No abstract available.
Dacryocystorhinostomy*

PURPOSE: The solid variety of cerebella r tumors in adult is relatively uncommon. This study is to describe the characteristic MR findings of various solid cerebellar tumors in adult. METHODS: Twenty three cerebellar solid tumors from 22 consecutive patients over age of 15 with surgical confirmations were retrospectively evaluated with MR imaging. H istologic diagnosis included hemangioblastoma (n=6), metastasis (n=6), high-grade astrocytoma (n=3), and medulloblastoma (n=8). The MR findings were reviewed with attention to the size, the signal intensity of the tumors, pattern of enhancement, tumoral margin, degree of peritumoral edema, signal void vascular structures within and/or around the tumor, and location in relation to attachment to the pial surface of the tumor. RESULTS: Solid hemangioblastomas consistently showed slightly low or iso signal intensity on T1 -weighted images and high intensity on T2-weighted images, dense homogeneous enhancement, and signal void vessels within and/or around the mass. Metastatic tumors showed various find ings with predominantly low or iso signal intensity on T2-weighted images. Medulloblastomas was midline and/or paramidline in location, and had larger mass formation. High-grade astrocytomas revealed nonspecific MR findings with no signal void vessels. CONCLUSION: Hemangioblastoma, metastasis, malignant astrocytoma, and medulloblastoma should be included in differential diagnosis of solid cerebellar tumors in adult. Dense homogeneous enhancement and signal void vessels are characteristic of hemangioblastoma. The signal intensity of the tumor, and presence of signal void vessels, location and enhancement pattern can be some value in differential diagnosis of solid cerebellar tumors in adult.
Adult* ; Astrocytoma ; Cerebellar Neoplasms* ; Diagnosis ; Diagnosis, Differential ; Edema ; Hemangioblastoma ; Humans ; Magnetic Resonance Imaging ; Medulloblastoma ; Neoplasm Metastasis ; Retrospective Studies

BACKGROUND: Positive end expiratory pressure (PEEP) ventilation is well established as an integral part of the management of patients with the acute lung injury. PEEP is a key element in the treatment of hypoxemia resulting from pulmonary edema. Pulmonary capillary pressure (Pcap) is the most important factor influencing lung edema formation, and an understanding of how Pcap is altered by variations of PEEP or pulmonary arterial occlusion pressure (PAOP) is important to improve the treatment of acute lung injury patients. This study was performed to evaluate the effects of PEEP on the pulmonary capillary pressure in acute lung injury patients. METHODS: This was a prospective study of 11 acute lung injury patients. The effect of PEEP on pulmonary circulation at four different levels (0,4,8, and 12cm H2O) was analyzed. Pcap was estimated visually at bed side with Swan Ganz catheters. The pulmonary vasculature was analyzed by calculating the pressure difference at the arterial and venous parts of the circulation. RESULTS: As PEEP increased from 0 to 12 cm H2O, the mean puhnonary arterial pressure (PAP) and Pcap increased respectively from 22.7 ± 7.4 to 25.3 ± 7.3 mmHg and 15.3 ± 3.3 to 17.8 ±3.2 mmHg (p<0.05). Similarly, PAOP increased from 9.8 ± 2.1 to 12.8 ± 2.1 mmHg and the central venous pressure increased from 6.1 ± 1.6 to 9.3 1: 2.3 mmHg(p<0.05). However, the pressure gradient at the arterial (PAP-Pcap) and venous (Pcap-Pcwp) part of pulmonary circulation remained unchanged at all evaluated PEEP levels. CONCLUSION: Although Pcap increasoo gradually with increased PEEP, the pressure gradient at the arterial and venous part of the pulmonary vasculature remained unchanged at all evaluated PEEP levels in acute lung injury patients.
Acute Lung Injury* ; Anoxia ; Arterial Pressure ; Capillaries* ; Catheters ; Central Venous Pressure ; Edema ; Humans ; Lung ; Positive-Pressure Respiration* ; Prospective Studies ; Pulmonary Circulation ; Pulmonary Edema ; Ventilation

We reviewed 56 patients who received mandibulotomy at Yonsei medical center between 1989 and 1999. We also analysed the complications associated with mandibulotomy and its contributing factors. The complications occur in 16 patients(28.6%) and are classified into two categories; intraoperative and postperative complications. Nonunion was observed in 5 patients and osteoradionecrosis in 5. The patients who received preoperative radiation therapy were more tend to develop nonunion and osteoradionecrosis. This study suggests the benefits of mandibulotomy as a surgical approach to oral cancer: 1. Paramedian osteotomy was recommended for preservation of neurovascular bundle and ease of surgical access. 2. By using thin saw blade, reapproximation was improved with minimal bone loss. 3. osteotomy on anterior mandible which lies outside the usual portals of radiation therapy decreases the incidence of osteoradionecrosis.
Humans ; Incidence ; Mandible ; Mouth Neoplasms* ; Osteoradionecrosis ; Osteotomy

No abstract available.

