There are many reports of ventricular arrhythmias following the injection of epinephrine under general anesthesia with halothane or cyclopropane. Raventos reported that catecholamines given animals during chloroform, cyclopropane or halothane anesthesia have caused ventricular arrhythmias which sometimes developed into ventricular fibrillation. But there are a few reports of atrial arrhythmias in patients under general anesthesia with alone halothane. While it is known that hypercapnia can elicit arrhythmia during halothane anesthesia, Black and coworkers that hypercapnia of 60 to 140mmHg (average 92mmHg) is necessary for the occurrence of arrhythmias during halothane anesthesia. Hellewell and Potts reported 12 cases of arrhythmias under halothane anesthesia which were treated by propranolol, producing a return of sinus rhythm in an average time of 46 seconds. The authors reported one case with atrial arrhythmias induced by halothane anesthesia, which were arrested by the IV injection of 5mg of tolamolo, beta-receptor blocking agent. Thereafter arrhythmias did not reappear.
Anesthesia* ; Anesthesia, General ; Animals ; Arrhythmias, Cardiac* ; Catecholamines ; Chloroform ; Epinephrine ; Halothane* ; Humans ; Hypercapnia ; Propranolol ; Ventricular Fibrillation

No abstract available.
Biliary Atresia* ; Hepatitis*

The lymphoepithelial cyst (LEC) rarely occurs in the thyroid gland. The LEC has been thought to be related to developmental rest, namely solid cell nest, which is derived from ultimobranchial body. We report a case of lymphoepithial cyst in a 34- year-old woman clinically diagnosed with Hashimoto's thyroiditis. The cyst was located in mid to lower portion of the left lobe. It was a single unilocular cyst, which for the most part was lined with squamous epithelium, and at certain foci with ciliated columnar epithelium. The cyst wall showed a dense lymphocytic infiltration, numerous lymphoid follicles with germinal centers and admixed thyroid follicles. This morphology is similar to the branchial cleft cyst, with the exception of the thyroid follicles in the cyst wall. Near the cyst were several solid epidermoid cell nests. Immunohistochemical stain of this cyst-lining epithelium and solid cell nests showed CEA positivity. In view of the similarity in histomorphology and CEA positivity to branchial cleft cyst of the lateral neck, the LEC of the thyroid could also have been of branchial origin. However, the admixed thyroid follicles in the cyst wall suggests that the LEC of the thyroid gland might have derived from another branchial cleft as a ultimobranchial body, because it has the potential for thyroid follicular differentiation.
Branchial Region* ; Branchioma ; Epithelium ; Female ; Germinal Center ; Humans ; Neck ; Thyroid Gland* ; Thyroiditis ; Ultimobranchial Body

PURPOSE: Choledochal cyst is a rare malformation of the pancreatobiliary ductal system, manifested by dilatation of biliary tree with or without anomalous insertion of the common bile duct into pancreatic duct. The purpose of this study is to review the incidence of anomalous pancreatobiliary union(PBU) and the shape of common bile duct based on the angle of pancreatic duct and common bile duct union. MATERIALS AND METHODS: We analyzed cholangiopancreatographic findings of 21 patients with choledochal cyst, emphasizing PBU. The PBU was classified into acute-angled PBU, right-angled PBU, normal PBU, and unknown PBU on the basis of common bile duct insertion to pancreatic duct. The shape of common bile duct dilatation was evaluated with regard to angle of PBU. RESULTS: Fourteen of 21 patients had anomalous PBU with slender or ectatic form of common channels. Three patients had normal opening of common bile duct and pancreatic duct, and in remaining 4 patients the PBU was not visualized. Among 14 patients with PBU, 5 patients had right-angled PBU and 9 patients had acute-angled PBU. Cystic form of common bile duct dilatation was seen in 13 patients and cylindrical form was in 8 patients. Cystic dilatation of common bile duct was seen in 4 patients out of 5 right-angled PBU. CONCLUSION: Patients with choledochal cyst had high incidence of anomalous PBU with common channel (67%). The shape of common bile duct dilatation was cystic in 62% of patients, and the right-angled PBU was prone to be cystic dilatation (80%).
Biliary Tract ; Choledochal Cyst* ; Common Bile Duct ; Dilatation ; Humans ; Incidence ; Pancreatic Ducts

