Hamartoma of the bladder is quite a rare entity which is composed of a disorderly admixture of mature cellular elements normally present in the urinary bladder. There is a great controversy regarding the pathogenesis of this lesion. Whether it is a true hamartomatous lesion or metaplastic lesion developed secondary to the inflammatory process. Similar or identical lesions has often been given by other names such as florid examples of cystitis glandularis. We prefer to cell florid examples of cystitis glandularis rather than hamartoma when it was occurred in an old age higher then 50th decade. Here we report a case of hamartoma of the urinary bladder in 44 years old man. Cystoscopic examination revealed a papillary polypoid mass which was attached to the fundus of bladder by long stalk. The mass measured 1.5 cm in greatest diameter. It was composed of epithelial nests resembling von Brunn's nest, cystitis glandularis or cystitis cystica dispersed in a stroma rich in smooth muscle and fibrous tissue.
Hamartoma

Histopathologic and immunohistochemical analysis using antibodies for S-100 protein and keratin has been conducted on 21 cases of malignant schwannomas. The 21 cases were divided into the following three groups Group A: tumors originating from the nerve trunk or neurofibroma; Group B: tumors related to von Recklinghausen's disease; and Group C: other tumors not belonging to the above groups but histologically diagnosed as malignant schwannoma. The commonest histological pattern consisted of either closely packed or loosely arranged interlacing fascicles of slender spindle cells with wavy fibrillar cytoplasm, followed by myxoid change, perithelial pattern, hyaline change of the blood vessels, and hyalinlzed cords or nodules. Nine out of 12 cases of malignant schwannomas in group A and B, and 7 out of 9 cases of group C were positive for S-100 protein. None of the above cases showed positive staining reaction for keratin. Since 7 of 9 malignant schwannomas in Group C stained with S-100 protein, we can conclude that careful histological analysis supplemented by immunohistichemical study can make a conclusive diagnosis in most of the cases of malignant schwannomas even in cases that do not fulfil the traditional strict criteria.

BACKGROUND: Cardiac hypertrophy is the compensatory response of the myocadium to increased workload. Compensatory mechanisms come into play when the hypertrophied heart can no longer accommodate the increased demand or persistent stimuli. Although it has been reported that the molecular changes in hypertrophied hearts that initially mediate enhanced function may contribute to the development of heart failure, the structural/biochemical/molecular basis for myocardial contractile failure is still obscure. This study was aimed to clarify the structural basis for relation between hypertrophy and failure. METHOD: Nine pairs of rabbits were sacrificed at 8,12,24,48 hours and 1,2,4,6,8 weeks after experiment aortic constriction. There hearts were studied with routine histopathology. Each heart was weighed and compared with total body weight. Multiple sections were embedded in paraffin, sectioned at 5um, and stained with hematoxylin and cosin and Masson's trichrome and analysed. RESULTS: The heart weight to body weight ratio(g/Kg) increased progressively with time after aortic banding. Banding of the aorta in the rabbit resulted in multifocal areas of myofiber degeneration, necrosis and fibrosis through the wall of the left ventricle, in the papillary muscles of the left ventricle and in the left ventricular portions of the interventricular septum in rabbit of 6 and 8 weeks after aortic banding. By 4 weeks after banding, the foci of necrosis were not observed. CONCLUSION: There findings suggest that the increased necrosis, fibrosis in animals with cardiac hypertrophy induced by banding the aorta may play a role in progression to heart failure.
Animals ; Aorta ; Body Weight ; Cardiomegaly ; Constriction ; Fibrosis ; Heart Failure ; Heart Ventricles ; Heart* ; Hematoxylin ; Hypertrophy ; Necrosis* ; Papillary Muscles ; Paraffin ; Rabbits

BACKGROUND: The measurement of nonspecific bronchial hyperreactivity is valuable for diagnosis and management of bronchial asthma. Methacholine or histamine is used for the pharmacologic provocation test. Usually a methacholine bronchial provocation test is performed by a dosing technique with counted number of breaths. A dosimeter is indispensable in the dosing technique. Recently a timed tidal breathing technique which dose not need an expensive dosimeter was introduced. We measured the degree of nonspecific bronchial hyperreactivity to histamine using a simple timed tidal breathing technique. METHOD: Forty two healthy volunteers, 12 patients with bronchial asthma(BA), 10 patients with rhinitis(RH) and 10 patients with upper respiratory infection(URI) participated in the study. The subject's nose was clipped and inhalation continued during tidal breathing for 2 minutes via a face mask. FEV1 was measured at 30 seconds, 90 seconds after inhalation and inhalation of next solution was continued until there was a fall in FEV1 of 20%. Histamine PC20 was defined as the concentration at 20% fall of FEV1 and it was obtained from the log dose-response curve by linear interpolation. RESULTS: Inhalation of serial dilution of histamine could be performed in all patients without significant side of effects. The geometric mean±standard deviation of histamine PC20 in healthy volunteers is 8.27±2.22mg/ml, BA group 0.33±3.02mg/ml, RH group 0.85 ±3.24mg/ml, and URI group 1.47±1.98mg/ml. CONCLUSION: Histamine bronchial provocation test using timed tidal breath method is a simple and suitable tool for management of patients with bronchial hyperreactivity.
Asthma ; Bronchial Hyperreactivity ; Bronchial Provocation Tests* ; Diagnosis ; Healthy Volunteers ; Histamine* ; Humans ; Inhalation ; Masks ; Methacholine Chloride ; Nose ; Respiration*

Home health care is moving into a set of new realities. An era of competition and cost containment has arrived. Before nurses are able to contain costs or describe the relationship between nursing activities, cost must be accurately measured based on the nurse's workload. Nurses in home health care usually desire to measure expenses for one of three reasons : reimbursement, management, or research. The purpose of the study was to investigate the work input by Registered Nurse in each of the home health care activities by relative value units and identify the factors affecting the nurses' total work input in health care services. To measure the work input by nurses, work was defined by four dimensions: time, physical effort, mental effort, and stress. This study used a descriptive-correlational design. Data collection consisted of two phases. In phase I, data on home health activities performed by nurses were collected. In phase II, data on nurses' time, physical effort, mental effort, and stress in each of home health care activities discovered phase I were collected. In this method, the respondent was asked to rate a service in relation to a reference service using a ratio scale. The sample included 39 home health care nurses. The results of the study indicated that home health care activities performed by the nurses were in 10 categories and 69 items. Measuring the relative work inputs in each of home health care activities, and foley catheterization was selected as the reference to service. In terms of time and physical effort dimensions, full bath service was rated as the most strenuous among 69 activities by the respondents, and intramuscular injection was rated as least. It was found that emergency treatment required the highest mental effort and the highest stress, while blood sugar tests required the lowest mental effort. Approximately 91.3% of the variance in total work input was accounted for by the linear combination of time, physical effort, mental effort judgement, and stress. Examining the regression coefficients of those variables, physical effort, time, and stress were found as the predictors which were significantly associated with the total work of nurses in home health care. Professional nursing's next step in the conundrum of economic volatility is to develop a tool to reflect the interaction of functional deficiency and direct professional nursing care. And this will be a more accurate predictor of nursing resource use and ultimately a great forcaeter cost.
Baths ; Blood Glucose ; Cost Control ; Surveys and Questionnaires ; Delivery of Health Care* ; Emergency Treatment ; Injections, Intramuscular ; Nursing ; Nursing Care ; Physical Exertion ; Urinary Catheterization ; Volatilization

Atherosclerotic heart disease is a major source of cardiovascular morbidity and mortality in adult populations. To assess the prevalence of anatomical and functional abnormalities of the heart in such patients, we studied total 50 subjects with atherosclerotic heart disease by echocardiography and compared with 27 control subjects. We found significant change(p<0.05) of aortic root dimension, left ventricular mass, mitral valve E-F slope, E-point septal separation, and functional measurements show significant change in ejection fraction and fractional shortening of left ventricle. Characteristically, abnormal septal movement reveals in 70% of patients including paradoxical, flat & diminished, hyperactive motion, and among them paradoxical movement is the most frequent. Also left ventricular posterior wall movement is abnormal in 30% of the patient group. The prevalence of echocardiographic abnormalities is 80 percentile of total, which include 30 percentile subjects with only echocardiographic abnormalities without abnormality in 12-lead ECG, chest X-ray and laboratory findings. And these abnormalities can be detected well by echocardiography before they were otherwise apparent.
Adult ; Echocardiography* ; Electrocardiography ; Heart Diseases* ; Heart Ventricles ; Heart* ; Humans ; Mitral Valve ; Mortality ; Prevalence ; Thorax

