Fibrohistiocytic tumors are a diverse group of benign and malignant soft tissue lesions, including dermatofibroma, dermatofibrosarcomaprotuberans, and malignant fibrous histiocytoma. On the clinical point of view, the distinction between benign and malignant lesions and malignancy grading is far more important. Therefore, we investigated 23 fibrohistiocytic tumors, using PCNA (PC10) which was a useful marker of proliferating activity, to differentiate the benign lesions from the malignant and correlate with other prognostic factors including tumor necrosis. cellularity, histologic grade, and mitotic counts. The results obtained were as follows 1) Positive tumor cells were clearly identified by the characteristic diffuse or granular nuclear staining. 2) The number of PCNA-positive tumor cells were 2.16+/-2.39% in dermatofibroma, 16.12+/-7.38% in dermatofibrosacoma protuberans, and 28.02+/-17.47% in the malignant fibrous histiocytoma. The numbers of PCNA-positive tumor cells in the malignant lesions higher than in the benign (p<0.001). 3) Deep seated, large size (>5 cm) and recurred or metastatic cases of MFH were more the high PCNA index (more than 20%) than the low index (less than 20%) groups. 4) PCNA index in MFHs had positive correlation with the number of mitotic counts (r=0.7582, p<0.001), cellularity (r=0.5908, p<0.05) and histologic grade (r=0.4164, p<0.05). These results suggested that reactivity on PCNA might assist in the distinction between benign and malignant lesions in fibrohistiocytic tumors, and could be a useful prognostic factor in the patients with malignant fibrous histiocytoma.
Neoplasm Metastasis

PURPOSE: To investigate the therapeutic effectiveness of ultrasound (US)-guided trigger point injection for myofascial trigger points (MTrPs) in the internal rotator muscles of the shoulder in post-mastectomy patients. MATERIALS AND METHODS: This pilot study was a non-controlled, prospective, clinical trial. Nineteen post-mastectomy patients with a diagnosis of at least one active MTrP in the subscapularis and/or pectoralis muscles were included. We performed trigger point injections into the subscapularis muscle deep behind the scapula as well as the pectoralis muscle for diagnostic and therapeutic purpose by the newly developed US-guided method. RESULTS: Visual analogue scale and range of motion of the shoulder for external rotation and of abduction showed significant improvement immediately after the first injection and 3 months after the last injection compared with baseline (p<0.05 for both). Duration from onset to surgery and duration of myofascial pain syndrome in the good responder group were significantly shorter than in the bad responder group (p<0.05). Patients did not report any complications related to the procedure or serious adverse events attributable to the treatment. CONCLUSION: In post-mastectomy patients with shoulder pain, US-guided trigger point injections of the subscapularis and/or pectoralis muscles are effective for both diagnosis and treatment when the cause of shoulder pain is suspected to originate from active MTrPs in these muscles, particularly, the subscapularis.
Adult ; Aged ; Anesthetics, Local/administration & dosage/therapeutic use ; Female ; Humans ; Injections, Intramuscular/methods ; Lidocaine/administration & dosage/therapeutic use ; Mastectomy ; Middle Aged ; Muscle, Skeletal/drug effects/ultrasonography ; Myofascial Pain Syndromes/drug therapy ; Pectoralis Muscles/drug effects/*ultrasonography ; Trigger Points/*ultrasonography

PURPOSE: We expected the motion fraction could be checked, with simple radiographic examination, according to the guide-line of fluoroscopic technique, and recovery of the function also could be correlated with the improvement of the motion fraction. MATERIALS AND METHODS: We measured the motion fraction of the glenohumeral and scapulothoracic movement using fluoroscope in 30-degree intervals of arm elevation in the scapular plane. The ratio of glenohumeral to scapulothoracic movement (thetaGH/thetaST) was 1.6 for the full range of motion in scapular plane. During arm elevation, scapular tilting from the coronal plane was decreased from 42 degrees to 20 degrees tilting as well as internal rotation (scapular extension). We also measured the motion fraction (thetaGH/thetaST) and functional recovery of the shoulder in 11 patients after operative treatment of the shoulder instability in 15 patients from December 1996 to August 1997. RESULTS: We could find out a significant correlation between the recovery of motion fraction and shoulder function. These results would be applied in planing rehabilitation program after treatment of the shoulder instability. CONCLUSIONS: The measuring technique of glenohumeral to scapulothoracic movement (thetaGH/thetaST) with fluoroscopy could be applied to the simple radiographic measurement at the out-patient clinic in order to identify the pathology and recovery of shoulder motion after treatment
Arm ; Fluoroscopy ; Humans ; Outpatients ; Pathology ; Range of Motion, Articular ; Rehabilitation ; Shoulder*