PURPOSE: The purpose of this study is to determine predictive MR features for grading of astrocytic gliomas and to evaluate the accuracy of MR grading in these tumors. MATERIALS AND METHODS: We retrospectively reviewed 135 cases of supratentorial astrocytic gliomas in adult (age > 15 years), all of which were proved by open biopsy. Two observers analysed MR images independently with criteria of margin, edema, mass effect, signal heterogeneity, necrcosis, cyst formation, hemorrhage, tumor vascularity, enhancement degree, and enhancement size. The patterns of enhancement were categorized into no, homogeneous, heterogeneous, thin smooth rim, thin irregular rim, and thick irregular rim enhancement patterns. Observers finally diagnosed each case as one of low-grade astrocytoma, anaplastic astrocytoma or glioblastoma multiforme. RESULTS: Statistically significant MR features for grading of these tumors were revealed as necrosis (p < 0. 001), edema (0.008), and signal heterogeneity (p < 0.025). When compared with histopathologic grading, MR graded correctly 76%-77% of cases in two tiered system(low-grade astrocytoma versus high-grade astrocytoma), but only 67%-69% of cases in three tiered system(low-grade astrocytoma, anaplastic astrocytoma, glioblastoma multiforme). No contrast enhancement was seen in 45% and 23% of low-grade astrocytoma and anaplastic astrocytoma respectively. Glioblastoma multiforme frequently showed thick irregular rim enhancement (57%), but no enhancement at all in 8%. CONCLUSION: We have concluded that necrosis and edema are significant predictive MR features for gradomg of supratentorial astrocytic gliomas in adult, and MR was correct in 76%--77% of cases for predicting pathologic grading of astrocytomas in two tiered system.
Adult* ; Astrocytoma* ; Biopsy ; Edema ; Glioblastoma ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Necrosis ; Neoplasm Grading* ; Population Characteristics ; Retrospective Studies

BACKGROUND: Following major lung resection, patients have routinely been monitored in the intensive care unit (ICU). Recently, however, patients are increasingly being placed in a general thoracic ward (GTW). We investigated the safety and efficacy of the GTW care after lobectomy for lung cancer. MATERIALS AND METHODS: 316 patients who had undergone lobectomy for lung cancer were reviewed. These patients were divided into two groups: 275 patients were cared for in the ICU while 41 patients were care for in the GTW immediately post-operation. After propensity score matching, postoperative complications and hospital costs were analyzed. Risk factors for early complications were analyzed with the whole cohort. RESULTS: Early complications (until the end of the first postoperative day) occurred in 11 (3.5%) patients. Late complications occurred in 42 patients (13.3%). After propensity score matching, the incidence of early complications, late complications, and mortality were not different between the two groups. The mean expense was higher in the ICU group. Risk factors for early complications were cardiac comorbidities and low expected forced expiratory volume in one second. The location of postoperative care had no influence on outcome. CONCLUSION: Immediate postoperative care after lobectomy for lung cancer in a GTW was safe and cost-effective without compromising outcomes in low-risk patients.
Comorbidity ; Forced Expiratory Volume ; Hospital Costs ; Humans ; Incidence ; Intensive Care Units ; Lung ; Lung Neoplasms ; Postoperative Care ; Postoperative Complications ; Propensity Score ; Risk Factors

Yakovlev demonstrated that the Schizencephalies appear to result from injury to developing cerebral vesicles in the second month of intrauterine life. There is a total loss of neurons in restricted symmetrical zones of each developing hemisphere and on either side of the resulting cleft-shaped defects are evidences of subtotal injury to developing neuroblasts. A case of a 4 years old male with Schizencephaly is reported.
Child, Preschool ; Humans ; Male ; Malformations of Cortical Development* ; Neurons

Calcifying fibrous pseudotumors (CFP) are rare soft tissue tumors that have unique histopathologic features characterized by a dense hyalinized collagenous tissue interspersed with benign spindle cells, lymphoplasmacytic infiltrate, and psammomatous or dystrophic calcifications. We report here on a case of calcifying fibrous pseudotumors in the pleura and provide a literature review.
Collagen ; Hyalin ; Pleura ; Pleural Diseases

PURPOSE: To evaluate the impact of primary Gleason grade in Gleason score (GS) 7 prostate cancer on biochemical recurrence (BCR) after radical prostatectomy in Korean men. MATERIALS AND METHODS: We retrospectively reviewed records of 1,026 patients who underwent radical prostatectomy at Seoul National University Bundang Hospital between November 2003 and June 2009. We excluded patients who had received neoadjuvant therapy and had positive resection margins. Finally, 295 and 113 patients with GS 3+4 and GS 4+3, respectively, were included in this study. All patients were followed for at least 2 years. RESULTS: Of the 408 GS 7 patients, 295 (72.3%) were 3+4 and 113 (27.7%) were 4+3. Mean serum prostate specific antigen level in primary Gleason 3 was 8.99 ng/ml and primary Gleason 4 was 11.11 ng/ml. Patients with GS 4+3 were more likely to have extracapsular extension (30.1% vs. 17.6%, p<0.010) and lymphatic invasion (16.8% vs. 7.1%, p<0.005). After 2 years follow up BCR was detected in a total of 40 patients. In GS 7 with primary Gleason 3, BCR occurred in 15 (5.08%) patients while 20 (17.70%) showed BCR in GS 7 with primary Gleason 4. CONCLUSIONS: In this study of a large, single center cohort of Korean men with GS 7 prostate cancer a noticeable difference in BCR was seen. Primary Gleason grade 4 have a higher risk of BCR compared to primary Gleason grade 3. This information may be useful when counseling patients on their prognosis and further management options.
Biopsy ; Cohort Studies ; Counseling ; Follow-Up Studies ; Humans ; Male ; Neoadjuvant Therapy ; Neoplasm Grading ; Prognosis ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Recurrence ; Retrospective Studies