Bilateral putaminal hemorrhages rarely occur simultaneously in hypertensive patients. The association of intracerebral hemorrhage with cerebral edema (CE) has been rarely reported in diabetic patients. We present a patient with bilateral putaminal hemorrhage (BPH) and CE during the course of hyperglycemic hyperosmolar syndrome (HHS). A 40-year-old man with a history of diabetes mellitus and chronic alcoholism was admitted with acute impaired mentality. His blood pressure was within the normal range on admission. Laboratory results revealed hyperglycemia and severe metabolic acidosis without ketonuria. After aggressive treatment, plasma sugar fell to 217 mg/dl, but brain CT showed BPH and diffuse CE. Our case demonstrated that HHS should be considered as a cause of BPH with CE. Initial brain imaging study may be recommended for patients with diabetic coma.
Adult ; Brain/pathology ; Brain Edema/*etiology ; Case Report ; Human ; Hyperglycemic Hyperosmolar Nonketotic Coma/*complications ; Male ; Putaminal Hemorrhage/*etiology ; Tomography, X-Ray Computed

BACKGROUND: Lipomas are common benign soft tissue tumors composed of mature white adipocytes, with histological features including a well-circumscribed and lobular mass covered with a thin fibrous capsule. However, lipomas that are poorly demarcated from the surrounding fat are often encountered during surgery despite a postoperative histological diagnosis. We investigated the complications associated with different types of lipomas. METHODS: This retrospective study included 119 patients who underwent lipoma excision and computed tomography (CT) imaging at our clinic between January 2011 and August 2018. We classified the lipomas as encapsulated or nonencapsulated according to the histology, CT findings, and clinical criteria. Nonencapsulated lipomas were defined as relatively heterogeneous without a distinct capsule, whereas encapsulated lipomas were homogeneous with a distinct capsule. The analyzed complications included delayed wound healing, which can cause prominent scarring, hematoma or seroma, and recurrence. RESULTS: Encapsulated and nonencapsulated lipomas were diagnosed in 89 (74.8%) and 30 (25.2%) patients, respectively. Encapsulated lipomas occurred most commonly on the head, whereas nonencapsulated lipomas occurred most commonly on the neck and trunk (P=0.000, P=0.002, and P=0.031, respectively). The Fisher exact test showed a significantly higher incidence of delayed wound healing for nonencapsulated than encapsulated lipomas (P=0.014). CONCLUSIONS: Preoperative classification of lipomas using CT imaging is important for predicting the incidence of postoperative complications. Direct excision is adequate for removing encapsulated lipomas. However, nonencapsulated lipomas might require alternative methods, such as ultrasonic liposuction, to prevent postoperative complications. Our results will help reduce the incidence of scarring by providing guidance on surgical methods.
Adipocytes, White ; Cicatrix ; Classification ; Diagnosis ; Head ; Hematoma ; Humans ; Incidence ; Lipectomy ; Lipoma ; Neck ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Seroma ; Ultrasonics ; Wound Healing

Background: Benign tumors of the forehead are highly prevalent and can cause facial asymmetry, discomfort, and psychological issues for patients. Generally, excision is performed via an incision directly over the mass, which can produce suboptimal cosmetic outcomes. Many methods involving remote incisions have been developed to conceal scars at the hairline. This study compared patient satisfaction after remote and direct incisional approaches. Methods: We retrospectively enrolled 122 patients who underwent forehead mass excision at our clinic between January 2010 and May 2019 and compared the remote and direct removal of benign forehead lesions. Data on demographics, tumor size, operative time, imaging method, the incidence of complications, and pathological results were collected. Patient satisfaction was assessed via a telephone survey. The complications monitored included hypoesthesia due to nerve injury, wound dehiscence or necrosis, hematoma or seroma, and recurrence. Results: A total of 79 patients underwent direct-approach mass excision, and 43 underwent excision with a remote approach. Lipoma was the most common tumor (70 patients), followed by osteoma (26 patients). Statistical analyses with the Mann-Whitney and Fisher exact tests revealed significantly higher satisfaction among the remote-approach group than among the direct-approach group (P<0.05). Conclusions From the perspective of scaring and complication, the group that removed forehead mass through remote approach had significantly better results than the group that removed through direct approach. However, patients’ perception of scar visibility strongly influenced their satisfaction. Therefore, a remote approach should be considered for patients who are concerned about cosmetic outcomes, and the patient’s hairstyle should also be considered.

PURPOSE: To evaluate the response and survival rate after three-dimensional conformal radiation therapy (3D-CRT) of patients with a solitary sternal relapse of breast cancer. MATERIALS AND METHODS: Seventeen patients between May 1996 and June 2005 were evaluated with the salvage 3D-CRT treatment of a solitary sternal relapse of breast cancer. The treatment fields included the gross tumor volume with 2 cm margins. The total radiation dose was 35.0~61.5 Gy (biologic effective dose of 43.7 ~76.9 Gy(10) using an alpha/beta ratio of 10 Gy), with a daily dose of 1.8~3.0 Gy. The tumor response was evaluated by the change in maximum tumor size via follow up CT scans 1~3 months after the completion of treatment. RESULTS: An objective tumor response was achieved in all patients, with a complete response in 5 patients and a partial response in 12 patients. The 5-year overall survival rate was 51.9% (median survival time: 27 months), and the most important factor affecting overall survival was the disease-free interval (interval from primary surgery of breast cancer to the development of sternal metastasis): The 5-year overall survival rate was 61.8% for patients with a disease-free interval > or =12 months and 0.0% for patients with disease-free interval <12 months (p=0.03). CONCLUSION: The response to 3D-CRT was good in patients with solitary sternal relapse of breast cancer. Particularly, patients with long disease-free interval from primary surgery survived significantly longer than patients with short disease-free interval from primary surgery.
Breast ; Breast Neoplasms ; Follow-Up Studies ; Humans ; Recurrence ; Survival Rate ; Tumor Burden

BACKGROUND: Epidermal cysts seldom arise on the palm or sole because of the absence of pilosebaceous apparatus in palmoplantar skin. Palmoplantar epidermal cysts (PPECs) are not included in this location's tumor category, because they appear as slightly elevated, hardly movable dermal or subcutaneous nodules without a central punctum, unlike other epidermal cysts. As a result, PPECs often mimic corns, calluses, or verruca. OBJECTIVE: The purpose of this study was to review the clinical features of PPECs and to explore the usefulness of ultrasonography as a diagnostic tool. METHODS: We retrospectively reviewed the medical records and ultrasonographic findings of 31 patients with PPECs among 341 patients with a confirmed epidermal cyst. Among them, 12 patients were evaluated preoperatively by ultrasonography. The data were compared between the ultrasonographic diagnosis and the final diagnosis. RESULTS: Unlike previous reports, PPECs were relatively common, and comprised 9.1% (31/341) of all epidermal cysts. They also appeared more on the sole than on the palm. In addition, PPECs were confused with corns, calluses, and other benign tumors at the first visit, because of their different clinical features from ordinary epidermal cysts. However, preoperative ultrasonography of 12 cases enabled us to make a correct diagnosis. After the operation, no recurrence was found at the last follow-up in any of the patients. CONCLUSION: PPECs have some different clinical features compared to typical epidermal cysts with a non- palmoplantar location. Therefore, it is often difficult to distinguish PPECs from other benign tumorous conditions. However, ultrasonography was useful for the preoperative diagnosis of PPECs because of its safety, low cost, non-invasiveness and, most importantly, its accuracy.
Bony Callus ; Callosities ; Epidermal Cyst ; Follow-Up Studies ; Humans ; Hydrazines ; Medical Records ; Recurrence ; Retrospective Studies ; Skin ; Warts ; Zea mays

OBJECTIVE: To investigate the diagnostic value of CT colonography for the detection of colorectal polyps. MATERIALS AND METHODS: From December 2004 to December 2005, 399 patients underwent CT colonography and follow-up conventional colonoscopy. We excluded cases of advanced colorectal cancer. We retrospectively analyzed the CT colonography findings and follow-up conventional colonoscopy findings of 113 patients who had polyps more than 6 mm in diameter. Radiologists using 3D and 2D computer generated displays interpreted the CT colonography images. The colonoscopists were aware of the CT colonography findings before the procedure. RESULTS: CT colonography detected 132 polyps in 107 of the 113 patients and conventional colonoscopy detected 114 colorectal polyps more than 6 mm in diameter in 87 of the 113 patients. The sensitivity of CT colonography analyzed per polyp was 91% (41/45) for polyps more than 10 mm in diameter and 89% (101/114) for polyps more than 6 mm in diameter. Thirteen polyps were missed by CT colonography and were detected on follow-up conventional colonoscopy. CONCLUSION: CT colonography is a sensitive diagnostic tool for the detection of colorectal polyps and adequate bowel preparation, optimal bowel distention and clinical experience are needed to reduce the rate of missing appropriate lesions.
Adult ; Aged ; Aged, 80 and over ; Colonic Polyps/*diagnosis ; Colonography, Computed Tomographic/*methods ; Colonoscopy/methods ; Colorectal Neoplasms/*diagnosis ; Contrast Media/administration & dosage ; False Negative Reactions ; False Positive Reactions ; Follow-Up Studies ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Iohexol/analogs & derivatives/diagnostic use ; Middle Aged ; Observer Variation ; Predictive Value of Tests ; Radiographic Image Enhancement/methods ; Retrospective Studies ; Sensitivity and Specificity

Ectopic pancreas is defined as pancreatic tissue found outside the usual anatomic location. It is often found incidentally at different sites in the gastrointestinal (GI) tract. The incidence of ectopic pancreatic tissue in autopsy series is 1% to 2%, with 70% of the ectopic lesions found in the stomach, duodenum and jejunum. Although it is usually a silent anomaly, an ectopic pancreas may become clinically evident when complicated by inflammation, bleeding, obstruction or malignant transformation. We report a case of ectopic pancreas located in the jejunum and presenting as an obscure GI bleeding, which was diagnosed by capsule endoscopy.
Autopsy ; Capsule Endoscopy ; Duodenum ; Gastrointestinal Hemorrhage ; Hemorrhage ; Incidence ; Inflammation ; Jejunum ; Pancreas ; Stomach

