The cystic hypersecretory duct carcinoma of the breast was first described in 1984 by Rosen and Scott and warrants separate discussion because of its unusual pathological features. It is morphologically distinguishable from juvenile (secretory) carcinoma and from mucinous (colloid) carcinoma or mucocele-like tumor. We present a case report of intraductal cystic hypersecretory carcinoma of the breast with hormone receptor and oncogene study. The histologic differential diagnosis, with an emphasis on benign lesions that may have a predominant cystic component, is also discussed.
Breast Neoplasms ; Breast* ; Diagnosis, Differential ; Mucins ; Oncogenes

Nevoid basal cell carcinoma syndrome is a genetically determined disorder characterized by multiple basal cell carcinoma, palmoplantar pits and defects in other organs or tissues. Basal cell carcinoma may arise any sit of body. But infrequently typical basal cell carcinomas arise from the depressed epidermis which forms the base of the pits on the hands and feet. The patient was a 12 years old girl who developed multiple black-colored papules on the face and a dark reddish to black-colored pit over the palm and skin-colored depressed circumscribed pits on the plantar surface of feet. she also had an odontogenic cyst in the right maxilla, epidermal cyst on the trunk and mutiple intradermal nevi on the face. But the family history was not present. The histopathologic findings of the depressed pit of the palm showed a crater on the stratum corneum, and a well marginated tumor nest of basal cell carcinoma showing keratotic feature on the center of the lesion and reticulated feature on the periphery.
Basal Cell Nevus Syndrome* ; Carcinoma, Basal Cell* ; Child ; Epidermal Cyst ; Epidermis ; Female ; Foot ; Hand ; Humans ; Maxilla ; Nevus, Intradermal ; Odontogenic Cysts

A 47-year-old woman visited the hospital in 1989 for the evaluation of severely pruritic reddish to brownish patches of 3 year's duration on the face, trunk, back, upper and lower extremities. With the diagnosis of mycosis fungoides(premycotic stage), she had been treated with topical steroids, nitrogen musterd and PUVA with a recurrence. Then five years later, a tumorous skin lesion with ulceration developed on the left wrist joint, which did not respond to the previous topical therapies and cherriotherapy(BAM-M). So we tried electron beam therapy with a high-dose radiation(4,000cGy, 6 MeV). The electron beam therapy for 1 month resulted in a complete remission, which did not reveal any evidence of relapse during the one year follow-up period. As the electron beam therapy in mycosis fungoides has not yet been reported in Korean literature, we report a case of mycosis fungoides of advanced stage(TNM II b) showing a favorable response to the electrori beam therapy.
Diagnosis ; Female ; Follow-Up Studies ; Humans ; Lower Extremity ; Middle Aged ; Mycosis Fungoides* ; Nitrogen ; Recurrence ; Skin ; Steroids ; Ulcer ; Wrist Joint

The pathogenesis of systemic lupus erythematosus (SLE) appears to be multifactorial, including both genetic and environmental influences. The genetic factor of SLE is well known to have an important role in the pathogenesis based on epidemiological analysis and studies of monozygotic twins. The disease occur. more commonly in first degree relatives and may affect multiple persons in single families. We report a family in which two sisters developed systernic lupus erythematosus. The clinical, laboratory and histopathological findings showed characteristic features of systemic lupus erythematosus. HLA testing revealed that the two sisters shared common HLA-DR15(2)and HLA-A2.
HLA-A2 Antigen ; Humans ; Lupus Erythematosus, Systemic* ; Siblings* ; Twins, Monozygotic

Background: Endoscopic submucosal dissection has become popular. However, this can cause serious complications. In this case, esophageal perforation caused bilateral tension pneumothorax.Case: A 60-year-old man with esophageal adenoma underwent endoscopic submucosal dissection under general anesthesia. The peak airway pressure was 25 cmH2O after induction but abruptly increased to 40 cmH2O after 30 min. Respiratory sounds were barely heard. The lack of lung sliding in either (right-dominant) lung on ultrasound. Within minutes, oxygen saturation and systolic blood pressure decreased to 52% and 70 mmHg. Emergent needle thoracostomy, followed by chest tube insertion, was performed on right chest and his vital signs stabilized. Upon transfer to intensive care unit, oxygen saturation and blood pressure decreased again; therefore, a left chest tube was inserted. Conclusions Pneumothorax due to esophageal perforation can lead to life-threatening tension pneumothorax. Anesthesiologists should be aware of the risks and emergency treatment. Ultrasound can be useful for immediate bedside patient-care decisions.

Background: Endoscopic submucosal dissection has become popular. However, this can cause serious complications. In this case, esophageal perforation caused bilateral tension pneumothorax.Case: A 60-year-old man with esophageal adenoma underwent endoscopic submucosal dissection under general anesthesia. The peak airway pressure was 25 cmH2O after induction but abruptly increased to 40 cmH2O after 30 min. Respiratory sounds were barely heard. The lack of lung sliding in either (right-dominant) lung on ultrasound. Within minutes, oxygen saturation and systolic blood pressure decreased to 52% and 70 mmHg. Emergent needle thoracostomy, followed by chest tube insertion, was performed on right chest and his vital signs stabilized. Upon transfer to intensive care unit, oxygen saturation and blood pressure decreased again; therefore, a left chest tube was inserted. Conclusions Pneumothorax due to esophageal perforation can lead to life-threatening tension pneumothorax. Anesthesiologists should be aware of the risks and emergency treatment. Ultrasound can be useful for immediate bedside patient-care decisions.

