We report a rare case of carcinosarcoma arising in the stomach. The tumor is presented in the posterior wall of the gastric lower body and antrum of a 56-year-old man. Grossly the tumor has polypoid appearance with diffuse surface ulceration and measures 5.5 cm in diameter. The tumor is accompanied with three separate well differentiated early gastric adenocarcinomas (two EGC type IIc & IIa). Microscopically, the tumor consists of moderately well differentiated adenocarcinoma in the periphery, and lobulated sarcomatous areas in the center, which shows chondroid differentiation. Transitional areas between adenocarcinoma and chondrosarcoma are evident. Immunohistochemical studies show positivity for cytokeratin and carcinoembryonic antigen in the epithelial component, and for vimentin and S-100 in the sarcomatous component. The transitional areas are positive in carcinoembryonic antigen, vimentin, S-100, and cytokeratin. The tumor extended to the subserosa and showed metastasis of only adenocarcinomatous component in six out of 47 dissected perigastric lymph nodes.
Adenocarcinoma ; Carcinoembryonic Antigen ; Carcinosarcoma* ; Chondrosarcoma ; Humans ; Keratins ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis ; Stomach* ; Ulcer ; Vimentin

No abstract available.
Pleural Effusion*

Thie study was conducted in the Anesthesiology Department of Chosun University Hospital from March to August 1987 using 0.5% isobaric bupivacaine and 0.4% hyperbaric bupivacaine as agents for spinal anesthesia. The following results were obtained. 1) The segmental heights and the highest level of sensory loss were significantly increased with increased dosage. In the hyperbaric bupivacaine groups of 15 mg and 20 mg respectively, the sensory lose in comparison with isobaric groups was significantly increased. 2) Less time was needed to achieve, complete motor blockade in the 15 mg hyperbaric bupivacaine group than in the isobaric groups but there were no significant differences between the other groups. The duration of motor blockade was more prolonged in the isdobaric bypivacaine groups using 15mg And 20 mg than in the hyperbaric groups. 3) The Group using 20 mg of hyperbaric bupivacaine demonstrated a significant decrease in blood pressure as coupared wish the group using 20 mg of isobaric bupivacaine. 4) Following spinal anesthesia, headache developed in 5 cases (5.6%). From the above results we conluded that isobaric bupivacaine and hyperbaric bupivacaine are appropriate anesthesia agents for surgery on the lower abdomen and lower extremities.
Abdomen ; Anesthesia ; Anesthesia, Spinal* ; Anesthesiology ; Blood Pressure ; Bupivacaine* ; Headache ; Lower Extremity

Chemical rhizotomy with the intrathecal alcohol injection was firstly attempted by Dogliotti in 1931, and with phenol in 1955 by Maher. The intrathecal neurolytic injection was a very simple, effective and nonsurgical procedure without any great danger. Good indications for the procedure are the bilateral pelvic and lower limb pain syndrome, well circumscribed pain in limited area and in poor general condition. We have reported two cases of intractable pain of limited area, successfully relieved by chemical rhizotomy, and discussed the importance of the procedure and presented the review of literatures.
Lower Extremity ; Pain, Intractable* ; Phenol ; Rhizotomy

BACKGROUND: Cardiac tamponade is associated with the expiratory increase and the expira-tory decrease in left ventricular filling flow. With Doppler echocardiography, we analyzed the respiratory variations of mitral and tricuspid inflows, and pulmonary and hepatic venous flows in patients with cardiac tamponade. METHODS: Respiratory hemodynamic changes in mitral and tricuspid inflows and pulmonary and hepatic venous flows were evaluated using Doppler echocardiography in 13 patients (6 men and 7 women; mean age 51+/-13 years) with large pericardial effusion and clinical cardiac tamponade, and compared the results with those of 11 control subjects (3 men and 8 women, mean age 53+/-13 years). Doppler examination was repeated after pericardiocentesis in 6 patients. RESULTS: Peak velocity of early diastolic mitral inflow (E velocity) decreased during inspiration compared with expiratory increase; the mean percentage change was 40%. Peak velocity of late diastolic mitral inflow (A velocity) decreased 13% during inspiration. E/A ratio decreased 31% during inspiration. Deceleration time (DT) and isovolumic relaxation time (IVRT) increased by 26% and 44%, respectively, during inspiration. But respiratory variations of tricuspid inflow were opposite to those of mitral inflow. Tricuspid E velocity increased during inspiration and decre-ased during expiration. The mean percentage change was 123%, which was larger than thte 40% of mitral inflow. The most characteristic findings of pulmonary venous flow during respiration were the expiratory increases of peak diastolic velocity (DV) and diastolic time-velocity integral (D-TVI). The mean percentage changes of peak systolic velocity (SV), DV and D-TVI during respiration were 27%, 45% and 53% respectively. In contrast, the SV and DV of hepatic venous flow increased during inspiration and decreased during expiration. The respiratory variations of peak systolic reverse flow velocity (SR) and peak diastolic reverse flow velocity (DR) were opposite to those of SV and DV. DR notably increased during expiration, and the mean percentage change was 61%. The ratio of RFI (Inspiratory reverse flow integral) to FFI (forward flow integral) of the tamponade group was 270%. The mean percentage changes of each parameters decreased after pericardiocentesis. CONCLUSION: Patients with cardiac tamponade showed inspiratory increases of diastolic tri-cuspid filling flow and hepatic forward flow. Expiratory increases included diastolic mitral filling flow, pulmonary venous systolic and diastolic flow, and hepatic venous reverse flow. Such res-piratory variations decreased after pericardiocentesis.
Cardiac Tamponade* ; Deceleration ; Echocardiography* ; Echocardiography, Doppler ; Female ; Hemodynamics ; Humans ; Male ; Pericardial Effusion ; Pericardiocentesis ; Relaxation ; Respiration

This study was performed to investigate the effects of enflurane anesthesia and surgery on thyroid function by determining the plasma concentration of thyroxid(T4) and trilodothyronine(T3) in 10 patients who had neither hepatic disorder nor endocrine disease. Each patient was premedicated with diazepam 10mg and atropine sulfate 0.5mg intramuscularly one hour before induction of anesthesia. Anesthesia was induced with pentohal sodium and maintained with enflurane and oxygen supplemented with pancuronium bromide in divided dose as needed. plasma concentrations of thyroxine and triiodothyronine were measured by means of radiommunoassay. The results obtained were as follows: 1) No significant change in the plasma concentration of thyroxine was detected during enflurane anesthesia and surgery. 2) Plasma concentration of triidothyronine decreased significantly, compared with the control level, during enflurane anesthesia alone and anesthesia plus surgery. Although the precise mechanisms for the decrease in triiodothyronine following anesthesia and surgery remain unknown, decreased peripheral conversion from T4 to T3 may be responsible for this decline. Our data imply that enflurane anesthesia did not stimulate thyroid funcion judged by plasma concentration of T4 or T3. Therefore, enflurane anesthesia may be an useful anesthetics for patients with hyperthyroidism.
Anesthesia* ; Anesthetics ; Atropine ; Diazepam ; Endocrine System Diseases ; Enflurane* ; Humans ; Hyperthyroidism ; Oxygen ; Pancuronium ; Plasma ; Sodium ; Thyroid Gland* ; Thyroxine ; Triiodothyronine

The clinical value of lumbar epidural venography(L.E.V.) has been stressed in diagnosing lumbar disc since Batson's desciption of vertebral venous system in 1940. We have tried this procedure by the selective catheterization of ascending lumbar and, or internal iliac vein to 16 patients with disc symptoms. In 6 patients with abnormal myelography, 4 revealed abnormal L.E.V. and in 2, the above procedure was failed. In 6 patients with disc-like symptoms but normal myelography, 2 were abnormal L.E.V., 2 normal and 2 failed. 3 with disc-like symptoms but equivocal myelography, abnormal L.E.V. was definitely shown in 2 patients and failed. Operation was done in 7 patients(6, abnormal myelography and one, only abnormal L.E.V.).
Catheterization ; Catheters ; Humans ; Iliac Vein ; Myelography ; Phlebography*

No abstract available.

The authors report a case of arachnoid cyst arisen in the middle cranial fossa combined with intracystic hemorrhage. The pre-operative diagnosis was confused with chronic subdural hematoma. The post-operative final pathologic diagnosis was arachnoid cyst. The plain skull and C-T findings are illustrated. The light microscopic features of arachnoid cyst are presented. The brief description of the treatment and its prognosis are given.
Arachnoid* ; Cranial Fossa, Middle* ; Diagnosis ; Hematoma, Subdural, Chronic ; Hemorrhage ; Prognosis ; Skull

BACKGROUND: This study was undertaken in order to investigate any cardiopulmonary changes caused by the surgical procedure during a Nuss operation in patients with pectus excavatum. METHODS: Thirty patients undergoing the Nuss operation were divided into two groups. The patients were randomly assigned to either Group-V (n = 15) which volume controlled ventilation was applied, or to Group-P (n = 15) where pressure controlled ventilation was applied. Mechanical ventilation provided a tidal volume to be set at approximately 10 ml/kg and a frequency set to keep ETCO2 in range, between 32 mmHg and 38 mmHg. During the surgical procedure, we recorded expired volume (VE) and inspired maximal pressure (Pmax) changes according to the ventilator mode, and then also recorded changes in vital signs. RESULTS: Heart rate and blood pressure had no significant changes in either groups. In Group-V, during rotation of the metal bar, there was a significant decrease in expired volume (P< 0.001), changes of inspired maximal pressure gradually increased with the operation (P< 0.001). In Group-P, rotation of the metal bar caused a significant decrease in expired volume (P< 0.001). CONCLUSIONS: During the Nuss operation, there should be careful observation of changes in the vital signs, expired volume and maximal pressure during insertion and rotation of the metal bar.
Blood Pressure ; Funnel Chest* ; Heart Rate ; Humans ; Respiration, Artificial ; Tidal Volume ; Ventilation* ; Ventilators, Mechanical ; Vital Signs*