Hamartoma of the breast is a rare benign lesion presenting as palpable mass. They are, however, sometimes misdiagnosed by pathologist due to their resemblance to other benign or physiologic conditions of the breast. We report two cases of hamartomas of the breast. The clinical diagnosis was fibroadenoma in both cases. One patient was a 49-year-old woman presented with palpable mass for the duration of 5 months. Mammography showed a well demarcated round mass with homogeneous density which is slightly greater than the surrounding glandular tissue. Grossly it was a 3.5 3.0 2.0 cm sized round firm mass covered by thin fibrous tissue. Microscopically it was a well defined mass composed of variable amount of breast lobules, dilated ducts and adipose tissue surrounded by dense hyalinized connective tissue. The adipose tissue accounted for 30% of the entire lesion. Cellular atypism was not found. The other patient was a 18-year-old woman presented with palpable mass of the duration of 3 years, which was increased in size recently. Mammography demonstratesd a well delimited lobulated mass with lucent halo. Ultrasonography showed a well encapsulated low echoic mass admixed with high echoic areas. Grossly, it was a 4.0 4.0 2.0 cm sized well demarcated oval-shaped firm mass with translucent thin fibrous capsule.. Microscopic findings were similar to the former. The amount of adipose tissue was 20%.
Adipose Tissue ; Adolescent ; Breast* ; Connective Tissue ; Diagnosis ; Female ; Fibroadenoma ; Hamartoma* ; Humans ; Hyalin ; Mammography ; Middle Aged ; Ultrasonography

Thrombotic thrombocytopenic purpura (TTP) is an uncommon disorder, frequently fatal, characterized by a pentad of thrombocytopenia, microangiopathic hemolytic anemia, fluctuating neurologic symptoms, fever, and renal disease. TTP is characterized by widespread noninflammatory thrombotic occlusions of arterioles and capillaries with material containing fibrin and platelets. Generally, gross infarct is rare in the patient with TTP. We present a case of TTP with multiple gross infarcts on brain CT scan. A 53-year-old-man was presented with left hemiparesis and confused mentality. On laboratory study, he had microangiopathic hemolytic anemia & thrombocytopenia. Brain CT showed multiple gross infarct areas in the right basal ganglia, right parietal lobe and right cerebellar hemisphere. When managing the patient with acute stroke syndrome, we should consider TTP as a diagnostic possibility for early proper treatment, even if CT scan of brain show multiple gross infarctions.
Anemia, Hemolytic ; Arterioles ; Basal Ganglia ; Brain ; Capillaries ; Fever ; Fibrin ; Humans ; Infarction* ; Neurologic Manifestations ; Paresis ; Parietal Lobe ; Purpura, Thrombotic Thrombocytopenic ; Stroke ; Thrombocytopenia ; Tomography, X-Ray Computed

Heart failure unresponsive to bed rest, low sodium diet, digitalis, diuretics, vasodilators and cardiac inotropic agents is a difficult therapeutic problem. Although remission was achieved with such treatment, its duration was short and easily recurred. We present a report of severe refractory congestive heart failure in three patients successfully treated with Continuous Ambulatory Peritoneal Dialysis (CAPD). These patients were admitted to the hospital many times and treated by conventional methods but cannon maintain their condition for a long time. In all three patients, edema, pulmonary congestion, electrolyte abnormalities, decreased ejection fraction and fractional shortening of myocardioum were eliminated or improved by CAPD. All three patients improved from Class IV congestive heart to Class II, as defined by the New York Heart Association, and experienced a define improvement in their sense of well being We conclude CAPD as an effective and the useful treatment for servere congestive heart failure refractory to conventional medical treatments.
Bed Rest ; Diet ; Digitalis ; Diuretics ; Estrogens, Conjugated (USP)* ; Heart ; Heart Failure* ; Humans ; Peritoneal Dialysis, Continuous Ambulatory ; Pulmonary Edema ; Sodium ; Vasodilator Agents

Avellis syndrome is a clinical disorder characterized by ipsilateral paralysis of palate, larynx, and vocal cord paralysis and contralateral hemianesthesia. The syndrome is usually due to lesion of medulla oblongata. Involeved structures are nucleus ambiguus, lateral spinothalamic tract, and descending sympathetic fibers. We present 2 cases of Avellis syndrome with MRI findings, which showed infarction of right-sided upper medulla oblongata.
Adrenergic Fibers ; Infarction ; Larynx ; Magnetic Resonance Imaging ; Medulla Oblongata ; Palate ; Paralysis ; Spinothalamic Tracts ; Vocal Cord Paralysis

