Radiation recall phenomenon is an inflammatory reaction which occurs at a previously irradiated area after the administration of causative agents, especially anticancer drugs. Radiation recall mostly involves skin and rarely affects internal organs. We, hereby, report a rare case of radiation recall myositis. A 51-years-old man visited the hospital due to pain and weakness of the left thigh. He had been diagnosed with a skin metastasis of pancreatic adenocarcinoma, at the left thigh and treated with radiotherapy and subsequent combination chemotherapy of 5-FU and cisplatin. After the 5th cycle of chemotherapy, the patient developed pain and weakness localized at the previous radiation field. An MRI revealed myositis of left gluteus medius muscle. Muscle biopsy showed no malignant cells or signs of infection. He was diagnosed as having radiation recall myositis and treated with steroid and NSAID. Soon after, pain and weakness gradually improved. Although rare, a possibility of radiation recall myositis should be considered when a patient with history of radiotherapy has a myopathy.
Adenocarcinoma ; Biopsy ; Cisplatin ; Drug Therapy, Combination ; Fluorouracil ; Humans ; Muscles ; Muscular Diseases ; Myositis ; Neoplasm Metastasis ; Skin ; Thigh

No abstract available.
Coronary Artery Bypass* ; Coronary Vessels* ; Echocardiography*

A primary genitourinary melanoma is rare, accounting for less than 1% of all cases of melanoma. They have been presented in case reports, with a subsequent paucity of insight into the natural history of the disease and appropriate management of patients. The prognosis of patients with a genitourinary melanoma is poor. Delay in seeking medical attention for symptoms, and misdiagnosis at presentation, contribute to a more advanced stage at diagnosis. Our case involved a 71 year old woman, who came to our hospital due to vaginal spotting. On local excision, mass was found on the vestibule and forward to the urethra. The pathological diagnosis, by special immunohistochemical staining, such as S-100 protein and HMB-45, was that of a malignant melanoma.
Aged ; Diagnosis ; Diagnostic Errors ; Female ; Humans ; Melanoma* ; Metrorrhagia ; Natural History ; Prognosis ; S100 Proteins ; Urethra ; Vagina

Behcet's disease (BD) is a rare, multisystemic disorder characterized by vasculitis. Although renal involvement rarely coexists with BD, several types of renal involvements have been reported: amyloidosis, glomerulonephritis and vascular involvement. Herein, we report a rare case of BD complicated with IgA nephropathy (IgAN). A 42-year-old woman visited the hospital due to joint pains and painful subcutaneous nodules. Based on her medical history of recurrent orogenital ulcers, arthritis, enteral ulcers, erythema nodosum-like skin lesions, and a positive pathergy test, we diagnosed her with BD. To evaluate proteinuria, we performed a renal biopsy. The patient was diagnosed with BD complicated with IgAN, and treated with a low dosage of steroid, colchicine, as well as angiotensin II type I receptor blockers. Although renal involvement in BD is rare, it is important to periodically perform renal function assessments in patients with BD involving abnormal urine results.
Adult ; Angiotensin II Type 1 Receptor Blockers ; Arthralgia ; Arthritis ; Biopsy ; Colchicine ; Erythema Nodosum ; Female ; Glomerulonephritis ; Glomerulonephritis, IGA ; Humans ; Immunoglobulin A ; Proteinuria ; Skin ; Ulcer ; Vasculitis

A 59-year-old woman presented with abdominal pain. Abdominal computerized tomography was suggestive of biliary stones. During endoscopic retrograde cholangiopancreatography, adult worms resembling Clonorchis sinensis (C. sinensis) were drained. Eggs were detected in stool using the formalin-ether concentration method and C. sinensis-specific antibody was detected in the serum. A diagnosis of C. sinensis infection was made. The symptoms of the patient gradually resolved after treatment with anti-parasite medication. The patient lived in a non-endemic region for C. sinensis infection and had no history of intake of raw or undercooked freshwater fishes. South Korea is one of the endemic countries for C. sinensis infection and people can be infected via indirect routes of transmission such as cooking utensils. Therefore, the possibility of C. sinensis infection should be considered in patients presenting with biliary diseases in South Korea. We describe the clinical findings of this case with a review of literature.
Abdominal Pain ; Adult ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystitis ; Cholecystitis, Acute ; Clonorchis sinensis ; Cooking and Eating Utensils ; Diagnosis ; Eggs ; Female ; Fishes ; Fresh Water ; Humans ; Korea ; Methods ; Middle Aged ; Ovum

BACKGROUND AND PURPOSE: Alzheimer's disease (AD) is associated with structural alterations in the medial temporal lobe (MTL) and functional alterations in the posterior cortical region, especially in the early stages. However, it is unclear what mechanisms underlie these regional discrepancies or whether the posterior cortical hypometabolism reflects disconnection from the MTL lesion or is the result of local pathology. The precuneus, an area of the posteromedial cortex that is involved in the early stages of AD, has recently received a great deal of attention in functional neuroimaging studies. To assess the relationship between the precuneus and hippocampus in AD, we investigated the volumes of these two areas using a magnetic resonance volumetric method. METHODS: Twenty-three subjects with AD and 14 healthy age-matched controls underwent T1-weighted three-dimensional volumetric brain magnetic resonance imaging. Volumetric measurements were performed in the precuneus and hippocampus. RESULTS: Compared to controls, AD patients exhibited a significant reduction in total precuneal volume, which was more prominent on the right side, and significant bilateral reductions in hippocampal volume. No correlation was found between the total volumes of the precuneus and hippocampus in the AD group. CONCLUSIONS: These results suggest that volumetric measurements of both the precuneus and hippocampus are useful radiological indices for the diagnosis of AD. Furthermore, the lack of correlation is attributable to local pathology rather than being a secondary consequence of MTL pathology.
Alzheimer Disease ; Brain ; Functional Neuroimaging ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Temporal Lobe

BACKGROUND AND PURPOSE: Alzheimer's disease (AD) is associated with structural alterations in the medial temporal lobe (MTL) and functional alterations in the posterior cortical region, especially in the early stages. However, it is unclear what mechanisms underlie these regional discrepancies or whether the posterior cortical hypometabolism reflects disconnection from the MTL lesion or is the result of local pathology. The precuneus, an area of the posteromedial cortex that is involved in the early stages of AD, has recently received a great deal of attention in functional neuroimaging studies. To assess the relationship between the precuneus and hippocampus in AD, we investigated the volumes of these two areas using a magnetic resonance volumetric method. METHODS: Twenty-three subjects with AD and 14 healthy age-matched controls underwent T1-weighted three-dimensional volumetric brain magnetic resonance imaging. Volumetric measurements were performed in the precuneus and hippocampus. RESULTS: Compared to controls, AD patients exhibited a significant reduction in total precuneal volume, which was more prominent on the right side, and significant bilateral reductions in hippocampal volume. No correlation was found between the total volumes of the precuneus and hippocampus in the AD group. CONCLUSIONS: These results suggest that volumetric measurements of both the precuneus and hippocampus are useful radiological indices for the diagnosis of AD. Furthermore, the lack of correlation is attributable to local pathology rather than being a secondary consequence of MTL pathology.
Alzheimer Disease ; Brain ; Functional Neuroimaging ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Temporal Lobe

