No abstract available.

Spontaneous rupture of subcapsular liver hematoma in pregnancy is rare but potential life threatening complication of preeclampsia. We experienced a case of spontaneous rupture of subcapsular hematoma of liver that was treated with conservative method. So, we present the case with a brief review of literatures as first report in Korea.
Hematoma* ; Korea ; Liver* ; Pre-Eclampsia ; Pregnancy* ; Rupture, Spontaneous

No abstract available.

Breast thermography produces a picture of the heat emitted from the surface of the breast. And abnormal temperature over the breast has been suggested as an indicator of malignancy. The mechanisms for the heat production at the area of the skin over the breast are suggested hypermetabolism, hypervascularization, and hyperfusion of the affected regions of the breast. The purpose of this study was to evaluate the diagnostic accuracy of breast thermography in breast cancer. One hundred thirty breast cancers and one hundred ten benign breast masses were examined by a digital infrared thermographic system (NEC San-ei, Therm Tracer 6T67) between January 1991 and December 1995. In this study, thermograms were classified as normal (Th-1), equivocal (Th-2), or abnormal (Th-3). Normal thermograms were those with normal symmetric vascularity, equivocal thermograms were those with only heat in the area of mass, and abnormal thermograms were those with heat and increased vascularity in the area of mass. Among the 110 benign breast masses, there were 98 Th-1 cases (89.1%), 2 Th-2 cases (1.8%) and 10 Th-3 cases (9.1%). Among the 130 breast cancers, there were 98 Th-3 cases (75.4%), 20 Th-2 cases (16.2%), and 12 Th-1 cases (9.2%). The sensitivity of the breast thermograms was 90%, the specificity 89.1%, and the diagnostic accuracy 89.6%. A thermal difference(deltaT) of less than 1oC was seen in 10 cases (7.7%) of breast cancer, and a deltaT of more than 1oC was seen in 120 cases (92.3%). Among the latter of a deltaT of more than 3oC was seen in 67 cases(51.4%). The correlation of the breast-cancer tumor size with deltaT was highly significant(p<0.0001). The classification of the thermographic diagnosis was found to be statistically correlated with tumor size (p<0.0001), axillary node status (p<0.001) and nuclear grade (p<0.05), but not with the presence or abscence of estrogen receptor. These results suggest that thermography is useful as a diagnostic tool for breast cancer. And that a deltaT of more than 2oC of on a breast thermogram strongly suqqests a malignancy.
Breast Neoplasms* ; Breast* ; Classification ; Diagnosis* ; Estrogens ; Hot Temperature ; Sensitivity and Specificity ; Skin ; Thermogenesis ; Thermography*

No abstract available.

Ectopic paragonimiasis has been diagnosed in many organs such as the mesentery, ovary, pleura, central nervous system, subcutis and very rarely in the liver. However, simultaneous involvement of the colon and liver, which mimics colonic cancer with liver metastasis, is quite unusual, and to our knowledge has never been reported. Our case is a 63 year old woman who visited our hospital because of upper abdominal pain. Radiologically, space occupying lesions were detected in the transverse colon, mesocolon and left hepatic lobe. After the radical presection, they were proved to be an ectopic paragonimiasis forming multiple cavitary parasitic granulomas with Charcot-Leyden crystals and degenerating eggs.
Abdominal Pain ; Central Nervous System ; Colon* ; Colon, Transverse ; Colonic Neoplasms ; Eggs ; Female ; Granuloma ; Humans ; Liver* ; Mesentery ; Mesocolon ; Middle Aged ; Neoplasm Metastasis ; Ovary ; Ovum ; Paragonimiasis* ; Pleura

We report here on a rare case of a ruptured basilar tip aneurysm that was successfully treated with coil embolization in the bilateral cervical internal carotid artery (ICA) occlusions with abnormal vascular networks from the posterior circulation. A 43-year old man with a familial history of moyamoya disease presented with subarachnoid hemorrhage. Digital subtraction angiography demonstrated complete occlusion of the bilateral ICAs at the proximal portion and a ruptured aneurysm at the basilar artery bifurcation. Each meningeal artery supplied the anterior cranial base, but most of both hemispheres were supplied with blood from the basilar artery and the posterior cerebral arteries through a large number of collateral vessels to the ICA bifurcation as well as the anterior cerebral and middle cerebral arteries. The perfusion computed tomography (CT) scans with acetazolamide (ACZ) injection revealed no reduction of cerebral blood flow and normal cerebrovascular reactivity to ACZ. An abdominal CT aortogram showed no other extracranial vessel abnormalities. A ruptured basilar tip aneurysm was successfully treated with coil embolization without complications. Endovascular embolization may be a good treatment option with excellent safety for a ruptured basilar tip aneurysm that accompanies proximal ICA occlusion with vulnerable collateral flow.
Acetazolamide ; Aneurysm ; Aneurysm, Ruptured ; Angiography, Digital Subtraction ; Basilar Artery ; Carotid Artery, Internal ; Collateral Circulation ; Glycosaminoglycans ; Meningeal Arteries ; Middle Cerebral Artery ; Moyamoya Disease ; Perfusion ; Posterior Cerebral Artery ; Skull Base ; Subarachnoid Hemorrhage

OBJECTIVE: The aim of this study was to determine the role of intra-arterial (IA) nimodipine injections for cerebral vasospasm secondary to ruptured subarachnoid hemorrhage (SAH) and to investigate the factors that influence vasodilation and clinical outcomes. METHODS: We enrolled 29 patients who underwent aneurysm clipping for ruptured cerebral aneurysms between 2009 and 2011, and who received IA nimodipine after subsequently presenting with symptomatic vasospasm. The degree of vasodilation shown in angiography was measured, and the correlation between the degree of vasodilation and both the interval from SAH to cerebral vasospasm and the interval from clipping to cerebral vasospasm was determined. The change in blood flow rate after IA injection was assessed by transcranial Doppler ultrasound. Multiple clinical parameters were completed before and after IA nimodipine injection to evaluate any improvements in clinical symptoms. RESULTS: For eight patients, Glasgow Coma Scale (GCS) scores increased by two or more points. The regression analysis demonstrated a positive correlation between the change in GCS scores after IA nimodipine injection and the change in blood vessel diameter (p=0.025). A positive correlation was also observed between the interval from SAH to vasospasm and the change in diameter (p=0.040); and the interval from clipping to vasospasm and the change in diameter (p=0.022). CONCLUSION: IA nimodipine injection for SAH-induced vasospasm led to significant vasodilation in angiography and improvement in clinical symptoms without significant complications. Our findings suggest that IA nimodipine injection should be utilized when intractable vasospasm develops despite rigorous conservative management.
Aneurysm ; Aneurysm, Ruptured ; Angiography ; Blood Vessels ; Glasgow Coma Scale ; Glycosaminoglycans ; Humans ; Injections, Intra-Arterial ; Intracranial Aneurysm ; Nimodipine ; Subarachnoid Hemorrhage ; Vasodilation ; Vasospasm, Intracranial

After the introduction of antibiotics, empyema is a rare complication of retropharyngeal abscess caused by acute epiglottitis. But once it occurs, it may be a fatal outcome. Retropharyngeal abscess may spread to mediastinum and pleural cavity along the deep cervical fascia, then it can induce pneumonia, mediastinitis, empyema, and sepsis. Because of its fatal complication, early diagnosis and intensive surgical treatment, such as incision and drainage, is necessary. Now we have a experience of empyema caused by retropharyngeal abscess in a 56-year old diabetic patient with nephropathy. He was admitted to our hospital because of hoarseness and sore throat due to acute epiglottitis. Several days after his admission, he complained of swelling of neck, which was diagnosed as retropharyngeal abscess by the computerized tomography. Retropharyngeal abscess was managed with antibiotics, incision and drainage and culture revealed Peptostreptococcus prevotii. Subsequently empyema developed in his right chest, which was managed with closed thoracotomy, though, he expired due to progression of sepsis.
Anti-Bacterial Agents ; Drainage ; Early Diagnosis ; Empyema* ; Epiglottitis* ; Fascia ; Fatal Outcome ; Hoarseness ; Humans ; Mediastinitis ; Mediastinum ; Middle Aged ; Neck ; Peptostreptococcus ; Pharyngitis ; Pleural Cavity ; Pneumonia ; Retropharyngeal Abscess* ; Sepsis ; Thoracotomy ; Thorax

BACKGROUND: Somato-sensory evoked potential (SSEP) monitoring has been used to help minimize neurologic morbidity during spinal surgery. However, SSEP is affected by anesthetics, technical errors and physiologic aspects. We reviewed 50 cases of spinal surgery done with total intravenous anesthesia under SSEP monitoring. METHODS: Fifty patients, ASA class I-II, free of neurologic disease and scheduled for elective spinal surgery were randomly selected for the study. All of the operations were performed under general anesthesia employing the method of total intravenous anesthesia with propofol and fentanyl (Group I, P-F) or ketamine (Group II, P-K), and monitored by SSEP. We checked the changes of blood pressure and heart rates during the operation, recorded latency and amplitude of SSEP in the pre-induction, post-induction, during screw insertion and post-distraction periods. Also, we checked the number transfers to the ICU and application of a ventilator. RESULTS: Systolic and diastolic blood pressure were increased significantly in the propofol-ketamine group (P < 0.05), but there was no difference in heart rate between both groups. In addition there were no statistical differences in latencies and amplitudes of SSEP. The number of patients transferred to the ICU and placed on a ventilator showed no statistical difference. CONCLUSIONS: We think that the combination of propofol and fentanyl or ketamine used for total intravenous anesthesia is a very useful method in spinal surgery under SSEP monitoring.
Anesthesia* ; Anesthesia, General ; Anesthesia, Intravenous ; Anesthetics ; Blood Pressure ; Evoked Potentials* ; Fentanyl ; Heart Rate ; Humans ; Ketamine ; Propofol ; Spine* ; Ventilators, Mechanical