We report a case of successful heart transplantation after 67 days of support with venoarterial extracorporeal membrane oxygenation (ECMO) in a patient who underwent surgery for type A aortic dissection and myocardial infarction complicated by irreversible myocardial damage and a deep sternal wound infection. During ECMO support, left heart vent and distal limb perfusion were performed. Mediastinitis was treated with mediastinal washout and irrigation. Multiple complications from peripheral ECMO were successfully managed.
Cardiomyopathies ; Extracorporeal Membrane Oxygenation* ; Extremities ; Heart Transplantation* ; Heart* ; Humans ; Mediastinitis* ; Myocardial Infarction ; Perfusion ; Shock ; Transplantation ; Wound Infection

Syringoma of the vulva is a rare disorder and limitation of the lesions to this site appears unique. Lesions can be clinically diagnosed without difficulty, since it is characterized by multiple, bilateral, asymptomatic skin-colored papules. Vuluar syringoma should be considered in the differential diagnosis of multicentric papular lesions of the vulva. The patient presented here is a 30-year-old healthy woman; lesions are multiple, biiateral, asymptomatic, angular or round, skin-colored to yellowish brown, firm papules localized on the vulvar region and showing a characteristic histologic findings.
Adult ; Diagnosis, Differential ; Female ; Humans ; Syringoma* ; Vulva*

We report a case of B-cell chronic lymphocytic leukemia (CLL) with trisomy 12 detected by FISH using chromosome 12 alpha-satellite Probe (Oncor , USA) in uncultured interphase cells. Chromosome studies did not produce an analyzable metaphase by standard short term culture and revealed only normal female karyotype by B cell mitogen (phorbol 12-myristate 13-acetate) stimulated 96 hr culture. The patient, a 59-year-old female, did not have hepatomegaly, splenomegaly, lymphadenopathy and any other symptoms. The peripheral blood of the patient showed marked lymphocytosis (WBC : 28,300/microL, Lymphocyte: 80%) and the diagnosis by immunophenotyping was B cell CLL:CD5, CDl9, CD2O, SmIg, HLA-DR positive.
Chromosomes, Human, Pair 12 ; Diagnosis ; Female ; Fluorescence* ; Hepatomegaly ; HLA-DR Antigens ; Humans ; Immunophenotyping ; In Situ Hybridization* ; Interphase ; Karyotype ; Leukemia, Lymphocytic, Chronic, B-Cell* ; Lymphatic Diseases ; Lymphocytes ; Lymphocytosis ; Metaphase ; Middle Aged ; Splenomegaly ; Trisomy*

We report a case of B-cell chronic lymphocytic leukemia (CLL) with trisomy 12 detected by FISH using chromosome 12 alpha-satellite Probe (Oncor , USA) in uncultured interphase cells. Chromosome studies did not produce an analyzable metaphase by standard short term culture and revealed only normal female karyotype by B cell mitogen (phorbol 12-myristate 13-acetate) stimulated 96 hr culture. The patient, a 59-year-old female, did not have hepatomegaly, splenomegaly, lymphadenopathy and any other symptoms. The peripheral blood of the patient showed marked lymphocytosis (WBC : 28,300/microL, Lymphocyte: 80%) and the diagnosis by immunophenotyping was B cell CLL:CD5, CDl9, CD2O, SmIg, HLA-DR positive.
Chromosomes, Human, Pair 12 ; Diagnosis ; Female ; Fluorescence* ; Hepatomegaly ; HLA-DR Antigens ; Humans ; Immunophenotyping ; In Situ Hybridization* ; Interphase ; Karyotype ; Leukemia, Lymphocytic, Chronic, B-Cell* ; Lymphatic Diseases ; Lymphocytes ; Lymphocytosis ; Metaphase ; Middle Aged ; Splenomegaly ; Trisomy*

No abstract available.
Dexamethasone*

Retroperitoneal duodenal rupture is rare and is often difficult to diagnose on the plain abdominal x-ray. From a review of the plain abdomen films of 21 cases with retroperitoneal duodenal rupture, confirmed by operation, pneumoretroperitoneum was revealed in 16 cases; Air in the peritoneum was manifested as a bubbly shadow in 12 cases, a renal halo in 9 cases, air shadow along the right psoas margin in 2 cases, air along the diaphragmatic crus in 2 cases and air in the right properitoneal fat in 2 cases, US and CT also revealed air bubbles and fluid collection around the right kidney. We recommend the plain abdomen as a useful diagnostic method for detection of pneumoretroperitoneum.
Abdomen* ; Kidney ; Methods ; Peritoneum ; Retropneumoperitoneum ; Rupture*

To present CT and clinical features of active tuberculomas, we analyzed retrospectively CT findings of 14 tuberculomas (n=14) in 13 patients which appeared as solitary pulmonary nodules on plain radiographs and evaluated the response of tuberculomas to antituberculous chemotherapy. Nine tuberculomas (64%) were ovoid in shape and 10 (72%) showed smooth margin. Twelve(86%) tuberculomas were shown as low density lesions on unenhanced or enhanced CT scans. Calcification and cavitation were noted in three (21%) and eight (57%) tuberculomas respectively. Seven (50%) tuberculomas were accompanied by satellite nodules. Acid-fast bacilli (AFB) was positive in all tuberculomas in sputum, lavage fluid, or percutaneous transhoracic needle aspiration (PTNA). Smear and culture of lavage fluid and PTNA aspirate were superior to the detection of AFB than sputum examination. Follow-up study with antituberculous chemotherapy in 14 tuberculomas resulted in complete disappearance in three, decrease in size in seven, and no visible change in the remaining four. These observations suggest that tuberculomas are well-defined, ovoid, and low-density nodules containing calcifications and/or cavitations. Tuberculomas are relatively indolent even with threatment.
Drug Therapy ; Follow-Up Studies ; Humans ; Needles ; Retrospective Studies ; Solitary Pulmonary Nodule ; Sputum ; Therapeutic Irrigation ; Tomography, X-Ray Computed ; Tuberculoma*

BACKGROUND: Tumor angiogenesis is required for tumor growth and metastasis. In this study, we investigated the correlation between the intensity of angiogenesis and stage, nodal status, histologic type, metastasis and survival rate of non-small cell lung cancer. METHOD: Formalin fixed, paraffin embedded surgical specimens of 45 patients who had surgically resected primary non-small cell lung cancers without pre or post perative adjuvant chemotherapy or radiotherapy were examined. The microvessel count(MVC) was demonstrated by immunohistochemical staining for CD31(platelet ednothlial cell adhesion molecule, PECAM). RESULTS: Microvessel counts(MVCs)in stage IIIA and IIIB were higher than in stage I and II(p<0.05). The MVC in patients with lymph node metastasis was higher than that in patients without lymph node metastasis, although the difference was not statistically significant(p>0.05). However, in adenocarcinoma, the MVC in patients with lymph node metastasis was significantly higher than that seen in patients without lymph node metastasis(p<0.05). The MVC in adenocaricinoma was higher than that in squamous cell carcinoma(p<0.05). The difference between the MVCs of adenocarcinoma and squamous cell carcinoma was not statistically significant in stage Iand II or NO stage(p>0.05). However, in stage IIIA and IIIB or N1~3 stage, the MVC in adenocarcinoma was higher than that in squamous cell carcinoma(p<0.05). MVC was more increased when metastasis developed within 12 months. In the same histologic type and stage, the duration of survival time in patients with high MVC was shorter than in patients with low MVC, however the difference was not statistically significant(p>0.05). The survival rate in patients with high MVCs was lower than that in patients with low MVCs(P<0.05). CONCLUSION: In non-small cell lung cancer, MVC correlated relatively well with pathologic stage, nodal status (limited in patients with adenocarcinoma), histologic type, postoperative metastasis and survival rate. However, in the same histologic type and stage, MVC was not significantly related to the duration of survival. Therefore the assessment of the intensity of angiogenesis in non-small cell lung cancer may be helpful in predicting prognosis and in selecting patients for systemic adjuvant therapy of potential metastasis according to the results.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Cell Adhesion ; Chemotherapy, Adjuvant ; Formaldehyde ; Humans ; Lung Neoplasms ; Lymph Nodes ; Microvessels ; Neoplasm Metastasis ; Paraffin ; Prognosis* ; Radiotherapy ; Survival Rate

