No abstract available.
Carcinoma, Hepatocellular* ; Diagnosis*

The clinicopathology of nine cases of eccrine spiradenoma was examined. The ages of the patients ranged from 32 to 65 years, with an average age of 46 years. There were four males and five females. Eight tumors out of the nine presented on the ventral surface of the upper body. The tumors were solitary in seven cases and multiple in two cases(cases 8 and 9). Six tumors were either painful or tender to palpation. Histologically, two cases(cases 1 and 2) were adenomas with well developed tubular structures, while the remaining seven cases were epitheliomas with poor organization and prominent reticular pattern. All tumors were composed of two distinct cell types. Since four cases showed considerable edema with a lot of cystic change, it was difficult in some areas to differentiate these from other adnexal tumors or vascular tumors. Immunohistochemical staining was performed on paraffin-embedded sections of 5 eccrine spiradenomas. CEA and EMA were expressed in the cytoplasm of tumor cells in all cases. Cytokeratin was expressed in 4 out of 5 cases, and S-100 in 3 out of 5 cases. There has been no evidence of recurrence in 8 cases. In one case(case 9) the tumor recurred locally with carcinomatous transformation- characterized by the presence of solid areas of tumor which was composed of large cells with irregularly shaped nuclei and mitotic figures. There were foci of ductal differentiation, extensive areas of tumor necrosis and invasion into surrounding connective tissue. The carcinomatous portion revealed positive reaction for CEA, EMA, S-100 protein and cytokeratin.
Female ; Male ; Humans ; Adenoma

Neurofibromatosis, or von Recklinghausen's disease, is a hereditary, harmartomatous disorder that primarilyinvolves neuroectoderm and mesoderm. The estimated incidence is 1 in 2,500 to 3,000 births. The clinical featuresare skin manifestations such as cafe-au-lait spots, skeletal manifestations primarily in volving vertebrae,central and peripheral nervous manifestations, and other associated abnormalities with increased risk ofmalignancy. The authors analysed the radiologic findings of 18 cases of patients with neurofibromatosis whovisited Pusan Kosin Medical Center and Taegu Dongsan Medical Center during the last five years. All were proven bysurgery, biopsy and other diagnostic criteria. The results obtained were as follows: 1. The male ot female ratiowas 11:7 and the age ranged from 11 months to 51 years. 2. All the cases fulfilled the diagnotic criteria of Croweand associates. 3. Bone manifestations were present in 44% of the cases. The other radiologic findings wereintrathoracic meningocele, bilateral acoustic neurinomas, mediastinal or chest wall mass shadows, and peripheralsoft tissue masses. 4. One of the soft tissue masses was proved to be malignant.
Biopsy ; Busan ; Cafe-au-Lait Spots ; Daegu ; Female ; Humans ; Incidence ; Male ; Meningocele ; Mesoderm ; Neural Plate ; Neurofibromatoses ; Neurofibromatosis 1 ; Neurofibromatosis 2 ; Parturition ; Skin Manifestations ; Thoracic Wall

PURPOSE: The incidence of congenital hypothyroidism (CH) has increased in several countries. Lower cut-off in screening programs have led to an increase in the proportion of transient hypothyroidism (TH) cases diagnosed, leading to debate on the associated clinical and economic impact. This study aimed to identify factors that would allow discrimination between TH and permanent CH (PH) in patients with a eutopic thyroid gland. METHODS: Sixty-six patients with CH from 3 different hospitals were studied: 26 cases of TH, and 40 cases of PH. Laboratory findings and clinical parameters were analysed in 56 patients with eutopic thyroid gland. RESULTS: Initial serum thyroid stimulating hormone levels and L-thyroxine dose at 12 and 24 months of age were significantly higher in PH than TH patients with a eutopic thyroid gland. The area under the curve for the 12-month and 24-month dose for the prediction of TH in eutopic CH was 0.799 (95% confidence interval [CI], 0.678-0.919; P<0.001) and 0.925 (95% CI, 0.837-1.000; P<0.001), respectively. The optimum 12-month and 24-month dose in predicting TH is 3.25 microg/kg (12-month: sensitivity, 87.1%; specificity, 68.0%; 24-month: sensitivity 93.5%, specificity 88%). CONCLUSION: Infants with CH requiring lower L-thyroxine doses (<3.25 microg/kg) are likely to have TH, and thus might be re-evaluated at 12 months or 24 months rather than 3 years of age.
Congenital Hypothyroidism* ; Discrimination (Psychology) ; Humans ; Hydrogen-Ion Concentration ; Hypothyroidism ; Incidence ; Infant ; Mass Screening ; Thyroid Gland ; Thyrotropin ; Thyroxine*

PURPOSE: The placement of a drainage tube in the common bile duct, following a choledochotomy, has become accepted as routine procedure since it was first reported, by Abbe, in 1892. However, many complications are associated with T-tube drainage, such as bile peritonitis after its removal, accidental dislodgement, bile leakage from the T-tube track and a high incidence of postoperative bacteremia, have been reported. This study was designed to evaluate the primary closure as a suitable surgical technique in placce of T-tube drainage following a choledochotomy METHODS: Between January and December 2002, primary closures were performed in 41 cases and T tube drainage in 112, following a choledochotomy. These cases were divided into 2 groups (group A: primary closure, and group B: T-tube drainage). The medical records of the patients were reviewed, and the following data analysed -age, sex, preoperative laboratory value, intraoperative finding, postoperative laboratory value, complication, and days of postoperative hospital stay. RESULTS: There were no significant differences observed in the data of the investigated parameters, with the exception of the mean post-operative hospital stay. The mean post- operative hospital stays were 11.82 and 18.08 days in groups A and B (P=0.0034), respectively. The complication rates of each group showed no statistical difference. However bile peritonitis or bile leakage after T-tube removal developed 5 cases from group B. There were 2 and 5 deaths due to MODS & ARDS, respectively. CONCLUSION: A primary closure, following a choledochotomy, may be a suitable alternative technique to T-tube drainage under reasonable conditions.
Bacteremia ; Bile ; Choledocholithiasis* ; Common Bile Duct ; Drainage* ; Humans ; Incidence ; Length of Stay ; Medical Records ; Multiple Organ Failure ; Peritonitis

Type II membranoproliferative glomerulonephritis (MPGN) is characterized by thickening of the glomerular basement membrane owing to electron-dense deposits on electron microscopy. We experienced a case of type II MPGN in a child presenting with proteinuria, hematuria on school urinary screening tests. He had been treated with losartan and enalapril. This is the first case report of type II MPGN detected by school urinary screening tests in Korea. Thus we report a case of 10-years-old male with type II MPGN with a review of brief literature.
Child ; Enalapril ; Glomerular Basement Membrane ; Glomerulonephritis, Membranoproliferative ; Hematuria ; Humans ; Korea ; Losartan ; Male ; Mass Screening ; Microscopy, Electron ; Proteinuria

No abstract available.
Behcet Syndrome* ; Renal Insufficiency*

BACKGROUND: Laryngoscopy and tracheal intubation are associated with hemodynamic pressor responses, which lead to adverse effect. Opioids have been used to reduce the hemodynamic change. The purpose of this study was to investigate an optimal dosage of remifentanil for attenuating hemodynamic change. METHODS: 120 ASA class 1-2 patients, scheduled for elective surgery, were divided randomly into 4 groups. Anesthesia was induced with vecuronium priming dose (0.01 mg/kg) and TCI of propofol target concentration 8 microgram/ml. This was reduced to 4 microgram/ml when the effect-site concentration had been 3 microgram/ml. After the effect-site concentration had reached 4 microgram/ml, vecuronium (0.09 mg/kg) was given. At the same time, control group received normal saline, group R0.25 received remifentanil 0.25 microgram/kg, group R0.5 received remifentanil 0.5 microgram/kg, group R1 received remifentanil 1 microgram/kg over 60s and an infusion 0.2 microgram/kg/min. Intubation was performed after maximum depression of the single twitch was shown by single twitch stimulation test. Sytolic blood pressure, mean arterial pressure, diastolic blood pressure, heart rate and BIS value were measured preinduction, after propofol induction, immediately before and after intubation and 1, 2, 3, 4 minutes after intubation, respectively. RESULTS: Post-intubation mean arterial pressure decreased significantly from pre-intubation value in group R0.5 and R1 (P < 0.05). In group R0.5 and R1, hypotension and bradycardia occurred but there were no significant differences in their incidence between two groups. CONCLUSIONS: We suggest that remifentanil 0.5 microgram/kg bolus and an infusion of 0.2 microgram/kg/min attenuate the pressor response to tracheal intubation in patients anesthetized with propofol TCI.
Analgesics, Opioid ; Anesthesia ; Arterial Pressure ; Blood Pressure ; Bradycardia ; Depression ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Incidence ; Intubation* ; Laryngoscopy ; Propofol* ; Vecuronium Bromide

