Clear cell sarcoma of tendon and aponeurosis is a rare malignant tumor. It occurs chiefly in young adults, predominates in women and is most common in the regions of the foot and ankle. We report a case of clear cell sarcoma of tendon and aponeurosis in s 22-year-old man. he pstient had had a asymptomatic, normal skin colored, relativerly hard, dome shsped nodule on the anterior chest for 6 months. Histopsthologic findings revealed uniform pattern composed of compact nests of round or fusiform cells which had clear cytoplasm and were surrounded by delicate framework of fibrocollagenous tissue, and the individual tumor cell had a fairly regular appearance of possessing round to avoid vesicular nucleus with prominent basophilic nucleolus. One year after surgical excision and post operative radiotherapy, there was no recurrence.
Ankle ; Basophils ; Cytoplasm ; Female ; Foot ; Humans ; Radiotherapy ; Recurrence ; Sarcoma, Clear Cell* ; Skin ; Tendons ; Thorax* ; Young Adult

No abstract available.
Anesthesiology* ; Education* ; Publications*

The present study compared the actigraphic indices between both wrist actigraphies (WATGs), and the sleep estimates between each WATG and nocturnal polysomnography (NPSG) to assess their differences and consistencies. We studied 22 right-handed subjects (mean age 43.9+/-13.3 years, M:F=14:8) with untreated primary sleep disorders (primary insomnia=8, simple snorer=2, obstructive sleep apnea=12) undergone by overnight both WATGs and NPSG, simultaneously. Comparison and correlation were analyzed between right and left wrist actigraphic data. In the sleep estimates of both WATGs and NPSG, each WATG was compared and correlated with NPSG in sleep period time (SPT), total sleep time (TST), sleep latency (SL), sleep efficiency (SE) and wake time (WT). Sleep indices between both WATGs showed significant positive correlations with no correlations in SL and fragmentation index (FI). There were no differences in sleep indices between both WATGs. SPTs of both WATGs, SL of left WATG, and TST of right WATG showed positively significant correlations, and SE of right WATG did negatively significant correlation in sleep indices between each WATG and NPSG. As each WATG was compared to PSG, SPTs of both WATGs and WT of right WATG were decreased, and TST and SE of right WATG and SL of left WATG were increased. Inconsistent SL and FI between both WATGs indicate that the activities between both WATGs can differentially happen during wake or arousal. Inconsistent sleep estimates between each WATG and NPSG may indicate the limited usefulness in measuring and analyzing one-night sleep by using WATG.
Arousal ; Functional Laterality ; Polysomnography* ; Sleep Wake Disorders ; Wrist*

BACKGROUND: Extramammary Paget's disease (EMPD) is an intraepithelial carcinoma usually occurring on the skin or mucosa of the perineum. Clinically, it resembles eczema or dermatitis, and misdiagnosis and treatment delays are common. The treatment of choice for EMPD is a wide excision with adequate margins. Wide excision with intraoperative frozen biopsy and Mohs micrographic surgery are common methods; however, these are associated with a high recurrence rate and long operation time, respectively. METHODS: Between January 2010 and June 2013, 21 patients diagnosed with EMPD underwent mapping biopsy. Biopsy specimens were collected from at least 10 areas, 2 cm from the tumor margin. When the specimens were positive for malignancy, additional mapping biopsy was performed around the biopsy site of the positive result, and continued until no cancer cells were found. Based on the results, excision margins and reconstruction plans were established preoperatively. RESULTS: The patients (18 male, 3 female) had a mean age of 66.5 years (range, 50-82 years). Almost all cases involved in the perineal area, except one case of axillary involvement. Permanent biopsy revealed one case (4.8%) of positive cancer cells on the resection margin, in which additional mapping biopsy and re-operation was performed. At the latest follow-up (mean, 27.4 months; range, 12-53 months), recurrence had not occurred. CONCLUSIONS: Preoperative mapping biopsy enables accurate resection margins and a preoperative reconstructing plan. Additionally, it reduces the operation time and risk of recurrence. Accordingly, it represents an effective alternative to Mohs micrographic surgery and wide excision with intraoperative frozen biopsy.
Biopsy* ; Carcinoma in Situ ; Dermatitis ; Diagnostic Errors ; Eczema ; Follow-Up Studies ; Frozen Sections ; Humans ; Male ; Mohs Surgery ; Mucous Membrane ; Paget Disease, Extramammary* ; Perineum ; Recurrence ; Skin

The present study was undertaken to evaluate bone regenerative capacity around titanium screw implants placed in irradiated rat's tibiae. At one week after single 15-Gy dose irradiation, miniaturized titanium screw implants were inserted into anterior aspect of the upper tibia of rats weighing 200-250g. Seventy rats were involved: 35 rats were control and 35 rats radiation group. The rats were killed at different intervals as 1, 2, 3, 4, 6, 8, 12 weeks after implantation for histologic observation, histomorphometric analysis and immunohistochemical study with fibronectin and CD34 antibody. 1. Histologically, various stages of bone maturation and ossification can be seen at 4 weeks and regenerated bone close to edges demonstrates more advanced calcification, and network of new bone are well formed at 12 weeks in non-irradiated group. In contrast, active bone formation with increased contact of newly formed bone to implant surface was noted at 4 weeks and a significant amount of new bone formation and bone-implant contact is oberved at 12 weeks in irradiated group. 2. Histomorphometrical analysis confirmed these histologic findings. A significant difference in implant-bone contact and bone density was measured between the control and radiation group. Mean MBD was 62.2% in control group and 27.5% in radiation group, mean MBIC was 86.6% in control group and 47.7% in radiation group, and mean TBIC was 87.3% in control group and 45.6% in radiation group at 12 weeks after implantation. 3. In immunohistochemical study with fibronectin and CD34, radiation reduced hematopoietic progenitor cells severely and disturbed differentiation of osteoblast in bone marrow. The results of this study revealed bone healing capacity around implant after radiation therapy was severely impaired and irradiation reduces the capacity for osseointegration of titanium implants. Many factors including radiation dose, period between radiation and implantation, bone quality, time elapse between first and second surgery, type of prosthetics and hyperbaric oxygen therapy must be considered carefully in postradiation implantation.
Animals ; Bone Density ; Bone Marrow ; Fibronectins ; Hematopoietic Stem Cells ; Hyperbaric Oxygenation ; Immunohistochemistry ; Osseointegration ; Osteoblasts ; Osteogenesis ; Rats ; Tibia* ; Titanium*

STUDY DESIGN: Case report. OBJECTIVES: To report a case of a giant intramuscular lipoma after a blunt trauma. SUMMARY OF LITERATURE REVIEW: Lipomas are the most frequent benign tumor of the mesenchymal tissue. Although the etiopathogenesis is not complete understood yet, it is known that lipoma develope with a 1% rate after traumas in the related localizations. Traumata induce hematoma and initiates inflammatory reactions in fatty tissue and can trigger the development of lipoma. MATERIALS AND METHODS: 2 years after a blunt trauma a 56years male patient developed a back mass. A massive lipoma was confirmed clinical and radiological. RESULTS: A total excision was performed and the result was histopathologic confirmed. CONCLUSIONS: Patients who develop hematoma after a trauma need a close lipoma progress observation which decrease the invasive treatment of post-trauma hematoma.
Adipose Tissue ; Hematoma ; Humans ; Lipoma* ; Male

