Pheochromocytomas are rare catecholamine-secreting neuroendocrine tumors arising from chromaffin cells in the adrenal medulla. Typical classic triad are consisted of headaches, palpitations, and profuse diaphoresis. But some patients with pheochromocytomas have other cardiovascular manifestations such as left ventricular hypertrophy, congestive heart failure, and cardiac arrhythmia. Rarely, pheochromocytomas manifest as acute myocardial infarction leading to delayed diagnosis and treatment. We experienced one case of pheochromocytoma initially manifesting as acute myocardial infarction which showed normal coronary artery on coronary angiography. Pheochromocytoma should be suspected and evaluated in patients with acute myocardial infarction whose coronary angiography shows normal coronary without definite thrombosis.
Adrenal Medulla ; Arrhythmias, Cardiac ; Chromaffin Cells ; Coronary Angiography ; Coronary Vessels ; Delayed Diagnosis ; Headache ; Heart Failure ; Humans ; Hypertrophy, Left Ventricular ; Myocardial Infarction* ; Neuroendocrine Tumors ; Pheochromocytoma* ; Thrombosis

Image findings of hepatic lymphoma have been reported as variable, ranging from single or multiple small nodules to diffuse infiltrative patterns. On MRI, most hepatic lymphomas show T1 low signal intensity, T2 high signal intensity. Dynamic imaging reveals a hypointense appearance in the arterial phase, followed by delayed enhancement in the portal venous and transitional phase. In the hepatobiliary phase using a hepatocyte-specific contrast agent (which have recently aided in increasing the access to the focal liver lesions), hepatic lymphoma is known to exhibit low signal intensity. We report a case of hepatic lymphoma, which shows iso-signal intensity on hepatobiliary phase, using gadoxetic acid (Gd-EOB-DTPA).
Liver ; Lymphoma* ; Magnetic Resonance Imaging*

Uterine malformations consist of a group of miscellaneous congenital anomalies of the female genital system, and these anomalies are the result of major disturbances in the development, such as formation or fusion of the Mullerian or paramesonephric ducts during fetal life. The Mullerian anomalies have been estimated to occur in up to 0.001~10%, and these anomalies may be associated with numerous congenital anomalies, and ipsilateral renal anomalies especially are the most common. The uterine didelphys with obstructed hemivagina and ipsilateral renal agenesis clinically may result in dysmenorrhea, low abdominal pain, endometriosis or pelvic mass after menarche. Furthemore the delayed diagnosis causes infertility and poor pregnancy outcome due to continued retrograde menstruation which leads to endometriosis and distorted pelvic anatomy. These anomalies could be diagnosed with ultrasonography and MRI that have the high sensitivity and specificity. Excision of vaginal septum and marsupialization are appropriate treatments to relieve symptoms and reserve fertility. We report 7 cases of uterine didelphys with obstructed hemivagina and ipsi-unilateral renal agenesis with a brief review of relevant literatures to help understand these anomalies.
Abdominal Pain ; Congenital Abnormalities ; Delayed Diagnosis ; Dysmenorrhea ; Endometriosis ; Female ; Fertility ; Humans ; Infertility ; Kidney ; Kidney Diseases ; Menarche ; Menstruation Disturbances ; Pregnancy ; Pregnancy Outcome ; Sensitivity and Specificity

This is a report of cardiac arrests which occurred in the operating room of National Medical Center from Jan. 1, 1970 to Dec. 31, 1976. All kinds of operations were performed in this hospital, butlopen heart surgery was excluded from this study. During this period 22, 825 surgical operations were done and 74 cardiac arrests occurred among them. Overall incidence of cardiac arrest was 1: 308 (0. 32%) and 43% of cardiac arrests were successfully resuseitated.
Heart Arrest* ; Incidence ; Operating Rooms* ; Thoracic Surgery

OBJECTIVE: The aim of this study was to evaluate the correlation between severity of endometriosis and the incidence of endometrial polyp. METHODS: The study population consisted of six hundred thirty-one women who had undergone laparoscopic operation due to infertility, severe dysmenorrhea or ovarian tumors. We divided two groups: 434 women with endometriosis (study group) and 197 women without the disease (control group). The presence of endometriosis was documented by diagnostic or therapeutic laparoscopic operation and the disease severity was scored according to revised The American Fertility Society classification. We confirmed the endometrial polyps by pathologic examination after hysteroscopic polypectomy, and compared endometrial polyp incidence according to severity of endometriosis. RESULTS: There was no significant difference between groups with regard to age, mean duration of infertility. Endometrial polyps were found in 274 women (63.0%) with endometriosis and in 58 controls (29.8%, p=0.0000). The incidence of endometrial polyps differed significantly according to stage of endometriosis. The incidence of endometrial polyps were 77/142 (54.2%), 58/90 (64.4%), 73/108 (67.6%, p<0.05), 66/94 (70.2%, p<0.05) in endometriosis stage I, II, III, and IV. There was a linear correlation between stage of endometriosis and endometrial polyps incidence (p=0.008). CONCLUSION: Endometriosis is accompanied by endometrial polyps. This results showed positive correlation between severity of the endometriosis and incidence of endometrial polyps. It is the possible mechanism for low pregnancy rate in the severe endometriosis
Classification ; Dysmenorrhea ; Endometriosis* ; Female ; Fertility ; Humans ; Incidence* ; Infertility ; Polyps* ; Pregnancy Rate

