Glomeruloid hemangioma is a histologically distinctive cutaneous angioma which is rarely de-scribed in patients with POEMS (polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes) syndrome and multicentric Castleman's disease. We report an additional case of glomeruloid hemangioma in a 30-year-old Korean woman with multicentric Castleman's disease showing features of POEMS syndrome. Histopathology revealed multiple dermal dilated vascular spaces composed of a conglomerate of capillaries, resulting in structures reminiscent of renal glomeruli. Periodic acid-Schiff-positive and diastase-resistant eosinophilic globules were found within the cytoplasm of vacuolated endothelial cells. The endothelial cells lining the capillary loops showed positive immunostaining for factor VIII-related antigen and CD31.
Adult ; Capillaries ; Cytoplasm ; Endothelial Cells ; Eosinophils ; Female ; Giant Lymph Node Hyperplasia* ; Hemangioma* ; Humans ; POEMS Syndrome ; Skin ; von Willebrand Factor

Twenty-five patients presenting with severe hemorrhage from benign peptic ulcers were randomized to either endoscopic injection sclerosis using a combination of hypertonic saline- epinephrine solution and 5% ethanolamine or to hypertonic-saline epinephrine solution only. Only high risk patients with active bleeding or endoscopic stigmata of recent hemorrhage of ulcers were considered. A median duration of hospital admission and median transfusion requirements between the two types of treated groups were not significant difference. The initial hemestatic effects of HS-E solution injection group(n=l5) or combination of HS- E solution and 5% ethanolamine injection group(n=l0) were 93%, 90% respectively. The rebleeding rate of HS-E solution injection group(n =15) or combination of HS-E solution and 5% ethanolamine injection group(n=10) were 33%, 30%, respectively. So, both HS-E solution therapy group and comination of HS-E solution & 5% ethanolamine injection group were effective in initial hemostasis for bleeding peptic ulcer patients. However, for the further evaluation of therapeutic effect and comparison of rebleeding rate between the two types of therapy, we think that it will be indispensable to collect more cases and to compare with control group.
Christianity ; Epinephrine ; Ethanolamine ; Hemorrhage* ; Hemostasis ; Humans ; Peptic Ulcer* ; Sclerosis* ; Ulcer

PURPOSE: In order to classify the involving patterns of maxillary sinus aspergillosis on CT that will be an important guidance for functional endoscopic sinus surgery(FESS) and to evaluate CT findings of each pattern. MATERIALS AND METHODS: We reviewed CT findings of 37 cases of maxillary sinus aspergillosis which were confirmed pathologically. These were classified into three patterns according to the location:the maxillary pattern(I), the infundibular pattern(11), and combined pattern(Ill). All cases were correlated with FESS findings. We also evaluated CT density, presence of contrast enahncement and calcifications, and surrounding bony changes of each pattern. RESULT: The combined pattern was most commonly seen in 24 of 37 cases(64.9%). The maxillary pattern was identified in 8(21.6%), with 5(13.5%)cases demonstrating the infundibular patttern. These patterns were consistent with FESS findings. Calcifications were seen in 28 cases(75.7%). 31 cases(83.8%) revealed hypodensity and 16cases among them showed peripheral enhancement. Central high density with peripheral low density rim was shown in 25%(2/8) of the maxillary pattern and 12.5%(3/24) of combined patttern. Surrounding bony changes were noted mainly in infundibular pattern and combined pattern. Erosion of uncinate process showed all cases of both patterns. Erosion or elevation of ethmomaxillary plate was seen in 3 of 5 cases of infundibular pattern and all cases of the combined pattern. CONCLUSION: CT fidnings of maxillary sinus aspergillosis can be classified into 3 patterns according to their distribution. These classification could be helpful for planning FESS approach. Calcifications are the most characteristic findings of maxillary sinus aspergllosis whereas CT density or enhancement pattern do not contribute to diagnosis.
Aspergillosis* ; Classification ; Diagnosis ; Maxillary Sinus*

