Computerized Tomography can make accurate diagnosis in most of the mediastinal tumors and cysts by assessingtheir location, shape and internal architecture. Authors analysed and present CT findings of 89 surgically provenmediastinal tumpors and cysts that were studied and treated in Seoul National University Hospital during recent 5years. The results are as follows; 1. The most common tumor was teratoma(25 cases). Neurogenic tumor (20 cases),thymic tumor or cyst (16 cases), lymphoma(7 cases), bronchogenic cyst (6 cases), intrathoracic goiter (6 cases),pericardial cyst(3 cases) and cystic hygroma(2 cases) were next in order of frequency. 2. The most constant findings of teratoma was thick walled cystic area(100%), while pathognomonic fat and calcified density were seenonly in 52% and 48% of cases, respectively. 22 cases were located in anterior mediastinum, 2 cases were inposterior mediastinum and a case is in middle mediastinum. 3. There were 20 cases of neurogenic tumor consiting of6 neurilemmomas, 7 ganglioneuromas, 4 neurofibromas, 1 ganglioneuroblastoma, 1 neuroblastoma and 1 malignantschwannoma. Most of them were located in posterior mediastinum with exception of 2 neurilemmomas arising from leftvagus nerve and left recurrent laryngeal nerve in middle mediastinum. Cystic change was seen in 2 cases ofneurilemmoma and in a case of ganglioneuroma. Calcification was seen in 3 cases, of neuroblastoma, aneurilemmoma,and a ganglioneuroma. 4. There were 11 cases of thymoma showing homogeneous solid mass with speckeldcalcification in 4 cases and irregular cystic change in 3 cases. 2 cases were invasive thymoma and myastheniagravis was present in 4 cases. A case of thymolipoma and a case of thymic cyst were included. 5. Lymphoma(2Hodgkin's and 4 non-Hodgkin's) appeared as lobulated, matted mass in anterior mediastinum especially inprevascular area expnading bilaterally. 6. Intrathoracic goiter appeared as slingtly high density mass within termingled calcification and cystic area in 5 cases of secondary goiter and homogeneous high densitymass(100-110 H.U. in precontrast scan) in a case of primary goiter. 7. Among the 6 bronchogenic cysts, 3 werelocated in subcarinal area, 2 were above carina and one was in left hilar area. 3 cases showed high CT number morethan 70 H.U. and others showed water density. 8. 3 cases of pericardial cyst were located in right cardiophrenicangle and all of them showed water density. 9. 2 cases of cystic hygroma were located in superior mediastinum,with extension to lower neck and all of them showed water density.
Bronchogenic Cyst ; Diagnosis ; Ganglioneuroblastoma ; Ganglioneuroma ; Goiter ; Goiter, Substernal ; Granuloma ; Lymphangioma, Cystic ; Mediastinal Cyst ; Mediastinum ; Neck ; Neurilemmoma ; Neuroblastoma ; Neurofibroma ; Recurrent Laryngeal Nerve ; Seoul ; Teratoma ; Thymoma ; Water

PURPOSE: To evaluate the clinical characteristics, treatments and outcome of patients with hemorrhagic shock and encephalopathy(HSE) syndrome. METHODS: We performed a clinical study on 14 patients who were diagnosed as hemorrhagic shock and having encephalopathy syndrome in the Department of Pediatrics, from 1984 to 1998. Age, sex, clinical symptoms and physical findings at admission, the most deranged laboratory findings, radiologic findings, treatments and outcome were analyzed. RESULTS: The age of onset was 1.0+/-0.9 years and the male to female ratio was 1: 1.8. At admission, clinical findings included dehydration in 85.7%, shock in 85.7%, fever in 71.4%, vomiting in 71.4%, diarrhea in 64.3%, GI bleeding in 50%, convulsion in 42.9%, and edema in 35.7%. Altered mental state was found in 100%, hepatomegaly in 64.3%, and splenomegaly in 21.4%. Laboratory findings revealed D-dimer positive in 92.9%, the mean hemoglobin level 8.2+/-2.1g/dL, BUN 35.7+/-24.0mg/dL, creatinine 1.9+/-1.5mg/dL, AST 561.0+/-1,412.1IU/L, ALT 858.9+/-1,649.8IU/L, blood glucose 229.5+/-197.4mg/dL, ammonia 195.4+/-129.7pg/dL, and total bilirubin 4.9+/-8.2mg/dL. On serologic tests, rotavirus and Epstein-Barr virus was found in 1 patient(7.1%), respectively. The mortality rate was 78.6%. CONCLUSION: We found that shock and disseminated intravascular coagulation(DIC) played important roles in the pathogensis of HSE syndrome, and encephalopathy, hepatic and renal insufficiency, and respiratory failure were secondary complications resulting from shock and DIC. Despite vigorous treatment, the prognosis was very poor. We feel more efforts should be focused on investigating the etiology and pathophysiology of HSE to prevent as well as develop a specific therapy. (J Korean Pediatr Soc 2000;43:814-819)
Age of Onset ; Ammonia ; Bilirubin ; Blood Glucose ; Creatinine ; Dacarbazine ; Death, Sudden* ; Dehydration ; Diarrhea ; Edema ; Female ; Fever ; Hemorrhage ; Hepatic Encephalopathy ; Hepatomegaly ; Herpesvirus 4, Human ; Humans ; Infant* ; Male ; Mortality ; Pediatrics ; Prognosis ; Renal Insufficiency ; Respiratory Insufficiency ; Rotavirus ; Seizures ; Serologic Tests ; Shock ; Shock, Hemorrhagic* ; Splenomegaly ; Vomiting

