Mural nodules in ovarian mucinous tumors, whether benign, borderline, or malignant, have been described by several authors since Prat and Scully first described sarcoma or sarcoma-like mural nodules occurring in association with mucinous epithelial neoplasia in 1979. Three distinct types of the mural nodule have been identified; i. e., 1) sarcoma-like lesion, 2) true mesenchymal sarcome, and 3) anaplastic carcinoma simulating a sarcoma. Mural nodules of sarcomatous and carcinomatous foci associated with mucinous ovarian tumors should be separated from sarcoma-like nodules because of the poor prognosis of the former compared to the favorable prognosis of the latter. We experienced a case of ovarian mucinous cystadenocarcinoma with sarcoma-appearing mural nodule of anaplastic carcinoma occurred in a 59-year-old woman and reported with brief review of the literatures.
Carcinoma* ; Cystadenocarcinoma, Mucinous* ; Female ; Humans ; Middle Aged ; Mucins* ; Ovary ; Prognosis ; Sarcoma

No abstract available.
Endocarditis*

Osteoid osteoma is a small, oval or roundish, nidus like neoplasm of bone. The lesion usually does not exceed a centimenter in its greatest dimension, and it consists of osteoid, trabeculae of newly formed osseous tissues and a substratum of highly vascularized osteogenic connective tissue. In a differential diagnosis, consideration should be given to Brodies abscess, sclerosing osteomyelitis of Garre, Fibrous dysplasia and healing fractures. From Janua 1960 to December 1980, we have seen and studied 18 cases of osteoid osteoma and the results obtained from this study were follows: l. Eleven cases were found in second decade and 17 cases were developed before thirty years old. 2. The sex ratio was nearly equal and duration of disease from onset was average 16 months. 3. Location of lesions were predominantly in lower extremities, 9 in tibia and 3 in femur. 4. Pain was noted in 16 cases and aspirin affected in 8 cases. 5. Nidus was found in 11 cases. 6. All cases were treated by radical excision of lesions with disappearance of pain and satisfactory results.
Abscess ; Aspirin ; Clinical Study ; Connective Tissue ; Diagnosis, Differential ; Femur ; Lower Extremity ; Osteoma, Osteoid ; Osteomyelitis ; Sex Ratio ; Tibia

No abstract available.
Lung Diseases, Interstitial*

Elevated plasma level of the sulfur amino acid homocysteine, termed hyperhomocysteinemia, is now recognized as a contributing factor to various pathological states of the brain including vascular, degenerative and other neurologic disorders. Endothelial dysfunction may be one of the underlying mechanisms leading to proatherogenic and neurotoxic effects associated hyperhomocysteinemia. We conducted electron microscopic studies to investigate microvascular changes in hyperhomocysteinemic rat brain due to folate deficiency. Dietary folate deprivation caused an increase in plasma Hcy by 317% from 6.15 +/- 0.9 micro mol/l to 19.5 +/- 3.2 micro mol/l with time up to 8 weeks of folate deprivation. In electron microscopic study, perivascular amorphous fibrosis, and pericytic and endothelial cell degenerative appearance were frequently found in hyperhomocysteinemic microvasculature. These findings are very similar with the typical cerebral microvascular pathology observed in neurodegenerative and aging processes. From these results, it can be suggested that hyperhomocysteinemia -induced blood -brain barrier disruption give rise to subsequent neuronal dysfunction in hyperhomocysteinemia.
Aging ; Animals ; Brain ; Endothelial Cells ; Fibrosis ; Folic Acid ; Homocysteine ; Hyperhomocysteinemia* ; Microscopy, Electron ; Microvessels* ; Nervous System Diseases ; Neurons ; Pathology ; Plasma ; Rats ; Sulfur

BACKGROUND: Due to rapid economic growth and the development of medical science, the human life span is increasing nowadays. Due to this, old-aged people are increasing in number. However, the physiologic reserve power of old-aged people is lower than that of younger people. Therefore, it is necessary to be very careful about peri-operative care when doing surgery on old-aged people under general or spinal anesthesia. METHODS: We analyzed the medical records of 460 patients over 65 years of age who had undergone operations from August 1990 to July 1996 at the Department of General Surgery, Inchon Medical Center. RESULTS: (1) The ratio of geriatric surgical patients to all surgical patients during the same period was 14.7% (460/3122). Especially, the proportion of geriatric surgical patients increased to 17.0% during the last 2 years of this study compared to 16.2% for the previous 2 years, and 10.6% for the first 2 years. (2) The age distribution was 148 patients from 65 to 69 years (32.2%), 158 patients from 70 to 74 years (34.3%), 90 patients from 75 to 79 years (19.6%), and 64 patients over 80 years (13.9%). There was no significant difference between the number of men and women, there being 232 men and 228 women. (3) Among the 464 cases, 99 cases (21.3%) were malignant diseases compared to 365 cases (78.7%) of benign disease. Stomach cancer was the most common, 36 cases, colon cancer accounted for 31 cases and hepatobiliary cancer for 12 cases. Of the benign diseases, 103 cases (28.2%) were acute appendicitis, 85 (23.4%) were hepatobiliary diseases, 73 (20.1%) were hernias, and 35 (9.6%) were anal diseases. (4) Two hundred twenty-two (222) preoperative-associated diseases were found in 460 patients (48.3%). Cardiovascular disease was the most common (17.4%), and pulmonary disease was the 2nd most common (15.9%). (5) Of the total 133 cases of postoperative complication occurrence, wound infection was the most common, 43 cases, followed by pneumonia, 30 cases, respiratory failure, 11 cases, and renal failure, 7 cases. (6) The postoperative mortality rate was 5.0% and the most common cause was respiratory failure, 8 cases, followed by sepsis, 8 cases. CONCLUSION: The field of geriatric surgery must be pioneered and developed more by surgeons because the number of geriatric surgical patients is increasing more rapidly at present than in the past.
Age Distribution ; Anesthesia, Spinal ; Appendicitis ; Cardiovascular Diseases ; Colonic Neoplasms ; Economic Development ; Female ; Hernia ; Humans ; Incheon ; Lung Diseases ; Male ; Medical Records ; Mortality ; Pneumonia ; Postoperative Complications ; Renal Insufficiency ; Respiratory Insufficiency ; Sepsis ; Stomach Neoplasms ; Wound Infection

BACKGROUND: The main advantage of drug administration by target-controlled infusion (TCI) is that it allows rapid adjustments of blood concentrations to individual patients requirements. In this study, we tried to confirm the side effects, relation, safety range and minimum effective analgesic concentration (MEAC) of fentanyl at the effect site. METHODS: Sixty ASA physical status 1 or 2 patients (age: 20 - 50 years) undergoing orthopedic surgery with regional anesthesia were randomly allocated to one of three groups according to effect site concentration of fentanyl (1, 1.5, or 2 ng/ml, n = 20 for each group). Total infusion time, total amount of drugs, vital signs, muscular rigidity, respiratory depression, level of consciousness, nausea, vomiting and pruritus was investigated. Meanwhile, we evaluated the MEAC by checking the effect site concentration of fentanyl when the patient complained of pain following propofol-fentanyl-N2O anesthesia using a computer assisted continuous infusion (n = 30). RESULTS: Demographic data and averaging scores of each parameter showed no difference among groups. However, incidences tended to increase above 1.5 ng/ml except with rigidity in the 1.5 ng/ml fentanyl group. The MEAC of fentanyl was checked as 0.61 +/- 0.18 ng/ml. CONCLUSIONS: Estimated MEAC of fentanyl was 0.61 +/- 0.18 ng/ml. There were increased side effects and complaints of patients above 1.5 ng/ml. The optimal initial postoperative target concentration of fentanyl was considered as 1 ng/ml.
Analgesia* ; Anesthesia ; Anesthesia, Conduction ; Consciousness ; Fentanyl* ; Humans ; Incidence ; Muscle Rigidity ; Nausea ; Orthopedics ; Pain, Postoperative ; Pruritus ; Respiratory Insufficiency ; Vital Signs ; Vomiting

Plasmapheresis has been used for some conditions during pregnancy and puerperium, such as hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome. We present one case of the HELLP syndrome which was treated with plasmapheresis and also review the indications, complications and guidelines for repetitive plasma exchange.
Blood Platelets ; Female ; HELLP Syndrome* ; Hemolysis ; Liver ; Plasma Exchange ; Plasmapheresis* ; Postpartum Period* ; Pregnancy

The purpose of this study was to investigate the ontogeny of oxytocin- and vasopressin-specific neurons in the supraoptic and paraventricular nuclei of the human fetal hypothalamus. Eight human fetuses, 17- to 22-week gestation, were used in this study. Tissues of fetal hypothalami were fixed with 10% neutral buffered formalin, embedded in paraplast, and cut serially in coronal planes. Representative sections were stained with cresyl violet for the contour of both nuclei and monoclonal antibodies to oxytocin and vasopressin were used for immunohistochemistry. In the hypothalamus, oxytocin- and vasopressin-specific neurons were first observed in a 18-week fetus. In the fetus oxytocin-specific neurons were observed in both supraoptic and paraventricular nucleus and vasopressin-specific neurons were observed only in the supraoptic nucleus. Both neurons were observed in both nuclei of the fetuses and after 19-week of gestation. In both nuclei, oxytocin-specific neurons predominate in number in each stages. The shape of two cell types was mostly oval, and no significant differences of the size between two in each stages.
Antibodies, Monoclonal* ; Fetus* ; Formaldehyde ; Humans* ; Hypothalamus ; Immunohistochemistry ; Neurons* ; Oxytocin ; Paraventricular Hypothalamic Nucleus ; Pregnancy ; Supraoptic Nucleus ; Vasopressins ; Viola

PURPOSE: To evaluate the CT appearance of renal cell carcinoma and to correlate it with nuclear grading andcell type. MATERIALS AND METHODS: The size, outer margin and heterogeneity of inner texture of renal cell carcinomas in 86 patients were evaluated on CT scan and were correlated with nuclear grade and cell type. RESULTS: Tumors less than 5cm were of low grade in 28 of 31 patients, while those larger than 5cm were of low grade in 28 of 55 patients. The lesions which showed no or round protrusion with a sharp margin were of low grade in 26 of 28 patients, while those which showed an undulated or indistinct margin were of low grade in 30 of 58 patients. Lesions which showed a homogeneous solid appearance, focal low densities, or mostly cystic changes were of low grade in 23 of 26 patients, while those which showed multiple or confluent low densites were low grade in 33 of 60 patients. There was a significant difference in the distribution of nuclear grading between the groups. Differences in CT apperance according to cell type were not found. CONCLUSION: Differences in less than 5cm showing no or round protrusion with a sharp margin, homogeneous inner texture with solid appearance, and heterogeneous inner texture with cystic appearance or focal low densities on CT scan were thought to be the findings suggesting low nuclear grading.
Carcinoma, Renal Cell* ; Humans ; Population Characteristics ; Tomography, X-Ray Computed