We report a case of hepatocellular carcinoma presented with severe hypoglycemia. Computerized tomography and ultrasonography revealed a massive bilateral tumor with portal vein thrombosis. The levels of IGF-I (113 ng/mL) and IGFBP- (815 ng/mL) measured in the plasma, were lower than normal range. There was strong immunoreactivity of IGF- and IGF-I in immunohistochemical stain of tumor cells.
Carcinoma, Hepatocellular* ; Carrier Proteins* ; Fibrinogen* ; Hypoglycemia* ; Insulin-Like Growth Factor Binding Proteins ; Insulin-Like Growth Factor I ; Plasma ; Reference Values ; Ultrasonography ; Venous Thrombosis

No abstract available.
Carcinoma, Non-Small-Cell Lung* ; Fingers*

A sound understanding of the preferred appearance of the external nose is central to successful rhinoplasty. A survey using photographs was conducted among college students and employees aged 20 to 39 years in Inchon, Korea. Three hundred and twenty-one subjects filled out a questionnaire about their preferences regarding external nasal appearance. The most commonly preferred height of the nasion, measured from the corneal plane, was 6 mm among both sexes, and the most commonly preferred depth of the nasion, measured from the glabella plane, was 3 mm among both sexes. Regarding the nasofrontal angle, men preferred an angle of 135 degrees and women preferred an angle of 140 degrees. Men preferred a nasofacial angle of 33 degrees while women preferred an angle of 30 degrees. A straight nasal dorsum was most commonly preferred among both sexes and the most commonly preferred dorsal width was 13 mm among men and 10 mm among women. The most commonly preferred tip projection was 30 mm among men and 27 mm among women and the preferred tip angle was 105 degrees among both sexes. The angle of the apex in the most commonly preferred nasal base configuration was 85 degrees among men and 70 degrees among women. The angle of the apex in the most commonly preferred lobular configuration was 65 degrees among both sexes. The most commonly preferred ratio between nostril length and the distance from the subnasale to the tip was 45 percent among both sexes. The most commonly preferred angle between both nostril axes was 60 degrees among both sexes. The most commonly preferred nasolabial angle was 90 degrees among men and 95 degrees among women. The main difference in preference between Koreans and Caucasians seemed to center on the radix area rather than the tip. These results can be useful as basic guidelines for rhinoplasty.
Female ; Humans ; Incheon ; Korea ; Male ; Nose ; Rhinoplasty ; Surveys and Questionnaires

BACKGROUND: Urinary tract infections (UTIs) are the most frequent nosocomial infections and are frequently associated with indwelling urinary catheters. It is known that adherence to standard infection control measures for urinary catheters can reduce UTIs in hospitals. This study was performed to evaluate the effect of education in reducing catheter-related UTIs (CR-UTIs) in intensive care units (ICUs) of a university hospital. METHODS: CR-UTIs were prospectively monitored for all patients with indwelling urinary catheters in ICUs from July 2006 through December 2007. Recommendations based on previously known guidelines for catheter insertion, catheter management, and specimen collection to prevent CR-UTIs were formulated and educated in March 2007. Knowledge and adherence level were evaluated before and after educating healthcare workers about the recommendations using questionnaire. Changes in knowledge and adherence level before and after education were compared by Chi-square test. Changes in the rate of CR-UTIs and urinary catheter utilization ratios were also analyzed by Fisher's exact test. RESULTS: After education, knowledge level of and adherence level to most of the recommendations were improved significantly. The rate of CR-UTIs significantly decreased by 48% from 7.43/1,000 catheter-days before intervention to 3.87/1,000 catheter-days after intervention (P=0.02). CONCLUSION: Surveillance for nosocomial infections and education for standard infection control measures are very important in preventing CR-UTIs in ICUs.
Catheters ; Cross Infection ; Delivery of Health Care ; Humans ; Infection Control ; Critical Care ; Intensive Care Units ; Prospective Studies ; Specimen Handling ; Urinary Catheterization ; Urinary Catheters ; Urinary Tract ; Urinary Tract Infections ; Surveys and Questionnaires

The nose is located centrally in the face and occupy an important place in the harmonic architecture of the face. Also, it plays important functions such as respiraton, olfaction and phonation. Therefore, reconstructive rhinoplasty is dealt with both cosmetic and functional aspect in mind. We have recently experienced three cases of reconstructive rhinoplasty for seborrheic keratosis of the nose, traumatic nasal defect, and basal cell carcinoma of the nose. Local flap and split calvarial bone graft were used for the reconstruction of the nose.
Carcinoma, Basal Cell ; Keratosis, Seborrheic ; Nose ; Phonation ; Rhinoplasty* ; Smell ; Transplants*

Granulomatosis with polyangiitis (GPA) is a disease characterized by a granulomatous necrotizing vasculitis of the small vessels, along with the presence of antineutrophil cytoplasmic antibody (ANCA), serologically. GPA is a multisystem disease, in which the diagnosis is frequently based on respiratory and renal manifestations, with rare breast invasion. To date, several cases of breast invasion by GPA have been published, and most cases have been positive for ANCA. However, ANCA-negative forms of breast invasion by GPA are extremely rare and have not been reported in Korea thus far. Therefore, we report a case of ANCA-negative GPA in a 70-year-old woman, who was initially presented with a localized palpable mass in the left breast.
Aged ; Antibodies ; Antibodies, Antineutrophil Cytoplasmic ; Breast* ; Cytoplasm* ; Diagnosis ; Female ; Humans ; Korea ; Vasculitis

BACKGROUND AND PURPOSE: The level of 14-3-3 protein in the cerebrospinal fluid (CSF) is increased in Creutzfeldt-Jakob disease (CJD) patients, which has led to it being used as a clinical biomarker for the ante-mortem diagnosis of human prion diseases. However, the specificity of the 14-3-3 protein is less reliable for CJD diagnosis. Newly developed assays including real-time quaking-induced conversion (RT-QuIC) have made it possible to detect the PrPSc-like abnormal prion isoform with a high sensitivity in animal and human specimens that might contain a minute amount of PrP(Sc) due to in vitro prion replication. METHODS: This study applied a highly sensitive RT-QuIC assay using recombinant human PrP to detect PrP(Sc) in the CSF of 81 patients with sporadic CJD (sCJD) in Korea. RESULTS: RT-QuIC analysis of the CSF samples based on the expression levels of 14-3-3 and total tau proteins revealed positivity in 62 of 81 sCJD patients (sensitivity of 76.5%) but no positive results in the 100 non-CJD patients. CONCLUSIONS: The sensitivity of the RT-QuIC in this study was similar to that in some previous reports, and the specificity of RT-QuIC was higher than that of 14-3-3 in CSF, suggesting that RT-QuIC analysis can complement the weakness of the specificity of 14-3-3 for the diagnosis of sCJD. These results indicate that RT-QuIC might be very useful for the rapid and specific diagnosis of sCJD and provide a practical novel method for the ante-mortem diagnosis of human prion diseases.
14-3-3 Proteins ; Animals ; Cerebrospinal Fluid ; Complement System Proteins ; Creutzfeldt-Jakob Syndrome* ; Diagnosis* ; Humans ; Korea* ; Prion Diseases ; Sensitivity and Specificity ; tau Proteins

PURPOSE: We investigated if there are some differences in characteristic of recent renal infection from the past one and evaluated the need of ultrasonography in acute renal infection and the efficiency of antibiotics that have been used primarily in treatment of past renal infection. MATERIALS AND METHODS: We reviewed charts of 232 patients with acute renal infection retrospectively, who took admission treatment from 1991 to 1995 at our hospital. The laboratory tests such as complete blood count, urinalysis and urine culture with sensitivity and radiologic evaluations such as abdominal ultrasonography, excretory urography or voiding cystourethrography were performed. RESULTS: The most common age groups were 3rd decade(26.7%) and 4th decade(24.1%). Female was predominant in all age groups(M:F=1:8.7) except 1st decade(M:F=1.6:1). Acute pyelonephritis was the most common disease (87.1%) and then followed by acute focal bacterial nephritis(8.2%), renal abscess(4.3%) and perirenal abscess(0.4%). Five cases(2.2%) were accompanied by vesicoureteral reflux. Abdominal ultrasonography was done in 90.5%, but 74.8% of them were completely normal and most of abnormal findings at abdominal ultrasonography were clinically insignificant. Result of ultrasonography did not affect the outcome of the disease or the treatment plan. The significant bacterial isolation(more than 10(5)CFU/ml) in urine culture was 46.6%. Among them, E. coli was the most common organism(92.6%) and others were Enterobacter, Klebsiella or Pseudomonas. Causative agents were resistant to some drugs such as ampicillin or bactrim which have been usually used for urinary tract infection. CONCLUSIONS: Routine ultrasonography in renal infections without urinary tract obstruction was not helpful in treatment plan or outcome of this disease and selection of antibiotics in treatment of recent renal infection should be changed from the past one.
Ampicillin ; Anti-Bacterial Agents ; Blood Cell Count ; Enterobacter ; Female ; Humans ; Klebsiella ; Pseudomonas ; Pyelonephritis ; Retrospective Studies ; Trimethoprim, Sulfamethoxazole Drug Combination ; Ultrasonography* ; Urinalysis ; Urinary Tract ; Urinary Tract Infections ; Urography ; Vesico-Ureteral Reflux

Common atrium is a rare congenital heart disease characterized by complete absence of the interatrial septum, and is commonly accompanied by malformation of the atrioventricular valve. Most patients with common atrium experience symptoms during childhood. Here, we describe a patient with common atrium who experienced his first obvious symptom at 48 years of age.
Adult ; Heart Atria ; Heart Defects, Congenital ; Humans

Skeletal muscle involvement has been well documented and muscular symptoms are common in patients with polyarteritis nodosa (PAN). However, the level of muscle enzyme is uncommonly elevated and overt rhabdomyolysis is very rare. We report a case of PAN presenting as rhabdomyolysis. A 22-year-old man was admitted because of fever, severe myalgia and swelling in all extremities. Laboratory investigations showed markedly increased levels of serum creatine kinase and myoglobin. There was diffusely increased muscular uptake in bone scan. Muscle biopsy from the right deltoid revealed vasculitis involving medium-sized vessel with ischemic necrosis of muscle. On angiography, saccular aneurysms were found in multiple arterities. Therapy with methylprednisolone pulse therapy and cyclophosphamide was followed by improvement of his symptoms.
Aneurysm ; Angiography ; Biopsy ; Creatine Kinase ; Cyclophosphamide ; Extremities ; Fever ; Humans ; Methylprednisolone ; Muscle, Skeletal ; Myalgia ; Myoglobin ; Necrosis ; Polyarteritis Nodosa* ; Rhabdomyolysis* ; Vasculitis ; Young Adult