Stereotactic vacuum-assisted breast biopsy (VAB) has been used to evaluate microcalcifications or non-palpable breast lesions on mammography. Although stereotactic VAB is usually performed in a prone or upright position, an expensive prone table is necessary and vasovagal reactions often occur during the procedure. For these reasons, the lateral decubitus position can be applied for stereotactic VAB, and true lateral mammography can be used to detect the lesion. We report on 15 cases of lateral decubitus positioning for stereotactic VAB with true lateral mammography for non-palpable breast lesions or microcalcifications. The mean procedure time was approximately 30.1 minutes, and no complications occurred during the procedures. Fourteen cases had benign breast lesions and one case had a ductal carcinoma in situ. The lateral decubitus stereotactic VAB with true lateral mammography can be applied for microcalcifications or non-palpable breast lesions and helps to minimize anxiety and vasovagal reactions in patients.
Anxiety ; Biopsy ; Breast ; Carcinoma, Intraductal, Noninfiltrating ; Humans ; Mammography ; Stereotaxic Techniques

Swallow or deglutition syncope is a rare cause of syncope. It occurs due to a vagal reflex while swallowing. We present here a patient with recurrent loss of consciousness after swallowing liquid. He had a 1-month history of concurrent chemoradiotherapy due to non-small cell lung cancer. Electrocardiogram monitoring revealed atrioventricular block with swallowing of beverages. The details of this case suggest that chemoradiotherapy to mediastinum may cause neurogenic swallow syncope.
Atrioventricular Block ; Beverages ; Carcinoma, Non-Small-Cell Lung ; Chemoradiotherapy* ; Deglutition ; Electrocardiography ; Humans ; Lung Neoplasms* ; Lung* ; Mediastinum ; Reflex ; Syncope* ; Unconsciousness

A 43-year-old woman presented with dizziness, ataxia and right hearing difficulty. Her magnetic resonance images demonstrated an inhomogeneously contrast-enhanced large tumor growing into right cavernous sinus and Meckel's cave located totally within intradural retroclival region. She underwent retromastoid suboccipital craniotomy to resect the tumor mass and adjuvant gamma knife radiosurgery for remnant tumor at 1 month after operation. Adjuvant radiosurgery after surgical excision seems to be effective for the treatment of intradural extraosseous chordomas.
Adult ; Antineoplastic Combined Chemotherapy Protocols ; Ataxia ; Cavernous Sinus ; Chordoma ; Craniotomy ; Cyclophosphamide ; Dizziness ; Doxorubicin ; Female ; Hearing ; Humans ; Magnetic Resonance Spectroscopy ; Podophyllotoxin ; Radiosurgery ; Vincristine

PURPOSE: To evaluate the efficacy of stereotaxic breast core biopsy using a prone table system, and theeffects of operator experience, lesion characteristics and number of samples on biopsy results in cases involvingnonpalpable breast lesions. MATERIALS AND METHODS: We performed stereotaxic core biopsies of 62 nonpalpablemammographic lesions in 61 patients. Subsequent surgical excision was performed in 11 cases with micro calcifications and one case with a mass. We equally divided patients with micro calcifications into two groups(early and late periods) and analyzed the mammographic findings. Correlation of the pathologic results of corebiopsy with those of surgical excision were investigated. RESULTS: In two patients, stereotaxic biopsy wasimpossible due to poor visibility of micro calcifications and thinness of the compressed breast. In 59 patients,core biopsy was successfully performed and specimens were adequate for pathologic examination. The average numberof micro calcifications seen on specimen mammography in the two groups was 1.8 (range: 0~8) and 2.5 (range:0~4)respectively. In patients from whom less than five and five or more samples were taken, the average number of micro calcifications seen on specimen mammography was 1.5 (range: 0~6) and 2.6 (range: 0~8), respectively,throughout the whole period. The pathologic findings were fibrocystic change in 50 cases, fibroadenoma in four,ductal carcinoma in situ in four, invasive ductal carcinoma in one, and atypical ductal hyperplasia in one. Theagreement rate of pathologic results between core biopsy and surgical excision was 83% (10/12) for malignancy and75% for histology. In three cases with disagreement between core and surgical pathologic results, the samplingnumber was small (3~4 times) and in two of the three cases, micro calcifications were not visible on mammography. CONCLUSION: Operator experience and sampling numbers larger than five results in an increased number of micro calcifications in specimens and more reliable core biopsy.
Biopsy* ; Breast* ; Carcinoma in Situ ; Carcinoma, Ductal ; Fibroadenoma ; Humans ; Hyperplasia ; Mammography ; Thinness

Mitochondrial encephalomyopathy with lactic acid and stroke-like episodes (MELAS) is a multisystem mitochondrial disorder that typically presents in childhood. We report a case of MELAS syndrome diagnosed in a 45-year-old man presented with chronic kidney disease before a stroke-like episode. Genetic testing revealed a m.3243A>G point mutation in the mtDNA. The original diagnostic criteria for MELAS required the onset of stroke-like episodes prior to 40 years of age but this case demonstrates that disease onset may delay in certain individuals.
DNA, Mitochondrial ; Genetic Testing ; Humans ; Lactic Acid ; Late Onset Disorders ; MELAS Syndrome* ; Middle Aged ; Mitochondrial Diseases ; Mitochondrial Encephalomyopathies ; Point Mutation ; Renal Insufficiency, Chronic* ; Stroke

The causes of sudden death after medullary infarction involve arrhythmia, central respiratory failure, and dysautonomia. Sudden cardiac arrest in a medullary infarction is uncommon. Most of these cases experienced sudden cardiopulmonary arrest within 2 weeks from stroke onset as the extent of lesion increased. Here, we report two cases of medullary infarction presenting as sudden cardiac arrest. These cases indicate that medullary infarction could be one of the causes of sudden cardiac arrest.
Arrhythmias, Cardiac ; Death, Sudden ; Death, Sudden, Cardiac ; Heart Arrest ; Infarction ; Medulla Oblongata ; Primary Dysautonomias ; Respiratory Insufficiency ; Stroke

Objective: Baseline amyloid burden in mild cognitive impairment (MCI) has been linked to conversion to Alzheimer’s disease (AD), but the comparison of baseline and longitudinal changes in amyloid burden for predicting AD remains unresolved. The objectives of this study aimed to compare the prognostic ability of baseline and longitudinal changes in amyloid burden in MCI patients. Methods: Seventy-five individuals with MCI were recruited and examined annually by clinical interviews for a mean follow-up of 24 months (range, 11.6–42.0). [18F]Florbetaben positron emission tomography (PET) scans were performed. T1-weighted 3D volumes were acquired for co-registration, and to define regions of interest. We examined whether baseline and longitudinal amyloid burden changes can improve AD conversion by Cox proportional hazard model analysis and receiver operating characteristic (ROC) curve analysis. Results: Cox proportional hazards model analysis showed that baseline amyloid burden was significantly associated with increased risk of conversion to AD (hazard ratio [HR]=10.0; 95% confidence interval [CI], 1.15–85.39; p=0.04), but longitudinal amyloid burden changes was not (HR=0.2; 95% CI, 0.02–1.18; p=0.07). When predicting AD, longitudinal amyloid burden changes had better ROC accuracy of 65.2% (95% CI, 48.4–82.0) than baseline amyloid burden of 59.6% (95% CI, 40.3–79.0), without statistical significance in pairwise comparison. Conclusion A single baseline amyloid PET could be sufficient in the prediction of AD conversion in MCI.

PURPOSE: We reviewed 100 cases of HLA-matched sibling allogeneic bone marrow transplantation(allo-BMT) in children and wish to share these results. MEHTODS: One hundred children had undergone allo-BMT from HLA-identical siblings between Nov. 1983 and May 1998. There were 50 males and 50 females with a median age of 10 years and a median follow-up of 38 months. Out of 100 cases, 43 children were transplanted for severe aplastic anemia (SAA), 29 for acute myelogenous leukemia (AML), 18 for acute lymphocytic leukemia (ALL), 8 for chronic myelogenous leukemia (CML) and 2 for hemophagocytic lympho-histiocytosis (HLH). RESULTS: SAA : The 5-year event free survival (EFS) of SAA was 91%. The types of events that occurred were 3 thrombotic thrombocytopenic purpura (TTP), 2 venoocclusive disease (VOD) and 1 rejection. AML : In 25 of 29 cases, the 4-year EFS after allogeneic BMT in first remission was 71%. That of the TBI-based and Busulfan-based group was 44% and 77%, respectively. The most favorable results were observed in the Busulfan-based group in first remission with an EFS of 81% (n=18). The types of events that occurred were 4 TTP, 3 VOD, 2 rejections and 1 relapse. ALL : Five-year EFS of children with complete remission (CR; n=14, 7 CR1, 7 CR2) was 81%. CML : For the 6 children who received transplants while in the first chronic phase, the event free survival was 67%. HLH : Both of the two children with HLH survived 9 months and 24 months after BMT, respectively. Acute GVHD (> or =Grade ll) was observed in 13 children. Chronic GVHD developed in 10 children; 8 cases were localized and 2 were extensive type. CONCLUSION: Allo-BMT can cure children with refractory stem cell disorders. The most important factor that influences survival after transplantation is interval between diagnosis and transplantation for patients with severe aplastic anemia and remission state at transplantation for patients with leu-
Anemia, Aplastic ; Bone Marrow Transplantation* ; Bone Marrow* ; Child* ; Diagnosis ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukemia, Myeloid, Acute ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Purpura, Thrombotic Thrombocytopenic ; Recurrence ; Siblings* ; Stem Cells

PURPOSE: We reviewed 100 cases of HLA-matched sibling allogeneic bone marrow transplantation(allo-BMT) in children and wish to share these results. MEHTODS: One hundred children had undergone allo-BMT from HLA-identical siblings between Nov. 1983 and May 1998. There were 50 males and 50 females with a median age of 10 years and a median follow-up of 38 months. Out of 100 cases, 43 children were transplanted for severe aplastic anemia (SAA), 29 for acute myelogenous leukemia (AML), 18 for acute lymphocytic leukemia (ALL), 8 for chronic myelogenous leukemia (CML) and 2 for hemophagocytic lympho-histiocytosis (HLH). RESULTS: SAA : The 5-year event free survival (EFS) of SAA was 91%. The types of events that occurred were 3 thrombotic thrombocytopenic purpura (TTP), 2 venoocclusive disease (VOD) and 1 rejection. AML : In 25 of 29 cases, the 4-year EFS after allogeneic BMT in first remission was 71%. That of the TBI-based and Busulfan-based group was 44% and 77%, respectively. The most favorable results were observed in the Busulfan-based group in first remission with an EFS of 81% (n=18). The types of events that occurred were 4 TTP, 3 VOD, 2 rejections and 1 relapse. ALL : Five-year EFS of children with complete remission (CR; n=14, 7 CR1, 7 CR2) was 81%. CML : For the 6 children who received transplants while in the first chronic phase, the event free survival was 67%. HLH : Both of the two children with HLH survived 9 months and 24 months after BMT, respectively. Acute GVHD (> or =Grade ll) was observed in 13 children. Chronic GVHD developed in 10 children; 8 cases were localized and 2 were extensive type. CONCLUSION: Allo-BMT can cure children with refractory stem cell disorders. The most important factor that influences survival after transplantation is interval between diagnosis and transplantation for patients with severe aplastic anemia and remission state at transplantation for patients with leu-
Anemia, Aplastic ; Bone Marrow Transplantation* ; Bone Marrow* ; Child* ; Diagnosis ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukemia, Myeloid, Acute ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Purpura, Thrombotic Thrombocytopenic ; Recurrence ; Siblings* ; Stem Cells

The objective of this study was to develop a pre-clinical large animal model for the in vivo hemodynamic testing of prosthetic valves in the aortic position without the need for cardiopulmonary bypass. Ten male pigs were used. A composite valved conduit was constructed in the operating room by implanting a prosthetic valve between two separate pieces of vascular conduits, which bypassed the ascending aorta to the descending aorta. Prior to applying a side-biting clamp to the ascending aorta for proximal grafting to the aortic anastomosis, an aorta to femoral artery shunt was placed just proximally to this clamp. The heart rate, cardiac output, Vmax, transvalvular pressure gradient, effective orifice area and incremental dobutamine stress response were assessed. A dose dependant increase with dobutamine was seen in terms of cardiac output, Vmax, and the peak transvalvular pressure gradient both in the native and in the prosthetic valve. However, the increment was much steeper in the prosthetic valve. No significant differences in cardiac output were noted between the native and the prosthetic valves. The described pre-clinical porcine model was found suitable for site-specific in-vivo hemodynamic assessment of aortic valvular prosthesis without cardiopulmonary bypass.
Adrenergic beta-Agonists/pharmacology ; Animals ; Aorta/pathology ; Aortic Valve/*pathology ; Disease Models, Animal ; Dobutamine/pharmacology ; Dose-Response Relationship, Drug ; Heart Rate ; *Heart Valve Prosthesis ; Male ; Pressure ; *Prosthesis Implantation ; Support, Non-U.S. Gov't ; Swine ; Thoracic Arteries/pathology