Fibromatosis can occur at various sites, but intracranial fibromatosis is exceptionally rare. Here, we report a case of intracranial fibromatosis arising in the suprasellar area of a 52-year-old woman who had undergone a surgery at that site. A computed tomography scan revealed a heavily calcified, highly enhancing, poorly demarcated mass in the left sellar area that extended into the left suprasellar, parasellar areas, and orbital apex and completely encased the left distal inferior cerebral artery. Histologic and immunohistochemical features were compatible with those of fibromatosis, although the cellularity was focally higher than usual. The etiology of extra-abdominal fibromatosis is unknown, but physical injuries such as trauma and irradiation have been reported to be associated with its occurrence. Although fibromatosis is rare in the intracranial area, it should be considered as a differential diagnosis when an intracranial mass occurs at a previously injured site.
Central Nervous System ; Cerebral Arteries ; Diagnosis, Differential ; Female ; Fibroma ; Fibromatosis, Aggressive ; Humans ; Middle Aged ; Orbit ; Sella Turcica

Fibromatosis can occur at various sites, but intracranial fibromatosis is exceptionally rare. Here, we report a case of intracranial fibromatosis arising in the suprasellar area of a 52-year-old woman who had undergone a surgery at that site. A computed tomography scan revealed a heavily calcified, highly enhancing, poorly demarcated mass in the left sellar area that extended into the left suprasellar, parasellar areas, and orbital apex and completely encased the left distal inferior cerebral artery. Histologic and immunohistochemical features were compatible with those of fibromatosis, although the cellularity was focally higher than usual. The etiology of extra-abdominal fibromatosis is unknown, but physical injuries such as trauma and irradiation have been reported to be associated with its occurrence. Although fibromatosis is rare in the intracranial area, it should be considered as a differential diagnosis when an intracranial mass occurs at a previously injured site.
Central Nervous System ; Cerebral Arteries ; Diagnosis, Differential ; Female ; Fibroma ; Fibromatosis, Aggressive ; Humans ; Middle Aged ; Orbit ; Sella Turcica

PURPOSE: High false negative results on fine needle aspiration cytology (FNAC) have been reported in the diagnosis of breast cancers, which are small sized, desmoplastic type, infiltrating lobular cancers, tubular cancers, and mucinous cancer. METHODS: From Jan. 1997 to Dec. 1998, we performed 622 FNACs at the Department of Surgery, Korea University Hospital. Among those aspirates, 246 cases were followed by subsequent pathological confirmation and were included in this study. Pathological reports for breast specimens were reviewed for the size, the location, the grade or the pathological subtype, and the presence of fibrosis in the breast lesions. The pathological characteristics were compared statistically with the results of the fine needle aspiration cytology. RESULTS: The likelihood ratios for malignant, suspicious, atypical, benign, and unsatisfactory cytological diagnoses were 98.7, 5.5, 1.1, 0.07, and 0.6, respectively. The absolute and the complete sensitivities for the malignant lesions were 64.5% and 90.3%, respectively. The rate of unsatisfactory diagnosis was 9.3%, and the false-negative rate was 4.3%. The concordance rates of FNAC results were 75% for tumors less than 1 cm in size, 60.7% for 1-2 cm, 76.5% for 2-5 cm, and 50% for greater than 5 cm (p=0.01). The location of the tumor also affected the FNAC result, and the highest concordant rate was found in tumors of the lower outer quadrant of the breast (73.3%, p=0.001). The Bloom-Richardson grade and histologic type of the breast cancer also affected the FNAC result. Low-grade tumors, medullary carcinomas, metaplastic carcinomas, lobular carcinomas, adenoid cystic carcinomas, and mucinous carcinomas usually showed discordant FNAC results. The presence or the absence of fibrotic pathology did not affect the FNAC result (p=0.39). CONCLUSION: The sensitivity of FNAC was 90.3% in the diagnosis of breast cancer and the false negative rate was 4.3%. The greatest concordance of FNAC diagnosis was found in the patients with tumor less than 5 cm in size and located in the axilla and locoregional recurrent area. The FNAC results for breast cancer were frequently incorrect for low-grade tumors and cancers of a rare pathological type.
Adenocarcinoma, Mucinous ; Axilla ; Biopsy, Fine-Needle* ; Brain Stem Neoplasms ; Breast Neoplasms* ; Breast* ; Carcinoma, Adenoid Cystic ; Carcinoma, Lobular ; Diagnosis* ; Fibrosis ; Humans ; Korea ; Mucins ; Pathology

