No abstract available.
Cyclosporine* ; Scleredema Adultorum*

No abstract available.
Humans ; Inpatients*

PURPOSE: Algorithms to get cross-sectional bone density pattern(transverse histogram) to predict the loosening of hip prosthesis using DXA(Dual X-ray Absorptiometry) have been developed. We performed this study to analyze the correlation between radiologic findings and densitometric pattern of the THRA(Total Hip Replacement Arthroplasty) patients. MATERIALS AND METHODS: Thirty-six hips of 32 THRA patients were evaluated. The duration between THRA and DXA was from 1 year 7 months to 15 years. On transverse histogram, the periprosthetic bone density patterns were classified as 3 types;type I, rigid fixation in 17, type II, definite loosening in 8, and type III, partial loosening in 11 cases. Surgical findings, plain X-ray findnings and transverse histogram using DXA were correlated. RESULTS: Among 14 cases performing revision for acetabular prosthesis loosening, 5 cases revealed loosening of fernoral stems while 9 cases revealed rigid fixation of femoral stems. Sensitivity was 100% for either plain X-ray or DXA. Specificity was 88%, 77% for plain X-ray and DXA respectively. CONCLUSION: This preliminary study reveals that periprosthetic bone density pattern on transverse histogram on DXA may be useful in the evaluation of the loosening. However, further study will be needed for clinical application.
Acetabulum ; Arthroplasty, Replacement, Hip* ; Bone Density ; Hip ; Hip Prosthesis ; Humans ; Prosthesis Failure ; Sensitivity and Specificity

Studies on the correlation between proliferative activity of biopsied specimen and pathologic findings of resected specimen have been carried out to find the prognostic factors. To estimate the proliferative activity, 100 cases of biopsied specimen of gastric adenocarcinoma were tested for the PCNA (proliferating cell nuclear antigen) and the AgNOR (argyrophilic nucleolar organizer region) by the immunohistochemical and histochemical stainings, respectively. The resected tumors classified by histologic type, differentiation, depth of invasion, and nodal metastatic status were followed by cell cycle analysis using flow cytometry. The PCNA LI (labelling index) were higher in well or moderately differentiated tumors (P<0.01) than the poorly differentiated ones and the aneuploid tumors (P<0.05) more than in diploid ones. However, there were no correlations among histologic types, depth of invasion, nodal metastatic status and PCNA LI. The AgNOR counts were higher in advanced tumor than in the EGC (early gastric cancer) (P<0.01). In cases with nodal metastasis, most of them showed the AgNOR counts higher than those without nodal metastasis. There were no correlations between the AgNOR counts and the DNA ploidy, histologic type, or differentiation. High PCNA LI and high AgNOR counts were shown in cases with advanced tumors (P=0.000) and nodal metastasis (P<0.05). No correlation was shown with the histologic type or differentiation. The results show that proliferative activity of the biopsied specimen of gastric adenocarcinoma is correlated with the differentiation and the invasion depth of resected specimen. Especially, better correlation is obtained by analyzing both the PCNA LI and the AgNOR counts than by analyzing each.
Adenocarcinoma* ; Aneuploidy ; Cell Cycle ; Diploidy ; DNA ; Flow Cytometry ; Neoplasm Metastasis ; Nucleolus Organizer Region ; Ploidies ; Proliferating Cell Nuclear Antigen ; Stomach Neoplasms

Central hypoventilation syndrome (CHS) can be caused by any lesions to the medullary respiratory centers, cerebral cortex, corticospinal pathways, and their connections. We report 5 patients with central hypoventilation syndrome and analyzed 26 patients who experienced central hypoventilation syndrome during sleep and waking states. We compared initial clinical symptoms and signs, maximal neurologic deficits, brain MRI and pathologic findings, and associated autonomic dysfunctions. The patients with respiratory failure during waking states showed quadriplegia, a rapidly progressing respiratory failure. The patients who had automatic respiratory failure showed mild hemiparesis, bulbar dysfunction, dysautonomia, and subacute to chronic recurrent respiratory failures. These results support the concept of two separate respiratory systems: a voluntary system and an automatic system. The respiratory management of these patients with central hypoventilation syndrome should be considered critical to their survival.
Brain ; Cerebral Cortex ; Humans ; Hypoventilation* ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Paresis ; Primary Dysautonomias ; Pyramidal Tracts ; Quadriplegia ; Respiratory Center ; Respiratory Insufficiency ; Respiratory System

