Granulomatous inflammation is characterized by granuloma formation with a cellular infiltrate of epithelioid cells, giant cells, and chronic inflam-matory cells.It could be diagnosed as a subtype of inflammatory pseudotumor when such identifiable causes of granulomatous inflammation have been ruled out. We performed excisional biopsy on 3 patients who complained of upper eyelid mass.The levator muscle was mainly affected in two patients and the lacrimal gland in one patient. Microscopic examination of the mass demonstrated chronic granulomatous inflammation including non-caseating necrosis, diffuse chronic inflammatory cell infiltrates, and granuloma com-posed of histiocytes, multinucleated giant cells, lymphocytes, and epithelioid cells in all 3 patients.There was no evidence of foreign material and infec-tion with tuberculosis, mycosis, and parasites.The diagnosis of sarcoidosis, connective tissue disease, and Wegener's granulomatosis could be ruled out through the basic hematological test, chest radiograph, and blood tests such as angiotensin converting enzyme, lysozyme, antinuclear antigen, and anti-neutrophil cytoplasmic antibody. We experienced 3 cases of chronic granulomatous inflammation of the eyelids without identifiable causes which responds to excision and postoperative steroid therapy without recurrences.
Antibodies, Antineutrophil Cytoplasmic ; Biopsy ; Connective Tissue Diseases ; Diagnosis ; Epithelioid Cells ; Eyelids ; Giant Cells ; Granuloma ; Granuloma, Plasma Cell ; Hematologic Tests ; Histiocytes ; Humans ; Inflammation* ; Lacrimal Apparatus ; Lymphocytes ; Muramidase ; Necrosis ; Peptidyl-Dipeptidase A ; Radiography, Thoracic ; Recurrence ; Sarcoidosis ; Tuberculosis ; Wegener Granulomatosis

Langerhans'cell histiocytosis[LCH], or histiocytosis X, is an uncommon multisystemic disorder of unknown etiology, which is characterized by accumulation of histiocytes in various tissues including orbit. We have recently experienced 4 cases of orbital LCH presenting with exophthalmos. Four patients[3 children and 1 adult]presented with exophthalmos that progressed over 2 to 3 weeks and were found to have orbital mass on ocular examination and orbital CT scan. Two children had concomitant hepatomegaly. Orbital CT scan showed a soft tissue mass with destruction of adjacent bones. Microscopic examination of the orbital mass showed a collection of Langerhans 'cells intermixed with eosinophils and other inflammatory cells. In two cases, immunohistochemistry revealed positive staining for S-100 protein. In three cases, a definite diagnosis was made by detection of Birbeck's granules by electron microscopy. Three children received chemotherapy and one adult had mass excision. The mass markedly decreased in size or nearly disappeared in all patients, and no recurrence has been noted for more than 9 months of follow-up.
Adult ; Child ; Diagnosis ; Drug Therapy ; Eosinophils ; Exophthalmos ; Follow-Up Studies ; Hepatomegaly ; Histiocytes ; Histiocytosis* ; Histiocytosis, Langerhans-Cell ; Humans ; Immunohistochemistry ; Microscopy, Electron ; Orbit* ; Recurrence ; S100 Proteins ; Tomography, X-Ray Computed

The vagina is an infrequent site of primary sarcomas, which are less than 2% of all malignant vaginal neoplasm. The most common malignant mesenchymal tumor of the vagina is rhabdomyosarcoma, but leiomyosarcoma is rare type tumor of the vagina. Microscopically, spinle cells with pleomorphic nuclei and mitotic figures were frequently noted, but cross-striations were not found in the tissue. Alpha-smooth muscle actin and desmin were positive, but sarcomeric actin was negative in the tumor cells. The authors report a case of primary leiomyosarcoma of the vagina with brief literature review.
Actins ; Desmin ; Leiomyosarcoma* ; Rhabdomyosarcoma ; Sarcoma ; Vagina* ; Vaginal Neoplasms

