No abstract available.
Adrenocortical Carcinoma*

PURPOSE: We evaluated the frequency of detection of small hepatic cystic lesion(SHC) on abdominal CT films and its significance in patients with extrahepatic malignancies. METHODS AND MATERIALS: We retrospectively reviewed the abdominal CT films of a total 1112 patients to determine the frequency of detection of SHC, and 62 patients who had both extrahepatic malignancies and SHC were selected. A total 106 SHC determined as benign or malignant in 40 patients was analyzed according to the size(< 1 cm, 1 2cm), the number(1, 2 4, >4), the margin(well-defined, iil-defined),and the location(central, peripheral) of individual cystic lesions. The findings of follow-up CT and ultrasonography and the results of biopsy were also reviewed. The frequency of combined renal cyst was also considered. RESULT: SHC of those 62 patients were classified as benign(27 patients, 43.6%), malignant(13 patients, 20. 9%), or undetermined(22 patients, 35.5%) by the follow-up CT, ultrasonography, and biopsy. Most benign SHC (74.4%) measured under 1 cm, but 75% of the malignant SHC were in 1 -2cm in size. The percentage of the malignancy in one and two to four SHC was 37.5% and 40%, respectively. The margin of SHC was ill-defined in 67.9% of the benign and 64.3% of the malignant lesions. SHCs were mainly located at the periphery of the liver(benign :62.7%, malignant: 64.3%). Coexisting renal cyst was rare. CONCLUSION: SHC is not uncommon finding(13.2%) in patients with extrahepatic malignancy and has a high probablity of metastasis when it is larger than 1 cm, which should be closely followed and intensively studied further.
Biopsy ; Follow-Up Studies ; Humans ; Incidence* ; Neoplasm Metastasis ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography

Few cases of ichthyosis bullosa of Siemens(IBS) have been reported since 1939, as a distinct entity from bullous congenital ichthyosiform erythroderma(BCIE). IBS can be differentiated from BCIE by the absence of congenital erythroderma and a different distribution of involved skin area. It's characteristic features include blistering, superficial erosion or moulting of the outer skin. Histological features are tonofilaments aggregation confined to the granular and upper spinous layer of the epidermis. However, in BCIE these findings are present in the whole suprabasal compartment. The original reports of Siemens and cases from other authors showed an autosomal dominant inheritance. Our patient developed IBS sporadically without a familial background.
Blister ; Dermatitis, Exfoliative ; Epidermis ; Humans ; Ichthyosis Bullosa of Siemens* ; Ichthyosis* ; Intermediate Filaments ; Molting ; Skin ; Wills

OBJECTIVES: Delirium is a disorder defined as a sudden disturbance in thinking, speaking, acting and sleep pattern due to altered level of consciousness and cognitive function. The objective of this study is to analyze characteristics and therapeutic methods of the delirious patients during the recent 5 years, and provide basic data for further studies and investigation regarding delirium in the occurrence and treatment. METHODS: We retrospectively reviewed medical records of 475 patients who were consulted for delirium in Kyunghee University Medical Center from January 2007 to December 2011. RESULTS: During the 5 years, among the 475 patients who were diagnosed as delirium, men were more common(61.7%). The most commonly consulted reason and cause were sleep disturbance(80.8%) and post-operational delirium(30.9%), respectively. The medication prescription percentage was 76.6% and was significantly increased year after year. Ratio of using antipsychotics were 76.4% among prescribed medication and the most frequently prescribed antipsychotic drug was quetiapine(46.8%). Other specialists commonly misdiagnosed delirium when the patient was previously diagnosed as dementia(6.8%). CONCLUSIONS: In our study, post-operational delirium was the most commonly referred reason and the percentage of medication prescription tended to increase. Patients with history of dementia were more easily misdiagnosed as diseases other than delirium. Our study suggests that we should evaluate symptoms, causes, reasons of consultation, management tendency of delirium. We should also closely observe changes in sleep patterns and establish the prevention strategies for post-operational delirium and therapeutic bases for pharmacotherapy.
Academic Medical Centers ; Antipsychotic Agents ; Consciousness Disorders ; Delirium ; Dementia ; Humans ; Male ; Medical Records ; Prescriptions ; Retrospective Studies ; Specialization ; Thinking

