The prolapse of a fallopian tube into the vagina is a rare complication of hysterectomy. We recently experienced a case of tubal prolapse after a laparoscopic hysterectomy in a 44-year-old woman. The vaginal examination showed a polypoid mass in the vaginal apex. Microscopically, the mass had the typical appearance of a fallopian tube with chronic inflammation. The cytologic finding of a vaginal vault smear was also described.
Adult ; Fallopian Tubes* ; Female ; Gynecological Examination ; Humans ; Hysterectomy* ; Inflammation ; Prolapse* ; Vagina

Sinus histiocytosis with massive lymphadenopathy(SHML) is a benign, generally selflimited pseudolymphomatous disease that typically appears with cervical massive lymphaclenopathy. Extranodal involvement including skin occurs in the 28% of the cases. We report a case af SHML in 51 year-old male who had several, prominent firm masses ranging from 1-10cm in the cervical, axillary, inguinal areas and multiple, plum colored nodules and plaques in the face, trunk for about 10 years. The histopathological findings of cervical lymph node, facial nodule showed dense heavy infiltration of large histiocytes with abundant pale eosinophilic cytoplasm in the subcapsular and medullary sinuses of lymph node and dermis of skin. No atypical cells suggesting malignancy is seen in the infiltrates. The patient had been treated with combination of prednisolone and vinblasstine, but he expired 1 month later.
Cytoplasm ; Dermis ; Drug Therapy ; Eosinophils ; Histiocytes ; Histiocytosis, Sinus* ; Humans ; Lymph Nodes ; Male ; Middle Aged ; Prednisolone ; Prunus domestica ; Skin

At present, spinal anesthesia is often recommanded for a safe operation and the management of pain. However the complications from the spinal anesthesia, such as hypotension, dyspnes, nauses and vomiting, pulmonary embolism, headache, auditory and visual disturbances, lumbago, urinary difficulty and neurologic sequelae have often reported from time to time. Thus an attempt to study the complications of spinal anesthesia, particularly the differences of complications between needle sizes(22 gauge and 25 gauge), has been done by our department. The following results were observed: 1) The most common sequelae of spinal anesthesia was hypotension(35.6%) and in order frequency, urinay difficulty(23.3%), headache(16.7%), lumbago(15.3%), nauses of and vomiting(12.8%), dyspnes(8.9%), auditory and visual disturbances(0.83%) and minor neurologic sequelse(0.56%). 2) The incidence of headache and lumbago was more frequent in the 22G, group, but there were no statistically significant differences(p>0.05). 3) The incidence of headache was higher in the females than the males and there were statistically significant differences(p<0.01). 4) The incidence of lumbago was higher in the fourth decade (21.7%), and females showed a higher incidence than in males and there were statistically significant differences(p<0.05). 5) The incidence of lumbago and headache and the degree of headache was without correlation to the number of punctures in both groups(22G group and 26G group). 6) The time to postoperative urination had no correlation to the level of anesthesia.
Anesthesia ; Anesthesia, Spinal* ; Female ; Headache ; Humans ; Hypotension ; Incidence ; Low Back Pain ; Male ; Needles ; Pulmonary Embolism ; Punctures ; Urination ; Vomiting

The authors introduced flip back spin echo (FBSE) technique for MR imaging of the temporomandibular joint (TMJ) instead of conventional spin echo (SE) technique, and evaluated whether FBSE technique in MRI of TMJ is adequate for the diagnosis of the disorders or not. FBSE T1 parasagittal images in closed mouth state and sequential opening and closing mouth states using patient's own finger(s) were obtained and then FBSE T1 paracoronal image in closed mouth state and STAGE(short tip angle gradient echo) parasagittal T2WI were followed. All 30 images of the symptomatic TMJs using FBSE technique were excellent in the visualization of articular and their displacement, and we could easily diagnose the internal derangement. FBSE technique was adequate for the diagnosis of internal derangement of the TMJ, and the modified cine display from images using FBSE technique was advantageous in the diagnosis of the disorders by visualization of the dynamic motion of the TMJ.
Diagnosis ; Magnetic Resonance Imaging* ; Mouth ; Temporomandibular Joint*