We experienced anaphylaxis during general anesthesia twice in the same patient. After the first incidence of anaphylaxis at the induction of anesthesia, we speculated that the allergen was rocuronium. Thus, we administered sugammadex as well as a vasopressor to treat the anaphylaxis and the vital signs gradually recovered to nearly normal. Thereafter, we could not avoid the administration of another muscle relaxant, cisatracurium, since the patient moved uncontrollably after the surgery was restarted. A second anaphylactic event then occurred. We speculated that the second allergen was cisatracurium and stopped using it. The results of the investigation after the surgery showed that the allergens were indeed rocuronium and cisatracurium. When we encounter anaphylaxis during general anesthesia, it is necessary to suspect all administered medicines as the cause, with the potential of two or more causes, especially with muscle relaxants.
Allergens ; Anaphylaxis* ; Anesthesia ; Anesthesia, General* ; Humans ; Incidence ; Intradermal Tests ; Vital Signs

The heart disease during gestation complicates approximately 0.5-1.5% of pregnancies. The common cause of heart disease during gestation is acquired rheumatic valvular lesions and congenital heart defects. In contrast, infective endocarditis during pregnancy or the puerperium is quite rare, with fewer than 100 cases reported over the past 50 years. We present a case of bacterial endocarditis complicated by severe tricuspid valvular insufficiency and associated septic pulmonary emboli. Therapy consisted of cesarean section at 32 weeks gestation followed by tricuspid valvular replacement, removal of vegetation and primary closure of congenital ventricular septal defect.
Cesarean Section ; Endocarditis ; Endocarditis, Bacterial* ; Female ; Heart Defects, Congenital ; Heart Diseases ; Heart Septal Defects, Ventricular ; Postpartum Period ; Pregnancy*

OBJECTIVE: This study was aimed to evaluate the obstetric and perinatal outcomes of women with unexplained infertility following assisted reproductive technology (ART). METHODS: From January 1999 to February 2002, a total of seventy-nine singleton pregnancies which progressed beyond 20 weeks gestation following embryo transfer in women finally diagnosed as unexplained infertility by diagnostic laparoscopy were enrolled in this study. The matched control was spontaneously conceived 172 singleton pregnancies. Retrospectively, we analyzed the obstetric outcome and compared gestational age at delivery, birth weight, Apgar score, and the incidence of perinatal mortality, preterm labor, preeclampsia, gestational diabetes mellitus, and oligohydramnios between two groups. RESULTS: The mean gestational duration of study group was shorter than control group (38.2 +/- 0.5 vs. 39.4 +/- 0.1 weeks, p=0.001). The incidence of gestational diabetes mellitus was significantly higher in the study group (7.6% vs. 1.2%, p=0.01). There was no significant difference in the mean birth weight (3088.1 +/- 86.1 g vs. 3243.8 +/- 37.2 g), the incidence of small for gestational age (10.1% vs. 11.6%), preeclampsia (3.8% vs. 2.3%), oligohydramnios (3.8% vs. 5.8%), preterm labor (7.6% vs. 5.2%), cesarean delivery (45.6% vs. 41.3%), and perinatal mortality (1.3% vs. 0.6%) between the two groups. CONCLUSION: The gestational duration of women with unexplained infertility after IVF-ET was shorter, but the incidence of preterm birth was not increased. And the incidence of gestational diabetes mellitus of study group was higher than that of spontaneously conceived pregnancies.
Apgar Score ; Birth Weight ; Diabetes, Gestational ; Embryo Transfer ; Female ; Gestational Age ; Humans ; Incidence ; Infertility* ; Laparoscopy ; Obstetric Labor, Premature ; Oligohydramnios ; Perinatal Mortality ; Pre-Eclampsia ; Pregnancy ; Premature Birth ; Reproductive Techniques, Assisted* ; Retrospective Studies

PURPOSE: The prognosis for patients with stage IV gastric cancer is very poor. However, recently, some studies have reported benefits from a gastric resection for metastatic gastric cancer. This clinical study was performed to evaluate the effectiveness of a noncurative gastrectomy in treating stage IV gastric cancer with hepatic metastasis. MATERIALS AND METHODS: A retrospective analysis was performed on 98 gastric cancer patients who had undergone gastric resection, in spite of hepatic metastasis, between January 1990 and December 1996 at the Department of Surgery in 11 General Hospitals in Korea. RESULTS: The average age was 58 years old, and the male-to-female ratio was 69: 29. The laboratory tests were unable to predict hepatic metastasis. In 54 cases, hepatic metastasis was not identified before the surgery. The most common location of gastric cancer was antrum (72 cases). The most common gross type was Bonmann type III (78 cases). The serosa-exposed cases were 80. The peritoneal seeding was combined in 17 cases. A total gastrectomy was performed in 18 cases and a distal gastrectomy in 80. Lymph-node dissection was performed in 23 Dl, and 51 D2 cases. Hepatic resection was performed in 36 cases, The frequent histologic types were moderately differentiated and poorly differentiated tubular adenocarcinoma. Postoperative adjuvant chemotherapy was done in 70 cases. The complication rate (7%) was low. The median survival time was 15 months, with mean survival time of 18 months. The 2-year and 3-year survival rates were 23%, and 7%, respectively. In the univariate analysis, good survival was closely related to limitation of hepatic metastasis to one lobe, a few metastases to both lobes, negativity of peritoneal seeding and lymph node dissection more than D2 (p<0.05), CONCLUSIONS: An aggressive gastric resection for stage IV gastric cancer with hepatic metastasis might be beneficial in lengthening the survival period. A prospective study is needed, especiaUy one with an exact evaluation and analysis of the quality of life between the gastrectomy and nonresection groups.
Adenocarcinoma ; Chemotherapy, Adjuvant ; Gastrectomy* ; Hospitals, General ; Humans ; Korea ; Lymph Node Excision ; Middle Aged ; Neoplasm Metastasis* ; Prognosis ; Quality of Life ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate