; Melanins ; Skin

Urinary cytology has become an essential element in the diagnosis and management of transitional cell carcinoma(TCC) of the urinary tract. It has the advantage of being noninvasive, inexpensive, and easily accessible. Besides that it can even detect malignancy when unsuspected at cystoscopy. We report a retrospective review of urine cytology in the diagnosis of 83 TCC cases that underwent 295 cytologic evaluation. All patients had biopsy-proven TCC of the bladder, ureter and renal pelvis. The overall inci- dence of the positive cytology cases was 66.2%. To define the cytologic features of tumor cells, we tried to use three cytologic gradings such as "grade 1", "grade 2", and "grade 3" according to the cytologic degree of anaplastic neoplastic cells. These cytologic gades of TCC were relatively well correlated with the histologic grade and tumor invasiveness. This result suggests that the recognition of characteristic cellular features of TCC can suspect the histologic grade and tumor stage. The false negative TCC cases were 78.9%. They showed severe inflammatory or bloody background and a few neoplastic cells. Therefore, a cautious approach for accurate interpretation, personal experience, and proper fixation and processing could expand the role of urinary cytology.
Cystoscopy ; Diagnosis ; Humans ; Kidney Pelvis ; Nocturnal Enuresis* ; Retrospective Studies ; Risk Factors* ; Thyroid Gland ; Ureter ; Urinary Bladder ; Urinary Tract

No abstract available.
Heel* ; Molluscum Contagiosum* ; Weight-Bearing* ; Zea mays

No abstract available.
Early Diagnosis* ; Osteogenesis* ; Ultrasonography*