Under the postulation that the double Ruiz procedure could increase the effect of radial keratotomy (RK), RK combined with horizontal and vertical Ruiz procedure was performed in three groups of 22 rabbit eyes. In the group A of six eyes, RK with vertical Ruiz procedure was performed, and eight weeks later horizontal Ruiz procedure was added. In the group B of eight eyes, RK with horizontal Ruiz procedure was performed, and four weeks later vertical Ruiz procedure was added. In the group C of eight eyes, RK with horizontal and vertical Ruiz procedure was performed simultaneously. As a control, in the group D of eight eyes, RK without Ruiz procedure performed. Changes in keratometry for four weeks and eight weeks postoperatively were analyzed. The results were as follows: 1. At eight weeks postoperatively, mean changes in keratometry were 6.434D, 3.663D, 4.030D and 1.585D in groups A, B, C and D, respectively. 2. Mean changes in keratometry of groups A, B and C were significantly higher than that of group D. 3. Mean changes in keratometry of 6.434D in group A was significantly the highest of the three groups in which double Ruiz procedure was performed. For the above results, it was concluded that double Ruiz procedure increased the effect of RK, and the procedure was more effective when the secondary Ruiz procedure was added eight weeks later.
Animals ; Astigmatism ; Cornea/*pathology/physiopathology ; Keratotomy, Radial/adverse effects/*methods ; Rabbits ; Time Factors

Under the postulation that double Ruiz procedure could increase the effect of radial keratotomy(RK), RK combined with horizontal and vertical Ruiz procedure was performed in three groups of 22 rabbit eyes. In the group A of six eyes, RK with vertical Ruiz procedure was performed, and eight weeks later the horizontal Ruiz procedure was added. In the group B of eight eyes, RK with horizontal Ruiz procedure was performed, and four weeks later the vertical Ruiz procedure was added. In the group C of eight eyes, RK with horizontal and vertical Ruiz procedure were performed simultaneously. As a control, in the group D of eight eyes, RK without Ruiz procedure was performed. Changes in keratometry for four weeks and eight weeks postoperatively were analyzed. The results were as follows: 1. At eight weeks postoperatively, mean changes in keratometry were 6.434D, 3.663D, 4.030D and 1.585D in groups A,B,C and D, respectively. 2. Mean changes in keratometry of groups A,B and C were significantly higher than that of group D. 3. Mean change in keratometry of 6.434D in group A was significantly the highest of the three groups in which the double Ruiz procedure was performed. From the above results, it was concluded that the double Ruiz procedure increased the effect of RK and that the procedure was more effective when secondary Ruiz procedure was added eight weeks later.
Rabbits ; Animals

PURPOSE: To illustrate frequently encountered anatomic variations on PNS computed tomography(CT) and to assess their clinical significance. MATERIALS AND METHODS: CT findings of 1523 patients, who underwent PNS CT with no history of sinus surgery, were reviewed, and prevalence of each anatomic variation and its relationship with mucociliary clearance pathway was evaluated. RESULTS: Two categories of anatomic variations were encountered. The first group included variations of the turbinates, such as concha bullosa(28.6% ), paradoxical middle turbinate(31.5%), of the uncinate process, such as medially bent or folded(36.3%), laterally bent(3.7%) or uncinate bulla(0.5%), of the ethmoidal sinus, such as Haller's ce11(28.2%), large agger nasi ce11(9.6%) or large ethmoidal bulla(23.5%) and nasal septal deviation(24. 1%), which might cause obstruction of mucociliary clearance pathway and thus give rise to secondary obstructive sinusitis. The second group included Onodi ce11(1.4%) and medial depression of the lamina papyracea (3.5%), which were not related with obstructive sinusitis. 87 cases of large agger nasi cell were associated with obstruction of nasofrontal recess. Large ethmoidal bulla(452 cases), Haller's ce11(245 cases) and true concha bullosa (25 cases) contributed to narrowing of the infundibulum. Medially bent uncinate process(220 cases), concha bullosa(157 cases), paradoxical middle turbinate(126 cases) and nasal septal deviation(93 cases) were observed in middle meatal obstruction and supreme concha (3 cases) accompanied sphenoethmoidal recess obstruction. CONCLUSION: Recognition of anatomic variations on PNS CT is important to build a treatment plan in patients with obstructive sinusitis as they may represent causes of the disease, and to avoid critical complications during functional endoscopic sinus surgery.
Anatomic Variation ; Depression ; Humans ; Mucociliary Clearance ; Prevalence ; Sinusitis ; Turbinates

