Schwannoma is a benign encapsulated nerve sheath tumor and is histologically characterized by a mixture of Antoni type A and B tissue. A preoperative diagnosis of schwannoma by fine needle aspiration cytology or by any other means is important to preserve clinically important nerves. Therefore, it is necessary to make a specific cytological diagnosis of nerve sheath tumor. However, there are a few reports regarding cytological features of schwannoma in Korea. We experienced seven cases of solitary schwannoma and here we report their characteristic cytological features with a review of literatures. The characteristic features of schwannoma on cytology were the presence of both Antoni type A and B tissue. The cytologic findings common to all cases of schwannoma generally corresponded to the histologic findings of Antoni type A tissue, consisting of fragments of tightly cohesive fascicles with variable cellularity. Dense fibrillary substances were found, along with palisading nuclei and Verocay bodies. Individual tumor cells consisted of cohesive cells having spindle or oval nuclei, with pointed ends and indistinct cell borders. Variation in nuclear size and shape was also present. The Antoni type B consisted of scattered wavy or short spindle cells and some histiocytes and lymphocytes in the abundant myxoid background with formation of microcysts. Immunohistochemistry for S-100 protein revealed a uniformly strong positive reaction and was helpful to make more accurate diagnosis of schwannoma.
Hemangioma

BACKGROUND: There are situations in anesthesia in which it may be desirable to achieve rapid tracheal intubation. Rapid tracheal intubation with rocuronium has been studied using a probability-based approach. But these studies used intravenous anesthetics for anesthetic induction. Therefore, we aimed to predict doses of rocuronium giving 90% and 95% probabilities of intubation within 60 seconds and to estimate their action durations using sevoflurane for anesthetic induction. METHODS: Anesthesia was induced in sixty patients with sevoflurane. Patients received randomly rocuronium, 0.0, 0.3, 0.6, 0.9 or 1.2 mg/kg (n = 12/dose). Laryngoscopy began 40 seconds later, aiming for intubation at 60 seconds, and conditions were graded as either perfect, acceptable or unacceptable, with the first two conditions being taken as successful intubation. Duration of action was accepted as time until a twitch height recovery of 15%. The dose versus the fraction of patients showing successful intubation was analyzed by logistic regression. Doses giving 90% and 95% (D90 and D95) probabilities of successful intubation were calculated. RESULTS: Of the 12 patients in each group (0.0, 0.3, 0.6, 0.9 or 1.2 mg/kg), intubation was successful in 4, 10, 12, 12 and 12 patients, respectively. The D90 and D95 doses were determined to be 0.34 and 0.43 mg/kg, respectively. CONCLUSIONS: After induction with sevoflurane, rocuronium at 0.43 mg/kg, gives a 95% probability of successful intubaton at 60 seconds.
Anesthesia* ; Anesthetics, Intravenous ; Humans ; Intubation* ; Laryngoscopy ; Logistic Models

Patients undergoing maintenance dialysis show an increased susceptibility to tuberculosis because host immunity is decreased secondary to malnutrition, impaired cellular immunity, acidosis and etc. Extrapulmonary tuberculosis is more prevalent in patients with end stage renal disease than in normal subjects. Among the extrapulmonary tuberculosis in patients receiving hemodialysis, the diagnosis of tuberculous spondylitis is difficult because the symptoms are non specific and attributable to uremia, and the appearance of plain radiographs is often normal during the early phase of the disease. We experienced a case of tuberculous spondylitis in a hemodialysis patient. A 55 years old female admitted with fever, weight loss and back pain. Conventional radiograph of T-spine showed no definite abnormal finding. However, chest CT revealed heterogeneously enhancing soft tissue around the T8 vertebral body and T-spine MRI showed compatible finding to tuberculous spondylitis. She received radical excision of involved vertebra and confirmed tuberculous spondylitis with histologic finding from a surgical specimen. Following the administration of anti-tuberculosis medication(isoniazid, rifampin, pyraziamide, ethambutol) and radical excision, patient's symptom and sign were improved. The patient is maintaining dialysis with anti-tuberculosis medication for 5 months.
Acidosis ; Back Pain ; Diagnosis ; Dialysis ; Female ; Fever ; Humans ; Immunity, Cellular ; Kidney Failure, Chronic ; Magnetic Resonance Imaging ; Malnutrition ; Middle Aged ; Renal Dialysis* ; Rifampin ; Spine ; Spondylitis* ; Tomography, X-Ray Computed ; Tuberculosis ; Uremia ; Weight Loss

A rare case of a spontaneous intracerebellar hemorrhage from a solid cerebellar hemangioblastoma is reported with review of articles. The cerebellar hemangioblastoma was strongly suspected in the postoperative brain computerized tomography and vertebral angiography. It was successfully removed by second operation and confirmed histologically.
Angiography ; Brain ; Hemangioblastoma ; Hemorrhage