No abstract available.
Aspergillosis* ; Maxillary Sinus*

The goal of total knee replacement is to relieve pain, to stabilize joint movement and to correct deformity. It is indicated for patients with rheumatoid arthritis, osteoarthritis and severe post-traumatic arthritis. The author analyzed 71 patients(106 cases), who received the PFC type of total knee replacement from August 1992 and the results were as follows; 1. Among the 71 patients, male was 8 patients and female was 63 patients whose average age was 56 years and average follow up period was 24 months, ranged from 8 months to 3 years 8 months. 2. Rheumatoid arthritis was the most common cause with 31 patients(56 cases) followed by osteoarthritis with 39 patients(49 cases). There was also one patient(1 case) that showed bony union of the knee due to old tuberculosis. The average duration of the illness was 12 years and the average weight of the patients was 57.7kg. 3. Flexion contracture decreased from an average of 21 degrees to 5 degrees after the operation. The range of motion increased from an average of 92 degrees before the operation to 117 degrees afterwards in cases of rheumatoid arthritis and decreased slightly from 108 degrees to 106 degrees in cases of osteoarthritis. 4. The tibiofemoral angle was corrected from an average 1.5 degrees varus before the operation to an average 6.7 degrees valgus after operation. Eighty seven percent of patients with rheumatoid arthritis showed valgus deformity and seventy eight percent of degenerative osteoarthritis patients showed varus deformity preoperatively. 5. Radiographically, the joint line position shifted an average 2.3mm in rheumatoid arthritis and an average 0.3mm in osteoarthritis. The component position, the femoral flexion was an average 89.6 degrees in the anteroposterior view, an average 87 degrees in the lateral view. 6. The thickness of the patella measured in the operating room of 61 cases was an average 21mm and after resection of patella, the remaining bone measured an average of 13.6mm. 7. To achieve soft tissue balance, 29 patients(33 cases) underwent medial stripping and 23 patients(30 cases) had patella lateral release. 8. The Insall Knee Rating Score was used to evaluate the results. The results were 69 cases excellent, 33 cases good, 3 fair and 1 poor. Ninety two percent of the patients had good or excellent results in average 24 months follow-up. 9. The complications consisted of one case of delayed deep infection, one case of patellar subluxation and one case of supracondylar fracture of the femur.
Arthritis ; Arthritis, Rheumatoid ; Arthroplasty, Replacement, Knee ; Congenital Abnormalities ; Contracture ; Female ; Femur ; Follow-Up Studies ; Humans ; Joints ; Knee ; Male ; Operating Rooms ; Osteoarthritis ; Patella ; Range of Motion, Articular ; Tuberculosis

Rud's syndrome (RS), basically composed of ichthyosis, mental deficiency and hypogonadism, is a rare hereditary disease. Some varying dermatologic, neurologic, endocrinologic, ophthalmologic and musculoskeletal abnormalities have coincided with RS. No case of RS has been documented from Asian countries except one from Japan. We describe a 16-year-old girl who presented with lamellar ichthyosis, mental retardation, hypogonadism, short stature, alopecia, sparse eyebrows, strabismus, cataracts, and congenital dislocation of the hip. To our knowledge, RS coexisting congenital dislocation of the hip herein is the first case in English literature.
Adolescent ; Alopecia ; Asian Continental Ancestry Group ; Cataract ; Dislocations ; Eyebrows ; Female ; Genetic Diseases, Inborn ; Hip ; Humans ; Hypogonadism ; Ichthyosis ; Ichthyosis, Lamellar ; Intellectual Disability ; Japan ; Musculoskeletal Abnormalities ; Strabismus

PURPOSE: The purposes of this study were to analyze the MR findings of medulloblastoma, and to evaluate the subarachnoid dissemination and the significance of contrast enhanced MR of brain and spine for tumor.. MATERIALS AND METHODS: The preoperative brain MR studies of 18 patients (9 males, 9 females;mean age, 9.4 years) with surgically proved medulloblastomas were retrospectively reviewed to characterize these neoplasms with regard to their location, size, MR signal intensity, appearance after contrast enhancement, presence of cyst and necrosis, subarachnoid dissemination, and other associated findings. In 14 patients postoperative spine MR studies were evaluated for staging and therapeutic planning. RESULTS: The most frequent location of medulloblastoma was the inferior vermis and the mean tumor size was 4.1 x 3.6 x 3.9 cm. On Tl-weighted image, medulloblastomas generally had low to intermediate signal, predominantly hypointense relative to white matter. On T2-weighted image, medulloblastomas showed modetately high signal, hyperintense relative to white matter. Inhomogeneous contrast enhancement was demonstrated in 13 patients(72.2%) after injection of gadopentetate dimeglumine(Gadolinium). Cyst and necrosis within the tumor were visualized in 15 patients(83.3%). Subarachnoid disseminations of medulloblastomas were noted in 11 patients(61.1%), of which 6 demonstrated intracranial and 2 intraspinal dissemination. Three had both intracranial and intraspinal dissemination. In nine cases with intracranial lesions, there were intraparenchymal mass formation(7), subarachnoid nodules(5), infundibular lesions(2) and diffuse gyral enhancement(I). In five cases with intraspinal lesions, there were extramedullary intradural small nodules(3), central canal nodules(2), intradural masses(I)and fine nodular and sheet-like leptomeningeal enhancement(1). Other associated findings included intratumoral hemorrhage(11.1%), per/tumoral edema(44.4%), tonsillar herniation(44.4%), hydrocephalus(88.9%) and calcification(44.4%). CONCLUSION: Medulloblastomas revealed low to intermediate signal intensity on Tl-weighted image and intermediate to moderately high signal intensity on T2-weighted image, relative to cerebellar white matter. Medulloblastomas were solid tumors with cystic necrosis, which showed inhomogeneous enhancement and subarachnoid disseminations to the intracranial and intraspinal spaces after Gd-DTPA enhancement. Gd-enhanced MR of brain and spine was an useful diagnostic modality in preoperative diagnosis and in staging of postoperative cases of medulloblastomas, which was superior to postcontrast CT or precontrast MR.
Brain* ; Diagnosis ; Gadolinium DTPA ; Humans ; Male ; Medulloblastoma ; Necrosis ; Retrospective Studies ; Spine*

