PURPOSE: The purpose of this study was to evaluate the usefulness of diffusion-weighted imaging (DWI) for the differential diagnosis of various intracranial cystic lesions. MATERIALS AND METHODS: This study included 19 patients (13 males, 6 females) with a mean age of 42.5 years. The final histopathological diagnoses for 14 patients were pyogenic brain abscess (n=3), glioblastoma (n=3), ependymoma (n=1), anaplastic astrocytoma (n=1), pilocytic astrocytoma (n=1), hemangioblastoma (n=2), arachnoid cyst (n=1), epidermoid (n=1) and schwannoma (n=1). The other cases of metastasis (n=4) and arachnoid cyst (n=2) were diagnosed on the basis of clinical, laboratory and imaging data. DWI imaging studies were performed with a 1.5 T MR system. A single shot spin echo EPI pulse sequence was applied. B values were set at 0 and 1000 sec/mm2. The apparent diffusion coefficient (ADC) were calculated from the ADC map of 10 different cystic brain lesions. Conventional MR imaging included T2WI, T1WI, FLAIR and contrast enhanced T1WI. We analyzed the location, nature, signal intensity on DWI, and the enhancement pattern of the lesions. RESULTS: All of the 3 cases of brain abscess, 1 of 4 cases of metastasis and 1 case of epidermoid showed hyperintensity on DWI. The mean ADC value of brain abscess (2 cases) was less than 1.15 (0.13x10-3 mm2/s). The mean ADC values of the other cystic lesions (8 cases) were variable, ranging from 2.840.66 to 3.100.16 (10-3 mm2/sec). CONCLUSION: DWI and ADC values were useful in the differential diagnosis of various intracranial cystic lesions, but some metastatic tumors may mimic a brain abscess on DWI. Therefore, a clinical correlation is mandatory.
Arachnoid ; Astrocytoma ; Brain ; Brain Abscess ; Diagnosis ; Diagnosis, Differential* ; Diffusion* ; Ependymoma ; Glioblastoma ; Hemangioblastoma ; Humans ; Magnetic Resonance Imaging ; Male ; Neoplasm Metastasis ; Neurilemmoma

Acute lymphoblastic leukemia (ALL), in general, can be diagnosed by detecting blasts in peripheral blood or bone marrow. Some of the cases of ALL do not show typical leukemic features, and only manifest as refractory anemia, thrombocytopenia, myelofibrosis and lymphocytic infiltration into bone marrow. Several months after presentation, they may reveal typical leukemic features and are diagnosed as ALL. This kind of leukemia is called ALL with aleukemic prodrome. Although the incidence of ALL with aleukemic prodrome is 1.5~2.2% of childhood ALL cases, it is rarely reported in Korea. We experienced a 6 month-old female infant who presented with refactory anemia and thrombocytopenia, and two serial of bone marrow examination revealed only myelofibrosis. She subsequently developed ALL 3 months later. We report this case with a brief review of related literatures.
Anemia ; Anemia, Refractory ; Bone Marrow ; Bone Marrow Examination ; Female ; Humans ; Incidence ; Infant ; Korea ; Leukemia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Primary Myelofibrosis ; Thrombocytopenia

BACKGROUND: To determine the natural progression of conservatively treated rotator cuff tears, we evaluated changes in radiologic and clinical parameters in patients whose recalcitrant tears were neglected after conservative treatment. METHODS: A total of 73 patients with recalcitrant rotator cuff tears in spite of conservative treatment were included in this study. We measured changes in tear size and in the extent of fatty infiltration of the rotator cuff by comparing the initial and final follow-up magnetic resonance imagings (MRIs). To determine factors influencing the change in tear size, we collected the medical history of patients taken at the time of initial admission. RESULTS: The average follow-up period was 20.1 months, and the average increase in tear size across this period was 6.2 mm. In terms of steroid injection, we found that the increases in tear size of the steroid injection group (p=0.049) and of the sub-group that had received more than three steroid injections (p=0.010) were significantly greater than that of the non-steroid injection group. CONCLUSIONS: We found that the increase in cuff tear size was on average 6.2 mm across the follow-up period, indicating that neglecting cuff tears may cause them to progress into more severe tears. We also observed that a history of steroid injection might be a possible risk factor for a worse prognosis of cuff tears. Therefore, we suggest that patients with rotator cuff tears and a history of steroid injection are recommended aggressive modes of treatment such as surgery.
Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Prognosis ; Retrospective Studies* ; Risk Factors ; Rotator Cuff* ; Tears*

PURPOSE: Recently, the clinical performance examination (CPX) using standardized patients has been introduced to several Korean medical schools. The purpose of this paper is to evaluate the correlation of CPX scores with the scores of other clinical clerkship assessments and written examinations. METHODS: We evaluated the correlation of the scores of CPX, which was administered to third-year medical students (n=230) at Seoul National University College of Medicine in January 2005, with the scores of a slide examination in internal medicine, an objective structured clinical examination (OSCE) in pediatrics and obstetrics/gynecology, and the written examinations in internal medicine and general surgery. RESULTS: CPX scores showed a mild correlation with the scores of the slide examination in internal medicine and OSCE in pediatrics and obstetrics/gynecology (r=0.19, 0.28, 0.30). CPX scores were also mildly correlated with written examination scores in internal medicine but not associated with those in general surgery. CONCLUSION: Considering the mild correlation of CPX scores with scores of other clinical clerkship assessments and written examinations, CPX should be affirmatively considered as an examination complementary to previous examinations.
Clinical Clerkship* ; Humans ; Internal Medicine ; Pediatrics ; Schools, Medical ; Seoul ; Students, Medical

BACKGROUND: Commercial kits of PCR method are widely used in HLA-B27 typing; however, their cost is relatively high. In this study, we evaluated the utility of an in-house PCR method by comparing it with that of a commercial kit. METHODS: HLA-B27 typing was done in 188 patients by using two PCR methods, Absolute(TM) HLAB27 PCR kit (Biosewoom, Korea) and an in-house PCR method. The primers used in the in-house method were prepared by Bioneer (Korea). Both PCR tests were done by Gene Amp PCR System 9600 (Perkin-Elmer Centus Corp., USA). RESULTS: The commercial kit and in-house PCR showed 100% concordance rate with each other in HLA-B27 typing. Of 188 patients tested 72 (38.3%) were positive and 116 (61.7%) were negative by the both tests. Of 62 patients with ankylosing spondylitis, 50 were positive (80.7%). CONCLUSIONS: The in-house PCR is a reliable and cost-effective method and can replace or supplement commercial kits for HLA-B27 typing.
Adult ; Female ; HLA-B27 Antigen/blood/*genetics ; Histocompatibility Testing/*methods ; Humans ; Male ; Polymerase Chain Reaction/*methods ; Reagent Kits, Diagnostic ; Sensitivity and Specificity

BACKGROUND: Aquaporin-11 (AQP11) is a novel member of the aquaporin family. Disruption of the murine Aqp11 gene causes severe proximal tubular injury and renal failure. The rs2276415 (G>A) single-nucleotide polymorphism in the human AQP11 gene results in glycine to serine substitution in a functionally important domain. In this study, the role of the genetic predispositions of AQP11 rs2276415 (G>A) on renal allograft outcomes was evaluated. METHODS: A total of 198 pairs of donors and recipients were enrolled in this study. Long-term graft survival was traced and clinical parameters that could have influenced graft outcome were collected through the electronic medical record system. RESULTS: The genotype distribution and allele frequency of rs2276415 polymorphism were not different between donors and recipients. Despite similar allele frequencies between donors and recipients, the minor allele rs2276415 (GA+AA) of AQP11 from the donors, but not from the recipients, had a harmful effect on the graft survival compared with the wild-type donor (GG; P=0.029). This association was significant after adjusting for several risk factors including age, sex, human leukocyte antigen mismatch, donor type, hypertension, and diabetes mellitus (P=0.032). CONCLUSION: A donor-derived, not recipient-derived, genetic AQP11 polymorphism has different effects on graft outcome. Thus, the genetic influence from donors should be carefully considered for proper management of allografts after kidney transplantation.
Alleles ; Allografts* ; Aquaporins ; Diabetes Mellitus ; Electronic Health Records ; Gene Frequency ; Genetic Predisposition to Disease* ; Genotype ; Glycine ; Graft Survival ; Humans ; Hypertension ; Kidney Transplantation* ; Leukocytes ; Polymorphism, Single Nucleotide ; Renal Insufficiency ; Risk Factors ; Serine ; Tissue Donors* ; Transplants

