No abstract available.

No abstract available.
Epilepsy*

A 62-year-old man presented with a tender, solitary nodule on the left upper arm. He had no specific family history of the lesion. A biopsy specimen showed various sized irregular vascular lumens in the upper dermis. The vascular walls consisted of an endothelial cell layer and rim of one to three layers of glomus cell nests outside the endothelial cells. The cell nests consisted of round shaped epitheloid cells with relatively uniform round or oval shaped nuclei and pale cytoplasm. These tumor cells were strongly positive for vimentin, and a-smooth muscle actin. On electron microscopic examination, the cytoplasm of these tumor cells contained fine filamentous components and many electron dense bodies were found at the plasma membrane and the cytoplasm. We report a case of a solitary glomus tumor(glomangioma) that showed the histological features of the multiple type of glomus tumor. In addition we describe the results of an immunohistochemical and electron microscopic study.
Actins ; Arm ; Biopsy ; Cell Membrane ; Cytoplasm ; Dermis ; Endothelial Cells ; Glomus Tumor ; Humans ; Middle Aged ; Vimentin

No abstract available.

The subluxation of the femoral head is one of important prognostic factors in LCPD and current treatment of LCPD is based on the premise that adequate containment of the vulnerable femoral head within the acetabulum during the process of repair should result in a more spherical femoral head and a more congruous joint than if treatments were not provided.We analised the arthrographic findings of 18 hips in unilateral LCPD in order to determine the changes of the femoral head and acetabulum, degree of the subluxation and containment of the femoral head in various position of hip. The results were as follows: 1. According to the result of sphericity, the femoral head was deformed mainly in coronal plane in LCPD. 2. Average medial joint space of normal hip was about 3.8mm in the AP view of hip, but it was more increased in any position of LCPD. 3. In abduction with internal rotation, average subluxation ratio was 7.5% in normal hip and 10.9% in LCPD. In abduction with external rotation, it was 8.3% in normal hip and 12.4% in LCPD. 4. In normal hip, the containment ratio was more than 1.0 in any position of hip, but the containment ratio was 1.03 in abduction with internal rotation and 0.95 in abduction with external rotation of hip in LCPD. 5. On the basis of these results, efficacy of the Scottish Rite orthosis was doubtful in most hips of LCPD.
Acetabulum ; Arthrography ; Containment of Biohazards ; Head ; Hip ; Joints ; Legg-Calve-Perthes Disease ; Orthotic Devices

In the treatment of congenital heart in Korea, a big progress has made so far, and successful results have been achieved. However, there were few reports pertaining to the age and cause of death in congenital heart disease patients. Now, the author made observation on the mortality, the age and the mode of death in 3817 patients of congenital heart disease who had been admitted to Severance Hospital during the period of 15 years, from Jan 1972 to Dec 1986. The overall hospital mortality of the congenital heart disease was 6.1% ; 10.1% in the unoperated cases and 4.5% in the patients who underwent surgery. The hospital mortality of indivisual congenital heart disease was, in the order of increasing frequency, 1.0% for ventricular septal defect, and for the complicated heart disease, such as transposition of great vessels(12.5%), and total anomalous pulmonary venous return(15.8%) the death rate was higher in general. The mortality was highest under 1 year of age, especially during the neonatal period, i.e. under 1 month of age. The mode of death in the unoperated cases were congestive heart failure, infection, and hypoxia, in the order of frequency, comprising 84.5%, and in the patients who underwent surgery were congestive heart faliure or low cardiac output syndrome and htpoxia, 62.3%. Among the patients who died in the neonatal period, 76.9% died without accurate diagnosis, and 38.5% were under 5 days of age. Hypoxia(27%), congestive heart faliure(19.4%), and sepsis(11.6%) were the main mode of death. The analysis of the dead patients with congenital heart disease revealed the following results.The mortality was high in the complicated heart disease ; the major mode of death in surgical patients were congestive heart faliure or low cardiac output syndrome ; and the mortality was high in patients under one year of age, especially in the neonates, and most of then lacked accurate diagnosis.Therefore, more accurate properative diagnosis of complicated heart disease and better surgical techniques, development of diagnostic tools in neonatal period, and the need for early surgery and emergency medical management are uregently demanded.
Anoxia ; Cardiac Output, Low ; Cause of Death ; Child* ; Diagnosis ; Emergencies ; Estrogens, Conjugated (USP) ; Heart ; Heart Defects, Congenital* ; Heart Diseases ; Heart Failure ; Heart Septal Defects, Ventricular ; Hospital Mortality ; Humans ; Infant, Newborn ; Korea ; Mortality

No abstract available.
Diagnosis* ; Heart Failure* ; Heart Septal Defects, Ventricular ; Heart*

PURPOSE: We investigated whether myocardial SPECT had additional usefulness to clinical, functional or surgical indices for the preoperative evaluation of cardiac risks in noncardiac surgery. MATERIALS AND METHODS: 118 patients (M: F=66:52, 62.7+/-10.5 years) were studied retrospectively. Eighteen underwent vascular surgeries and 100 nonvascular surgeries. Rest T1-201/stress Tc-99m-MIBI SPECT was performed before operation and cardiac events (hard event: cardiac death and myocardial infarction; soft event: ischemic ECG change, congestive heart failure and unstable angina) were surveyed through perioperative periods (14.6+/-5.6 days). Clinical risk indices, functional capacity, surgery procedures and SPECT findings were tested for their predictive values of perioperative cardiac events. RESULTS: Peri-operative cardiac events occurred in 25 patients (3 hard events and 22 soft events). Clinical risk indices, surgical procedure risks and SPECT findings but functional capacity were predictive of cardiac events. Reversible perfusion decrease was a better predictor than persistent decrease. Multivariate analysis sorted` out surgical procedure risk (p=0.0018) and SPECT findings (p=0.0001) as significant risk factors. SPECT could re-stratify perioperative cardiac risks in patients ranked with surgical procedures. CONCLUSION:: We conclude that myocardial SPECT provides additional predictive value to surgical type risks as well as clinical indexes or functional capacity for the prediction of preoperative cardiac events in noncardiac surgery.
Death ; Electrocardiography ; Heart Failure ; Humans ; Multivariate Analysis ; Myocardial Infarction ; Myocardial Ischemia ; Perfusion ; Perioperative Period ; Retrospective Studies ; Risk Factors ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND AND OBJECTIVES: Dual isotope myocardial SPECT, rest thallium-201/dipyridamole stress Tc-99m sestamibi is used to diagnose coronary artery disease. We examined predictive value of myocardial SPECT for the prognosis of patients having or suspected coronary artery disease. MATERIALS AND METHOD: We examined 692 patients referred for dipyridamole stress myocardial perfusion SPECT. Cardiac events (hard and soft events) were followed up with medical record review and telephone interview. Survival analysis and multivariate Cox proportional hazard model were used to find significant predictors and the incremental predictive value of myocardial SPECT. Patients with coronary angiography (n=246) were analyzed in separate group. RESULTS: There were 4 hard events and 3 soft events in 341 normal SPECT group (1.20%/yr). There were 5 hard events and 21 soft events in 351 abnormal SPECT group (4.69%/yr). Survival curve was separated between normal SPECT group and abnormal SPECT group (p<0.01). In univariate analysis, smoking, history of myocardial infarction, typical chest pain and SPECT findings were important variables. In multivariate analysis, SPECT result was the single most independent predictor. Large reversible perfusion abnormality predicted worse prognosis. In patients with coronary angiography, SPECT did not add statistically significant predictive value to the coronary angiography. CONCLUSION: Dipyridamole stress Tl-201/ MIBI dual isotope myocardial perfusion SPECT provided excellent prognostic information. Extent of reversible perfusion decrease was the independent predictor of future cardiac events.
Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Dipyridamole ; Humans ; Interviews as Topic ; Medical Records ; Multivariate Analysis ; Myocardial Infarction ; Perfusion ; Prognosis ; Proportional Hazards Models ; Smoke ; Smoking ; Tomography, Emission-Computed, Single-Photon*

Candidiasis is the most common fungal infection complicating the course of patients with hematologic malignant neoplasms. Although widespread organ involvement is characteristic of disseminated candidiasis, reports of skin are rare. Reports describing typical clinical and histopathological finding of cutaneous lesions are very important since it may enable a diagnosis of disseminated candidiasis to be made and thus antifungal therapy can be initiated earlier. A 50-year-old housewife was admitted with a 5-month history of fatigue and easy bruising. She was diagnosed as ha.ving acute myelocytic leukemia and treatment was begun with daunorubicin and cytosin, arabinoside. Eight days after the start of chemotherapy, she developed a fever and generalized tender well demacated erythematous to purplish papulonodular eruption. A biopsy specimen from the skin lesion showed perivascular mononuclear cell infiltration and spore and pseudohypae v,rere found within the dermis and subcutis in PAS stain. Cultures of one skin biopsy specimen and one of four blood sarnples grew Candida tropicalis. The patient was treated with intravenous amphotericin B for disseminated candidiasis. On the tenth day of antifun gal therapy, she developed cardiopulmonary arrest and died.
Amphotericin B ; Biopsy ; Candida tropicalis ; Candidiasis* ; Daunorubicin ; Dermis ; Diagnosis ; Drug Therapy ; Fatigue ; Fever ; Heart Arrest ; Humans ; Leukemia, Myeloid, Acute ; Middle Aged ; Skin Manifestations* ; Skin* ; Spores