No abstract available.

No abstract available.
Female ; Humans ; Marriage*

PURPOSE: The aims of this study were to find the risk factor and outcomes of patients with an early recurrence (ER) of a hepatocellular carcinoma (HCC) after liver transplantation (LT) and the actual impact of transarterial chemoembolization (TACE) before LT for a HCC on patient survival and HCC recurrence. METHODS: Ninety-eight cases of adult LT, performed between September 1995 and January 2006, were evaluated. The risk factors and prognosis of patient with a HCC after transplantation for an ER, defined as a recurrence within 6 months of transplantation, and the effects of Pre-LT TACE on the disease-free and overall survival rates, as well as the patterns of recurrence after LT, were studied. RESULTS: A total of 18 patients (18.4%) experienced a HCC recurrence after LT; 10 and 8 patients had early and late recurrences, respectively. From a univariate analysis, the serum alpha-fetoprotein (P=0.003), tumor size (P=0.003), serosa invasion (P=0.000), tumor grade (P=0.011) and vascular invasion (P=0.014) were statistically significant risk factors for an ER. From a multivariate analysis, the presence of serosa invasion of a HCC was the only independent risk factor for an ER (P=0.009; OR=9.407: 95% CI, 1.764~50.164). There was no difference in the disease free sur-vival and overall survival rates between the TACE and without TACE groups, but the extrahepatic recurrence rate was higher in the TACE than without TACE group. CONCLUSION: Serosa invasion by a HCC is independently associated with an ER of HCC after LT. Pre-LT TACE does not influence the disease-free and overall survivals after LT for a HCC.
Adult ; alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Humans ; Liver Transplantation* ; Liver* ; Multivariate Analysis ; Prognosis ; Recurrence* ; Risk Factors* ; Serous Membrane ; Survival Rate

BACKGROUND: Diffusion-weighted MR imaging (DWI) was designed to detect the random molecular otion of water in tissue. DWI has gained increasing interest recently because it can demonstrate yperacute stroke earlier than any other imaging methods so far. The purpose of our study was to etermine the clinical usefulness and significance of DWI compared with those of Fast Spin Echo T2-weighted image (SE T2WI) and Fluid Attenuated Inversion Recovery (FLAIR) image in acute and subacute ischemic stroke. METHOD: Twenty-five adult patients with clinical diagnoses of acute or subacute cerebral infarctions were imaged with fast SE T2WI, FLAIR and DWI using a 1.5-T image. RESULTS:All the patients had areas of high signal intensity indicating acute or subacute lesions on DWI and these lesions provide an excellent clinicoanatomic correlation. CONCLUSIONS: DWI is most useful in the diagnosis and localization of acute or subacute lacuna or subcortical infarction in patients with preexisting chronic infarctions or white matter hyperintensity showing high signal intensity similar to acute or subacute infarctions on T2WI or FLAIR image.
Adult ; Brain ; Cerebral Infarction ; Diagnosis ; Diffusion* ; Humans ; Infarction ; Magnetic Resonance Imaging ; Stroke*

Ovarian myoma is a rare mesenchymal tumor, accounting for only 1% of benign ovarian neoplasm. These tumors only originate from smooth muscle on the walls of blood vessels in the cortical stroma, in the corpus luteum and in the ovarian ligaments at the point of attachment to the ovary. Most patients are asymptomatic and the tumors are usually found incidently during operations or at autopsies. Two cases of ovarian myoma experienced in our hospital recently are reported with a brief review of the literatures."
Autopsy ; Blood Vessels ; Corpus Luteum ; Female ; Humans ; Leiomyoma* ; Ligaments ; Muscle, Smooth ; Myoma ; Ovarian Neoplasms ; Ovary

Multiple endocrine neoplasia (MEN) 2B is charaterized by tumors of endocrine glands, consisting of medullary thyroid carcinoma (MTC), pheochromocytoma and mucosal neuromas of the tongue, lips and other sites. Especially, MTC is the main cause of death in patients who have not received early prophylactic treatment, and MTC in MEN 2B represents more aggressive progress than that of MEN 2A. We encountered two cases of multiple endocrine neoplasia type 2B. One was a 13 month old boy who had familial history of MEN 2B without any symptoms, and the other was a 6-year old boy who manifested multiple mucosal neuromas of the tongue which had been aggravated in four months. Their genetic analysis revealed a point mutation 918th cordon in the RET proto-oncogene. Both of them underwent an operation for prophylactic total thyroidectomy and the 6 year old boy's specimen turned out to be thyroid medullary carcinoma. We encountered two cases of MEN 2B with prophylactic thyroidectomy by early diagnosis of RET proto-oncogene, and report the cases with review of literature.

PURPOSE: With a duration of action of approximately 24 hours and peakless levels, Lantus is a more physiologic basal insulin analogue compared with NPH. The aim of this study was to compare the glycemic control of Lantus plus Humalog with that of premixed insulin in children and adolescents with type 1 diabetes mellitus. METHODS: The subjects consisted of 25 patients with type 1 diabetes mellitus, aged 12-19 years, who changed their insulin regimen from premixed insulin to Lantus plus Humalog. Daily insulin doses, frequency of hypoglycemia, fasting blood glucose, C-peptide concentration and HbA1c before and 6 months after Lantus treatment were compared. 24 hour blood glucose of 11 patients among Lantus treatment group (n=25) and premixed insulin treatment group (n=10) were self-monitored and compared. RESULTS: 6 months after Lantus treatment, the episodes of hypoglycemia were reduced by 50%(15.1 vs. 7.6 events/month), especially nocturnal hypoglycemia by 67%(6.7 vs. 2.5 events/month). HbA1c was reduced from 9.3% to 8.7% after Lantus treatment. Self-monitored blood glucose of Lantus treatment group at postbreakfast 30, 60, 90 and 120 minutes were 171.1, 169.5, 171.0 and 154.1 mg/dL respectively and lower than those of premixed insulin treatment group (259.7, 282.7, 280.0 and 250.9 mg/dL respectively). CONCLUSION: Compared with premixed insulin, Lantus plus Humalog is more effective in glycemic control and reduction in nocturnal hypoglycemia in children and adolescents with type 1 diabetes mellitus.
Adolescent* ; Blood Glucose ; C-Peptide ; Child* ; Diabetes Mellitus, Type 1* ; Humans ; Hypoglycemia ; Insulin ; Insulin Glargine ; Skin

Lymphocytic infundibuloneurohypphysitis(LINH) is a newly classified disorder and proposed as a common cause of idiopathic central diabetes insipidus. It is characterized by thickening of the infundibulum and/or pituitary stalk and absence of high signal in the neurohypophysis in sellar MRI and the microscopic findings of diffuse lymphocytic infiltration within the neurohypophysis. A 12year-old boy presented polyuria and headache. The result of water deprivation test was compatible with central diabetes insipidus. Brain MRI showed thickening of the pituitary stalk and loss of high signal in the neurohypophysis. Craniotomy and excisional bi6opsy was done under the impression of pituitary tumor. Microscopically, neurohypophysis showed dense lymphocytic infiltration and no malignant cells. Six months after the operation, the previously thickened pituitary stalk and neurohypophysis appeared normal in follow-up MRI.
Brain ; Craniotomy ; Diabetes Insipidus, Neurogenic ; Follow-Up Studies ; Headache ; Humans ; Magnetic Resonance Imaging ; Male ; Pituitary Gland ; Pituitary Gland, Posterior ; Pituitary Neoplasms ; Polyuria ; Water Deprivation

PURPOSE: Gonadotropin releasing hormone agonist (GnRHa) treatment is widely used in precocious puberty to delay rapid pubertal growth and increase final height. But, girls who enter puberty 8 to 9 years also have same course with precocious puberty in many cases. Therefore GnRHa treatment is used in girls with early puberty, but the effects are controversial. We analyzed growth velocity and sex hormone concentrations in early puberty during and after GnRHa treatment. METHODS: The subjects were included 77 girls who had sexual development during 8 to 9 years, and they were treated with GnRHa over 6 months. We analyzed chronologic age (CA), bone age (BA), predicted adult height (PAH), breast development and serum LH, FSH, E2 levels during and after treatment. Additionally we analyzed height and growth velocity of 17 subjects who were treated with GnRHa plus GH. RESULTS: CA was 8.7+/-1.1 yrs and BA was 10.3+/-1.7 yrs at diagnosis. Growth velocity was decreased from 7.4+/-2.0 cm/yr to 4.9+/-1.1 cm/yr during treatment, but they were increased to 7.9+/-1.7 cm/yr in 6 months off treatment. PAH SDS was increased from -1.9+/-1.6 to -1.5+/-1.5 during treatment. Serum E2 levels were decreased from 16.1+/-8.7 ng/dL to 9.4+/-2.4 ng/dL in 3 months after treatment and maintained in low level during treatment. But they began to increase at 3 months off treatment (P=0.059). Breast development was decreased in 3 months after treatment, however it began to increase in 3 months off treatment. Growth velocities were increased from 4.7 cm/yr to 6.6 cm/yr in 3months after combination treatment of GnRHa plus GH. PAH SDS was significantly increased in GnRHa plus GH treatment compared to GnRHa treatment only. CONCLUSION: GnRHa treatment suppressed rapid progress of early puberty effectively from start of treatment. It could be useful to relieve psychosocial problems in early puberty. PAH SDS was increased during GnRHa treatment, but it was increased more in GnRHa plus GH treatment. GH combination treatment should be considered if growth velocity was decreased seriously.
Adolescent ; Adult ; Breast ; Diagnosis ; Female* ; Gonadotropin-Releasing Hormone* ; Gonadotropins* ; Growth Hormone ; Humans ; Puberty* ; Puberty, Precocious ; Sexual Development

Paraclinoid aneurysms arose from the proximal internal carotid artery between the site of emergence of carotid artery from the roof of the cavernous sinus and posterior communicating artery. Surgery of these aneurysms presents special difficulties because of its complicated osseous, dura, and neurovascular structures;sella turcica, cavernous sinus, optic nerve. The clinical and radiological characteristics in twenty-seven patients with the paraclinoid aneurysms were reviewed and classified into four subgroups according to their branch of origin in this segment;1) carotid cave aneurysm(2 cases), 2) ophthalmic artery aneurysm(11 cases), 3) superior hypophyseal artery aneurysm(11 cases), 4) proximal posterior carotid artery wall aneurysm or global type aneurysm(3 cases). Surgery required orbital unroofing and removal of anterior clinid process with release of dural ring. To provide easy proximal control, exposure of cervical carotid artery was helpful in some cases. Preoperative balloon occlusion testing was man datory. Outcomes were considered as good to fair in 19 patients, poor in five, and three patients died. The patients who had poor results were poor preoperative status-four were grade IV, one was grade II(Hunt-Hess grade). The causes of death were premature rupture(2 cases) and extensive vasospasm(1 case). Preoperative classification of these lesions provides excellent correlation of operative findings and surgical preparation to expose the proximal part of internal carotid artery.
Aneurysm* ; Arteries ; Balloon Occlusion ; Carotid Arteries ; Carotid Artery, Internal ; Cause of Death ; Cavernous Sinus ; Classification* ; Humans ; Ophthalmic Artery ; Optic Nerve ; Orbit