Background: We hypothesized that intravenous lidocaine mixed with propofol may have an influence on anesthesia induction and hemodynamic responses to propofol induction and endotracheal intubation as well as propofol-induced pain on injection. Methods: Seventy-five patients were allocated to group L1 (2% lidocaine 1.5 mg/kg, n=25), group L2 (2% lidocaine 2 mg/kg, n=25) or group C (normal saline 0.05 mL/kg, n=25) according to the lidocaine dosage mixed with propofol 2 mg/kg. The pain on injection was scored as none, mild, moderate, and severe. The site of pain and recall of pain were also recorded. Loss of verbal response was observed during induction. Mean arterial blood pressure (MAP) and heart rate (HR) were recorded before anesthetic induction (baseline value), immediately before and after endotracheal intubation, and every min until 5 min thereafter. Results: Ninety-two percent of patients reported pain upon injection in group C, whereas 8% of the patients in group L1 and no patient in group L2. Loss of verbal response before injection of total dose of propofol was observed in 44% in group L2, 36% in group L1 and 28% in group C. Lowered MAP caused by propofol increased significantly after endotracheal intubation in all three groups (p<0.05). HR increased immediately and 1 min after endotracheal intubation in all three groups (p<0.05). Conclusions: Our results indicate that intravenous lidocaine 1.5 mg/kg or 2 mg/kg mixed with propofol 2 mg/kg significantly reduces the incidence and the degree of pain, but does not affect anesthesia induction and hemodynamic responses to propofol and tracheal intubation.
Anesthesia ; Arterial Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Incidence ; Intubation* ; Intubation, Intratracheal ; Lidocaine* ; Propofol*

Malignant transformation develops in a little less than 2% of mature cystic teratomas. A wide variety of malignant tumors may arise within benign mature cystic teratomas, and the most common of these is squamous cell carcinoma, which account for 75~85%. In general, the tumors are in an advanced stage and the prognosis is poor as most patients die within a year. However, when the tumor is confined to the ovary, they have a good prognosis and the 5-year survival rate is 63~83%. We experienced three cases of squamous cell carcinoma arising in mature cystic teratoma. Two of the carcinomas occurred in postmenopausal women: 58-(case 1) and 66-(case 2) year-old, and were confined to the ovaries. They were alive 37 months and 18 months after the operation, respectively. The third case was a 45-year-old premenopausal woman who had an extraovarian extension of the tumor and early recurrence within two months. Histologically, cases 1 and 3 were conventional well to moderately differentiated squamous cell carcinomas and case 2 showed a well-differentiated squamous cell carcinoma with exuberant proliferating trichilemmal tumor-like areas.
Carcinoma, Squamous Cell* ; Female ; Humans ; Middle Aged ; Ovary* ; Prognosis ; Recurrence ; Survival Rate ; Teratoma*

PURPOSE: Hemodynamically significant patent ductus arteriosus (PDA) may increase the mortality of premature infants who received ventilator care by aggravating hypoxia, acidosis, pulmonary edema and hypotension. The risk factors for PDA in premature infants are low gestational age, infusion of excessive fluid, and severity of neonatal respiratory distress syndrome. We studied the risk factors of PDA in very low birth weight infants (VLBW) to establish a guideline for the treatment. METHODS: VLBW infants who were born at Severance Hospital, Yonsei Medical Center from January, 1989 through December, 1995 and survived for at least 5 days with ventilator care were recruited for this study. Patent ductus arteriosus was diagnosed according to the clinical diagnostic criteria of Yeh (Yeh et al, 1981b). Thirty six infants had diagnosed as PDA (PDA group), and thirty seven infants who had not PDA were selected as control. Both groups of infants received restrictive fluid therapy. RESULTS: 1) Gestational age, sex, Apgar score, administration of surfactant, mode of delivery, toxemia and use of antenatal dexamethasone were similar between PDA and control infants. 2) In PDA group, ventilatory index and duration of vetilator care were significantly greater (P<0.05), and a/ApO2 was significantly lower than control group (P<0.05). There was no difference in peak inspiratory pressure at initial setting, the highest peak inspiratory pressure and mean airway pressure during ventilator care. 3) During the first 3 days of life, the urine output was similar between groups. On the 4th and 5th days of life, PDA group had significantly reduced urine ouput compared with control (on day 4; 2.6+/-1.1 ml/kg/h vs. 3.2+/-1.2ml/kg/h, P<0.05; on day 5, 2.9+/-1.4ml/kg/h vs. 3.6+/-1.6ml/kg/h, P<0.05) . 4) The percent weight loss compared to birth weight was siginificantly lower in PDA group (12.5% vs. 15.1%, P<0.05). 5) The PDA group had higher incidences of bronchpulmonary dysplasia and intraventricular hemorrhage (P<0.05). CONCLUSION: Among Vlnfants who received restrictive fluid therapy during the first 5 days of life, infants with PDA had reduced urine output and percent weight loss than control group.
Acidosis ; Anoxia ; Apgar Score ; Birth Weight ; Dexamethasone ; Ductus Arteriosus* ; Ductus Arteriosus, Patent ; Fluid Therapy ; Gestational Age ; Hemorrhage ; Humans ; Hypotension ; Incidence ; Infant* ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight* ; Mortality ; Pulmonary Edema ; Respiratory Distress Syndrome, Newborn ; Risk Factors* ; Toxemia ; Ventilators, Mechanical ; Weight Loss

In addition to many of the widely accepted risk factors of bronchopulmonary dysplasia (BPD), such as prematurity, oxygen toxicity, barotrauma, and infection, the amount of fluid intake during the early phase of life has recently been reported to be an important factor, especially the amount of colloid. Forty-one premature infants who were admitted to the NICU of Severance Hospital, Yonsei University College of Medicine between Jan. 1990 and Jun. 1992 and treated for respiratory difficulty with mechanical ventilation and restrictive fluid therapy were included in the study. fourteen were diagnosed as BPD and the rest were grouped as Non-BPD. We confirmed prematurity, low birth weight, high oxygen concentration, high ventilator pressures and rates, perinatal asphyxia, acidosis, and low blood pressures as risk factors. However, with restrictive fluid therapy that we have used, there was no difference in the amount of total fluid, of crystalloid, or of colloid between BPD and Non-BPD groups, as were the urine output, serum electrolyte concentrations, and percent body weight change. The amount of colloid when used for the maintenance of adequate blood pressures and for the prevention and treatment of hypovolemia, oliguria, anemia of sepsis under the scheme of restrictive fluid therapy would not influence adversely in the development of BPD. Instead, the amount of colloid used may imply the severity of illness of the patient; that is, the more severe the condition of the patient the more the amount of colloid used.
Acidosis ; Anemia ; Asphyxia ; Barotrauma ; Body Weight Changes ; Bronchopulmonary Dysplasia* ; Colloids ; Fluid Therapy* ; Humans ; Hypovolemia ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature* ; Oliguria ; Oxygen ; Respiration, Artificial* ; Risk Factors* ; Sepsis ; Ventilators, Mechanical

In newborn infants, normal adrenal glands are characterized by a relatively thin echogenic center surroundedby a thick, hypoechoic cortical rim as seen on ultrasound (US). Various disorders involving the neonatal adrenalgland include adrenal hemorrhage, hyperplasia, cyst, Wolman's disease, and congenital neuroblastoma. Adrenalhemorrhage is the most common cause of an adrenal mass in the neonate, though differentiation between adrenalhemorrhage and neuroblastoma is in many cases difficult. We describe characteristic US, CT and MR imaging findingsin neonates with various adrenal disorders.
Adrenal Glands ; Hemorrhage ; Humans ; Hyperplasia ; Infant, Newborn ; Magnetic Resonance Imaging ; Neuroblastoma ; Ultrasonography ; Wolman Disease