As public awareness of the various warning signs of malignancy increases, so does the concern evoked by the self identified finding of mass in the head and neck area. Not all the palpable masses are always significantly abnormal, but any nontender mass especially to the adult is significant enough to warrant further full investigation and follow up, the object of which should be to determine the possibility of malignancy and urgency of treatment. Approach to the diagnosis of the neck mass is so important in that it affects decision regarding further evaluation would lead to the determination of the most efficacious mode of therapy, eventually to the good prognosis. So, it should be emphasized that approach to the diagnosis of neck mass should be planned, systematic and thorough, this begins with the taking careful history following performance of complete examination of the head and neck especially to the nasopharynx, tongue base, pyriform sinus, palatine tonsil and larynx. Then a number of laboratory and radiologic studies are available, following triple endoscopy under general anesthesia and blind biopsy if needed. The most important rule to keep is that any biopsy procedures should be delayed to the last modality of effort to the diagnosis and if it should be done, under the plan of radical neck dissection.
Adult ; Anesthesia, General ; Biopsy ; Diagnosis ; Endoscopy ; Follow-Up Studies ; Head ; Humans ; Larynx ; Nasopharynx ; Neck Dissection ; Neck* ; Palatine Tonsil ; Prognosis ; Pyriform Sinus ; Tongue

PURPOSE: We evaluated the importance of redistribution and 24 hour reinjection images in Tl-201 SPECT assessment of myocardial viability after acute myocardial infarction (AMI). MATERIALS AND METHODS: We performed dipyridamole stress-4 hour redistribution-24 hour reinjection Tl-201 SPECT in 43 patients with recent AMI (4-16 days). The myocardium was divided into 16 segments and perfusion grade was measured visually with 4 point score from 0 to 3 (absent uptake to normal uptake). A perfusion defect with stress score 2 was considered moderate. A defect was considered severe if the stress score was 0 or l (absent uptake or severe perfusion decrease). Moderate defect on stress image were considered viable and segments with severe defect were considered viable if they showed improvement of 1 score or more on redistribution or reinjection images. We compared the results of viability assess-ment in stress-redistribution and stress-reinjection images. RESULTS: On visual analysis, 344 of 688 segments (50%) had abnormal perfusion. Fifty two (15%) had moderate perfusion defects and 292 (85%) had severe perfusion defects on stress image. Of 292 severe stress defects, 53 were irreversible on redistribution and reversible on reinjection images, and 15 were reversible on redistribution and irreversible on reinjection images. Two hundred twenty four of 292 segments (76.7%) showed concordant results on stress-redistribution and stress-reinjection images. Therefore 24 hour reinjection image changed viability status from necrotic to viable in 53 segments of 292 severe stress defect (18%). However, myocardial viability was underestimated in only 5% (15/292) of severe defects by 24 hour reinjection. CONCLUSION: The 24 hour reinjection imaging is useful in the assessment of rnyocardial viability. It is more sensitive than 4 hour redistribution imaging. However, both redistribution and reinjection images are needed since they complement each other.
Complement System Proteins ; Dipyridamole ; Humans ; Myocardial Infarction* ; Myocardium ; Perfusion ; Tomography, Emission-Computed, Single-Photon

Hydroa vacciniforme is a very rare photosensitivity disorder. The primary skin lesion is a vesicle or bulla which then heals with vacciniform scarring. We report a case of hydroa vacciniforme recurred after 3 years period of quiescence in a 20 year-old man who had had history of the disease from the age of two. The duplication of the natural lesion, clinically and histologically, was successfully made by artificial UV-A irradiation on the patient's back.
Cicatrix ; Hydroa Vacciniforme* ; Photosensitivity Disorders ; Skin

