No abstract available.
Animals ; Borrelia burgdorferi* ; Borrelia* ; Murinae*

The lymphoepithelial cyst (LEC) rarely occurs in the thyroid gland. The LEC has been thought to be related to developmental rest, namely solid cell nest, which is derived from ultimobranchial body. We report a case of lymphoepithial cyst in a 34- year-old woman clinically diagnosed with Hashimoto's thyroiditis. The cyst was located in mid to lower portion of the left lobe. It was a single unilocular cyst, which for the most part was lined with squamous epithelium, and at certain foci with ciliated columnar epithelium. The cyst wall showed a dense lymphocytic infiltration, numerous lymphoid follicles with germinal centers and admixed thyroid follicles. This morphology is similar to the branchial cleft cyst, with the exception of the thyroid follicles in the cyst wall. Near the cyst were several solid epidermoid cell nests. Immunohistochemical stain of this cyst-lining epithelium and solid cell nests showed CEA positivity. In view of the similarity in histomorphology and CEA positivity to branchial cleft cyst of the lateral neck, the LEC of the thyroid could also have been of branchial origin. However, the admixed thyroid follicles in the cyst wall suggests that the LEC of the thyroid gland might have derived from another branchial cleft as a ultimobranchial body, because it has the potential for thyroid follicular differentiation.
Branchial Region* ; Branchioma ; Epithelium ; Female ; Germinal Center ; Humans ; Neck ; Thyroid Gland* ; Thyroiditis ; Ultimobranchial Body

PURPOSE: We studied results of the communited distal radius fracture treated with allogenic cancellous bone graft and volar locking plate in the elderly. MATERIALS AND METHODS: We studied 29 cases of communited distal radius fracture treated with allogenic cancellous bone graft and volar locking plate from April 2009 to April 2013. Fracture was classified according to AO/OTA classification. Postoperative clinical evaluation was performed with measurement of wrist range of motion (ROM) at last follow-up, modified Mayo wrist scoring system (MMWS), and visual analogue pain scale (VAS). Radiologic evaluation was performed with measurement of radial length on immediate postoperation and last follow-up, radial inclination, volar tilt and ulnar variance checked at the last follow-up using Sarmiento criteria. RESULTS: Using the MMWS, 13 cases were classified as 'good', 10 'fair', and 5 'normal'. The average wrist ROM was 88.5% for flexion, 92.2% for extension, 90.5% for adduction, and 94.0% for abduction. The average VAS was 1.7. On the last follow-up, average radius length, radial inclination and volar tilt did not show statistically significant improvement (p>0.05) compared to immediate post operation measurements, and according to Sarmiento criteria, 5 cases were classified as 'good', 14 'fair', and 7 'normal'. CONCLUSION: Treatment of severe communited distal radius fracture accompanied by bone defect with volar locking plate and allogenic cancellous bone graft is a satisfying and effective treatment method in the elderly.
Aged* ; Classification ; Follow-Up Studies ; Humans ; Pain Measurement ; Radius ; Radius Fractures* ; Range of Motion, Articular ; Transplants* ; Wrist

Assessment of the optic nerve head or the retinal nerve fiber layer is essential for the early diagnosis and monitoring of glaucoma. We compared mean retinal nerve fiber layer[RNFL]thickness with Average, and compared RNFL CSA with Integral between Heidelberg Retina Tomograph[HRT] and GDx nerve fiber analyzer[GDx]at global, superior, inferior, nasal and temporal area. Mean RNFL thickness in HRT was significantly greater than Average in GDx at all quadrants[p<0.001], and correlated with Average at global, superior and inferior area[p<0.05]. RNFL CSA in HRT was significantly greater than Integral in GDx at superior, inferior and nasal quadrants[p<0.001], and correlated with Integral at superior and inferior quadrants[p<0.05]. In conclusion, the two parameters related to nerve fiber layer in HRT were measured greater than those in GDx. Correlations of the above parameters between HRT and GDx were mainly present at superior and inferior quadrant. These results may come from regional difference in measurement between HRT and GDx, and uncorrected disc tilting in HRT appears to have adverse effects on the correlations of the above parameters between HRT and GDx at nasal or temporal quadrant.
Early Diagnosis ; Glaucoma ; Nerve Fibers* ; Ophthalmoscopes* ; Optic Disk ; Retina ; Retinaldehyde*

