The cutaneous lymphadenoma is a recently described tumor with a distinctive histologic picture representing a basaloid epithelial proliferation and intraepithelial lymphocytic infiltration; it seems to be a benign adnexal neoplasm of uncertain histogenesis. We documented one example of cutaneous lymphadenoma showing typical histologic features. The tumor typically presented as a well circumscribed nodule with scant or no epidermal connections. The proliferating one consisted of multiple rounded lobules of basaloid cells with some degree of peripheral palisading. There was an intense infiltrate of small lymphocytes within the lobules but few in the stroma. No clear adnexal differentiation is noted. Immunohistochemically, the basaloid cells show weak immunoreactivity for high molecular weight keratin and carcinoembryonic antigen, small lymphocytes for T-cell marker and some dendritic cells for S-100 protein. After surgical resection, we found no evidence of local recurrence or distant metastasis for four years, so we considered this tumor as a benign one and diagnosed as cutaneous lymphadenoma by typical histologic features.
Carcinoembryonic Antigen ; Dendritic Cells ; Lymphocytes ; Molecular Weight ; Neoplasm Metastasis ; Recurrence ; S100 Proteins ; Skin ; T-Lymphocytes

No abstract available.
Humans

Acute peripheral vestibulopathy, of which the chief complaint is positional vertigo, comprises benign paroxysmal positional vertigo (BPPV), labyrinthitis, labyrinthine fistula, and cerebellopontine angle tumors. Since the typical presentation of labyrinthine fistulas may be sensorineural hearing loss, positional vertigo, or disequilibrium, it is often difficult to distinguish from BPPV or Meniere's disease. Herein we report a 61-year-old female patient with typical symptoms and signs attributable to geotropic type variant of the lateral semicircular canal BPPV on the left side, who eventually was confirmed as having a labyrinthine fistula from chronic otitis media with cholesteatoma on the left side. This is another case where, even in the presence of isolated vertigo showing typical findings of acute peripheral vestibulopathy, other otologic symptoms and signs must not be overlooked.
Cholesteatoma* ; Ear, Inner ; Female ; Fistula* ; Hearing Loss, Sensorineural ; Humans ; Labyrinthitis ; Meniere Disease ; Middle Aged ; Neuroma, Acoustic ; Otitis Media ; Semicircular Canals ; Vertigo* ; Vestibular Neuronitis

BACKGROUND: An epidemiologic study was performed after the outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) in the medical intensive care unit (MICU) from December 2006 to May 2007. METHODS: A retrospective case-control study was performed using the medical records of the patients. The case and control patients were compared for age, gender, total length of stay in MICU, prior carbapenem use, Acute Physiology and Chronic Health Evaluation II (APACH II) score, presence of central line, effect of mechanical ventilation, and sputum suction. Environmental and hand-washing studies were performed during the outbreak. RESULTS: Ten CRAB-affected patients and 29 controls were enrolled in this study. Univariate analysis showed that the age, total length of stay in MICU, presence of central line, and prior carbapenem use were associated with the CRAB outbreak. However, multivariate analysis showed that only prior carbapenem use was associated with the CRAB outbreak (odd ratio: 8.67, P=0.01). The outbreak disappeared after implementing a combined infection control strategy, including the sequential disinfection of MICU and strict compliance with cross-transmission prevention protocols. CONCLUSION: The use of carbapenem was associated with an increased risk of CRAB infection. This study suggests that the MICU contamination and infection transmission by health-care workers played a major role in the CRAB outbreak. Novel strategies such as restricted use of broad-spectrum antibiotics, strict hand hygiene, strict isolation of the patients, and MICU disinfection may be required to prevent the CRAB outbreak.
Acinetobacter ; Acinetobacter baumannii ; Anti-Bacterial Agents ; APACHE ; Case-Control Studies ; Compliance ; Disease Transmission, Infectious ; Disinfection ; Epidemiologic Studies ; Hand Hygiene ; Humans ; Infection Control ; Critical Care ; Intensive Care Units ; Length of Stay ; Medical Records ; Multivariate Analysis ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Sputum ; Suction

