PURPOSE: The aim of this study was to define the capsules of synchronous multicentric small hepatocellular carcinomas (HCCs) with use of high-frequency intraoperative ultrasonography (IOUS). METHODS: Among the 131 consecutive patients undergoing hepatic resection and high-frequency IOUS for HCC, 16 synchronous multicentric small HCCs in 13 patients were histologically diagnosed in the resected specimens. High-frequency IOUS and pathologic findings of these lesions were compared, with particular focus on the presence and appearance of the capsule in or around each lesion. RESULTS: Synchronous multicentric small HCCs were pathologically classified into distinctly nodular (n=12) or vaguely nodular (n=4) types. All 12 distinctly nodular HCCs including six subcentimeter lesions showed detectable capsules on high-frequency IOUS and pathology. The capsules appeared as a hypoechoic rim containing hyperechoic foci (n=6), hypoechoic rim (n=5), or hyperechoic rim (n=1) with varying degrees of coverage around each lesion. Histologically, the capsules were composed of a combination of one to four layers consisting of a fibrous capsule, peritumoral fibrosis, prominent small vessels, and entrapped hepatic parenchyma. CONCLUSION: Synchronous multicentric small HCCs with distinctly nodular type, even at subcentimeter size, can show capsules with varying coverage and diverse echogenicity on high-frequency IOUS.
Capsules ; Carcinoma, Hepatocellular* ; Fibrosis ; Humans ; Liver Neoplasms ; Pathology ; Ultrasonography*

BACKGROUND/AIMS: Cholecystectomy is necessary for the treatment of symptomatic or complicated gallbladder (GB) stones, but oral litholysis with bile acids is an attractive alternative therapeutic option for asymptomatic or mildly symptomatic patients. This study was conducted to evaluate the efficacy of magnesium trihydrate of ursodeoxycholic acid (UDCA) and chenodeoxycholic acid (CDCA) on gallstone dissolution and to investigate improvements in gallstone-related symptoms. METHODS: A prospective, multicenter, phase 4 clinical study to determine the efficacy of orally administered magnesium trihydrate of UDCA and CDCA was performed from January 2011 to June 2013. The inclusion criteria were GB stone diameter < or =15 mm, GB ejection fraction > or =50%, radiolucency on plain X-ray, and asymptomatic/mildly symptomatic patients. The patients were prescribed one capsule of magnesium trihydrate of UDCA and CDCA at breakfast and two capsules at bedtime for 6 months. The dissolution rate, response rate, and change in symptom score were evaluated. RESULTS: A total of 237 subjects were enrolled, and 195 subjects completed the treatment. The dissolution rate was 45.1% and the response rate was 47.2% (92/195) after 6 months of administration of magnesium trihydrate of UDCA and CDCA. Only the stone diameter was significantly associated with the response rate. Both the symptom score and the number of patients with symptoms significantly decreased regardless of stone dissolution. Adverse events necessitating discontinuation of the drug, surgery, or endoscopic management occurred in 2.5% (6/237) of patients. CONCLUSIONS: Magnesium trihydrate of UDCA and CDCA is a well-tolerated bile acid that showed similar efficacy for gallstone dissolution and improvement of gallstone-related symptoms as that shown in previous studies.
Adult ; Aged ; Antacids/*administration & dosage ; Chenodeoxycholic Acid/*administration & dosage ; Cholagogues and Choleretics/*administration & dosage ; Drug Administration Schedule ; Drug Combinations ; Female ; Gallstones/*drug therapy ; Humans ; Magnesium Hydroxide/*administration & dosage ; Male ; Middle Aged ; Prospective Studies ; Severity of Illness Index ; Solubility/drug effects ; Ursodeoxycholic Acid/*administration & dosage

There are three compartments of the forearm by fascia: volar, dorsal and lateral. Compartment syndrome of the forearm, which commonly develops in the volar deep compartment, can be induced by various causes. We experienced a case of acute dorsal compartment syndrome of the forearm in a patient with rhabdomyolysis. Because of severe pain and progressive palsy of the posterior interosseous nerve, fasciotomy and release of posterior interosseous nerve were performed. Acute compartment syndrome localized at the dorsal compartment of the forearm is very rare, and compartment syndrome of the forearm in a patient with rhabdomyolysis has not been reported previously. We report the case with review of literatures.
Compartment Syndromes* ; Fascia ; Forearm* ; Humans ; Paralysis ; Rhabdomyolysis*

Avascular necrosis of the metacarpal head named as 'Dieterich disease' is a very rare condition. Because of the lack of information about the natural course and treatment of this disease, the ideal treatment has not been established as yet. We report a case of avascular necrosis that occurred at the 3rd metacarpal head after fractures of the 4th and 5th metacarpal base; this was treated conservatively and obtained the spontaneous resolution.
Head ; Metacarpal Bones ; Metacarpus ; Necrosis ; Osteonecrosis

