PURPOSE: As vesicoureteral reflux (VUR) could lead to renal functional deterioration when combined with urinary tract infection, we need to decide whether operative anti-reflux treatment should be performed at the time of diagnosis of VUR. Predictive value of radioisotope voiding cystography (RIVCG) for renal outcome was tested. MATERIALS AND METHODS: In 35 children (18 males, 17 females), radiologic voiding cystourethrography (VCU), RIVCG and DMSA scan were performed. Change in renal function was evaluated using the follow-up DMSA scan, ultrasonography, and clinical information. Discriminant analysis was performed using individual or integrated variables such as reflux amount and extent at each phase of voiding on RIVCG, in addition to age, gender and cortical defect on DMSA scan at the time of diagnosis. Discriminant function was composed and its performance was examined. RESULTS: Reflux extent at the filling phase and reflux amount and extent at postvoiding phase had a significant prognostic value. Total reflux amount was a composite variable to predict prognosis. Discriminant function composed of reflux extent at the filling phase and reflux amount and extent at postvoiding phase showed better positive predictive value and specificity than conventional reflux grading. CONCLUSION: RIVCG could predict renal outcome by disclosing characteristic reflux pattern during various voiding phases.
Child ; Diagnosis ; Follow-Up Studies ; Humans ; Male ; Prognosis ; Sensitivity and Specificity ; Succimer ; Ultrasonography ; Urinary Tract Infections ; Vesico-Ureteral Reflux

PURPOSE: To evaluate the effectiveness of radioiodine treatment for metastatic thyroid carcinoma, we reviewed results of radioactive iodine treatment in patients with functional lung or bone metastases. MATERIALS ANF METHODS: Of 760 patients who were treated for differentiated thyroid cancer between 1984 and 1998, we detected pulmonary metastases and bone metastases in 76 patients (10.0%) and 20 patients (2.6%), respectively. Among them, we could evaluate the effectiveness of I-131 therapy in 53 patients with lung metastases and 15 patients with bone metastases. RESULTS:Of 53 patients who received I-131 therapy with a mean cumulative dose of 26.2 GBq (1.1-84.4 GBq) for pulmonary metastases, metastatic lung lesions completely resolved in 19 patients (35.8%) and improved in 22 patients (41.5%). In 13 of 19 patients with complete remission of pulmonary metastases, the total accumulated dose of I-131 was less than 18.5 GBq. We found 43 sites of metastatic bone lesions in 15 patients with bone metastases. Of 29 lesions which received I-131 therapy, metastatic lesions improved in 14 sites (48.3%), but did not change or progress in 15 sites (51.7%) despite the I-131 therapy. Three lesions were completely cured with a combination treatment of surgery(+/- external radiotherapy) and I-131 therapy, and the other 11 lesions improved. CONCLUSION: Radioactive iodine treatment gives favorable results for pulmonary metastases. However, for bone metastases, there might be a need to use combination therapy including I-131 and surgery or external irradiation.
Atrial Natriuretic Factor ; Humans ; Iodine ; Lung ; Neoplasm Metastasis* ; Thyroid Gland* ; Thyroid Neoplasms*

Four cases of sudden unexpected death during hospitalization are described where autopsy examination showed lobar pneumonia. As widely accepted, sudden death is defined as a natural unexpected death within 1 hour of symptoms and it is well known that pneumonia can be a cause of sudden death. Although pneumonia is a common finding in autopsy, it is not usual that pneumonia is a direct cause of death, especially in medicolegal autopsy cases. In the present study about 4 cases, pneumonia was primary illness and direct cause of death. 4 victims were all male(39~74 years) and found dead on the bed or corridor couch during their admission. The authors describe the autopsy findings, clinical features and courses, and predisposing factors, with literature review.
Autopsy* ; Causality ; Cause of Death ; Death, Sudden ; Hospitalization ; Humans ; Pneumonia*

In forensic autopsies, some cases of poisoning of cyanide and agrochemical substances are noted. In these cases, the appearance of gastric mucosa and its content is essential and important to determine the cause of death because the appearance of them is usually specific to kinds of cyanide and agrochemical substances. So, full awareness of the appearance of gastric mucosa and its content is very important to forensic pathologist in these cases. The 134 autopsy cases are reviewed and the photographs of gastric mucosa and its content are collected. After the choose of good and typical photographs, the illustrations of these cases are displayed. The purpose of this study is offering the guidelines of appearance of gastric mucosa and its contents in cases of poisoning.
Autopsy ; Cause of Death ; Gastric Mucosa* ; Poisoning*

PURPOSE: Larger tumor size and more extensive lymph node (LN) involvement have been considered independent factors for poor prognosis of breast cancer. We evaluated whether smaller tumor size may be a factor of worse prognosis compared with larger tumor size in small-sized breast cancer with LN involvement. METHODS: A retrospective analysis was conducted at a single center for 1,400 patients with small-sized (≤2 cm) and LN involved (N1–N3) breast cancer who underwent radical surgery, had no distant metastases, and were diagnosed between 2004 and 2014. We subdivided their tumor size into four subgroups (T1mi, T1a, T1b, T1c) graded using the 7th American Joint Committee on Cancer staging and two subgroups (T1ab [≤1 cm] and T1c [>1 cm]) divided by tumor size. The relationship between tumor size, prognosis and specific features were analyzed using the Chi-square test, Kaplan-Meier method, and Cox regression analysis. RESULTS: There were significant differences in estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 (HER2) and HER2 amplified type among the four subgroups in all patients. Especially, HER2-amplified type also appeared in distribution significantly between the two subgroups in all patients (T1ab [13.0%] vs. T1c [8.0%], p=0.008). The overall survival of the T1N1 staged patients in the smaller-sized tumor group (T1ab) was lower than that of those in the larger-sized group (T1c) (p=0.005). In the multivariate Cox regression analysis of all patients, the T1ab group showed a higher mortality risk compared with the T1c group (adjusted hazard ratio, 2.540; 95% confidence interval, 1.195–5.397; p=0.015). CONCLUSION: Smaller-sized tumors with LN involvement indicated worse prognosis compared with larger-sized tumors.

OBJECTIVE: The validity of olfactory bulbectomized rat as an animal depression model and the possibilities of the NMDA antagonist as an antidepressant would be evaluated by demonstrating structural alterations in their brain MRIs and histological findings of hippocampus. METHODS: Those 8-week old male Sprague-Dawley rats received either an olfactory bulbectomy or sham operation and volume changes at ventricles and caudate nucleus in their brain MRI were acquired at preoperation and postoperation. Those olfactory bulbectomized rats received either memantine, an uncompetitive NMDA antagonist, or normal saline, a placebo, and their brain structural changes in MRI were acquired. At preoperation, postoperation, and postmedication each one of the rats with sham-operation, with memantine, and with placebo was sacrificed to acquire histological impressions. RESULTS: 1) Comparison of the volume changes between preoperation and postoperation showed statistical significance; the volumes of the left and right lateral ventricles (p=0.007, p=0.008) and the third ventricle (p=0.003) increased significantly but the volumes of left and right caudate nucleus decreased (p=0.014, p=0.032), compared to that of the controls. 2) After 6-weeks of memantine administrations, the OB rats revealed more definite recovery in brain MRIs statistically than the controls: the volumes of left and right ventricles and left and right caudate nucleus (p=0.004, p=0.03 ; p=0.04, p=0.05). 3) The hippocampus histological findings of the olfactory bulbectomy showed frequently eosinophilic cytoplasm and hyperchromatic nucleus with shrinkage in CA3. After memantine intake, the hippocampus histological findings returned to nearly normal and showed mixtures of normal cell and abnormal neuron cell. CONCLUSION: The OB models would be valid as an animal model of depression and alterations in their brain MRI images after administrations of NMDA antagonist could be an indicator of antidepressant effects.
Animals ; Brain ; Caudate Nucleus ; Cytoplasm ; Depression* ; Eosinophils ; Heart Ventricles ; Hippocampus ; Humans ; Lateral Ventricles ; Magnetic Resonance Imaging* ; Male ; Memantine* ; Models, Animal ; N-Methylaspartate ; Neurons ; Rats* ; Rats, Sprague-Dawley ; Third Ventricle

PURPOSE: Tertiary hyperparathyroidism (tHPT) means a persistent secondary hyperparathyroidism even after successful renal transplantation. Parathyroidectomy (PTX) is an efficient way to treat tHPT. In this study, we reviewed our single center Experience of PTX in regard to postoperative outcomes and analyzed any differences by the types of surgery. METHODS: Among 2,589 recipients who underwent renal allograft between April. 1979 and Dec. 2006, 11 patients (0.4%) were identified to have tHPT and underwent PTX. Levels of intact parathyroid hormone (iPTH) and serum calcium were measured before and after PTX to evaluate therapeutic effect, and serum-creatinine and GFR using the Modification of Diet in Renal Disease (MDRD) equation to investigate any effect to graft function. RESULTS: One patient showed persistent hyperparathyroidism and hypercalcemia after subtotal PTX. We experienced 10 successful PTXs in which 2 total PTX with autotransplantations, 4 subtotal PTXs and 4 limited PTXs. Level of iPTH and serum calcium were at normal range after PTX. Serum creatinine increased and estimated GFR decreased after PTX. Total PTX with autotransplantation showed a tendency of more decrease in the values of iPTH, and GFR after PTX than Subtotal PTX. CONCLUSION: PTX can cure tHPT-specific symptoms and sign by the recovery of hypercalcemia but may carry the risk of deterioration of kidney graft function. Subtotal PTX rather than total PTX might be recommended in the surgical treatment of tHPT to prevent any risk of kidney graft deterioration.
Allografts ; Autografts ; Calcium ; Creatinine ; Diet ; Humans ; Hypercalcemia ; Hyperparathyroidism* ; Hyperparathyroidism, Secondary ; Kidney ; Kidney Transplantation* ; Parathyroid Hormone ; Parathyroidectomy ; Reference Values ; Transplants

