The glomus tumor is a distinct neoplasm composed of modified perivascular smooth-muscle cells identical to those described in the glomus body. Malignant glomus tumor, also referred to as glomangiosarcoma, is exceedingly rare. It has been subdivided into locally infiltrative glomus tumor, glomangiosarcoma arising in a benign glomus tumor, and glomangiosarcoma arising in de novo. A few cases of malignant glomus tumor arising in a benign glomus tumor have been reported. A 55-year-old man underwent resection of a solitary nodule in the right shoulder area. The tumor was biphasic with a typical benign glomus tumor at the periphery and the central sarcomatous area composed of oval to elongated pleomorphic cells with a single prominent nucleolus and occasional mitotic figures. Both tumor components showed intense staining for vimentin, smooth muscle actin, and muscle specific actin. Herein, we report a case of a malignant glomus tumor arising in a benign glomus tumor with an immunohistochemical study and a review of literatures.
Actins ; Glomus Tumor* ; Humans ; Middle Aged ; Muscle, Smooth ; Shoulder ; Vimentin

Tetralogy of Fallot constitutes the highest proportion of cyanotic congenital heart disease and has four basic abnormal anatomical pictures including ventricular septal defect, pulmonary stenosis, aortic overriding and right ventricular hypertrophy. The work of Edward, et al(1965), Guntheroth, et al(1965) and Lev and Eckner(1964) has shown that the anatomical picture in a combination of just first two morphological characteristics, the aortic overriding and right ventricular hypertrophy being a consequence of the ventricular septal defect and pulmonary stenosis. Basic signs involve two categories, one is change of shunt rate depending on pulmonary stenosis, ventricular septal defect and systemic vascular resistance, and the other is physiological response to the chronically lowered PaO2. Thus the pathophysiological status presents to us more problems than other congenital heart disease in the care of patients during operation and anesthesia. Therefore, the anesthesiologist must understand the basic pathophysiology, various findings of examination, symptoms and signs, the problems during anesthesia and postoperative care. The purpose of this study was to evaluate the anesthetic management in total corrective surgery of tetralogy of Fallo which was performed at Severance Hospital. Out of consecutive 160 cases of tetralogy of Fallot in our past ten years experiences from 1971 to 1980, we selected the clinical results on anesthetic care of 12 cases which received total corrective surgery under hypothermia and extracorporeal circulation. The results were as follows: 1) Out of 121 cases, 82 cases were male(67.8%) and female was 39 cases(32.2%). The group aging from 6 to 10 year old was the highest proportion (44.6%) and the next proportion was the group aging from 11 to 15(22.3%). 2) Out of 121 cases, 91 cases were cyanotic(75.2%). On the diagnostic distribution, tetralogy of Fallot without any other anomaly was the most common(66.9%). 3) As for premedicants, secobarbital was the highest proportion(28.1%). For anesthetic maintenance, methoxyflurane with nitrous oxide was the most common(43.8%). 4) During cardio-pulmonary bypass, high flow perfusion was commonly used and the highest mean arterial pressure was 89.09+/-1.21 mmHg and the lowest mean arterial pressure was 36.33+/-1.21mmHg. 5) The major complications after operation and anesthesia were dysrhythmia(13.1%), pleural effusion(10.3%), main wound infection(10.3%), hemorrhage(8.3%), acute renal failure(8.3%), heart failure(6.9%), low output syndrome(4.1%) and cerebral infarction due to air emboliam(2.7%). 6) Out of 121 cases were expired and hospital mortality was 23.1%. The causes of death were heart failure(50%), acute renal failure(14.3%) and cerebral infarction(14.3%). in conclusion, anesthetic care for total corrective surgery of teralogy of Fallot should be based upon the understanding of the pathophysiology of disorder itself.
Female ; Humans ; Mortality

The amplification of c-myc oncogene was evaluated in 42 cases of ovarian carcinomas to correlate with clinical parameters. Using oligonucleotide primers, sequences from the c-myc exon-3 gene and from a control gene, tissue plasminogen activator (tPA), were amplified simultaneously by polymerase chain reaction (PCR). After the products of differential PCR (d-PCR) were electrophoresed, slot blot hybridization was performed, and hybridized with P32 dATP-labeled myc and tPA oligonucleotide probes and then autoradiographed. The signal intensities of the two products were quantitated by densitometry and the ratios of two products (c-myc/tPA) were measured. The ovarian carcinomas showed significantly increased amplification of c-myc oncogene Oligonucleoti compared to normal control group (p<0.05). 15 of 42 cases (35.7%) showed various degrees of the MYC gene amplification up to 27 folds in various histologic types of ovarian carcinomas. No significant differences of the MYC gene amplification according to histologic subtypes, tumor action) grades and clinical stages of ovarian carcinomas were present.
Densitometry ; DNA Primers ; Genes, myc ; Oligonucleotide Probes ; Oncogenes* ; Polymerase Chain Reaction* ; Tissue Plasminogen Activator

A case of the recurrent neurilemmoma of vagus nerve in the neck is presented. It was located in the upper third of the right lateral neck. The patient was presented with hoarseness and monoparesis of the right arm. The tumor was composed of large cystic portion and solid nodule in the right carotid fossa. Since total surgical removal of the tumor could cause functional deterioration of the involved vagus nerve, it was removed by means of intracapsular enucleation. Postoperatively, the monoparesis of the right arm was disappeared with preservation of vagus nerve function. It would appear that an intracapsular enucleation may be advisible in some cases of neurilemmomas of the cervical vagus nerve to maintain the function of the involved vagus nerve.
Arm ; Hoarseness ; Humans ; Neck ; Neurilemmoma* ; Paresis ; Vagus Nerve*