PURPOSE:We compared anthropomorphic measures and hormone levels in girls with atypical thelarche (AT) and central precocious puberty (CPP) and tried to find out factors discriminating AT from CPP. METHODS:We analyzed clinical and laboratory data of 62 girls with precocious breast development from May 2004 to May 2008 at Kangnam St. Marys Hospital. Immunoradiometeric assay (IRMA) was used to estimate gonadotropins and growth related hormones. CPP was diagnosed if peak luteinizing hormone (LH) level was >6.9 IU/L after gonadotropin hormone releasing hormone (GnRH) stimulation test. A multiple logistic regression analysis and the area under the receiver operating characteristics curve (AUC) were used to analyse the prediction capacity of variable factors to diagnose CPP. RESULT:The basal LH levels (P=0.001), IGF-I levels (P=0.049) and the peak LH levels (P<0.001) in GnRH-stimulation test in girls with CPP were higher than those with AT. Girls with AT had a lower degree of breast maturation than girls with CPP (P=0.001). A multivariate logistic regression model including the basal LH levels and IGF-I levels revealed a strong relation of the basal LH levels to CPP [OR:2.7, 95% confidence interval (CI): 1.1-6.7, P=0.035]. The AUC for basal LH levels showed prediction capacity of basal LH levels to diagnose CPP [AUC: 0.70, 95% CI: 0.57-0.81, P=0.009]. The statistically ideal cut-off value of basal LH levels to discriminate CPP from AT was 2.66 IU/L (sensitivity 40%, specificity 98%) and the clinically meaningful cut-off value was 1.86 IU/L (sensitivity 70%, specificity 62%). CONCLUSION:These results suggest that the basal LH level using IRMA could be a useful parameter discriminating AT from CPP. Further study with larger number of subjects will be needed.
Area Under Curve ; Breast ; Gonadotropins ; Insulin-Like Growth Factor I ; Logistic Models ; Luteinizing Hormone ; Piperazines ; Puberty, Precocious ; ROC Curve ; Sensitivity and Specificity

Trigeminal neurinoma is a rare condition arising from the gasserian or trigeminal nerve root. It comprises 0.2% of all brain tumors, and usually affects middle life, but about 10% of it appears in adolescents. Middle fossa syndrome, symptoms and signs of cerebellopontine angle tumor and mixture of these may be developed through the extension of the tumor. Symptoms and signs of cerebellar and midbrain compression may also be elicited in some stage of the tumor. Erosion of the Anteromedial portion of the petrous apex and defect of the flow of the middle fossa contribute to the diagnosis. Air studies and cerebral antiography have been used, and recently pantopaque basal cisternography has been introduced. The route of operation depends upon the main localization of the tumor, but transtemporal approach with tentorial section is widely used for dumbbell-shaped tumor. A case of cerebellopontine angle tumor which had been postoperatively proved to be a trigeminal neurinoma is reported.
Adolescent ; Brain Neoplasms ; Diagnosis ; Humans ; Iophendylate ; Mesencephalon ; Neurilemmoma* ; Neuroma, Acoustic ; Puberty* ; Trigeminal Nerve