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

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

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

Mucinous adenocarcinoma of the renal pelvis is a very rare entity. We report a case of mucinous adenocarcinoma developed in the renal pelvis with brief review of literatures. The patient was a 53 year-old woman who had a history of adenocarcinoma of the cervix at 5 years ago.
Adenocarcinoma ; Adenocarcinoma, Mucinous* ; Cervix Uteri ; Female ; Humans ; Kidney Pelvis* ; Middle Aged ; Mucins*

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*

BACKGROUND: Cisatracurium is a nondepolarizing muscle relaxant. It less likely release histamine and has better cardiovascular stability. It presumably undergoes pH and temperature- dependent, nonenzymatic chemical process, Hofmann reaction. In vitro studies, Hofmann reaction was enhanced with increasing pH, but, in vivo the influence of acid-base imbalance is not well defined. METHODS: To evaluate the effects of acid-base imbalance on the neuromuscular blockade of cisatracurium in the cat, we induced acid-base imbalance and performed cumulative dose-response studies. RESULTS: ED50 of the cisatracurium was significantly reduced in all groups. Dose-response curves from all acid-base imbalance groups did not have significant differences in slopes. But, all showed shift-to-left when compared with control curve, showing decreased ED50. Duration of action was not affected. Recovery index was significantly changed in respiratory and metabolic alkalosis. CONCLUSIONS: It may be concluded that acid-base imbalance significantly augmented the potency of cisatracurium, but, changes of recovery index in this study may be resulted from systemic instability such as unstable hemodynamic state by the prolonged experiment.
Acid-Base Imbalance* ; Alkalosis ; Animals ; Cats* ; Chemical Processes ; Hemodynamics ; Histamine ; Hydrogen-Ion Concentration ; Neuromuscular Blockade*

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

Central hyperthermia is a very rare disease; however, once it happens, it is associated with a poor prognosis and high mortality for patients with severe brainstem strokes. Following a pontine hemorrhage, a 46-years-old female developed prolonged hyperthermia. Work-ups to the fever gave no significant clues for the origin of fever, and hyperthermia did not respond to any empirical antibiotics or antipyretic agents. The patient's body temperature still fluctuated in a range of 37.5degrees C to 39.2degrees C. Considering the lesion of hemorrhage, we suspected central hyperthermia rather than infectious diseases. We started with baclofen administration at a dose of 30 mg/day. The body temperature changed to a range of 36.6degrees C to 38.2degrees C. We raised the dose of baclofen to 60 mg/day. The patient's body temperature finally dropped to a normal range. Central hyperthermia, caused by failures of thermoregulatory pathways in brainstem, following the pontine hemorrhage rarely occurs. Baclofen can be used to treat suspected central hyperthermia in a patient with pontine hemorrhage.
Anti-Bacterial Agents ; Antipyretics ; Baclofen* ; Body Temperature ; Brain Stem ; Communicable Diseases ; Female ; Fever* ; Hemorrhage* ; Humans ; Mortality ; Pons ; Prognosis ; Rare Diseases ; Reference Values ; Stroke