Among various types of supernumerary nipples, intra-areolar polythelia (IAP) is an extremely rare congenital malformation. The authors report a case of a young woman with unilateral IAP on her right breast. The patient was 24 years old; she had had it since she was 5 or 6 years old, and it had enlarged 3 to 4 years before presentation to our clinic. Surgical excision was performed under local anesthesia as a prophylaxis against breast cancer and cosmetic problems.
Anesthesia, Local ; Breast ; Breast Neoplasms ; Female ; Humans ; Nipples ; Reconstructive Surgical Procedures

Familial Mediterranean fever (FMF) is known to be a genetic disorder that prevalent among populations surrounding the Mediterranean Sea. Since Mediterranean fever gene (MEFV) was discovered at 1997, some cases have been reported in countries not related or close to this area like Japan. In addition it has been generally accepted that the clinical onset of FMF begins before 20 yr of age in most patients. Onset of the disease at an older age may occur but is rare. Adult-onset FMF may be a form of disease with distinct clinical, demographic and molecular characteristics. We describe a case of adult-onset FMF confirmed by DNA analysis of the MEFV gene in a Korean patient. A 32-yr-old man, who has no family history of FMF, presented with periodic fever, abdominal pain and vomiting. Though several various tests were thoroughly performed to evaluate the cause of his symptoms, there was no evidence of infectious, autoimmune or neoplastic diseases. Several gene analysis of periodic fever syndrome was finally performed and two point mutations (p.Leu110Pro, p.Glu148Gln) were identified. We confirmed the first adult case of FMF through detection of MEFV gene mutations in Korea and describe his clinical characteristics.
Abdominal Pain/etiology ; Adult ; Cytoskeletal Proteins/*genetics/metabolism ; DNA Mutational Analysis ; Familial Mediterranean Fever/*diagnosis/genetics ; Fever/etiology ; Humans ; Male ; Polymorphism, Single Nucleotide ; Republic of Korea ; Tomography, X-Ray Computed ; Vomiting/etiology

Familial Mediterranean fever (FMF) is known to be a genetic disorder that prevalent among populations surrounding the Mediterranean Sea. Since Mediterranean fever gene (MEFV) was discovered at 1997, some cases have been reported in countries not related or close to this area like Japan. In addition it has been generally accepted that the clinical onset of FMF begins before 20 yr of age in most patients. Onset of the disease at an older age may occur but is rare. Adult-onset FMF may be a form of disease with distinct clinical, demographic and molecular characteristics. We describe a case of adult-onset FMF confirmed by DNA analysis of the MEFV gene in a Korean patient. A 32-yr-old man, who has no family history of FMF, presented with periodic fever, abdominal pain and vomiting. Though several various tests were thoroughly performed to evaluate the cause of his symptoms, there was no evidence of infectious, autoimmune or neoplastic diseases. Several gene analysis of periodic fever syndrome was finally performed and two point mutations (p.Leu110Pro, p.Glu148Gln) were identified. We confirmed the first adult case of FMF through detection of MEFV gene mutations in Korea and describe his clinical characteristics.
Abdominal Pain/etiology ; Adult ; Cytoskeletal Proteins/*genetics/metabolism ; DNA Mutational Analysis ; Familial Mediterranean Fever/*diagnosis/genetics ; Fever/etiology ; Humans ; Male ; Polymorphism, Single Nucleotide ; Republic of Korea ; Tomography, X-Ray Computed ; Vomiting/etiology

Multiple primary cancer is defined as the multiple occurrence of malignant neoplasm in the same individual. Synchronous cancers are usually defined as finding the second cancer at the same time or within a 6-month period after the diagnosis of the primary lesion, and metachronous cancers are found at more than 6 months after the initial diagnosis. Multiple primary cancers have been increasing reported on due to prolonged lifespans and the improvement of diagnostic techniques. Nevertheless, triple synchronous cancers have been regarded as a relatively rare finding. We report here on an unusual case of triple synchronous cancer of early gastric cancer, carcinoid tumor of the ampulla of Vater and renal cell carcinoma.
Adenocarcinoma* ; Ampulla of Vater* ; Carcinoid Tumor* ; Carcinoma, Renal Cell* ; Diagnosis ; Neoplasms, Second Primary ; Stomach Neoplasms

BACKGROUND: Lung pericytes are important constituent cells of blood-air barrier in pulmonary microvasculature. These cells take part in the control of vascular contractility and permeability. In this study, it was hypothesized that change of lung pericytes might be attributable to pathologic change in microvasculature in acute lung injury. The purpose of this study was how hypoxia change proliferation and genetic expression in lung pericytes. METHODS: From the lungs of several Sprague-Dawley rats, performed the primary culture of lung pericytes and subculture. Characteristics of lung pericytes were confirmed with stellate shape in light microscopy and immunocytochemistry. 2% concentration of oxygen and 200muM CoCl2 were treated to cells. Tryphan blue method and reverse transcription-polymerase chain reaction were done. RESULTS: 1. We established methodology for primary culture of lung pericytes. 2. Hypoxia inhibited cellular proliferation in pericytes. 3. Hypoxia could markedly induce vascular endothelial growth factor(VEGF) and smad-2. 4. Hypoxia-inducible factor-1alpha (HIF-1alpha)was also induced by 2% oxygen. CONCLUSION: Viability of lung pericytes are inhibited by hypoxia. Hypoxia can stimulate expression of hypoxia-responsive genes. Pericytic change may be contributed to dysfunction of alveolar-capillary barrier in various pulmonary disorders.
Acute Lung Injury ; Anoxia ; Blood-Air Barrier ; Cell Proliferation ; Immunohistochemistry ; Lung* ; Microscopy ; Microvessels ; Oxygen ; Pericytes* ; Permeability ; Rats, Sprague-Dawley ; Vascular Endothelial Growth Factor A

Pseudomembranous colitis (PMC) is mostly related with the antibiotics and it presents with diarrhea, abdominal pain, fever, hypoalbuminemia and hypovolemia. In the clinical course of pseudomembranous colitis (PMC), ascites is a rare presentation, and high elevation of carcinoembryonic antigen (CEA) associated with PMC is also a very rare presentation. We experienced a case taken cephalosporin group antibiotics for six weeks and presented with fever, abdominal pain, severe diarrhea, and massive ascites. During evaluation, we found low serum-ascites albumin gradient and high level of CEA in both ascites and plasma. With the impression of hidden malignancy, the special studies were done, but PMC was only found without malignancy. After vancomycin therapy, all symptoms were relieved and CEA level declined.
Abdominal Pain ; Anti-Bacterial Agents ; Ascites* ; Carcinoembryonic Antigen ; Diarrhea ; Enterocolitis, Pseudomembranous* ; Fever ; Hypoalbuminemia ; Hypovolemia ; Plasma ; Vancomycin

PURPOSE: Ingested foreign bodies present a common clinical problem. It is well known that most of them pass uninterrupted through the gastrointestinal tract. We evaluated the role of endoscopy and Foley catheter for removal of foreign bodies in the gastrointestinal tract. METHODS: We investigated retrospectively 60 cases with foreign bodies in the gastrointestinal tract. They had been treated at Wonju Christian Hospital, Yonsei University of Korea, from January, 1996 through December, 1999. RESULTS: The age of the patients ranged from 7 months to 13 years. Patients under 5 years were 57 cases (97%) and there was no significant difference in sex (M : F=1.07 : 1). 45 cases of the patients had no symptom. The most common foreign bodies were coins (43 cases). The most common location was esophagus (31 cases). The number of foreign body removal using flexible endoscopy and Foley catheter was 22 (36.7%) and 18 (30.0%) cases, respectively. In 18 cases (30.0%), foreign bodies passed spontaneously. Only 1 case (1.7%), curtain pin impaction at ileocecal region, required surgery. CONCLUSION: Early foreign body removal from esophagus and stomach is recommended to lessen the morbidity and complication. Fluoroscopic foley catheter technique and flexible endoscopy for removal of esophageal foreign bodies in children is safe and effective.
Catheters ; Child* ; Endoscopy ; Esophagus ; Foreign Bodies* ; Gangwon-do* ; Gastrointestinal Tract ; Humans ; Korea* ; Numismatics ; Retrospective Studies ; Stomach