No abstract available.
Stomach Neoplasms*

The incidence of pancreatic trauma is increasing and still remains a major source of morbidity and mortality. We have graded the pancreatic trauma on CT according to its pattern into four grades. We also determine the accuracy of CT in the evaluation of pancreatic trauma and the role of CT for delineation of pancretic ductal injury which is critical factor in outcome of pancreatic trauma. CT correctly diagnosed the pancreatic trauma and its traumatic pattern and severity in 22 of 25 cases. Pancreatic enlargement was the most common findings observed in 19 cases. Other findings were 15 cases of intrapancreatic low density hematoma, 12 cases of parenchymal fracture which were predilected in pancreatic neck area. CT grade III and IV could predict the pancreatic ductal injury, and was well correlated with severity of posttraumatic pancreatitis, duration of admission days and incidence of complications. So we concluded that CT can play a definite role for diagnosing and determining the prognosis of pancreatic trauma.
Diagnosis* ; Hematoma ; Incidence ; Mortality ; Neck ; Pancreatic Ducts ; Pancreatitis ; Prognosis

PURPOSE: In order to elucidate the actual mechanism and the optimal concentration of Lamotrigine(LTG) that suppresses epileptiform discharges, we observed epileptiform discharges from hippocampal slices of immature rat in 4-aminopyridine(4-AP) added Mg2+ - free medium of artificial cerebrospinal fluid(aCSF) with various LTG concentrations. METHODS: We divided 19-23 day-old Sprague-Dawley rats into 4 groups; control group(n=12) and 3 LTG groups depending on the concentrations of LTG such as 400 (n=9), 800(n=7), and 1,000(n=8) microM. The rats were anesthetized and their brains were taken, soaked in aCSF(NaCl 125 mM, KCl 2.5 mM, NaH2PO4 2 mM, MgSO4 1.25 mM NaHCO3 25 mM, CaCl2 2 mM, Glucose 10 mM, pH 7.3-7.4). And then the brains were cut into 400 microm hippocampal slices by a vibratome. The slices of control group were soaked in 200 microM 4-AP added Mg2+ -free medium of aCSF for 1 hour, and then extracellular recordings were performed in hippocampal CA1 pyramidal region. The slices of LTG groups were soaked in the solution containing 400, 800, and 1,000 microM LTG, then extracellular recordings were performed. RESULTS: Interictal discharges were observed in all the control and the LTG groups. The latency to the first interictal discharges after 4-AP addition was 52.7+/-26.9 sec in control group, but was 225.0+/-28.2 sec in 800 microM and 322.1+/-116.4 sec in 1,000 microM group of LTG(P<0.05). The duration of interictal discharges was 64.6+/-35.6 sec in control group, but was the shortest in 800 microM group of LTG at 39.3+/-12.6 sec. Ictal discharges were observed in all of control and 400 microM group, but the frequency was decreased as the concentration of LTG increases, 57.1% in 800 microM, 12.5% in 1,000 microM group. The latency to ictal discharge after 4-AP addition was 142.1+/-52.6 sec in control group, but increased as the concentration of LTG increases, 304.4+/-84.5 sec in 400 microM group and 689.8+/-213.1 sec in 800 microM group(P<0.05). The duration of ictal discharges was 1,534.7/-339.3 sec in control group, but decreased as the concentration of LTG increases, it was 126.5+/-76.1 sec in 800 microM group(P <0.05) and 42 sec in 1,000 microM group. CONCLUSION: The antiepileptic effects of LTG were most significant when the concentration, inhibiting epileptiform discharges induced by 4-AP and Mg2+ -free medium in hippocampal slices of immature rats, was 800 microM or higher. Although the basic pharmacologic mechanism of LTG is the inhibition of sodium channel, it may also work on potassium channel at higher concentrations.
4-Aminopyridine* ; Animals ; Brain ; Glucose ; Hydrogen-Ion Concentration ; Potassium Channels ; Rats* ; Rats, Sprague-Dawley ; Sodium Channels

Forty five patients with inferior vena cava (IVC) thrombosis were studied with the use of ultrasonography (US) and computed tomography (CT). Thirty seven cases were cased by tumor extension and the primary neoplasms were hepatocellular Ca. (26cases), renal cell Ca. (6 cases), Wilms' tumor (1 case), IVC leiomyosarcoma (1 case) and retroperitoneal metastatic tumor (3 cases). Non-tumor thrombus were 8 cases which included 5 cases of Budd-Chiari syndrome and 3 cases of thrombophlebitis. US and CT both were good for the diagnosis of IVC thrombosis. Cranial extension was better demonstrated by US whereas CT yielded better delineation of the lower extension. Even though, differentiation of tumor non-tumor thrombi by the echogenecity and density of the thrombus was not possible, the finkdings of adjacent tumor mass, complete obstructive thrombus within dilated lumen with bulging wall, and nontapered acute margin of thrombus made the possibility of tumor thrombus more likely.
Budd-Chiari Syndrome ; Diagnosis ; Humans ; Leiomyosarcoma ; Thrombophlebitis ; Thrombosis* ; Ultrasonography ; Vena Cava, Inferior* ; Wilms Tumor

