Giant cell tumor of tendon sheath(GCTTS) is a benign mesenchymal lesion composed of cytologically bland mononuclear cells admixed with multinucleated giant cells. Our report describes the clinical and pathologic features of a 36-year-old female's tumor with a two years history over the lateral side of the left little finger, Especially, we could observe the characteristic thre types of cells in an electromicroscopic study, histiocyte-like cells, fibroblast-like cells and multinucleated giant cells. In lmmunohistochemical studies, we demonstrated that the tumor cells of GCTTS exhibit a phenotype consistent with histiocyte differentiated to Langerhan's cell.
Adult ; Fingers ; Giant Cell Tumors* ; Giant Cells* ; Histiocytes ; Humans ; Phenotype ; Tendons*

OBJECTIVE: This study set out to determine the antinuclear antibody (ANA) frequency and fluorescence pattern, as well as the incidence of drug-induced lupus (DIL) in patients on long term medications with anticonvulsants. METHODS: Sera from 200 patients on medications with anticonvulsants for at least 6 months and from 105 healthy controls were tested by indirect immunofluorescence on immunotype (IT)-1 cells, and the medical records were retrospectively reviewed. The patients included 72 on valproic acid, 24 on phenytoin, 75 on carbamazepine, and 29 patients on two or more anticonvulsants. RESULTS: ANA were positive in 3 of the 105 normal controls (3%). Twenty nine percent of patients on valproic acid, 26% on phenytoin, 8% on carbamazepine, and 34% on two or more different anticonvulsants were positive for ANA. The cytoskeletal pattern was prominent in patients on valproic acid and the speckled pattern in phenytoin. Most were of low titers. CONCLUSION: Long-term ingestion of valproic acid and phenytoin were shown to influence ANA, while carbamazepine was not. No definite relationship was observed between ANA positivity and DIL. However, positive ANA indicates effects of anticonvulsants on the immune system, and therefore progression to DIL cannot be ruled out. Therefore, patients on long-term medications with anticonvulsants should be regularly tested for ANA.
Antibodies, Antinuclear* ; Anticonvulsants* ; Carbamazepine ; Eating ; Fluorescence ; Fluorescent Antibody Technique, Indirect ; Humans ; Immune System ; Incidence ; Medical Records ; Phenytoin ; Retrospective Studies ; Valproic Acid

BACKGROUND: This study was set to determine the antinuclear antibody (ANA) frequency and fluorescence pattern, as well as the incidence of drug-induced lupus (DIL) in patients on long term medications with cardiovascular drugs and antihyperglycemic agents. METHODS: Sera from 301 patients on medications with cardiovascular drugs or antihyperglycemic agents for at least 6 months and 105 serum samples from healthy controls were tested by indirect immunofluorescence on immunotype (IT)-1 cells, and the medical records were retrospectively reviewed. The patients included 39 on digoxin, 38 on theophylline, 8 on theophylline and digoxin, 26 on captopril, 15 on diltiazem, and 182 on antihyperlycemic agents. RESULTS: ANA was positive in 3 of the 105 normal controls (3%). Thirty four percent of patients on medication with digoxin, 29% on theophylline, 31% on captopril, 7% on diltiazem, and 8% on antihyperglycemic agents were positive for ANA. The prominent ANA pattern was cytoplasmic type in patients on digoxin and theophylline, and the speckled type in captopril, however, most of them showed low titers. CONCLUSIONS: Long-term ingestion of theophylline, digoxin, captopril were shown to influence ANA, but not for diltiazem and antihyperglycemics. Therefore, patients on long-term medications with theophylline, digoxin, captopril should be regularly tested for ANA.
Antibodies, Antinuclear* ; Captopril ; Cardiovascular Agents* ; Cytoplasm ; Digoxin ; Diltiazem ; Eating ; Fluorescence ; Fluorescent Antibody Technique, Indirect ; Humans ; Hypoglycemic Agents* ; Incidence ; Medical Records ; Retrospective Studies ; Theophylline

