Quality assurance analysis of frozen section diagnosis is very important for the pathologists to improve the diagnostic ability and the quality of medical service. We analysed 5,273 consecutive cases of frozen section diagnosis which were done in Samsung Medical Center during 10 months from June 1, 1998 to March 31. 1999 with special reference to the discordance between frozen section diagnosis and final diagnosis. The concordance rate was 97.65%, discordance rate 1.34%, and deferred diagnosis (type 1) rate 1.01%. Category A (discordant diagnosis without any effect on the patients) was 53 cases (1.01%), category B (discordant diagnosis with minimal but no serious effect on the patients) was 10 cases (0.19%), and category C (discordant diagnosis with serious effect on the patients) was 8 cases (0.15%). Type 2 (discordant diagnosis by extra-pathologist problem) was 22 cases (0.42%) and type 3 (discordant diagnosis by pathologist problem) was 49 cases (0.93%). The most frequent causes of type 2 and 3 discordant diagnosis were presence of new lesions on deeper sections and the misinterpretation of lesions. Discordant diagnosis was noted in lymphoreticular system, central nervous system, thyroid, gastric resection margin, breast, female genital organs, intestine, hepatobiliary system, upper aerodigestive tract, urinary tract, lung, and soft tissue in descending order of frequency. Frozen section diagnosis was deferred in central nervous system, lymphoreticular system, gastric resection margin, female genital organs, thyroid, intestine, upper aerodigestive tract, lung, and soft tissue in descending order of frequency. The most important cause of discordant diagnosis was a misinterpretation of the lesions. Based on our results, a continuous and careful follow-up of quality assurance analysis of frozen section diagnosis and a share of experience of problematic cases are mandatory for the pathologists to improve the quality of medical services.
Breast ; Central Nervous System ; Diagnosis* ; Female ; Frozen Sections* ; Genitalia, Female ; Intestines ; Lung ; Thyroid Gland ; Urinary Tract

A case of unusual lung abscess induced by psoas abscess in tuberculosis of the thoracolumbar spine complicated with complete spastic paraplegia is reported. Usually the tuberculous psoas abscess drains out along the fascia and ligament by it's own gravity. The common site of drainage of the tuberculous psoas abscess are the Petit triangle, the femoral triangle, the sciatic notch, the adductor region of the thigh and the lumbar region. In the reported case the left psoas abscess penetrated into the diaphragm and induced a lung abscess. This was confirmed by operation as no communication was inspected between the paravertebral abscess. The abscess was completely evacuated through thoracotomy and the tuberculous lesion in T-11,12 was operated by complete removal of focus and simultaneous anterior spinal fusion, another lesion in the lumbar spine was operated by radical operation three weeks after first operation. The paraplegia was recovered three months after first operation with satisfactory bony union and the patient was allowed to be up and about. A satisfactory result was obtained by radical ressection and anterior interbody fusiao of T-11,12 of the diseased vertebrae through the left extrapleural approach. This was followed by focal deberidement of right psoas abscess.
Abscess ; Diaphragm ; Drainage ; Fascia ; Gravitation ; Humans ; Ligaments ; Lumbosacral Region ; Lung Abscess ; Lung ; Paraplegia ; Psoas Abscess ; Spinal Fusion ; Spine ; Thigh ; Thoracotomy ; Tuberculosis

No abstract available.
Myasthenia Gravis*

No abstract available.
Blepharoptosis*

Sex cord tumor with annular tubules (SCTAT) is a rare ovarian neoplasm which usually occurs in two forms. In patients associated with Peutz-Jeghers syndrome, the tumors are usually small, bilateral or multifocal, and show benign clinical course. However, tumors from patients without the syndrome are often large, usually unilateral, and rarely show malignant behavior. Serous surface papillary carcinoma (SSPC) is an aggressive neoplasm which involves peritoneal linings, including ovarian surface. Recently, we encountered a case of an unusual combination of SCTAT and SSPC in the ovary of a 55-year-old Korean woman presented with abdominal distention for one year. Systemic review and physical examination were within normal limit, except for abdominal discomfort and distention. There was no stigmata of Peutz-Jeghers syndrome in all diagnostic examinations, including gastroscopy and colonoscopy. Pelvic computed tomography showed adnexal mass with multiple peritoneal nodules. Exploration revealed uterine and ovarian surfaces covered with multiple, yellow-white papillary nodules. However, the sizes of both ovaries were within normal limit. Typical serous papillary carcinomas were identified in nodules from peritoneum and ovarian surfaces. Well-circumscribed columnar epithelial cell nests composed of ring-shaped tubules encircling hyalinized basement membrane-like materials were found in the ovary away from serous surface papillary carcinoma.
Carcinoma, Papillary* ; Christianity ; Colonoscopy ; Epithelial Cells ; Female ; Gastroscopy ; Humans ; Hyalin ; Middle Aged ; Ovarian Neoplasms ; Ovary* ; Peritoneum ; Peutz-Jeghers Syndrome ; Physical Examination

Between Jan. 1976 and May 1987, Sixteen supracondylar fractures of the femur were treated by interlocking nailing. Of the 16 cases, 7 cases were intercondylar, 12 cases were segmental fractures of the femur, 4 cases were open fractures in the type of wound. 1. The simple supracondylar fracture involving the distal 9cm of the femur can be treated by interlocking nailing which makes firm fixation and allows early ambulation. 2. If the supracondylar fracture is accompanied with intercondylar fracture, careful reduction and transcondylar fixation by means of tibial bolt or cancellous screws are essential before the insertion of the nail. 3. The shape of the bent nail must be depended on the type of the fracture. If the nail is to be inserted into the anterolateral aspect of the distal fragment, the degree of bending of the nail is 400cm, and posteromedial is 110cm in radius. 4. The authors made several sagittal holes the at dorsum of the nail. So the screw can be easily inserted to the nail perpendicularly or obliquely, when the insertion of the screw through the transverse holes is difficult. 5. Of the 15 cases treated by interlocking nailing, 5 cases were excellent, 4 cases were good, 2 cases were fair, 4 cases were failure by schatzker assessment.
Early Ambulation ; Femur ; Fractures, Open ; Radius ; Wounds and Injuries

We describe a case of cutaneous angiomyolipoma found in the ear lobe, that is not associated with tuberous sclerosis. The lesion developed on the youngest patient yet reported in the literature.
Angiomyolipoma* ; Ear ; Humans ; Tuberous Sclerosis

Forty five patients with urinary tract infection were treated with 100mg Norfloxacin twice daily for 3 or 7 days according to the seriousness of infection. Of the 19 patients with uncomplicated urinary tract infection including 5 patients with acute bacterial prostatitis or acute epididymitis, none had bacteriuria 7 days after therapy and 1 patient was reinfected 14 days after therapy discontinuation. Of the 26 patients with complicated urinary tract infection, 17 patients(65%) were uninfected 7days after therapy and among them, 3 patients were reinfected I4 days after discontinuation of therapy. Of the 9 patients with persistent infection, 4 patients had resistant bacteriuria and 5 patients had bacteriuria different from that found before therapy. Eradication rate of E. coli, Enterobacter spp., Proteus spp., Pseudomonas spp., and Serratia spp. were 100%,, 100%,, 100%,, 80% and 40%, respectively. Further clinical envaluation seems worthwhile especially in pseudomonas infections since it offers one of the very few alternatives for oral treatment of pseudomonas infections which today may require hospitalization only for the purpose of injectible antibiotics.
Anti-Bacterial Agents ; Bacteriuria ; Enterobacter ; Epididymitis ; Hospitalization ; Humans ; Male ; Norfloxacin ; Prostatitis ; Proteus ; Pseudomonas ; Pseudomonas Infections ; Serratia ; Urinary Tract Infections* ; Urinary Tract*

No abstract available.
Balloon Valvuloplasty* ; Constriction, Pathologic*

There is increasing evidence that inactivation of tumor-suppressor genes can promote tumor growth. Retinoblastoma protein (pRb) is the product of the retinoblastoma gene located on chromosome 13q14. pRb negatively regulates cell growth when functioning normally. Mutational inactivation of the Rb gene has been observed in retinoblastomas, osteosarcomas and soft tissue sarcomas. Recently, several other human cancers have also been shown to carry abnormalities of the Rb gene. The potential role of the Rb gene in cutaneous squamous cell carcinomas (SCCs) and basal cell caicinomas (BCCs), has not been determined and was the focus of this study. Immunohistochemical expression of pRb in 16 cutaneous SCCs and 17 BCCs was examined. The expression of PCNA was studied in parallel to assess the cellular proliferation rate in these lesions. The pRb and PCNA immunoreactivity were localized to the nuclei of tumor cells. A few pRb and PCNA positive cells were seen in normal squamous epithelium, sebaceous glands, sweat glands and hair follicles. The loss of expression of pRb was seen in 3 of 16 SCCs(18.8%) and 6 of 17 BCCs (35.3%). PCNA immunoreactivity was slightly high in pRb-negative or lower-positive cases. PCNA immunoreactivity was similar to that produced by pRb in some cases. These results suggest that mutational inactivation of the Rb gene may be related to the carcinogenesis of cutaneous SCC and BCC, though the frequency is relatively low.
Carcinogenesis ; Carcinoma, Basal Cell* ; Carcinoma, Squamous Cell* ; Cell Proliferation ; Epithelium ; Genes, Retinoblastoma ; Hair Follicle ; Humans ; Osteosarcoma ; Proliferating Cell Nuclear Antigen ; Retinoblastoma Protein* ; Retinoblastoma* ; Sarcoma ; Sebaceous Glands ; Sweat Glands