The abnormalities in Hypothalamic-pituitary-adrenal(HPA) axis are associated with many psychiatric symptoms including depression. We present a report of a 71 year old man who was admitted to the psychiatric department presenting symptoms of headache, avolition, loss of energy, psychomotor retardation, poor appetite, insomnia, anxiety resulting from adrenal insufficiency and hypopituitarism. Hypothyroidism and electrolyte disturbance were managed and headache, insomnia, anxiety, GI symptoms were improved. But he remained in anergic state. After discharge, he was readmitted to infection department with high fever and drowsy mentality. Adrenal insufficiency was recognized and he was treated with corticosteroid replacement therapy. Finally his diagnosis was made as panhypopituitarism and overall symptoms were resolved. In this case, we showed how the atypical symptoms resulting from hypopituitarism develop and progress. Hypothyroidism, adrenal insufficiency, and growth hormone deficiency resulting secondarily from panhypopituitarism were associated with various nonspecific symptoms such as loss of energy, fatigue, insomnia, weight loss, decreased appetite etc. In clinical situation, differential diagnosis with depression is needed when clinicians were met a patient with these nonspecific symptoms. It is important that laboratory tests and differential diagnosis with endocrine diseases should be conducted, especially in geriatric patients with nonspecific symptoms like anergia, fatigue, poor appetite and so on.
Adrenal Insufficiency ; Anxiety ; Appetite ; Axis ; Depression ; Diagnosis, Differential ; Endocrine System Diseases ; Fatigue ; Fever ; Growth Hormone ; Headache ; Humans ; Hypopituitarism ; Hypothyroidism ; Sleep Initiation and Maintenance Disorders ; Weight Loss

PURPOSE: The occurrence of traumatic aneurysm is rare in head injury, but this complication is important as it is a potentially treatable cause delayed onset of intracranial hemorrhage. Authors report one case of traumatic aneurysm involving A1 and A2 junction of anterior cerebral artery. MATERIALS AND METHODS: A-28-year-old man with traffic accident was examined with brain CT & cerebral angiography. RESULTS: l) Brain CT:lnitial scan shows multiple skull fractures involving right frontal bones with subarachnoid hemorrhage and pneumocephalus. Follow-up scan shows intracerebral hemorrhage at bilateral frontal lobes. 2) Cerebral angiography:A traumatic aneurysm which is slowly filling and delayed emptying is noted at the junctional portion of A1 and A2 segment of the anterior cerebral artery. CONCLUSION: This report demonstrates radiologic findings of traumatic aneurysm at anterior cerebral artery with the brief review of the literatures.
Accidents, Traffic ; Aneurysm ; Anterior Cerebral Artery ; Brain ; Cerebral Angiography ; Cerebral Hemorrhage ; Craniocerebral Trauma ; Follow-Up Studies ; Frontal Bone ; Frontal Lobe ; Intracranial Aneurysm* ; Intracranial Hemorrhages ; Pneumocephalus ; Skull Fractures ; Subarachnoid Hemorrhage

Extrathoracic metastasis of a thymoma is rare ; we report a case of metastasis to the liver of a large solitary thymoma. Biopsy of the mass showed it to be predominantly lymphocytic and histologically the same as a primary thymoma operated on four years previously. On ultrasound and CT scan, the majority of the metastatic tumor was hemorrhagic, necrotic and/or cystic, with a peripheral, irregularly thick solid component and rather thin, smooth encapsulation.
Biopsy ; Liver* ; Neoplasm Metastasis* ; Thymoma* ; Tomography, X-Ray Computed ; Ultrasonography

