Although methotrexate(MTX) has been known to have many side effects, especially toxicity on the hemopoietic cells and the liver, it has been used as a potent anticancer drug and for the treatment of psoriasis or rheumatoid arthritis. The severity of hepatotoxicity varies from mild fatty change to chronic active hepatitis(CAH) and cirrhosis. We experienced two cases of MTXinduced CAH in patients with psoriasis, which prompted us to report in view of the absence of biopsy proven MTX hepatotoxicity in the Korean literature. Microscopically, the liver showed a distorted lobular architecture with portal fibrous expansion, piecemeal necrosis and bridging necrosis/fibrosis. The hepatic lobules revealed fatty changes of hepatocyte, focal hepatocytolysis, delicate collagen deposits along the space of Disse and the characteristically marked polyploid nuclear change of hepatocytes.
Biopsy

To evaluate the tissue expression rate and pattenr of HBsAg and HBcAg in tumors and peritumoral livers, an immunohistochemical study was undertaken on 47 surgically resected hepatocellular carcinomas(HCCs). The results are as follows. 1. Patient's sera were positive for HBsAg in 40 cases(85.1%). In the remaining 7 cases, the tumor and peritumoral liver expressed neither HBcAg nor HbSaG, suggesting that they were caused by other etiologies than hepatitis B virus. 2. The peritumoral liver had HBsAg and HBcAg in 95.0% and 27.5% among the 40 cases, respectively. But the tumor expressed HBsAg in 50.0% and HBcAg in none. 3. The expression of HBsAg within the tumor and both HBsAg and HBcAg in the peritumoral liver tended to be more frequent in the pretreated cases before surgery. 4. Edmondson-Steiner grade IV tumors revealed a lower expression rate of HBsAg than the low grade tumors(p<0.05). Incases with cirrhosis at peritumoral tissues, HBcAg was less frequently found than in those without cirrhosis. The majority of tissue HBsAg and HBcAg was represented as groups of positive cells. These results suggest that, during the development and progression of HCCs, the HBcAg containing cells are repeatedly removed and the HBcAg negative cells are selected, because cellular expression of HBcAg is the target of host immune response.
Carcinoma, Hepatocellular

We described a case of diffuse biphasic cutaneous amyloidosis, a unique form of localized cutaneous amyloidosis. A 41-year-old man has gradually developed a lichenoid papular and a grouped spotted pigmented macular eruption on the trunk and upper extremities over the past 15 years. Histopathologic examination revealed that amyloid deposits were present in the papillary dermis. It was confirmed by Congo red staining, immunohistochemistry and electron microscopy. There was no evidence of systemic amyloidosis.
Adult ; Amyloidosis* ; Congo Red ; Dermis ; Humans ; Immunohistochemistry ; Microscopy, Electron ; Plaque, Amyloid ; Upper Extremity

Intracranial aneurysms in the neonate are very rare and their clinicopathological findings remain unclear. We report a 26-day-old premature neonate who underwent microsurgical clipping on the ruptured middle cerebral artery bifurcation aneurysm successfully with a review of relevant literature.
Aneurysm ; Humans ; Infant, Newborn ; Intracranial Aneurysm ; Middle Cerebral Artery

The anterior choroidal artery has several kinds of variations. Among them, the transposition of anterior choroidal artery and posterior communicating artery origins has been extremely rare. We report a case with cerebral aneurysm arising from posterior communicating artery which origin was distal to the anterior choroidal artery and review the relevant literature.
Arteries ; Choroid ; Intracranial Aneurysm

OBJECTIVE: Endovascular treatment of cerebral aneurysms with detachable coils has proved to be a safe and effective. However, long term result was not satisfactory in less than 30% for regrowth or coil compaction. This paper highlighted the safety and technique of microsurgical clipping and coil removal in previously coiled aneurysms showing recurrence or remnant growth. METHODS: Sixty two patients from 2007 to 2010 were treated by endovascular coiling. Among them, six patients (9.6%) showed recurrence, who had near complete obliteration initially. We retrospectively analyzed the clinical data and radiographic images of these patients (male 2, female 4, mean age 46.6) who underwent microsurgical clipping with partial (4 cases) or complete (2 cases) coil removal. Computerized tomographic angiogram (CTA) was performed soon after microsurgical clipping for the evaluation. RESULTS: Four aneurysms were located at anterior circulation and two were at the posterior circulation. Four patients were detected by routine followed CTA or angiography and one had recurrent subarachnoid hemorrhage and another one had severe eyeball pain. Microsurgical treatment were performed about 12.9 months (range: 2~26) after coiling. Complete coil removal was done in two patients. Complete obliteration was performed in all, which were confirmed by postoperative CTA with less coil artifact. All patients attained the same neurological state presented prior to surgery (the Glasgow Outcome Scale (GOS) 4~5). CONCLUSION: Microsurgical clipping and coil removal following a previous endovascular coil embolization are not so common. However, these would be permanent treatment options without any morbidity in properly selected patients. These are challenging and risky procedure, but necessary to avoid postoperative coil artifact on the follow-up radiologic evaluation.
Aneurysm ; Angiography ; Artifacts ; Female ; Follow-Up Studies ; Glasgow Outcome Scale ; Humans ; Intracranial Aneurysm ; Recurrence ; Retrospective Studies ; Subarachnoid Hemorrhage

BACKGROUND: An effective control of postoperative pain may contribute to success of day-case surgery. After knee arthroscopy, local anesthetics was injected into the knee joint to reduce postoperative pain, but results were variable and the duration of action may be short. The recent reports have suggested that intraarticular morphine would provide more effective and longer acting analgesia than expected from the same dose given systemically. METHODS: A randomized, controlled study was conducted in patients undergoing elective knee arthroscopy under general anesthesia to assess the analgesic effect of intraarticular bupivacaine and morphine, either alone or in combination. Patients in group I(n=20) received 20 ml of normal saline as a control; patients in group II(n=20) received 20 ml of 0.25% bupivacaine; patients in group III(n=20) received 5 mg of morphine in 20ml of normal saline; patients in IV(n=20) received a combination of 5 mg of morphine and 50 mg of bupivacaine in 20 ml of normal saline. All the drugs were injected intraarticularly. Postoperative pain was assessed using the VAS at 1, 2, 4, 8, 12, and 24h after the intraarticular injection. Whenever patients want supplemental analgesia, 90 mg of diclofenac(dicknol ) was injected intramuscularly and then the need for supplemental analgesia was recorded. RESULTS: Patients in groups III and IV had significantly lower pain scores than those in groups I and II. There was no significant difference in the pain scores or analgesics requirements between groups III and IV. CONCLUSIONS: We conclude that intraarticular morphine(5 mg) significantly reduces postoperative pain following knee arthroscopy and there is no significant advantage of combining bupivacaine with morphine.
Analgesia ; Analgesics ; Anesthesia, General ; Anesthetics ; Anesthetics, Local ; Arthroscopy* ; Bupivacaine* ; Humans ; Injections, Intra-Articular ; Knee Joint ; Knee* ; Morphine* ; Pain, Postoperative*

BACKGROUND: Metabolic syndrome is a major risk factor for cardiovascular disease. The combination of an aging population with a chronic diseased population is leading to an increase in the mortality rate due to cardiovascular diseases. The purpose of this study was to assess the prevalence of metabolic syndrome in the Korean population and to evaluate its related factors for sex differences. METHODS: From April 2007 to December 2008, a total of 2,729 volunteers aged 40-69 years living in Changwon city underwent a clinical examination at a hospital in Changwon, Korea. Metabolic syndrome was diagnosed following the criteria defined in Circulation 2009. The clinical examination included measuring anthropometric variables and cardiovascular risk factors, while lifestyle factors were assessed through a questionnaire. RESULTS: The prevalence of metabolic syndrome in our sampling pool was 25.2% with a break down by sex showing a rate of 30.2% in men and 22.2% in women. Related factors associated with metabolic syndrome common to both sex were age, self-health assessment, and alcohol consumption. Sleep duration seemed to be a related factor in men, while income, education, and menstruation status played significant roles in women. CONCLUSIONS: To better manage metabolic syndrome, men need to be educated on alcohol use and women of low socioeconomic status require particular attention as do the aging population and postmenopausal women.
Adult ; Aged ; Aging ; Alcohol Drinking ; Cardiovascular Diseases ; Female ; Humans ; Korea ; Life Style ; Male ; Menstruation ; Prevalence ; Risk Factors ; Sex Characteristics ; Social Class

In the paper by Lee et al., the name of the corresponding author was given incorrectly. The correct name should be Chan-Young Choi as given above.

Two patients with cutaneous leishmaniasis were treated with itraconazole. One patient was a 24-year-old man who had several erythematous papulonodules on the extremities for 1 month, which revealed cutaneous leishmaniasis, histopathologically. He was treated with itraconazole (200 mg/day) for 2 months. After treatment he showed clinical healing and the biopsy specimens no longer showed leishmania organisms. The other patient was a 27-year-old female who had several erythematous papulonodules on the face and neck for 3 months. The skin lesions revealed leishmania organisms in the tissue sections and culture media. She was also treated with itraconazole (200 mg/day) for 2 months. After treatment she also showed satisfying clinical healing and the biopsy specimens revealed no leishmania organisms. No specific side effects were encountered in both patients during the treatment. From these results, itraconazole is considered to be one of the promising anti-leishmanial drugs.
Adult ; Biopsy ; Culture Media ; Extremities ; Female ; Humans ; Itraconazole* ; Leishmania ; Leishmaniasis, Cutaneous* ; Neck ; Skin ; Young Adult