No abstract available.
Aspergillosis*

The embryological and anatomical features of urachal anomalies have been well defined. Because of the variable clinical presentation, uniform guideline for evaluation and treatment are lacking. Although urachal remnants are rarely observed clinically, they often give rise to a number of problems such as infection and late malignant changes. Therefore, a total assessment of the disease with a particular focus on embryology, anatomy and clinical symptoms, as well as the most advisable management, is called for. Twenty six patients with urachal remnants were treated at the Department of Pediatric Surgery from August 1980 to June 1998. Of these 26, 9 were classified as patent urachus, 11 as urachal sinus, 4 urachal cyst, 1 urachal diverticulum and 1 alternating sinus. The group consisted of 11 males and 15 females. The age distribution was 20 neonates, 3 infants, 2 preschoolers and 1 adult. Infection was the most frequent complication and Staphylococcus aureus was the predominant causative microorganism. Fistulogram was performed in 4 cases and ultrasound examination disclosed cysts or sinus in 7 cases. Excision was performed in 24 patients and incision and draniage in 2 cases as a primary treatment. There was no postopreative complication or recurrence.
Adult ; Age Distribution ; Diverticulum ; Embryology ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Recurrence ; Staphylococcus aureus ; Ultrasonography ; Urachal Cyst ; Urachus

Broncho-gastric fistula caused by benign gastric ulcer perforation after esophagectomy is very rare. In general anesthesia of a patient with broncho-gastric fistula, in spite of hyperventilation, leakage of the anesthetic gases through fistula may make the patient hypercapneic, and positive pressure ventilation may increase the risk of the pulmanary aspiration by the regurgitation of gastric fluid by stomach distension. For that reason, in this patient, denitrogenation was performed during patient's voluntary respiration with 100% oxygen for 5 minutes, and induction was performed without positive pressure ventilation, and one lung ventilation was carried out. Hypoxemia was followed by one lung ventilation because his pulmonary function was moderate obstructive type and his lung was damaged by aspiration of gastric fluid via broncho-gastric fistula. A low level of continuous positive airway pressure (CPAP) has no significant hemodynamic effect and can maintain the patency of nonventilated lung, so hypoxemia induced by one lung ventilation may be reduced. Thus we carried out one lung ventilation with CPAP (10 cmH2O) in nonventilated lung and blocked broncho-gastric fistula with a bronchial blocker for prevention of both regurgitation of gastric fluid and leakage of anesthetic gases. One lung anesthesia was performed without any problem in this case.
Anesthesia ; Anesthesia, General* ; Anesthetics, Inhalation ; Anoxia ; Continuous Positive Airway Pressure ; Esophagectomy ; Fistula* ; Hemodynamics ; Humans ; Hyperventilation ; Lung ; One-Lung Ventilation ; Oxygen ; Positive-Pressure Respiration ; Respiration ; Stomach ; Stomach Ulcer

No abstract available.
Cardiomyopathy, Hypertrophic*

Pachydermodactyly is a rare distinct form of fibromatosis characterized by acquired, asymptomatic dense fibrosis and fibroblastic proliferation around one or more proximal interphalangeal joints. Intralesional triamcinolone injection may be helpful in improving the clinical appearance. A 20-year-old unemployed female patient gave a four years history of progressive swelling of the fingers affecting predominantly the proximal interphalangeal joints of index fingers of left hand and index, middle fingers of right hand. There was no pain and tenderness. Physical examination, complete blood count, antinuclear antibody, rheumatoid factor were unremarkable and radiograph of both hands showed soft tissue swelling only without bony abnormality. We excised the redundant soft tissue from the both sides of proximal interphalangeal joint with longitudinal elliptical fashion. After operation, the fingers of the patient showed marked improvement cosmetically. There were no motor or sensory changes. Pachydermodactyly was first reported in 1996 in Korea. Histologic features include an increased dermal accumulation of collagen and occasionally an increased number of fibroblast. We report for one patient with pachydermodactyly treated with longitudinal elliptical excision and obtained an improvement of clinical appearance.
Antibodies, Antinuclear ; Blood Cell Count ; Collagen ; Female ; Fibroblasts ; Fibroma ; Fibrosis ; Fingers ; Hand ; Humans ; Joints ; Korea ; Physical Examination ; Rheumatoid Factor ; Triamcinolone ; Young Adult

