We report herein a case of subcutaneous granuloma pyogenicum developed on the fourth interdigital space of right foot of 36-year-old housewife. Histopathological findings showed characteristic lobular capillary hemangioma. The subcutaneous nodule had a thick fibrous capsule and were composed of multiple, confluent cellular, angiomatous lobules separated by loose fibrous tissue. Most lobules contained round, oval or angular capillaries, lined by proliferated prominant endothelial cells projecting into the lumina of the vessels. Clinically, the lesion was a tender subcutaneous nodule with macerated surface aind soft corn or traumatic epidermal cyst were considered in the differential diagnoses.
Adult ; Capillaries ; Diagnosis, Differential ; Endothelial Cells ; Epidermal Cyst ; Foot ; Granuloma* ; Granuloma, Pyogenic* ; Humans ; Zea mays

PURPOSE: To evaluate the efficacy and safety of retroperitoneoscopic nephroureterectomy in patients with a transitional cell carcinoma of the renal pelvis and the ureter. MATERIALS AND METHODS: A total of 30 patients underwent nephroureterectomy for an upper tract transitional cell carcinoma. Of these, 16 underwent a retroperitoneoscopic nephroureterectomy(RNU) and 14 an open nephroureterectomy(ONU). After the retroperitoneal radical nephrectomy had initially been performed, a 5-6cm modified Gibson incision was then created to allow dissection of the lower ureter and bladder cuff and extraction of the intact specimen. A retrospective chart review was performed and the operating time, blood loss, analgesic requirement, ambulation time, interval to resume oral intake, hospital stay and complications assessed in both surgical groups. RESULTS: The RNU was superior to the ONU group with regard to blood loss(240.6+/-103.1 versus 519.3+/-62.3ml, p<0.05), analgesic requirement (118.8+/-24.7 versus 240+/-26mg, p<0.05), ambulation time(21.5+/-3.7 versus 36.3+/-5.1 hours, p<0.05), interval to resume oral intake(34+/-3.3 versus 58+/-7.1 hours, p<0.05), and hospital stay(5.5+/-1.4 versus 10.9+/-3.9days, p<0.05). Complications developed in 6 and 14 of the RNU and ONU patients, but all of complications in both group were resolved with conservative management. The mean operating time of the RNU group was longer than that of the ONU group(270.6+/-53.2 versus 233.6+/-20.2 mins, p<0.05). The operating time of the initial 8 patients in the RNU group(311.3+/-38.8 mins) was significantly longer than that of the ONU group(p<0.05). However, the difference in the operating times between the final 8 patients in the RNU group(230+/-7.5 mins) and those in the ONU group were not significant(p>0.05). CONCLUSIONS: A retroperitoneoscopic nephroureterectomy is better tolerated by patients than an open nephroureterectomy as the surgery for an upper tract transitional cell carcinoma, and is also an efficacious alternative to open surgery. However, a long-term oncological evaluation will be required.
Carcinoma, Transitional Cell* ; Humans ; Kidney Pelvis ; Laparoscopy ; Length of Stay ; Nephrectomy ; Pelvis ; Retrospective Studies ; Ureter ; Urinary Bladder ; Walking

Osteoporosis is a major health-care problem for aging communities. And postmenopausal osteoporosis is a common disorder characterized by an increase in bone resorption relative to bone formation, generally in conjunction with an increased rate of bone turnover. Twenty female rats were used as rat model of osteoporosis. They randomly were divided into two groups: a normal control group, and calcium-free diet groups treated with bilateral ovariectomy. The animals were sacrified at 12 weeks after treatment. In the rats with osteoporosis, there was significant thining and loss of trabeculae, accompanied by a disconnection of trabeculae. And acid mucopolysaccharides were decreased in osteoporotic animals. In order to setup conditions of invivo micro-CT, proper anesthetic is ketamine (50 mg/kg) /xylazine (6 mg/kg). And proper breathing rate of experimental animals is 1.3~1.6/sec. Our finding suggest that bilateral ovariectomy and calcium-free diet induce decrease in thickeness of trabecular bone and decrease in acid mucopolysaccharide, therefore cause weakness of bone. And micro-CT imaging system is useful to evaluate trabecular bone. Anesthetic time, anesthetics and respiration rate also signify much in micro-CT imaging system.
Aging ; Anesthetics ; Animals ; Bone Resorption ; Diet ; Female ; Glycosaminoglycans ; Humans ; Ketamine ; Models, Animal ; Osteogenesis ; Osteoporosis* ; Osteoporosis, Postmenopausal ; Ovariectomy ; Rats ; Respiration ; Respiratory Rate

A 42 year-old male with a history of multidrug-resistant pulmonary tuberculosis suddenly developed massive hemoptysis. Embolization of a bronchial artery branch and the collateral systemic arteries did not resolve the recurrent bleeding. Spiral computerized tomography(spiral CT) of the chest showed contrast enhanced nodules within a large cavity at the left lower lobe in the arterial phase suggesting a Rasmussen aneurysm. A pulmonary angiogram showed abnormal vascular nodules at that site. Coils were deployed at both the proximal and distal vessels of this aneurysmal sac for embolization. Transcatheter arterial embolization is a safe and effective means of controlling bleeding from this pulmonary arterial pseudoaneurysm. Here we report a case of a Rasmussen aneurysm diagnosed by spiral CT, which was successfully treated by pulmonary arterial embolization with a coil.
Aneurysm* ; Aneurysm, False ; Arteries ; Bronchial Arteries ; Embolization, Therapeutic ; Hemoptysis ; Hemorrhage ; Humans ; Male ; Respiratory Insufficiency ; Thorax ; Tomography, Spiral Computed ; Tuberculosis, Pulmonary

We investigate the potentials and limitations of computational fluid dynamics (CFD) analysis of patient specific models from 3D angiographies. There are many technical problems in acquisition of proper vascular models, in pre-processing for making 2D surface and 3D volume meshes and also in post-processing steps for display the CFD analysis. We hope that our study could serves as a technical reference to validating other tools and CFD results.
Angiography ; Arteries ; Carotid Arteries ; Hemodynamics ; Humans ; Hydrodynamics

PURPOSE: To analyze factors influencing clinical results after microfracture surgery in patients with osteoarthritic knee. MATERIALS AND METHODS: After microfracture surgery, in sixty-six patients with sixty-eight knees having full thickness chondral defect by arthroscopic evaluation, clinical results were evaluated with Baumgartner's nine-point scale during the follow-up of 1 year 4 months (range, 1-2 years 5 months). Results were analyzed according to age, the degree of preoperative varus and the existence of flexion contracture. RESULTS: Sixty-three knees showed excellent or good results at clinical evaluation. According to age, a significant difference was observed about 65 years old (p<0.05). The patients without flexion contracture and with less varus change had better clinical results, as did patients whose medial deviation of mechanical axis was less than 75% (p<0.05). CONCLUSION: Better clinical results, after microfracture surgery, were obtained in patients who were under the age of 65, with less than 75% of medial deviation of the mechanical axis on standing AP radiogram and no flexion contracture.
Aged ; Axis, Cervical Vertebra ; Contracture ; Follow-Up Studies ; Humans ; Knee* ; Osteoarthritis

PURPOSE: Autoimmune hepatitis is a chronic inflammatory liver disease with unknown cause that is characterized by liver histology, circulating autoantibodies and increased levels of immunoglobulin G. Only sporadic reports are available on autoimmune hepatitis in children. The aim of this study was to evaluate the clinical, biochemical, and histological features, and the long-term outcome of autoimmune hepatitis in Korean children. METHODS: We reviewed the medical records of 14 children diagnosed as having autoimmune hepatitis at Seoul National University Children's Hospital from 1990 to 2004, and analyzed clinical, biochemical, and histological features, and clinical outcomes. RESULTS: Mean age at diagnosis was 9 years and 11 of the 14 children were female. Six children presented with acute hepatitis-like manifestations. Jaundice and fatigue were the most common symptoms. Other autoimmune diseases accompanied in 6 children. Anti-nuclear antibody was detected in 13 patients and anti-smooth muscle antibody was positive in 8. All 14 patients were type 1 autoimmune hepatitis. The main histologic findings were interface hepatitis, rosette formation, and cirrhosis. Clinical and biochemical features were improved in six patients treated with ursodeoxycholic acid. Eight patients were treated with corticosteroid alone or in combination with azathioprine and five of them are in biochemical remission. CONCLUSION: Autoimmune hepatitis is an inflammatory liver disease, which has a favorable long-term outcome if it is diagnosed and treated promptly. Therefore, autoimmune hepatitis should be suspected in children with chronic hepatitis of unknown etiology, especially in female patients who show hypergammaglobulinemia or some clinical features of autoimmune disease.
Autoantibodies ; Autoimmune Diseases ; Azathioprine ; Child* ; Diagnosis ; Fatigue ; Female ; Fibrosis ; Hepatitis ; Hepatitis, Autoimmune* ; Hepatitis, Chronic ; Humans ; Hypergammaglobulinemia ; Immunoglobulin G ; Jaundice ; Liver ; Liver Diseases ; Medical Records ; Prognosis* ; Rosette Formation ; Seoul ; Ursodeoxycholic Acid

