BACKGROUND: The length of postoperative drug therapy remains controversial in pulmonary tuberculosis. We analyzed our experiences to determine the postoperative duration of chemotherapy after resection. METHODS: A retrospective review was performed in 66 of 95 patients that underwent pulmonary resection for pulmonary tuberculosis between January 1993 and December 1998. We compared the relapse rates according to the length of postoperative chemotherapy in each group, classified by the results of sputum AFB culture before the surgery, the number of resistant durgs, the number of prior treatment and the division of anti-TB drugs used postoperatively. RESULTS: Fifty three of 66(80.3%) were men and 13(19.7%) were women with a median age of 33.5 years(range, 16 to 63). The mean lengths of the pre-and post-operative chemotherapies were 4.9 months, and 12.9 months respectively. Five of 66 patients(7.6%) relapsed during the mean period of follow up(39.7 months). In the group less than three times of the prior treatment, there were two relapses(20%) in Ed-the highlight above-rephrase 10 patients that were medicated for 6 months or less, and one relapse in 43 patients(2.3%) that took medicine for more than 6 months(p=0.03). In the group using second-line drugs postoperatively, there was one relapse(25%) in four patients that were medicated for 12 months or less. No patient in a total of 17 that received medicine for more than 12 months relapsed(p=0.03). CONCLUSION: We recommend that patients with the prior treatment less than three times should be treated for more than 6 months after resection and patients using the second-line drugs postoperatively should be medicated for more than 12 months.
Drug Therapy ; Female ; Humans ; Male ; Recurrence ; Retrospective Studies ; Sputum ; Tuberculosis, Pulmonary*

We observed a case of tuberculosis cutis orificialis, which occurred in 50 year-old man. He had been suffered from single markedly inflamed, erythematous painful ulcer, covered by dirty brown pseudomembranous material, around anus for 3 months. The laboratory findings (CBC, routine urinalysis, stool ova and parasite with occult blood) are within normal limits except elevated ESR (52mm/hr.). Staphyloeoccus aureus and proteus are observed on wound culture, and many AFB are seen on scrapings of wound but not on sputum for 3 times. Unfortunately culture was not done. Tuberculin skin test revealed strong reaction (36mm/hr.). Chest PA and small bowel series showed far advanced pulmonary tuberculosis and intestinal tuberculosis on ileocecal area. But the findings of upper gastro-intestinal series and barium enema are within normal limits. Histopathologic findings of skin lesion showed tuberculous and tuberculoid granuloma in the deep dermis and subcutaneous tissue. We observed a case of tuberculosis cutis orificialis, which occurred in 50 year-old man. He had been suffered from single markedly inflamed, erythematoas painful ulcer, covered by dirty brown pseudomembranous material, around anus for 3 months. The laboratory findings (CBC, routine urinalysis, stool ova and parasite with occult blood) are within normal limits except elevated ESR (52mm/hr.). Staphyloeoccus aureus and proteus are'observed on wound culture, and many AFB are seen on scrapings of wound but not on sputum for 3 times. Unfortunately culture was not done. Tuberculin skin test revealed strong reaction (36mm/hr.). Chest PA and small bowel series showed far advanced pulmonary tuberculosis and intestinal tuberculosis on ileocecal area. But the findings of upper gastro-intestinal series and barium enema are within normal limits. Histopathologic findings of skin lesion showed tuberculous and tuberculoid granuloma in the deep dermis and subcutaneous tissue. Treatment with INH, myambutol and rifampin resulted in some improvment on the chest and considerable improvement on the skin and intestine within 6 months.
Anal Canal ; Barium ; Dermis ; Enema ; Ethambutol ; Granuloma ; Humans ; Intestines ; Middle Aged ; Ovum ; Parasites ; Proteus ; Rifampin ; Skin ; Skin Tests ; Sputum ; Subcutaneous Tissue ; Thorax ; Tuberculin ; Tuberculosis* ; Tuberculosis, Pulmonary ; Ulcer ; Urinalysis ; Wounds and Injuries

Vulva syringomas are rare in reviewing literature. In our case, a 29-year-old had multiple papular lesions involving both sides of the vulva. Microscopically the lesion showed dilated cystic sweat ducts some of which have small comma like tails resembling tadpoles. It is the purpose of this report to present a rare case of syringoma which was limited to the vulva without involvement of other sites.
Adult ; Humans ; Larva ; Sweat ; Syringoma* ; Vulva*

An endodermal sinus tumor is a malignant germ cell tumor that usually arises in the gonads, but on rare occasion occurs in extragonadal locations. Our case was that of a 3 year old girl who complained of a rapid growing orbital mass. On histologic examination it revealed the typical picture of an endodermal sinus tumor and it also disclosed a positive reaction for alphafetoprotein using an immunoperoxidase technique. An orbital exenteration was performed followed by chemotheraphy, but the patient died 5 months after the onset of the disease.