BACKGROUND: Smaller guiding catheter had a problem with poor backup support during the transradial coronary intervention which resulted in higher failure rate. This study sought to prove the usefulness of deep seating technique which improves the backup support of the guiding catheter required to deliver interventional materials during the transradial coronary intervention. METHODS: Thirthy-five patients(23 males) were included in this study since March 1998 to August 1999. Clinical presentation of these patients were stable angina(7 patients), unstable angina(17 patients), acute myocardial infarction(11 cases). The mean age was 68+/-8 years. The treated vessel was left anterior descending artery in 22, left circumflex artery in 2 and right coronary artery in 11 of 35 vessels. RESULT: Twenty-six lesions were treated with stents, 3 with PTCA, and 6 with rotablator. Procedural success were achieved in 33 out of 35 cases(94%). Guiding catheters were used mostly with 6 Fr(30/35). In the left coronary system, usual Judkins left type was used in most of the patients(24/26, 92%), and in right coronary Judkins, Amplatz and multipurpose catheters were used similiarly. Hypotension and sinus bradycardia was encountered in one case without clinical significance and there was no dissection in all patients. CONCLUSION: Deep seating technique is a safe and effective technique without major adverse event during the transradial coronary intervention in selected cases.
Arteries ; Bradycardia ; Catheters ; Coronary Vessels ; Humans ; Hypotension ; Stents

BACKGROUND: Smaller guiding catheter had a problem with poor backup support during the transradial coronary intervention which resulted in higher failure rate. This study sought to prove the usefulness of deep seating technique which improves the backup support of the guiding catheter required to deliver interventional materials during the transradial coronary intervention. METHODS: Thirthy-five patients(23 males) were included in this study since March 1998 to August 1999. Clinical presentation of these patients were stable angina(7 patients), unstable angina(17 patients), acute myocardial infarction(11 cases). The mean age was 68+/-8 years. The treated vessel was left anterior descending artery in 22, left circumflex artery in 2 and right coronary artery in 11 of 35 vessels. RESULT: Twenty-six lesions were treated with stents, 3 with PTCA, and 6 with rotablator. Procedural success were achieved in 33 out of 35 cases(94%). Guiding catheters were used mostly with 6 Fr(30/35). In the left coronary system, usual Judkins left type was used in most of the patients(24/26, 92%), and in right coronary Judkins, Amplatz and multipurpose catheters were used similiarly. Hypotension and sinus bradycardia was encountered in one case without clinical significance and there was no dissection in all patients. CONCLUSION: Deep seating technique is a safe and effective technique without major adverse event during the transradial coronary intervention in selected cases.
Arteries ; Bradycardia ; Catheters ; Coronary Vessels ; Humans ; Hypotension ; Stents

BACKGROUND:Rotational atherectomy has been developed for several years. It is a useful tool in complex coronary lesion morphologies such as diffuse, calcific, ostial and angulated lesion. We report initial experience of the rotational atherectomy in complex coronary artery morphology. METHODS: We included 64 patients who was treated with rotational atherectomy since July 1997 to February 1999. Mean age was 56+/-9 years with 47 male patients. Clinical diagnosis was 12 acute myocardial infarction, 49 unstable angina, and 3 stable angina. Rotational atherectomy was done by transfemoral or transradial approach with adjunctive ballooning and/or stenting in all patients. RESULTS: Ninty-one percent of the treated lesions showed complex lesion morphologies (B2/C lesion) with 43 left anterior descending artery and 19 right coronary artery. Rotational atherectomy was done in 37 de novo lesion (58%) and 27 (42%) restenosis patients. Transradial approach was done in 33 patients (52%). Mean maximal burr size was 1.68 mm and mean burr to reference artery ratio was 0.63. Rotastenting were done in 58% of the patients with higher post-procedure minimal lumen diameter, % diameter stenosis and net gain than rotablator with adjunctive balloon angioplasty. Overall procedural success was 94% (62/64). Complications were one non-Q infarction, one coronary artery perforation, two slow flow, and one guidewire fracture. None of the patients showed inhospital mortality or 30 day cardiac event (death, emergency CABG, Q-infarction, or re-intervention). CONCLUSION: Rotational atherectomy is a useful technique with high success rate without showing major cardiac events during inhospital period and within 30 days.
Angina, Stable ; Angina, Unstable ; Angioplasty, Balloon ; Arteries ; Atherectomy ; Atherectomy, Coronary* ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Emergencies ; Hospital Mortality ; Humans ; Infarction ; Male ; Myocardial Infarction ; Stents

