Herein we wish to report a case of pernicious anemia and myasthenia gravis occurred after treatment with removal of an invasive thymoma and irradiation. Nine years ago, the male patient was visited due to chest pain, and was found a mediastinal mass at his age of 55. He received open thoracotomy and was found stage III invasive thymoma which infiltrated phrenic nerve and pericardium. After removal of thymoma, he received 4,500cGy of radiation. Two years later, he complained of left eyelid drooping and diagnosed as myasthenia gravis with tensilon test. His myasthenic eye symptom was controled with Mestinon. After 9 years from thymectomy, he complained of dizziness and dyspnea on exertion. Bone marrow smear revealed megaloblastic anemia and serum vitamin B12 level was 42.24pg/ml. Gastric juice analysis revealed achlorhydria with positive anti-intrinsic factor antibody. 6 weeks after treatment with parenteral vitamin B12, hematologic findings were normalized.
Achlorhydria ; Anemia, Megaloblastic ; Anemia, Pernicious* ; Bone Marrow ; Chest Pain ; Dizziness ; Dyspnea ; Edrophonium ; Eyelids ; Gastric Juice ; Humans ; Male ; Myasthenia Gravis* ; Pericardium ; Phrenic Nerve ; Pyridostigmine Bromide ; Thoracotomy ; Thymectomy* ; Thymoma* ; Vitamin B 12

To elucidate the clinical avaiability of FNAB, we reviewed retrospectively medical records of 30 patients who had infiltrative pulmonary lesion or pulmonary nodule or mediastinal mass, and got percutaneous fine needle aspiration biopsy using Westcott needle, 20~22 gauge, at the department of Pediatrics, Hanyang university hospital from July, 1986 to June, 1993. The obtained results were as follows: 1) There were 30 patients, aged 6 months to 15 years. 2) There were 17 male patients and 13 female patients with sex ratio of 1.3:1 3) Among 30 cases, we discovered 16 cases of infiltrative lesions, 7 cases of pulmonary nodules and 7 cases of mediastinal mass lesions. In mediastinal there were 4 cases of anterior mediastinum and 3 cases of posterior mediastinum. 4) Overall success rate on fine needle aspiration biopsy was 60% (18/30). The success rate was 50% (8/16) in infiltrative lesions, 50% (8/15) in pulmonary nodules and 71% (5/7) in mediastinal mass lesions, respectively. 5) Eight infiltrative lesione were diagnosed as Pneumocystis carinii pneumonia. Five pulmonary nodules were diagnosed as aspergillosis (2 cases), tuberculosis (1 case), mucormycosis (1 case), lung metastasis of metastasis of neuroblastoma (1 case). Five mediastinal mass lesions were diagnosed as teratoma (2 cases), lymphoma (1 case), malignant neurogenic tumor (1 case), ganglioneuroblastoma (1 case). 6) The complications occured in 20% (6 cases) among 30 procedures. All cases were due to pneumothorax: 3 cases spontaneously resolved, and 3 cases needed chest tube insertion. There were no death related with this procedures.
Aspergillosis ; Biopsy* ; Biopsy, Fine-Needle* ; Chest Tubes ; Child* ; Diagnosis* ; Female ; Ganglioneuroblastoma ; Humans ; Lung ; Lymphoma ; Male ; Mediastinum ; Medical Records ; Mucormycosis ; Needles ; Neoplasm Metastasis ; Neuroblastoma ; Pediatrics ; Pneumonia, Pneumocystis ; Pneumothorax ; Retrospective Studies ; Sex Ratio ; Teratoma ; Tuberculosis

Plasma col1 leukemia with motility-related morphological behavior is rarely studied. The plasma cells have variable degrees of cytoplasmic morphologies as dairy Projections, long extensions and pseudopods. These morphological evidences show the papa bility of wide spread and dissemination of disease itself. We present a case of a 38 year old woman who had back pain for 4 months and was diagnosed as a solitary plasmacytoma of the third lumbar vertebra. In spite of resection of the tumor and chemotherapy, the plasmacytoma was disseminated into both breasts and ovaries within less than a year. On her blood examination, we counted 34% of plasma cells in peripheral blood and 91.6% of plasma cells in bone marrow aspiration. Most of them resealed hairy projections and pseudopods of the cytoplasm.
Adult ; Back Pain ; Bone Marrow ; Breast ; Cytoplasm ; Drug Therapy ; Female ; Humans ; Leukemia ; Leukemia, Plasma Cell* ; Ovary ; Plasma Cells* ; Plasma* ; Plasmacytoma ; Spine

