The occurrence of fistulous tract between the thoracic subarachnoid space and the pleural cavity due to injury is uncommon. The one was developed after traffic accident and treated by surgical repair of the fistula : The other was post-operative complication of costotransversectomy for T2 sympathectomy. The complication was realized by the surgeon who was aware of the small leakage of cerebrospinal fluid from the dura propria of the T2 nerve root at the time of surgery. Intermittent pleural punctures for drainage and semisitting position were followed by spontaneous closure of the fistula. These cases were reported so that the uncommon condition might be added to the differential diagnosis of pleural effusion.
Accidents, Traffic ; Cerebrospinal Fluid ; Diagnosis, Differential ; Drainage ; Fistula* ; Pleural Cavity ; Pleural Effusion ; Punctures ; Subarachnoid Space ; Sympathectomy

OBJECTIVE: The goal of this study was to review the etiologies, phathophysiology, clinical presentations and to compare the results of the surgical methods of subdural empyema especially in infants. PATIENTS AND METHODS: We reviewed the clinical data of five infantile subdural empyemas experienced in our hospital from 1993 to 1998 which were all surgically treated by craniotomy or burr hole trephination. We experienced five cases of infantile subdural empyema: two males and three females. The ages ranged from 40 days to 11 months. RESULTS: The etiologies of all five cases were unproven but all five cases had meningitis before the subdural empyemas were diagnosed. The causative organism in one was streptococcus pneumoniae, and the other were unknown. Two were treated with craniotomy(one with a good outcome and the other died) and three were treated with burr hole trephination(all three had a good outcome). CONCLUSION: Subdural empyema is a rapid progressing disease and it is important to detect and treat in the early stages of disease. The choice of surgical method must be based on the stage of the disease and its location in the cranial cavity.
Craniotomy ; Empyema, Subdural* ; Female ; Humans ; Infant* ; Male ; Meningitis ; Streptococcus pneumoniae ; Trephining

PURPOSE: To evaluate differential points of clustered microcalcification in malignant and benign lesions on histopathology and correlate with mammographic findings. MATERIALS AND METHODS: Authors evaluated differential points of malignant and benign calcifications in histopathologically confirmed 24 cases. In two patients, mapping studies and paraffin block mammographic examinations were done to correlate calcification on mammography with histopathologic morphology. RESULT: On histopathology, malignant calcifications were located in ductal lumen, while benign ones were usually located in ductal epithelium(p<0.05). However, associated three benign lesions of the 10 malignant lesions showed still benign calcifications adjacent to proven cancer. The typical malignant calcifications were the shape of lamination, while benign calcifications showed granular and salty on light microscope. In 2 mapping studies, malignant-looking calcifications within the area of predominant benign calcifications yielded atypical ductal hyperplasia. Mammographic pepper, granular, punctate, salty and S-shaped calcifications were correlated with granular and salty calcification on light microscope. Mammographic linear, branching, comma, tadpole and wormiform calcifications were correlated with histopathologic laminated calcification. CONCLUSION: Authors have recognized about characteristics of malignant Vs. benign clustered microcalcifications on histopathology. Authors concluded that if malignant-looking calcification such as linear, branching, comma, tadpole and wormiform are present in an are a of predominant benign calcifications, specimen radiographic correlation and mapping study will be necessary for better demonstration of the atypical ductal hyperplasia, hidden or associated breast cancer.
Breast Neoplasms ; Humans ; Hyperplasia ; Larva ; Mammography* ; Paraffin

Animals ; Atrophy ; Blotting, Western ; Humans ; Male ; Rats ; Rats, Sprague-Dawley ; Receptors, Mineralocorticoid ; RNA, Messenger ; Salivary Ducts ; Sodium ; Submandibular Gland

The aim of this study was to show the feasibility and potential advantages of using the new intraoral distraction device for alveolar ridge augmentation. Four adult mongrel dogs were used. We designed intraoral distraction device for augmentation of vertical height of the edentulous ridge. The left upper and lower premolars and first molars were extracted and an alveoloplasty was performed to simulate an atrophic ridge. After 12 weeks of healing, an osteotomy was made and the intraoral distraction device was applied in order to distract alveolar segment upward. A permucosal pin was exposed intraorally. Latency period was allowed for 7 days before distraction began. The distraction device was activated with a rate of 1.0 mm/day for 9 days. At 2 weeks after completion of the distraction, the device was removed. At 8 weeks after distraction, the animals were sacrificed. Clinical, radiographic, and histologic examinations were performed. Macroscopically, no significant abnormalities such as infection were occurred in the distracted area. The average distracted distance was 7.6+/-1.4 mm and new bone was formed in the distracted gap in all animals. Bone remodeling without crestal bone resorption was observed in the distracted area. In several animals, fibrous tissue was present in the buccal cortical bone area. These results suggest that the intraoral diatraction device may have the potential for use in augmentation of the atrophic edentulous ridge.
Adult ; Alveolar Process* ; Alveolar Ridge Augmentation* ; Alveoloplasty ; Animals ; Bicuspid ; Bone Remodeling ; Bone Resorption ; Dogs* ; Humans ; Latency Period (Psychology) ; Molar ; Osteogenesis, Distraction ; Osteotomy

