We herein describe a case of a 55-year-old healthy woman with localized primary thymic amyloidosis presented as a mediastinal mass, found incidentally by chest radiography. Computed tomography revealed a 4.1 cm soft tissue lesion with nodular calcification in the left anterior mediastinum. The resected specimen was a well-defined lobulating mass with calcification. Microscopically, the mass was consisted of amorphous eosinophilc hyalinized substances involving the thymus and intrathymic lymph nodes. These eosinophilic substances showed apple-green bi-refringence under polarized light after staining with Congo red. In immunohistochemical study, they were positive for kappa and lambda light chains and negative for amyloid A. There was no evidence of systemic amyloidosis in clinical investigations. A final diagnosis of localized primary thymic amyloidosis was made.
Amyloid ; Amyloidosis ; Congo Red ; Eosinophils ; Female ; Humans ; Hyalin ; Light ; Lymph Nodes ; Mediastinum ; Middle Aged ; Thorax ; Thymoma ; Thymus Gland

Pulmonary embolism is the impaction of material into branches of the pulmonary arterial bed. It usually occurs in patients with primary hypercoagulable states or secondary hypercoagulable states like cancer, preganancy, and estrogen replacement therapy. We report a case of a pulmonary embolism in a patient with positive lupus anticoagulant who received estrogen replacement therapy. The patient was referred due to suddenly developed shortness of breath and echogenic mass densities in the right atrium on 2 dimensional echocardiography. The patient was markedly improved with intravenous urokinase and subsequent oral anticoagulant therapy. Related articles are also reviewed.
Dyspnea ; Echocardiography ; Estrogen Replacement Therapy* ; Estrogens* ; Female ; Heart Atria ; Humans ; Lupus Coagulation Inhibitor* ; Pulmonary Embolism* ; Urokinase-Type Plasminogen Activator

We report a case of cystic adenocarcinoma of the prostate in a 67-year-old man who showed severe obstructive voiding symptoms. In this case, the mechanism of the cyst formation from the prostate cancer is thought to be related to the secondary cystic formation, which was due to either the central necrosis of the cancer tissue or intracancerous tissue hemorrhage. Prostate cystic adenocarcinoma is a rare disease, and there are only a few cases reported in the literature. A cyst of the prostate may be either congenital or acquired. A congenital cyst arises from the mesonephric (Wolffian) or paramesonephric (Mullerian) duct system, while an acquired cyst is subdivided into the retention, malignant, and parasitic cyst. A huge prostatic cyst was found in a 67-year-old man. The lesion was presumed to be a prostate cystic adenocarcinoma.
Adenocarcinoma* ; Aged ; Hemorrhage ; Humans ; Necrosis ; Prostate* ; Prostatic Neoplasms ; Rare Diseases

The authors present a case of Fahr's disease which is characterized by idiopathic symmetrical calcifications in the basal ganglia and the dentate nuclei. Computerized tomographic scans of the brain demonstrated bilateral calcified lesions recognized in the region of the dentate nuclei of both cerebellar hemispheres and the basal ganglia. A review of the literature on several cases of intracranial ferrocalcinosis is presented.
Basal Ganglia ; Brain

The authors presented an unusual case of an occipital artery aneurysm which developed spontaneously. The patient was a 41-year-old woman who suffered from the sudden onset of right hemiparesis and slurred speech. Computerized tomography scans of the brain demonstrated an intracerebral hemorrhage in the left parietal lobe. The carotid angiography revealed an incidental saccular aneurysm in the left occipital artery. The aneurysm was not treated because the patient's relatives refused operation and there were no subjective complaints by the patient. Certain particularities of this lesion are discussed in the context of the literature.
Adult ; Aneurysm* ; Angiography ; Arteries* ; Brain ; Cerebral Hemorrhage ; Female ; Humans ; Paresis ; Parietal Lobe

Anatomical information of the circle of Willis is important in evaluating the various cerebrovascular diseases and surgical procedures. In this study, we present the anatomical structures of the circle of Willis in 54 Korean adults. The authors observed the morphological characteristics of the vasculature, the incidence of deficiency or incompleteness in the circle and clinical considerations. Measurements of the outer diameter and the length of each arterial segments were performed. Number and the origin of perforators from individual arteries were also oserved. Results of this study were as followings. Normal circles of Willis was oserved in 35 cases(64.81%) and abnormal circles in 19 cases(35.9%). 2) Incidental detection of aneurysms occurred in 5 cases(9.26%). 3) Frequency of anomalies were most commonly observed in the anterior communicating arteries(N=16, 20.37%). 4) A string-like artery was most frequently observed in te post-erior communicating artery(N=11, 20.37%). 5) Anomalous origin of the P1 segment of the posterior cerebral artery was observed, fetal type was in 12 cases(22.2%) and transitional typ was in 3 cases(5.55%) respectively. 6) The longest artery was the A1 segmnt of the anterior cerebral artery;the second, posterior communicating artery;the third, P1 segment of the posterior cerebral artery;and the shortest, anterior communicating artery. 7) The outer diameters of the basilar artery and internal carotid artery were almost, equal, A1 segment was half of ICA, AcoA was two thirds of A1 segment, PcoA was half of P1 segment and P1 segment was two thirds of the basilar artery. There were difference the anterior and posterior portion of the circle Willis. In the anterior communicating arteries, duplicated structure were frequently found. And also, inequality in the outer diameter of both A1 segmnts was observed. String-like arteries were often revealed in the posterior communicating arteries. Anomalous origin of P1 segments that may be persistant embryonic derivatives were frequently demonstrated in posterior cerebral arteries.
Adult* ; Aneurysm ; Arteries ; Basilar Artery ; Carotid Artery, Internal ; Circle of Willis* ; Humans ; Incidence ; Posterior Cerebral Artery ; Socioeconomic Factors

Brain metastasis from primary uterine cervical carcinoma have been described but are extremely rare and usually occur in the presence of widely disseminated diseases. The authors report a case of solitary cerebellar metastasis from uterine cervical carcinoma, which was confirmed by histopathological examination. The patient has shown no evidence of metastatic lesions elsewhere, thus far, but had undergone a radical hysterectomy under the diagnosis of uterine cervical carcinoma 52 months prior to the surgical excision of the cerebellar metastasis.
Brain ; Diagnosis ; Humans ; Hysterectomy ; Neoplasm Metastasis*

OBJECTIVE: Methicillin resistant Staphylococcus aureus (MRSA) is the most common cause of postoperative infection in instrumented fusion surgery. Although MRSA is well-known cause of nosocomial infection, emerging evidence supports that there could be MRSA infection from community. This study evaluated the nasal colonization rate of MRSA among healthy adults within the age range of spinal fusion surgery in Korea. METHODS: Nasal swabs were collected from 99 participants who visited health promotion center. A structured questionnaire regarding healthcare-associated MRSA risk factors was collected simultaneously. Staphylococcus aureus was confirmed by latex agglutination. The resistance to methicillin was identified by oxacillin screening test. RESULTS: Of the 99 participants, 12 (12.1%) had S. aureus isolates. The nasal carriage rate of methicillin susceptible S. aureus (MSSA) was 9 (9.1%). MRSA was identified in 3 participants (3.0%). CONCLUSION: Among the age range of possible spinal fusion surgery, nasal colonization study revealed substantial rate of preoperative MRSA carriers even in healthy adults. A postoperative MRSA infection should not be exclusively considered to be due to surgery-related contamination.
Adult ; Agglutination ; Colon ; Cross Infection ; Health Promotion ; Humans ; Latex ; Mass Screening ; Methicillin ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Nasal Surgical Procedures ; Oxacillin ; Surveys and Questionnaires ; Risk Factors ; Spinal Fusion ; Staphylococcus ; Staphylococcus aureus ; Surgical Wound Infection