Purpose: Osteosynthesis of a clavicular fracture can obtain good clinical results even with conservative treatment. The development of surgical techniques and improvements in internal fixation have led to the use of metal plates and screws. Although there are intramedullary nails or minimally invasive plate osteosynthesis that can reduce soft tissue damage, these techniques are not used often because most require a skin incision about the length of the metal plate to be inserted. This study compared the postoperative pain to determine the appropriate injection depth. Materials and Methods: A prospective, single-institute, single-blind, randomized study was designed. The patients in the study had clavicular fractures and who underwent the removal of implant. The patients judged to have difficulty indicating pain were excluded.Ropivacaine was injected between plate fixation and muscle suturing. The visual analog scale (VAS) pain score, patient-controlled analgesia (PCA) use, and additional pain medication usage were measured after surgery and every 4 hours. Results: Thirty-four clavicle shaft fracture patients were classified into 16 patients in the subcutaneous injection group and 18 in the muscle injection group. Seventeen implant removal patients were divided into eight patients in the subcutaneous injection group and another nine in the muscle injection group. In the fracture group, the mean VAS for the subcutaneous injection group was 4.20±2.68 immediately after surgery, 4.47±1.85 at 4 hours, 1.93±1.44 at 24 hours, and 1.60±1.35 at 48 hours. The mean VAS for the muscle injection group was 4.23±1.59 immediately after surgery, 3.00±1.47 at 4 hours, 1.69±1.03 at 24 hours, and 1.31±1.11 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.332). In the implant removal group, the mean VAS for the subcutaneous injection group was 4.75±1.58 immediately after surgery, 3.75±1.04 at 4 hours, 1.75±0.89 at 24 hours, and 1.75±0.89 at 48 hours. The mean VAS for the muscle injection group was 3.78±1.20 immediately after surgery, 3.22±0.83 at 4 hours, 1.89±1.17 at 24 hours, and 1.11±1.01 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.181). Conclusion The postoperative VAS pain score and PCA usage were not statistically significant regardless of the ropivacaine injection site in clavicular surgery, but each group had significantly different VAS pain scores and PCA usage according to time after surgery. In addition, the muscle injection group tended to have a lower average VAS than the subcutaneous injection group in the implant removal patient group.

Purpose: Osteosynthesis of a clavicular fracture can obtain good clinical results even with conservative treatment. The development of surgical techniques and improvements in internal fixation have led to the use of metal plates and screws. Although there are intramedullary nails or minimally invasive plate osteosynthesis that can reduce soft tissue damage, these techniques are not used often because most require a skin incision about the length of the metal plate to be inserted. This study compared the postoperative pain to determine the appropriate injection depth. Materials and Methods: A prospective, single-institute, single-blind, randomized study was designed. The patients in the study had clavicular fractures and who underwent the removal of implant. The patients judged to have difficulty indicating pain were excluded.Ropivacaine was injected between plate fixation and muscle suturing. The visual analog scale (VAS) pain score, patient-controlled analgesia (PCA) use, and additional pain medication usage were measured after surgery and every 4 hours. Results: Thirty-four clavicle shaft fracture patients were classified into 16 patients in the subcutaneous injection group and 18 in the muscle injection group. Seventeen implant removal patients were divided into eight patients in the subcutaneous injection group and another nine in the muscle injection group. In the fracture group, the mean VAS for the subcutaneous injection group was 4.20±2.68 immediately after surgery, 4.47±1.85 at 4 hours, 1.93±1.44 at 24 hours, and 1.60±1.35 at 48 hours. The mean VAS for the muscle injection group was 4.23±1.59 immediately after surgery, 3.00±1.47 at 4 hours, 1.69±1.03 at 24 hours, and 1.31±1.11 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.332). In the implant removal group, the mean VAS for the subcutaneous injection group was 4.75±1.58 immediately after surgery, 3.75±1.04 at 4 hours, 1.75±0.89 at 24 hours, and 1.75±0.89 at 48 hours. The mean VAS for the muscle injection group was 3.78±1.20 immediately after surgery, 3.22±0.83 at 4 hours, 1.89±1.17 at 24 hours, and 1.11±1.01 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.181). Conclusion The postoperative VAS pain score and PCA usage were not statistically significant regardless of the ropivacaine injection site in clavicular surgery, but each group had significantly different VAS pain scores and PCA usage according to time after surgery. In addition, the muscle injection group tended to have a lower average VAS than the subcutaneous injection group in the implant removal patient group.

Purpose: Osteosynthesis of a clavicular fracture can obtain good clinical results even with conservative treatment. The development of surgical techniques and improvements in internal fixation have led to the use of metal plates and screws. Although there are intramedullary nails or minimally invasive plate osteosynthesis that can reduce soft tissue damage, these techniques are not used often because most require a skin incision about the length of the metal plate to be inserted. This study compared the postoperative pain to determine the appropriate injection depth. Materials and Methods: A prospective, single-institute, single-blind, randomized study was designed. The patients in the study had clavicular fractures and who underwent the removal of implant. The patients judged to have difficulty indicating pain were excluded.Ropivacaine was injected between plate fixation and muscle suturing. The visual analog scale (VAS) pain score, patient-controlled analgesia (PCA) use, and additional pain medication usage were measured after surgery and every 4 hours. Results: Thirty-four clavicle shaft fracture patients were classified into 16 patients in the subcutaneous injection group and 18 in the muscle injection group. Seventeen implant removal patients were divided into eight patients in the subcutaneous injection group and another nine in the muscle injection group. In the fracture group, the mean VAS for the subcutaneous injection group was 4.20±2.68 immediately after surgery, 4.47±1.85 at 4 hours, 1.93±1.44 at 24 hours, and 1.60±1.35 at 48 hours. The mean VAS for the muscle injection group was 4.23±1.59 immediately after surgery, 3.00±1.47 at 4 hours, 1.69±1.03 at 24 hours, and 1.31±1.11 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.332). In the implant removal group, the mean VAS for the subcutaneous injection group was 4.75±1.58 immediately after surgery, 3.75±1.04 at 4 hours, 1.75±0.89 at 24 hours, and 1.75±0.89 at 48 hours. The mean VAS for the muscle injection group was 3.78±1.20 immediately after surgery, 3.22±0.83 at 4 hours, 1.89±1.17 at 24 hours, and 1.11±1.01 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.181). Conclusion The postoperative VAS pain score and PCA usage were not statistically significant regardless of the ropivacaine injection site in clavicular surgery, but each group had significantly different VAS pain scores and PCA usage according to time after surgery. In addition, the muscle injection group tended to have a lower average VAS than the subcutaneous injection group in the implant removal patient group.

BACKGROUND: Recently, the PPAR gamma2 Pro12Ala polymorphism has been associated with type 2 diabetes and diabetic nephropathy. In the present study, we investigated the association between Pro12Ala polymorphism and diabetic nephropathy in korean subjects. METHODS: A total of 180 patients with type 2 diabetes and 100 normal controls were enrolled in this studies. Screening for mutation at codon of PPAR gamma2 were carried out by PCR-RELP analysis. Also, we measured important covariables, such as duration of diabetes, blood pressure, renal function and serum lipids. RESULTS: In PCR-RELP, it showed that there were no difference in the PPAR gamma2 genotype frequencies between diabetic subjects (Pro/Pro: 80.5%, Pro/Ala: 19.5%) and normal controls (88%, 12%). However, it showed that there were significant difference in the PPAR gamma2 genotype frequencies between diabetic subjects with nephropathy (Pro/Pro: 74.5%, Pro/Ala: 25.5%) and diabetic subjects without nephropathy (87.8%, 12.2%) (p=0.040). In diabetic subjects, Pro/Ala genotypes were significantly different from Pro/Pro regarding serum creatinine, 24 hour proteinuria, systolic pressure, and LDL-cholesterol. In diabetic nephropathy, genotypes with Pro/Ala significantly increased serum creatinine (2.7+/-0.41 vs 1.7+/-0.68 mg/dL), 24hour urine protein (median+-SE: 1.9+/-1.02 vs 0.9+/-0.44 g/day), systolic pressure (161+/-27.8 vs 152+/-32.4 mmHg), LDL cholesterol (134+/-30.4 vs 125+/-20.0 mg/dL), and triglyceride (151+/-86.5 vs 135+/-60.9 mg/dL) than genotypes with Pro/Pro. CONCLUSION: Our results suggested that Pro12Ala Polymorphism of the PPAR gamma2 gene may be associated with diabetes with nephropathy in korean patients.
Blood Pressure ; Cholesterol, LDL ; Codon ; Creatinine ; Diabetic Nephropathies* ; Genotype ; Humans ; Mass Screening ; Peroxisome Proliferator-Activated Receptors* ; Proteinuria ; Triglycerides