• 제목/요약/키워드: Clinical Manifestation

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Clinical, Radiologic, and Endoscopic Manifestations of Small Bowel Malignancies: a First Report from Thailand

  • Tangkittikasem, Natthakan;Boonyaarunnate, Thiraphon;Aswakul, Pitulak;Kachintorn, Udom;Prachayakul, Varayu
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권18호
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    • pp.8613-8618
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    • 2016
  • Background: The symptoms of small bowel malignancies are mild and frequently nonspecific, thus patients are often not diagnosed until the disease is at an advanced stage. Moreover, the lack of sufficient studies and available data on small bowel cancer makes diagnosis difficult, further delaying proper treatment for these patients. In fact, only a small number of published studies exist, and there are no studies specific to Thailand. Radiologic and endoscopic studies and findings may allow physicians to better understand the disease, leading to earlier diagnosis and improved patient outcomes. Objective: To retrospectively analyze the clinical, radiologic, and endoscopic characteristics of small bowel cancer patients in Thailand's Siriraj Hospital. Materials and Methods: This retrospective analysis included 185 adult patients (97 men, 88 women; mean age = $57.6{\pm}14.9$) with pathologically confirmed small bowel cancer diagnosed between January 2006 and December 2013. Clinical, radiologic, and endoscopic findings were collected and compared between each subtype of small bowel cancer. Results: Of the 185 patients analyzed, gastrointestinal stromal tumor (GIST) was the most common diagnosis (39.5%, n=73). Adenocarcinoma was the second most common (25.9%, n = 48), while lymphoma and all other types were identified in 24.3% (n = 45) and 10.3% (n = 19) of cases, respectively. The most common symptoms were weight loss (43.2%), abdominal pain (38.4%), and upper gastrointestinal bleeding (23.8%). Conclusions: Based on radiology and endoscopy, this study revealed upper gastrointestinal bleeding, an intra-abdominal mass, and a sub-epithelial mass as common symptoms of GIST. Obstruction and ulcerating/circumferential masses were findicative of adenocarcinoma, as revealed by radiology and endoscopy, respectively. Finally, no specific symptoms were related to lymphoma.

Cystic Fibrosis: Clinical Phenotypes in Children and Adolescents

  • dos Santos, Ana Luiza Melo;de Melo Santos, Helen;Nogueira, Marina Bettiol;Tavora, Hugo Tadashi Oshiro;da Cunha, Maria de Lourdes Jaborandy Paim;de Melo Seixas, Renata Belem Pessoa;Monte, Luciana de Freitas Velloso;de Carvalho, Elisa
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • 제21권4호
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    • pp.306-314
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    • 2018
  • Purpose: The objective of this study was to describe the clinical phenotypes of children and adolescents with cystic fibrosis (CF); and to assess the role of pancreatic insufficiency and neonatal screening in diagnosis. Methods: A cross-sectional study was conducted, which included 77 patients attending a reference center of CF between 2014 and 2016. Epidemiological data, anthropometric measurements, and the presence of pulmonary, pancreatic, gastrointestinal and hepatobiliary manifestations were evaluated based on clinical data and complementary examinations. Results: Of the 77 patients, 51.9% were male, with a median age of 147 months (7.0-297.0 months), and the majority showed adequate nutritional status. The most common phenotype was pulmonary (92.2%), followed by pancreatic (87.0%), with pancreatic insufficiency in most cases. Gastrointestinal manifestation occurred in 46.8%, with constipation being the more common factor. Hepatobiliary disease occurred in 62.3% of patients. The group with pancreatic insufficiency was diagnosed earlier (5.0 months) when compared to the group with sufficiency (84.0 months) (p=0.01). The age of diagnosis was reduced following implementation of neonatal screening protocols for CF (6.0 months before vs. 3.0 months after, p=0.02). Conclusion: The pulmonary phenotype was the most common, although extrapulmonary manifestations were frequent and clinically relevant, and should mandate early detection and treatment. Neonatal screening for CF led to earlier diagnosis in patients with pancreatic failure, and therefore, should be adopted universally.

말초신경에 생긴 다발성 신경초종 - 증례 보고 3예 - (Multiple Schwannomas in the Peripheral Nerve - 3 Cases Report -)

  • 강호정;이대영;윤홍기;한수봉;박찬일;양석우
    • 대한골관절종양학회지
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    • 제11권1호
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    • pp.105-109
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    • 2005
  • 제 2형 신경섬유종증(Neurofibromatosis)의 임상적 특징 없이 말초에 발생한 티넬징후를 보이는 다발성신경초종(Schwannomatosis) 3례를 경험하여 이를 보고하고자 한다. 주증상은 동통이었으며 3예에서 청장년에서 발생하였다. 발생부위는 상완신경총, 슬와부 그리고 수부였다. 상기 환자 모두에서 이명과 현훈 및 시력저하소견 관찰되지 않았으며 가족력은 없었다. 3예에서 모두에서 두부 자기공명영상 촬영상 전정신경초종(Vestibular schwannoma)이 관찰되지 않았다. 병리소견상 신경초종이 확인되었다. 앞으로 더 많은 증례의 수집과 연구로 다발성 신경초종의 임상양상, 임상경과 그리고 유전학적 특징에 대한 추가적인 연구가 필요할 것으로 사료된다.

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한국 보병에서 발생한 중족골 행군골절 양상의 예비적 보고 (Preliminary report of March Fractures in Infantry Soldiers of Korea - About 15 (19cases) march fracture patients -)

  • 배영재;윤성일
    • 대한족부족관절학회지
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    • 제2권2호
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    • pp.57-63
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    • 1998
  • Stress or march fractures among military personnel, especially recruits, has been appreciated for many years. According to the classical references, the second metatarsal was one of the first sites identified as a focus for march fractures and radiological evidence of fracture appeared as late as several weeks. The purpose of this study was to document the clinical feature of march fractures in Korean infantry soldiers. From 1997 to 1998, at one infantry medical company of OO infantry corps in Korea, 15 (19cases) patients with march fracture were detected among infantry soldiers. There were some different finding in the fracture site and its clinical features from the previous foreign reports. 1. There were pain and local swelling in all cases as clinical manifestation. By physical examination, direct point tenderness on the location of the fractured metatarsal shaft was characteristic. 2. On roentgenographic examination, cortical fissuring or break was seen one week after onset of symptoms and external callus was seen from two weeks or at the least four weeks. Oblique view was more useful than AP view in the diagnosis of march fractures. 3. The third metatarsal was the most frequently involved site(7 cases, 48%). and the second metatarsal was Jess frequent(3 cases, 20%). This difference of frequent site with previous reports might be attributed to the relatively long shaft of the third metatarsal, but should be analyzed in further study. 4. The incidence of the development of march fracture was 1 per 104 infantry soldiers.

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한국인에서의 사이트린 결핍증의 경험 (Korean Experiences of Citrin Deficiency: Seven cases of citrin deficiency and nine major mutation screening in newborns in Korea)

  • 김주현;김구환;유한욱
    • 대한유전성대사질환학회지
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    • 제6권1호
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    • pp.96-107
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    • 2006
  • Citrin deficiency resulting from mutations of SLC25A13is associated with two major clinical phenotypes; neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) and adult-onset type 2 citrullinemia (CTLN2). In Korea, 7 cases of citrin deficiency have been diagnosed based on biochemical and molecular findings. Four NICCD cases were identified by newborn screening using MS/MS or presenting symptoms like cholestatic jaundice. They are all males, presenting with conjugated hyperbilirubinemia, elevated liver enzymes, hypoalbuminemia, mild hyperammonemia, elevated citrullin, methionine and threonine. All of them have been spontaneously recovered from hepatic manifestation by the age of 6-8 months. Mutation analysis has been performed using their genomic & cDNAs obtained from skin fibroblasts. They turned out to be compound heterozygotes carrying each of 851del4, IVS11+1G>A, and IVS13+1G>A. Three CTLN2 patients were identified. Two adult male patients presented with a sudden loss of consciousness, seizure, vomiting, hyperammonemia and citrullinemia in their twenties. They carried an IVS13+1G>A, 851del4, and IVS11+1G>A mutant alleles. The other CTLN2 patient was 52 year old female patient, manifesting lethargy, altered consciousness, irritability and hyperammonemia. Similar clinical symptoms had recurred at the delivery of first and second babies in her past medical history. She was managed by hemodialysis and survived with neurological sequellae. Also, we screened the presence of 9 common mutations in 500 Korean newborns using dried blood spot of filter papers. Only a allele carried 854del4 mutation. In conclusion, the entire picture of citrin deficiency in Korea including incidence, genotype, clinical features and natural courses, is still vague at the present time.

