A malignant granular cell tumor (MGCT) occurred in the left shoulder of a 62-year-old man. The patient underwent wide marginal excision followed by chemotherapy and radiotherapy. A metastatic tumor was identified in the axillary lymph node 22 months after the excision of the shoulder mass. The primary tumor was a poorly circumscribed mass measuring 5 5 4 cm. On cut section, it was a solid mass with yellowish tan color. Histologically, both primary and metastatic tumor consisted of polygonal cells with abundant granular cytoplasm and a vesicular nucleus with a prominent nucleolus. Two to three mitotic figures per ten high power fields at 200 were counted. Tumor cells were weakly stained with periodic acid-Schiff (PAS) preparation both before and after diastase digestion, and were positive for S-100 protein, neuron-specific enolase (NSE), and vimentin. By electron microscopy, the cytoplasm was filled with numerous autophagolysosomes containing myelin figures, mitochondria, and fragmented rough endoplasmic reticula. Basal laminae and angulated bodies were also noted. These findings suggest schwannian differentiation of this tumor.
Amylases ; Basement Membrane ; Cytoplasm ; Digestion ; Drug Therapy ; Granular Cell Tumor* ; Humans ; Immunohistochemistry ; Lymph Nodes ; Microscopy, Electron ; Middle Aged ; Mitochondria ; Myelin Sheath ; Phosphopyruvate Hydratase ; Radiotherapy ; S100 Proteins ; Shoulder* ; Triacetoneamine-N-Oxyl ; Vimentin

As the population is aging, the prevalence of presbycusis is increasing proportionally. The prevalence of tinnitus, which usually accompanies presbycusis, is also growing. Presbytinnitus, defined as tinnitus which accompanies presbycusis, not only influences the individual's well-being and productivity but also causes communication problems, isolation, and social withdrawal. We now need to adopt more aggressive approaches to treating presbytinnitus in the elderly population, rather than giving them discouraging comments on the course of disease progression. Although the exact mechanisms of presbytinnitus have not been revealed and the specified therapeutic methods have not yet been established, an increasing number of studies using masking, retraining therapy, psychological therapy, and some medications have shown promising outcomes for the management of presbytinnitus. Therefore, appropriate treatment with multidisciplinary modalities should be provided for patients with presbytinnitus in order to reduce a growing social burden.
Aged ; Aging ; Disease Progression ; Efficiency ; Humans ; Masks ; Presbycusis ; Prevalence ; Tinnitus

Augumentation rhinoplasty using autogenous cranial bone graft (outer table) can be used more successfully than other methods. In patients with congenital or posttraumatic severe saddle nose deformity and lateral deviation, cranial bone graft is an excellent method of augumentation. The advantages of cranial bone graft compared with traditional method of bone graft are summarized as follows; 1. Easy to reach donor site 2. Abundance of material 3. Little pain and functional disability 4. Shorter hospitalization period 5. Inconspicuous donor scar 6. No secondary deformity of donor site 7.Appropriate curvature can be obtained by proper selection of donor site. With the above advantages, we conclude that augumentation rhinoplasty using split cranial bone graft is a good method in correction of congenital or posttraumatic deformity of nose.
Cicatrix ; Congenital Abnormalities ; Hospitalization ; Humans ; Methods ; Nose ; Rhinoplasty* ; Tissue Donors ; Transplants*

The long QT syndrome is believed to result from abnormalities of cardiac sympathetic innervation and of myocardial repolarization. The therapeutic modalities for patients with ventricular arrhythmias due to the long QT syndrome include beta blocker, cardiac sympathetic denervation, pacemaker and ICD implantation. Recently, we underwent transvenous ICD implantation in a patient with this syndrome who had recurrent syncopal episodes due to rapid polymorphic ventricular tachycardia and strong family history of sudden death.
Arrhythmias, Cardiac ; Death, Sudden ; Humans ; Long QT Syndrome* ; Sympathectomy ; Syncope ; Tachycardia, Ventricular

The long QT syndrome is believed to result from abnormalities of cardiac sympathetic innervation and of myocardial repolarization. The therapeutic modalities for patients with ventricular arrhythmias due to the long QT syndrome include beta blocker, cardiac sympathetic denervation, pacemaker and ICD implantation. Recently, we underwent transvenous ICD implantation in a patient with this syndrome who had recurrent syncopal episodes due to rapid polymorphic ventricular tachycardia and strong family history of sudden death.
Arrhythmias, Cardiac ; Death, Sudden ; Humans ; Long QT Syndrome* ; Sympathectomy ; Syncope ; Tachycardia, Ventricular

The occurrence of atrial fibillation during an electrophysiologic study or catheter ablation in patients with accessory pathways is a common problem and sometimes complicates the localization and ablation procedure of accessory pathways. In patients with sustained atrial fibrillation, it is often time-consuming to terminate atrial fibrillation by drugs or electrical cardioversion. We performed successful radiofrequency catheter ablation in a patient with right-sided accessory pathway during atrial fibrillation requiring repeated electrical cardioversion. The target site was determined by activation mapping and morphology of unipolar electrogram at a site of early ventricular activation.
Atrial Fibrillation* ; Catheter Ablation ; Electric Countershock ; Humans

No abstract available.
Free Tissue Flaps*

Discoid meniscus in the knee joint is common. From July 1990 through June 1994, the authors performed arthroscopy on 968 symptomatic knee joints. One hundred and six knees of 102 patients had discoid meniscus. Of the 106 knees, 14(13.2%) cases were associated with other intraarticular anatomic variants. There were 7(6.6%) cases with anomalous insertion of the anterior horn of the medial meniscus into the anterior cruciate ligament, and 7(6.6%) cases with anterior transposition of the insertion of the anterior cruciate ligament below the anterior tibial margin like the insertion of the posterior cruciate ligament. Of the 14 patients, the discoid meniscus were reshaped in 11 knees, partially resected in 2 knees, and one patient was treated with repair of a peripheral tear and reshaping. But had no treatment in associated intraarticular anatomic variants. The follow up was done from 24 to 54 months(average 37 months) after surgery. The results were excellent in 8 knees ; good in 4 knees and fair in 2 knees(Ikeuchi scale, 1982) The patients with excellent or good results were satisfied as were the authors, and these anatomical variants other than the discoid meniscus were not related to the patient's symptoms.
Animals ; Anterior Cruciate Ligament ; Arthroscopy ; Follow-Up Studies ; Horns ; Humans ; Knee ; Knee Joint ; Menisci, Tibial ; Posterior Cruciate Ligament ; Tears

The precise diagnosis of internal derangement of the knee is difficult, since the signs and symptoms are frequently obscure. For this reason, diagnostic aids have long been sought, and arthrogrphy has been widely used as a means to improve diagnostic accuracy. Recently, post-arthrographic high resolution computed tomogrphy has been added to the diagnostic techniques for the evaluation of the knee. Arthrography and post-arthrographic high resolution computed tomography were carried out in 97 cases of clinically suspicious meniscal tear from January 1986 to October 1987. Among them, 40 cases were confirmed by arthroscopic surgery and following results were obtained. l. Arthorgraphy resulted in a diagnostic accuracy of 92.5% and 72.5% for medial and lateral meniscal lesion. Post-arthrographic high resolution computed tomography resulted in that of 95.0% and 90.0% for each meniscal lesion. 2. 16 cases of them were discoid meniscus. 13 cases(92.5%) were detected by arthrography and 16 cases(100%) by post-arthrographic high resolution computed tomography. 3. The sensitivity of arthrography was proved to be 100% and 65.4% for medial and lateral meniscal lesion, and thst of post-arthrographic high resolution computed tomography to be 100% snd 88.5% for each meniscal lesion. The specificity of arthrography was 90.0 and 85.7% in each meniscal lesion and that of post-arthrographic high resolution computed tomography was 93.3% and 92.9% in each meniscal lesion. 4. Post-arthrogrsphic high resolution computed tomography was proved to show better diagnostic accuracy, and good visualization of the relationship and extent of torn meniscal lesions. The meniscal anatomy that was displayed by high resolution computed tomography more accurately depicted the anatomical findings that were seen at arthroscopy. With this additional information, arthroscopists could plan more appropriate surgical approach.
Arthrography ; Arthroscopy ; Diagnosis ; Knee ; Sensitivity and Specificity ; Tears

BACKGROUND: Mutated or deregulated expression of C-erbB-2 causes this gene to function as a potent oncogene. Vascular endothelial growth factor (VEGF) is a crucial angiogenic molecule in lung cancer. Both C-erbB-2 and VEGF can promote growth, proliferation and metastasis in non-small cell lung cancer (NSCLC). The purpose of this study was to investigate evaluate the relationship between the expressions of the C-erbB-2 and VEGF genes using immunohistochemistry. MATERIALS AND METHODS: Ninety-five patients with NSCLC were involved (60 squamous cell carcinoma and 35 adenocarcinoma). The formalin-fixed paraffin embedded specimens were immunohistochemically stained for C-erbB-2 and VEGF using the avidin-biotin complex method. RESULTS: Positive C-erbB-2 expression was observed more often in adenocarcinomas than squamous cell carcinomas (p<0.05). Although the immunohistochemical expressions of C-erbB-2 and VEGF in non-small-cell lung cancer showed increased tendencies at an advanced stage, the correlation between early and advanced cancers was insignificant. In adenocarcinomas, the expressions of VEGF and C-erbB-2 were significantly (p<0.05). CONCLUSION: The overexpression fo C-erbB-2 was significantly higher in adenocarcinomas than squamous cell carcinomas, and correlated with the expression of VEGF in adenocarcinomas of the lungs.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Humans ; Immunohistochemistry ; Lung ; Lung Neoplasms ; Neoplasm Metastasis ; Oncogenes ; Paraffin ; Vascular Endothelial Growth Factor A*