An unusual case of metastatic choriocarcinoma of the kidney found in 31 year old Korean woman is presented.
Adult ; Choriocarcinoma* ; Female ; Humans ; Kidney* ; Pregnancy

1. Partial nephrectomy was done on 7 cases of various renal diseases including 5 cases of renal tuberculosis, 1 case of renal stone and l case of focal nephritis.Satisfactory results were noted in 5 cases of them. while in other 2 cases secondary nephrectomy was indicated because of severe postoperative shock and profuse hematuria. 2. Through the clinical experiences on the partial nephrectomy, it is believed that the method of choice in effective hemostasis during the operation should be included (a) the blunt division of renal parenchyma using scalpel han8e, (b) accurate ligation of the parenchymal vessels found during the division and (c) suture of the arcuate vessels at the corticomedullary junction under the aid of renal arterial clamping. On the other hand, tense and deep mattress suture to get indirect hemostasis is considered to be inadequate and unfavorable for the method having brought parenchymal necrosis and profuse delayed hemorrhage in a few instances. 3. Duration of renal arterial clamping using Bulldog clamp ranged about 30 minutes or so, and no definite renalinjury followed after the procedure.
Constriction ; Hand ; Hematuria ; Hemorrhage ; Hemostasis* ; Ligation ; Necrosis ; Nephrectomy* ; Shock ; Sutures ; Transcutaneous Electric Nerve Stimulation ; Tuberculosis, Renal

No abstract available.
Mandible*

A retrospective study of 274 patients who presented with constipation was done. The following results were obtained by recording colonic transit time. The male to female ratio was 72 : 197, and most patients were in their third and fifth decade, each age group accounting for 21% of total number. Associated symptoms were anal discomfort(33%), abdominal discomfort (25%), hematochezia (23%), reduced stool caliber (11%), and tenesmus (8%). As a result, 223 patients had normal transit time and 51 patients had abnormal transit time. Eighty-six patients with normal transit time and 51 patients with abnormal transit time underwent barium enema or colonoscopic examination. Abnormal lesions such as polyps and diverticulums were found in 10 patients with normal transit time and 7 patients with abnormal transit time. Therefore barium enema and colonoscopic examination in the patients with abnormal transit time were meaningful (P=0.024). Eighteen out of 25 patients with normal transit time and 8 (67%) of 12 patients with abnormal transit time showed abnormal defecogram results. The rectocele was the most frequent cause of abnormality in defecogram. Abnormal anal manometry results were obtained in 5 (22%) of 23 patients with normal transit time and 3 (50%) of 6 patients with abnormal transit time. Three types were classified in the patients with abnormal transit time. With type II patients, anal manometry findings were normal and 2 patients showed abnormal results in defecogram. With type III patients, 5 (43%) of 12 patients showed abnormal results in defecogram and 3 (50%) of 6 patients had abnormal anal manometry findings. Conclusively, if abnormal transit time is found in the patients with chronic consipation, further evaluations such as barium enema or colonoscopic examination are necessary. And even in the patients without any abnormality in transit time, selected performance of defecogram and anal manometry depending on clinical symptoms are preferable.
Barium ; Colon* ; Constipation* ; Diverticulum ; Enema ; Female ; Gastrointestinal Hemorrhage ; Humans ; Male ; Manometry ; Polyps ; Rectocele ; Retrospective Studies

BACKGROUND : Borame hospital nuns geriatric wards with 120 beds (40 beds for patients in Dept. of Internal Medicine, 40 for patients in Dept. of Orthopedics 40 for patients in Dept. of Neurology) from December 1996. We studied clinical characteristics of admissions to acute geriatric wards in Borame hospital in order to assess current status of geriatric wards in Korea. METHODS : 334 patients admitted from December 1996 to May 1997 were studied. By reviewing clinical records of these patients, we studied clinical characteristics of patients in geriatric wards retrospectively. RESULTS : 1) Age distribution: 8.6% of patients were over 85 years old. 16.4% of patients were between age of 80-84. 20.0% between 75-79, 31.3% between 70-74, 26.3% between 65-69, respectively. 2) Disease: 43% of patients have single disease, 67% of patients have multiple disease(23% of patients with 2 disease, 25% with 3 disease, 6% with 4 disease, 3% with over 5 disease respectively). 3) Mortality rate :Total mortality rates were 4.3% with 6.1% of patients in Internal medicine, 3.2% of patients in Neurology. These rates were much higher compared with mortality rates of 2.4% in general wards but similar to those (6.7%) in general wards in Internal medicine. 4) Causes of admission: Malignancies were most common causes of admissions in males, and then cerebrovascular diseases, infectious diseases, musculoskeletal diseases, in order. Musculoskeletal diseases were most common causes, and then diabetes mellitus, infectious diseases, cerebrovascular diseases. CONCLUSION : The elderly patients tend to have multiple diseases, longer hospital stays and higher mortality rates compared with younger patients in general wards. but differences of hospital stays and mortality rates are less than be expected.
Age Distribution ; Aged ; Aged, 80 and over ; Communicable Diseases ; Diabetes Mellitus ; Humans ; Internal Medicine ; Korea ; Length of Stay ; Male ; Mortality ; Musculoskeletal Diseases ; Neurology ; Orthopedics ; Patients' Rooms ; Retrospective Studies

The abnormalities in Hypothalamic-pituitary-adrenal(HPA) axis are associated with many psychiatric symptoms including depression. We present a report of a 71 year old man who was admitted to the psychiatric department presenting symptoms of headache, avolition, loss of energy, psychomotor retardation, poor appetite, insomnia, anxiety resulting from adrenal insufficiency and hypopituitarism. Hypothyroidism and electrolyte disturbance were managed and headache, insomnia, anxiety, GI symptoms were improved. But he remained in anergic state. After discharge, he was readmitted to infection department with high fever and drowsy mentality. Adrenal insufficiency was recognized and he was treated with corticosteroid replacement therapy. Finally his diagnosis was made as panhypopituitarism and overall symptoms were resolved. In this case, we showed how the atypical symptoms resulting from hypopituitarism develop and progress. Hypothyroidism, adrenal insufficiency, and growth hormone deficiency resulting secondarily from panhypopituitarism were associated with various nonspecific symptoms such as loss of energy, fatigue, insomnia, weight loss, decreased appetite etc. In clinical situation, differential diagnosis with depression is needed when clinicians were met a patient with these nonspecific symptoms. It is important that laboratory tests and differential diagnosis with endocrine diseases should be conducted, especially in geriatric patients with nonspecific symptoms like anergia, fatigue, poor appetite and so on.
Adrenal Insufficiency ; Anxiety ; Appetite ; Axis ; Depression ; Diagnosis, Differential ; Endocrine System Diseases ; Fatigue ; Fever ; Growth Hormone ; Headache ; Humans ; Hypopituitarism ; Hypothyroidism ; Sleep Initiation and Maintenance Disorders ; Weight Loss

We report a case of subcutaneous fat necrosis associated with pancreatitis that may be the first case in Korean hterature as for we know. The patient was a 41-year-old man wbo presented erythema nodesum-like erythematous subcufaneous nodules on both lower extremities. Histopathologic findings showed subcutaneoms focal fat necrosis and ghoat-like cells. Granular basophilic material was deposited in and around the necrotic fat cells and stained positively with von Kossa stain. The lesioas subsided gradwdly without any specific treatment, as the underlying pancreatitis was ameliorated.
Adipocytes ; Adult ; Basophils ; Erythema ; Fat Necrosis ; Humans ; Lower Extremity ; Necrosis* ; Pancreatitis* ; Subcutaneous Fat*

PURPOSE: This study was tried to evaluate the potential benefits of concurrent chemoradiation therapy (low dose daily cisplatin combined with split course radiation therapy) compared with conventional radiation therapy alone in stage III non-small cell lung cancer. The end points of analyses were response rate, overall survival, survival without locoregional failure, survival without distant metastasis, prognostic factors affecting survival and treatment related toxicities. MATERIAL AND METHODS: Between April 1992 and March 1994, 32 patients who had stage III non-small cell lung cancer were treated with concurrent chemoradiation therapy. Radiation therapy for 2 weeks (300cGy given 10 times up to 3000cGy) followed by a 3 weeks rest period and then radiation therapy for 2 more weeks (250cGy given 10 times up to 2500cGy) was combined with 6mg/M2 of cisplatin. Follow-up period ranged from 13 months to 48 months with median of 24 months. Historical control group consisted of 32 patients who had stage III non-small cell lung cancer were received conventionally fractionated (daily 170-200cGy) radiation therapy alone. Total radiation dose ranged from 5580cGy to 7000cGy with median of 5940 cGy. Follow-up period ranged from 36 months to 105 months with median of 62 months. RESULTS: Complete reponse rate was higher in chemoradiation therapy (CRT) group than radiation therapy (RT) group (18.8% vs. 6.3%). CRT group showed lower in-field failure rate compared with RT group (25% vs. 47%). The overall survival rate had no significant differences in between CRT group and RT group (17.5% vs. 9.4% at 2 years). The survival without locoregional failure (16.5% vs. 5.3% at 2 years) and survival without distant metastasis (17% vs. 4.6% at 2 years) also had no significant differences. In subgroup analyses for patients with good performance status (Karnofsky performance scale 80), CRT group showed significantly higher overall survival rate compared with RT group (62.5% vs. 15.6% at 2 years). The prognostic factors affecting survival rate were performance status and pathologic subtype (squamous cell cancer vs. nonsquamous cell cancer) in CRT group. In RT alone group, performance status and stage (IIIa vs IIIb) were identified as a prognostic factors. RTOG/EORTC grade 2-3 nausea and vomiting (22% vs. 6%) and bone marrow toxicities (25% vs. 15.6%) were significantly higher in CRT group compared with RT alone group. The incidence of RTOG/EORTC grade 3-4 pulmonary toxicity had no significant differences in between CRT group and RT group (16% vs. 6%). The incidence of WHO grade 3-4 pulmonary fibrosis also had no significant differences in both group (38% vs. 25%). In analyses for relationship of field size and pulmonary toxicity, the patients who treated with field size beyond 200cm2 had significantly higher rates of pulmonary toxicities. CONCLUSION: The CRT group showed significantly higher local control rate than RT group. There were no significant differences of survival rate in between two groups. The subgroup of patients who had good performance status showed higher overall survival rate in CRT group than RT group. In spite of higher incidence of acute toxicities with concurrent chemoradiation therapy, the survival gain in subgroup of patients with good performance status were encouraging. CRT group showed higher rate of early death within 1 year, higher 2 year survival rate compared with RT group. Therefore, to evaluate the accurate effect on survival of concurrent chemoradiation therapy, systematic follow-up for long term survivors are needed.
Bone Marrow ; Carcinoma, Non-Small-Cell Lung* ; Cisplatin ; Follow-Up Studies ; Humans ; Incidence ; Nausea ; Neoplasm Metastasis ; Pulmonary Fibrosis ; Survival Rate ; Survivors ; Vomiting

No abstract available.

PURPOSE: The staging of bladder carcinoma is a major determinant of operative management. CT of bladder carcinoma has been widely used to diagnose external extension (pT3b and over), but tumors confined to the bladder wall (from pT1 to pT3a) are poorly delineated. The authors describe CT findings of the superficial bladder carcinoma (below T1, stage A) in thin section CT with air insufflation technique (air insufflation-CT) to facilitate early detection and to aid correct staging of the superficial bladder carcinoma. MATERIALS AND METHODS: The materials consisted of proved 24 cases (1'9 patients, single tumor: 16 patients, multiple tumors :3 patients) of stage A bladder carcinomas. Air insufflation-CT was performed by the infusion of approximately 200 mL of air into the bladder via a Foley catheter. After the routine pelvic CT, bladder tumors were re-scanned with 1.5 to 5 mm thickness and intervals. RESULTS: The superficial bladder carcinomas were detected as nodular(5 cases, 20.8%), papillary(15 cases, 62.5%), pyramidal(2 cases, 8.3%), and domed(2 cases, 8.3%) forms on air insufflation CT. These tumors were classified into three types according to the size of the tumoral neck:type I(pedundulated polypold tumor:4 cases, 16.6%), type II(polypid tumor with short neck :13 cases, 54.2%), and type Ill(sessile tumor :7 cases, 29. 2%). The mean size(tumoral width x height x base o, neck/stalk) of the tumors was 22 x 20 x 16mm. The average tumoral sizes according to each type of the superficial tumors were type 1:22 x 25 x 6mm, type 11:23 x 22 x 18mm, and type III :18 x 15 x 18mm. The mean width of the type I--II tumoral necks was 15mm. The mean length of the type I tumoral neck(pedicle) was 2.5mm. Papillary fronds of the tumors were seen in 10 cases(41.7%) of 24 superficial tumors. Outer margin of the involved bladder wall was smooth in all cases. CONCLUSION: Thin-sectin CT with air insufflation technique for bladder carcinoma was useful in tumoral demonstration, and characteristics of the superficial bladder carcinomas were small polypold tumors had a short neck mostly and smooth outer wall of the involved bladder wall.
Catheters ; Humans ; Insufflation* ; Neck ; Urinary Bladder Neoplasms ; Urinary Bladder*