So far with the advancement in treatment modalities for malignant bone and soft tissue sarcomas the survival rate become higher. Till now there are some questions who can survive. Temporary procedure not affecting the treatment schedule would have more advantages than primary permanent one. When there is higher possibility of survival, this can be switched to permanent one. From Dec. 1986 to Jan. 1994, we had performed 40 cases of temporary arthrodesis after segmental resection of malignant bone and soft tissure tumors around the knee by using intramedullary nail andbone cement. Thirty eight cases of bone tumors[osteosarcoma(33), malignant fibrous histiocytoma(MFH)(3), chondrosarcoma(1), Ewing's sarcoma(1)] and 2 cases of soft tissue sarcomas[MFH(1), squamous cell carcinoma(1)] were analysed. Types of intramedullary nail used were rigid(Huckstep, 23 cases) or flexible(Ender, 17 cases). Six cases(15%) showed mechanical implant failure due to fracture (Huckstep;5, Ender;1) between 2 to 20 months after operation. Rearthrodesis using Ender nail and bone cement(5) or arthroplasty using Kotz prosthesis(1) were done for fractured cases. The other complicaitons were deep infection(2), peroneal nerve palsy(2), or transfixing screw fracture(2). Second reconstruction procedure was carried out in 2 cases with arthroplasty using Kotz prothesis. For IM nail, multiple Ender nailing seems to be superior to the Huckstep in mechanical strength. Contrary to the primary permanent reconsturction of the bone defect, this procedure has several advantages: 1) simple and does not hinder postoperative chemotherapy, 2) even in the extensively involved cases, can save the limb if the neurovascular structures are spared, 3) in Stage III, can save the salvagable limb, 4) economic and immediate stability can be helpful in the patient's quality of life, 5) two years later, when the survival approaches plateau, we can switch to another kinds of salvage operation, 6) Ender nail was superior to Huckstep in mechanical stability, 7) can be used for children expecting leg lengthening near puberty. It is useful for sarcoma patients around knee who require prolonged chemotherapy anbd whose life expectancy is relatively unexpectable.
Adolescent ; Appointments and Schedules ; Arthrodesis ; Arthroplasty ; Child ; Drug Therapy ; Epithelial Cells ; Extremities ; Humans ; Knee ; Leg ; Life Expectancy ; Peroneal Nerve ; Puberty ; Quality of Life ; Sarcoma ; Survival Rate

BACKGROUND: The importance of extended-spectrum beta-lactamases (ESBL) produced in gramnegative bacilli is now well recognized, but most clinical laboratories have problems in detecting and interpreting ESBL and implicating the findings in nosocomial infections caused by ESBL producing gram-negative bacilli. The present study aims primarily to evaluate the distributions of these enzymes among Escherichia coli and Klebsiella pneumoniae, the most frequent isolates of Enterobacteriaceae producing ESBL, to differentiate the types of enzymes in theses isolates and finally to relate the clonality of specific types within a part of Daegu city. METHODS: The clinical isolates of 1, 242 E. coli and 859 K. pneumoniae were screened for ESBL production by the disk diffusion method of the National Committee of Clinical Laboratory Standard, and it was confirmed by the double-disk synergy test (DDS). Antimicrobial susceptibility test was performed by the agar dilution method. The presence of -lactamase was tested by polymerase chain reaction (PCR) and plasmid analysis. Isoelectric focusing and nucleotide sequence analysis were performed to evaluate ESBL types. Pulsed-field gel electrophoresis (PFGE) of XbaI-digested DNA fragments was carried out to determine the extend of clonality within the hospital. RESULTS: Of 34 isolates of E. coli and 31 isolates of K. pneumoniae ramdomly selected from those isolates screened for ESBL production were further tested by DDS to confirm its production: 30 (88.2%) E. coli and 29 (93.5%) K. pneumoniae were positive. TEM-52 and SHV-12 were present both in E. coli and K. pneumoniae, but SHV-2a was distributed only in K. pneumoniae. The resistance was transferable in 66.7% of E. coli and 68.9% of K. pneumoniae. Six and 5 PFGE patterns were shown by E. coli and K. pneumoniae, respectively. Among the 5 patterns of K. pneumoniae, type B was dominant, suggesting a clonal outbreak in the hospital. CONCLUSIONS: The ESBL specific enzyme types were TEM-52, SHV-2a and SHV-12. Despite many different PFGE patterns of the ESBL producing isolates, a few outbreak and edemic clones appear to be prevalent in Dongsan Medical Center.
Agar ; Base Sequence ; beta-Lactamases* ; Clone Cells ; Cross Infection ; Daegu ; Diffusion ; DNA ; Electrophoresis, Gel, Pulsed-Field ; Enterobacteriaceae ; Escherichia coli* ; Isoelectric Focusing ; Klebsiella pneumoniae* ; Plasmids ; Pneumonia ; Polymerase Chain Reaction

