Tolosa-Hunt syndrome (THS) is a clinical syndrome of painful ophthalmoplegia associated with an idiopathic inflammation in the superior orbital fissure or cavernous sinus. We report a 61-year-old woman with recurrent THS. She had been treated with steroids for the painful ophthalmoplegia. After a symptom-free period, she developed similar symptoms. The postcontrast brain MRI showed increased signal in the cavernous sinus, which was also seen in the previous MRI.
Brain ; Cavernous Sinus ; Female ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Middle Aged ; Ophthalmoplegia ; Orbit ; Steroids ; Tolosa-Hunt Syndrome*

No abstract available.
Dysgerminoma*

From Jan. 1984 to Dec. 1993, 46 patients with malignant germ cell tumor of ovary were identified in tumor registry of Seoul National University Hospital. The clinicopathologic features of these patients were reviewed. The mean age of patient was 21.6 years (range 1-54), and common presenting symptoms were abdominal mass (19/46), abdominal pain (9/46), abdominal distension (7/46), and epigastric discomfort (2/46) in order. Dysgerminoma was the most common histologic type (19/46, 41.3%), followed by endodermal sinus tumor (13/46, 28.2%), mixed germ cell tumor (6/46, 13/0%), embryonal carcinoma(5/46, 10.8%), immature teratoma(2/46, 4.3%), and chorio- carcinoma (1/46, 2.1%). Among 6 mixed germ cell tumors, dysgerminoma mixed with endodermal sinus tumor component was the most frequent combination. Fifty percent of patients were with FIGO stage I, and 26% with stage III. Overall two year disease free survival was 89.1%. Patients with dysgerminoma showed more favorable 2 year disease free survival (100%) than endodermal sinus tumor or mixed germ cell tumor (84.6%, 66.6% respectively). Patients age, disease stage, histologic type and future child-bearings should be considered in the management of malignant ovarian germ cell tumor. Multicenter prospective randomized studies are needed to identify the more rational treatment strateges of these rare malignant tumors.
Abdominal Pain ; Disease-Free Survival ; Dysgerminoma ; Endodermal Sinus Tumor ; Female ; Germ Cells* ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Ovary ; Seoul

OBJECTIVE: The importance of surgico-pathologic staging in endometrial cancer to identify risk factors of the therapeutic and prognostic value has been recognized only recently. Recognition of subsets of patients should minimize treatment related morbidity and mortality for those patients with a good prognosis, while identifying patients who are at high risk for recurrence and therefore likely to benefit from adjuvant therapy. METHODS: This rettospective study was based on clinical review of 76 patients with endometrial cancer from 1983 through 1994 who underwent surgical treatment in Department of Obstettics and Gynecology at Seoul National University Hospital. All cases were restaged using the newly adopted FIGO surgical staging. Univariate and multivariate analysis were carried to compare the importance of prognostic variables. RESULTS: Significant prognostic factors in endometrial cancer were histologic subtype, depth of myometrial invasion, cervical invasion, parametrial invasion, adnexa metastasis, lymph node metastasis and peritoneal cytology(p<0.05). Age and histologic grade were not significant prognostic factors(p>0.05). Multivariate analysis showed that surgical stage and depth of myometrial invasion were important factors that predict recurrence(p<0.05). CONCLUSION: This study has yielded important information for therapeutic approach to endometrial cancer.
Endometrial Neoplasms* ; Female ; Gynecology ; Humans ; Lymph Nodes ; Mortality ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Risk Factors ; Seoul

BACKGROUND & AIMS: Management of ovarian carcinoma presents most commonly by surgery and subsequent platinum-based chemotherapy, but most patients will have either residual or recurrent disease. Taxol, a new antimicrotubule agent, has been indicated as a salvage measure after failure of first-line or subsequent chemotherapy. The purpose of this study is to investigate the efficacy and toxicity of Taxol used as a salvage therapy. MATERIALS & METHODS: Between January 1994 and Jun 1996, 19 patients aged 38-64 years(median 52) with ovarian carcinoma were given Taxol-containing regimen. Taxol was administered at a dose of 135mg/m2 intravenously with cisplatin or carboplatin every 3 weeks. The patients who treated with Taxol only were received 175mg/m2 intravenously with same interval. The median treatment cycle was 6.6 cycles(range, 3 to 15 cycles). Patient's response were evaluated with tumor marker(CA-125) and CT or MRI before and after chemotherapy. Responses and toxicities were defined according to the Gynecologic Oncology Group criteria. (continue)
Carboplatin ; Cisplatin ; Drug Therapy* ; Humans ; Magnetic Resonance Imaging ; Ovarian Neoplasms ; Paclitaxel* ; Salvage Therapy*

Kaposi's varricelliform eruption is a characteristic syndrome of disseminated vesiculopustules superimposed on variable pre-existing dermatoses. Among these, atopic dermatitis is most common disease. We report two cases of Kaposi's varicelliform eruption associated with atopic dermatitis in a pair of identical twins. Diagnosis was made by the history, clinical feature, histologic examination and serologic test. These patients' condition was much improved by the treatment with antiviral agent and antibiotics.
Anti-Bacterial Agents ; Dermatitis, Atopic ; Diagnosis ; Humans ; Kaposi Varicelliform Eruption* ; Serologic Tests ; Skin Diseases ; Twins, Monozygotic*

