Milwaukee shoulder syndrome is a rare clinical entity that is a rapid destructive shoulder arthropathy associated with deposition of calcium hydroxyapatite crystals. It mainly affects elderly women. It is characterized by the presence of large amount of noninflammatory synovial fluid containing calcium hydroxyapatite crystals, a complete tear of the rotator cuff and progressive degenerative changes at the humeral head, leading to almost complete functional impairment. We present a case of a 65-year-old woman suffered by Milwaukee shoulder syndrome with literature view.
Aged ; Durapatite ; Female* ; Humans ; Humeral Head ; Rotator Cuff ; Shoulder* ; Synovial Fluid

The coexistence of polymyositis and primary biliary cirrhosis is rare. Both are characterized by chronic inflammation and immunological abnormalities. We report a case of 54-year-old female patient presenting with these two autoimmune diseases. She exhibited symmetrical proximal muscle weakness and elevated serum levels of muscle enzymes. Polymyositis was confirmed by electromyography and muscle biopsy. The diagnosis of primary biliary cirrhosis was based on increased serum levels of alkaline phosphatase, IgM immunoglobulin, presence of antimitochodrial antibody and characteristic liver biopy findings. This is the first case who manifest polymyositis and primary biliary cirrhosis simultaneously in Korea.
Alkaline Phosphatase ; Autoimmune Diseases ; Biopsy ; Diagnosis ; Electromyography ; Female ; Humans ; Immunoglobulin M ; Immunoglobulins ; Inflammation ; Korea ; Liver ; Liver Cirrhosis, Biliary* ; Middle Aged ; Muscle Weakness ; Polymyositis*

BACKGROUND AND OBJECTIVES: We sought to characterize the lesion characteristics of mitral valve prolapse (MVP), which is being increasingly recognized as a cause of mitral regurgitation (MR) in Koreans SUBJECTS AND METHODS: 497 Patients with MVP that was diagnosed by echocardiography in 13 university-affiliated hospitals from Jan to Dec 2003 were prospectively enrolled in our study. RESULTS: A total of 497 patients (270 males, 54%) were enrolled and their mean age was 52+/-17 years. Grade 4 MR was present in 272 patients (54.7%); grade 3, 2 and 1 MR as present in 30.2%, 10.7% and 4.2%, respectively. MVP of the anterior and posterior mitral leaflet was present in 170 patients (34.2%) and 223 patients (44.9%), respectively; MVP developed in both leaflets in 104 patients (20.9%). In 37 patients (7.4%), MVP developed in all 6 segments of the mitral leaflet and these patients were younger (37+/-14 versus 54+/-16 years, respectively, p<0.05) and had a lower prevalence of chordae rupture and severe MR compared to the other patients. Among the 266 mitral segments showing prolapse in the 132 patients (26.6%) who underwent transesophageal echocardiography, the posterior medial scallop was the most frequently diseased one (26%), and this was followed by the posterior middle scallop (18%), the medial (17%), lateral (14%) and middle (13%) part of the anterior leaflet, and the posterior lateral scallop (12%). Younger patients with a mean age <45 years showed a lower prevalence of single segment prolapse, hypertension, severe MR and chordae rupture compared to the older patients (p<0.001, each). CONCLUSION: The medial part of both mitral leaflets was the predilection site for the development of MVP in Koreans and the lesion characteristics were different according to the patients' age.
Echocardiography* ; Echocardiography, Transesophageal ; Humans ; Hypertension ; Korea* ; Male ; Mitral Valve Insufficiency ; Mitral Valve Prolapse* ; Mitral Valve* ; Pectinidae ; Prevalence ; Prolapse ; Prospective Studies* ; Rupture

Colchicine has been used in the treatment of autoimmune diseases such as Behcet disease. Long-term use of colchicine can cause vacuolar myopathy on rare occasions. We report colchicine-induced myopathy with myotonia in Behcet disease. A 34-year-old man with Behcet disease presented progressive proximal weakness, myalgia, and difficulty in relaxation of grip after increasing the dosage of colchicine. Electrophysiological findings showed myotonic myopathy. Muscle biopsy revealed vacuolar myopathy. His symptoms were resolved with the discontinuation of colchicine.
Adult ; Autoimmune Diseases ; Behcet Syndrome* ; Biopsy ; Colchicine ; Hand Strength ; Humans ; Muscular Diseases* ; Myalgia ; Myotonia* ; Myotonic Disorders ; Relaxation

The chordoid glioma is a recently recognized rare neoplasm of the third ventricle and hypothalamus and, as the name implies, has a chordoid appearance. Using histological, immunohistochemical and ultrastructural studies, we report a case of a 32-year-old man with a chordoid glioma in the third ventricle. Magnetic resonance T1-weighted images of the brain with homogenous contrast enhancement revealed a well circumscribed, isointense mass occupying the third ventricle. Histologically, the tumor showed cords and clusters of epithelioid cells within a mucinous background along with lymphoplasmacytic infiltrate, and appeared to be reminiscent of a chordoma or chordoid meningioma. Immunohistochemically, the tumor cells were immunoreactive for glial fibrillary acidic protein, vimentin and CD34 but negative for epithelial membrane antigen. Ultrastructural study revealed round to spindle shaped cells with abundant cytoplasmic intermediate filaments and cytoplasmic zonation.
Adult ; Brain ; Chordoma ; Cytoplasm ; Epithelioid Cells ; Glial Fibrillary Acidic Protein ; Glioma* ; Humans ; Hypothalamus ; Intermediate Filaments ; Meningioma ; Mucin-1 ; Mucins ; Third Ventricle ; Vimentin

Papillary endothelial hyperplasia(PEH), usually originates in extracranial soft tissue, is considered a reactive proliferation of endothlium and an unusual form of thrombus organization. However the occurance of PEH in the cranial cavity is very rare. The authors report a case of a PEH involving intracranial sella, parasella, cavernous sius, ethmoid and sphenoid sinus in an 11-year-old boy. The patient was presented with sudden right visual disturbance. Magnetic resonance image showed a well-enhanced mass in the right cavernous sinus extending into the ethmoid and sphenoid sinus. The cerebral angiography demonstrated a vigorous tumor staining supplied by both internal and external carotid arteries. The right fronto-temporal craniotomy and subtotal resection of the tumor were performed. The mass was comprised in a highly vascular red-black nodular tissue associated with a mixture of fresh and organizing thrombi. The histopathological examination revealed papillary structures lined by endothelium within vascular space with organized thrombus. While the patient was waiting for second operation in order to remove remaining small tumor in the ethmoid and sphenoid sinues, the lesion exhibited rapid regrowth and the size became to the preoperative size at three months after operation. At reoperation, gross total removal was accomplished by a combination of trans-cranial and trans-sphenoidal approaches. Postoperative radiotherapy was given.
Carotid Artery, External ; Cavernous Sinus* ; Cerebral Angiography ; Child ; Craniotomy ; Endothelium ; Humans ; Hyperplasia* ; Male ; Radiotherapy ; Reoperation ; Sphenoid Sinus* ; Thrombosis

No abstract available.
Animals ; Brain* ; Rats*

BACKGROUND: Rifampicin (RFP) is a key component of the antituberculous short-course chemotherapy and the RFP resistance is a marker of multi-drug resistant (MDR) tuberculosis. RpoB gene encodes the beta-subunit of RNA polymerase of M. tuberculosis which is the target of RFP. And the mutations of rpoB gene have been found in about 96% of rifampicin resistant clinical isolates of M. tuberculosis. So in order to find a rapid and clinically useful diagnostic method in identifying the REP resistance, we compared the PCR-line probe method with PCR-SSCP for the detection of the rpoB gene mutation in cultured M. tuberculosis. METHODS: 45 clinical isoLates were collected from patients who visited Sung Kyun Kwan University Hospital. The REP susceptibility test was referred to the referral laboratory of the Korean Tuberculosis Institute. 33 were rifampicin resistant and 12 were rifampicin susceptible. The susceptibility results were compared with the results of the PCR-SSCF and PCR-line probe method. RESULTS: We could find rpoB mutations in 27/33(81.8%) RFP-resistant strains by PCR-line probe method, and in 23/33(69.7%) by PCR-SSCP and there was no significant difference between two methods. There was no mutation in rifampicinn susceptible strains by both methods.: Comparison of PCR-line probe and PCR-SSCP methods for detection rifampicin resistance CONCLUSION: PCR-Iine probe method would be a rapid, sensitive and specific method for the detection of rifampicin resistant Mycobacterium tuberculosis.
DNA-Directed RNA Polymerases ; Drug Resistance ; Drug Therapy ; Humans ; Mycobacterium tuberculosis* ; Mycobacterium* ; Polymorphism, Single-Stranded Conformational ; Referral and Consultation ; Rifampin* ; Tuberculosis

We report a case of hyalinizing trabecular adenoma of the thyroid gland with its immunohistochemical and ultrastructural features. A 53 year-old euthyroid woman presented a well defined small cold nodule on a thyroid iodine scan. Microscopically, oval and elongated tumor cells were arranged in trabeculae, clusters and a "zellballen" pattern resembling paraganglioma with scattered follicles. Nuclear features were characterized by fine nuclear grooves, acidophilic intranuclear cytoplasmic inclusions and perinucleolar halos. Abundant extracellular eosinophilic fibrohyaline matrix resembling amyloid were also noted. Immunostaining of tumor cells was positive for thyroglobulin and negative for calcitonin. In addition, tumor cells displayed an unexpected, unique cytoplasmic immunoreactivity for MIB1. Electron microscopy revealed euchromatic nuclei with grooves, intranuclear cytoplasmic inclusions, intermediate filament stuffed cytoplasms and abundant extracellular basal lamina material.
Adenoma* ; Amyloid ; Basement Membrane ; Calcitonin ; Cytoplasm ; Eosinophils ; Female ; Humans ; Hyalin* ; Inclusion Bodies ; Intermediate Filaments ; Iodine ; Microscopy, Electron ; Middle Aged ; Paraganglioma ; Thyroglobulin ; Thyroid Gland*

There are many ways to evaluate the learning achievement of medical students. We are familiar with the problems related to the traditional laboratory course practical examinations of pathology and histology courses, which deal with morphology heavily. In order to overcome the limitations inherent to the traditional evaluation methods, we used Internet for the written and practical examinations for the pathology course. Two tests were conducted on the internet with thirty medical students. Each student used his/her personal computer, which was connected to Local Area Network(LAN), in the computer laboratory. The examinee entered the Pathology Department home page(address: http://ajoupath. ajou.ac.kr) and took their tests made up of descriptive and multiple choice questions including related gross and microscopic images. Common Gateway Interface(CGI) program of Perl language was used for automatic scoring and analysis of the multiple choice questions. The server computer in the Pathology Department scored the results instantaneously upon the answer selection and push down of the "send" button by the examinee. Furthermore, the computer program was capable of providing data regarding how many students got the correct answer and the degree of difficulty for each item. The students were requested to provide hand-written descriptions for the questions requiring descriptive answers, because of the technical limitation. We believe that the tests on the internet were performed successfully. The "dreadful" old fashioned examination using timer were no longer needed because high quality gross and microscopic images on the monitor were available for the examinee. We believe that the internet is very useful for the comprehensive evaluation of the medical students' learning achievement.
Education, Medical ; Humans ; Internet* ; Learning* ; Microcomputers ; Pathology ; Students, Medical