OBJECTIVE: The purpose of this study is to prove and quantify motor tract disruption and to correlate with motor weakness and its recovery in thalamic and putaminal hemorrhage using diffusion tensor magnetic resonance(MR) image. METHODS: We studied 24 patients with thalamic and putaminal hemorrhage with motor weakness who did not underwent surgery(hematoma volume < 25ml). We performed diffusion tensor MR image within a week, and then calculated FA(fractional anisotropy) index and FA ratio of posterior limb of internal capsule. We checked motor power of the patients at initial, 2 weeks, 1 month, 3 months and 6 months after hemorrhage. We divided patients into three groups according to FA ratio(group A: FA ratio < 50.0%, group B: FA ratio 50.0~75.0%, group C: FA ratio > 75.0%)and compared means of motor power at each time. RESULTS: The means of FA ratio were 42.5% in group A, 63.0% in group B and 88.2% in group C. The means of motor power were 1.1, 2.3 and 3.7 at initial. After 6 months the means of motor power were 3.0, 4.0 and 4.5. The group of lower FA ratio had more severe motor weakness and showed worse motor recovery clinically than the group of higher FA ratio(P < 0.01). Though patients had severe motor weakness initially, the patients with high FA ratio showed good recovery. CONCLUSION: In thalamic and putaminal hemorrhage, diffusion tensor MR image can prove the degree of motor tract damage and predict the degree of motor recovery.
Diagnosis* ; Diffusion* ; Extremities ; Hemorrhage ; Humans ; Internal Capsule ; Magnetic Resonance Imaging* ; Putaminal Hemorrhage*

The effect of anesthetic volume on the spread of hypobaric tetracaine were sutdied after intrathecal injection in thirty patients with prone jackknife and 15 degree Trendelenburg position for perinal surgery. The patients were assigned randomly into the one of three groups divided by the 3, 4, or 5 ml of volume of anesthetic solution. The results show that the volume of tetracaine in distilled water with hypobaric spinal anesthesia in prone jackknife and l5 degree Trendelenburg position had a important effect on the anesthetic dermatomal levels in spite of slightly rapid onset with large. volume. Therefore, we concluded that for the perianal surgery in prone jackknife position, as the volume of the anes- thetic solution with hypobaric spinal anesthesia, 3 or 4 ml of the volume are sufficient to get the adequate anesthetic levels.
Anesthesia, Spinal* ; Head-Down Tilt ; Humans ; Injections, Spinal ; Tetracaine ; Water

OBJECTIVE: This study is to determine the cross-cultural adaptation and validation of the Korean version of the EQ-5D (KEQ-5D) in various rheumatic patients. METHODS: We performed translation, backward translation and cognitive debriefing by the guidelines of the EuroQol group. The validity was evaluated by using the KEQ-5D, Korean Short- Form 36 (KSF-36) and disease-specific measures on 508 out-patients with ankylosing spondylitis, fibromyalgia syndrome, rheumatoid arthritis, osteoarthritis or systemic lupus erythematosus. Construct validity were evaluated by testing a-priori hypotheses of the association between the KEQ-5D and other measures. For the verification of reliability, we gave the same questionnaires twice to another 57 patients 1-week apart, and intra-class correlations and Kappa statistics were estimated. To test responsiveness, 60 patients with RA repeated the KEQ-5D at 12-week intervals within the context of 12-week clinical trials of a TNF blocker, and we calculated the t-test, effect size and standardized response mean RESULTS: There were no major modifications on the cross-cultural adaptation. The relationships between the KEQ-5D and the generic or disease-specific measures were observed to be as we expected previously in a-priori hypotheses:higher KEQ-5Dindex and KEQ-5DVAS scores were correlated with generic or disease-specific measures on the better health status, and groups with a better functional class showed higher KEQ-5D scores. The intra-class correlations of the KEQ-5Dindex and KEQ-5DVAS were 0.751 and 0.767, respectively, and Kappa statistics for agreement ranged from 0.455 to 0.772 across five dimensions. The standardized response means of KEQ-5Dindex and KEQ-5DVAS were 0.649 and 0.410. CONCLUSION: The KEQ-5D had good validity and sensitivity in several rheumatic conditions. Also, its reliability and responsiveness were moderate to good.
Arthritis, Rheumatoid ; Fibromyalgia ; Humans ; Korea ; Lupus Erythematosus, Systemic ; Osteoarthritis ; Outpatients ; Quality of Life ; Surveys and Questionnaires ; Rheumatic Diseases* ; Spondylitis, Ankylosing

