OBJECTIVES: The aim of this study was to assess the effect of gonadotropin-releasing hormone (GnRH) agonist co-treatment for gonadal protection in patients with hematologic neoplasms undergoing chemotherapy. METHODS: Young premenopausal women who were diagnosed with leukemia or lymphoma between March 2010 and February 2012 and undergoing chemotherapy in a university hospital were included in this study. RESULTS: Twenty-nine patients aged 15.39 years participated in this study. Among the patients, five patients were receiving leuprolide concomitant with chemotherapy, and twenty-four patients were receiving chemotherapy alone. Seventeen patients in the chemotherapy alone group stopped menstrating and were diagnosed with primary ovarian insufficiency (POI) within one year after chemotherapy; and only one patient had POI in the chemotherapy plus leuprolide group, but these differences were not statistically significant (P = 0.054). In the chemotherapy plus leuprolide group, serum anti-mullerian hormone (AMH) levels were significantly lower than basal serum AMH levels (5.57 +/- 0.18 ng/mL) (P < 0.001) after treatment (1.84 +/- 0.22 ng/mL). CONCLUSION: GnRH agonist may be a promising option for the prevention of POF, but the effectiveness of GnRH agonist is still debatable. A large prospective multi-center trial with adequate follow-up is needed.
Aged ; Anti-Mullerian Hormone ; Female ; Gonadotropin-Releasing Hormone ; Gonads ; Hematologic Neoplasms ; Humans ; Leukemia ; Leuprolide ; Lymphoma ; Primary Ovarian Insufficiency

BACKGROUND/AIMS: The aim of this study was to determine whether the margin of early to be detected gastric cancer (EGC) and gastric adenoma is easier to be detected with autofluorescence imaging (AFI) than with white-light endoscopy (WLE). METHODS: A total of 102 lesions (48 EGCs and 54 gastric adenomas) found in 98 patients were removed endoscopically or surgically. The measured length of each pathology specimen was compared with the lengths estimated using WLE, AFI, and chromoendoscopy. RESULTS: The lesions could be discriminated from surrounding mucosa by AFI in 86 cases (84.3%). The detection rates were similar for elevated lesions (85.1%) and flat/depressed lesions (82.9%, p=0.770). In terms of histology, the detection rate was slightly higher for adenomas (90.7%) than for cancer (77.1%, p=0.058). The estimated length was shorter than the pathologic length in 31.4% of cases when using WLE and 22.1% of cases when using AFI (p=0.168). The resection range was larger for EMR than for AFI in 24 of 80 cases (30.0%). CONCLUSIONS: WLE tends to underestimate the size of EGCs, whereas AFI tends to overestimate their size.
Adenoma ; Endoscopy ; Fluorescence ; Humans ; Mucous Membrane ; Optical Imaging ; Prospective Studies ; Stomach Neoplasms

Juvenile dermatomyositis is a common idiopathic inflammatory myopathy in childhood and is characterized by symmetric proximal muscle weakness and specific cutaneous manifestations. We here report on a 12-year-old boy who presented with violaceous maculopatches with multiple deep skin ulcerations on the right arm and lower back 4 months ago. One month after the initial visit, he had difficulty climbing stairs and elevating his arms above the head. Laboratory tests showed elevation of the serum levels of skeletal muscle enzymes, and electromyogram and muscle biopsy indicated myopathy. Histopathological analysis of the ulceration indicated necrotizing vasculitis and calcification. Based on these findings, his condition was diagnosed as juvenile dermatomyositis. We believe that this case is unique because of the difficulty in diagnosing the condition, as skin ulceration is a rare cutaneous manifestation of dermatomyositis.
Arm ; Biopsy ; Child ; Dermatomyositis* ; Head ; Humans ; Male ; Muscle Weakness ; Muscle, Skeletal ; Muscular Diseases ; Myositis ; Skin Ulcer* ; Ulcer ; Vasculitis

No abstract available.
Intussusception* ; Peutz-Jeghers Syndrome*

A 46-year-old woman was admitted with an ulcerative lesion on the posterior neck. Four months before admission, the patient took part in a faith healing ritual, which the pastor performed with his fingernails causing wounds. This abnormal method of healing caused repeated injury to the patient in the posterior neck area. Treatment with cefazolin was begun, but the lesion did not improve. Biopsy of the skin lesion and cervical lymph nodes was performed. Microscopical examination revealed findings highly suggestive of syphilis. Serological tests for syphilis were positive and a computed tomographic (CT) scan of the neck showed enlargement of regional lymph nodes and tonsils. A single dose of penicillin G 2.4 million units was given intramuscularly. Two weeks later, the wound had healed. Eight weeks after treatment, the Venereal Disease Research Laboratory titer had decreased and a CT scan of the neck showed a decrease in the size of the lymph nodes. We reasoned that syphilis was non-sexually transmitted, and that the healing ritual was the cause. Our case suggests that skin trauma by scratching with the fingernails may cause an accidental direct inoculation of Treponema pallidum, resulting in extragenital primary syphilis.
Biopsy ; Cefazolin ; Faith Healing ; Female ; Humans ; Lymph Nodes ; Middle Aged ; Nails* ; Neck ; Palatine Tonsil ; Penicillin G ; Serologic Tests ; Sexually Transmitted Diseases ; Skin ; Syphilis* ; Tomography, X-Ray Computed ; Treponema pallidum ; Ulcer ; Wounds and Injuries