Postoperative muscle pain is well known to occur in man following intravenous administration of succinylcholine. The mechanism of muscle pain is yet unknown. A number of methods for preventing muscle pains or decreasing their severity have been suggested, including nondepolarizing relaxants prior to succinylcholine (Churchill-Davidson, 1954: Cullen, 1971: Wig and Bali, 1979) or lidocaine(Usubiaga et al., 1967: Haldia et al., 1973: Fry, 1975), use of vitamin C (Gupte & Savant, 1971), procaine chloride(Morris & Dunn, 1957), thiopental sodium (Craign, 1964) or diazepam (Verma et al., 1978) and the use of a "self-taming" method of succinylcholine by prior injection of a small dose(Baraka, 1977). To investigate methods of preventing muscle pains or decreasing their severity after intravenous injection of succinylcholine, we studied four groups, a control group and three experimental groups (a lidocaine group, a d- Tubocurarine group and a succinylcholine self-taming group). The following results were obtained: 1) In the lidocaine group, the incidence of muscle pain was lower than in the control group, but there was no significant difference between the two groups. However the incidence of muscle pain in the d-Tubocurarine group or the succinylcholine self-taming group were lower than in the control group and there were statistically significant differences(p<0.0005). 2) In most of the patients of each group, the degree of postoperative muscle pain was mild and a difference of degree of muscle pain was not found in each group (p>0.05).3) The muscle pain usually appeared in the first day after operation and disappeared usually within three days. 4) The degree of muscle fasciculation showed a significant decrease with lidocaine, d-Tubocurarine or the succinylcholine self-taming group over the control group(p<0.0005), but there was no significant relationship between the degree of muscle fasciculation and the incidence of postoperative muscle pain(p>0.05). 5) The degree of muscle relaxation during intubation in the d-Tubocurarine group was less complete than in the other 3 groups and it was statistically significant(Zi>1.96). It is suggested from the above results that d-Tubocurarine(0.05~0.06mg/kg) prior to succinylcholine or the method of self-taming of succinylcholine(prior use of succinylcholine 0.15mg/kg) can be used as methods to prevent muscle pain after intravenous administration of succinylcholine, but lidocaine(2mg/kg) prior to succinylcholine is not effective in preventing muscle pain following succinylcholine administration.
Administration, Intravenous ; Ascorbic Acid ; Diazepam ; Fasciculation ; Humans ; Incidence ; Injections, Intravenous ; Intubation ; Lidocaine ; Methods ; Muscle Relaxation ; Myalgia* ; Procaine ; Succinylcholine ; Thiopental ; Tubocurarine

In 10 cases with intracranial arterivenous malformation (AVMs) diagnosed by MR spin echo images, MR angiography was evaluated and compared with conventional angiography in regard to depiction of nidus, arterial feeders, and draining veins. Spin echo images demonstrated the nidus of the AVM in all cases, but displayed the feeding vassels inadequately. These vessels were directly visualized with 3 dimensional STAGE(small tip angle gradient echo) MR angiography using rephasing/dephasing pulse sequences. In 5 cases MR angiography and conventional angiography showed the same results. However, in the others, MR angiography showed lower resolution than conventional angiography. MR angiography is useful in preangiographic evaluation of intracranial AVM but improvement in image resolution, which is dependent on MR hard ware and pulse sequence, is still to be desired.
Angiography* ; Intracranial Arteriovenous Malformations* ; Veins

Pseudoangiomatous stromal hyperplasia (PASH) of the breast occurs in premenopausal women and is characterized by anastomosing channels lined by spindle cells. It has been suggested to be of hormonal origin. This unusual condition may also be mistaken for a vascular tumor. We analyzed eight cases of PASH of the breast in Samsung Cheil Hospital from 1992 through 1998. All patients were premenopausal and had painless breast lump. Clinical diagnoses were fibroadenomas. Grossly, the masses were well circumscribed, nonhemorrhagic and measure 2.2 to 5 cm. Histologically, they consisted of complex interanastomosing channels lined by slender spindle cells, which resembled low grade angiosarcoma. Cells that line the interanastomosing channels showed no immunoreactivity for Factor VIII and electron microscopic findings consistent with fibroblast. All patients were treated with surgical excision and none of them had recurrence for 1 to 69 months (mean: 19 months) postoperatively. Pathologic diagnosis of PASH may be difficult unless the pathologists are aware of the presence of a mass lesion and appreciate the characteristic stromal changes. PASH should be included in the differential diagnosis of a circumscribed mass, especially in the premenopausal women.
Breast* ; Diagnosis ; Diagnosis, Differential ; Factor VIII ; Female ; Fibroadenoma ; Fibroblasts ; Hemangiosarcoma ; Humans ; Hyperplasia* ; Recurrence

Recently developed new classifications (Holland, Van Nuys, modified Lagios) of ductal carcinoma in situ (DCIS) linked to outcome have emphasized the importance of nuclear morphology rather than architecture. We have evaluated these three classifications in ductal carcinomas composed of in situ and invasive carcinomas. The reproducibility of three classifications was assessed (n=49), and the histological grade of the DCIS was compared with the histologic differentiation (modified Bloom & Richardson method) and nuclear grade (modified Black method) of the coexisting invasive ductal carcinoma (n=45). According to Holland classification, the DCIS component was poorly differentiated in 51.0%, intermediately differentiated in 40.8%, and well differentiated in 8.2%. Using the Van Nuys classification, the DCIS component was group 3 (high grade with or without necrosis) in 44.9%, group 2 (non-high grade with necrosis) in 28.6%, and group 1 (non-high grade without necrosis) in 26.5%. According to the modified Lagios classification, the DCIS component was high-grade in 42.8%, intermediate-grade in 32.7%, and low-grade in 24.5%. The histologic grades of the three classifications revealed significant correlations between Holland and Van Nuys classification (p<0.0001) and between Holland and modified Lagios classification (p<0.0001), especially in poorly differentiated/group 3/high-grade DCIS. The reproducibility of classification of the DCIS was 71.4% in the Holland, 61.2% in the Van Nuys, and 55.1% in the modified Lagios classifications. The grade of the DCIS showed significant correlation with the grade of coexisting invasive ductal carcinoma (p<0.0001), especially in poorly differentiated/group 3/high-grade DCIS. In conclusion, DCIS grade, determined by the Holland, Van Nuys or modified Lagios classifications, is closely correlated with the histologic grade of the invasive ductal component in tumors composed of in situ and invasive ductal carcinoma, and may be a useful factor to estimate clinical behavior of DCIS. In our experience the Holland classification is recommended for DCIS classification due to its high reproducibility.
Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Classification* ; Netherlands

PURPOSE: This study was carried out to identify the factor of decisional balance for exercise. This was composed of a set of variables at the level of decision making when the elderly decide to do exercise. It was used to classify and identify the characteristics of the stages of change for exercise to which the elderly belong, and was used to identify the variables of decisional balance which influence the stage of change for exercise in the elderly. METHODS: Convenient samples of 198 subjects over age 60 in Seoul( mean age=70) were selected from community living, mentally competant older adults and the data was collected from April 1, 1999 to May 31, 1999. The research instrument was the Decisional Balance Measure for Exercise(Marcus &Owen., 1992), Stage of Change Measure(Marcus et al,1992). The data was analyzed by SAS Program. RESULTS: 1. According to stage of change measure, without missing data,191 subjects were distributed in each stage of change for exercise: 50 subjects(26.1%), 7 subjects (3.6%), 52 subjects(27.2%), 4 subjects(2%), and 78(40.8%) belonged to the pre- contemplation stage, contemplation stage, preparation stage, action stage and maintenace stage. 2. Factor analysis identified 3 factors of decisional balance as appropriate factors for exercise of the elderly and named by researchers; 1)'Perceived Physical-psychological benefit', 2)'Perceived Physical-psychological burden', and 3)'Perceived time burden'. 3. The analysis of variance showed that the two components Perceived Physical - psychological benefit(F=45.95, P=.0001), and Perceived Physical-psychological burden (F=26.52, P=.0001) were significantly associated with stage of change. 4. Through the discriminant analysis, it was found that both 'Self Perceived Physical - Psychological benefit' and 'Perceived Physical-Psychological burden' were the influential variables in discriminating the three stages of change(pre-contemplation, preparation, and maintenance). CONCLUSION: Results are consistent with the application of the Transtheoretical model, which has been used to understand how people change health behaviors. Even though this study is a cross-sectional, not a longitudinal study, the findings of this study give useful information for exercise intervention about especially the factors relating to decision making for exercise of the elderly in the different stages of change of exercise.
Adult ; Aged* ; Decision Making ; Health Behavior ; Humans

The purpose of this study was to identify causal relationships among variables of transtheoretical model for exercise in the elderly. A predictivel model explaining the stage of change was constructed based on a transtheoretical model. Empirical data for testing the hypothetical model was collected from 198 old adults over 60 years old in a community setting in Seoul, Korea in April and May,1999. Data were analyzed by descriptive statistics and correlational analysis using pc-SAS program. The Linear Structural Modeling (LISREL) 8.0 program was used to find the best fit model which predicts causal relationship of variables. The fit of the hypothetical model to the data was X2=132.85. (df=22, p=.000). GFI=.88, NNFI=.35, NFI=.77, AGFI=.59 which was not favorable but the fit of modified model to the data was X2=46.90. (df=27, p=.01).GFI= .95, NNFI=.91, NFI=.92, AGFI=.87) which was more than moderate. The predictable variables of stage of change for exercise of the Korean elderly were helping relationship, self cognitive determination, conversion of negative condition in process of change and efficacy for exercise . These variables explained 68% of stage of change for exercise of the Korean elderly.
Adult ; Aged* ; Humans ; Korea ; Middle Aged ; Models, Structural ; Self Efficacy ; Seoul