Paramyotonia congenita (PMC), an autosomal dominant non-progressive muscle disorder, is characterised by cold-induced stiffness followed by muscle weakness. The weakness is considered to be caused by a dysfunction of the sodium channel in muscle fiber. We report a 37-year-old male patient with PMC, complaining of episodic myotonia and motor weakness on cold exposure. In this patient, we performed clinical and neurological examination, electrophysiologic examination and muscle biopsy. On electrophysiologic study, needle EMG showed spontaneous myotonic discharges at room temperature but disappeared after cooling. Amplitude of compound action potential in abductor pollicis brevis muscle decreased significantly after cooling the tested extremity. Muscle biopsy showed a minimal variation of muscle fiber diameters, internal nuclei, chained nuclei, occasional atrophic fibers in vastus lateralis muscle. His mother, his son, three of six siblings, and five of eleven nephewes are affected with same symptomes.
Action Potentials ; Adult ; Biopsy ; Extremities ; Humans ; Male ; Mothers ; Muscle Weakness ; Muscular Diseases ; Myotonia ; Myotonic Disorders* ; Needles ; Neurologic Examination ; Quadriceps Muscle ; Siblings ; Sodium Channels

The blink reflex is an electrically induced glabella response that has long been used in clinical neurology. The blink reflex is now known to be a polysynaptic reflex with an afferent arc through sensory fibers of the trigerminal nerve and with an c,fferent arc through the motor fibers of the facial nerve. This study was performed to determine the relationship of latency and amplitude to ethnic groups sex and age and to obtain the normal data of korean in the blink reflex(BR) and direct facial nerve stimulation test(DFNS). BR and DFNS were recorded in 103 normal korean adults that consisted of 52 men and 51 women and the age ranged 22 to 77 years. The results are as follows: (1) the Rl wave was more stable than R2 and contralateral R2 wave, (2) there seerns to be no significant difference of latency and amphtude between ethnic groups, (3) the latency of Rl wave was shorter and the amplitude of CMAP was larger m men compared with women and (4) the latency of Rl wave was increased by aging.
Adult* ; Aging ; Blinking* ; Ethnic Groups ; Facial Nerve* ; Female ; Humans ; Male ; Neurology ; Reflex

A clinical study performed on respiratory care of 608 critically ill patients who had been admitted in respiratory intensive care unit(RICU) in 1985. 1) The number of patients who neeeded respiratory care was 608 and mortality in RICU decreased to 3.0%(18 cases) in 1985. 2) The average duration of ventilatory support was 2.3 days. The patients of thoracic surgery needed respiratory support for 2.2 days. 3) The mortalities according to department were 2.6%(14 of 547 cases) in thoracic sureerr, 11.1%(2 of 27 cases) in pediatric surgery and 10%(1 of 10 cases) in neurosurgery. 4) The Most frequently used ventilator was Bonnet MA-1 ventilator and the next were Bear-ll Bourns and Roche in orders. 5) Endotracheal intubation was used in 98.7% of patient and the incidence of tracheost-omy decreased to 1.3%. 6) Major causes of death in RICU were low cardiac output syndrome(72%) and sepsis(16.7%) as last lear.
Cardiac Output, Low ; Cause of Death ; Critical Illness* ; Humans ; Incidence ; Critical Care* ; Intubation, Intratracheal ; Mortality ; Neurosurgery ; Thoracic Surgery ; Ventilators, Mechanical

