We report a case of Becker's nevus associated with smooth muscle hamartoma, in a 21-year-old male patient, which shows clinically match-head sized, flat topped, round to oval, grouped papules with hairs on the outer surface of the right arm, and microscopically reveals numerous bundles of smooth muscle fiber in the dermis.
Arm ; Dermis ; Hair ; Hamartoma* ; Humans ; Male ; Muscle, Smooth* ; Nevus* ; Young Adult

PURPOSE: With the development of endovascular interventions, hybrid reconstructions, which include the combination endovascular procedure and open bypass surgery, have been increasingly used for the management of peripheral arterial occlusive disease (PAOD). The goal of this study is to present our results in the management of PAOD and to define the role of staged hybrid techniques in patients who need revascularization compared to other revascularization procedures, such as open or endovascular techniques. METHODS: We reviewed 104 patients who underwent arterial revascularization between January 2005 and June 2010, retrospectively. The data were divided into three groups by treatment modality: the open bypass group (n=47, 45.2%), the endovascular group (n=46, 44.2%), and the staged hybrid group (n=11, 10.6%), and were classified according to the Trans-Atlantic Society Consensus II (TASC II) A/B/C/D. Patients' characteristics, overall primary and secondary patency rates, and 30-day complications were compared between the three groups. RESULTS: Mean age was 69.6 years and 84.6% were male. There were more TASC II D lesions and multiple lesions in the hybrid group. There were no statistically significant differences in the 36-month mortality rate, primary patency rate, and secondary patency rate among the three groups (P=0.170, 0.838, and 0.767, respectively). CONCLUSION: Staged hybrid revascularization is an acceptable strategy in patients with PAOD, especially TASC II D and multiple lesions for suitable case with comparable patency, even though the number of cases was relatively small.
Arterial Occlusive Diseases ; Chimera ; Consensus ; Endovascular Procedures ; Humans ; Male ; Peripheral Arterial Disease ; Retrospective Studies

BACKGROUND: Pulmonary thromboembolism is relatively frequent and potentially fatal. However, it is commonly misdiagnosed. The incidence of pulmonary thromboembolism is not decreasing despite advances in diagnosis and effective prophylatic measures. Its potential for significant sequela necessitates a prompt diagnosis and treatment. Unfortunately, there are many difficulties and problems regarding accurate diagnosis. There is a low prevalence of deep vein thrombosis and pulmonary thromboembolism in Korea and only few reports on this subject are available. METHOD: The clinical features of 36 patients, who were diagnosed with pulmonary thromboembolism at the Korea University medical center, were reviewed. RESULTS: 1) There was no significant difference in prevalence between men an women, and the mean age was 50.9 years in men 59.2 years in women. 2) The frequent causes of pulmonary thromboembolism were malignancies (22.2%), surgery (22.2%), and heart disease(8.2%). Specific causes were not identified in 33.3%. 3) The most common symptom was dyspnea(72.2%), and the most common sign was tachypnea(61.1%). 4) The EKG findings were normal in 28.6%, and S1Q3T3 pulmonale pattern in 25.7%, ST or QRS changes in others. 5) The chest X-ray findings indicated pulmonary infiltation in 37.5%, cardiomegaly in 15.6%, pleural effusion in 12.5%, and normal in 27.8%. The perfusion lung scan showed a high probability in 66.7%, and intermediate or low probability in 33.3%. 6) The pulmonary arterial pressure(PAP) in the high probability groups was 57.9mmHg with a higher mortality rate(35%). CONCLUSION: Pulmonary thromboembolism is not uncommon in Korea and its clinical features do not differ greatly from those reported in the literature. When pulmonary thromboemblism of unknown causes are diagnosed, a search for an occult malignancy is recommended. Rapid diagnosis and treatment are achieved when thromboemblism is suspected.
Academic Medical Centers ; Cardiomegaly ; Diagnosis ; Electrocardiography ; Female ; Heart ; Humans ; Incidence ; Korea ; Lung ; Male ; Mortality ; Perfusion ; Pleural Effusion ; Prevalence ; Pulmonary Embolism* ; Thorax ; Tomography, Spiral Computed ; Venous Thrombosis

Fitz-Hugh-Curtis syndrome (FHCS) is characterized by inflammation of the perihepatic capsules associated with the pelvic inflammatory disease (PID). FHCS is not a serious disease, but if not treated properly, it can result in increased medical costs, prolonged treatment, and dissatisfaction with treatment. However, early recognition of FHCS in the emergency department can be difficult because its symptoms or physical findings may mimic many other diseases. Although contrast-enhanced computed tomography (CECT) is the useful imaging modality for recognition of FHCS, it is available only when a high suspicion is established. We performed point-of-care ultrasonography in an 18-year-old woman who had a sharp right upper quadrant (RUQ) abdominal pain without PID symptoms and found a thickened or three-layer hepatic capsule. These findings coincided with areas showing increased hepatic capsular enhancement in the arterial phase of CECT. These results show that if the thickened or three-layer hepatic capsule without evidence of a common cause of RUQ pain is observed on ultrasonography in women of childbearing age with RUQ abdominal pain, the physician can consider the possibility of FHCS.

Fitz-Hugh-Curtis syndrome (FHCS) is characterized by inflammation of the perihepatic capsules associated with the pelvic inflammatory disease (PID). FHCS is not a serious disease, but if not treated properly, it can result in increased medical costs, prolonged treatment, and dissatisfaction with treatment. However, early recognition of FHCS in the emergency department can be difficult because its symptoms or physical findings may mimic many other diseases. Although contrast-enhanced computed tomography (CECT) is the useful imaging modality for recognition of FHCS, it is available only when a high suspicion is established. We performed point-of-care ultrasonography in an 18-year-old woman who had a sharp right upper quadrant (RUQ) abdominal pain without PID symptoms and found a thickened or three-layer hepatic capsule. These findings coincided with areas showing increased hepatic capsular enhancement in the arterial phase of CECT. These results show that if the thickened or three-layer hepatic capsule without evidence of a common cause of RUQ pain is observed on ultrasonography in women of childbearing age with RUQ abdominal pain, the physician can consider the possibility of FHCS.
Abdominal Pain ; Adolescent ; Capsules ; Emergency Service, Hospital ; Female ; Humans ; Inflammation ; Pelvic Inflammatory Disease ; Point-of-Care Systems ; Ultrasonography

BACKGROUND AND OBJECT: Immunostimulatory CpG-oligodeoxynucleotides (ISS CpG-ODN) up-regulate the TH1-type immune response and down-regulate the TH2-type response. This study was performed to investigate the immune response changes resulting from ISS CpG-ODN on bronchial hyperrestponsiveness, eosinophilic inflammation and mucus hypersecretion in rat asthma. MATERIALS AND METHODS: 10 normal controls(NC) and 26 asthmatic rats, which were generated by ovallbumin(OVA) sensitization and challenge, were studied. The asthmatic rats were randomized into 11 asthma controls(AC) and 15 in the asthma-CpG treatment group(CpG). The CpG group was administered ISS CpG-ODN intramuscularly and the AC group was administered a placebo(0.9% NaCl)on day 15 and 20. After CpG-ODN or placebo administration, we measured the IFN-(TH1-type cytokine) and IL-4(TH2-type cytokine) levels in the bronchoalveolar lavage fluid(BALF), the specific airway resistance(sRaw), eosinophilic fraction in BALF, eosinophilic infiltration, goblet cell dysplasia and MUC5AC gene expression in the lung tissue. RESULTS: In the BALF of the CpG group, the IFN-γ concentration was significantly high and the IL-4 concentration was significantly low when compared with the AC group. Both the sRaw and eosinophilic fraction, and infiltration into the BALF and lung tissue significantly lower in the CpG group when compared with the AC group. However, little difference in goblet cell dysplasia and MUC5Ac gene expression was observed between the CpG group and the Ac group. CONCLUSION: ISS CpG-ODN decreases bronchial hyperresponsiveness and eosinophilic inflammation in the rat asthma model through the up-regulation of the TH1-type immune response with the down-regulation of the TH2-type response. However, the effect of these immune response changes on mucus hypersecretion was is not remarkable in this study.
Animals ; Asthma* ; Bronchoalveolar Lavage ; Down-Regulation ; Eosinophils ; Gene Expression ; Goblet Cells ; Inflammation ; Interleukin-4 ; Lung ; Mucus ; Rats* ; Up-Regulation

The characteristics of radionuclide brain scan imaging of intracranial lesion are determined, in part, by the rate and quantity of radioactive material in the region of involvement, which is associated with alterations in the blood brain barrier. Findings, noted on the blood flow studies, often serve to direct attention to forthcoming imaging of specific pathological change on the status studies, e.g, carotid artery occlusion and cerebral infarction. We have seen that the 62 year old woman with left side hemiparesis shows typical "Flip-Flap" pattern in brain scan imaging, thought to be due to carotid artery occlusion.
Blood-Brain Barrier ; Brain ; Carotid Arteries ; Cerebral Infarction ; Female ; Humans ; Middle Aged ; Paresis

PURPOSE: Rotter's nodes are removed in the course of a radical mastectomy, however they are not routinely removed in a modified radical mastectomy and breast conserving surgery, although they can be. Having been relatively ignored, the prognostic value and correlation of Rotter's nodes with axillary nodal status have rarely been reported or systematically studied. The aims of the present study were to assess the frequency and pattern of Rotter's node metastasis in breast cancer patients, and to compare the incidence of axillary lymph node metastasis and Rotter's node. We also investigated the rate of skip metastasis. METHODS: In order to investigate the predictability of axillary node positivity, we compared the status of axillary lymph nodes and the pathological prognostic markers. In 580 consecutive mastectomies performed for breast carcinomas between 1987 and 1999, axillary and Rotter's nodes were routinely dissected and separately sampled during mastectomy. RESULTS: The mean number of axillary lymph nodes and Rotter's nodes were 19.5 and 0.9. Axillary lymph nodes metastases were found in 47.2% of all patients. The frequency of axillary lymph node metastasis and the involvement of a higher level of axillary lymph node were significantly increased with increasing tumor size. However, metastasis at Rotter's nodes did not follow this pattern. Rotter's nodes were anatomically present in 39.8% of patients and an average of 2.3 lymph nodes was found in the interpectoral region. Rotter's metastases were found in 5% of all patients, and 10.6% of those with axillary lymph node metastases. The number of Rotter's nodes metastases was higher as the metastases were found at a higher level (p<0.05). CONCLUSION: The presence of axillary metastases was related to histologic grade, nuclear grade and lymphovascular invasion, but was not related to the mitotic index or perineural invasion. It is apparent that the potential risks from Rotter's and skip metastases were not great in all patients, although the routine excision of Rotter's nodes should be applied to patients with more locally advanced disease (T2-3, N1-N2).
Breast Neoplasms* ; Breast* ; Humans ; Incidence ; Lymph Nodes ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mastectomy, Segmental ; Mitotic Index ; Neoplasm Metastasis

