Mediastinum is bounded by sternum, vertebra, 1st rib, and diaphragm externally, and by pleural cavity internally and includes important structures such as great vessels, nerves, thymus and many lymph nodes. Primary and metastatic cancers, cysts and inflammatory lesions can develop in this region, and the tumor developing in the mediastinum has a tendency to developed in a specific area of mediastinum depending on the histologic type. Therefore the developing site of tumor and the clinical findings are very important in diagnosing the tumor of the mediastinum. We studied not only the characteristics of mediastinal tumor and tumorlike conditions but the histologic classification and frequency of mass to a specific area and then observed if there is any information that could help in diagnosis of the lesion of the mediastinum. Results obtained were as follows: 1) Of the 95 cases of mediastinal lesion which excludes inflammatory process, there were 70 cases (73.5%) of primary tumors, 13 cases (13.1%) of metastatic tumors and 12 cases (12.6%) of tumor-like conditions. 2) Of the 70 cases of primary tumor, 54 cases (76.8%) were benign, 13 cases (20%) were malignant and 3 cases were unclassified or unidentified tumor with the overall 3.8:1 prevalence rate of benign tumor compared to malignancy. 3) Histologic classification of the 70 cases of primary tumor showed 27 cases (28.4%) of germ cell tumor, 22 cases (23.2%) of neurogenic tumor, 7 cases (7.4%) of thymoma, 6 cases (6.3%) of lymphoma and 5 cases (5.3%) of soft tissue tumors with the highest frequency of germ cell tumor. Germ cell tumor and neurogenic tumor exceeded to 50% of total primary mediastinal tumor. 4) Male to female prevalence rate showed that benigh tumor had a high frequency in female with the the ratio of 1:1.4. But malignant tumor showed much higher frequency in male with the ratio of 4.2:1. 5) Anterior mediastinum had germ cell tumor, thymoma and lymphoma in order of frequency. Metastatic tumor was the most common in superior mediastinum. Superior mediastinum had germ cell tumor and neurogenic tumor with about the equal number, and soft tissue tumor was also developed. Middle mediastinal tumor was less common in number compared to other portions of mediastinum but the majority of tumors developed was developmental cysts and metastatic tumors. And the majority of neurogenic tumors occured at the posterior mediastinum. 6) Mass sized 5-10 cm in diameter were about 55.7% of all tumor, 2.5-5 cm and 10-15 cm were 20% respectively. But the mass sized smaller than 2.5 cm and larger than 15 cm were about 5% respectively. And the malignant tumors have more larger size than benign tumors. 7) Patient with benigh tumor had no symptoms at all or some complaints of chest tightness, dyspnea, chest pain, shoulder pain and dysphagia. In addition to above symptoms, patient with malignant tumor complained of systemic symptoms such as weight loss and fever.
Female ; Male ; Humans ; Cysts ; Neoplasm Metastasis

No abstract available.
Female ; Humans ; Premenstrual Syndrome*

Individual tumors, even those of the same histologic type, show varying sensitivity to specific cytotoxic agent. Therefore, sensitivity testing assume an increasingly important as an orientational aid in planning chemotherapy. In the past decade there have been many attempts to develop a chemosensitivity test that would predict the clinical effectiveness of various chemostherapeutic agents against human neoplasms. In the United States National Institue's anticancer drug screening program, a colorimetric assey based on the ability of live cells to reduce a tetrazolium-base compound(MTT) to a blue formazan product was used. There has been an increase in reports of a chemosensitivity assay that use tetrazolium dyes and current the assay is in use in our country. The efficacy of several anticancer drug (vincristine sulfate, Etoposide, doxorubicin CDDP) were evaluated using the in vitro chemosensitivity of MTT assay with two cancer cell lines (MOLT-4, KHOS/NP). The follows obtained. 1) CI50 on MOLT-4 are 0.55ng/ml and 0.81ng/ml for vincristine and oncovin, 142.30ng/ml and 78.75ng/ml for lastet and vepesid, and 19.75ng/ml, 20.43ng/ml and 8.66ng/ml for ADR, ADM and adriblastin, respectively. 2) CI50 on KHOS/NP are 691.35ng/ml, 873.73ng/ml, 1,205.22ng/ml, 768.81ng/ml and 672.19ng/ml for cisplan, cisplatin, cispatin, platinol and cisplatin G, and 9.22ng/ml, 11.46ng/ml and 4.28ng/ml for ADR, ADM and adriblastin, respectively. In conclusion the MTT dye reduction assay to anticancer drug sensitivity using short-term microplate culture might serve as a reliable tool for the selection of effective chemotherapeutic agents in patients with cancers.
Cell Line ; Cisplatin ; Coloring Agents ; Doxorubicin ; Drug Evaluation, Preclinical ; Drug Therapy ; Etoposide ; Humans ; United States ; Vincristine