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이하선 종양의 임상적 연구 (THE CLINICAL STUDY ON PAROTID GLAND TUMOR)

  • 신상훈;허준;김기현;정인교
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제26권1호
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    • pp.80-84
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    • 2000
  • Tumors of the parotid gland are the most frequently encountered salivary gland tumors. Knowledge of the histology and anatomy of the salivary gland is important when considering the histiogenesis of salivary gland tumors, requiring close cooperation between the pathologist and the surgeon. Most tumors are benign epithelial formations. Pleomorphic adenomas predominate. Superficial lobectomy is adequate treatment. When the tumor involves a deep lobe, total parotidectomy is indicated. Treatment of malignant tumors depends on the histology, its TNM stage and other factors. Total parotidectomy with lymph adectomy and radiotherapy are needed in case of high grade malignancy. In children, vascular neoplasias are the most frequent, followed by malignant tumors. Their histological features and treatment are the same as for adults. We reviewed 64 cases of the parotid tumors at Department of surgery, Dong-A University Hospital from July. 1990 to Jan. 1999 for the purpose of apprehension of parotid gland tumor by the clinical study and review. Over all sex ratio was 1:1.13(M:F), mean age was 38.9 years, mean size was 3.53cm. According to histologic findings of 64 cases, pleomorphic adenoma was 55(85.9%), Warthin's tumor was 3(4.7%), mucoepidermoid carcinoma was 3(4.7%), squamous cell carcinoma was 2(3.1%), acinic cell carcinoma was 1(1,6%). Post op. facial nerve palsy 16(25%), Frey's syndrome 11(17.2%) cases were happened. Hence, the clinical manifestation of pain, tenderness, facial N. palsy suggest malignant tumors.

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식물 제제와 연관된 급성 독성 간염으로 인한 간이식 : 원인 제제와 손상 유형에 대한 후향적 분석 (Liver Transplantation for Acute Toxic Hepatitis due to Herbal Medicines and Preparations)

  • 손창환;차명일;오범진;여운형;이재호;김원;임경수
    • 대한임상독성학회지
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    • 제6권2호
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    • pp.110-116
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    • 2008
  • Purpose: Acute toxic hepatitis is a common cause of acute liver failure (ALF). We investigated the causes, clinical manifestation, and outcomes of ALF patients who underwent liver transplantation due to acute toxic hepatitis caused by herbal medicines and preparations. Methods: Between January 1992 and May 2008, we retrospectively reviewed the medical records of 24 patients who were transplanted due to acute toxic hepatitis caused by herbal medicines and preparations. We applied the RUCAM score to patients with acute toxic hepatitis and assessed the relationship between herbal preparations and liver injury. We studied the patients' medication history, liver function tests, and clinical outcomes. Results: The type of liver injury was divided into three groups: hepatocellular type, 14 patients (58.3%); cholestatic type, 4 patients (16.7%); and mixed type, 6 patients (25%). Polygonum multiflorum Thunberg (3 cases) was the most common cause of acute toxic hepatitis, followed by Acanthopanax senticosus (2 cases), pumpkin juice (2 cases), Dictamnus dasycarpus Turcz (2 cases), Hovenia dulcis (1 case), Phellinus linteus (1 case), and Artemisia capillaries (1 case). One year survival after liver transplantation was 76%. Conclusion: We identified the herbal preparations leading to acute liver failure. Many patients consider herbal remedies to be completely free of unwanted side effects. However, we found that many herbal products have biological activities that can lead to severe hepatotoxicity.

