A 35-year-old man was admitted with a 20 day history of generalized edema and muscular weakness of the lower extremities. He was alert with a pale puffy face and an ejection murmur was heard at the cardiac apex. The electrocardiogram disclosed low voltage, first degree atrioventricular block, and a right bundle branch block. During the hospitalization an intractable diastolic hypotension developed, which measured 0 mmHg at the lowest point. At that time the echocardiogram revealed a dilated, akinetic right ventricle. Eventually a multiorgan failure developed and an autopsy following his death presented a fibrofatty replacement of the right ventricular myocardium. This might be a case of an arrhythmogenic right ventricular dysplasia/cardiomyopathy, which is usually characterized clinically by a ventricular tachycardia and may cause a sudden death in young adults.
Adult ; Atrioventricular Block ; Autopsy* ; Bundle-Branch Block ; Death, Sudden ; Edema ; Electrocardiography ; Heart Ventricles ; Hospitalization ; Humans ; Hypotension ; Lower Extremity ; Muscle Weakness ; Myocardium ; Systolic Murmurs ; Tachycardia, Ventricular ; Young Adult

Fine-needle aspiration (FNA) of lymph nodes has been regarded as a useful method in the diagnosis of lymphadenopathy. However, this procedure has been shown to be of limited value in the diagnosis of low or intermediate grade malignant lymphomas in some studies. Immunophenotyping is an essential adjunct to cytomorphology for the diagnosis of lymphoma by FNA. Immunophenotyping using flow cytometry (FCM) is rapid, objective and reliable. Using FCM, multiparametric analysis of 33 FNA materials from lymph nodes was performed and profiles of surface markers of lymphoid cells were assessed. In reactive hyperplasia, patterns of cell surface markers were quite variable, but disclosed polyclonality. Most of the B-cell lymphomas showed immunophenotypes for B-cell lineages with their kappa: lambda or lambda: kappa ratio being over 3:1. In T-cell lymphomas, T-cell surface markers were predominantly expressed as well. In conclusion, our results suggest that immunophenotyping of lymph node aspirates is a valuable diagnostic adjunct for lymphoproliferative disorders, particularly in B-cell lymphomas because immunophenotyping can be easily and adequately performed by FCM.
Antigens, CD19/analysis ; Antigens, CD20/analysis ; Antigens, CD3/analysis ; Antigens, CD4/analysis ; Antigens, CD5/analysis ; Antigens, CD7/analysis ; Antigens, CD8/analysis ; B-Lymphocytes/immunology ; B-Lymphocytes/chemistry ; Biopsy, Needle ; Flow Cytometry/methods* ; Hodgkin Disease/pathology ; Human ; Immunophenotyping ; Lymph Nodes/pathology ; Lymph Nodes/chemistry ; Lymphatic Diseases/pathology* ; Lymphatic Metastasis/pathology ; Lymphoma, B-Cell/pathology* ; Lymphoma, Non-Hodgkin/pathology ; T-Lymphocytes/immunology ; T-Lymphocytes/chemistryt

Mesenchymal hamartoma of the liver is a rare benign tumor, usually presenting in early childhood. Five children with mesenchymal hamartoma of the liver pathologically verified at Seoul National University Children's Hospital between 1978 and 2000 were analyzed retrospectively. There were two girls and three boys, and their mean age at the operation was 16.0months (range, 4 - 32 months). Three patients presented with abdominal distension. A patient was detected incidentally, and another was detected by prenatal ultrasongraphic examination. Tumor size ranged from 10x8.5cm to 34x29cm. Three tumors were located in the right lobe and two in the left lobe. Four cases underwent complete surgical resection, and the other one underwent incomplete surgical resection and marsupialization. Recurrence or malignant transformation was not noted. Five patients survived without evidence of disease for 35, 36, 38, 142 and 228 months. In conclusion, although mesenchymal hamartoma of the liver is benign lesion, it may be confused, and mixed with embryonal sarcoma. A recent report showed recurrence or malignant transformation after partial excision of the tumor. Therefore, complete excision of the tumor with surrounding normal liver tissue is recommended.
Child ; Female ; Hamartoma* ; Humans ; Liver* ; Recurrence ; Retrospective Studies ; Sarcoma ; Seoul

A total of 35 patients with velopharyngeal incompetence were treated by surgical correction from 1995 to 2001. Twenty-six patients underwent lateral port control superior based pharyngeal flap and 9 patients underwent sphincteric pharyngoplasty. Speech analysis and fluorolaryngo-graphy was performed preoperatively and postoperatively. The nasality of open vowel, round vowel and sentence and articulation accuracy in 26 patients who underwent the pharyngeal flap improved from 37.7+/-10.71%, 49.1+/-9.54%, 50.1+/-9.03% and 68.9+/-10.11% preoperatively to 20.4+/-9.77%, 25.4+/-10.11%, 38.5+/-9.34% and 80.1+/-6.47% postoperatively, and hypernasality and articulation accuracy improved significantly (p<0.05). In case of 9 patients who underwent sphincteric pharyngoplasty, results were from 41.2+/-11.27%, 42.4+/-17.04%, 53.8+/-7.63% and 72.3+/-10.87% preoperatively to 20.7+/-8.27%, 20.8+/-14.34%, 29.7+/- 11.47% and 80.7+/-12.47% postoperatively, and hypernasality improved significantly (p<0.05). As far as postoperative fluorolaryngography is concerned, the velopharyngeal space was closed in patients with postoperative normal range of nasality. In conclusion, these results suggest that patients with velopharyngeal incompetence will improve speech dysfunction effectively if is chosen appropriately either superior based pharyngeal flap or sphincteric pharyngoplasty.
Humans ; Reference Values ; Velopharyngeal Insufficiency*

Patients with chronic leg arterial occlusion usually present with claudication or chronic critical limb ischemia (CCLI). Infrainguinal bypasses are usually indicated for those patients with CCLI and intermittent claudication that is causing severe disability. PURPOSE: To observe the differences in outcomes of leg arterial bypasses between the patients with CCLI and disabling claudication. METHODS: Three hundreds consecutive patients, with 400 leg bypasses (327 vein grafts and 67 prosthetic grafts, and 6 composite grafts), were enrolled, and stratified into CCLI (n= 245) and disabling claudication (n=155) groups. After a comparison of their demographic features, frequency of coexisting diseases and details of bypass procedures, the early and long-term results of leg arterial bypasses between 2 groups were also compared. The graft patency was determined by periodic measurements of the ankle brachial index and duplex scanning, and the patient survival was determined with the help of a governmental office database. The graft patency, patient survival and amputation-free survival rates were calculated using the Kaplan Meier method, and compared with Log rank tests. RESULTS: The demographic features and frequency of coexisting morbidity were not significantly different between the 2 groups, with the exception of a female preponderance in the CCLI group. Infrapopliteal bypasses were more commonly performed in the CCLI group 40 vs. 20%, P<.0005) and the primary graft patencies were significantly higher in the claudication group (at 3, 5 and 7 years; 90.2, 74.6 and 63.9% vs. 61.9, 58.0 and 50.7%, P<.0005) only after vein bypass. The patient survivals were also significantly longer in the claudication compared to the CCLI group (at 3, 5 and 7 years; 94.7, 74.8 and 68.5% vs. 51.0, 30.8 and 20.5%, P<.0005). CONCLUSION: Despite there being no significant difference in the age or frequencies of coexisting morbidity, a significantly longer patient survival was found in the claudication group. Considering the longer vein graft patency of the claudication group was inconclusive in this retrospective study, an infrainguinal bypass, with an autologous vein, should be considered as a primary treatment for better long-term results in selected claudication patients.
Ankle Brachial Index ; Arterial Occlusive Diseases ; Extremities* ; Female ; Humans ; Intermittent Claudication ; Ischemia* ; Leg* ; Retrospective Studies ; Survival Rate ; Transplants ; Veins

BACKGROUND AND OBJECTIVES: Cyclin-dependent kinase inhibitor (CDKI) is known to play an important role in oncogenesis, but its clinical effect in head and neck cancer has not been reported yet. This study was designed to evaluate the correlation between the pattern of expression in p16 and p21, and tumor progress in laryngeal squamous cell carcinoma. MATERIALS AND METHOD: Paraffin-embedded tissue specimens from 54 patients, who were operated for laryngeal squamous cell carcinoma between Dec. 1990 and Apr. 1997, were immunohistochemically stained for p16 and p21 protein. The clinical features from these patients were retrospectively evaluated. RESULTS: In p16, the proportion of early T stage (T1, T2) and early N stage (N0) was relatively larger in the diffusely staining type than in the other staining pattern; but, the correlation between expression of p16 and T N stage was not significant (p=0.07, 0.65). In p21, proportion of early T stage (T1, T2) and early N stage (N0) was relatively larger in the diffusely staining type than in the other staining pattern; and again, the correlation between expression of p21 and T N stage was not significant (p=0.06, 0.10). CONCLUSION: Other factors were suggested to be strongly related to the clinical aspects of laryngeal squamous cell carcinoma, such as N stage and T stage than p16 and p21. Further study will be needed to understand the role of p16, p21 in oncogenesis of laryngeal squamous cell carcinoma.
Carcinogenesis ; Carcinoma, Squamous Cell* ; Genes, Tumor Suppressor ; Head and Neck Neoplasms ; Humans ; Phosphotransferases ; Retrospective Studies