Pleomorphic (undifferentated) carcinoma is a rare histologic type of carcinomas of the gallbladder and an atypical carcinoid is thought to be an intermediated type between carcinoid tumor and small cell carcinoma. Dense core "neurosecretory" granules can be found in the above mentioned tumors. We experienced a case of a double tumor of the gallbladder in a 51-year old male patient. Grossly, a large solid mass, about 5.0 cm in diameter, was found in the fundic portion and the neck portion also had a small 1.5 cm-sized polypoid mass. Microscopically, these lesions had features of pleomorphic carcinoma and atypical carcinoid, respectively. Immunohistochemically, they manifested reactivity for neuron specific enolase. Ultrastructural study revealed neurosecretory granules in the cytoplasms of tumor cells of the fundic and neck masses. Although light microscopic features of these tumor masses are quite different, we consider that these tumors represent a spectrum of neuroendocrine differentiation.
Male ; Humans

PURPOSE: Current enucleation and socket reconstruction techniques often require reinforcement of an orbital implant or wound by use of a tissue graft. Common source is usually allograft tissue(cadaveric sclera, fascia, etc.). Disadvantages of allografts include possible inflammatory reaction, unpredictable vascularization rate, variable resorption, antigenicity, and cost. METHODS: The authors used autogenous lamella sclera obtained from the enucleated eye. Seven autogenous lamella scleral grafts were used to cover biointegrated implant spheres(hydroxyapatite or Medpor(r)). RESULTS: After the follow-up period of 6 to16 months(average 10.8 months), superior sulcus deformity(1 case) and transient exposure of implant(1 case) were developed. Postoperative prosthetic motility was satisfactory in all cases. CONCLUSIONS: These techniques are presented as an alternative to using human bank tissue or remote incision autografts for reconstruction of the anophthalmic socket.
Allografts ; Autografts ; Durapatite ; Fascia ; Follow-Up Studies ; Humans ; Orbit* ; Orbital Implants* ; Sclera ; Transplants* ; Wounds and Injuries

Klippel-Feil syndrome(KFS) consists of short neck, low posterior hairline and restriction of motion of the neck due to fusion of cervical vertebrae. The typical disorder results from a failure of the normal segmentation of mesodermal somites during 3-8 weeks of gestation. In 1912, the first complete clinical description of this syndrome was given by Klippel and Feil. Feil reported additional cases in 1919 and distinguished between three morphologic groups. The incidence of KFS has been estimated to be approximately 1 : 40,000-42,000 births. A slight female predilection has been noted. Although the disorder is sporadic, there are examples of familial occurrence; how ever, no clear mechanism of inheritance has been accepted. Since the disturbance producing a short neck occurs early in embryogenesis, defects in other organ systems may occur at the same time. Common musculoskeletal anomalies that accompany KFS include scoliosis, as well as Sprengel's deformity in as many as one-third of cases. Neurologic, cardiovascular, and urinary tract anomalies are associated with KPS. We report a case of Klippel-Feil syndrome with associates anomalies include Sprengel's deformity.
Cervical Vertebrae ; Congenital Abnormalities ; Embryonic Development ; Female ; Humans ; Incidence ; Klippel-Feil Syndrome* ; Mesoderm ; Neck ; Parturition ; Pregnancy ; Scoliosis ; Somites ; Urinary Tract ; Wills

PURPOSE: The effect of global inhomogeneity on quantitative susceptibility mapping (QSM) was investigated. A technique referred to as Simultaneous Unwrapping Phase with Error Recovery from inhomogeneity (SUPER) is suggested as a preprocessing to QSM to remove global field inhomogeneity-induced phase by polynomial fitting. MATERIALS AND METHODS: The effect of global inhomogeneity on QSM was investigated by numerical simulations. Three types of global inhomogeneity were added to the tissue susceptibility phase, and the root mean square error (RMSE) in the susceptibility map was evaluated. In-vivo QSM imaging with volunteers was carried out for 3.0T and 7.0T MRI systems to demonstrate the efficacy of the proposed method. RESULTS: The SUPER technique removed harmonic and non-harmonic global phases. Previously only the harmonic phase was removed by the background phase removal method. The global phase contained a non-harmonic phase due to various experimental and physiological causes, which degraded a susceptibility map. The RMSE in the susceptibility map increased under the influence of global inhomogeneity; while the error was consistent, irrespective of the global inhomogeneity, if the inhomogeneity was corrected by the SUPER technique. In-vivo QSM imaging with volunteers at 3.0T and 7.0T MRI systems showed better definition in small vascular structures and reduced fluctuation and non-uniformity in the frontal lobes, where field inhomogeneity was more severe. CONCLUSION: Correcting global inhomogeneity using the SUPER technique is an effective way to obtain an accurate susceptibility map on QSM method. Since the susceptibility variations are small quantities in the brain tissue, correction of the inhomogeneity is an essential element for obtaining an accurate QSM.
Brain ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; Methods ; Volunteers

We report a case of primary undifferentiated cardiac sarcoma. The tumor originated from the left atrial free wall with multi-organ metastases, e.g., lung, and adrenal gland. The patient gradually grew worse with dyspnea and hemoptysis because of the obstructed left atrial outflow. Surgical resection of the left atrial sarcoma was undertaken to save the patient's life, followed by chemotherapy and brain irradiation as adjuvant therapy. The prognosis of cardiac sarcoma with metastases is very poor. However, in patients with hemodynamic instability, surgical intervention could be a therapeutic modality as palliation.
Adrenal Glands ; Brain ; Drug Therapy ; Dyspnea ; Heart Neoplasms ; Hemodynamics ; Hemoptysis ; Humans ; Lung ; Neoplasm Metastasis* ; Prognosis ; Sarcoma*

BACKGROUND: The Pentax-AWS is a newly developed rigid video laryngoscope. In comparison to the Macintosh laryngoscope, it offers a significantly improved laryngeal view and facilitates endotracheal intubation. The present study was performed to compare the general efficiency and the cardiovascular responses generated by Macintosh and Pentax-AWS systems during endotracheal intubation. METHODS: This study included 120 patients with American Society of Anesthesiologists (ASA) physical status class 1 or 2 requiring tracheal intubation for elective surgery. All patients were randomly allocated into two groups: Pentax-AWS (group P) and Macintosh (group M). Induction of anesthesia was performed using fentanyl, thiopental and succinylcholine intravenously. Systolic, mean and diastolic blood pressure (SBP, MBP, DBP) and heart rate (HR) were recorded just prior to induction, 1, 3, and 5 minutes after intubation. RESULTS: There were no significant differences in SBP, MBP, DBP and HR between both groups. However, group P showed a higher POGO (Percentage of Glottic Opening) score than group M during endotracheal intubation. CONCLUSIONS: Use of Pentax-AWS in endotracheal intubation did not increase hemodynamic changes compared to the use of Macintosh laryngoscope. Furthermore, Pentax-AWS offered an improved laryngeal view during endotracheal intubation.
Anesthesia ; Blood Pressure ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopes ; Succinylcholine ; Thiopental

Because the penetrating cervical tracheoesophageal injury may be associated with significant morbidity and mortality, it is important to choose the optimal method of diagnosis and management in patient with tracheoesophageal injury. We obtained a satisfactory result from repair of tracheoesophageal injuries using cardiopulmonary bypass. If the bleeding from the unidentified deep injury and the spread of infection could be controlled, the repair using CPB might increase the margin of safety during operation in the similar cases.
Cardiopulmonary Bypass ; Diagnosis ; Hemorrhage ; Humans ; Mortality ; Wounds, Stab*

Surgical management of oral cancer results in compromised masticatory and swallowing function which affects patient in social and psychological aspects due to reduced phonetic ability and facial deformity, thus, it is imperative to provide applicable prosthetic treatment to overcome such complications. This clinical study describes rehabilitation of a patient with squamous cell carcinoma treated with marginal mandibulectomy and implantation on preserved posterior portion of mandible to provide stability and support for subsequent denture treatment. Kennedy class IV removable partial denture has provided satisfactory results in esthetics and function. Bone level stability around implants was reported to be maintained during eight months of clinical observation.
Carcinoma, Squamous Cell ; Congenital Abnormalities ; Deglutition ; Denture, Partial, Removable* ; Dentures ; Esthetics ; Humans ; Mandible ; Mouth Neoplasms ; Rehabilitation*

No abstract available.
Bile Ducts, Extrahepatic*

BACKGROUND: Myxoma makes up close to 50% of adult primary cardiac tumors, and this mainly occurs in the left atrium, and rarely in the right atrium or ventricle. The patients clinically present with symptoms of hemodynamic obstruction, embolization or constitutional changes. Diagnosis is currently established most appropriately with 2-D echocardiography. Surgical resection of myxoma is a safe and effective treatment. MATERIAL AND METHOD: We reviewed our clinical experience in the diagnosis and management of 57 cases of cardiac myxoma that were seen over a 20-year period from July 1984 to July 2004. RESULT: The mean age of the patients was 53.5+/-14.0 years (range: 12 to 76 years). There were 38 (67%) females and 19 (33%) males. The preoperative symptoms included dyspnea on exertion in 27 patients, palpitation in 4, chest pain in 9 and syncopal episode in 4. The diagnosis was made by echocardiography alone in 51, and by combination of echocardiography, CT and angiography in 6. The tumor attachment sites were the interatrial septum in 50, the mital valve annulus in 3 and the left atrial wall in cases. The tumor was excised successfully via biatriotomy in 33 (58%), left atriotomy in 15 (26%), the septal approach via right atriotomy in 3, Inverted T incision in 3 and the extended septal approach in 3. The follow-up time ranged from 1 to 229 months (mean follow-up: 84.0+/-71.3 months). There were no early and late deaths and no recurrence during the follow-up period except for follow-up loss in 5 patients. CONCLUSION: It's concluded that excision of cardiac myxoma is curative and the long-term survival is excellent. Immediate surgical treatment was indicated because of the high risk of embolization or of sudden cardiac death. Radical tumor excision may prevent recurrences.
Adult ; Angiography ; Chest Pain ; Death, Sudden, Cardiac ; Diagnosis ; Dyspnea ; Echocardiography ; Female ; Follow-Up Studies ; Heart Atria ; Heart Neoplasms ; Hemodynamics ; Humans ; Male ; Myxoma* ; Recurrence ; Syncope