Differential diagnosis of posterior neck pain is very challenging based on symptoms and physical examination only. Retropharyngeal calcific tendinitis is a rare and frequently misdiagnosed entity in various causes of neck pain. It results from calcium hydroxyapatite deposition in the longus colli muscle which is characterized by severe neck pain, painful restriction of neck movement, dysphagia, and odynophagia. We herein report a case of a patient with acute retropharyngeal calcific tendinitis, who complained of posterior neck pain, initially diagnosed and treated as a myofascial neck pain syndrome.
Deglutition Disorders ; Diagnosis, Differential ; Durapatite ; Humans ; Myofascial Pain Syndromes ; Neck Pain* ; Neck* ; Physical Examination ; Tendinopathy*

BACKGROUND/AIMS: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas has a favorable prognosis, but seems to be associated with a high incidence of extrapancreatic tumors. The purpose of this study was to evaluate the incidence and clinicopathological features of extrapancreatic tumors associated with IPMN. METHODS: Thirty-seven patients with IPMN of the pancreas, confirmed by surgical resection and typical findings of endoscopic ultrasonography and CT imaging between October 1, 1998 and August 31, 2006 were included. Seventeen patients were diagnosed with surgical resection and biopsy, and others by typical imaging findings of IPMN. These patients were examined for the development of extrapancreatic tumors. RESULTS: Of 37 patients with IPMN, 14 (38%) had 18 extrapancreatic tumors, and 10 (27%) had 13 extrapancreatic malignancies. Five, six, and two extrapancreatic malignancies had diagnosed before during, and after the diagnosis of IPMN. Gastric adenocarcinoma (3 patients, 23%) and colorectal carcinoma (3 patients, 23%) were the most common neoplasms. Other extrapancreatic tumors included lung cancer (n=2), prostatic cancer (n=1), renal cell carcinoma (n=1), cholangiocelluar carcinoma (n=1), urinary bladder cancer (n=1), and gallbladder cancer (n=1), respectively. As benign tumor, there were two gallbladder adenoma, one gastric adenoma, one colonic adenoma and one benign ovarian cystic neoplasm, respectively. CONCLUSIONS: IPMN is associated with high incidence of extrapancreatic tumors, particularly gastric and colorectal neoplasms. Upper gastrointestinal endoscopy and colonoscopy should be done, and systemic surveillance for the possible occurrence of other tumors may allow early detection of extrapancreatic tumor in patients with IPMN.
Adenocarcinoma, Mucinous/*diagnosis/pathology/ultrasonography ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology/ultrasonography ; Carcinoma, Papillary/*diagnosis/pathology/ultrasonography ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasms, Multiple Primary/diagnosis/*epidemiology ; Neoplasms, Second Primary/diagnosis/*epidemiology ; Pancreatectomy ; Pancreatic Neoplasms/*diagnosis/pathology/ultrasonography ; Retrospective Studies ; Tomography, X-Ray Computed

Hyponatremia is rarely reported to cause rhabdomyolysis and there has been only one case report on rhabdomyolysis due to hyponatremia, possibly complicated by benzodiazepines. We experienced a case of rhabdomyolysis due to hyponatremia during the use of benzodiazepines in a patient with an acute psychosis. A 60-year-old man was admitted to the emergency room due to altered mentality. He had been taking benzodiazepines for 1 month because of insomnia, uneasiness, and depression. His initial blood chemistry revealed severe hypotonic hyponatremia in the absence of polydipsia, edema, and features of dehydration. While correcting the hyponatremia, rhabdomyolysis developed with no evidence of trauma, seizures, or tremor. In patients with acute psychosis, the development of rhabdomyolysis due to hyponatremia or its correction should not be underestimated and should be assessed thoroughly. Clinicians also need to be aware of the potential risk of benzodiazepines for the development of rhabdomyolysis.
Benzodiazepines ; Dehydration ; Depression ; Edema ; Emergencies ; Humans ; Hyponatremia ; Middle Aged ; Polydipsia ; Psychotic Disorders ; Rhabdomyolysis ; Seizures ; Sleep Initiation and Maintenance Disorders ; Tremor