BACKGROUND/AIMS: It remains unclear whether atrophic gastritis can affect dyspeptic symptoms. We aimed to investigate whether the extent of atrophic gastritis is associated with specific dyspeptic symptoms. METHODS: Consecutive adults in a routine health-checkup program were enrolled in the study. The extent of atrophic gastritis was classified into 3 groups based on the Kimura-Takemoto criteria; the gastritis with no or little atrophy (group A: C0), the gastritis with atrophy mainly in the antrum (group B: C1 and C2), and the gastritis with atrophy in the large area of the corpus (group C: C3 and O). Upper gastrointestinal symptoms were categorized into "typical reflux symptoms," "epigastric pain syndrome (EPS)-related symptoms," and "postprandial distress syndrome (PDS)-related symptoms." RESULTS: A total of 1827 patients (1009 males, mean age 45.1 years) were included in the analysis. The subgroups of atrophic gastritis were as follows: group A (n = 1218, 66.7%), group B (n = 392, 21.4%), and group C (n = 217, 11.9%). Typical reflux, EPS-related, and PDS-related symptoms were present in 10.5%, 19.8%, and 16.2% of the subjects, respectively. PDS-related and EPS-related symptoms were significantly more prevalent in the group C of male patients and the group B of female patients, respectively, compared with other groups. PDS-related and EPS-related symptoms were independently associated with the group C in males (OR, 2.123; 95% CI, 1.090-4.136) and the group B in females (OR, 2.571; 95% CI, 1.319-5.025), respectively. CONCLUSIONS: The extent of atrophic gastritis appears to affect the generation of specific dyspeptic symptoms in a gender-dependent manner.
Adult ; Atrophy ; Dyspepsia ; Female ; Gastritis ; Gastritis, Atrophic* ; Humans ; Male

The retrograde approach through a collateral artery is now thought to improve the success rate of percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO), and different kinds of strategies for this technique have been developed. However, the basic principles of PCI for CTO, such as firm back-up support with a guiding catheter and fine control of the guide wire, should be adhered to more strictly to succeed with this complex procedure. We present a case in which a CTO of the proximal left anterior descending artery was successfully opened by the retrograde approach through a collateral from the left circumflex artery, during which two guiding catheters were simultaneously used in the same coronary artery for the purpose of strong back up support for the retrograde device and fine control for the antegrade device.
Angioplasty, Balloon, Coronary ; Arteries ; Catheters ; Coronary Occlusion ; Coronary Vessels ; Percutaneous Coronary Intervention

BACKGROUND: Primary malignant tumors of the trachea are extremely rare entities and account for a mere 0.1 percent of all malignancies of the respiratory tract Because of vague localizing signs, symptoms and a usually negative routine chest film, the patients with tracheal tumors are often treated for asthma or chronic obstructive pulmonary disease for considerable period of time before correct diagnosis. METHODS: We Have made a review of the 17 cases of primary tracheal tumors in recent 15 years. We reviewed the clinical features including history of smoking arid respiratory symptoms, the official readings of initial routine chest film, the cytologic examination of sputum, the time of delay in diagnosis, and the response according to the therapeutic modalities. RESULTS: Eight out of 9 patients with squamous cell carcinoma(SCC) were above 50 years old, five out of 6 patients with adenoid cystic carcinoma(ACC) were below 50 years old. The most common location of primary tracheal tumors was the upper one-third of trachea in 8 cases(47%). The most frequent symptoms were dyspnea in 13/17 cases(76%) and then strider or wheezing, cough, and sputum in order. The routine chest roentgenographic examinations wore not helpful to diagnose tracheal carcinoma and the cytologic examinations of sputums were helpful to diagnose tracheal carcinoma in only one case with adenocarcinoma. The mean times of delay in diagnosis of patients with SCC and ACC were S months and 24.9 months respectively. We bad bronchial asthma in 8 cases(47%) and tracheal tumors in 4 cases(23%) as initial clinical impression CONCLUSION: We would like to perform more comprehensive diagnostic too]s(high KVP technique, the fibroptic bronchoscopic examination, chest CT scan etc.) in patients who had the suggestive points for the tracheal tumors(1. unexplained hemoptysis or hoarsness, 2. inspiratory wheezing or stridor, 3. wax arid waning of dyspnea according to changes of position. 4. progressive asthmatics unresponsive to antiasthmatic therapy) and radical resection of tumor or external radiation therapy with curative aim as possible.
Adenocarcinoma ; Adenoids ; Asthma ; Cough ; Diagnosis ; Dyspnea ; Hemoptysis ; Humans ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; Reading ; Respiratory Sounds ; Respiratory System ; Smoke ; Smoking ; Sputum ; Thorax ; Tomography, X-Ray Computed ; Trachea