No abstract available.
Diagnosis* ; Osteoma, Osteoid*

BACKGROUND: One of the main disadvantages of caudal block is the long latent period before a satisfactory blockade is obtained. Many investigators have used various preparations of local anesthetic solutions to improve the speed of onset. This study was performed to evaluate the effectiveness of prewarming of lidocaine HCl for caudal block. METHODS: Fifty healthy young patients (ASA I) were allocated into two groups, A and B. In group A, the local anesthetic solution were injected at room temperature (25 degrees C), while in group B, they were injected at 37oC. All the caudal block were performed using 2% lidocaine HCl 20 ml with fentanyl 100ug and epinephrine 1:200,000. The onset time was defined as the period from completion of injection until the patient first noticed loss of sensation to pin-prick on perianal region. Assessment of sensory loss was made at 15 seconds interval. We have compared the onset of sensory blockade between groups. The duration of analgesia and any significant side effects were also recorded. RESULTS: The onset of sensory blockade was significantly faster in group B (3.5 +/- 0.5 minutes) than group A (6.2 +/- 0.9 minutes). The duration of analgesia were not significantly changed between groups. Side effects of urinary retention, pruritus and nausea were noted between both groups but the difference was not significant. CONCLUSIONS: We have found that the onset time was 44% faster with warm lidocaine-fentanyl mixture (37 degrees C) than with the room temperature (25 degrees C). The improved clinical usefulness was achieved with no increase in side effects. The technique is a safe and effective method to reduce the latency of onset.
Analgesia ; Epinephrine ; Fentanyl ; Humans ; Lidocaine ; Nausea ; Pruritus ; Research Personnel ; Sensation ; Urinary Retention

PURPOSE: As well as patient survival, the restoration of postoperative function such as ambulation is important in limb salvage operations for treatment of malignant bone tumors involving the proximal femur. The authors analyzed clinical outcomes of limb salvage operations using tumor prostheses for metastatic or primary malignant bone tumors in the proximal femur. MATERIALS AND METHODS: From February 2005 to January 2014, 20 cases (19 patients) with malignant bone tumor involving the proximal femur with pain or complicated pathologic fracture were treated with segmental resection and limb salvage operations with tumor prostheses. Mean age was 63.1 years (range 35-86). Fourteen patients were male and six ones were female. The mean follow-up period was 20 months (1-94 months). There were 15 cases of metastatic bone tumor, 4 cases of osteosarcoma, and 1 case of multiple myeloma. The primary tumors of the metastatic bone tumors included 4 lung cancers, 3 hepatocellular carcinomas, and 3 renal cell carcinomas. Other primary tumors were breast cancer, thyroid cancer, colon cancer, prostate cancer, and malignant spindle cell tumor, each in 1 case. Modular tumor prostheses were used in all cases; (Kotz's(R) Modular Tumor prosthesis (Howmedica, Rutherford, New Jersey) in 3 cases, MUTARS(R) proximal femur system (Implantcast, Munster, Germany) in 17 cases). Perioperative pain was assessed with Visual Analogue Scales (VAS). Postoperative functional outcome was assessed with Musculoskeletal Tumor Society (MSTS) grading system. RESULTS: Out of 20 cases (19 patients), 11 cases (10 patients) survived at the last follow-up. Average postoperative survival of the 9 deceased patients was 10.1 months (1-38 months). VAS score improved from pre-operative average of 8.40 (5-10) to 1.35 (0-3) after operation. Average postoperative MSTS function score was 19.65 (65.50%, 7-28). The associated complications were 2 local recurrences, 3 hematomas, 3 infections, 2 scrotal swellings, and 1 dislocation. There was no case of periprosthetic fracture or loosening. CONCLUSION: Limb salvage operation with tumor prosthesis is an appropriate treatment for early pain reduction and functional restoration in malignant bone tumors in the proximal femur with pain an/or complicated pathologic fractures.
Breast Neoplasms ; Carcinoma, Hepatocellular ; Carcinoma, Renal Cell ; Colonic Neoplasms ; Dislocations ; Female ; Femur* ; Follow-Up Studies ; Fractures, Spontaneous ; Hematoma ; Humans ; Limb Salvage* ; Lung Neoplasms ; Male ; Multiple Myeloma ; Osteosarcoma ; Periprosthetic Fractures ; Prostatic Neoplasms ; Prostheses and Implants* ; Recurrence ; Thyroid Neoplasms ; Walking ; Weights and Measures

