Pagets disease is charaterized by a unilateral sharply defined eczema with or without an underlying ductal adenocarcinoma of the female nipple which was described by James Paget on 1874. We experienced 2 cases of Pagets disease confined to the nipple & areola with or without a palpable mass. The one was 44-year-old female, who had been suffered from pea. sized, eczematous lesion and crust formation on the Lt. nipple and areola with a painful palpable mass in the Lt, breast and nipple retraction since about 3years ago(Fig. 1). The another one was 52-year-old female, who had been suffered frorn palm sized, same lesions of the former on the Lt. breast with accompanying itching sensation and without a palpable mass and nipple retraction since about 7years ago(Fig. 5). Histopathologically, there were large, round, clear staining cells with Iarge nuclei in the epidersi and an inflammatory infiltration in the dermis. Diagnosis was confirmed by the clinical and histological pictures. The former was treated by simple mastectomy and the latter by radical mastectorny.
Adenocarcinoma ; Adult ; Breast ; Dermis ; Diagnosis ; Eczema ; Female ; Humans ; Mastectomy, Simple ; Middle Aged ; Nipples ; Peas ; Pruritus ; Sensation

OBJECTIVES: Anticardiolipin antibody (ACA) and lupus anticoagulant (LA) are acquired antiphospholipid antibodies (APAs), which are regarded as important risk factors far vascular thrombosis and recurrent fetal loss. Although the clinical relevance of APAs in dialysis patients is uncertain, recent studies have suggested that APAs are involved in bioincompatibility and thrombogenic complications in hemadialysis (HD) patients. METHOD: We performed a cross sectional study of ACA and LA in 50 stable HD patients and their 68 vascular accesses (52 native arteriovenous fistulae and 16 synthetic arterovenous grafts), with the analysis of factors associated with the presence of APAs and the retrospective evaluation of vascular access occlusion (VAO). LA was assessed by platelet neutralization method whereas IgG-ACA was measured by a solid phase ELISA. Values higher than 23GPLU/ml (IgG phospholipid units) were considered to be positive for IgG-ACA and positive values for LA was more than 8 seconds in prolongation of the clotting time with human platelet lysate. Vascular access survival was assessed by Kaplan- Meier method, RESULTS: The mean age of the subject (M:F 21:29) was 46 years and the mean duration of hemodialysis was 49 months. The frequency of VAO in entire subjects was 0.45+/-0.98 episodes/patient year. The median value of IgG-ACA was 16.0 GPLU/ml with a distribution from 2.7 to 46.1GPLU/ ml. The median titer of I.A was 4.5 (3.1-45.6) seconds. Fourteen patients (28%) were found to have at least one episode of VAO. In spite of comparable clinical and biochemical data according to the presence of VAO, the titers of IgG-ACA (13.6+/-7.7 vs, 20.3+/-8.7GPLIJ/ml, P<0.05) and LA (4.5+/-2.9 vs. 11.7 +/-12.6sec, P<0.05) were significantly higher in VAO group. Six out of 50 patients(12%) had an increased titer of IgG-ACA and LA was found in 11 patients(22%). No patients were positive for ACA and LA simultaneously. There was no significant difference in sex, etiology of ESRD, diabetic status, the dosage of heparin during HD or the amount of erythropoietin administered according to the presence of APAs. We could not find any significant correlation between the titer of APAs and age, duration of dialysis, blood pressure, platelet count and biochemical parameters. In the patients with positive ACA, the frequency of VAO was 1.05+/-0.12 episodes/patient year, which was significantly higher than patients without ACA (0.33+/-0.17 episodes/ patient year, P<0.05). In the patients with the presence of LA(1.06+/-0.43 vs. 0.12+/-0.06 episodes/ patients year, P<0.01). The median vascular access survival time in IgG-ACA positive patients (32.7 months) was significantly decreased compared to 66.8 months in IgG-ACA negative group. CONCLUSION: Our data suggest that the presence of APAs (ACA and/or LA) affects the event-free vascular access survival in HD patients. Therefore the evaluation of APAs status have to be included in the diagnostic strategies for the patients with recurrent VAO. Further studies are necessary to explore the pharmacologic intervention method to decrease APAs and prevent VAO in HD patients.
Antibodies, Anticardiolipin* ; Antibodies, Antiphospholipid ; Arteriovenous Fistula ; Blood Platelets ; Blood Pressure ; Dialysis ; Enzyme-Linked Immunosorbent Assay ; Erythropoietin ; Heparin ; Humans ; Kidney Failure, Chronic ; Lupus Coagulation Inhibitor* ; Platelet Count ; Renal Dialysis* ; Retrospective Studies ; Risk Factors ; Thrombosis

BACKGROUND: The purpose of this study was to compare the time course of the bradycardia and hypotensive effects of esmolol. METHODS: Thirty patients who undergoing gynecologic operation were anesthetized with nitrous oxide and enflurane. After the steady state of anesthesia was achieved, esmolol 500microgram/kg for 1 minute followed by 25, 50, or 100microgram/kg/min for 60minuts infused by intravenous catheter. Heart rate, mean arterial pressure, cardiac index, stroke volume, and systemic vascular resistance was measured by 1, 3, 5, 10, 15, 20, 25, 30, 45, and 60 minutes. RESULTS: Heart rate was changed abruptly within 3 to 5 minutes, and decreased rapidly for 15minutes. Mean arteral pressure was decreased rapidly for 30 minutes, but slower than heart rate. Cardiac index was decreased rapidly for 20 minutes and differed significantly on the dose of 25, 50, 100microgram/kg. Stroke volume was decreased for 30 minutes, and systemic vascular resistance was increased rapidly for 10 minutes. It was decided the onset time that was expressed 90% of ultimate response of esmolol effect, and was calculated in each group. The onset time of heart rate of esmolol 25, 50, 100microgram/kg were 8.0 +/- 4.1, 4.8 +/- 2.3, 8.1 +/- 4.4 minutes, the time of mean arterial pressure were 30.0 +/- 7.5, 21.1 +/- 6.2, 19.9 +/- 7.8 minutes, and the time of cardiac index were 25.1 +/- 4.7, 14.8 +/- 5.0, 14.2 +/- 4.6 minutes. Thus heart rate, mean arterial pressure, cardiac index, stroke volume, and systemic vascular resistance responses of administration of esmolol did not occur with equal rapidity. CONCLUSIONS: Thus although esmolol has an ultrashort kinetic half life, only the heart rate effect can be considered to have an ultrashort onset.
Anesthesia ; Arterial Pressure ; Bradycardia ; Catheters ; Enflurane ; Half-Life ; Heart Rate ; Humans ; Nitrous Oxide ; Stroke Volume ; Vascular Resistance

PURPOSE: The identification of factors present at the time of initial evaluation may be important to predict the prognosis in patients with superficial bladder carcinoma. Attempts were made to identify predictive factors of recurrence and progression. MATERIALS AND METHODS: This study included twenty seven patients with superficial bladder tumor(pTa-pTl) who had no recurrence within 5 years. A comparative non-randomized study was performed of a control group of twenty six patients with same superficial bladder tumor who had recurrence within 1 year after transurethral resection of bladder tumor(TURBT) was done. Between the former and the latter patients cumulative and multivariate analyses were performed to estabilish predictive factors of pathological recurrence and progression. The resected tumors were immunohistochemically stained with anti-lamin rabbit serum to evaluate the presence or absence of basement membrane breakage, the vascular and/or lymphatic invasion, and to count number of neovascularizasion. RESULTS: In superficial bladder carcinoma, invasion of basement membrane, grade, invasion of lymphatics and vessels, and neoangiogenesis were significant factors affecting recurrence and progression, and these factors acted independently. CONCLUSIONS: These factors used to predict recurrence and progression of superficial bladder tumor were thought to be the important risk factors. These results suggested that close follow-up and aggressive treatment such as BCG instillation should be considered for the treatment of superficial bladder cancer with unfavourable prognostic factors.
Basement Membrane ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Mycobacterium bovis ; Prognosis ; Recurrence* ; Risk Factors ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: We evaluated the diagnostic accuracy and clinical usefulness of fluoroscopy-guided bone biopsy. MATERIALS AND METHODS: A total of 31 patients with various skeletal lesions underwent fluoroscopy-guided bone biopsies. The targets were long bones in 16 cases, pelvic bones in 7 cases, spines in 6 cases, and ribs in the rest 2 cases. RESULTS: The overall accuracy was 71%(22/31). The accuracy was 100% in case of primary sarcoma and multiple myeloma. But it was low in malignant lymphoma(1/4), malignant fibrous histiocytoma(0/1), and nonossifying fibroma(0/1). CONCLUSION: Percutaneous fluoroscopy-guided bone biopsy is a simple, safe, not-expensive, and rather accurate diagnostic procedure in evaluation of bone tumors. In addition to that, it is useful in the managment planning and fllow-up of the patients.
Biopsy* ; Humans ; Multiple Myeloma ; Pelvic Bones ; Ribs ; Sarcoma ; Spine

To evaluate the effect of preoperative treatment on proliferative activity and prognosis of the hepatocellular carcinomas(HCCs), fifty-three surgically resected HCCs were studied. Twenty cases were treated preoperatively and thirty-three were not treated before surgery. The proliferation index(PI, % of proliferating cell nuclear antigen positive cells) of the remaining cancer cases(35.41). Although PI was similar among gross types and among histologic grades, tumors of the expanding type and of the histologic grade I revealed distinctly low PI in pretreated cases. Two-year survival rate was not significantly different between pretreated and not-pretreated cases(67.4 vs 52.7). But the differences between gross types(p<0.05) and between histologic grades(p<0.01) were significant. Total necrosis of tumor occurred in five pretreated patients, all of whom were alive during two-year follow-up. Smaller HCCs showed better prognosis(p<0.01). Although PI appeared not correlated well with the two tear survival rate, the pretreated HCCs preoperative modalities induce tumor necrosis, but do not reduce the proliferative activity of tumor cells significantly, and that pretreatment does not affect the long-term prognosis of HCCs except for the accasions of total necrosis of tumor.
Carcinoma, Hepatocellular

We report herein three cases of subcutaneous sarcoidosis without apparent internal lesion. The patients had multiple subcutaneous nodules on the extremities and abdomen. Hyper-gammaglobulinemia, a relative increase of T suppressor cells, and increased serum angiotensin converting enzyme level and skin anergy were observed. Histopathologic findings revealed sarcoidal granulomas involving the subcutaneous fat tissue. The lesions of two cases resolved spontaneously and the other one case required systemic corticosteroid therapy.
Abdomen ; Extremities ; Granuloma ; Humans ; Peptidyl-Dipeptidase A ; Sarcoidosis* ; Skin ; Subcutaneous Fat

The effect of induced hypotension with sodium nitroprusside(SNP) on alveolar-arterial oxygen tension difference and pulmonary shunting in 10 surgical patients with normal pulmonary function was studied under general anesthesia. Heart rate, mean arterial pressure, central venous pressure, blood gases and hemoglobin were measured before, during and after SNP infusion. Using the above data, alveolar-arterial oxygen tension difference and pulmonary shunting were calculated. The results were as follows. 1) Mean arterial pressure decreased significantly from 98+/-9.1mmHg before SNP infusion to 61+/-3.0 mmHg during SNP infusion(p<0.001), and increased to 96+/-6.7mmHg again after SNP infusion. 2) Heart rate increased significantly from 78+/-10.5 beats/min. to 101+/-11.9 beats/min.(p<0.001), and decreased to 84+/-11.5 beats/min. again. 3) Arterial oxygen tension decreased from 489+/-32.5mmHg to 480+/-25.0mmHg, but was not statistically significant. (p>0.05). 4) Alveolar-arterial oxygen tension difference increased from 188+/-29.0mmHg to 196+/-25.0mmHg, but was not statistically significant(p>0.05). 5) Pulmonary shunting increased from 9.0+/-1.83% to 9.2+/-1.50%, but was not statistically significant.(p>0.05). The above findings suggest that pulmonary shunting in patients with normal lung function will not affected during induced hypotension with SNP.
Anesthesia, General ; Arterial Pressure ; Central Venous Pressure ; Gases ; Heart Rate ; Humans ; Hypotension* ; Lung ; Nitroprusside* ; Oxygen* ; Sodium*

Quantitative serial measurements of Alpha-fetoprotein (a-FP) and Beta-human chorionic gonadotropin (B-HCG) using radioimmunoassay were performed in a patient with recurrent non-germinomatous germ cell tumor (NGGCT) into CNS during radiotherapy and chemotherapy. When the pineal tumor was initially presented, elevated levels of serum a-FP and B-HCG fell dramatically to normal rage after the completion of cranial irradiation (5,060cGy). Three months later, the patient had a rise in serum and CSF tumor markers coincident with recurrence of tumor into lumbal spinal canal. Serum levels were not changed despite of 15 days of whole spine irradiation (2,000cGy) although decreased remarkably 1 month after the completion of radiotherapy (4,230cGy). At the time of relapse in the suprasella area and the cerebellopontine angle, serum and CSF levels rised again. As a result of two courses of chemotherapy the tumor markers fell markedly, but the tumor was spread to other sites into CNS. We conclude serial measurements of a-FP and B-HCG are useful for the diagnosis of the non-germinomatous germ cell tumor into CNS and for monitoring disease activity.
alpha-Fetoproteins ; Cerebellopontine Angle ; Chorionic Gonadotropin ; Cranial Irradiation ; Diagnosis ; Drug Therapy ; Germ Cells* ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Pinealoma ; Radioimmunoassay ; Radiotherapy ; Rage ; Recurrence ; Spinal Canal ; Spine ; Biomarkers, Tumor*

OBJECTIVES: The purpose of this study was to get help in order to diagnose orthopaedic disease, measure its activity and determine treatment plan by measuring the beta-glucuronidase activity in urine, serum and joint fluid. METHODS: The beta-glucuronidase activity was determined in the serum, urine and joint fluid of the patients with degenerative arthritis, rheumatoid arthritis, osteomyelitis and osteogenic sarcoma, and some other disease to study the change of the enzyme activity. These values of each specimen were calculated by standard curve and treated by statistical analysis. RESULTS: The results obtained were summarized as follows. 1. The beta-glucuronidase activity in the serum, urine and joint fluid was increased in patients with degenerative arthritis, rheumatoid arthritis, osteomyelitis and osteogenic sarcoma etc. 2. The increased beta-glucuronidase activity in the serum and joint fluid of each disease does not show a specific finding about respective disease, but the increased beta-glucuronidase activity was statistically significant in the urine of all disease groups(male:p=0. 0041, female:p=0. 0001). CONCLUSIONS: On the basis of these results, it was suggested that beta-glucuronidase activity was affected by the orthopaedic disease and differed according to each specimen.
Arthritis, Rheumatoid ; Glucuronidase* ; Humans ; Joints ; Osteoarthritis ; Osteomyelitis ; Osteosarcoma