Adenocarcionma of fetal type is in lung is a newly recognized malignant tumor sharing morphologic features with the epithelial component of the pulmonary blastoma devoid of sarcomatous component. We present a case of adenocarcinoma of fetal type in a 28-year-old female, consisting of numerous branching tubules or glands and morula-like epithelial complexes. Histologically, the tubules and glands were composed of glycogne-rich nonciliated epithelial cells showing in part argyrophilia. Some of tubular and morula-like epithelial cells revealed immunoreactivity for neuron-specific enolase. We report this case with a review of literatures with special references on the histogenisis. This report is the pathologically confirmed second case of the pulmonary adenocarcinoma of fetal type in Korea, following the report of Cho and Lee, 1990.
Female ; Humans ; Adenocarcinoma

Purpose: The purpose of this study was to systematically review and conduct meta-analysis on factors affecting career preparation behavior of Korean nursing students. Methods: Related articles published in Korean and English were collected based on search terms and converted into a numerical database. Data extraction, quality assessment and analysis including a systematic review and meta-analysis were completed. Results: The review included 27 studies. There were 25 factors influencing career preparation behavior of Korean nursing students. Factors were categorized into four sub-factors: personal, contextual, cognitive-emotional, and goal-related. In the meta-analysis of 27 articles the total effect size (ESr) was .34. The effect sizes of the four sub-factors were .37 for individual factors, .25 for situation factors, .34 for cognitive and emotional factors, and .41 for target factors. The main factors were .53 for career-related efficacy, .43 for self-leadership, and .43 for career decision level. Conclusion Nursing students with high career-related efficacy and self-leadership are more likely to demonstrate career preparation behavior. Based on these results, educational institutions for nursing students must improve students’ self-leadership and career effectiveness through education so that they can set career goals.

Dorsal root ganglionotomy of the S5 nerve is useful for pain around the coccyx. The S5 dorsal root ganglion lies behind the sacrum at a level 1 cm caudal to the S2 foraminal opening and approximately 2 mm lateral to the midline of the sacrum. A small burr-hole was made through the plates of the posterior sacrum to approach the dorsal root ganglion of S5 nerve. Sensory stimulation was performed at 0.3 V, 50 Hz. No motor fasciculations was noted at 0.6 V, 2 Hz. A thermal lesion was created at 75oC for 60 sec. The patient whom we report now was a 67-year-old male who suffered from the pain around the coccyx due to rectal cancer metastasis. He failed to respond to other oral and invasive conventional therapy. We experienced a successful result in the treatment of his intractable pain after the S5 dorsal root ganglionotomy.
Aged ; Coccyx ; Fasciculation ; Ganglia, Spinal ; Humans ; Male ; Neoplasm Metastasis ; Pain, Intractable ; Rectal Neoplasms ; Sacrum ; Spinal Nerve Roots*

BACKGROUND: In ambulatory surgery, which is of short duration, anesthesiologists often do not use a muscle relaxant, or any other induction technique which could facilitate muscle relaxation for endotracheal intubation.Incomplete muscle relaxation, however, results in vocal cord movement and the possibility of damage to the vocal cords and adjacent structure.The aim of this study was to evaluate the macroscopic sequelae of intubation on vocal cord and laryngeal structure and assess postoperative sore throat or hoarseness. METHODS: 100 patients with class I or II ASA physical status were enrolled in this study.It was divided into two groups, Group C (conventional intubation dose of rocuronium; 0.6 mg/kg) and group L (low intubation dose 0.45 mg/kg).Anesthesia was induced with 10microgram/kg of alfentanil and 2.0 mg/kg of propofol i.v.Intubation was performed 90 second after rocuronium injection and the intubation condition was checked.Macroscopic sequelae ofthe laryngeal structure were evaluated using a flexible fiberoptic bronchoscope. After completion of surgery, the patient was asked to report sore throat or hoarseness. RESULTS: Macroscopic sequelae, such as erythema or hemorrhage, were statistically different between the two groups.There were no cases of minimal hemorrhage of either vocal cords or of the arryepiglottic folds in group C whereas there were two cases in group L.There was no statistical difference in incidence and severityof sore throat or hoarseness between the two groups. CONCLUSIONS: Although there were more macroscopic effects in the vocal cords and aryepiglottic folds, a low intubation dose of rocuronium can be used during surgery of short duration without fear of any significant sore throat or hoarseness after surgery.
Alfentanil ; Ambulatory Surgical Procedures ; Androstanols ; Bronchoscopes ; Erythema ; Hemorrhage ; Hoarseness ; Humans ; Incidence ; Intubation ; Muscle Relaxation ; Muscles ; Pharyngitis ; Propofol ; Vocal Cords