Previous studies showed that whole body vibration could prevent bone resorption and stimulate new bone formation. The aim of this study is to detect and track effect of whole body vibration for osteoporotic bone of OVX rats. 12 Female rats were used and allocated into 5 group, CON, SHAM, WBV 17, WBV 30 and WBV 45. Rats except SHAM group were ovariectomised to induce osteoporosis. Rats in WBV groups were stimulated whole body vibration at magnitude of 1 mm(peak-peak) and frequency 17 Hz, 30 Hz and 45 Hz, repectively, for 8 weeks (20 min, 5 days/week). The 4th lumbar in rats were scanned at a resolution of 35 micrometer at baseline, before stimulation, and 8 weeks by In-vivo Micro-CT. To detect and track changes of morphological characteristics in lumbar trabecuar bone of rats, structural parameters were measured and calculated from acquiring images. In the results, changes of structural characteristics of WBV group were smaller than those of CON group. Loss of quantity of trabecular bone in WBV 45 was the least. In contrast, that in WBV 17 was the biggest. These results showed that reasonable whole body vibration beneficially affected osteoporotic bones. In addition to, whole body vibration was likely to be substituted partly for drug treatment.
Animals ; Bone Resorption ; Female ; Humans ; Osteogenesis ; Osteoporosis ; Rats* ; Vibration*

Postoperative complications of liver transplantation include rejection, infection, hepatic vascular thrombus, and primary graft failure, etc. Among them, fungal infection shows nonspecific clinical symptoms and overlapping laboratory findings with variable etiologies causing post-transplant hepatic dysfunction. Therefore, early diagnosis of fungal infection is not easy. Here, we report an autopsy case of disseminated candidiasis and aspergillosis in a liver transplant patient. The case was at first misinterpreted as acute cellular rejection on biopsy because the histology of predominantly cellular infiltration, ductulitis and endothelialitis were similar to those of acute cellular rejection. On autopsy, the liver, lung and kidney showed multifocal hemorrhagic infarcts due to intra-arterial fungal emboli, which were composed mostly of candida species and a minor fraction of aspergillus. Fungal thrombi invading portal vein, intrahepatic arterioles with subsequent coagulation necrosis, venulitis and ductulitis were ascribed to the misdiagnosis on biopsies. It is unusual that systemic candidiasis, unlike aspergillosis, involves large arteries.
Arteries ; Arterioles ; Aspergillosis* ; Aspergillus ; Autopsy* ; Biopsy ; Candida ; Candidiasis* ; Diagnostic Errors ; Early Diagnosis ; Graft Rejection ; Humans ; Kidney ; Liver Transplantation ; Liver* ; Lung ; Necrosis ; Portal Vein ; Postoperative Complications ; Thrombosis ; Transplants

Background: A 35-year-old woman was admitted to the emergency room with sudden dyspnea that developed one day prior. The initial Chest X-ray showed multiple bullous changes at the right middle and lower lung field and long standing fibrotic tuberculous changes at the right upper lung field. The left lung field was totally collapesed by an fibrotic old tuberculous lesion. In spite of supportive medical care with oxygen therapy after admission, the radiographic lesions were no significant change but the respiratory distress had worsend. The patient suffered respiratory failure and receive mechanical ventilatory support. The HRCT showed a localized tension pneumothorax mimicking multiple giant bullae at the right lower lung field. Immediately after a closed thoracostomy with a 32 French chest tube and air drainage, her vital signs and dyspnea were gradually improved. The patient was successfully weaned from mechanical ventilation after 5 days of mechanical ventilatory support. The patient had receive talc pleurodesis through a chest tube to prevent the recurrence of the life-threatening localized pneumothorax. The patient was discharged without recurrence of the pneumothorax.
Adult ; Chest Tubes ; Drainage ; Dyspnea ; Emergency Service, Hospital ; Female ; Humans ; Lung ; Oxygen ; Pleurodesis ; Pneumothorax* ; Recurrence ; Respiration, Artificial ; Respiratory Insufficiency ; Talc ; Thoracostomy ; Thorax ; Vital Signs