Tetanus is rare in Korea due to the introduction of vaccination programs and the advancement in public health. Its common signs are trismus, voice disturbance, neck stiffness, and difficulty in swallowing, etc. A 56 years old man was injured by grasping a high voltage electric cable. After the accident, he fell down on a steel plate and had a head trauma. When he visited Emergency Department, there was multiple electric burn wound on left arm and left facial area. He was hospitalized on a department of neurosurgery, because intra cranial hemorrhage was presumed. 12 days later, he was referred to department of OMFS with developed painful masseter spasms and trismus. That night he violently bit his tongue with his denture. Because masseter muscle and temporal muscle constriction was involuntary, tongue was lacerated and denture was distorted. At first we supposed that the symptom was related with neurologic disturbance following head trauma or electric shock. But it was revealed that trismus was caused by tetanus on an electrophysiological test. By using mechanical ventilation and administration of tetanus immunoglobulin, muscle-relaxant, and sedatives at ICU, symptoms had subsided (4-weeks). Because tetanus is rare disease, we rarely suppose tetanus infection to be a cause of a trismus. Especially it is more difficult to diagnose in patient who has head trauma, burn and neurologic problem as in this case.
Arm ; Burns* ; Burns, Electric ; Constriction ; Craniocerebral Trauma ; Deglutition ; Dentures ; Emergency Service, Hospital ; Hand Strength ; Hemorrhage ; Humans ; Hypnotics and Sedatives ; Immunoglobulins ; Korea ; Masseter Muscle ; Middle Aged ; Neck ; Neurosurgery ; Public Health ; Rare Diseases ; Respiration, Artificial ; Shock ; Steel ; Temporal Muscle ; Tetanus* ; Tongue ; Trismus* ; Vaccination ; Voice Disorders ; Wounds and Injuries

Purpose: This study aimed to conduct a comparison between 2D thin section intermediate-weighted Dixon turbo spin echo (TSE), 3D intermediate-weighted SPACE (sampling perfection with application-optimized contrasts using flip angle evolutions) TSE, and 2D fat-suppressed T2-weighted TSE in terms of their image quality and diagnostic performance for ankle ligament evaluation. Materials and Methods: Thirty-eight ankle MRI studies were retrospectively analyzed. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the multiplanar reformation images of the sequences were obtained. For each sequence, the subjective image quality and the diagnostic performance for ankle ligament tear were analyzed. Results: The Dixon demonstrated the highest CNR both between ligament and fluid and between ligament and bone marrow. The 3D SPACE showed the highest SNR of the ligament. Regarding subjective image quality, it was significantly higher in the T2-weighted image than it was in the SPACE (p < 0.05), while there was no significant difference between the Dixon and the SPACE. The Dixon showed the highest sensitivity for anterior talofibular ligament (ATFL) tear (80.0%; 95% confidence interval [CI], 64.4–92.3) and deep deltoid ligament (DL) tear (86.4%; 95% CI, 65.1–97.1), and it showed the highest specificity for ATFL tear (70.2%; 95% CI, 59.3–79.7). The interobserver agreement was moderate to good (intraclass correlation coefficient [ICC], 0.50–0.93) in most cases except for the SNR of deep DL (ICC of 0.35–0.62). Conclusion For ankle ligament evaluation, the 2D thin section Dixon provides adequate image quality with high SNR and CNR and the highest sensitivity for detecting tears.