No abstract available.
Jaundice, Obstructive* ; Pancytopenia* ; Ticlopidine*

Extrahepatic recurrence of hepatocellular carcinoma (HCC) has been considered unsuitable for surgical resection since the disease is considered to be extensive. However, solitary local lymph node recurrence in small HCC is rarely reported with suitable treatment modality being uncertain. We herein, present a case of 60-year-old female patient with small HCC showing late lymph node metastasis after complete resection of primary HCC. A 2 cm-sized hepatic mass was completely resected by segmentectomy (VIII). Eight months later, CT and PET scan revealed a 4.5 cm-sized portocaval lymph node (LN). In addition, whole body PET/CT scan strongly suggested a solitary tumor recurrence. Radical lymphadenectomy was performed. Tumor was confirmed as LN metastasis from HCC by excisional histopathological examination. Adjuvant chemotherapy and radiotherapy were followed.
Carcinoma, Hepatocellular/*pathology/surgery ; Combined Modality Therapy ; Female ; Humans ; Liver Neoplasms/*pathology/surgery ; Lymph Node Excision ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Recurrence, Local/*pathology ; Positron-Emission Tomography ; Tomography, X-Ray Computed

PURPOSE: We performed a multicenter, prospective study to evaluate the efficacy of imipramine and desmopressin to improve arousability and prevent nocturnal enuresis(NE). MATERIALS AND METHODS: The total of 48 children with NE were given questionnaires that included a scoring system for the assessing arousal from sleep. They were assigned into two groups: group 1(imipramine 25 mg, 3 girls and 16 boys, mean age 7.9 years), group 2(desmopressin 0.2 mg, 9 girls and 9 boys, mean age 7.5 years). The assessment of arousability was repeated 2 weeks and 4 weeks after medication. Eleven children were excluded because of incomplete data. RESULTS: Mean wetting events in group 1 decreased from 8.8 to 5.1 times(2 weeks) and 3.0 times(4 weeks)(p=0.009) versus 10.2 to 5.5 times(2 weeks) and 6.4 times(4 weeks)(p=0.007) for group 2. The mean threshold of arousability in group 1 was 4.9(baseline), 4.4(2 weeks), and 3.7(4 weeks), and, for group 2, 5.1(baseline), 4.8(2 weeks), and 4.8(4 weeks). The two groups were not different(p=0.14, p=0.73). CONCLUSIONS: Imipramine and desmopressin, which are commonly used in treating NE in Korea, influenced wetting events but not arousability.
Arousal ; Child ; Deamino Arginine Vasopressin ; Humans ; Imipramine ; Korea ; Nocturnal Enuresis ; Prospective Studies

PURPOSE: To evaluate predictors of the success rate for one session of shock wave lithotripsy (SWL), focusing on the relationships between pretreatment hydronephrosis grade and one-session SWL success rates. MATERIALS AND METHODS: The medical records of 1824 consecutive patients who underwent an initial session of SWL for treatment of urinary stones between 2005 and 2013 were reviewed. After exclusion, 700 patients with a single, 4–20 mm diameter radiopaque calculus were included in the study. RESULTS: The mean maximal stone length (MSL) and skin-to-stone distance were 9.2±3.9 and 110.8±18.9 mm, respectively. The average values for mean stone density (MSD) and stone heterogeneity index (SHI) were 707.0±272.1 and 244.9±110.1, respectively. One-session success rates were 68.4, 75.0, 75.1, 54.0, and 10.5% in patients with hydronephrosis grade 0, 1, 2, 3, and 4, respectively. Patients were classified into success or failure groups based on SWL outcome. Multivariate logistic regression analyses revealed that MSL [odds ratio (OR) 0.888, 95% confidence intervals (CI): 0.841–0.934, p<0.001], MSD (OR 0.996, 95% CI: 0.995–0.997, p<0.001), SHI (OR 1.007, 95% CI: 1.005–1.010, p<0.001), and pretreatment hydronephrosis grade (OR 0.601, 95% CI: 0.368–0.988, p=0.043) were significantly associated with one-session success. CONCLUSION: Pretreatment grades 3 or 4 hydronephrosis were associated with failure of SWL in patients with a single ureteral stone. In the presence of severe hydronephrosis, especially hydronephrosis grade 4; physicians should proceed cautiously in choosing and offering SWL as the primary treatment for ureteral stone.
Calculi ; High-Energy Shock Waves ; Humans ; Hydronephrosis* ; Lithotripsy* ; Logistic Models ; Medical Records ; Population Characteristics ; Shock* ; Ureter* ; Ureteral Calculi ; Urinary Calculi

Persistent left superior vena cava (PLSVC) is a rare but one of the most common venous anomalies. Its incidence is reported as 0.3 - 0.5% in the general population, but in those with congenital heart disease, its incidence may range as high as 3 - 10%. PLSVC draining into coronary sinus is usually of little hemodynamic consequences, but it may become significant during cardiac catheterization, transvenous pacemaker insertion and cardiac surgery. Some investigators suggested that this anomaly is related with cardiac electrical instability due to anomalous development of AV nodal tissue with venous draining anomaly, and others suggested that the predisposing anomaly is in the sinus node and the dysrrhythmia is part of sick sinus syndrome. We report a 48 year-old female who had intermittent palpitation and near syncope, was diagnosed as sick sinus syndrome and underwent to implant permanent dual pacemaker implantation. Before implantation, we suspected PLSVC in 2-dimensional and contrast echocardiogram and confirmed it by cardiac catheterization. So, we successfully performed pacemaker implantation via right subclavian approach.
Cardiac Catheterization ; Cardiac Catheters ; Coronary Sinus ; Echocardiography ; Female ; Heart Defects, Congenital ; Hemodynamics ; Humans ; Incidence ; Middle Aged ; Research Personnel ; Sick Sinus Syndrome* ; Sinoatrial Node ; Syncope ; Thoracic Surgery ; Vena Cava, Superior*