Purpose: We prospectively compared the diagnostic accuracy of kidney dynamic computed tomography (KDCT), magnetic resonance imaging (MRI), and contrast-enhanced ultrasonography (CEUS) for the assessment of small renal mass (SRM) (≤4 cm). Materials and Methods: Seventy-six patients with SRM (mean age, 58.4±13.1 years) who underwent renal biopsy (n=11) or nephrectomy (partial or radical) (n=65) were enrolled. All patients underwent KDCT, MRI, and CEUS before renal biopsy or nephrectomy. Results: The mean maximal tumor size was 21.0±9.8 mm. The mean R.E.N.A.L nephrometry score was 7.0±1.7. Fifty-six patients had renal cell carcinoma (RCC) (clear cell, 42; papillary, 7; chromophobe, 5; succinate dehydrogenase deficient, 1; unspecified RCC, 1). Twenty patients had a benign tumor (angiomyolipoma, 11; oncocytoma, 3; others, 6). Clinicopathologic variables were comparable in RCC and benign groups. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of KDCT were 89.3%, 10.0%, 73.5%, and 25.0%, respectively. The sensitivity, specificity, PPV, and NPV of MRI were 89.3%, 10.0%, 73.5%, and 25.0%, respectively. The sensitivity, specificity, PPV, and NPV of CEUS were 85.7%, 50.0%, 82.8%, and 55.6%, respectively. The diagnostic accuracy of KDCT, MRI, and CEUS were 68.4%, 68.4%, and 76.3%, respectively. In a subgroup analysis based on clinical tumor size of 10 mm and 20 mm, CEUS also showed the highest diagnostic accuracy. Conclusions CEUS had the highest specificity, PPV, and NPV and may help improve the assessment of SRM.

Background/Aims: Coronavirus disease 2019 (COVID-19) can reportedly cause gastrointestinal symptoms. Therefore, we investigated the clinical characteristics of COVID-19 patients with diarrhea. Methods: We included 118 COVID-19 patients admitted to a single hospital from February 20 to March 31, 2020. Medical records with clinical characteristics, laboratory data, treatment course, and clinical outcomes were compared based on the presence or absence of diarrhea. Prognostic factors for disease severity and mortality in COVID-19 were also assessed. Results: Among patients, 54 (45.8%) had diarrhea, whereas seven (5.9%) had only diarrhea. The median age of patients with diarrhea was 59 years (44 to 64), and 22 (40.7%) were male. Systemic steroid use, intensive care unit admission, septic shock, and acute respiratory distress syndrome were less frequent in the diarrhea group than in the non-diarrhea group. No significant differences were observed in total hospital stay and mortality between groups. On multivariate analysis, age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.01 to 1.12; p = 0.044), diabetes (OR, 3.00; 95% CI, 1.25 to 20.47; p = 0.042), and dyspnea (OR, 41.19; 95% CI, 6.60 to 823.16; p < 0.001) were independent risk factors for septic shock. On Cox regression analysis, diabetes (hazard ratio [HR], 4.82; 95% CI, 0.89 to 26.03; p = 0.043) and chronic obstructive pulmonary disease (HR, 16.58; 95% CI, 3.10 to 88.70; p = 0.044) were risk factors for mortality. Conclusions Diarrhea was present in 45.8% of patients and was a common symptom of COVID-19. Although patients with diarrhea showed less severe clinical features, diarrhea was not associated with disease severity or mortality.

Primitive neuroectodermal tumor (PNET) is relatively uncommon, arising outside the central nervous system. Very rarely, it occurs within the urinary system. A 55-year-old woman presented with gross hematuria and right flank pain which had begun two months earlier. A well-marginated, low-density mass containing high-density portions representing hemorrhage was seen in the right kidney at pre-enhanced CT; contrast enhancement was not prominent. At both T1- and T2- weighted MR imaging, a multilocular cystic mass with high signal intensity portions representing hemorrhage was observed. Contrast enhancement was absent. We report the radiologic findings in this case of renal PNET.
Central Nervous System ; Female ; Flank Pain ; Hematuria ; Hemorrhage ; Humans ; Kidney* ; Magnetic Resonance Imaging ; Middle Aged ; Neuroectodermal Tumors, Primitive*

