Spinal Teratoma Concomitant with Intracranial Lipid Droplet Dissemination

A teratoma is a neoplasm that contains tissues originating from three germ cell layers at ectopic sites. The embryology of teratomas remains unclear. Teratomas are usually composed of cystic and solid components, and they are usually associated with syringomyelia. Cystic lesions of teratomas may rupture in a spontaneous, iatrogenic, or traumatic manner. Lipid droplets in the ventricles and subarachnoid space are rare. We managed a case of a spinal teratoma in the lumbar region in a 67-year-old man. He complained of nocturia, frequent urination, and difficulty in walking for 2 months. Radiographic imaging revealed a lumbar spinal intradural mass. Intracranial lipid droplets dissemination was also existed. The patient underwent surgery, and a diagnosis of mature teratoma was confirmed histopathologically. During the operation, the cystic portion of the intradural mass ruptured. During the hospital stay, the patient's mental status declined. On radiological examination, slightly enlarged ventricle size was observed. Dissemination of lipid droplets within ventricles occurs because of spontaneous, iatrogenic, or traumatic rupture. Additional lipid droplet dissemination to the intracranial space associated with neurologic deterioration after a spinal teratoma surgery should be considered when iatrogenic rupture of the cyst portion occurs.

Translocation of Intrauterine Device / 대한산부인과학회잡지

OBJECTIVE: To study the clinical characteristics on translocation of intrauterine device and the methods of removal. METHODS: A retrospective review was performed on 77 cases of translocation of intrauterine device from June 1994 to December 2002. RESULTS: Among 77 cases undergoing removal of intrauterine device, 17 cases (22.1%) were translocted intraperitoneally. Fifteen cases were removed by laparoscopy, 2 cases were by laparotomy and there was no specific postoperative complication. The incidence of intraperitoneal translocation was not related to the type of IUD. Between intrauterine and extrauterine translocation, the incidence of symptoms were not different, but low abdominal pain were slightly increased in extrauterine (35.3%) than intrauterine (10.0%) group. The time lapse after insertion of IUD was ranged from 1 month to 35 year, the mean duration was 9.39 year, that was not related to the incidence of intraperitoneal translocation. In the cases of extrauterine translocation, the mean hospital day was significantly increased (p=0.001), the mean duration was 2.5 day (1-7 day), compaired with 0.7 day (0-6 day) of the cases of not translocated. CONCLUSION: As the type of IUD or symptoms, it is difficult to anticipate the possibility of the intraperitoneal translocation of IUD. But, in cases of extrauterine translocation of intrauterine device, the incidence of low abdominal pain was slightly increased, and ring type IUD was rarely extrauterne translocated. So, it is necessary to further study what factors contribute the extrauterine translocation of IUD.

The association of the percentage change of bone mineral density and bone markers after one year of hormone replacement therapy in postmenopausal women

BACKGROUND: To predict the therapeutic efficacy of osteoporosis, one or two years is needed to evaluate the therapeutic effect by the measurement of bone mineral density(BMD), whereas three to six months is sufficient with bone markers. Using this information, we can change therapeutic plan or modulate drug dosage if necessary. This approach would provide appropriate therapy for osteoporosis. The purpose of this study is to evaluate the association between the percentage change of BMD which was measured by peripheral quantitative computed tomography(pQCT), and bone markers after 1 year of hormone replacement therapy(HRT) in healthy postmenopausal women. METHODS: Bone mineral density of nondominant distal forearm in 89 postmenopausal women was measured by pQCT. We measured serum alkaline phosphatase(ALP) and intact osteocalcin(iOC, Novocalcin) as bone formation markers, urinary deoxypyridinoline(dPyr, PyriLinks-D(TM)) as bone resorption marker by using enzyme immunoassay. After 1 year of HRT, 54 subjects dropped out and 33 subjects were reevaluated. RESULTS: After 1 year of HRT, the drop-out rate was 61%. There was no significant difference in age, age of menopause, years since menopause, initial BMD, initial bone markers between remained and drop out groups. But osteocalcin level was significantly high in remained group(p=0.02). ALP(-27.6 %), iOC(-29.9%), dPyr(-25.2%) were significantly decreased after 1 year of HRT(p0.05). The levels of BMD and bone markers between before and after was significantly correlated, demonstrating the homogeneity of response to HRT. The percentage change of trabecular BMD was negatively correhted with the percentage change of dPyr after HRT(r=-0.45, p=0.01). The variance of the percentage change of dPyr contributed to the percentage change of trabecular BMD by 20%. There was no correlation between the percentage change of total BMD or cortical BMD and the change of ALP, iOC, or dPyr after HRT. CONCLUSIONS: After 1 year of HRT in postmenopausal women, all biochemical bone markers were decreased significantly, whereas only trabecular BMD measured by pQCT was increased significantly. This result suggests that bone markers was more sensitive than BMD to monitor the therapeutic efficacy of HRT. The percentage change of trabecular BMD was correlated with the change of dPyr after HRT only. dPyr might be the most sensitive marker among bone markers tested. Therefore, we can predict the change of BMD after HRT through monitoring the levels of dPyr.

A Case of Chronic Inflammatory Demyelinating polyradiculoneuropathy with Intestinal Pseudoobstruction / 대한내과학회지

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) represents an important acquired condition characterized by progressive, symmetrical, proximal and distal weakness. CIDP is characterized by sensory loss and weakness, areflexia, elevated CSF protein and electrodiagnostic evidence of multifocal demyelination with or without superimposed axonal degeneration. Some reports are made that an antecedent illness in the weeks preceding the onset of symptoms such as upper respiratory syndrome or flu-like illness, gastrointestinal syndrome etc., but intestinal pseudoobstruction as the main clinical feature in CIDP is an uncommon finding. The clinical course is variable. The condition is responsive to immunosuppressive therapy, especially prednisone and plasma exchange. We report a case of intestinal pseudoobstruction secondary to CIDP diagnosed by clinical features, electrodiagnostic study and nerve biopsy pathology.

Mammographic Changes in Postmenopausal Women: Comparative Effects between Continuous Combined Hormone and Single Estrogen Replacement Therapy

PURPOSE: As the use of hormone replacement therapy for the menopausal women increases, some caution is advised, since there is an increased risk of breast cancer. Accordingly, the importance of regular mammography has been addressed. This cross-sectional study analyzed the effects of different hormone therapies on mammographic density. MATERIALS AND METHODS: Sixty-seven postemenopausal women who had completed one year of hormone therapy and had undergone follow-up mammography, were divided into two groups : Group I : continuous conjugated equine estrogen, 0.625 mg, plus continuous medroxyprogesterone acetate, 2.5 mg (n=48), Group II : continuous conjugated equine estrogen 0.625 mg (n=19). The mammograms were read by two radiologists. RESULTS: With regard to the radiologists involved, interobserver reliability (kappa) was 0.70 and intraobserver reliability (kappa) was 0.51 and 0.67. Before hormone therapy, factors related to decreased mammographic density were age and number of full term pregnancies (p<0.05). After one year of hormone therapy, body fat showed a significant increase (p<0.05), but in spite of this, increased mammographic density induced by hormone therapy remained significantly high (p<0.05). Compared with Group II, Group I showed a significant increase in mammographic density (p<0.05). In Group I, mammographic density increased from P2 to DY pattern in two cases, but there was no such change in Group II. CONCLUSION: The increase of mammographic density seen in Group II was much more significant statistically than that seen in Group I. The mammograms of women who have undergone continuous combined hormone therapy should therefore be interpreted very cautiously.