A 26-year-old man presented with a bluish speckled patch on the dorsum of the left hand. It had apperaed at birth as a bluish spot. Since adolescence the lesion extended and at the time of visiting hospital it covered the most part of the dorsum of the left hand and even some palmar aspect. The histopathological and ultrastructural examination revealed numerous dermal melanocytes, mainly in the upper dermis. Clinically and pathologically, the patient was diagnosed as having dermal melanocyte hamartoma, a distinct type of dermal melanocytosis.
Adolescent ; Adult ; Dermis ; Hamartoma* ; Hand ; Humans ; Melanocytes* ; Parturition

BACKGROUND: The fixed dose regimen with activated coagulation time (ACT) is the most commonly employed method for determining the required dosage of heparin and protamine during cardiopulmonary bypass (CPB). MATERIAL AND METHOD: We performed a prospective study on a fixed dose regimen for analyzing adequate dosages of heparin and protamine, the incidence of heparin resistance and heparin-induced thrombocyt openia, factors affecting ACT during CPB, and changes of ACT during aprotinin usage. 300 units/kg of heparin were administered to patients, and ACTs were measured after 5 mins. ACTs were checked at 10 mins and 30 mins after the onset of CPB, and then at 30 min intervals thereafter. If the measured ACT was under 400 secs, we added 100 units/kg of heparin. The heparin was reversed with 1 mg of protamine for each 100 units administered. If the measured ACT was longer than 130 secs 30 mins after protamine administration or if there was definitive evidence of a coagulation defect, we administered a further 0.5 mg/kg of protamine. RESULT: We studied 80 patients (50 adults and 30 children) who underwent open heart surgery (OHS) at Seoul National University Hospital. Preoperative ACT was 114.3+/-19.3 secs in adults, and 119.5+/-18.2 secs in children. There were no differences in preoperative ACT due to age, body weight, body surface area, or sex. The preoperative ACT was not influenced by a positive past history of OHS. Ten adults (20%) and 3 pediatric patients (10%) needed additional doses of heparin to maintain the ACT above 400 secs. Additional protamine administration was needed in 9 adults (18%) and 10 children (33%). Heparin resistance was found in only two adults. Heparin-induced thrombocytopenia was detected in 2 adults and 1 child. During CPB, ACT was prolonged. 12 adult patients received a low dose of aprotinin and showed longer celite activated ACT compared to the control group.The kaolin activated ACT showed a lower tendency than the celite activated ACT in aprotinin users. CONCLUSION: In conclusion, fixed dose regimen of heparin and protamine can be used without significant problems, but the incidence of need of additional dosage remains unsatisfactory.
Adult ; Aprotinin ; Body Surface Area ; Body Weight ; Cardiopulmonary Bypass* ; Child ; Diatomaceous Earth ; Heparin* ; Humans ; Incidence ; Kaolin ; Prospective Studies ; Seoul ; Thoracic Surgery ; Thrombocytopenia

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. Several recent findings that there are activating mutations in the KIT and PDGFRA (platelet-derived growth factor receptor-alpha) genes of GISTs provide the rationale for using targeted therapies such as imatinib or sunitinib. Sunitinib, an oral multitargeted receptor tyrosine kinase inhibitor that inhibits kinases such as KIT, PDGFR (platelet-derived growth factor recepter), and VEGFR (vascular endothelial growth factor receptor), was recently approved for the treatment of imatinib-refractory GIST. Sunitinib is generally well tolerated and has an acceptable toxicity profile; an adverse event such as bowel perforation is rare. We present a patient with imatinib-refractory GIST who was successfully treated using sunitinib, but developed bowel perforation. The mechanism involved in bowel perforation associated with sunitinib is unknown. However, we presume that in our patient, the dramatic reduction in disseminated peritoneal metastases and bowel invasion of recurrent GIST during sunitinib treatment might have resulted in the bowel perforation.
Endothelial Growth Factors ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Humans ; Intestinal Perforation ; Neoplasm Metastasis ; Phosphotransferases ; Protein-Tyrosine Kinases ; Imatinib Mesylate