BACKGROUND: In patients with endometrial carcinoma, preoperative evaluation of exact staging has important prognostic and therapeutic implications. The incidence of pelvic and aortic lymph node involvement in endometrial carcinoma depends on grade of tumor differentiation and depth of myometrial invasion. MATERIAL AND METHOD: To evaluate whether MRI provides a preoperative assessment for staging of endometrial carcinoma, MRI was undertaken in 28 patients, a few weeks before operation. Myometrial invasion was devided in three categories, and involvement of cervix, adnexa, and pelvic cavity were classified. RESULTS: The results of MR imaging were compared with these of pathology. The preoperative MRI staging of endometrial carcinoma was correct in 22 out of 28 patients. In the evaluation of myometrial invasion, the MR imaging underestimated in 4 cases and overestimated in 1 case. CONCLUSION: In patients with endometrial carcinoma, MR imaging is very useful in the assessment of the depth of myometrial invasion, stromal invasion of cevix, lymphatic & pelvic metastases and extent of the lesion.
Cervix Uteri ; Endometrial Neoplasms* ; Female ; Humans ; Incidence ; Lymph Nodes ; Magnetic Resonance Imaging* ; Neoplasm Metastasis ; Pathology

Autoimmune insulin syndrome is characterized by insulin autoantibody, hyperinsulinemia, and fasting hypoglycemia without previous insulin immunization. This syndrome shows discordant levels between immunoreactive insulin and C-peptide. Negative results of an anatomic study of the pancreas and an inability to reproduce hypoglycemia during a prolonged fast may be helpful in excluding insulinoma. Symptomatic hypoglycemia usually develops during an oral glucose tolerance test. This syndrome is a self-limited disorder. Recently, we experienced one case that developed symptomatic hypoglycemia during both the fasting & oral glucose tolerance test, and another that developed symptomatic hypoglycemia during the oral glucose tolerance test but not the fasting test. Hereby, we present these cases with a review of the literature.
C-Peptide ; Fasting ; Glucose Tolerance Test ; Hyperinsulinism ; Hypoglycemia* ; Immunization ; Insulin* ; Insulinoma ; Pancreas

Primary serous papillary carcinoma of the peritoneum is a rare neoplasm arising from the mesothelium. Histologically it is indistinguisable from ovarian serous papillary carcinoma, but it should be free of tumor or involved only superficially with the ovary. Radiologically its common findings are peritoneal and omental masses with ascites, and it is indistinguisable from peritoneal carcinomatosis or malignant mesothelioma. We report a case of surgically proven primary serous papillary carcinoma of the peritoneum in a 63-year-old woman.
Ascites ; Carcinoma ; Carcinoma, Papillary* ; Epithelium ; Female ; Humans ; Mesothelioma ; Middle Aged ; Ovary ; Peritoneum*

OBJECTIVES: Changes of GABAergic neurotransmission in response to the application of different types of environmental stress have been the subject of research for over two decades. However, the nature of the changes induced by stress appear to show a dependent phenomena on the type and duration of stressor agent employed. METHODS: For this reason, this study was performed to observe the effects of repeated stress on the radioligands binding to GABA A/benzodiazepine receptors of discrete brain regions. The author also examined the activity of GABA transaminase and the concentration of endogenous GABA. Male Sprague-Dawley rats, weighing 150-200g were forced to suffer an immobilization stress for 2 hours during 14 consecutive days. RESULTS: Repeated immobilization stress decreased the binding of [3H]flunitrazepam on the benzodiazepine receptor in the cortex, hippocampus and hypothalamus. Saturation experiments followed by scatchard analyses of the results showed decreased density of benzodiazepine receptor and the affinity remained unchanged. Repeated immobilization stress did not affect the binding of [3H]muscimol on the GABAA receptor, the activity of GABA transaminase, and the concentration of endogenous GABA in the brain regions. CONCLUSIONS: From these results, it can be concluded that repeated immobilization stress modulated GABAergic neurotransmission via downregulation of the benzodiazepine receptor in the brain.
4-Aminobutyrate Transaminase ; Animals ; Brain ; Down-Regulation ; gamma-Aminobutyric Acid ; Hippocampus ; Humans ; Hypothalamus ; Immobilization ; Male ; Rats* ; Rats, Sprague-Dawley ; Receptors, GABA ; Receptors, GABA-A ; Synaptic Transmission*

BACKGROUND: Congenital nephrogenic diabetes insipidus (NDI) is a rare inherited disorder, in which two different hereditary forms, X-linked and autosomal recessive traits, have been identified. The X-linked recessive form, mostly (>90%) congenital NDI, has been known to be caused by mutation of the arginine-vasopressin receptor 2 (AVPR2) gene. AVPR2 mutation sites are different in ethnic groups and recently 72 different mutation sites have been reported among AVPR2 gene. This study aimed to analyze AVPR2 gene in selected members in a Korean family with NDI and provided a report of the existence of a new mutation site in AVPR2 gene. METHODS: Three-generation maternal pedigree of the index patient (21-year old male, patient I) and his younger brother (19-year old male, patient II) with NDI was collected. Genomic DNA was obtained from patient I, II, III (index patient's male maternal cousin with NDI), index patient's mother, three maternal aunts, one female maternal cousin and, for control, one healthy male volunteer. Three coding exons of AVPR2 gene were amplified by PCR using 4 pairs of oligonucleotide primers. After direct sequencing of amplified PCR products, the sequence was compared with whole squence of normal AVPR2 gene and identification of a new site of mutation in this gene was done. RESULTS: 1) all three male patients had transversion of G to C at position 1033 of the AVPR2 gene, resulting in a subsequent change of amino acid from glycine to cysteine in codon 201. 2) Two small peaks of G and T, the result of direct sequencing in five female members in this family, would suggest that they are carriers of G to N transversion. CONCLUSION: These results can demonstrate the significant functional correlation of the mutation in AVPR2 gene sequence with clinical NDI, and suggest the clinical utility of direct mutation testing for congenital NDI in family.
Clinical Coding ; Codon ; Cysteine ; Diabetes Insipidus, Nephrogenic ; DNA ; DNA Primers ; Ethnic Groups ; Exons ; Female ; Glycine ; Humans ; Male ; Mothers ; Pedigree ; Polymerase Chain Reaction ; Receptors, Vasopressin* ; Siblings ; Vasopressins* ; Volunteers

BACKGROUND: Since the bioavailability of itraconazole capsule is influenced by patients gastric acidity, it results in treatment failure due to its low dissolution and subsequent low absorption when administered in fasting. Itraconazole Melt-Extrusion tablet has been lately developed in order to improve its dissolution profile. It is the first clinical study to evaluate the efficacy and safety of itraconazole Melt-Extrusion tablet in Korea. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of itraconazole melt-extrusion tablet 400mg daily for 1 week(pulse therapy) for hyperkeratotic type of tinea pedis and manus. METHODS: A clinical and mycological investigation was made of 812 outpatients with hyperkeratotic type of tinea pedis and/or tinea manus who had visited at 52 general hospitals under the lead of the Korean Dermatological Association from June to December, 1998. Patients confirmed by clinically and microscopically as hyperkeratotic type of tinea pedis and/or tinea manus were administered 2 tablets twice a day for one week and followed up for 8 weeks from the start of the medication. RESULTS: The results were summarized as follows; 1. Clinical symptoms of hyperkeratotic type of tinea pedis and/or tinea mauns were significantly improved at the end of study, week 8(p<0.001). 2. Clinical response rate, defined as more than 50% decrease of the sum of the clinical symptom scores, was 79.3%(512/646). 3. Mycological cure rate, dafined as both culture and KOH negative at week 8, was 78.2%(244 /312). 4. 40(5.5%) patients, of the 727 patients evaluable for drug safety evaluation, were reported to have adverse event. CONCLUSION: Itraconazole Melt-Extrusion tablet 400mg/day for 1 week (pulse therapy) is effective and safe in the treatment of hyperkeratotic type of tinea pedis and/or tinea manus.
Absorption ; Biological Availability ; Fasting ; Gastric Acid ; Hospitals, General ; Humans ; Itraconazole* ; Korea ; Outpatients ; Tablets ; Tinea Pedis* ; Tinea* ; Treatment Failure

PURPOSE: To determine the time of magnetic resonance(MR) signal intensity changes in denervated skeletal muscle and to compare MR imaging with electromyography(EMG) in the evaluation of peripheral nerve injury. MATERIALS AND METHODS: We evaluated MR imagings of denervated muscles after experimental transection of the sciatic nerve in five rabbits using 1.0T MR unit. MR imaging and EMG were performed 3 days and 1, 2 and 3 weeks after denervation. T1-weighted images(T1-WI), T2-WI and Short Tau Inversion Recovery(STIR) images were obtained. The signal intensity (SI) of muscles in the denervated and normal sides were visually and quantitatively compared. After measuring the SI of the normal and abnormal areas, the time of SI change was determined when there was significant difference (P<0.05) of SI between the normal and denervated sides. RESULTS: On STIR images, two of the five rabbits showed significant SI changes at the third day(P<0.05) and all showed significant changes(P<0.05)at the first week. On T2-WI, one rabbit showed significant SI changes at the third day, and all showed significant SI changes at the first week. On T1-WI, significant SI changes were seen in one rabbit at the second week and in one at the third. One week after denervation, all showed denervation potential on EMG. CONCLUSION: This study suggests that MR imaging using STIR images is a useful method in the evaluation of denervated muscle, and that MR signal changes of denervated muscle may precede EMG changes after denervation. To localize and to determine the severity of the peripheral nerve injury, future analysis of the distribution of abnormal MR SI in denervated muscles would be helpful.
Denervation ; Magnetic Resonance Imaging* ; Muscle, Skeletal* ; Muscles ; Peripheral Nerve Injuries ; Rabbits* ; Sciatic Nerve