Renal Epithelioid Angiomyolipoma with Epithelial Cysts Mimicking Cystic Renal Cell Carcinoma: A Case Report of Combination of Two Rare Entities.

Renal angiomyolipomas (AMLs) are typically solid tumors, but there have been few reports of a rare cystic variant of AML. AML with epithelial cysts, where the epithelial cyst has a cuboidal epithelial lining, account for the majority of them. Next, epithelioid AML (EAML) with cystic changes due to hemorrhage and necrosis, which is composed of epithelioid cells with abundant eosinophilic cytoplasm, have also been reported. These rare cystic types of AML can be mistaken for other cystic tumors, such as cystic renal cell carcinoma, in preoperative imaging. We report the imaging findings of a rare case of EAML with epithelial cysts.

Factors associated with clinical and structural outcomes after arthroscopic rotator cuff repair with a suture bridge technique in medium, large, and massive tears.

BACKGROUND: This study was conducted to evaluate clinical outcomes, maintenance of repair integrity, and retear rate after arthroscopic rotator cuff repair by a suture bridge technique among patients with medium, large, and massive rotator cuff tears. METHODS: We evaluated 147 patients who had undergone arthroscopic rotator cuff repair. Clinical and functional evaluations were performed with the Constant and University of California-Los Angeles scores. All patients were confirmed to have magnetic resonance imaging evidence of tendon healing at least 12 months postoperatively. RESULTS: The average postoperative time to follow-up magnetic resonance imaging was 23.4 months (range, 12-48 months). A total of 25 (17.0%) retears were observed. All clinical outcome scores were improved significantly at follow-up. Larger intraoperative tear sizes were correlated with higher retear rates. The incidence of retear was also higher in cases in which the preoperative fatty degeneration grade was higher. The incidence of retear increased with age and in the heavy worker group (e.g., farmers, carriers, car mechanics) but was not statistically significant. CONCLUSIONS: Arthroscopic rotator cuff repair by a suture bridge technique yields improvements in clinical outcome measures and a relatively high degree of patient satisfaction despite the fact that repair integrity is not maintained in many cases.

Usefulness of contrast enhanced FLAIR imaging for predicting the severity of meningitis.

The aim of this study was to evaluate whether contrast enhanced fluid attenuated inversion recovery (CE-FLAIR) imaging can be used to predict the severity of meningitis based on leptomeningeal enhancement (LE) score and cerebrospinal fluid signal intensity (CSF-SI) on CE-FLAIR. We retrospectively analyzed data collected from 43 consecutive patients admitted to our hospital due to meningitis. Clinical factors including initial Glasgow Coma Scale (GCS) score, CSF glucose ratio, log CSF protein, log CSF WBC, and prognosis were evaluated. The LE score was semi-quantitatively scored, and we evaluated CSF-SI ratio at the interpeduncular or quadrigerminal cisterns on CE-FLAIR. We evaluated the differences in clinical variables, LE scores and CSF-SI ratios between the recovery and the complication group. We assessed the correlation between clinical variables, LE scores and CSF-SI ratios. The values of log CSF protein, CSF-SI ratio, and LE score were significantly higher in the complication group (p value <0.05). GCS score and CSF glucose ratio were significantly lower in the complication group (p value <0.01). The LE scores had significant negative correlation with GCS scores and CSF glucose ratios (p value <0.001). The LE score was significantly positively correlated with the value of log CSF protein and CSF-SI ratio (p value <0.01). The CSF-SI ratio was negatively correlated with GCS score and CSF glucose ratio (p value <0.01). The CSF-SI ratio was positively correlated with the value of log CSF protein (p value <0.05). Our results suggest that LE score and CSF-SI ratio are well correlated with clinical prognostic factors. We may predict the clinical severity of meningitis by using LE scores and CSF-SI ration on CE-FLAIR imaging.

Acute invasive small-bowel Anisakiasis: clinical and CT findings in 19 patients.

PURPOSE: To evaluate the clinical and CT findings in patients with small-bowel Anisakiasis. MATERIALS AND METHODS: Nineteen patients with small-bowel Anisakiasis and who underwent abdominal CT between 2005 and 2012 were enrolled in our study. All of these patients were diagnosed using either a serologic test for Anisakiasis (n = 18) or by pathology (n = 1). Their medical records were reviewed in order to determine the clinical findings. CT images were retrospectively reviewed by two radiologists to evaluate the characteristics of the involved bowel wall and the ancillary findings. RESULTS: All patients had presented with the acute onset of severe abdominal pain as well as a history of having recently eaten raw fish. The mean time interval from eating the fish to the onset of abdominal pain was 1.7 days. Eighteen patients were treated conservatively and experienced resolution of their symptoms within seven days of hospitalization. One patient underwent surgical exploration for presumed small-bowel ischemia. The sites of involvement included the ileum (16/19, 84%) and jejunum (3/19, 16%). All patients had circumferential bowel-wall thickening (mean, 0.8 cm) with an intermediate length of involved bowel (mean, 7.9 cm). Small-bowel obstruction occurred in 16 patients (84%). The target sign was present in 17 patients (89%), ascites, particularly in the perilesional area, in 16 patients (84%), and mesenteric edema in 15 patients (79%). CONCLUSION: Small-bowel Anisakiasis should be considered in the differential diagnosis of acute abdomen in order to avoid unnecessary surgery when patients present with abdominal pain after having recently eaten raw fish, concentric bowel-wall thickening with the target sign in the ileum, perilesional ascites, as well as bowel obstruction seen on CT.

[Teaching medical humanities through an illness narrative].

There has been growing interest regarding the 'medical humanities' in most medical schools in Korea. Medical humanities is an interdisciplinary field of humanities, social science, and the arts that aims to have a critical or supplementary role in medical education and practice. Thus, diverse educational methods should be applied to achieve the goals of medical humanities. The illness narrative is one of the most powerful tools in this context. An illness narrative is a patient's story about his illness, including the meaning of the illness in his life. The illness narrative is widely accepted as an effective educational tool in medical humanities. But, in Korea, there has been concern about the nature, theoretical background, and usefulness of the illness narrative. Medical students and doctors can obtain empathy and clinical wisdom through telling, hearing, reading, and writing illness narratives. In this article, I will examine the nature and meaning of illness narratives in teaching medical humanities and discuss several examples of narrative training programs.

Low-dose and standard-dose unenhanced helical computed tomography for the assessment of acute renal colic: prospective comparative study.

PURPOSE: To compare the efficacy of low-dose and standard-dose computed tomography (CT) for the diagnosis of ureteral stones. MATERIAL AND METHODS: Unenhanced helical CT was performed with both a standard dose (260 mAs, pitch 1.5) and a low dose (50 mAs, pitch 1.5) in 121 patients suspected of having acute renal colic. The two studies were prospectively and independently interpreted for the presence and location of ureteral stones, abnormalities unrelated to stone disease, identification of secondary signs, i.e. hydronephrosis and perinephric stranding, and tissue rim sign. The standard-dose CT images were interpreted by one reviewer and the low-dose CT images independently by two reviewers unaware of the standard-dose CT findings. The findings of the standard and low-dose CT scans were compared with the exact McNemar test. Interobserver agreements were assessed with kappa analysis. The effective radiation doses resulting from two different protocols were calculated by means of commercially available software to which the Monte-Carlo phantom model was given. RESULTS: The sensitivity, specificity, and accuracy of standard-dose CT for detecting ureteral stones were 99%, 93%, and 98%, respectively, whereas for the two reviewers the sensitivity of low-dose CT was 93% and 95%, specificity 86%, and accuracy 92% and 94%. We found no significant differences between standard-dose and low-dose CT in the sensitivity and specificity for diagnosing ureter stones (P >0.05 for both). However, the sensitivity of low-dose CT for detection of 19 stones less than or equal to 2 mm in diameter was 79% and 68%, respectively, for the two reviewers. Low-dose CT was comparable to standard-dose CT in visualizing hydronephrosis and the tissue rim sign. Perinephric stranding was far less clear on low-dose CT. Low-dose CT had the same diagnostic performance as standard-dose CT in diagnosing alternative diseases. Interobserver agreement between the two low-dose CT reviewers in the diagnosis of ureter stones and alternative diseases, the identification of secondary signs, and tissue rim sign were high, with kappa values ranging from 0.769 to 0.968. On standard-dose CT scans, the calculated mean effective radiation dose was 7.30 mSv for males and 10.00 mSv for females. On low-dose CT scans, the calculated mean effective radiation dose was 1.40 mSv for males and 1.97 mSv for females. CONCLUSION: Compared with standard scans using 260 mAs, low-dose unenhanced helical CT using a reduced tube current of 50 mAs results in a concomitant decrease in the radiation dose of 81%. Although low-dose CT was limited in its ability to depict small-sized calculi less than or equal to 2 mm, it is still comparable to standard-dose CT for the diagnosis of ureter stones and alternative disease.

Perforated ileal duplication cyst with haemorrhagic pseudocyst formation.

Duplication cysts of the gastrointestinal tract are rare congenital abnormalities. Ectopic gastric mucosa, which can be found in duplications, may cause peptic ulceration, gastrointestinal bleeding or perforation. We report a 1-year-old boy with a perforated ileal duplication cyst with haemorrhagic pseudocyst formation caused by peptic ulceration of the duplication cyst. It presented a snowman-like appearance consisting of a small, thick-walled, true enteric cyst and a large, thin-walled haemorrhagic pseudocyst on US and CT. It is an unusual manifestation of a duplication cyst, which has not been reported in the English language literature.

[A study of treatise on medicine by King Sejo].

This paper explores historical backgrounds and contents of Treatise on Medicine written by King Sejo (r. 1455-1468) including his views on traditional medicine and pharmacy in the early Chosen period. The Treatise declared by King Sejo in 1463 has been considered as an important and unique manual of medicine because it was the exclusive example written by the king of Chosen. It was the King Sejo' s era when the medical milieu in both social and medical aspects was highly encouraged thanks to the previous achievements by King Sejong the Great (r.1418-1450). King Sejo, in particular, who was much interested in practical learning called 'Miscellaneous Studies', emphasized on court medicine. His writing can be understood in such historical frame. Another reason why he wrote the Treatise can be said that he felt necessary for establishing the medical ethic codes for inefficient court medicine-officials. In personal background, he tried to find available remedies since he had been suffered from some chronic diseases. The contents of the Treatise can be broadly fallen to the clinical and ethical aspects. In the former one, the Treatise focuses on treatment without hesitation through the sharp and exact diagnosis by medical doctors. In the latter one, eight categories of medical doctors are discussed according to their moral degrees: sim'eui, sik'eui, yak'eui, hon'eui, kwang eui, mang'eui, sa'eui, and sal'eui. Finally, musim' ji-eui was supplemented. Among them, sal'eui, medicine-official lacking both medical ability and ethical attitude, was classified as the lowest degree; sim'eui, medicine-official sincerely making his all efforts for patients, was thought to be a paragon of medical morality. In conclusion, the Treatise on Medicine by King Sejo played an important role as a manual for the principle of medical practice and for the instruction to enhance ethical attitude among medicine-officials.