Carcinosarcomas of the female genital tract have generally been regarded as a type of sarcoma. Recent studies, however, suggest the tumor may be more closely related to carcinoma and may represent metaplastic carcinoma in histogenesis. We analyzed clinicopathologic and immunohistochemical features of 10 carcinosarcomas to evaluate the relative importance of the carcinomatous and sarcomatous components in metastasis and recurrence. The primary tumor originated in the uterine body in seven cases, the uterine cervix in two and the ovary in one. Patient,s ages ranged from 54 to 71 years (mean, 64). The most common symptom of the uterine mass was vaginal bleeding. The median survival time was 21 months following diagnosis in five cases. Surgico-pathologic FIGO stages of five patients who received an operation were stage III and IV, but clinical FIGO stage of three patients (60%) among them were I. Lymphovascular invasions were identified in seven areas; five vascular invasion lesions showed the carcinomatous component alone, one the sarcomatous component alone, and remained one admixture of both components. Metastatic and recurrent lesions to the paraaortic lymph node, ovary, pelvic wall, or vaginal vault showed characteristically carcinomatous component only. Immunohistochemically, positive reactions for cytokeratin and epithelial membrane antigen were noted in the sarcomatous component of five cases. Vimentin positivity was detected in carcinomatous component of three cases. We conclude that the dominant element in carcinosarcomas of the female genital tract is the carcinomatous component. The survival rate of carcinosarcoma is extremely poor. The surgico-pathologic stage is better indicator of survival than the clinical stage. Immunohistochemical findings suggest that carcinosarcoma may represent a metaplastic carcinoma in histogenesis.
Carcinosarcoma* ; Cervix Uteri ; Diagnosis ; Female* ; Humans ; Keratins ; Lymph Nodes ; Mucin-1 ; Neoplasm Metastasis ; Ovary ; Recurrence ; Sarcoma ; Survival Rate ; Uterine Hemorrhage ; Vimentin

Over the past three decades, a large number of genetic studies have been aimed at finding genetic variants associated with the risk of asthma, applying various genetic and genomic approaches including linkage analysis, candidate gene polymorphism studies, and genome-wide association studies (GWAS). However, contrary to general expectation, even single nucleotide polymorphisms (SNPs) discovered by GWAS failed to fully explain the heritability of asthma. Thus, application of rare allele polymorphisms in well defined phenotypes and clarification of environmental factors have been suggested to overcome the problem of 'missing' heritability. Such factors include allergens, cigarette smoke, air pollutants, and infectious agents during pre- and post-natal periods. The first and simplest interaction between a gene and the environment is a candidate interaction of both a well known gene and environmental factor in a direct physical or chemical interaction such as between CD14 and endotoxin or between HLA and allergens. Several GWAS have found environmental interactions with occupational asthma, aspirin exacerbated respiratory disease, tobacco smoke-related airway dysfunction, and farm-related atopic diseases. As one of the mechanisms behind gene-environment interaction is epigenetics, a few studies on DNA CpG methylation have been reported on subphenotypes of asthma, pitching the exciting idea that it may be possible to intervene at the junction between the genome and the environment. Epigenetic studies are starting to include data from clinical samples, which will make them another powerful tool for research on gene-environment interactions in asthma.
Alleles ; Allergens ; Asthma/*genetics ; Endotoxins ; Environment ; *Epigenesis, Genetic ; *Gene-Environment Interaction ; Genome-Wide Association Study ; Humans ; Phenotype ; *Polymorphism, Genetic ; Polymorphism, Single Nucleotide

Global aphasia without other focal neurologic lateralizing signs (GWLS) is an uncommon stroke syndrome. The pathogenesis of GWLS has been thought as the result of multiple cardioembolism. However, a few cases of GWLS with a single lesion have been reported. We report an unusual case of GWLS with a single left superior temporal infarction. A 73-year-old right handed man was admitted with receptive and expressive language impairment without other focal neurologic lateralizing signs. The patient's global aphasia symptom has being 4 weeks after symptom onset. Brain CT showed only one lesion of left superior temporal lobe. Our case notes that the multiple lesions of the speech area are not only necessary to produce GWLS, and it is not necessarily imply a double lesion or an embolic causes.
Aged ; Aphasia* ; Brain ; Hand ; Humans ; Infarction ; Stroke ; Temporal Lobe

No abstract available.
Adhesives

BACKGROUND: The evaluation of a breast after breast reconstruction depends on a surgeon's subjective criteria. We used computed tomography (CT) scans to obtain an objective evaluation of the postoperative results by measuring the breast volume of patients who had undergone breast reconstruction using pedicled transverse rectus abdominis myocutaneous (TRAM) flaps. This research will help in the objective postoperative evaluation of reconstructed breasts, and also in the preoperative flap size designs. METHODS: A total of 27 patients underwent breast reconstruction using pedicled TRAM flaps after mastectomy from September 2007 to July 2010. Of these, 10 patients who were followed up and underwent CT scans 2 or more times during the follow-up period were included in this study. We evaluated the change in breast volume over time using CT scans, and the interval breast volume change between CT scans. RESULTS: All of the 10 patients' reconstructed breasts showed a volume decrease over time. The breast volume changes in the intervals between CT scans were as follows: 5.65% decrease between the first CT and second CT scan, 2.3% decrease between the second CT and third CT scan, (statistically significant) and 1.89% decrease between the third CT and forth CT scan. (not statistically significant). CONCLUSIONS: This research shows the possibility of objectively evaluating the postoperative breast volume changes. The findings will be helpful in designing the size of TRAM flaps to use on defects after mastectomy. Based on these results, we should also closely observe the reconstructed breast volume for at least 2 years.
Breast ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Mastectomy ; Multidetector Computed Tomography ; Organ Size ; Rectus Abdominis

PURPOSE: Hodgkin lymphoma involving the orbit and ocular adnexal tissue is very rare and usually appears in the form of a metastatic tumor at the end stage of the disease. Primary Hodgkin lymphoma in the orbit has not been previously reported, and herein we report a case of primary Hodgkin lymphoma occurring in the bilateral orbit. CASE SUMMARY: A 64-year-old male presented with a left lower eyelid mass that increased in size over 2 years. The patient had no specific past medical history or family history except diabetes. During the physical examination, a fixed mass was gently palpated in the left lower eyelid. Mild upgaze limitation was observed during extraocular muscle movement examination in both eyes. Orbital computed tomography and magnetic resonance imaging showed soft tissue masses involving the bilateral inferior rectus muscle and left lower eyelid. The patient was diagnosed with nodular sclerosing Hodgkin lymphoma after pathological examination following incisional biopsy. The patient was transferred to the oncology department for tumor staging. Positron emission tomography showed no involvement of other organs except both orbits. After systemic chemotherapy and radiation therapy, the patient was under observation for 14 months without ophthalmic and systemic complications or recurrence. CONCLUSIONS: The authors present a case of primary nodular sclerosing Hodgkin lymphoma that occurred in the orbit. After systemic chemotherapy and radiation therapy, the patient was in good general condition.
Biopsy ; Drug Therapy ; Eyelids ; Hodgkin Disease* ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Staging ; Orbit* ; Physical Examination ; Positron-Emission Tomography ; Recurrence

PURPOSE: By analysing frequency and disease progression, this study aimed to investigate and predict the prognosis of mycoplasma pneumonia according to radiographic pattern. MATERIALS AND METHODS: We retrospectively reviewed plain chest radiographs of 230 patients in whom mycoplasm pneumonia had been serologically confirmed.Their age ranged from two months to 14 years and two months, and 203(88.3%) were younger than eight years. Radiographic patterns were classified as air space consolidation, bronchopneumonic, interstitial pneumonic ordiffuse mixed infiltrating type. The radiologic resolution period for each type was analysed by the resolution of symptoms and normalization of radiologic findings. RESULTS: The bronchopneumonic type, which was the most common, was seen in 82 patients (35.6%), airspace consolidation in 58 (25.2%), interstitial in 55 (23.9%), and diffuse mixedin 22 (9.57%). In thirteen patients (5.7%), chest radiographs were normal, though the clinical and radiologic resolution period for each type was variable. The mean resolution period of the air space consolidation type was 14.5 days, bronchopneumonic, 7.6 days ; interstitial, 10.5 days, and diffuse mixed, 15.6 days. The airspace consolidation type needed the longest recovery period, exceeded only by the diffuse mixed type. CONCLUSION: The bronchopneumonic type was the most common radiographic pattern of mycoplasma pneumonia. The prognosis of the airspace consolidation type seems to be poorest, since this required the longest recovery period.
Child* ; Disease Progression ; Humans ; Mycoplasma* ; Pneumonia ; Pneumonia, Mycoplasma* ; Prognosis ; Radiography, Thoracic ; Retrospective Studies

BACKGROUND: This study was undertaken in surgical patients to evaluate the comparative analgesic, hemodynamic, sedative effects of clonidine or epinephrine when added to lidocaine solution in patients receiving epidural anesthesia. METHODS: The effects of clonidine were assessed in 38 men scheduled for knee surgery. Patients received 20 ml of 2% lidocaine with clonidine 50 microgram (group C50, n=11), with clonidine 100 microgram (group C100, n=10), with epinephrine 100 microgram (group E, n=9), or plane (group L, n=8) via epidural catheter. Sensory anesthetic level was assessed by pinprick and the time to L1 analgesia and the maximum number of segments of analgesia were checked. Systolic blood pressure (BP) and heart rate (HR) were measured at 2, 5, 10, 15, 20, 30, 45, 60 min after epidural injection. Sedation was defined on a scale of 0 to 3. The sedation score was checked at 5-minute intervals after epidural injection. Samples of venous blood were obtained before and 5, 10, 20, 30, 45, 60, 90 min after epidural injection. RESULTS: No significant differences in the time of L1 analgesia and number of segments of analgesia found at any observation period among the four groups of patients. There was no decrease in BP and no differences among four groups. HR decreased significantly in patients given clonidine, but did not change in those given lidocaine plain or with epinephrine. Significant differences were also observed in sedation scores between clonidine group and group L or E. Maximal plasma lidocaine concentrations in group C100 were similar to the group C50 and L, but were significantly greater than those in group E (p<0.05). CONCLUSIONS: These results indicate that the addition of clonidine to lidocaine for epidural anesthesia provides a sedative effect and relatively stable hemodynamics, and that clonidine in a concentration 1:200,000 in contrast to 1:200,000 epinephrine, tends to increase rather than to suppress the plasma lidocaine concentration.
Analgesia ; Anesthesia, Epidural* ; Blood Pressure ; Catheters ; Clonidine* ; Epinephrine ; Heart Rate ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; Injections, Epidural ; Knee ; Lidocaine* ; Male ; Plasma

OBJECTIVES: The object of this study was to indentify characteristics of cardiovascular disease in the employed population in comparson with the non-employed group. METHODS: The study subjects were patients aged 20~65 from 3 university based hospital emergency centers and a structured questionnaire were used for comparing the characteristics of cardiovascular disease according to employment status. Multivariate logistic regression was used to analyze the association between employment status and cardiovascular disease risk factors. RESULTS: Among the patients, 573 people were employed (482 males, 91 females) and 251 were non-employed (117 males, 134 females). Compared to the non-employed group, the employed group was distinctive in that it contained patients of younger age, had a male dominant gender distribution, and a higher proportion of smoking and drinking patients. The employed group was less likely to be previously-diagnosed with diabetes, hypertension, chronic renal failure, cardiovascular disease, or cerebrovascular disease. The employed group was generally more stressed out but there was no significant differences in sleeping time. Infarction was more frequent in the employed group, but hemorrhage was more frequent in the non-employed group. According to the multivariate logistic regression analysis results, the odds ratio of drinking and stress was 1.89(95% CI: 1.25~2.86) and 2.68(95% CI: 1.80~3.99) respectively. CONCLUSIONS: Infarction was more frequent in the employed group. Drinking and stress were also more frequent in the employed group. The results of this study don't necessarily mean that stress and drinking are more important than other risk factors but, it means stress and drinking control are more important in the employed group compared to the non-employed group.
Aged ; Cardiovascular Diseases ; Drinking ; Emergencies ; Employment ; Hemorrhage ; Humans ; Hypertension ; Infarction ; Kidney Failure, Chronic ; Logistic Models ; Male ; Odds Ratio ; Questionnaires ; Risk Factors ; Smoke ; Smoking

We experienced one case of pulmonary lymphangioleiomyomatosis in 26-year-old female patient. She had taken antituberculous medication under the impression of miliary tuberculosis on simple chest X-ray at peripartum period. On outpatient follow-up she complained of progressive exertional dyspnea in spite of medication. Through careful history taking and physical examination, high resolutional CT, and open lung biopsy she was diagnosed as pulmonary lymphangioleiomyomatosis combined with incomplete type of tuberous sclerosis. So, we presented the case with the brief review the literatures.
Adult ; Biopsy ; Dyspnea ; Female ; Follow-Up Studies ; Humans ; Lung ; Lymphangioleiomyomatosis* ; Outpatients ; Peripartum Period ; Physical Examination ; Thorax ; Tuberculosis, Miliary* ; Tuberous Sclerosis