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The Retrospective Study of Advanced Cancer Patients Receiving Integrative Cancer Treatments in single Comprehensive and Integrative Medicine Hospital

  • Jeonghyun Joo;Songha Chon;Kicheul Sohn;Sanghun Lee
    • 대한한의학회지
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    • 제43권3호
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    • pp.16-26
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    • 2022
  • Objectives: Traditional Korean medicine (TKM) has been supplied as part of a national health care system in South Korea under a dual medical system, however it has been difficult to mix western medicine and TKM medical practices in existing hospitals. For the objective of innovative integration between them, Comprehensive and Integrative Medicine Hospital were founded in Daegu, South Korea. Here, we discussed the clinical outcomes of cancer patients who received integrative cancer treatment (ICT). Methods: A total of 678 patients previously diagnosed with cancer were retrospectively checked in our institution for 2 years. After applying inclusion/exclusion criteria, 573 patients were eligible for the final analysis. The overall survival (OS) of these patients in the aftercare period were determined. We looked at how clinical factors and treatments including chemotherapy, complementary and alternative medicine (CAM), and TKM affected the OS. Results: At the first visit, 212 subjects had no evidence of disease after tumor resection and 355 ones with advanced cancer, who receiving ICT including chemotherapy, CAM, and TKM showed better OS compared to the CAM including TKM or the best supportive care (median OS = 216, 78, and 46 days, respectively). The median OS was not reached in TKM only, even though the sample size was small (N=12). Even after adjusting for clinical factors associated to liver, renal, and hematologic manifestation, ICT still remained significant. Conclusions: We demonstrated that ICT might be beneficial for advanced cancer regardless of the performance status, liver and renal function, since it positively affected the OS.

무릎 밑 동맥의 혈관 내 치료의 최신 지견 (Current Strategy in Endovascular Management for Below-the-Knee Arterial Lesions)

  • 황교수;박상우
    • 대한영상의학회지
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    • 제82권3호
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    • pp.541-550
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    • 2021
  • 발을 향해 가는 혈류의 중요한 길목인 무릎 밑 동맥은 다리 혈관 중 가장 가늘며, 협착 등의 병변이 발생하거나 폐쇄가 발생하게 되면 중증하지허혈을 유발할 수 있다. 중증하지허혈이란 말초동맥 질환의 가장 심한 임상 양상 중 하나로서 휴지기 동통, 족부궤양 또는 괴저의 형태로 나타난다. 일반적으로 동맥경화 질환의 진행은 미만성으로 나타나며 대다수의 환자에서 무릎 밑 동맥을 침범한다. 치료의 목표는 동맥혈류 재개통과 사지구제이다. 기술적으로 가능한 경우, 그리고 환자가 걷지 못하는 상태가 아니라면 중증하지허혈이 있는 환자는 혈관의 재개통이 즉시 이루어져야 한다. 따라서 혈관 내 치료는 무릎 밑 동맥을 포함한 모든 환자의 표준 치료가 될 것이며, 혈관재건술을 시행하는 외과의의 임상적 역할은 줄어들 것이다.

위장관 출혈의 영상의학적 진단법 (Radiologic Diagnosis of Gastrointestinal Bleeding)

  • 김세형
    • 대한영상의학회지
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    • 제84권3호
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    • pp.520-535
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    • 2023
  • 위장관 출혈은 단일 질환이 아니라 광범위한 위장 질환의 증상 및 임상적 발현이다. 임상적 양상에 따라 명백한 출혈, 잠재 출혈, 원인 불명 출혈로 나눌 수 있으며, 출혈 위치에 따라 Treiz 인대를 기준으로 상부 또는 하부 위장관 출혈로 분류할 수 있다. 혈관 질환, 용종, 종양, 크론병, 이소성 췌장 및 이소성 위조직 등 다양한 질환이 위장관 출혈을 일으킬 수 있다. 명백한 출혈을 위한 영상 검사기법은 CT 혈관조영술, 고식적 혈관조영술 및 핵의학적 검사 등이 사용된다. 잠재 위장관 출혈을 평가하기 위한 영상검사로는 CT 소장조영술이 주로 사용되며, 위장관을 적절히 팽창해서 영상을 획득해야 위음성 혹은 위양성을 최소화하여 진단능을 높일 수 있다. CT 소장조영술에서 진단이 확실하지 않은 경우, Meckel scan이 보완적으로 사용될 수 있다. 원인 불명 위장관 출혈에 대한 검사는 임상 양상과 임상의 혹은 영상의학과 의사의 선호도에 따라 다양한 검사가 시행될 수 있으며, 이에 대한 추가적인 연구가 필요하다.