Renal dysplasia results from aberrant histogenesis in metanephric differentiation. It is characterized morphologically by abnormal organization and a persistence of primitive structures, such as cartilage, undifferentiated mesenchyme, and immature tubules. Six cases of renal dysplasia from five children and one adult are reviewed. Five patients were female and one patient was male. The chief complaint was urinary incontinence in four patients, dysuria in one patient, and the sixth patient suffered from vesicoureteral reflux. No evidence of family history of renal dysplasia in any patient was seen. According to Risdon's classification, three cases were hypoplastic dysplasia, one case was dysplasia in a duplex system, one case was dysplasia in a triplex system, and one case was dysplasia with vesicoureteral reflux. The ipsilateral ectopic ureteral orifice was identified in four patients, two of which drained into a Gartner's duct cyst, and the orifice was suggested in one patient. On histologic examination, all cases showed primitive ducts surrounded by concentrically arranged primitive mesenchyme. Nests of metaplastic cartilage were observed within the stroma in three of the six cases.
Adult ; Cartilage ; Child ; Classification ; Dysuria ; Female ; Humans ; Male ; Mesoderm ; Ureter ; Urinary Incontinence ; Vesico-Ureteral Reflux

No abstract available.
Facial Pain* ; Immunosuppression ; Kidney Transplantation* ; Kidney* ; Organ Transplantation

PURPOSE: The purpose of this study was to evaluate the utility of two-phase dynamic CT, early and equilibrium pahse, in the preoperative staging of rectal cancers. MATERIALS AND METHODS: We performed incremental dynamic CT after rectal infusion of water in 34 patients with pathologically proved rectal cancers. Two-phase dynamic CT findings were prospectively analyzed and correlated with surgical and histopathologic findings. A total of 150ml of nonionic contrast medium was intravenously administered with a power injector at a flow rate of 5ml/sec for 30 sec, and two-phase images were obtained at 30 sec(early phase) and 2 min (equilibrium phase) after bolus injection. Local tumor staging and regional lymph node were classified by TNM staging. RESULTS: All 34 rectal cancers showed a moderate to marked enhancement in the early phase and a homogeneous and prolonged enhancement of the entire lesion in the equilibrium phase. T-staging of primary tumors were 85.3%(29/34) in early phase and 70.6%(24/34) in equilibrium phase. The accuracy in determining the perirectal fat invasion of rectal cancer was 92%(23/25) in early phase, and 72%(18/25) in equilibrium phase. The sensitivity & specificity of the regional lymph node metastasis were 63.6% and 79.1% in early phase, and 54.5% and 65.2% in equilibrium phase, respectively. CONCLUSION: Early phase dynamic CT was more accurate for the preoperative staging of rectal cancer than that at equilibrium phase.
Humans ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm Staging ; Prospective Studies ; Rectal Neoplasms* ; Sensitivity and Specificity ; Water

Pulmonary embolism is a serious complication, which is well known in patients undergoing total hip or total knee arthroplasty or lower extremity fracture surgery. But, there are few literatures concerning pulmonary embolism after upper extremity surgery. Pulmonary embolism after minor upper extremity fracture surgery is extremely rare. We report a case of 66-year-old female patient that developed pulmonary embolism after percutaneous cannulated screw fixation for a greater tubercle fracture of the proximal humerus with literature review.
Aged ; Arthroplasty ; Female ; Fracture Fixation ; Hip ; Humans ; Humerus* ; Knee ; Lower Extremity ; Pulmonary Embolism* ; Shoulder Fractures ; Upper Extremity

BACKGROUND/AIMS: Acute calculous suppurative cholangitis(ACSC) is the most severe complication of bile duct stone(s) and carries 100% mortality if left untreated, and emergent decompression is a life-saving procedure. Endoscopic therapy such as endoscopic sphincterotomy(EST) or endoscopic nasobiliary drainage(ENBD) are well-mtablished treatment of choice instead of emergent surgieal or percutaneous drainages which have a high mortality or morbity, respectively. However, EST and subsequent stone removal is operator-dependent, time consuming, associated with complication rate of 6~12%, and may be inadequeate in many critically ill patients. Recently, endoscopic retrograde biliary drainage(ERBD) is suggested to be as effective in temporary biliary drainage for retained common duct stone and acute cholangitis as ENBD is, and preferred to ENBD in some reports, because ENBD can be pulled out occasionally by confused patient, more time consuming, unpleasant, a hindrance for the patient, and does not seem to be any more effective than ERBD. So, we performed this study to evaluate the role of ERBD in patient with ACSC. METHODS: In Gil Hospital from March 1995 to April 1997, 35 patients were diagnosed as ACSC among the 289 patients with common bile duct stone(s). Of those with ACSC, "the emergent group" were 19 patients with common bile duct stone(s) in which polyethylene biliary stent was placed with the proximal end above the stone and the distal end in the duodenum within 1 days after admission, and "the delayed group" were 9 patients with common bile duct(CBD) stone(s) in which biliary stenting was delayed for 1 days or longer after admission. In both groups, diagnosis rate according to the endoscopic retrograde cholangiopancreatography(ERCP) timing, clinical manifestations at admission, clinical and laboratory effectiveness of ERBD, and mortalities were analyzed and compared by the unpaired t-test. RESULTS: 1. The mean ages and male to female ratio in the emergent group were 65.1, 11:8, respectively and 61.4, 5:4 in the delayed group. On admission, hypotension and confused mentality were more frequent in the emergent group than in the delayed group, but there were no difference in the frequency of medical disease, cholecystectomy history between the two groups. 2. In laboratory findings, anemia, leukocytosis, and thrombocytopenia were more severe in the emergent group than in the delayed group, but there were no difference in the liver function test between the two groups. 3. The diagnosis rate of ACSC according to the ERCP timing was 90.9% by the emergent ERCP, whereas 1.9% by delayed ERCP, and among the 33 procedures of emergent ERCPs, 5 ERCPs were performed without aid of fluoroscopy. 4. In endoscopic findings of papilla, the incidence of gross pus, impacted stone, choledochoduodenal fistula, and papillary hyperemia was 100%, 53.6%, 46.4%, and 21.4%, respectively. In ERCP findings, single CBD stone was most common(53.6%), followed by multiple CBD stone(46.4%), IHD stone(s)(21.4%), and GB stone(14.2%). There were no differences in endoscopic and ERCP findings between the two groups. 5. After ERBD, abdominal pain and fever, and the level of total bilirubin and GOT were subsided or normalized more rapidly in the emergent group than in the delayed group, but there were no differences in the duration of hypotension and the level of GPT, ALP, and creatinine between the two groups. 6. The success rate of ERBD were 100% in the emergent group and 77.8% in the delayed group, so overal l success rate was 92.3%. After ERBD, the effectiveness determined by clinical and laboratory findings were 94.7% in the emergent group and 100% in the delayed group, so overall effectiveness was 96.2%. 7. Definite treatment consisted of endoscopic management in 23 patients(82.1%), elective operation for gallbladder or IHD stone(s) in 3(10.7%) after endoscopic removal of CBD stone(s), permanent biliary stenting due to the patient's refusal of further endoscopic or surgical management after recovery from sepsis in 3 patients(10.7%), and urgent operation in 1 patient(3.6%) in the emergent group. One patient in the delayed group died of sepsis in spite of successful biliary drainage, so overall mortality rate was 3.6%. CONCLUSIONS: ERBD is an effective alternative method of decompressing the bile duct in patient with ACSC due to CBD stone(s), and high index of suspicion of the diagnosis is necessary because failure of diagnosis can result in delaye ddrainage and may be associated corresponding increase in mortality.
Abdominal Pain ; Anemia ; Bile ; Bile Ducts ; Bilirubin ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis* ; Cholecystectomy ; Common Bile Duct ; Creatinine ; Critical Illness ; Decompression ; Diagnosis ; Disulfiram ; Drainage* ; Duodenum ; Female ; Fever ; Fistula ; Fluoroscopy ; Gallbladder ; Humans ; Hyperemia ; Hypotension ; Incidence ; Leukocytosis ; Liver Function Tests ; Male ; Mortality ; Polyethylene ; Sepsis ; Stents* ; Suppuration ; Thrombocytopenia

PURPOSE: Percutaneous needle aspiration biopsy under the imaging guidance in the diagnosis of intrathoracic diseases has become a standard practice. Core tissue obtained by automated gun biopsy(AGB) is believed to be more diagnostic than materials from fine needle aspiration(FNA) by many cytopathologists. The authors evauated the role of automated gun biopsy in localized pulmonary lesions with respect to the its accuracy and complications. MATERIALS AND METHODS: We performed 107 percutaneous biopsies in localized pulmonary lesions under fluoroscopic guidance among 107 patients:AGB using 18G or 20G was done in 81 patients, and both AGB and FNA was done in 26 patients. RESULTS: Biopsy samples sufficient for histologic diagnosis were obtained in 94(87.9%) of 107 patients, AG8 in 73(90.1%) of 81 patients and AGB and FNA in 21(80.8%) of 26 patients. 11 of 13 negative results were due to inadeguate specimen size for the histologic diagnosis or were composed of necrotic areas, and 2 of 13 negative results were obtained through nontarget tissue. 10 patients developed pneumothorax and 4 of them required chest tube insertion. Minimal hemoptysis was found in 3 patients. CONCLUSION: Percutaneous automated gun biopsy under fluoroscopic guidance was easy and simple method of obtaining specimens of good quality and quantity. It may be an useful procedure in the diagnosis of localized pulmonary lesions.
Biopsy* ; Biopsy, Needle ; Chest Tubes ; Diagnosis ; Hemoptysis ; Humans ; Needles ; Pneumothorax