PURPOSE: We analysed CT findings of thyroid mass to determine the difference between a benign and a malignant mass and to evaluate the differential findings, if any. MATERIALS AND METHODS: The subjects were 87 cases with apathologically proven thyroid mass (malignancy in 66 cases, benign mass in 21 cases). CT findings were retrospectively analysed. For the primary masses, bilaterality, size, margin, attenuation of the mass, spotty portion with distinct high attenuation(which may suggest calcification), necrosis, cystic change, solid portion within the cyst, and invasion of adjacent structures were evaluated. For the lymph nodes, size, high attenuated spotty portion, necrosis, cystic change, and solid portion within the cyst were evaluated. CT findings of thyroid masses and lymph nodes were evaluated in order to determine whether these were benign or malignant. Statistical analysis was performed using the Mann-Whitney U-Wilcoxon rank sum test. RESULTS: In malignant masses, compared with benign, an indistinct margin of the mass(48% vs 19%), invasion of adjacent structures(53% vs 0%), and associated lymph node enlargement(50% vs 0%) were more frequent. With regard to bilaterality, size, attenuation, high-attenuated spotty portion(which may suggest calcification), necrosis, cystic change, and solid portion within the cyst, there was no significant difference between benign andmalignant masses. In masses of the former type, enlarged lymph node or invasion of adjacent structure were not seen at all. When the papillary solid portionwithin the cystic mass was additionally evaluated, papillany carcinoma was the most common finding(77% 14\18). CONCLUSION: General findings of malignancy such as margin, invasion of the mass, and lymph node enlargement are of help in the differential diagnosis of a malignant mass. High attenuated spotty portion, which may suggest calcification within the mass, or size of the mass are non-specific findings, and are not helpful in differential diagnosis. The papillary solid portion within the cyst of the mass could suggest papillary carcinoma as a first possibility and could be helpful in differential diagnosis.
Carcinoma, Papillary ; Diagnosis, Differential* ; Lymph Nodes ; Necrosis ; Thyroid Gland*

PURPOSE: Despite advances in the treatment of cancer, recurrence and metastasis continue to pose major problems in clinical mamagement. Recently, molecular based peripheral blood assay using the reverse transcriptase-polymerase chain reaction(RT-PCR) has been shown to be highly sensitive molecular staging modality for detecting extraprostatic disease pre-and post-operatively. The assay uses primers those are specific for prostate specific antigen(PSA) and prostate specific membrane antigen(PSMA). MATERIALS AND METHODS: We compared the application of RT-PCR assay for PSA versus PSMA. These assays were applied to ribonucleic acids extracts from the peripheral blood lymphocyte fraction of 29 patients with metastaic prostate cancer, in which, 13 cases were non neoadjuvant hormonal therapy(NHT) group. In addition, blood specimens from 5 clinically localized cancer were tested. RESULTS: Of 13 metastatic untreated patients 6 had positive for PSA, while 10 cases had positive results for PSMA. Among the 16 patients with hormone treated metastatic cancer patients, 8 (50%) had positive for PSMA while only 1 had positive for PSA. Of 5 localized prostatic cancer, only 1 had positive result just for PSMA. In neoadjuvant hormone treated group, marked reduction in incidence of positive RT-PCR for PSA was noted. An additional explanation is that PSMA may be expressed in hormone refractory cancer. CONCLUSIONS: Presently RT-PCR assay using PSMA is highly sensitive and more accurate than PSA RT-PCR for predicting micrometastasis. We are continuing to increase our patient number and may increase our ability to detect early localized cancer using a molecular approach.
Humans ; Incidence ; Lymphocytes ; Membranes ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Prostate ; Prostatic Neoplasms* ; Recurrence ; RNA

