BACKGROUND AND OBJECTIVES: As previously reported, unstable angina is usually related to characteristic coronary artery lesion's morphology analyzed by coronary angiogram. This takes the form of an eccentrically placed convex stenosis with a narrow neck due to one or more overhanging edges or irregular, scalloped borders, or both. Although most studies were done for lesions with high degree stenosis(>50%), recent studies emphasized the role of vulnerability of plaque in acute coronary syndrome and even mild degree stenotic lesions may progress rapidly to evoke acute coronary syndrome. Therefore in this study, we analyzed the morphological characteristics of coronary artery lesions with mild degree stenosis as well as severe stenosis. MATERIALS AND METHODS: We conducted a retrospective study of 96 patients with angina pectoris (42 of stable patients and 54 of unstable patients) who underwent coronary angiography. Each lesions with 25% or greater diameter stenosis were categorized into simple and complex lesion(convex intraluminal obstruction with a narrow neck or irregular borders, diffuse irregularities, ulceration, thrombus). Calcification of coronary artery, extents of lesions were analyzed and stenosis grade and location were categorized by AHA classification. RESULTS: There were no significant differences between the stable angina and unstable angina in risk factors and vessel involvement, numbers of lesions, calcification and total obstruction. In morphologic analysis, complex lesions were more frequent in unstable angina than stable angina (49% vs 33%, p<0.05). The mean of percent diameter stenosis was not signigicantly different between two groups, but severe stenotic lesions with 90% or more stenosis were more frequent in unstable angina (34% vs 22%, p<0.05). Locations of involved vessels were similar between the angina groups. Complex lesions were distributed more frequent in RCA and simple lesions were more in LAD and LCX (p<0.05). CONCLUSIONS: The lesions with both complex morphology and severe degree stenosis are closely implicated in unstable angina.
Acute Coronary Syndrome ; Angina Pectoris ; Angina, Stable ; Angina, Unstable* ; Classification ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels* ; Humans ; Neck ; Pectinidae ; Retrospective Studies ; Risk Factors ; Ulcer

The lymphoepithelial cyst (LEC) rarely occurs in the thyroid gland. The LEC has been thought to be related to developmental rest, namely solid cell nest, which is derived from ultimobranchial body. We report a case of lymphoepithial cyst in a 34- year-old woman clinically diagnosed with Hashimoto's thyroiditis. The cyst was located in mid to lower portion of the left lobe. It was a single unilocular cyst, which for the most part was lined with squamous epithelium, and at certain foci with ciliated columnar epithelium. The cyst wall showed a dense lymphocytic infiltration, numerous lymphoid follicles with germinal centers and admixed thyroid follicles. This morphology is similar to the branchial cleft cyst, with the exception of the thyroid follicles in the cyst wall. Near the cyst were several solid epidermoid cell nests. Immunohistochemical stain of this cyst-lining epithelium and solid cell nests showed CEA positivity. In view of the similarity in histomorphology and CEA positivity to branchial cleft cyst of the lateral neck, the LEC of the thyroid could also have been of branchial origin. However, the admixed thyroid follicles in the cyst wall suggests that the LEC of the thyroid gland might have derived from another branchial cleft as a ultimobranchial body, because it has the potential for thyroid follicular differentiation.
Branchial Region* ; Branchioma ; Epithelium ; Female ; Germinal Center ; Humans ; Neck ; Thyroid Gland* ; Thyroiditis ; Ultimobranchial Body

No abstract available.
Carbon*

PURPOSE: Hypoxic-ischemic encephalopathy is a major neurologic problem and one of the most important perinatal causes of neurological morbidity. Evaluation of the presence, extent, and subsequent evolution of hypoxic-ischemic lesions may be very important. We studied the significance of imaging modality through the analysis of brain MRI findings of hypoxic-ischemic encephalopathy during neonatal period and comparison with findings of brain ultrasonography. METHODS: We analysed the forty-seven infants retrospectively who were diagnosed as hypoxic-ischemic encephalopathy and underwent brain MRI and ultrasonography from Jan. 1992 to May 1996. RESULTS: 1) The mean gestational age and birth weight of the twenty-seven infants who were premature were 32.8+/-2.08weeks and 1.97+/-0.44kg respectively. The mean gestational age and birth weight of twenty infants who were fullterm were 39.3+/-1.04weeks and 2.98+/- 0.93kg respectively. The primary hypoxic-ischemic insults occurred during antenatal, intrapartum and postnatal period. 2) The findings of brain MRI were classified into periventricular leukomalacia, encephalomalacia, basal ganglia lesion, focal parenchymal hemorrhage, ventriculomegaly without other lesion and normal finding. 3) Three infants among twenty-five infants with periventricular leukomalacia, four infants among seven infants with basal ganglia lesion and six infants among seven infants with focal parenchymal hemorrhage were not diagnosed by brain ultrasonography. 4) All of ten infants with encephalomalacia and four infants with ventriculomegaly without other lesion were diagnosed by brain ultrasonography. CONCLUSIONS: MRI can diagnose the hypoxic-ischemic lesions which would not be possible by brain ultrasonography. Therefore MRI is the imaging modality of choice for diagnosis in infants with hypoxic-ischemic encephalopathy. We believe that the benefits of MRI outweigh its somewhat higher cost, lack of portability and monitoring difficulties.
Basal Ganglia ; Birth Weight ; Brain ; Diagnosis ; Encephalomalacia ; Gestational Age ; Hemorrhage ; Humans ; Hypoxia-Ischemia, Brain* ; Infant ; Infant, Newborn ; Leukomalacia, Periventricular ; Magnetic Resonance Imaging* ; Retrospective Studies ; Ultrasonography

PURPOSE: Hypoxic-ischemic encephalopathy is a major neurologic problem and one of the most important perinatal causes of neurological morbidity. Evaluation of the presence, extent, and subsequent evolution of hypoxic-ischemic lesions may be very important. We studied the significance of imaging modality through the analysis of brain MRI findings of hypoxic-ischemic encephalopathy during neonatal period and comparison with findings of brain ultrasonography. METHODS: We analysed the forty-seven infants retrospectively who were diagnosed as hypoxic-ischemic encephalopathy and underwent brain MRI and ultrasonography from Jan. 1992 to May 1996. RESULTS: 1) The mean gestational age and birth weight of the twenty-seven infants who were premature were 32.8+/-2.08weeks and 1.97+/-0.44kg respectively. The mean gestational age and birth weight of twenty infants who were fullterm were 39.3+/-1.04weeks and 2.98+/- 0.93kg respectively. The primary hypoxic-ischemic insults occurred during antenatal, intrapartum and postnatal period. 2) The findings of brain MRI were classified into periventricular leukomalacia, encephalomalacia, basal ganglia lesion, focal parenchymal hemorrhage, ventriculomegaly without other lesion and normal finding. 3) Three infants among twenty-five infants with periventricular leukomalacia, four infants among seven infants with basal ganglia lesion and six infants among seven infants with focal parenchymal hemorrhage were not diagnosed by brain ultrasonography. 4) All of ten infants with encephalomalacia and four infants with ventriculomegaly without other lesion were diagnosed by brain ultrasonography. CONCLUSIONS: MRI can diagnose the hypoxic-ischemic lesions which would not be possible by brain ultrasonography. Therefore MRI is the imaging modality of choice for diagnosis in infants with hypoxic-ischemic encephalopathy. We believe that the benefits of MRI outweigh its somewhat higher cost, lack of portability and monitoring difficulties.
Basal Ganglia ; Birth Weight ; Brain ; Diagnosis ; Encephalomalacia ; Gestational Age ; Hemorrhage ; Humans ; Hypoxia-Ischemia, Brain* ; Infant ; Infant, Newborn ; Leukomalacia, Periventricular ; Magnetic Resonance Imaging* ; Retrospective Studies ; Ultrasonography

A 74-year-old woman presented with an abrupt onset of dyspnea that she had experienced for a week. She had been suffering from cutaneous nodules in the scalp for a year. Thoracentesis of the pleural fluid was performed. The Papanicolaou-stained smears, Thin prep and cell block preparations revealed clusters of oval-shaped cells concentrically layered about amorphous acellular cores, i.e., there was microacinar lumen formation as well as singly scattered atypical cells. The cells occasionally demonstrated intracytoplasmic vacuoles and hemosiderin deposits. Those cells stained for CD31 and they were negative for pancytokeratin. Punch biopsy from the scalp nodules revealed angiosarcoma. There are currently few reported cases of angiosarcoma in an exfoliative pleural effusion. Angiosarcoma has diverse, heterogeneous cytologic features. Making the cytologic diagnosis of metastatic angiosarcoma in pleural fluid is a challenge for pathologists. Knowledge of the clinical history is of great help for diagnosing this tumor when it appears in rare sites. Immunopanels with CD31, pancytokeratin and TTF-1 are helpful for making the differential diagnosis. The pathologists should look for clues suggesting the presence of vascular differentiation in the exfoliative cytologic materials when a diagnosis of angiosarcoma is suspected.
Aged ; Biopsy ; Diagnosis, Differential ; Dyspnea ; Female ; Hemangiosarcoma ; Hemosiderin ; Humans ; Pleural Effusion ; Pleural Effusion, Malignant ; Scalp ; Stress, Psychological ; Vacuoles

Neonatal hyperbilirubinemia is a significant risk factor for the developemtn of otoneurologic disorder. Hyperbilirubinemia resulting in kernicterus produces widespread neuronal damage with the most common sites of staining and destruction involving the hippocampus, basal ganglia and the brainstem nuclei in the floor of the fourth ventricle, including the dorsal cochlear nucleus. ABR may be a useful tool for the monitoring early bilirubin toxicity and postcteric sequelae in infants. This study attempts to evaluate the clinical neurodevelopmental outcome in hyperbilirubnemic infants requiring exchange transfusion through the assessment of ABR. Eight hyperbilirubinemic neonates with severely abnormal ABR findings and twelve hyperbilirubinemic neonates with normal ABR findings were studied to assess their neurodevelopemental outcome. The results were as follows; 1) There were 8 severely abnormal ABR cases, including 5 cases of bilateral flat wave and 3 cases of unilateraly elevated hearing throeshold. 2) The major cause of hyperbilirubinemia was ABO incompatibility(65%) 3) Significant clinical finding associated with severely abnormal ABR was kernicterus(p<0.05) 4) Significant laboratory findings associated with severely abnormal ABR were lower levels of hemoglobin and hematocrit(p<0.05) 5) 2 cases of bilateraly flat ABR and 3 cases of unilaterally elevated hearing threshold could be classified into sensorineural type hearing defect by latency-intensity function curve. 6) At the follow up tests of 3 cases of bilaterally flat ABR, 2 cases showed no change and 1 case showed mild improvement. 7) Among 5 follow up cases of severely abnormal BR, only 1 case showed normal neurodevelopmental outcome, 3 cases showed major neurodevelopmental defect and 1 case showed minor neurodeveoplemental defect. Among them, 1 case has had definite hearing disability.
Basal Ganglia ; Bilirubin ; Brain Stem ; Cochlear Nucleus ; Evoked Potentials, Auditory, Brain Stem* ; Follow-Up Studies ; Fourth Ventricle ; Hearing ; Hippocampus ; Humans ; Hyperbilirubinemia* ; Hyperbilirubinemia, Neonatal ; Infant ; Infant, Newborn* ; Kernicterus ; Neurons ; Risk Factors

Neonatal hyperbilirubinemia is a significant risk factor for the developemtn of otoneurologic disorder. Hyperbilirubinemia resulting in kernicterus produces widespread neuronal damage with the most common sites of staining and destruction involving the hippocampus, basal ganglia and the brainstem nuclei in the floor of the fourth ventricle, including the dorsal cochlear nucleus. ABR may be a useful tool for the monitoring early bilirubin toxicity and postcteric sequelae in infants. This study attempts to evaluate the clinical neurodevelopmental outcome in hyperbilirubnemic infants requiring exchange transfusion through the assessment of ABR. Eight hyperbilirubinemic neonates with severely abnormal ABR findings and twelve hyperbilirubinemic neonates with normal ABR findings were studied to assess their neurodevelopemental outcome. The results were as follows; 1) There were 8 severely abnormal ABR cases, including 5 cases of bilateral flat wave and 3 cases of unilateraly elevated hearing throeshold. 2) The major cause of hyperbilirubinemia was ABO incompatibility(65%) 3) Significant clinical finding associated with severely abnormal ABR was kernicterus(p<0.05) 4) Significant laboratory findings associated with severely abnormal ABR were lower levels of hemoglobin and hematocrit(p<0.05) 5) 2 cases of bilateraly flat ABR and 3 cases of unilaterally elevated hearing threshold could be classified into sensorineural type hearing defect by latency-intensity function curve. 6) At the follow up tests of 3 cases of bilaterally flat ABR, 2 cases showed no change and 1 case showed mild improvement. 7) Among 5 follow up cases of severely abnormal BR, only 1 case showed normal neurodevelopmental outcome, 3 cases showed major neurodevelopmental defect and 1 case showed minor neurodeveoplemental defect. Among them, 1 case has had definite hearing disability.
Basal Ganglia ; Bilirubin ; Brain Stem ; Cochlear Nucleus ; Evoked Potentials, Auditory, Brain Stem* ; Follow-Up Studies ; Fourth Ventricle ; Hearing ; Hippocampus ; Humans ; Hyperbilirubinemia* ; Hyperbilirubinemia, Neonatal ; Infant ; Infant, Newborn* ; Kernicterus ; Neurons ; Risk Factors

BACKGROUND: Continuous epidural morphine infusion is a good and popular method to control postoperative pain. But intravenous morphine infusion after general anesthesia can avoid anxiety during operation and also control postoperative pain. We compared analgesia and side effects between continuous epidural infusion and continuous intravenous infusion of morphine sulfate to control of postoperative pain after cesarean section. METHODS: Forty women who received cesarean section were randomly divided into epidural and IV groups. Morphine 0.08 mg/kg was administered intravenously as an initial loading dosage for both groups. Morphine 0.08 mg/kg for epidural group or morphine 0.8 mg/kg for IV group was diluted into 96ml of normal saline. A mixture was injected into Two-day Infusor which is continuously infused 2 ml/hr. The patients received morphine solution into epidural or intravenous route with Two-day Infusor according to their allocated group. The assessments for pain score with VAS, VRS, patient's satisfaction score and side effects were made at recovery room, 0.5, 3, 12, 24, 36, 48 and 60 hours after operation. RESULTS: The VAS in IV group was significantly higher than that in epidural group at 3, 12, 24 and 36 hours after the operation (P<0.05). The VRS in IV group was significantly higher than in epidural group at recovery room and 3 hours of postoperative period (p<0.05). The frequency of pruritus, nausea, vomiting, back pain and urinary retention were less in IV group than in epidural group. The patient's satisfaction scores were similar in both groups. CONCLUSIONS: The management of postoperative pain in epidural group was more effective than the continuous intravenous morphine infusion. But the incidence of complications was more frequent in the epidural group while patient's satisfaction scores were similar in both groups. Therefore, the continuous intravenous morphine infusion can be used effectively as a postoperative pain management.
Analgesia* ; Anesthesia, General ; Anxiety ; Back Pain ; Cesarean Section* ; Female ; Humans ; Incidence ; Infusion Pumps ; Infusions, Intravenous ; Morphine* ; Nausea ; Pain, Postoperative ; Postoperative Period ; Pregnancy ; Pruritus ; Recovery Room ; Urinary Retention ; Vomiting

PURPOSE: A tension-free hernia repair using a mesh is considered to be the standard method. The Prolene Hernia system (PHS) is a more recently introduced hernia-repair device in Korea. We report the results of hernia repair using the PHS in 120 cases at our department. METHODS: We retrospectively analyzed 120 cased of herniorrhaphy using PHS. between December 2002 and September 2004. RESULTS: There were 104 male and 16 female patients with a mean age of 54 years: 85 indirect, 32 direct, 2 femoral, and 2 pantaloon hernias. There were 20 cases postoperative complications: including 6 hematoma, 3 seroma, 3 wound swelling, 2 dysuria, 2 testicular swelling, 1 scrotal swelling and 1 peritoneal irritation. There were no postoperative infection and recurrence. The median operative time was 54.6 min (range 23~165min). We thought that lesser than 30 cases need to be performed to become skillful in the hernia repair with PHS. CONCLUSION: Hernia repair with PHS is easy to learn and to perform. And this procedure has lesser postoperative complications.
Dysuria ; Female ; Hematoma ; Hernia* ; Herniorrhaphy* ; Humans ; Hydrogen-Ion Concentration ; Korea ; Male ; Operative Time ; Polypropylenes ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Seroma ; Wounds and Injuries