BACKGROUND: In korea, tsutsugamushi disease is one of the common diseases which occurs in more than 40% among acute febrile diseases during Autumn. The diagnosis is confirmed with Rickettsia tsutsugamushi antibody, and is characterised by fever, chill, headache, myalgia, skin rash, escha and lymphadenopathy. METHODS: We have conducted a survey on 16 clinically and serologically confirmed cases of Tsutsugamushi disease occurring during the period of October -November, 2000. RESULTS: Of 16 cases,7 were males and 9 were females with an average age of 67.76. Most patients had fever, chill, headache, myalgia, sore throat, cojunctival injection, cough, abdominal, pain, nausea, vomiting, hematuria in order of frequency. The physical findings were eachar (81.257) and skin rash (62.77) . Serologically 7 cases (43.75%) of 16 cases were confirmed positively R.tsutsugamushi antibody. General hematologic findings were decreased platelet count (37.57) , increased or decreased WBC (31.25% and 25% each other) , and anemia (25%) , Test for liver function included elevated AST, ALT (68.76%) , alkaline phosphatase (62.6%) , hypoalbuminemia (12.6%) , and hyperbilirubinemia(6.25) . Urinalysis showed hematuria (50%) , proteinuria (50%) , and pyuria (12.67) . Doxyrcycline therapy decreased fever in 2.85 days and after 5-6 days patients were discharged with improvement of almost all symptoms. CONCLUSION: Primary care physician in a community should always consider tsutsugamushi disease when he encounters patients with acute febrile disease in late Autumn and early winter and expect good prognosis with early diagnosis and treatment.
Alkaline Phosphatase ; Anemia ; Cough ; Diagnosis ; Early Diagnosis ; Exanthema ; Female ; Fever ; Headache ; Hematuria ; Humans ; Hypoalbuminemia ; Jeollabuk-do* ; Korea ; Liver ; Lymphatic Diseases ; Male ; Myalgia ; Nausea ; Orientia tsutsugamushi ; Pharyngitis ; Physicians, Primary Care ; Platelet Count ; Prognosis ; Proteinuria ; Pyuria ; Scrub Typhus* ; Urinalysis ; Vomiting

No abstract available.
Pyelonephritis*

PURPOSE: Acute renal failure (ARF) is one of the common complications after liver transplantation (LT) and could be fatal unless promptly treated. Identification of risk factors is needed to prevent ARF and to attenuate the unfavorable outcomes of ARF after LT. The aim of this study was to analyze risk factors for development of postoperative ARF (between day 0 and day 30 after LT). METHODS: Total 72 LTs were performed between 1996 and 2005. Sixty six patients' records, excluding 6 patients with preoperative serum creatinine level more than 2.5 mg/dl, were reviewed retrospectively for preoperative, intraoperative, and postoperative variables to compare patients presenting ARF with the remaining patients. RESULTS: Postoperative ARF occurred in 36 transplants (54.5%) after LT. Preoperative serum sodium, bilirubin and BUN, creatinine level were higher in ARF group. ARF group had more child-pugh class C, and more episodes of preoperative hepatic encephalopathy. During intraoperative period, anhepatic time was longer and total doses of intraoperative furosemide was larger in ARF group. Also, postoperative blood immunosuppressant level was higher, and postoperative episodes of bleeding and hypotension were more common in ARF group. In multivariate analysis, preoperative child-pugh class C (P=0.041), preoperative serum creatinine level (> or =1.0 mg/dL, P=0.032), and postoperative episodes of hypotension and bleeding (P=0.045, P=0.03 respectively) were identified as risk factors for postoperative ARF. CONCLUSION: This study showed that preoperative renal and liver function, and postoperative hemodynamic condition were independent risk factors for development of ARF after LT.
Acute Kidney Injury* ; Bilirubin ; Creatinine ; Furosemide ; Hemodynamics ; Hemorrhage ; Hepatic Encephalopathy ; Humans ; Hypotension ; Intraoperative Period ; Liver Transplantation* ; Liver* ; Multivariate Analysis ; Retrospective Studies ; Risk Factors* ; Sodium

Occupational asthma has been defined airway inflammation, hyperresponsiveness, and reversible airway obstruction related to exposure in workplace. Several drugs can cause asthma by inhalation during the manufacture. We report a case of cephalosporin induced occupational asthma which had not been reported in Korea yet. A 28 year-old male, an laboratorian, developed paroxysmal cough, dyspnea and chest tightness for four months. He has handled powder of cephalosporins and its precursors for thirty months. His symptoms used to be worsened during and shortly after his work and subsided several hours after work. When he visited our hospital, he denied such symptoms and revealed no abnormality on physical examinations. Skin prick test revealed positive result for ceftriaxone, ACT and 7-ACA, but negative for the other antibiotics. Bronchial provocation with 7-aminocephalosporanic acid elicited a single early response. In this case, the patient showed a positive bronchial provocation test to 7-aminocephalosporanic acid and a positive skin prick test to 7-ACA, aminocephalosporanic thiazine, ceftriaxone. We presumed that pathogenic mechanism of cephalosporin-induced asthma may be an IgE-mediated allergic reaction by the strong positive reaction in skin test. But further studies will be necessary to evaluate exact pathogenesis of cephalosporin-induced asthma.
Adult ; Airway Obstruction ; Anti-Bacterial Agents ; Asthma ; Asthma, Occupational* ; Bronchial Provocation Tests ; Ceftriaxone ; Cephalosporins ; Cough ; Dyspnea ; Humans ; Hypersensitivity ; Inflammation ; Inhalation ; Korea ; Male ; Physical Examination ; Skin ; Skin Tests ; Thorax

BACKGROUND: It is known that sympathetic stimulation and increase in cerebral blood flow velocity can be induced by desflurane. Cerebral oxygen balance could be disturbed during desflurane induction. Aim of this study was to elucidate that cerebral oxygen imbalance induced by desflurane mask induction can be reduced by combination of remifentanil and hypocapnia. METHODS: Twenty ASA 1-2 subjects were allocated randomly into 5 groups divided by concentration of remifentanil (0.0, 0.5, 1.0, 1.5, and 2.0 ng/ml). After confirmation of attaining proposed concentration of remifentanil, propofol and vecuronium were administered and mechanical ventilation was done with 8% desflurane with facial mask. Subsequently, changes in regional cerebral oxygen saturation (DeltarSO2), arterial blood pressure, heart rate, cardiac index, estimated alveolar concentration of desflurane (PDESF), and end-tidal concentration of carbon dioxide (PETCO2) were recorded for the following 10 minutes. According to concentration of desflurane and remifentanil, DeltarSO2 and hemodynamic factors were checked. RESULTS: During desflurane induction, changes in cerebral oximetry reached up to +10% (6 [first quartile], 13 [third quartile]). Arterial blood pressure, heart rate, and cardiac index were changed within clinical ranges. The DeltarSO2 showed S-shaped increasing pattern according to increasing PDESF. Hypocapnia and concentration of remifentanil reduced the maximum DeltarSO2 (P = 0.0046, P = 0.0060). Hypocapnia also shifted the curve to left (P = 0.0001). CONCLUSIONS: During 8% desflurane induction, regional cerebral oxygen saturation (rSO2) increases maximum +25%. Hypocapnia and use of remifentanil can reduce the increase in regional cerebral oxygen saturation.
Arterial Pressure ; Blood Flow Velocity ; Carbon Dioxide ; Heart Rate ; Hemodynamics ; Hypocapnia ; Isoflurane ; Masks ; Oximetry ; Oxygen ; Piperidines ; Propofol ; Respiration, Artificial ; Vecuronium Bromide

BACKGROUND: Ventilation is a major determinant of the alveolar concentration of inhaled anesthetics. Hyperventilation accelerates the equilibration of anesthetic in the lungs, but decelerates it in the brain. We evaluated this phenomenon for desflurane. METHODS: Twenty healthy subjects were enrolled after IRB approval. End-tidal concentrations of desflurane (P.DESF) were recorded during 10 minutes of mask induction with 8% desflurane. P.DESF was modeled with time and end-tidal concentrations of CO2 (P.ETCO2) using a two-exponential pharmacokinetic equation. Bispectral index (BIS) values were also measured to find out the component reflecting the cerebral concentration of desflurane. RESULTS: During induction, the rise of P.DESF could be separated into two components: early and late rises. Individual BIS values showed a higher correlation with the late component of P.DESF (P = 0.000). P.ETCO2 had two different effects on the rise of P.DESF. CONCLUSIONS: Hyperventilation hastened the early rise and delayed the late rise of P.DESF (P = 0.00, P = 0.00). Hyperventilation should be avoided to obtain rapid anesthesia induction with desflurane.
Anesthesia ; Anesthesia, Inhalation ; Anesthetics ; Brain ; Ethics Committees, Research ; Hyperventilation ; Isoflurane ; Lung ; Masks ; Nonlinear Dynamics ; Ventilation

PURPOSE: This study was conducted to evaluate the expressions of the mdr1 gene and the MRP gene in tumor and adjacent normal gastric tissues. MATERIALS AND METHODS: The specimens were obtained from 53 patients who had gastric cancer. None of these patients had received any kind of preoperative chemotherapy. The reverse transcription polymerase chain reaction and immunohistochemical stain were used to check the level of expressions of mRNAs and their associated proteins. RESULTS: Highly positive expressions of mdr1 mRNA, MRP mRNA, p-glycoprotein, and MRP (multidrug resistance associated protein) were observed in the tumor and the adjacent normal tissues. Most tumor tissues coexpressed mdr1 mRNA and MRP mRNA significantly (p<0.001). The expression of these genes in the tumor was much stronger than in the normal counterpart tissues. The expression of the p-glycoprotein was correlated only with the pathological stage (p<0.05). MRP expression was correlated with lymph node metastasis (p<0.05). CONCLUSION: Normal gastric tissue showed strong physiologic expressions of the mdr1 and MRP genes. Overexpressions of these genes were observed in gastric cancer tissue. The presence of multidrug resistance should be considered when planning anticancer chemotherapy for treating gastric cancer.
Drug Resistance, Multiple ; Drug Therapy ; Humans ; Lymph Nodes ; Mucous Membrane* ; Multidrug Resistance-Associated Proteins ; Neoplasm Metastasis ; P-Glycoprotein ; Polymerase Chain Reaction ; Reverse Transcription ; RNA, Messenger ; Stomach Neoplasms*