ABSTRACT
Malignant solitary fibrous tumor (MSFT) is a well-described entity, from which heterologous differentiation is extremely rare. We encountered a case of MSFT with rhabdomyosarcomatous differentiation in a 56-year-old man. This patient presented with a large mass in his posterior thigh. He had been treated with chemoradiation for sarcoma involving the cervical spine, right femoral head, and both lungs 6 months earlier. A wide excision was performed. The mass measured 10.6 cm and showed a fish-flesh cut surface with necrotic foci. Microscopically, the tumor showed heterogeneous cellularity with a hemangiopericytic vascular pattern. A hypercellular area showed spindle cells or epithelioid cells with high mitotic activity (63/10 high-power fields) and immunoreactivity for CD34 and CD99. A hypocellular area and a cystic area showed pleomorphic rhabdoid cells with immunoreactivity for desmin and myogenin. This is a report of a rare case of MSFT with rhabdomyosarcomatous differentiation and presents new histologic features of MSFT.
ABSTRACT
BACKGROUND: The ideal alternative airway device should be intuitive to use, yielding proficiency after only a few trials. The Clarus Video System (CVS) is a novel optical stylet with a semi-rigid tip; however, the learning curve and associated orodental trauma are poorly understood. METHODS: Two novice practitioners with no CVS experience performed 30 intubations each. Each trial was divided into learning (first 10 intubations) and standard phases (remaining 20 intubations). Total time to achieve successful intubation, number of intubation attempts, ease of use, and orodental trauma were recorded. RESULTS: Intubation was successful in all patients. In 51 patients (85%), intubation was accomplished in the first attempt. Nine patients required two or three intubation attempts; six were with the first 10 patients. Learning and standard phases differed significantly in terms of success at first attempt, number of attempts, and intubation time (70% vs. 93%, 1.4 ± 0.7 vs. 1.1 ± 0.3, and 71.4 ± 92.3 s vs. 24.6 ± 21.9 s, respectively). The first five patients required longer intubation times than the subsequent five patients (106.8 ± 120.3 s vs. 36.0 ± 26.8 s); however, the number of attempts was similar. Sequential subgroups of five patients in the standard phase did not differ in the number of attempts or intubation time. Dental trauma, lip laceration, or mucosal bleeding were absent. CONCLUSIONS: Ten intubations are sufficient to learn CVS utilization properly without causing any orodental trauma. A relatively small number of experiences are required in the learning curve compared with other devices.
Subject(s)
Humans , Education , Hemorrhage , Intubation , Intubation, Intratracheal , Lacerations , Learning Curve , Learning , LipABSTRACT
OBJECTIVES: The aim of this study was to evaluate the differences in patients with positional dependent sleep apnea according to their non-supine apnea-hypopnea index (AHI, > or =5 vs. or =5 ; group II was non-supine AHI having less than 5. Statistical analysis was performed to find the difference between two groups. RESULTS: In 92 patients, the number of group I patients was 11 (12%) and the number of group II patients was 81 (88%). In the severe AHI group, percentage of group I was dominated (70%) and showing a significant difference compared with the mild and moderate AHI groups (p or =5 than non-supine AHI<5.
Subject(s)
Humans , Body Mass Index , Sleep Apnea Syndromes , Sleep Apnea, ObstructiveABSTRACT
Central serous chorioretinopathy (CSCR) is potential ophthalmologic sequelae of steroid use characterized by an idiopathic serous detachment of neurosensory retina within the macula. Its etiology and pathophysiology are still unknown, but what has been implicated to cause CSCR is the the use of corticosteroid via multiple administration routes including oral, intravenous, inhaled, intranasal, epidural and intraarticular as well as topical forms. We report, with a review of the literature, an additional case of CSCR, which developed during systemic corticosteroid treatment in a Bell's palsy patient.
