라똑 헛똑

국보1호를 불태워 먹은 나라, 대한민국

숭례문이 전소되었다는 뉴스를 접하고 씁쓸한 마음을 달래기 위해 조립해 보았습니다.

도색은 엄두도 못내겠네요. 썰렁합니다.

1. Normal coronary artery scoring study

2. Calcified LAD and left main coronary artery

3. LAD and right coronary calcification. Angston score

4. Calcification at origin of left main coronary artery

5. Stenosis in LAD

6. Type A dissection

7. Type A dissection extends into iliac arteries

##########13*

8. Diseased LAD

9. CT angiogram with aberrant right coronary artery

10. Aberrant right coronary artery

1: Unfallchirurg. 1999 Jan;102(1):13-22

[Subtalar fusion after conservative or surgical treatment of calcaneus fracture. A comparison of long-term results]

ELASTOFIBROMA

Article Last Updated: Jun 1, 2007

AUTHOR AND EDITOR INFORMATION

Author: Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School

Robert A Schwartz is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Coauthor(s): Sonja Stander, MD, Staff Physician, Department of Dermatology, University-Hospital Muenster, Germany; Thomas Schwarz, MD, Vice Chairman, Professor, Department of Dermatology, University of Kiel, Germany

Editors: Kathryn Schwarzenberger, MD, Associate Professor, Departments of Dermatology and Medicine, Medical University of South Carolina; Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA; Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, Medicine, University of Texas Health Science Center-San Antonio; Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University; Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center

Synonyms and related keywords: elastofibroma dorsi, connective-tissue tumor, connective tissue tumor, elastogenesis

INTRODUCTION

Background
Elastofibroma is a rare, benign, slow-growing connective-tissue tumor that occurs most often in the subscapular area in elderly women. Jarvi and Saxen1 first described this rare entity in 1961. It is characterized by accumulated abnormal elastic fibers and is generally regarded as a reactive process, an unusual fibroblastic pseudotumor.

Pathophysiology
The etiology of this tumor remains unclear, although prevalence is increased in persons who perform manual labor involving the shoulder girdle. Thus, repeated trauma due to mechanical friction of the scapula against the ribs has been suggested to induce this process. This theory provides an explanation for the right-sided preponderance; however, in up to 66% of cases, the tumor is bilateral. Rarely, elastofibromas are multiple in the same individual. In up to one third of cases, the patient has a family history of the tumor, suggesting a nontraumatic genetic origin.

In a 2002 study, chromosomal gains have been speculated as a cause for the development of elastofibromas. Nishio et al3 detected DNA copy number changes involving 1 or 2 chromosomes in 33% of 27 patients. The most common recurrent gains were at bands Xq12-q22 and 19. High-level amplifications and recurrent losses were not observed. No correlation was found between DNA copy number changes and elastofibroma size. The authors concluded that these chromosomal regions may contain genes involved in the development of at least some elastofibromas.

Coexistence of an elastofibroma with a high-grade spindle cell sarcoma and a high-grade leiomyosarcoma has been reported. Moreover, because a number of other entities, including lipomas, metastases, sarcomas, and extra-abdominal fibromatoses and hemangiomas, may occur on the back and in the subscapular site, the diagnosis must be confirmed with biopsy.

Cytogenetic chromosomal instability and some recurrent or clonal chromosomal changes have raised the possibility that the lesion represents a neoplastic process.2 Recent findings suggest that CD34-positive mesenchymal cells are an integral component of elastofibroma, presumably representing a clonal fibrous proliferation.

Frequency
United States
Elastofibromas are rare.

Mortality/Morbidity
Mortality rates are unknown. Morbidity is not expected.

Sex
Of persons affected, 93% are female.

Age
Elastofibromas occur most often in elderly women but have been reported in persons aged 35-94 years.

CLINICAL

History

See Physical

Physical
Clinically, patients usually present with a large, well-circumscribed tumor that most often does not adhere to the overlying skin. One case of ulceration has been described. In 99% of cases, elastofibromas are located in the periscapular area, in relation to the latissimus dorsi, rhomboid, and serratus anterior muscles.

Uncommon locations include the deltoid muscle, ischial tuberosity, greater trochanter, olecranon, thoracic wall, foot, stomach, mediastinum, orbita, cornea, and oral mucosa. Occasionally, the tumor invades the surrounding tissues and becomes fixed to the underlying periosteum. Usually, the lesions are prominent and measure several centimeters in length; however, a small elastofibroma may be overlooked unless the patient is asked to move his or her arm laterally or anteriorly. Most patients with elastofibromas are asymptomatic. Only rarely do they report stiff shoulders, local pain with arm movement, and/or an annoying click with shoulder motion occur.

Causes
The histogenesis of the morphologically unique elastic fibers is controversial. Note particularly that the elastinophilic structure may result from elastotic degeneration of collagen. Recent immunohistochemical, ultrastructural, and biochemical investigations have shown that the elastinophilic material is composed of elastic fibers with only a slight difference in the amino acid composition. This elastic material possibly derives from an abnormal process of elastogenesis rather than representing degenerative changes in collagen or elastic fibers themselves.

DIFFERENTIALS

Lipomas

Other Problems to be Considered

Extra-abdominal fibromatosis
Sarcoma
Subcutaneous metastasis

WORKUP

Imaging Studies

Elastofibromas have a typical sonographic appearance consisting of arrays of linear strands against an echogenic background. However, in some cases, the ultrasound pattern of an elastofibroma dorsi may be very similar to the surrounding muscular tissue, and neither a clear cleavage surface nor a specific vascular pattern can be seen. In these cases, the elastofibroma may be very difficult to distinguish from surrounding tissue.

