A 50 year-old woman was scheduled for clipping of giant middle cerebral artery (MCA) aneurysm. Preoperative four-vessel angiography and computed tomography scan revealed a giant aneurysm (3.5x3.3x3.5 cm) at bifurcation of right MCA. Induced hypotension and brain protection using sodium nitroprusside (SNP) and thiopental loading were planned to prevent cerebral damage during the operation. Before induction, esmolol, lidocaine and vecuronium were administered. Mask ventilation with isoflurane in N2O and O2 was performed over 5 minutes and then tracheal intubation was done. Anesthesia was maintained by isoflurane+N2O+O2 with pancuronium. Electrocardiography, pulse oxymetry, capnography, central venous pressure, evoked potential and invasive arterial blood pressure were monitored. She was hyperventilated intraoperatively with a PaCO2 around 30 mmHg. Perioperative hypotension was achieved with infusion of SNP (0.3~1.0 microg/kg/min). During the actual aneurysm surgery, mean arterial pressure was lowered to approximately 50 mmHg. Adjuvant drugs such as methylprednisolone, mannitol and furosemide to reduce intracranial pressure were also administered. This technique established good brain conditions during clipping of the aneurysm. A thiopental loading (4 mg/kg) was supplied while the aneurysm was approached. Satisfactory and well-controlled hypotension was obtained after thiopental and SNP. Postoperatively, the patient was transferred to the intensive care unit.
Anesthesia ; Aneurysm ; Angiography ; Arterial Pressure ; Brain ; Capnography ; Central Venous Pressure ; Electrocardiography ; Evoked Potentials ; Female ; Furosemide ; Humans ; Hypotension ; Intensive Care Units ; Intracranial Aneurysm* ; Intracranial Pressure ; Intubation ; Isoflurane ; Lidocaine ; Mannitol ; Masks ; Methylprednisolone ; Middle Cerebral Artery ; Nitroprusside ; Pancuronium ; Thiopental ; Vecuronium Bromide ; Ventilation

Trichogenic tumors are very rare and described as cutaneous neoplasms probably derived from hair germ which develops into hair follicles. We report a case of trichoblastic fibroma on the left parietal scalp of a 45-year-old man. The lesion was a solitary, firm, non-tender, 2×2cm subcutaneous nodule. The histopathological study showed a well circumscribed dermal tumor composed of abundant basophilic palisading basaloid lobules with some keratinous cysts, hair follicle differentiation and fibroblastic stroma.
Basophils ; Fibroblasts ; Fibroma* ; Hair ; Hair Follicle ; Humans ; Middle Aged ; Rabeprazole ; Scalp

The Measurement of CSF glucose and CSF glucose-to-blood glucose ratio is a very useful laboratory test for the differential diagnosis of meningitis. We have observed the change of blood glucose & CSF glucose-to-blood glucose ratio according to the time of blood sampling in 84 patients with aseptic meningitis who had been admitted to the department of pediatrics, Dong Kang hospital from May 1993 to June 1993. The results obtained were as follows: 1) The blood glucose level examined with blood sample drawn just before lumbar puncture and one just after lumbar puncture was 98.29+/-16.20mg/dl and 106.49+/-19.47mg/dl, respectively. 2) The blood glucose level examined with blood sample drawn just before lumbar puncture and one 30 min. after lumbar puncture was 96.47+/-21.52mg/dl and 117.00+/-22.12mg/dl, respectively. 3) The CSF glucose-to-blood glucose ratios examined with blood sample drawn just before lumbar puncture and one just after lumbar puncture was 67.70+/-12.40% and 62.83+/-12.62%, respectively. 4) The CSF glucose-to-blood glucose ratios examined with blood sample drawn just before lumbar puncture and one just after lumbar puncture was 70.10+/-21.77% and 56.35+/-13.75%, reskpectively. We concluded that a simultaneous blood glucose level should be taken just before lumbar puncture.
Blood Glucose ; Diagnosis, Differential ; Glucose* ; Humans ; Meningitis ; Meningitis, Aseptic* ; Pediatrics ; Spinal Puncture

Cystadenomas are benign neoplasm in which the epithelium demonstrates adenomatous proliferation. Several morphologic variants of cystadenomas have bean described, including papillary-oncocytic, mucous, and seromucous subtypes. Cystadenomas arising from salivary glands are very rare and seromucous cystadenoma of parotid gland has not been reported in Korea so far. Cystadenomas of the parotid gland usually Present as asymptomatic slowly growing mass and those of the minor salivary glands produce smooth nodules that may be compressible. We performed a superficial parotidectomy in a patient with a seromucous cystadenoma. This may be the first report of seromucous cystadenoma of carotid gland in Korea.
Cystadenoma* ; Epithelium ; Humans ; Korea ; Parotid Gland* ; Salivary Glands ; Salivary Glands, Minor

BACKGROUND: Molluscum contagiosum is a common viral infect oudisease of the skin and mucous membrane that is caused by a molluscum contagiosum virus(MCV; which belongs to the poxviridae family. One of the characteristic histopathologic findings is an epidermal hyperplasia Porter and Archard reported that this phenomenon might be explained by a virus induced epidermal growth factor (EGF) like polypeptide. There was a report that epidermal prolifeation in viral infection might be modulated by other factors than the virus itself such as local immune response. OBJECTIVE: The purpose of this study was to examine the expression pattern of epidermal growth factor receptor and other immunocompetent cells by immunohistochemical stainings. METHOD : We performed iinmunoperoxidase staining on the 11 slaecmens of formalin-fixed, paraffin-embedded molluscum lesions and 15 specimens of snap frozen mollucum lesions with nine primary antibodies(EGFR, factor XIIIa, CDla, S-100 protein, MAC 387, HLA-IR, CD4, CDS, L26) RESULTS: EGF receptors were strongly expressed in lesional MCV ifect,ed keratinocytes. The number of CDla and factor XIIIa positive dermal dendritic cells were sigtly increased. In inflamed lesions, CD4 and HLA-DR expressions were increased in the dermis and per lesional epidermis. CONCLUSION: This study shows that 1) increased EGFR expression is of MCV infected keratinocytes may be related to the pathogenesis of epidermal hyperplasia. 2) helper T lyrnphocytes may operate in inflamed molluscum lesions.
Dermis ; Epidermal Growth Factor ; Epidermis ; Factor XIIIa ; HLA-DR Antigens ; Humans ; Hyperplasia ; Keratinocytes ; Langerhans Cells ; Molluscum Contagiosum* ; Mucous Membrane ; Poxviridae ; Receptor, Epidermal Growth Factor ; S100 Proteins ; Skin

S-100 protein is a mixture of three proteins, that is, S-100 ao(aa), S-100 a(ab) and, S- 100 b(bb). Twenty-two case, of sweat gland tumors were stained with immunoperoxidase technique (ABC method) for the presence of S-100a and b-subunit. Four syringomas, four eccrine poromas, two eccrine porocarcinomas, two ecerine spirdeiomas, one papillary eccrine adenoma, three clear cell hidradenomas, three mixed tumr rs of the skin, two papillary syringocystadenomas, and one cylindroma were included. All specimens were formalin-fixed and paraffin-embedded. The results were as follows : 1) The staining patterns of anti-S-100a and b-protein antibodies we e simillar to those of anti-S-100 protein antibody except in eccrine poroma and porocare nomal. 2) In eccrine poroma and porocarcinoma, scattered S-100-positive dendritic cells within tumor cell nests were stained by S-100-protein antibody (3/6), but not by anti-S-100a protein antibody. S-100p is present in normal Langerhans cells. Therefore this finding suggests that these cells niay be Langerhans cells
Acrospiroma ; Adenoma ; Antibodies ; Antibodies, Monoclonal* ; Carcinoma, Adenoid Cystic ; Dendritic Cells ; Eccrine Porocarcinoma ; Immunoenzyme Techniques ; Langerhans Cells ; Poroma ; S100 Proteins ; Skin ; Sweat Glands* ; Sweat* ; Syringoma

In normal hurnan dermis, factor XIIIa positive dermal dendrocyte are located in the papillary areas closely associated with blood vessels and the upper reticular dem These cells represent a specific type of bone marrow derived dermal cells, distinct from Langerhans cells having some features in common with rnonocyte/macrophage lineage and with potential antier presenting activity. Although the significance of these cells has not yet been fully established, it been suggested that they play a major role in skin immune iesponses, in collagen synsthesis regultic and in wound repair. We report a case of acaqired fibrokeratoma which is studiec conventional histopathology and immunohistochemistry. Histopathologic findings of this case showed ovascular proliferation and the increased presence of fibroblast like cells as a common fe;ture of these benign tumors. Immunohistochemical staining with anti factor XIIIa antibody deiaoi strates increased numbera of positive dendritic cells in the upper dermis. There finding supports the fat that some fibroblagt like cells in the upper dermis of acquireid fibrokeratoma may be factor XIIIa positive dermal dendritic cells.
Blood Vessels ; Bone Marrow ; Collagen ; Dendritic Cells ; Dermis ; Factor XIIIa* ; Fibroblasts ; Immunohistochemistry ; Langerhans Cells ; Skin ; Wounds and Injuries

Neutrophilic eccrine hidradenitis(NEH) was originally described in 1982 by Harrist et al. in a patient with myelogenous leukemia receiving chemotherapy. Clinically NEH represents various cutaneous manifestations with or without tenderness and pruritus. Histologic examination demonstrates a neutrophilic infiltrate within and around the eccrine gland and degeneration of the eccrine gland structures. Although the pathogenesis and possible cause of NEH remain unknown, it is probably an unusual cutaneous reaction to chemotherapeutic agents. A few cases of infection associated eccrine hidradenitis are found in the literature. We report three cases of neutrophilic eccrine hidradenitis. Two cases were associated with hematologic malignancy. The third case was associated with an infection of Vibrio vulnificus.
Drug Therapy ; Eccrine Glands ; Hematologic Neoplasms ; Hidradenitis* ; Humans ; Leukemia, Myeloid ; Neutrophils* ; Pruritus ; Vibrio vulnificus

Purulent pericarditis is an infrequent but fulminant and frequently lethal disease. Purulent pericarditis tends to occur as direct extension of bacterial pneumonia or empyema in past. In recently, purulent pericarditis tends to occur in adult via contiguous spread from an early postoperative infection after thoracic surgery or trauma, infection related to infective endocarditis, extension from a subdiaphragmatic suppurative source, and hematogenous spread during bacteremia. Endogenous causes of purulent pericarditis are frequently characterized as esophageal perforations. Common causes of esophageal perforations related to purulent pericaditis which usually develop in association with mediastinitis, pneumonia and empyema include corrosive esophagitis, complication after esophageal and tracheal instrumentation and Boerhaave's syndrome. There is very little reference to the development of pericarditis in associated with esophageal perforation which does not directly communicate with the pericardium. while, although most uncommon, it is well documented that the esophagus can perforate directly into the pericardium and produce pericarditis. We experienced a case of acute purulent pericarditis after esophageal and pericardial perforation by a small fish bone in a previously healthy man. The patient was treated successfully with systemic antibiotics and pericardiotomy.
Adult ; Anti-Bacterial Agents ; Bacteremia ; Empyema ; Endocarditis ; Esophageal Perforation ; Esophagitis ; Esophagus ; Foreign Bodies* ; Humans ; Mediastinitis ; Pericardiectomy ; Pericarditis* ; Pericardium ; Pneumonia ; Pneumonia, Bacterial ; Thoracic Surgery

BACKGROUND: Aconitium species have been used for a material of oriental herb medicine for analgesic and anti-inflammatory effects. But Aconitium species were known to have the potent poisons like aconitine, mesaconitine and hypaconitine which are of C19 diterpenoid alkaloids. The intoxication symptoms are nausea, vomiting, discomfort and cardiac arrhythmias which are well known as a main cause of death. METHOD AND MATERIALS: We obtained the specimens from the five poisoned cases and analyzed those specimens by GC/MS-SIM for 2002-2004. These cases were divided into two groups. The first group was the victims who ingested raw Aconitium roots and leaves and were all dead. The second was those who ingested processed Aconitium roots. One of them drank Aconitium root-submersed alcohol (root wine) and died. Another victim had ingested some liquid extract of herb medicine for three months but the person's symptom was manifested by jaundice and hematuria without fatality. RESULTS: Autopsy pathology on the cases of raw Aconitium ingestion and root wine drinking revealed similar gross and microscopic feature. The benzoylaconine analogues were detected in root wine (dead case) and hypaconitine, benzoylmesaconine and benzoylhypaconine were detected in herb liquid (living case). The aconitine analogues are hydrolyzed to make less toxic benzoylaconine analogues but the toxicity of hydrolyzed products and the methods of detoxification are still in controversy. CONCLUSION: We could conclude that benzoylaconine is relatively more toxic than benzoylmesaconine and benzoylhypaconitine. And the hypaconitine is relatively less toxic than aconitine and mesaconitine.
Aconitine ; Alkaloids ; Arrhythmias, Cardiac ; Autopsy ; Cause of Death ; Chromatography, Gas ; Drinking ; Eating ; Hematuria ; Jaundice ; Mass Spectrometry ; Nausea ; Poisons ; Vomiting ; Wine