PURPOSE: Androgen deprivation therapy (ADT) is associated with loss of bone mineral density (BMD). Preexisting bone losses in men with prostate cancer are of great concern because of accelerated bone loss during ADT. We sought to identify the risk factors associated with osteoporosis in Korean patients with prostate cancer who had not received ADT. MATERIALS AND METHODS: Patients who underwent biopsy of the prostate because of a high prostate-specific antigen (PSA) level or a palpable nodule in a digital rectal examination were included in this study. The patients (n=90) were divided into 2 major groups according to biopsy results: the prostate cancer group (group 1, n=41) and non-prostate cancer group (group 2, n=49). The age, body mass index (BMI), lifestyle, testosterone concentration, BMD, and disease variables in prostate cancer were obtained and analyzed prospectively. BMD of the lumbar spine and femoral neck was measured by dual-energy X-ray absorptiometry. RESULTS: In group 1, 41.4% had osteopenia (36.6%) or osteoporosis (4.8%); in group 2, 26.5% had osteopenia (22.4%) or osteoporosis (4.1%). The estimated mean T-score was significantly (p=0.037) lower in group 1 (-0.668+/-1.364) than in group 2 (-0.041+/-1.426). The significant factors correlated with BMD (T-score) in prostate cancer were age (p=0.012), serum testosterone level (p=0.019), and BMI (p=0.004). CONCLUSIONS: BMDs were lower in men with prostate cancer who had not received ADT than in the control group. Consideration should be given to counseling on risk factors and lifestyle issues in prostate cancer patients with old age, low serum testosterone, and slender stature before initiating ADT.
Absorptiometry, Photon ; Biopsy ; Body Mass Index ; Bone Density ; Bone Diseases, Metabolic ; Counseling ; Digital Rectal Examination ; Femur Neck ; Humans ; Life Style ; Male ; Osteoporosis ; Prospective Studies ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Risk Factors ; Spine ; Testosterone

Spontaneous intracerebral hemorrhage is very rare in patients with neurofibromatosis type 1. A 30-year-old woman was referred to our hospital for evaluation of headaches, nausea, and vomiting. She was diagnosed with neurofibromatosis type 1 and a spontaneous intracerebral hemorrhage. She was treated with conservative management, including antihypertensive medications for 32 months. However, because of sustained hypertension, we performed screening tests for a pheochromocytoma. The 24 hr urine VMA and urine metanephrines were elevated. Abdominal CT showed a right adrenal mass, 7.5 x 5.8 cm in size.. After a successful resection of the tumor, the hypertension resolved without medication for > 1 year. This case illustrates that delayed diagnosis and treatment of pheochromocytoma can cause serious complications from hypertension, such as cerebrovascular hemorrhage. Thus, in patients with neurofibromatosis and hypertension, screening for pheochromocytoma is important for the early detection of an adrenal tumor.
Adult ; Cerebral Hemorrhage ; Delayed Diagnosis ; Female ; Headache ; Hemorrhage ; Humans ; Hypertension ; Mass Screening ; Nausea ; Neurofibromatoses ; Neurofibromatosis 1 ; Pheochromocytoma ; Vomiting

BACKGROUND AND OBJECTIVES: The aims of this study were to assess the long term overall survival of patients after an acute myocardial infarction (AMI), and to determine the association of survival with the occurrence of ventricular arrhythmia, as recorded by Holter electrocardiography (ECG) and signal-averaged electrocardiography (SAECG). SUBJECTS AND METHODS: One hundred fifty two patients with an AMI were enrolled between January 2000 and August 2006. SAECG and Holter ECG were performed before hospital discharge (at range of 2-10 day). The grading system of Lown was used to evaluate the ventricular premature beats on Holter ECG. Three groups of patients were identified based on the seriousness of the ventricular arrhythmia, as identified by the Holter ECG: Lown grade 0, Lown grades 1, 2 and Lown grades 3, 4, 5. SAECG was performed with a high pass frequency of 25 Hz and 40 Hz. The presence of late potentials (LPs) recorded on SAECG was evaluated. The predictors for survival were assessed using Cox's proportional hazard model and Kaplan-Meier analysis. RESULTS: The mean duration of follow-up was 45.8+/-25.5 months. Twenty four patients (15.8%) died during follow-up. The multivariate predictors of all cause death included age [hazard ratio (HR)=1.25, 95% confidence interval (CI)=1.08-1.47, p=0.003] and Lown grades 3, 4 and 5 (HR=19.17, 95% CI=1.25-290.80, p=0.034). Survival analysis did not show a significant relationship between LPs and overall patient survival. The only predictors for overall mortality were age and the Lown grade. CONCLUSION: SAECG did not predict mortality for the patient with AMI. The ventricular arrhythmias recorded by conventional Holter before hospital discharge may be a useful noninvasive prognostic test after an AMI.
Arrhythmias, Cardiac ; Cardiac Complexes, Premature ; Electrocardiography ; Electrocardiography, Ambulatory ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Myocardial Infarction ; Prognosis ; Proportional Hazards Models

BACKGROUND AND OBJECTIVES: Drug-eluting stents (DES) have been shown to substantially reduce both angiographic and clinical restenosis. Cypher(R) (sirolimus-eluting stent, Cordis, Johnson and Johnson, Florida, USA) and Taxus(R) (paclitaxel-eluting stent, Boston Scientific, Boston, USA) are the two most widely used DESs, and they both have distinct pharmacological properties and release kinetics. It has been not studied whether these two DESs show different angiographic outcomes when they are simultaneously implanted in the same patient. SUBJECTS AND METHODS: We retrospectively analyzed the angiographic findings of the short-term follow-up in 34 patients (average age: 63 year old, 9 women) in whom both Cypher and Taxus stents were implanted at the same time for the treatment of obstructive coronary lesion. RESULTS: There was no significant difference in the basal angiographic characteristics of the lesions that had two stents deployed in terms of the AHA/ACC classification, reference diameter, the percent diameter stenosis and minimal luminal diameter. The post-procedure results were similar between the two stents. At 6 months follow-up, the Cypher stent displayed significantly less in-stent lumen loss compared with the Taxus stent (0.16+/-0.04 mm vs 0.27+/-0.04 mm; respectively, p=0.040) and a smaller percent diameter stenosis (15.9+/-1.3% vs 19.9+/-2.2%, respectively, p=0.049). CONCLUSION: The Cypher stent showed significantly less luminal loss during short term follow-up compared with the Taxus stent when implanted in the same patient. This result suggests that in a given individual patient, the Cypher stent induces less neointimal proliferation than does the Taxus stent.
Classification ; Constriction, Pathologic ; Coronary Restenosis ; Drug-Eluting Stents ; Florida ; Follow-Up Studies ; Humans ; Kinetics ; Middle Aged ; Paclitaxel ; Phenobarbital ; Retrospective Studies ; Sirolimus ; Stents* ; Taxus*

BACKGROUND/AIMS: Genetic polymorphism of cytochrome P450 CYP2C19 influences the efficacy of proton pump inhibitor (PPI) in Helicobacter pylori (H. pylori) eradication therapy. We investigated the difference in the cure rates of H. pylori infection by triple (rabeprazole plus amoxacillin and clarithromycin) therapy in relation to CYP2C19 genotype status. METHODS: One hundred and sixteen H. pylori infected patients with gastric ulcer and duodenal ulcer completed the triple therapy with 10 mg of rabeprazole b.i.d., 1,000 mg amoxacillin b.i.d. and 500 mg of clarithromycin b.i.d. for one week. The genotype of CYP2C19 was determined by a PCR-restriction fragment length polymorphism method. RESULTS: According to the univariate analysis, heterozygous extensive metabolizers (hetero EMs) and poor metabolizers (PMs) showed the highest (87.0%) and the lowest (80.0%) eradication rates, respectively. The difference in the therapeutic efficacy of rabeprazole among the different CYP2C19 genotypes was insignificant. With regard to gender, age and smoking history in relation to eradication rate, a statistical significance was noted only with age with odds ratio of 1.063 and p-value of 0.0202. CONCLUSIONS: In the eradication therapy of H. pylori, no statistically significant difference in therapeutic efficacy of rabeprazole was found among different CYP2C19 genotypes.
2-Pyridinylmethylsulfinylbenzimidazoles ; Adult ; Aged ; Amoxicillin/administration & dosage ; Anti-Bacterial Agents/administration & dosage ; Anti-Ulcer Agents/*administration & dosage ; Aryl Hydrocarbon Hydroxylases/*genetics ; Benzimidazoles/*administration & dosage ; Clarithromycin/administration & dosage ; Drug Therapy, Combination ; Duodenal Ulcer/drug therapy/*genetics/microbiology ; Female ; Genotype ; Helicobacter Infections/*drug therapy ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Mixed Function Oxygenases/*genetics ; Omeprazole/analogs & derivatives ; Proton Pumps/*antagonists & inhibitors ; Stomach Ulcer/drug therapy/*genetics/microbiology

No abstract available.
Root Planing* ; Splints*