Malignant hibernoma, also called round cell liposarcoma, is a subtype of liposarcome. It is composed of so-called mulberry cells with scanty stroma. The characteristic mulberry cell has a centrally located nucleus and multivaculoated foamy cytoplasm in which eosinophilic fat droplet granules are contained. The authors experienced a case of malignant hibernoma. The patient, 16-year-old male, had a slowly growing nontender firm solitary subcutaneous mass on the center of chin for about 6 months. He hadn't episode of trauma or exposure to X-ray irradiation on the chin. Histopathological findings of punch biopsied skin specimen revealed compact mulberry cells intermingled with normally matured fat cells in the deep dermis and muscle layer, but there were neither significant infiltrations of lymphocyte nor myxoid changes. The tumor mass was totally removed including surrounding tissues as much as possible. The surgically removed tissue specimen revealed brownish discoloration in the center. Histopathologically, it revealed numerous capillaries and massive extravasated erythrocytes like a hemangiona, just beneath the hibernoma mass. There was no evidence of local recurrence or metastasis during 2.5 years of post-operative observation.
Adipocytes ; Adolescent ; Capillaries ; Chin ; Cytoplasm ; Dermis ; Eosinophils ; Erythrocytes ; Humans ; Lipoma* ; Liposarcoma ; Lymphocytes ; Male ; Morus ; Neoplasm Metastasis ; Recurrence ; Skin

No abstract available.
Leishmaniasis, Cutaneous*

Post-thoracotomy pain is so severe that may lead to postoperative complications, such as sputum retention, atelectasis, pneumonia and respiratory failure. These complications are associated with shallow breathing and inability to cough due to pain. To reduce postoperative pulmonary complications and improve respiratory mechanics, effective pain relief is essential. Among the many methods, epidural administrations of narcotics or local anesthetics have been shown to provide profound relief of postoperative pain. Forty-five patients undergoing thoracotomy were randomized into three groups based on a postoperative pain regimen as indi-cated: Group I; intermittent intramusculal injections of nalbuphine 0.2mg/kg for pain control(n= 15) Group II; intermittent epidural injections of mixtures of 0.2% bupivacaine and fentanyl 3 ug/ ml (n=15) Group III: continuous epidural infusion of mixtures of 0.2% bupivacaine and fentanyl 3 ug/ml at a rate of 4-5 ml/hr with supplementation on pain complaint. We evaluated postoperative pain score at 30 minutes, 8 hours, 16 hours, 24 hours, 32 hours, 40 hours, and 48 hours after thoracotomy. And we observed the duration of analgesia and the incidence of systemic side effects of three methods. The results were as follows; 1) The pain score was significantly decreased in group III compared to group I and II<0. 05). 2) The mean duration of analgesia was significantly longer in group III compared to group I and II(p<0.05). 3) the number of case of systemie side effects in group I was one case of nausea and vomiting, in group II, two cases of mild hypotension, and one case of nausea and vomiting, pruritus, headache, and urinary retention each respectively and in group III, one case of ruinary retention.
Analgesia* ; Anesthetics, Local ; Bupivacaine* ; Cough ; Fentanyl* ; Headache ; Humans ; Hypotension ; Incidence ; Injections, Epidural ; Nalbuphine ; Narcotics ; Nausea ; Pain, Postoperative ; Pneumonia ; Postoperative Complications ; Pruritus ; Pulmonary Atelectasis ; Respiration ; Respiratory Insufficiency ; Respiratory Mechanics ; Sputum ; Thoracotomy* ; Urinary Retention ; Vomiting

