No abstract available.
Child* ; Down Syndrome* ; Humans ; Hypothyroidism* ; Incidence*

No abstract available.
Leptospira interrogans* ; Leptospira*

This report concerns a rare malignant smooth muscle neoplasm of the skin and the subcutaneous tissue, which was examined immunohistochemically and ultrastructurally. It occured in a 48-year-old female patient who had suffered from painful nodules on the left shoulder. The nodules were removed and diagnosed as a benign fibrohistiocytic tumor. One year after local excision, multiple nodules were detected by physical examination at the previous operation site. Grossly, thirteen well-defined small nodules had spread in the dermis and the subcutaneous tissue, of which nine were located from lower dermis to the subcutaneous tissue and four were in the subcutaneous tissue. Histologically, each nodule consisted mainly of epithelioid tumor cells having eosinophilic or clear plump cytoplasm and round to oval nuclei with small nucleoli, and some peripheral spindle tumor cells. The tumor cells were negative for PAS reaction with and without diastase digestion or alcian blue. Immunohistochemically, tumor cells were positive for smooth muscle actin and vimentin. Ultrastructurally, the tumor cells showed actin filaments and dense bodies in cytoplasm. This case was diagnosed as an epithelioid leiomyosarcoma of the skin and the subcutaneous tissue with local metastasis one year after local excision.
Actin Cytoskeleton ; Actins ; Alcian Blue ; Amylases ; Cytoplasm ; Dermis ; Digestion ; Eosinophils ; Female ; Humans ; Leiomyosarcoma* ; Middle Aged ; Muscle, Smooth ; Neoplasm Metastasis ; Periodic Acid-Schiff Reaction ; Physical Examination ; Shoulder ; Skin* ; Subcutaneous Tissue ; Vimentin

No abstract available.
Chromatography, Liquid* ; Ciprofloxacin* ; Therapeutic Equivalency*

OBJECTIVE: Allelic losses or loss of heterozygosity (LOH) at many chromosomal loci have been found in the cells of meningiomas. The objective of this study was to evaluate LOH at several loci of different chromosomes (1p32, 17p13, 7q21, 7q31, and 22q13) in different grades of meningiomas. METHODS: Forty surgical specimens were obtained and classified as benign, atypical, and anaplastic meningiomas. After DNA extraction, ten polymorphic microsatellite markers were used to detect LOH. Medical and surgical records, as well as pathologic findings, were reviewed retrospectively. RESULTS: LOH at 1p32 was detected in 24%, 60%, and 60% in benign, atypical, and anaplastic meningiomas, respectively. Whereas LOH at 7q21 was found in only one atypical meningioma. LOH at 7q31 was found in one benign meningioma and one atypical meningioma. LOH at 17p13 was detected in 4%, 40%, and 80% in benign, atypical, and anaplastic meningiomas, respectively. LOH at 22q13 was seen in 48%, 60%, and 60% in benign, atypical, and anaplastic meningiomas, respectively. LOH results at 1p32 and 17p13 showed statistically significant differences between benign and non-benign meningiomas. CONCLUSION: LOH at 1p32 and 17p13 showed a strong correlation with tumor progression. On the other hand, LOH at 7q21 and 7q31 may not contribute to the development of the meningiomas.
DNA ; Hand ; Loss of Heterozygosity ; Meningioma ; Microsatellite Repeats ; Retrospective Studies

PURPOSE: The evaluation of tumor recurrence or metastasis in postgastrectomy cancer patients usually depends on a serum tumor marker test or radiologic study, but in both cases, accuracy is difficult to determine. The purpose of this study was to evaluate the relationship between abdominal CT and serum tumor markers. MATERIALS AND METHODS: In 337 cases involving 226 patients who had undergone curative surgery for gastric cancer, we compared serum tumor markers and CT for the evaluation of metastasis. Among these 337 cases, CEA level was measured in 317, CA 19-9 level in 166, and both of these in 146. The cutoff level for serum carcinoembryonic antigen (CEA) and CA19-9 were 10 ng/ml and 33 U/ml, respectively. RESULTS: CEA level was elevated in 59 of 317 cases (18.6 %) and that of CA 19-9 in 58 of 166 (34.9 %). Slightly higher overall senstivity and specificity was observed for CEA than for CA 19-9 (72.9 % vs 67.2 %, 83.3 % vs 70.4 %, respectively). Among the total of 337 cases, liver or lymph node metastases were detected in 91 cases (27.0 %) on CT. Negative predictive value was significantly higher in CEA than in CA 19-9 (93.1 % vs 80 %, respectively) (p < 0.01), but positive predictive value was lower (50 % vs 54.9 %, respectively). On CT scan, there was a significant relationship between serum tumor marker level and hepatic and nodal metastasis ; specificity and positivity of serum tumor markers were both higher than sensitivity and negativity. CONCLUSION: Follow-up CT less useful when tumor markers levels are not elevated, but when these are elevated in postgastrectomy cancer patients, meticulous radiologic evaluation is necessary for the early detection of residual or recurrent tumors.
Carcinoembryonic Antigen ; Follow-Up Studies ; Humans ; Liver ; Lymph Nodes ; Neoplasm Metastasis* ; Recurrence ; Sensitivity and Specificity ; Stomach Neoplasms* ; Tomography, X-Ray Computed ; Biomarkers, Tumor*

We have performed 10 primary liver transplantations between August 1993 and September 1995 in patients with end stage liver disease at Department of Surgery, Catholic University, Medical College. Donor and recipient operations were performed using modified techniques described by Starzl et al. Cyclosporine and prednisone were used as the principal immunosuppressive regimen and cyclosporine levels were monitored daily with dosage adjustment. when acute rejection was suspected based on clinical parameters, methylprednisolone was given for 2 days and if there was no response, we treated with the OKT3 monoclonal antibody. Our clinical results were as follows : 1. Mean age of donors was 32 years, ranging from 17 to 50 years, eight males, 2 females. The causes of brain death were traffic accident in 5 cases, falling down in 3 cases, and others (CVA, brain tumor). 2. Mean age of recipient was 41 years, ranging from 18 to 57 years and all were male. The indications of liver transplantation were liver circhosis related to viral hepatitis in 9 cases and alcoholic cirrhosis in one. 3. In arterial reconstruction, aortic carrel patch of common hepatic artery was sewn to hepatic-gastroduodenal bifurcation (5 transplants), to supraceliac aorta (3 transplants), and to infrarenal aorta (2 transplants). The biliary anastomosis was a choledochocholedochostomy with T-tube stent in nine and Roux-en-Y choledochojejunostomy in one transplant. 4. Average length of operation was 9 hours 28 minutes (range 7. 6-12 hours), and liver ischemia 6 hours 14 minute. An average requirements of packed red cell were 21.2 unit (range 12-31 units) 5. The surgical complication occurred in 3 patients (postoperative bleeding, hepatic arterial thrombosis and bile peritonitis), acute rejection in 5 patients, bacterial infection in 5 patients and coma in 2 patients. 6. Of the 10 patients, 6 are alive ranging from 15 days to 27 month and four patients died in the early postoperative period : one of postoperative bleeding, one of hepatic arterial thrombosis, one of acute rejection and one of neurologic complication. 7. In the consideration of prognostic factors from donor, the dosage of vasopressor and liver enzyme but not donor age were significant in early postoperative mortality. As perioperative parameters of recipients, preoperative general status, serum BUN, bilirubin, and reversibility of respiratory, renal and graft function within the first week following transplant were important.
Accidents, Traffic ; Aorta ; Bacterial Infections ; Bile ; Bilirubin ; Brain ; Brain Death ; Choledochostomy ; Coma ; Cyclosporine ; End Stage Liver Disease ; Female ; Hemorrhage ; Hepatic Artery ; Hepatitis ; Humans ; Ischemia ; Liver Cirrhosis, Alcoholic ; Liver Transplantation* ; Liver* ; Male ; Methylprednisolone ; Mortality ; Muromonab-CD3 ; Postoperative Period ; Prednisone ; Stents ; Thrombosis ; Tissue Donors ; Transplants