BACKGROUND: The diagnosis of hepatitis C virus (HCV) infection is screened by anti-HCV enzymelinked immunosorbant assay (ELISA) and confirmed by recombinant immunoblotting assay (RIBA) or HCV RT-PCR. We attempted to evaluate the results between anti-HCV ELISA and a qualitative HCV RT-PCR. METHODS: Four hundred and twenty patients who were tested with anti-HCV ELISA and HCV RTPCR, simultaneously, from January 2002 to June 2005 were enrolled in this study. Anti-HCV ELISA was performed by AxSYM HCV version 3.0 (Abbott Laboratories, USA). HCV RT-PCR was performed using in-house RT-nested PCR methods from January 2002 to October 2004 and HCV Genotype Amplification Kit (LiPA) (Bayer Healthcare, USA) from November 2004 to June 2005. RESULTS: Of the 420 patients tested, 321 were positive for anti-HCV ELISA, and 204 were positive for RT-PCR. The positive predictability of anti-HCV ELISA was 63.6%. Among anti-HCV positive patients, RT-PCR was positive in 7.3% of the patients with sample/cut-off (S/CO)<6, compared with 82.8% of the patients with S/CO> or =6. Among the 117 patients with positive anti-HCV, but with negative HCV RT-PCR, 64 had liver diseases such as chronic hepatitis C, chronic hepatitis B, or hepatocellular carcinoma. Twelve patients showed positive HCV RT-PCR, but negative anti-HCV results; of these 9 had hepatic dysfunction. CONCLUSIONS: In the patients who were positive for anti-HCV ELISA with a low S/CO, HCV RT-PCR positivity was shown in a low proportion. Therefore, in such cases, the results should be confirmed by RIBA or HCV RT-PCR. The liver function test showed increased levels of hepatic enzymes in patients with positive HCV RT-PCR, but negative anti-HCV. Such findings correlate to an early phase of chronic hepatitis C, suggesting the necessity of continuous follow up.
Carcinoma, Hepatocellular ; Delivery of Health Care ; Diagnosis* ; Enzyme-Linked Immunosorbent Assay* ; Follow-Up Studies ; Genotype ; Hepacivirus ; Hepatitis B, Chronic ; Hepatitis C ; Hepatitis C, Chronic ; Humans ; Immunoblotting ; Liver Diseases ; Liver Function Tests ; Polymerase Chain Reaction

Takayasu arteritis (TA) is a chronic systemic inflammatory disease that most commonly affects the aorta and its major branches. TA-induced renal artery stenosis (TARAS) can result in malignant hypertension, severe renal dysfunction, cardiac decompression and premature death. Surgical management for TARAS has been proved to be effective and safe, especially in the medically or interventionally-intractable cases. We report here on a 39-year-old patient with recently deteriorating hypertension and renal function because of a recurred RAS, for which he underwent "y-shaped" aorto-birenal reconstruction surgery 20 years ago. CT angiography showed bilateral diffuse calcified stenosis in the previous renal graft and there was a partial rupture of a pseudoaneurysm in the suprarenal abdominal aorta segment between the celiac axis and the renal graft. We performed descending thoracic aorto-abdominal aortic bypass together with a graft-renal bypass and exclusion of the pseudoaneurysm. The renal function was normalized and the blood pressure became stable without any antihypertensive medication. He recovered and was discharged without any complications.
Adult ; Aneurysm, False ; Angiography ; Aorta ; Aorta, Abdominal ; Axis, Cervical Vertebra ; Blood Pressure ; Constriction, Pathologic ; Decompression ; Humans ; Hypertension ; Hypertension, Malignant ; Hypertension, Renovascular ; Mortality, Premature ; Renal Artery Obstruction ; Rupture ; Takayasu Arteritis ; Transplants

We report an extremely rare case of a diffuse hepatic hemangiomatosis without extrahepatic involvement in an adult. The imaging findings of this tumor were similar to those of a hepatic hemangioma and included contrast enhancement with a centripetal filling pattern of the entire hepatic tumor on the delayed phase of a dynamic CT and inhomogeneous diffuse uptake of the entire tumor on blood-pool images obtained five hours later on a 99mTc-labeled red blood cell scan. Despite its rarity, diffuse hepatic hemangiomatosis can be suggested in adult patients with diffusely involved hepatic tumors showing the radiological findings of a hepatic hemangioma.
Adult ; Female ; Gated Blood-Pool Imaging ; Hemangioma/*diagnosis/pathology/ultrasonography ; Humans ; Liver Neoplasms/*diagnosis/pathology/ultrasonography ; Tomography, X-Ray Computed

PURPOSE: This study was done to test a hypothesized model, the Biobehavioral Family Model (BBFM), on the relationship of family emotional climate, security of parent-child relationship, depression symptoms and eating problems in adolescent girls, to further understanding of eating problems in this population. METHODS: With a convenience sample of 647 girls, aged 15 to 18, a self-report survey was conducted which included the Korean form of the Eating Attitude Test (EAT-26) to assess eating problems. RESULTS: The estimated results of the structural equation modeling indicated a good fit of data to the hypothesized model proposing that family emotional climate and security of parent-child relationship were associated with the risk of eating problems by way of depression symptoms. That is, negative family emotional climate and insecure parent-child relationship increased the risk of eating problems indirectly by way of depression symptoms. CONCLUSION: The findings are consistent with the BBFM, which suggests a psychobiologic influence of specific family processes on children's stress-sensitive physical disease activity by way of depression symptoms. Therefore, the applicability of the BBFM for understanding adolescent girls' eating problems is supported. The psychobiologic pathways from depression to eating pathology should be addressed in future studies.
Adolescent ; Aged ; Climate ; Depression ; Eating ; Feeding and Eating Disorders ; Humans ; Parent-Child Relations