BACKGROUND: Mannitol is widely used in neurosurgical patients and may induce an increase in serum potassium concentration according to doses and administration rates with unknown mechanism. The treatment of hyperkalemia is aimed at eliminating the causes and includes calcium, sodium bicarbonate, glucose with insulin, loop diuretics and hyperventilation. This study was undertaken to observe the effects of hyperventilation on the serum potassium concentration following infusion of mannitol (2.0 gm/kg). METHODS: We studied 30 patients who were operated brain aneurysm clipping surgery and were divided into 3 groups (n=10). In control group, mild hypocapnia was maintained (PaCO2, 32 2 mmHg) before and after mannitol infusion. In group I, moderate hypocapnia was maintained (PaCO2, 27 2 mmHg) before and after mannitol infusion. In group II, mild hypocapnia (PaCO2, 32 2 mmHg) was maintained before 30 minutes of mannitol infusion and moderate hypocapnia (PaCO2, 27 2 mHg) after mannitol infusion. We started infusion of 20% mannitol with a dosage of 2.0 gm/kg, 15~20 min after cranium was opened. RESULTS: The changes of serum potassium were as follows (Mean SD mEq/l) (just before and 15min, 30min, 60min after mannitol infusion): 3.79 0.48, 4.66 0.60, 4.44 0.48, 4.13 0.40 (Control group), 3.62 0.18, 3.63 0.42, 4.14 0.51, 3.95 0.33 (Group I), 3.76 0.20, 3.91 0.15, 4.11 0.30, 4.04 0.23 (Group II). After 15 minutes of mannitol infusion, the serum potassium levels of group I and II were lower than that of control group (p<0.05) and there was no significant difference between group I and II. CONCLUSIONS: These results suggest that hyperventilation may blunt the increase in serum potassium concentration following rapid infusion of high dose mannitol.
Calcium ; Glucose ; Humans ; Hyperkalemia ; Hyperventilation* ; Hypocapnia ; Insulin ; Intracranial Aneurysm ; Mannitol* ; Potassium* ; Skull ; Sodium Bicarbonate ; Sodium Potassium Chloride Symporter Inhibitors

Carcinoid tumor of the kidney is extremely rare neoplasm. The tumor occurs equally frequently in men and women and appears to have no age, or sire predilection, but it generally exhibits a less aggressive biologic behabior than renal cell carcinoma. Only three of the carcinoid tumors were reported on have arisen in horseshoe kidney. Because of the scarcity of the lesion, prognosis and characterized, feature are not well characterized, and histogenesis is unknown. We report a case of primary carcinoid tumor found in a 43-year-old man with a horseshoe kidney. This is the first case of cacinoid tumor arising in horseshoe kidney documented in Korea.
Adult ; Carcinoid Tumor* ; Carcinoma, Renal Cell ; Female ; Humans ; Kidney* ; Korea ; Male ; Prognosis

A rat model of focal cerebral ischelma has been established by mhe tecbnique of elecvrocamtery for me middle oerebral artery occlusion (MCAO). We investigated mhe effect of naloxone pretreatment on the size of infarction and the regional cerebral blood flow (rCBF) Another purpose of this study was to determine the effecbve dose (high-or lowdose) in focal cerebral ischemia. The rats were given Img/Kg I.v. (low-dose), 4mg/Kg I.v. (high-dose) of naloxone 30 min before MCAO and infused continuously with 0.5mg/Kg/hr (low dose) or 2mg/Kg/hr (high-dose) over next I hour by am infusion pump. The control group was given normal salin of the same amount by the same method. Dunng the peDod of saline amd naloxone infusion, mean arterial blood pressure was monitored. Arterial blood gas analysis and blood glucose measuremert were performed just after MCAO. The rectal temperature of rat was maintained within 37)0.5C by a heating lamp. Twenty-fow hours after MCAO, eight 2mm-thick coronal sections of one rat brain were stained by TTC solution and the size of infarction was described as the percentage of ipsilateral hemisphere. The rCBFs were measured by an autoradiography using 14C-iodoantipyrine and the chamges of rCBFs were analyzed by three methods of (1) rCBF ratio, (2) 1 mm-serial rCBF measurement of cerebral cortex, and (3) areas of rCBF below critical values(<25, 25-50, <50ml/100g/min). The results were as follows; 1. There was no significamt chamge of blood pressure during the infusion of saline. Iow-dose and high-dose naloxones 2. Arterial blood gas amalysis amd blood glucose measurement showed that there were no significant differences of pH, PC02, PO2 and blood glucose between saline and low dose and high-dose naloxone groups 3. High-dose naloxone pretreatment reduced significantly the size of infarction(p<0.05 vs saline-treated group by Mann-Whitney U test). 4. High-dose naloxone pretreatment improved significantly the rCBF ratios of caudate head and CA 3 area (p<0.05 vs. saline-treated group by Mann-Whitney U test) There was no significant improvement of rCBF ratios in the low-dose naloxone treated group. 5. One-mm serial rCBF measurement of cerebral cortex indicated that while low-dose naloxone group showed no improvement of rCBF of cerebral cortex, high-dose nalox one pretreatment produced an improvement of rCBF in penumbra and its neighboring area 6. The area below 25ml/100g/min or rCBF was reduced significantly by high-dose naloxone pretreatment(high-dose naloxone group: 15.0+4.1mm2, saline group:23.3)5.3 mm2, p <0.05). In summary these results indicate that high-dose naloxone pretreatment reduced the size of infarction and improved the rCBFs in the focal cerebral ischemia of rats.
Animals ; Arterial Pressure ; Arteries ; Autoradiography ; Blood Gas Analysis ; Blood Glucose ; Blood Pressure ; Brain ; Brain Ischemia* ; Cerebral Cortex ; Head ; Heating ; Hot Temperature ; Hydrogen-Ion Concentration ; Infarction* ; Infusion Pumps ; Models, Animal ; Naloxone* ; Rats*

BACKGROUND: Thoracic outlet syndrome(TOS) is caused by the compression of neurovascular structures that supply to the upper extremities. Only a few reports have been published in Korea, and this study attempts to investigate the clinical aspects and results of the patients who underwent surgical treatment. MATERIAL AND METHOD: This study consist of 16 patients who underwent operations for thoracic outlet syndrome from May, 2002 to October, 2004. The surgical indications were confined to patients with: 1) symptoms too severe to perform ordinary daily life because of pain, paresthesia, edema of upper extremities, 2) no improvement after proper physical therapy, 3) definite findings of compression confined by radiologic examinations (MRI, angiography, etc), and 4) no other diseases such as cervical intervertebral herniation, myositis, neurologic diseases below the brachial plexus. The surgical approaches were by transaxillary approaches in 12 cases, supraclavicular approaches in 2 cases, and infraclavicular approaches in 2 cases. RESULT: There were 15 males and one female with an average age of 23.9 years (range: 19~39). Rib anomalies were observed in four cases (25.0%), but the others had no abnormal ribs. Right lesions were found in eight cases (50.0%), left lesions in five cases (31.3%), and bilateral lesions in three cases (18.7%). The follow-up period was 9~26 months and recurrence rate was 12.5% (2/16). Complications were one case of ulnar nerve palsy, one case of persistent pain despite radiologic improvement and three cases of wound dehiscence due to fat necrosis and hematoma. CONCLUSION: Although the choice of treatment in patients with TOS has been disputed, patients who have no response with proper physical therapies can benefit from the surgical treatment which may help patients to return to normal daily activity in shorter period of time.
Angiography ; Brachial Plexus ; Edema ; Fat Necrosis ; Female ; Follow-Up Studies ; Hematoma ; Humans ; Korea ; Male ; Myositis ; Paresthesia ; Recurrence ; Ribs ; Thoracic Outlet Syndrome* ; Ulnar Neuropathies ; Upper Extremity ; Wounds and Injuries

The amniotic band syndrome is rare congenital deformity, presumably due to rupture of amniotic sac during the early pregnancy and appears to cause fetal injury through deformation, malformation, or disruption. This syndrome is given many names yet follows a clearly defined clinical pattern. The diagnosis was based on sonographic visualization of either amniotic bands or bands associated with fetal deformation or deformities in nonembryologic distribution. Recently, we experienced a case of amniotic band syndrome, in which partial absence of cranial bone, asymmetric facial dysmorphism and amputation of right lower leg were detected. At our best knowledge, this is one of few case describing prenatal ultrasound diagnosis of amniotic band syndrome in Korea. So, we present this case with a brief review of the literatures.
Amniotic Band Syndrome* ; Amputation* ; Congenital Abnormalities* ; Diagnosis ; Infant, Newborn ; Korea ; Leg* ; Pregnancy ; Rupture ; Ultrasonography

The present study was done to determine the efficacy and safety of varicose vein removal using a minimally invasive, powered vein-extracting device with cutaneous transillumination and tumescent anesthesia techniques and then compared this to a retrospective group of conventional phlebectomy operations. There were 133 limbs in 104 patients(72 women, 32 men) treated with the use of the vein extractor aided by transcutaneous illumination. The hydrodissection was performed with TrivexTM Irrigated Illuminator(Smith and Nephew ) system using normal saline after the 2~3mm sized skin incision. Varicose clusters were extracted by the use of TrivexTM Resector(Smith and Nephew ) system under transillumination. After the varisoce vein extraction, the operation area was compressed with surgical pad for bleeding control. The complication rate was 3.84%. The mean number of incisions was 3.24 and mean operative time per limb was 65.9 minutes. The mean hospitalization was 1.86 days. The varicose vein extraction using transilluminated powered phlebectomy(TIPP) is a safe, efficacious and cosmetically satisfactory method. The procedure decreases the operating time and the number of incisions repuired to remove varicose clusters. Further evaluation and long term follow up will be necessary to determine the recurrence rate and long term complications.
Anesthesia ; Extremities ; Female ; Follow-Up Studies ; Hemorrhage ; Hospitalization ; Humans ; Lighting ; Operative Time ; Recurrence ; Retrospective Studies ; Skin ; Transillumination ; Varicose Veins* ; Veins

Shilajit, a medicine herb commonly used in Ayurveda, has been reported to contain at least 85 minerals in ionic form that act on a variety of chemical, biological, and physical stressors. The substantia gelatinosa (SG) neurons of the trigeminal subnucleus caudalis (Vc) are involved in orofacial nociceptive processing. Shilajit has been reported to be an injury and muscular pain reliever but there have been few functional studies of the effect of Shilajit on the SG neurons of the Vc. Therefore, whole cell and gramicidin-perfotrated patch clamp studies were performed to examine the action mechanism of Shilajit on the SG neurons of Vc from mouse brainstem slices. In the whole cell patch clamp mode, Shilajit induced short-lived and repeatable inward currents under the condition of a high chloride pipette solution on all the SG neurons tested. The Shilajit-induced inward currents were concentration dependent and maintained in the presence of tetrodotoxin (TTX), a voltage gated Na+ channel blocker, CNQX, a non-NMDA glutamate receptor antagonist, and AP5, an NMDA receptor antagonist. The Shilajit-induced responses were partially suppressed by picrotoxin, a GABAA receptor antagonist, and totally blocked in the presence of strychnine, a glycine receptor antagonist, however not affected by mecamylamine hydrochloride (MCH), a nicotinic acetylcholine receptor antagonist. Under the potassium gluconate pipette solution at holding potential 0 mV, Shilajit induced repeatable outward current. These results show that Shilajit has inhibitory effects on the SG neurons of Vc through chloride ion channels by activation of the glycine receptor and GABAA receptor, indicating that Shilajit contains sedating ingredients for the central nervous system. These results also suggest that Shilajit may be a potential target for modulating orofacial pain processing.
6-Cyano-7-nitroquinoxaline-2,3-dione ; Animals ; Brain Stem ; Central Nervous System ; Chloride Channels ; Facial Pain ; Gluconates ; Mecamylamine ; Mice ; Minerals ; N-Methylaspartate ; Neurons ; Picrotoxin ; Potassium ; Receptors, Glutamate ; Receptors, Glycine ; Receptors, Nicotinic ; Resins, Plant ; Strychnine ; Substantia Gelatinosa ; Tetrodotoxin

Malignant fibrous histiocytoma (MFH) is a primitive sarcoma originating in the deep soft tissue and composed of fibrocytic and histiocytic cells in a storiform pattern. It is rare but the most common soft tissue sarcoma of adulthood. MFH occurred in various epithelial organs derived from the supportive mesenchymal elements. The lung represents an extremely rare primary site. We have experienced one case of MFH, arising in the lung parenchyme in 67 years old male patient with cough for 6 months. The patient was taken right upper lobe and right middle lobe lobectomy with good post-operative results. But another MFH was recurred in the left upper lobe 3 months after complete resection. So he had been treated with chemotherapy and radiofrequency ablation of tumor. Then he continued to be treated with chemotherapy
Aged ; Catheter Ablation ; Cough ; Drug Therapy ; Histiocytoma, Malignant Fibrous* ; Humans ; Lung* ; Male ; Sarcoma

EGFR and KRAS mutations are two of the most common mutations that are present in lung cancer. Screening and detecting these mutations are of issue these days, and many different methods and tissue samples are currently used to effectively detect these two mutations. In this study, we aimed to evaluate the testing for EGFR and KRAS mutations by pyrosequencing method, and compared the yield of cytology versus histology specimens in a consecutive series of patients with lung cancer. We retrospectively reviewed EGFR and KRAS mutation results of 399 (patients with EGFR mutation test) and 323 patients (patients with KRAS mutation test) diagnosed with lung cancer in Konkuk University Medical Center from 2008 to 2014. Among them, 60 patients had received both EGFR and KRAS mutation studies. We compared the detection rate of EGFR and KRAS tests in cytology, biopsy, and resection specimens. EGFR and KRAS mutations were detected in 29.8% and 8.7% of total patients, and the positive mutation results of EGFR and KRAS were mutually exclusive. The detection rate of EGFR mutation in cytology was higher than non-cytology (biopsy or resection) materials (cytology: 48.5%, non-cytology: 26.1%), and the detection rate of KRAS mutation in cytology specimens was comparable to non-cytology specimens (cytology: 8.3%, non-cytology: 8.7%). We suggest that cytology specimens are good alternatives that can readily substitute tissue samples for testing both EGFR and KRAS mutations. Moreover, pyrosequencing method is highly sensitive in detecting EGFR and KRAS mutations in lung cancer patients.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung/genetics/metabolism/*pathology ; DNA Mutational Analysis ; DNA, Neoplasm/chemistry/metabolism ; Female ; Humans ; Lung Neoplasms/genetics/metabolism/*pathology ; Male ; Middle Aged ; Mutation ; Receptor, Epidermal Growth Factor/*genetics/metabolism ; Retrospective Studies ; ras Proteins/*genetics/metabolism

Lymphangioleiomyomatosis (LAM) is a rare disease in women of childbearing ages that eventually leads to respiratory failure. Lung transplantation is the only conclusive therapeutic modality in end-stage LAM. While single-lung transplantation is the preferred operation, the graft failure or recurrence of LAM was reported. We performed a single lung transplantation on a 36-year-old woman suffering from respiratory failure due to lymphangioleiomyomatosis. After a 1-year follow up, the patient was readmitted because of graft failure with collapsed transplanted lung. The lung volume reduction surgery (LVRS), tracheostomy and ventilator care were performed. However, neither the medical nor surgical treatment had any effect. Subsequently, we performed a contralateral single lung re-transplantation and had a good postoperative results.
Adult ; Female ; Follow-Up Studies ; Humans ; Lung Transplantation ; Lung* ; Lymphangioleiomyomatosis* ; Pneumonectomy ; Rare Diseases ; Recurrence ; Reoperation ; Respiratory Insufficiency ; Tracheostomy ; Transplants* ; Ventilators, Mechanical