Evaluation of inadevertent dural puncture occuring among 308 epidural blocks done for the relief of pain from various conditions was performed. Dural puncture was suspected in 5 out of 308 eqidural bloks(1.6%). Aspiration of CSF was negative 3 cases in which dural puncture was suspected only after developing spinal anesthesia. Of the 3 negative CSF aspirations, one case had a history of laminectomy. Adhesions of the adjacent tissues might result in the loss of flexibility and a decreases in potential epidural space which might cause dural tearing during injection and subarachoid injection of the local anesthetic followed by high spinal anesthesia. In another case, the needle tip was obstructed by tissue which led to negative aspiration of CSF and failure to feel loss of resistance. The second injection at the same site many cause subarachonold injection of the local anesthetic through the previously perforated dura mater and in turn, lead to spinal anesthesia. In the last case, there was no reason to suspect dural puncture since the loss of resistance plus air rebound were definite and aspiration of CSF was negative, but dural puncture was suspected after the patient developed spinal anesthesia.
Anesthesia, Spinal ; Aspirations (Psychology) ; Dura Mater ; Epidural Space ; Humans ; Laminectomy ; Needles ; Pliability ; Punctures*

No abstract available.
Smoking* ; Tobacco Products*

PURPOSE: The purpose of the present study was to develop and optimize solenoid coil for animal- model in 3 T MRI system and investigate and compare with the birdcage coil concerning the image quality with the various parameters such as SNR and Q-factor. MATERIALS AND METHODS: Solenoid coil for animal-model was made on the acryl structure (diameter 4 cm, length 10 cm) 3 times-winding cooper tape of width 2 cm , thickness 0.05 cm and length 10 cm with 2 cm interval between winded tapes. Capacitors from 2 pF to 100 pF were used, and the solenoid coil was designed for receiver only coil. RESULTS: SNR of the developed solenoid was 985 in CuSO4 0.7 g/L and 995 in rat experiment. Q-factor was 84-89 in unloaded condition and 203-206 in loaded condition. CONCLUSION: The resolution of the image obtained from solenoid was relatively higher than that of the conventional birdcage coil. In addition, the homogeneity of RF field by coil simulation was significantly excellent. The present study demonstrated that the solenoid coil could be useful to obtain small animal images with better contrast, resolution, visibility than images from birdcage.
Animals* ; Magnetic Fields* ; Magnetic Resonance Imaging* ; Rats ; Wind

BACKGROUND: A papillary carcinoma in the breast is a rare carninoma with a predominantly papillary growth patttern. Its incidence is said to be 1% to 2% of all breast carcinomas in women. Because of its rarity, little is known about its histopathological features. This study was undertake to analyze the histopathological characteristics of papillary breast cancer. METHODS: During the 17 years from January 1980 through December 1996, among 2166 primary breast cancer patients, 26 patients, who had been diagnosed with papillary breast cancer pathologically at the Department of Surgery, Seoul National University Hospital, were elegible for this study. The histopathological characteristics of the tumors in these patients, including immunohistochemically stained tumor marker-e.g., bcl2, c-erbB2, cathepsin D, and p53-were compared to those of patients with an invasive ductal carcinoma, NOS (IDC). RESULTS: The mean age of the patients was 47 years old, ranging from 28 to 74 years. There was no statistically significant difference in the primary tumor size between the papillary cancer and the IDC (2.62 cm vs 3.33 cm, p=0.127). Twenty-four of the papillary cancer patients had no metastatic axillary node, and metastatic nodes were present in the papillary cancer than in the IDC, with statistical significance (0.27+/-0.19 vs 3.43+/-0.08, p=0.023). Papillary cancer seemed to have more frequent ER and PgR (60%, 77.8%) than IDC (44.1%, 56.1%), but there was no significance to these results (p=0.351, 0.309). In terms of tumor markers, the positivity of bcl2, c-erbB2, cathepsin D, and p53 in papillary cancer were 42.9%, 100%, 85.5%, and 66.7%, respectively. Of all significance, immunohistochemically determined tumor markers, c-erbB2 expression was observed with statistical significance, more frequently in papillary cancer (100% vs 68.5%, p=0.044). Patients with papillary cancer had an overall 10-year survival rate of 83.3%. CONCLUSION:Papillary breast cancer had fewer metastatic axillary node, but with little statistical significance for a more favorable outcome. The relation between c-erbB2 expression and papillary cancer seems to be interesting and needs to be further elucidated.
Biomarkers, Tumor ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Carcinoma, Papillary ; Cathepsin D ; Female ; Humans ; Incidence ; Middle Aged ; Seoul ; Survival Rate