Chest wall radiographic findings are usually normal; however, elevation of the scapula from the chest wall has been detected in a few cases.

CT scanning and MRI reveal a lenticular, unencapsulated, soft tissue mass with skeletal muscle attenuation interspersed with strands of fat attenuation. Small elastofibromas may be difficult to visualize on CT scans or MRIs, but they can be enhanced by the use of gadolinium. Its characteristic location (periscapular region) and specific imaging appearance on ultrasound images, CT scans, and MRIs facilitates accurate diagnosis.

Incidental detection of bilateral elastofibroma dorsi with F-18 fluorodeoxyglucose positron emission computed tomography scanning has been described.

Procedures

A biopsy specimen should be obtained from the affected area. The surgical excision should be large and should include skin, subcutaneous fatty tissue, and, if necessary, deeper tissue. A shave or punch biopsy is not sufficient.

Histologic Findings
The tumor grossly appears as an ill-defined mass with a white or gray-white, glistening surface.

Upon light microscopy, elastofibromas are dermal unencapsulated tumors composed of branched and unbranched elastic fibers, eosinophilic collagen bundles, and scattered fatty tissue. The elastic fibers have a degenerated, beaded appearance or are fragmented into small globules or droplets arranged in a linear pattern. The epidermis is usually unaffected. The interspersed spindle or stellate cells show a fibroblastlike appearance and were almost consistently positive for vimentin and frequently positive for CD34 and lysozyme immunohistochemically.

At an ultrastructural level, the elastic fibers appear as an irregular granular or fibrillary aggregation of electron-dense, amorphous material surrounded by microfibrils and collagen fibers. Collagen fibers are commonly incorporated within the elastic material.

Immunohistochemically, elastofibromas stain positively for vimentin but negatively for smooth muscle actin, S-100, desmin, and p53.

Because of their densely fibrous nature, hypocellularity may be observed in fine-needle aspiration biopsy specimens of elastofibromas; thus, diagnostic material may be overlooked. The smears show evidence of mature adipocytes, fibroblasts, collagen fibers, globular bodies, and characteristic braidlike or fernlike structures, revealing degenerative elastic fibers. Careful evaluation of the background of the smears coupled with full knowledge of the clinical and radiological findings, including those from MRIs, is required to establish the correct diagnosis; therefore, a skin biopsy is preferable.

TREATMENT

Surgical Care

Complete surgical excision is the treatment of choice in symptomatic patients. Recurrence after surgery is unusual and has been reported in only one case. In another case, spontaneous regression was observed without treatment.

출처 : http://www.emedicine.com/derm/topic115.htm : 원본내용 그대로 일부 재편집

탈장

http://kr.blog.yahoo.com/dr_kaljaby/1594

http://www.thisisgame.com/board/view.php?id=166063&category=106

공감백배군요.

하지만 2차 예판에서 주문해버렸다는 거..

현재 차량용 AV system으로 파이오니어 제품(1DIN)을 쓰고 있는데

1. DVD 및 CD 인식이 느리다.

2. 한글지원 안됨

3. USB 지원 안됨

4. 기타

등의 문제로 심각하게 업그레이드를 고려 중 입니다.

제1순위가 JVC - KD-DV8306 입니다.

사양은 아래와 같구요.

• 한글 지원 디스플레이 (Korean/Thai/Russian/Simplified Chinese /Traditional Chinese)
• 최대출력: 50W x 4 Max. (MOS-FET)
• DivX®/WAV/MP3/WMA 재생가능 (DVD/CD/USB)
• DTS Digital Out/Dolby Digital/MPEG Audio
• 24-bit Audio DAC
• Digital 7-Band iEQ
• 조정가능한 Line 입력 단자
• 5V Line Output Level
• Line 출력 단자 (2 pairs)
• Video 출력 단자
• Second Audio 출력
• Subwoofer Output Terminals with Level/Frequency Control
• Optical Digital Output

혹시 추천할 만한 제품은 없나요?

http://cartoon.stoo.com/guro/html/

음.. 나도 서민의 아들이야! 퍽!

아이나비 UZ

브랜드 팅크웨어 아이나비

터치스크린, SD슬롯, e-book, 차계부, 가넷레드/에머시스트블랙/오팔그레이

.

작년 상반기에 PNS(Personal Navigation System)라는 거창한 신조어를 내세우며 출시되었던 아이나비 UZ를 갑자기 주문해 버렸다.

이렇게 지르는게 언제 이유가 있었던가?

그래도 나름 이유를 생각해보면

1. 뚜벅이용 GPS가 필요할 때가 가끔 있다.
2. 믿었던 GPS수신기 내장 PDA POZ-G300은 하루에도 몇번씩 뻗어버리니 더 이상 신뢰할 수가 없다.
3. SCH-M420, SCH-M450 등을 써봤지만 추가 GPS수신기까지 붙이고 나면 사실상 흉물스럽다. 
4. 차량용 네비게이션(V7과 X7)은 어디까지나 차량용이다.

이런 이유로 갑자기 머리 속에 떠오른 UZ에 대해 검색해 보니 배터리 시간이 예상 외로 짧은 것을 제외하면 휴대성을 포함한 실용성에서 상당히 점수를 얻는 것 같아 결국 지름신을 영접하고 말았다.

조만간 FM송수신기, 블루투스 내장형 PNS 시스템이 나올게 틀림이 없는데..