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Reflex Movements in Patients with Brain Death: A Prospective Study in A Tertiary Medical Center.

Suk Geun HAN ; Gyeong Moon KIM ; Kwang Ho LEE ; Chin Sang CHUNG ; Ki Young JUNG

Journal of Korean Medical Science.2006;21(3):588-590. doi:10.3346/jkms.2006.21.3.588

Reflex movements have been reported to occur in up to 75% of brain-dead patients, but this issue has not been addressed in Korea. The patients admitted to our hospital who met the criteria for brain death were enrolled between March 2003 and February 2005. The frequency and type of reflex movements in these patients were evaluated prospectively using a standardized protocol. Brain death was determined according to the guideline of Korean Medical Association. Of 26 patients who were included, five (19.2%) exhibited reflex movements such as the pronation-extension reflex, abdominal reflex, flexion reflex, the Lazarus sign, and periodic leg movements. This finding suggests that the frequency of spinal reflex movements is not rare and the awareness of these movements may prevent delays in brain-dead diagnosis and misinterpretations.
Spinal Cord/physiopathology ; *Reflex ; Prospective Studies ; Physical Stimulation ; Organ Transplantation ; Movement ; Middle Aged ; Male ; Humans ; Female ; Extremities/physiopathology ; Brain Death/*pathology ; Adult

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Bucillamine-Induced Pemphigus Vulgaris in a Patient with Rheumatoid Arthritis and Polymyositis Overlap Syndrome.

Jin Wuk HUR ; Chang Woo LEE ; Dae Hyun YOO

Journal of Korean Medical Science.2006;21(3):585-587. doi:10.3346/jkms.2006.21.3.585

Bucillamine is a disease modifying anti-rheumatic drug, structurally similar to D-penicillamine. Although D-penicillamine-induced pemphigus has been not infrequently demonstrated, pemphigus associated with bucillamine was rarely reported. We describe a patient complicating pemphigus vulgaris after bucillamine treatment in rheumatoid arthritis (RA) and polymyositis (PM) overlap syndrome. PM and RA overlap syndrome was diagnosed three years ago and bucillamine was administrated for 20 months. Skin lesions including erythematous flaccid blisters on her chest, axillae, and back were occurred and were compatible with pemphigus vulgaris by typical pathology. Withdrawal from bucillamine and prednisolone treatment made rapid improvement of pemphigus lesions.
Syndrome ; Skin/pathology ; Polymyositis/*complications/*drug therapy ; Pemphigus/*chemically induced/*pathology ; Middle Aged ; Humans ; Female ; Cysteine/adverse effects/*analogs & derivatives ; Biopsy ; Arthritis, Rheumatoid/*complications/*drug therapy ; Arthritis ; Antioxidants/*adverse effects

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Winged Scapula Caused by Rhomboideus and Trapezius Muscles Rupture Associated with Repetitive Minor Trauma: A Case Report.

Sam Gyu LEE ; Jae Hyung KIM ; So Young LEE ; In Sung CHOI ; Eun Sun MOON

Journal of Korean Medical Science.2006;21(3):581-584. doi:10.3346/jkms.2006.21.3.581

We experienced a rare case of winged scapula that was caused by the rupture of the rhomboideus major and the lower trapezius muscles without any nerve injury in a 12 yr old female after she had carried a heavy backpack. Electrodiagnostic study revealed that the onset latencies, amplitudes and conduction velocities were normal in the long thoracic nerve, the spinal accessory nerve and the dorsal scapular nerve. The needle EMG findings were normal as well. An explorative operation was performed and the rupture of the rhomboideus major and lower trapezius muscles was detected. Direct surgical repair of the ruptured muscle was carried out and the deformity was corrected. The anatomical and functional restoration was satisfactorily accomplished.
Weight Lifting/injuries ; Thoracic Nerves/*injuries ; Scapula/anatomy & histology/*physiopathology ; Rupture ; Neurons/metabolism ; Muscle, Skeletal/*injuries/innervation/*pathology ; Humans ; Female ; Electromyography/*methods ; Child

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Langerhans Cell Sarcoma Arising from Langerhans Cell Histiocytosis: A Case Report.

Jong Sil LEE ; Gyung Hyuck KO ; Ho Cheol KIM ; In Seok JANG ; Kyung Nyeo JEON ; Jeong Hee LEE

Journal of Korean Medical Science.2006;21(3):577-580. doi:10.3346/jkms.2006.21.3.577