BACKGROUND: To evaluate the effects of inhaled nitric oxide (NO) and sphingosine 1-phosphate (S1P) as potential therapeutic agents of acute lung injury, we analyzed the morphology in vivo of the pulmonary microstructure using intravital videomicroscopy in a rat model of acute lung injury. MATERIAL AND METHOD: Sprague Dawley rats were divided into five groups: a control group that underwent normal saline aspiration, an acute lung injury (ALI) group that underwent hydrochloric acid aspiration, and three treatment groups that underwent hydrochloric acid aspiration and were administered therapeutic agents- the S1P group, the NO group, and the S1P+NO group (n=7 per group). To quantify alveolar compliance and interstitial edema, the diameters of all measurable alveoli and interalveolar septa were averaged at one and two hours after aspiration. Alveolar compliance was determined according to diameter changes during the respiratory cycle and the change in tidal volume. RESULT: At two hours after aspiration, the mean alveolar compliance (% change) in the ALI group decreased significantly versus the control group of rats (respiratory cycle: 1.9% for the ALI group vs 6.5% for the control group, p=0.03; tidal volume: 3.2% for the ALI group vs 9.1% for the control group, p=0.003) and versus the NO group (tidal volume: 3.2% for the ALI group vs 16.9% for the NO group, p=0.001). At two hours after aspiration, the mean interalveolar septal thickness in the NO group tended to be smaller as compared to that in the ALI group (15.2micrometer for the ALI group vs 12.3micrometer for the NO group, p=0.06). S1P did not exert a significant effect on the pulmonary microstructure of the injured rat lung. CONCLUSION: Improved alveolar compliance and reduced interstitial edema, observed by intravital videomicroscopy, suggest that inhaled NO ameliorates lung injury.
Acute Lung Injury ; Animals ; Compliance ; Edema ; Hydrochloric Acid ; Lung ; Lung Injury ; Lysophospholipids ; Microscopy, Video ; Nitric Oxide ; Rats ; Rats, Sprague-Dawley ; Sphingosine ; Tidal Volume

BACKGROUND/AIMS: It have been reported that operative mortality and morbidity rate rise significantly when emergency cholecystectomy is performed in critically ill patients with acute cholecystitis(AC), and many studies have also concluded that delayed or interval laparoscopic cholecystectomy(LC) in patients with AC demonstrated high conversion rate and complication rate compared with early LC. However, if the acutely inflamed gallbladder(GB) is decompressed by emergent percutaneous gallbladder drainage(PGBD), it may decrease the technical difficulty of LC allowing successful delayed LC or may decrease the wound complication of delayed open cholecystectomy, when the patient is in better condition. The purpose of this retrospective study was to assess the outcome of delayed cholecystectomy focused on LC following PGBD in patients with AC METHODS: A total of 181 patients with AC were divided into PGBD(n= 66) and non-PGBD group(n= 115), and each group were subdivided into PGBD-delayed LC(after 72 hours of admission, n= 32), PGBD-open cholecystectomy(n= 20), non-PGBD-early LC(within 72 hours of admission, n= 40), non- PGBD-delayed LC(n= 17), non PGBD-open cholecystectomy group(n= 58) and others. PGBD group had higher incidence of comorbidity compared with non-PGBD group. Outcomes of cholecystectomy was assessed by conversion rate and morbidity rate(chi2 test), LC time and hospital stay(median test) for LC, and morbidity for open cholecystectomy in PGBD group compared with those of non PGBD group. RESULTS: PGBD promptly relieved of symptom of AC in 94 % of patients and showed 3 % of technical failure and 4.5 % of complication rate. Compared with non PGBD-early and delayed LC group, the PGBD-delayed LC group showed longer LC time(median 110 min vs 82.5, p < 0.05, vs 95 min), a little lower conversion rate(12.5 % vs 22.5 % vs 17.6 %), similar morbidity rate(19% vs 17.5 % vs 29 %) and prolonged total hospital stay(median 12.5 days vs 7 days, p < 0.001, vs 10 days). In open cholecystectomy series, PGBD group showed lower morbidity rate compared with non PGBD group(5% vs 24 %, p < 0.05) CONCLUSION: Unlike to open cholecystectomy series, PGBD did not significantly improve the outcome of LC for AC as assessed by conversion and morbidity rate and hospital stay compared with non PGBD. Thus we can conclude that although PGBD is a safe and effective emergency procedure for AC, it should be limited to higher risk group such as elderly or critically ill patients and to acalculous cholecystitis.
Acalculous Cholecystitis ; Aged ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute* ; Comorbidity ; Critical Illness ; Drainage* ; Emergencies ; Gallbladder* ; Humans ; Incidence ; Length of Stay ; Mortality ; Retrospective Studies ; Wounds and Injuries

PURPOSE: To assess the clinical features and the outcomes of conservative treatment of condensing osteitis of the medial end of the clavicle. MATERIALS AND METHODS: We reviewed 24 patients among 44 patients with pain and protrusion on the medial clavicle, who were diagnosed as condensing osteitis and followed over one year between April 2003 and August 2008. Plain radiograph and laboratory examination (24 cases), bone scan (12 cases), computed tomography (3 cases), MRI (1 case) and biopsy (1 case) were performed. Patients were followed with UCLA score, VAS (Visual Analogue Scale) and change of protrusion. RESULTS: In all cases, mild sclerosis and expansion were seen at the medial clavicle and sternoclavicular joint was preserved. Laboratory examination showed nonspecific results but various abnormal findings. Protrusion was not changed in 20 cases (83%) and decreased in 4 cases (17%). VAS for pain was improved from 3.4 to 1.2 and VAS for function was improved from 25.5 to 29.1. UCLA score was improved from 28.8 points to 33.7 points. CONCLUSION: Physical and radiologic examination was important for diagnosis of condensing osteitis and laboratory exmination was useful to differentiate it from other diseases. Conservative treatment with rest and nonsteroidal anti-inflammatory drugs showed satisfactory result.
Biopsy ; Clavicle ; Humans ; Osteitis ; Sclerosis ; Sternoclavicular Joint

PURPOSE: The purpose of this study was to evaluate compartmental changes using combined single-photon emission computerized tomography and conventional computerized tomography (SPECT/CT) after open wedge high tibial osteotomy (OWHTO) for providing clinical guidance for proper correction. MATERIALS AND METHODS: Analysis was performed using SPECT/CT from around 1 year after surgery on 22 patients who underwent OWHTO. Postoperative mechanical axis was measured and classified into 3 groups: group I (varus), group II (0°–3° valgus), and group III (>3° valgus). Patella location was evaluated using Blackburne-Peel (BP) ratio. On SPECT/CT, the knee joint was divided into medial, lateral, and patellofemoral compartments and the brighter signal was marked as a positive signal. RESULTS: Increased signal activity in the medial compartment was observed in 12 cases. No correlation was observed between postoperative mechanical axis and medial signal increase. Lateral increased signal activity was observed in 3 cases, and as valgus degree increased, lateral compartment’s signal activity increased. Increased signal activity of the patellofemoral joint was observed in 7 cases, and significant correlation was observed between changes in BP ratio and increased signal activity. CONCLUSIONS: For the treatment of medial osteoarthritis, OWHTO requires overcorrection that does not exceed 3 valgus. In addition, the possibility of a patellofemoral joint problem after OWHTO should be kept in mind.
Humans ; Knee ; Knee Joint ; Osteoarthritis ; Osteotomy ; Patella ; Patellofemoral Joint ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: Chlamydia trachomatis is currently classified into 15 serovars (A, B, Ba, C, D, E, F, G, H, I, J, K, L1, L2, L3) and a large number of serovariants. Typing of C. trachomatis serovars has generally been performed by the MOMP (major outer membrane protein) serotyping method, which requires a large panel of polyclonal and monoclonal antibodies. Recently the PCR was successfully applied to the genotyping of different C. trachomatis serovars by means of restriction fragment length polymorphism (RFLP) analysis and direct sequencing of amplified omp1 DNA. The objective of this study was to evaluate the serotyping of C. trachomatis by PCR-FLP and to determine the serovars of C. trachomatis urogenital isolates. METHODS: The 15 reference strains of C. trachomatis and 27 clinical isolates were analyzed by PCR-FLP. The C. trachomatis omp1 gene was amplified by PCR. For serotyping by RFLP analysis, the omp1 PCR products were digested with AluI and were electrophoresed through a 7% polyacrylamide gel with ethidium bromide staining. If necessary, the PCR products were analyzed with HinfI, a combination of EcoRI and DdeI, or CfoI. RESULTS: In serotyping of 15 reference strains of C. trachomatis, serovars A, B, Ba, E, F, G, K, and L2 were clearly identified after AluI digestion. However serovars C, H, I, J, L3 and serovars D, L1 were respectively identical patterns after AluI digestion. Serovars C and J and serovars D and L1 were further discriminated by a second step of enzyme digestion with HinfI. Serovar H, I, and L3 were distinguished by enzyme digestion with EcoRI and DdeI. In serotyping of C. trachomatis from 27 urogenital isolates, 25 isolates were clearly typed. Nine were typed as serovar E, 8 were typed as serovar D, 6 were typed as F, 2 were typed as serovar H. Two isloates showed unidentifiable RFLP pattern which was not in accordance with any of the existing C. trachomatis prototypes. CONCLUSIONS: PCR-FLP analysis is a rapid, simple, and powerful tool for differentiating serovars of C. trachomatis. Therefore, this approach is recommended for future epidemiological studies of C. trachomatis. And the serovar E, D, and F are the most prevalent types found in urogenital specimens, representing 92% of those investigated.
Antibodies, Monoclonal ; Chlamydia trachomatis* ; Chlamydia* ; Digestion ; DNA ; Ethidium ; Membranes ; Polymerase Chain Reaction* ; Polymorphism, Restriction Fragment Length* ; Serotyping*

