No abstract available.
DNA Topoisomerases* ; DNA*

PURPOSE: To understand the cause of atypical sonograpic findings by analyzing their pathologic correlation tointernal echogenicity of breast fibroadenoma. MATERIALS AND METHODS: Between January 1995 and April 1997, thepresence of 91 fibroadenomas in 81 patients was histopathologically proven. These mass lesions weresonographically interpreted and their descriptive criteria-internal echo content (both strength and homogeneity),the presence of septum, bilateral shadowing, and posterior echo pattern-were tabulated. A pathologist reviewedeach case and independently recorded the following data : cell type, the presence of septum, duct dilatation,calcification, fibrosis, hyalinization, and vascularity. We analyzed the correlation of sonographic withpathologic findings. RESULT: There was significant correlation between increased vascularity and increasedinternal echo strength and between increased fibrosis and decreased internal echo strength. There was nosignificant correlation between internal echo homogeniety or posterior shadowing and vascularity or stromalfibrosis, nor between hyalinization or cell type and internal echo strength, homogeneity or posterior shadowing.There was correlation between absent or thin capsule and the absence of bilateral shadowing. CONCLUSION: Increased vascularity or decreased stromal fibrosis might be the cause of atypical fibroadenoma.
Breast* ; Fibroadenoma* ; Fibrosis ; Humans ; Hyalin ; Shadowing (Histology) ; Ultrasonography

BACKGROUND: During ophthalmologic surgery, various intravenous anesthetic induction agents are used to prevent an intraocular pressure (IOP) increase. This study was designed to compare the effects of etomidate on IOP with those of thiopental sodium and propofol in patients receiving vecronium bromide, and in whom tracheal intubation was performed. METHODS: Forty-five patients undergoing elective surgery were ramdomized to receive etomidate 0.3 mg/kg (E group, n = 15), thiopental sodium 5 mg/kg (T group, n = 15) or propofol 2.5 mg/kg (P group, n = 15). IOP, systolic arterial pressure (SAP) and heart rate (HR) were measured before induction (B), after the adminstration of the induction agents (I1), before intubation (I2) and at 1, 2 and 3 mins after intubation (T1, T2 and T3). RESULTS: The IOP after I1 and I2 in the E , T and P groups were significantly lower than in group B (P < 0.05). The IOP at T1, T2 and T3 in the E, T and P groups were not found to be significantly different from group B. The IOP, SAP and HR at T1, T2, and T3 in the E, T and P groups were significantly higher than at I1 and I2 (P < 0.05). No significant differences were observed between the groups in term of IOP. The SAP and HR at T1, T2 and T3 in the P group were significantly lower than in the other two groups (P < 0.05). CONCLUSIONS: We concluded that etomidate, thiopental sodium and propofol may be useful induction agents for general anesthesia in ophthalmologic surgery but that they do not prevent IOP elevation during endotracheal intubation.
Anesthesia, General ; Arterial Pressure ; Etomidate* ; Heart Rate ; Humans ; Intraocular Pressure* ; Intubation* ; Intubation, Intratracheal ; Propofol* ; Thiopental*

Cortical blindness is characterized by visual sensation loss with retention of pupillary reaction to light, and a normal fundoscopic examination. The suggested causes are emboli, profound hypotension, anemia, and infarction of watershed areas in the parietal or occipital lobe. We experienced a case of cortical blindness with severely reduced visual acuity after penile cancer surgery under general anesthesia. In the acute stage, visual acuity was slightly improved, but over the course of several months, no further improvement in visual acuity occurred. In this case there was no severe hypotension or anemia during the operation. Two days after the operation, electroencephalography (EEG) was performed during the period of blindness and the recording obtained was abnormal, with no alpha rhythm. Biparieto-occipital lucency was found by magnetic resonance imaging (MRI). Therefore parieto-occipital infarction due to seizure, embolus, or thrombosis could be considered a possible etiology. We concluded that cortical blindness can unexpectedly develop perioperatively and postoperatively, and that close monitoring of the patient and adequate management are essential.
Alpha Rhythm ; Anemia ; Anesthesia, General* ; Blindness ; Blindness, Cortical* ; Electroencephalography ; Embolism ; Humans ; Hypotension ; Infarction* ; Magnetic Resonance Imaging ; Male ; Occipital Lobe ; Penile Neoplasms ; Rabeprazole ; Seizures ; Sensation ; Thrombosis ; Visual Acuity

Septic pulmonary embolism (SPE) is different from non-infectious thromboembolism in that it causes pulmonary arterial obstruction and inflammation by infectious emboli from various sources. There are increased risks of SPE in patients with chronic kidney disease because of decreased immunity and frequent venous puncture with the use of indwelling venous catheters or arterio-venous graft (AVG). However, SPE related with AVG infection in end-stage renal failure patient is very rare. Recently, we experienced a typical case of septic pulmonary embolism occurring in a 57-year-old man with infected AVG during hemodialysis. The patient had started hemodialysis 10 years ago due to diabetic end stage renal failure. Due to functional failure of the arterio-venous fistula, hemodialysis had been performed through an AVG on the upper left arm 3 years before admission.
Arm ; Arteriovenous Fistula ; Blood Vessel Prosthesis ; Catheters ; Fistula ; Humans ; Inflammation ; Kidney Failure, Chronic ; Middle Aged ; Pulmonary Embolism ; Punctures ; Renal Dialysis ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Sepsis ; Thromboembolism ; Transplants

BACKGROUND: Laparoscopic surgery has many advantages compared with conventional methods and may allow a significant reduction in postoperative pain and analgesic consumption. Nevertheless, some patients still experience significant pain. Therefore, many clinicians have tried various methods to reduce of postoperative pain. We investigated degrees of postoperative pain and the incidences of shoulder pain versus the different methods of gas removal after laparoscopic surgery. METHODS: Sixty ASA class I or II patients were included in this study. In Group A (Control group, n = 20), residual carbon dioxide was removed by the classic method without a drain tube. In Group B (Suction group, n = 20), residual carbon dioxide was removed using a suction device aggressively without a drain tube. In Group C (Drain group, n = 20), residual carbon dioxide was removed by the classic method with a drain tube. The intensities of abdominal and shoulder pain were assessed 1, 6, 24 and 48 hours after surgery using a visual analog scale (VAS) and a verbal rating scale (VRS). We also assessed the mean hospital stay for the three groups. RESULTS: The abdominal pain scores (VAS and VRS) at 1 hour after surgery and the incidence of shoulder pain, epigastria pain and flank pain were significantly higher in Group A than in the other groups for 1hour after surgery (P <0.05). Mean hospital stay was significantly longer for group C. CONCLUSIONS: After laparoscopic surgery, the active removal of residual carbon dioxide may be a simple and safe method that significantly reduces postoperative shoulder and abdominal pain.
Abdominal Pain ; Carbon Dioxide ; Flank Pain ; Gases* ; Humans ; Hysterectomy* ; Incidence ; Laparoscopy ; Length of Stay ; Pain, Postoperative* ; Shoulder ; Shoulder Pain ; Suction ; Visual Analog Scale

Primary hyperoxaluria is a rare autosomal recessive inherited metabolic disease which results from endogenous overproduction of oxalic acid. It causes variant phenotypes from renal failure in infancy to mere urolithiasis in late adulthood. We report a case of primary hyperoxaluria in a 11-year-old boy. He presented with recurrent multiple renal stones since 3 years of age. He had renal failure and markedly increased hyperoxaluria (568.26 microgram/mg of creatinine (normal: 0.04-0.15)) and his stones consisted of a mixture of calcium oxalate (30%) and calcium phosphate (10%) in contrast to pure calcium oxalate monohydrate in the other primary hyperoxaluria type 1 patients. A renal biopsy showed interstitial cellular infiltration with crystals which are birefringent under polarized light within the tubules. His general conditions were improved after hemodialysis treatment. For definite cure of disease, combined liver-kidney transplantation is considered.
Biopsy ; Calcium ; Calcium Oxalate ; Child ; Creatinine ; Humans ; Hyperoxaluria ; Hyperoxaluria, Primary* ; Kidney Failure, Chronic* ; Male ; Metabolic Diseases ; Nephrolithiasis ; Oxalic Acid ; Phenotype ; Renal Dialysis ; Renal Insufficiency ; Urolithiasis

PURPOSE: To compare the detection rate of the patients with retinal nerve fiber layer (RNFL) defect and the amount of RNFL defect according to the patients' age. METHODS: Retrospective chart reviews of 22,811 subjects, who visited the health care center from January 2009 to December 2009 were performed. The detection rate, location and average amount of RNFL defect and the proportions of the patients who were diagnosed with glaucoma through Humphrey visual field (HVF) test or determined as a glaucomatous optic disc were compared according to the patients' age. RESULTS: The proportions of the patients whose RNFL defect were detected was highest in the patients 60 years old or older (2.3%) and was statistically significant (p = 0.012). However, there was no significant difference among the other age groups (under 40 years: 1.7%, 40 thru 49 years: 1.5%, 50 thru 59 years: 2.0%). The proportions of the patients who were determined as glaucoma through the HVF test or glaucomatous optic disc were also highest in the patients 60 years old or older (1.4%), however, there was no statistically significant difference (p = 0.070) among the age groups (under 40 years: 1.1%, 40 thru 49 years: 0.9%, 50 thru 59 years: 1.2%). CONCLUSIONS: The RNFL defect is likely to be detected in subjects less than 40 years of age and the detection rate is similar to subjects in their 40's and 50's. The use of fundus photography to detect RNFL defect in a health care center is recommended in subjects under 40 years of age.
Delivery of Health Care ; Glaucoma ; Humans ; Nerve Fibers ; Photography ; Retinaldehyde ; Retrospective Studies ; Visual Fields

BACKGROUND: Many factors cause postoperative hepatic dysfunction, and anesthetic agents and type of surgery are belived to contribute to hepatic dysfunction. The authors planned this study to evaluate the effect of different anesthetic agents (sevoflurane, desflurane, enflurane or propofol) on liver enzymes in the patients who undergone laparoscopic cholecystectomy. METHODS: 80 patients were randomly selected from among those who had undergone cholecystectomy and divided into 4 groups; an enflurane group (n = 20), a sevoflurane group (n = 20), a desflurane group (n = 20) and a propofol group (n = 20). Preoperative values of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were compared with those on postoperative days 1 and 3 in all groups. RESULTS: In all groups, ALT and AST were significantly elevated after operation, and then showed a decrease 3 days after operation, but remainrd of above preoperative levels (P < 0.05). However, no differences were observed between the 4 groups (P < 0.05). CONCLUSIONS: We consider that propofol, sevoflurane, desflurane and enflurane are equally usable and that they have little effect on liver function after laparoscopic cholecystectomy.
Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia* ; Anesthetics ; Aspartate Aminotransferases ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Enflurane* ; Humans ; Liver* ; Propofol*

BACKGROUND: Neostigmine has been added to local anesthetic regimen for epidural or intrathecal block, and this resulted in prolonged and improved analgesia, but evidence of its benefit in intravenous regional anesthesia (IVRA) is controversial. The purpose of this study was to evaluate the effects of neostigmine added to ropivacaine for IVRA. METHODS: Forty patients undergoing hand or forearm surgery were randomly assigned to two groups to receive IVRA: Group I received 40 ml of 0.2% ropivacaine plus 1 ml of normal saline, and group II received 40 ml of 0.2% ropivacaine plus 500microgram (1 ml) of neostigmine. Sensory block onset time, postoperative visual analogue scale (VAS) scores, recovery time from motor block after deflation, mean arterial pressure (MAP), heart rate (HR), and pulse oximeter saturation (SpO2) values were measured. The incidence of side effects was recorded. RESULTS: Group II had a shorter sensory block onset time, a prolonged motor block recovery time, and lower postoperative VAS scores. No significant difference was found between the two the groups in terms of MAP, HR, SpO2 and side effects. CONCLUSIONS: The addition of neostigmine to ropivacaine in IVRA is believed to be a useful effective method for outpatient arm surgery due to a shortened sensory onset time and improved postoperative analgesia.
Analgesia ; Anesthesia, Conduction* ; Arm ; Arterial Pressure ; Forearm ; Hand ; Heart Rate ; Humans ; Incidence ; Neostigmine* ; Outpatients