PURPOSE: To determine the MR imaging findings of synovial sarcoma, with emphasis on the signal characteristicsof pathologically correlated T2-weighted images. MATERIALS AND METHODS: MR images of 14 cases ofpathologically-proven synovial sarcomas were retrospectively reviewed and correlated with the histopathologicfindings. We analyzed the signal intensity of T1- and T2-weighted images and the incidence of triple signalintensity, and evaluated the frequency of fluid-fluid levels, internal fibrous septa, calcification, the invasionof bone or neurovascular bundles and the involvement of joint capsules, as well as the size, location and marginof the tumors and pattern of contrast enhancement. RESULTS: Necrosis, cystic change or hemorrhage was suggested in11 cases, ten of which showed triple signal intensity, and in all cases, was pathologically confirmed. Fluid-fluidlevels were found in three cases and internal septa in ten. In four cases, maximum diameter was less than 5cm, andin nine, was greater than this. No mass was detected in one case. The tumor was located in the low extremity(n=9),pelvic girdle and hip joint area(n=2), scapular(n=1), shoulder joint area(n=1), and scalp(n=1). Eleven casesshowed a relatively well-defined margin and nine showed lobulation. Except in the area of necrosis and cysticchange, the pattern of contrast enhancement was diffuse and inhomogenous. Bony invasion was detected in two cases,neurovascular encasement in four, calcification in four, and joint capsule invasion in four. CONCLUSION: OnT2-weighted images, synovial sarcoma frequently showed triple signal intensity and internal septa with fluid-fluidlevels ; this was induced by cystic changes due to necrosis and hemorrhage.
Hemorrhage ; Hip Joint ; Incidence ; Joint Capsule ; Magnetic Resonance Imaging* ; Necrosis ; Retrospective Studies ; Sarcoma, Synovial* ; Shoulder Joint

OBJECTIVE: The anatomy of middle cerebral artery (MCA) bifurcation aneurysms has been noted to be unfavorable for endovascular treatment. Our purpose was to analyze the clinical and angiographic results of coiling of the MCA bifurcation aneurysms. METHODS: From January 2004 to April 2007, 26 patients harboring 29 MCA bifurcation aneurysms were treated with coils. Of these patients, 16 had subarachnoid hemorrhages (SAH). The bleeding source was a ruptured MCA bifurcation aneurysm in 11 patients and a ruptured aneurysm in a different location in 5 patients, respectively. Treatment-related complications, clinical outcomes, and postprocedural and follow-up angiography results were retrospectively evaluated. RESULTS: 29 MCA bifurcation aneurysms (11 ruptured, 18 unruptured) were occluded with coils in 26 patients. Occlusion was complete for 24 (82.8%) of the 29 aneurysms, incomplete for 3 (10.3%), and partial for 2 (6.9%) aneurysms. Procedural complications included thromboembolism in 6, a small nonocclusive thrombus formation in 1, and intraprocedural aneurysmal rupture in 1. All of symptomatic complications were thromboembolic events that occurred 3 patients with unruptured aneurysm and they discharged with moderate disability state. Follow-up angiograms were available on 16 patients with 18 aneurysms and 1 patient with an initial complete occlusion had a slight neck recanalization. CONCLUSION: Coiling of MCA bifurcation aneurysm could be achieved without treatment-induced neurologic deficit in 88.5% (23/26) of the patients while at the same time obtaining favorable anatomic results. Improvements in device technology and technique will certainly greatly increase the safety of coiling of MCA bifurcation aneurysm, widening its indications.
Aneurysm ; Aneurysm, Ruptured ; Angiography ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Neck ; Neurologic Manifestations ; Retrospective Studies ; Rupture ; Subarachnoid Hemorrhage ; Thromboembolism ; Thrombosis

The purpose of this study is to assess abdominal sensation after free TRAM flap for breast reconstruction. 74 patients underwent breast reconstruction with free TRAM flap by authors and were followed up to check the sensation on abdomen following the surgery at the out patient clinic. They are compared with 20 female volunteer controls. Abdomens were divided into 13 zones, and assessed for superficial touch, superficial pain, temperature, two-point discrimination, and vibration. For all five sensory modalities, subjects were found to have decreased sensation in the umbilical and infraumbilical regions. This was statistically significant compared with controls. Division following pedicle dissection showed more reduction of sensation than non-dissection side. Both Inguinal areas below the donor site closure also showed markedly decreased sensation. Sensation on most area of abdomen recovered in postoperative 1 year, however, there were remained hypoesthesia in umbilical and infraumbilical area after post operative 1 year. This study clearly demonstrates that there is a significant and persistent reduction in abdominal sensibility following free TRAM flap surgery.
Abdomen* ; Breast* ; Discrimination (Psychology) ; Female ; Humans ; Hypesthesia ; Mammaplasty* ; Sensation ; Tissue Donors ; Vibration ; Volunteers