An appreciation of the radiation changes in the brain adjacent to radiated glioma is of considerable importance from both clinical and pathological standpoint because the alteration in the brain parenchyma may result in a picture that mimics recurrence of the neoplasm. A 35 years old woman was admitted because of deterioration of consciousness which has started about 20 days ago. Past history revealed removal of left frontal brain tumor 4 years earlier and the diagnosis was grade II astroma. Postoperative radiation was done at that time. Sine then, she has been doing well. Computerized tomogram showed an ill defined huge low density mass at right frontal and left posterior parietal areas, which was irregularly enhanced in postcontrast study. Unlikely to the usual brain tumors, there was no mass effect on adjacent structures. Histologically acellular necrotic zone was alternating with hypercellular zone and most striking changes were vascular and glial reaction. Most of the vessels showed acellular hyliane thickening of their wall and some vessels were almost completely occluded. There was marked glial proliferation with considerable cellular and nuclear irregularities. Gemistocytic astrocytes were frequently seen and some were multinucleated.
Female ; Humans

PURPOSE: The purpose of this study was to describe the clinical outcome after pancreatcetmy and its relationship with pathological appearances and clinical features in patients with persistent hyperinsulinemic hypoglycemia of infancy(PHHI). METHODS: Medical records of 10 patients(9 males and 1 female, mean age:40.4+/-1.5 months) who were diagnosed as PHHI and underwent pancreatectomy from 1988 to 2000 were reviewed. Clincal and biochemical data were recorded. Subjects were classified arbitrarily into early-onset or late-onset group according to age of onset. Pathologic appearance of pancreas was divided into 2 forms:diffuse or focal. The former had a focal pancreatic adenomatous hyperplasia and the latter was characterized by increased number of betacells with similar distribution seen in normal neonates. RESULTS: One patient had focal, and nine had diffuse lesions. After near-total pancreatectomy, 4 patients(40.0%) showed complete response, 4(40.0%) had persistent hypoglycemia, and 2(20.0%) developed diabetes mellitus. As neurological sequelae, 6 patients(60.0%) had persistent seizures, and 6(60.0%) had delayed motor and speech development. No clinical or biochemical factors related to postoperative outcome were found. CONCLUSION: This data indicate that early diagnosis of patients who present with hypoglycemic symptoms in infancy, especially early in life, and development of more effective therapy are warranted, because there is no clinical or biochemical factor predicting final outcome after near-total pancreatectomy and only 40% of patients with PHHI remained euglycemic after surgery with possible severe neurological sequelae.
Age of Onset ; Congenital Hyperinsulinism* ; Diabetes Mellitus ; Early Diagnosis ; Female ; Humans ; Hyperplasia ; Hypoglycemia ; Infant, Newborn ; Male ; Medical Records ; Pancreas ; Pancreatectomy* ; Seizures

Pulmonary thromboembolism (PTE) is a serious postoperative complication. Prompt diagnosis of PTE is important but it is difficult because clinical manifestations of PTE are not obvious in most cases. A 59 year-old woman received cholecystectomy and choledocholithotomy under general anesthesia. At the 9th postoperative day, syncope, hypoxemia and hypotension were developed suddenly and the patient was transfered to intensive care unit. PTE was suspected with hemodynamic monitoring from pulmonary arterial catheter and echocardiography and diagnosed with lung perfusion scan and venogram of lower extremities. Proper cardiopulmonary support was done and the patient was recovered and discharged in improved condition. In conclusion, if a patient have syncopal attack with shock in postoperative period, PTE must be thought to be an one of possible causes of syncope and thoroughly investigated.
Anesthesia, General ; Anoxia ; Catheters ; Cholecystectomy ; Diagnosis ; Echocardiography ; Female ; Hemodynamics ; Humans ; Hypotension ; Intensive Care Units ; Lower Extremity ; Lung ; Middle Aged ; Perfusion ; Postoperative Complications ; Postoperative Period ; Pulmonary Embolism* ; Shock ; Syncope

Thirty-three cases of the fracture of the femur and tibia on the same limb were treated at the Orthopedic Department of the Chosun University Hospital during the period from January 1977 to December 1983. The following results were obtained. 1. The incidence of trauma was high in the young man, most frequent in the third decade (45.4%). 2. The most common cause of the fracture was traffic accident (81;8%). 3. The most common shape of the fracture was comminuted in both femur and tibia. 4. The common fracture site were middle one-third in both femur and tibia. 5. Eight patients were treated by conservative means on both femxr and tibia. The patients were treated by internal fixation on femur and by conservative means on tibia. Internal fixation was .done in ten patients on both femur and tibia. Two patients were treated by inteinal fixation on tibia and by conservative means on femur. Three patients were amputated. 6. Average healing time of fracture was 21 weeks in femur and 24.2 weeks in tibia. 7. Functional end results were assessed and rated with satisfactory results in rigid internal fixation of the femur and tibia.
Accidents, Traffic ; Clinical Study ; Extremities ; Femur ; Humans ; Incidence ; Inteins ; Orthopedics ; Tibia

Cubitus varus deformity is the most common angular deformity resulted by supracondylar fractures in children. Although, this deformity rarely limit elbow function, the correction is frequently requested due to cosmetic problem. The normal carrying angle can be restored by supracondylar osteotomy. Previous reports controversy over the cause of the deformity, the necessity and timing of operative correction, the operative technique itself, and the attendant risks. We performed 18 lateral closing wedge osteotomies with French technique(10 cases), and Sherman plate fixation(8 cases) by posterolateral approach from January 1978 to December 1988 at Chosun University Hospital. The results were as follows: 1. The most common cause of cubitus varus was suprcondylar fracture of the humerus(88.9%). 2. The results of supracondylar osteotomies were excellent is 8 cases(44.8%), good in 7 cases (38.9%), poor in 3 cases(16.7%). 3. The varus and rotational deformities were corrected by modified French method and Sherman plate fixation after lateral closing osteotomy. 4. In case of plate fixation, good results were obtained even older cases because of reducing time of extermal immobilization and promotion early joint exercise.
Child ; Congenital Abnormalities ; Elbow ; Humans ; Immobilization ; Joints ; Methods ; Osteotomy

BACKGROUND: Subcapital femoral neck is known to cause many complications, such as avascular necrosis (AVN) of the femoral head or nonunion, compared with other femoral neck fractures. The purpose of this study was to analyze the incidence of AVN and fixation failures in patients treated with internal fixation using cannulated screws for the subcapital femoral neck fractures. METHODS: This study targeted a total of 84 cases of subcapital femoral neck fractures that underwent internal fixation using cannulated screws. The average follow-up time after surgery was 36.8 months (range, 24 to 148 months). RESULTS: Nine hips (10.7%) showing AVN of the femoral head and 6 hips (7.1%) showing fixation failures were observed. The factors affecting the incidence of AVN of the femoral head after sustaining fractures correlated well with fracture types in the Garden classification (p = 0.030). The factors affecting fixation failure were the degree of reduction (p = 0.001) measured by the Garden alignment index and firm fixation (p = 0.009) assessed using the technique of 3-point fixation through the inferomedial cortical bone of the femoral neck. CONCLUSIONS: The complication rates for subcapital femoral neck fractures were lower than those previously reported; hence, internal fixation could be a primary treatment option for these fractures.
Classification ; Femoral Neck Fractures* ; Femur Neck* ; Follow-Up Studies ; Fracture Fixation ; Head ; Hip ; Humans ; Incidence ; Necrosis ; Risk Factors

No abstract available.
Lymphohistiocytosis, Hemophagocytic*

PURPOSE: To evaluate the changes and normal ranges of the artery-bronchus ratio (ABR) during respiration MATERIALS AND METHODS: We analyzed HRCT of 10 healthy adults. The HRCT findings of ten healthy adults were analysed. CT scanning was performed with 1 mm collimation at 3 mm intervals during full inspiration and full expiration, with a range during inspiration from 2 cm to 4 cm above the carina and from 4 cm above to 2 cm below the right hemidiaphragm. The range during expiration was from 1 cm to 3 cm above the carina and from 4 cm above to 2 cm below the right hemidiaphragm. ABiR (defined as the diameter of pulmonary artery divided by the inner diameter of the bronchus), ABoR (defined as the diameter of pulmonary artery divided by the outer diameter of the bronchus) and BLR (defined as the inner diameter of the bronchus divided by the outer diameter of the bronchus) were measured on the display console. RESULTS: The mean inner diameter of the bronchi was 2.04+/-0.73 mm during inspiration and 1.68+/-0.51 mm during expiration, while the mean diameter of the arteries was 3.95+/-1.03 mm during inspiration and 4.37+/-1.09 mm during expiration. The diameters of the bronchi were thus seen to increase during inspiration, and the diameters of the pulmonary arteries, to decrease. The mean thickness of the bronchial wall was 1.07+/-0.19 mm during inspiration and 1.06+/-0.24mm during expiration; thus, no change in thickness was seen during respiration (p<0.05). Mean ABiR was 2.01+/-0.60 (range 1.15-4.58) during inspiration and 2.59+/-0.74(range 1.16-4.9) during expiration, and in all cases the inner diameter of the bronchus was less than that of the accompanying pulmonary artery. Mean ABoR was 0.91+/-0.19 during inspiration and 1.09+/-0.22 during expiration. while for BLR, the corresponding fingures were 0.46+/-0.06, and 0.44+/-0.09. CONCLUSION: HRCT is a useful tool for evaluating changes in the pulmonary arteries and bronchi during respiration.
Adult ; Arteries ; Bronchi ; Humans ; Pulmonary Artery ; Reference Values ; Respiration* ; Tomography, X-Ray Computed

