• Title/Summary/Keyword: Diagnosis, Differential

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Intestinal pseudo-obstruction as the initial presentation of systemic lupus erythematosus in a 13-year-old girl (장 가성 폐쇄로 진단된 전신 홍반 루푸스 1예)

  • Cho, Ky Young;Khil, Tae Young;Ahn, Hye Mi;Lee, Sun Wha;Seo, Jeong Wan
    • Clinical and Experimental Pediatrics
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    • v.51 no.6
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    • pp.655-659
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    • 2008
  • Intestinal pseudo-obstruction (IPO) is a rare and poorly understood manifestation of systemic lupus erythematosus (SLE), especially in children. The characteristic clinical feature of IPO is obstruction without an identifiable obstructive lesion. The authors a 13-year-old girl whose first symptom of SLE was IPO. The patient presented with a 3-day history of nausea, bilious vomiting, abdominal distention, and no bowel movement. Simple abdominal radiographs revealed mild dilatation with partial air-fluid levels in the small intestine. Abdominal CT and methylcellulose small bowel studies showed massive ascites, engorgement of the small mesenteric vessels, pleural effusion, and diffuse bowel wall thickening of the gastric antrum, duodenum. and jejunum. The delayed passage of contrast for 15 days after the methylcellulose small bowel studies was suggestive of decreased bowel motility. Laboratory findings were positive for ANA, anti-double-stranded DNA, anti-Smith and lymphopenia. After 10-day treatment with high-dose corticosteroids, the symptoms improved. IPO associated with SLE should be considered in the differential diagnosis for patients presenting with symptoms of intestinal obstruction. Early recognition of IPO in SLE and appropriate therapy are important for prevention of complications and unnecessary surgery. This case raises awareness among pediatricians that although rare, IPO can be the presenting symptom of SLE in children.

A Study on Clinical Findings about Vertebral Disease Diagnosed with MRI (MRI로 진단된 척추질환의 임상적 소견)

  • Kim, Ham-Gyum
    • Journal of radiological science and technology
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    • v.29 no.3
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    • pp.157-165
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    • 2006
  • In order to analyze clinical characteristics like sex- and age-based onset frequency and onset region from vertebral disease cases, this study investigated total 1,291 cases of vertebral disease that were diagnosed via magnetic resonance imaging(MRI) from January to December 2004 at B University Hospital in metropolitan area. For higher diagnostic accuracy in cases of spinal disorder diagnosed, this study analyzed findings from data reading conducted by veteran specialists in diagnostic radiology. But this study excluded uncertain lesion cases, the cases requiring differential diagnosis from other disorders and so on from subjects under analysis. This study employed superconductive 1.5 Tesla SIGNA MR/i for MRI test and basically received resulting images via FSE(fast spin echo). In particular, this study obtained T1 and T2 myelogram with regard to regional characteristics(such as cervical vertebrae, thoracic vertebrae and lumbar vertebra) and imaging characteristics for sagittal and transverse section. As a result, this study came to the following conclusions : 1. In terms of general characteristics of subjects under analysis, male group comprised 53.5% and female 46.5% out of total 1,291 subjects. 2. The regional onset frequency of spinal disorders was converged primarily on lumbar vertebra(65.5%), which was followed by cervical vertebrae(27.3%) and thoracic vertebrae(7.0%) respectively. 3. Top 10 cases with high onset frequency of spinal disorders can be listed as follows : 1) posterior bulging disc 65.8% 2) narrowing of neural foramen 23.8% 3) herniated intervertebral disc (HIVD) 22.4% 4) spinal stenosis 16.7% 5) osteochondrosis 6.4% 6) compression fracture 6.4% 7) facet joint arthropathy 6.2% 8) spondylolisthesis 6.0% 9) spinal cord tumor 3.5% 10) inter body fusion 2.6%

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Bilateral Extraocular Muscle Metastasis of Nasal Rhabdomyosarcoma Mimicking a Thyroid Associated Orbitopathy: A Case Report (갑상선 안병증으로 오인된 비강 내 횡문근육종의 양쪽 외안근 전이: 증례 보고)

  • Shin, Jin-Ho;Lee, Jeong-Hyun;Lim, Hyun-Kyung;Lee, Ha-Young;Park, Jee-Won;Baek, Hye-Jin;Choi, Young-Jun;Ahn, Jin-He;Baek, Jung-Hwan
    • Investigative Magnetic Resonance Imaging
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    • v.15 no.2
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    • pp.176-180
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    • 2011
  • Metastases to the orbit usually affect the intraorbital fat and bone than the extraocular muscles. Metastasis to the extracoular muscles commonly occurs unilaterally, and diffuse enlargement of the bilateral extraocular muscles due to metastasis is extremely rare. In this report, we will describe a case of diffuse metastasis to the bilateral extraocular muscles from nasal rhabdomyosarcoma masquerading as thyroid associated orbitopathy. We will also discuss about the MR imaging findings helpful for differential diagnosis from thyroid associated orbitopathy.

Development of Yin-Deficiency Questionnaire and Examine the Reliability and Validity (음허증 측정도구의 개발 및 신뢰도 타당도 검정)

  • Lee Sang Jae;Park Jong Bae;Lee Song Shil;Kim Kwang Ho
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.18 no.2
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    • pp.376-380
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    • 2004
  • The purpose of this study is the develop a questionnaire for measuring Yin-Deficiency and examine the reliability and validity for its' value as a barometer for evaluating Yin-Deficiency. Questionnaire was developed according to the symptoms of Yin-Deficiency suggested in the 'Standardization of diagnostic terms and requirements of Korean Medicine', With and as a reference, each symptom has been worked on to be put on the questionnaire. Visual analogue scales(VAS) was used as a barometer for measuring frequency of manifestation of symptoms. A study was performed to measure validity and reliability of the final questionnaire for analysis. reliability of YinDQ was measured by Cronbach's alpha coefficient and test-retest method. This study utilized factor analysis and clinical validity for evaluation of validity. For the purpose of decreasing the amount of data-the number of factors, and at the same time minimize the loss of information factor analysis was performed Component factors were extracted using Principal Component Analysis. This study evaluated the clinical validity for examination of difference between the normal group and the patient group. Evaluation on the's internal consistency showed strong internal consistency with value of 0.8615. reliability from test-rest with three-week interval, followed by comparisons of the correlation coefficient and mean values of each item between the two. The Spearman correlation coefficient was 0.54-0.79. By factor analyse two factors with Eigen value of greater than 2.2 were selected. Factor 1 consists of items of 'irritable fever on the five Hearts', 'flushing of the zygomatic region in the afternoon', 'tidal fever', 'night sweats', and 'dryness on the mouth or the throat'. Factor two consists of items of 'emaciation', 'dizziness', 'insomnia', 'decreased amount of urine with yellowish color', and 'constipation'. The comparison between the patient group and the normal group showed significant differences for every ten questions. The results implies that YinDQ is a barometer with sufficient reliability and validity. The questionnaire for Yin-Deficiency may not be enough to replace the specific differential diagnosis by a doctor of Oriental medicine. Nevertheless, it can be effectively utilized as an assisting method in consultation or a method of measuring the degree of Yin-Deficiency in a group.

Differential Diagnosis between Small Cell Carcinoma and Adenocarcinoma of Lung in Fine Needle Aspiration Cytology (세침흡인 세포검사에서 폐의 소세포암종과 샘암종의 감별진단)

  • Choi, Young-Hee;Koh, Jae-Soo;Park, Sun-Hoo;Kim, Min-Suk;Cho, Soo-Youn;Kim, Jung-Soon;Ha, Hwa-Jung;Lee, Seung-Sook
    • The Korean Journal of Cytopathology
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    • v.17 no.2
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    • pp.120-125
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    • 2006
  • Distinguishing small cell carcinoma from other lung malignancies is of great clinico-therapeutic significance. Small cell carcinoma is an aggressive tumor with a tendency to metastasize early. Survival time if untreated is low but this tumor is highly responsive to chemotherapy. We have occasionally experienced difficulties in differentiation between adenocarcinoma and small cell carcinoma of the lung in fine needle aspiration cytology (FNAC). The aim of this study was to investigate the possibility of distinguishing small cell carcinoma from adenocarcinoma of the lung in FNAC. We evaluated cytomorphological features of FNAC specimens from 62 small cell carcinomas and 57 adenocarcinomas from the lung that were confirmed by biopsy and/or immunohistochemistry on cell block. Cytomorphological details of the two tumors were compared. Nuclear smearing and nearly absent cytoplasm were the most distinct findings in small cell carcinoma compared to adenocarcinoma (p<0.05). Necrotic background, architecture and chromatin pattern, nuclear molding and nucleoli were significantly different (p<0.05). Nuclear size, nuclear membrane nature and nuclear size variation however were not helpful in distinguishing the two tumors. Combining several features described above, small cell carcinoma can be properly differentiated from adenocarcinoma on FNAC. FNAC is proposed as a diagnostic tool of small cell carcinoma of the lung in the case of inaccessibility to biopsy, and so may allow the proper therapeutic strategies to be determined in such cases

A Case of Glutaric Aciduria Type I with Macrocephaly (Glutaric Aciduria Type I 1례)

  • Shin, Woo Jong;Moon, Yeo Ok;Yoon, Hye Ran;Dong, Eun Sil;Ahn, Young Min
    • Clinical and Experimental Pediatrics
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    • v.46 no.3
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    • pp.295-301
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    • 2003
  • Glutaric aciduria type 1(GA1) is an autosomal recessive disorder of the lysine, hydroxylysine and tryptophan metabolism caused by the deficiency of mitochondrial glutaryl-CoA dehydrogenase. This disease is characterized by macrocephaly at birth or shortly after birth and various neurologic symptoms. Between the first weeks and the 4-5th year of life, intercurrent illness such as viral infections, gastroenteritis, or even routine immunizations can trigger acute encephalopathy, causing injury to caudate nucleus and putamen. But intellectual functions are well preserved until late in the disease course. We report a one-month-old male infant with macrocephaly and hypotonia. In brain MRI, there was frontotemporal atrophy(widening of sylvian cistern). In metabolic investigation, there were high glutarylcarnitine level in tandem mass spectrometry and high glutarate in urine organic acid analysis, GA1 was confirmed by absent glutaryl-CoA dehydrogenase activity in fibroblast culture. He was managed with lysine free milk and carnitine and riboflavin. He developed well without a metabolic crisis. If there is macrocephaly in an infant with neuroradiologic sign of frontotemporal atrophy, GA1 should have a high priority in the differential diagnosis. Because current therapy can prevent brain degeneration in more than 90% of affected infants who are treated prospectively, recognition of this disorder before the brain has been injured is essential for treatment.

Literature Review on Parkinson's Disease in Oriental Medicine (파킨슨병의 한의학적 고찰 -병인병리(病因病理)와 침구요법(鍼灸療法)을 중심으로-)

  • Park, Sang-min;Lee, Sang-hoon;Yin, Chang-shik;Kang, Mi-kyeong;Chang, Dae-il;Kang, Sung-keel;Lee, Yun-ho
    • Journal of Acupuncture Research
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    • v.21 no.1
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    • pp.202-210
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    • 2004
  • Objective: In order to find oriental medical therapies on Parkinson's disease and to make a fundamental basis for clinical application, this study was performed. Methods: We reviewed 35 kinds of the ancient and modern text, and related articles. Results: Parkinson's disease is an extrapyramidal disease characterized by akinesia, tremor at rest, rigidity, and slowness of movement. In old oriental medical text, Parkinson's disease is described as Jinjeon(振顫), Chi, Gyeong (痙), Gyejong, Ryeon(攣) and Pyeongo(偏枯), Tantan, Jungbu(中腑症) of Jungpung(中風). According to the text, major pathological causes were Wind(風), Fire(火), Phlegm(痰), and Blood stasis(瘀血). And Parkinson's disease can be classified into four clinical types as liver & kidney yin-deficiency, qi & blood deficiency, retention of phlegm-heat, and qi-stagnation & blood stasis. Standardized acupuncture points are GV20, GB20, GV14 on head, CV12, ST25 on abdomen, GV26, ST7, GB1, S14, LI20 on face, LI4, LI11, TE5, SI3, HT3, LI15, SI6 on upper extremity, and ST36, GB34, SP6, LR3, KI1, GB30, BL40 on lower extremity. Other methods, such as scalp acupuncture, electro-acupuncture, and herb-acupuncture, can be applied to treat Parkinson's disease. Conclusions: We find out that there are oriental medical concepts related with Parkinson's disease such as Jinjeon(振顫), Chi, Gyeong (痙), Gyejong, Ryeon(攣) and Pyeongo(偏枯), Tantan, Jungbu(中腑症) of Jungpung(中風), of which major causes are Wind(風), Fire(火), Phlegm(痰), and Blood stasis(瘀血). We can also apply many effective acupuncture points and acupuncture therapies according to differential diagnosis, for example, liver & kidney yin-deficiency. qi & blood deficiency, retention of phlegm-heat, and qi-stagnation & blood stasis.

