No abstract available.
Bone Marrow* ; Breast Neoplasms* ; Breast* ; Neoplasm Micrometastasis*

No abstract available.
Child* ; Evoked Potentials, Auditory, Brain Stem* ; Humans

Pneumomediastinum is a relatively uncommon, infrequently reported entity, In the evaluation of these entity, it is important to exclude pathological causes, including Boerhaave's syndrome which carries a high mortality. Spontaneous pneumomediastinum is related to excessive intraalveolar pressure leading to rupture of perivascular alveoli in the setting of a Valsalva maneuver without communication to gut material. So, it has a benign self-limited course and rarely requires medical intervention. On the contrary, secondary pneumomediastinum caused by instrumental, traumatic, and spontaneous perforation of esophagus. Although the prognosis have been improved since the advent of broad-spectrum antibiotics and nutritional support, pneumomediastinum due to esophageal perforation still has a high morbidity and mortality. The most important prognostic factor is the time interval between perforation and initiation of therapy, and an awareness and a high clinical suspicion is critical in the early diagnosis and treatment. Recently, we have experienced 2 cases of pneumomediastinum, one case was spontaneous pneumomediastinum and the other may be caused by instrumental esophageal perforation. We report the clinical course of the patients with a current literature review.
Anti-Bacterial Agents ; Early Diagnosis ; Esophageal Perforation ; Esophagus ; Fibrinogen ; Humans ; Mediastinal Emphysema* ; Mortality ; Nutritional Support ; Prognosis ; Rupture ; Valsalva Maneuver

BACKGROUND: Since percutaneous mitral valvuloplasty(PMV) using balloon was introduced by Inoue in 1984, this procedure has been accepted as a new non-surgical therapeutic modality for the treatment of selected patients with mitral stenosis. Pregnant women with mitral stenosis has suffered from life threatening complication due to altered hemodynamic changes and heart failure. Surgical valvotomy has been performed after failure of medical therapy with high risk of fetal mortality and teratogenicity. PMV can be an adequate alternative to surgical valvotomy in pregnant women. METHODS: After precise echocardiographic examination of mitral valve and its surrounding structures including thrombi in left artrium was performed, antegrade transseptal procedure was done in all 3 cases with abdominal shield using Inoue balloon technique. RESULTS: Mitral valve area increased over 1.5cm2 and hemodynamic variables improved immediately after PMV. Symptoms subsided soon after PMV in all 3 cases. Healthy normal babies were delivered transvaginally without difficulties in all 3 patients. CONCLUSIONS: Percutaneous mitral valvuloplasty is a safe and effective therapeuteic alternative to surgical valvotomy in a pregnant women with mitral stenosis who failed medical therapy, in a high risk or symptomatic pregnant women.
Echocardiography ; Female ; Fetal Mortality ; Heart Failure ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Stenosis ; Pregnancy* ; Pregnant Women

No abstract available.
Bronchopulmonary Dysplasia* ; Humans ; Infant, Newborn

Alpasia cutis congenita is an anomaly characterized by absence of localized areas of the integument. The most common type of aplasia cutis congenita is Aplasia cutis congenita limited to the scalp, although other areas of the body may also be involved. We experienced a case of aplasia cutis congenita in a male newborn infant. The skin defects were extensive with symmetrical involvement of lower extremities. The multiple bullae were found on the both fingers and toes. No similar conditions and other associated congeital anomalies were found in the family membes of this particular case. The light microscopic examinaton of the denuded skin areas how absence of epidemis and the demis contain atrophic and hypoplastic adnexa. The bullae have a split within the dermis below lamina densa on electron microscopy. The skin defects were healed by supportive therapy for 4weeks.
Dermis ; Ectodermal Dysplasia* ; Epidermolysis Bullosa* ; Fingers ; Humans ; Infant, Newborn ; Lower Extremity ; Male ; Microscopy, Electron ; Scalp ; Skin ; Toes

The classical Roentgenographic features of tuberculosis of the spine such as narrowing of the intervertebraldisc, collapse of the vertebral bodies, with or without the shadow of a cold abscess, present a specific pictureof the actural pathological process. However, the diagnosis of tuberculosis is not confirmed unless proven bybiopsy, or the finding of the tubercle bacillus. 120 cases of proven spinal tuberculosis, at Kwangju ChristianHospital during the period form Jan 1973 through Aug. 1980, were studied and analysed. The results were asfollows; 1. The ratio of male to female was 1:1.1. The age preference was under 30 years old. 2. The most frequentsite of involvement was the lumbar spine(44.1%) and next the thoracic(39.2%0. 3. The incidence of lytic type was50.8%, mixed type 36.7%, and sclerotic type 12.5%. 4. Associated pulmonary tuberculous lesions were observed in 94patients (78.3%). 5. The central type, with wedging or collapse of the vertebral body, was more common in theyounger age group and the intrevertebral articular type in older patients. 6. The incidences of typical radiologicfindings were : Collapse of vertebral body(90%), cold abscess (78.3%) and narrowing of intervertebral space(70%).7. Associated kyphosis was observed in 37 cases (30.8%). Among these 37 cases the range of angulation was between21 to 40 degrees in 40%.
Abscess ; Bacillus ; Diagnosis ; Female ; Gwangju ; Humans ; Incidence ; Kyphosis ; Male ; Spine ; Tuberculosis ; Tuberculosis, Spinal

BACKGROUND: Abdominal pain is one of the most common complaints in the emergency department and the evaluation presents an extraordinary challenge to the emergency physician's skill. C-reactive protein, an acute phase protein which is increased in the presence of inflammation in various clinical conditions, has been proven useful in assessing disease severity, in monitoring the development of complications, and in evaluating the response to specific treatments. So we tried to determine whether CRP offers an advantage over other clinical or laboratory variables for decision-making in the management of acute abdominal pain in the emergency department. METHOD: Patients who came to a University Hospital ED with acute abdominal pain, between september 1, 1998 and November 30, 1998, were included in this study, Data collection included age, sex, duration of symptom, location of pain, and laboratory dta(white blood cell count, portion of neutrophils, ESR, CRP, amylase). RESULT: This study included 85 patients, 34 of whom were men. The mean age was 36.9+/-19.1 years. CRP might be useful to detect the serious condition, sensitivity 81%, but more useful to differentiate normal condition from serious condition in acute abdominal pain patients, specificity 83%. CONCLUSION: CRP is an useful indicator of decision-making to abdominal patients in the emergency department. Hospitalization or operation is very unlikely when CRP value is normal.
Abdominal Pain* ; Acute-Phase Proteins ; Blood Cell Count ; C-Reactive Protein* ; Data Collection ; Emergencies ; Emergency Service, Hospital ; Hospitalization ; Hospitals ; Humans ; Inflammation ; Male ; Neutrophils ; Sensitivity and Specificity

Changes of bone turnover with aging are responsible for bone loss and play a major role in osteoporosis. Among the early postmenopausal women, as are known by previous study, there are about 35% ""fast bone losers and bone turnover is more uncoupled in osteoporotic group than in normal control. So, early detection of such fast losers"" and women who have high turnover rate is important to prevent postmenopausal osteoporosis and spontaneous fracture. Dual-energy X-Ray absorptiometry (DEXA), however, cannot reflect current bone loss because changes in bone mineral density (BMD) are only seen after 1 or more years of bone densities declining. In this study, we have measured a battery of new sensitive and specific markers of bone turnover which reflect current bone loss. To investigate the changing pattern of those markers, 674 healthy women including 451 postmenopausal women were classified, according to their menopausal period (less than 5 years, 5-10 years, more than 10 years). Bone formation was assessed by serum osteocalcin (OC), bone-specific alkaline phosphatase (BSAP) and bone resorption by the urinary excretion of deoxypyridinoline (DPD), cross-linked N-telopeptide of type I collagen (NTX). All Biochemical markers, except OC, significantly increased after menopause (p < 0.05). NTX and BSAP remained elevated after 10 years of menopause. These data indicated that the overall rates of both bone formation and bone tesorption increased after menopause and remained high in elderly women.
Absorptiometry, Photon ; Aged ; Aging ; Alkaline Phosphatase ; Biomarkers ; Bone Density ; Bone Resorption ; Collagen Type I ; Female ; Fractures, Spontaneous ; Humans ; Menopause ; Osteocalcin ; Osteogenesis ; Osteoporosis ; Osteoporosis, Postmenopausal

Papillary stenosis is characterized by fixed fibrosis leading to structural outflow obstruction and it is usually secondary to inflammation and fibrosis from the chronic passage of gallstones, episodes of acute pancreatitis, chronic pancreatitis, sclerosing cholangitis, peptic ulcer disease, and cholesterolosis. However, obstructive jaundice with or without acute cholangitis which leads the physician to suspect the presence of malignancy as a cause is a rare manifestation of papillary stenosis. We report here a case of papillary stenosis presenting with obstructive jaundice and acute cholangitis. The lesion was so difficult to exclude the presence of malignancy preoperatively and intraoperatively that a pylorus-preserving pancreaticoduodenectomy was performed. Histologic examination of the resected specimen revealed fibrosis, adenomatoid ductal hyperplasia, and mild chronic inflammation of the papilla of Vater and distal common bile duct.
Acute Disease ; Case Report ; Cholangitis/etiology* ; Cholestasis/etiology* ; Cholestasis/complications* ; Common Bile Duct Diseases/complications* ; Human ; Male ; Middle Age ; Vater's Ampulla*/radiography ; Vater's Ampulla*/pathology