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Cervical Spinal Cord Infarction Presenting Brown-Séquard-plus Syndrome.

Sang Won PARK ; Seok Kyung KWON ; Jin Suk KIM ; Bijoy K. MENON ; Jeong Ho HONG ; Sung Il SOHN

Keimyung Medical Journal.2014;33(1):44-47.

Brown-Séquard-plus syndrome is characterized by hemiparesis, contralateral spinothalamic sensory deficits with additional abnormal findings of other organs. We report a case of an 81-year-old man who had right hemiparesis, left sensory deficit and Horner syndrome on right eye. Diffusion-weighted MRI of the cervical spine and lower medulla confirm the diagnosis of anterior unilateral cervical spinal cord infarction. It is very rare that the unilateral long spinal cord infarction at the C1-C4 associated with Brown-Séquard-plus syndrome.
Aged, 80 and over ; Diagnosis ; Horner Syndrome ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Paresis ; Spinal Cord* ; Spine ; Vertebral Artery

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Colonic Endometriosis with Extensive Smooth Muscle Metaplasia Simulating Leiomyoma.

Ilseon HWANG

Keimyung Medical Journal.2014;33(1):39-43.

It is difficult to distinguish colonic endometriosis with smooth muscle metaplasia from a colonic neoplasm. Especially, in a small biopsy specimen, marked smooth muscle proliferation can be misdiagnosed as a spindle cell lesion such as leiomyoma or as a gastrointestinal stromal tumor. We present the case of a woman aged 48 years who had a colonic polyp, raising suspicion of a submucosal tumor. In a endoscopic polypectomy specimen, the lesion showed marked smooth muscle proliferation but in the resection specimen, a nodular mass, composed of endometrial glands, stroma, and a smooth muscle component, was identified. By immunohistochemical staining, smooth muscle cells were positive for estrogen receptor, progesterone receptor, smooth muscle actin, and smooth muscle myosin heavy chain. Endometriosis in the colon can be misinterpreted as a benign or malignant neoplasm. When examining small biopsy specimens, clinicians and pathologists should be aware of the potential of this condition to mimic other intestinal diseases.
Actins ; Biopsy ; Colon* ; Colonic Neoplasms ; Colonic Polyps ; Endometriosis* ; Estrogens ; Female ; Gastrointestinal Stromal Tumors ; Humans ; Intestinal Diseases ; Leiomyoma* ; Metaplasia* ; Muscle, Smooth* ; Myocytes, Smooth Muscle ; Myosin Heavy Chains ; Receptors, Progesterone

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Nevoid Melanoma in the Forearm.

Misun CHOE ; Hye Ra JUNG ; Gyu Suk LEE

Keimyung Medical Journal.2014;33(1):34-38.

Nevoid melanoma is a very rare histological subtype of vertical growth phase melanoma. Histologically, it mimics benign nevus and thus may lead to an erroneous diagnosis. We report a case of nevoid melanoma arising in a 53-year-old American woman. High index of suspicion and evaluation of cytologic atypia with ancillary tests may help in establishing the diagnosis.
Diagnosis ; Female ; Forearm* ; Humans ; Melanoma* ; Middle Aged ; Nevus ; Skin

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A Case of Double-unit Cord Blood Transplantation in Primary Refractory Acute Myeloid Leukemia.

Mi Hwa HEO ; Won Young JANG ; Myung Soon PARK ; Eu Gene HAN ; Jin Young KIM ; Keon Uk PARK ; Young Rok DO

Keimyung Medical Journal.2014;33(1):28-33.

Umbilical cord blood is an attractive source of hematopoietic stem cells in allogeneic hematopoietic stem cell transplantation. Umbilical cord blood transplantation has merits of rapid availability and low risk of severe acute graft versus host disease. Umbilical cord blood should be an important source of stem cell transplantation for patients who have no suitable human leukocyte antigen-matched bone marrow, or peripheral stem cell donor. Transplantation of umbilical cord blood is limited by insufficient cell doses. This had led to the alternative concept of attempting to increase the number of cell doses using two cord blood units from different donor. We report a case of double-unit cord blood transplantation for 55-year-old male with primary refractory acute myeloid leukemia.
Bone Marrow ; Fetal Blood* ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Leukemia, Myeloid, Acute* ; Leukocytes ; Male ; Middle Aged ; Stem Cell Transplantation ; Stem Cells ; Tissue Donors

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Effect of Immunosuppressive Drugs on the Metalloproteinase in the Glioma Cells and Osteoblasts.

Kyo Cheol MUN

Keimyung Medical Journal.2014;33(1):23-27.