Subject(s)
Humans , Bell Palsy , Central Serous Chorioretinopathy , Retina , SteroidsABSTRACT
BACKGROUND AND OBJECTIVES: Hump resection by osteotome or rasp is a commonly used surgical technique in hump correction. However, during this procedure, the structure of the osseous-cartilaginous framework is altered and may lead to an open roof deformity or dorsal irregularity. So we preserved the hump as much as possible, and then augmented the radix with silicone. We compared this result to that of the hump resection group. SUBJECTS AND METHOD: We retrospectively studied 21 patients who underwent rhinoplasty with hump correction. We classified the patients into two groups by operation technique; hump preservation and hump resection. The result of surgery was evaluated by comparing nasal measurements on pre and postoperative photos. Patient's satisfaction about cosmetic results were investigated using the visual analogue scale (VAS). All results were statistically tested. RESULTS: The hump preservation group (N=13) had 12 cases (92.3%) of isolated hump type and one pseudo hump type (7.7%), whereas the hump resection group (N=8) had 5 cases (62.5%) of generalized hump type and 3 isolated hump type (37.5%). The preoperative nasofrontal angle in hump preservation (129.4degrees+/-10.6) was significantly lower than that in the hump resection group (139.3degrees+/-8.2). The nasion/nasal tip depth ratio in the hump preservation group (0.22+/-0.1) was also lower than that in the hump resection group (0.29+/-0.1) preoperatively; but there was no significant difference between the two groups. VAS was improved significantly in both groups after surgery. CONCLUSION: Hump preservation and radix augmentation can be an effective and less complicated surgery for patients who have an acute nasofrontal angle with an isolated hump.
Subject(s)
Humans , Congenital Abnormalities , Cosmetics , Nose , Retrospective Studies , Rhinoplasty , SiliconesABSTRACT
BACKGROUND AND OBJECTIVES: The effectiveness of many treatment regimens on acoustic trauma has been debated, but there is no established treatment yet. The purpose of this study was to evaluate the efficacy of steroid treatment in acoustic trauma caused by rifles and to find a critical time limit for the treatment to be effective. SUBJECTS AND METHOD: A retrospective review was conducted for 86 conscripted policemen (97 ears) who suffered acoustic trauma after rifle exercise. Pure tone audiograms were compared before and after treatment at 0.5, 1 and 2 kHz (speech-frequency pure tone average, speech-PTA) and at 4, 6 and 8 kHz (high tone pure tone average, high-PTA). Treatment consisted of drugs (steroid, ascorbic acid, gingko biloba, dextran) and carbogen therapy. The patients who came to the hospital after the first 14 days following injury were grouped as control. Hearing outcomes of patients treated within 3 days and within 7 days were compared to the control. Pre-and post-treatment hearing was compared according to the elapsed time before treatment. RESULTS: Hearing outcomes of patients who received treatment within 3 days of acoustic trauma was better than the control group. Speech-frequency did not show any difference. Treatment within 7 days showed no statistical difference compared to the control. Hearing gain was better when treated within 7 days, especially if it was within 3 days. Speech-frequency showed significant spontaneous recovery within 3 days. CONCLUSION: Our data showed a possible effectiveness of treatment of acoustic trauma on the recovery of high frequency hearing when started within 3 days. Speech-frequency seems to recover spontaneously within 3 days.
Subject(s)
Humans , Acoustics , Ascorbic Acid , Carbon Dioxide , Firearms , Ginkgo biloba , Hearing , Hearing Loss, Noise-Induced , Noise , Oxygen , Porphyrins , Retrospective StudiesABSTRACT
Primary anti-retroviral resistance is considered one of the major problems of HIV treatment. Contrary to reports from western countries, prior Korean studies have reported a relatively low primary resistance rate (less than 5%). Based on Korean HIV/AIDS cohort data, we estimated the primary resistance rate among treatment-naive HIV-infected patients. According to the results, the primary resistance rate was higher (8.8%) than reported previously in Korean studies. However, the major PI mutation was not found.
Subject(s)
Humans , Cohort Studies , Drug Resistance , HIVABSTRACT
Primary anti-retroviral resistance is considered one of the major problems of HIV treatment. Contrary to reports from western countries, prior Korean studies have reported a relatively low primary resistance rate (less than 5%). Based on Korean HIV/AIDS cohort data, we estimated the primary resistance rate among treatment-naive HIV-infected patients. According to the results, the primary resistance rate was higher (8.8%) than reported previously in Korean studies. However, the major PI mutation was not found.