BACKGROUND: Many studies document the presence of abnormalities in amino acids metabolism in chronic uremia. These abnormalities have been attributed to low protein intake, deficiency of excretory and metabolic functions of the diseased kidneys, toxic effects of uremia on the intermediary metabolism of amino acids and in dialysis patients, loss of protein and amino acids by the dialytic procedure. METHODS: This study was designed to compare anthropometric measurement, biochemical characteristics and plasma amino acid concentration between patients with end stage renal disease on maintenance hemodialysis (HD) and normal controls. A cross sectional study of overnight fasting plasma amino acids and plasma albumin, prealbumin, triglyceride (TG), cholesterol, transferrin concentration were performed on 20 hemodialysis patients and 20 normal controls, matched by age and sex. RESULTS: The concentrations of prealbumin (25.60+/-7.05 mg/dL vs 35.08+/-8.11 mg/dL, p<0.005), transferrin (158.30+/-39.66 mg/dL vs 275.50+/-55.46 mg/dL, p<0.001) were found to be lower in HD patients. No differences in albumin, cholesterol and TG were observed between the two groups. Several amino acids (taurine, cystine, phosphoserine) were found to be higher in the HD patients, while the concentrations of other five amino acids (serine, alanine, valine, leucine, tyrosine) were lowered in HD patients. No differences in nine amino acids (asparagine, glutamine, proline, glycine, methionine, isoleucine, lysine, histidine, arginine) were observed between the two groups. CONCLUSION: Our results suggest that chronic renal failure patients have malnutrition and amino acids abnormalities. To correct the amino acids abnormalities and improve nitrogen utilization in hemodialysis patients, correction of acidosis and supplementation of the diet with serine should be considered.
Acidosis ; Alanine ; Amino Acids ; Cholesterol ; Cystine ; Dialysis ; Diet ; Fasting ; Glutamine ; Glycine ; Histidine ; Humans ; Isoleucine ; Kidney ; Kidney Failure, Chronic ; Leucine ; Lysine ; Malnutrition ; Metabolism ; Methionine ; Nitrogen ; Nutritional Status* ; Plasma* ; Prealbumin ; Proline ; Renal Dialysis* ; Serine ; Serum Albumin ; Transferrin ; Triglycerides ; Uremia ; Valine