Langerhans cell sarcoma (LCS) is a neoplastic proliferation of Langerhans cells that have overtly malignant cytologic features. It is a very rare disease and theoretically, it can present de novo or progress from an antecedent Langerhans cell histiocytosis (LCH). However, to our knowledge, LCS arising from an antecedent LCH has not been reported on. We present here a case of LCS arising from a pulmonary LCH. A 34 yr-old man who was a smoker, had a fever and a chronic cough. Computed tomographic (CT) scan revealed multiple tiny nodules in both lungs. The thoracoscopic lung biopsy revealed LCH. The patient quit smoking, but he received no other specific treatment. One year later, the follow up chest CT scan showed a 4 cm-sized mass in the left lower lobe of the lung. A lobectomy was then performed. Microscopic examination of the mass revealed an infiltrative proliferation of large cells that had malignant cytologic features. Immunohistochemical stains showed a strong reactivity for S-100 and CD68, and a focal reactivity for CD1a. We think this is the first case of LCS arising from LCH.
Tomography, X-Ray Computed ; Sarcoma/*pathology ; S100 Proteins/biosynthesis ; Radiography, Thoracic ; Pancreatic Neoplasms/*pathology ; Male ; Langerhans Cells/*pathology ; Immunohistochemistry ; Humans ; Histiocytosis, Langerhans-Cell/diagnosis/*pathology ; Gene Expression Regulation, Neoplastic ; Antigens, Differentiation, Myelomonocytic/biosynthesis ; Antigens, CD1/biosynthesis ; Antigens, CD/biosynthesis ; Adult

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A Case of Non-Functioning Huge Adrenocortical Carcinoma Extending Into Inferior Vena Cava and Right Atrium.

Kye Hun KIM ; Jong Chun PARK ; Sang Yup LIM ; Il Suk SOHN ; Kyung Ho YUN ; Sang Hee CHO ; Young Joon HONG ; Hyung Wook PARK ; Ju Han KIM ; Weon KIM ; Young Keun AHN ; Ik Joo CHUNG ; Myung Ho JEONG ; Jeong Gwan CHO ; Jung Chaee KANG

Journal of Korean Medical Science.2006;21(3):572-576. doi:10.3346/jkms.2006.21.3.572

Primary adrenocortical carcinoma (ACC) is a rare tumor and its usual sites of metastasis are the lung (71%), lymph node (68%), liver (42%), and bone (26%). However, intracaval invasion extending into the right atrium is very rare and spontaneous regression of tumor burden in adrenal carcinoma is also rare. We report a case of ACC with direct invasion of the inferior vena cava and right atrium. A 34-yr-old male patient presented with progressive dyspnea, weight loss, and poor oral intake over 3 months. Non-functioning ACC with direct invasion of the inferior vena cava and right atrium was confirmed by imaging, pathologic, and hormonal study. Chemo-radiotherapy was attempted. However, tumor burden was not changed, but rather toxic hepatitis and thrombocytopenia were developed. His subjective symptoms and general conditions were improved after 1 month of conservative management and the patient was discharged. During clinical follow-up, this tumor showed spontaneous regression.
Vena Cava, Inferior/*pathology ; Tomography, X-Ray Computed ; Remission Induction ; Neoplasm Metastasis ; Male ; Humans ; Heart Neoplasms/pathology/*secondary ; Heart Atria/*pathology ; Follow-Up Studies ; Echocardiography ; Biopsy ; Adult ; Adrenocortical Carcinoma/*diagnosis/*pathology ; Adrenal Cortex Neoplasms/*diagnosis/*pathology

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A Successful Live Birth Through in vitro Fertilization Program After Conservative Treatment of FIGO Grade I Endometrial Cancer.

Joon Cheol PARK ; Chi Hum CHO ; Jeong Ho RHEE

Journal of Korean Medical Science.2006;21(3):567-571. doi:10.3346/jkms.2006.21.3.567

Infertile women with chronic anovulation are prone to be exposed to unopposed estrogen stimulation and have the high risk of being suffering from endometrial hyperplasia or even endometrial carcinoma. A few reports have suggested that nulliparous young women (under 40 yr of age) with endometrial carcinoma could be treated conservatively to preserve fertility and succeed the live birth. We report on a 36-yr-old woman who received conservative treatment of endometrial carcinoma (stage I, grade 1) by curettage and progestin. After megestrol medication of total 71,680 mg during 24 weeks, we found the regression of endometrial lesion by curettage and hysteroscopic examination. Then we decided to perform in vitro fertilization program. Two embryos were transferred and heterotypic pregnancy was diagnosed 27 days after embryo transfer. After right salpingectomy, she received routine obstetrical care and delivered by cesarean section at 38 weeks in gestational periods. Two years after delivery, she is healthy without any evidence of recurrent disease. The fertility preserving treatment is an option in endometrial cancer patients if carefully selected, and assisted reproductive technologies would be helpful.
Progestins/therapeutic use ; Pregnancy Outcome ; Pregnancy ; Live Birth ; Humans ; Fertilization in Vitro/*methods ; Female ; Endometrial Neoplasms/surgery/*therapy ; Adult ; Adenocarcinoma/surgery/*therapy

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Report of a Korean Patient with Cystic Fibrosis, Carrying Q98R and Q220X Mutations in the CFTR Gene.

Won Jung KOH ; Chang Seok KI ; Jong Won KIM ; Jeong Ho KIM ; Seong Yong LIM

Journal of Korean Medical Science.2006;21(3):563-566. doi:10.3346/jkms.2006.21.3.563

Although cystic fibrosis (CF) is one of the most frequently seen autosomal-recessive disorders in Caucasians, it is extremely rare in the Korean population. Recently, a 15-yr-old Korean boy was admitted to our hospital complaining of coughing, sputum, and exertional dyspnea. Chest radiographs and computed tomographic chest and paranasal sinus scans revealed diffuse bronchiectasis and pansinusitis. Pulmonary function tests revealed severe obstructive impairment. The average sweat chloride concentrations on both of the patients' forearms were 63.0 mM/L (reference limit: < 40 mM/L). Upon mutation analysis, two different mutations (Q98R and Q220X) were identified in the cystic fibrosis transmembrane conductance regulator gene, both of which had been previously detected in CF patients, one from France and the other from England. As CF is quite rare in Korea, the diagnosis of CF in this patient might be delayed. Therefore, we recommend that a diagnosis of CF should be suspected in patients exhibiting unexplained chronic respiratory symptoms.
Radiography, Thoracic ; Pedigree ; *Mutation ; Male ; Korea ; Humans ; Heterozygote ; *Genetic Predisposition to Disease ; Female ; DNA Mutational Analysis ; Cystic Fibrosis Transmembrane Conductance Regulator/*genetics ; Cystic Fibrosis/*genetics ; Adolescent

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Gastric Syphilis Mimicking Adenocarcinoma: A Case Report.

Yoon La CHOI ; Jae Joon HAN ; Da Keun LEE ; Min Ho CHO ; Ghee Young KWON ; Young Hyeh KO ; Cheol Keun PARK ; Geunghwan AHN

Journal of Korean Medical Science.2006;21(3):559-562. doi:10.3346/jkms.2006.21.3.559

Syphilis is an unexpected diagnosis in the stomach, and the reduced incidence of syphilis has made its clinical presentation less widely appreciated. We report a 43-yr-old man suffering from epigastric tenderness with an initial diagnosis of gastric carcinoma; gastric syphilis was confirmed by demonstrating spirochetes in a gastric biopsy specimen by silver impregnation. Excessive lymphoplasmacytic infiltration with diffuse thickening of gastric rugae should raise suspicion of gastric syphilis, which should be considered in the differential diagnosis of diffuse erosive gastritis and infiltrative lesions of the stomach.
Syphilis/*diagnosis ; Stomach Neoplasms/*diagnosis ; Stomach Diseases/*diagnosis/microbiology ; Stomach/microbiology ; Male ; Humans ; Fluorescent Treponemal Antibody-Absorption Test ; Enzyme-Linked Immunosorbent Assay ; *Diagnosis, Differential ; Biopsy ; Adult ; Adenocarcinoma/*diagnosis

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Delayed Bronchostenosis After Blunt Chest Trauma in Children: CT and Pathologic Findings.

Hye Kyung YOON ; Tae Sung KIM ; Joungho HAN ; Kang Mo AHN ; Young Mog SHIM

Journal of Korean Medical Science.2006;21(3):555-558. doi:10.3346/jkms.2006.21.3.555

Tracheobronchial disruption is an uncommon injury associated with blunt chest trauma. We report CT features and pathologic findings of two pediatric cases in which a bronchial injury was unnoticed initially but was diagnosed later by appearance of delayed bronchostenosis with distal atelectasis after blunt chest trauma in recent motor vehicle accidents. Pathologically, obliteration of the bronchial lumen was caused by dense fibrous overgrowth and granulation tissue.
Wounds, Nonpenetrating/*diagnosis ; Tomography, X-Ray Computed/*methods ; Time Factors ; Thoracic Injuries/*diagnosis ; Male ; Humans ; Constriction, Pathologic ; Child, Preschool ; Child ; Bronchial Neoplasms/*pathology ; Bronchi/*injuries/pathology ; Accidents, Traffic

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Metachronous Germinoma After Total Removal of Mature Teratoma in the Third Ventricle: A Case Report.

Jae Min KIM ; Jin Hwan CHEONG ; Hyeong Joong YI ; Koang Hum BAK ; Choong Hyun KIM ; Suck Jun OH

Journal of Korean Medical Science.2002;17(2):287-291. doi:10.3346/jkms.2002.17.2.287

A rare case of intraventricular germinoma in the third ventricle, which occurred 30 months after total removal of mature teratoma on the same location in a 29- yr-old man is presented. Recurrence is supposed to represent an acceleration of localized dysplastic processes of totipotent germ cells present in the midline neuraxis or a growth of unidentified microscopic residue of germinoma component in mature teratoma. Although the radiation therapy after total removal of mature teratoma is still controversial, careful follow-up is warranted for evaluating a possible recurrence of other germ cell tumors.
Adult ; Cerebral Ventricle Neoplasms/classification/pathology/*radiography/surgery ; Germinoma/classification/pathology/*radiography/surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Neoplasms, Second Primary/classification/pathology/*radiography/surgery ; Teratoma/complications/*surgery ; Tomography, X-Ray Computed ; Ventriculoperitoneal Shunt

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