There is a lot of difficulty in the diagnosis of follicular lesions of the thyroid by fine needle aspiration cytology(FNAC). The main purpose of this report is offering more guidance regarding the cytologic appearance to distinguish follicular neoplasm from nodular goiter and laying stress on the presence of mixed group. The histologic and cytologic findings of 23 follicular neoplasms and 13 nodular (adenomatous) goiters were reviewed. Histologic specimens were classified into the microfollicular(MIF), mixed(MIX), and nodular goiter(NG) groups. The comparison of histologic patterns with histologic diagnosis revealed that all the lesions with predominantly microfollicular, trabecular, or solid pattern were follicular carcinoma and all the lesions with predominantly macrofollicular pattern were nodular goiter. The distinguishing cytologic features for the MIF group were irregular cell arrangement in cell groups(100%, p=0.00001), absence of atrophic follicular cells(100%, p=0.0007), abundant microfollicles(100%, p=0.002), pleomorphic nuclei(100%, p=0.002), not predominant syncytial smear pattern(100%, p=0.002), heterochromatin(100%, p=0.032), absence of macrofollicles(100%, p=0.038), scant colloid(100%, p=0.04), clear background(83%, p=0.00006), and uniform sized follicles(83%, p=0.014). And regular cell arrangement(honeycomb appearance) in cell groups(85%, p=0.0000), atrophic change of follicular cells(69%, p=0.0002), syncytial smear pattern(54%, p=0.006), monomorphic nuclei(85%, p=0.008), and hemorrhagic background(100%, p=0.027) were characteristic features of the NG group. Seventeen out of 36 cases(47%) were the MIX group composed of combined cytologic features of the MIF and NG groups. Therefore the frequent presence of the MIX group is considered to be main cause of the difficultyin the diagnosis of follicular lesions by FNAC. The mixed morphologic feature may support the hypothesis of a biologic "continuum" between nodular goiter and follicular neoplasm of thyroid gland.
Biopsy, Fine-Needle* ; Diagnosis ; Goiter ; Goiter, Nodular* ; Thyroid Gland*

Membranous glomerulonephropathy is a common cause of nephrotic syndrome in adults. Kaposi sarcoma is a well-known entity with distinct clinical forms such as nodular cutaneous lesions, generalized lymphadenopathy and visceral involvement. Incidence of Kaposi sarcoma is greater in patients with immunosuppression, particularly those having undergone renal transplantation, but also in patients with other underlying disorders treated with immunosuppressive therapy, notably, corticosteroids. We present a case of Kaposi sarcoma in patient with membranous glomerulopathy during corticosteroid therapy. A 49- year-old man was admitted with a complain of facial and leg edema, 5-kg weight gain for 1 month, and foamy urine. Kidney biopsy showed membranous glomerulopathy. We started corticosteroid therapy to the patient. Two month later, his 24 hr urinary protein was decreased to 2.1 g/day. But, the well defined, various-sized, purple-colored papules and plaque appeared on the both hands and feet. He underwent skin biopsy, which revealed abnormally proliferated and dilated vessels, vascular slits, spindle-shaped cells and extravasated erythrocytes in the dermis. The findings were in accordance with Kaposi sarcoma. So he received cryotherapy with discontinuing corticosteroid. Four months after cryotherapy, skin lesions were cleared leaving slight hypopigmentation and amount of proteinuria was preserved without definite aggravation.
Adrenal Cortex Hormones ; Adult ; Biopsy ; Cryotherapy ; Dermis ; Edema ; Erythrocytes ; Foot ; Glomerulonephritis, Membranous* ; Hand ; Humans ; Hypopigmentation ; Immunosuppression ; Incidence ; Kidney ; Kidney Transplantation ; Leg ; Lymphatic Diseases ; Nephrotic Syndrome ; Proteinuria ; Sarcoma, Kaposi* ; Skin ; Weight Gain

Several investigators have described an interaction between muscle relaxants and hydrocortisones which have showed different results. The exact mechanism of this action is not clear and ther conflicting results have further confusion. The experimental methods were two ways. In the one of method, a group that vecuronium 0.1mg/kg was given intravenously is control and a group that hydrocortisones of various doses(0.3, 0.5 and 1 mg/kg) were administered into vein when T1 was appeared is compared. In the another of method, a control group was anticholinesterase(pyridostigmine 0.12 mg/kg, robinul 0.004mg/kg) were given at the time when T1 reached 25% and a group treated with hydrocortisone 0.5 mg/kg when T1 was appeared is compared. Neuromuscular blockade was measured by recording the twitch response following ulnar nerve stimulation by EMG(ABM, Datex Co. 2Hz 30mA supramaximal voltage). The recovery time from 25% to 75% recovery of twitch height was measured according to recovery index(RI). The results obtained were as follows: `) The RI of control group treated with vecuronium 0.1mg/kg alone was 40.32+/-20.24 minutes and the group which hydrocortisone 0.5mg/kg was combined, was shorten to 18.79+/-5.17 minutes, but in the group combined with hydrocortisone 1.0mg/kg and 0.3mg/kg, the RI was also tended to short, but not significant. 2) In the RI of vecuronium 0.1mg/kg, anticholinesterases were given, was 8.46+/-5.06 minutes and the group combined with hydrocortisone 0.5mg/kg was shorten to 4.77+/-1.82 minutes significantly. Conclusively, in the small doses of hydrocortisone, there is a effect of antagonism to the vecuronium induced blockade and a potentiated effect to the anticholinesterase activity to the vecuronium.
Cholinesterase Inhibitors ; Humans ; Hydrocortisone* ; Neuromuscular Blockade* ; Research Personnel ; Ulnar Nerve ; Vecuronium Bromide* ; Veins

PURPOSE: Endothelin-1 is the most potent vasoconstrictor. This study was investigated the correlation of plasma endothelin-1 and pulmonary hypertension associated with congenital heart defect. METHODS: We evaluated the concentration of ET-1 in 24 cases of congenital heart disease diagnosed at the Department of Pediatrics, Pusan National University, from December 1993 to September 1994. The patients were divided into 2 groups according to mean pulmonary arterial pressure: Pulmonary artery hypertension group(Group I) and normal pulmonary artery pressure group(Group II). Between 2 groups, there was no statistical significance in mean age, sex and oxygen saturation. GroupI included 9 patients of VSD and 1 patient of COA. Group II included 9 patients of VSD, 3 patients of TOF and 1 patient of PS, 1 patient of PS with DORV. RESULTS: The results were summarized as follows; 1) The mean pulmonary arterial pressure and pulmonary-to-systemic flow ratio (Qp/Qs), pulmonary vascular resistance in GroupIwere significantly higher than those in Group II. 2) The plasma concentrations of ET-1 in GroupI was significantly higher than those in Group II. 3) But there were no statistical significance between the concentrations of ET-1 and the mean pulmonary artery pressure, Qp/QS, pulmonary vascular resistnace. CONCLUSIONS: Based on these results, plasma ET-1 concentraions were elevated in patients with pulmonary hypertension associated with congenital heart defects.
Arterial Pressure ; Busan ; Endothelin-1* ; Heart Defects, Congenital* ; Humans ; Hypertension ; Hypertension, Pulmonary* ; Oxygen ; Pediatrics ; Plasma* ; Pulmonary Artery ; Vascular Resistance

BACKGROUND: Diffusion-weighted MR imaging (DWI) was designed to detect the random molecular otion of water in tissue. DWI has gained increasing interest recently because it can demonstrate yperacute stroke earlier than any other imaging methods so far. The purpose of our study was to etermine the clinical usefulness and significance of DWI compared with those of Fast Spin Echo T2-weighted image (SE T2WI) and Fluid Attenuated Inversion Recovery (FLAIR) image in acute and subacute ischemic stroke. METHOD: Twenty-five adult patients with clinical diagnoses of acute or subacute cerebral infarctions were imaged with fast SE T2WI, FLAIR and DWI using a 1.5-T image. RESULTS:All the patients had areas of high signal intensity indicating acute or subacute lesions on DWI and these lesions provide an excellent clinicoanatomic correlation. CONCLUSIONS: DWI is most useful in the diagnosis and localization of acute or subacute lacuna or subcortical infarction in patients with preexisting chronic infarctions or white matter hyperintensity showing high signal intensity similar to acute or subacute infarctions on T2WI or FLAIR image.
Adult ; Brain ; Cerebral Infarction ; Diagnosis ; Diffusion* ; Humans ; Infarction ; Magnetic Resonance Imaging ; Stroke*

The leiomyosarcoma is uncommom tumor that consists of 10% of all sarcoma incidence and commonly arise from retroperitomeum or mesentery. But leiomyosarcoma arose from mediastinum is very rare and only incidental case report is present. Mediastial leiomyosarcoma may originate from superior vene cava, pulmonary artery, small vessels of alveoli, esophagus and cardiac muscle. Common symptoms that are related with leimoyosarcoma of mediastinum are cough and dydpnea but dysphagia, chest pain and hemoptysis can be produced. Although long term survival after complete resection of tumor was reported in localized disease, there wes no effective therapy that prolong the survival in patients who had disseminated disease of huge tumor mass. We report the case of posterior mediastinal leiomyosarcoma confirmed by aspiration cytology and immunohistochemical staining, along with a review of literature.
Chest Pain ; Cough ; Deglutition Disorders ; Esophagus ; Hemoptysis ; Humans ; Incidence ; Leiomyosarcoma* ; Mediastinum ; Mesentery ; Myocardium ; Pulmonary Artery ; Sarcoma

Congenital smooth muscle hamartomas (CSMHs) usually appear at birth as skin-colored or slightly hyperpigmented patches or plaques on the trunk or extremities and are often covered by and increased amount of vellus hair. Histopathologically, it represents a proliferation of smooth muscle bundles within the dermis(1,2). We herein report on three cases of localized CSMHs; Case 1 was a 2-month-old boy who presented with a skin-colored, 6x5cm-sized plaque with folds, hypertrichosis and pseudo- Darier's sign on the face, an unusual site. But there was no hyperpigmentation. Case 2 and 3 were both 1-month-old boys who presented with typical hyperpigmented, hairy plaques on the lateral aspect of the left thigh.
Extremities ; Hair ; Hamartoma* ; Humans ; Hyperpigmentation ; Hypertrichosis ; Infant ; Infant, Newborn ; Male ; Muscle, Smooth* ; Parturition ; Thigh

Subparalyzing dose of nodepolarizing relaxants prior to injection of succinylcholine has been used to prevent various adverse effects induced after succinylcholine. For investigating interactions between succinylcholine and small doses of four non-depolar-izing agents, the 112 subjects that were ASA class 1-2 and no existing neuromuscular conduction system disorder were divided into 5 groups that were control group(only succinylcholine 1 mg/kg) and pretreated group d-tubocurarine 0.5 mg/kg, atracurium 0.08 mg/kg, vecuronium 0.01 mg/kg and pancuronium 0.01 mg/kg. In each group, the plasma concentration of K+ and PChE before and after use of succinylcholine, fasciculation, onset and recovery time of succinylcholine block and intubating conditon were observed. The results are as follows; In the pretreated group, there were no significant changes of plasma concentration of K+ and plasma cholinesterase(Table 3) but diminished the incidence of fascieulation, delayed the onset time and shorted the recovery time of succinylcholine block(Table 4), and worse in intubating condition(Table 5) except pancuronium treated group. It was concluded that these seem to make worse condition of intubation, while small doses of nondepolarizing muscle relaxants except pancuronium antagonize depolarizing muscle relaxant.
Atracurium ; Fasciculation ; Incidence ; Intubation ; Pancuronium ; Plasma ; Succinylcholine* ; Tubocurarine ; Vecuronium Bromide

Subparalyzing dose of nodepolarizing relaxants prior to injection of succinylcholine has been used to prevent various adverse effects induced after succinylcholine. For investigating interactions between succinylcholine and small doses of four non-depolar-izing agents, the 112 subjects that were ASA class 1-2 and no existing neuromuscular conduction system disorder were divided into 5 groups that were control group(only succinylcholine 1 mg/kg) and pretreated group d-tubocurarine 0.5 mg/kg, atracurium 0.08 mg/kg, vecuronium 0.01 mg/kg and pancuronium 0.01 mg/kg. In each group, the plasma concentration of K+ and PChE before and after use of succinylcholine, fasciculation, onset and recovery time of succinylcholine block and intubating conditon were observed. The results are as follows; In the pretreated group, there were no significant changes of plasma concentration of K+ and plasma cholinesterase(Table 3) but diminished the incidence of fascieulation, delayed the onset time and shorted the recovery time of succinylcholine block(Table 4), and worse in intubating condition(Table 5) except pancuronium treated group. It was concluded that these seem to make worse condition of intubation, while small doses of nondepolarizing muscle relaxants except pancuronium antagonize depolarizing muscle relaxant.
Atracurium ; Fasciculation ; Incidence ; Intubation ; Pancuronium ; Plasma ; Succinylcholine* ; Tubocurarine ; Vecuronium Bromide

The purpose of this study was to determine the meaning of the pain and experiences of elderly women with osteoarthritis, by adopting Colaizzi's phenomenological method. The participants were 7 elderly women over the age of 65. They were selected using a theoretical sampling technique. The Data was collected by in-depth and open-ended interviews from Dec. 1. 1999. to Feb, 28. 2000. The length of the interviews varied from 120 minutes to 180 minutes. Data was recorded and analyzed by a constant comparative method. From the data, significant statements were extracted and then organized into 48 themes, which resulted in 15 clusters of themes and 6 categories. The final descriptions turned out to be valid through the interviewee' validation process. Essential themes of the pain experiences emerged : "physical discomfortness(disturbances)", "negative state of mind", "influence of the death", "positive change in life", "Cause of pain perceived", and "change of their personal relationships". From these results, it was found that elderly women need nursing care based on a deep understanding of pain, and a reflection on their past is imperative to overcome their given situations. In conclusion, it is suggested that the care givers provide more support to solve the problems experienced by the elderly. Thus the researchers expect to provide understanding of older people and give basic data of holistic care for them.
Aged* ; Arthritis ; Caregivers ; Female ; Humans ; Nursing Care ; Osteoarthritis*