No abstract available.
Estrogens, Conjugated (USP)* ; Heart Failure* ; Humans

The Brunner's gland adenoma is characterized by a nodular proliferation of histologically normal Brunner's gland, accompanied by ducts and scattered stromal elements. First descrived by Salvioli in 1876, the tumor is relatively rare, with 119 cases reported by 1977, The most common benign tumor of the small bowel is the adenoma, 25% of which occur in the duodenum. They make up 30% to 50% of all hyperplastic polyps of the duodenum. Most frequently these tumors are discovered in patients in the fourth to sixed decades of life, though the age in reported caes ranges from l 1 days to 80 years. The benign tumors of the duodenum 30% to 50% contain elements of Brunner's gland and 10.6% of them are adenomas of Brunner's gland. We report a case of Brunner's gland adenoma treated by endoscopic polypectomy in 63 year-old woman, and reviewed the literatues of adenoma of the Brunne'r gland.
Adenoma* ; Duodenum ; Female ; Gastrointestinal Hemorrhage ; Humans ; Middle Aged ; Polyps

Stent dislogement or migration is not a rare complication. Its incidence varies from 1.4% to 8% of the cases. When stent migration occurs, the usual treatment or management is to implant stent in the distal peripheral artery or proximal coronary artery. But, probably the best treatment is safe retrieval of the dislodged stent. During the transfemoral coronary intervention, undeployed stent can be more easily retrieved into the guiding catheter with relatively larger guiding catheter luminal space. Also, larger sheath can be changed more easily when the retrieval of stent is difficult. In the transradial coronary stenting, usual size of guiding catheter is 6 Fr, makes it difficult to retrieve relatively bulky stent when deployment of stent fails. We report 2 cases of stent dislodgment during transradial coronary stenting which can be successfully removed by using myocardial biopsy forcep through 8 Fr sheath. These combination could be one of the valuable methods, especially during transradial stenting.
Arteries ; Biopsy ; Catheters ; Coronary Vessels ; Incidence ; Phenobarbital ; Stents* ; Surgical Instruments*

Lower eyelid retraction is usually managed by recession of the lower lid retractors and interposition of a spacer graft including ear cartilage, nasal septal cartilage, donor sclera or autogenous tarsoconjunctiva.We have used hard palate mucosa as a spacer in 10 patients (11 eyelids)with lower lid retraction.Average age at operation was 36 years with the range of 10 years to 59 years.Causes of the lower lid retraction were thyroid ophthal-mopathy (4 eyelids), strabismus surgery (2 eyelids), entropion repair (2 eye-lids), eyelid infection (2 eyelids), and trauma (1 eyelid).Of 11 eyelids, 7 eye-lids were combined with entropion due to the shortage of posterior lamella. The follow-up period ranged from 3 to 45 months (mean 17 months).Surgi-cal results in all 11 eyelids were satisfactory.There was no complication in donor site.Hard palate closely approximates lower lid tarsus in terms of contour, thickness, and stiffness, provides a mucosal surface and shows only minimal shrinkage. We suggest hard palate mucosal grafts as one of the best available spacer material for the treatment of lower lid retraction.
Ankle ; Cartilage ; Ear Cartilage ; Entropion ; Eyelids ; Follow-Up Studies ; Humans ; Mucous Membrane* ; Palate ; Palate, Hard* ; Sclera ; Strabismus ; Thyroid Gland ; Tissue Donors ; Transplants*