Parathyroid carcinoma is a relatively rare endocrine tumor, accounting for approximately 1 to 5% of patients with primary hyperparathyroidism. Patients with parathyroid carcinomas are often symptomatic, have markedly elevated calcium levels, and have a palpable cervical mass. They are equally distributed between the sexes and usually present 10 years before their benign counterparts. The diagnosis is suspected when the tumor is large, parathyroid hormone levels are high, and a palpable mass is present in the neck. Parathyroid carcinoma is often misdiagnosed preoperatively, suspected intraoperatively, and only confirmed postoperatively. We experienced a case of hyperfunctioning parathyroid carcinoma in a 36 year old man, which was confirmed microscopically. The tumor showed: 1) capsular and blood vessel invasion; 2) frequent mitotic figures in the parenchymal cells; 3) a trabecular pattern, and 4) intervening thick fibrous bands. Immunohistochemical stain of p53 may be one of the useful methods in identifying malignancy of parathyroid gland.

BACKGROUND: In 1996, our emergency department(ED) had 148.4 patients per day and an average time for managing simple and uncomplicated patients was 248 minutes. To relieve congestion, delay and conflict in ED, we have developed Fast Track to treat patients with minor illness rapidly and effectively. The Fast Track area is located in a separate area in front to the main department. The efficiency and effectiveness of new system and patients satisfaction were investigated. METHODS: All ambulatory patients(> 15 years of age) were triaged and treated at Fast Track by emergency physicians. Patients, triaged as severe illness, were moved directly to main ED and the other patients with minor illness were managed in Fast Track. We analysed the patients who were managed at Fast Track from Jan. 1st 1997 through Nov. 30th 1997. The total time staying in Fast Track from beginning of trige to final decision such as discharge or admission was recorded retrospectively. A questionnaire was obtained from random patients in the same period to evaluate the patient's satisfaction. RESULTS: The number of patients who were managed in Fast Track was 13,378, and it was 55.8% of all adult patients who visited ED during the period. The average staying time was decreased significantly with time, (140.9+/-2.9 minutes in June, 125.4+/-2.8 minutes in July, and 97.7+/-1.0 minutes after July). The 75 percentile weighted average time was also decreased significantly; 196 minutes in June, 107 minutes in July, 135 minutes from August to November(p<0.01). The questionnaire were obtained from 107 patients. The results were revealed that 90 of 107 patients(84.1%) were satisfied with emergency care at Fast Track, and the remaining patients expressed unsatisfied comments such as long waiting time(4.7%), overcrowding(1.9%), unsatisfactory care(1.9%). CONCLUSION: The Fast Track system could decrease patient's staying time and improve patient's satisfaction. In addition, the efficiency and effectiveness of the acute care in ED would be enhanced by managing minor illness in Fast Track rapidly and effectively.
Adult ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Estrogens, Conjugated (USP) ; Humans ; Surveys and Questionnaires ; Retrospective Studies ; Tertiary Care Centers*

A forty-nine-year-old woman with polycystic disease had a right nephrectomy for what was preoperatively thought to be a polycystic disease, but at surgery turned out to be a tumor based on frozen section. Microscopic examination revealed papillary type, renal cell carcinoma with classical features of adult polycystic kidneys. Radiologic findings revealed multiple cysts in the liver. The clinical recognition of a carcinoma developing in polycystic kidneys is often difficult because of the presence of preexisting large renal masses and occasional hematuria. Renal cell carcinoma should be thought of when confronted with abdominal pain or back pain, severe hematuria, sudden dysuria or a new renal mass occurring in a patient with polycystic kidneys.
Adult ; Male ; Female ; Humans ; Cysts

Serous cystadenoma of the pancreas, also known as microcystic adenoma or glycogen-rich cystadenoma, is an unusually benign tumor. It is usually large and composed microscopically of many small cysts lined by small, cuboidal or flattened cells containing abundant glycogen. It has been suggested that serous cystadenoma probably arise from the ductular cells or centroacinar cells. Herein, we report on a case of serous cystadenoma of the pancreas in a 55-year-old female. The tumor, measuring 13.5x11.5x10.0 cm, was located in the head of the pancreas and the cut surface revealed a sponge-like appearance due to innumerable tiny cysts containing clear serous fluid. Microscopic analysis showed cystic spaces lined by cuboidal cells with intracytoplasmic glycogen.
Female ; Humans ; Cysts ; Adenoma

