No abstract available.
Low Back Pain*

No abstract available.
Neurons*

Mucormycosis is an uncommon, frequently fatal, opportunistic fungal infection. Rhino-cerebral and pulmonary involvement are the most common forms and usually occur in immunecompromised patients. Gastrointestinal involvement is extremely rare, the stomach being the most frequently involved site among them. We report a case of gastric mucormycosis in a 37 year old male alcoholic with gastric ulcer. On histological examination, characteristic findings of hyphae with irregular width and right angle branchings were observed in the gastric mucosa and ulcer debris. The diagnosis of gastric mucormycosis was made by the characteristic histological nature. The patient was treated aggressively with antibiotics and antiulcer regimen for 6 weeks, and then no fungus was present on follow up biopsy of gastric mucosa.
Adult ; Alcoholics ; Anti-Bacterial Agents ; Biopsy ; Diagnosis ; Follow-Up Studies ; Fungi ; Gastric Mucosa ; Humans ; Hyphae ; Male ; Mucormycosis* ; Stomach ; Stomach Ulcer* ; Ulcer

We report a case of malignant paraganglioma with hepatic metastases. A 70-year old woman developed huge hepatic tumor 2years after complete resection of the retroperitoneal paraganglioma. CT imaging of abdomen revealed huge hepatic masses, which had not been found previously. A needle biopsy on the liver was performed, resulting in a diagnosis of malignant paraganglioma. These tumors are usually benign but can occasionally produce local and distant metastases. Development of metastatic localizations is the only formal proof of malignancy as histology cannot distinguish between benign and malignant paragangliomas. Surgery is the basis of treament and should be performed early in the operable course. Both chemotherapy and radiotherapy could be given, but satisfactory outcomes were not obtained. We suggest that close investigations for metastasis in patient with paraganglioma, seemed benign initially, as well as periodic follow up examinations should be emphasized.
Abdomen ; Aged ; Biopsy, Needle ; Diagnosis ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Liver ; Neoplasm Metastasis* ; Paraganglioma* ; Radiotherapy

PURPOSE: There is increasing consideration about the preemptive transplantation, transplantation without any preceding dialysis, as a one of options of a renal replacement therapy (RRT). This study evaluates a beneficial effect on recipient and allograft survival of preemptive transplantation and compares the outcome to that according to the dialysis modality and duration. METHODS: All patient who had received a kidney transplant from a living donor in the Seoul National University Hospital (SNUH) between January 1990 and October 2004 are included in this retrospective study. Patients were subdivided into three groups; preemptive transplant group (group 1, n=47), hemodialysis group (group 2, n=307) and peritoneal dialysis group (group 3, n=52). RESULTS: The characteristics of each groups were not statistically different except recipient age. Ten-year patient survival was 97.8% in PE group, but is not significantly higher than in HD (89.4%) and in PD (90.7%) groups. However, 10-year graft survival was higher in PE group than in HD group (p<0.05; 100%, 74.7% respectively). The differential effect of pretransplant dialysis duration on graft survival was prominent if the patients had been on the pretransplant dialysis for more than 42 months (p<0.05; 10-year graft survival; PE, 100% and dialysis more than 42 months, 77.9% respectively) Compared with HD group as a pre-transplant dialysis modality, PD group showed better patient and graft survival rate, but not statistically significant. CONCLUSION: Depending on the above results, we may suggest PE or PD being a superior pre-transplant modality than HD. And we should be considerate of choosing treatment modality and duration before transplantation.
Allografts ; Dialysis* ; Graft Survival* ; Humans ; Kidney Transplantation* ; Kidney* ; Living Donors* ; Peritoneal Dialysis ; Renal Dialysis ; Renal Replacement Therapy ; Retrospective Studies ; Seoul ; Transplants*

This is the first case report of a patient with a large serous cystadenoma accompanied by a juvenile granulosa cell tumor that was discovered in the remaining ovarian tissue. A 25-year-old female was presented with constipation and amenorrhea. Ultrasonography revealed a large cystic mass in the left ovary with a normal uterus. The remaining ovarian tissue seemed normal at first look after cystectomy, but showed abnormal consistency on palpation. The remaining ovarian tissue was removed and granulosa cell tumor was confirmed by pathologic examination. The patient has been followed up for 30 months without evidence of recurrence. We would like to emphasize the importance of inspection, and palpation of remaining ovarian tissue during operation to avoid risks of remaining ovarian pathology.
Adult ; Amenorrhea ; Constipation ; Cystadenoma, Serous* ; Cystectomy ; Female ; Granulosa Cell Tumor* ; Granulosa Cells* ; Humans ; Ovarian Neoplasms ; Ovary* ; Palpation ; Pathology ; Recurrence ; Ultrasonography ; Uterus

BACKGROUND: We evaluated the clinical relevance of pretransplant donor-specific HLA antibodies (DSA) in renal transplantation patients who had negative T-cell cytotoxicity crossmatches. METHODS: From 328 consecutive renal transplant recipients, we selected 28 patients who had positive pretransplant (historical or at the time of transplantation) flow cytometry crossmatches, but negative T-cell cytotoxicity crossmatches at the time of transplantation. The presence of DSA and its level at the time of transplantation were retrospectively tested using Luminex single antigen assays. RESULTS: DSA was present in 16 (57.1%) of 28 patients. Biopsy-proven acute rejection (9 patients) occurred more frequently in patients with DSA than in those without DSA (56.3% vs. 0.0%; P=0.003). The positivity rate of class II DSA was significantly higher in patients with antibody-mediated rejection (AMR) than in those without AMR (100% vs. 21.7%; P=0.003). However, the positivity rate of class I DSA was not different between the two groups (40% vs. 40.9%). Among patients with class II DSA, those with AMR tended to have higher antibody levels (median fluorescence intensity, MFI) than those without AMR (16,359 vs. 5,910; P=0.056). A cut-off MFI value of 4,487 for class II DSA predicted the occurrence of AMR with good sensitivity and specificity (100% and 87.0%). CONCLUSIONS: In patients with negative T-cell cytotoxicity crossmatches, the presence of class II DSA and its level at the time of transplantation were associated with the occurrence of AMR. Pretransplant DSA measurement with Luminex single antigen assay would be useful in renal transplantation.
Adolescent ; Adult ; Aged ; Antibodies/*immunology ; Female ; Graft Rejection/immunology ; HLA-DQ Antigens/*immunology ; HLA-DR Antigens/*immunology ; Histocompatibility Testing ; Humans ; Kidney Transplantation/immunology ; Male ; Middle Aged ; T-Lymphocytes, Cytotoxic/*immunology ; Tissue Donors ; Young Adult

We report a case of a 61-year-old man who presented with a cough and abdominal discomfort. CT scan of the chest showed two lesions across both lungs, and an abdominal CT scan revealed multiple hypodense lesions in the spleen with cystic lesions on the splenic hilum. Upper gastrointestinal tract endoscopy found creamy yellowish discharge through a fistula between the stomach and splenic hilum. Under fluoroscopic guidance, forceps was inserted into the fistula tract, and forcep biopsy was done. The pathology was consistent with tuberculosis, and a nine-month anti-tuberculosis medication regimen was started. Imaging performed three months after finishing medication indicated improvement of splenic lesions, and the gastro-splenic tract was sealed off. This case is a very rare clinical example of secondary splenic tuberculosis with a gastro-splenic fistula formation in an immunocompetent patient.
Antitubercular Agents/therapeutic use ; Fluoroscopy ; Gastric Fistula/pathology ; Gastroscopy ; Humans ; Male ; Middle Aged ; Spleen/diagnostic imaging/pathology ; Splenic Diseases/*diagnosis/diagnostic imaging/pathology ; Tomography, X-Ray Computed ; Tuberculosis, Splenic/*diagnosis/drug therapy/microbiology ; Ultrasonography

BACKGROUND/AIMS: Sunitinib is an oral multitargeted tyrosine kinase inhibitor used mainly for the treatment of metastatic renal cell carcinoma. The renal adverse effects (RAEs) of sunitinib have not been investigated. The aim of this study was to determine the incidence and risk factors of RAEs (proteinuria [PU] and renal insufficiency [RI]) and to investigate the relationship between PU and antitumor efficacy. METHODS: We performed a retrospective review of medical records of patients who had received sunitinib for more than 3 months. RESULTS: One hundred and fifty-five patients (mean age, 58.7 +/- 12.6 years) were enrolled, and the mean baseline creatinine level was 1.24 mg/dL. PU developed in 15 of 111 patients, and preexisting PU was aggravated in six of 111 patients. Only one patient developed typical nephrotic syndrome. Following discontinuation of sunitinib, PU was improved in 12 of 17 patients but persisted in five of 17 patients. RI occurred in 12 of 155 patients, and the maximum creatinine level was 3.31 mg/dL. RI improved in two of 12 patients but persisted in 10 of 12 patients. Risk factors for PU were hypertension, dyslipidemia, and chronic kidney disease. Older age was a risk factor for RI. The median progression-free survival was significantly better for patients who showed PU. CONCLUSIONS: The incidence of RAEs associated with sunitinib was lower than those of previous reports. The severity of RAEs was mild to moderate, and partially reversible after cessation of sunitinib. We suggest that blood pressure, urinalysis, and renal function in patients receiving sunitinib should be monitored closely.
Aged ; Antineoplastic Agents/*adverse effects ; Carcinoma, Renal Cell/complications/drug therapy/mortality ; Female ; Humans ; Incidence ; Indoles/*adverse effects ; Kidney Neoplasms/complications/drug therapy/mortality ; Male ; Middle Aged ; Proteinuria/*chemically induced/epidemiology ; Pyrroles/*adverse effects ; Renal Insufficiency/*chemically induced/epidemiology ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Treatment Outcome

OBJECTIVE: To evaluate planned pregnancy rate and associated factors related planned pregnancy. METHODS: We surveyed 1,396 cases from May 2002 to December 2002. The cases were derived from the Maternity school. They filled out questionnaire including planned pregnancy, medico-social-economic status. Then, we assessed the planned pregnancy rate with associated medico-social-economic state, through the prospective study. RESULTS: The planned pregnancy rate is 51.4%. The major factor which affected the planned pregnancy rate is the income of the family. The association with the planned pregnancy rate and the parity, age, and educational attainment of the women are not statistically significant. In unplanned group, exposure to alcohol, X-ray and medication is significantly increased in early pregnancy. CONCLUSION: The planned pregnancy can prevent induced abortion and reduce the birth defects due to early exposure to teratogen. Therefore it is important to make an effort to raise the planned pregnancy rate.
Abortion, Induced ; Congenital Abnormalities ; Family Planning Services* ; Female ; Humans ; Parity ; Pregnancy ; Prospective Studies ; Surveys and Questionnaire