Lobular carcinoma of the male breast is very rare, because of the absence of lobules in the normal male breast. Herein, a case of lobular carcinoma of the male breast with cellular features of signet ring cells is described. A 57-year-old man presented with a left breast mass. Histologic examination showed classic invasive lobular carcinoma with in situ component. Most infiltrating tumor cells had a prominent signet ring cell appearance. The patient was phenotypically male and had fathered children. There was no history of predisposing factors to breast lesion, such as hormone use or gynecomastia.
Breast* ; Carcinoma, Lobular* ; Causality ; Child ; Fathers ; Gynecomastia ; Humans ; Male* ; Middle Aged

Lobular carcinoma of the male breast is very rare, because of the absence of lobules in the normal male breast. Herein, a case of lobular carcinoma of the male breast with cellular features of signet ring cells is described. A 57-year-old man presented with a left breast mass. Histologic examination showed classic invasive lobular carcinoma with in situ component. Most infiltrating tumor cells had a prominent signet ring cell appearance. The patient was phenotypically male and had fathered children. There was no history of predisposing factors to breast lesion, such as hormone use or gynecomastia.
Breast* ; Carcinoma, Lobular* ; Causality ; Child ; Fathers ; Gynecomastia ; Humans ; Male* ; Middle Aged

We had two cases of hepatitis developing after surgery. Case 1. A 47 year old male underwent surgery for amputation of the lower leg under enflurance anesthesia. Preoperative liver function test were slightly abnormal. On the 25th portoperative day, serum transaminases were elevated and the A/G ratio was reversed. On the 65th postoperative day, the liver function tests returned to near normal leve. Case 2. A 37 year old male underwent the first surgery for reduction of a pateliar fracture under spinal anesthesia. Preoperative serum transaminages were elevated and other laboratory findings at normal levels. On the 20th postoperative day serum transaminases were more elevated and on the 120th postoperative day, ti became normal again. This patient underwent the second surgery for removal of a K-wire under enflurane anesthesia and afterwards hepatitis recurred. On the 60th 2nd postoperative day LEFs became nearer to normal level and he was discharged in good health. Possible causes of the hepatitis in these cases were considered to be the preoperative liver disease, blood transfusion, the stress of the surgery and anesthesia.
Adult ; Amputation ; Anesthesia ; Anesthesia, Spinal ; Blood Transfusion ; Enflurane ; Hepatitis* ; Humans ; Leg ; Liver Diseases ; Liver Function Tests ; Male ; Middle Aged ; Transaminases

BACKGROUND: Core temperature decreases rapidly after the induction of general anesthesia, because the heat is redistributed to peripheral tissues. Thermoregulatory responses of volatile anesthetics have been tested, but their effects have not been directly compared. Therefore, we evaluated the thermoregulatory responses to sevoflurane, desflurane, and isoflurane. METHODS: Sixty healthy patients scheduled for laparoscopic myomectomy or radical hysterectomy were allocated into three groups; Group S (sevoflurane, n = 20), Group D (desflurane, n = 20), and Group I (isoflurane, n = 20). Anesthesia was maintained with 1 minimum alveolar concentration (MAC) of sevoflurane, desflurane, and isoflurane in a 50/50 mixture of N2O/O2. Patients were maintained in a normovolemic and normocapnic state. The core temperature and forearm minus fingertip skin-temperature gradient (an index of peripheral vasoconstriction) were monitored after the induction of general anesthesia. RESULTS: Each of the seven patients given sevoflurane, desflurane, and isoflurane vasoconstricted at a core temperature of 35.3 +/- 0.5degrees C, 33.6 +/- 0.4degrees C, and 35.2 +/- 0.4degrees C, respectively. The vasoconstriction threshold was the lowest in patients anesthetized with desflurane. The core temperature gradient (Ti-Tf) was significantly higher in patients that were anesthetized with desflurane than in those that were anesthetized with sevoflurane or isoflurane. The core temperature of desflurane was significantly lower than that of sevoflurane or isoflurane 15 minutes after the induction of anesthesia until 180 minutes of anesthesia. CONCLUSIONS: These results indicate that the core temperature is maintained at a higher level in patients that have been anesthetized with sevoflurane or isoflurane than in those that have been anesthetized with desflurane.
Anesthesia ; Anesthesia, General ; Anesthetics ; Forearm ; Hot Temperature ; Humans ; Hysterectomy ; Isoflurane ; Laparoscopy ; Methyl Ethers ; Vasoconstriction

BACKGROUND: The insertion of a mouth gag causes acute hemodynamic changes such as hypertension and tachycardia. Several adjuvant drugs have been used to attenuate such responses. The aim of this study was to determine the effects of remifentanil in preventing the hemodynamic changes associated with the insertion of mouth gag after a remifentanil injection. METHODS: Thirty children, ASA1 or 2, who were scheduled for elective surgery, were divided randomly into two groups; group I (placebo; normal saline 0.05 ml/kg, n = 15), and group II (remifentanil 0.05microg/kg, n = 15). After inducing general anesthesia with thiopental sodium (5 mg/kg) and rocuronium (0.06 mg/kg), anesthesia was maintained by the inhalation of sevoflurane 2 vol% in N2O/O2 (50/50) via an endotracheal tube. The patients in group I and II received normal saline 0.05 ml/kg, and remifentanil 0.05microg/kg 1 minute before inserting the mouth gag, respectively. The patients' blood pressure heart rate were measured before and after inserting mouth gag. RESULTS: The hemodynamic changes in group I were minimal after inserting the mouth gag compared with group II. CONCLUSIONS: Remifentanil is effective in attenuating the increase in blood pressure and heart rate after inserting a mouth gag.
Anesthesia ; Anesthesia, General ; Blood Pressure ; Child ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Inhalation ; Mouth* ; Tachycardia ; Thiopental ; Tonsillectomy*