This case series study demonstrates the possibility of successful implant rehabilitation without bone augmentation in the atrophic posterior maxilla with cystic lesion in the sinus. Sinus lift without bone graft using the lateral approach was performed. In one patient, the cyst was aspirated and simultaneous implantation under local anesthesia was performed, whereas the other cyst was removed under general anesthesia, and the sinus membrane was elevated in a second process, followed by implantation. In both cases, tapered 11.5-mm-long implants were utilized. With all of the implants, good stability and appropriate bone height were achieved. The mean bone level gain was 5.73 mm; adequate bone augmentation around the implants was shown, the sinus floor was moved apically, and the cyst was no longer radiologically detected. Completion of all of the treatments required an average of 12.5 months. The present study showed that sufficient bone formation and stable implantation in a maxilla of insufficient bone volume are possible through sinus lift without bone materials. The results serve to demonstrate, moreover, that surgical treatment of mucous retention cyst can facilitate rehabilitation. These techniques can reduce the risk of complications related to bone grafts, save money, and successfully treat antral cyst.
Anesthesia, General ; Anesthesia, Local ; Dental Implants ; Humans ; Maxilla ; Maxillary Sinus* ; Membranes* ; Osteogenesis ; Rehabilitation* ; Sinus Floor Augmentation ; Transplants

PURPOSE: To evaluate the CT and MRI findings of neurosyphilis. MATERIALS AND METHODS: We retrospectivelyreviewed the CT and MR imaging findings in five patients with intracranial neurosyphilis confirmed by CSF, VDRL,TPHA, and clinical follow-up. MR imaging was performed in all five cases, and CT in two. RESULTS: The MRI and CTfindings of intracranial neurosyphilis included infarction (n=3), focal inflammation (n=1) and encephalopathy(n=1). There was a total of ten infaretions : three of the basal ganglia, two each of the frontal lobe, watershedzone, and cerebellum, and one of the occipital lobe. Intaretion was most common in MCA territory (n=9; 50%),followed by the watershed zone (16.6%), posterior cerebral artery territory (16.6%), and posterior inferiorcerebellar artery territory (11.1%), The size of the lesion varied from 1cm to larger than one lobe. One patientshowed diffuse high signal intensity in the left temporal lobe, but on follow-up MRI, this had resolved. CONCLUSION: The most common finding of neurosyphilis, as seen on MRI and CT, was infarction in middle cerebralarterial territory.
Arteries ; Basal Ganglia ; Cerebellum ; Follow-Up Studies ; Frontal Lobe ; Humans ; Infarction ; Inflammation ; Magnetic Resonance Imaging* ; Neurosyphilis* ; Occipital Lobe ; Posterior Cerebral Artery ; Syphilis ; Temporal Lobe

PURPOSE: The purpose of this article was to evaluate the efficiency of an automated prescription program serving pediatric patients who visited our emergency department. We expected that the program would reduce pediatric patient prescription errors and shorten the length of stay in the emergency department. METHODS: We developed the computerized physician order entry system to serve the pediatric patients visiting the emergency department and recommended that the emergency medicine residents use this program. We compared the rate of error as it affected prescription dosage and length of stay in the emergency department, before and after the program was deployed. We also performed a survey with 20 emergency medicine residents that have used the program. RESULTS: Of the total number of prescriptions filled, the number of prescription dosing errors observed was 40(4.5%) before and 22(2.8%) after the program was deployed. The results of the survey revealed high system usability and satisfaction. However, the length of stay in the emergency department was not affected. CONCLUSION: The computerized physician order entry system for pediatric patients visiting the emergency department was effective in reducing prescription related medical errors.
Emergencies ; Emergency Medicine ; Humans ; Length of Stay ; Medical Errors ; Medical Order Entry Systems ; Prescriptions