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

This study is based on 155 patients of congenital me colon. For the diagnosis, 93 cases were histologically proven and the remaining 63 cases were diagnosed on clinical basis including barium enema or surgical gross findings. On histologic examination, 80 cases(86%) showed typical features of absence of ganglion cell in the myenteric plexus and the 13 cases(14%) had atypical features which were segmental absence Of ganglion cell in one case. There we 127 males(82%) and 28 females(18%). The age at diagnosis was younger than 30 days in 87 cases(56%), I month to 1 year in 39 cases(25%) and older than I year in 29 cases(18%). The levels of aganglionosis were variable: short segment (rectosigmoid) in 134 cases(86%), intermediate segment (more proximal colon) in 14 cases(100%). and 6 cases(4%) had total aganglionosis. Common clinical presentations were abdominal distention, delayed meconium passage or bilious vomiting in neonate, and chronic constipation in infancy or childhood. Following initial colostomy or ileostomy, a definitive procedure was performed in 151 cases(Duhamel type in 150 cases; Soave type in 2 cases; Swenson type in 3 cases). Frequently associated problems after definitive procedure were persistent constipation(ll%) due to septum formation, fecaloma, remnant aganglionic segment and rectal stenosis. Overall mortality rate was 4%, and increased mortality was associated with enterocolitis(14%) which was the most frequent cause of death. The follow-up study longer than 3 months was available in 138 patients who underwent a definitive procedure(mean 2 year 11 months). Seventy-three cases(53%) had normal bowel function, 38cases(27.5%) had occasionally used enema or stool softners, and 27 cases(19.5%) had severe constipation or soiling. The bowel habit improved with time, and were considered normal in 60% of patients after follow-up more than 3 years. The results of definitive procedures for congenital megacolon including Duhamel operation was satisfactory, and long-term follow-up appeared an important and critical component of patients'care.
Child ; Male ; Female ; Infant, Newborn ; Humans ; Mortality ; Follow-Up Studies

Vaginal clear cell adenocarcinoma is a very rare malignant disease and it has been known to be associated with in utero exposure to DES. We expreienced a case of clear cell adenocarcinoma of the cagina in 40 years ole woman, and present the case with a brief review of related literatures.
Adenocarcinoma, Clear Cell* ; Female ; Humans ; Vagina*

Vaginal clear cell adenocarcinoma is a very rare malignant disease and it has been known to be associated with in utero exposure to DES. We expreienced a case of clear cell adenocarcinoma of the cagina in 40 years ole woman, and present the case with a brief review of related literatures.
Adenocarcinoma, Clear Cell* ; Female ; Humans ; Vagina*

BACKGROUND: As co-factors of metalloenzymes, zinc(Zn) and copper(Cu) have a considerable effect on nearly all the metabolism that takes place in organs of the body, including the skin. OBJECTIVE: The purpose of this study was to evaluate zinc and copper status in alopecia areata patients. METHODS: We measured serum levels of zinc and copper in 30 cases of alopecia areata patients and 10 normal individuals by atomic absorption spectrometry. Furthermore, we studied the significance of the ratio between serum levels of the two metals. RESULTS: The serum levels of zinc were significantly lower in alopecia areata patients than in healthy controls. The serum levels of copper were slightly lower in alopecia areata patients than in healthy controls. Ratios of Cu/Zn were slightly higher in alopecia areata patients than in healthy controls. But their differences were not statistically significant. CONCLUSION: We suggest that a serum Zn assay should be included in the chemical assessment of patients with alopecia areata.
Absorption ; Alopecia Areata* ; Alopecia* ; Copper* ; Humans ; Metabolism ; Metals ; Skin ; Spectrum Analysis ; Zinc*

Aortic root diameter by two dimensional and M-mode echocardiography in predicting prosthetic aortic valve size preoperatively was measured in 10 adult patients undergoing aortic valve replacement. Correlation of aortic root diameter measured by two dimensional echocardiography and actual prosthetic valve size implanted by aortic valve replacement was excellent. Correlation coefficient was statistically significant (r=0.91, P<0.001). Correlation of aortic root diameter measured by M-mode echocardiography and actual prosthetic valve size was also excellent. Correlation coefficient was statistically significant (r=0.86, P<0.001). This study demonstrates that aortic root diameter by two dimensional and M-mode echocardiography can accurately predict prosthetic aortic valve size in patient undergoing aortic valve replacement.
Adult ; Aortic Valve* ; Echocardiography* ; Humans