No abstract available.
Liver Cirrhosis* ; Liver*

No abstract available.
Islets of Langerhans* ; Lymph Nodes* ; Neoplasm Metastasis*

Medico-legal investigations in Korea depend mostly on postmortem inspection without autopsy. Both untrained physicians and experienced forensic pathologists may not be able to determine the cause and manner of death only by postmortem inspection. The aim of our study was to show the limitations of postmortem inspection by evaluating the discrepancy between the results of postmortem inspection and autopsy after natural death. The manner of death by postmortem inspection changed to unnatural death in 9.4% of the cases (12 cases/127 cases) after autopsy. The cause of death in most cases was consumption of alcohol, agricultural chemicals, and antipsychotic intoxication. The cause of death by postmortem inspection changed in 24.3% of the cases (26 cases/107 cases) among cases of confirmed natural death after autopsy. The positive predictive value of cause of death by postmortem inspection was higher for cardiovascular disease (79.0%) and lower for chronic alcoholism and/or chronic liver disease (28.6%). This study shows that forensic pathologists could make considerable errors in determining the cause and manner of death without autopsy and emphasizes the necessity to refine medico-legal investigations in Korea by introducing the limited autopsy with toxicologic study and supportive postmortem imaging.
Agrochemicals ; Alcoholism ; Autopsy ; Cardiovascular Diseases ; Cause of Death ; Korea ; Liver Diseases

Cerebral infarction caused by Carotid injury after blunt trauma to the head and neck is rare, but these injuries have high mortality. Recently we experienced a case of carotid artery occlusion probably related to the traffic accident. A 38-year-old man was motorcycling and was struck on the front of his motorcycle by a car. He sustained rib fractures and sprain of the neck, but there was no disturbance of consciousness or paresis of extremities. 16 days later, he developed right hemiparesis. CT scan revealed infarction in the distribution of the left middle cerebral artery territories, angiography revealed total thrombotic occlusion of the left internal carotid artery just distal to the bifurcation. He died 21 days after the accident, and the postmortem exam findings were concordant with clinical findings.
Accidents, Traffic ; Adult ; Angiography ; Autopsy* ; Carotid Arteries* ; Carotid Artery Thrombosis* ; Carotid Artery, Internal ; Cerebral Infarction ; Consciousness ; Extremities ; Head ; Humans ; Infarction ; Middle Cerebral Artery ; Mortality ; Motorcycles ; Neck ; Paresis ; Rib Fractures ; Sprains and Strains ; Thrombosis ; Tomography, X-Ray Computed

