Intravascular Large B-cell Lymphoma Presenting as Rapidly Progressive Encephalopathy

Intravascular large B-cell lymphoma (IVLBCL) is a rare form of non-Hodgkin’s lymphoma that selectively involves the lumina of vessels, and may present as ischemic stroke. A 62-year-old man presented with progressive aphasia, dementia, seizure and stroke-like symptom. Brain magnetic resonance imaging revealed dynamic progressive fluid attenuated inversion recovery lesions and multiple punctate microbleeds in the bilateral subcortical region. A kidney biopsy revealed IVLBCL. We report a patient with IVLBCL presenting as rapidly progressive encephalopathy.

Molecular Biological Differences Between Younger and Older Breast Cancer Patients Based on the Status of a Microsatellite Marker

PURPOSE: Younger women exhibit more aggressive pathological features of breast cancer than older women, based on previous studies. We wished to evaluate any molecular biological differences in breast cancer between younger and older women by determining the status of a microsatellite marker. METHODS: Microsatellite instability (MSI) and loss of heterozygosity (LOH) were investigated in paired tumour and normal tissue DNA from 32 younger (age less than 40 years old) and 32 older (age more than 50 years old) breast cancer patients with 12 simple repeated primer sets. RESULTS: MSI was observed at a single locus in 5 (15.6%) of the younger patients. In older patients, MSI was observed at a single locus in 5 (15.6%) and at multiple loci in 1 (3.1%) of the older patients. LOH was noted at a single locus in 7 (21.8%) and at multiple loci in 22 (68.7%) of 32 younger patients. In older patients, LOH was noted at a single locus in 9 (28.1%) and at multiple loci in 15 (46.9%). The greatest frequency of LOH was at loci UT5320 (37.5%), D8S321 (34.4%), D9S242 (31.3%), and D19S394 (31.3%) in younger patients and at loci L17686 (34.4%) and D19S394 (28.1%) in older patients. LOHs at D19S394 and L17686 were highly identified in both age groups. LOHs at D9S242 and D8S321 were significantly higher in the carcinomas of younger women (P=0.013, P=0.016, respectively). The LOH status was unrelated to clinical stage, nodal status, tumour size, histological grade or estrogen receptor (ER) status. A LOH at D8S321 was associated with tumor size (P=0.048) and a LOH at UT5320 was associated with histological grade (P=0.012) and ER status (P=0.018). CONCLUSION: These results indicate that the pattern of chromosomal alterations are not exactly the same, especially at loci D9S242 and D8S321, in the carcinomas of the two age groups and suggest that the molecular pathogenesis of the carcinomas is not similar.

A 3-Year Follow-Up Study of Posttraumatic Stress Disorder among North Korean Defectors / 신경정신의학

OBJECTIVE: This study is a follow-up of a first survey of 200 North Korean defectors who entered South Korea in 2001. The purpose of this study is to examine changes in the current prevalence of partial PTSD and full PTSD after 3 years and to evaluate related factors. METHODS: This study followed up on 151 of the 200 North Korean defectors from our first survey. 20 interviewers conducted face-to-face interviews and assisted defectors in completing a self-report assessment. The traumatic events which participants with chronic PTSD and delayed onset PTSD experienced were then examined. RESULTS: Over the 3 years, the current prevalence rate of partial PTSD was reduced from 31.8% to 5.3%, and the current prevalence rate of full PTSD was reduced from 27.2% to 4.0%. Of particular interest was that 88.8% of those diagnosed with full or partial PTSD in the first survey had recovered after 3 years. CONCLUSION: The current prevalence rate of partial and full PTSD rapidly decreased during 3 years.

3-Year Follow up Study of the Way of Thinking and Satisfaction Level of North Korean Defectors in South Korea / 신경정신의학

OBJECTIVES: The aim of this study was to examine the change in attitudes and satisfaction level of North Korean defectors in South Korea over a 3 year period (2001-2004). METHODS: In our first study in 2001, a total of 200 defectors were interviewed. In the follow up study after 3 years, 151 defectors were re-interviewed by an in-person interview. RESULTS: The level of satisfaction to the governmental support policy to defectors decreased significantly. However, the general level of satisfaction increased slightly (from 3.52 to 3.56 ; 5-score scale). This shows that North Korean defectors are stably adapting to South Korean society. The level of satisfaction significantly correlated with the defectors' confusion of the different value systems, the defectors' understanding of the South Korean people, satisfaction with their physical and mental health, and the prejudice of South Korean people to defectors. In terms of the attitudes, the type of schooling, the military service and the communist party membership in North Korea were not related to the change in attitude. However, there was a significant correlation with gender and age. Women showed a greater change in attitude compared to men. Older people had difficulty in understanding the South Korean people, but they showed little psychological affiliation to North Korea. Moreover, they showed a high level of satisfaction with the economic situation in South Korea and had an optimistic viewpoint for their future than younger people. Even though many defectors attended churches, religion was not associated with the level of satisfaction or their change in attitude. CONCLUSION: The factors that influence the level of satisfaction and attitudes of North Korean defectors have changed over 3 years. Therefore, the government, nongovernmental organizations (NGOs) associated with defectors and the churches need to be more sensitive to these changes and make plans to support the adaptation of defectors to South Korean society.

Cognitive and Group Treatment of Internet Addiction in Adolescents

A review of the literature and the authors' recent researches on the treatment of internet addiction among adolescents based on a cognitive behavioral approach suggest that most severely addicted adolescents have various co-morbid psychiatric problems and that the cognitive behavioral approach in a group setting is effective in the improvement of not only addictive behavior but also emotional and general behavioral problems including insight, depression, anxiety, and impulsiveness. Adolescents with internet addiction, especially who are severely affected, need a comprehensive psychiatric treatment of co-morbid problems and other behavioral problems.

Expression of Cyclooxygenase-2 and p53 Protein in Colonic Adenoma with Malignant Change / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of this study was to investigate the value of expression of COX-2 and p53 protein in colonic adenoma with or without malignant change. METHODS: We studied twenty-five cases of colonic adenoma with malignant change and twenty-five cases of colonic adenoma without malignant change treated by colonoscopic polypectomy in Chungnam National University Hospital from January, 1999 to July, 2002. We compared the expression of COX-2 and p53 protein by immunohistochemical stain in both group. RESULTS: In immunohistochemical staining, the expression of COX-2 was demonstrated 68.0% (17 of 25) of colonic adenoma with malignant change and not different with that of colonic adenoma without malignant change. The overexpression of p53 protein was detected immunohistochemically in 88.0% (22 of 25) of colonic adenoma with malignant change and 32% (8 of 25) of colonic adenoma only (p <0.05). CONCLUSIONS: The degree of COX-2 expression was similar in colonic adenoma and colonic adenoma with malignant change, but the expression of p53 in colonic adenoma with malignant change was significantly higher (p <0.05). These results suggest COX-2 might operate on early step of adenoma-carcinoma sequence. Also these results remind us that mutation of p53 gene operates on the late step of adenoma-carcinoma sequence.

Clinical Significance of Transiently Elevated Serum AFP Level in Developing Hepatocellular Carcinoma in HBsAg Positive-Liver Cirrhosis / 대한소화기학회지

BACKGROUND/AIMS: Serum alpha fetoprotein (alpha-FP) measurement has a limitation to detect hepatocellular carcinoma (HCC) because it is elevated in various liver diseases. Therefore, we studied the sensitivity and specificity of high alpha-FP in the diagnosis of HCC. METHODS: We studied 253 patients with HBsAg positive liver cirrhosis prospectively. We analyzed incidence of HCC related cut-off values of serum alpha-FP levels. During the follow-up period, we analyzed sensitivity and specificity of cut-off values of alpha-FP for the diagnosis of HCC, and alpha-FP elevation rate in relation to mass size. RESULTS: One hundred and twenty-five patients had a transient elevation of alpha-FP levels above 20 ng/mL. The corresponding incidences of HCC were 27.2% (34/125) and 15.6% (20/128 patients without elevation of alpha-FP), respectively with a statistically significant difference (p=0.03). Among 54 patients with HCC, 18 patients (33.0%) had levels of alpha-FP below 20 ng/mL on the time of diagnosis of HCC. When we defined cut-off values of serum alpha-FP as 20, 100 and 500 ng/mL, the corresponding sensitivity and specificity for HCC were 62.9% and 24.0%, 7.4% and 54.2%, 77.3% and 91.9%, respectively. We studied sensitivity according to cut-off values of alpha-FP defined as 20, 100, 200, 500 ng/mL in patients with small HCC below 2 cm. The corresponding sensitivity were 50.0%, 43.7%, 25.0%, 18.7%, respectively. In patients with levels of serum alpha-FP below 20 ng/mL, percentages of mass size less than 2 cm, 2~3 cm, 3~5 cm and more than 5 cm were 50.0%, 25.0%, 28.5% and 25.0%, respectively. CONCLUSIONS: We suggested that in order to detect HCC, careful periodic monitoring with alpha-FP, ultrasonography and abdominal computed tomography is needed in patients with HBsAg positive liver cirrhosis and whose serum level of alpha-FP is above 20 ng/mL.

Acute Appendicitis in Pregnant Patients and Non-Pregnant Patients: Recent Clinical Experience of the Tertiary Hospital

PURPOSE: Acute appendicitis is one of the most common surgical problems in pregnancy requiring emergency surgical intervention. To evaluate the clinical characteristics of surgical emergency in pregnancy, we conducted this study. METHODS: A clinical and pathologic retrospective review was conducted of 42 pregnant and 87 non-pregnant patients who underwent appedectomy with preoperative diagnosis of acute appendicitis at Chonnam National University Hospital from January, to December, 2000. RESULTS: Thirty-four (81.0%) of the 42 pregnant patients and 75(86.0%) of the 87 non-pregnant patients had pathologically proven acute appendicitis. Among the 34 cases of acute appendicitis in pregnant patients, the gestational stage at presentation was first trimester in 5 (14.7%), second trimester in 23 (67.6%), and third trimester in 6 patients (17.7%). Two instances of combined Caesarian section and 6 of preterm labor or abortion were associated with surgery. Mean leukocyte count was 13,344/mm3 in the pregnant patients and 12,469/mm3 in the non-pregnant patients. Operation time from symptom presentation was 1.90 days in the pregnant patients and 2.70 days in non-pregnant patients. There were some differences between the two groups. Perforation occurred in 4 (11.8%) of the pregnant patients and 13 (17.8%) of the non-pregnant patients. Postoperative wound infection occurred in 9 (26.5%) of the pregnant patients and 11 (14.7%) of the non-pregnant patients. CONCLUSION: We concluded that there were more difficulties in the diagnosis of acute appendicitis during pregnancy, and that there were no significant differences in clinical findings except for the location of tenderness. Acute appendicitis in pregnancy was associated with fetal morbidity and more rapid progress. In acute abdomen pregnancy, early suspicion and prompt intervention may prevent maternal and fetal complications.

Examination of Endoscopic Mucosal Resection as a Curative Treatment of Early Gastric Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) has been accepted as a treatment option for cases of early gastric cancer (EGC) where the probability of lymph node metastasis is low. The purpose of this study was to define the indication and limitation of EMR of EGC. METHODS: We studied thirty-five cases of EGC treated by EMR in Chungnam National University Hospital from January, 1999 to July, 2001. RESULTS: The rate of complete resection on EGC was 94.3% (33/35). The size affected the curability; 94.4% (17/18) of lesions less than 10 mm, 93.3% (14/15) of lesions 11 to 20 mm and 100% (2/2) of those larger than 20 mm were resected completely. The depth of cancer invasion also affected the curability; 100% of lesion was confined to mucosa while 71.4% of those invaded submucosa. Of the thirty-three lesions which were completely resected, twenty-seven lesions had no recurrences during the follow-up period, four lesions were residual cancers and two developed local recurrences. CONCLUSIONS: In curative treatement for EGC with EMR, although follow-up period was short there is a possibility that indications for EMR could extend to the elevated lesion which is larger than 20 mm and to the superficial submucosal (sm1) cancer.

Differentiation of Parathyroid and Thyroid Nodule by Tc-99m Sestamibi Scintigraphy / 대한내분비외과학회지

PURPOSE: Differentiation of parathyroid and thyroid nodule is often difficult even with aids of ultrasonography and computed tomography. Tc-9m sestamibi (MIBI) scintigraphy is useful in the detection of hyperfuntioning parathyroid nodules. However, its role in the differentiation between parathyroid and thyroid nodules including malignancies is not well studied. Therefore, the purpose of this study is to evlauate the role of Tc-99m MIBI imaing in the differentiation of parathyroid adenoma from thyroid malignancy. METHODS: Six patients (4 women, 2 men, mean age 43 years) with parathyroid adenoma and 4 patients (2 women, 2 men, mean age 56 years) with thyroid papillary cancer were enrolled. Ten and 180 minutes after injection of 740 MBq Tc-99m MIBI, pinhole image of the anterior neck was obtained. Nodule-to-thyroid ratio (N:T) was measured from same sized region of interests over nodule and normal thyroid bed. Retention Index (RI) was calculated as N:T 10 minus N:T 180 divided by N:T 10. RESULTS: as those with thyroid cancer (1.09 ± 0.35, 1.24 ± 0.36, respectively, P>0.05 ). However, RI of parathyroid patients was higher than thyroid cancer patients (0.64 ± 0.29, -0.12 ± 0.20, respectively, P<0.05). CONCLUSION: Parathyroid adenoma showed higher retention rate of Tc-99m MIBI than thyroid cancer. Therefore, differntiation of parathyroid and thyroid nodule could be possible using Tc-99m MIBI scintigraphy.

Examination of Endoscopic Mucosal Resection of Early Gastric Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: The endoscopic mucosal resection has now been adopted for a useful modality in both curative therapy and accurate diagnosis of early gastric cancer. A retrospective study was done to evaluate the indication and the limitation of endoscopic mucosal resection of early gastric cancer. METHODS: We studied 20 cases of early gastric cancer treated by endoscopic mucosal resection in Chungnam National University Hospital from November, 1995 to July, 1997. RESULTS: 1) The size affected the curability: 83. 3% of lesions less than 2 cm and 50. 0% of those larger than 2 cm were resected completely. 2) The depth of cancer invasion affected the curability: 87. 5% of lesion confined to mucosa were resected completely, while all of submucosal cancers were resected incompletely. 3) Among fourteen cases resected completely, three cases of lesions larger than 2 cm were residual cancer and two of those less than 2 cm were recurred locally. CONCLUSIONS: To be a curative therapy by endoscopic mucosal resection of early gastric cancer, we think that careful selection of the lesion, that is lesion less than 2cm and confined to mucosa, is necessary

Clinical Study of the Acute Hepatitis due to Salmonella typhi / 대한간학회지

BACKGROUND/AIM: It is not easy to differentiate Salmonella from acute viral hepatitis (AVH), especially in the case of jaundice. Therefore we analyzed the differences between Salmonella hepatitis and AVH-B. METHOD: Our study was performed retrospectively on 11 patients with acute hepatitis who had positive blood culture for Salmonella typhi and 11 patients with AVH-B as controls. RESULT: The greater proportion of patients with Salmonella experienced fever, headache, diarrhea, relative bradycardia and hepatomegaly in contrast to the patients with AVH-B (p<0.05). But jaundice was detected more frequently in patients with AVH-B. The laboratory findings that were noted more in Salmonella patients than AVH-B patients were: left shift of leukocyte, anemia, thrombocytopenia, hypoproteinemia, hypoalbuminemia, lower peak levels of aminotransferase and total bilirubin, a trend toward a higher peak level of serum LDH and lower ratio of ALT/LDH expressed as a multiple of the upper limit of normal level on admission (p<0.05). Acute cholecystitis was complicated in 2 patients with Salmonella. One was resolved by cholecystostomy and the other had surgical intervention. The other 9 patients recovered with appropriate administration of antibiotics. CONCLUSION: The clues that raise the possibility of Salmonella over AVH-B include: high fever, headache, diarrhea, relative bradycardia, hepatmegaly, left shift of leukocyte, anemia, thrombocytopenia, hypoproteinemia, hypoalbuminemia, a markedly elevated serum level of LDH and lower ALT/LDH ratio (less than 4) on admission. Of these, ALT/LDH ratio is the best discriminator between Salmonella and AVH-B. Early diagnosis and appropriate administration of antibiotics are necessary for the successful treatment of Salmonella.