Mature cystic teratomas of the ovary are one of the most common ovarian neoplasms found in reproductive age women. Malignant transformation is an uncommon complication in a mature cystic teratoma of the ovary, usually being reported in about 1-3% of cases. Of malignant transformations, squamous cell carcimona is the most common type and sarcomatous transformation is rare, its prognosis is poor. Adenocarcinoma occurs with less frequency. We experienced a case of squamous cell carcinoma and adenocarcinoma arising in mature cystic teratoma of the ovary, so we present this case with brief review of the literature.
Adenocarcinoma* ; Carcinoma, Squamous Cell* ; Female ; Humans ; Ovarian Neoplasms ; Ovary* ; Prognosis ; Teratoma*

BACKGROUND: Carpal tunnel syndrome(CTS) is a long-term complication in dialysis patients which results from compression of the median nerve within the carpal tunnel. It has been reported to occur with increased frequency in the hemodialysis population, but, there are few reports concering long-term complications in CAPD because of the relatively shorter duration of dialysis in most CAPD patients. The aim of this study was to determine the incidence of CTS in patients undergoing CAPD. METHODS: We analyzed 21 chronic renal failure (CRF) patients(males 14, females 7; age range 19-79 yr) undergoing CAPD. The patients were evaluated by questionnare, physical examination, and nerve conduction test(NCT). Age, gender, duration of CRF before CAPD, duration of CAPD, diabetic history were determined. RESULTS: Among the total 21 patients undergoing CAPD, only 5 patients(24%) were CTS, diagnosed by NCT. Two of these patients were symptomatic CTS, three patients were non-symptomtic CTS. So, there were no relationship between the incidence of CTS and clinical symptoms. Among the diabetic dialysis patients, the incidence of CTS was 28.57%. Also there was no increase in the number of diatetic patients with CTS. CONCLUSION: It is concluded that the incidence of CTS in CAPD patients was similar with the previous reported incidence(2-31%) of hemodialysis patients. Since CTS is treatable, annual or even semiannual nerve conduction tests is indicated all CRF patients on chronic dialysis.
Carpal Tunnel Syndrome* ; Dialysis ; Female ; Humans ; Incidence ; Kidney Failure, Chronic* ; Median Nerve ; Neural Conduction ; Peritoneal Dialysis, Continuous Ambulatory ; Physical Examination ; Renal Dialysis

BACKGROUND: The possibility that anesthesia may alter the course of an infection has been under consideration for more a century. Alterations have been found in every component of the immune response during anesthesia and surgery. In this work, we have investigated the effect of lidocaine and propofol on interleukin-2 (IL-2), interleukin-4 (IL-4), and nitric oxide (NO) production in mice. METHODS: The culture supernatants of splenocytes exposed with anesthetics and lipopolysaccharide (LPS), or sera from mice injected with these agents were harvested to assay IL-2, IL-4, and NO. RESULTS: We detected that IL-2 productions of splenocytes culture supernatants and mice sera after exposure with lidocaine or propofol were decreased while IL-4 productions were increased. In addition, NO of mice sera was increased after lidocaine or propofol exposures. CONCLUSIONS: These findings suggest that lidocaine and propofol interfere with IL-2, IL-4, and NO production. This may explain the clinically well-recognized disturbance of human immunity after surgery and anesthesia.
Anesthesia ; Anesthetics ; Animals ; Humans ; Interleukin-2 ; Interleukin-4* ; Interleukins* ; Lidocaine* ; Mice* ; Nitric Oxide* ; Propofol*

BACKGROUND: To validate Omron HEM 907 XL blood pressure monitor (test device) against auscultatory mercury sphygmomanometer in children aged 7-8 years old in accordance with International Protocol of European Society of Hypertension revised in 2010 (ESH-IP2) and British Hypertension Society (BHS) protocol. METHODS: Seventy-five children and adolescents were recruited for the study. A validation procedure was performed following the protocol which was prepared on the basis of ESH-IP2 and BHS protocol for children and adolescents. Each underwent 7 sequential BP measurements alternatively with a mercury sphygmomanometer and the test device. The results were analyzed according to the validation criteria of ESH-IP2. RESULTS: The mean (blood pressure [BP], +/- standard deviation [SD]) difference of absolute value between the test device and mercury sphygmomanometer readings in all the 75 subjects was 3.26 +/- 3.08 mm Hg for systolic BP and 4.11 +/- 3.50 mm Hg for diastolic BP. These results fulfilled AAMI criterion of mean +/- SD below 5 +/- 8 mm Hg for both systolic and diastolic BP. The proportion of test device-observer mercury sphygmomanometer BP differences within 5, 10 and 15 mm Hg were 81%, 96%, 99% for SBP and 72%, 93%, 99% for diastolic blood pressure (DBP), respectively, in the part 1 analysis, so both systolic blood pressure (SBP) and DBP passed the part 1 criteria. As for the part 2 analysis, SBP passed the criteria, bur DBP failed. CONCLUSIONS: Omron HEM 907 XL BP monitor failed an adapted ESH-IP2, though SBP passed. When comparing the BP readings by oscillometers with mercury sphygmomanometer, the differences between them, particularly in diastolic BP, should be taken into account, because DBP can be underestimated.
Adolescent ; Aged ; Blood Pressure ; Blood Pressure Determination ; Blood Pressure Monitors ; Child ; Humans ; Hypertension ; Organothiophosphorus Compounds ; Oscillometry ; Reading ; Sphygmomanometers

OBJECTIVE: Facial nerve palsy is a common complication of treatment for vestibular schwannoma (VS), so preserving facial nerve function is important. The preoperative visualization of the course of facial nerve in relation to VS could help prevent injury to the nerve during the surgery. In this study, we evaluate the accuracy of diffusion tensor tractography (DTT) for preoperative identification of facial nerve. METHODS: We prospectively collected data from 11 patients with VS, who underwent preoperative DTT for facial nerve. Imaging results were correlated with intraoperative findings. Postoperative DTT was performed at postoperative 3 month. Facial nerve function was clinically evaluated according to the House-Brackmann (HB) facial nerve grading system. RESULTS: Facial nerve courses on preoperative tractography were entirely correlated with intraoperative findings in all patients. Facial nerve was located on the anterior of the tumor surface in 5 cases, on anteroinferior in 3 cases, on anterosuperior in 2 cases, and on posteroinferior in 1 case. In postoperative facial nerve tractography, preservation of facial nerve was confirmed in all patients. No patient had severe facial paralysis at postoperative one year. CONCLUSION: This study shows that DTT for preoperative identification of facial nerve in VS surgery could be a very accurate and useful radiological method and could help to improve facial nerve preservation.
Diffusion Tensor Imaging ; Diffusion* ; Facial Nerve Injuries ; Facial Nerve* ; Facial Paralysis ; Humans ; Neuroma, Acoustic* ; Paralysis ; Prospective Studies

BACKGROUND AND OBJECTIVE: Precise assessment of lesion severity is fundamental for the clinical decision making in the patients with coronary artery disease. Coronary angiography has limitation to projection imaging techniques. Intravascular ultrasound (IVUS) has been known to be a gold standard of morphological severity of coronary stenosis. Fractional flow reserve (FFR) is known to be a lesion specific functional index of epicardial stenosis that can be derived from intracoronary pressure assessed during maximal vasodilation. The objective of this study was to investigate the validity of fractional flow reserve for stenosis severity in comparison with IVUS. METHODS: The study population consisted of 24 patients with angina pectoris (M:F=19:5, age: 58+/-12 yrs). The IVUS and intracoronary pressure wire performed at 26 lesions after diagnostic coronary angiography. We measured angiographical diameter stenosis (DST), minimal luminal diameter (MLD), minimal luminal area (MLA) and reference area stenosis (r-AST). FFR was defined by the ratio of distal mean coronary pressure (Pd) to aortic mean pressure (Pa). RESULTS: FFR showed significant correlation with both r-AST (r=-0.93, p<0.00001) than DST (r=-0.79, p<0.0001). When the lesions with MLD less than 1.1 mm were excluded, considering the limitation of IVUS for the thickness of its catheter, FFR showed excellent correlation with r-AST with higher correlation coefficient (r=-0.96, p<0.00001). FFR showed significant correlation with MLA (r=0.87, p=0.0001) or MLD (r=0.83, p=0.0005). CONCLUSION: FFR with excellent correlation with r-AST measured by IVUS seems to be a useful lesion specific functional index for the assessment of coronary stenosis in angina patients.
Angina Pectoris ; Catheters ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Decision Making ; Humans ; Phenobarbital ; Ultrasonography* ; Ultrasonography, Interventional ; Vasodilation

BACKGROUND: We evaluated the optimal concentrations of eye opening and orientation after propofol- fentanyl TCI by CSDT of the pharmacokinetic model using DiprifusorTM in adults retrospectively. Furthermore, we tried to compare those data with the cases of using propofol TCI alone that had been reported. METHODS: After obtaining informed consent and IRB approval, 124 patients of ASA class I or II scheduled for elective surgery were allocated into 3 groups according to age. Three groups were group 1 (n = 40): 18 - 29 years, group 2 (n = 42): 30 - 39 years, group 3 (n = 42): 40 - 54 years. Propofol infusion was started at a propofol target concentration (CT) of 6 microgram/ml by using DiprifusorTM. Anesthesia was mostly maintained with propofol CT 3.5 microgram/ml and fentanyl CT 1.5 ng/ml using a Stelpump and 67% nitrous oxide in oxygen. We estimated the average concentrations of propofol at eye opening and orientation in each group with DiprifusorTM, and we also evaluated the correlation coefficient. RESULTS: Total requirements of propofol in cases of propofol-fentanyl TCI were decreased by 18-26% than in propofol TCI alone. The average concentrations of propofol at eye opening and orientation after surgery were 1.2 - 1.4 microgram/ml. The times to show eye opening and orientation after surgery from stopping of nitrous oxide and infusion were 10.4 - 14.5 min in the propofol-fentanyl group compared with 7.5 - 11 min using propofol TCI alone. CONCLUSIONS: We concluded that the optimal concentrations of propofol at eye opening and orientation after surgery in cases of combination with fentanyl were 1.2 - 1.4 microgram/ml instead of 1.4 - 1.6 microgram/ml with using propofol alone.
Adult ; Anesthesia ; Ethics Committees, Research ; Fentanyl ; Humans ; Informed Consent ; Nitrous Oxide ; Oxygen ; Propofol* ; Retrospective Studies

The area overlying the ischium is a frequent site for the development and recurrence of pressure sores because they directly overlie the points of maximum pressure on the sitting surface. Furthermore, they are frequently complicated by abnormal lesional bursae, or by extension, fistula toward the perineum or peritoneal cavity. In all cases of the ischial pressure sores, total en bloc excision of the ulceration, underlying bony prominence with immediate closure, and healthy, well-vascularized soft tissue is required to obtain the satisfactory result. It is well known that the choice of the treatment of the ischial pressure sore is the gluteal or posterior thigh flap. There have been many reports on the reconstruction of the ischial pressure sores such as cases involving the fasciocutaneous flap, muscle and musculocutaneous flaps, V-Y advancement flaps, rotation flaps, and long random flaps. In spite of these varieties, the recurrence of the ischial pressure sore after treatment still remains about seventy-five percent according to Conway and Griffith.9 Consequently, any surgical plane for ischial pressure sores must provide a stable, durable soft tissue cover that can be reused in the event of recurrence. From February to December 2002, we have performed the reconstruction of the ischial pressure sores on the posterior thigh's transposition flap in order to get following advantages: simplicity of the operation, sufficiency of padding with skin flap, preservation of the adjacent normal tissues and the capability of recycling this same flap in case of recurrences. Its design is somewhat different from and more extended widely than that of the gluteal or posterior thigh flap. This flap was elevated above the deep fascia to be cutaneous with appropriate backcut incision; some perforators from the inferior gluteal artery were also preserved. We present some cases of ischial pressure sores treated with a laterally based posterior thigh transposition flap herein. Therefore, the need to perform repetitive surgery in the future must be considered so that the maximum number of reconstructive options can be preserved. Although the follow-up period has not always been satisfactory, we have not had any serious complications in these patients until recently.
Arteries ; Fascia ; Fistula ; Follow-Up Studies ; Humans ; Ischium ; Myocutaneous Flap ; Perineum ; Peritoneal Cavity ; Pressure Ulcer* ; Recurrence ; Recycling ; Skin ; Thigh* ; Ulcer

PURPOSE: Laparoscopy-assisted distal gastrectomy (LADG) is gaining wider acceptance for the treatment of early gastric cancer. However, firm evidence supporting the long-term outcome after LADG for gastric cancer is unknown. This study compared long-term quality of life after LADG versus an open distal gastrectomy (ODG) for early gastric cancer. METHODS: This study included 29 patients who underwent LADG and 57 patients who underwent ODG for the treatment of stage I gastric cancer. Quality of life was evaluated based on the Korean version of EORTC QLQ-C30 (version 3.0) and EORTC QLQ-STO22 one year after surgery. All patients underwent a Billroth II gastrectomy for stage I gastric cancer between January 2003 and December 2004. RESULTS: A total of 86 (58%) out of 154 patients responded to the questionnaire. Demographic features showed no difference between the two groups of patients for age, sex, depth of invasion, lymph node metastasis except for tumor size and the number of retrieved lymph nodes. The mean score for global health status was not statistically different (LADG, 60.3+/-20.4 vs ODG, 57+/-20.6; P=0.413). The total score of 21 items related to stomach cancer (EORTC QLQ-STO22) also was not statistically different (LADG, 68.9+/-64.9 vs ODG, 94.5+/-97.3; P=0.340). CONCLUSION: Based on the results of the Korean version of EORTC QLQ-C 30 (version 3.0) and EORTC QLQ-STO22, LADG does not seem to have any long-term benefit over ODG on 'quality of life'.
Gastrectomy* ; Gastroenterostomy ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Quality of Life* ; Surveys and Questionnaires ; Stomach Neoplasms

A 24-year-old man presented with mental change, fever, abdominal pain, tenderness and palpable mass on the lower abdomen. He was a non-Korean engineer and did not accompany a legal guardian, so medical history taking was difficult due to his mental status. Brain magnetic resonance imaging showed multiple rim-enhanced lesions of the brain, and abdominal computed tomography showed huge paraspinal abscess. Chest X-ray and computed tomography showed poorly defined nodular opacities. We initially thought that this patient was infected with toxoplasmosis with typical cerebral image finding and immunoglobulin laboratory finding of cerebrospinal fluid and serum study. The abdominal abscess was confirmed as tuberculosis through the pathologic finding of caseous necrosis. We used anti-tuberculosis medication and anti-toxoplasmosis medication for almost 4 months, and then his clinical state and radiological findings were considerably improved.
Abdomen ; Abdominal Abscess ; Abdominal Pain ; Abscess ; Brain ; Fever ; Humans ; Immunoglobulins ; Legal Guardians ; Magnetic Resonance Imaging ; Medical History Taking ; Necrosis ; Thorax ; Toxoplasmosis ; Toxoplasmosis, Cerebral ; Tuberculosis ; Young Adult