The authors present 12 cases of far lateral disc herniation(FLDH) diagnosed and treated in our institution from march, 1992 to February, 1994. In the author's series the incidence of far lateral disc herniation was 5% of all lumbar disc herniations. The average age of the patients was 4 years and there were 7 men and 5 women. The L4-5 intervertebral disc level was the most commonly involved level. All patients initially presented with symptoms of radiculopathy. Cases with double herniations at the same level and on the same side seemed to have the most potential source of misdiagnosis and mismanagement, and a careful surgical consideration was needed for such cases. In 4 cases, a combined intraspinal and extraforaminal approach was performed with preservation of facet joints and in 2 cases, paramedian muscle splitting approach was performed. Chemonucleolysis and the usual partial hemilaminectomy were undertaken in 5 cases and in 1 case, respectively. The combined approaches proved to be an effective means of treatment for cases with double herniations, but misdiagnosis of such lesion can lead to an inappropriate and an ineffective treatment and poor surgical results. Furthermore, in the diagnosis of far lateral disc herniation, differentiation must be made from symptoms of conjoined nerve root and congested epidural vein.
Diagnosis ; Diagnostic Errors ; Estrogens, Conjugated (USP) ; Female ; Humans ; Incidence ; Intervertebral Disc ; Intervertebral Disc Chemolysis ; Male ; Radiculopathy ; Veins ; Zygapophyseal Joint

We report a case of intratumoral fat in neurofibroma and coexistance of eccrine hidrocystoma on the occipital area of the scalp for one year duration. There are several diseases showing fatty change histopathologically. Among them, few cases of neurofibroma showing fatty change had been reported. The mechanism of fatty change is unclear, but several hypotheses are proposed. Here we report a case of neurofibroma showing fatty change and coexistence of eccrine hidrocystoma, and discuss the pathomechanism of fatty change and its relationship with disease.
Hidrocystoma* ; Neurofibroma* ; Scalp

Submucosal tumors in the gastrointestinal tract are covered with a mucous membrane such as the surrounding tissue. Therefore, the use of endoscopic biopsy to diagnose submucosal tumors is not as effective as that for epithelial tumors. Although imaging tools such as ultrasonography or computed tomography have made great advances, it is still difficult to diagnose submucosal tumors before resection. The surgical resection of tumors is the most accurate diagnostic method, yet less invasive endoscopic resection has been preferred in recent years. We report herein on a rare case of ganglionueroma arising from the Ampulla of Vater and this lesion was incidentally found during performance of routine esohagogastroduodenoscopy. The lesion was diagnosed as a ganglioneuroma, and it was successfully removed through endoscopic resection.
Ampulla of Vater ; Biopsy ; Ganglioneuroma ; Gastrointestinal Tract ; Mucous Membrane

BACKGROUND/AIMS: Long-term lamivudine therapy can induce the emergence of lamivudine resistant hepatitis B virus (HBV) mutants. Clinically emergence of the mutant is expressed by the reappearance of disappeared HBV DNA in serum. Continued lamivudine treatment has been usually recommended in cases of viral breakthrough. However, the clinical outcome in patients with viral breakthrough is not clear. The aim of this study was to investigate the clinical course of chronic hepatitis B patients after viral breakthrough during lamivudine therapy. METHODS: A total of 74 patients with chronic hepatitis B who showed viral breakthrough after at least 6 months of lamivudine treatment were included in this study. They had positive HBeAg and HBV DNA before treatment. The median follow-up duration after breakthrough was 13 months. RESULTS: After viral breakthrough, only 8 patients (11%) maintained normal ALT levels and 66 patients (89%) showed elevation of ALT. 30 patients (41%) showed acute exacerbation of hepatitis (ALT increase over five-times upper normal limit). These acute exacerbations occurred within three months after breakthrough in 19 patients (63%). In the cases of acute exacerbation, 6 patients showed decompensated progression such as elevation of serum total bilirubin. One of them died of hepatic failure. A predictive factor for acute exacerbation was not found. HBeAg seroconversion occurred in 8 patients after viral breakthrough but their clinical course was highly variable. CONCLUSIONS: Chronic hepatitis B patients who had viral breakthrough during lamivudine therapy should be followed carefully and regularly in mind of potential clinical deterioration. New strategies are needed to manage the cases of acute exacerbation after viral breakthrough.
Adult ; Antiviral Agents/*therapeutic use ; Drug Resistance, Viral ; English Abstract ; Female ; Hepatitis B Virus/drug effects/growth & development ; Hepatitis B, Chronic/drug therapy/*virology ; Human ; Lamivudine/*therapeutic use ; Male ; Middle Aged

