We report a case of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), which had a history of spontaneous resorption of late seroma before diagnosis. A 47-year-old woman with a history of augmentation mammoplasty with round textured implants in January 2013 presented with a swelling on her right breast 6 years later, which was diagnosed as late seroma with suspected intracapsular rupture using ultrasonography (USG). Although aspiration was not done at the time of the initial USG, the seroma resolved spontaneously within weeks. A further workup proceeded with USG-guided aspiration followed by magnetic resonance imaging. Cytology of the aspirated fluid showed atypical cells. Cell block cytology and immunohistochemical staining confirmed the diagnosis of BIA-ALCL. En bloc resection with total capsulectomy and explantation was performed as curative surgery. Pathologic stage pT2N0M0 was confirmed and the patient was followed up without further treatment. Although the classic presentation of BIA-ALCL is known as late persistent seroma, an atypical manifestation such as spontaneous resorption may occur, as in the current case. A high level of suspicion and a thorough investigation with appropriate modalities will make it possible to detect this rare and potentially devastating disease.

In Korea, Plasmodium vivax (P. vivax) is the most common agent of malaria infection. However, as travel to regions where malaria is endemic increases, so do the numbers of Plasmodium falciparum and mixed infections. P. falciparum predominates, while P. vivax is rare in west-central Africa. We report on a case of mixed malaria infection with severe hemolytic anemia caused by P. falciparum and P. vivax in a 38-year-old man after traveling to Angola. A diagnosis of P. falciparum malaria was made by microscopic examination. However, both P. vivax and P. falciparum were detected by the polymerase chain reaction (PCR). As a radical cure P. vivax, the patient was treated with mefloquine, artemether, and primaquine. Both P. falciparum and P. vivax had disappeared from peripheral blood by admission day 4, however, low grade fever and headache persisted, and his hemoglobin and hematocrit levels were depleted. A peripheral blood smear was negative for both P. vivax and P. falciparum; however, a direct anti-globulin test and anti-nuclear antibody test were positive, suggesting immune hemolytic anemia. After conservative treatment, which included a transfusion with packed red blood cells (RBC), his symptoms and signs showed improvement and laboratory findings were normalized.
Adult ; Africa ; Anemia, Hemolytic ; Angola ; Artemisinins ; Coinfection ; Erythrocytes ; Fever ; Headache ; Hematocrit ; Hemoglobins ; Humans ; Korea ; Malaria ; Mefloquine ; Plasmodium falciparum ; Plasmodium vivax ; Polymerase Chain Reaction ; Primaquine

Chronic pancreatitis is a rare problem in childhood and sometimes shows pancreatic calcification. The most common symptom is recurrent upper abdominal pain with or without associated nausea or vomiting. Pancreatic calcifications are virtually pathognomonic of chronic pancreatitis. In our case, however, chronic pancreatitis caused by multiple pancreatic stones in dilated pancreatic duct, which was very rare in childhood. Endoscopic retrograde cholangiopancreaticography (ERCP) is valuable in confirming the diagnosis and decision making process for further medical or surgical management of pancreatic disease. We experienced a case of chronic relapsing pancreatitis with pancreatic stones in 13-year-old girl who presented with recurrent upper abdominal pain. She was investigated with ERCP and treated by endoscopic sphincterotomy of sphincter of Oddi and by some stone removal with endoscopic basket. We report this case and review related literatures briefly.
Abdominal Pain ; Adolescent ; Cholangiopancreatography, Endoscopic Retrograde ; Decision Making ; Diagnosis ; Female ; Humans ; Nausea ; Pancreatic Diseases ; Pancreatic Ducts ; Pancreatitis* ; Pancreatitis, Chronic ; Sphincter of Oddi ; Sphincterotomy, Endoscopic ; Vomiting

The change of conditions of hydroxyapatite synthesis can affect not oniy the material properties, but also the body reaction to the hydroxyapatite implants. To find out conditions for preparing more biocompatible hydroxyapatite implants as bone graft substitute. we evaluated the biologic response to the dense synthetic hydroxyapatite implants, made with various synthetic conditions, placed in corticocancellous defects of rabbits' long bone. The hydroxyapatites were synthesized with coprecipitation technique using Ca(NO3) 4H2O and (NH4)2HPO4, made with various Ca/P ratio and aging temperatures. Four kinds of hydroxyapatites were selected to use as implants(HA I: Ca/P ratio 1.5, aging temperature 90degrees C; HA V :1.5 , 30degrees C; HA VI: 1.83, 30degrees C; and HA lX: 1.67, 30degrees C). These hydroxyapatites were pressed and sintered at l300degrees C to fabricate dense plates. Biomechanical test and rnorphological examination were performed using Instron, light microscope and electron microscope. The characteristics of hydroxyapatite powder and sintered body were more significantly affected by siarting Ca/P ratios. The bonding strength of HA IX(1.67, 30degrees C) with bone was grcatest at 4 or 8 weeks after implantation with statistically significant difference(p<0.05). Bonding behavior betweeb HA IX and bone was most excellent in terms of new bone formation and new bone ingrowth into resorbed surface of hydroxyapatite plate.
Aging ; Durapatite* ; Hydroxyapatites ; Osteogenesis ; Transplants