BACKGROUND: Precutaneous mitral balloon valvuloplasty(PMV) is known to produce shortterm hemodynamic and symptomatic improvement in selected patients with restenosis after previous surgical commissurotomy. METHODS: To evaluated the long-term efficacy of PMV and identify the risk factors for restenosis after this procedure in patients with mitral restenosis after previous surgical commissurotomy, we obtained 30.4+/-13.0 months(range, 6-53) follow-up data in 19 patients with restenosis after previous surgical commissurotomy on whom PMV was successfully performed since April, 1988. RESULTS: There were 10 females and 9 males with mean age of 42.7+/-8.7(range, 28-59). 11 patients were in atrial fibrillation. Restenosis occurred in 8 patients(42%) during follow-up. Median value for restenosis by Kaplan-Meier survival analysis was 40 months. Restenosis by univariate analysis correlated with smaller valve area after PMV and short interval from previous surgical commissurotomy to restenosis. Mitral valve area after PMV and echoscore were found to be the determinant predictors of restenosis by Cox proportional hazard analysis. For mitral valve area after PMV, patients with post-PMV valve area less than 1.6cm2have relatively high risk for restenosis than those with post-PMV valve area more than 1.6cm2. CONCLUSION: Half of the patients who underwent PMV due to restenosis after previous surgical commissurotomy maintained optimal result up to 40 months. Poorer long-term outcome can be predicted in patients with unfavorable valve morphology or post-PMV valve area less than 1.6cm2.
Atrial Fibrillation ; Balloon Valvuloplasty* ; Echocardiography* ; Female ; Follow-Up Studies* ; Hemodynamics ; Humans ; Male ; Mitral Valve ; Risk Factors

Colorectal cancer(CRC) is the most common gastrointestinal malignancy in the Western world. The total number of CRC cases in Korea is increasing probably due to western-style diets. CRC is relatively uncommon in the young adult group. Nevertheless, these cases warrant special attention because they are often diagnosed in an advanced stage and are more likely to involve a family history of CRC. Controversies still exist over the determination of the age range and over the true value of age factor in the prognosis for the young adults. The aim of this study is to calculate the incidence, to evaluate the clinicopathologic characteristics and the outcome of management of young adult with CRC. A retrospective review of 864 patients with an adenocarcinoma of the colon or rectum, who were surgically treated and followed-up in our Department of the Kang Buk Samsung Hospital, Sung Kwun Kwan University College of Medicine, Seoul, Korea, between January 1970 and December 1995 was performed. Among these patients, 138 were in the young adult group, aged less than 40. All cases accompanied by familial adenomatous polyposis coli and ulcerative colitis were excluded. Young adults accounted for 16.0% of all patients with CRC, showing no significant sex difference compared with the control group. The rectum and sigmoid colon were the most frequent sites of the lesion (80.4%). The incidences of Dukes' stage C and poorly differenciated adenocarcinoma cases were significantly higher in the young adult group (p<0.05). The curative resection rate of tumors in young patients was 93.4%. Despite of the more advanced stage and poorly differenciation, the stage-related and overall 5-year survival rate was not significantly different between old and young patients (57.9% and 59.4% in young and old patients, respectively). CRC in young adults in Korea is increasing in number, but its proportion is decreasing. The results of our study indicate that the prognosis and the stage-related survival for CRC in young adults are not related to age.
Adenocarcinoma ; Adenomatous Polyposis Coli ; Age Factors ; Colitis, Ulcerative ; Colon ; Colon, Sigmoid ; Colorectal Neoplasms* ; Diet ; Humans ; Incidence ; Korea ; Prognosis ; Rectum ; Retrospective Studies ; Seoul ; Sex Characteristics ; Survival Rate ; Western World ; Young Adult*