The authors examined a case of Bednar tumor(pigmented dermatofibrosarcoma protuberans). A 35-year-old woman presented with protruding black back mass 3x2.5 cm in surface dimension and 1 cm in heigh, which has grown slowly for 30 years. Microscopically the lesion is characterized by spindle cells arranged in storiform pattern and admixed with melanin containing dendritic cells. Ultrastructural study revealed three cell populations: (1) cells resembling fibroblasts, (2) cells resembling perineural cells, and (3) melanocytes. The immunohistochemical study using S-100 protein alpha-1 antitrypsin, antichymotrypsin and EMA revealed negative reaction in spindle fibroblastic tumor cells. The histogenesis of this neoplasm remains controversial; neuroectoderm, perineural cell, fibroblast and histiocyte. Through the ultrastructural study and immunohistochemical study, the authors suggested that Bedner tumor arises form the neuroectoderm with bidirectional to perineural and fibroblastic differentiation.
Female ; Humans

From September 1987 to June 1994, the authors had performed posterolateral fusion in one patient, anterior spinal fusion alone in four patients, anterior spinal fusion after posterior augmentation with Rectangle Luque and posterolateral fusion in four patients of tuberculosis of the lumbosacral junction. The purpose of this study was evaluated the reliability of the posterior augmentation with Rectangle Luque and posterolateral fusion. We divided into two groups: the study group was anterior spinal fusion after posterior augmentation with Rectangle Luque in four patients, the control group was anterior spinal fusion alone in four patients. The average follow up was obtained at 16 months(12 to 20 months) in study group, at 42.7 months in control group. Results were as follows: 1. Clinical results according to Moskowitz criteria were 2 patients with grade I. 2 patients with grade II in the study group; one patient with grade I, one patient with grade II, one patient with grade III, one patient with grade IV in the control group. Hypolordosis(less than 10 degree) at the lumbosacral junction was associated with a higher incidence of back pain. 2. Radiographically well consolidated anterior fusion was noted in all patients within average 6 months (5-7 months) in the study group and 7.2 months (5-10 months) in the control group. 3. Radiologically the lumbosacral saggital angle was corrected after operation and the mean angle was 16.5 degrees(12 to 20 degrees) in the study group, 7.2 degrees(3 to 20 degrees) in the control group. The mean loss of angular correction was 5 degrees(1 to 8 degrees) in the study group, 6.2 degrees(1 to 13 degrees) in the control group at postoperative one year follow up. In conclusion, this results suggest that the anterior spinal fusion concomitant with the posterior augmentation with Rectangle Luque is the recommendable methods for tuberculosis of the lumbosacral junction in adults.
Adult ; Back Pain ; Follow-Up Studies ; Humans ; Incidence ; Spinal Fusion ; Tuberculosis

No abstract available.
Humans ; Prostate* ; Prostatic Neoplasms* ; Quality of Life*

No abstract available.
Cleft Lip*

Many investigators are trying to elucidate the pathogenesis of psychiatric disorders on the basis of neuroendocrine responses to stimulation or perturbation. Dexamethasone(DEX) suppression has been the most widely utilized as the prototypical challenge test. Dexamethasone suppression test(DST) has proven to be valuable in diagnosing the depressive spectrum disorder. Reported specificity of diagnosis of depression is relatively high, but sensitivity is limited. Some researchers used the combination of dexamethasone and corticotropin releasing hormone(CRH) in order to improve the sensitivity. They reported that combined DEX/CRH test, i.e., we administered the insulin instead of CRH. Total subjects were 28(7 normal controls, 10 manic patients, 11 schizophrenic, patients). Subject were token DEX(1.5mg p.o.) at 11 p.m., insulin 16 hours later(0.1 unit/kg i.v.). Five blood samples for the determination of cortisol and ACTH were serially drawn at 15 minute interval. The results are as following : 1) The cortisol an ACTH levels of manic subjects increased following insulin administration. Manic subjects showed higher levels of cortisol and ACTH than schizophrenic and normal control subjects. The cortisol and ACTH levels of schizophrenic and normal control subjects did not show gross changes. 2) The sensitivity of the test was lower than that of reported DEX/CRH test.
Adrenocorticotropic Hormone ; Depression ; Dexamethasone ; Diagnosis ; Humans ; Hydrocortisone ; Insulin ; Research Personnel ; Sensitivity and Specificity

