The fine needle aspiration (FNA) cytologic findings in 16 cases of histologically confirmed thymoma are reported. The aspirates were obtained under fluoroscopic guidance. The cytologic diagnoses were inadequate sample in one case, thymoma in 12 (75%), small cell carcinoma or thymoma in 1, benign mesenchymal tumor in 1, and germ cell tumor in one. The cytologic features were detailed according to the constituent epithelial cell type, and to the ratio of epithelial cells and lymphocytes. Fifteen cases were classified into 4 small epithelial cell type, 6 intermediate epithelial cell type, 1 large epithelial cell type, 1 large pleomorphic epithelial cell type, and 3 spindle-shaped epithelial cell type. Cytologic differential diagnosis was discussed, and the important criteria for the cytologic diagnosis of thymoma were reviewed. This review leads us to think that nonoperative cytologic approaches in the diagnosis of the thymoma are possible, and that correct cytologic diagnosis of thymoma with FNAs can easily be made, if adequate samples are obtained. However, the invasiveness and histologic type could not be predicted by cytological features only. Knowing various cytologic and histologic features of thymoma will be helpful for the diagnosis of thymoma and the differential diagnosis of mediastinal tumors.
Diagnosis, Differential

Purpose: We evaluated a new color vision test, thus the ColorDx Cone contrast test HD ([CCT-HD]; Konan Medical, Inc., Irvine, CA, USA) in normal and color vision-deficient (CVD) eyes of Koreans. Methods: The CCT-HD was performed on 66 healthy Koreans (125 normal eyes) and 25 patients (50 eyes) with congenital CVD. The results from normal eyes were compared and analyzed in terms of binocular agreement, patient ages, and spherical equivalents. The CCT-HD results on CVD eyes were compared and analyzed. Results: We found no significant difference in any of the long (L), medium (M), or short wavelength (S) cone cell sensitivity (L-CCT, M-CCT, S-CCT) scores for normal eyes; also, there was no significant effect of age and no significant correlation between the spherical equivalent and the CCT score. In normal eyes, all scores were >75 (normal ≥75). The average protan L-CCT score was significantly reduced (13.0 ± 13.2; p < 0.001) as was the average deutan M-CCT score (31.7 ± 16.6; p < 0.001). The CCT-HD L-CCT and M-CCT exhibited 100% sensitivity and specificity in terms of diagnosing protans and deutans respectively. Conclusions CCT-HD allows classification and quantitative evaluation of protans and deutans, and is thus useful when examining color vision status.

An elevated serum concentration of uric acid may be associated with an increased risk of acute kidney injury (AKI). The aim of this study was to investigate the impact of preoperative uric acid concentration on the risk of AKI after coronary artery bypass surgery (CABG). Perioperative data were evaluated from patients who underwent CABG. AKI was defined by the AKI Network criteria based on serum creatinine changes within the first 48 hr after CABG. Multivariate logistic regression was utilized to evaluate the association between preoperative uric acid and postoperative AKI. We evaluated changes in C statistic, the net reclassification improvement, and the integrated discrimination improvement to determine whether the addition of preoperative uric acid improved prediction of AKI. Of the 2,185 patients, 787 (36.0%) developed AKI. Preoperative uric acid was significantly associated with postoperative AKI (odds ratio, 1.18; 95% confidence interval, 1.10-1.26; P<0.001). Adding uric acid levels improved the C statistic and had significant impact on risk reclassification and integrated discrimination for AKI. Preoperative uric acid is related to postoperative AKI and improves the predictive ability of AKI. This finding suggests that preoperative measurement of uric acid may help stratify risks for AKI in in patients undergoing CABG.
Acute Kidney Injury/*etiology ; Coronary Artery Bypass/*adverse effects ; Creatinine/*blood ; Female ; Humans ; Hyperuricemia/*blood ; Kidney Function Tests ; Male ; Middle Aged ; Postoperative Complications/*etiology ; Postoperative Period ; Preoperative Period ; Retrospective Studies ; Uric Acid/*blood

PURPOSE: The aim of this study is to investigate the clinical features and outcomes of 9 consecutive patients who suffered with leptomeningeal carcinomatosis (LMC) originating from gastric cancer. METHODS: Between January 1995 and December 2010, we retrospectively reviewed the medical records of 9 patients with gastric LMC who had been treated at St. Vincent's Hospital, The Catholic University of Korea. RESULTS: With the exception of 1 patient, the primary gastric cancer was Borrmann type III or IV, and 5 cases had poorly differentiated or signet ring cell histology. TNM stage of the primary gastric cancer was III in 6 patients. The median interval from diagnosis of the primary malignancy to the diagnosis of LMC was 9 months. Headache (6 cases), altered mental status (4 cases), and dysarthria (3 cases) were presenting symptoms of LMC. Computed tomography findings were abnormal in 4 of 7 cases, while magnetic resonance imaging revealed abnormality in 4 of 5 cases. Radiation therapy was administered to 5 patients and intrathecal chemotherapy was administered to only 1 patient. Median overall survival duration from the diagnosis of LMC was 3 months. CONCLUSION: LMC originating from gastric cancer had a fatal clinical course and treatment strategies remain challenging.
Diagnosis ; Drug Therapy ; Dysarthria ; Headache ; Humans ; Korea ; Magnetic Resonance Imaging ; Medical Records ; Meningeal Carcinomatosis* ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies* ; Stomach Neoplasms*

Airway management during carinal resection should provide adequate ventilation and oxygenation as well as a good surgical field, but without complications such as barotraumas or aspiration. One method of airway management is high frequency jet ventilation (HFJV) of one lung or both lungs. We describe a patient undergoing carinal resection, who was managed with HFJV of one lung, using a de-ballooned bronchial blocker of a Univent tube without cardiopulmonary compromise. HFJV of one lung using a bronchial blocker of a Univent tube is a simple and safe method which does not need additional catheters to perform HFJV and enables the position of the stiffer bronchial blocker more stable in airway when employed during carinal resection.
High-Frequency Jet Ventilation/*instrumentation/*methods ; Humans ; Lung/*surgery ; Lung Neoplasms/*surgery ; Male ; Middle Aged ; Pulmonary Surgical Procedures/*instrumentation/*methods

PURPOSE: To evaluate the radiologic findings of granulosa cell tumor of the ovary. MATERIALS AND METHODS: Fourteen cases (fifteen tumors) of pathologically confirmed ovarian granulosa cell tumor were retrospectively analyzed on the basis of CT (n=10), MR imaging (n=4), and ultrasound (n=7) findings. The patients' mean age was 44.3 (range, 5-71) years. RESULTS: The mean diameter of the tumors was 12.1 (range, 5-26.5)cm. Thirteen cases were unilateral, and one was bilateral. Eleven tumors (ten cases) were mainly solid and eight of these had focal cystic components. Multilocular cysts accounted for three cases, and in two of these, mural nodules were present. One case was a unilocular cyst with no mural nodule. Ten cases were well demarcated. All the solid tumors were enhanced on postcontrast CT and MR imaging. Endometrial thickening was seen in five cases, ascites in six, and peritoneal implants or omental fat infiltration in five. One was associated with lymph node metastasis. All the postmenopausal patients had solid tumors, whereas 66.7% (4 of 6 cases) of young adults and children had cystic tumors. CONCLUSION: Granulosa cell tumors of the ovary were solid or cystic; the former were more common. There were no characteristic findings which permitted definitive differentiation from other ovarian tumors.
Ascites ; Child ; Female ; Granulosa Cell Tumor* ; Granulosa Cells* ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Ovary* ; Retrospective Studies ; Ultrasonography ; Young Adult