Nephrogenic diabetes insipidus (NDI) can cause nonobstructive hydronephrosis. Congenital NDI (CNDI) is caused by a genetic mutation. This case report presents a 12-year-old girl who was incidentally diagnosed with nonobstructive hydronephrosis due to NDI caused by AQP2 gene mutation after being evaluated for microscopic hematuria found on routine health examination at school. The patient's medical and family history was unremarkable, and she complained of nocturia only at the time of the clinic visit. Bilateral hydronephrosis on abdominal ultrasonography prompted a water deprivation test, leading to diagnosis of NDI. Genetic study confirmed p.Asn (AAC)123Ser (AGC) in exon 2 of the AQP2 gene. Polyuria and hydronephrosis improved following arginine-vasopressin therapy. CNDI responsive to treatment should be considered as a possible cause of nonobstructive hydroureter.
Ambulatory Care ; Child ; Diabetes Insipidus, Nephrogenic* ; Diagnosis ; Exons ; Female ; Hematuria ; Humans ; Hydronephrosis* ; Nocturia ; Polyuria ; Ultrasonography ; Water Deprivation

Tracheal stenosis is well known complication of endotracheal intubation. However, severe post intubation tracheal stenosis that requires interventional bronchoscopy or tracheal surgery is un-common. Necrosis induced by cuff pressure-related loss of regional blood flow is the central injury leading to postinubation tracheal stenosis. The large volume, low pressure cuff of endo-tracheal tubes have markedly reduced the occurrence cuff-induced injury. However, in any patient who develops symptoms of airway obstruction, who has been intubated and ventilated in the recent past, possibility of tracheal stenosis should be considered. We report a case of severe tracheal stenosis by tracheal web formation a 52-year-old following ventilator therapy for ARDS.
Airway Obstruction ; Bronchoscopy ; Humans ; Intubation ; Intubation, Intratracheal ; Middle Aged ; Necrosis ; Regional Blood Flow ; Tracheal Stenosis ; Ventilators, Mechanical

The cystic mesothelioma is a very rare tumor which has a clinically and histologically benign nature. Here in reported is the case of a cystic mesothelioma presented as a palpable mass of the inguinal area in a 28-year-old male. Ultrasound showed a cystic tumor at the inguinal canal, and the other physical and laboratory examinations were within normal limits. Grossly, the tumor consisted of cysts containing clear serous fluid and focally solid areas. Microscopically, the tumor was encapsulated with fibrocollagenous wall, and the tumor cells were cuboidal or polygonal epithelial cells with single or multiple layers and had clear cytoplasm. Some areas showed thyroid follicle-like structures. The content of follicle-like structures showed eosinophilia in the H&E section, but positive in mucin stain. Neither cytologic atypia nor mitoses were present. Immunohistochemical staining revealed positive reaction for keratins of low molecular weight, while negative for the thyroglobulin and CEA. These findings suggested mesothelial in origin. We concluded that this tumor was primary rather than metastatic, because he had no evidence of a tumor in gastrointestinal, genitourinary tracts and scrotum.
Adult ; Cytoplasm ; Eosinophilia ; Epithelial Cells ; Humans ; Inguinal Canal ; Male ; Mesothelioma, Cystic* ; Mitosis ; Molecular Weight ; Mucins ; Scrotum ; Thyroglobulin ; Thyroid Gland ; Ultrasonography

To investigate the genetic variation within pspA from 17 clinical isolates of Streptococcus pneumoniae representing 12 capsular serotypes, we used specific PCR primers LSM12 and LSM2 derived from the DNA sequence of pspA of S. pneumoniae Rxl (type 2). We have found that all 17 isolates of S. pneumoniae have a pspA gene whose size ranges from 1.8 to 2.3 kb. RFLP analysis of the PCR-amplified pspA genes of the isolates exhibited distinct restriction patterns. Even within the same capsular type, the individual isolates of S. pneumoniae generally differed in PspA molecular masses and showed variabilities in the pspA gene locus. The nucleotide sequence of the pspA gene of S. pneumonaie KNIH1156 (type 19F) isolated from a blood specimen was determined. The sequence revealed an open reading frame of 1,827 bp nucleotides. Predicted size of the mature PspA was approximately 63 kDa. Deduced amino acid sequence of PspA of S. pneumonaie KNIH1156 revealed 57.0% identity with that of S. pneumonaie Rxl. Comparison of the nucleotide and amino acid sequences of PspA S. pneumoniae KNIH1156 (type 19F) with those of Rxl (type 2) showed considerable differences in the a-helical coiled-coil region of the two PspAs. These results suggest that the PspA of S. pneumoniae KNIH1156 has antigenic variations distinguished from those of Rxl strains.
Amino Acid Sequence ; Base Sequence ; Cloning, Organism ; Genetic Variation ; Korea* ; Nucleotides ; Open Reading Frames ; Pneumonia ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Sequence Analysis* ; Staphylococcal Protein A* ; Streptococcus pneumoniae* ; Streptococcus*

The effects of flumazenil, a benzodiazepine antagonist were evaluated in a clinical study in which midazolam (0.1 mg/kg) was used as a sedative agent during the spinal anesthesia. Sixty patient were divided into two groups as group F (n=30) and group S (n=30). Flumazenil 0.3 mg (3 mL) in group F and saline 3 mL in group S were administered at the end of surgery. Blood pressure, pulse rate, respiratory rate and oxygen saturation (SaO2) were checked just before and at, 5, 15, 30, 60 and 120 minutes after the administration of flumazenil or saline. Also we evaluated the level of conciousness and orientation in time and space. The results were as follows; 1) Changes in blood pressure, pulse rate and respiratory rate were not different between two groups, exeept SaO2 was which increased significantly in the flumazenil group. 2) The flumazenil group revealed improved level of consciousness and orientation in time and space which began 5 minutes after flumazenil and was maintained 30 minutes thereafter. 3) We could not observe the any side effects of flumazenil.
Anesthesia, Spinal* ; Benzodiazepines ; Blood Pressure ; Consciousness ; Flumazenil* ; Heart Rate ; Humans ; Midazolam* ; Oxygen ; Respiratory Rate

PURPOSE: The purpose of this study is to analyze college sudents' attitudes toward people with disabilities, and factors affecting the attitudes, and further to examine possible ways to improve the attitudes. and to furnish guideline of curriculum and practice in rehabilitation nursing on the basis of this analysis. METHOD: A descriptive. relational study design was used. The subjects of this study were 448 college students. A convenient sampling is used. Data were collected through 4 types of previous questionnaires used to examine attitude from May 1 to May 30, 2003. RESULT: 1. The attitude toward people with disabilities whose mean is 3.762 was responded somewhat negatively. Especially, a contact tension whose mean was 4.00 is high. 2. As a result of analyzing the attitudes of college students toward people with disabilities. some factors were statistically significant. They were experience of contact with the disabled. concern toward the disabled, voluntary work related to the disabled, and disability experience education. 3. The more negative experience of people with disabilities and the lower stereotype of disability and the higher effects of parents, teachers, and mass media, then the more positive response of peoples attitude with disabilities. 4. The main factors of determining the attitude of people with disabilities were the stereotype of disability. contact experience concern about disability, voluntary work experience. CONCLUSION: These results suggested that an appropriate educational intervention and strategy is needed in order to change the attitudes of college students toward people with disabilities. Also experimental researches are needed to do it.
Curriculum ; Disabled Persons ; Education ; Humans ; Mass Media ; Parents ; Surveys and Questionnaires ; Rehabilitation Nursing