Turner's syndrome results from complete or partial monosomy of the X chromosome and is characterized by hypogonadism or related other congenital anomalies in phenotypic females. In these patients, there are failure to develop normal secondary sex characteristics, amenorrhea, or short stature at puberty and the ovaries are reduced to atrophic fibrous strands devoid of ova and follicles(streak gonads). Individuals with this condition are particularly prone to the development of gonadoblastoma. For this reason, the gonads should be early removed and supplemental estrogen therapy given. We experienced a case of Turner's syndrome, 45, XO/46, XY karyotype in a 20-year-old phenotypic female complained an amenorrhea. On the exploratory laparotomy, the right gonadal mass is sevearly adhered to the adjacent organs and measures 8 x 5 x 5 cm in dimension and 75gm in weight and shows multiple foci of hemorrhage with necrosis. The left streak gonad measures 3.5 x 2 x 1.5 cm in dimension and shows multiple foci of calcification. Microscopically, the right gonadal mass reveals malignant mixed germ cell tumor, composed of endodermal sinus tumor, composed of endodermal sinus tumor with dysgerminoma and gonadoblastoma. The left streak gonad consists of mainly dense fibrous connective tissue and shows some foci of calcification associated with gonadoblastoma. On immunohistochemical and special stainings, the cytoplasm and hyalin droplets of the endodermal sinus tumor component reveal strong positivity to the a-fetoprotein and PAS. After removal of both gonads, the serum level of the a-fetoprotein is markedly down from 1742ng/ml to 2.6 ng/ml.
Female ; Humans

Ketotifen, a benzocycloheptathiophene, has an orally effective antiallergic as well as antihistaminic properties. In pervious studies, Ketotifen has shown encouraging results on patient with allergic rhinitis, either perennial or seasonal. 39 patients with allergic rhinitis had been treated with Ketotifen 1 mg twice daily for 8 weeks. And we obtained following results. 1) The efficacy rate in sneezing attack was 73.5%, in nasal discharge 71%, in nasal obstruction 58%. 2) Some improvements in at least one of three-major symptoms were noted within 1 week in 30.7%, within 2 weeks in 55.8%, within 3 weeks in 66.7%, within 8 weeks in 87.2%. 3) Physical findings such as colour, swelling of turbinate, character of rhinorrhea were not improved significantly. 4) Side effect was observed only in one patient with abdominal pain and diarrhea, which was subsided after interruption of administration. These results suggested that Ketotifen was effective in treatment of allergic rhinitis.
Abdominal Pain ; Diarrhea ; Humans ; Ketotifen* ; Nasal Obstruction ; Rhinitis, Allergic* ; Seasons ; Sneezing ; Turbinates

We have experienced 17 cases of the upper brain stem compression lesions diagnosed by serial vertebral angiography and other ancillary studies from October, 1972 to August, 1975. All the cases were proven by serial vertebral angioraphy using the Seldinger catheter technique through the femoral artery and other studies such as carotid angiography, conray ventriculograpy, brain scan and pneumoencephalography. Angiographical analysis were attempted. The results were as following: 1. The location of lesion is:supratentorial lesions; 8 cases, infratentorial lesions; 5 cases, tentorial lesions; 3 cases, bilateral hippocampal herniation due to otitic hydrocephalus; 1 case. 2. We have tried to classify the upper brain stem compression lesions according to the direction of compression, i.e., (1) forward, (2) medial, (3) backward and (4) downward and analyzed their angiographic findings in detail. 3. Lesions compressed the upper brain stem forward were one case of bilateral occipital meningioma, one case of fourth ventricle tumor, two cases of medulloblastoma and one case of cerebellar hemispheric tumor. Their main angiographic findings were as follows;(1) Separation of quadrigeminal segment of superior cerebellar artery and posterior cerebral artery, (2) Compression of basilar artery against clivus and depression or elevation of bifurcation of basilar artery, (3) Stretching of thalamoperforating artery, (4) Elevation and forward basilar artery, (3) Stretching of thalamoperforating artery, (4) Elevation and forward displacement of posterior mesencephalic vein and posterior displacement of precentral cerebellar vein, (5) Elevation of vein of Rosenthal. 4. Lesions compressed the upper brain stem medially were two cases of parietal ependymoma, one case of temporal meningioma, one case of bilateral hippocampal herniation and three cases of tentorial tumors. Their main angiography findings were as follows; (1) Medial displacement of posterior cerebral artery, superior cerebelar artery, bifurcation of basilar artery, distal portion of vein of Rosenthal, lateral mesencephalic vein and internal cerebral vein in Towne's view, (2) Elevation or depression of posterior mesencephalic vein, (3) Depression of bifurcation of basilar artery, (4) Stretching of thalamoperforating artery, (5) Depression of crural and ambient segment of superior cerebellar artery. 5. Lesions compressed the upper brain stem backward were one case of pituitary tumor and one case of cerebellopontine angle tumor. Their main angiographic findings were as follows; (2) Posterior displacement of distal portion of basilar artery, (2) Posterior displacement of anterior pontomesencephalic vein, (3) Elevation of posterior cerebral artery and superior cerebellar artery, (4) Elevation of vein of Rosenthal and posterior mesencephalic vein, (5) Stretching and elevation of posterior communicating artery. 6. Lesions compressed the upper brain stem downward were one case of thalamic tumor, one case of thalamic hemorrhage, and one case of pinealoma. Their main angiographic findings were as follows; (1) Stretching of posterior cerebral artery and superior cerebellar artery, (2) Displacement and stretching of internal cerebral vein, vein of Rosenthal and posterior mesencephalic vein, (3) Depression of bifurcation of basilar artery, (4) Stretching of thalamoperforating artery, (5) Depression of posterior cerebral artery and superior cerebellar artery, (6) Depression of internal cerebral vein, vein of Rosenthal, posterior mesencephalic vein and anterior pontomesencephalic vein. 7. We have concluded that in order to diagnosis the upper brain stem compression lesions serial vertebral angiography is the most important procedure and at the same time the analysis of the arteriographic and venographic findings in detail is important.
Angiography* ; Arteries ; Basilar Artery ; Brain Stem* ; Brain* ; Catheters ; Cerebral Veins ; Cranial Fossa, Posterior ; Depression ; Diagnosis ; Ependymoma ; Femoral Artery ; Fourth Ventricle ; Hemorrhage ; Hydrocephalus ; Medulloblastoma ; Meningioma ; Neuroma, Acoustic ; Pinealoma ; Pituitary Neoplasms ; Pneumoencephalography ; Posterior Cerebral Artery ; Rabeprazole ; Veins

