A poroma is usually described as a benign neoplasm arising from ductal epithelium of eccrine gland. However, in recent years there have been several reports on poromas featuring with combined sebaceous, follicular, and ductal differentiation, and thus establishment of this separate disease entity, "apocrine poroma" may well be justified considering the common embryologic origin of folliculosebaceous-apocrine unit. In our case, the tumor presented as a dark red nodule on the pubic area, being revealed as poroid neoplasm with folliculosebaceous components embedded in the lobules. Immunohistochemically, poroid cells stained with lysozyme. Taking the immunohistochemical staining results as well as the histopathologic findings of folliculosebaceous differentiation into consideration, we have concluded that this tumor is a case of an "apocrine poroma".
Eccrine Glands ; Epithelium ; Muramidase ; Poroma*

Background & Objective: Hiccups is a disabling condition of lateral medullary infarction (LMI). Unlike other symptoms of LMI, the anatomical lesions of hiccups are not well known. Few studies have evaluated the relationship between the lesional location of LMI and hiccups. We performed this study to correlate hiccups and magnetic resonance imaging (MRI)-based lesional location in pure LMI. Methods: Between January 1997 and February 2013, we identified 24 patients with pure LMI who presented with hiccups in addition to typical lateral medullary syndrome. Sixty six pure LMI patients without hiccups were included as a control group. Clinical and radiologic findings were compared between the two groups. MRI-identified lesions were classified rostrocaudally as rostral, middle and caudal, and horizontally as typical, ventral, large, lateral and dorsal. Results: The pure LMI patients with hiccups had significantly more frequent aspiration pneumonia (P = 0.001) and longer hospital stay (P = 0.03). The patients with hiccups significantly more often had dorsal rather than ventral lesion at horizontal levels (P = 0.012). But, there were no rostro-caudal differences at vertical levels (P = 0.162). Conclusions: We suggest that pure LMI associated with hiccups often locates in the dorsal medulla at horizontal correlation. This MRI-based comparative study has advanced the understanding of the neural substrate for hiccups in LMI, and indicates that hiccups become predictable when specific lesional locations in the lateral medulla are considered.

Giant cell tumor is a predominantly benign condition but often the tumor is locally aggressive and tends to have high rate of recurrence and it can evolve into a malignant tumor. Thus the lesions have a practically difficult therapeutic problem for the orthopaedic surgeon and any method of treatment has not been satisfied. Between March 1984 and March 1993, clinical observation was carried out on 22 cases of giant cell tumor of bone to analyse the recurrence rate and functional evaluation of the joint according to the treatment methods, pathological grade and cortical destruction. The mean follow-up time was 75. 2 months. The recurrence rate of the intralesional excision group was 54.5% and that of the wide excision group was 9%, There was no relationship between the pathologic grade and recurrence rate. There was no recurrent case in the grade I cortical destruction but almost all of recurrence was occurred in the grade I or II cortical destruction. The functional result of the giant cell tumor occurred around the knee joint was that the mean ratings in the intralesional excision group were 79% and in the wide excision group were 51%. In conclusion, to achieve better joint function and less recurrence rate, intralesional or marginal excision with heat using bone cement or with chemical cauterization using phenol and alcohol can be used for cases of radiological grade I or II, and wide excision for grade III.
Cautery ; Follow-Up Studies ; Giant Cell Tumor of Bone ; Giant Cell Tumors ; Giant Cells ; Hot Temperature ; Joints ; Knee Joint ; Methods ; Phenol ; Recurrence

Mucosal bridge, endoscopically observed as a cord-like mucosal connection across the lumen, looking like a bridge, may infrequently arise anywhere from the esophagus to the colon. Mucosal bridges have been more frequently reported in the colon than in the esophagus, stomach, and duodenum. The causes of the mucosal bridge are congenital origin or acquired origin as the inflammatory diseases. We experienced a 49-year-old male patient who had multiple esophageal diverticula with mucosal bridges. We report this case with a review of relevant literatures.
Colon ; Diverticulum ; Diverticulum, Esophageal* ; Duodenum ; Endoscopy ; Esophagus ; Humans ; Male ; Middle Aged ; Stomach

BACKGROUND: Defective adhesion and migration of melanocyte may be involved in pathogenesis of vitiligo. Tenascin, a glycoprotein of the extracellular matrix, has a role in cell adhesion and migration. It has been reported that abundant expression of tenascin in vitiligo lesion may inhibit melanocyte adhesion and migration. OBJECTIVE: To investigate the tenascin expression in vitiligo skin lesions and to compare with clinical findings. METHODS: We studied 9 patients with vitiligo. The expressions of tenascin were studied by immunahistochemieal techniques.
Cell Adhesion ; Extracellular Matrix ; Glycoproteins ; Humans ; Melanocytes ; Skin ; Tenascin* ; Vitiligo*