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Prostate Cancer Screening in the Fit Chilean Elderly: a Head to Head Comparison of Total Serum PSA versus Age Adjusted PSA versus Primary Circulating Prostate Cells to Detect Prostate Cancer at Initial Biopsy

  • Murray, Nigel P.;Reyes, Eduardo;Orellana, Nelson;Fuentealba, Cynthia;Jacob, Omar
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.2
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    • pp.601-606
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    • 2015
  • Background: Prostate cancer is predominately a disease of older men, with a median age of diagnosis of 68 years and 71% of cancer deaths occurring in those over 75 years of age. While prostate cancer screening is not recommended for men >70 years, fit elderly men with controlled comorbidities may have a relatively long life expectancy. We compare the use of age related PSA with the detection of primary malignant circulating prostate cells mCPCs to detect clinically significant PC in this population. Materials and Methods: All men undergoing PC screening with a PSA >4.0ng/ml underwent TRUS 12 core prostate biopsy (PB). Age, PSA, PB results defined as cancer/no-cancer, Gleason, number of positive cores and percentage infiltration were registered. Men had an 8ml blood sample taken for mCPC detection; mononuclear cells were obtained using differential gel centrifugation and mCPCs were identified using immunocytochemistry with anti-PSA and anti-P504S. A mCPC was defined as a cell expressing PSA and P504S; a positive test as at least one mCPC detected/sample. Diagnostic yields for subgroups were calculated and the number of avoided PBs registered. Esptein criteria were used to define small grade tumours. Results: A total of 610 men underwent PB, 398 of whom were aged <70yrs. Men over 70 yrs had: a higher median PSA, 6.24ng/ml versus 5.59ng/ml (p=0.04); and a higher frequency of cancer detected 90/212 (43%) versus 134/398 (34%) (p=0.032). Some 34/134 cancers in men <70yrs versus 22/90 (24%) of men >70yrs complied with criteria for active surveillance. CPC detection: 154/398 (39%) men <70yrs were CPC (+), specificity for cancer 86%, sensitivity 88%, 14/16 with a false (-) result had a small low grade PC. In men >70 years, 88/212 (42%) were CPC (+); specificity 92%, sensitivity 87%, 10/12 with a false (-) had small low grade tumours. False (+) results were more common in younger men 36/154 versus 10/88 (p<0.02). With a PSA cutoff of 6.5ng/ml, in men <70yrs, 108 PB would be avoided, missing 56 cancers of which 48 were clinically significant. Using CPC detection, 124 biopsies would be avoided, missing only 2 clinically significant cancers. In men >70 yrs using a PSA >6.5ng/ml would have resulted in 108 PB with 34 PC detected, of which 14(41%) were small low grade tumours. Conclusions: The use of CPC detection in the fit elderly significantly decreases the number of PBs without missing clinically significant cancers, indicating superiority to the use of age-related PSA.