PURPOSE: Rotter's nodes are removed in the course of a radical mastectomy, however they are not routinely removed in a modified radical mastectomy and breast conserving surgery, although they can be. Having been relatively ignored, the prognostic value and correlation of Rotter's nodes with axillary nodal status have rarely been reported or systematically studied. The aims of the present study were to assess the frequency and pattern of Rotter's node metastasis in breast cancer patients, and to compare the incidence of axillary lymph node metastasis and Rotter's node. We also investigated the rate of skip metastasis. METHODS: In order to investigate the predictability of axillary node positivity, we compared the status of axillary lymph nodes and the pathological prognostic markers. In 580 consecutive mastectomies performed for breast carcinomas between 1987 and 1999, axillary and Rotter's nodes were routinely dissected and separately sampled during mastectomy. RESULTS: The mean number of axillary lymph nodes and Rotter's nodes were 19.5 and 0.9. Axillary lymph nodes metastases were found in 47.2% of all patients. The frequency of axillary lymph node metastasis and the involvement of a higher level of axillary lymph node were significantly increased with increasing tumor size. However, metastasis at Rotter's nodes did not follow this pattern. Rotter's nodes were anatomically present in 39.8% of patients and an average of 2.3 lymph nodes was found in the interpectoral region. Rotter's metastases were found in 5% of all patients, and 10.6% of those with axillary lymph node metastases. The number of Rotter's nodes metastases was higher as the metastases were found at a higher level (p<0.05). CONCLUSION:The presence of axillary metastases was related to histologic grade, nuclear grade and lymphovascular invasion, but was not related to the mitotic index or perineural invasion. It is apparent that the potential risks from Rotter's and skip metastases were not great in all patients, although the routine excision of Rotter's nodes should be applied to patients with more locally advanced disease (T2-3, N1-N2).
Breast Neoplasms* ; Breast* ; Humans ; Incidence ; Lymph Nodes ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mastectomy, Segmental ; Mitotic Index ; Neoplasm Metastasis

PURPOSE: Surgical axillary dissection to determine the status of nodes remains as a part of the standard operation in the management of breast cancer. Rotter's nodes are removed in the course of a radical mastectomy but they are not routinely removed in a modified radical mastectomy and breast conserving surgery, although they can be. Having been relatively ignored, the prognostic value and correlation of Rotter's nodes with axillary nodal status have been rarely reported or systematically studied. The aim of the present study was to access the frequency and pattern of Rotter's node metastasis in breast cancer patients, and compare the incidence of axillary lymph node metastasis and Rotter's node. We also investigated the rate of skip metastasis. MATERIALS AND METHODS: To investigate the predicting axillary node positivity, we compared the status of axillary lymph node and pathological prognostic markers. In 580 consecutive mastectomy performed for breast carcinomas between 1987 to 1999, axillary and Rotter's node were routinely dissected and separately sampled during mastectomy . RESULTS: The mean number of axillary lymph node and Rotter's nodes were 19.5 and 0.9. Axillary lymph nodes metastases were found in 47.2% of all patients. Frequency of axillary lymph node metastasis and involvement of higher level of axillary lymph node were significantly increased by increasing tumor size. But metastasis at Rotter's nodes was not following this pattern. Rotter's nodes were anatomically present in 39.8% of patients and average 2.3 lymph nodes were found in the interpectoral region. Rotter's metastases were found in 5% of all patients, and 10.6% of those with axillary lymph nodes metastases. Number of Rotter's nodes metastases were higher as the metastases were found to higher level(P<0.05). CONCLUSION: The presence of axillary metastases were related to histologic grade, nuclear grade and lymphovascular invasion, but not related to mitotic index and perineural invasion. In summary, number of axillary lymph node and metastatic rate of axillary lymph nodes were similar to western reports. It is apparent that potential risk from Rotter's and skip metastases were not great in all patients, but routine excision of Rotter's nodes should be applied to patients with more locally advanced disease.
Breast Neoplasms* ; Breast* ; Humans ; Incidence ; Lymph Nodes ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mastectomy, Segmental ; Mitotic Index ; Neoplasm Metastasis