BACKGROUND: Troponin T(TnT), a 37 kDa polypeptide subunit of contractile protein, is part of the troponin complect in striated muscle, where it binds to tropomyosin. TnT is not usually found in circulating blood, but increase in serum by cytoplasmic damage. Because the amino acid sequence is unique to cardiac muscle, one can immunologically differentiate skeletal muscle and cardiac protein isoforms. METHODS: We evaluated serum cardiac TnT (ELISA, Troponin-T, Boehringer Mannheim, Germany) versos CK-MB mass (IMX CK-MB, Abbott Laboratories, USA) in 46 cases (173 samples) of acute myocardial infarction, 28 cases (94 samples) of ansi na pectoris, 23 cases (62 samples) of other cardiac disease, and 32 cases of non-cardiac disease from September 1994-June 1996. RESULTS: TnT was detected in serum(cutoff value 0.20 ng/ml) within 6 hours after onset of chest pain, slightly earlier than CK-MB mass (cutoff value 5.0 ng/ml). Sensitivity of TnT (81%) is not statistically different from CK-MB mass (84%) within 24 hour of cutest pain but more sensitive after 24-72 hours of symptom, Specificity (79.5%) and positive predictive value (70.7%) of TnT were superior to that of CK-MB mass within 24 fours of cutest pain, and persistent to 6 days, which was longer than that of Cl4-MB mass. More patients show increment of TnT in unstable angina pectoris(40.0%) than stable angina pectoris(15.4%), No difference in detection rate of TnT between angina pectoris(28.6%) and other cardiac disease patients(34.8%). Only 3.1 % of non-cardiac disease patients show TnT increment. CONCLUSIONS: We concluded that TnT Is not detected In most of non-cardiac disease patients, and is an early and later marker with very wide diagnostic time win-dow. Also, TnT can be used as a valuable masker for ischemic myocardial damage in any underlying causes.
Amino Acid Sequence ; Angina, Stable ; Angina, Unstable ; Chest Pain ; Cytoplasm ; Heart Diseases ; Humans ; Muscle, Skeletal ; Muscle, Striated ; Myocardial Infarction* ; Myocardial Ischemia* ; Myocardium ; Protein Isoforms ; Sensitivity and Specificity ; Trinitrotoluene ; Tropomyosin ; Troponin T* ; Troponin*

No abstract available.
Brachial Plexus Neuropathies*

No abstract available.
Female ; Hypertension, Pregnancy-Induced* ; Pregnancy ; Pregnancy* ; Prolactin* ; Umbilical Cord*

Tetralogy of Fallot constitutes the highest proportion of cyanotic congenital heart disease and has four basic abnormal anatomical pictures including ventricular septal defect, pulmonary stenosis, aortic overriding and right ventricular hypertrophy. The work of Edward, et al(1965), Guntheroth, et al(1965) and Lev and Eckner(1964) has shown that the anatomical picture in a combination of just first two morphological characteristics, the aortic overriding and right ventricular hypertrophy being a consequence of the ventricular septal defect and pulmonary stenosis. Basic signs involve two categories, one is change of shunt rate depending on pulmonary stenosis, ventricular septal defect and systemic vascular resistance, and the other is physiological response to the chronically lowered PaO2. Thus the pathophysiological status presents to us more problems than other congenital heart disease in the care of patients during operation and anesthesia. Therefore, the anesthesiologist must understand the basic pathophysiology, various findings of examination, symptoms and signs, the problems during anesthesia and postoperative care. The purpose of this study was to evaluate the anesthetic management in total corrective surgery of tetralogy of Fallo which was performed at Severance Hospital. Out of consecutive 160 cases of tetralogy of Fallot in our past ten years experiences from 1971 to 1980, we selected the clinical results on anesthetic care of 12 cases which received total corrective surgery under hypothermia and extracorporeal circulation. The results were as follows: 1) Out of 121 cases, 82 cases were male(67.8%) and female was 39 cases(32.2%). The group aging from 6 to 10 year old was the highest proportion (44.6%) and the next proportion was the group aging from 11 to 15(22.3%). 2) Out of 121 cases, 91 cases were cyanotic(75.2%). On the diagnostic distribution, tetralogy of Fallot without any other anomaly was the most common(66.9%). 3) As for premedicants, secobarbital was the highest proportion(28.1%). For anesthetic maintenance, methoxyflurane with nitrous oxide was the most common(43.8%). 4) During cardio-pulmonary bypass, high flow perfusion was commonly used and the highest mean arterial pressure was 89.09+/-1.21 mmHg and the lowest mean arterial pressure was 36.33+/-1.21mmHg. 5) The major complications after operation and anesthesia were dysrhythmia(13.1%), pleural effusion(10.3%), main wound infection(10.3%), hemorrhage(8.3%), acute renal failure(8.3%), heart failure(6.9%), low output syndrome(4.1%) and cerebral infarction due to air emboliam(2.7%). 6) Out of 121 cases were expired and hospital mortality was 23.1%. The causes of death were heart failure(50%), acute renal failure(14.3%) and cerebral infarction(14.3%). in conclusion, anesthetic care for total corrective surgery of teralogy of Fallot should be based upon the understanding of the pathophysiology of disorder itself.
Female ; Humans ; Mortality