A case of primary amelanotic melanoma of the vagina diagnosed in scraping smear is described. A 64-year-old woman complained of vaginal bleeding with a 2.5x2cm sized, fungating mass on the right lateral vaginal wall near the introitus for 2 months. Scraping smears from the mass showed scattered individual tumor cells with single, bi- or multi-nucleated eccentric nuclei having prominent macronucleoli and occasional intranuclear inclusions. The cytoplasm was plump and cyanophilic with a indistinct rim. No melanin pigment was identified. Characteristic cytologic features of this case were very helpful to exclude more common squamous cell carcinoma in the vagina, which was strongly suggested in biopsy specimen.
Biopsy ; Carcinoma, Squamous Cell ; Child* ; Cytoplasm ; Female ; Humans ; Intranuclear Inclusion Bodies ; Mediastinum ; Melanins ; Melanoma, Amelanotic ; Middle Aged ; Proteinuria* ; Thyroid Gland ; Uterine Hemorrhage ; Vagina

Exercise induced asthma (EIA) is defined as acute, reversible, usually self-limiting airway obstruction which develop after strenous exercise in patients with asthma. EIA is a bigger problem in children than adults due to more active and smaller airways which obstruct more easily when bronchospasm develops. The exercise elicited many change in pulmonary function of asthmatic children. These change could be measured by measurements of PEFR, FEV1, FVC, or SRaw. The propose of this study is to determine the changes and sensitivity of different pulmonary function test in asthmatic children. 37 asthmatic children exercised on free running and pulmonary function tests were performed before and every 5 minutes during 15 minutes after exercise. The results were as follows. 1) In 37 asthmatic children, EIA developed in 23 children (62%) and did not developed in 14 children (38%). The difference in sex, height, weight, total eosinophil count, serum IgF and test between EIA and Non-EIA were not significant (P>0.05). 2) In EIA group, %PEFR was changed from 109.56% to 83.56%, But in Non-EIA group, %PEFR was not changed before and after exercise loading test. 3) In EIA group, %FEV1 was changed from 90.91% to 74.87%. But in Non-EIA group, %FEV1 was not changed before and after exercise loading test. 4) In EIA group, %FVC changed from 91.83% to 75.35%. But in Non-EIA group, %FVC was not change before and after exercise loading test. 5) There was significant difference in pre-exercise specific airway resistance between EIA (6.7+/-1.7) and normal children (5.8+/-2.2)(p<0.05). In EIA group, %SRaw was changed from 115.7% to 161.2%. But in Non-EIA group, %SRaw was not changed before and after exercise loading test. 6) During the post-exercise observation period, increasement of SRaw was greater than changes in any other pulmonary function test. SRaw is the most sensitive test for the ditection of exercise induced airway obstruction is asthmatic children.
Adult ; Airway Obstruction ; Airway Resistance* ; Asthma ; Asthma, Exercise-Induced ; Bronchial Spasm ; Child* ; Eosinophils ; Humans ; Peak Expiratory Flow Rate ; Respiratory Function Tests ; Running

BACKGROUNDS: To examine the effects of seizure laterality and stimulus type on Wada memory performance in patients with temporal lobe epilepsy(TLE). METHODS: The subjects were 43 patients with medically intractable TLE (left TLE 26, Right TLE 17) who had no or rare seizures after surgery. The memory stimuli were concrete figures for some subjects and abstract figures for the other subjects. RESULTS: A clinical criterion of at least 2-points difference between left and right injections correctly classified 31(72%) patients into left and right TLE groups, with 4(9%) patients falsely classified. A discriminant function analysis(DFA) based on left and right injection scores allowed for a correct classification of 37(86%) patients into left and right TLE groups. When the memory stimuli were concrete figures, the correct classification rate was greater for right than left TLE patients. In contrast, with abstract figures, the correct classification rate was greater for left than right TLE patients. CONCLUSIONS: The Wada memory test is a valuable diagnostic aid in lateralizing temporal epileptogenic foci. Stimulus type as well as seizure lateralization is a major determinant of Wada memory asymmetries.
Amobarbital* ; Classification ; Epilepsy, Temporal Lobe ; Humans ; Memory* ; Seizures ; Temporal Lobe*