A 36 year-old woman immigrated from Nepal showed erythematous plaques on her face, buttock and legs one month after the immigration. Before the correct diagnosis was made, the patient had been erroneously treated as anallergic dermatitis for three months. Clinico-pathologically, her skin lesion was borderline lepromatous type leprosy with bacilli positive. We report the case to keep the high index of suspicion for leprosy when we meet with patients from the countries where leprosy is still epidemic.
Buttocks ; Dermatitis ; Emigrants and Immigrants ; Emigration and Immigration ; Female ; Humans ; Leg ; Leprosy ; Leprosy, Multibacillary ; Nepal ; Skin

Ethanol sclerotherapy for the treatment of low-flow vascular malformations can cause catastrophic cardiopulmonary complications, including pulmonary embolism and pulmonary hypertension, that can result in right heart failure and fatal arrhythmias, leading to death. We here report a case of abrupt cardiovascular collapse that developed immediately following ethanol sclerotherapy in 31-year-old female patient who had a large arteriovenous malformation in her leg. Anesthesiologists should be aware of the fatal cardiopulmonary complications that are associated with ethanol sclerotherapy and consider the use of invasive hemodynamic monitoring, such as pulmonary artery pressure monitoring, when large doses of ethanol are required.
Adult ; Arrhythmias, Cardiac ; Arteriovenous Malformations ; Ethanol* ; Female ; Heart Arrest ; Heart Failure* ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Leg ; Pulmonary Artery ; Pulmonary Embolism ; Sclerotherapy* ; Vascular Malformations

BACKGROUND: The disposable patient-controlled analgesia (PCA) devices are convenient for portability and management. An ideal PCA can be developed as an electronic device with various functions of safety and control. Recently, Accumate 1000(R) was developed as an electronic pump in Korea, and has passed the relevant laboratory criteria of safety and efficacy. We conducted a clinical study on the safety and efficacy when the device is applied to patients. METHODS: Fentanyl 1,500microgram, ketorolac 180 mg, and ondansetron 8 mg were used for PCA. Continuous infusion rate, bolus dose, and lockout time were set at 1 ml/h, 1 ml, and 15 min, respectively. Fifty patients were monitored for 48 h. The safety of Accumate 1000(R) was evaluated by backflow and siphonage, auto-clamp function, and lockout time intraoperatively. The efficacy was evaluated by the accuracy of bolus and total infused dose, and the satisfaction rates of patients and users. RESULTS: Backflow and siphonage did not occur, and the auto-clamp function was excellent. There was no bolus infusion during lockout time, and the bolus dose was infused accurately after lockout time. For the accuracy of the total infused dose, the mean and median value of performance error between the infused and target doses were -0.55%, and -0.29%, respectively. Noise, button sense, and convenience of cable were rated as satisfactory by 90%, 78%, and 84%, of patients respectively. CONCLUSIONS: The safety and efficacy of Accumate 1000(R) were established by clinical trial. We can provide patients with the more precise and optimal analgesia. The history of drug infusion can be used as research data.
Analgesia ; Analgesia, Patient-Controlled* ; Fentanyl ; Humans ; Ketorolac ; Korea ; Noise ; Ondansetron ; Passive Cutaneous Anaphylaxis

The transurethral resection of the prostate (TURP) syndrome is caused by intravascular absorption of an electrolyte-free irrigating fluid during TURP for benign prostatic hypertrophy or prostatic carcinoma. The clinical symptoms and signs include hypertension, bradycardia, respiratory distress, hypotension, nausea, vomiting, confusion, blindness, seizure, coma, hyponatremina, and hypoosmolality. In this case, we incidentally detected very severe dilutional hyponatremia (99 mmol/L) without any symptoms during TURP and immediately took measures to treat TURP syndrome. On the third postoperative day, the hyponatremia had resolved within the normal range.
Absorption ; Blindness ; Bradycardia ; Coma ; Hypertension ; Hyponatremia* ; Hypotension ; Nausea ; Prostate* ; Prostatic Hyperplasia ; Reference Values ; Seizures ; Transurethral Resection of Prostate ; Vomiting