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

PURPOSE: Since the laparoscopic cholecystectomy became an usual procedure, operative indications of the gallbladder polyps have had the tendency to enlarge. There are no precise management plan about the gallbladder polyps which is not included in the accepted operative indications. Therefore a management plan may be required for the patients who has gallbladder polyps which is not accepted operative indications. METHODS: We retrospectively analysed 106 patients with gallbladder polyps who were diagnosed preoperatively by ultrasound and CT from January 1991 to January 2005. Our operation indications are polyp above 10 mm, symptomatic polyp, sessile polyp, coincidence of stone, focal thickening of gallbladder wall, diffuse wall thickening and detection during other operations. The gallbladder polyps which were suspected to the gallbladder cancer strongly on radiologic studies and polyps above 20 mm size were excluded in this studies. RESULTS: Among the 106 patients, 87 patients underwent operation, and polypoid lesions disappeared during the follow-up period in 3 patients, and 16 patients are on regular follow up. Fifty-six cases received operation with accepted operative indications, and the thirty-one cases underwent operation by the patient's demand. Two groups showed significant difference in true polyp on pathological diagnosis (P < 0.001). There was 16.07% true polyp in opertive indication based 56 patients and no true polyp in patient's demanded 31 cases. The pathologic diagnoses were cholesterol polyp in 27 patients (87.15%), no polyp in 2 patients, adenomatous hyperplasia in 2 patients. The correlation of the polyp size and pathologic diagnosis was an inverse relation to the polyp size and incidence of pseudopolyp (P=0.014). CONCLUSION: We propose that the 6-month-interval follow-up observation is fully safe for polyps sized below 10 mm and not included in accepted operative indications.
Cholecystectomy, Laparoscopic ; Cholesterol ; Diagnosis ; Follow-Up Studies ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Hyperplasia ; Incidence ; Polyps ; Retrospective Studies ; Surgical Procedures, Operative ; Ultrasonography

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

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

Wrong-route or -patient medication errors due to human mistakes have been considered difficult to resolve in clinical settings. In this study, we suggest a safety injection system that can help to prevent an injection when a mismatch exists between the drug and route or patient. For this, we prepared two distinct adapters with key and keyhole patterns specifically assigned to a pair of drug and route or patient. When connected to a syringe tip and its counterpart, a catheter injection-port, respectively, the adapters allowed for a seamless connection only with their matching patterns. In this study, each of the adapters possessed a specific key and keyhole pattern at one end and the other end was shaped to be a universal fit for syringe tips or catheter injection-ports in clinical use. With the scheme proposed herein, we could generate 27,000 patterns, depending on the location and shape of the key tooth in the adapters. With a rapid prototyping technique, multiple distinct pairs of adapters could be prepared in a relatively short period of time and thus, we envision that a specific adapter pair can be produced on-site after patient hospitalization, much like patient identification barcodes.
Catheters ; Hospitalization ; Humans ; Medication Errors* ; Syringes ; Tooth