This study was performed to determine the incidence and seroprevalence of hepatitis A virus (HAV) infections in young soldiers in the Republic of Korea Army. From January 2000 through December 2004, a total of 147 hepatitis A cases were reported to the Armed Forces Medical Command. The annual incidence rates were 7.4 per 100,000 persons in 2000, 1.6 in 2001, 4.4 in 2002, 9.8 in 2003, and 6.2 in 2004, based on the reported cases among approximately 500,000 soldiers. All patients were males with a median age of 21 yr (range, 19-27). The most common symptom was nausea (86.5%), and all patients had recovered without complications. In addition, in order to evaluate the seroprevalence of HAV infection in young adults, serum samples were obtained from randomly selected young subjects among those who had been admitted to the Armed Forces Capital Hospital from September 2005 to February 2006. A total of 200 subjects were enrolled in the study to analyze the anti-HAV immune status. The overall anti-HAV IgG seropositive rate was 2% (4/200, 95% CI, 0.60-5.21%). Given the changing epidemiology of the disease and the associated increase in morbidity, it was suggested that the routine HAV vaccination for Korean military personnel might be necessary.
Adult ; Hepatitis A/*blood/*epidemiology/immunology ; Hepatitis A Antibodies/immunology ; Hepatitis A virus/*metabolism ; Humans ; Immunoglobulin G/blood ; Incidence ; Korea ; Male ; Military Personnel ; Seroepidemiologic Studies

Strongyloides stercoralis hyperinfection in immunocompromised patients is difficult to control due to delayed diagnosis, especially in nonendemic areas. A 70-year-old diabetic woman came in with an intermittent diarrhea. She received massive steroid therapy for a week under the impression of idiopathic gastrointestinal eosinophilic syndrome. Diagnosis of strongyloidiasis was made by demonstration of filariform larvae in two repeated sputum specimens two months later. Despite massive administration of albendazole, she died of diabetic ketoacidosis and septic shock. Autopsy revealed a diffusely thickened bowel wall, superimposed invasive pulmonary aspergillosis and the near total destruction of the lungs. Filariform larvae were detected only in the cutaneous lesions. It was presumed that Strongyloides stercoralis hyperinfection was caused by autoinfection in the patient's immunosuppressed status. The present case has two clinical importances; first, intensive treatment with albendazole could erradicate parasites except for the skin but sepsis presumably occurred due to a hypersensitivity reaction against liberated endotoxins during the death of the parasites by the drug. Second, cutaneous parasitic lesion resists the intensive antihelminthic treatment in an immunocompromised host.
Aged ; Albendazole ; Autopsy* ; Delayed Diagnosis ; Diabetic Ketoacidosis ; Diagnosis ; Diarrhea ; Endotoxins ; Eosinophils ; Female ; Humans ; Hypersensitivity ; Immunocompromised Host ; Invasive Pulmonary Aspergillosis ; Larva* ; Lung ; Parasites ; Sepsis ; Shock, Septic ; Skin ; Sputum ; Strongyloides stercoralis ; Strongyloidiasis*

PURPOSE: This study compared the effect of three intraoral repair systems on the bond strength between composite resin and zirconia core. MATERIALS AND METHODS: Thirty zirconia specimens were divided into three groups according to the repair method: Group I- CoJet(TM) Repair System (3M ESPE) [chairside silica coating with 30 microm SiO2 + silanization + adhesive]; Group II- Ceramic Repair System (Ivoclar Vivadent) [etching with 37% phosphoric acid + Zirconia primer + adhesive]; Group III- Signum Zirconia Bond (Heraus) [Signum Zirconia Bond I + Signum Zirconia Bond II]. Composite resin was polymerized on each conditioned specimen. The shear bond strength was tested using a universal testing machine, and fracture sites were examined with FE-SEM. Surface morphology and wettability after surface treatments were examined additionally. The data of bond strengths were statistically analyzed with one-way ANOVA and Tamhane post hoc test (alpha=.05). RESULTS: Increased surface roughness and the highest wettability value were observed in the CoJet sand treated specimens. The specimens treated with 37% phosphoric acid and Signum Zirconia Bond I did not show any improvement of surface irregularity, and the lowest wettability value were found in 37% phosphoric acid treated specimens. There was no significant difference in the bond strengths between Group I (7.80 +/- 0.76 MPa) and III (8.98 +/- 1.39 MPa). Group II (3.21 +/- 0.78 MPa) showed a significant difference from other groups (P<.05). CONCLUSION: The use of Intraoral silica coating system and the application of Signum Zirconia Bond are effective for increasing the bond strength of composite resin to zirconia.
Ceramics ; Collodion ; Phosphoric Acids ; Polymers ; Silicon Dioxide ; Wettability ; Zirconium

PURPOSE: There are no specific clinical and histopathologic characteristics of malignant pheochromocytoma and the optimal treatment modality has not been established yet. We analyzed the clinical and histopathologic features of malignant pheochromocytoma and treatment results. MATERIALS AND METHODS: We reviewed the clinical records of 10 patients with malignant pheochromocytoma diagnosed at Seoul National University Hospital from March 1987 to June 1998. RESULTS: Nine of 10 (90%) patients had functional tumors. The biochemical laboratory findings showed elevated 24-hour urine VMA level in nine patients available. The median size of the tumors was 11x11 cm. Six of 10 (60%) patients were initially diagnosed as malignant tumors because of direct invasions to adjacent tissues or distant metastases. On the other hand, remaining 4 patients were initially diagnosed as benign, but the distant metastases developed metachronously after resection of the primary lesion. The median duration between the initial operation and the detection of metastases was 57 months (range: 47~72 months) in these patients. The liver was the most common site of metastases (60%). With regards to the histopathological features, most of the tumors (87.5%) showed capsulation, necrosis and hemorrhage. The findings of lymphatic invasion, angio-invasion, and mitosis were found in 62.5% of the cases. All but 2 patients were initially treated with radical operation for the primary lesions. The disease recurrences or metastases occurred in 7 out of 10 patients. Of these, 4 patients were treated with chemotherapy or interferon- a after recurrences. Overall, the median survival for all patients was 82 months (range: 37~143 months). Two patients is alive and only one patient is alive without recurrence. CONCLUSION: The careful follow-up for at least 5 years and the aggressive multi-disciplinary therapy may be needed for the diagnosis and the management of malignant pheochromocytoma.
Diagnosis ; Drug Therapy ; Follow-Up Studies ; Hand ; Hemorrhage ; Humans ; Liver ; Mitosis ; Necrosis ; Neoplasm Metastasis ; Pheochromocytoma* ; Recurrence ; Seoul

PURPOSE: H rthle cell neoplasm of the thyroid gland is a rare disease. The reported cases in Korea are not so many; thus, there has been a lack of common therapeutic and prognostic guidance. METHODS: The cases of 15 patients with a H rthle cell neoplasm of the thyroid gland, hospitalized at Seoul National University Hospital from Nov. 1981 to Feb. 1998, were retrospectively reviewed. RESULTS: There were 4 males and 11 females. The ages varied from 23 to 69 years old (mean: 46.3 years old). Among them, 13 had neck masses with a mean size of 3.3 cm (1.2-6.0 cm), and the mean duration of the symptom was 4 years (5 months-8 years). Of the other two, one had laryngeal discomfort for 2 months, and the other one was diagnosed through a fine needle aspiration follow-up. One of the 15 patients had hyperthyroidism whereas the others had euthyroidism. The thyroid scans for 10 of them showed cold nodules. The operations consisted of a unilateral lobectomy in 2 cases, a unilateral lobectomy and isth mectomy in 11 cases, a unilateral lobectomy, isthmectomy and contralateral partial lobectomy in 1 case, and a total thyroidectomy and neck lymph node dissection in the 1 case that was combined with a papillary carcinoma. Thirteen patients (86.7%) had a H rthle cell adenoma, and two of them (13.3%) had a H rthle cell carcinoma. The mean duration of follow-up was 33 months (range 1 month-12 years), and no recurrence or death occurred during the follow-up period. CONCLUSIONS: The incidence of H rthle cell neoplasms is higher in women and the sex ratio is 1:2.8. The incidence of H rthle cell carcinomas among H rthle cell neoplasms is 13.3% (2/15). We found no specific clinical features for differentiating a H rthle cell adenoma from a H rthle cell carcinoma and no factors for adequate operative methods and prognosis due to the rarity of the condition and the short duration of the follow-up. Because of the low incidence of H rthle cell neoplasms and our limited experience, not only co-research of centers but also pathologic research is needed.
Adenoma ; Aged ; Biopsy, Fine-Needle ; Carcinoma, Papillary ; Female ; Follow-Up Studies ; Humans ; Hyperthyroidism ; Incidence ; Korea ; Lymph Node Excision ; Male ; Neck ; Prognosis ; Rare Diseases ; Recurrence ; Retrospective Studies ; Seoul ; Sex Ratio ; Thyroid Gland* ; Thyroidectomy

The purpose of this study is to investigate the spectra of a magnetic resonance spectroscopy (MRS) in accordance with the variance of TE and the volumes of metabolites in a localized voxel for the quality assurance using a designed single voxel spectroscopy QA phantom. Because a cone-shape phantom is designed as the volume of metabolite in a localized voxel is changeable, we try to analyze the peaks of each metabolite (NAA, Cr, Cho, Lac, etc.) in accordance with metabolite volume in a localized voxel as well as echo time (TE). All data were obtained using a 3T MRI/MRS machine and analyzed using jMRUI(R). The results of this study show that TE is in inverse proportion to the noise of MRS and the longer TE and the less metabolite volume in the localized voxel, the peak intensities of each metabolite decrease. In case of the lactate, its peak was observed on the all TE only if the greatest metabolite is included in the localized voxel. Then, the intensity of a metabolite is more sensitive to the metabolite volume in the localized voxel than the TE. These obtained in vitro MRS data is provide the guideline that is important for in vivo metabolite quantification. But, in the edge of cone-shape vial air bubbles were observed and spectrum could not obtained. Therefore our cone-shape MRS phantom needs to be modified in order to solve these problems.
Lactic Acid ; Magnetic Resonance Spectroscopy ; Noise ; Spectrum Analysis