We report 13 chromophobe renal cell carcinomas (10.8%) observed among 120 renal cell carcinomas in adults. The average age was 53 (range: 34-72) years old, and 6 were males and 7 females. The mean tumor size was 10 (range: 5-17) cm, mean nuclear grade 2.4, and mean Robson's stage was 1.9. There were two distinct histologic variants; typical variant (n=9) and eosinophilic variant (n=4). Both of them showed typical light microscopic features and positive reaction with Hale's colloidal iron and carbonic anhydrase II, a marker protein of intercalated cells of renal collecting ducts. A strong positive immunoreactivity for epithelial membrane antigen was noted in the cytoplasm in 12 of 13 tumors. Numerous microvesicles, 180~440 nm in diameter, were identified ultrastructurally. DNA aneuploidy was found in 3 out of 10 cases. Neither local recurrence nor metastasis have been identified during the following period of 4~144 (mean 48) months.
Adult ; Aneuploidy ; Carbonic Anhydrase II ; Carcinoma, Renal Cell* ; Colloids ; Cytoplasm ; DNA ; Eosinophils ; Female ; Humans ; Iron ; Male ; Mucin-1 ; Neoplasm Metastasis ; Recurrence

A 49-year-old man was admitted to Baptist Hospital on September 1, 1990. For mitral valve replacement due to mitral regurgitation. He has been treated by implantation of artificial pacemaker due to complete heart block for 1 year ago. We have experienced anesthetic management above patient who was scheduled of MVR. The patient with a cardiac pacemaker (VVI type) could give anesthesiologist many associated problems during the operation and anesthesia. During anesthesia an anesthesiologist should be able to manage the problems which might occur because of a cardiac pacemaker by various origins. Authors report this case with evaluation of references.
Anesthesia ; Heart Block ; Heart* ; Humans ; Middle Aged ; Mitral Valve ; Mitral Valve Insufficiency ; Pacemaker, Artificial ; Protestantism ; Thoracic Surgery*

Hypoxemia remains one of the most common postoperative problems. It is difficult to detect but potentially lethal, especially in combination with other complications. A case is presented of persistent hypoxemia resulting from pneumothorax in a 44-year-old male patient having surgery for the pancreatic head cancer under general anesthesia. He was catheterized in the right subclavian vein by the infraclavicular approach for the measurement of CVP on the first preoperative day and developed pneumothorax subsequently. This complication was thought to have been aggravated due to inattentive positive pressure ventilation and diffusion on N2O during anesthesia. This patient recovered from postoperative hypoxemia after needle aspiration of air from the pleural cavity without any other problem in the recovery room.
Adult ; Anesthesia ; Anesthesia, General ; Anoxia* ; Catheters ; Diffusion ; Head and Neck Neoplasms ; Humans ; Male ; Needles ; Pleural Cavity ; Pneumothorax* ; Positive-Pressure Respiration ; Recovery Room ; Subclavian Vein

Listeria monocytogenes is a gram-positive rod which can be isolated from soil, vegetation, and many animal reservoirs. Human disease due to Listeria monocytogenes is uncommon but occurs most frequently in the neonatal period, during pregnancy and in elderly or immuno-suppressed patients. Listeriosis in pregnant women may cause spontaneous abortion, fetal distress, preterm labor, fetal death, or neonatal septicemia/meningitis. Maternal infection alone may occur without infection of the infant, especially at the end of pregnancy. One case of septicemia with Listeria monocytogenes in pregnant women at the 35th weeks of pregnancy with fetal distress is presented.
Abortion, Spontaneous ; Aged ; Animals ; Female ; Fetal Death ; Fetal Distress* ; Humans ; Infant ; Listeria monocytogenes ; Listeriosis ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Trimester, Third* ; Pregnant Women ; Sepsis ; Soil

Pendipronil(R) overdose is uncommon in Korea. Pendipronil(R) is a selective herbicide used to control most annual grasses and certain broadleaf weeds in field corn, potatoes, rice, etc. and is the substance including pendimethalin and propanil. Pendimethalin is slightly to practically nontoxic by ingestion but may be mildly to moderately irritating to the linings of the mouth, nose, throat, and lungs. Propanil toxicity is evidenced by varying clinical pictures ranging from deep cyanosis in an otherwise alert normal appearing individual to restlessness, dyspnea, extensive hemolytic anemia, methemoglobinemia, sulfhemoglobinemia and serious central nervous system dysfunction. For the treatment of methemoglobinemia, gastric lavage, activated charcoal, methylene blue and exchange transfusion should be used. We experienced a case of acute massive Pendipronil(R) intoxication in 31 years old woman due to voluntary ingestion of 48g of this drug as a suicide attempt. A moderate methemoglobinemia developed, accompanied by drowsy mental status, nausea, vomiting, headache, intensive cyanosis. The patient recovered completely after intravenous methylene blue injection and cellulose coated hemoperfusion charcoal (Adsorba 300C(R)) and conservative treatment.
Adult ; Anemia, Hemolytic ; Cellulose ; Central Nervous System ; Charcoal ; Cyanosis ; Dyspnea ; Eating ; Female ; Gastric Lavage ; Headache ; Hemoperfusion* ; Humans ; Korea ; Lung ; Methemoglobinemia ; Methylene Blue* ; Mouth ; Nausea ; Nose ; Pharynx ; Poaceae ; Poisoning* ; Propanil ; Psychomotor Agitation ; Solanum tuberosum ; Suicide ; Sulfhemoglobinemia ; Vomiting ; Zea mays

From march, 1983 to May, 1987, we experienced 17 patients of Marfan syndrome. The clinical profile and course of 17 patients of Marfan syndrome were reviewed. 1) Their ages ranged from 13 to 50 years with a mean age of 30 years and 16 patients were male and 1 patient was female. 2) musculoskeletal features were present in 14(88%) of the 16 examined. Ocular features were found in 5(42%) of 12 examined. Familial features were present in 7(47%) of 15 examined. 3) Among cardiovascular manifestations dissecting aneurysm was present in 10(59%) patients, aortic annuloectasia in 15(94%), MR in 4(24%) and MVP in 1(6%). 4) Modified Bentall operation was performed to 8 patients. Two of them died. The other 8 patients took a conservative medical therapy. Four of them died.
Aneurysm, Dissecting ; Female ; Humans ; Male ; Marfan Syndrome*

17 cases of acute myocardial infarction with no or insignificant narrowing of major coronary arteries on angiogram and without any-other types of heart disease were found in a series of 133 consecutively studied patients with acute myocardial infarction(12,7%). There were no differences in risk factors between groups. Although the infarction site were similar in both groups, the patients with normal coronary arteries had fewer complications during hospitalization(p<0.05) and lesser ST segment change during the exercise test before discharge(p<0.05). In the hemodynamic fingings, cardiac index, left ventricualr and diastolic pressure and resional wall motion were similar in both groups of the patients, but ejection fraction was higher(p<0.05) in the patients with the normal coronary arteries. In conclusion, it could be predicted that the acute myocardial infarction with the normal coronary arteries would have the better prognosis. And a transient coronary occlusion, as the most likely pathogenic mechanism of the acute mtocardial infarction with normal coronary arteries, might be studied in the aspect of the thrombosis following lysis, the coronary artery spasm and the platelet aggregation.
Angiography* ; Blood Pressure ; Coronary Occlusion ; Coronary Vessels ; Exercise Test ; Heart Diseases ; Hemodynamics ; Humans ; Infarction ; Myocardial Infarction* ; Platelet Aggregation ; Prognosis ; Risk Factors ; Spasm ; Thrombosis

The implatnation of malignant cells along the needle tract is an extremely rare complication after a percutaneous fine-needle aspiration biopsy(FNAB). However, it is very serious and may result in a change in the prognosis of lung cancer, especially in the curable early stage(T1-2,N0,M0). Recently, we experienced two cases of such complications. A 43 years old female underwent a fine needle aspiration biopsy and a right middle lobectomy with adjuvant chemotherapy due to an adenocarcinoma(T2N0M0). Two years later, a new tumor developed at the site of the needle aspiration biopsy. It had the same pathological findings as the previous lung cancer. Therefore, it was concluded to be an implantation metastasis, and she was treated successfully by a right pneumonectomy and a resection of the chest wall mall with adjuvant radiotherapy. In another case, a 62 years old man was diagnosed with squamous cell lung cancer by a fine needle aspiration biopsy and underwent a right upper lobectomy(T2N0M0) with adjuvant chemotherapy. eight months later, a protruding chest wall mass developed at the aspiration site. It showed the same pathological findings as the previous lung cancer. Consequently, a total excision of the mass with adjuvant radiotherapy was done. Two years after the second operation, although the right lung was intace a metachronous squamous cell lung cancer was found at the left lower lobe. The two patients were still alive 15 and 37 months after thenresection of the chest wall mass, respectively.
Biopsy ; Biopsy, Fine-Needle* ; Biopsy, Needle ; Chemotherapy, Adjuvant ; Female ; Humans ; Lung Neoplasms* ; Lung* ; Needles ; Neoplasm Metastasis* ; Pneumonectomy ; Prognosis ; Radiotherapy, Adjuvant ; Thoracic Wall* ; Thorax*

Brain meningioma, the most common benign brain tumor, has been reported to account for 13-26% of all intracranial tumors, with a crude incidence rate of 2.3 per 100,000 persons for all types of meningiomas. The prevalence of neuropsychiatric lupus erythematosus is 15-91% and its clinical manifestations are diverse: from mild cognitive dysfunction to serious neurological or psychiatric symptoms. Here, we report the first Korean patient with brain meningioma and systemic lupus erythematosus who had undergone surgical tumor resection.
Brain Neoplasms ; Brain* ; Headache ; Humans ; Incidence ; Lupus Erythematosus, Systemic* ; Meningioma* ; Prevalence

OBJECTIVE: The incidence of posterior inferior cerebellar artery (PICA) aneurysms is rare, and neurosurgeons have found that the direct open surgical approach for PICA aneurysms is challenging. [0]We analyzed the results of treating posterior inferior cerebellar artery (PICA) aneurysms by embolization or by open surgery. METHODS: 41 patients (1% of all the aneurysms treated; 13 (32%) men, 18 (68%) women; mean age: 55.5 yr) with ruptured or unruptured PICA aneurysms underwent treatment at our hospital. The clinical outcomes of these patients were studied retrospectively by using the medical records and the neuroimaging studies. RESULTS: The sites of PICA aneurysms were at the junction of the vertebral artery and PICA (63%), the lateral medullary segment (7%), the tosillomedullary segment (10%), the telovelotonsillar segment (13%) and the cortical segment (7%). The shapes of the PICA aneurysm were either the saccular type (85%) or the fusiform type (15%). 25 patients with PICA aneurysm underwent surgical treatment and 16 patients with PICA aneurysms underwent endovascular treatment. Open surgery was used more often to treat a distal PICA than an endovascular procedure. Within the open surgery group, 24% of the patients received the Hunt and Hess (HH) grades IV and V, whereas among the endovascular-treated patients, 37.5% of the patient had HH IV and V grades. Twenty eight percent of the patients In the surgery group achieved a Glasgow Outcome Scale (GOS) score of I through III, and 72% patients had gained a GOS score IV or V. For the endovascular-treated patients, 37% of these patients achieved a GOS score of I through III and 63% patients gained a GOS score IV or V. CONCLUSION: We found that the open surgery patients had better clinical outcomes than the endovascular treated patients and they especially achieved higher HH grades. However, Fisher's exact test and Chi-square tests did not show any statistically significant difference between the two groups (p=0.49, which is explained by the selection bias). In the previous literature, the predictors of the outcome for intracranial aneurysms, such as age, the size of the aneurysms, the HH grade and the Fisher grade showed statistical significance for the GOS grade. Yet in our study, we showed that there was no statistical significance between the above mentioned predictors and the GOS grade, while a strong correlation existed between the HH grade and the GOS grade.
Aneurysm ; Arteries ; Endovascular Procedures ; Glasgow Outcome Scale ; Humans ; Incidence ; Intracranial Aneurysm ; Male ; Medical Records ; Neuroimaging ; Pica ; Retrospective Studies ; Vertebral Artery