Transient increases in blood pressure and heart rate following laryngoscopy, endotracheal intubation and extubation are common(King et al, 1951; Takeahima et al, 1964; Forbes and Dally, 1970; Edde, 1979; Paik et al, 1980). Tomori and Widdicombe(1969) found these responses are associated with an increased impulse traffic in the cervical sympathetic efferent nerve fibers. These nervous activities were especially increased by mechanical stimulation of the epi. and alryngopharyngeal regions(Forbes and Dally, 1970). Also various arrhythmias were elicited by vagal stimulation during endotracheal in tubation (Buratein et al, 1950 : King et al, 1951; Lander and Moyer, 1965; Forbes and Dally 1970). and it has been known that cardiac arrest could occur in some cases(Dwyer, 1953; Raffan, 1954). Increased blood pressure and heart rate can produce cerebral hemorrhage, left ventricular failure and life threatening cardiac arrhythima. So pharmacologic attempts to lessen these blood pressure and heart rate elevation and appearances of arrhythmias have been tried but these approaches have been only partially successful. The present study was undertaken to observe the effects of intubation and extubation on the cardiovascular system. Adult patients who had received elective surgery under general anesthesia with endotracheal intubation were randomly selected at Severance Hospital. Eighty five patients in one group and sixty in the other were selected for the responses following intubation and extubation respectively, and these were divided into 3 groups each: Group l served as a control group for intubation(n=25) and extubation(n=20). Group ll served as a intravenous lidocaine injected group for intubation(n=30) and extubation(n=20). Group lll served as a lidocaine sprayed group for intubation(n=30) and extubation(n=20). The changes of arterial blood pressure and pulse rate and the appearance of arrhythmias following intubation and extubation were analysed and data were compared among the groups. The results were as follows: 1) In the lidocaine intravenously injected or sprayed group, the systolic blood pressure elevation following intubation was of less magnitude than in the control group (statistically significant) and rapidly returned to the pre-induction level. 2) In the lidocaine sprayed group, the magnitude of diastolic blood pressure elevation following intubation was ess than in the control and intravenous lidocaine injected groups (statistically significant). 3) In the lidocaine intravenously injected or sprayed groups, the magnitude of the heart rate elevation following intubation was less than in the control group (statistically significant). In the lidocatine sprayed group, systolic blood pressure elevation following extubation was prevented (statistically significant). 4) In the lidocaine intravenously injected group, the magnitude of systolic blood pressure elevation following extubation was less than in the control group (statistically significant). In the lidocaine sprayed group, systolic blood pressure elevation following extubation was prevented (statistically significant). 5) The diastolic blood pressure elevation following extubation was prevented in the lidocaine intravenously injected group (statistically significant) and more rapidly returned to pre-extubation levels in the lidocaine sprayed group than in the control group. 6) The elevation of the heart rate following extubation was prolonged in the lidocaine intravenously injected group and more rapidly returned to pre-extubation levels in the lidocaine sprayed group than in the control group. 7) The effects of lidocaine on the prevention of EKG abnormalities following intubation and extubation were not significant. It is suggested from the above results that the lidocaine intravenous injection and spray of the laryngopharyngeal region decreases the magnitude of blood pressure elevation following intubation and extubation under general anesthesia and is effective for rapid return to the awake level.
Adult ; Anesthesia, General ; Arrhythmias, Cardiac ; Arterial Pressure ; Blood Pressure* ; Cardiovascular System ; Cerebral Hemorrhage ; Electrocardiography ; Heart Arrest ; Heart Rate* ; Heart* ; Humans ; Injections, Intravenous ; Intubation ; Intubation, Intratracheal ; Laryngoscopy ; Lidocaine ; Nerve Fibers