PURPOSE: To investigate the error tendency between preoperative expected refraction and postoperative manifest refraction based on anterior chamber depth (ACD) and axial length (AXL) in cataract surgery cases and to report how ACD and AXL affect determination of intraocular lens (IOL) power. METHODS: We retrospectively studied 82 eyes of 62 patients who underwent cataract surgery in our hospital between August 2008 and January 2009. Anterior chamber depth and AXL were measured using IOL Master(R), and IOL power was calculated using the SRK II and SRK/T formulae. Patients were divided into three groups based on ACD and into another three based on AXL. Refractive error (RE) was analyzed one month after surgery. RESULTS: Though the RE of each group showed a tendency for hyperopic shifts, only those obtained with the SRK/T formula showed statistically significant differences between groups (p<0.05). Using the SRK/T formula, we found that an increasing AXL was associated with an increased hyperopic shift. This was more pronounced in those with shallow ACD (<2.5 mm), though the difference was not statistically significant. Similarly, an increase in ACD was associated with an increased hyperopic shift, and this difference was more pronounced in those with short AXL (<22.5 mm), and this time the difference was statistically significant. CONCLUSIONS: As ACD and AXL significantly affect RE, both should be considered when investigating postoperative RE tendency and when determining IOL power. Postoperative RE will be greatly affected by a short AXL or a shallow ACD, and therefore these factors should be considered in IOL power determination.
Anterior Chamber ; Cataract ; Eye ; Humans ; Lens Implantation, Intraocular ; Lenses, Intraocular ; Refractive Errors ; Retrospective Studies

Blue nevus may rarely appear in a plaque form. Because of its rarity and unusual appearance, this nevus may present a diagnostic problem and gives no definite prognosis. We report a case of plaque -type blue nevus in a 25-year-old man. He presented an irregularly demarcated plaque, measuring 1.5 x 3 cm, composed of multiple grouped slate gray to blue papules of varying size with intervening faint gray-blue discoloration on the back, which had existed for 10 years. Histopathological examination showed clumps of numerous heavily melanin-laden dendritic melanocytes in the reticular dermis with intervening stromal fibrosis. Numerous melanophages were intermingled with the melanocytes. There were no islands of pale cells seen in the cellular blue nevus and no malignant changes such as nuclear and cytoplasmic pleomorphism, mitotic figures and so on. The diagnosis of plaque-type blue nevus was made and its histopathological features were consistent with a common blue nevus.
Adult ; Cytoplasm ; Dermis ; Diagnosis ; Fibrosis ; Humans ; Islands ; Melanocytes ; Nevus ; Nevus, Blue* ; Prognosis

Air embolism can occur during central venous catheter removal. We encountered a patient diagnosed with cerebral air embolism associated with the removal of an internal jugular venous catheter. The patient was 65 years old and was admitted to the intensive care unit due to pneumonia. He had a catheter placed in the right internal jugular vein. Five days thereafter, the catheter was removed in semi-Fowler's position using the Valsalva maneuver. Immediately after the catheter removal, the patient became pale, felt dyspneic, lost consciousness and exhibited seizure activity. A neurological examination, revealed left upper arm (grade I) and lower leg paralysis (grade II) as well as left facial palsy. A brain computed tomogram showed that, air was trapped in the cavernous sinus. In diffusion weighted magnetic resonance imaging, signal changes were reported in the right frontal cortex, indicating acute cerebral infarction. Hyperbaric oxygen therapy and ventilatory support with synchronized intermittent mandatory ventilation mode was applied. Twenty days thereafter, consciousness and motor functions were recovered completely except for mild weakness of the upper arm (grade IV).
Arm ; Brain ; Catheters ; Cavernous Sinus ; Central Venous Catheters ; Cerebral Infarction ; Consciousness ; Diffusion ; Embolism, Air ; Facial Paralysis ; Humans ; Hyperbaric Oxygenation ; Intensive Care Units ; Intracranial Embolism ; Jugular Veins ; Leg ; Magnetic Resonance Imaging ; Neurologic Examination ; Paralysis ; Pneumonia ; Seizures ; Valsalva Maneuver ; Ventilation

PURPOSE: Papillary thyroid carcinoma (PTC) is the most common malignancy that develops from the thyroid gland and its prognosis is quite excellent. One of the characteristic behaviors of PTC is that it often occurs at multiple foci. The purpose of this study was to investigate the clinicopathologic features and risk factors of multifocal papillary thyroid cancer. METHODS: A retrospective review was carried out on 624 patients with PTC and who underwent surgery from January 2005 to December 2007. Two hundred twenty-nine of them were found to have multiple tumor foci (≥2 foci). The risk factors that included gender, age at diagnosis, tumor size, capsular invasion, extrathyroidal extension (ETE), cervical lymph node (LN) involvement, the TNM classification, local recurrence and distant metastasis were comparatively analyzed between the solitary PTC and multifocal PTC groups. RESULTS: The enrolled patients were 59 male and 565 females. The mean age was 46 years (range: 15~77 years). Age (P=0.025), tumor size (P=0.027), capsular invasion (P<0.001), ETE (P<0.001) and cervical LN metastasis (P=0.002) were the significantly related factors for multifocal papillary thyroid cancer. However, gender was not significantly related with multifocality. CONCLUSION: The results of this study showed that multifocal tumors were significantly associated with age, tumors size, capsular invasion, ETE and cervical LN metastasis in patients with PTC. LN metastasis was mostly influenced by multifocality in the PTC patients. It seems certain that total thyroidectomy and formal central node dissection with postoperative adjuvant therapy are essential treatment for these patients, and closely surveying the nodal status is needed on the follow up of patients with multifocal PTC.
Classification ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy