No abstract available.
Homocystine ; Homocystinuria*

No abstract available.
Injections, Intralesional* ; Tuberculosis*

Paget's disease of the breast occurs almost exclusively in women, and is characterized by a unilateral, sharply defined eczematous skin lesion caused by epidermal metastases from underlying ductal adenocarcinoma of the breast. Paget's disease of the male breast is extremely rare. A 61-year-old patient had a skin lesion on the right nipple for 1 year. The lesion was a well defined, brownish, crusted, and keratotic papule, and was associated with an underlying walnut sized, fixed, hard mass and a palpable ipsilateral axillary lymph node. Histologic findings were consistent with Paget's disease. Results of immunoperoxidase staining technigues for S-100 protein and carcinoembryonic antigen were negative. After a modified radical mastectomy and chemotherapy, the patient has been in remission for 12 months.
Adenocarcinoma ; Breast* ; Carcinoembryonic Antigen ; Drug Therapy ; Female ; Humans ; Juglans ; Lymph Nodes ; Male* ; Mastectomy, Modified Radical ; Middle Aged ; Neoplasm Metastasis ; Nipples ; Paget's Disease, Mammary ; S100 Proteins ; Skin

A case of sporotrichosis misdiagnosed as lupus vulgaris was presented. A 56-year-old woman had been to pea sized, nontender pustules and a hypertrophic-scar-like nodule on the right thigh. She denied any trauma before the lesions developed. Histopathologic findings from the lesion showed tuberculosis-like granulomatous changes. And she was diagnosed as lupus vulgaris. She also had pulmonary tuberculosis and had been treated with antituberculous drugs for 1 year. But skin lesions was not cleared. We suspected the lesions as one of deep mycoses and could confirm sporotrichosis by mycologic studies. They showed characteristic gross colonies and microscopic findings of Sporothrix schenckii..
Female ; Humans ; Lupus Vulgaris* ; Middle Aged ; Mycoses ; Peas ; Skin ; Sporothrix ; Sporotrichosis* ; Thigh ; Tuberculosis, Pulmonary

We report a case of piroxicam-induced photosensitive dermatitis in a 54-year-old female. She had taken oral piroxicam and was exposed to the sunlight on her way home for a few minutes. Several hours after the sun-exposure she developed well-defined, confluent, erythematous plaques and numerous vesicobullae with pruritus and prickling sensation on the sun-exposed areas. A phototest was done on her first visit. The minimal erythemogenic dose (2 J/cm²) of ultraviolet (UV) A was markedly decreased whereas that of UVB was within a normal limit. Visible light irradiation for 30 minutes did not cause skin lesions. Six months after the initial skin lesions, a photopatch test with 1% and 10% piroxicam solution followed by UVA (10 J/cm²) irradiation showed positive responses on both concentrations.
Dermatitis* ; Female ; Humans ; Light ; Middle Aged ; Piroxicam ; Pruritus ; Sensation ; Skin ; Sunlight

No abstract available.

No abstract available.
Gynecology*

Laparoscopic cholecystectomy (LC) is considered as the gold standard operation for the removal of a nonmalignant, diseased gallbladder. With the increasing number of LCs, a number of gallbladder carcinomas have been unexpectedly found either during or following this procedure. The removal of unexpected gallbladder carcinomas by LC can cause also a new complication, port site metastasis (PSM), which is developed by the implantation of tumor cells into the abdominal wall at the port site. We report a rare case of PSM of gallbladder carcinoma which was unsuspected at the time of LC. A 65-year-old man underwent LC at another hospital for calculous cholecystitis. The histologic examination revealed an adenocarcinoma of the gallbladder infiltrating the muscle wall. Despite the surgeon's advice, the patient refused any additional treatment. Ten months after surgery, he visited our hospital because of a painful and palpable subcutaneous mass at the scar of the periumbilical trocar incision. The mass was biopsed and histological examination confirmed metastasis from the gallbladder carcinoma.
Abdominal Wall ; Adenocarcinoma ; Aged ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cicatrix ; Gallbladder* ; Humans ; Neoplasm Metastasis* ; Surgical Instruments