Adult ; Alveolar Process ; Animals ; Bicuspid ; Bone Resorption ; Dogs ; Humans ; Latency Period (Psychology) ; Molar ; Osteotomy

A case of huge craniopharyngioma which was removed radically is presented. A 14-year-old girl was hospitalized because of the impairment of vision and a history of generalized seizures. The computed tomogram of the brain disclosed the huge mass consisting of a large cystic part extending to the frontal base and solid part medial and posterior to the cystic. Despite of the large size and adhesion to the vital structures, the tumor was removed successfully. To remove the tumor radically, it seemed to be important not to interrupt the outer structure of the mass during dissection. The postoperative course was uneventful except transient diabetes insipidus. We report this case with brief review of the references.
Adolescent ; Brain ; Craniopharyngioma* ; Diabetes Insipidus ; Female ; Humans ; Seizures

PURPOSE: The status of the axillary nodes in breast carcinoma patients is one of the most significant prognostic factors. Although many trials in order to gain information concerning axillary status, to date there is no satisfactory procedures other than axillary lymph node dissection (ALND) which has many complications. Recently sentinel lymphadenectomy has become accepted as an alternative to ALND. METHODS: Sentinel lymphadenectomy followed by ALND was performed in 157 patients with invasive breast carcinoma between Nov. 1998 and Dec. 2000. The period from Nov. 1998 to May. 1999, which included the first 54 patients was set as a learning period. 99m Tc antimony trisulfide colloid was used in the detection of the sentinel node, with a gamma camera preoperatively and then a gamma probe in the operating room. The dissected sentinel nodes were examined by both frozen section and serial section (SS) with immunohistochemical stains (IHC). RESULTS: The detection rate was 96.8%. The false negative rate was 22.6% for the frozen sections and 4.8% for the permanent sections. The detection rate and the false negative rate had improved after the learning period with statistic significance (P-value<0.05). The false negative rate for tumors less than 2 cm was significantly lower than that for tumors greater than 2 cm (P-value=0.000). CONCLUSION: Sentinel lymphadenectomy using 99m Tc anti-nomy trisulfide colloid showed high detection rate and low false negative rate. The learning period is thought to be necessary for its clinical application. In the future, sentinel lymphadenectomy may replace axillary lymph node dissection in certain subgroups of breast carcinoma patients.
Antimony ; Breast Neoplasms* ; Breast* ; Colloids ; Coloring Agents ; Frozen Sections ; Gamma Cameras ; Humans ; Learning ; Lymph Node Excision* ; Operating Rooms

PURPOSE: To analyze and characterize the radiologic findings of lobular carcinoma of the breast, a carcinoma which is very rare in Korea. MATERIALS AND METHODS: Twelve patients with pathologically proven lobular carcinoma were included in this study. Mammography was performed in all patients and ultrasonography in six. Clinical manifestations, mammographic findings and ultrasonographic findings were retrospectively analysed. RESULTS: Mean age of the patients was 45.9 years and the most common clinical manifestation was palpable breast mass (9/12). Radiologic findings of lobular carcinoma were spiculation (11/12), mass density (8/12), asymmetric vessel (6/12), and microcalcifications (6/12). Ultrasonography showed intermediate or lower echoic mass (4/6). Posterior enhancements and shadowings were noted in the same proportion. Breast MRI in two patients showed mass lesion with rapid strong enhancement at 1 minute after contrast injection on dynamic study. Tumor stages were stage II (6/12) followed by stage I (3/12), and most advanced case was stage IIIb. CONCLUSION: On mammogram, the most common finding of lobular carcinoma of the breast was spiculation, and calcifications showed more frequently than in other reports. Ultrasound study showed ellipsoid mass with transverse long axis. Internal echogenicity and posterior sonic enhancement or shadowing of the mass were not characteristic of the tumor.
Axis, Cervical Vertebra ; Breast* ; Carcinoma, Lobular* ; Humans ; Korea ; Magnetic Resonance Imaging ; Mammography ; Retrospective Studies ; Shadowing (Histology) ; Ultrasonography

Bacillus anthracis is generally accepted as the most potent biological warfare agent because of its highly pathogenic nature and transmission efficiency. Identification of chromosomal markers for the rapid detection of B. anthracis is difficult since significant chromosomal homology exists among B. anthracis, B. cereus and B. thuringiensis. In this study, we tested whether the gyrB sequence could be used as the target for the PCR detection of B. anthracis. The gyrB sequence, composed of 1,923 bp, was identical in 17 Korean B. anthracis isolates. The comparison of gyrB sequence between B. anthracis and B. cereus type strain showed 8.8% difference (105 bp among 1,194 bp), and the gyrB sequence similarities of B. cereus, B. thuringiensis and B. mycoides with B. anthracis were 92.3%, 86.9% and 86.1%, respectively. When polymerase chain reaction was designed and performed based on the gyrB sequence, a specific amplicon (351 bp) could be amplified. These results indicate that gyrB could be useful as a chromosomal marker for the rapid screening of B. anthracis by PCR or differentiation of B. anthracis from other related species by multiplex PCR with other plasmid markers.
Bacillus anthracis* ; Bacillus* ; Biological Warfare Agents ; Mass Screening ; Multiplex Polymerase Chain Reaction ; Plasmids ; Polymerase Chain Reaction