PURPOSE: To compare functional MR imaging of the motor cortex during active and passive movement. MATERIALS AND METHODS: Seven healthy, right-handed volunteers (M:F=6:1; age:25-30 years) were included in this study. A 1.5-T whole body scanner and the multislice EPI BOLD method were used. The motor paradigm was flexion-extension of a thumb against rest. In the active motion task, the thumb was flexed voluntarily once a second, while in the passive task, it was tied with a thread and pulled to flex and extend passively at the same interval and with the same intensity as in the active task. For image postprocessing, an SPM 96 program was used. The sites, numbers, and signal intensity of the activated pixels were determined, and the threshold for significance was set at p<0.001 to p<0.01. RESULTS: In the active motion task, strong activation at the contralateral side of the primary sensorimotor cortex and supplementary motor cortex occurred in all 14 examples in all seven volunteers. Additionally, the ipsilateral primary sensorimotor cortex and supplementary motor area were activated in 12/14 and 11/14 such tasks, respectively. During passive motion tasks, on the other hand, weak activation occurred at the contralateral side of the primary sensorimotor cortex in all cases, but in the contralateral supplementary motor cortex in only three. In the ipsilateral primary sensorimotor cortex and supplementary motor area, there was no activation. CONCLUSION: Compared with the active motion task, activation occurring in the contralateral primary sensorimotor cortex and supplementary cortex was weaker and less frequent during the passive task, and during this latter, the ipsilateral motor cortex remained inactive. These results may be useful for the clinical application of functional MR imaging in unconscious patients or in animal studies.
Animals ; Hand ; Humans ; Magnetic Resonance Imaging* ; Motor Cortex* ; Thumb ; Volunteers

PURPOSE: To report the treatment results of 7 cases of distal radius nonunion with a review of the relevant literature. MATERIALS AND METHODS: Seven patients treated with an autoiliac bone graft and rigid internal fixation for nonunion of the distal radius were analyzed retrospectively for the cause of injury, the factors affecting nonunion, radiological findings, treatment method and complications. The results were analyzed radiologically using Kreder's method and functionally using the Anderson' protocols. RESULTS: Union was achieved in all cases after a mean period of 19 weeks. The functional result of treatment at the last follow-up was excellent in 4 cases and satisfactory in 3 cases. The probable factors of nonunion were instability of the fracture site in three cases, type II or III open fracture in 2 cases, postoperative infection in one case and idiopathic in one case. CONCLUSION: Infection control using a stepwise operation, rigid internal fixation and autogenous iliac bone graft showed satisfactory results in distal radius nonunion, which had developed in those with severe open fractures, postoperative infection, instability on the fracture site and associated distal ulnar fracture.
Follow-Up Studies ; Fractures, Open ; Humans ; Infection Control ; Radius ; Retrospective Studies ; Transplants

We herein report a case of large cell neuroendocrine carcinoma (NEC) of the gallbladder confirmed by laparoscopic surgery. A 60-year-old male was HBsAg-positive. Abdominal computed tomography showed a 2.5 x 2.5 cm enhancing polypoid mass in the gallbladder and multiple masses in liver segments 4 and 5 that enhanced in the arterial phase and washed out in the delayed phase. Liver biopsy findings showed only poorly differentiated morphology. A laparoscopic operation was performed for diagnosis of the masses because curative resection seemed impossible to perform, which showed unusual findings of either hepatocelluar carcinoma or gallbladder cancer. Therefore, laparoscopic liver biopsy and cholecystectomy were performed. The final pathologic results of the masses showed large cell NEC of the gallbladder with liver metastasis. Central bisegmentectomy and extensive lymph node dissection were ultimately performed. The patient was still alive 16 months after diagnosis.
Biopsy ; Carcinoma, Neuroendocrine ; Cholecystectomy ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Laparoscopy ; Liver ; Lymph Node Excision ; Male ; Neoplasm Metastasis

Intestinal tuberculosis presents with nonspecific and variable clinical manifestations. It is rarely seen in current clinical practice and the diagnosis may be missed or confused with many other disorders such as Crohns disease and intestinal neoplasms. The route of infection by tuberculous enteritis is variable and the treatment regimens used for treating pulmonary tuberculosis are generally effective for tuberculous enteritis as well. Uncomplicated tuberculous enteritis can be managed with a nine to 12- month course of antituberculous chemotherapy. If not treated early, the prognosis for intestinal tuberculosis is poor, with an overall mortality of between 19 percent and 38 percent. However, 90 percent of patients will respond to medical therapy alone if started early. Therefore, early detection and treatment is essential. Here we report a case of intestinal tuberculosis secondary to miliary tuberculosis.
Crohn Disease ; Diagnosis ; Drug Therapy ; Enteritis ; Humans ; Intestinal Neoplasms ; Mortality ; Prognosis ; Tuberculosis* ; Tuberculosis, Miliary* ; Tuberculosis, Pulmonary