Background & Objective: Although the clinical manifestations and outcomes of neuralgic amyotrophy have been previously described, some controversies remain. Thus, we evaluated clinical manifestations and outcomes of patients with neuralgic amyotrophy. Methods: We evaluated the clinical and electrodiagnostic data, and the outcomes, of 32 patients with neuralgic amyotrophy.Of the 32 patients, 26 were followed-up for one year after onset of the disease.Results:The initial symptoms were pain (50.0%), pain with weakness (21.9%), other sensory symptoms without weakness (6.3%), and painless weakness or atrophy (21.9%). The commonly involved nerves were the median (75.0%), radial (68.8%), suprascapular (50.0%), ulnar (50.0%), axillary (46.9%), and musculocutaneous (40.6%) nerves. The initial symptoms were not associated with nerve involvement. Of all patients, 59% recovered fully, 16% had residual mild weakness without functional disability, and 6% experienced persistent severe weakness and were unable to return to work. Some patients were not evaluated because they were lost to follow-up. Conclusions: Painless weakness as an initial symptom of neuralgic amyotrophy may be more common than previously noted. Of all patients, 75% enjoyed favorable outcomes by one year after disease onset. These results will be useful when planning treatment strategies and will deepen our understanding of prognosis of neuralgic amyotrophy.
Brachial Plexus Neuritis

Recently it is known that Turner's syndrome is frequently associated with hypothyroidism. We report a case of Turner's syndrome associated with subclinical hypothyroidism. A 23-year-old female was admitted to the hospital with complaints of amenorrhea and short stature. She had a mosaicism of 45, X0/46, Xi(X_q) in the cell, cultured from the peripheral blood. The plasma thyroxine and triiodothyronine were normal and there was no clinical symptom of hypothyroidism. But the thyroid-stimulating hormone(TSH) concentration was unusually higher(184 uU/L). She has been treated with the cyclic therapy of conjugated estrogen and medroxyprogesterone, in addition to the thyroxine replacement therapy. After 2 months, the menstruation was restored and TSH was normalized.
Amenorrhea ; Cells, Cultured ; Estrogens ; Female ; Humans ; Hypothyroidism ; Medroxyprogesterone ; Menstruation ; Mosaicism ; Plasma ; Thyroxine ; Triiodothyronine ; Turner Syndrome ; Young Adult

PURPOSE: To assess the value of preoperative ultrasonography (US) - guided skin marking for the investigation of cervical lymph node (LNs) metastasis in papillary cancer patients who had not undergone evaluation of cervical LNs at the initial diagnosis. METHODS: We evaluated cervical lymph nodes in 40 patients with papillary thyroid cancer. Ultrasonography wasperformed just prior to surgery. The shape, echogenicity, size, and location of lymph nodes were noted and the location of lymph nodes was marked on the skin surface with a pen under ultrasound guidance. The retrieved lymph nodes underwent intraoperative frozen section analysis to plan the extent of surgery. RESULTS: One hundred thirty two LNs were detected on preoperative US, 1087 LNs were surgically removed. Of 40 patients, 28 patients had lymph node metastasis. The cystic appearance, the presence of calcifications, hyperechogenicity and the absence of an echogenic hilum were significantly greater in malignant LNs than in benign LNs (P< 0.001). Among these, the cystic appearance and the presence of calcifications showed a very high specificity and seemed to be the most reliable in indicating malignant LNs. CONCLUSION: In papillary thyroid cancer patients, preoperatively ultrasound-guided localization of cervical LNs with skin marking shows good potential to determine surgical extent. Ultrasound features of LNs help in the selection of the node to remove with intraoperative frozen section analysis.
Diagnosis ; Frozen Sections ; Humans ; Lymph Nodes* ; Neoplasm Metastasis ; Sensitivity and Specificity ; Skin* ; Thyroid Gland* ; Thyroid Neoplasms* ; Ultrasonography

PURPOSE: An increase in optic nerve sheath diameter (ONSD) has been associated with elevated intracranial pressure due to brain lesions, such as hemorrhage, infarction, and tumor. The aim of this study was to evaluate whether the difference of both ONSDs can predict surgical treatment in patients with traumatic brain hemorrhage. METHODS: A prospective analysis of the data acquired between September 2016 and November 2016 was performed. We included 155 patients with traumatic brain hemorrhage undergoing computed tomography in the emergency room. We performed an ultrasonography to measure ONSDs for all included patients. The primary outcome of this study was operation indication in patients with traumatic brain hemorrhage. RESULTS: The average age was 63.4±17.0 years (male 60.3±17.3, female 69.8±14.4). There were 61 (39.35%) patients with an indication for operation and 94 (60.65%) patients with an indication for no operation. Indications for operation showed a strong association with the difference of both ONSDs in patients with subdural hemorrhage (p<0.001), no association between them in patients with epidural and intracerebral hemorrhage. In patients with subdural hemorrhage, the area under the curve was 0.988 (0.653-0.998), and the cut-off value for the difference of ONSDs with respect to determining the indications for operation was 0.295 mm f maximizing the sum of the sensitivity (96.9%) and specificity (90.7%) using the receiver operating curve. CONCLUSION: A difference of both ONSDs above 0.295 mm was useful in predicting the indications for operation in patients with traumatic subdural hemorrhage, but not in patients with epidural and intracerebral hemorrhage.
Brain ; Brain Hemorrhage, Traumatic* ; Cerebral Hemorrhage ; Emergency Service, Hospital ; Female ; Hematoma, Subdural ; Hemorrhage ; Humans ; Infarction ; Intracranial Hypertension ; Optic Nerve* ; Prospective Studies ; Sensitivity and Specificity ; Ultrasonography*