A 16-year-old girl was transferred to the department of thoracic and cardiovascular surgery because of a spontaneous pneumothorax with prolonged air leakage. Chest computed tomography demonstrated a cystic lesion measuring 2×3 cm and involving the left upper lobe. Left upper lobectomy was performed via video-assisted thoracoscopic surgery. A pathologic examination of the specimen revealed a mesenchymal cystic hamartoma. Despite the rarity of pulmonary mesenchymal cystic hamartoma, it should be considered a potential cause of pneumothorax for patients with a large pulmonary cyst. Further, surgical resection must be considered because serious complications such as hemothorax, hemoptysis, and malignant transformation have been reported.
Adolescent ; Female ; Hamartoma* ; Hemoptysis ; Hemothorax ; Humans ; Lung* ; Pneumothorax ; Thoracic Surgery, Video-Assisted ; Thorax

A 49-year-old male patient presented at our clinic with back pain due to an insignificant injury that had occurred approximately 7 months earlier. Although the patient had been treated at primary clinics, the pain had gradually become aggravated and characterized by resting and night pain. We initially diagnosed the patient with myofascial pain syndrome and began treatment comprised of trigger point injection (TPI) on the back muscles to control the pain. His symptoms improved after the first treatment (TPI), but he complained of back pain again several days later. At that time he also reported that he had lost 10 kg over the 4 months preceding his initial visit. Plain radiographs of the thoracolumbar spine revealed L1-L5 compression fractures and generalized osteopenia. The patient was then diagnosed with multiple myeloma based on the results of a bone marrow biopsy. This case demonstrates the importance of using comprehensive diagnostic approaches when the patient manifests symptoms that are unresponsive to conventional treatment.
Back Pain ; Biopsy ; Bone Diseases, Metabolic ; Bone Marrow ; Fractures, Compression ; Humans ; Low Back Pain ; Male ; Middle Aged ; Multiple Myeloma ; Muscles ; Myofascial Pain Syndromes ; Spine ; Trigger Points

BACKGROUND: Platelet Function Analyzer-100 (PFA-100, Dade-Behring, Germany) is an instrument that simulates in vivo hemostatic plug formation under high shear flow by measuring the time required to occlude aperture. We performed this study to reconfirm preanalytical variables and establish the reference intervals of Korean adults. METHODS: A total of 120 healthy individuals were enrolled. Closure times (CT) with the collagen/ epinephrine (CEPI) and the collagen/ADP (CADP) cartridges were measured. RESULTS: The reference intervals by the central 95th percentile were 82-182 sec for CEPI-CT and 62-109 sec for CADP-CT. Females had significantly longer CEPI- and CADP-CT than males (P=0.034 and 0.022, respectively). Individuals over 40 yr showed shorter CEPI- and CADP-CT compared with younger ones (P=0.002 and 0.003, respectively). CEPI- and CADP-CT values measured in the afternoon were significantly longer than corresponding ones in the morning (P<0.0001 in both conditions). Group O blood groups were related to longer CEPI- and CADP-CT compared with non-O blood groups (P=0.0003 and <0.0001, respectively). CADP-CT was weakly correlated with hematocrit (r=-0.296, P=0.001), but not CEPI-CT. CONCLUSIONS: We reconfirmed the preanalytical variables and established the reference intervals of PFA-100 CT in Korean adults. It is recommended that reference interval of this test should be verified according to age, diurnal variation, and ABO blood groups for optimal utilization.
ABO Blood-Group System ; Adult ; Female ; Humans ; Korea ; Male ; Middle Aged ; Platelet Function Tests/*instrumentation/standards ; Reference Values ; Regression Analysis ; Time Factors

The title of page 189 should be corrected.

No abstract available.
Dendritic Cells*

We evaluated the antihypertensive effect of amlodipine, a calcium channel bloker, in 35 cases of essential hypertention. After 12 weeks' administration(5~10mg q.d.), the following results were obtained : 1) The systoloic and diastolic blood pressure were decreased significantly(170.3+/-12.2mmHg vs 143.7+/-13.0mmHg p<0.01 and 104.7+/-5.9mmHg vs 87.8+/-6.5mmHg, p<0.01, respectively) but the heart rate was independant of amlodipine administration. 2) The systolic blood pressure was lowered by 20mmHg or more in 26(76.5%) of 34 patients and the diastolic pressure was lowered by 10mmHg or more in 26(76.5%) of 34 patients at 12 weeks after amlodipine administration. 3) The adverse effects of amlodipine were dizziness in 5, edema in 5, indigestion in 3, constipation in 2, headache, flushing, insomnia in 1 patient respectively and only one of them discontinued amlodipine administration due to severs facial flushing and skin eruption.
Amlodipine* ; Blood Pressure ; Calcium Channels ; Constipation ; Dizziness ; Dyspepsia ; Edema ; Flushing ; Headache ; Heart Rate ; Humans ; Skin ; Sleep Initiation and Maintenance Disorders