Nephrotic syndrome is associated with a hypercoagulable state, which results in thromboembolism as one of its main complications. Various pathogenetic factors that cause the hypercoagulable state in nephrotic syndrome have been recognized. We report on a 19-year-old female with a minimal-change disease who developed pulmonary thromboembolism combined with intracardiac thrombus while on tapering steroid. Our patient showed hypoalbuminemia with an episode of shock, and was successfully treated with thrombolysis and anticoagulation therapy.
Female ; Humans ; Hypoalbuminemia ; Nephrotic Syndrome* ; Pulmonary Embolism* ; Shock ; Thromboembolism ; Thrombosis* ; Young Adult

Incidental focal acantholytic dyskeratosis (IFAD) has been described for various cutaneous lesions. A 58-year-old man presented with a purple colored, 5 mm crusted papule on the back. An excisional biopsy was performed and histopathological examination showed angiomatous tissue occurring in a discrete mass. It was enclosed by a collarette of acanthotic epidermis. The angiomatous tissue comprised a variably dilated network of blood-filled capillaries, which was surrounded by myxoid stroma. Hyperkeratosis, acantholysis, dyskeratosis and intraepidermal clefts were also focally present. Correlation of the clinical features and the histopathology results established a diagnosis of pyogenic granuloma showing IFAD.
Acantholysis ; Biopsy ; Capillaries ; Epidermis ; Granuloma, Pyogenic ; Humans ; Middle Aged

Generally, self expandable metallic stents (SEMSs) are widely used for the treatment of malignant gastrointestinal stenosis due to their effectiveness and low complication rate. On the contraty, balloon dilatation or Bougie dilatation is commonly used for treating benign gastrointestinal stenosis as non-invasive methods. However, their such complications such as recurrence, hemorrhage and perforation are problematic when these dilation techniques are used. Temporary placement of a SEMS in a benign gastric outlet obstruction is expected to be a promising therapeutic modality despite of several major complications such as migration. Rarely, stent removal can, on rare occasions, be difficult or cause bleeding or perforation when the stent is embeded in the mucosa due to mucosal hyperplasia at the tips of the stent. We report here on a case of a stent, partially embeded in the mucosa after temporary stenting for treating a benign pyloric stenosis, which was successfully removed using argon plasma coagulation.
Argon ; Argon Plasma Coagulation ; Constriction, Pathologic ; Dilatation ; Gastric Outlet Obstruction ; Hemorrhage ; Hyperplasia ; Mucous Membrane ; Pyloric Stenosis ; Recurrence ; Stents

Several cases of photodynamic therapy (PDT) for the curative treatment of early gastric cancer have recently been reported. However, PDT has been performed in only limited cases because it is impossible to determine the pathologic subtype or stage of the malignant lesion after the procedure. Nevertheless, PDT combined with endoscopic submucosal dissection (ESD) is expected to enhance the accuracy of the pathologic assessment and enable more effective, safe treatment for early gastric cancer. Furthermore, PDT may exert a complementary and synergetic effect on ESD for the atypical forms of early gastric cancer. From this background, we report here on a case of early gastric cancer that mimicked submucosal tumor, and this was removed by ESD, and then this was followed by adjuvant PDT. The patient had a high risk for operation due to his old age and comorbidity. After the procedure, he achieved complete remission and he is currently under follow up: he is without recurrence of tumor one year after ESD.
Comorbidity ; Humans ; Photochemotherapy ; Recurrence ; Stomach Neoplasms ; Triazenes

BACKGROUND: As of 2006, the residents of family medicine occupies about 9 percent among the total. However, expansion of more general practice doctors is in demand to conduct desirable general practice. Accordingly, this study was conducted to survey the motivation to apply for family medicine residency and the actual situation. METHODS: A questionnaire survey of 862 residents of nationwide family medicine from June 2006 to July 2006 was performed via e-mails. Hospital, size, years, gender, age, university, career, time and motivation to apply, and existence and nonexistence of lecture in medical school or clinical practice of family medicine for students were reviewed. RESULTS: Among the total, 415 (48.14%) residents from 72 training hospitals answered. For the motivation, 'the necessity to diagnose and treat various patients' was 53.49%, 'advantageous to start practice' was 21.93%, and 'relatively short training period' was 11.33%. For the time, during 'intern' was 49.40%, 'on getting a job' 16.63%, and as a 'student' 15.42%. When they had lectures of family medicine in medical school, decision made as a student was 19.93%, and during clinical practice was 21.61%. CONCLUSION: Among the reasons that motivated to apply for family medicine, 'the necessity to diagnose and treat various patients' was the biggest, which conforms to the training goal of Academy of Family Physicians. Since there is a tendency to select family medicine residency earlier when they are exposed to lectures of family medicine or clinical practices in medical school, the effort to expand substantial lectures and clinical practices is needed.
Electronic Mail ; General Practice ; Humans ; Internship and Residency ; Lectures ; Motivation* ; Physicians, Family ; Schools, Medical ; Surveys and Questionnaires

A 6-year old boy was admitted with high fever and redness of the right eyelids and the surrounding area. He had previously suffered cerebral contusion, basal skull fracture and pneumocephalus following a traffic accident which required six months' hospitalization. Since then, and prior to admission, he had twice suffered probable bacterial meningitis and had been treated at an outstanding hospital. At the time of this admission, the patient again developed high fever, with redness of the right eyelid and surrounding area. His symptomatology suggested bacterial meningitis and cerebrospinal fluid culture revealed Streptococcus pneumoniae sensitive to penicillin. In accordance with the clinical course of meningitis and accompanying sinusitis, the appropriate antibiotic and its duration of usage were determined. Recurrent episodes of bacterial meningitis in this child raised the possibility of anatomical defect as an a contributory factor. Computerized tomographic(CT) cisternography suggested leakage of cerebrospinal fluid and revealed herniated frontal brain tissue protruding through a gap in the right frontal skull base, three dimensional CT(3-D CT) confirmed this defect, which was 3X4cm in size. After recovery from meningitis, surery to prevent recurrent meningitis, was performed. To locate pathologic areas, the subfrontal approach,involving bicoronal skin incision and bifrontal bone flap was used. Multiple fracture lines and a large bony defect on the orbital roof were observed, together with a dural defect, through which cerebromalatic tissue was herniated as encephalocele. Using lyophilized dura, the dural defect was made watertight; the bony defect was packed with autologous fats and covered with titanium mesh. The patient improved after surgery. Recurrent meningitis with anatomical pathologic focus after head trauma requires surgical intervention.
Accidents, Traffic ; Brain ; Cerebrospinal Fluid ; Child ; Contusions ; Craniocerebral Trauma ; Encephalocele ; Eyelids ; Fats ; Fever ; Hospitalization ; Humans ; Male ; Meningitis* ; Meningitis, Bacterial ; Orbit* ; Penicillins ; Pneumocephalus ; Sinusitis ; Skin ; Skull Base ; Skull Fractures* ; Skull* ; Streptococcus pneumoniae ; Titanium