The c-erbB-2 oncogene, which is a new human proto-oncogene similar to EGFR structurally, generates a glycoprotein of tyrosine kinase family with a molecular weight of 185,000 To evaluate the prognostic significance of c-erbB-2 oncogene expression in colorectal carcinoma, We analysed 73 colorectal carcinomas in paraffin sections immunohistochemically, using the monoclonal antibody specific for the c-erbB-2 oncogene product and correlated with clinicopathological data. The results were as follows 1) The immunoreactivity for c-erbB-2 oncogene was localized to cell membrane of the tumor cells and occasionally observed within the cytoplasm. 2) The positivity of c-erbB-2 oncogene expression was 71.2%(52/73) of the colorectal carcinomas overall. According to the histological types, the positivity of c-erbB-2 oncogene in adenocarcinoma(77.4%) was higher than that in mucinous carcinoma(36.4%)(p<0.05). 3) Expression of c-erbB-2 oncogene was significantly correlated with lymph node metastasis or distant metastasis(p=0.0117), Dukes stage(p=0.0432), and TNM classification(p=0.0102). These results suggest that c-erbB-2 oncogene expression may be used as a prognostic factor of colorectal carcinoma because of its correlation with other clinicopathological prognostic factors.
Humans ; Neoplasm Metastasis

Diagnosis and management of abdominal pain in old age is considered a challenge to emergency physicians. Stercoral perforation is an infrequent event, which most commonly develops in old age. We report on a case of stercoral perforation in an elderly woman, which, to the best of our knowledge, is one of a few reported cases in the medical literature. A 74-year-old woman who presented at our emergency department complaining of lower abdominal pain was found to have a perforation of the colon. Examination revealed a stercoral perforation by fecaloma. She underwent Hartman's operation and colostomy. Stercoral perforation is rare; however, emergency physicians should consider this disease entity in elderly patients with abdominal pain.
Abdominal Pain ; Aged ; Colon ; Colostomy ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Female ; Humans ; Intestinal Perforation ; Peritonitis

PURPOSE: We investigated the correlations between the expression of claudin-1 and claudin-7 in clear cell renal cell carcinoma (clear cell RCC) and clinical parameters. MATERIALS AND METHODS: The subjects of this study were 119 patients with confirmed clear cell RCC between January 2000 and December 2007. Their RCC tissues were immunohistochemically stained for claudin-1 and claudin-7. The correlations between the expression of claudin and parameters such as sex, age, body mass index (BMI), tumor size, TNM stage, Furhman nuclear grade, postoperative distant metastasis, and cancer-specific survival were analyzed. RESULTS: Among the total 119 subjects, claudin-1 was expressed in 18 (15.1%) and claudin- 7 in 31 (26.1%). Claudin-1 was expressed in patients who were older (p=0.007), who had a greater tumor size (p=0.001), who had a higher pathologic T stage (p=0.009), who had preoperative distant metastasis (p=0.035), and who had a higher Furhman nuclear grade (p=0.004). Claudin-7 was expressed only in patients who had a higher Furhman nuclear grade (p=0.031). The risk of postoperative distant metastasis was associated with the expression of claudin-1 (p<0.001) but not with the expression of claudin-7 (p=0.668). The expression of claudin-1 and -7 was not associated with cancer-specific survival (p>0.05). CONCLUSIONS: In clear cell RCC, claudin-1 was expressed in patients who were older and who had a greater tumor size, who had higher T or M stages, and who had a higher Furhman nuclear grade. The expression of claudin-1 was associated with a higher risk of postoperative distant metastasis.
Body Mass Index ; Carcinoma, Renal Cell ; Claudin-1 ; Humans ; Neoplasm Metastasis

The Say–Barber–Biesecker–Young–Simpson variant of Ohdo syndrome (SBBYSS) (Online Mendelian Inheritance in Man #603736) is a rare autosomal dominant disorder and clinically features blepharophimosis with ptosis, a mask-like facial appearance, cryptorchidism, congenital heart defect, long thumbs/great toes, and thyroid dysfunction. The etiology of SBBYSS has been shown to be due to heterozygous KAT6B gene mutation. Here we report a case of a neonate with SBBYSS identified a novel mutation in KAT6B gene. The patient showed typical dysmorphic facies, cryptorchidism with micropenis, overriding fingers, and long thumbs and toes at birth. He had also hypothyroidism, large atrial septal defect, and sensorineural hearing loss. The next generation sequencing identified a heterozygous novel variant, c.5206C>T (p.Gln1736Ter) in KAT6B gene. At the 9 months of age, he underwent patch closure for atrial septal defect. Until the 12-month follow-up, he was under-developed.

Purpose: To investigate the effects of simultaneous soft and hard tissue augmentation and the addition of polydeoxyribonucleotide (PDRN) on regenerative outcomes. Materials and Methods: In five mongrel dogs, chronic ridge defects were established in both mandibles. Six implants were placed in the mandible, producing buccal dehiscence defects. The implants were randomly allocated to one of the following groups: 1) control: no treatment; 2) GBR: guided bone regeneration (GBR) only; 3) GBR/PDRN: GBR+PDRN application to bone substitute particles; 4) GBR/CTG: GBR+connective tissue grafting (CTG);5) GBR/VCMX: GBR+soft tissue augmentation using volume stable collagen matrix (VCMX); and 6) group GBR/VCMX/ PDRN: GBR+VCMX soaked with PDRN. The healing abutments were connected to the implants to provide additional room for tissue regeneration. Submerged healing was achieved. The animals were euthanized after four months. Histological and histomorphometric analyses were then performed. Results: Healing abutments were gradually exposed during the healing period. Histologically, minimal new bone formation was observed in the dehiscence defects. No specific differences were found between the groups regarding collagen fiber orientation and density in the augmented area. No traces of CTG or VCMX were detected. Histomorphometrically, the mean tissue thickness was greater in the control group than in the other groups above the implant shoulder (IS). Below the IS level, the CTG and PDRN groups exhibited more favorable tissue thickness than the other groups. Conclusion Failure of submerged healing after tissue augmentation deteriorated the tissue contour. PDRN appears to have a positive effect on soft tissues.

PURPOSE: For an isolated tear of the subscapularis tendon, the presented technique using a subclavian portal provides both a good angle for anchor placement and sufficient space for managing the upper portion of a subscapularis tendon tear. MATERIALS AND METHODS: The conventional method needs 2 additional portals for traction, debriding the footprint and anchor fixation for repair. The presented technique requires only an anterior portal for suture management and a subclavian portal without cannula for suture anchoring and placement of suture hooks. RESULTS: The two suture limbs of the anchor can be placed on the subscapularis tendon by the switching technique and these limbs are repaired sequentially. CONCLUSION: This technique is simple and reproducible and it can be applied to partial tears and minimally retracted subscapularis tears.
Catheters ; Extremities ; Suture Anchors ; Sutures ; Tendons ; Traction

Prostaglandin E1 (PGE-1) is a potent vasodilator, which also inhibits platelet aggregation, affects the blood flow viscosity, and fibrinolysis. The compound also excerts anti-inflammatory effects by inhibiting the monocyte and neutrophil function. PGE-1 has been widely administered following microvascular flap surgery, along with perioperative antithrombotic agents such as low molecular weight heparin or aspirin, showing excellent results. We report a case showing successful salvage recovery from post-traumatic ischemic necrosis of the finger via PGE-1 assisted conservative treatment.
Alprostadil* ; Aspirin ; Fibrinolysis ; Fibrinolytic Agents ; Fingers* ; Heparin, Low-Molecular-Weight ; Ischemia ; Monocytes ; Necrosis* ; Neutrophils ; Platelet Aggregation ; Salvage Therapy* ; Viscosity