No abstract available.
Condylomata Acuminata* ; Dermoscopy* ; Diagnosis, Differential* ; Lymphangioma* ; Vulva*

Primary pulmonary Hodgkin's lymphoma is a rare but distinct entity to be distinguished from nodal Hodgkin's lymphoma and from lymphomas involving lung secondarily. This lymphoma affects women more frequently than men, and typically involves superior portions of the lung. This case is reported to illustrate the clinical, radiographic and anatomic characteristics of the primary pulmonary Hodgkin's lymphoma. A 34-year-old woman presented for the evaluation of hemoptysis. A chest CT revealed a large poorly defined mass in the medial aspect of the right upper lobe, extending to the right mediastinum and trachea. The microscopic examination of the biopsied lesion revealed fibroblastic stroma infiltrated by a mixture of lymphocytes, histiocytes, and eosinophils. The clinical impression was inflammatory pseudotumor, presumably due to slightly favorable response to corticosteroid therapy. Two months later the patient's symptoms worsened despite the steroid therapy and a lobectomy was done. The specimen showed a soft to firm, pale yellow, ill defined mass, 10.0 8.0 cm, involving the visceral pleura. A few satellite nodules around the main mass were noted. The histologic findings were consistent with Hodgkin's lymphoma, nodular sclerosis type.
Adult ; Eosinophils ; Female ; Fibroblasts ; Granuloma, Plasma Cell ; Hemoptysis ; Histiocytes ; Hodgkin Disease* ; Humans ; Lung ; Lymphocytes ; Lymphoma ; Male ; Mediastinum ; Pleura ; Sclerosis ; Tomography, X-Ray Computed ; Trachea

No abstract available.
Dermoscopy ; Melanoma*

The widespread application of coronary angiography and poen heart surgery have resulted in more frequent detection of patients with coronary artery anomaly. In 0.6 to 1.2 percent of individials, the coronary arteries arise aberrantly from the aorta. Anomalous origin of the left coronary artery from the fight coronary sinus with subsequent coursing between the aorta and pulmonary artery is a rare and sometimes fatal coronary amonaly. This anomaly has been reported in young and healthy men who died suddenly during or immediately forllowing vigorous physical exercise. The exact mechanism of sudden death is unclear. It is believed to be related to either extrinsic compression of the left coronary artery or distorsion of the vessel orifice, with resultant global ischemia and ventricular fibrllation. A 13-years old healthy boy, who was completely asymptomatic until he had sudden chest pain after running, arrived at hospital with typical clinical picture of acute myocardial infarction. The electrocardiography taken on admission demonstrated pathologic Q wave changes on lead I, aVL, V2, V3 and V4. Cardiac enzymes were elevated. The selective coronary angiography demonstrated that left coronary artery arose from the right coronary sinus. The anomalous left coronary artery passed posterioly around aortic root to reach its normal position in the interventricular groove. We report the patient with anomalous origined left coronary artery which causes the acute myocardial infarction.
Adolescent ; Aorta ; Chest Pain ; Coronary Angiography ; Coronary Sinus* ; Coronary Vessels* ; Death, Sudden ; Electrocardiography ; Exercise ; Humans ; Ischemia ; Male ; Myocardial Infarction* ; Pulmonary Artery ; Running ; Thoracic Surgery

BACKGROUND AND OBJECTIVES: QT dispersion (QTd) represents the inhomogeneity of ventricular repolarization and has been suggested to predict ventricular arrhythmia in patients with coronary artery disease (CAD). This study investigates the short-term effect of percutaneous transluminal coronary angioplasty (PTCA) on QTd in patients with CAD and no history of previous myocardial infarct. MATERIALS AND METHODS: In 84 angina patients (65 men and 19 women, mean age of 58.3+/-9.0 yeras) who underwent successful PTCA of single coronary artery, ECG was checked in baseline, immediate, 1day and 1 month after PTCA. QTd and corrected QTd (c-QTd) were measured in these ECGs by digitizer. RESULTS: PTCA was performed at left anterior descending artery (LAD) in 56, left circumflex artery (LCx) in 12 and right coronary artery (RCA) in 16 patients. Mean and standard error of QTd (c-QTd) at baseline, immediate, 1day and 1month after PTCA was 51.3+/-4.2 (50.7+/-4.1), 54.2+/-4.5 (52.8+/-4.5), 47.7+/-4.3 (48.5+/-4.8) and 36.3+/-4.5 (37.5+/-4.6)msec, respectively. QTd and c-QTd significantly decreased at 1 month following PTCA. The difference was more prominent in pateints with LAD lesion than LCx or RCA lesion and independent of gender, severity of stenosis and use of beta-blockers. CONCLUSION: QTd decreases in CAD patients with no history of myocardial infarct at 1 month following successful PTCA. This may facilitate a favorable recovery from inhomogenous repolarization. These findings call for long-term follow-up of QTd and the incidence of ventricular tachyarrhythmias and sudden death following successful PTCA.
Angioplasty, Balloon, Coronary ; Arrhythmias, Cardiac ; Arteries ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Death, Sudden ; Electrocardiography ; Female ; Humans ; Incidence ; Male ; Myocardial Infarction ; Tachycardia

Vinorelbine, a vinca alkaloid anticancer drug, is widely used to treat various cancers. Several dermatological side effects of vinorelbine, such as acral erythema, phlebitis, and severe extravasation reactions, have been reported. Vinorelbine is categorized as non-DNA binding vesicant that undergoes high metabolism and clearance, which limits the degree of tissue injury if extravasation occurs. A 73-year-old male presented with erythematous linear patches on his left wrist and a 51-year-old male presented with erythematous eroded patches and bullae on his right forearm. Histopathologic study showed interface changes with basal vacuolar degeneration and epidermal dysmaturation. Separation of the dermis from the epidermis was observed, as well as interstitial and perivascular inflammatory infiltrates in the dermis. Both patients were being treated with vinorelbine for lung cancer. Before the onset of the skin lesions, accidental intravenous extravasation of vinorelbine had occurred. Herein, we report two cases of chemotherapy induced drug reaction due to extravasation of vinorelbine.
Aged ; Cytochrome P-450 CYP1A1 ; Dermis ; Drug Therapy ; Epidermis ; Erythema ; Forearm ; Humans ; Lung Neoplasms ; Male ; Metabolism ; Middle Aged ; Phlebitis ; Skin ; Vinca ; Wrist

BACKGROUND: Adaptive remodeling of the wall of diseased arterial segments occurs to compensate for the accumulation of atherosclerotic plaque. Histopathologic studies and intraoperative high-frequency epicardial coronary ultrasound imaging as well as intracoronary ultrasound imaging have shown that human coronary arteries enlarge in parallel with the formation of atherosclerotic plaque. Therefore, the lumen area is preserved until the progressive accumulation of plaque exceeds the compensatory mechanisms of the vessel. In 1995, however, Pastercamp et al. reported that arterial wall constriction (shrinkage) or inadequate enlargement may be a different mechanism associated with the development of severe arterial lumen narrowing in addition to plaque proliferation. The aim of this study is to examine what extent of de novo native coronary arterial stenosis is accompanied by compensatory enlargement and to find the predictors of inadequate remodeling with intravascualr ultrasound. METHODS: Fifty eight patients were enrolled from February 1997 through October 1997. Patients who had the lesion of more than 50% stenosis of minimal luminal diameter in coronary angiography were indicated. The lesion which was located in the ostium or was very tortuous or angulated was excluded. The lesion which had the history of balloon angioplasty or stent insertion was also excluded. We used 20 MHz endosonic intravascular ultrasound catheter. We measured EEM area (External Elastic Membrane area), lumen area and plaque plus media area and analysed plaque characteristics. RESULTS: 1) Fifty-eight consecutive patients (43 men, 15 women; mean age 55.4 years, range 33 to 78) who had not undergone previous catheter intervention were studied with a single intravascular ultrasound system. 2) Among 58 patients, 20 patients (35%) had acute myocardial infarction, 30 patients (52%) unstable angina, 6 patients (10%) stable angina and 2 patients (3%) old myocardial infarction. Lesions were located at the left anterior descending arteries in 29 patients (50%), right coronary arteries in 21 patients (36%) and left circumflex coronary artery in 8 patients (14%). 3) Compensatory enlargement was observed in 19 (32%) of 58 lesions and inadequate compensatory enlargement in 39 (68%). 4) EEM and plaque areas at lesion site of compensatory enlargement group were significantly larger than those of inadequate enlargement group (p<0.05). 5) Risk factors for coronary arterial disease including diabetes mellitus, hypertension, hypercholesterolemia (serum cholesterol<0A65B>240 mg/dl), smokings and plaque characteristics were not statistically related with inadequate enlargement. Although there was no statistical significance, there was a tendency of inadequate enlargement in patients with diabetes mellitus and calcified plaque. 6) The only predictor of inadequate remodeling was the postmenopausal female (p<0.05). CONCLUSION: Adaptive compensatory coronary arterial remodeling was occured less frequently in patients with acute coronary syndromes than in patients with stable angina. The only statistically significant predictor of adaptive compensatory coronary arterial remodeling was postmenopausal women. Inadequate compensatory coronary arterial remodeling was occured more frequently in patients with diabetes mellitus or calcified plaque but without statistical significance.
Acute Coronary Syndrome ; Angina, Stable ; Angina, Unstable ; Angioplasty, Balloon ; Arteries ; Catheters ; Constriction ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Diabetes Mellitus ; Female ; Humans ; Hypercholesterolemia ; Hypertension ; Male ; Membranes ; Myocardial Infarction ; Phenobarbital ; Plaque, Atherosclerotic ; Risk Factors ; Smoke ; Stents ; Ultrasonics* ; Ultrasonography