BACKGROUND: Recently technetium-99m sestamibi (99mTc MIBI), which dose not require withdrawal of thyroid hormone, has been used for imaging of thyroid carcinoma. The aim of this study was to determine the clinical usefulness of Tc MIBI scintigraphy after total thyroidectomy for thyroid carcinoma. The results were compared with those of standard 131I scintigraphy. METHODS: One hundred twelve patients with a median age of 44 years (range, 14-76 years) were included in the study. After optimal endogenous thyroid stimulating hormone stimulation (>50 mIU/mL), whole body scintigraphy using 4 mCi of 'I and 20 mCi of Tc sestamibi were done simultaneously. Concomitantly serum thyroglobulin and anti-thyroglobulin antibody levels were checked. If abnormal findings on any of the scintigraphic methods or high levels of thyroglobulin (> 10ng/mL) were detected, diagnostic imaging studies were done to confirm the existence of the disease. And high dose (150-200 mCi) 'I was administered as therapy and then whole body scans were performed again after the therapy. The presence or absence of thyroid cancer was established by pathologic, radiologic, and/or high dose I scan findings. RESULTS: In 11 patients, Tc MIBI scan revealed positive accumulations which were not found on 131I scan, of whom 6 had elevated thyroglobulin levels. In these cases, 5 cases were interpreted to have normal thyroid remnant and 6 cases showed pathologic findings (2 lung, 1 lymph node, 1 lung and lymph node, 1 local recurrent cancer, and 1 false positive accumulation of 99mTc MIBI). Metastasis or residual cancer were confirmed histologically in 1 and radiologically in 4 cases. Negative 99mTc MIBI scans, despite of positive I scans, occurred in 9 patients, of whom 2 had abnormal thyroglobulin levels. Seven cases were interpreted to have thyroid remnant, 2 cases were confirmed to have lung metastasis, and another one was misinterpreted due to breast shadow. CONCLUSION: In conclusion, these results suggest that 99mTc MIBI scan may have similar sensitivity and specificity for the detection of residual or metastatic differentiated thyroid carcinoma. The 99mTc MIBI scan, especially in cases of negative 131I scan despite of abnormal thyroglobulin levels, can be used as a very useful complementary diagnostic tool.
Breast ; Diagnostic Imaging ; Follow-Up Studies* ; Humans ; Lung ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm, Residual ; Radionuclide Imaging* ; Sensitivity and Specificity ; Technetium Tc 99m Sestamibi ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyrotropin ; Whole Body Imaging

A case of metastatic tumor of the skin is described with literature review. Cutaneous metastases of malignant tumor is rarely seen but lung cancer in male and breast cancer in female are not infrequently reported. This patient, 37 year old male, had lung cancer, had several chest tappings for pleural effusion and a pleural biopsy. 8 months later, skin manifestation of diffuse erythematous sclerotic patches and confluent nodules was noted on pleural biopsy site, right lateral chest wall. Histopathological finding was compatible with metastatic carcinoma. This metastatic skin tumor is considered to be arisen from the lung probably due to pleural biopsy.
Adult ; Biopsy* ; Breast Neoplasms ; Carcinoma, Bronchogenic* ; Female ; Humans ; Lung ; Lung Neoplasms ; Male ; Neoplasm Metastasis* ; Pleural Effusion ; Skin Manifestations ; Skin* ; Thoracic Wall ; Thorax

No abstract available.
Child* ; Humans ; Peritoneal Dialysis, Continuous Ambulatory*