We have experienced 29 cases of microvascular surgery during a year since Apr. 1981. We performed 18 cases of composite tissue transfer in 17 patients. 3 cases of axillary flap, 5 cases of dorsalis pedis flap, 4 cases of living fibula transplantation, 2 cases of groin flap using deep circumflex iliac vessels, a case of osseocutaneous flap using the 11th rib, living M-P joint from the 2nd toe to finger, neurovascular island flap from the lateral side of the 3rd finger, and a case of musculocutaneous flap using the gracilis muscle were done. The causes of the soft tissues and/or bone loss were open fracture, which is the most common cause, osteomyelitis, congenital pseudarthrosis of the tibia, bone tumor, and scar contractures, etc. The success rate of the composite tissue transfer was 89%. The 2 cases of failure were observed. The one is due to the vascular damage after the leg lengthening in congenital pseudarthrosis of the tibia and the other due to the infection on the grafted area. The follow up period was from 4 to 18 months. The patients except failed 2 cases were pleased the result of the surgery. The composite tissue transfer using microvascular surgery has many advantages in that the tissue defect can be filled by one stage operation, the patient would be less dependent wish shorter hospital stay, the patient would be less morbid with better function than the patient with multi-staged complex operations. The composite bone and soft tissue transfer used for the infected bony defect made the infection heal more rapidly than the other conventional methods. The deep circumflex iliac artery played a good role in making the osseocutaneous flap, which has many advantages such that Taylor had described. But it is not the truth for the skin only problem. So we darely suggest the third category of the arterial supply to the skin as osseocutaneous artery to supply the overlying skin through the bone, which is exampled with the deep circumflex iliac artery. The vessels in the area of a limb lengthening would be stretched and severely damaged. And the overstretched vessels in limb lengthening should not be used in the microvascular surgery, if the time interval from the traction is not plentifully elapsed and the vessel status is not converted to normal.
Arteries ; Cicatrix ; Contracture ; Extremities ; Fibula ; Fingers ; Follow-Up Studies ; Fractures, Open ; Groin ; Humans ; Iliac Artery ; Joints ; Leg ; Length of Stay ; Myocutaneous Flap ; Osteomyelitis ; Pseudarthrosis ; Ribs ; Skin ; Tibia ; Toes ; Traction ; Transplants

The coexistence of spinal stenosis and scoliosis in lumbar spines is becoming a more frequent problem in elderly persons. Decreased bone mass in most of these patients also complicates their management. Recently, the pedicle screw instrumentation systems offer the way to solve these difficult problems. Most of the cases with degenerative scoliosis itself don't require surgical intervention. However, the case with severe clinical manifestations need surgery. From Jan. 1988 to Oct. 1993, authors had treated operatively for 15 cases of spinal stenosis with degenerative lumbar scoliosis. After adequate posterior decompression, pedicular instrumentation was carried out and correction of scoliotic deformity was attempted. Cotrel-Dubousset instrumentation was used in six patients, Graf instrumentation in three patients, and combined(Steffee and Graf) instrumentation in six patients. Follow up was obtained at an average of 20.4 months(Range; 10
Aged ; Animals ; Congenital Abnormalities ; Decompression ; Follow-Up Studies ; Humans ; Lordosis ; Methods ; Pedicle Screws ; Scoliosis ; Spinal Stenosis ; Spine

No abstract available.
Intubation, Intratracheal ; Temporomandibular Joint

We describe a case of cutaneous angiomyolipoma found in the ear lobe, that is not associated with tuberous sclerosis. The lesion developed on the youngest patient yet reported in the literature.
Angiomyolipoma* ; Ear ; Humans ; Tuberous Sclerosis

A case of hepatocellular carcinoma (HCC) complicating with secondary biliary cirrhosis due to intrahepatic bile duct growth of the tumor is presented. The patient was 34 years-old male who had been suffered from right upper quadrant pain with intermittent fluctuating jaundice for 4 months. Left lobectomy specimen contained a single, 4 cm sized, relatively well circumscribed and partly protruding nodular HCC in the medial seqment of left lobe. It compressed the left hepatic duct, and the intra and extra-hepatic ducts were completely plugged with tumor casts (extending to the common bile duct at the operating table). Remaining hepatic parenclyma was the seat of advanced secondary biliary cirrhosis in which were abundance of HBsAg-containing hepatocytes possibily representing a HBsAg carrier status. Biliary cirrhosis in HCC is an extremely rare manifestation, reflecting the delayed adequate clinical procedure by unusual pattern of obstructive jaundice. In such a case presenting as persisting and fluctuating obstructive jaundice in HCC, an intrabile duct tumor growth should be suspected.
Male ; Humans ; Carcinoma, Hepatocellular