Pacemaker-mediated tachycardia (PMT) is a well-known complication of dual-chamber pacemaker with atrioventricular sensing and pacing (DDD) or atrial synchronous, ventricular demand pacemaker (VDD). PMT usually starts with sensing a retrograde P waves linked to ventricular extrasystole with retrograde ventriculoatrial conduction and forms reentrant or circus movement tachycardia with the pacemaker itself as an antegrade limb and the conducting tissue of the heart as a retrograde limb. Recently, a number of pacemaker manufactures have incorporated in their devices a variety of relatively complex algorithms to prevent PMT. Despite these measures, PMT may still occur because of inappropriate programming or unpredictable variations of ventri-culoatrial conduction. We report two cases of PMT in 78 year-old man and 60 year-old man who received DDD type pacemakers due to sick sinus syndrome, and a case of PMT in 69 year-old man who had suffered complete heart block and received a VDD type pacemaker. In these cases, we investigate symptoms, mechanism of PMT, programed parameters of pacemaker and treatments of PMT.
Aged ; Dichlorodiphenyldichloroethane ; Extremities ; Heart ; Heart Block ; Humans ; Middle Aged ; Sick Sinus Syndrome ; Tachycardia* ; Ventricular Premature Complexes

BACKGROUND: Lactate dehydrogenase (LDH) has been reported to be a sensitive indicator of pancreatic necrosis (PN), and some studies suggested that an elevation of the ratio of LDH to AST (LDH/AST ratio) woud be more accurate indicator of PN in acute biliary pncreatitis (BP). However, there were no studies in alcoholic pancreatitis (AP). The aim of this study was to assess the clinical usefulness of LDH/AST ratio in alcoholic pancreatitis (AP) as a indicator of PN. METHODS: On the basis of CT scan findings, the patients were categorized into two groups as having PN or non-PN. The plasma levels of the LDH, AST and LDH/AST ratio over two weeks postadmission period were evaluated and compared with in two groups of patients with BP (consiting of 12 PN and 34 non-PN patients), and with AP (consisting of 14 PN and 38 non-PN patients). RESULTS: In acute BP, on post-admission days 1 and 2, the LDH/AST ratio were low in both groups without significant difference. In the group with PN, thereafter, the LDH/AST ratio increased gradually, reached peak values at the 7th days and decreased. In the non-PN patients, the LDH/AST ratio increased gradually, but remained below the control range. The LDH/AST ratios were significantly higher from post-admission day 3 in the group with PN than in the non-PN group. In acute AP, the LDH levels were significantly higher over two weeks from admission day in the PN patients. The LDH/AST ratios were remained within or below the control range in both groups, though with statistically significnat difference. CONCLUSION: The LDH/AST ratio could be used as an indicator of PN in acute BP. In acute AP, however, LDH was a more useful indicator from the early stage in the course.
Alcoholics* ; Humans ; L-Lactate Dehydrogenase ; Necrosis* ; Pancreatitis, Alcoholic* ; Plasma ; Tomography, X-Ray Computed

In order to assess the difference of autonomic dysfunction according to the absence or presence of nephropathy in patients with NIDDM, tests for cardiovascular autonomic function were performed in 23 NIDDM patients without nephropathy(M : F 14 : 9, mean age 50+/- 8) and in 21 patients with nephropathy (M : F 13 : 8, mean age 57+/-12). Tests for cardiovascular autonomic function included the R-R interval changes in response to respiration, Valsalva maneuver, and lying-standing, the blood pressure changes in response to lying-standing and sustained handgrip exercise. The prevalence of autonomic dysfunction was different between the patients without and with nephropathy(69.6% vs 85.7%). For patients without symptoms suggesting autonomic neuropathy, the significant differences were found in the change of R-R interval in response to respiration(22.16+/-21.30 vs 11.73+/-10.83; p=0.0390), in the change of lying-standing blood pressure(10.63+/-9.70 vs 22.00+/-13.67; p= 0.0044) and in the change of blood pressure during handgrip exercise(16.89+/-10.28 vs 8.40+/-7.24; p=0.0065). These results suggested that autonomic neuropathy may occur more frequently in patients with diabetic nephropathy than diabetes mellitus without neuropathy.
Blood Pressure ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Diabetic Nephropathies ; Diabetic Neuropathies ; Humans ; Prevalence ; Respiration ; Valsalva Maneuver