The matrix metalloproteinases (MMPs) play a key role in the normal physiology of connective tissue during development, morphogenesis, and wound healing. Dysregulation of their activity has been implicated in numerous diseases including encephalopathy and the process of bone loss. Thus, MMPs may play a role in the encephalopathy and post-transplantation bone disease by immunosuppressive drugs such as cyclosporine (CsA) and tacrolimus. Gelatin zymography of MMP-9 and MMP-2 was performed in the glioma cells and osteoblast after CsA or tacrolimus treatment. Glioma cells or rat osteoblast ROS17/2.8 cells were treated with CsA or tacrolimus to make final concentration from 2 to 250 µM. After incubation, gelatin zymography of MMP-9 and MMP-2 was performed. And the density for the MMP bands were measured using luminescent image analyzer system. Both MMP-9 and MMP-2 activities in the osteoblast cells were decreased depending on the concentration of CsA or tacrolimus. MMP-2 activity was increased after CsA or tacrolimus treatment in the glioma cells. However, MMP-9 activities were decreased after CsA or tacrolimus treatment in the glioma cells. These results indicate that dysregulation of MMPs in the osteoblast and in the glioma cells by immunosuppressive drugs may one of the contributing factors in post-transplantation bone disease and in the encephalopathy by tacrolimus or cyclosporine.
Animals ; Bone Diseases ; Connective Tissue ; Cyclosporine ; Gelatin ; Glioma* ; Matrix Metalloproteinases ; Morphogenesis ; Osteoblasts* ; Physiology ; Rats ; Tacrolimus ; Wound Healing

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Relationship of Chief Complaints at Hospital with Prognosis in Acute Myocarditis Children.

Yoon Jung KIM ; Yeo Hyang KIM ; Hee Joung CHOI

Keimyung Medical Journal.2014;33(1):16-22.

We evaluated the clinical characteristics of acute myocarditis children, especially chief complaints on first visit at a hospital and prognosis. A retrospective descriptive study was conducted to identify patients with myocarditis who presented over a 10-year span at a regional tertiary hospital. Patients were identified based on the international classification of diseases 10, diagnostic codes. Total 18 patients were enrolled in the study. The patients had a median age of 16 months and 61% of them were male. Common chief complaints were shortness of breath, lethargy, cough or palpitation. Of the patients, 5 patients showed gastrointestinal symptoms such as vomiting, abdominal pain and loose stool as initial symptoms. Eighty nine percent of patients had cardiomegaly on chest x-ray, and 72% of patients had an abnormal electrocardiogram results. On first admission, 4 patients were died and 3 of them showed vomiting and abdominal pain as first chief complaints. These data suggest that abdominal pain and vomiting may be chief complaints of acute myocarditis. And myocarditis patients who showed gastrointestinal symptoms initially had poor prognosis. In addition, to distinguish an acute myocarditis, cardiomegaly on chest x-ray and an abnormal electrocardiogram may be useful.
Abdominal Pain ; Cardiomegaly ; Child* ; Cough ; Dyspnea ; Electrocardiography ; Humans ; International Classification of Diseases ; Lethargy ; Male ; Myocarditis* ; Prognosis* ; Retrospective Studies ; Shock ; Tertiary Care Centers ; Thorax ; Vomiting

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The Treatment Results in Site of Tibia Fracture Treated with Interlocking Intramedullary Nail.

Ki Cheor BAE ; Kyoung Rak LEE

Keimyung Medical Journal.2014;33(1):10-15.

Intramedullary nailing is the treatment of choice for most diaphyseal fractures of the tibia. The purpose of this study is to evaluate the result of tibia fractures treated with interlocking intramedullary nail, according to different sites of fractures. From september 2004 to august 2012, 106 cases of tibia fracture with a minimum follow up until bony union were selected and analyzed retrospectively. The mean follow-up period of the patients was 24.5 months. The location of fractures were divided into three groups, proximal (n = 18), mid (n = 42), distal (n = 46). Delayed union, mal-alignment and additional operation were investigated. The number of angle change over 5 degrees in the coronal plane and 10 degrees in the sagittal plane were 7 cases in proximal, 7 cases in mid, and 12 cases in distal with statistic significance. And an additional operation was required in 6 patients in proximal fracture, 2 patients in mid fracture, and 7 patients in distal fracture during bony union. Conclusively, intramedullary nailing in proximal and distal tibia fracture showed higher delayed union rate and could result in excessive angle change due to mal-alignment. Therefore, proximal level or distal level tibia fractures need more accurate reduction of fracture than midshaft level would need more accurate reduction of fracture and observe bony union through regularly radiography examination.
Follow-Up Studies ; Fracture Fixation, Intramedullary ; Humans ; Radiography ; Retrospective Studies ; Tibia*

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Association of Carbonic Anhydrase IX Expression on the Prognosis and Therapeutic Response in Clear Cell Renal Cell Carcinoma.

Hyoung Jong KIM ; Chae Han JEON ; Wonho JUNG ; Ji Yong HA ; Byung Hoon KIM ; Chun Il KIM ; Mi Sun CHOE ; Hye Ra JUNG ; Choal Hee PARK

Keimyung Medical Journal.2014;33(1):1-9.

Recent studies of Carbonic anhydrase IX (CAIX) expression and clinical significance in renal cell carcinoma (RCC) have given rise to disagreements in the usefulness of CAIX as a prognostic factor. The purpose of this study was to evaluate the association between CAIX expression and clinical factors in RCC. The medical record of 172 RCC patients in hospital (from January 1999 and December 2007) were reviewed retrospectively. Patients were divided into a high expression group (109 cases) and low expression group (63 cases) according to their degree of CAIX expression. We evaluated the association between CAIX expression and age, body mass index (BMI), type of renal neoplasm, tumor stage, nuclear grade, metastasis after surgery and tumor-specific survival rate. The mean age of the high expression group and the low expression group were 56 years and 54 years respectively. The mean BMI of the high expression group and the low expression group were 24.2 kg/m2 and 24.5 kg/m2 respectively. Comparing the difference between clear cell RCC and non clear cell RCC, CAIX was significantly more expressed in clear cell RCC. There was no significant differences between high expression clear cell RCC and low expression clear cell RCC according to age, BMI, nuclear grade, metastasis after surgery and tumor-specific survival rate (p=0.237, p=0.802, p=0.382, p=0.551). However, in clear cell RCC, CAIX expression was significantly more expressed in patients with higher T or N stages (p=0.015, p=0.033). CAIX was significantly higher expressed in clear cell RCC and was significantly lower expressed in patients with higher T stage or N stage.
Body Mass Index ; Carbon* ; Carbonic Anhydrases* ; Carcinoma, Renal Cell* ; Humans ; Kidney Neoplasms ; Medical Records ; Neoplasm Metastasis ; Prognosis* ; Retrospective Studies ; Survival Rate

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Uremic Pericarditis Accompanying Cardiac Tamponade after Emergency Hemodialysis.

Ha Yeun PARK ; Seong Sik KANG ; Yae Rim KIM ; O Hyun KWON ; Kyu Bok JIN ; Seung Yeup HAN ; Sung Bae PARK ; Woo Yeong PARK

Keimyung Medical Journal.2016;35(1):25-29.

Although the incidence of uremic pericarditis was high in the past, it has decreased in recent decades with early and appropriate dialysis. However, cardiac tamponade caused by uremic pericarditis is still a life-threatening emergency and it requires urgent management. Herein we report a case of 38-year-old man with chronic renal disease who represented critical uremic pericarditis followed by cardiac tamponade despite of appropriate hemodialysis. Careful consideration of risk factors and aggressive treatment are very important for effective and safe treatment of uremic pericarditis and cardiac tamponade.
Adult ; Cardiac Tamponade* ; Dialysis ; Emergencies* ; Humans ; Incidence ; Pericardial Effusion ; Pericardiocentesis ; Pericarditis* ; Renal Dialysis* ; Renal Insufficiency, Chronic ; Renal Replacement Therapy ; Risk Factors

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An Intra-procedural Stent Thrombosis in a Prasugrel Resistant Patient Treated with Ticagrelor.

Jung Ho PARK ; Seung Ho HUR ; Yun Kyeong CHO ; Hyoung Seob PARK ; Hyuck Jun YOON ; Sang Hoon LEE ; Hyung Seop KIM ; Chang Wook NAM ; Seong Wook HAN

Keimyung Medical Journal.2016;35(1):18-24.

Stent thromboses due to multifactorial causes including hypercoagulable conditions and high on treatment platelet reactivity (HTPR), which means a low response to anti-platelet therapy, especially clopidogrel. Prasugrel is a third generation thienopyridine and inactive pro-drug requiring metabolic activation in vivo, which improves the rate of HTPR with clopidogrel. This drug is mostly effective, with a potent, fast, and consistent anti-platelet action, but rare cases of inadequate platelet inhibition with prasugrel have been reported. Here we describe the case of a 47-year-old man who presented with a recurrent acute myocardial infarction and ST during an intravascular ultrasound pullback and was resistant to prasugrel, was successfully treated with ticagrelor.
Activation, Metabolic ; Blood Platelets ; Humans ; Middle Aged ; Myocardial Infarction ; Prasugrel Hydrochloride* ; Stents* ; Thrombosis* ; Ultrasonography

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