BACKGROUND: The hemodynamic status of critically ill patients is poorly predicted from clinical examination and chest x-ray findings, so equipments such as pulmonary artery catheter are needed for monitoring of hemodynamics. The authors undertook this study to evaluate physician's accuracy in predicting hemodynamic profiles, rates of therapeutic change resulting from catheterization and to compare the outcomes with or without therapeutic changes. METHODS: Pulmonary artery catheters were inserted in 19 critically ill patients. The physicians accuracy of predicting the hemodynamic profile, the rate of therapeutic changes by monitoring actual hemodynamic profiles were calculated and compared to the outcome between the patients with and without therapeutic change, RESULTS: Hemodynamic profiles were correctly predicted in 63% of all cases. Hemodynamic data from pulmonary artery catheter made the therapeutic plan changed in 53% of all cases. The cardiac index and left ventricular stroke work index were improved and the mortality rate was lower in patients with therapeutic changes, but there were no significant statistical differences between the patients with and without therapeutic changes. Complications occurred in 6 cases but had no effect on patient' s outcome. CONCLUSIONS: Hemodynamic data from a pulmonary artery catheter could lead to a more accurate diagnosis and therapeutic changes.
Catheterization ; Catheterization, Swan-Ganz* ; Catheters ; Critical Illness* ; Diagnosis ; Hemodynamics* ; Humans ; Mortality ; Pulmonary Artery* ; Stroke ; Thorax

PURPOSE: To evaluate the effect of respiration on the sizes of intrathoracic vasculature, and the trachea,and the main bronchus. MATERIALS AND METHODS: Seventeen volunteers (10males aged 20-39 years and 7 females aged20-39 years) underwent spiral CT, between the apex and lowest base of the lung, collimation was 10mm, pitch was 1,and images were obtained at breath hold forced end-inspiration and breath hold forced end-expiration. Crosssecional areas or diameters were measured in each respiration state at the aorta (ascending, descending, lowerthoracic) and great branches, the IVC (thoracic, abdominal), the SVC, pulmonary artery (right main, leftdescending) and the tracheobronchus (trachea, left upper bronchus). Changes in the size of vessels and airwaysbetween the respiration states were evaluated and compared between inspiration and expiration. RESULT: Duringbreath-hold forced end-inspiration CT, the ascending, descending, and lower thoracic aorta and itsbranches(brachiocephalic, left common carotid, left subclavian) as well as the thoracic IVC and SVC and the rightmain and left descending pulmonary arteries decreased in size: during breath-hold forced end-expiration CT, thesize of all these vessels increased. For the trachea, left upper lobe bronchus and abdominal IVC, the situationwas reversed. Statistically significant changes(p<0.05) were noted in the ascending aorta and descending aorta,the lower thoracic aorta, the thoracic and abdominal IVC, the SVC, the right main and left pulmonary arteries, andthe trachea. CONCLUSION: During respiration, changes in the size of the thoracic vasculature and airways isprobably due to changes in intrathoracic pressure. In the measurement and diagnosis of stenosis or dilatation inthe intrathoracic vesculature and airways, respiration states should therefore be considered.
Aorta ; Aorta, Thoracic ; Bronchi* ; Constriction, Pathologic ; Diagnosis ; Dilatation ; Female ; Humans ; Lung ; Pulmonary Artery ; Respiration* ; Tomography, Spiral Computed ; Trachea* ; Volunteers