Nonfunctioning carcinoma of the adrenal cortex is an extremely rare disease. We have presented a case of nonfunctioning adrenocortical carcinoma. The patient was a 35 year-old female who had complained of discomfort and gradually growing mass in the left upper quadran1. No significant laboratory findings or evidence of hormonal disturbance wee clinically noted. Ultrasonography and abdominal CT revealed about 15 x 13cm sized mass in the left suprarenal area. Left adrenal gland. kidney and spleen were removed. The tumor was multilobulated but well encapsulated. measuring 16 x 15 x 13cm in size and weighing 420 grams. Cut surface of the tumor showed massive hemorrhage and necrosis, Microscopically, the tumor showed marked cellular pleomorphism, nuclear hyperchromatism and increased mitoses with some atypical mitoses. Capsular and vascular invasion of tumor cells was observed.
Adrenal Cortex ; Adrenal Glands ; Adrenocortical Carcinoma* ; Adult ; Female ; Hemorrhage ; Humans ; Kidney ; Mitosis ; Necrosis ; Rare Diseases ; Spleen ; Tomography, X-Ray Computed ; Ultrasonography

Background: In this study, the bleaching effect and surface damage of two types of over-the-counter home tooth bleaching agents were explored using an in vitro study of bleaching agents applied to bovine teeth specimens for 14 days. Methods: Domestic over-the-counter home tooth bleaching agents of gel and patch form that shared common active ingredients and manufacturers were selected and tested. The experiment specimens were made using composite resin with bovine tooth samples and then measured the initial microhardness. Specimens were then divided into a Gel group and a Patch group and underwent bleaching treatment once a day for two weeks for 30 to 60 minutes (recommended) or 7 hours. All specimens were coffee-stained prior to bleaching. The bleaching effect was measured using a spectrophotometer and surface damage was measured using a microhardness meter. Results: The difference in color following the bleaching procedure was positive in both the Gel and Patch group, although there were no statistically significant differences in bleaching effect between groups. There was no significant difference in bleaching effect based on duration. The microhardness test revealed that both the Gel group and the Patch group had surface damage after bleaching. The greatest surface damage was found in the Patch group that had undergone a 7-hour bleaching treatment, although the differences were not statistically significant. Conclusion The bleaching effect of the home tooth bleaching agent was visible to the naked eye. However, longer applications than recommended did not result in greater bleaching, unlike consumers’ expectations, and instead increased the chance of enamel damage. As such, there is a need for consumers to be alert and adhere to recommendations provided by each company.

Late recurrence over 10 years after surgery and endobronchial metastasis are some of the spe‑ cific biological behaviors of renal cell carcinoma (RCC). The current report describes a case of solitary endobronchial metastasis at a subsegmental bronchus that developed 20 years after curative nephrectomy for RCC. A 71‑year‑old male was admitted to our hospital for pneumonia.Chest radiography showed multifocal ill-defined nodular opacities in the right lower lung zone, suggesting pneumonia. Subsequent chest CT confirmed pneumonic infiltration in the right lung. However, a 4.3-cm, well-defined, elongated mass with a branching pattern was also iden‑ tified in the right lower lobe, and a right nephrectomy scar was detected on the covered upper abdomen. The patient had undergone right nephrectomy 20 years ago due to clear cell RCC. Af‑ ter right lower lobectomy, the postoperative pathological diagnosis was endobronchial meta‑ static clear cell RCC. Endobronchial metastasis should be considered in a patient with a history of RCC who presents with a suspected endobronchial tumor, even decades after curative surgery.

Late recurrence over 10 years after surgery and endobronchial metastasis are some of the spe‑ cific biological behaviors of renal cell carcinoma (RCC). The current report describes a case of solitary endobronchial metastasis at a subsegmental bronchus that developed 20 years after curative nephrectomy for RCC. A 71‑year‑old male was admitted to our hospital for pneumonia.Chest radiography showed multifocal ill-defined nodular opacities in the right lower lung zone, suggesting pneumonia. Subsequent chest CT confirmed pneumonic infiltration in the right lung. However, a 4.3-cm, well-defined, elongated mass with a branching pattern was also iden‑ tified in the right lower lobe, and a right nephrectomy scar was detected on the covered upper abdomen. The patient had undergone right nephrectomy 20 years ago due to clear cell RCC. Af‑ ter right lower lobectomy, the postoperative pathological diagnosis was endobronchial meta‑ static clear cell RCC. Endobronchial metastasis should be considered in a patient with a history of RCC who presents with a suspected endobronchial tumor, even decades after curative surgery.

PURPOSE: The purpose of this study was to conceptualize and clarify a concept of "preparatory grief" in terminal cancer patients. METHOD: A hybrid model of concept development was applied to develop a concept of preparatory grief, which included a field study carried out in Busan, Korea. Participants of this study were 8 cancer patients. RESULTS: On the basis of our literature, research and clinical experience, the concept of preparatory grief emerged as a complex phenomenon playing an important role in five areas; physical, emotional, interpersonal, religious, and transcendental dimensions. Two new attributes were defined through a field phase; trust of the post-mortal world and a serene state of mind. Indicators reflected attitudes of sadness, worry, regret, capability to adapt and hope. The results of preparatory grief were loss of energy and interest, emotional chaos, contemplation, taciturnity and restoration. CONCLUSIONS: Differentiating among preparatory grief and other symptoms in cancer patients is essential because of therapeutic implications. Understanding preparatory grief is necessary in order to manage cancer patients for promoting quality of life so that its application may have a positive impact on the patient's life.
Adaptation, Psychological ; Aged ; *Concept Formation ; Counseling/*methods ; Female ; *Grief ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Neoplasms/nursing/*psychology ; Quality of Life ; *Terminal Care

Multiple minute digitate hyperkeratosis (MMDH) is a rare disorder of keratinization characterized clinically by multiple, tiny, spiky, keratotic papules. Herein, we report a new case of MMDH. There was no family history of similar lesions or a personal history of underlying disease. The lesions were limited to the face and associated with acne vulgaris. We consider this case as a postinflammatory type of MMDH.
Acne Vulgaris ; Humans

Epinephrine is frequently used to control local bleeding during surgery. However, it may be associated with complications, such as pulmonary edema, reversible cardiomyopathy, and cardiac arrest. We encountered a case of stress induced cardiomyopathy (SIC) after local epinephrine instillation. The SIC is manifested with typical left ventricular apical ballooning and clinical symptoms of a myocardial infarction without coronary stenosis. Although its prognosis is more favorable than a myocardial infarction, anesthesiologists need to be aware of the possible adverse effects of local epinephrine infiltration.
Cardiomyopathies ; Coronary Stenosis ; Epinephrine ; Heart Arrest ; Hemorrhage ; Myocardial Infarction ; Prognosis ; Pulmonary Edema

Takayasu's arteritis is generally recognized as a chronic, idiopathic, inflammatory disease, which affects the aorta and the proximal portions of its major branches. We experienced a patient with Takayasu's arteritis who was presented with main pulmonary artery stenosis and right coronary ostial occlusion without involvement of aorta nor its major branches. She was managed with pulmonary arterioplasty and coronary artery bypass graft. This case emphasize that the disease cannot affect the aorta.
Aorta ; Constriction, Pathologic* ; Coronary Artery Bypass ; Coronary Vessels* ; Humans ; Pulmonary Artery* ; Takayasu Arteritis* ; Transplants

OBJECTIVE: Tardive dyskinesia (TD) is one of the serious side effects caused by long-term treatment with neuroleptic medication. Many investigators are trying to elucidate the pathophysiological mechanism of TD, and some candidate genetic polymorphisms have been reported as associated with TD. This study investigated the association of the 5-HT2A receptor promoter gene polymorphisms with TD in Korean schizophrenic subjects. METHODS: The subjects in this study of 5-HT2A receptor gene polymorphisms were 119 schizophrenia patients, 59 with TD and 60 without. TD was evaluated by using the Abnormal Involuntary Movement Scale (AIMS). Genomic DNA was amplified by PCR and digested with MspI. RESULTS: There were no statistically significant differences in the demographic variables of age, sex ratio, duration of illness and duration of antipsychotic drug exposure between the TD and control groups. 1) A-1438G polymorphisms and TD, By comparing the TD and control groups, the -1438A/G allele was found to be associated with a significantly increased risk for TD (x2=5.560, df=1, p=0.018). 2) Three AIMS categories of TD and A-1438G genotype. There were statistically significant differences in the three AIMS categories (x2=6.835, df=2, p=0.033). CONCLUSION: These results suggest that the -1438A/G genotype of the 5-HT2A receptor gene is related to the development of TD. The -1438A/G genotypes were associated with significantly higher AIMS orofacial dyskinesia scores. These findings suggest that the 5-HT2A receptor gene is partly associated with susceptibility to TD in patients with chronic schizophrenia.
Alleles ; DNA ; Dyskinesias ; Genotype ; Humans ; Movement Disorders* ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Receptor, Serotonin, 5-HT2A* ; Research Personnel ; Schizophrenia ; Sex Ratio

BACKGROUND: Skin organ culture is widely used as a tool to investigate skin biology or skin disease. OBJECTIVE: The objective of the present study was to develop an ideal skin organ culture model for evaluation of melanin pigmentation. METHODS: An air-liquid interface and submerged method were used. The histology of the cultured skin was studied with H&E stain. To examine the epidermal pigmentation, Fontana-Masson stain and NKI/beteb stain were performed. Pigment modifiers (arbutin, LY294002) were applied to the culture medium for 3 days as an air-liquid interface culture. RESULTS: The general architecture of the skin was well maintained for 5 days. The melanin pigment decreased during culture without change of the number of melanocytes. As expected from previous reports, the effect of pigment modifiers (arbutin, LY294002) on cultured skin was demonstrated. CONCLUSION: The results indicate that this skin organ culture model is useful in evaluating the melanin pigmentation
Biology ; Melanins* ; Melanocytes ; Organ Culture Techniques* ; Pigmentation* ; Skin Diseases ; Skin*