BACKGROUND: Bcr-abl rearrangement is the molecular hallmark of chronic myelogenous leukemia (CML). The test for bcr-abl rearrangement, especially using RT-PCR, is the standard test for the diagnosis of CML. We analyzed hematological significances of bcr-abl rearrangement by RT-PCR and the breakpoint distribution within the major bcr in CML patients. METHODS: From 1994 October to 1997 September, we performed the bcr-abl rearrangement using RT-PCR, in 268 untreated patients with various hematologic diseases, and classified the breakpoints within BCR gene as three types (b2a2, b3a2, e1a2) according to PCR product sizes. We compared hematologic parameters between two groups of b2a2 and b3a2 breakpoints in CML. RESULTS: Among the patients with clinically diagnosed CML, 96.8% (61/63) were bcr-abl positive. In ALL, 52.8% (19/36) were bcr- abl positive. All patients with hematologic diseases other than CML or ALL were bcr- abl negative. Among 61 CML patients with positive bcr-abl rearrangement, 19 patients (31.1%) showed b2a2 type and 42 patients (68.9%) b3a2 type. Patients with b3a2 breakpoints showed more frequent peripheral basophilia (P<0.01) than those with b2a2 type. However, other hematologic parameters were not statistically significant. CONCLUSION: RT-PCR test for bcr-abl rearrangement is a specific and efficient test for the diagnosis of CML. However, the hematological significance of b2a2 and b3a2 types is uncertain in CML.
Diagnosis ; Hematologic Diseases ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Polymerase Chain Reaction

PURPOSE: The purpose of this study was to evaluate the degree of liver injury after injection of ethanol, hot normal saline and hot hypertonic saline into normal rat liver. MATERIALS AND METHODS: Sixty white rats weighing 200-300g were used. There were three groups (ethanol, hot normal saline, and hot hypertonic saline), and these were divided into subgroups (5 rats in each) according to amount of injected material and duration. Under either anesthesia, each drug (ethanol -0.05ml, 0.1ml, 0.2ml ; hot normal saline -0.1ml, 0.2ml, 0.4ml ; hot hypertonic saline -0.1ml, 0.2ml, 0.4ml ) was introduced directly into the liver. Pathologic specimens were obtained 7 and 14 days after injection. RESULTS: With regard to histologic change after 7 days, the ethanol group showed less tissue damage such as coagulation necrosis and inflammatory infiltration-than the hot saline group. There was however, no significant difference among the three groups in tissue damage 14 days. Nor was there any significant histologic difference between the different saline concentration groups. CONCLUSION: Histologically, there was no significant difference among the three groups in tissue damage at 14 days, and it is suggested that this is due to irreversible change in damaged tissue. Tissue damage was caused mainly by the high temperature of saline rather than by high osmolarity.
Anesthesia ; Animals ; Ethanol* ; Liver* ; Necrosis ; Osmolar Concentration ; Rats*

OBJECTIVE: Classical markers of infection cannot differentiate reliably between inflammation and infection after neurosurgery. This study investigated the dynamics of serum procalcitonin (PCT) in patients who had elective spine surgeries without complications. METHODS: Participants were 103 patients (47 women, 56 men) who underwent elective spinal surgery. Clinical variables relevant to the study included age, sex, medical history, body mass index (BMI), site and type of surgery, and surgery duration. Clinical and laboratory data were body temperature, white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and PCT, all measured preoperatively and postoperatively on days 1, 3, and 5. RESULTS: PCT concentrations remained at <0.25 ng/mL during the postoperative course except in 2 patients. PCT concentrations did not correlate with age, sex, DM, hypertension, BMI, operation time, operation site, or use of instrumentation. In contrast, CRP concentrations were significantly higher with older age, male, DM, hypertension, longer operation time, cervical operation, and use of instrumentation. CONCLUSION: PCT may be useful in the diagnosing neurosurgical patients with postoperative fever of unknown origin.
Blood Sedimentation ; Body Mass Index ; Body Temperature ; C-Reactive Protein ; Calcitonin ; Female ; Fever of Unknown Origin ; Humans ; Hypertension ; Inflammation ; Leukocyte Count ; Leukocytes ; Male ; Neurosurgery ; Protein Precursors ; Spine

