Diabetes insipidus(DI) of central origin is a clinical syndrome resulting from low blood levels of antidiuretic hormone secreted from the posterior lobe of the pituitary gland, which is usually caused by lesions involving the hypothalamus-neurohypophyseal axis. MR imaging can reveal absence of the posterior pituitary bright signal(PPBS)in DI. The authors reviewed four patients with intracranial germinomas who had DI due to hypothalamus involvement. All patients before radiotherapy revealed absence of PPBS on MRI. Three cases recovered from DI after radiotherapy and showed reappearance of PPBS. Another one patients who continued DI didn't show signal change of the posterior pituitary gland. Ws speculated that the reappearance of PPBS is related to clinical improvement of DI.
Diabetes Insipidus* ; Follow-Up Studies* ; Germinoma* ; Humans ; Hypothalamus ; Magnetic Resonance Imaging ; Pituitary Gland ; Pituitary Gland, Posterior ; Radiotherapy*

Angiosarcomas are rare tumors that are derived from vascular endothelial cells. They may occur in various sites, including the skin, breast, visceral organs and deep soft tissues. The pleura usually a metastatic site from angiosarcomas. However, thirty one cases of primary pleural angiosarcomas have been reported worldwide. Here, we report a 61-year-old man with a primary angiosarcoma of the pleura with a brief review of the literature.
Breast ; Endothelial Cells ; Hemangiosarcoma* ; Humans ; Middle Aged ; Pleura* ; Skin

A wide range of denomination has been used for inflammatory myofibroblastic tumor (IMT). IMT is not entirely homogeneous, even though it shows some overlapping histologic features such as haphazard proliferation of spindle cell and polymorphic chronic inflammatory cell infiltraion. The spindle cell is considered to be of myofibroblastic origin but follicular dendritic cell origin was reported recently. IMT is known as nonneoplastic, aberrant inflammatory response. However, IMT could show local invasion, recurrence, vascular invasion, and malignant transformation, and clonal characteristics and aneuploidy of IMT support the hypothesis that IMT may be a neoplastic process. In order to define the nature of spindle cell of IMT, immunohistochemical stains for smooth muscle actin (SMA), vimentin (VMT), lysozyme, S-100 protein, cytokeratin, CD21 were done. Additional immunohistochemical stains for MIB-1 for proliferating activity and LMP (latent membrane protein) for Epstein-Barr virus (EBV) were done. IMTs were composed of each 2 cases from lung, liver and lymph node and one case from common bile duct, maxillary sinus, bladder and thigh, and were histologically subclassified according to Coffin et al. Nine cases (90%) were positive for SMA and VMT, but no correlation between SMA and VMT immunoreactivity and histologic types was identified. Five cases (50%) were positive for lysozyme and S-100 protein, and histologic type III was negative for lysozyme and S-100 protein, and immunoreactivity for S-100 protein was different according to the histologic subtypes. All 11 cases were negative for CD21 and EBV LMP. MIB-1 labelling index was less than 1% in all cases. In summary, the spindle cell is regarded as myofibroblastic origin rather than follicular dendritic cell origin. Relationship with EBV is not clear, and negligible MIB-1 reaction suggests that IMT might have a good prognosis.
Actins ; Aneuploidy ; Coloring Agents ; Common Bile Duct ; Dendritic Cells, Follicular ; Herpesvirus 4, Human ; Immunohistochemistry ; Keratins ; Liver ; Lung ; Lymph Nodes ; Maxillary Sinus ; Membranes ; Muramidase ; Muscle, Smooth ; Myofibroblasts* ; Prognosis ; Recurrence ; S100 Proteins ; Thigh ; Urinary Bladder ; Vimentin

Three-dimensional CT imaging is efficient in examining specific structures in the craniofacial area by reproducing actual measurements through minimization of errors from patient movement and image magnification. Due to the rapid development of digital image technology and the expansion of treatment range a need for developing three-dimensional analysis has become urgent. Therefore the purpose of this study was to evaluate the percentage of error and magnification of three-dimensional CT using a dried skull and Vworks programTM (Cybermed Inc., Seoul, Korea) and also to obtain landmarks that are easy to designate and reproduce in three-dimensional images using the Vmorph-proto programTM (Cybermed Inc., Seoul, Korea). The following conclusions were obtained; 1. In the comparison of actual measurements from the dried skull and the three-dimensional image obtained from the Vworks program, the mean error was 0.99mm and the magnification was 1.04%. 2. Clinically useful hard tissue landmarks from three-dimensional images were Supraorbitale, Lateral orbital margin, Infraorbitale, Nasion, ANS, A point, Zygomaticomaxilla, Upper incisor, Lower incisor, B point, pogonion, Menton, PNS, Condylar inner margin, Condylar outer margin, Porion, Condylion, Gonion1, Gonion2, Gonion3, Sigmoid notch and Basion. 3. Clinically useful soft tissue landmarks from three-dimensional images were Endocanthion, Exocanthion, Soft tissue Nasion, Pronasale, Alare lateralis, Upper nostril point, Lower nostril point, Subnasale, Upper lip point, Cheilion, Stomion, Lower lip center, Soft tissue B, Pogonion, Menton and Preaurale. The Vworks program can be considered a clinically efficient tool to produce and measure three-dimensional images. Most of the hard and soft tissue landmarks proposed above are anatomically important points which are also easily reproducible and designated. These landmarks can be beneficial in three-dimensional diagnosis and the prediction of changes before and after surgery.
Colon, Sigmoid ; Diagnosis ; Humans ; Imaging, Three-Dimensional ; Incisor ; Lip ; Orbit ; Seoul ; Skull

BACKGROUND: Bronchial asthma is classically defined as a reversible obstruction and hypsrresponsiveness of the airway attributed to an inflammatory process. However, some individuals with asthma show an irreversible component of airflow obstruction. It may be associated with structural changes in the airway resulting from severe or long standing air- way inflammation and remodelling. OBJECTIVE: The study was undertaken to compare the clinical characteristics of patient and airway remodelling as shown in bronchial wall thickness in HRCT according to the duration of asthma. MATERIALS AND METHODS: A retrospective clinical study was done on 119 patients with bronchial asthma, who had been admitted to Ewha Womans University Mokdong Hospital. Patients were divided to three groups according to disease duration and, clinical characteristics, pulmonary function test and HRCT were done. RESULTS: Basal FEV, and FVC was significantly lower in patient with longer duration. (p<0. 05) However pulmonary function was improved regardless of disease duration after 2 weeks steroid and bronchodilator therapy, and there was no significant difference in level changes according to the disease duration. The inner diameter of the bronchi and thickness of the bronchial wall at segmental and subsegmental bronchi increased significantly in patient with longer duration of asthma(p<0.05). Conclusion: These findings showed that airway remodelling was more extensive in patients with longer duration of disease resulting in decreased pulmonary function. These facts suggested that early anti-inflammatory therapy would be helpful for prevention of airway remodelling.
Airway Remodeling* ; Asthma* ; Bronchi ; Female ; Humans ; Inflammation ; Respiratory Function Tests ; Retrospective Studies

Endothelial cell have been shown to play an active role in many phases of immunologic process, including binding of T lymphocytes, neutrophils, platelets, and monocytes to the endothelium, as well as phagocytosis. Endothelial cells can also serve as targets that undergo cell injury. The most prominent mediators of endothelial cell activation are IL-1beta and TNF-alpha. VLA-4 was first identified as an endothelial cell surface receptor. We performed the culture of endothelial cells derived from human glomerular capillaries and studied the cytokine-regulated expression of VCAM-1, and the effect of dexamethasone and TGF-beta on the cytokine induced VCAM-1 expression using ELISA method. Expression of VCAM-1 was not detectable above background level in the basal unstimulated state. However, VCAM-1 was rapidly induced after exposure to IL-1beta (5ng/ml) or TNF-alpha (1, 10ng/ml) (O.D.=1.76+/-0.15, 1.95+/-0.35, 1.88+/-0.17, mean+/-S.E., control=0.36+/-0.028, n=8-24, P<0.05). But IFN-gamma did not increase the expression of VCAM-1. Addition of dexamethasone (10 micrometer) and TGF-beta1 (1ng, 10ng/ml) blunted IL-1beta and TNF-alpha induced expression of VCAM-1. Therefore, VCAM-1 could be inducible in human glomerular endothelial cells, and it was regulated by dexamethasone and TGF-beta1. The negative findings in histopathology may reflect the transience of VCAM-1 expression and does not necessarily exclude an important role of this molecule in the early stages of renal disease.
Capillaries ; Dexamethasone* ; Endothelial Cells* ; Endothelium ; Enzyme-Linked Immunosorbent Assay ; Humans ; Integrin alpha4beta1 ; Monocytes ; Neutrophils ; Phagocytosis ; T-Lymphocytes ; Transforming Growth Factor beta ; Transforming Growth Factor beta1 ; Tumor Necrosis Factor-alpha ; Vascular Cell Adhesion Molecule-1*

BACKGROUND: Combined spinal epidural (CSE) anesthesia has become the technique of anesthesia for cesarean section. We attempted to find the most suitable spinal and epidural local anesthetic doses providing high quality analgesia and minimal side effects during CSE anesthesia. METHODS: Thirty nine parturients were divided into 3 groups by dose of local anesthetics. The dose of 0.5% hyperbaric bupivacaine for spinal anesthesia were 6mg (group 1), 4 mg (group 2) and 2 mg (group 3) and 2% lidocaine for epidural anesthesia were 100 mg (group 1), 200 mg (group 2) and 300 mg (group 3). RESULTS: The number of request of analgesics during operation were 2 in group 1, 1 in group 2 and 3 in group 3. Group 3 had higher incidence of hypotension than other groups. The time to T4 level block were faster in group 1 and 2 than group 3. CONCLUSIONS: The CSE technique using 0.5% hyperbaric bupivacaine 4mg for subarachnoid and 2% lidocaine 200mg for epidural is most suitable for rapid onset, sufficient analgesia and few side effects in this study.
Analgesia ; Analgesics ; Anesthesia ; Anesthesia, Epidural* ; Anesthesia, Spinal ; Anesthetics, Local* ; Bupivacaine ; Cesarean Section* ; Female ; Hypotension ; Incidence ; Lidocaine ; Pregnancy

BACKGROUND: Hypoxemia during one lung ventilation (OLV) for thoracotomy in patients in the lateral position remains a clinical problem. And thoracic epidural anesthesia (TEA) during one lung ventilation recently has been combined with general anesthesia in our clinical practice for thoracic surgery. Then the effects of TEA combined with general anesthesia on PaO2 remains controversial. The aim of this study to investigate whether thoracic epidural anesthesia (TEA) affect PaO2 and pulmonary shunt during one lung anesthesia. METHODS: Fifteen patients undergoing lobectomy with one lung ventilation were examined. Each group was injected normal saline (control group, n = 7) or 1% lidocaine (TEA group, n = 8) 8 ml through thoracic epidural catheter after induction. We compared pulmonary shunt fraction (Qs/Qt) after OLV 30, 60 minutes and after two lung ventilation (TLV). RESULTS: We found the significant increases of intrapulmonary shunt fraction (%) in the TEA group compared to control group at each event, OLV30, 60 and TLV. And significant increase of intrapulmonary shunt was found after one lung ventilation in the both groups. CONCLUSIONS: These results suggest that TEA may influence hypoxic pulmonary vasoconstriction (HPV) by blockade of sympathetic activity during OLV.
Anesthesia* ; Anesthesia, Epidural* ; Anesthesia, General ; Anoxia ; Catheters ; Humans ; Lidocaine ; Lung* ; One-Lung Ventilation ; Tea ; Thoracic Surgery ; Thoracotomy ; Vasoconstriction ; Ventilation

To evaluate the technique to provide rapid onset of anesthesia and postoperative pain control for cesarean section, we have used spinal anesthesia and epidural analgesia with a 26-gauge, long spinal needle through a 18-gauge Tuohy needle(Espocan) for elective cesarean section in twenty cases, 0.5% heavy bupivacaine 8-12mg was injected through spinal needle for anesthesia during operation, and then spinal needle was removed and epidural catheter was inserted into the epidural space for postoperative pain control. Ten milliliters of bupivacaine 0.125% with 0.45 mg buprenorphine was injected into epidural space through epidural catheter at the time of pain recognition in postoperative period. The results were as follows; 1) There were 5 cases(25%) of hypotension after spinal anesthesia. 2) There were 4 cases(20%) of complaint of pain during operation. 3) The time from injection of 0.5% heavy bupivacaine to onset of anethesia to T4 level is 3.8+/-1.5 minutes and the time from induction of spinal anesthesia to deliverly of infant is 10.1+/-2.9 minutes. 4) Two cases of postoperative headache were noted, but they were mild and relieved spontaneously. 5) Other analgesics were needed in two cases at postoperative periods. The technique is recommended for the anesthesia of cesarean section because it allows rapid onset of anesthesia with spinal anesthesia and gives advantages of postoperative pain control with epidural catheter.
Analgesia, Epidural* ; Analgesics ; Anesthesia ; Anesthesia, Spinal* ; Bupivacaine ; Buprenorphine ; Catheters ; Cesarean Section* ; Epidural Space ; Female ; Headache ; Humans ; Hypotension ; Infant ; Needles ; Pain, Postoperative ; Postoperative Period ; Pregnancy

BACKGROUND: A retrospective study was performed to evaluate postoperative mortality within 30 days following surgery. METHODS: The records of 31,806 patients who received operation under general anesthesia were reviewed. RESULTS: 1) Postoperative deaths were 184 cases, the ratio of which was comprising 0.57% of all surgical operative cases. 2) The highest ratio of the mortality in age group was 51~60 years group which was 24.5%, and in physical status it was ASA class III which was 36.4%. The highest ratio to the mortality rate in postoperative days was 8~30 days which was 45.1%. 3) The most common causes of death was low cardiac output due to heart failure on operating theater, and hypovolemic shock within postoperative 2 days, and intracranial problem within postoperative 7 days, and pulmonary complication within postoperative 30 days. CONCLUSION: We conclude that fatality rate could be decreased by intensive and multidisciplinary care for postoperaive complications as respiratory and renal failure.
Anesthesia, General ; Cardiac Output, Low ; Cause of Death ; Heart Failure ; Humans ; Mortality ; Renal Insufficiency ; Retrospective Studies ; Shock