BACKGROUND: Oxygen increases the cardiac vagal tone, blood pressure, systemic vascular resistance and vascular tone in healthy adults.This study assessed the autonomic tone according to different oxygen flow rates via different types of masks with using the heart rate variability (HRV) in the PACU after total intravenous anesthesia (TIVA). METHODS: We prospectively studied 27 patients after TIVA in the PACU.The 5 L group received oxygen via a simple mask with an oxygen rate of 5 L/min and the 10 L group received oxygen via a mask with a reservoir bag at a rate of 10 L/min in the PACU. We evaluated the HRV at the point of stabilization before anesthesia (BL), 5 min in the PACU (PACU 5), 30 min in the PACU (PACU 30) and 60 min in the PACU (PACU 60). RESULTS: In the 5 L group, the nuHF was increased to 42.4 +/- 24.2 at 60 min in the PACU as compared with 27.1 +/- 19.1 at 5 min in the PACU.In the 5 L group, the LFHFr was decreased to 2.3 +/- 2.1 at PACU 60 as compared with 6.6 +/- 9.7 at PACU 5 and the nuLF was decreased to 56.9 +/- 23.2 at PACU 60 as compared with 72.9 +/- 19.0 at PACU 5.There were no significant changes between the two groups at PACU 5, PACU 30 and PACU 60.The oxygen saturation was increased at PACU 60 compared with PACU 5 in the two groups. CONCLUSIONS: These finding indicates that 1 h of oxygen administration with 5 L/min during emergence from anesthesia increased the relative vagal tone, and the arterial blood pressure is stable irrespective of the oxygen flow rate.
Anesthesia ; Anesthesia, Intravenous ; Arterial Pressure ; Blood Pressure ; Heart ; Heart Rate ; Humans ; Masks ; Oxygen ; Prospective Studies ; Vascular Resistance

BACKGROUND: In the past, the diagnosis of ductal carcinoma in situ (DCIS) was rare, but today the incidence of DCIS has become much more frequent, particularly in patients who underwent mammographic screening. The management of patients with DCIS has become a major clinical dilemma. It has become increasingly difficult to justify the routine use of mastectomy for patients with DCIS, because its natural history is uncertain and breast-conserving therapy (BCT) is currently used for the treatment of many patients with invasive breast cancer. METHODS: To investigate the incidence, clinicopathologic features and the outcome of treatment of DCIS and microinvasive carcinoma (MIC), the medical records and pathology slides of 91 patients with DCIS and MIC who had been treated at KCCH between 1983 and 1996 were reviewed retrospectively. Median follow-up period was 69.4 (4-158) months. RESULT: The results were as follewd; 1) The inciednce was 2.72% (91/3,343) and had been increasing (2.1% in 1980s and 3.3% 1990s). 2) The mean age was 44.2 years and peak age group was fifth decade. 3) The most common clinical features was a palpable mass (69%), followed by nipple discharge, MMG abnormality and Paget's disease in decreasing order of frequency. 4) According to the pathologic classification of Schwartz, comedo type was the most common (32%), followed by cribriform (23%), papillay (20%), mixed (11%), solid (9%) and micropapillary type (5%), 5) There were 58 cases (69%) of pure DCIS and 16 cases (17.5%) of MIC. In 17 case (18.5%) the presence of microinvasion was equivocal or could not be assessed. 6) There were no significant differences between DCIS and MIC in terms of mean age (44.5 years vs 43.8 years), mean tumor size (2.15 cm vs 2.25 cm), the frequency of comedo type (29% vs 36%), lymph node metastasis (0% vs 6%) and multicentricity (3.3% vs 3.0%). However, the palpable mass was more common in MIC than DCIS (82% vs 62%, p<0.05). 7) 75 patients (82%) were treated with mastectomy and 16 patients were treated with breast conserving surgery. 8) Bedsides 2 cases of systemic recurrence among MIC, there was no case of recurrence or disease-associated death during the period of follow-up. CONCLUSIONS: The incidence of DCIS and MIC showed increasing tendency primarily due to the increasing use of screening mammography. Even though the rates of BCT has been increasing, MRM was still the most common procedure for the treatment of DCIS and MIC. The outcome of treatment, in terms of recurrence or survival, was very excellent and almost the same for both groups of pure DCIS and MIC. More long-term follow-up and multicenter study seems to be neccessary to identify the differences in clinical features and outcome between pure DCIS and MIC in Korea.
Breast Neoplasms ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Classification ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Lymph Nodes ; Mammography ; Mass Screening ; Mastectomy ; Mastectomy, Segmental ; Medical Records ; Natural History ; Neoplasm Metastasis ; Nipples ; Pathology ; Recurrence ; Retrospective Studies

BACKGROUND: Rocuronium has been reported to develop a rapid onset of action and may be suitable as a component of a rapid-sequence intubation. The purpose of this study was to compare the onset of rocuronium at the adductor pollicis and the larynx and to determine the time suitable for intubation. METHODS: Fifteen ASA physical status 1 and 2 adult patients were studied. Anesthesia was induced and maintained with propofol and alfentanil. The recurrent laryngeal nerve was stimulated superficially and movement of the vocal cords were recorded on video tape by using a fiberoptic bronchoscope passed via a laryngeal mask airway. Neuromuscular function was recorded at the adductor pollicis by using mechanosensor. After the administration of rocuronium 0.9 mg.kg(-1), the times to loss of fourth twitch response in train -of - four stimulation at the larynx and hand were observed. RESULTS: The times to loss of fourth twitch response in train-of-four stimulation at the larynx and hand are 47.3 +/- 12.8 sec and 70 +/- 13.6 sec respectively. CONCLUSIONS: Video imaging may be a useful research technique for estimating the neuromuscular blockade at the larynx and showing the onset time of rocuronium is significantly faster at the larynx than hand.
Adult ; Alfentanil ; Anesthesia ; Bronchoscopes ; Hand ; Humans ; Intubation ; Laryngeal Masks ; Larynx* ; Neuromuscular Agents* ; Neuromuscular Blockade ; Propofol ; Recurrent Laryngeal Nerve ; Research Design ; Vocal Cords

One lung ventilation with a double-lumen endotracheal tube or Univent tube may be achieved difficultly or dangerously in some patient such as young age, anatomic anomaly, low body weight and tracheostomy patient. Bronchial blocker with a Fogarty catheter has been used successfully for such situations. Here, we reported the clinical experience in using a Fogarty embolectomy catheter as a bronchial blocker in patient with tracheostomy after pharyngectomy and laryngectomy. The patient was received left upper lobectomy with thoracotomy due to metastatic lung cancer.
Body Weight ; Catheters* ; Embolectomy ; Humans ; Laryngectomy* ; Lung Neoplasms ; One-Lung Ventilation* ; Pharyngectomy* ; Thoracotomy ; Tracheostomy*

We report a case of a metastatic renal tumor secondary to breast cancer 9 years postmastectomy. This is the first case report of solitary renal metastasis from breast cancer with no other evidence of metastasis. A 47-year-old woman underwent a modified radical mastectomy and 6 cycles of CEF chemotherapy (Cyclophosphamide, Epirubicin, 5-FU) for cancer of the left breast. She was followed closely, but no recurrence or metastases were detected on either a physical or radiological examination. 9 years later, on a routine follow-up examination for metastatic breast cancer, abdomen ultrasound revealed a solid mass (4cm in diameter) in the upper portion of the right kidney. Computed tomography (CT) was used to further evaluate the solitary renal mass, which had become moderately enhanced. No regional lymph node, visceral or pulmonary metastases were found. A radionuclide bone scan confirmed no bony involvement. A laparoscopic radical nephrectomy was performed for a right renal tumor. The histopathological features were identical to those for cancer of the right breast. The patient was treated with adjuvant combination chemotherapy (docetaxel and adriamycin), and is still alive 9 months after a right radical nephrectomy, with no evidence of recurrence.
Abdomen ; Breast Neoplasms* ; Breast* ; Drug Therapy ; Drug Therapy, Combination ; Epirubicin ; Female ; Follow-Up Studies ; Humans ; Kidney ; Kidney Neoplasms ; Lymph Nodes ; Mastectomy, Modified Radical ; Middle Aged ; Neoplasm Metastasis ; Nephrectomy ; Recurrence ; Ultrasonography

BACKGROUND: To minimize hemodynamic responses to laryngoscopy and endotracheal intubation, 10% lidocaine spray to laryngopharyngeal area seems to be favorable. The aim of this study was to evaluate plasma concentration and hemodynamic responses following different dose of 10% lidocaine spray before laryngoscopic intubation. METHODS: Fifteen patients (ASA I, II) were randomly allocated. Group I (n = 5) patients were received saline spray for control, group II (n = 5) patients were received 1 mg/kg 10% lidocaine spray on laryngopharynx before induction of anesthesia and received 1 mg/kg 10% lidocaine topical spray to trachea under direct laryngoscopic view one minute before intubation, group III (n = 5) patients were received 1.5 mg/kg lidocaine spray. Hemodynamic response were measured at baseline, postspray 1 min, postintubation, postspray 2, 4, 6, 8, 10 min. Arterial blood samples for lidocaine concentration analysis were obtained at baseline and 2, 4, 6, 8, 10, 20, 30, 60, 120 minutes after larygopharyngeal and intratracheal administration of lidocaine. RESULTS: The highest lidocaine concentrations in arterial blood were 1.76 +/- 0.52microgram/ml for group II, 2.86 +/- 0.40microgram/ml for group III (mean +/- SD) 2 to 10 minutes after laryngopharyngeal and intratracheal administration. There weren't any definitive toxic symptoms observed during the study. Hemodynamic responses of group II and III were not satisfactory but remarkably stable compared with group I. There were no differences between group II and III. CONCLUSION: Sympathetic responses after 2-3 mg/kg lidocaine spray on laryngopharynx are favorably but not sufficiently attenuated during endotracheal intubation.
Anesthesia ; Hemodynamics* ; Humans ; Hypopharynx ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Lidocaine* ; Plasma* ; Trachea