A retrospective analysis was performed on 69 follow-up cases of ducal carcinoma in situ(DCIS) treated from Jan. 1981 to Dec. 1995 at Department of Surgery, Seoul National University Hospital. The results are as follows. The mean age was 45.4 years that ranged from 28 to 68. The proportion of DCIS to breast cancer was increased from 1.3% to 7.2% for 15 years. Clinical presentations of DCIS were mass, nipple discharge and suspicious mammographic findings. Patients presenting mass were decreased, while mammographically detected DCIS were increased. In 49.3% of cases, the tumor size was smaller than 2cm and in 21.3% of the cases, the tumor was not palpable. Treatment modality was changed to more conservative procedures. All of the patients survived well without local recurrence or distant metastasis for a mean follow-up of 36.3 months(range 7 to 146). Histopathologic review was also performed on 52 cases of which paraffin blocks were saved, by one pathologist and diagnosis was confirmed. Pure DCIS composed 16 cases(30.8%), and DCIS with microinvasion was 36 cases(69.2%). Clinical presentation of DCIS, such as age, nipple discharge, calcification on mammography and mass size were not related to the microinvasion, but mass palpability was related to microinvasion(p=0.018). There was no histopathologic features to predict progression to invasive carcinoma, regardless of comedo type, histologic grade and nuclear grade. The expression of cathepsin-D, nm23, p53 and c-erbB-2 protein, was also evaluated using immunohistochemical methods. The relationship between expression of immunohistochemical antibodies and prognostic variables such as tumor size, histologic grade, nuclear grade, and microinvasion was assessed. The overexpression of c-erbB-2 protein was associated with lower nuclear grade(p=0.033), and a strong correlation was seen between tumor size and cathepsin-D and p53 protein(p=0.035, p=0.016). In this study, we conclude that the fine classification and analysis of DCIS subtype, not only by histopathologic but also by immunohistochemical study can be helpful to predict biological behaviour of DCIS and decide the modality of treatment.
Antibodies ; Breast ; Breast Neoplasms ; Carcinoma in Situ* ; Carcinoma, Intraductal, Noninfiltrating ; Classification ; Diagnosis ; Follow-Up Studies ; Humans ; Mammography ; Neoplasm Metastasis ; Nipples ; Paraffin ; Receptor, erbB-2 ; Recurrence ; Retrospective Studies ; Seoul

Malignant fibrous histiocytoma(MFH) was first introduced referring to a group of soft tissue tumors characterized by a storiform or cartwheel-like growth pattern. MFH is an aggressive soft-tissue sarcoma that most commonly occurs in the skeletal muscle of the extremities or retroperitoneum of adults. We report 2 cases of MFH occurring in 59-year-old man and 57-year-old woman. In the first case, the tumor occurred in right upper arm and has been removed totally. It was consisted of storiform, pleomorphic and myxoid area. In the second case, a painful nodule developed in right shin where the tumor had been excised 1 year ago. A biopsy revealed plump spindle cells appearing in a storiform-pleomorphic pattern.
Adult ; Arm ; Biopsy ; Extremities ; Female ; Histiocytoma, Malignant Fibrous* ; Humans ; Middle Aged ; Muscle, Skeletal ; Sarcoma

PURPOSE: To correlate SOhographic and pathologic findings of gallbladder adenoma, and to evaluate the clinical significance of sonographic findings. MATERIALS AND METHODS: Ultrasound findings of twenty gallbladder adenomas were retrospectively reviewed to evaluate the size, shape and echogenicity of the adenoma, and was correlated with the pathological finding. RESULTS: Among 14 patients, 11 patients had single lesion and 3 patients had multiple lesions. Three patients showed 2, 3 and 4 adenomas, respectively. Nine of 20 lesions showed focal dysplasia pathologically. Among the nine adenomas with dysplasia, two adenomas showed focal cancerous change. The nine adenomas showing focal dysplasia measured 25.6mm (14-35mm) in mean diameter, while the mean diameter of adenomas without dysplasia was 8.7 mm (3-13mm). The echogenicity of adenoma with focal dysplasia were hyperechoic in 8, isoechoic in 1. The echogenicity of adenomas without dysplasia were hyperechoic in 7, isoechoic in 4. Sessile(7/9) and papillary shape(6/9) were predominant in adenoma with dysplasia, but smooth shape(8/11) and stalked type(9/11) were predominant in adenoma without dysplasia. Two adenomas with focal cancerous change showed histological transition from cancer to dysplasia and to adenomatous tissue. In adenoma with dysplasia, the diameter more than 14 mm on sonography was statistically significant (p<0. 005). Also age of patient was significantly different between the two groups (p<0.01), while echogenicity and associated stone were not statistically significant. CONCLUSION: As gallbladder adenoma more than 14ram in diameter on US is suggestive of dysplasia on pathology, so, close follow up US or surgery is recommended.
Adenoma* ; Follow-Up Studies ; Gallbladder* ; Humans ; Pathology ; Retrospective Studies ; Ultrasonography