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

We analyzed the factors of importance for nonunion in series of 91 open fractures of tibial diaphysis which were treated with external fixation. Factors analyzed included, age and sex of the patients, the mechanism of injury, the amount of soft tissue damage, the grade of comminution, the level at which the tibia was fractured, the presence of an intact fibula, the presence of the multiple injuries, the type of the external fixation used(AO external fixator, EXTOR; monotube external fixator, Ilizarov), and the need to supplement the stability of the reduction. We found that the amount of soft tissue damage and comminution of the fracture played a role in the development of the nonunion.
Diaphyses ; External Fixators ; Fibula ; Fractures, Open ; Humans ; Multiple Trauma ; Tibia ; Tibial Fractures*

Fractures of the acetabulum are relatively uncommon, but because they involve a major weight bearing joint in the low extremity, they assume great clincal importance. The principle of management for this fracture is as for any other displaced intra-articular fracture, nsmely that anstomical reduction is essential for good long term function of the obtained by closed means, but more often, open reduction followed stable internsl fixation allowing early active or passive motion will be required. In the past, the achievement of this ideal, that is anatomical reduction, has been difficult because technical problems such as those caused by complicated anatomy, difficulty with surgical exposure, severe comminution in many cases, and major associated injuries. We classified the acetabular fractures of 71 patients with 72 hips from 1980 to 1987 and clinical analysis was performed on 51 hips allowing the possible follow-up evaluation beyond the 12 months. Following results were obtained. 1. The most common associated injury was the pelvic bone fracture(25.5%). 2. The most common types of fracture on each classification were posterior wall fracture in Letournel(37.5%), posterior acetabular fracture in Rowe & Lowell(42.3%), central fracture- dislocation without involving of weight bearing dome of acetabulum in Carnesale(23.9%). 3. According to calssification method, the interpretation for characteristics of fracture type and frequency of acetabular fracture was very different each other. 4. The Leournels classification was relatively simple and could contain with many types of fracture and was helpful to determine the index of treatment. 5. The prognosis of linear undisplaced fracture and posterior fracture was better than acetabular medial, superior and bursting fracture in both conservative and operative treatment. 6. The posterior wall fracture with widely displaced fracture or joint instability, acetabular dome fracture, intraarticular fragment was absolute indication for operative treatment. 7. The treatment result and prognosis was influenced to the accurate classification of fracture type, anatomical reduction and rigid internal fixation.
Acetabulum ; Classification ; Dislocations ; Extremities ; Follow-Up Studies ; Hip ; Humans ; Intra-Articular Fractures ; Joint Instability ; Joints ; Methods ; Pelvic Bones ; Prognosis ; Weight-Bearing

PURPOSE: We experienced six cases of late infection of the hydroxyapatite (HA) orbital implant treated with surgical procedures. METHODS: Exposures of the HA and pyogenic granulomas around conjunctival dehiscence helped us to confirm infections of the HA orbital implants. Infections were not controlled by medical therapies so the HA implants were exchanged by silicone implants in all cases. Finally, the silicone implants were replaced by Medpor(R) after the inflammation had been controlled. Dermis fat graft was also performed in two cases due to insufficient conjunctival sac. RESULTS: Infections of HA orbital implants occurred at 62 to 106 months postoperatively. Staphylococcus aureus and Pseudomonas aeruginosa were cultured from removed implants. All cases show successful outcomes during 12 to 42 months after Medpor(R) implantations. CONCLUSIONS: Infections of peg-inserted HA orbital implants occurred after five years due to exposure of HA orbital implants. To replace infected HA implants with Medpor(R) implants is considered a functionally and aesthetically effective therapeutic method.
Dermis ; Durapatite* ; Granuloma, Pyogenic ; Inflammation ; Orbit* ; Orbital Implants* ; Pseudomonas aeruginosa ; Silicones ; Staphylococcus aureus ; Transplants

One hundred and three patients with strabismus who were undergoing extraocular muscle surgery were studied to compare the incidence of arrhythmia following the traction of ex- traocular muscles under halothane and sevoflurane anesthesia. Fifty four patients were anesthetized with O2-halothane(halothane group) and forty nine patients with O2-sevoflurane (sevoflurane group). The incidences of arrhythmia were 74.1% and 71.4% in halothane and sevoflurane group, respectively. There was no significant change of blood pressure in either group when arrhythmia occurred. The incidence of arrhythmias in female patients of the sevoflurane group was higher than that in male patients, while not in the halothane group. In the sevoflurane group, the incidence of arrhythmia followed by the traction of medial rectus muscle was significantly higher than that of lateral rectus muscle. In conclusion, there was no significant difference in the incidence of arrhythmia following the traction of extraocular muscles between halothane and sevoflurane anesthesia, and sinus bradycardia was the most common arrhythmia with either anesthetic.
Anesthesia ; Anesthetics* ; Arrhythmias, Cardiac ; Blood Pressure ; Bradycardia ; Female ; Halothane ; Humans ; Incidence ; Male ; Muscles ; Solubility* ; Strabismus ; Traction