Objective: Viral infections play an important role in the development of schizophrenia, inducing the faulty immunological responses and aberrant inflammation. IFN-γ-inducible protein 16 (IFI16) is an immunological DNA sensor against viral infections, triggering the inflammatory responses. In this study, we investigated an association between putative promoter single nucleotide polymorphisms (SNPs) and haplotypes of IFI16 and schizophrenia. Methods: A total of 280 schizophrenia patients and 427 control subjects were recruited in this study. We genotyped three promoter SNPs (rs1465175, rs3754464, rs1417806) using direct sequencing. Associations of SNPs and haplotypes of IFI16 with schizophrenia were analyzed. The promoter activities on the haplotypes of IFI16 were measured. Results: The T allele of rs1465175 and the C allele of rs1417806 were protectively associated with schizophrenia (p=0.021 on rs1465175; p=0.016 on rs1417806), whereas the G allele of rs3754464 was associated with an increased risk of schizophrenia (p=0.019). In haplotype analysis, a significant association between the GGA haplotype and schizophrenia was shown (p=0.013). Moreover, we found that the GGA haplotype elevated the promoter activity compared to the GAA haplotype, whereas the TAC haplotype reduced that. Conclusion The promoter SNPs and haplotypes of IFI16 may contribute to the susceptibility of schizophrenia, affecting the promoter activity of IFI16.

PURPOSE: MR findings of the spinal metastasis and the tuberculosis are well known, but sometimes it might be difficult to differentiate these lesions. Therefore we reviewed and analyzed the MR findings which would be useful for the differentiation. MATERIALS AND METHODS: T1- and T2-weighted spin echo images and gadolinium-enhanced Tl-weighted images were obtained with 1. 5T and 1. 0T superconductive MR imager. We reviewed MR findings in 16 cases of spinal metastases and 24 cases of spinal tuberculosis in terms of signal intensity, contrast enhancement pattern, disc space involvement, spinal canal compressing feature and paraspinal soft tissue mass. RESULTS: The signal intensities of both lesions were hypointense on T1WI and hyperintense on T2WI except those of the metastatic lesions from the prostatic carcinoma. Heterogeneous enhancement was noted in 63% of metastasis, whereas peripheral rim enhancement was noted in 83% of spinal tuberculosis(p (.001). Spinal canal compression by collapsed vertebra was only noted in spinal metastasis, and that by paraspinal soft tissue was noted in both spinal metastasis and tuberculosis(p (.001). Disc space invasion was noted in 19% of spinal metastasis and 88% of spinal tuberculosis. Spinal tuberculosis was common at lower thoracic spine(T10) and typically involved two or more adjacent vertebral bodies(96%). CONCLUSION: The important differential point between spinal metastasis and tuberculosis was the enhancement pattern, involvement of two or more contiguous vertebral bodies and the feature of spinal canal compressing. The secondary importance was the disc space involvement pattern.
Neoplasm Metastasis* ; Spinal Canal ; Spine ; Tuberculosis ; Tuberculosis, Spinal*

PURPOSE: Ingested foreign bodies present a common clinical problem. It is well known that most of them pass uninterrupted through the gastrointestinal tract. We evaluated the role of endoscopy and Foley catheter for removal of foreign bodies in the gastrointestinal tract. METHODS: We investigated retrospectively 60 cases with foreign bodies in the gastrointestinal tract. They had been treated at Wonju Christian Hospital, Yonsei University of Korea, from January, 1996 through December, 1999. RESULTS: The age of the patients ranged from 7 months to 13 years. Patients under 5 years were 57 cases (97%) and there was no significant difference in sex (M : F=1.07 : 1). 45 cases of the patients had no symptom. The most common foreign bodies were coins (43 cases). The most common location was esophagus (31 cases). The number of foreign body removal using flexible endoscopy and Foley catheter was 22 (36.7%) and 18 (30.0%) cases, respectively. In 18 cases (30.0%), foreign bodies passed spontaneously. Only 1 case (1.7%), curtain pin impaction at ileocecal region, required surgery. CONCLUSION: Early foreign body removal from esophagus and stomach is recommended to lessen the morbidity and complication. Fluoroscopic foley catheter technique and flexible endoscopy for removal of esophageal foreign bodies in children is safe and effective.
Catheters ; Child* ; Endoscopy ; Esophagus ; Foreign Bodies* ; Gangwon-do* ; Gastrointestinal Tract ; Humans ; Korea* ; Numismatics ; Retrospective Studies ; Stomach