Role of Ca2+/calmodulin complex in intracellular Ca2+ mobilization in neutrophils has not been clearly elucidated. In this study, effects of chlorpromazine, trifluoperazine and imipramine on the intracellular Ca2+ mobilization, including Ca2+ influx, in C5a-activated neutrophils were investigated. Complement C5a-stimulated superoxide production and myeloperoxidase release in neutrophils were inhibited by chlorpromazine, trifluoperazine and imipramine, except no effect of imipramine on myeloperoxidase release. A C5a-elicited elevation of (Ca2+)i in neutrophils was inhibited by chlorpromazine, trifluoperazine, imipramine, staurosporine, genistein, EGTA, and verapamil but not affected by pertussin toxin. The intracellular Ca2+ release in C5a-activated neutrophils was not affected by chlorpromazine and imipramine. Chlorpromazine and imipramine inhibited Mn2+ influx by C5a-activated neutrophils. Thapsigargin-evoked Ca2+ entry was inhibited by chlorpromazine, trifluoperazine, imipramine, genistein, EGTA and verapamil, while in the activation process of neutrophils. The depressive action of calmodulin inhibitors on the elevation of cytosolic Ca2+ level in C5a-activated neutrophils appears to be accomplished by inhibition of Ca2+ influx from the extracellular medium.
Calmodulin* ; Chlorpromazine ; Complement C5a ; Complement System Proteins* ; Cytosol ; Depression* ; Egtazic Acid ; Genistein ; Imipramine ; Neutrophils* ; Peroxidase ; Staurosporine ; Superoxides ; Trifluoperazine ; Verapamil

Antioxidant effects of serotonin and L-DOPA on neuronal tissues were examined by studying the oxidative damages of brain synaptosomal components. The study further explored the mechanism by which they exert protective actions. Serotonin and L-DOPA (1 muM to 1 mM) significantly inhibited lipid peroxidation of brain tissues by either Fe2+ and ascorbate or t-butyl hydroperoxide in a dose dependent fashion. Protective effect of serotonin on the peroxidative actions of both systems was greater than that of L-DOPA. Protein oxidation of synaptosomes caused by Fe2+ and ascorbate was attenuated by serotonin and L-DOPA. Protein oxidation more sensitively responded to L-DOPA rather than serotonin. Serotonin and L-DOPA (100 muM) decreased effectively the oxidation of synaptosomal sulfhydryl groups caused by Fe2+ and ascorbate. The production of hydroxyl radical caused by either Fe3+, EDTA, H2O2 and ascorbate or xanthine and xanthine oxidase was significantly decreased by serotonin and L-DOPA (1 mM). Equal concentrations of serotonin and L-DOPA restored synaptosomal Ca2+ uptake decreased by Fe2+ and ascorbate, which is responsible for SOD and catalase. Protective effects of serotonin and L-DOPA on brain synaptosomes may be attributed to their removing action on reactive oxidants, hydroxyl radicals and probably iron-oxygen complex, without chelating action on iron.
Antioxidants* ; Brain* ; Catalase ; Edetic Acid ; Hydroxyl Radical ; Iron ; Levodopa* ; Lipid Peroxidation ; Neurons ; Oxidants ; Serotonin* ; Synaptosomes* ; tert-Butylhydroperoxide ; Xanthine ; Xanthine Oxidase

Background/Aims: Enzymatic analysis of aspartate/alanine aminotransferase (AST/ALT) does not exactly represent the progression of liver fibrosis or inflammation. Immunoassay for AST (cytoplasmic [c] AST/mitochondrial [m] AST) and ALT (ALT1/ALT2) has been suggested as one alternatives for enzymatic analysis. The objective of this study was to evaluate the efficacy of immunoassay in predicting liver fibrosis and inflammation. Methods: A total of 219 patients with chronic hepatitis B (CHB) who underwent hepatic venous pressure gradient (HVPG) and liver biopsy before antiviral therapy were recruited. Serum samples were prepared from blood during HVPG. Results of biochemical parameters including enzymatic AST/ALT and immunological assays of cAST, mAST, ALT1, and ALT2 through sandwich enzyme-linked immunosorbent assay (ELISA) immunoassay with fluorescence labeled monoclonal antibodies were compared with the results of METAVIR stage of live fibrosis and the Knodell grade of inflammation. Results: METAVIR fibrosis stages were as follows: F0, six (3%); F1, 52 (24%); F2, 88 (40%); F3, 45 (20%); and F4, 28 patients (13%). Mean levels of AST and ALT were 121 ± 157 and 210 ± 279 IU/L, respectively. Mean HVPG score of all patients was 4.7 ± 2.5 mmHg. According to the stage of liver fibrosis, HVPG score (p < 0.001, r = 0.439) and ALT1 level (p < 0.001, r = 0.283) were significantly increased in all samples from patients with CHB. ALT (p < 0.001, r = 0.310), ALT1 (p < 0.001, r = 0.369), and AST (p < 0.001, r = 0.374) levels were positively correlated with Knodell grade of inflammation. Conclusions ALT1 measurement by utilizing sandwich ELISA immunoassay can be useful method for predicting inf lammation grade and fibrosis stage in patients with CHB.