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*

PURPOSE: To describe CT findings and differential points of cystic thymic lesions. MATERIAL AND METHOD: We evaluated retrospectively total 19 masses with well marginated cystic lesions at thymic area on CT scans. They were 10 teratomas, 3 congenital thymic cysts, 2 multilocular thymic cysts(associated with thymoma and myasthenia gravis in each), 2 cysts Assciated with thymic Hodgkin's lymphomas an ectopic parathyroid cyst, and an infected thymic cyst. The radiological abnormalities evaluated were thickness of the wall, presence or abscene of septa, mural nodule, solid component, calcification and fat component. RESULTS: All three cases of congenital thymic cysts and an ectopic parathyroid cyst appeared as thin-walled unilocular cyst with homogeneous internal density and without identifiable solid component. In multilocular thymic cyst, there were thick wall and solid components(n=2), thick internal septa and calcifications(n=l). The cysts of teratomas manifested thick walls(n=9), internal septa(n=4), calcifications(n=6), fat components(n=4), and solid components(n=4). Cysts in Hodgkin's diseases appeared as multilocular or unilocular and had thick wall and septa without calcification. infected thymic cyst presented with multilocular cystic mass with identifiable wall and septa, calcification, and solid components. CONCLUSION: The thymic diseases with cystic lesion include teratomas, congenital thymic cysts, multilocular thymic cysts, parathyroid cyst, .and Hodgkin's disease. Congenital thymic cyst and ectopic parathyroid cyst are thin-walled unilocular cystic lesions. Cystic lesions associated with teratoma, Hodgkin's disease, and multilocular thymic cyst are thick-walled cystic lesions with or without solid component.
Hodgkin Disease ; Mediastinal Cyst ; Myasthenia Gravis ; Retrospective Studies ; Teratoma ; Thymoma ; Tomography, X-Ray Computed

In Korea medical record administrators/technicians are coding diagnoses and procedures of discharged patients based on their medical records mostly using International Classification of Diseases, 9th revision(ICD-9) and International Classification of Procedures(ICPM) by WHO. This study examined consistency of coding in 63 hospitals in the year of 1992. The statistical data showed great inconsistency in coding patterns among many hospitals. The main reasons of inconsistency were coders errors, ill-defined diagnoses/procedures, no unified route to make new code numbers for the new or ambiguous diagnoses/procedures, inconsistency of selection of using optional(additional) codes, and inconsistency of reference records on coding. Near half of the hospitals do not recheck the accuracy of coding after completion of medical records by physicians. Most of the coders review operation record, admission and discharge record, discharge summary, progress notes, pathology report, and consultation record as references on coding, but 14 hospitals do not review the whole record when they code diagnoses and procedures. Twenty-three hospitals discuss with physicians when they have questions in assigning code numbers. Further study should be done continuously for valid and reliable statistics of diseases and operations and for establishing a systematic unified channel for the new and ambiguous cases.
Classification ; Clinical Coding* ; Diagnosis ; Humans ; International Classification of Diseases* ; Korea ; Medical Records ; Pathology

Cystic parathyroid adenoma is one of the rare causes of hyperparathyroidism, and is usually located in neck and mediastinum. This type of adenoma tends to cause increased serum level of parathyroid hormone and alkaline phosphatase, similar serum calcium level when compared to those of solid adenoma. Thanks to current radioimmunoassay and easy accessibility to serum autoanalyzer, serum calcium level and parathyroid hormone level are more easily measured, which in turn lead to more easier diagnosis of hyperparathyroidism. Also improvement in imaging and nuclear diagnostic method of parathyroid lesion are suggested to enable easy diagnosis of cystic parathyroid adenoma. A 35-year-old male presented with easy fatigability for 12 months. The serum calcium, phosphate, alkaline phosphotase were 11.5mg/dL, 1.4mg/dL, 194IU/L respectively and his parathyroid hormone level in serum was 126.42pg/mL. Neck CT showed enlargement of right lobe of thyroid gland with well defined inhomogenously enhanced density inside the right thyroid gland. The patient was diagnosed of hyperparathyroidim due to parathyroid adenoma and was surgically removed. The surgical biopsy showed cystic parathyroid adenoma. After operation his general condition was improved and serum calcium, phosphate, parathyroid hormone level were normalizd. We report a case of hyperparathyroidism caused by cystic parathyroid adenoma with brief review of literature.
Adenoma ; Adult ; Alkaline Phosphatase ; Biopsy ; Calcium ; Diagnosis ; Humans ; Hyperparathyroidism* ; Male ; Mediastinum ; Neck ; Parathyroid Hormone ; Parathyroid Neoplasms* ; Radioimmunoassay ; Thyroid Gland