INTRODUCTION: The location of parotid gland tumors in the superficial or deep lobes can affect the time and difficulty of operations. Therefore, accurate preoperative evaluation of the tumor location is important for surgical outcomes. MATERIALS AND METHODS: A total of 16 patients with parotid gland tumors and who underwent a parotidectomy between April 2003 and March 2011 were retrospectively reviewed in terms of demographic background, tumor location, surgical treatment, and treatment outcomes. Tumor location was estimated by four landmarks on contrast enhanced computerized tomography scans, which were Conn's arc, the facial nerve (FN) line, the Utrecht line, and the retromandibular vein. Tumor location was confirmed by relative position depending on the facial nerve during surgery. It was assumed positive since the tumor lies in the superficial lobe of the parotid gland, the sensitivity, specificity, positive predictive value, negative predictive value, and efficiency of each landmark were evaluated. RESULTS: Our result revealed that the facial nerve line had a sensitivity of 83.3%, specificity of 100%, positive predictive value of 100%, negative predictive value of 71.4%, and efficiency of 87.5%. Some would be more efficient preoperative evaluation methods of the relationship of parotid gland tumors to the facial nerve than others. CONCLUSION: In our study, the FN line was found to be the most reliable analysis method.
Facial Nerve ; Humans ; Parotid Diseases ; Parotid Gland ; Parotid Neoplasms ; Retrospective Studies ; Sensitivity and Specificity ; Veins

PURPOSE: The purpose of this study was to evaluate the safety and efficacy of intravenous patient-controlled analgesia (PCA) with fentanyl and ketorolac for postoperative pain management in patients with cerebral palsy. MATERIALS AND METHODS: Sixty patients were categorized based on operation complexity into either a minor operation group or a major operation group, and then subdivided based on the analgesic methods used, i.e., intravenous PCA with fentanyl and ketorolac or intravenous pethidine injection. Pain intensity was assessed using the Wong-Baker's faces pain scale. RESULTS: In the major operation group, patients that received PCA had significantly lower pain scores than those who received intravenous pethidine injection, while no significant differences in pain scores were observed in the minor operation group. Moreover, the side effects of these two analgesic methods did not differ significantly. CONCLUSION: Intravenous PCA with fentanyl and ketorolac is effective and safe for moderate to severe postoperative pain control in pediatric patients with cerebral palsy.
Analgesia, Patient-Controlled* ; Cerebral Palsy* ; Fentanyl ; Humans ; Ketorolac ; Meperidine ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis

Schwannomas or neurilemmomas of the gastrointestinal tract are very rare and constitute less than 1% of all gut neoplasms. We experienced a case of schwannoma in the stomach, which is an extremely rare site. The patient was a 55-year-old woman who complained of an abdominal mass. At endoscopy, a 10-cm ulcerated submucosal mass was seen in the posterior wall of the body of the stomach. Computed tomography showed a heterogenous mass in the stomach without metastasis. The tumor was resected with the stomach. Both histological and immunohistochemical staining with S-100 protein revealed that it was a schwannoma.
Endoscopy ; Female ; Gastrointestinal Tract ; Humans ; Middle Aged ; Neoplasm Metastasis ; Neurilemmoma ; S100 Proteins ; Stomach ; Ulcer

OBJECTIVE: This study was designed to describe the radiological findings of extensively drug-resistant (XDR) pulmonary tuberculosis (TB) and to compare the observed findings with findings of drug-sensitive (DS) and non-XDR multidrug-resistant (MDR) TB in non-AIDS patients. MATERIALS AND METHODS: From September 1994 to December 2007, 53 MDR TB patients (M:F = 32:21; mean age, 38 years) and 15 XDR TB non-AIDS patients (M:F = 8:7; mean age, 36 years) were enrolled in the study. All of the MDR TB patients had received no treatment or less than one month of anti-TB treatment. In addition, all XDR TB patients received either no anti-TB treatment or only first-line anti-TB drugs. In addition, 141 consecutive DS TB patients (M:F = 79:62; mean age, 51 years) were also enrolled in the study for comparison. Chest radiograph, CT and demographic findings were reviewed and were compared among the three patient groups. RESULTS: For patients with XDR TB, the most frequent radiographic abnormalities were nodules (15 of 15 patients, 100%), reticulo-nodular densities (11 of 15, 73%), consolidation (9 of 15, 60%) and cavities (7 of 15, 47%) that were located mainly in the upper and middle lung zones. As seen on radiographs, significant differences were found for the frequency of nodules and ground-glass opacity lesions (all p < 0.001) (more frequent in DS TB patients than in MDR and XDR TB patients). For the use of CT, significant differences (more frequent in MDR and XDR TB patients) were found for the frequency of multiple cavities, nodules and bronchial dilatation (p = 0.001 or p < 0.001). Patients with MDR TB and XDR TB were younger as compared to patients with DS TB (p < 0.001). Imaging findings were not different between patients with MDR TB and XDR TB. CONCLUSION: By observation of multiple cavities, nodules and bronchial dilatation as depicted on CT in young patients with acid-fast bacilli (AFB) positive sputum, the presence of MDR TB or XDR TB rather than DS TB can be suggested. There is no significant difference in imaging findings between patients with XDR TB and MDR TB.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Drug Resistance, Bacterial ; Drug Resistance, Multiple, Bacterial ; Female ; Humans ; Image Processing, Computer-Assisted/methods ; Lung/drug effects/radiography ; Male ; Middle Aged ; Observer Variation ; Retrospective Studies ; Tomography, X-Ray Computed/methods ; Tuberculosis, Multidrug-Resistant/*radiography ; Tuberculosis, Pulmonary/*drug therapy/*radiography ; Young Adult

The null mutation of cardiac Na+-Ca2+ exchanger (NCX1) gene in mice caused death of embryo in utero at embryonic day (ED) 9.0-9.5 and this embryonic lethality appears resulted from abnormal heart development. In the present study, we investigated whether transgenic re-expression of NCX1 in mutant cardiac myocytes could rescue these lethal defects. Transgenic mice expressing the canine NCX1 in a cardiac specific manner were bred into the NCX1 knock-out background but did not prevent the fetal lethality associated with the NCX1 null allele. However, the NCX1 knock-out embryos with an NCX1 transgene survived with heart beatings until ED 10.5 which was one day longer than the survival of the NCX1 knock-out embryos (ED 9.5). At ED 10.5, however, the partially rescued NCX1 embryos might have succumbed to the lack of an organized vasculature in the yolk sacs. The placental labyrinth layer was reduced in size and largely avascular. The transgenic re-expression of NCX1 rescued heart beatings and survived longer, but was still insufficient for the mice to be completely rescued. Importantly, NCX1 was observed to express in the yolk sac and the placenta of wild type mice. The results suggest that defects in extra-embryonic compartments are causal to the lethality, and that NCX1 may play an important role in establishing vascularization in extra-embryonic tissues.
Animals ; Embryo/*metabolism/pathology ; Embryo Loss ; Female ; Gene Deletion ; *Gene Expression ; Genetic Complementation Test ; Mice ; Mice, Knockout ; Mice, Transgenic ; Myocytes, Cardiac/metabolism ; Phenotype ; Placenta/metabolism/pathology ; Sodium-Calcium Exchanger/*genetics/*metabolism ; Survival Rate ; Yolk Sac/embryology/metabolism/pathology

Bone Resorption ; Follow-Up Studies ; Humans ; Mandible ; Surgery, Oral ; Tissue Donors ; Transplants

Thymic epithelial tumor is a distinctive pathologic entity exhibiting variable histologic features and heterogeneous oncologic behavior. Among the various classification systems, that of the World Health Organization has been adopted because of good correlation between histologic appearance and oncologic behavior. Radiologically, a smooth contour and round shape are most suggestive of a type-A tumor, whereas an irregular contour most strongly suggests type C. Pleural seeding is rare in type-A and AB tumors; calcification is suggestive of type B. Type-C tumors are significantly larger and more commonly associated with lymphadenopathy than type B3. At T2-weighted MR imaging, lobular internal architecture is more prominent in types B1, B2, and B3 tumors than in others. However, imaging findings among the various types overlap to some extent, and the ability of imaging studies to differentiate types AB, B1, B2, and B3 is limited.

OBJECTIVE: We aimed to review the patterns of lung abnormalities of pulmonary cryptococcosis on CT images, position emission tomography (PET) findings of the disease, and the response of lung abnormalities to the therapies in non-AIDS patients. MATERIALS AND METHODS: We evaluated the initial CT (n = 23) and 18F-fluorodeoxyglucose (FDG) PET (n = 10), and follow-up (n = 23) imaging findings of pulmonary cryptococcosis in 23 non-AIDS patients. Lung lesions were classified into five patterns at CT: single nodular, multiple clustered nodular, multiple scattered nodular, mass-like, and bronchopneumonic patterns. The CT pattern analyses, PET findings, and therapeutic responses were recorded. RESULTS: A clustered nodular pattern was the most prevalent and was observed in 10 (43%) patients. This pattern was followed by solitary pulmonary nodular (n = 4, 17%), scattered nodular (n = 3, 13%), bronchopneumonic (n = 2, 9%), and single mass (n = 1, 4%) patterns. On PET scans, six (60%) of 10 patients showed higher FDG uptake and four (40%) demonstrated lower FDG uptake than the mediastinal blood pool. With specific treatment of the disease, a complete clearance of lung abnormalities was noted in 15 patients, whereas a partial response was noted in seven patients. In one patient where treatment was not performed, the disease showed progression. CONCLUSION: Pulmonary cryptococcosis most commonly appears as clustered nodules and is a slowly progressive and slowly resolving pulmonary infection. In two-thirds of patients, lung lesions show high FDG uptake, thus simulating a possible malignant condition.
Adult ; Aged ; Contrast Media/diagnostic use ; Cryptococcosis/*radiography/*radionuclide imaging/therapy ; Disease Progression ; Female ; Fluorodeoxyglucose F18/diagnostic use ; Follow-Up Studies ; Humans ; Lung Diseases, Fungal/*radiography/*radionuclide imaging/therapy ; Male ; Middle Aged ; Positron-Emission Tomography/*methods ; Radiopharmaceuticals/diagnostic use ; Retrospective Studies ; Tomography, Spiral Computed/*methods

We aimed to evaluate prospectively the efficacy of positron emission tomography (PET)/computed tomography (CT) plus brain magnetic resonance imaging (MRI) for detecting extrathoracic metastases in lung adenocarcinoma. Metastatic evaluations were feasible for 442 consecutive patients (M:F=238:204; mean age, 54 yr) with a lung adenocarcinoma who underwent PET/CT (CT, without IV contrast medium injection) plus contrast-enhanced brain MRI. The presence of metastases in the brain was evaluated by assessing brain MRI or PET/CT, and in other organs by PET/CT. Diagnostic efficacies for metastasis detection with PET/CT plus brain MRI and with PET/CT only were calculated on a per-patient basis and compared from each other. Of 442 patients, 88 (20%, including 50 [11.3%] with brain metastasis) had metastasis. Regarding sensitivity of overall extrathoracic metastasis detection, a significant difference was found between PET/CT and PET/CT plus brain MRI (68% vs. 84%; P=0.03). As for brain metastasis detection sensitivity, brain MRI was significantly higher than PET/CT (88% vs. 24%; P<0.001). By adding MRI to PET/CT, brain metastases were detected in additional 32 (7% of 442 patients) patients. In lung adenocarcinoma patients, significant increase in sensitivity can be achieved for detecting extrathoracic metastases by adding dedicated brain MRI to PET/CT and thus enhancing brain metastasis detection.
*Adenocarcinoma/diagnosis/pathology/radiography ; Adult ; Aged ; Aged, 80 and over ; *Carcinoma, Non-Small-Cell Lung/diagnosis/pathology/radiography ; Female ; Humans ; *Lung Neoplasms/diagnosis/pathology/radiography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; *Neoplasm Metastasis ; Positron-Emission Tomography/*methods ; ROC Curve ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods ; Young Adult

A case of simultaneous bilateral tubal pregnancy following in-vitro fertilization and embryo transfer is presented. On the 22 days after ET, the patient complained of low abdominal pain and vaginal spotting for one day and was suspected of left tubal pregnancy by transvaginal ultrasonography. However, laparoscopy revealed the bilateral tubal pregnancy and laparoscopic bilateral salpingectomy was performed. This unusual type of ectopic pregnancy must be kept in mind when evaluating a patient suspected of a possible early abnormal gestation after assisted reproductive technologies. It is critical to perform a close inspection of the abdomen, pelvis, and contralateral tube during surgery.
Abdomen ; Abdominal Pain ; Embryo Transfer* ; Embryonic Structures* ; Female ; Fertilization* ; Humans ; Laparoscopy ; Metrorrhagia ; Pelvis ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Tubal* ; Reproductive Techniques, Assisted ; Salpingectomy ; Ultrasonography