The Clinical Manifestations of the Five Cases of Lymphangitic Carcinomatosis of the Lung Presented as Diffuse and Interstitial Disease (미만성 간질성 폐질환으로 발현한 폐장의 암종성 림프관염 환자 5예에 대한 임상적 고찰)

  • Sung, Young-Joo;Choi, Soo-Jeon;Lee, Bong-Chun;Kim, Dong-Soon;Seo, Yeon-Lim
    • Tuberculosis and Respiratory Diseases
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    • v.39 no.1
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    • pp.55-61
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    • 1992
  • Background: The lung is the most common site of metastasis and usually it manifests as a single or multiple nodules in chest X-ray. But less commonly the cancer spreads through the lymphatics and X-ray shows diffuse reticulonodular densities. Sometimes, patient is presented with respiratory symptoms only with interstitial lung infiltration before the signs of primary tumor and in that cases, the differential diagnosis with other interstitial lung disease is required. We have experienced 5 such cases, who were diagnosed as lymphangitic carcinomatosis by transbronchial lung biopsy. Methods: Clinical manifestation, pulmonary function test, modified thin section CT, bronchoalveolar lavage and transbronchial lung biopsy were done. Results: The primary tumor was gastric cancer in 3, lung cancer in 2. Pulmonary function test showed restrictive pattern with low DLco in 2 patients and obstructive pattern in one. Bronchoalveolar lavage showed lymphocytosis in 4 patients and malignant cells were found in one patient. Transbronchial lung biopsy revealed malignant cells localized to the lymphatics (peribronchial, perivascular and perialveolar). Cell type was adenocarcinoma in 4 and squamous cell carcinoma in one. Conclusion: Rarely lymphangitic carcinomatosis can be presented as diffuse interstitial lung disease and easily diagnosed by transbronchial lung biopsy.

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A Study of the Influence of illness on Body Image and Self Concept -Specifically in Children with Asthma- (만성 질환이 자아개념 (Self Concept)과 신체상(Body Image)에 미치는 영향 -천식 환아를 중심으로-)

  • 장효순
    • Journal of Korean Academy of Nursing
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    • v.12 no.2
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    • pp.80-90
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    • 1982
  • This study was undertaken to determine the influence of a chronic disease on body image, and to show that body image is directly related to one's self concept. Body image is the concept of one's own body based on present and past perception, and is elated to one's self concept. Body image is a dynamic concept constantly changing throughout the life cycle but it changes greatly in illness, surgery, and accident. The child with a chronic disease experiences pain and immobilization due to illness and he/she experiences a strange environment in the hospital. illness often brings feeling of frustration and loss of self-esteem. Therefore this study was done to compare the body image of a child with a chronic disease(Asthma), with that of a normal healthy child, and to determine the relationship between the body image and self concept. The subjects in this study were 36 children being treated for asthma at the allergy clinic of Y University Hospital in Seoul (patient group) and 44 children attending elementary school in Kwanak Ku Seoul (normal healthy group). For the measurement of the body image, the researcher used Secord & Jourard's Body Cathexis Scale, and another scale which was constructed after reading about Osgood's Semantic Differential Method. For the measurement of the self concept, the researcher used Jacox & Stewart's Health Self Concept. The period for data collection was from October 7th to October 27th, 1982. The analysis of data was done by use of Percentage, t-test, Chi-square test, Pearson Correlation Coefficient and ANOVA, The results of the study were as follows: 1. The first hypothesis,“That the chronically ill (Asthma) child will have a more negative body image than the normal healthy child.”was supported. 2. The second hypothesis,“The more negative the body image, the lower the self concept.”was also supported. 3. The researcher failed to obtain statistically significant results in the analysis of the general characteristics which affect the body image except in the case of the older child as compare to the younger Child having a mole positive body image (r=.2751, r=.2481, p<.05). However it was found that, 1) Boy's have a more positive body image than girls (Mean=〔37.81, 141.09〕,〔37.00, 126.54〕), 2) The child who has been hospitalized has a more negative body image than the child who has never been hospitalized (Mean=〔33.25, 122.45〕,〔35.68, 129.93〕). 3) The younger the child when the disease is discovered and diagnosed, the more negative the body image (Onset of illness: Mean=〔31.44, 117.33〕,〔34.00, 103.50〕, 〔35.75, 140.38〕,〔36.33, 130.00〕, Time of Diagnosis: Mean=〔29.00, 117.33〕,〔33.89, 115.00〕,〔33.36, 124.93〕,〔37.10, 139. 20〕). In conclusion the chronically ill(.Asthma) child has a more negative body image than the normal healthy child, and the more negative the body image the lower the self concept. Therefore the concept of body image is useful in understanding the influences of chronic disease on body' image and self concept.

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