We have experienced a 50-year-old male patient, who died of multiple metastatic nodular melanoma which had the primary lesions on the right hallux and forefoot with eventual involvement of skin and internal organs. An autopsy was performed for the evidence of metastatic features of the internal organs and their spreading routes, with concurrent histopathologic findings. The autopsy findings revealed diffuse metastases to the ipsilateral femoral and inguinal lymph nodes via ascending vascular channels and to the internal organs: 1. The heart had multiple metastatic lesions on the pericardium and right ventricular wall. And the mediastinal, periaortic and periesophageal lymph nodes were also involved. 2. The both lungs were moderately indurated and focally discolored, and showed metastatic lesions in the right lower lobe and hilar areas, Melanoma cells were diffusely invaded to the interstitia and alveoli. 3. The right 5th and 6th ribs showed the invsion of melanoma cells on their bone marrows, periostia, and Haversians canals. 4. The liver was enlarged and showed multiple various sized nodules on the surface with adesion to the parts of peritoneum, omentum and diaphragm. Melanoma cells were seen mostly on and around the sinusoidal spaces and parenchyma. 5. The stomach wall had an ulcerated metastatic lesion and the melanoma cells invaded deeply into the muscle layer. 6. The pancreas was normal in its size and shape but had multiple metastatic lesions on the head and body with melanoma celi infiltration. 7. The both kidneys were grar ular surfaced and showed two metastatic lesions on the right renal cortex and two on the left. Renal tubules and parenchyma were widely invaded by melanoma cells but the glomerular tufts were intact. 8. The adreral and thyroid glands showed four and two metastatic lesions respectively and diffuse invasion of melanoma cells into the parenchyma. 9. The brain was normal in gross appearance, but the cortex was edematous and showed settered melanoma cell infiltration.
Autopsy* ; Bone Marrow ; Brain ; Diaphragm ; Hallux ; Head ; Heart ; Humans ; Kidney ; Liver ; Lung ; Lymph Nodes ; Male ; Melanoma* ; Middle Aged ; Neoplasm Metastasis ; Omentum ; Pancreas ; Pericardium ; Peritoneum ; Ribs ; Skin ; Stomach ; Thyroid Gland ; Ulcer

Anaphylactic reaction during the perioperative period typically exhibits rapid onset, varying clinical manifestations, and an expected mortality rate of 1.5-9%. Neuromuscular blocking agents are the leading cause of perioperative anaphylaxis. Here, we report a severe case of anaphylaxis that developed in a 66-year-old man due to cisatracurium administration. And he was successfully managed by extracorporeal membrane oxygenation. Cardiopulmonary resuscitation was performed by extracorporeal membrane oxygenation, and the patient was successfully weaned off 24 hours later.
Aged ; Anaphylaxis* ; Cardiopulmonary Resuscitation ; Extracorporeal Membrane Oxygenation* ; Heart Arrest* ; Humans ; Mortality ; Neuromuscular Blocking Agents ; Perioperative Period

Neuroblastoma is the most common extracranial solid tumor of childhood which presents various clinical symptoms depending on the primary and metastatic sites. However, it has been rarely reported that sudden onset of blindness was the chief complaint of neuroblastoma. A four years old boy was admitted to the Yeungnam University Hospital with the chief complaint of a sudden onset of blindness due to a distant metastasis of abdominal neuroblastoma to the sphenoid sinus. On admission, both side pupils were dilated without light reflex, fundoscopy showed pale optic disk, electroretinogram was subnormal and visual evoked potential showed no response. The liver was palpable in 3 ½ finger breadth from the right costal margin and adult fist sized mass was palpable in the right flank. Skull X-ray showed destructed sphenoid bone and clinoid process and brain CT scan showed tumor mass in the sphenoid sinus and left orbit. Ultrasonogram and CT scan of the abdomen showed large tumor masses around the right kidney and para-aortic and retropancreatic lymph node. IVP showed displaced right calyceal system with preserved contour. Left supraclavicular lymph node which appeared after admission was biopsied and it showed poorly differentiated neuroblasts. He was treated according to the multiagent chemotherapy schedule for stage IV neuroblastoma patient of children's cancer study group. Abdominal tumor masses and sphenoid sinus mass were markedly reduced after 2 courses of the combination chemotherapy of cyclophosphamide, vincristine, DTIC, adriamycin and VM-26. Eventhough the blindness was not improved, the patient has been in good clinical codition.
Abdomen ; Adult ; Appointments and Schedules ; Blindness* ; Brain ; Cyclophosphamide ; Dacarbazine ; Doxorubicin ; Drug Therapy ; Drug Therapy, Combination ; Evoked Potentials, Visual ; Fingers ; Humans ; Kidney ; Liver ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Neuroblastoma* ; Optic Disk ; Orbit ; Pupil ; Reflex ; Skull ; Sphenoid Bone ; Sphenoid Sinus ; Teniposide ; Tomography, X-Ray Computed ; Ultrasonography ; Vincristine

No abstract available.
Hemangioma* ; Manubrium*

The incidence of fetal cardiac arrhythmia is approximately 1-3%. Sustatined fetal tachyarrhythmia may cause fetal hydrops and rnay lead to fetal death. We experienced a case of fetal atrial flutter without fetal hydrops at 34 weeks of gestation, which was diagnosed by fetal echocardiography. Transplacental fetal therapy with maternal digoxin administration resulted in restoration of normal fetal sinus rhythm. At birth, the infant showed normal electrocardiographic finding with normal Apgar scores.
Arrhythmias, Cardiac ; Atrial Flutter* ; Digoxin ; Echocardiography ; Electrocardiography ; Fetal Death ; Fetal Therapies ; Humans ; Hydrops Fetalis ; Incidence ; Infant ; Mothers* ; Parturition ; Pregnancy ; Tachycardia

No abstract available.
Jaundice

No abstract available.
Humans ; Pregnancy, Twin*

No abstract available.
Abscess* ; Drainage*

No abstract available.
Aortic Aneurysm* ; Humans ; Rupture*

BACKGROUND: Previous findings demonstrated that the expression of cytotoxic effector molecules is increased in acute rejection of renal allografts. In the present study, we serially examined the gene expression of perforin, granzyme B and Fas ligand(FasL) in peripheral blood lymphocytes(PBLs) of renal allograft recipients to assess the potential of their expression as a marker of acute rejection. METHODS: PBLs were isolated from blood samples taken on days 2, 4, 6, 8, 10 and 12 after transplantation. Competitive PCR was performed to evaluate the abundance of mRNA of perforin, granzyme B and FasL. The mean value of each molecule plus 2 SD for the control group was set as a discriminatory level. RESULTS: When all measured samples were compared, perforin expression was significantly higher in patients with acute rejection than in the control group(1.84+/-3.01 versus 0.71+/-0.48, p=0.01). The percentage of perforin expression exceeding the discriminatory level was also significantly higher in patients with acute rejection(p=0.0003). Five patients in the rejection group(5/7, 71.4%) showed perforin expression exceeding the discriminatory level, while only 1 patient in the control group did so(1/8, 12.5%)(p= 0.02). Perforin expression of days 0 and 1 of rejection crisis was the highest over the study period. No consistent pattern of granzyme B and FasL expression was identified in relation to rejection crisis. CONCLUSION: Gene expression of perforin by PBLs was upregulated in accordance with acute rejection, thus offering the possibility that it may be utilized as a marker of acute rejection.
Allografts* ; Gene Expression ; Granzymes* ; Humans ; Kidney Transplantation ; Lymphocytes* ; Perforin ; Polymerase Chain Reaction ; RNA, Messenger