Despite advanced effective prophylaxes, pulmonary complications still occur in a high proportion of all hematopoietic stem cell recipients, accounting for considerable morbidity and mortality. The aim of our study was to describe the causes, incidences and mortality rates secondary to pulmonary complications and risk factors of such complications following hematopoietic stem cell transplantation (HSCT). We reviewed the medical records of 287 patients who underwent either autologous or allogeneic HSCT for hematologic disorders from February 1996 to October 2003 at Samsung Medical Center (134 autografts, 153 allografts). The timing of pulmonary complications was divided into pre-engraftment, early and late period. The spectrum of pulmonary complications included infectious and non-infectious conditions. 73 of the 287 patients (25.4%) developed pulmonary complications. Among these patients, 40 (54.8%) and 29 (39.7%) had infectious and non-infectious conditions, respectively. The overall mortality rate from pulmonary complications was 28.8%. Allogeneic transplant, grade II-IV acute graft-versus-host disease (GVHD) and extensive chronic GVHD were the risk factors with statistical significance for pulmonary complications after HSCT. The mortality rates from pulmonary complications following HSCT were high, especially those of viral and fungal pneumonia, diffuse alveolar hemorrhage and idiopathic pneumonia syndrome.
Transplantation, Homologous ; Transplantation, Autologous ; Transplantation Conditioning ; Middle Aged ; Male ; Lung Diseases/*etiology ; Lung/microbiology ; Humans ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Graft vs Host Disease ; Female ; Bacterial Infections/etiology ; Aged ; Adult ; Adolescent

The association between a multiple myeloma and a secondary solid tumor is not well established. Some reports showed an increased risk of secondary solid neoplasms in multiple myeloma patients, but others have not. Three cases of the synchronous occurrence of multiple myelomas and solid tumors, namely, a small cell carcinoma of the lung, an adenocarcinoma of the colon and a squamous carcinoma of the pyriform sinus were experienced at our hospital. Therefore, herein is reported the clinical courses and treatment results. The stage of multiple myeloma was Durie-Salmon stage I in all of three cases; therefore, the solid tumors were treated as a primary target because the prognosis of early stage multiple myeloma is generally better than that of advanced solid tumor, while a smoldering or stage I myeloma do not need primary therapy until progression of the multiple myeloma. Two patients died of their solid tumors, but one patient is alive.
Adenocarcinoma ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Colon ; Humans ; Lung ; Multiple Myeloma* ; Neoplasms, Multiple Primary ; Neoplasms, Second Primary ; Prognosis ; Pyriform Sinus

Androgen insensitivity syndrome (AIS) is a X-linked disorder of sexual differentiation resulting from defective androgen receptor (AR) function. Androgens are secreted by the testes of 46,XY individuals, but there is loss of target organ response to the hormone. The abnormalities of AR are due to defects in the AR gene, and many mutations causing AIS have been reported since the cloning of AR gene. In this study, we analyzed the AR genes in twelve Korean patients with androgen insensitivity syndrome: 9 patients with complete AIS and 3 patients with partial AIS DNAs were isolated from patients with AIS, and the coding region of AR gene was amplified by a polymerase chain reaction using 7 pairs of primers (exon B-H). Sequence analysis of the AR gene was performed using direct sequencing and single strand conformational polymorphism (SSCP). The AR gene mutations were identified in 7 out of 12 patients: 6 of 9 patients with complete AIS, and one of 3 patients with partial AIS. Mutations found were as follows: the point mutation (ATT->ACT) at position 680 of exon D, point mutation (TGG->TGC) at position 751 of exon E, point mutation (CAA->TAA) at position 792 of exon F, point mutations (CGC->TGC, GTG->ATG) at position 855 and 866 of exon G, and the deletion of 13 nucleotides (CGTATCATTGCAT) at position 840 of exon G, respectively. To the best of our knowledge, the point mutations found in exon D, exon E, and exon F, and the deletion in exon G have not been observed before. SSCP revealed bands with abnormal mobility in 10 out of 12 patients tested. Mutations were found 5 out of these 10 patients. The other two patients showed no abnormal band on SSCP, but showed mutations by direct sequencing. In conclusion, we have demonstrated the AR gene mutations, including three novel mutations, in Korean patients with AIS, and these abnormalities might be related to the pathogenesis of androgen insensitivity syndrome.
Androgen-Insensitivity Syndrome* ; Androgens ; Clinical Coding ; Clone Cells ; Cloning, Organism ; DNA ; Exons ; Humans ; Male ; Nucleotides ; Point Mutation ; Polymerase Chain Reaction ; Polymorphism, Single-Stranded Conformational ; Receptors, Androgen* ; Sequence Analysis ; Sex Differentiation ; Testis