Small cell lung cancer(SCLC) is frequently associated with paraneoplastic syndromes, which occur in approximately 20% of patients at presentation. Clinical Cushing's syndrome secondary to ectopic ACTH production is uncommon, occurring in approximately 5% of all SCLC patients. However, biochemical evidence of hypercortisolism can be detected in up to 50% of patients. Patients with Cushing's syndrome from ectopic ACTH production show hypertension, weakness, hyperglycemia, and hypokalemic metabolic alkalosis, but differ from patients with classic Cushing's disease in that symptoms develop more rapidly. Ectopic ACTH production is associated with a poor response to chemotherapy, short survival, and a high risk of treatment-related complications. We report a case of Cushing's syndrome associated with ectopic corticotropin production in 59-year-old male patient with extensive stage of SCLC.
Adrenocorticotropic Hormone* ; Alkalosis ; Cushing Syndrome* ; Drug Therapy ; Humans ; Hyperglycemia ; Hypertension ; Lung Neoplasms* ; Lung* ; Male ; Middle Aged ; Paraneoplastic Syndromes

PURPOSE: To determine the antitumor activity of VACOP-B regimen for advanced non- Hodgkin's lymphoma (NHL) in terms of complete response rate, disease free survival, and overall survival, to assess the toxicities of this regimen, and to analyze the prognostic factors influencing the treatment results.Patients and methods: Between Apr. 1991 and Aug. 1993, thirty-six previously untreated patients with the intermediate or high grade NHL were treated with VACOP-B (etoposide/doxorubicin/cyclophosphamide/vincristine/prednisolone/bleomycin) combination chemotherapy. In case of initial bulky disease or residual disease after chemotherapy, radiation therapy of involved field was added. RESULTS: Complete response (CR) was achieved in 69% (25/36) of the eligible patients after VACOP-B chemotherapy, and 5 of 11 patients who remained in partial response (PR) after chemotherapy achieved CR after additional radiation therapy of involved field, resulting in 83% (30/36) of CR rate. With a median follow-up of 47.2 months, the disease free survival was 1~42.1+ months, and its median was 24 months. The range of survival time was 7~49.1+ months, and the median survival time was not reached at this time. The projected 3-year survival rate was 70%. Leukopenia was observed in 43% of chemotherapy cycles and thrombocytopenia in 2.3%. However, no treatment-related death was observed. For non-hematologic toxicities, nausea and vomiting were observed in 58% of patients, stomatitis in 58%, peripheral neuropathy in 58%, pulmonary toxicity in 3% and congestive heart failure in 3%. These toxicities were tolerable and all reversible. The prognostic factors influencing the complete response rate were performance status of patient (p=0.026) and relative dose intensity of cyclophosphamide (p=0.013). CONCLUSION: VACOP-B regimen is an effective and tolerable regimen for the intermediate and high grade NHL. And long term follow-up and phase III study will be needed for evaluation of these results compared to previous other treatment modality.
Cyclophosphamide ; Disease-Free Survival ; Drug Therapy ; Drug Therapy, Combination* ; Follow-Up Studies ; Heart Failure ; Hodgkin Disease ; Humans ; Leukopenia ; Lymphoma, Non-Hodgkin* ; Nausea ; Peripheral Nervous System Diseases ; Stomatitis ; Survival Rate ; Thrombocytopenia ; Vomiting

Endometriosis is a benign gynecologic disease, characterized by the presence and growth of functional endometrial-like tissue outside uterus. This ectopic endometrial tissue is most commonly found in the peritoneum, ovaries and uterosacral ligaments, but extremely rarely there is involvement of the appendix or cecum. Here we report a case of cecal endometriosis presenting as a subepithelial tumor diagnosed by surgical excision.
Appendix ; Cecum ; Colonic Neoplasms ; Endometriosis* ; Female ; Genital Diseases, Female ; Ligaments ; Ovary ; Peritoneum ; Uterus

BACKGROUND: It has been demonstrated that within 2 weeks following acute myocardial infarction (AMI), exercise-induced ST-segment depression (STD) indicates subendocardial ischemia in the viable myocardium within infarcted or remote area from the infarction. Exercise-induced ST-segment elevation (STE) in leads with abnormal Q wave is associated with left ventricular dysfunction or aneurysm rather than transmural ischemia. We studied whether each pattern of ST-segment shift on exercise ECG during recovery phase following AMI is correlated with the perfusion status of infarcted myocardium evaluated by myocardial contrast echocardiog-raphy (MCE), regardless of findings of coronary angiography (CAG). METHOD: Study population was consisted of 25 patients with AMI (anteior wall: 11 patients, inferior wall: 14 patients, mean age=57.3+/-8.9years). Patients underwent exercise ECG and coronary angiography at 10 days post-AMI. After CAG, sonicated Hexabrix was injected into both coronory arteries alternatively and 2-D echocardiography was taken in parasternal short axis, apical 4, and 2 chamber views. To analyze the echocardiographic image semiquantitively, left ventricle was divided into 20 segments and perfusion status was graded as good, partial, and no opacification. RESULT: All patients with exercise-induced STE (n=8) in Q-leads had patent infarcted-related artery and poor collaterals on CAG, which was associated with poor or no opacification of infarcted myocardium on MCE. Patients with exercise-induced STD (n=9) frequently had closed infarct-related artery (67%), but good opacification of infarcted myocardium was shown by retrograde perfusion via collaterals, which was commonly seen in patients with multivessel disease. CONCLUSION: In early recovery phase of acute myocardial infarction, exercise-induced ST elevation in Q leads was associated with poor perfusional status in infarcted myocardium, even with patent infarct-related artery on CAG, while exercise-induced ST depression was frequently seen in the good perfusional status despite of closed infarted-related artery, which was commonly observed in patients with multivessel disease.
Aneurysm ; Arteries ; Axis, Cervical Vertebra ; Coronary Angiography ; Depression ; Echocardiography ; Electrocardiography ; Heart Ventricles ; Humans ; Infarction ; Ioxaglic Acid ; Ischemia ; Myocardial Infarction* ; Myocardium* ; Perfusion* ; Ventricular Dysfunction, Left

BACKGROUND: It has been demonstrated that within 2 weeks following acute myocardial infarction (AMI), exercise-induced ST-segment depression (STD) indicates subendocardial ischemia in the viable myocardium within infarcted or remote area from the infarction. Exercise-induced ST-segment elevation (STE) in leads with abnormal Q wave is associated with left ventricular dysfunction or aneurysm rather than transmural ischemia. We studied whether each pattern of ST-segment shift on exercise ECG during recovery phase following AMI is correlated with the perfusion status of infarcted myocardium evaluated by myocardial contrast echocardiog-raphy (MCE), regardless of findings of coronary angiography (CAG). METHOD: Study population was consisted of 25 patients with AMI (anteior wall: 11 patients, inferior wall: 14 patients, mean age=57.3+/-8.9years). Patients underwent exercise ECG and coronary angiography at 10 days post-AMI. After CAG, sonicated Hexabrix was injected into both coronory arteries alternatively and 2-D echocardiography was taken in parasternal short axis, apical 4, and 2 chamber views. To analyze the echocardiographic image semiquantitively, left ventricle was divided into 20 segments and perfusion status was graded as good, partial, and no opacification. RESULT: All patients with exercise-induced STE (n=8) in Q-leads had patent infarcted-related artery and poor collaterals on CAG, which was associated with poor or no opacification of infarcted myocardium on MCE. Patients with exercise-induced STD (n=9) frequently had closed infarct-related artery (67%), but good opacification of infarcted myocardium was shown by retrograde perfusion via collaterals, which was commonly seen in patients with multivessel disease. CONCLUSION: In early recovery phase of acute myocardial infarction, exercise-induced ST elevation in Q leads was associated with poor perfusional status in infarcted myocardium, even with patent infarct-related artery on CAG, while exercise-induced ST depression was frequently seen in the good perfusional status despite of closed infarted-related artery, which was commonly observed in patients with multivessel disease.
Aneurysm ; Arteries ; Axis, Cervical Vertebra ; Coronary Angiography ; Depression ; Echocardiography ; Electrocardiography ; Heart Ventricles ; Humans ; Infarction ; Ioxaglic Acid ; Ischemia ; Myocardial Infarction* ; Myocardium* ; Perfusion* ; Ventricular Dysfunction, Left