Subject(s)
Humans , Cohort Studies , Drug Resistance , HIVABSTRACT
Only a few case studies describe reversible parkinsonism after organophosphate poisoning and their brain imagings are found to be normal. However, we experienced chronic, irreversible parkinsonism by acute organophosphate poisoning with bilateral basal ganglia lesions found on a brain MRI. We suggest that brief, large amounts of organophosphate intoxication can produce irreversible parkinsonism according to individual susceptibility and further studies including the investigation of insecticides as an environmental factor of parkinsonism should be done using neuroimagings.
Subject(s)
Basal Ganglia , Brain , Insecticides , Magnetic Resonance Imaging , Neurotoxins , Organophosphate Poisoning , Organophosphates , Parkinsonian DisordersABSTRACT
The so-called racemose cysticercosis, a rare variety of neurocysticercosis occurring in ventricles or basal cisterns, is characterized by abnormal growth of cystic membranes with degeneration of Taenia solium heads (scolex). Although lesions of this type are known to follow a progressive course even after ventricular shunting, there are limitations of case series treated with antiparasitic drugs, and the optimal duration of the treatment is not yet known. We report a case of relapsed racemose cysticercosis in the Sylvian fissure, who has been successfully treated with albendazole and adjunct corticosteroid for 4 weeks. The patient had been previously treated with praziquantel and ventriculoperitoneal shunt, and maintained on the anticonvulsant drug for one year, but returned to the hospital due to seizure recurrence. The patient has been well in seizure-free state for the follow-up 2 years after albendazole therapy. The subarachnoid racemose cysticercosis seems to respond well to treatment of corticosteroid along with prolonged albendazole.
Subject(s)
Humans , Albendazole , Antiparasitic Agents , Cysticercosis , Follow-Up Studies , Head , Membranes , Neurocysticercosis , Praziquantel , Recurrence , Seizures , Taenia solium , Ventriculoperitoneal ShuntABSTRACT
The so-called racemose cysticercosis, a rare variety of neurocysticercosis occurring in ventricles or basal cisterns, is characterized by abnormal growth of cystic membranes with degeneration of Taenia solium heads (scolex). Although lesions of this type are known to follow a progressive course even after ventricular shunting, there are limitations of case series treated with antiparasitic drugs, and the optimal duration of the treatment is not yet known. We report a case of relapsed racemose cysticercosis in the Sylvian fissure, who has been successfully treated with albendazole and adjunct corticosteroid for 4 weeks. The patient had been previously treated with praziquantel and ventriculoperitoneal shunt, and maintained on the anticonvulsant drug for one year, but returned to the hospital due to seizure recurrence. The patient has been well in seizure-free state for the follow-up 2 years after albendazole therapy. The subarachnoid racemose cysticercosis seems to respond well to treatment of corticosteroid along with prolonged albendazole.
Subject(s)
Humans , Albendazole , Antiparasitic Agents , Cysticercosis , Follow-Up Studies , Head , Membranes , Neurocysticercosis , Praziquantel , Recurrence , Seizures , Taenia solium , Ventriculoperitoneal ShuntABSTRACT
OBJECTIVE: To determine the frequency and degree on change in mammographic densities, and calcification in the breast tissue, during different types of hormone replacement therapy and to evaluate the factors that play a role on the breast cancer. METHOD: A retrospective review of 268 cases menopausal women for HRT group and 52 cases menopausal women for unmatched control group. Mammographic evaluations for the distribution of breast densities and calcification, new solid mass and cyst in four different type of HRT were performed each every year during 5 years. The significant increase of breast densities and calcifications and new formation of neoplasm were taken with breast sonogram. 10 cases were biopsied for the confirmation of maliganancy. RESULT: Compared with the conrol groups, the hormone user group have a significant increase in the breast densitiy for 5 years (p0.05). Among 10 cases in suspicious malignancy, 9 cases were confirmed to the malignancy by biopsy. CONCLUSION: The results of this study revealed that not only progesterone combined HRT but also estrogen only HRT significantly increased mammographic density. There is no relationship on the calcification and HRT in this study. The annual checking of mammography is necessary to HRT.
Subject(s)
Female , Humans , Biopsy , Breast Neoplasms , Breast , Estrogens , Hormone Replacement Therapy , Mammography , Progesterone , Retrospective StudiesABSTRACT
OBJECTIVE: To determine the frequency and degree on change in mammographic densities, and calcification in the breast tissue, during different types of hormone replacement therapy and to evaluate the factors that play a role on the breast cancer. METHOD: A retrospective review of 268 cases menopausal women for HRT group and 52 cases menopausal women for unmatched control group. Mammographic evaluations for the distribution of breast densities and calcification, new solid mass and cyst in four different type of HRT were performed each every year during 5 years. The significant increase of breast densities and calcifications and new formation of neoplasm were taken with breast sonogram. 10 cases were biopsied for the confirmation of maliganancy. RESULT: Compared with the conrol groups, the hormone user group have a significant increase in the breast densitiy for 5 years (p0.05). Among 10 cases in suspicious malignancy, 9 cases were confirmed to the malignancy by biopsy. CONCLUSION: The results of this study revealed that not only progesterone combined HRT but also estrogen only HRT significantly increased mammographic density. There is no relationship on the calcification and HRT in this study. The annual checking of mammography is necessary to HRT.
Subject(s)
Female , Humans , Biopsy , Breast Neoplasms , Breast , Estrogens , Hormone Replacement Therapy , Mammography , Progesterone , Retrospective StudiesABSTRACT
BACKGROUND: Skin prick test has been the primary diagnostic tool used to recognize causative allergens, and there is some evidence that skin reactivity to allergens can be altered by changes in the environment. OBJECTIVE: We performed this study to evaluate whether there are changes in skin reactivity to inhalant allergens among patients with bronchial asthma. MATERIALS AND METHOD: We reviewed the skin prick test results of 384 bronchial asthmatics tested in the early 1990s (June 1992-May 1994) with 52 common inhalant allergens and compared the results of 500 asthmatics tested in the mid 1980s (Jan 1984 - May 1987) with the same kinds of allergens provided by the same manufacturer. RESULTS: Of the 384 subjects tested in the early 1990s, 276 subjects(71.9%) had positive reaction to one or more inhalant allergens and the positive rate was not different from that of the mid 1980s(74%). But, skin reactivity to pollens was significantly increased. In individual allergens, house dust mite(D. farinae and D. pteronyssinus) was the most reactive allergen (52.3%, 43.2% respectively) in the early 1990s. Significant differences in skin reactivity to ragweed (10.0% vs 22.1%, p<0.05) and cockroach (12.7% vs 25.0%, p<0.05) were found when the results of the 1980s and the 1990s were compared. CONCLUSION: House dust mite was the most important allergen in asthmatics from the mid 1980s to the early 1990s. There was increased sensitization to cockroach and ragweed allergen in the early 1990s. Further prospective immunologic and environmental studies are recommended for proper interpretation of the changes in skin reactivity.
Subject(s)
Humans , Allergens , Ambrosia , Asthma , Cockroaches , Dust , Pollen , Pyroglyphidae , SkinABSTRACT
OBJECTIVES: The critical pathways provide high quality of medical services in a cost-effective manner. To investigate the decrease in length of hospital stay and increase of cost effectiveness by using critical pathways, we compared hospital stay, cost of treatment, and the patient's satisfaction before and after critical pathway use. METHODS: We made a critical pathway team, which consisted of obstetric staff members, a resident, two nurses, a pharmacist, two clerical staff members. We made critical pathways for the medical team and patients. A prospective evaluation of a critical pathway for cesarean section was used as a comparison for control patients. RESULTS: The data for 305 patients with a critical pathway were compared to those of 136 control patients. The mean hospital stay is shorter in critical pathway patients than control patients. The cost of treatment decreased and differences between DRG (Diagnosed Related Groups) and cost of treatment increased in critical pathway patients. CONCLUSIONS: Using critical pathways in cesarean section decreased the duration of hospital stay and increased cost effectivesess. The critical pathways were useful as a means to minimize cost while increasing patient satisfaction.
Subject(s)
Female , Humans , Pregnancy , Cesarean Section , Cost-Benefit Analysis , Critical Pathways , Diagnosis-Related Groups , Length of Stay , Patient Satisfaction , Pharmacists , Prospective StudiesABSTRACT
OBJECTIVE: Because endometriosis is difficult to diagnose and has a high recurrence rate after treatment, a reliable serum marker of endometriosis is necessary. Therefore, the aim of this study is to measure the serum levels of CA125 and CA19-9 in patients with endometriosis before and after treatment and during recurrence, and to assess the usefulness of these levels in the diagnosis, clinical follow up and prediction of recurrence in endometriosis. METHODS: Eighty-eight patients who visited the department of Obstetrics and Gynecology of Ewha Mokdong Hospital from January 1994 to December 1998 and were diagnosed as endometriosis by laparoscopy or explo-laparotomy were enrolled as subjects. A retrospective analysis of serum CA125 and CA19-9 levels at 1 month before and 3 to 6 months after initiation of treatment was done. RESULTS: The serum CA125 and CA19-9 levels of endometriosis group(81.0+/-252.5, 36.6+/-53.4 ; mean+/-2SD, U/ml) before treatment was significantly higher than control group(11.6+/-12.8, 9.4+/-8.6)(p<0.05). Overall sensitivity rate for CA125, CA19-9 levels and both was 53.4%, 42.9% and 64.3% respectively. The sensitivity rate for endometriosis, stage 3 and 4(85.4%, 55.0%) was significantly higher than that, stage 1 and 2(p<0.05). The serum CA125 level in endometriosis group showed a significant increment according to stages(p<0.05) while the serum CA19-9 level showed an increasing trend(p=0.055) and both levels decreased significantly after treatment(p<0.05). The serum CA125 level was also higher at recurrence after treatment(p<0.05). CONCLUSIONS: The serum CA125 and CA19-9 levels are a useful marker for diagnosing severity of disease, monitoring efficacy of treatment and predicting recurrence in endometriosis.
Subject(s)
Female , Humans , Biomarkers , Diagnosis , Endometriosis , Follow-Up Studies , Gynecology , Laparoscopy , Obstetrics , Recurrence , Retrospective StudiesABSTRACT
PURPOSE: To review the simple radiographic and sonographic findings in infants with neonatal sepsis. MATERIALS AND METHODS: We retrospectively analyzed simple chest and abdominal radiographs, and brain sonograms in 36 newborn infants (preterm: term=23:13). With neonatal sepsis diagnosed by blood culture and clinical manifestations. RESULTS: Pulmonary parenchymal infiltrate excluding respiratory distress syndrome and pulmonary edema or atelectasis was found in 22 infants (61%). Paralytic ileus, hepatosplenomegaly, and necrotizing enterocolitis were present in 18 (50%), 9 (25%), and 1 (3%) infants, respectively, while skeletal changes suggesting osteomyelitis were found in three. Brain sonography was performed in 29 infants and in four, abnormalities were seen ; these comprised three germinal matrix hemorrhages and one intraparenchymal hemorrhage. In six patients (17%) radiologic examinations revealed no abnormality. CONCLUSION: In patients with neonatal sepsis, pulmonary infiltrates and paralytic ileus were common abnormalities. Although these were nonspecific, radiologic findings may be used to supplement clinical and laboratory findings in diagnosing neonatal sepsis and planning its treatment.
Subject(s)
Humans , Infant , Infant, Newborn , Brain , Enterocolitis, Necrotizing , Hemorrhage , Intestinal Pseudo-Obstruction , Osteomyelitis , Pulmonary Atelectasis , Pulmonary Edema , Retrospective Studies , Sepsis , Thorax , UltrasonographyABSTRACT
Leiomyorrw is the mest cunmon in the uterine hunor. Smooth muscle tumors of the female genital taact arise mostly from the uterine myometrium and only rarely from the broad ligament. We experienced a cases of huge leiomyoma of the broad ligarnent with secondary cystic degeneration. In the respect of rarity, we report this case with a brief review.