Background: Hematopyometra, an accumulation of bloody, purulent material in the ute-rine cavity, is a relatively uncommon event. The incidence is almost 0.01~0.5% in gynec-ologic patients. The most common cause of this condition is interference with the normal drainage of the uterus;endocervical obstruction by malignant disease. Other obstructive causes are the benign tumors in uterus, senile endocervicitis, long-term use of intrauterine device, cervical occlusion after surgery or radiation, intrauterinel infection, and congenital cervical anomaly. Methods: This report was performed to evaluate the hematopyometra patients, who were diagnosed and treated at Catholic University Medical College Hospitals from 1991 to 1995. Forty cases of hematopyometra were retrospectively reviewed by charts, radiologic and pathologic findings concerning with the clinical features. Results: 1) The most frequent age of hematopyometra patients was 50 to 59 years(45 %) and mean age was 63 years old. 2) Four patients(10 %) were at premenopausal period, and remaining 36 patients(90 %) were at the period of menopause(p<0.01). 3) The clinical manifestations of the patients were variable;profuse vaginal discharge(75 %), vaginal ble- eding or spotting(40 %), and lower abdominal pain(30 %). 4) The associating medical cond- itions or possible risk factors of hematopyometra are senile atrophic change(52.5 %), IUD inserted condition(25 %), genital malignant diseases(17.5 %), and uterine myoma(5 %). 5) The bacterial infection are frequently associated with hematopyometra and the causative ag ents are streptococci(50 %), E. coli(42 %), and mixed type(17 %). 6) Eight cases of them showed generalized peritonitis in the preoperative clinical course and three patients had been serious condition by septicemia. 7) The genital malignant diseases are associated with he- matopyomerta in 7 cases(17.5 %) of them(cervical cancer;4 cases, endometrial cancer;2 cases, and ovarian cancer;1 case). 8) All the cancer patients could be followed-up at le-ast for 2 years. Two patients, who were diagnosed for cervical cancer in the stage IIb and III, died of the persistent or recurrent disease in the period of following-up after the pri-mary treatment.
Bacterial Infections ; Drainage ; Female ; Humans ; Incidence ; Intrauterine Devices ; Menopause ; Middle Aged ; Peritonitis ; Premenopause ; Retrospective Studies ; Risk Factors ; Sepsis ; Uterine Cervical Neoplasms ; Uterus*

A carotid-cavernous sinus fistula is a rare condition in which an abnormal communication exists between the internal or external carotid artery and the cavernous sinus. It typically occurs within a few weeks after craniomaxillofacial trauma. In most cases, the carotid-cavernous sinus fistula occurs on the same side as the craniomaxillofacial fracture. We report a case of delayed carotidcavernous sinus fistula that developed symptoms 7 months after the craniomaxillofacial fracture. The fistula developed on the side opposite to that of the craniomaxillofacial fracture. Based on our experience with this case, we recommend a long follow-up period of 7–8 months after the occurrence of a craniomaxillofacial fracture. We also recommend that the follow-up should include consideration of the side contralateral to the injury.
Carotid Artery, External ; Carotid-Cavernous Sinus Fistula ; Cavernous Sinus ; Fistula ; Follow-Up Studies

Psychrobacter sanguinis has been described as a Gram-negative, aerobic coccobacilli originally isolated from environments and seaweed samples. To date, 6 cases of P. sanguinis infection have been reported. A 53-year-old male was admitted with a generalized tonic seizure lasting for 1 minute with loss of consciousness and a mild fever of 37.8℃. A Gram stain revealed Gram-negative, small, and coccobacilli-shaped bacteria on blood culture. Automated microbiology analyzer identification using the BD BACTEC FX (BD Diagnostics, Germany) and VITEK2 (bioMérieux, France) systems indicated the presence of Methylobacterium spp., Aeromonas salmonicida, and the Moraxella group with low discrimination. The GenBank Basic Local Alignment Search Tool and an Ez-Taxon database search revealed that the 16S rRNA gene sequence of the isolate showed 99.30% and 99.88% homology to 859 base-pairs of the corresponding sequences of P. sanguinis, respectively (GenBank accession numbers JX501674.1 and HM212667.1). To the best of our knowledge, this is the first human case of P. sanguinis bacteremia in Korea. It is notable that we identified a case based on blood specimens that previously had been misidentified by a commercially automated identification analyzer. We utilized 16S rRNA gene sequencing as a secondary method for correctly identifying this microorganism.
Aeromonas salmonicida ; Bacteremia* ; Bacteria ; Databases, Nucleic Acid ; Discrimination (Psychology) ; Fever ; Genes, rRNA ; Humans ; Korea ; Male ; Methods ; Methylobacterium ; Middle Aged ; Moraxella ; Psychrobacter* ; RNA, Ribosomal, 16S ; Seaweed ; Seizures ; Unconsciousness