OBJECTIVE: The purpose of this study is to determine the time evolution and distribution of cerebral apoptosis using the middle cerebral artery occlusion model in rats. METHODS: A total of twenty four male rats - with 2, 3, 4, 6, 8, 12, 24 and 48 hours of middle cerebral artery occlusion respectively - were studied. The terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick-end labeling(TUNEL) method was used for the observation of the apoptotic cells. The apoptotic ratio was calculated and the distribution of apoptosis was inspected in the pyriform cortex, basal ganglia and middle cerebral artery territory cortex. The rats were divided into three groups(Group I: 2~4 hours of occlusion, Group II: 6~12 hours of occlusion, Group III: 24~48 hours of occlusion). RESULTS: In this study, the proportion of apoptosis increased with the duration of middle cerebral artery occlusion and reached a maximum after about 12 hours of middle cerebral artery occlusion. The mean values of the apoptotic ratio were 30.7+/-11.3% in group I, 60.8+/-2.6% in group II and 48.7+/-0.7% in group III. The distribution of apoptosis differed in the pyriform cortex, basal ganglia and middle cerebral artery territory cortex according to the duration of time of the middle cerebral artery occlusion. CONCLUSION: In the middle cerebral artery occlusion model of the rats, apoptosis is found to increase according to the occlusion time, reaching a peak after 6 hours, and the distribution of apoptosis changed from the pyriform cortex to the basal ganglia and middle cerebral artery territory cortex.
Animals ; Apoptosis* ; Basal Ganglia ; Deoxyuridine ; Humans ; Infarction, Middle Cerebral Artery* ; Ischemia ; Male ; Middle Cerebral Artery* ; Rats*

BACKGROUND: Currently no information is available about the effective dose (ED) of rocuronium in Koreans. The purpose of this study was to determine the ED of rocuronium in a Korean cohort. METHODS: We studied one hundred and twenty patients with a class I or II ASA physical status. Anesthesia was induced with propofol 2 mg/kg and fentanyl 2microgram/kg intravenously, and maintained by the continuous infusion of propofol 5 mg/kg/h and 100% oxygen by mask ventilation. Additional increments of fentanyl 50microgram were given as required, and surface electrodes were applied over the ulnar nerve at the wrist. Before each dose of rocuronium was administered intravenously, all patients were stimulated with a 50 Hz supramaximal tetanic stimulation for 5 seconds followed by a 1 Hz single twitch stimulation for 5 minutes to stabilize muscle contraction. The control value was then calibrated by acceleromyography. Twenty female patients were cumulatively administered rocuronium, at an initial dose of 100microgram/kg followed by doses incremented by 50microgram/kg. And 100 patients were allocated to five single dose groups. Subjects these dose groups were randomly administered 100microgram/kg, 150microgram/kg, 200microgram/kg, 250microgram/ kg, or 300microgram/kg of rocuronium. We recorded both the 0.1 Hz single twitch responses of the adductor pollicis and the onset times to maximal blockade. The effect of rocuronium on single twitch was calculated as % reduction versus the control. Results were expressed as means +/- SD or as 95% confidence intervals. A P value of <0.05 was considered statistically significant. EDs were estimated by linear regression analysis using a probit model. RESULTS: No significant differences were found in age, weight, height, or temperature among the dose groups. ED50 and ED95 were determined to be 184microgram/kg and 382microgram/kg, respectively. For men, ED50 and ED95 were 188microgram/kg, 386microgram/kg and for women, 180microgram /kg, 376microgram/kg, respectively. The ED50 and ED95 as determined by the cumulative method in women were 212microgram/kg, 445microgram/kg, respectively. As the dose of rocuronium increased, onset times decreased. Mean onset time was 178 sec. CONCLUSIONS: The mean ED95 of rocuronium in Koreans was determined to be 382microgram /kg, and the ED of women was lower than that of men. The dose-response curve of the cumulative method was positioned to the right of that of the single bolus method in women. The onset time to maximum blockade reduced as the dose was increased.
Anesthesia ; Cohort Studies ; Electrodes ; Female ; Fentanyl ; Humans ; Linear Models ; Male ; Masks ; Muscle Contraction ; Oxygen ; Propofol ; Ulnar Nerve ; Ventilation ; Wrist

Of all forms of ectopic gestation, the possibility of fertility catastrophe is highest with a cervical pregnancy. Though rare, it is a potentially life-threatening condition. In the past it was diagnosed late, after there was profuse hemorrhage from the cervix and it usually required hysterectomy. With ultrasound, diagnosis can be made earlier and conservative management attempted in order to preserve the reproductive potential. Methotrexate has been used both systemically and intra-amniotically to treat cervical ectopic gestation conservatively.
Cervix Uteri ; Diagnosis ; Female ; Fertility ; Hemorrhage ; Hysterectomy ; Methotrexate ; Pregnancy* ; Ultrasonography