Corpus callosum is a co mmisural fiber connecting the cerebral hemispheres. The gender difference in the size or the shape of corpus callosum is a long standing dispute. Analysis of sexual dimorphism has been expected to provide a clue to explain sociopsychological differences. Some reported that adult female CC had more bulbous splenium and larger area considering brain size, others failed to show sexual dimorphism reported in previous studies. Only few studies were reported on sexual dimorphism of the during development. The 200 midsagittal ultrasonographs were obtained through anterior fontanelle from healthy Korean neonates (100 males, 100 females). The neonates born after 38 ~42 weeks conception were scanned and each image was analyzed with NIH image. The average area of total corpus callosum was 97.61 +/-21.05 (Mean +/-SD) mm 2 in male, 99.54 +/-20.82 mm 2 in female. Mean length of corpus callosum was 45.06 +/-4.51 mm in male, 44.46 +/-3.71 in female and mean height was 14.06 +/-1.86 mm in male, 13.4 +/-1.75 mm in female. The height of male corpus callosum was significantly higher than that of female. We could find out sexual dimorphism of spatial orientation of the corpus callosum, although there was no significant gender difference in area of corpus callosum.
Adult ; Brain ; Cerebrum ; Corpus Callosum* ; Cranial Fontanelles ; Dissent and Disputes ; Female ; Fertilization ; Humans ; Infant, Newborn* ; Male

OBJECTIVES: The most important therapeutic strategy in acute myocardial infarction(AMI) is early recanalization of infarct-related artery(IRA). In Korea the commonly used method for recanalization is urokinase infusion in early phase of disease. But total dosage and method of urokinase infusion are still arbitary. Thus this study was undertaken to evaluate the patency rate of infarct-related artery by urokinase in AMI patients. METHODS: 42 acute myocardial infarction patients were treated with intravenous urokinase(40.000U/kg in 32 patients, 3,00,000U in 10 patients). IRA patency was evaluated with coronary angiography at 90 minutes and 7-10 days after intravenous urokinase. The clinical findings and coronary angiographic findings according to dose of urokinase or pain to time for urokinase injection were analysed prospectively. RESULTS: Mean pain to Door time was 251 minutes and door to urokinase time was 74 minutes. Early patiency of IRA was 61.8%(21/42) and no difference was observed between the dosage of intravenous urokinase. In open IRA group(21 patients) the reocclusion was not observed at 7-10 days later. The ejection fraction on admission was similiar in patent or non-patent IRA group, but follow up ejection fraction was significantly lower in closed IRA group than open IRA group(P=0.0185). Life- threatened bleeding complications were developed in 2 cases(4.8%, I intracranial hemorrhage, 1 gastrointestinal bleeding). CONCLUSION: IRA patency was achieved in 61.8% of acute myocardial infarction by intravenous urokinase as evaluated by coronary angiography. The patency of IRA at 90 minutes was important in preserving the global left ventricular function in early recovery phase of acute myocardial infarction. But large, prospective study may be needed to determine optimal and effective intravenous urokinase dosage in acute myocardial infarction.
Arteries ; Coronary Angiography ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Korea ; Myocardial Infarction* ; Prospective Studies ; Urokinase-Type Plasminogen Activator* ; Ventricular Function, Left

Mesenteric ischemia is rare and is often diagnosed late. Fatal complications or acute ischemic events can occur in the absence of proper treatment. Any sensitive and specific tests are not available for functional diagnosis of mesenteric ischemia until now. If another causes of abdominal pain and weight loss have been confidently ruled out, evidence of visceral artery occlusion at noninvasive imaging (CT angiography, Doppler US, and MR angiography) suggests mesenteric ischemia. Until the 1990s, open surgery was considered the only treatment of choice. Percutaneous transluminal angioplasty (PTA) was reserved for patients to whom surgery carried a high risk. However, open surgery carries a non-egligible risk of morbidity and mortality. In recent years, PTA with stent placement has been recognized as a minimal invasive treatment option for obtaining good long term results with an acceptable recurrence rate and consequently has been suggested for primary treatment of mesenteric ischemia. We describe the successful application of PTA to the inferior mesenteric artery stenosis by using drug eluting stent.
Abdominal Pain ; Angiography ; Angioplasty ; Arteries ; Colitis, Ischemic* ; Constriction, Pathologic ; Diagnosis ; Humans ; Ischemia ; Mesenteric Arteries ; Mesenteric Artery, Inferior ; Mortality ; Recurrence ; Stents* ; Weight Loss

PURPOSE: The aim of this study was to verify renal inflammation following Kawasaki disease (KD) using single photon emission computed tomography along with Technetium-99m dimercaptosuccinic acid scintigraphy (DMSA renal SPECT). METHODS: From March 2011 to October 2011, 15 patients diagnosed with KD at the National Health Insurance System Ilsan Hospital were enrolled in the study. All patients underwent DMSA renal SPECT to evaluate renal involvement during the acute phase of KD. Urine beta2-microglobulin (beta2-MG), a marker of renal proximal tubular dysfunction, was also measured to assess renal damage. RESULTS: All 15 patients had normal renal function test results. However, microscopic hematuria and pyuria were observed in 13% and 33% of the patients, respectively. Moreover, urine beta2-MG was elevated in 46% of the patients. In addition, patients were divided into two groups based on beta2-MG level: those with an increased beta2-MG level, and those with a normal beta2-MG level. No significant differences were found between these two groups in clinical characteristics, laboratory, sonography, and echocardiography findings. All patients' DMSA renal SPECT scans were normal. CONCLUSION: Our study showed that mild abnormalities in the urinalysis and elevated urine beta2-MG were the only findings of renal involvement in KD. However, no aggressive renal manifestations were detected on DMSA renal SPECT.
Echocardiography ; Hematuria ; Humans ; Inflammation ; Mucocutaneous Lymph Node Syndrome* ; National Health Programs ; Pyuria ; Radionuclide Imaging ; Succimer ; Tomography, Emission-Computed, Single-Photon ; Urinalysis

OBJECTIVE: Some reports have shown the gender-related clinical differences in Obsessive-compulsive disorder (OCD), but no study has yet been done in Korea. The purpose of this study was to investigate the gender-related differences of clinical features in the obsessive-compulsive patients in Korea. METHODS: Two hundred forty nine patients with OCD were included in this study; 180 subjects were male and 69 subjects were female. The two groups were analyzed in terms of demographic data including clinical variable, Y-BOCS (Yale-Brown Obsessive Compulsive Scale) scores, clinical course and treatment response. RESULTS: We found the earlier age at onset of OC symptoms in males and the more frequent washing and somatization type in female. There were no gender difference in comorbidity, clinical course and the treatment response. CONCLUSION: We could observe some of the gender-related clinical differences in Korean OCD patients. The further studies would be required to evaluate the gender difference in the long-term clinical course and therapeutic response of Korean OCD patients.
Comorbidity ; Female ; Humans ; Korea ; Male ; Obsessive-Compulsive Disorder*