BACKGROUND: Chlamydia trachomatis is currently classified into 15 serovars (A, B, Ba, C, D, E, F, G, H, I, J, K, L1, L2, L3) and a large number of serovariants. Typing of C. trachomatis serovars has generally been performed by the MOMP (major outer membrane protein) serotyping method, which requires a large panel of polyclonal and monoclonal antibodies. Recently the PCR was successfully applied to the genotyping of different C. trachomatis serovars by means of restriction fragment length polymorphism (RFLP) analysis and direct sequencing of amplified omp1 DNA. The objective of this study was to evaluate the serotyping of C. trachomatis by PCR-FLP and to determine the serovars of C. trachomatis urogenital isolates. METHODS: The 15 reference strains of C. trachomatis and 27 clinical isolates were analyzed by PCR-FLP. The C. trachomatis omp1 gene was amplified by PCR. For serotyping by RFLP analysis, the omp1 PCR products were digested with AluI and were electrophoresed through a 7% polyacrylamide gel with ethidium bromide staining. If necessary, the PCR products were analyzed with HinfI, a combination of EcoRI and DdeI, or CfoI. RESULTS: In serotyping of 15 reference strains of C. trachomatis, serovars A, B, Ba, E, F, G, K, and L2 were clearly identified after AluI digestion. However serovars C, H, I, J, L3 and serovars D, L1 were respectively identical patterns after AluI digestion. Serovars C and J and serovars D and L1 were further discriminated by a second step of enzyme digestion with HinfI. Serovar H, I, and L3 were distinguished by enzyme digestion with EcoRI and DdeI. In serotyping of C. trachomatis from 27 urogenital isolates, 25 isolates were clearly typed. Nine were typed as serovar E, 8 were typed as serovar D, 6 were typed as F, 2 were typed as serovar H. Two isloates showed unidentifiable RFLP pattern which was not in accordance with any of the existing C. trachomatis prototypes. CONCLUSIONS: PCR-FLP analysis is a rapid, simple, and powerful tool for differentiating serovars of C. trachomatis. Therefore, this approach is recommended for future epidemiological studies of C. trachomatis. And the serovar E, D, and F are the most prevalent types found in urogenital specimens, representing 92% of those investigated.
Antibodies, Monoclonal ; Chlamydia trachomatis* ; Chlamydia* ; Digestion ; DNA ; Ethidium ; Membranes ; Polymerase Chain Reaction* ; Polymorphism, Restriction Fragment Length* ; Serotyping*

The diaphragm is especially important in sustaining minute ventilation in the neonate. Consequently, diaphragmatic paralysis is not tolerated well by the neonate and often results in prolonged respiratory failure. We experienced a case of unilateral diaphragmatic paralysis with the brachial plexus palsy in a male newborn infant who presented with apnea and cyanosis due to birth asphyxia. After endotracheal intubation, mechanical ventilaton was started. At two weeks after therapy, chest X-ray showed atelectasis and elevation of the right hemidiaphragm. The diagnosis of unilateral diaphragmatic paralysis was confirmed by real-time ultrasonography. At 4 weeks old, after several unsuccessful attempts at weaning from ventilatory support, right hemidiaphragm was plicated. On the second postoperative day, he could be weaned from ventiatory support without difficulty. He was doing well at follow-up 3 months later.
Apnea ; Asphyxia ; Brachial Plexus* ; Cyanosis ; Diagnosis ; Diaphragm ; Follow-Up Studies ; Humans ; Infant, Newborn* ; Intubation, Intratracheal ; Male ; Paralysis* ; Parturition ; Pulmonary Atelectasis ; Respiratory Insufficiency ; Respiratory Paralysis* ; Thorax ; Ultrasonography ; Ventilation ; Weaning