The dynamic blood flow is regulated by the numerous complex mechanisms. Since blood flow varies directly with the radius of the vessel, blood flow is markedly affected by small changes in the caliber of the vessels. Using the hotoplethysmography, we assessed the relative changes of blood flow after topical application of the vasoactive drugs to the femoral arteries of the rabbits. It is the purpose of this study to evaluate the immediate and delayed effects of the vasoactive drugs such as epinephrine, methylergonovine, chymopapain, and lidocaine in course of time when the drugs applied topically to the vessel. 60 rabbits were divided into 6 experimental groups. In group I, the femoral artery was surgically exposed only. In Group g-A, epinephrine was applied to the femoral artery after surgical exposure. In Group Il-B, after spplication of epinephrine, the effect of epiniphrine was reversed with lidocaine. Another drugs were applied as follows methylergonovine in Group Hl-A, methylergonovine and lidocaine in Group Ill-B as in group Il-B, Chymopapain in Group lV. The relstive changes of blood flow were measured by the photoplethymograph for 3 weeks. The results are as follows ; 1. The amplitude of the photoplethysmographic wave decreased immediately after the topical application of epinephrine, methylergonovine and chymopapain. Such an effect could be observed until the 3rd week after the topical application of the drugs, 2. The delayed dffect of reducing the amplitude could be seen during the 1st week in the epinephrine and methylergonovine treated groups. However, it was seen after 1st week in the chymopapain treated group. 3. The delayed effect of epinephrine and methylergonovine could be reversed with lidocaine. 4. It seems that lidocaine can be used clinically to preyent the delayed effect of epinephrine and methylergonovine.
Blood Vessels ; Chymopapain ; Epinephrine ; Femoral Artery ; Lidocaine ; Methylergonovine ; Photoplethysmography ; Rabbits ; Radius

The purpose of this study is to confirm the effectiveness of stay-suture which is commonly used in the procedure of end to end anastomosis, to find out general biomechanical properties of peripheral nerve with gradual stretching and to evaluate the histological difference after breakage of the nerve. The sciatic nerves of adult rabbits were excised and they were grouped by I and II. Group I was composed of 14 normal sciatic nerves and group II, 14 sciatic nerves sutured with 5-0 nylon after transection. They were stretched on the "Instron" universal testing machine at a constant rate of 200mm/min until breakage took place and the results were compared. The mean maximal tensile strength was 13.6N in group I and 2.1N in group II, representing about one seventh value. The mean ultimate tensile strength was 4.2MPa in group I and 0.9MPa in group II, representing about one fifth value. In load-elongation curve of group I, viscoelastic property was noted as all other biological tissues have. The mean modulus of elasticity was 19 in normal sciatic nerves, which is somewhat lower value than other tissues, indicating superior elastic property of peripheral nerves. Transverse histologic examination showed that epineurium lost its continuity earlier than perineurium, implying perineurium is a more resistant structure than epineurium. However, to confirm this, it is thought to be necessary to examine the nerves serially during distraction at each different status. In conclusion, stay-suture provided about one fifth of ultimate tensile stress, implying its usefullness of resisting excessive tension in end to end anastomosis of peripheral nerves. Normal sciatic nerves showed viscoelastic property with mean modulus of elasticity of 19.
Adult ; Elastic Modulus ; Humans ; Nylons ; Peripheral Nerves ; Rabbits ; Sciatic Nerve ; Tensile Strength

The cell cycle is composed of G1, S, G2 and M phase. The transitions between different phases are regulated at checkpoint such as Start(restriction), S phase and mitotic checkpoint. These checkpoints are regulated by specific cyclins and Cdks(cyclin-dependent kinases). Especially, Start checkpoint in late G1 is though to be very important in control of cell cycle. In this study, it was shown various CDKN2(p16ink4A) alteration, including deletions, mutations, down regulations, and performed differential expression of p53, Cdk4, PCNA and pRb in stomach cancer tissues. 1. The frequency of CDKN2 mutations was not observed in the 19 primary stomach cancer tissues. In contrast to the mutations of CDKN2, mRNA levels was showed by Northern blot analysis that expression of CDKN2 was absent or decreased in 10 of the 19(53%) primary stomach adenocarcinoma. Western blot analysis was performed to determine the differential expression of p53, Cdk4, PCNA related to Start checkpoint. Overexpression of p53 was shown 38%, Cdk4 was expressed in all each specimens, and expression of PCNA was not shown. 2. As the other method to determine the differential expression of p53, Cdk4, PCNA and pRb, immunohistochemical analyses were performed on each 14 formalin-fixed and paraffin embedded tumor tissues of stomach adenocarcinoma. p53 overexpression was showed to clear nuclear staining only in tumor cells not in nonneoplastic cells. In staining for cdk4, the tumor was considered to be cdk4 positive if there was nuclear staining in tumor cells, regardless of cytoplasmic staining. PCNA staining for carcinoma tissues showed more intense nuclear staining in tumor cells than in nonneoplastic cells. pRb overexpression was show in tumor cells. Significant differences were observed in the expression of the proteins among the cancers from different anatomic site. Overexpression of adenocarcinomas had high rate of p53(57.1%) and pRb(71.4% ), and low late of cdk4(7.1% ) and PCNA(14.3% ), As these results, deletion of CDKN2 gene in human stomach cancer was not observed but mRNA expression was down regulated in restriction checkpoint, G1 phase. Inactivation of the CDKN2 gene due to hypermethylation may play an important role in development of cancer. And one of the abnormalities in p53, Cdk4, PCNA or pRb function occurs very common in various cancers, especially oral adenocarcinoma, osteosarcoma and squemous cell carcinoma, suggest that components in restriction checkpoint also play an critical role in the carcinogenesis and progression of cancers.
Adenocarcinoma ; Blotting, Northern ; Blotting, Western ; Carcinogenesis* ; Cell Cycle ; Cell Division ; Cyclins ; Cytoplasm ; G1 Phase Cell Cycle Checkpoints ; Genes, p16 ; Humans ; M Phase Cell Cycle Checkpoints ; Osteosarcoma ; Paraffin ; Proliferating Cell Nuclear Antigen ; RNA, Messenger ; S Phase ; Social Control, Formal ; Stomach ; Stomach Neoplasms

Fifty-one consecutive 186 patients with aneurysmal subarachnoid hemorrhage were treated from the day of admission with nimodipine which was given first as an IV infusion at 30ug/kg/hr for 1 week and then orally in a dose of 360mg/day for 2 weeks and compared with 135 patients which were treated without nimodipine for the past 2 years. A comparision based on clinical and radiological variables influencing both the coruse and the outcome of the disease showed no significant difference between the nimodipine treated group and the control group except the delayed timing of surgery in the control group. There was no significant difference in the outcome between the nimodipine treated patients and the patients treated without nimodipine, however in Hung & Hess grade IV patients nimodipine treatment was associated with a significantly better outcome. Nimodipine treatment reduced the occurrence of delayed ischemic deficts(DID) in grade III, IV patients. Significant improvement in the outcome occurred in the nimodipine treated patients with subarachnoid hemorrhage of large amount(Fisher classification III).
Aneurysm* ; Classification ; Humans ; Intracranial Aneurysm ; Nimodipine* ; Subarachnoid Hemorrhage*

Fungi have been recognized as a significant cause of external otitis and it may be the primary pathogen or be part of a mixed infection. In the immunocompromised host, fungus is capable of producing infection in inner ear or middle ear. Otomycoses are most frequently caused by Aspergillus spp. and Candida sap. There are few reports that Aspergillus species other than A. fumigatus, A. niger and f. flavus have caused chronic otitis media. We report two cases of chronic otitis media caused by Aspergillus ferrous in Korea. One case is a 7-year-old girl who had recurrent serous otorrhea and otalgia for 4 years, was reattended otolaryngology clinics with otorrhea of 3 days durations and another is a 6-year-old girl who had serous otorrhea for 2 months and 3 day fever, was attended otolaryngology clinics with them. Microscopic appearance and colony morphology from ear discharge cultures revealed A. ferrous. The infection responded well to topical ketoconazole therapy. This report should help to raise medical personnel's awareness of such human opportunistic fungal ear infections.
Aspergillus* ; Candida ; Child ; Coinfection ; Ear ; Ear, Inner ; Ear, Middle ; Earache ; Female ; Fever ; Fungi ; Humans ; Immunocompromised Host ; Ketoconazole ; Korea ; Niger ; Otitis Externa ; Otitis Media* ; Otitis* ; Otolaryngology ; Otomycosis