Medial orbital wall fracture was described by Converse and Smith in the first time in 1957. These fractures which comprise more than 30% of all the orbital wall fracture are may easily be overlooked in routine orbital radiology. Accordingly, examination with orbital CT is essential for accurate diagnosis and appropriate treatment. These type of fracture are followed frequently by post-oprative complication such as diplopia and enophthalmos because it is very difficult to approach to orbital medial was in these operations. The mechanism of the orbital wall fractures are abruptly increased hydraulic pressure by sudden impact on orbital rim or soft tissue of orbital region. So patients who show the signs of subcutaneous emphysema, edema on the orbital region or diplopia need to get through examination with orbital CT for accurate diagnosis and immediate reconstruction of the fractured orbital wall. Conventional approaches in the operations of the orbital medial wall fractures are that with bicoronal incision, subciliary incision, transconjunctival incision and infra-orbital rim incision. But, approach with bicoronary incision, needs broader dissection and longer time for operation. Operations with transconjunctival incision and that with subciliary incision have difficulty to approach to fractured sites. Operations with other conventional methods may be also followed by scar problem. The authors performed reduction and reconstruction of the fractured orbital medial wall fractures successfully without any complications and difficulties by intra-eyebrow approach with which they made incision of 2 - 2.5 cm on mid-area of eyebrow to expose fractured medial wall with good operative field.
Cicatrix ; Diagnosis ; Diplopia ; Edema ; Enophthalmos ; Eyebrows ; Humans ; Orbit* ; Subcutaneous Emphysema

Papillary carcinoma of the thyroid is a well differentiated neoplasm and usually has a good prognosis. However, a subset of morphologically distinct papillary carcinoma has bad prognoses. The tall cell variant of papillary carcinoma (TCPC), characterized by tall columnar cells with a height at least twice the width, is the one of these. In order to differentiate TCPC from usual papillary carcinoma (UPC) in terms of prognosis, we performed immunohistochemical studies for the expression of p53, bcl-2 and Leu-M1 proteins in 25 cases of TCPC, 26 cases of UPC and 14 cases of poorly differentiated, solid type papillary carcinoma (SPC) with an analysis of clinical parameters. The nuclear expression of p53 was noted in one case each of UPC and TCPC. The cytoplasmic p53 expression of TCPC, UPC, and SPC was observed in 17/25 cases (68%), 14/26 cases (54%), 3/14 cases (21%), respectively. bcl-2 expression was 19/25 cases (76%), 18/26 cases (69%), 5/14 cases (36%), and that of Leu-M1 was 21/25 cases (84%), 18/26 cases (69%), 4/14 cases(29%), respectively. There were no statistical significance in the expression of those immunoproteins among these three groups (p>0.05). The p53 protein was consistently expressed in the cytoplasm rather than nucleus in this study and was very well correlated to bcl-2 positivity (p<0.01). There were no statistical significance in any clinical parameters examined among these three groups (p>0.05). In conclusion, TCPC can not be separated from UPC as a distinct entity in this study and the cytoplasmic expression of p53 protein provides another mechanism of p53 inactivation in tumorigenesis of the thyroid papillary carcinoma, possibly by bcl-2 related mechanism.
Carcinogenesis ; Carcinoma, Papillary ; Cytoplasm ; Immunoproteins ; Prognosis ; Thyroid Gland* ; Thyroid Neoplasms*

No abstract available.
Breast Neoplasms* ; Breast*

Carcinosarcoma of the female genital tract, also called malignant mixed mullerian tumor (MMMT), is a rare and relatively aggressive tumor with various homologous and heterologous components. There have been various studies to find prognostic factors and to investigate the histogenesis, including tissue culture, electron microscopy, and immunohistochemical studies. We investigated carcinomatous, sarcomatous, and transitional areas of 6 cases of carcinosarcoma of the uterus and ovary by using epithelial and mesenchymal markers. Immunohistochemical profiles of the transitional areas were significantly different from those of carcinomatous and sarcomatous areas. Immunoreactivities for cytokeratin and epithelial membrane antigen (50% and 22.2%) were weaker than those of carcinomatous areas (95.2% and 100%), but stronger than those of sarcomatous areas (11.1% and 5.6%)(p<0.01). In transitional areas, vimentin, smooth muscle actin and S-100 protein were more strongly expressed than in carcinomatous areas, but more weakly expressed than in sarcomatous areas (p<0.01, p<0.01, and p=0.018, respectively). Myoglobin was entirely negative in carcinomatous areas and immunoreactive in minor portions of transitional and sarcomatous areas (22.2% and 16.7%, respectively). These results suggest that the transitional areas are between the carcinomatous and sarcomatous nature in differentiation, further supporting that the carcinosarcomas of the female genital tract may arise, through metaplastic change, from a type of carcinoma.
Actins ; Carcinosarcoma* ; Female* ; Humans ; Immunohistochemistry ; Keratins ; Metaplasia ; Microscopy, Electron ; Mucin-1 ; Muscle, Smooth ; Myoglobin ; Ovary ; S100 Proteins ; Uterus ; Vimentin

