Although gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract, it also occurs in the non-gastrointestinal tract, and is referred to as extragastrointestinal stromal tumor (EGIST). In this report, we describe a 48-year-old female patient who presented with hematuria, and who was finally diagnosed with a primary extragastrointestinal stromal tumor of the pelvic cavity involving the bladder, vagina and left ureter. Tumor cells were positive for immunohistochemical staining for CD117 antigen (proto-oncogene protein c-kit), CD34, and vimentin, whereas they were negative for desmin, smooth muscle actin, and S-100 protein. These findings provide histopathological and immunohistochemical evidence for diagnosing this tumor as EGIST.
Actins ; Desmin ; Female ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Hematuria ; Humans ; Middle Aged ; Muscle, Smooth ; Proto-Oncogene Proteins c-kit ; S100 Proteins ; Ureter ; Urinary Bladder ; Vagina ; Vimentin

BACKGROUND: Low flow anesthesia provides many advantages, including reduced cost, conservation of body heat and airway humidity. This study was performed to compare low flow anesthesia with high flow anesthesia and to investigate whether the advantages of low flow anesthesia during positive pressure ventilation can be combined with the laryngeal mask airway in paralyzed pediatric patients. METHODS: Thirty-one pediatric patients of ASA physical status 1 or 2 were studied and divided into two groups according to the fresh gas flow (FGF) in the breathing system; low flow group (FGF approximation 1 L/min, n = 17) or high flow group (FGF approximation 4 L/min, n = 14). Each respiratory parameter was measured when a steady state was reached at 20 min after induction. RESULTS: There were no significant differences of respiratory data between the two groups except that the inspired oxygen concentration was lower in the low flow group than in the high flow group. Hemodynamic changes with the laryngeal mask airway insertion were not statistically significant. CONCLUSIONS: A laryngeal mask airway is an effective airway device for low flow anesthesia as well as for high flow anesthesia in paralyzed pediatric patients.
Anesthesia* ; Hemodynamics ; Hot Temperature ; Humans ; Humidity ; Laryngeal Masks* ; Oxygen ; Pediatrics* ; