We have experienced three cases of extrarnsmmary Pagets disease. The first case was a 77-year-old female who showed 8x10cm sized, erythematous plaque on the suprspubic area of one year's duration. The second case was a 60-year-old male who showed erythematous, oozing, crusted, well circumscribed patches on the right scrotum and the pubic area of 8 years' duration. Third case was a 79-year-old male who showed erythernstous to gray, eczemstoid plaques with marginal elevation on the right side of the scrotum, penile root and pubic area of 3 years duration. On histologic exarnination, the third case showed swest gland adenocarcinoma in the dermis.
Adenocarcinoma ; Aged ; Dermis ; Female ; Humans ; Male ; Middle Aged ; Paget Disease, Extramammary* ; Scrotum

OBJECTIVE: The ideal treatment of intracranial aneurysms is an occlusion of the neck with a clip, which preserves the parent vessels. Upward projecting anterior communicating artery(Acom) aneurysms appear to be directed both above and below the plane formed by the two A2 segments, which usually conceal the contralateral A2 takeoff. It is difficult to perform complete clipping when these lesions are tightly adherent to the A2 segment. Neurosurgeons need to focus on the safe treatment of these lesions. A variety of clipping techniques can be used depending on the aneurysm anatomy, size, and morphology. The authors recommend a safe method of clipping these lesions safely. METHODS: The authors operated on 109 patients with upward projecting Acom aneurysms over the last 16 years. Among them, 34 aneurysms were clipped using fenestrated clips through the side of the dominant A1 segment, which were closely adhered to the A2 segment. RESULT: In each case, the aneurysm and both A2 segments formed a straight line in the narrow surgical field and were not easily separated, and consequently it was difficult to handle the aneurysm behind the ipsilateral A2. After partial identification of the Acom complex, careful dissection of the posterior aspect of the ipsilateral A2 and the aneurysm dome was continued to allow mobilization of both A2 segments and the aneurysm. All aneurysms were secured successfully without any surgery related complications. CONCLUSION: The authors recommend that fenestrated clip incorporating the ipsilateral A2 segment after complete mobilization of both A2 segments and the aneurysm may be useful for definitive clipping of upward projecting Acom aneurysm which is densely adherent to the A2 segment.
Aneurysm ; Humans ; Intracranial Aneurysm* ; Neck ; Parents

OBJECTIVE: It is mandatory to optimaze clip placement in situ for complete clipping of cerebral aneurysm. Intraoperative microvascular doppler sonography (MDS) provides a functional and non-invasive intraoperative examination of the aneurysm proper. The present study was performed to investigate the reliability of MDS for assessing the complete aneurysm closure. METHODS: Blood flow velocities in the aneurysm sac were determined by MDS with a 20-MHz probe before and after aneurysm clipping, to confirm the obliteration of aneurysm since 1997. Complete aneurysm obliteration was confirmed by absent flow patterns in the domes of all aneurysms after clipping. RESULTS: The 1 mm microprobe was able to insonate all vessels and their major branches. The immediate adjustment of aneurysm clip placement or another clipping was done because hemorrhage after puncturing of completely clipped aneurysms on MDS developed in five patients including 3 middle cerebral artery aneurysms, 1 posterior communicating artery aneurysm, and 1 anterior communicating artery aneurysm. CONCLUSIONS: MDS is safe and cost-efficient for evaluation of aneurysm obliteration. In many cases, it can preclude the need of postoperative angiogram. However, although an intra-aneurysmal flow velocity is absent on MDS, it is necessary to puncture or cut the aneurysm sac if that is not shrunken after clipping, especially in cases of a complex aneurysm with a broad irregular base and atherosclerotic or thrombotic sac.
Aneurysm* ; Blood Flow Velocity ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Punctures

PURPOSE: To report a case of infectious crystalline keratopathy caused by Alternaria in the corneal center. CASE SUMMARY: A 66-year-old male visited our clinic with right ocular pain and visual loss after corneal trauma caused by a foreign body hitting his right eye while performing farm work 1 month prior to his visit. The patient had no history of corneal surgery and long-term use of topical corticosteroid. A corneal epithelial defect and whitish snowflake margin infiltration around the corneal stroma were observed in the corneal center, but there was an absence of conjunctival injection and anterior segment inflammation. Cultures and a biopsy of the corneal scrapings revealed Alternaria species fungus. The patient was treated with 1% topical voriconazole and 0.5% moxifloxacin, together with oral voriconazole (400 mg/day). After 2 months of treatment, the disease was completely cured, with a minute corneal opacity. CONCLUSIONS: We successfully treated a rare case of infectious crystalline keratopathy caused by Alternaria, which has not been previously reported in the Republic of Korea.
Aged ; Agriculture ; Alternaria ; Biopsy ; Corneal Injuries ; Corneal Opacity ; Corneal Stroma ; Crystallins ; Foreign Bodies ; Fungi ; Humans ; Inflammation ; Male ; Republic of Korea ; Voriconazole

Esthetics ; Facial Asymmetry ; Genioplasty ; Humans ; Jaw ; Orthognathic Surgery ; Osteotomy ; Rhinoplasty ; Seoul ; Surgery, Oral ; Surgery, Plastic

A dermoid cyst of the head and neck region is a relatively infrequent occurrence and accounts for only 6.9% of all dermoid cysts. Its anatomical distribution is the orbit, floor of the mouth, other midline and nose in the order of frequency. A dermoid cyst of the parotid gland is extremely rare, and due to this and the absence of pathognomonic findings, it is often difficult to diagnose preoperatively. Thus thorough and careful examination including ultrasonic study is needed to evaluate this lesion. It must be differentiated from malignant tumors and other cystic lesions. Dermoid cysts usually recur after simple excision, so it is mandatory to excise it completely with a parotidectomy. This paper presents two cases of parotid gland dermoid cyst with a brief review of the literature.
Adult ; Case Report ; Dermoid Cyst/*diagnosis/surgery ; Human ; Male ; Parotid Gland/pathology/radiography ; Parotid Neoplasms/*diagnosis/surgery ; Sialography ; Ultrasonography

BACKGROUND: Calcium plays a key role in vascular contraction and regulates receptor sensitivity to certain neurotransmitters. Calcium channel blockers are useful in the treatment of both clinical and experimental hypertension. The present study was designed to examine whether there is an alteration of the activity of calcium channels in association with the development of hypertension. METHODS: Deoxycorticosterone acetate(DOCA)-salt hypertension was made by subcutaneous implantation of DOCA(200mg/kg)strip plus saline drinking(1%) and 2-kidney, 1 clip(2KIC)hypertension by clipping the left renal artery with a silver clip(internal gap of 0.2mm). They were used 4 weeks later. Age-matched normal rats served as a control. Mean arterial pressure(MAP) and heart rate(HR) were continuously recorded from the right femoral artery. The drugs were administered intravenously. RESULTS: Vehicle alone was without effect on MAP or HR. In normotensive rats, nifedipine infusion(5 and 10ug/kg/min)caused a dose-dependent decrease in MAP without significant changes in HR, while Bay k 8644(Bay K, 5 and 10 ug/kg/min) increased MAP transiently. Both the depressor response to nifedipine and the pressor response to Bay k were more marked in DOCA-salt hypetensive rats than in normotensive rats. The maximal changes in MAP indced by nifedipine(5 and 50 ug/kg) or Bay K(5 and 50 ug/kg) were also enhanced in 2KIC hypertensive rats as compared with control rats. CONCLUSION: These results indicate that calcium channel inhibitors and activators can affect on the regulation of blood pressure in an opposite fashion. It is also suggested that the activity of calcium channels might be altered in the developement of experimental hypertension.
3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethyl-5-nitro-4-(2-(trifluoromethyl)phenyl)-, Methyl ester* ; Animals ; Bays* ; Blood Pressure ; Calcium ; Calcium Channel Blockers ; Calcium Channels ; Desoxycorticosterone ; Femoral Artery ; Heart ; Hypertension ; Neurotransmitter Agents ; Nifedipine* ; Rats* ; Renal Artery ; Silver