Many trials to get informations from arterial waveforms have been done. But it was not so simple as expected because of normally fluctuating characteristics of arterial waveform due to respiration, extracardiac neuro-humoral control, etc. By using power spctral analysis we can figure out powers of these extrinsic contribting factors as well as contours of individual pulse wave by harmonic analysis. The purpose of this study is to compare the results of power spectral analysis and some basic parameters of arterial waveform before and after anesthesia to establish the basic changes during halothane anesthesia. The analog informations, obtained from patients undergoing operation with radial artery cannulated for continuous monitoring, was obtained from analog output of the Cardiocap monitor. It was transformed to digital information by A/D converter and saved to IBM compatible computer with mathcoprocessor. The data was processed offline by the signal analysis software DADiSP version 1.05 with the same computer. Results of mean arterial pressure, heart rate, dp/dt, low frequency peak, high frequency peak and harmonic pulse contour analysis were compared before and after anesthesia. We could conclude that halothane anesthesia diminishes all powers of harmonic components of arterial wave and powers of extrinsic components that affect low frequency area.
Anesthesia* ; Arterial Pressure ; Chromonar ; Halothane* ; Heart Rate ; Humans ; Radial Artery ; Respiration

PURPOSE: The purpose.of this study was to characterize the enhancing patterns of hepatocellular carcinoma (HCC) on two-phase dynamic incremental liver scan with spiral CT. MATERIALS AND METHODS: Two-phase dynamic incremental liver scan using spiral CT was performed on 230 lesions in 107 patients with HCC. CT scanning was performed with a table speed of 13mm/sec and a section thickness of 10 mm;120 mL of contrast medium was injected intravenously with a automatic injector at the rate of 3mL/sec. CT scans were started 35 sec(early phase) and 3 min(delayed phase) after beginning injection of contrast medium. The tumors were divided into 2 groups according to size(< or = 3cm and > 3cm), the contrast enhancement patterns of HCCs and capsules in the early and delayed phases were analyzed in each group. RESULTS: Most of HCCs appeared as high-attenuating lesions in the early phase(75% in tumors smaller than 3cm and 61% in tumors larger than 3cm), and as low-attenuating lesions in the delayed phase(68% in tumors smaller than 3cm and 90% in tumors larger than 3cm). Forty-eight percent of HCCs smaller than 3cm and 58% of HCCs larger than 3cm were high-attenuating in the early phase and low-attenuating in the delayed phase. Thirty-two percent of capsules were low- or iso-attenuating in the early phase and high-attenuating in the delayed phase. Capsules were demonstrated in 22% in HCCs smaller than 3cm and 67% in HCCs larger than 3 cm(p <. 01). CONCLUSION: Two-phase dynamic scan with spiral CT is useful in the diagnosis of HCC because of a precise display of hemodynamic characteristics of HCCs.
Capsules ; Carcinoma, Hepatocellular* ; Diagnosis ; Hemodynamics ; Humans ; Liver ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed

The correlation of ventilatory support with sex, age, operation time, aortic cross clamp time was studied in 274 patients undergone open heart surgery after dividing them into total, congenital heart disease, acquired heart disease groups. 1) Ventilatory support time was not significantly different between male and female. 2) In total group, ventilatory support time increased significantly with an increase of pump time, aortic cross clamp time (p<0.05) and age (p<0.01). 3) In congenital heart disease group, ventilatory support time increased significantly with an increase of operation time (p<0.05), pump time, aortic cross clamp time (p<0.001). 4) In acquired heart disease group, ventilatory support time increased significantly with an increase of age (p<0.001).
Anesthesia* ; Female ; Heart Defects, Congenital ; Heart Diseases ; Heart* ; Humans ; Male ; Thoracic Surgery*