Pseudochylothorax is an uncommon pleural effusion disease characterized by the presence of cholesterol crystals or high lipid content not resulting from a disrupted thoracic duct. Most of the cases reported so far had been found in patients with long-standing pleural effusion due to a chronic inflammatory disease such as old tuberculous pleurisy or chronic rheumatoid pleurisy. Authors encountered a case of pseudochylothorax in a 45-year-old man who had been treated for tuberculous pleurisy 6 years before his visit to authors' hospital. After that, he had visited the emergency department many times for removal of pleural effusion. The patient's chest X-ray revealed dyspnea and large left-sided pleural effusion. Although a large amount of pleural fluid was removed with a drainage catheter, massive pleural effusion was likely to recur, and the underlying lung was able to fully re-expand. Accordingly, decortication was done, and the patient's symptom was improved without postoperative complications.
Catheters ; Cholesterol ; Drainage ; Dyspnea ; Emergency Service, Hospital ; Humans ; Lung ; Middle Aged ; Pleural Effusion ; Pleurisy ; Postoperative Complications ; Thoracic Duct ; Thorax ; Tuberculosis ; Tuberculosis, Pleural*

Craniopharyngiomas are rare primary intracranial tumors. Despite their benign histological appearance, they are often associated with an unfavorable prognosis. The typical manifestations upon diagnosis are headache, visual impairment, polyuria/polydypsia, growth retardation, disturbance of pubertal development, and significant weight gain. The treatment options include radical surgery or radiotherapy, or a combination of these modalities. Slipped capital femoral epiphysis (SCFE) is the most common adolescent hip disorder. SCFE occurs when the capital femoral epiphysis displaces posteriorly on the femoral neck at the level of the physis. The etiology of SCFE is thought to be multifactorial and may include obesity, growth surges, and less common endocrine disorders. The related endocrine disorders include hypothyroidism, growth hormone supplementation, hypogonadism, and panhypopituitarism. Reported herein is a case of panhypopituitarism caused by craniopharyngioma combined with SCFE.
Adolescent ; Craniopharyngioma* ; Diagnosis ; Epiphyses ; Femur Neck ; Growth Hormone ; Headache ; Hip ; Humans ; Hypogonadism ; Hypopituitarism ; Hypothyroidism ; Obesity ; Prognosis ; Radiotherapy ; Slipped Capital Femoral Epiphyses* ; Vision Disorders ; Weight Gain

Hepatic portal venous gas (HPVG) is a rare radiographic finding associated with severe intra-abdominal disease and fatal outcome. Most cases of HPVG are historically related to mesenteric ischemia accompanied by bowel necrosis. The current spread of computed tomography scan promotes not only the early detection of related severe diseases but also the identification of other causes of HPVG. It has been reported in many non-fatal conditions, such as inflammatory bowel disease, intra-abdominal abscess, bowel obstruction, paralytic ileus, endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy, and gastric dilatation. Among these, paralytic ileus is a very rare condition, with no case yet reported in South Korea. Reported herein is a case of HPVG in paralytic ileus, which was treated well internally and was promptly resolved.
Abdominal Abscess ; Cholangiopancreatography, Endoscopic Retrograde ; Fatal Outcome ; Gastric Dilatation ; Ileus ; Inflammatory Bowel Diseases ; Intestinal Pseudo-Obstruction* ; Ischemia ; Korea ; Mesenteric Veins ; Necrosis ; Portal Vein ; Sphincterotomy, Endoscopic

Protein S deficiency is one of the several risk factors for thrombophilia and can cause blood clotting disorders such as deep vein thrombosis and pulmonary embolism. A 54-year-old man was admitted with the complaint of dyspnea and was diagnosed with pulmonary embolism. The patient had very low level of free protein S, total protein S antigen, and protein S activity (type I protein S deficiency). In history taking, we found that his mother, 78 year old, had a history of same disease 10 years ago, and confirmed the pronounced low level of protein S. The patient's son also had very low level of protein S, however there had not been any history of pulmonary embolism yet. This case study suggests that asymptomatic persons with a family history of protein S deficiency and pulmonary embolism should be checked regularly for early detection of the disease, as protein S deficiency can be suspected.
Blood Coagulation ; Dyspnea ; Humans ; Middle Aged ; Mothers ; Protein S ; Protein S Deficiency* ; Pulmonary Embolism* ; Risk Factors ; Thrombophilia ; Venous Thrombosis

Multiple symmetric lipomatosis (MSL) is a rare disease characterized by symmetrical massive fatty deposits on the face, neck, shoulders, and upper trunk. We report a 74-year-old man who complained of painless subcutaneous nodules on his posterior neck that developed 3 weeks earlier. In a week, variably-sized similar lesions developed on both his shoulders and upper extremities. At the time of his hospital visit, several firm nodules as big as a walnut to a child's fist and with the normal-skin-hue were observed on his posterior neck, both shoulders, upper extremities, and trunk. The histological examination of his upper left arm revealed more mature adipocytes without encapsulation in the subcutaneous tissue. MSL was generally known to occur slowly over months or years. However, this is an unusual case that showed a fast-growing nature.
Adipocytes ; Aged ; Arm ; Humans ; Juglans ; Lipomatosis, Multiple Symmetrical* ; Neck ; Rare Diseases ; Shoulder ; Subcutaneous Tissue ; Upper Extremity

Extramedullary plasmacytoma (EMP) is a rare disease that occurs in 3% to 5% of patients with plasma cell disorder. It occurs most commonly in the upper respiratory tract and the oral cavity. Very few EMP cases have been reported in the central nervous system (CNS). We report herein an unusual case of EMP in the nasal cavity that recurred in the CNS without systemic involvement. A 67-year-old man visited our hospital due to a month-long bout with exophthalmos. He was diagnosed with EMP in the nasal cavity, paranasal sinus, and orbital cavity. He received radiotherapy to which he had complete responses. After 2 years, he visited our hospital because of a month-long headache. He was diagnosed with EMP recurrence in the CNS via brain magnetic resonance imaging and cerebrospinal fluid analysis. He was treated with whole brain radiotherapy and intrathecal chemotherapy with methotrexate, but he expired due to pneumonia.
Aged ; Brain ; Central Nervous System* ; Cerebrospinal Fluid ; Drug Therapy ; Exophthalmos ; Headache ; Humans ; Magnetic Resonance Imaging ; Methotrexate ; Mouth ; Nasal Cavity ; Orbit ; Plasma Cells ; Plasmacytoma* ; Pneumonia ; Radiotherapy ; Rare Diseases ; Recurrence ; Respiratory System

Cardiovascular beriberi is caused by thiamine deficiency and usually presents as high cardiac output failure associated with predominantly right-sided heart failure and rapid recovery after treatment with thiamine. Because of its rarity in developed countries, the diagnosis can often be delayed and missed. We recently experienced a case of cardiovascular beriberi with pulmonary hypertension which successfully treated with thiamine infusion. A 50-year-old man with chronic heavy alcoholics was refered to our department for dyspnea with mental change. Echocardiography showed marked right ventricular (RV) dilatation and flattening of the interventricular septum with a D-shaped deformation of the left ventricle. Moderate tricuspid valve regurgitation was found and estimated RV systolic pressure was 52 mm Hg. Because of his confused mentality and history of chronic alcohol intake, neurological disorder due to thiamine deficiency was suspected and intravenous thiamine was administered and he continuously received a daily dose of 100 mg of thiamine. Follow up echocardiography showed marked reduction of RV dilatation and improvement of a D-shaped deformation of the left ventricle. He finally diagnosed as cardiovascular beriberi on the basis of dramatic response to intravenous thiamine. Thiamine deficiency can cause reversible pulmonary hypertension, and can still be encountered in the clinical setting. Thus high index of suspicion is critically needed for diagnosis.
Alcoholics ; Beriberi* ; Blood Pressure ; Cardiac Output, High ; Developed Countries ; Diagnosis ; Dilatation ; Dyspnea ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Heart Ventricles ; Humans ; Hypertension, Pulmonary* ; Middle Aged ; Nervous System Diseases ; Thiamine ; Thiamine Deficiency ; Tricuspid Valve Insufficiency

Acinic cell carcinoma (ACC) is an uncommon malignant tumor of the salivary glands that is difficult to diagnose. It grows slowly and shows distant metastasis rarely. We experienced a case of recurrent ACC in the parotid gland with cardiac metastasis and hypertrophic osteoarthropathy. The 29-year-old man had been suffering from severe multiple bones and joints pain for 2 months. Ten years earlier, he underwent superficial parotidectomy due to a right subauricular mass. The mass was diagnosed with ACC. After surgery, the tumor recurred twice. Then the patient was diagnosed with cardiac metastasis via positron emission tomography-computed tomography and trans-thoracic echocardiography. He also had hypertrophic osteoarthropathy with multiple bone metastasis. He was given palliative radiotherapy and conservative treatment. ACC in the parotid gland with cardiac metastasis and hypertrophic osteoarthropathy has not yet been reported in literature. From this case, it is recommended to evaluate multiple distant metastasis in the ACC of the parotid gland when joint and bone pain are present.
Adult ; Carcinoma, Acinar Cell* ; Echocardiography ; Electrons ; Humans ; Joints ; Neoplasm Metastasis* ; Parotid Gland* ; Parotid Neoplasms ; Radiotherapy ; Salivary Glands

We report our experience with a case of urethrolysis using a transvaginal suprameatal approach without lateral perforation of the urethropelvic ligament. A 43-year-old woman suffered from voiding difficulties such as hesitancy, frequency, urgency, decreased urinary flow, residual urine sensation after Marshall-Marchetti-Krantz operation concurrent with hysterectomy. The results of multidisciplinary work-ups of urethral obstruction such as history, vaginal examination, voiding cystourethrography, urodynamic study, showed that she had urethral obstruction due to a previous operation. Since clean intermittent catheterization and alpha-blocker therapy did not improve her symptoms, suprameatal transvaginal urethrolysis was performed to resolve the symptoms. Postoperative follow-up for 5 months showed that the patient remained free from voiding difficulty in their life. We believe that suprameatal transvaginal urethrolysis is worth attempting for urethral obstruction associated with anti-incontinence surgery.
Adult ; Female ; Follow-Up Studies ; Gynecological Examination ; Humans ; Hysterectomy ; Intermittent Urethral Catheterization ; Ligaments ; Sensation ; Urethral Obstruction* ; Urodynamics

BACKGROUND: In this study, we examined body image perception and dissatisfaction with weight and height in children and adolescents, according to age and body mass index. Additionally, we compared our findings with those of previous studies concerning eating disorders. MATERIALS AND METHODS: In July and August 2008, 1,501 students were sampled from elementary, middle, and high schools in Ulsan and assessed using self-completion questionnaires. We used the Korean version of the Eating Attitude Test-26 (EAT-26) to screen for eating risk groups. Participants were stratified by grade, gender, and body mass index. RESULTS: 1) Dissatisfaction with height, weight, and body image was greater in the older group. 2) Dissatisfaction with weight and body image was greater in the heavier group. 3) EAT-26 scores and the number of individuals at high risk for eating disorders were higher in the female group than in the male group. CONCLUSION: The EAT-26 score in this study was similar to those found in previous Western studies. 2) There were a number of high-risk individuals in the female group, with a tendency toward earlier presentation. Continuous health management and prevention programs are required.
Adolescent ; Body Image ; Body Mass Index ; Child ; Eating ; Feeding and Eating Disorders ; Female ; Humans ; Male ; Surveys and Questionnaires