No abstract available.
Adenocarcinoma* ; alpha-Fetoproteins*

BACKGROUND: The injection of rocuronium causes pain and withdrawal responses. This study was designed to determine an appropriate dose of remifentanil to prevent the withdrawal responses associated with injection of rocuronium in children. METHODS: Fourty five ASA physical status I and II pediatric patients were randomly allocated into three groups; Group I (placebo; normal saline 3 ml, n = 15), Group II (remifentanil 0.3microg/kg, n = 15), Group III (remifentanil 0.5microg/kg, n = 15). After the induction of anesthesia with 5 mg/kg of thiopental sodium, patients in groups I, II, and III received normal saline 3 ml, remifentanil 0.3microg/kg, and remifentanil 0.5microg/kg, respectively. After one minute, rocuronium 0.6 mg/kg was injected over 10 seconds. The patient's response after injection was graded using a four-point scale. The patient's heart rate (HR), mean arterial pressure (MAP) were measured at pre-anesthesia (T0), 1 minute after injection of thiopental sodium (T1), test drug (T2), and rocuronium (T3). RESULTS: The incidence of withdrawal responses was 100%, 66.7%, and 20% in groups I, II, and III, respectively. In addition, the severity of withdrawal responses was lowest in group III. CONCLUSIONS: Remifentanil 0.5microg/kg was an appropriate dose to prevent the withdrawal responses on injecting rocuronium.
Androstanols ; Anesthesia ; Arterial Pressure ; Child ; Heart Rate ; Humans ; Incidence ; Piperidines ; Thiopental

BACKGROUND: Hypoxemia during one-lung ventilation (OLV) remains a major concern. The present study compared the effect of alveolar recruitment strategy (ARS) on arterial oxygenation during OLV at varying tidal volumes (Vt) with or without positive end-expiratory pressure (PEEP). METHODS: In total, 120 patients undergoing wedge resection by video assisted thoracostomy were randomized into four groups comprising 30 patients each: those administered a 10 ml/kg tidal volume with or without preemptive ARS (Group H and Group H-ARS, respectively) and those administered a 6 ml/kg tidal volume and a 8 cmH2O PEEP with or without preemptive ARS (Group L and Group L-ARS, respectively). ARS was performed using pressure-controlled ventilation with a 40 cmH2O plateau airway pressure and a 15 cmH2O PEEP for at least 10 breaths until OLV began. RESULTS: Preemptive ARS significantly improved the PaO2/FiO2 ratio compared to the groups that did not receive ARS (P < 0.05). The H-ARS group showed a highest PaO2/FiO2 ratio during OLV, the L-ARS and H groups showed similarly improved arterial oxygenation, which was significantly higher than in group L (P < 0.05). The plateau airway pressure in group H-ARS was significantly higher than in group L-ARS (P < 0.05). CONCLUSIONS: Preemptive ARS can improve arterial oxygenation during OLV. Furthermore, a 6 ml/kg tidal volume combined with 8 cmH2O PEEP after preemptive ARS may reduce the risk of pulmonary injury caused by high tidal volume during one-lung ventilation in patients with normal pulmonary function.
Anoxia ; Humans ; Lung Injury ; One-Lung Ventilation* ; Oxygen* ; Positive-Pressure Respiration ; Respiratory Function Tests* ; Thoracostomy ; Tidal Volume* ; Ventilation

Leukemic reticuloendotheliosis (L.R.E.) was first described as a clinical and pathological entity by Ewald in 1923. LRE is a rare neoplastic disease of the hematopoietic system that is characterized cliniclly by chronic course with an insidious onset. marked splenomegaly with absence of substantial lymphadenopathy and predominant in male and characterized histologically by the presence of circulating abnormal mononuclear cells with many cytoplasmic projections, which have been refered to ??airy cells frequently. Splenectomy appeared to be the most beneficial treatment at present for those patients with massive splenomegaly and hypersplenism and chemotherapy is of little benefit in the treatment in LRE. Recently, the authors had the opportunity to observe a two year and eight old male child at this hospital whose clinical course and pathologid features were consistent with LRE. Splenectomy is performed and discharged with relatively good conditions.
Child ; Cytoplasm ; Drug Therapy ; Hematopoietic System ; Humans ; Hypersplenism ; Leukemia, Hairy Cell* ; Lymphatic Diseases ; Male ; Splenectomy ; Splenomegaly

BACKGROUND: The aims of this study were to compare the cytomorphologic features diagnostic of atypical squamous cells (ASC) in liquid-based preparations (LBPs) and conventional Pap (CP) smears and to cytomorphologically assess the performance of the Cell Scan 1500(TM) in cervical cytology practice. METHODS: Cervicovaginal smears were obtained from 938 women. Two smears were obtained simultaneously from each individual, one for an LBP and the other for a CP smear; the smears were independently examined. ASC was diagnosed in 24 patients, and their samples were cytomorphologically and semiquantitatively analyzed. RESULTS: A total of 24 of the 938 women (2.6%) were diagnosed with ASC by one or both methods. Results from LBPs and CP smears were in agreement in 13 of 24 cases of ASC diagnosis (absolute direct agreement, 54.2%; k<0.20; p-value from chi-square test=0.085). Diagnostic features of ASC in the LBPs included squamous cell atypia and atypical squamous metaplasia. CONCLUSIONS: The cellular features diagnostic of ASC present in one preparation can manifest themselves differently in the other. Changes in individual cells, particularly nuclear changes, are the most reliable features for diagnosing ASC. The Cell Scan 1500(TM) processor is more effective at detecting ASC than are CP smears.
Female ; Humans