In the late 1950, Greifenstein and associates have studied the properties of phenylcyelohexylamine derivatives and reported that these chemicals produced amnesia, analgesia, catatonia and catalepsy. Phencyclidine was the first of these drugs used in clinical anesthesia, but convulsive movement as well as excitatory behavior discouraged the use of the agent in human beings. Continued research for a more suitable derivative of phencyclidine with similar analgesic action, but shorter duratoin and lesser psychotomimetic action led McCarthy and Chen to investigate the pharmacologic properties of a large series of compounds. One of these, 2-ochlorophenylcyclohexylamine, was shown to have some advantages. Ketamine hydrochloride, chemically related to both phencyclidine and cyclohexylamine, proved to be more satisfactory for clinical anesthesia. Clinical investigations were begun in 1965 by Dominos group who first termed it dissociative anesthesia. As noted by Pender, the clinical signs of anesthesia with ketamine are completely different from those seen with conventional intravenous agents and gaseous compounds. Ketamine acts rapidly on intravenous or intramuscular administration to produce a state chracterized by catalepsy, analgesia and amnesia. It is devoid of sedation, hypnotic or convulsive properties. Normal pharyngeal-laryngeal reflexes are maintained and skeletal tone remains normal or increased. Since the introduction of ketamine by Domino's group, numerous reports have appeared to explain various aspects of the cardiovascular response(increased cardiac output, hypertention, little or no change in peripheral resistance) and respiratory response. However there are few reports on the effect of ketamine on intestinal motility. Thus we have made a study to observe the effect of ketamine on the intestinal motility of chickens. Strips of isolated muscle, 1 cm long, from adult fowl weighing l.2-1.5 kg and isolated smooth muscle of a patient with stomach cancer, were suspended in a muscle chamber containing Tyrode's solution into which was bubbled oxygen gas. The solution was. kept constant at 38 degrees C and contraction of the preparations was recorded on a polygraph. After being washed several times with fresh solution, the muscle strips attained constant motility and tonus. Ketamine and other drugs were added in various concentrations to the chamber. The results are as follows: 1) Ketamine did not exert any effect on human intestinal motility. It relaxed fowl intestinal muscle strips and potentiated the effect of epinephrine, norepinephrine, and isoproterenol. 2) The relaxing effects of ketamine on fowl intestinal muscle strips were not abolished by adrenergic blocking agents. 3) Ketamine demonstrated anticholinergic effect on the intestinal motility of the human and fowl. From the above results, it may be concluded that ketamine exerts a anticholinergic effect and depressant effect on intestinal motility of fowl without relation to adrenergic receptors.
Adrenergic Antagonists ; Adult ; Amnesia ; Analgesia ; Anesthesia ; Cardiac Output ; Catalepsy ; Catatonia ; Chickens* ; Cyclohexylamines ; Epinephrine ; Gastrointestinal Motility* ; Humans ; Isoproterenol ; Ketamine* ; Muscle, Smooth ; Norepinephrine ; Oxygen ; Phencyclidine ; Receptors, Adrenergic ; Reflex ; Stomach Neoplasms

The dose-response of intravenous thiopental (2.5%) for induction of general anesthesia in cesarean section (C/S) patients and in patients with end stage renal disease(ESRD) was studied at seven doses of 2.0, 3.0, 3.5, 4.0, 4.5, 5.0 and 6.0 mg/kg body weight. Thiopental was injected as an IV bolus into a preexisting IV catheter. Patients were divided into four groups(ESRD-CONTROL, C/S-CONTROL, C/S, and ESRD). Each patient was examined at 60 seconds after injection of thiopental. Presence or absence of verbal command response, lid reflex and trapexius reflex were observed. For each reflex, dose-response curves were analysed using the log probit model to determine ED 50, Ed95 and parallelism. The value of ED50 for verbal command response was lowest in the ESRD patient group (2.2mg/kg) and was similar in the remaining groups(2.5, 2.6mg/kg). The ED50 values for lid and trapezius reflex were lowest in the C/S group(2.9and 4.0mg/kg respectively) and the others had similar values (3.5~3.7mg/kg and 4.7~5.3mg/kg respectively). The ED95 values for trapezius reflex in all patients were distributed between a range of 6.5~9.1mg/kg and this suggests that the usual dose (3~6 mg/kg) is not sufficient to prevent the stress response of tracheal intubation. Also, the results indicate that the dose of thiopental for induction should be reduced because of the increasing sensitivity of the central nervous system with the cesarean section group and the free drug fraction of thiopental in patients with end stage renal disease. Therefore, if a patient with full term pregnancy or renal failure is to be induced with a single injection of thiopental, it is recommended to reduce the rate of injection.
Anesthesia, General* ; Body Weight ; Catheters ; Central Nervous System ; Cesarean Section* ; Female ; Humans ; Intubation ; Kidney Failure, Chronic* ; Pregnancy ; Reflex ; Renal Insufficiency ; Superficial Back Muscles ; Thiopental*