It is well known that intracranial pressure (ICP) and mean arterial pressure (MAP) are increased by laryngoscopy and endotracheal intubation during induction of general anesthesia, and it may be very dangerous in neurosurgical patients who had increased ICP. Therefore, this study was performed to know the range of ICP increase during induction of the conventional general anesthesia with intubation following thiopental and succinylchohne injections. Intracranial pressure and MAP were measured in 13 patients who underwent craniotomy. All the patients were monitored cerebral epidural ICP and intraarterial pressure preoperatively. The results were as follow: 1. Intracranial pressure was increased of 7.1±7.23 mmHg. 2. Arterial pressure was increased of 43.5±25.46 mmHg. 3. Cerebral perfusion pressure was increased of 33.3±27.53 mmHg. It is stressed that certain procedures are necessary to prevent from further increase of ICP due to induction of general anesthesia in patients with increased ICP.
Anesthesia, General ; Arterial Pressure ; Cerebrovascular Circulation ; Craniotomy ; Humans ; Intracranial Pressure* ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy* ; Thiopental

No abstract available.
Dyskeratosis Congenita* ; Female ; Humans

No abstract available.
Female* ; Humans

Neurilemmomas of the extremities are nerve sheath tumors involving peripheral nerves of the extremities. We analyzed MR images of 16 surgically proved tumors in 12 patients and compared the MR images with gross pathologic specimens in two tumors (2/16). Spin echo T1-weighted images were obtained in all the patients but T2-weighted images were obtained in six patients with a gradient echo technique. Gadolinium dimeglumine enhanced T1-weighted images were obtained in 11 patients (15/16). Signal on T1-weighted images was iso or slightly higher than that of the adjacent muscles. Signal on T2-weighted images ranged from homogeneous high to heterogeneous. After Gadolinium injection, all the 15 tumors showed enhancement. Small sized tumors were enhanced homogeneously but there was a tendency tobe enhanced heterogeneously to the central portion with peripheral rim enhancement as the size of the tumors increased. Pathologically, the enhanced portion was correlated the with solid protion was correlated the with solid portion of the tumors. Also encapsulation of the mass (12/16), suspended nerve strings (9/16) and bony erosion (1/16) were detected. MR characteristics of neurilemmoma include heterogeniety on enhanced T1 and T2 weighted images, encapsulation, and suspended nerve strings. Signal heterogeneity on enhanced T1 and T2 weignted images may be attributed to the variable cellularity, cystic changes, vascularity and focal hemorrhage of the tumors.
Extremities ; Gadolinium ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Muscles ; Nerve Sheath Neoplasms ; Neurilemmoma* ; Peripheral Nerves ; Population Characteristics

Neurilemmomas of the extremities are nerve sheath tumors involving peripheral nerves of the extremities. We analyzed MR images of 16 surgically proved tumors in 12 patients and compared the MR images with gross pathologic specimens in two tumors (2/16). Spin echo T1-weighted images were obtained in all the patients but T2-weighted images were obtained in six patients with a gradient echo technique. Gadolinium dimeglumine enhanced T1-weighted images were obtained in 11 patients (15/16). Signal on T1-weighted images was iso or slightly higher than that of the adjacent muscles. Signal on T2-weighted images ranged from homogeneous high to heterogeneous. After Gadolinium injection, all the 15 tumors showed enhancement. Small sized tumors were enhanced homogeneously but there was a tendency tobe enhanced heterogeneously to the central portion with peripheral rim enhancement as the size of the tumors increased. Pathologically, the enhanced portion was correlated the with solid protion was correlated the with solid portion of the tumors. Also encapsulation of the mass (12/16), suspended nerve strings (9/16) and bony erosion (1/16) were detected. MR characteristics of neurilemmoma include heterogeniety on enhanced T1 and T2 weighted images, encapsulation, and suspended nerve strings. Signal heterogeneity on enhanced T1 and T2 weignted images may be attributed to the variable cellularity, cystic changes, vascularity and focal hemorrhage of the tumors.
Extremities ; Gadolinium ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Muscles ; Nerve Sheath Neoplasms ; Neurilemmoma* ; Peripheral Nerves ; Population Characteristics

A series of 58 verified various sellar and parasellar lesions exclusive of aneurysms and inflammatory lesions was reviewed as to history, development and progression of the neurological features, spontaneous and steroid induced remission, endocrine disturbances, other laboratory findings, reontgenograms, differential diagnosis, operative methods and findings, and pathologic findings of the lesion. The author has only emphasized some interesting points illustrated in our cases because other results do not differ greatly from previous authors' reports. 1. No direct correlation was found to exist between the amount of the sellar destruction and the occurrence of endocrine disturbances. However, it was likely that marked endocrine changes were due to cystic formation in pituitary adenomas. 2. On angiograms of sellar and parasellar lesions, opening of the siphon and lateral displacement of the supraclinoid portion of the internal carotid artery were important in the diagnosis, and the event of nonvisualization of the posterior communicating and posterior cerebral arteries was observed in the majority of pituitary tumors. 3. In pituitary cystic adenomas, intracapsular bleeding was very hard to control on occasions because of rupturing vascular network or trabeculae in the cyst. 4. Definition of the empty sella was always obscure in intracranial exploration under the diagnosis of pituitary tumor when no definite lesion was found. 5. In a hydrocephalic patient with raised intracranial pressure and a markedly enlarged third ventricle extending into the sella turcica, third ventriculostomy still seems to be the choice of treatment.
Adenoma ; Aneurysm ; Carotid Artery, Internal ; Diagnosis ; Diagnosis, Differential ; Hemorrhage ; Humans ; Intracranial Pressure ; Pituitary Neoplasms ; Posterior Cerebral Artery ; Sella Turcica ; Third Ventricle ; Ventriculostomy

BACKGROUND: Colistin (polymyxin E) is active against multidrug-resistant Gram-negative bacteria (MDR-GNB). However, the effectiveness of inhaled colistin is unclear. This study was designed to assess the effectiveness and safety of aerosolized colistin for the treatment of ventilator-associated pneumonia (VAP) caused by MDR-GNB. METHODS: In this retrospective longitudinal study, we evaluated the medical records of 63 patients who received aerosolized colistin treatment for VAP caused by MDR-GNB in the medical intensive care unit (MICU) from February 2012 to March 2014. RESULTS: A total of 25 patients with VAP caused by MDR-GNB were included in this study. The negative conversion rate was 84.6% after treatment, and acute kidney injury (AKI) occurred in 11 patients (44%, AKI group). The average length of MICU stay and colistin treatment- related factors, such as daily and total cumulative doses and administration period, were not significantly different between groups. In-hospital mortality tended to be higher in the AKI group (p = 0.07). Multivariate analysis showed that a body mass index less than 18 was an independent risk factor of mortality (odds ratio [OR] = 21.95, 95% confidence interval [CI] 1.59-302.23; p = 0.02). Notably, AKI occurrence was closely related to the administration of more than two nephrotoxic drugs combined with aerosolized colistin (OR = 15.03, 95% CI 1.40-161.76; p = 0.025) and septic shock (OR = 8.10, 95% CI 1.40-161.76; p = 0.04). CONCLUSIONS: The use of adjunctive aerosolized colistin treatment appears to be a relatively safe and effective option for the treatment of VAP caused by MDR-GNB. However, more research on the concomitant use of nephrotoxic drugs with aerosolized colistin will be necessary, as this can be an important risk factor of development of AKI.
Acute Kidney Injury ; Body Mass Index ; Colistin* ; Drug Resistance, Microbial ; Gram-Negative Bacteria ; Hospital Mortality ; Humans ; Intensive Care Units ; Longitudinal Studies ; Medical Records ; Mortality ; Multivariate Analysis ; Pneumonia* ; Pneumonia, Ventilator-Associated ; Retrospective Studies ; Risk Factors ; Shock, Septic ; Treatment Outcome*

Leiomyosarcoma of the prostate is a rare malignant tumor. It originates from the smooth muscles of the prostatic gland and is usually found during old ages. Prognosis is usually poor especially in childhood. We report a case of leiomyosarcoma of the prostate measured 320gm in 64 years old man.
Humans ; Leiomyosarcoma* ; Middle Aged ; Muscle, Smooth ; Prognosis ; Prostate*

No abstract available.

Nevus sebaceous is a tumor of primary epithelial germ cells that is generally first noticed at birth. Clinically, there is a yellowish waxy plaque with overlying alopecia on the scalp. Less commonly, it can be seen on the face, trunk, and extremities. Syringocystadenoma papilliferum is the most common benign growth from nevus sebaceous, whereas basal cell carcinoma is the most frequent malignancy. The proportion of the malignant tumors occurring on nevus sebaceous is highly variable according to the published series, and there are controversies on the nature of these neoplasms. We experienced a rare case of nevus sebaceous, superimposed of 5 multiple type tumors at the comparatively young age: syringocystadenoma papilliferum, basal cell carcinoma, nevocellular nevus, sebaceous adenoma, and syringoma. We treated the patient with total excision, and followed up during 1 year. The patient showed no recurrence.
Adenoma ; Alopecia ; Carcinoma, Basal Cell ; Extremities ; Germ Cells ; Humans ; Nevus* ; Parturition ; Recurrence ; Scalp ; Syringoma