Spitz nevus is a benign melanocytic nevus, common in children or young adults, and it has histological features that are confused with those of malignant melanoma. Polypoid Spitz nevus is the benign counterpart of polypoid malignant melanoma. A 22-year-old woman presented with a solitary 1.5×1.5 cm-sized firm polypoid erythematous nodule on the left thigh. On dermoscopy, pink to yellowish lagoons intermingled by white fibrous septa were found but milky red globules or irregular linear vessels were not found. Therefore, melanoma almost could be ruled out cautiously. Histopathology showed symmetrical, well-circumscribed, polypoid architecture with predominant dermal nests of spindle cells. Immunohistochemically, the nevus cells were strongly positive for S-100 protein and negative for HMB-45. Thus, the diagnosis of polypoid Spitz nevus was made. Herein, we report a case of polypoid Spitz nevus that was differentiated from polypoid melanoma by histopathologic and dermoscopic findings.
Child ; Dermoscopy ; Diagnosis ; Female ; Humans ; Melanoma ; Nevus ; Nevus, Epithelioid and Spindle Cell* ; Nevus, Pigmented ; S100 Proteins ; Thigh ; Young Adult

BACKGROUND: The purpose of this study was to assess the clinical outcome and echocardiographic incidence of restenosis after successful percutaneous transmitral commissurotomy (PTMC) and to identify predictors of restenosis. METHODS: Between 1989 and 1992, Inoue PTM (n=73) and double balloon technique (n=85) were used in 158 consecutive patients (male 52, age; 41+/-11 year) with mitral stenosis. Clinical and echocardiographic examinations were performed annually in 137 patients who exhibited good initial result with PTMC (mitral valve area 1.5cm (2) and mitral regurgitation[MR] 2+). Restenosis was defined as a mitral valve area< (MVA) 1.5cm (2) or more than 50% loss of the initial gain in MVA. Commissural mitral regurgitation (CMR) was defined as MR originating from medical or lateral commissure on color flow imaging and regarded as an index of complete commissural splitting. RESULTS: Immediately after PTMC, MVA increased from 0.9+/-0.2cm (2) to 1.8+/-0.3cm (2) and functional class improved up to NYHA class 1 or 2 in all patients. Annual echocardiographic follow-ups were completed in 129 (94%) patients and mean follow-up duration was 54+/-21 months. Adverse events occurred in 16 (13%) patients (1 death, 3 mitral valve replacement, 3 re-PTMCs, 9 deterioration of the NYHA class), and restenosis occurred in 41 (32%) patients. Event-free and restenosis-free survival rates at 7 years were 776 % and 586 %, respectively. According to multivariate Cox analysis, restenosis (p=0.0017, relative risk[r.r]=2.82) was the only predictor of adverse events ; smaller increase ( 1.0cm (2)) of MVA (p=0.0001, r.r=4.8) and the absence of CMR (p=0.0000, r.r=4.8) were independent predictors of restenosis. CONCLUSION: Long-term clinical outcomes and restenosis rates after PTMC are favorable and immediate results after PTMC can predict late restenosis better than baseline clinical and echocardiographic characteristics.
Echocardiography* ; Follow-Up Studies ; Humans ; Incidence ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Survival Rate

Background/Aims: Periampuilary diverticulum has been known to be associated with various bilio-pancreatic diseases such as choledocholithiasis and disturbs performing selective cannuiation of ERCP and EST. This present study aims to investigate anatomical morphology of periampullary diverticulum and to determine whether periampullary diverticulurn influences difficulty and complication performing of ERCP and to analyse the relationship between periampullary diverticulum and choledocholithiasis. Methods: We reviewed records of chart and diverticular pictures in 1389 cases of underwent ERCP and evaluated the incidence, size, direction, location of periampullary diverticulum and its influence against performing of ERCP and investigated its relationship with bilio-pancreatic diseases such as choledocholithiasis.(continue..)
Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Diverticulum* ; Incidence