Of the bronchographic findings of 408 patients, performed in our hospital for recent 5 years, 108 cases showed definite bronchial obstruction, and 61 cases of those were selected and their obstructive findings were evaluated. All that not confirmed were abandoned. For evaluation of the reliability of 9 bronchographic obstruction signs onappplying to diagnose malignant or benign pulmonary diseases, each sign was identified and applied to each of the61 confirmed cases. In addition, obstructed bronchi, distance of obstruction from the bifurcation site, and thedirection of meniscus, if peresent, were evaluated. The reuslts were follows; 1. The most frequent cause ofbronchial obstruction was lung cancer (59.0%), and that of the benign obstruction was pulmonary tuberculosis(13.1%). 2. Amputation, asymmetric narrowing, thumbprint indentation, rat-tail narrowing and encasement signs werethe most accurate signs of malignancy and were practically diagnostic ones, 3, The most frequent sign in lungcancer was sharp cut off one, but it could be seen in lung abscess and in unresolved pneumonia, too. 4. Circumferential symmetric narrowing and regular concavity with a small central profection signs were specific onesto benignancy. 5. The most frequent obstruction sign in benign lung disease was gradual tapering sign, but it alsocould be seen inbronchogenic epidermoid and alveolar cell carcinoma. 6. Of all bronchial obstructions, 55.4% occurred at lobar bronchus and 77.4% of those were caused by lung cancer. 7. 77.2% of those obstruction which located within 3 times distance of the bronchial diameter at the nearest proximal bifurcation site, were lungcancer, but 75.0% of those located at over 3 times distance were benign pulmonary diseases. 8. There were nocorrelation of the direction of the meniscus at the obstructing and in differential diagnosis between benign andmalignant pulmonary diseases.
Adenocarcinoma, Bronchiolo-Alveolar ; Amputation ; Bronchi ; Bronchography ; Diagnosis, Differential ; Humans ; Lung Abscess ; Lung Diseases ; Lung Neoplasms ; Pneumonia

BACKGROUND: Tracheal intubation commonly results in sympathetic stimulation manifested by increased heart rate and arterial blood pressure. This study was carried out to determine whether lightwand would result in less hemodynamic changes than direct laryngoscopy. METHODS: With informed consent, fourty healthy female patients scheduled of elective surgical procedures were randomly allocated into two groups; lightwand (LW) or direct laryngoscopy (DL) group. Mean arterial pressure (MAP) and heart rate (HR) were recorded upon arrival. Under a standardized anesthetic technique, the patients were intubated either with no. 3 curved blade direct laryngoscopy (DL group) or with lightwand (LW group). The MAP and HR were recorded before intubation and every 1 minutes following intubaion. Time to intubation (TTI) was also recorded. All patients were intubated by a same fourth grade resident. RESULTS: Fourty patients were studied. Every intubation was successed in first attempt. The TTI was significantly shorter in LW group. Even while there was no significant difference in HR changes, there was significant difference in the increase of MAP following intubation. The increase of MAP was significantly greater with DL than with LW. CONCLUSIONS: This study suggests that lightwand intubation requires shorter TTI and may give rise to less blood pressure change than direct laryngoscopy. So we found no difference in disadvantage and may offers advantage in terms of hemodynamic stability.
Arterial Pressure* ; Blood Pressure ; Female ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Informed Consent ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy* ; Surgical Procedures, Elective

Pneumocystis carinii pneumonia is caused by Pneumocystis carinii. It usually occurs in premature or debilitated infants. Recently sporadic cases of human disease in patients who have been on long term steroid therapy, cytotoxic drug therapy, immunosuppressive drug were significantly increased. We recently experienced 35 cases of Pneumocystis carinii pneumonia in infants of an institution for foreign adoption in three epidemic period of Feb.1979, Mar. 1980, and Jan. 1980. The clinical review of 35 cases was made. Patients' age was between 1 to 4 months. Twenty-one cases (60%) occurred in 2-month-old infants. Many patients were included in poor weight gain and development. The common symptoms were tachypnea, cyanosis, restlessness, cough, diarrhea in order of frequency. The roentgenological findings were classified into three groups. normal finding, pulmonary emphysema only, and various forms of pneumonic infiltration. The roentgenological findings were somewhat characteristic. The most common finding (24 cases) showed streaky and mottled densities which began in both hill and were spreaded peripherally. The pneumonic infiltrations were spared peripheral lung, but progressed to total involvement. The prominence between alveolar and interstitial infiltration was almostly equal when patients were admitted. Nineteen cases (54%) showed pulmonary emphysema.
Cough ; Cyanosis ; Diarrhea ; Drug Therapy ; Humans ; Infant ; Lung ; Pneumocystis carinii ; Pneumonia ; Pneumonia, Pneumocystis ; Psychomotor Agitation ; Pulmonary Emphysema ; Tachypnea ; Weight Gain

Serial enzymatic determinations by electrophoresis were confined in serum of CK-BB(creatine kinase brain fraction), which were performed on 150 patients with acute head injury. The purpose of this study was to re-evaluate the usefulness of this serum enzyme value as a prognostic correlates. The results obtained are as follows : 1) 125 cases(83.3%) among 150 cases with head injury were revealed as CK-BB positive finding, whereas 25 cases (16.7%) with negative results have generally good outcome. 2) 3 cases (11.5%) of false positive finding were shown among 26 control group with back pain. 3) The maximum value of CK-BB(CK-BBmax) was een within 1st day(38.4%), and 3rd days (80.8%) following injury. 4) The appearance of mean CK-BBmax had two varieties of peak incidence on 1st-and 4th day following injury. 5) The Glasgow Coma Scale(GCS) Score on admission had close relationship to the value of inital CK-BB(CK-BBin) and CK-BBmax, respectively (P<0.001). 6) The ratio of mean value between CK-BBin and CK-BBmax had statistical significance in cases of skull fracture and contusional and/or intracerebral hemorrhage, respecitively (P<0.05, P<0.001). 7) The significant correlation of mean CK-BBin> or =1 IU.L) to outcome (P<0.003) was shown, whereas mean CK-BBmax> or =1 IU/L) to outcome did not (P=0.126). 8) The Glasgow Outcoem Scale (GOS) was strongly correlated to mean GCS Score (P<0.000) and mean CK-BBin (P<0.000), but not to mean CK-BBmzs (P<0.139). 9) The correlationship between mean value of CK-BBin and CK-BBmax was statistically significant only in good recovery and moderate disability group, respectively (P<0.000 & P<0.003).
Back Pain ; Brain ; Cerebral Hemorrhage ; Coma ; Contusions ; Craniocerebral Trauma* ; Creatine* ; Electrophoresis ; Head* ; Humans ; Incidence ; Phosphotransferases ; Skull Fractures

Attention has been called to the sudden expansion of a pituitary tumor by hemorrhage within it, causing sudden loss of vision. Management of the pituitary apoplexy should be regarded as a neurological emergency. The outstanding clinical features of acute pituitary apoplexy were sudden headache, depressed consciousness, opthalmoplegia, meningismus and signs of compression of the optic nerve or chiasm. The authors report two cases of pituitary apoplexy, one was chromophobe adenoma and pathological diagnosis was not obtained in the other. The first case was 45-year-old man admitted to the Department of Neurosurgery, Catholic Medical Center on June 20, 1977, with headache, double vision and impared left side visual acuity. On April 26, 1977, he experienced sudden severe headache and diplopia then became drowsy. The headache and impairment of consciousness improved subsequently. He was admitted to a university hospital following the onset. The work up at the hospital revealed an enlarged sella with hazy dorsum sellae on plain skull films. The carotid angiogram revealed an elevation of the A1 segments bilaterally and cisternal pneumogram revealed an evidence of suprasellar extension of the pituitary tumor. He was advised to have immediate surgery. The patient, however, refused the surgery and noticed the impaired visual acuity and diplopia were persisting. The studies in this hospital revealed marked impairment of left side vision and oculomotor nerve palsy of the left eye. The carotid angiogram and cisternal pneumogram revealed the no evidence of sellar mass or suprasellar extension of the tumor. The second case was 59-year-old woman admitted to the neurosurgical ward on September 30, 1977, after a sudden onset of severe bifrontal headache, vomiting, bilateral ocular pain and drowsy mental state. She was drowsy with panopthalmoplegia of the right side, and spinal fluid was xanthochromic. Skull X-ray, carotid angiogram and air study revealed an evidence of pituitary tumor with minimal suprasellar extension. Removal of pituitary tumor through the trans-sphenoidal approach was performed, and the tumor was proved to be chromophobe adenoma. Panopthalmoplegia was progressively improved postoperatively.
Adenoma, Chromophobe ; Consciousness ; Diagnosis ; Diplopia ; Emergencies ; Female ; Headache ; Hemorrhage ; Humans ; Meningism ; Middle Aged ; Neurosurgery ; Oculomotor Nerve Diseases ; Optic Nerve ; Pituitary Apoplexy* ; Pituitary Neoplasms ; Skull ; Visual Acuity ; Vomiting

PURPOSE: p53 mutations are one of the most common genetic alterations in human lung cancer. Although the prognostic value of mutant p53 is still debated, it is widely accepted as a relatively early genetic event in the development and progression of lung cancer. Moreover, there are growing reports about an association between smoking and p53 mutation, suggesting that the p53 gene could be a target of the smoking associated carcino- genesis in the lung cancer. MATERIALS AND METHODS: Surgically resected 89 primary non-small cell lung cancers were obtained from May of 1995 to May of 1997. p53 expression and Ki-67 expression were measured by immunohistochemistry, and each p53 expression and smoking amount were compared with Ki-67 expression and other clinical prognostic factors. RESULTS: Positive p53 expressions were found in 52 (58%) specimens, including 38 (69%) squamous cell carcinomas, 11 (39%) adenocarcinomas, and 3 (50%) large cell carcinomas, and closely associated with male and squamous cell carcinoma. Also close correlation was observed between smoking amount and p53 expression by the regression analysis. But p53 and Ki-67 expression showed no associations in pathologic stage and survival, and there was no association between p53 expression and survival after adjuvant radiotherapy. CONCLUSION: Smoking seems to affect p53 mutations in non-small cell lung cancer, and additional efforts are needed to evaluate the carcinogesis of lung cancer.
Adenocarcinoma ; Carcinoma, Large Cell ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Genes, p53 ; Humans ; Immunohistochemistry ; Lung Neoplasms ; Male ; Radiotherapy, Adjuvant ; Small Cell Lung Carcinoma* ; Smoke* ; Smoking*

OBJECTIVE: The objective of this study is to examine the effects of cranioplasty on the cerebral hemodynamics and cardiac function. METHODS: Twenty seven patients who had undergone cranioplasty were included in this study. Arterial blood flow velocities were assessed by transcranial doppler ultrasonography and the cerebral blood flow(CBF) measurements by perfusion computed tomography. Cardiac functions were evaluated using the echocar-diogram. RESULTS: The blood flow velocity on the cranioplasty side was decreased from 50.5+/-15.4cm/sec to 38.1+/-13.9cm/sec at the middle cerebral artery(MCA) and from 33.1+/-8.3cm/sec to 26.4+/-6.6cm/sec at the internal carotid artery(ICA)(p<0.05). On the opposite side, it was decreased from 61.9+/-15.7cm/sec to 48.7+/-16.9cm/ sec at the MCA and from 31.8+/-7.3cm/sec to 24.5+/-7.1cm/sec at the ICA(p<0.05). The evaluation of cardiac functions revealed that the stroke volume was increased from 64.7+/-18.3ml/beat to 73.3+/-20.4ml/beat(p< 0.05) ; the heart rate was decreased from 91.4+/-14.7beat/min to 82.2+/-15.1beat/min(p<0.05). CBF was increased from 39.1+/-7.2ml/100g/min to 44.7+/-8.9ml/100g/min on the cranioplasty side(p<0.05). CONCLUSION: Cranioplasty can remove the atmospheric pressure on the brain and may decrease the blood flow velocity and increase the CBF as well as improve the cardiac function. The authors insist that a skull defect should be corrected as quickly as possible after neurological stabilization of patients.
Atmospheric Pressure ; Blood Flow Velocity ; Brain ; Heart Rate ; Hemodynamics* ; Humans ; Perfusion ; Skull ; Stroke Volume* ; Stroke* ; Ultrasonography, Doppler, Transcranial

OBJECTIVE: Massive intracerebral hemorrhage (ICH) and major infarction (MI) are devastating cerebral vascular diseases. Decompression craniectomy (DC) is a common treatment approach for these diseases and acceptable clinical results have been reported. Author experienced the postoperative intracranaial pressure (ICP) trend is somewhat different between the ICH and MI patients. In this study, we compare the ICP trend following DC and evaluate the clinical significance.METHODS: One hundred forty-three patients who underwent DC following massive ICH (81 cases) or MI (62 cases) were analyzed retrospectively. The mean age was 56.3±14.3 (median=57, male : female=89 : 54). DC was applied using consistent criteria in both diseases patients; Glasgow coma scale (GCS) score less than 8 and a midline shift more than 6 mm on brain computed tomography. In all patients, ventricular puncture was done before the DC and ICP trends were monitored during and after the surgery. Outcome comparisons included the ictus to operation time (OP-time), postoperative ICP trend, favorable outcomes and mortality.RESULTS: Initial GCS (p=0.364) and initial ventricular ICP (p=0.783) were similar among the ICH and MI patients. The postoperative ICP of ICH patients were drop rapidly and maintained within physiological range if greater than 80% of the hematoma was removed. While in MI patients, the postoperative ICP were not drop rapidly and maintained above the physiologic range (MI=18.8 vs. ICH=13.6 mmHg, p=0.000). The OP-times were faster in ICH patients (ICH=7.3 vs. MI=40.9 hours, p=0.000) and the mortality rate was higher in MI patients (MI=37.1% vs. ICH=17.3%, p=0.007).CONCLUSION: The results of this study suggest that if greater than 80% of the hematoma was removed in ICH patients, the postoperative ICP rarely over the physiologic range. But in MI patients, the postoperative ICP was above the physiologic range for several days after the DC. Authors propose that DC is no need for the massive ICH patient if a significant portion of their hematoma is removed. But DC might be essential to improve the MI patients’ outcome and timely treatment decision.
Brain ; Cerebral Hemorrhage ; Cerebral Infarction ; Decompression ; Decompressive Craniectomy ; Glasgow Coma Scale ; Hematoma ; Humans ; Infarction ; Intracranial Hemorrhages ; Intracranial Pressure ; Male ; Mortality ; Punctures ; Retrospective Studies ; Stroke ; Vascular Diseases

BACKGROUND: Glucose transporter type 1 (GLUT1) expression is linked to glucose metabolism and tissue hypoxia. A recent study reported that GLUT1 was significantly associated with programmed death ligand 1 (PD-L1) as a therapeutic target in relapsed or refractory classical Hodgkin's lymphoma (cHL). The purpose of this study was to measure the expression of GLUT1 and assess its prognostic significance and potential relationships with PD-L1, programmed death ligand 2 (PD-L2), and programmed death-1 (PD-1) expressions in cHL. METHODS: Diagnostic tissues from 125 patients with cHL treated with doxorubicin, bleomycin, vinblastine, and dacarbazine were evaluated retrospectively via immunohistochemical analysis of GLUT1, PD-L1, PD-L2, and PD-1 expression. RESULTS: The median follow-up time was 4.83 years (range, 0.08 to 17.33 years). GLUT1, PD-L1, PD-L2, and PD-1 were expressed in 44.8%, 63.2%, 9.6%, and 13.6% of the specimens, respectively. Positive correlations were found between GLUT1 and PD-L1 expression (p = .004) and between GLUT1 and PD-L2 expression (p = .031). GLUT1 expression in Hodgkin/Reed-Sternberg (HRS) cells was not associated with overall survival or event-free survival (EFS) in the entire cohort (p = .299 and p = .143, respectively). A subgroup analysis according to the Ann Arbor stage illustrated that GLUT1 expression in HRS cells was associated with better EFS in advanced-stage disease (p = .029). A multivariate analysis identified GLUT1 as a marginally significant prognostic factor for EFS (p = .068). CONCLUSIONS: This study suggests that GLUT1 expression is associated with better clinical outcomes in advanced-stage cHL and is significantly associated with PD-L1 and PD-L2 expressions.

Compartment syndrome has a wide spectrum from muscle pain to a life-threatening condition, such as acute renal failure and disseminated intravascular coagulation (DIC). Intracerebral hemorrhage (ICH) due to compartment syndrome has not been reported. We report a patient who presented with ICH leading to death. A 25-year-old female with no significant past history developed extensive compartment syndrome followed by rhabdomyolysis, acute renal failure, DIC, and ICH. Although the patient underwent a fasciotomy and hemodialysis and received aggressive resuscitation with massive transfusions of blood and intravenous fluids, she died. This case stresses the importance of early diagnosis and prompt treatment of compartment syndrome to prevent devastating complications.
Acute Kidney Injury ; Adult ; Arm* ; Cerebral Hemorrhage* ; Compartment Syndromes* ; Dacarbazine ; Disseminated Intravascular Coagulation ; Early Diagnosis ; Female ; Humans ; Myalgia ; Renal Dialysis ; Resuscitation ; Rhabdomyolysis