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. Several recent findings that there are activating mutations in the KIT and PDGFRA (platelet-derived growth factor receptor-alpha) genes of GISTs provide the rationale for using targeted therapies such as imatinib or sunitinib. Sunitinib, an oral multitargeted receptor tyrosine kinase inhibitor that inhibits kinases such as KIT, PDGFR (platelet-derived growth factor recepter), and VEGFR (vascular endothelial growth factor receptor), was recently approved for the treatment of imatinib-refractory GIST. Sunitinib is generally well tolerated and has an acceptable toxicity profile; an adverse event such as bowel perforation is rare. We present a patient with imatinib-refractory GIST who was successfully treated using sunitinib, but developed bowel perforation. The mechanism involved in bowel perforation associated with sunitinib is unknown. However, we presume that in our patient, the dramatic reduction in disseminated peritoneal metastases and bowel invasion of recurrent GIST during sunitinib treatment might have resulted in the bowel perforation.
Endothelial Growth Factors ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Humans ; Intestinal Perforation ; Neoplasm Metastasis ; Phosphotransferases ; Protein-Tyrosine Kinases ; Imatinib Mesylate

Clinical observation was made on 11 cases of ureterosigmoidostomy during the period from 1959 to 1976. Age ranged from 27 to 65 years and 7 female and 4 male each. Underlying diseases at the time of operation were 6 cases of vesico-vaginal fistula and 5 cases of bladder tumor. Their operation time, amount of transfusion, electrolyte balance, early and late complications after operation were analyzed. It seemed to us that despite the many urologist abandon ureterosigmoidostomy and prefer ileal diversion, its usefulness is assessed in our paper and applicable to some selected patients.
Female ; Fistula ; Humans ; Male ; Urinary Bladder Neoplasms ; Water-Electrolyte Balance

No abstract available.
Complement System Proteins* ; Otitis Media with Effusion* ; Otitis Media* ; Otitis*

The coexistence of extraadrenal pheochromocytoma and renal artery stenosis is extremely rare. The mechanisms of renal artery stenosis with pheochromocytoma include direct compression of the tumor mass on the renal artery and catecholamine-induced vasospasm, fibromuscular hyperplasia, and fibrous adhesion. We report a rare case of renal artery stenosis caused by extraadrenal pheochromocytoma in a 29- year-old female. She was admitted to the hospital because of palpitation and headache. She had been treated for hypertension for 2 years. On admission, her plasma epinephrine and norepinephrine levels were elevated as were her plasma renin activity, urinary vanillylmandelic acid (VMA) and metanephrine levels. Through the use of abdominal computed tomography, 131I-MIBG scan, and renal arteriography, a mass was found in the hilus of the left kidney which affected left renal artery stenosis. Surgical removal of the mass and left kidney restored the catecholamine excretion, plasma renin activity, and blood pressure to normal. Electronmicroscopic examination of the mass confirmed the pheochromocytoma.
Angiography ; Blood Pressure ; Epinephrine ; Female ; Headache ; Humans ; Hyperplasia ; Hypertension ; Kidney ; Metanephrine ; Norepinephrine ; Pheochromocytoma* ; Plasma ; Renal Artery Obstruction* ; Renal Artery* ; Renin ; Vanilmandelic Acid

No abstract available.
Glomerulonephritis, IGA* ; Hodgkin Disease* ; Immunoglobulin A*

Popliteal artery entrapment syndrome can result from abnormal branching patterns of the popliteal artery or the anatomically abnormal placement of nearby muscles and tendons leading to a sustained compression of the popliteal artery. This compression leads to chronic capillary damage and early arteriosclerosis and embolism that can lead to distal ischemia. Thus early treatment is required to prevent harm to the lower limb. This is a rare congenital disease that mostly affects young adults, usually presenting with intermittent claudication of the leg, coldness and edema. A case where a 16-year-old female presented with pain and coldness in the lower right limb that started 1 year ago will be discussed. In this case, magnetic resonance imaging and arterial angiography lead to a diagnosis of popliteal artery entrapment resulting from an abnormal origin of the medial head of Gastrocnemius.
Angiography ; Arteries ; Arteriosclerosis ; Capillaries ; Cold Temperature ; Edema ; Embolism ; Extremities ; Female ; Head ; Humans ; Intermittent Claudication ; Ischemia ; Leg ; Lower Extremity ; Magnetic Resonance Imaging ; Muscle, Skeletal ; Muscles ; Popliteal Artery ; Tendons ; Young Adult

No abstract available.
Teratoma* ; Uterus*