Xanthogranulomatous cholecystitis (XGC) is an unusual and destructive inflammatory process that is characterized by thickening of the gallbladder (GB) wall with a tendency to adhere to neighboring organs. XGC is often mistaken for GB carcinoma, and the frequency of the coexistence of these two lesions is approximately 10%. Therefore, in case of severe XGC, there is chance of either overlooking the carcinoma or other significant lesions. CA 19-9 is commonly measured in the serum of patients with hepatobiliary malignancies. Although CA 19-9 can be elevated in benign conditions such as cholestasis, pancreatitis, tuberculosis, thyroid disease etc., malignancy should be considered at first in setting of its significant and persistent elevation. We report a case of a 62-year-old man who showed continuously rising level of CA19-9 over 2000 U/mL after cholecystectomy for xanthogranulomatous cholecystitis and finally was diagnosed as cholangiocarcinoma by short-term follow up.
Bile Duct Neoplasms/*diagnosis/pathology/radiography ; *Bile Ducts, Intrahepatic ; CA-19-9 Antigen/*blood ; Cholangiocarcinoma/*diagnosis/pathology/radiography ; Cholecystitis/pathology/*surgery ; Granuloma/pathology/*surgery ; Humans ; Male ; Middle Aged ; Positron-Emission Tomography ; Tomography, X-Ray Computed ; Xanthomatosis/pathology/*surgery

Intravenous leiomyomatosis is a rare entity of benign smooth muscle invading into the lumen of veins. We describe a case of intracardiac leiomyomatosis originating from the right gonadal vein, growing in the inferior vena cava, and extending into the right atrium. A 54 years old woman presented with chest discomfort and syncope four years after the removal of an uterine leiomyoma. The tumor was successfully removed in a two-staged operation using total circulatory arrest with a cardiopulmonary bypass, which proved to be a histologically benign leiomyoma. Although these tumors are histologically benign, they sometimes extend into the cardiac cavity and can cause sudden death due to their incarceration into the atrioventircular orifice. We report this rare case with a review of the literature.
Cardiopulmonary Bypass ; Death, Sudden ; Female ; Gonads ; Heart Atria* ; Humans ; Leiomyoma ; Leiomyomatosis* ; Middle Aged ; Muscle, Smooth ; Syncope ; Thorax ; Veins ; Vena Cava, Inferior

In Korea, the study about the normal depth of insertion of dauble lumen tubes bas not been reported yet. So we studied 50 adult patients(30 males and 20 females) undergoing thoracic surgery under one lung ventilation. Endotracheal intubation was done with the disposable polyvinylchloride Robertshaw-type double lumen endobronchial tube. The exact position of a left-sided double lumen endobronchial tube was confirmed by passing a fiberoptic bronchoscope through the tracheal lumen of the double lumen, The depth was measured when we had a view of a clear straight-ahead view of the tracheal carina, the right lumen going off to the right, and the upper surface of the blue left endobronchial balloon just below the tracheal carina, The resullts were as follows; 1) In the male patients, the average depth of the tube was 30.7+/-1.4cm and this measure- ments were related with height but not the weight and age. 2) In the female patients the average depth of the tube was 28,3+/-l.2cm and this measurements were unrelated with height, age and weight. 3) Among the male and female patients the average depth of the tube was 30.0+/-1.8cm and this measurements were related with a height but not with weight and age.
Adult ; Bronchoscopes* ; Female ; Humans ; Intubation, Intratracheal ; Korea ; Male ; One-Lung Ventilation ; Thoracic Surgery