Black adenoma is known to be a rare variant of adrenal cortical adenoma containing characteristic abundant lipofuscin pigments in the cytoplasm. Almost all of them are nonfunctioning and only occasionally they are associated with Cushing's syndrome or primary hyperaldosteronism. We present two cases of black cortical adenoma of the adrenal gland associated with Cushing's syndrome in a 24-year-old woman and a 64-year-old man. This report dealt with clinical and pathologic presentation including ultrastructural identification of lipofuscin pigment.
Female ; Male ; Humans ; Adenoma

No abstract available.
Breast* ; Female* ; Humans

No abstract available.
Chylous Ascites*

Sacrococcygeal chordoma is a rare malignant tumor which is believed to take its origin from remnants of the fetal notochord, and presents in the sacral hollow or occasionally posteriorly. The growth is leisurely and it is invasive rather than metastatic. In treatment, there is evidence that early diagnosis of sacrococcygeal chordoma followed by radical resection c palliative radiotherapy does provide the opportunity for cure. We have experienced two cases of sacrococcygeal chordoma, which were treated with one case of a complete surgical resection and the other case of only biopsy.
Biopsy ; Chordoma ; Early Diagnosis ; Notochord ; Radiotherapy

Objective: Sudden traumatic physical injuries often cause psychological distress, which may be associated with chronic disability. Although considerable effort has been expended to identify genetic predictors of post-traumatic stress disorder (PTSD) after traumatic events, genetic predictors of psychological distress in response to severe physical injuries have been yet to be elucidated using whole exome sequencing (WES). Here, the genetic architecture of post-traumatic syndrome (PTS), which encompasses a broad range of psychiatric disorders after traumatic events including depression, anxiety disorder, acute stress disorder, and PTSD, was explored using WES in severely physically injured patients, focusing on secondary findings and potential PTS-related variants. Methods: In total, 141 severely physically injured patients were consecutively recruited, and PTS was evaluated within 1 month of the injury. Secondary findings were analyzed according to PTS status. To identify PTS-related variants, genome-wide association analyses and the optimal sequencing kernel association test were performed. Results: Of the 141 patients, 88 (62%) experienced PTS. There were 108 disease-causing variants in severely physically injured patients. As secondary findings, the stress- and inflammation-related signaling pathways were enriched in the PTS patients, while the glucose metabolism pathway was enriched in those without PTS. However, no significant PTS-related variants were identified. Conclusion Our findings suggest that genetic alterations in stress and inflammatory pathways might increase the likelihood of PTS immediately after severe physical injury. Future studies with larger samples and longitudinal designs are needed.

PURPOSE: In this study we evaluated the long-term outcomes and prognostic factors of trabeculectomy with mitomycin C (MMC) in eyes with uveitic glaucoma (UG) compared with primary open-angle glaucoma (POAG). METHODS: We performed a retrospective chart review of 60 eyes with UG and 402 eyes with POAG that were followed up for at least 1 year after trabeculectomy with MMC between June 2000 and December 2012. The review included intraocular pressure (IOP), number of anti-glaucoma medications, and postoperative complications. Surgical success was analyzed using the Kaplan-Meier life-table method based on 2 definitions of successful IOP control with topical anti-glaucoma medications: Definition A (IOP < or = 15 mm Hg) and Definition B (IOP < or = 18 mm Hg). Risk factors for surgical failure of trabeculectomy were analyzed using the Cox proportional hazards model. RESULTS: Success rate at 5 years after trabeculectomy was lower in UG than in POAG (65.8% vs. 76.4%, Definition B), but without significant difference. However, UG had a significantly lower cumulative probability of success than POAG based on Kaplan-Meier survival curves (p = 0.049 and 0.044, respectively). Postoperative hypotony and hypotony maculopathy was more frequent in UG (p = 0.044 and 0.044, respectively). In UG, the Cox proportional hazards model showed postoperative shallow anterior chamber was associated with surgical failure in both Definition A and B. CONCLUSIONS: Long-term results of trabeculectomy with MMC in eyes with UG showed successful IOP control similar to POAG. Trabeculectomy with MMC is a reasonable surgical option for the management of UG.
Anterior Chamber ; Glaucoma* ; Glaucoma, Open-Angle* ; Intraocular Pressure ; Kaplan-Meier Estimate ; Mitomycin* ; Postoperative Complications ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Trabeculectomy*

The purpose of the present study was to compare prapofol, newly introduced anesthetic agnet, & thiopental as to the characteristics of induction & recovery as well as the safety of both anents. Fifty patients who presented for termination of pregnancy were allocated at random to recieve either propofol 2 mg/kg IV or thiopental 4 mg/kg IV. In addition all patients recevied fentanyl, 1 ug/kg IV, one minute befor the induction. Repeated bolus doses of either propofol 20 mg or thiopental 50 mg were given, if the patient respond to surgical stimulation by moving. The result were as follows. 1) Both propofol and thiopental produced smooth and rapid induction, but caused significant respiratory depression. 2) There was more cardiovascular depression with propofol than with thiopental. 3) Postoperative recovery(time to ambulation) was faster with propofol than with thiopental (36.5+/-1.4 vs 72.9+/-5.1 min, p<0.001). 4) Propofol was associated with less side effects(Nausea, vomithing, and dizziness) than thiopental. These results suggest 1) that propofol has significant advantage over thiopental in outpatient surgery, where early ambulation and discharge is desirable, and 2) that both propofol and thiopental should be administered by expert anesthesiologist only when ventiatory assistant device with oxygen is immediately available.
Ambulatory Surgical Procedures* ; Anesthesia* ; Depression ; Early Ambulation ; Fentanyl ; Humans ; Oxygen ; Pregnancy ; Propofol* ; Respiratory Insufficiency ; Thiopental*

Phenomenology has been developed by philosophers like Kant and Husserl since the late 18th century. Jaspers, a German psychiatrist, adopted it into psychopathology studies and accumulated data by closely observing and recording the patients' symptoms and signs. Among descriptions done even before the psychopathology or diagnostic criteria of disorders in the field of child psychiatry was established, we can find exact and valuable descriptions matching the autism spectrum disorder or attention deficit/ hyperactivity disorder. The diagnostic criteria of modern childhood psychiatric disorders were established based on these grounds. Phenomenological/descriptive methods in various psychiatric fields lead to medical study methods for social phenomenon such as oiettolie, hikikomori, and internet game addiction. Since Romanian orphans were adopted to the western world, descriptive studies along with neurobiological studies on the influence of stimulus deprivation on emotional and physical development are being conducted. While phenomenology, which was adopted by Jaspers to verify psychopathology, was developed mainly by observation and description, recent studies are explaining such descriptive phenomena even at the synapse level due to advances in neurobiology. Although phenomenological/descriptive psychiatry, describing precise and detailed experiences of patients, is less applied nowadays among modern study methods, we must remember that such descriptions may lead to biological studies and provide evidence to improve the accuracy of choosing and applying treatment methods.
Autistic Disorder ; Child ; Autism Spectrum Disorder ; Child Psychiatry* ; Child, Orphaned ; Humans ; Internet ; Neurobiology ; Psychiatry ; Psychopathology ; Romania ; Synapses ; Western World

The authors report two cases of clozapine-induced acute hepatitis. Two patients developed asymptomatic hepatitis and got better with conservative care. We decreased the dosage of clozapine and added hepatic protectors, resulting in normalized laboratory findings. The authors also reviewed side effects of clozapine in this report. We reviewed the suggested mechanism of either clozapine or chlorpromazine-induced hepatitis. Clozapine influences the liver cell via cytochrome P 450 and chlorpromazine does so via mild cholestasis. There may be a possibility that a patient who has experienced drug-induced hepatitis is vulnerable to clozapine-induced acute hepatitis. In this respect, those who have experienced drug-induced hepatitis must be observed more closely.
Chlorpromazine ; Cholestasis ; Clozapine ; Cytochrome P-450 Enzyme System ; Drug-Induced Liver Injury ; Hepatitis* ; Humans ; Liver

BACKGROUND: The lateral radiograph-based system described by Tsuyama is used widely to classify ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. However, OPLL is a complex 3-dimensional (3-D) lesion, not a simple and uniplanar one, which is often difficult to identify on a lateral radiograph. Furthermore, its reliability among spine surgeons has not been investigated. Given the popularity of a reconstructed computed tomography (CT), this study examined the inter- and intra-observer reliability of lateral radiograph-based OPLL classification using that modality. METHODS: Five spine surgeons independently reviewed the lateral radiograph, axial CT, 2-D (sagittal) and 3-D reconstructed CT images of 108 OPLL patients on 2 separate occasions. Based on these images, the reviewers classified each OPLL case according to the Tsuyama's system. The kappa values were used to assess the statistical reliability. RESULTS: The inter- and intra-observer kappa values were only 0.51 and 0.67 for the lateral radiograph, even in combination with the axial CT images, 0.70 and 0.85 for 2-D CT images, and 0.76 and 0.86 for 3-D CT images, respectively. These kappa values showed a good-to-excellent range for the 2-D and 3-D reconstructed CT images while those of the lateral radiograph indicated a fair range. According to the OPLL types, the inter- and intra-observer reliability was low in the continuous type and high in the circumscribed type on the lateral radiograph. However, the low reliability of the continuous type on lateral radiograph was overcome somewhat using 2-D and 3-D reconstructed CT images. CONCLUSIONS: The inter- and intra-observer kappa values were only 0.51 and 0.67 for the lateral radiograph, even in combination with the axial CT images, 0.70 and 0.85 for 2-D CT images, and 0.76 and 0.86 for 3-D CT images, respectively. These kappa values showed a good-to-excellent range for the 2-D and 3-D reconstructed CT images while those of the lateral radiograph indicated a fair range. According to the OPLL types, the inter- and intra-observer reliability was low in the continuous type and high in the circumscribed type on the lateral radiograph. However, the low reliability of the continuous type on lateral radiograph was overcome somewhat using 2-D and 3-D reconstructed CT images.
Adult ; Aged ; Cervical Vertebrae/radiography ; Female ; Humans ; Image Processing, Computer-Assisted ; Male ; Middle Aged ; Observer Variation ; Ossification of Posterior Longitudinal Ligament/*classification/*radiography ; *Tomography, X-Ray Computed