PURPOSE: Number of patients expecting for kidney transplantation and transplantations in foreign countries are rapidly increasing. However, there was a lack of information about clinical progresses and outcomes of kidney recipients, underwent cadaveric kidney transplantation in China. METHODS: We included 44 patients (China group), received cadaveric kidney transplantation in China and have been managed at our institute from Jan 2002 to Jan 2006 and 33 patients (domestic group), received cadaveric kidney transplantation at our institute from Feb 2000 to Jan 2006. We performed retrospective study based on medical records. RESULTS: Duration of pre-transplantation renal replacement therapy and of post-transplantation follow up was longer in domestic group (China group vs. domestic group; 89.9 months vs. 24.6 months, 31.9 months vs. 13.9 months) (p<0.05, p<0.05). Final GFR of China group was lower than domestic group (China group vs. domestic group; 54.97+/-18.92 mL/min vs. 64.26+/-18.23 mL/min) (p<0.05). Infection and rejection rates of China group were higher than domestic group (Incidences/ Pantients *Yr./1000; China group vs. domestic group; infection; 2.05 vs. 0.76, rejection; 1.34 vs. 0.51) (p<0.05). There was no difference of patient and graft survival between two groups. CONCLUSION: Korean recipients of Chinese cadaveric kidneys showed lower final GFR and higher rates of infection and rejection. We should be aware of the possible rejections and complications of kidney recipients undergoing cadaveric kidney transplantation in China. Mutual exchange of information about current status of patients, transplantation indications, donor status and treatment protocols is needed between foreign transplantation centers and our medical centers.
Asian Continental Ancestry Group ; Cadaver* ; China* ; Follow-Up Studies ; Graft Survival ; Humans ; Kidney Transplantation* ; Kidney* ; Medical Records ; Renal Replacement Therapy ; Retrospective Studies ; Tissue Donors

OBJECTIVE: We investigated whether GnRH agonists reduce aromatase cytochrome P450 and cyclooxygenase-2 by direct action in the eutopic endometrium of endometriosis and ovarian endometrioma. METHODS: Endometrial specimens and endometriotic tissues were obtained from infertility women undergoing laparoscopic surgery. Biopsy samples of the endometrium were obtained before and after GnRH agonist therapy. The stromal cells of eutopic endometrium in women with endometroisis and ovarian endometrioma were cultured in the presence of GnRH agonist (leuprolide acetate 0, 1, 5, and 10 uM) for 24 hours. The expression of aromatase cytochrome P450 and COX-2 was examined by Western blot. RESULTS: Protein of aromatase cytochrome P450 and COX-2 were decreased in the eutopic endometrium of patients treated with GnRH agonist for 3 months. The stromal cells culture of endometrial explants and ovarian endometrioma with GnRH agonist reduced aromatase cytochrome P450 and COX-2. Phosphorylated ERK was decreased in endometriotic stromal cultures with GnRH agonist. CONCLUSION: These findings demonstrate that GnRH agonist not only promoted a hypoestrogenic state but also reduced aromatase cytochrome P450 and COX-2 by direct action on eutopic endometrium in patients with endometriosis and ovarian endometrioma.
Aromatase* ; Biopsy ; Blotting, Western ; Cyclooxygenase 2* ; Cytochrome P-450 Enzyme System ; Endometriosis* ; Endometrium ; Female ; Gonadotropin-Releasing Hormone* ; Humans ; Infertility ; Laparoscopy ; Stromal Cells

OBJECTIVE: To assess the advantages, disadvantages, applicability, and complications of operative laparoscopy in ovarian pathologic lesions. MATERIALS AND METHODS: A retrospective case series which compares 354 patients who had laparoscopic surgery at Ajou University Hospital from June, 1994 to September, 2001 for ovarian pathology. RESULTS: The patient's ages ranged from 13 to 77 years, and their mean age was 30.9 years. Most of the lesions were less than 7 cm in size and unilateral. The operations performed were cystectomy in 225 cases (63.6%), salpingooophorectomy, oophorectomy, salpingectomy and fenestration or biopsy in order. Operative times were between 10 and 240 minutes (mean: 74.2 minutes). Pathologic examinations of unilateral ovarian tumors were performed in 305 cases. The most common pathology of unilateral ovarian tumor was teratoma (107/305, 35.1%), endometrioma and cystadenoma in order. Malignancies were found in 4 cases including borderline malignancy (1.3%). Pathologies of bilateral ovarian tumor were endometrioma (31/41, 75.6%), teratoma, and fibroma in order. Postoperative hospital stays were from 0 days to 19 days (mean: 2.5 days). There were 7 surgical complications including 3 vessel injury related hematomas, 1 abscess formation, and 3 exploratory laparotomy. CONCLUSIONS: We concluded that operative laparoscopy was useful in surgery of ovarian lesions, if there are carefully selected patients, standard procedures, and skilled laparoscopic surgeons.
Abscess ; Biopsy ; Cystadenoma ; Cystectomy ; Endometriosis ; Female ; Fibroma ; Hematoma ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Operative Time ; Ovariectomy ; Pathology ; Retrospective Studies ; Salpingectomy ; Teratoma