Glassy cell carcinoma is an unusual neoplasm of the uterine cervix with highly aggressive clinical behavior. On cervico-vaginal smear examination, the tumor has well confused of atypical repair cell of the endocervix. Recently, we have experienced two cases of glassy cell carcinoma of the uterine cervix, diagnosed on cervico-vaginal smears and confirmed on following histologic sections. The cervico-vaginal smears revealed abundant clusters with well defined boarders. The cell clusters were composed of large tumor cells. The tumor cells had distinct granular cytoplasm and eosinophilic macronucleoli. Characteristic cytologic features of this tumor were discussed in view of differential diagnosis.
Adenocarcinoma ; Breast ; Cervix Uteri ; Cytoplasm ; Diagnosis, Differential ; Eosinophils ; Female ; Hydronephrosis*

No abstract available.
Central Nervous System*

Free vascularized tissue transfer to preserve upper extremity amputation level is uncommon but very useful procedure. To cover the below-elbow amputee stump and restore the function of the elbow, we have used a free flap as a spare part concept from the contralateral hand which was so severely damaged that amputation was inevitable.
Amputation ; Amputees* ; Elbow* ; Forearm* ; Free Tissue Flaps ; Hand ; Humans ; Upper Extremity

BACKGROUND AND OBJECTIVES: We sought to determine whether an elevated homocysteine (Hcy) level is associated with a worse prognosis in Korean patients with coronary artery disease (CAD). SUBJECTS AND METHODS: A total of 5839 patients (60.4% male, mean age 61.3±11.2 years) with CAD were enrolled from 2000 to 2010 at Gangnam Severance Hospital. CAD was diagnosed by invasive coronary angiography. Laboratory values including Hcy level were obtained on the day of coronary angiography and analyses were performed shortly after sampling. Patients were divided into two groups according to their Hcy levels. Baseline risk factors, coronary angiographic findings, length of follow-up, and composite endpoints including cardiac death (CD) and non-fatal myocardial infarction (NFMI) were recorded. 1:1 propensity score matched analysis was also performed. RESULTS: Over a mean follow-up period of 4.4±2.5 years, there were 132 composite endpoints (75 CD and 57 NFMI) with an event rate of 2.3%. Mean Hcy level was 9.9±4.3 µmol/L (normal Hcy 7.9±1.5 µmol/L and elevated Hcy 13.9±5.1 µmol/L). Kaplan-Meier survival analysis showed an association of elevated Hcy level with worse prognosis (p<0.0001). In addition, a multivariate Cox regression analysis showed an association of elevated Hcy level with worse prognosis for both the entire cohort (hazard ratio [HR] 2.077, 95% confidence interval [CI] 1.467-2.941, p<0.0001) and the propensity score matched cohort (HR 1.982, 95% CI 1.305-3.009, p=0.001). CONCLUSION: Elevated Hcy level is associated with worse outcomes in Korean patients with CAD.
Cohort Studies ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Death ; Follow-Up Studies ; Homocysteine* ; Humans ; Male ; Myocardial Infarction ; Prognosis ; Propensity Score* ; Risk Factors

PURPOSE: To describe the surgical treatment of the complex dorsal metacarpophalangeal dislocations and its results, emphasizing on the modified volar approach with A1 pulley release. MATERIALS AND METHODS: We experienced 6 cases of dorsal dislocation of the metacarpophalangeal joint. We performed open reduction with the modified volar approach described by Eaton and Dray. Postoperatively posteroanterior and lateral radiographs of the index finger metacarpophalangeal joint and metacarpophalangeal joint range of motion was followed. RESULTS: One case with a large osteochondral fracture was operated with volar and doral approach both. Overall end results were good without any significant restriction of motion and stability of the fingers. CONCLUSION: Modified volar approach with A1 pulley release is an excellent method for complex dorsal metacarpophalangeal dislocations without osteochondral fracture.
Benzodiazepines ; Dislocations ; Fingers ; Metacarpophalangeal Joint ; Range of Motion, Articular

The authors analysed 53 cases of sudden cardiac death(SCD) without prominent structural abnormalies of heart out of witnessed 300 cases. Thirty four cases were associated with sleep and 19 with activity or rest. Twenty one cases were classified as having normal hearts, and the rest as structurally mild abnormal ones. Male was predominant, and almost of the victims were suffered in their twenties or thirties. All cases collapsed instantaneously or in very short time with various and not specific terminal symptoms. Inducing or trigger factors are not clarified in almost of the cases. Mechanisms or causes of death could not be defined clearly. We concluded that careful heart examination with detailed clinical history under the appropriate postmortem investigation system is only effective approach for the true mechanism and cause of death.
Adult* ; Cause of Death ; Death, Sudden, Cardiac* ; Heart* ; Humans ; Male

BACKGROUND: This study was designed to compare intramuscular diclofenac with intravenous fentanyl in the prevention of pain after tonsillectomy and adenoidectomy for day-surgery. METHODS: We studied 60 patients, aged 3-13 years, undergoing tonsillectomy with or without adenoidectomy. Patients were randomly assigned to receive placebo injecton (Group 1), intramuscular diclofenac 1 mg/kg (Group 2) or intravenous fentanyl 1 microgram/kg (Group 3) after induction of anesthesia. Pain was evaluated by using an observer pain score for the first 30 min, 60 min and 4 hrs postoperatively. RESULTS: It is statistically significant that group 2 and group 3 had lesser pain than group 1 at 30 min and 60 min. But there is no difference among any groups at 4 hr postoperatively. CONCLUSIONS: We conclude that diclofenac may have advantages compared to fentanyl in safety and convenience for the treatment of pain after tonsillectomy in children.
Adenoidectomy ; Anesthesia ; Child ; Diclofenac* ; Fentanyl* ; Humans ; Pain, Postoperative ; Tonsillectomy*

Old post burn contractures on feet still remain challenging problem for reconstructive surgeon. A 43-year-old male visited Hallym University Sacred Heart Hospital with the complain of foot deformity and difficulties in shoe fitting. His right 4th and 5th toes were inverted at dorsal foot. We released the contracture of 4, 5th metatarsophalangeal joint and lengthened extensor tendon by Z-plasty, and covered the resultant defect with the anterolateral thigh flap. The flap was successful and the deformity was corrected. As there have been few reports on reconstruction of foot dorsum, especially on post burn extension contractures in the toes, we report a rare case of contracture release and coverage by free flap.
Adult ; Burns* ; Congenital Abnormalities ; Contracture* ; Foot ; Foot Deformities ; Free Tissue Flaps* ; Heart ; Humans ; Male ; Metatarsophalangeal Joint ; Shoes ; Tendons ; Thigh ; Toes*

OBJECTIVES: Although bronchoscopy is an important diagnostic tool for lung disease, patients compliance is low due to discomfort. Recently, midazolam which has a favorable anterograde amnesia effect and short action duration, has been used to relieve patients discomfort during bronchoscopy. Midazolam was investigated in order to see the beneficial effect and safety during bronchoscopy. METHODS: The study design was single blind, randomized, prospective. 102 patients were included, in whom bronchoscopy was performed between June, 19% and October, 1995 at Samsung Medical Center. They were categorized into midazolam group and control group. Patients were asked about the amnesic effect, discomfort of procedure and the willingness to repeat procedure. The consciousness level of patients during procedure, patient cooperation during procedure and ease of procedure were also reported by bronchoscopists. RESULTS: 1) The difference of oxygen saturation between two groups: There was no significant difference in oxygen saturation between midazolam group and control group before and after bronchoscopy. During procedure, however, mean oxygen saturations in midazolam group (90+/-6.4%) was significantly lower than in control group (93+/-4.7%)(p<0.05). 2) Evaluations by patients (1) Effect of amnesia: 41 patients (82%) in midazolam group could not recall the procedure but 52 patients (100%) recalled the entire procedure in control group. A favorable amnesic effects could be found in midazolam group(p<0.05). {2) The discomfort during the procedure: 43 patents(86%) did not experience discomfort from procedure in midazolam group but 25 patients(48%) complained of discomfort in control group (p<0.05). (3) Most patients except two(96%) were willing to repeat fiberoptic bronchoscopy in midazolam group but 13 patients (25%) answered that they would never repeat bronchoscapy. There was a statistically significant difference between two groups in the willingness to repeat bronchocopy (p<0.05). 3) The evaluations by bronchoscopists Cooperations of the patients and ease of procedure were not different between two groups. The patients in midazolam group except eight could not respond to verbal stimuli but most patients were awakened during procedure in control group(p<0.05). CONCLUSION: Midazolam is a good sedative agent for a patient to give a favorable amnesia, reduction of discomfort during bronchoscopy. We concluded that midazolam is a safe and useful sedative agent and midazolam may be used routinely during bronchoscopy. Monitoring of oxygen saturation, however, is essential to prevent severe hypoxia during procedure.
Amnesia ; Amnesia, Anterograde ; Anoxia ; Bronchoscopy* ; Compliance ; Consciousness ; Humans ; Lung Diseases ; Midazolam* ; Oxygen ; Patient Compliance ; Prospective Studies*

PURPOSE: To evaluate the dynamic enhancement patterns of focal hepatic lesions using breath-hold dynamic MR imaging for differential diagnosis. MATERIALS AND METHOD: Thirty three patients (24 men and 12 women, mean age of 55 years) with 56 known liver masses on CT scan and US underwent MR imaging with 1.5T. After Tl-weighted fast multiplanar spoiled gradient recalled (FMPSPGR) imaging, breath-hold FMPSPGR images were obtained at 0, 1, 3, 5, and 10 minutes after bolus injection of Gd-DTPA. The cases consisted of 16 hepatocellular carcinomas, 24 hemangiomas, 6 metastases, 3 cholangiocellular carcinomas, and 7 hepatic cysts. The dynamic enhancement patterns were evaluated on the basis of initial enhancement study and, the degree of enhancement was also levaluaied. RESULTS: Of 24 hemangiomas, most cases showed centripetal filling-in pattern of enhancement except 3 cases which showed homogeneous enhancement pattern on the early dynamic phase. All hemangiomas showed very high signal intensity which persisted to the delayed phase. The eccentric enhancement pattern was the most common type in hemangiomas (63%). Hepatocellular carcinomas had heterogeneous enhancement pattern on early and delayed phase (81, 88%) and showed diminished signal intensity on the delayed images. 14 of 16 hepatocellular carcinomas (88%) had peritumoral halo. Variable enhancement pattern was observed in metastases including progressive centripetal filling-in pattern (67%). All metastases showed prominent peritumoral halos and low signal intensity. Cholangiocellular carcinomas showed early centripetal filling-in and heterogeneous enhancement pattern on delayed phase. None of hepatic cysts showed enhancement. CONCLUSIONS: Dynamic breath-hold MR imaging with Gd enhancement allows accurate assessment of hemodynamic status of hepatic lesions and is useful in differential diagnosis of focal hepatic lerions.
Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Diagnosis, Differential ; Female ; Gadolinium DTPA ; Hemangioma ; Hemodynamics ; Humans ; Liver ; Magnetic Resonance Imaging* ; Male ; Neoplasm Metastasis ; Tomography, X-Ray Computed