Although many experiments of renal infection in animals have been studied, its pathway, regional pathogenesis and the healing process are yet to be cleared exactly. Especially in human. we have infrequent opportunities to study the pathologic changes of the acute pyelonephritis by renal biopsy, because ot accompanying general symptoms such as fever and bacteremia. This study underwent to define these changes exactly. A strain of Escherichia coli No.018 :K77 was inoculated to rabbit bladder to produce retrograde pyelonephritis. The histopalho1ogical changes at the early stage of acute pyelonephritis, the pathways of bacterial invasion, distribution in the infected kidneys and healing process were studied by using light and electron microscope. The histopathological changes were characterized by degeneration and destruction of renal pelvis and tubular epithelial cells, and a massive infiltration of polymorphonuclear leukocytes. The inflammatory changes were initially found at renal fornix and progressed to medullar after 7 hours of bacterial inoculation. These changes extended to basement membrane accompanying with discrete chronic inflammatory changes after 9 hours. The inflammatory changes extended to cortex with bacilli within blood vessels after 12 hours and sustained until the end of first week. The chronic inflammatory. changes subsided as a whole of renal parenchyma until eighth weeks. Therefore we concluded that the retrograde pyelonephritis in rabbit extends rapidly from forniceal mucosa to capsule through tubule, interstitium and blood vessels, and the natural healing process occurs diffusery for longer period.
Animals ; Bacteremia ; Basement Membrane ; Biopsy ; Blood Vessels ; Epithelial Cells ; Escherichia coli ; Fever ; Humans ; Kidney ; Kidney Pelvis ; Mucous Membrane ; Neutrophils ; Pyelonephritis* ; Urinary Bladder

Studer's pouch was evaluated clinically and urodynamically. The pouch was constructed for bladder substitution in 18 and for bladder augmentation in 2 from July 1990 to November l995. Three patients of substitution were not included in this review because of operation related death in 1 case and short period(<6 months) of follow-up in 2 cases. Mean age is 53.2(range: 22-69) years. Mean follow-up period is 22.2(range: 2-64) months. Mean cystometric capacity was 445 ml, mean intraluminal pressure at 200 ml and 400 ml filled was 12.8(range: 5-30) and 23.7(range: 5-45) cmH2O, respectively. Maximal urethral closure pressure was 54.3(range: 18-112) cmH2O in bladder substitution cases. Maximal flow rate was 19.1(range: 12.9-26.0) ml/sec. Mean residual urine was 37.8(range: 0-80) ml. Reflux into ileal limb occurred in all patient at mean volume of 227(range : 30-400) ml. Reflux into kidney occurred in 20 of 24 renal units at mean volume of 291(range : 50-450) ml, but it drained completely and rapidly in all cases. No pelvocalyceal ectatic changes were seen. Urine was sterilized in 9 patients. Recurrent bacteriuria occurred in 6 patients. All of them had been controlled by parenteral antibiotic therapy. All of 15 substitution patients were completely continent during daytime. Two had mild daytime stress incontinence in early postoperative period, but which is improved as time passing. Three of them have nighttime incontinence. One of three has intermittent incontinence and is using a diaper for prevention from bed wetting. Two have total nighttime incontinence using a kismo every night. Though longer follow-up should be needed to confirm the safety of upper tract, we think that Studer's pouch seems not only to guarantee the continence but to be rather simple and easy to perform.
Bacteriuria ; Extremities ; Follow-Up Studies ; Humans ; Kidney ; Postoperative Period ; Urinary Bladder

No abstract available.
Adenoma*

Benign fibrous polyps of ureter are rare. Recently, the rate of preoperative diagnosis and conservative management was progressively increased due to developed endoscopic procedures. Two additional cases of long, fibrous ureteral polyps, one with obstruction of contralateral ureteropelvic junction and the other with protruding mass to bladder, are reported with a brief review of literatures.
Adult* ; Diagnosis ; Humans ; Polyps* ; Ureter* ; Urinary Bladder

Intraaortic balloon counterpulsation (IAB) has been shown to prolong survival in the critically ill cardiac patients. Originally developed for use in the patients with cardiogenic shock, the indications have been expanded. But despite technical advances, the complication rate associated with IAB remains high. The most commonly reported complications include damage to the femoral artery and distal embolization. Other reported major complications are balloon rupture, limb loss, bleeding, systemic infection and bowel infarction. We report a patient complicated by ischemic colitis causing stenosis and intestinal obstruction after IAB insertion.
Colitis, Ischemic* ; Constriction, Pathologic* ; Counterpulsation* ; Critical Illness ; Extremities ; Femoral Artery ; Hemorrhage ; Humans ; Infarction ; Intestinal Obstruction ; Rupture ; Shock, Cardiogenic

During the last decade, with the advent of prenatal ultrasound, multicystic dysplastic kidney is diagnosed with increasing frequency But the management of multicystic dysplastic kidney continues to be an ongoing controversy regarding both its cause and its current management. Herein we reviewed the records of four cases at our hospital between 1983-1993. All were unilateral and three cases were removed surgically and last one was observed and followed up only. The first case was a ten-month-old girl who was referred to our department because of hydronephrosis of kidney. The second was a five-year-old boy with chief complaints of flank pain. The third was a three-month-old girl, and the fourth was a two-day-old girl. Last two cases were referred to our department because of a sustained cystic dilatation of kidney detected by prenatal ultrasonography.
Dilatation ; Female ; Flank Pain ; Humans ; Hydronephrosis ; Kidney ; Male ; Multicystic Dysplastic Kidney* ; Ultrasonography ; Ultrasonography, Prenatal