Primary trabecular carcinoid of the ovary is very rare and less than 30 cases have been reported. Herein is reported a primary trabecular carcinoid of the ovary which contained an epidermoid cyst in a 80-year-old woman. Gross examination showed 12 x 11 x 7 cm- sized mass in the right ovary. On cut-surface, the mass was composed of multilocular cyst containing serous and keratinized material and of 5 x 3.5 cm-sized solid area with extensive necrosis and hemorrhage. Microscopic examination revealed that the tumor cells are almost arranged in trabeculae and focally in insular pattern. Also, the tumor contained an epidermoid cyst but not other teratomatous elements. Tumor cells were immunoreactive for cytokeratin, neuron specific enolase (NSE) and chromogranin. Electron microscopic tindings revealed characteristic, round-shaped neurosecretory granules and perinuclear microfilaments.
Actin Cytoskeleton ; Aged, 80 and over ; Carcinoid Tumor* ; Epidermal Cyst ; Female ; Hemorrhage ; Humans ; Keratins ; Necrosis ; Ovary* ; Phosphopyruvate Hydratase

The prevalence of parasitic infections was investigated in human immunodeficiency virus (HIV)-infected patients (n = 105) who visited Seoul National University Hospital, Seoul, Korea, during the period from 1995 to 2003. Fecal samples were collected from 67 patients for intestinal parasite examinations, and sputum or bronchoalveolar lavage samples from 60 patients for examination of Pneumocystis carinii. Both samples were obtained from 22 patients. Thirty-three (31.4%) of the 105 were found to have parasitic infections; Cryptosporidium parvum (10.5%; 7/67), Isospora belli (7.5%; 5/67), Clonorchis sinensis (3.0%; 2/67), Giardia lamblia (1.5%; 1/67), Gymnophalloides seoi (1.5%; 1/67), and Pneumocystis carinii (28.3%; 17/60). The hospital records of the 11 intestinal parasite-infected patients showed that all suffered from diarrhea. This study shows that parasitic infections are important clinical complications in HIV-infected patients in the Republic of Korea.
AIDS-Related Opportunistic Infections/*parasitology ; Adult ; Feces/parasitology ; Female ; HIV Infections/*complications ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Parasitic Diseases/*epidemiology ; Research Support, Non-U.S. Gov't

We reviewed 5 patients with infarcts involving the genu of the internal capsule, who revealed behavioral changes and cognitive defects. They developed an acute confusion and/or dementic feature along with other behavioral changes characterized by apathy, hypersomnia, memory impairment, and cognitive impairment, mimicking frontal lobe dysfunction. Brain MRI and/or CT scan localized the lesion to the genu of the internal capsule. Brain perfusion SPECT performed in 3 patients showed hypoperfusion in ipsilateral cerebral hemisphere. Two mechanisms are suggested to explain the development of confusion or dementia after capsular genu infarct. (I) a disconnection or diaschisis of thalamo-cortical interconnection (ii) selective neuronal loss of cerebral cortex due to chronic MCA or ICA occlusion with insufficient collateral blood flow. We suggest that capsular-genu infarction as a cause of acute confusion or dementia must be included in differential diagnosis.
Apathy ; Brain ; Cerebral Cortex ; Cerebrum ; Dementia ; Diagnosis, Differential ; Disorders of Excessive Somnolence ; Frontal Lobe ; Humans ; Infarction* ; Internal Capsule ; Magnetic Resonance Imaging ; Memory ; Neurons ; Perfusion ; Tomography, Emission-Computed, Single-Photon ; Tomography, X-Ray Computed