BACKGROUND: Fibrin-ring granuloma (FRG), which can be found in bone marrow or the liver, is a subtype of epithelioid granuloma characterized by a central fat vacuole and annular peripheral fibrinoid materials. FRG has been proven to be associated with many etiologies such as several infectious organisms (Coxiella burnett; Epstein-Barr Virus, EBV; cytomegalovirus, CMV; and hepatitis A virus), allopurinol induced hepatitis, Hodgkin's lymphoma, and peripheral T-cell lymphoma. METHODS: We retrospectively reviewed 24 patients diagnosed with FRG by bone marrow biopsy at a single institute between 1995 and 2004. We reviewed clinical symptoms and laboratory findings of the patients, classified them by etiology, and compared prognosis of each group. RESULTS: The most common cause of FRG was acute or chronic EBV infection. Chronic or acute EBV infection was associated with 41.4% of patients (10/24). Of the remaining patients, 33.3% (8/24) were leukemia or lymphoma patients after chemotherapy, 4.2% (1/24) was a patient with hepatic failure, and 20.8% (5/24) were diagnosed as fever of unknown origin. The most common symptom and clinical finding were fever and cytopenia. EBV-associated group comprised chronic active EBV infection, EBV-associated hemophagocytic histiocytosis, acute EBV infection, EBV-associated lymphoproliferative disease, and Langerhans' cell histiocytosis. The EBV-associated group showed a lower survival probability compared with the non-EBV group (P<0.05). CONCLUSIONS: Patients with bone marrow fibrin ring granuloma accompanied by fever require an active workup to find out the cause of infectious agents including EBV infection particularly due to their poor prognosis.
Adolescent ; Adult ; Aged ; Bone Marrow Diseases/diagnosis/*etiology/pathology ; Child ; Child, Preschool ; Epstein-Barr Virus Infections/*complications/diagnosis ; Female ; Fibrin/analysis ; Granuloma/diagnosis/*etiology/pathology ; Herpesvirus 4, Human/immunology/isolation & purification ; Humans ; In Situ Hybridization ; Male ; Middle Aged ; Polymerase Chain Reaction ; Prognosis ; Q Fever/diagnosis ; Retrospective Studies ; Survival Rate

PURPOSE: A major hepatobiliary resection (MHBR), liver resection of more than one lobe, has been recommended by some surgeons for advanced carcinomas (Ca) of the gallbladder (GB) and the hilar bile duct (HBD). However, high operative mortality and morbidity have been reported and its survival benefit has not been clearly documented. METHODS: We report the results of MHBR for such tumors to determine the safety and the effectiveness of this operation, which has been performed for GB Ca invading the right hepatic pedicle or liver bed by 2 cm or more and for HBD Ca of Bismuth type III or IV. The cases of fifty consecutive cases who received MHBR for GB Ca (n=11) or HBD Ca (n=39) during a 5 year-period were reviewed. RESULTS: Thirty right-sided and 20 left-sided hepatectomies were performed. There was no operative or hospital death. Minor and major complications developed in 64% of the cases. All the complications improved with conservative management, except two in which re operations were required, one due to portal vein thrombosis and the other to bleeding of the retro peritoneal dissection site. No specific factors were associated with the high complication rate. The long-term outcome of HBD Ca was better than that of GB Ca. In HBD Ca, differentiated cancer and less transfusion were associated with a better prognosis. CONCLUSION: MHBR was conducted with acceptable morbidity and no mortality. In terms of the long-term outcome, MHBR is recommended for HBD Ca whereas it should be considered more carefully for GB Ca.
Bile Ducts ; Biliary Tract* ; Bismuth ; Gallbladder ; Hemorrhage ; Hepatectomy ; Liver ; Mortality ; Prognosis ; Venous Thrombosis

PURPOSE: A major hepatobiliary resection (MHBR), liver resection of more than one lobe, has been recommended by some surgeons for advanced carcinomas (Ca) of the gallbladder (GB) and the hilar bile duct (HBD). However, high operative mortality and morbidity have been reported and its survival benefit has not been clearly documented. METHODS: We report the results of MHBR for such tumors to determine the safety and the effectiveness of this operation, which has been performed for GB Ca invading the right hepatic pedicle or liver bed by 2 cm or more and for HBD Ca of Bismuth type III or IV. The cases of fifty consecutive cases who received MHBR for GB Ca (n=11) or HBD Ca (n=39) during a 5 year-period were reviewed. RESULTS: Thirty right-sided and 20 left-sided hepatectomies were performed. There was no operative or hospital death. Minor and major complications developed in 64% of the cases. All the complications improved with conservative management, except two in which re operations were required, one due to portal vein thrombosis and the other to bleeding of the retro peritoneal dissection site. No specific factors were associated with the high complication rate. The long-term outcome of HBD Ca was better than that of GB Ca. In HBD Ca, differentiated cancer and less transfusion were associated with a better prognosis. CONCLUSION: MHBR was conducted with acceptable morbidity and no mortality. In terms of the long-term outcome, MHBR is recommended for HBD Ca whereas it should be considered more carefully for GB Ca.
Bile Ducts ; Biliary Tract* ; Bismuth ; Gallbladder ; Hemorrhage ; Hepatectomy ; Liver ; Mortality ; Prognosis ; Venous Thrombosis