BACKGROUND: Protamine sulfate (PS), used to neutralize the effect of heparin, is often associated with systemic hypotension. The present study was aimed to investigate the protective effects of CaCl2 on adverse hemodynamic reaction to PS. METHODS: Forty-six dogs of three groups were studied. Animals were randomly allocated to receive either; saline 10 ml (controls, n = 26), CaCl2 5 mg/kg (n = 10) or 10 mg/kg (n = 10), added to PS 3 mg/kg given intravenously 5 min after heparin (300 IU/kg, iv). Mean aortic pressure (MAP), mean pulmonary arterial pressure (MPAP), left ventricular end-diastolic pressure (LVEDP), LVdP/dtmax, and -LVdP/dtmin, and pulmonary artery (cardiac output) and left circumflex blood flow (LCX flow) were recorded up to 15 min after PS. RESULTS: PS caused significant reductions in MAP (-49%), cardiac index (CI, -66%), systemic vascular resistance index (SVRI, -22%), LVEDP (-67%), LVdP/dtmax (-36%), and LVdP/dtmin (-55%), but increased MPAP (39%) and PVRI (3.8 fold), which all increases and reductions peaked 1-3 min after PS injection in the control group. The addition of CaCl2 to PS significantly attenuated reductions of MAP (-35 and -26% in CaCl2 5 and 10 mg/kg treated dogs, respectively), CI (-34 and -37%), LVdP/dtmax (-14, -11% ), and -LVdP/dtmin (-34, -21%), and increases in PVRI (1.8 and 2.4 fold). However, both doses of CaCl2 increased MPAP (48, 82%), but not SVRI (-28, -21%) or LVEDP (-73, -75%). LCX flow increased similarly in all groups (75-137%). CaCl2 5 and 10 mg/kg iv increased plasma Ca2+ by 0.23 and 0.36 mM, respectively. CONCLUSIONS: These results suggest that the simultaneous administration of CaCl2 attenuates the adverse hemodynamic effects of PS, used to reverse heparin anticoagulation in the dog.
Animals ; Arterial Pressure ; Calcium Chloride* ; Calcium* ; Dogs* ; Hemodynamics* ; Heparin ; Hypotension ; Plasma ; Protamines* ; Pulmonary Artery ; Vascular Resistance

BACKGROUND: Perfusion scintigraphy with dipyridamole have been reported to be useful for diagnosis of coronary artery disease and the assessment of the presence and extent of myocardium at ischemic risk, especially in patients who can not undergo dynamic exercise testing. Dipyridamole, pharmacologic coronary vasodilator, also induces fall in blood pressure and rise in heart rate. The purpose of this study was to answer the question if dipyridamole induced peripheral hemodynamic responses were related to chest pain, ST changes on EKG, scintigraphic defect or extent of coronary stenosis. METHODS: Dipyridamole 99mTc-MIBI myocardial scintigraphy and coronary angiography on 43 subjects who were suspected to have coronary artery disease. The peripheral hemodynamic response was graded as absent(group 0) if there was a < or =10mm fall in systolic blood pressure (SBP) and/or < or =10 beats/min rise in geart rate(HR) ; moderate(group 1) if there was >10 but < or =20mm fall in SBP and/or >10 but < or =20 beats/min rise in HR ; and marked (group 2) if there was >20mm fall in SBP and/or >20 beats/min rise in HR. RESULTS: The overall diagnostic sensitivity and specificity for coronary artery disease of dipyridamole perfusion scintigraphy were 68%, 83% while per vessel sensitivity and specificity for coronary artery disease were 66%, 97%. The numbers of induced chest pain and ischemic ST changes among hemodynamic subgroups, were 40%, 40% in group 0, 33%, 27% in group 1 and 50%, 40% in group 2 without significant difference in each hemodynamic subgroups. Either the numbers of diseased coronary arteries or the numbers of patients demonstrationg reversible scintigraphic defects were not statically different among each subgroups. CONCLUSION: Although the peripheral hemodynamic response dose not always correlate with its central coronary effect but dipyridamlole 99mTc-MIBI myocardial perfusion scintigraphy is an useful test for diagnosis of coronary artery disease.
Blood Pressure ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Diagnosis ; Dipyridamole* ; Electrocardiography ; Exercise Test ; Heart Rate ; Hemodynamics* ; Humans ; Myocardial Perfusion Imaging ; Myocardium ; Perfusion Imaging ; Sensitivity and Specificity