PURPOSE: To report the clinical effect of a superior-inferior sliding conjunctival flap for pterygium using fibrin tissue adhesives (Tisseel(R); Baxter Healthcare Corporation, Glendale, CA) instead of sutures. METHODS: After the primary pterygial tissue was removed from the sclera, a superior-inferior sliding conjunctival flap was created. The fibrin tissue adhesive (Tisseel(R)) was composed of two solution types: fibrinogen containing aprotinin solution and a CaCl solution containing thrombin. The two solutions with 27 G needle were applied on the bare sclera in sequence, and the conjunctival flap was attached into the bare sclera within 5 seconds. We performed this procedure with a fibrin tissue adhesive instead of sutures in three patients, and follow-up for recurrence of pterygium and postoperative complications. RESULTS: The superior-inferior sliding conjunctival flaps were attached into the bare sclera in all patients using fibrin tissue adhesives. We didn't find any significant postoperative complications such as ocular pain, epiphora, foreign body sensation, wound defect, or dehiscence. CONCLUSIONS: A superior-inferior sliding conjunctival flap constructed with fibrin tissue adhesives should be a useful management tool for the inhibition of the recurrence of pterygial.
Aprotinin ; Delivery of Health Care ; Fibrin Tissue Adhesive* ; Fibrin* ; Fibrinogen ; Follow-Up Studies ; Foreign Bodies ; Humans ; Lacrimal Apparatus Diseases ; Needles ; Postoperative Complications ; Pterygium* ; Recurrence ; Sclera ; Sensation ; Sutures ; Thrombin ; Tissue Adhesives ; Wounds and Injuries

PURPOSE: We evaluated the relationship between the delayed visual acuity (VA) improvement and retinal features, including in the photoreceptor layer, after a successful macular hole surgery using optical coherence tomography (OCT) images during long-term post-operative observation. The goal was to find the mechanism in delayed VA improvement. METHODS: Postoperative OCT scans were analyzed in nine eyes of eight patients who underwent idiopathic macular hole surgery between June 2003 to June 2005. Horizontal and vertical OCT scans taken of the operated eyes immediately after absorption of intraocular gas and after VA improvement were exported to Adobe Photoshop 7.0. We measured changes in parameters of the central foveal thickness (central 1 mm area), photoreceptor layer thickness, relative reflectivity of photoreceptor to retinal pigment epithelium, and the defective area of photoreceptor layer. RESULTS: The median visual acuity was determined to be 0.2 (range: 0.15~0.3) at the VA unimproved period and 0.5 (range: 0.3~1.0) at VA improved period. The mean central foveal thickness decreased from 221.3 micrometer (range: 155~265 micrometer) to 191.2 micrometer (range: 150~231 micrometer), as VA improved (p=0.007). The mean photoreceptor layer thickness increased from 15.2 micrometer (range: 4.2~27.6 micrometer) to 22.6 micrometer (range: 4.2~35.8 micrometer) as VA improved (p=0.032), and mean relative reflectivity of photoreceptor layer increased from 0.43 (range: 0.08~0.67) to 0.48 (range: 0.10~0.70), as VA improved (p=0.415). The defective area of photoreceptor layer decreased from 70% (range: 90~45%) to 27% (range: 8~5), as VA improved (p=0.001). CONCLUSIONS: A decrease of the central foveal thickness and of photoreceptor layer defective signal, and an increase of photoreceptor layer thickness were observed on OCT during delayed vision improvement after a successful macular hole surgery. Improvement of macular edema and photoreceptor reorganization are suggested as important parts of the mechanism toward vision recovery.
Absorption ; Eye ; Humans ; Macular Edema ; Retinal Perforations ; Retinal Pigment Epithelium ; Retinaldehyde ; Tomography, Optical Coherence ; Vision, Ocular ; Visual Acuity

Mixed squamous cell carcinoma and papillary carcinoma in the thyroid gland is a very rare malignant tumor characterized by rapidly progressive clinical course and radioresistance. A 63-year-oid woman had mixed squamous cell carcinoma and papillary carcinoma in the thyroid gland diagnosed by fine needle aspiration cytology (FNA), and the diagnosis was confirmed by histological examination. She had complained of a fixed, egg-sized mass of the anterior neck with hoarseness for 1 year. The findings of FNA consisted of sheets and clusters of polygonal epithelial cells with hyperchromatic, pleomorphic nuclei and eosinophilic, abundant, laminated cytoplasm. These findings were consistent with squamous cell carcinoma. Also, foci of papillary carcinoma were noted, and the cells exhibited nuclear groovings and intranuclear cytoplasmic inclusions. Total thyroidectomy specimen showed a diffusely infiltrating tumor in the left thyroid which was composed of mixed papillary carcinoma and well-differentiated squamous cell carcinoma. In junction between two components, squamous metaplasia of papillary carcinoma was noted.
Biopsy, Fine-Needle ; Carcinoma, Papillary ; Carcinoma, Squamous Cell ; Child* ; Cytoplasm ; Diagnosis ; Eosinophils ; Epithelial Cells ; Female ; Giant Cell Tumors ; Giant Cells ; Glomerulosclerosis, Focal Segmental* ; Hoarseness ; Humans ; Inclusion Bodies ; Metaplasia ; Neck ; Ribs ; Thyroid Gland ; Thyroidectomy

PURPOSE: The purpose of this study was to identify relationships between quality of sleep, symptom cluster, depression, environmental disorder, and quality of life among hospitalized cancer patients. METHODS: The subjects were 114 patients who underwent chemotherapy for colon cancer, gastric cancer, gynecologic cancer and breast cancer. They were recruited from the cancer center of a university hospital. Data were collected from August 4th to 30th, 2011. The questionnaires included the Korean sleep scale A (quality of sleep), MDASI-K (symptom cluster), the environmental sleep disturbing scale, Zung's depression scale, and the Korean version of EORTC QLQ-C30. The collected data was analyzed by t-test, ANOVA, multiple regression analysis using the SPSS 19.0 program. RESULTS: Functional QOL was negatively associated with symptom QOL (r=-.798, p<.001). Symptom cluster, depression, & spouse (46.3%) were the most powerful predictors for functional QOL (46.3%) and symptom QOL (53.4%). CONCLUSION: It is evident that oncology nurses need to evaluate two dimensions of quality of life for cancer patients, for example, functional and symptom QOL. We recommend nurses develop specific protocols for relieving physical symptoms and alleviating depression, and furthermore test the effectiveness of them.
Breast Neoplasms ; Colonic Neoplasms ; Depression ; Humans ; Quality of Life ; Spouses ; Stomach Neoplasms ; Surveys and Questionnaires

Granular cell tumor is not uncommon and is a well recognized entity which may arise at virtually any site of the body. However, occurrence in the thyroid is extremely rare and has not been described well. Only three cases could be found in the English literatures. We report a case of granular cell tumor of the thyroid in a 30 year-old woman. The tumor was illdefined, infiltrative and was composed of diffuse sheets of polygonal to fusiform cells with abundant eosinophilic granular cytoplasm. The tumor showed evidence of Schwann cell differentiation in immunohistochemical and ultrastructural examinations. Differentiation from more common thyroid tumors having oncocytic granular cytoplasm should be made by immunohistochemistry or electron microscopy.
Adult ; Cell Differentiation ; Cytoplasm ; Eosinophils ; Female ; Granular Cell Tumor* ; Humans ; Immunohistochemistry ; Microscopy, Electron ; Thyroid Gland*

No abstract available.
Humans ; Infant, Newborn* ; Intracranial Hemorrhages* ; Vitamin K* ; Vitamins*

Invasive infection of the Streptococcus bovis group in a neonate is rare. In cases reported to date, the pathogen of neonatal S. bovis infections is usually Streptococcus gallolyticus subsp. pasteurianus (S. bovis biotype II/2). Streptococcus lutetiensis (S. bovis biotype II/1) was identified using 16S rRNA and tuf gene sequence analysis of the isolates from blood and cerebrospinal fluid (CSF) of a fever-presenting 28-day-old male. Blood culture analysis was performed using automatic equipment (VITEK 2) and identified Streptococcus infantarius supsp. infantarius, yet we were unable to get accurate results from the CSF culture. The fever subsided on the second day of hospitalization, and the patient was discharged without neurologic complication after 14 days of antibiotic therapy. In this case, we were able to accurately identify the pathogen using molecular genetic methods. To our knowledge, this is the first case of late onset neonatal bacteremia and meningitis caused by S. lutetiensis.
Bacteremia* ; Cerebrospinal Fluid ; Fever ; Hospitalization ; Humans ; Infant, Newborn ; Male ; Meningitis* ; Molecular Biology ; Sequence Analysis ; Streptococcus bovis ; Streptococcus*