Selective internal pudendal pharmaco-arteriographies were performed in 38 posttraumatic arteriogenic impotent patients who were supposed to undergo vascular reconstructive surgeries. The arteriographic findings in accordance with trauma character were analyzed and compared with penile brachial index (PBI), duplex sonogram of cavernosal artery and cavernosal artery occulusive pressure (CAOP). The results were obtained as follows : l. The arterial stenoses were found on both sides in 12 (63.1%) out of l9 patients of pelvic bone fracture with urethral rupture, and found on either one (3) or both sides (4) in 7 patients of pelvic bone fracture without urethral rupture and urethral rupture without pelvic bone fracture. The arteriograms were norma1 on both sides in 2 out of 7 patients of vertebral fractures and in one patient of electric burn on glans. 2. The stenotic lesions were most commonly Found in common penile artery (63.5%) followed by proximal cavernosal artery with or without dorsal artery (34.6%) and only one case of distal pudendal artery. Complete obstruction (66.7%) was most common in the common penile artery, whereas partial obstruction (77.8%) was most common in the proximal cavernosal artery. 3. Concerning site of the obstruction in accordance with the trauma character the stenosis occurred more frequently in the common penile artery after pelvic bone fracture with urethra` rupture and in the proximal cavernosal artery after penile injury, and occurred with similar frequency either in the common penile artery or in the proximal cavernosal artery after pelvic bone fracture without urethral rupture and urethral rupture without pelvic bone fracture. 4. Out of fourteen cases of complete or partial obstruction on the arteriograms, 9 (64.3%) have abnormal findings on the duplex sonograms. Among l2 cases of obstruction on the arteriogram, only 4 (33.3%) were less than O.7 of PBI. Four cases of normal arteriogram shower abnormal duplex sonogram but normal PBI in all. 5. CAOP was 20 mmHg or more lower than brachial systolic pressure in 6 (66.7%) out of 9 cases or obstruction on the arteriogram. In conclusion, selective internal pudendal pharmaco-arteriography seems to be a valuable diagnostic method to investigate enile arterial traumatic obstruction. However, it is thought that the arteriography should be done complementarily with another methods because it still has limits of specificity and sensitivity.
Angiography ; Arteries ; Blood Pressure ; Burns, Electric ; Constriction, Pathologic ; Erectile Dysfunction* ; Humans ; Male ; Pelvic Bones ; Rupture ; Sensitivity and Specificity

Selective internal pudendal pharmaco-arteriographies were performed in 38 posttraumatic arteriogenic impotent patients who were supposed to undergo vascular reconstructive surgeries. The arteriographic findings in accordance with trauma character were analyzed and compared with penile brachial index (PBI), duplex sonogram of cavernosal artery and cavernosal artery occulusive pressure (CAOP). The results were obtained as follows : l. The arterial stenoses were found on both sides in 12 (63.1%) out of l9 patients of pelvic bone fracture with urethral rupture, and found on either one (3) or both sides (4) in 7 patients of pelvic bone fracture without urethral rupture and urethral rupture without pelvic bone fracture. The arteriograms were norma1 on both sides in 2 out of 7 patients of vertebral fractures and in one patient of electric burn on glans. 2. The stenotic lesions were most commonly Found in common penile artery (63.5%) followed by proximal cavernosal artery with or without dorsal artery (34.6%) and only one case of distal pudendal artery. Complete obstruction (66.7%) was most common in the common penile artery, whereas partial obstruction (77.8%) was most common in the proximal cavernosal artery. 3. Concerning site of the obstruction in accordance with the trauma character the stenosis occurred more frequently in the common penile artery after pelvic bone fracture with urethra` rupture and in the proximal cavernosal artery after penile injury, and occurred with similar frequency either in the common penile artery or in the proximal cavernosal artery after pelvic bone fracture without urethral rupture and urethral rupture without pelvic bone fracture. 4. Out of fourteen cases of complete or partial obstruction on the arteriograms, 9 (64.3%) have abnormal findings on the duplex sonograms. Among l2 cases of obstruction on the arteriogram, only 4 (33.3%) were less than O.7 of PBI. Four cases of normal arteriogram shower abnormal duplex sonogram but normal PBI in all. 5. CAOP was 20 mmHg or more lower than brachial systolic pressure in 6 (66.7%) out of 9 cases or obstruction on the arteriogram. In conclusion, selective internal pudendal pharmaco-arteriography seems to be a valuable diagnostic method to investigate enile arterial traumatic obstruction. However, it is thought that the arteriography should be done complementarily with another methods because it still has limits of specificity and sensitivity.
Angiography ; Arteries ; Blood Pressure ; Burns, Electric ; Constriction, Pathologic ; Erectile Dysfunction* ; Humans ; Male ; Pelvic Bones ; Rupture ; Sensitivity and Specificity