A ciliated hepatic foregut cyst (CHFC) is a rare cystic lesion consisting of a ciliated pseudostratified columnar epithelium, subepithelial connective tissue, a smooth muscle layer, and an outer fibrous capsule. A CHFC is usually unilocular and occurs at a higher frequency in males. A predilection exists at the medial segment located at the left lobe of the liver. We report the first case of a ciliated hepatic foregut cyst mimicking hepatic metastasis on a CT scan of a patient concurrently afflicted with gastric cancer.
Cilia ; Connective Tissue ; Epithelium ; Humans ; Liver ; Liver Diseases ; Male ; Muscle, Smooth ; Neoplasm Metastasis ; Stomach Neoplasms ; Tomography, X-Ray Computed

PURPOSE: We wanted to evaluate the usefulness of MDCT for localizing a bleeding site and for helping make a decision on further management for acute intestinal bleeding. MATERIALS AND METHODS: We conducted a retrospective review of 17 consecutive patients who presented with acute intestinal bleeding and who also underwent MDCT before angiography or surgery. The sensitivity of MDCT for detecting acute intestinal bleeding was assessed and compared with that of conventional angiography. RESULTS: The sensitivity of MDCT for the detection of acute intestinal bleeding was 77% (13 of 17), whereas that of angiography was 46% (6 of 13). All the bleeding points that were subsequently detected on angiography were visualized on MDCT. In three cases, the bleeding focus was detected on MDCT and not on angiography. In four cases, both MDCT and angiogphy did not detect the bleeding focus; for one of these cases, CT during SMA angiography was performed and this detected the active bleeding site. CONCLUSION: In patients with acute intestinal bleeding, MDCT is a useful image modality to detect the bleeding site and to help decide on further management before performing angiography or surgery. When tumorous lesions are detected, invasive angiography can be omitted.
Angiography ; Hemorrhage* ; Humans ; Retrospective Studies

No abstract available.
Craniocerebral Trauma* ; Head* ; Protons*

BACKGROUND: Shivering is a frequent event during the perioperative period. We performed a prospective, randomized, double-blind study to determine whether intrathecal meperidine (0.2 mg/kg) decreases the incidence and intensity of shivering after spinal anesthesia for transurethral operations. METHODS: Fifty patients scheduled for elective transurethral resection operations under spinal anesthesia were randomly allocated to two groups. Spinal anesthesia consisted of 0.5% hyperbaric bupivacaine 8 mg and, mperidine (0.2 mg/kg) (meperidine group) or, normal saline (saline group). Data collection, including sensory block level (by pinprick), blood pressure, heart rate, sublingual temperature, incidence and intensity of shivering, pruritus, nausea, and vomiting was performed at 10 minute intervals. RESULTS: The incidence and intensity of shivering was significantly less in the meperidine group than saline group (P = 0.012 and P = 0.008, for incidence and intensity, respectively). However, pruritus was more common in the meperidine group compared with the saline group (16% vs. 0%, P < 0.05). CONCLUSIONS: The addition of meperidine 0.2 mg/kg to intrathecal bupivacaine lowers the incidence and severity of shivering during transurethral prostatectomy in elderly patients.
Aged ; Anesthesia ; Anesthesia, Spinal ; Blood Pressure ; Bupivacaine ; Data Collection ; Double-Blind Method ; Heart Rate ; Humans ; Incidence ; Meperidine ; Nausea ; Perioperative Period ; Prospective Studies ; Pruritus ; Shivering ; Transurethral Resection of Prostate ; Vomiting

A pathologic splenic rupture is rare, occurring primarily in a spleen affected by infective, hematological, and neoplastic disease. To the best of our knowledge, no prior reports of a pathologic splenic rupture due to scrub typhus exist. Intrasplenic pseudoaneurysms and focal infarctions are visible on an initial CT scan. Moreover, the spontaneous splenic rupture occurred a week later. We report a case of nontraumatic-splenic rupture in a patient with scrub typhus.
Aneurysm, False ; Humans ; Infarction ; Rupture ; Scrub Typhus ; Spleen ; Splenic Rupture ; Typhus, Endemic Flea-Borne

Eisenmenger's syndrome describes the elevation of pulmonary arterial (PA) pressure to the systemic level caused by an increased pulmonary vascular resistance with reversed or bi-directional shunt through an intracardiac or aortopulmonary communication. We report a case of an emergent craniotomy for cerebellar abscess in a 21-year-old male patient with Eisenmenger syndrome secondary to Large VSD. A PA catheter was inserted via right femoral vein, but could not be advanced pass the pulmonic valve. After futile attempts to place the catheter tip in the right ventricle. Anesthesia was induced with etomidate, rocuronium, midazolam and fentanyl and maintained with only high dose fentanyl. Milinone and norepinephrine were infused continuously to decrease right to left shunt. He was transferred to the intensive care unit under intubated state and treated with antibiotics for a few days due to intermittent high fever. The operation ended without major complications and the patient was discharged 42 days later.
Abscess ; Androstanols ; Anesthesia ; Anti-Bacterial Agents ; Catheters ; Craniotomy ; Eisenmenger Complex ; Etomidate ; Femoral Vein ; Fentanyl ; Fever ; Heart Ventricles ; Humans ; Hypogonadism ; Intensive Care Units ; Male ; Midazolam ; Milrinone ; Mitochondrial Diseases ; Norepinephrine ; Ophthalmoplegia ; Vascular Resistance ; Young Adult