No abstract available.
Endoderm* ; Endodermal Sinus Tumor*

BACKGROUND: Increasing coronary perfusion pressure with phenylephrine is important treatment strategies for right ventricular dysfunction caused by pulmonary hypertension. We compared the effects of phenylephrine on systemic and pulmonary hemondynamics in patients with and without pulmonary hypertension. METHODS: Twenty patients undergoing a valvular replacement were divided into two groups according to pulmonary artery pressure (PAP): control group (mean PAP < 25 mmHg, n = 9) or pulmonary hypertension group (mean PAP > 25 mmHg, n = 11). When systolic blood pressure decreased below 100 mmHg after the induction of anesthesia, phenylephrine was infused to raise systolic blood pressure up to 30% and 50% over baseline. Hemodynamic variables were measured at each time. RESULTS: Phenylephrine failed to raise systolic blood pressure up to 50% above baseline in more than half of the patients with pulmonary hypertension in contrast to successful increases in all patients without pulmonary hypertension. However, the ratio of PAP to systolic blood pressure was significantly reduced in patients whose systolic blood pressure was successfully increased up to 50% over baseline in the pulmonary hypertension group whereas the PAP concomitantly increased as systolic blood pressure was increased in the control group. CONCLUSIONS: Phenylephrine couldn't increase systolic blood pressure in some patients with pulmonary hypertension unlike in control group and it seemed to occur more often in patients with greater the ratio of PAP to systolic blood pressure. The baseline systemic vascular resistance index was high and cardiacoutput was low in the pulmonary hypertension group and these conditions seemed to restrict the effect of phenylephrine.
Anesthesia ; Blood Pressure ; Hemodynamics* ; Humans ; Hypertension, Pulmonary* ; Perfusion ; Phenylephrine* ; Pulmonary Artery ; Vascular Resistance ; Ventricular Dysfunction, Right

The depressive symptoms are frequent and important ones in the elderly population. We studied the various factors affecting the severity of depressive symptoms in the elderly population. The Korean elderly (more than 65 years old; n=490) in Seoul area (city) were studied on the identifying data and medical and psychiatric history, Mini-Mental State Examination (MMSE) Geriatric Depression Scale (GDS) Korean Depression Scale(KDS: under development)were also administered. In our study, the significant effect of sex, age, education, marital status, and the status of medical security on the severity of depressive symptoms were not found. Significantly higher GDS and KDS scores were found in the elderly who have more than one physical illness, subjective memory complaints, and seven life events. To examine the strength of association of these variables of depression, we conducted logistic regression. Depressive symptoms were associated with 1)the loss of spouse, 2)a current physical illness, and 3)low socioeconomic status. These results showed that depression in the elderly may be correlated with the loss of spouse, a current physical illness, and low socioeconomic status.
Aged* ; Depression* ; Education ; Humans ; Logistic Models ; Marital Status ; Memory ; Seoul ; Social Class ; Spouses

No abstract available.
Multicystic Dysplastic Kidney* ; Ultrasonography, Prenatal*

Congenital hypertrophy of the retinal pigment epithelium (CHRPE) has been described in association with systemic disorders such as Gardner's syndrome (intestinal polyposis, osteomas, and benign soft-tissue tumors), Turgot's syndrome (glioma-polyposis syndrome) and familial adenomatous polyposis (FAP) of the colon. FamiIial adenomatous polyposis is an autosomal dominant disorder characterized by hundreds of polyps throughout the entire colon, and in all patients carcinoma of the color, develops at the age of 40 to 50 years. We describe a family with familial adenomatous polylpcsis coli and congenital hypertrophy of the retinal pigment epithelium. All of them except mother showed flat, weII-demarcated, round to oval pigmented patches of CHRPE. We emphasize the importance of CHRPE as a clinical marker in identifying patients With FAP since they are at risk for cancer.
Adenomatous Polyposis Coli* ; Biomarkers ; Colon ; Gardner Syndrome ; Humans ; Hypertrophy ; Mothers ; Osteoma ; Polyps ; Retinal Pigment Epithelium* ; Retinaldehyde*

Congenital hypertrophy of the retinal pigment epithelium (CHRPE) has been described in association with systemic disorders such as Gardner's syndrome (intestinal polyposis, osteomas, and benign soft-tissue tumors), Turgot's syndrome (glioma-polyposis syndrome) and familial adenomatous polyposis (FAP) of the colon. FamiIial adenomatous polyposis is an autosomal dominant disorder characterized by hundreds of polyps throughout the entire colon, and in all patients carcinoma of the color, develops at the age of 40 to 50 years. We describe a family with familial adenomatous polylpcsis coli and congenital hypertrophy of the retinal pigment epithelium. All of them except mother showed flat, weII-demarcated, round to oval pigmented patches of CHRPE. We emphasize the importance of CHRPE as a clinical marker in identifying patients With FAP since they are at risk for cancer.
Adenomatous Polyposis Coli* ; Biomarkers ; Colon ; Gardner Syndrome ; Humans ; Hypertrophy ; Mothers ; Osteoma ; Polyps ; Retinal Pigment Epithelium* ; Retinaldehyde*

BACKGROUND: Peritoneal CO2 insufflation results in elevation of PaCO2 and decreased respiratory compliance. Respiratory mechanics can be measured with flow interrupter technique. This study was designed to evaluate the effect of increased intra-abdominal pressure and positions on respiratory mechanics during laparoscopic surgery. METHODS: Female patients undergoing cholecystectomy (10 degrees head-up group, n=9) and gynecologic operation (10 degrees head-down group, n=9) under laparoscopy were studied. The upper limit of intra-abdonimal pressure was set to 12 mmHg. We measured airway flow and airway pressure of patients at preoperation, during insufflation, during positioning, and postoperation. Respiratory data were obtained from D-lite(R)sensor on-line. RESULTS: After increased intra-abdominal pressure and positioning, dynamic compliances in both groups were significantly decreased by 31~35%, static compliances by 39~43%. There was no difference of compliance between positions. The elastic tissue resistance of head-up group was significantly elevated compared with after operation. After operation, the respiratory parameters returned nearly to control levels. CONCLUSIONS: This result suggests that the respiratory mechanics should be monitored under laparoscopy continuously. Further studies on clinical condition such as ascites, hemorrhage, and pregnancy were needed.
Ascites ; Cholecystectomy ; Compliance ; Elastic Tissue ; Female ; Hemorrhage ; Humans ; Insufflation ; Laparoscopy* ; Pregnancy ; Respiratory Mechanics*

Ancient schwannoma is a variant of schwannoma characterized by slow progression, degenerative changes, and a higher incidence in older adults. There have been two prior reported cases of ancient schwannoma arising from the distal ulnar nerve at the wrist level, but neither were longstanding or very large. Herein, we report an ancient schwannoma found in the ulnar nerve of the distal forearm that was found to be clinically meaningful in size. A 61-year-old man presented with complaints of tingling sensation of the fourth and fifth fingers and bulging of the ulnar side of the wrist. The patient reported that the mass in his wrist had grown very slowly, starting about 10 years ago, and that he had started experiencing a tingling sensation in his fourth and fifth fingers about 3 years prior, which had become worse in the past year. Based on the results of the preoperative examination, a benign nerve sheath tumor was suspected. As it was thought that the possibility of malignancy was not high, we elected to perform a marginal excision. Pathological examination confirmed ancient schwannoma. At his most recent visit, 3 years after surgery, he reported no recurrence and that he felt better than before surgery, but some tingling sensations remained. As with small ancient schwannoma in the distal wrist, most cases of large ancient schwannoma can be treated without special complications based on an accurate preoperative diagnosis.

Ancient schwannoma is a variant of schwannoma characterized by slow progression, degenerative changes, and a higher incidence in older adults. There have been two prior reported cases of ancient schwannoma arising from the distal ulnar nerve at the wrist level, but neither were longstanding or very large. Herein, we report an ancient schwannoma found in the ulnar nerve of the distal forearm that was found to be clinically meaningful in size. A 61-year-old man presented with complaints of tingling sensation of the fourth and fifth fingers and bulging of the ulnar side of the wrist. The patient reported that the mass in his wrist had grown very slowly, starting about 10 years ago, and that he had started experiencing a tingling sensation in his fourth and fifth fingers about 3 years prior, which had become worse in the past year. Based on the results of the preoperative examination, a benign nerve sheath tumor was suspected. As it was thought that the possibility of malignancy was not high, we elected to perform a marginal excision. Pathological examination confirmed ancient schwannoma. At his most recent visit, 3 years after surgery, he reported no recurrence and that he felt better than before surgery, but some tingling sensations remained. As with small ancient schwannoma in the distal wrist, most cases of large ancient schwannoma can be treated without special complications based on an accurate preoperative diagnosis.

Ancient schwannoma is a variant of schwannoma characterized by slow progression, degenerative changes, and a higher incidence in older adults. There have been two prior reported cases of ancient schwannoma arising from the distal ulnar nerve at the wrist level, but neither were longstanding or very large. Herein, we report an ancient schwannoma found in the ulnar nerve of the distal forearm that was found to be clinically meaningful in size. A 61-year-old man presented with complaints of tingling sensation of the fourth and fifth fingers and bulging of the ulnar side of the wrist. The patient reported that the mass in his wrist had grown very slowly, starting about 10 years ago, and that he had started experiencing a tingling sensation in his fourth and fifth fingers about 3 years prior, which had become worse in the past year. Based on the results of the preoperative examination, a benign nerve sheath tumor was suspected. As it was thought that the possibility of malignancy was not high, we elected to perform a marginal excision. Pathological examination confirmed ancient schwannoma. At his most recent visit, 3 years after surgery, he reported no recurrence and that he felt better than before surgery, but some tingling sensations remained. As with small ancient schwannoma in the distal wrist, most cases of large ancient schwannoma can be treated without special complications based on an accurate preoperative diagnosis.