We report a case of hepatocellular carcinoma presented with severe hypoglycemia. Computerized tomography and ultrasonography revealed a massive bilateral tumor with portal vein thrombosis. The levels of IGF-I (113 ng/mL) and IGFBP- (815 ng/mL) measured in the plasma, were lower than normal range. There was strong immunoreactivity of IGF- and IGF-I in immunohistochemical stain of tumor cells.
Carcinoma, Hepatocellular* ; Carrier Proteins* ; Fibrinogen* ; Hypoglycemia* ; Insulin-Like Growth Factor Binding Proteins ; Insulin-Like Growth Factor I ; Plasma ; Reference Values ; Ultrasonography ; Venous Thrombosis

Fournier's gangrene is a fulminating gangrene of the male genitalia. It is associated with severe systemic toxic effect and a high motality rate, and it requires early diagnosis and intensive care with surgical intervention. We report a case of Fournier's gangrene in 33-year-old man, who showed marked swelling and necrosis of the scrotum, and extending cellulitis on the right flank and chest. With prompt excision of all the gangrenous scrotal skin and drainage incisions made on the flank and chest, the healing was successful.
Adult ; Cellulitis ; Drainage ; Early Diagnosis ; Fournier Gangrene* ; Gangrene ; Genitalia, Male ; Humans ; Critical Care ; Male ; Necrosis ; Scrotum ; Skin ; Thorax

The transpedicular screw fixation is known to be capable of providing more secure correctional, force and rigid fixation to the spine. But it is often accompanied by various complications, including stress shield effects, loosening in osteoporotic spine, pseudoarthrosis, hardware problems and long-term change in motion behaviors at the adjacent motion segment and etc. The purpose of this study is to compare the flexible and rigid rods system in terms of complications and problems for various degenerative lumbar diseases. From September 1991 to November 1994, 41 patients were operated with the flexible rods system (group A) and 39 patients with the rigid rods system (group B). They were followed up for more than 4 years. The flexible rods system was composed of 41 cases of Wiltse system and the rigid rods system was composed of 29 cases of Diapason, 8 cases of TSRH and 2 cases of CD instrument. The resuits of the study were as follows: 1. By standard Cobb lateral measurement, 7 cases in group A and 10 cases in group B showed significant loss of sagittal angle (>4), post-operatively. 2. Hardware failure was noted in 7 cases in group A and 10 cases in group B. In group A, rod bending was seen in 4 cases, rod breakage in 2 and screw loosening in one. In group B, screw loosening was observed in 5 and screw-rod locking mechanism failure in 5 cases. 3. In spondylolisthesis patients, 10 cases in group A and 14 in group B, there was no statistically significant differences between the two groups in the reduction rate immediately after surgery and loss of reduction at the last follow up. 4. Clinical results were good to excellent in 85.4% of patients in group A and 82.1% of group B. No statistically significant differences between the two groups were found, 5. No statistically significant differences between the two groups were found with respect to degenerative changes at the adjacent motion segment to the fused level and pseudoarthrosis.
Follow-Up Studies ; Humans ; Pseudarthrosis ; Spine* ; Spondylolisthesis

Plexiform neurofibroma is considered to be pathognomic of neurofibromatosis type 1 (NF1). Herein we report a solitary plexiform neurofibroma which is not associated with NF1. A 61-year-old man presented with asymptomatic skin colored nodules on the medial side of his left great toe. No other abnormalities were found in his personal or family history. Clinically, the tumor was simulating the appearance of mucous cysts. Microscopically,it was a plexiform neurofibroma located in the dermis which seemed to originate from small superficial nerves. This case would seem to confirm that the superficial form of plexiform neurofibroma involving small nerves in the dermis or subcutis is not necessarily pathognomic for NF1.
Dermis ; Humans ; Middle Aged ; Neurofibroma, Plexiform* ; Neurofibromatosis 1 ; Skin ; Toes

We present a 37-year-old male who was found to had mas within the bronchus. This patients was admitted for the evaluation of cough. Chest CT scan showed endobronchial mass in the bifurcation of LUL and LLL bronchus. The left lower lobe was atelectatic. Lobectomy of the left lower lobe was done. On opening of the bronchus, there was a 2x1x1 cm sized endobronchial mass. Histologically, the mass was smooth muscle tumor composed of densely packed eosinophilic spindle cells in interlacing bundles with pale elongated nuclei covered by bronchial epithelium. On immunohistochemical staining, the tumor cells were positive for desmin. Ultrastructurally, the tumor cells exhibited numberous cytoplasmic microfilaments with focal densities, pinocytotic vesicles, and a thick basal lamina.
Male ; Humans

Opioid-induced chest wall rigidity is an uncommon complication of opioids. Because of this, it is often difficult to make a differential diagnosis in a mechanically ventilated patient who experiences increased airway pressure and difficulty with ventilation. A 76-year-old female patient was admitted to the intensive care unit (ICU) after surgery for periprosthetic fracture of the femur neck. On completion of the surgery, airway pressure was increased, and oxygen saturation fell below 95% after a bolus dose of fentanyl. After ICU admission, the same event recurred. Manual ventilation was immediately started, and a muscle relaxant relieved the symptoms. There was no sign or symptom suggesting airway obstruction or asthma on physical examination. Early recognition and treatment should be made in a mechanically ventilated patient experiencing increased airway pressure in order to prevent further deterioration.
Aged ; Airway Obstruction ; Analgesics, Opioid ; Asthma ; Diagnosis, Differential ; Female ; Femur Neck ; Fentanyl* ; Humans ; Intensive Care Units ; Lung Diseases, Obstructive ; Muscle Rigidity ; Oxygen ; Periprosthetic Fractures ; Physical Examination ; Thoracic Wall* ; Thorax* ; Ventilation

No abstract available.
Humans ; Hypoplastic Left Heart Syndrome* ; Survivors*

No abstract available.
Debridement* ; Knee* ; Osteoarthritis*

PURPOSE: To determine the MR parameters affecting India ink artifacts on opposed-phase chemical shift magnetic resonance (MR) imaging.MATERIALS AND METHODS: The use of a female Sprague-Dawley rat was approved by our Institutional Animal Care and Use Committee. Using an iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) images, which is a modified Dixon method, axial opposed-phase images of the abdominal cavity were obtained with different MR parameters: series 1, different repetition times (TRs; 400, 2000, and 4000 ms); series 2, different echo times (TEs; 10, 50, and 100 ms); series 3, different field of views (FOVs; 6, 8, 16, and 24 cm); series 4, different echo train lengths (ETLs; 2, 4, and 8); series 5, different bandwidths (25, 50, and 85); and series 6, different slice thicknesses (1, 2, 4, 8, and 16 mm). Artifacts on opposed images obtained with different parameters were compared subjectively by two radiologists. For objective analysis, the thickness of the artifact was measured. Spearman's correlation between altered MR parameters and thicknesses of India ink artifact was obtained via objective analysis.RESULTS: India ink artifact was increasingly apparent using shorter TE, larger FOV and ETL, and thicker slices upon subjective analysis. The objective analysis revealed a strong negative correlation between the thickness of the artifact and TE (r = -0.870, P < 0.01); however, strong positive correlations were found between FOV (r = 0.854, P < 0.01) and slice thickness (r = 0.971, P < 0.01).CONCLUSION: India ink artifact was thicker with shorter TE, larger FOV, and larger slice thickness.
Abdominal Cavity ; Animals ; Artifacts ; Female ; Humans ; India ; Ink ; Methods ; Rats ; Rats, Sprague-Dawley ; Water

We have compared the computed tomographic(C. T.) findings with those of conventional roentgenogram(simple AP and lateral radiograms) in 18 cases of osteochondritis dissecans of the capitellum humeri available for review. Among the 18 cases, 2 cases of them had a lesion of osteochondritis dissecans on C. T. which, however, had not been found on conventional rentgenograms. Fro the 5 cases, which had not clearly found on conventional rentgenograms, 2 loose body on conventional view, 3 cases had different numbers and locations of loose body on C. T. films. On the bases of our findings, we recommend that C. T. is necessary in early detection and the determination of anatomical location and status of osteochondritis dissecans of capitellum.
Osteochondritis Dissecans ; Osteochondritis