BACKGROUND/AIMS: Gastrointestinal involvement in vasculitis may result in life-threatening complications. However, its variable clinical presentations and endoscopic features, and the rarity of the disease, often result in delayed diagnosis. METHODS: Clinical characteristics, endoscopic features, and histopathological findings were reviewed from medical records. RESULTS: Of 6,477 patients with vasculitis, 148 were diagnosed as primary vasculitis with upper gastrointestinal involvement. Of these, 21 cases (14.2%) were classified as large-vessel vasculitis, 17 cases (11.5%) as medium-vessel vasculitis, and 110 cases (74.3%) as small-vessel vasculitis. According to the specific diagnosis, IgA vasculitis (Henoch-Schönlein purpura) was the most common diagnosis (56.8%), followed by Takayasu arteritis (14.1%), microscopic polyangiitis (10.1%), and polyarteritis nodosa (6.8%). Gastrointestinal symptoms were present in 113 subjects (76.4%), with abdominal pain (78.8%) the most common symptom. Erosion and ulcers were striking endoscopic features, and the second portion of the duodenum was the most frequently involved site. Biopsy specimens were obtained from 124 patients, and only eight (5.4%) presented histopathological signs of vasculitis. CONCLUSIONS: Diagnosis of vasculitis involving the upper gastrointestinal tract is difficult. Because of the widespread use of endoscopy, combining clinical features with endoscopic findings may facilitate making appropriate diagnoses; however, the diagnostic yield of endoscopic biopsy is low.
Abdominal Pain ; Biopsy ; Delayed Diagnosis ; Diagnosis ; Duodenum ; Endoscopy ; Gastrointestinal Tract ; Humans ; Immunoglobulin A ; Medical Records ; Microscopic Polyangiitis ; Polyarteritis Nodosa ; Strikes, Employee ; Takayasu Arteritis ; Ulcer ; Upper Gastrointestinal Tract ; Vasculitis*

Due to insufficient clinical information, most cervicovaginal smears from pregnant or postpartum women have been screened without regard to pregnancy-related cytological changes. Here, we have reviewed 116 abnormal cervicovaginal smears from 103 pregnant and postpartum women. Initial cytological diagnoses revealed the following: 9 cases of high-grade squamous intraepithelial lesions (HSIL), 8 cases of low-grade squamous intraepithelial lesions (LSIL), 85 cases of atypical squamous cells of undetermined significance (ASCUS), and 14 cases involving atypical glandular cells of undetermined significance (AGUS). 31 cases, upon review, involved pregnancy-related cytological changes, comprising 25 cases of decidua cells, 4 cases of Arias-Stella reaction, and 2 cases of decidual cells coupled with Arias-Stella reaction. Interpretation errors were detected in 14 cases: 13 cases of decidual cells interpreted as either ASCUS favor reactive or ASCUS ruled out HSIL, and one case of Arias-Stella reaction was interpreted as ASCUS ruled out HSIL. Decidual cells and degenerated glandular cells with Arias-Stella reaction can result in diagnostic mistakes. In order to avoid misdiagnosis and unnecessary surgeries, both clinicians and pathologists must be aware of the pregnancy-related cytological changes. The clinician should also always inform the pathologist on the pregnancy status of the patient.
Decidua ; Diagnosis ; Diagnostic Errors ; Female ; Humans ; Postpartum Period ; Pregnancy

Agmatine, a widely distributed molecule in mammalian tissues, shows neuroprotective effects in brain ischemia. We describe the neuroprotective effects of agmatine in the mouse MCAO model and the quantitative change of agmatine in ischemic injury. Brain ischemic injured mice were injected with agmatine (100 mg/kg of mouse, IP). Agmatine significantly reduced the infarct area after MCAO. Despite the similar patterns of agmatine change observed in control or agmatine injected animals, the agmatine levels of the penumbra were significantly higher than those of the striatum and the cerebral cortex during the early period (<1 hour after 2 hours of MCA occlusion). This suggests that the early period, during which agmatine levels increase in the brain, is the crucial period in terms of neuroprotective effect during ischemia.
Agmatine* ; Animals ; Brain Ischemia ; Brain* ; Cerebral Cortex ; Chromatography, High Pressure Liquid* ; Ischemia ; Mice ; Neuroprotective Agents ; Reperfusion

PURPOSE: Nodular lesions of the thyroid gland, composed predominantly of Hürthle cells, are so rare as to be difficult for pathologists to interpret properly and, consequently, for surgeons to treat appropriately. Our intent in evaluating these lesions was to try to establish pathologic and clinical criteria that could be used to differentiate more accurately between malignant and benign tumors. METHODS: We retrospectively evaluated 5 patients presenting with Hürthle cell tumors over the past 10 years. We focused on the clinicopathological analysis correlated with the tumor size, the type of operation and the prognosis. RESULTS: Five female patients were included in the study, their average age was 48.8 years (19~69 years). One case was carcinoma and the other 4 were adenomas. Average size of the tumor was 3.34 cm in diameter. Total thyroidectomy was performed in two cases including the carcinoma case. None of them died as a result of the disease, nor had a recurrence. No preoperative study was useful in differentiating between malignancy and benignancy. CONCLUSION: Many more cases need to be evaluated to determine the exact biological behavior of the Hürthle cell tumor of the thyroid gland. Clinical and pathological factors are required for surgeons to decide the type of operation appropriate in order to avoid compromising the therapeutic goals. We recommend total thyroidectomy for tumors with the intraoperative frozen section raising the suspicion of malignancy and for those with diameters over 2.5 cm.
Adenoma ; Adenoma, Oxyphilic* ; Female ; Frozen Sections ; Humans ; Prognosis ; Recurrence ; Retrospective Studies ; Surgeons ; Thyroid Gland* ; Thyroidectomy

PURPOSE: In many centers, voiding cystourethrography(VCUG) is routinely performed to identify some abnormalities which may compromise the success of transplantation and assess the abnormality of lower urinary tract. To evaluate the value of VCUG as routine pretransplatation workup, we retrospectively reviewed this investigation for renal transplant candidates. MATERIALS AND METHODS: 251 patients underwent transplantation at our center over a 7-year period from August 1990 to July 1996. 229 patients were fully evaluable excluding 22 patients due to incomplete records. All of them were taken VCUG. We tried to find an abnormal VCUG including vesicoureteral reflux, postvoid residual urine(PVR>50ml) and decreased bladder capacity(<100ml). RESULTS: An urological abnormality is identified by VCUG in 29 of 229 patients(12.7%). These abnormalities include 20 patients with VUR alone, 5 patients with increased PVR due to urethral stricture(1), benign prostatic hyperplasia(1), and unknown(3), 1 patient with decreased bladder capacity, 2 patients with unilateral VUR combined PVR, and 1 patient with bilateral VUR combined decreased bladder capacity. 4 of 29 patients had a known urological abnormality as the etiology of end stage renal disease. 41 of 229 patients evaluated had a previous urological history such as frequency, nocturia, urgency, incontinence and dysuria, recurrent UTI and pyelonephritis. But all 29 patients with abnormal VCUGs had a previous those history. 4 of 29 patients were managed due to increased PVR after transplantation as followings: clean intermittent catheterization(3), medication of alpha-blocker for BPH(1). Others were not required further managements. Hence, abnormal findings on VCUG did not lead to a surgical procedure for the abnormality before and/or after transplantation. CONCLUSIONS: These results show that VCUG may be not essential for the routine evaluation for renal transplantation. Therefore, it will necessary in selected individuals with a previous urological history.
Dysuria ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Nocturia ; Pyelonephritis ; Retrospective Studies ; Urinary Bladder ; Urinary Tract ; Vesico-Ureteral Reflux

PURPOSE: The management of patients with superficially invasive, stage T1N0M0 bladder cancer remains controversial. While some physicians advocated early cystectomy, others believe that with initial TURB and effective intravesical BCG, local disease control can be achieved in most patients. We evaluated the outcome of stage T1 transitional cell carcinoma of the bladder treated with TURB and intravesical BCG therapy. MATERIALS AND METHODS: We reviwed records of 109 patients with stage T1 bladder tumor who treated with BCG between February 1986 and January 1997 with respect to age, grade, interval of progression and recurrence and current status. Each course of BCG consisted of 6 weekly and subsequent 3 monthly treatments. RSEULTS: Forty five of 109 patients(41.3%) had initial grade I tumors, including 13 patients (28.9%) who had at least one or more local recurrences and 2 patients(4.4%) had disease progression. Fifty seven of 109 patients(52.3%) had grade II tumors, with local recurrence in 23 patients(40.4%) and disease progression in 4 patients(7.0%). Among remaining 7 patients (6.4%) who had grade III tumors had local recurrence in 1 patient(14.3%) and disease progression in 4 patients(57.1%). The median intervals of progression on patients with initial grade I, II and III were 20.5, 15.3 and 16.9 months, respectively. Five of 10 patients who had progressed died because of the metastasis despite salvage therapies. CONCLUSIONS: Intravesical BCG was appropriately treated for patients with initial grade I or II stage T1 tumor because of low risk of disease progression. Patients with initial grade 3 stage T1 tumor had high risk for disease progression and BCG did not seem to decrease this risk. Therefore, grade 3 stage T1 tumor was regarded as high risk of disease progression and should be treated to more aggressive modality like invasive tumor.
Bacillus* ; Carcinoma, Transitional Cell ; Cystectomy ; Disease Progression ; Humans ; Mycobacterium bovis ; Neoplasm Metastasis ; Recurrence* ; Salvage Therapy ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: The pressure-flow study is only objective study that can determine the presence or absence of bladder outlet obstruction and impaired detrusor contractility. Although many results of pressure-flow study are reported in diseased state such as benign prostatic hyperplasia, but are rarely evaluated in adult male patients without voiding symptoms as control group. The purpose of this study was to evaluate the findings of pressure-flow study in asymptomatic male patients. MATERIALS AND METHODS: Twenty-three male patients without voiding symptom were recruited for this study. Mean age of these patients was 49.8 years(range 21-70). Mean AUA symptom score was 1.1(range 0-4) and mean prostatic volume was 27.3gm(range 20-35) on digital rectal examination. The study was done by using 7 Fr. urethral catheter on sitting or standing position. RESULTS: Mean values were followed; PdetQmax was 48.1cmH2O(range 25-94), Qmax was 15.7ml/sec(range 3-23), and postvoid residual urine was 14.5ml(range 0-80). According to the Abrams-Griffiths nomogram, 8 were unobstructed and 4 were obstructed, the remaining 11 falling in the equivocal zone. In each types, mean group specific urethral resistance factor (URA) was 12.8cmH2O in unobstructive type, 51.5 in obstructive type, and 22.1 in equivocal type. CONCLUSIONS: The results were maybe guessed as following; First, the values of defining obstrucion were set too low. Second, obstruction was less relevance in the development of symptoms than had been suggested previosly by some observers. Therefore, we thought that interpretations of pressure-flow finding were carefully considered to method of test, and/or uncomfortable voiding.
Adult* ; Digital Rectal Examination ; Humans ; Male* ; Nomograms ; Prostatic Hyperplasia ; Urinary Bladder Neck Obstruction ; Urinary Catheters

Angiomyolipoma is a rare benign tumor and approximately 20 to 50% of patients with the diagnosis of angiomyolipoma have some or all of the other stigma of tuberous sclerosis. Patients with tuberous sclerosis tend to be younger, more likely to have multifocal and bilateral disease. Angiomyolipoma which is not associated with tuberous sclerosis mostly affects middle aged women. According to literature data, angiomyolipoma is very rare in child and almost exclusively associated with tuberous sclerosis. We report a case of 14 year-old girl who has a renal angiomyolipoma without clinical evidence of tuberous sclerosis.
Adolescent ; Angiomyolipoma* ; Child* ; Diagnosis ; Female ; Humans ; Middle Aged ; Tuberous Sclerosis*

Hemorrhage or cystic rupture of adrenal gland is uncommonly reported in infants. However, spontaneously ruptured nonfunctioning adrenocortical carcinoma has not been yet reported in Korean literature We describe a 65-year-old woman who developed unilateral spontaneous adrenal rupture in coexisting nonfunctioning adrenocortical carcinoma without trauma or infection. And our preoperative impression was suspicious ruptured renal cell carcinoma.
Adrenal Glands ; Adrenocortical Carcinoma* ; Aged ; Carcinoma, Renal Cell ; Female ; Hemorrhage ; Humans ; Infant ; Rupture ; Rupture, Spontaneous*

Elevations of serum PSA concentrations have been widely reported due to prostatic cancer, but other causes haute not been formally characterized or quantified. So that, we evaluated the causes of elevated serum PSA concentrations in men whose prostate biopsy showed no cancer. The effects of prostate volume, inflammation, echogenecity on ultrasound and calculi were examined in 43 men that serum PSA concentrations greater than 4.0 ng/ml with negative biopsy. These men were compared with 16 men who had suspicious rectal examinations, negative biopsy and serum PSA concentrations of 4.0 ng/ml. or less. Prostate volume (22.5%, p<0.005) and inflammation (3%, p<.05) were significantly associated with elevated serum PSA concentrations (>4.0 ng/ml) than control group (< or = 4.0 ng/ml) and age echogenecity on ultrasound and calculi were statistically less significant (p> or =0.05). In summary, prostate volume and inflammation were the most important factors contributing to increase serum PSA concentration in men that clinically undetectable prostatic cancer.
Biopsy ; Calculi ; Humans ; Inflammation ; Male ; Prostate ; Prostatic Neoplasms ; Ultrasonography