Although occasional patients with chronic myeloid leukemia (CML) have chromosomal changes other than Philadelphia chromosome early in the disease, in typical cases the 9;22 translocation remains the sole abnormality throughout the disease course in chronic phase. When disease progression occurs, however, 75-80% develop additional chromosome aberrations. These secondary changes sometimes precede the more aggressive manifestations hematologically and clinically and thus may serve as valuable prognostic indicators. ider (9) (q10)t (9;22) (q34;q11.2) is very rare and a recurrent chromosomal abnormality associated with acute lymphoblastic leukemias (ALL) and lymphoblastic crisis of CML. And ider (9) (q10)t (9;22) (q34;q11.2) is a lymphoid-specific rearrangement and the patients with this abnormality are of older age on average. They commonly show pre-B cell lineage immunophenotype and L2 morphology. We report a case of ider (9) (q10)t (9;22) (q34;q11.2) as secondary aberration in a patient with lymphoblastic crisis of CML.
Blast Crisis ; Chromosome Aberrations ; Disease Progression ; Humans ; Leukemia* ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Philadelphia Chromosome ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Precursor Cells, B-Lymphoid

The diagnosis of acute undifferentiated leukemia is made when the leukemic cells cannot be classified using morphologic and cytochemical analyses, and do not express myeloid or lymphoid antigens. Trisomy 13 is a rare primary chromosomal abnormality in acute leukemia and associated with lineage inconsistency and poor prognosis. We report a rare case of acute undifferentiated leukemia showing negativity in periodic acid-Schiff (PAS) and myeloperoxidase (MPO) without any lineage-specific cell surface marker expression and having trisomy 13. The patient was a 72- year-old male who visited our hospital because of anemia and general weakness. On examination, leukocytosis with proliferated blasts (76%) in peripheral blood was noted. Bone marrow aspirate showed blast proliferation (74%) with morphologically hand-mirror type. The blast expressed CD34 (96%) and HLA-DR (76%) in immunophenotyping. Cytogenetic study of bone marrow cells showed 46,XY,+13,-21[15]/46,XY[5]. Induction chemotherapy was failed and differentiation to monocytic series was noted.
Anemia ; Bone Marrow ; Bone Marrow Cells ; Chromosome Aberrations ; Cytogenetics ; Diagnosis ; HLA-DR Antigens ; Humans ; Immunophenotyping ; Induction Chemotherapy ; Leukemia* ; Leukocytosis ; Male ; Peroxidase ; Prognosis ; Trisomy*

No abstract available.
Glomerulonephritis, Membranous* ; Guillain-Barre Syndrome* ; Uveitis*

Povidone-iodine (PVP-1) is a widely used antiseptic because of its low toxicity and germicidal effect. A 16 year old patient who had undergone incision and debridement of an anal abscess developed contact dermatitis on his buttocks postoperatively. The lesion had been exposed to a gauze immersed in a 10% povidone-iodine solution for 8 hours, but the skin around the surgical field directly painted with 10% povidone-iodine solution didn't show any effect. A patch test with povidone-iodine produced a negative response in this patient. These observations indicate that prolonged exposure to wet povidone-iodine is harmful. It is important that povidone-iodine be used carefully to prevent contact dermatitis.
Abscess ; Adolescent ; Anesthesia, Caudal* ; Buttocks ; Debridement ; Dermatitis, Contact ; Dermatitis, Irritant* ; Humans ; Paint ; Patch Tests ; Povidone-Iodine* ; Skin

No abstract available.
Myelodysplastic Syndromes*