BACKGROUND: Fanconi's anemia (FA) is an autosomal recessive disease characterized by aplastic anemia, pre-malignancy, congenital malformations and chromosome breakage syndromes. As up to 30% of patients have no detectable congenital anomalies, the modern diagnosis of FA rests on chromosomal breakage of patient's cells induced by chemical clastogens such as diepoxybutane (DEB) or mitomycin-C (MMC). METHODS: We have done chromosome breakage test to differentiate FA from 11 aplastic anemia, three Diamond-Blackfan syndrome, three myelodysplastic syndrome, one acute leukemia with congenital anomaly and three siblings of FA. The peripheral blood lymphocytes from each individual were co-cultured in phytohemagglutinin-containing medium by the three methods, i.e., DEB treated, MMC treated and un-treated. RESULTS: Five cases were found to have increased chromosomal breakages to DEB and MMC, confirming diagnosis of FA. Other 21 cases showed no increased chromosomal breakages. No overlap was found between FA group and others (P<0.01). In one FA, there was no increased spontaneous breakage, but increased breakage to DEB and MMC. Of five FA, one case showed no congenital anomalies. CONCLUSIONS: Chromosme breakage test was shown to be simple, reliable and useful in ascertaining the diagnosis of FA.
Anemia, Aplastic ; Chromosome Breakage* ; Diagnosis* ; Fanconi Anemia* ; Humans ; Leukemia ; Lymphocytes ; Mitomycin ; Mutagens ; Myelodysplastic Syndromes ; Siblings

Statement of problem: One of common problems associated with dental implant is the loosening of abutment screws that retain the implants. Purpose: This study was performed to investigate the influence of abutment screw length and repeated tightening on screw loosening in dental implant. Material and method: Forty nine Hexplants (13mm length, 4.3mm diameter, Ti grade IV, Warantec. Co. Ltd. Seongnam, Korea) and cementation type abutments(straight abutment) and abutment screws (0.4mm/pitch) were divided into 7 groups, depending on abutment screw length. Each implant and abutment was tightened to 30Ncm by torque controller(MGT50, MARK-10 Inc., USA) and the removal torque values were measured during 10 consecutive closure/opening trials Results and Conclusion: The results of comparing the removal torque value are as follows: 1. There is no significant difference in the removal torque value between groups in 10 consecutive closure/opening trials(p=0.97). 2. If the fractured abutment screw is engaged in longer than 2.425 thread length, there is no significant difference in the preload between the fractured abutment screw and the new abutment screw when both are equally tightened to 30 Ncm 3. The removal torque value in the 1st trial(24.510 Ncm) was lower than that in the 2nd,3rd,4th,5th,6th,7th trials and the removal torque value in the 2nd trials(25.551 Ncm) was maximum and was decreased in following trials. The removal torque value in the 1st trial was significantly lower than that in the 2nd,3rd,4th trials and was significantly higher than that in the 8th,9th,10th trials(p<0.05). 4. In the 2nd,3rd,4th,5th,6th,7th trials, the abutment screw was mainly influenced by settling effect and the higher preload was obtained. In the 8th,9th,10th trials, the abutment screw was mainly influenced by adhesive wear and the progressively lower preload was obtained.
Adhesives ; Cementation ; Dental Implants* ; Gyeonggi-do ; Torque