A 66-year-old female patient had a firm, non-tender, dome shaped mass on the scalp. The lesion had enlarged slowly for 2 years, and measured about 4 × 6 cm. The histologic finding of the skin biopsy specimen demonstrated an infiltration of immature plasma cells in the dermis, which express monoclonal cytoplasmic lambda light chain by immunohistochemical stainings, and staging work-up after the biopsy revealed no evidence of disease in other foci. The mass on the scalp was treated successfully by radiation therapy, with the diagnosis of primary cutaneous plasmacytoma.
Aged ; Biopsy ; Cytoplasm ; Dermis ; Diagnosis ; Female ; Humans ; Plasma Cells ; Plasmacytoma* ; Scalp ; Skin

PURPOSE: We wanted to evaluate the recurrence rate and risk factors of recurrent venous thrombosis after the endovascular management of acute iliofemoral deep vein thrombosis (DVT). METHOD: Between January 2002 and March 2005, catheter-directed thrombolysis with Urokinase (n=40) and/or stent placement (n=33) and/or aspiration (n=29) was performed in 40 patients with acute iliofemoral DVT. The patients were divided into two groups according to DVT recurrence during the follow-up period: Group A (n=9) with recurrence and Group B (n=31) without recurrence. The risk factors of each group were analyzed for the duration of symptom before the thrombolytic therapy, the risk factors, the dose of Urokinase, and the duration and results of thrombolytic therapy. RESULT: 15 patients were men (mean age; 56.8 yr) and 25 were women (mean age; 61.4yr). The mean duration of symptoms prior to the initiation of thrombolysis for each group was 16.3+/-11.3 days vs. 7.0+/-7.0 days (P=0.040), the average total Urokinase dose was 4.83 million IU vs 2.07 million IU, respectively (P=0.080), and the average duration of therapy was 86.1 hours vs. 59.1 hours, respectively. Complete thrombus resolution was obtained in 33/40 cases. The incidence of decreased anticoagulants such as protein C/S, Antithrombin did not show any difference between two groups. DVT recurred in 5/33 (15.1%) patients for whom the DVT were completely resolved, and in 4/7 (57.1%) patients among the incompletely resolved cases (P=0.034). The causes of recurrence (5/33) in the completely resolved cases were as follows; poor compliance, and other anatomical and systemic diseases (lumbar body anomaly, Behcet's disease and cancer peritonii, after obstetrical dilatation & curettage). CONCLUSION: We can conclude that the residual venous thrombosis and duration of symptom before the thrombolytic therapy are important risk factors for recurrent thrombosis. Its assessment may help to modify the duration of anticoagulation therapy for DVT patient. Whether the evaluation of DVT risk factors may help for the secondary preventive treatment should be assessed by specifically designed intervention studies.
Anticoagulants ; Clinical Trial ; Compliance ; Dilatation ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Recurrence ; Risk Factors* ; Stents ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Venous Thrombosis*

PURPOSE: If significantly influenced by chronic otomastoiditis(COM), mastoid pneumatization and the position of the sigmoid sinus affect the operative procedure and postoperative complications in middle ear surgery. We evaluated mastoid pneumatization and sigmoid sinus position, and their relationship in COM, especially its during onset. MATERIALS AND METHODS: Using temporal bone CT and referring to any relevant medical records, we retrospect+tively analyzed 107 cases of COM and 49 cases of normal ear. The total case load comprised an adult group, aged above 16 years [100 cases of COM (M:F=46:54, mean age = 45 years), and 42 cases of normal ear,(M:F=20:22, mean age = 44 years)], and a childhood group, aged less than 16 years [7 cases of COM (M:F=4:3, mean age = 8.4 years), and 7 cases of normal ear (M:F=4:3, mean age = 7 years)]. We determined the thickness of the mastoid bone by measuring the shortest distance between the outer cortex of this bone and the deepest border of the sigmoid sinus; the depth of the sigmoid sinus; and the degree of mastoid pneumatization and sclerosis. Fifty-three patients whose medical history clearly included the onset of otomas-toiditis were divided into a child-onset group and an adult-onset group, and the relationship between the onset of otomastoiditis and the thickness of the mastoid bone was compared between the two groups. RESULTS: The mean axial thickness of the mastoid bone was 9.672 <+/-2.745 mm in COM and 12.430 +/-3.027 mm in normal ear. The difference was statisfically significant (p < 0.0001). The mean depth of the sigmoid sinus was 7.557 +/-1.868 mm in COM and 7.591 +/-2.315 mm in normal ear, with no statistically significant difference. In the childhood group, the mean axial thickness of the mastoid bone was 8.672 +/-2.978 mm in COM and 11.778 +/-3.087 mm in normal ear. This difference was statistically significant (p < 0.05). In the adult group, the corresponding figures were 9.742 +/-2.731 mm in COM and 12.538 +/-3.041 mm in normal ear, a dif-ference which was also statistically significant (p < 0.0001). Among patients with an obvious history of COM, child-onset cases totalled 24 (mean axial thickness of the mastoid bone, 9.2.0 +/-2.158 mm), while there were 29 adult-onset cases (mean axial thickness, 10.08 +/-2.99 mm). This difference in thickness between child-onset and adult-onset COM was statistically significant (p < 0.05). CONCLUSION: In COM, the degree of mastoid pneumatization is proportional to the axial thickness of the mastoid bone, and inversely proportional to the degree of sclerosis, anterior location of the sigmoid sinus and the onset of COM. If the sigmoid sinus is properly located, COM may inhibit mastoid pneumatization.
Adult ; Colon, Sigmoid* ; Ear ; Ear, Middle ; Humans ; Mastoid* ; Medical Records ; Postoperative Complications ; Sclerosis ; Surgical Procedures, Operative ; Temporal Bone

Dieulafoys lesion consists of abnormally large gastric submucosal artery which ruptures into the stomach causing massive or recurrent intragikstric bleeding. The lesion is very small and easily overlooked even at laparatomy and aan only be correctly diagnosed by endoscopy or arteriography if the patient is actively bleeding. Three patients who were admitted with bleeding of upper gastrointestinal tract and eventually diagnosed as having Dieulafoys lesions were analysed. All were men with age range of 44 to 55 years. All patient were asymptomatic before presenting with hematemesis. Two of the three patients had had history of upper Gl bleeding. One patient used analgesics daily for ureteral colic and two patient drank alcohol excessively. Gastroscopy was performed during the bleeding episode in all three patients. Dieulafoy's lesion was seen in all three cases and in the second case, there was concomittent diffuse petechia in the whole stomach. The lesion was situated on the posterior wall of upper body in one, on anterior wall of upper body in another, lesser curvature side of gastric fundus in the other case. All three patient underwent laparotomy for persistent bleeding and the lesion was suture ligated only in two patients while in one patient vagotomy and pyloroplasty was added. Resection biopsy was performed in two cases and both revealed only normal gastric mucosa. All patients discharged after complete recover.
Analgesics ; Angiography ; Arteries ; Biopsy ; Endoscopy ; Gastric Fundus ; Gastric Mucosa ; Gastroscopy ; Hematemesis ; Hemorrhage ; Humans ; Laparotomy ; Male ; Renal Colic ; Rupture ; Stomach ; Sutures ; Upper Gastrointestinal Tract ; Vagotomy

No abstract available.
Magnetic Resonance Imaging ; Malformations of Cortical Development*

Intravenous leiomyomatosis is a rare entity of benign smooth muscle invading into the lumen of veins. We describe a case of intracardiac leiomyomatosis originating from the right gonadal vein, growing in the inferior vena cava, and extending into the right atrium. A 54 years old woman presented with chest discomfort and syncope four years after the removal of an uterine leiomyoma. The tumor was successfully removed in a two-staged operation using total circulatory arrest with a cardiopulmonary bypass, which proved to be a histologically benign leiomyoma. Although these tumors are histologically benign, they sometimes extend into the cardiac cavity and can cause sudden death due to their incarceration into the atrioventircular orifice. We report this rare case with a review of the literature.
Cardiopulmonary Bypass ; Death, Sudden ; Female ; Gonads ; Heart Atria* ; Humans ; Leiomyoma ; Leiomyomatosis* ; Middle Aged ; Muscle, Smooth ; Syncope ; Thorax ; Veins ; Vena Cava, Inferior

Pulmonary involvement is more common in systemic lupus erythematosus (SLE) than in any other connective tissue disease, and more than half of patients with SLE suffer from respiratory dysfunction during the course of their illness. Although sepsis and renal disease are the most common causes of death in SLE, lung disease is the predominant manifestation and is an indicator of overall prognosis. Respiratory disease may be due to direct involvement of the lung or as a secondary consequence of the effect of the disease on other organ systems.
Cause of Death ; Connective Tissue Diseases ; Humans ; Lung ; Lung Diseases ; Lupus Erythematosus, Systemic* ; Prognosis ; Sepsis

The relationship between infective endocarditis and mycotic aneurysm formation appers clear : In about two to ten percent of patients with infective endocarditis harbor septic intracranial aneurysms. But the pathogenesis, natural course and management of these lesions remains controversial. Aggressive medical treatment of the underlying infected cardiac valve or surgical replacement therapy have significantly reduced the morbidity and mortality rates associated with infective endocarditis. Clinical predictors of mycotic aneurysm, especially neurologic prodromes prior to rupture have been ill-defined since most series contain few patients or include patients with infective aneurysms who have no infective endoarditis. Similarly there has been no consensus regarding the indications and timing of cerebral angiography in patients with infective endocarditis. We have experienced a case of cerebral mycotic aneurysm complicated with subarachnoid hemorrhage due to infective endocarditis in a 29 year-old female patient, who admitted to our hospital because of the pain and paralysis of sudden onset in right forearm, which was diagnosed by echocardiography, brain computed tomography and 4-vessel cerebral angiography. The patient died of sudden rupture of mycotic aneurysm in the 7th hospital day despite intensive medical treatment. We report one case of cerebral mycotic aneurysm with a brief of literature.
Adult ; Aneurysm ; Aneurysm, Infected* ; Brain ; Cerebral Angiography ; Consensus ; Echocardiography ; Endocarditis* ; Female ; Forearm ; Heart Valves ; Humans ; Intracranial Aneurysm ; Mortality ; Paralysis ; Rupture ; Subarachnoid Hemorrhage*

Spontaneously ruptured renal cell carcinoma (RCC) in end-stage kidney disease is very rare. Preoperative diagnosis is difficult because of the relatively small tumor size, associated hematoma, and surrounding acquired cysts. Two middle-aged men who were maintained on hemodialysis (HD) for over 10 years suddenly developed flank pain during HD. Computed tomography scans revealed an enhancing ruptured renal mass in one patient, and no obvious tumor lesion except for a hematoma in the other, both of which were later confirmed as RCCs by pathologic specimens.
Carcinoma, Renal Cell ; Flank Pain ; Hematoma ; Humans ; Kidney Failure, Chronic ; Male ; Renal Dialysis ; Rupture

Esophagopericardial fistala is a rare and usually life threatening complication of both benign and malignant esophageal disease. A case of pyopneumopericarduim in 45 year-old female is reported. Streptocoeeus viridana in pas celtore was isolated from pericardial pus. The disorder resulted from eaqyhagoyericardial fistula which probably developed as a complication of esophageal diverticnlum. The diagnasis of the fistula was established preoperatively on the basis of chest X-ray, esophagogram and. endoeeopic findings. The treatment was thoracotorny with drainage of pericardium, diverticulectomy and antimicrobial chemotherapy. The patieat improved postoperatively.
Drainage ; Drug Therapy ; Esophageal Diseases ; Female ; Fistula* ; Humans ; Middle Aged ; Pericardium ; Suppuration ; Thorax