Giant cell arteritis is a focal granulomatous inflammation of arteries of medium and small size that affects principally the cranial vessels, especially the temporal arteries, in older individuals. It appears to be a localized process; its significance apparantly depends on the organ affected. A 67-year-old man was admitted to hospital because of the left scrotal mass and pain lasting for 1 month. On physical examination, the hard masses were palpated at the superior part of the left epididymis without tenderness. Histologically, the spermatic cord showed granulomatous arteritis involving the small and medium sized arteries with a transmural inflammatory infiltrates centered on the inner media, and composed of lymphocytes, histiocytes, some eosinophils and multinucleated giant cells. The elastic tissue stain revealed the fragmentation of the internal elastic lamina along with numerous epithelioid histiocytes and giant cells.
Male ; Humans

PURPOSE: To evaluate the incidence of GB opacification, seen at CT, by contrast media injected a few hours earlier in adults with normal renal function and to assess the clinical significance of the opacification. MATERIAL AND METHODS: Seventeen patients with normal renal function were included in this study. Contrast enhanced CT scan was performed 4-13 hours after intravenous urography. As a control group, 17 patients in whom contrast media was not used in recent three days were included. The incidence of GB opacification and CT number of the GB were compared between 17 study patients and 17 control patients. RESULT: GB opacification(either homogeneous opacification or layering of contrast media and bile) was seen in 16 of 17 study patients(94%). GB was not opacified in any one of the control group. The mean CT number of GB was 174 HU in study patients, and was 27.3 HU in control patients. CONCLUSION:GB opacification seen at CT several hours after injection of water soluble contrast media seems to be a physiologic phenomenon, and that phenomenon should not be considered as a vicarious excretion due to impaired renal function.
Adult* ; Contrast Media* ; Humans ; Incidence ; Tomography, X-Ray Computed ; Urography

OBJECTIVE: To evaluate the clinical effect and reproductive outcome of pelviscopic ovarian drilling in infertile patients with polycystic ovarian syndrome resistant to clomiphene citrate. METHODS: Twenty two patients involved in this study were taken pelviscopic ovarian drilling with needle electrocautery. Change of characteristic LH/FSH ratio before and after operative treatment, ovulation and pregnancy success were followed up. Paired t-test was applied for hormonal change (p<0.05). RESULTS: Thirteen of 14 patients (93%) treated only with pelviscopic ovarian drilling showed successful ovulation with or without clomiphene citrate and among these 10 patients (71%) were success in pregnancy and 9 patients delivered full term babies. When including patients who needed other assisted reproductive technique and specific medication of endometriosis 17 of 22 patients (77%) were successfully pregnant and 15 patients (68%) delivered healthy babies. The mean LH/FSH ratio 2.0+/-0.5 before treatment were decreased to 1.26+/-0.37 after treatment (p<0.05). Interestingly, among 22 patients, various degree endometriosis were found during pelviscopy and specific medication with GnRH analogue were followed. CONCLUSION: Pelviscopic ovarian drilling showed successful ovulation rate and effective reproductive outcome in clomiphene-resistant infertile patients with PCO. This surgical technique seems to be an alternative step for the management of clomiphene-resistant infertile patients with PCO and also for the diagnosis of possible high rate of endometriosis in these patents.
Clomiphene* ; Diagnosis ; Electrocoagulation ; Endometriosis ; Female ; Gonadotropin-Releasing Hormone ; Humans ; Needles ; Ovulation ; Polycystic Ovary Syndrome* ; Pregnancy ; Reproductive Techniques, Assisted

Amniotic band syndrome is an uncommon congenital fetal abnormality with defects of skin resulting in ringlike strictures about the limbs and occasionally the trunk. Its pathogenesis has been still debated in the literature for many years. Amniotic band syndrome features multiple disfiguring and disabling manifestations. A clinical deformities include limb defects, craniofacial defect, visceral defect, body wall defect and other anomalies. We had experienced a case of amniotic band syndrome with retinopathy of prematurity, bilateral orofacial cleft, aphalangia of right hand, ventricular septal defect and atrial septal defect. We report this case with a brief review of the literature.
Amniotic Band Syndrome ; Congenital Abnormalities ; Constriction, Pathologic ; Extremities ; Hand ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Infant, Newborn ; Retinopathy of Prematurity ; Skin

Pheochromocytoma is originated from chromaffin cell of sympathetic nervous system and associated with other disease, such as neurofibromatosis, duodenal carcinoid, medullary thyroid cancer and parathyroid adenoma. Especially, pheochromocytoma is developed more than 50% in neurofibromatosis associated with hypertension. In such cases, several clinical features documented as more frequent bilateral phochromocytoma, more associated with other neuroendocrine tumors and thus more poor prognosis. We can observe the sustained hypertension despite of surgical resection of tumors in pheochromocytoma cases. One of the possible reason of post operative sustained hypertension is the pheochromocytoma originated from minor organ of Zukerkandl that was not resected during operation. Untreated or delayed treated cases with pheochromocytoma were often expired by complication of hypertension such as cerebrovascular hemorrhage, myocardial infarction, etc. Thus, in neurofibromatosis with hypertension, screening of pheochromocytorna is very important for the early detection of tumor and more favorable prognosis. Recently, We experienced a case of neurofibromatosis associated with bilateral pheochromocy-toma expired by cerebral hemorrhage during operation, so we report the case with literature review.
Carcinoid Tumor ; Cerebral Hemorrhage ; Chromaffin Cells ; Hemorrhage ; Hypertension ; Mass Screening ; Myocardial Infarction ; Neuroendocrine Tumors ; Neurofibromatoses* ; Parathyroid Neoplasms ; Pheochromocytoma* ; Prognosis ; Sympathetic Nervous System ; Thyroid Neoplasms

PURPOSE: Joubert syndrome presents neonatal respiratory abnormalities and other clinical manifestations. Pathologically the patients show hypoplasia or agenesis of cerebellar vermis and other intracranial anomalies. Our purpose is to evaluate the clinical manifestations and MR findings of Joubert syndrome. MATERIALS AND METHODS: Among the patients presenting with clinical stigmata of Joubert syndrome and agenesis of vermis on MR imaging, eight patients who did not satisfied the criteria of Dandy-Walker malformation, tectocerebellar dysraphia and rhombencephalosynapsis were selected. MR findings and clinical manifestation were analyzed. RESULTS: On MR imaging, agenesis of the cerebellar vermis (all cases), hypoplasia of the cerebellar peduncle (6cases), fourth ventricular contour deformity(6cases), tentorial elevation (4cases), deformity of the lateral ventricles (4cases), dysgenesis of the straight sinus (3cases) were demonstrated. Other findings were abnormalities of corpus callosum (3cases), falx anomalies (3 cases), occipital encephalomeningocele (2 cases) and fluid collection in posterior cranial fossa (2cases). Clinical manifestations were developmental delay (5cases), abnormal eyeball movement (3cases), hypotonia (2 cases), neonatal rerspiratoy abnormality (2cases), etc. CONCLUSION: Joubert syndrome showed various clinical manifestations and intracranial anomalies. MR imaging is an useful modality in detection of the cerebellar vermian agenesis and other anomalies of the patients.
Christianity ; Congenital Abnormalities ; Corpus Callosum ; Cranial Fossa, Posterior ; Dandy-Walker Syndrome ; Humans ; Lateral Ventricles ; Magnetic Resonance Imaging* ; Muscle Hypotonia

Purpose: Children have few small alveoli, which reduce lung compliance; in contrast, their cartilaginous rib cage makes their chest wall highly compliant. This combination promotes lung collapse. Prolonged inspiratory to expiratory (I:E) ratio ventilation is used to optimize gas exchange and respiratory mechanics in surgery. However, the optimal ratio is unclear in children. We hypothesized that, compared to a 1:2 I:E ratio, a 1:1 I:E ratio would improve dynamic compliance and oxygenation, and affect the peak airway pressure in pediatric patients undergoing surgery. Materials and Methods: Forty-eight patients aged ≤6 years who were scheduled to undergo surgery under general anesthesia with an arterial line were randomly allocated to receive 1:1 (group 1:1) or 1:2 (group 1:2) I:E ratio ventilation. Airway pressure, respiratory system compliance, and arterial blood gas analyses were compared between groups immediately after induction (T0), 30 min after induction (T1), 60 min after induction (T2), immediately after surgery (T3), and on arrival at the post-anesthesia care unit (T4). Results: Peak and plateau airway pressures were significantly lower in group 1:1 than in group 1:2 at T1 (p=0.044 and 0.048, respectively). The dynamic and static compliances were significantly higher in group 1:1 than in group 1:2 at T1 (p=0.044 and 0.045, respectively). However, the partial pressure of oxygen did not significantly differ between groups. Conclusion Compared to a 1:2 I:E ratio, a 1:1 I:E ratio improved dynamic compliance and lowered the peak airway pressure without complications in pediatric patients. Nevertheless, our results do not support its use solely for improving oxygenation.

Purpose: Children have few small alveoli, which reduce lung compliance; in contrast, their cartilaginous rib cage makes their chest wall highly compliant. This combination promotes lung collapse. Prolonged inspiratory to expiratory (I:E) ratio ventilation is used to optimize gas exchange and respiratory mechanics in surgery. However, the optimal ratio is unclear in children. We hypothesized that, compared to a 1:2 I:E ratio, a 1:1 I:E ratio would improve dynamic compliance and oxygenation, and affect the peak airway pressure in pediatric patients undergoing surgery. Materials and Methods: Forty-eight patients aged ≤6 years who were scheduled to undergo surgery under general anesthesia with an arterial line were randomly allocated to receive 1:1 (group 1:1) or 1:2 (group 1:2) I:E ratio ventilation. Airway pressure, respiratory system compliance, and arterial blood gas analyses were compared between groups immediately after induction (T0), 30 min after induction (T1), 60 min after induction (T2), immediately after surgery (T3), and on arrival at the post-anesthesia care unit (T4). Results: Peak and plateau airway pressures were significantly lower in group 1:1 than in group 1:2 at T1 (p=0.044 and 0.048, respectively). The dynamic and static compliances were significantly higher in group 1:1 than in group 1:2 at T1 (p=0.044 and 0.045, respectively). However, the partial pressure of oxygen did not significantly differ between groups. Conclusion Compared to a 1:2 I:E ratio, a 1:1 I:E ratio improved dynamic compliance and lowered the peak airway pressure without complications in pediatric patients. Nevertheless, our results do not support its use solely for improving oxygenation.

PURPOSE: To compare the tissue reactions of various water-soluble and oil-based contrast agents on the endometrium, salpingeat mucosa, and peritoneum. MATERIALS AND METHODS: Thirty-three rabbits were used for evaluating the histologic reactions of uterine endometrium, salpinx, and peritoneum. Hysterosalpingography(HSG) was underwent in these rabbits by using Lipiodol, Hexabrix, Rayvist, Ultravist-300, Ultravist-370, and normal saline. Pathotogic results were obtained in each of the six groups from the uterine endometrium, salpingeal mucosa, and peritoneum without knowledge of the contrast agent used and time interval from HSG. RESULTS: Mild inflammations were observed in the endometrium, salpingeal mucosa, and peritoneum during the first week of HSG in all rabbits in which water-soluble contrast agents were used. Although there was no significant difference in the degree of inflammation among the groups using various contrast agents, the group with oil-based contrast agent(Lipiodoi) showed delayed absorption of contrast agent in the peritoneum, frequent intravasation, fat granuloma, peritoneal adhesion, or uterine infarction. CONCLUSION: Our results suggest that water-soluble contrast agents can be used safely for HSG, but the use of oil-based contrast agent is questionable in safety and should be avoided in patients with tubal obstruction, salpingitis, or endometritis.
Absorption ; Contrast Media* ; Endometritis ; Endometrium* ; Ethiodized Oil ; Fallopian Tube Diseases ; Fallopian Tubes ; Female ; Granuloma ; Humans ; Infarction ; Inflammation ; Ioxaglic Acid ; Mucous Membrane* ; Peritoneum* ; Rabbits ; Salpingitis

The pure epithelioid malignant schwanoma is a rare form of malignant schwanoma and differs from the ordinary epithelioid malignant schwanoma because of the absence of a spindle cell component. We present a case of purely epithelioid malignant schwanoma arising in the parapharyngeal area from vagus nerve without difinite evidence of von Recklinghausen's disease. The patient was a 28-year-old man with palpable right neck mass and swallowing difficulty during 2 years. The mass was an ovoid encapsulated tumor and measured 5x3x3 cm in dimension. The cut surface showed brownish tan homogeneous nodular appearance with partly myxoid area. Microscopically the tumor showed nodular pattern composed of epitheliod cells which were arranged in both tight clusters and stringy cords. The cells were ovoid in shape and had vesicular nuclei with single prominent eosinophilic nucleolei and sometimes abundant intracytoplasmic mucin. Mitoses were infrequent. Ultrastructural study showed rudimentary cell junction and degenerated cytoplasmic organelles including scattered mitochondriae, short segments of rough endoplasmic reticulum and lipid droplets. There were no definite basement membrane and melanosome. Immunohistochemical study showed the cells being positive for S100 protein, neuron specific enolase and myelin basic protein and negative for cytokeratin.
Male ; Humans