Paecilomyces lilacinus is an ubiquitous saprophytic fungus and very rarely pathogenic to the human. Although it has been reported to cause endophthalmitis, orbital cellulitis, prosthetic valve endocarditis, and pulmonary infection, cutaneous infection caused by Paecilomyces lilacinus has been rarely reported. A 46-year-old Korean man had asymptomatic slowly growing multiple cutaneous nodules on the left arm and wrist for 8 months. He received a renal transplantation in 1991 because of end-stage renal disease. Postoperatively, he has taken cyclosporin and deflazacort for immunosuppression. Physical examination revealed that the lesions were discrete or confluent, firm, elevated, well-defined fluctuating nodules. Histologic section showed multiple well-encapsulated intradermal abscesses with some foci of chronic granulomatous changes composed of lymphocytes, histiocytes and giant cells. PAS positive fungal hyphae and spores were also found. On the Sabouraud's dextrose agar media, the organism grew rapidly to form velvety lilac-colored colonies with shallow radiating furrows. Slide culture showed brush-like conidiophores ending in flask-shaped phialides carrying chain of conidia. Because of the poor response to the oral antifungal drug for 2 months, all the lesions were completely excised.
Abscess* ; Agar ; Arm ; Cyclosporine ; Endocarditis ; Endophthalmitis ; Fungi ; Giant Cells ; Glucose ; Histiocytes ; Humans ; Hyphae ; Immunosuppression ; Kidney Failure, Chronic ; Kidney Transplantation ; Lymphocytes ; Middle Aged ; Orbital Cellulitis ; Paecilomyces* ; Physical Examination ; Spores ; Spores, Fungal ; Wrist

PURPOSE: Ultrasound is most effective study for evaluating thyroid nodules. In this review, we discuss that sonographic findings to differentiate benign from malignant nodules and suggest recommendations for indications of fine needle aspiration biopsy and thyroid nodule management. METHODS: Sonographic scans of 206 thyroid nodules in 164 patients were candidated for this study. We evaluated sonographic findings by shape, calcification, margin, and echogenicity, retrospectively. Sonographic findings that suggested malignancy included microcalcifications, a speculated margin, marked hypoechogenicity and a shape that was taller than wide. The final diagnosis of lesion as benign (n=180) or malignant (n=26) was confirmed by fine needle aspiration biopsy and follow-up (>6 months). We demonstrated the difference of the sensitivity, specificity, positive predictive value, negative predictive value and accuracy. RESULTS: Of 206 thyroid nodules, 26 were malignant. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy based on our sonographic classification method were 84.6%, 73.9%, 31.9%, 97.0% and 75.2%. CONCLUSION: Sonography can be helpful for making the differentiation between and malignant nodules. So, when well trained surgeon find thyroid nodules on sonography, we can make correct diagnosis of malignant nodules.
Biopsy ; Biopsy, Fine-Needle ; Classification ; Diagnosis ; Follow-Up Studies ; Humans ; Methods ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*

BACKGROUND: Varenicline is now very useful medication for cessation; however, there is only little result of researches with varenicline for cessation of hospitalized patients. This research attempted to analyze the cessation effect of medication and compliance of hospitalized patients. METHODS: This research included data for 52 patients who were prescribed varenicline among 280 patients who were consulted for cessation during their admission period. This research checked whether smoking was stopped or not after six months and analyzed their compliance, the factors for succeeding in smoking cessation. RESULTS: One hundred and ninety hospitalized patients participated in smoking cessation counseling among 280 patients who included consultation from their admission departments. And varenicline was prescribed for only 80 patients after counseling. Nineteen smokers were successful in smoking cessation among 52 final participants representing the rating of success of 36.5%. The linkage between compliance of varenicline and rate of smoking successful has no statistical significance. The factors for succeeding in smoking of hospitalized patients are admission departments, diseases, and economic states. CONCLUSION: Smoking cessation program has low inpatient compliance. Cooperation of each departments is very important for better compliance. Success rate of cessation was relatively high (36.5%). Cessation attempt during hospitalization is very effective strategy.
Compliance* ; Counseling ; Hospitalization ; Humans ; Inpatients ; Smoke* ; Smoking Cessation* ; Smoking* ; Varenicline

No abstract available.
Humans*

BACKGROUND: B-type natriuretic peptide (BNP) is a cardiac hormone that is primarily synthesized by the ventricular cardiac myocytes. Increased plasma BNP levels have been observed in patients suffering with congestive heart failure, ventricular hypertrophy and myocaridits and also during heart transplantation rejection. We investigated the serum BNP level as a predictive marker for rejection after heart transplantation. MATERIAL AND METHOD: To test the usefulness of measuring the BNP level in cardiac transplant patients, consecutive blood samplings for BNP, right ventricular endomyocardial biopsies, hemodynamic measurements and transthoracic echocardiogram were all done in 10 such patients between January 2004 and August 2005 at the Department of Thoracic and Cardiovascular Surgery in Asan Medical Center. Two groups were identified with using the median value: the low BNP group (n=28, BNP: < or =290 pg/mL) and the high BNP group (n=29, BNP: >290 pg/mL). We retrospectively analyzed rejection, the ejection fraction, tricuspid regurgitation, left ventricular hypertrophy, the pulmonary capillary wedge pressure and the right atrial pressure between the 2 groups. RESULT: There were no differences in age, gender, rejection, the ejection fraction, tricuspid regurgitation, left ventricular hypertrophy and the right atrial pressure between the 2 groups (p>0.05). However, a higher pulmonary capillary wedge pressure and a higher mean pulmonary atrial pressure were observed in the high BNP group (p<0.05). Further, BNP has linear correlation with the pulmonary capillary wedge pressure (r=0.590, p<0.001). Using the cut-off value of 620 pg/mL, the BNP predicted a high PCWP (>12 mmHg) with a sensitivity of 83.3% and a specificity of 91.1% (AUC: 0.900+/-0.045, p<0.001). CONCLUSION: The BNP level after heart transplantation does not show any significant correlation with rejection, yet it might be a predictive marker of ventricular diastolic dysfunction.
Atrial Pressure ; Biopsy ; Chungcheongnam-do ; Heart Failure ; Heart Transplantation* ; Heart* ; Hemodynamics ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Myocytes, Cardiac ; Natriuretic Peptide, Brain* ; Plasma ; Pulmonary Wedge Pressure ; Retrospective Studies ; Sensitivity and Specificity ; Tricuspid Valve Insufficiency