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

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

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

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

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*

Two cases of intracerebral and brain stem hemorrhage occurring after evacuation of chronic subdural hematoma and subdural hygroma are reported. A patient who had undergone craniotomy with closed drainage for subdural hygroma had intracerbral and fatal brain stem hemorrhage in the immediate postoperative period. Despite rapid and intensive treatment, he died. The other patient had intracerebral hematoma following drainage of chronic subdural hematoma and left with severe disability. Possible pathogenic mechanisms leading to development of the postoperative intraparenchymal hemorrhage are suggested. Sudden increase in cerebral blood flow combined with defective autoregulation seemed the most likely pathogenic mechanism to be responsible for the postoperative hemorrhage. If close neurosurgical observation of patients and clinical awareness for the intraparenchymal hemorrhage after evacuation of chronic extracerebral fluid collections given, this devastating complication may be avoided.
Brain Stem* ; Brain* ; Cerebral Hemorrhage ; Craniotomy ; Drainage ; Hematoma ; Hematoma, Subdural, Chronic* ; Hemorrhage* ; Homeostasis ; Humans ; Lymphangioma, Cystic* ; Postoperative Hemorrhage ; Postoperative Period ; Subdural Effusion

BACKGROUND: The most important hemodynamic disturbance in patients with hypertension is an increase in peripheral vascular resistance due to arteriolar constriction. The most desirable way to lower blood pressure is to decrease peripheral vascular resistance without any adverse effects to cardiovascular function. Accordingly, both alpha and beta-adrenoceptor antagonists are effective drugs for the treatment of hypertension. Amosulalol, a new drug which blocks both sympathetic nerve alpha and beta-receptors, has been developed. METHODS: In order to investigate the efficacy and safety of oral amosulalol on essectial hypertension, a daily dodse of 20mg to 60mg amosulalol was administered in 31 hypertensive patients(male : 14, female : 17, mean age : 52.7+/-7.9) with diastolic blood pressure in the range of 95mmHg-120mmHg while off all other anti-hypertensive agents. Blood pressure and heart rate were measured every 2 weeks. The complete blood count, blood chemistry by SMA-12 and derum electrolytes and urinalysis were performed at entry, 1st and 8th week of therapy. RESULTS: 1) Baseline blood pressure after 2 weeks of placebo at sitting positing were 167.5+/-12.0/107.8+/-6.6mmHg. There was statistically significant reduction of blood pressure after 2 weeks treatment of amosulalol which was maintained up to 8 weeks(167.5+/-12.0/107.8+/-6.6mmHg vs 157.9+/-12.4/103.7+/-9.5mmHg, P<0.05). There was a significant reduction of systolic and diastolic pressures after the treatment when comparing the average value of two observation periods with that of treatment period(161.1+/-31.6/104.8+/-20.3mmHg vs 145.1+/-13.5/94.7+/-8.8mmHG, P<0.05). 2) The proportion of the patient who had a tendency to decline of bloop pressure after treatment with amosulalol was 94%. When considering the safety and efficacy, 94% of patients demonstrated to be safe and efficacious. 3) There was a significant decrease of heart rate after amosulalol without severe bradycardia(72.7+/-8.3/min vs 67.5+/-7.2/min, p<0.05). 4) There were no significant changes in blood chemistry, serum electrolytes. hematologic findings except two patients who showed slight bilirubin elevation over the treatment period. 5) One patient experienced dizziness that requires to discontinue the medication. CONCLUSION: In patients with mild to moderate hypertension, twice daily amosulalol(20mg, 40mg and 60mg) provided significant anti-hypertensive effects without serious side effects.
Antihypertensive Agents ; Bilirubin ; Blood Cell Count ; Blood Pressure ; Chemistry ; Constriction ; Dizziness ; Electrolytes ; Female ; Heart Rate ; Hemodynamics ; Humans ; Hypertension* ; Urinalysis ; Vascular Resistance

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*