Granular cell tumor (GCT) of the breast is a rare neoplasm that is usually benign in nature. The results of physical examination and ultrasonographic findings of GCT of the breast often mimic those of other malignancies. A 46-year-old woman underwent wide excision for removal of a large mass in the left breast (about 10 cm in diameter). The pathologic finding of the excised mass was benign GCT. A year after initial surgery, recurrence of the left breast mass was found along with a newly developed mass in the contralateral right breast, which was excised. In this study, we describe the case of a newly developed GCT in the contralateral breast 1 year after excision of a larger breast GCT.
Breast* ; Female ; Granular Cell Tumor* ; Humans ; Middle Aged ; Physical Examination ; Recurrence

No abstract available.
Forehead* ; Hyaluronic Acid* ; Imaging, Three-Dimensional* ; Pilot Projects*

No abstract available.
Amebiasis* ; Diabetes Mellitus* ; Humans ; Kidney* ; Liver*

PURPOSE: To evaluate the NT in the first trimester associated with fetal chromosomal abnormality, fetal structural abnormality and adverse pregnancy outcome. METHODS: From Mar. 1993 to Dec. 1997, 133 cases of increased NT were reviewed retrospectively. All these fetues were taken a karyotyping and/or a high resolution ultrasonography for associated anomaly. The NT was measured by transvaginal ultrasonography(TVS) and transabdominal ultrasonography(TAS) if difficulty was encountered with TVS in the period of the 10th-14th week of gestation. The increased NT is approved when it is over 3mm. RESULTS: Of these 133 cases, 102 cases(76.7%) revealed normal outcomes and 31 cases(23.3%) revealed abnormal outcomes such as chromosomal abnormality, structural abnormality and adverse pregnancy outcome, The mean value of NT was 3.44+/-0.68mm in the normal group and 4.93+/-2.70mm in the abnormal group, respectively. The chromosomal abnormalities were found in 16 of the 31 cases: nine Down SD, two Patau syndrome, one Tuner synrome, one triploidy, one 46, XX,i(18q), one 47,iso(Xp)/46,XX one confined placental mosaicism. In 12 cases of the 31 cases, the structural anomalies were detected. Of these 12 cases, 3 cases were eventually developed to cytsic hygroma, 3 cases were cardiac anomaly, 3 cases were renal anomaly, 1 case was congenital diaphragmatic hernia, 1 case was skeletal dysplasia and 1 case was suspected syndrome. The adverse pregnancy outcome such as intrauterine growth restriction, intrauterine fetal death and preterm labor was revealed in 3 cases. In the cases of NT over 7mm, the result was 100% abnormal outcome. CONCLUSION: Increased NT in the first trimester could be a highly efficient the predictor for detection of chromosomal abnormality, structural anomaly and adverse pregnancy outcome.
Chromosome Aberrations ; Female ; Fetal Death ; Hernia, Diaphragmatic ; Humans ; Karyotyping ; Lymphangioma, Cystic ; Mosaicism ; Nuchal Translucency Measurement ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Outcome* ; Pregnancy Trimester, First ; Pregnancy* ; Retrospective Studies ; Triploidy ; Ultrasonography

OBJECTIVES: It is well known that pneumoconiotic patients experience impairments of macrophage function, as well as poor penetration of drugs into the fibrotic nodules and the immune system. Resultantly, pneumonia is frequently involved in pneumoconiotic patients and its treatment is not easy. Therefore, we conducted a clinical evaluation of immunoglobulin G which is known to be effective in severe infectious diseases. METHODS: We randomly selected 45 pneumoconiotic patients with pneumonia and classified them into 2 groups. The experimental group (IgG group) was scheduled to receive antibiotics and IgG (5 g I.V./day for 7 days). The control group was treated with antibiotics alone. Sputum gram stain (counts of WBCs and microorganisms), body temperature, arterial oxygen tension, and counts of peripheral venous blood leukocytes and band neutrophils were used as markers to assess the response effect therapy at time periods of 0, 2, 4, 6, and 8 days after completion of therapy. We compared the clinical scores between the two groups. RESULTS: The experimental IgG treated group was composed of 27 patients, and the control group comprised 18 patients. There was no statistical differences between two groups in terms of age, pneumoconiotic profusion, impairment degree of pulmonary function, or frequency of pathogen isolation in the sputum before medication. The experimental IgG treated group showed lower clinical scores as compared with the control group (p=0.083). CONCLUSIONS: These results suggest that IgG infusion with antibiotics will have an effect on pneumonia therapy in pneumoconiosis patients that are under 60 years and exhibit simple pneumoconiosis.
Anti-Bacterial Agents ; Body Temperature ; Communicable Diseases ; Humans* ; Immune System ; Immunoglobulin G* ; Immunoglobulins* ; Leukocytes ; Macrophages ; Neutrophils ; Oxygen ; Pneumoconiosis ; Pneumonia* ; Sputum

BACKGROUND: Tracheal intubation may be difficult in many patients with sleep apnea syndrome because of anatomical abnormalities in their upper airway. METHODS: For 30 patients with obstructive sleep apnea syndrome, we evaluated two classifications; Samsoon-Young and Cormack-Lehane, and five airway examinations; interincisors' distance on mouth opening (DI), angle on cervico-occipital extension (ACO), thyromental distance (TD), and existence of edentulous with atrophic mandible and prominent maxillary incisor. RESULTS: 20 patients (67%) belonged to class III or IV according to the Samsoon-Young classification and 22 patients (73%) to grade III or IV according to the Cormack-Lehane classification. The incidence rate for DI less than 40 mm, ACO less than 160o, TD less than 60 mm, atrophic mandible and prominent maxillary incisor were 30%, 37%, 50%, 13% and 27% respectively. CONCLUSIONS: According to our results, we concluded that most patients with obstructive sleep apnea syndrome are difficult for anesthesiologists to intubate. Therefore, we suggest that anesthesiologists must prepare variable methods for ventilation if there is any suspicion of difficult intubation in those patients.
Classification ; Humans ; Incidence ; Incisor ; Intubation ; Intubation, Intratracheal* ; Mandible ; Mouth ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Ventilation

PURPOSE: The aim of this study was to determine the advantage of adequate PTGBD in acute complicated cholecystitis patients. METHODS: We performed a retrospective review of a collected database from September 2001 to July 2008. Acute cholecystitis with gangrene or perforation was defined as acute complicated cholecystitis. A PTGBD was performed for these patients immediately after the diagnosis using US or CT and then a tubogram was performed after 5~7 days. After evaluating the gallbladder (GB) and common bile duct (CBD) with a tubogram, we removed the drainage tube and the patients underwent a LC after readmission. RESULTS: Three hundred seventy four of the 893 patients who were diagnosed with acute cholecystitis underwent PTGBD. While 19 (3.2%) of the total acute cholecystitis patients were converted to open cholecystectomy due to severe inflammation, 14 (3.7%) of the acute complicated patients were converted to open cholecystectomy. In 79 patients, the pre-operative tubogram showed the presence of CBD stone and so ERCP was performed. There were no post-operative deaths. CONCLUSION: PTBGD in acute complicated cholecystitis patients allows the early relief of acute cholecystitis symptoms. This allows sufficient evaluation and treatment for CBD during the PTGBD state. Furthermore, this decreases the mortality and morbidity in the high-risk patients due to sufficient evaluation and management of the underlying critical disease, which allows elective cholecystectomy when the patients is in better condition for surgery. Therefore, PTGBD can be useful for acute complicated cholecystitis.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Common Bile Duct ; Drainage ; Gallbladder ; Gangrene ; Humans ; Imidazoles ; Inflammation ; Nitro Compounds ; Retrospective Studies

PURPOSE: There are a number of conditions that can lead to a hypercoagulable state, however, protein C and S deficiencies are frequently described as causes of the hypercoagulable states. The aim of this study was to evaluate the clinical features and prognosis of vascular diseases associated with protein C and/or S deficiencies and to determine an adequate treatment modality for such cases. METHODS: We prospectively evaluated 7 cases with vascular disease caused by protein C and/or S deficiencies confirmed with serologic tests. RESULTS: Four patients showed venous thrombosis, 1 peripheral arterial insufficiency, 1 cerebral venous thrombosis and peripheral arterial insufficiency, and 1 portal vein thrombosis. Surgical intervention was required in 5 patients. Full anticoagulation with heparin sodium followed by warfarin sodium was done in all patients. CONCLUSION: Protein C and S deficiencies may influence clinical management. Patients presenting with atypical vascular involvement without evidence of other risk factors should be evaluated for a hypercoagulable state. Once the diagnosis is made, patients should be treated with full anticoagulation.
Diagnosis ; Heparin ; Humans ; Prognosis ; Prospective Studies ; Protein C* ; Risk Factors ; Serologic Tests ; Vascular Diseases* ; Venous Thrombosis ; Warfarin

OBJECTIVE: Many studies have demonstrated that carbon dioxide has direct depressive effects on the myocardium and dilates the vascular bed. However, it leads to an increase in arterial blood pressure and cardiac output because of sympathetic stimulating effect. Extensive epidural block may impair the sympathetic innervation to the heart as well as to the adrenal gland. The present study was set up in order to investigate how an extensive epidural block would affect the hemodynamic response to sympathetic stimulation induced by hypercapnia. METHODS: Twenty patients were mechanically ventilated under general anesthesia after epidural catheter insertion on T6–T7 intervertebral space. Hypercapnia was obtained by CO2 breathing. PaCO2 (partial pressure of CO2, arterial) was adjusted to 30, 45, and 60 mm Hg with each concentration being maintained for 10 minutes. In each period, hemodynamic variables were monitored by pulmonary artery catheter. After returning to normocarbia for 15 minutes, 20 mL of 0.375% ropivacaine was injected epidurally and PaCO2 was adjusted in the same manner, and then, the hemodynamic variables of each period were checked. RESULTS: There were no changes in mean arterial pressure and heart rate by hypercapnia after combined epidural anesthesia compared with general anesthesia only. Hypercapnia increased cardiac output and cardiac index. Systemic vascular resistance was decreased significantly. Pulmonary artery pressure was increased but not significantly. The degrees of hemodynamic changes were similar between in general anesthesia alone and in combined epidural anesthesia. CONCLUSION: In spite of an extensive epidural block, hemodynamic changes induced by hypercarbnia were not changed. There are some ‘escaped’ sympathetic nerve fibers.
Adrenal Glands ; Anesthesia* ; Anesthesia, Epidural* ; Anesthesia, General ; Arterial Pressure ; Carbon Dioxide ; Cardiac Output ; Catheters ; Heart ; Heart Rate ; Hemodynamics* ; Humans ; Hypercapnia* ; Myocardium ; Nerve Fibers ; Pulmonary Artery ; Respiration ; Vascular Resistance

Paraduodenal hernia is a rare congenital anomaly caused by abnormal rotation of the midgut in embryonic stage, with part of the small intestine becoming trapped posterior to the mesocolon. Right and left paraduodenal hernias are distinct and separate entities, varying not only in anatomical structure but also in embryological origin. Paraduodenal hernia is a rare cause of acute intestinal obstruction. Careful clinical evaluation is needed for prompt surgical treatment. Because it is difficult to diagnose before exploration, and since paraduodenal hernia may cause potentially lethal complications such as obstruction, gangrene or bowel perforation, the possibility of internal hernia should be considered in any patient with acute intestinal obstruction who has no previous abdominal operation or external hernia. If paraduodenal hernia is suspected to be the cause of acute intestinal obstruction, the recommended tool for diagnosis is abdominal computed tomography. We experienced three cases of paraduodenal hernia, one case was right paraduodenal hernia while the others were left paraduodenal hernia.
Diagnosis ; Gangrene ; Hernia* ; Humans ; Intestinal Obstruction ; Intestine, Small ; Mesocolon