BACKGROUND: UVB is responsible for most of the carcinogenic effects of sun exposure. OBJECTIVE: Aim of this study was to investigate the regulation and intracellular redistribution of p53 protein after UVB irradiation. METHODS: Cultured normal human melanocytes and G361 melanoma cells were used for west-ern blotting and confocal microscopic examination for determining expression and distribution of p53. RESULTS: UVB irradiation increased p53 expression in cultured normal human melanocytes and G361 malignant melanoma cells according to increasing doses of UVB. Furthermore, p53 moved from cytosol to nucleus after UVB irradiation. CONCLUSIONS: UVB irradiation induced overexpression and redistribution of p53 in cultured normal human melanocytes and G361 malignant melanoma cells.
Cytosol ; Humans ; Melanocytes* ; Melanoma* ; Solar System

We report a case of histiocytoid hemangioma (angiolymphoid hyperplasia with eosinophilia) in a 60 year-old female patient who was effectively treated with dapsone. The therapeutic effect of dapsone may support the hypothesis that immunologically mediated reactive process plays a role in the pathogenesis of histiocytoid hemangioma.
Dapsone* ; Female ; Hemangioma* ; Humans ; Hyperplasia* ; Middle Aged

We report a case of Winkelmann granuloma in a 63-year-old man. nstopathological findings of the biopsy specimens from the lesions of the ear, finger and iliac crest area were compatible with Winkelmann granuloma. Winkelmann granuloma is a rare disorder showing an association with systemic immunoreactive disorders. Although our patient did not have any definite systemic disease, he had characteristic clinical and histopathological findings of Winkelmann granuloma, arthralgia, an elevated erythrocyte sedimentation rate, positivity to the rheumatoid factor and antinuclear antibodies. Therefore, we believed that he was strongly suspected to have an unclassifiable systemic immunoreactive disease.
Antibodies, Antinuclear ; Arthralgia ; Biopsy ; Blood Sedimentation ; Ear ; Fingers ; Granuloma* ; Humans ; Middle Aged ; Rheumatoid Factor

The mortality and morbidity in tricyclic antidepressants (TCAs) overdose still remained high due to fatal cardiac toxicities despite their decreased prescriptions. Also, monoamine oxidase inhibitors (MAOIs) may show relatively high cardiac toxicities in excess or mixed overdoses. Selective serotonin reuptake inhibitors (SSRIs) and newer antidepressants have been known to be safe in overdose until recently. However, many researchers have found that SSRIs and newer antidepressants also showed serious and fatal toxicities in case of excess or mixed overdoses. Citalopram or escitalopram overdoses showed a relatively high incidence of cardiac toxicity with a dose-dependent manner. Also, venlafaxine, bupropion and trazodone overdoses showed significant cardiac toxicities, although degrees of the toxicities are different each other. Especially, venlafaxine's pattern and incidence of cardiac toxicities are the similar to those of TCAs. Mirtazapine and reboxetine show no significant toxicities in overdose although the present toxicological data are insufficient. To conclude, assessment of compliance, pharmacology education for patients and effective treatment may reduce the incidence and severity of toxicities in overdose.
Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Bupropion ; Citalopram ; Compliance ; Cyclohexanols ; Humans ; Incidence ; Mianserin ; Monoamine Oxidase Inhibitors ; Morpholines ; Prescriptions ; Serotonin Uptake Inhibitors ; Trazodone ; Venlafaxine Hydrochloride

No abstract available.
Arthrogryposis* ; Humans ; Siblings*

We report a case of meralgia paresthetica in a 25-year-old man who preferred to wear tight blue jeans. He complained of a tingling sensation and dysesthesia with progressive a nature on the right thigh that had been present for 2 years. The symptoms were relieved after wearing loose trousers.
Adult ; Humans ; Paresthesia ; Sensation ; Thigh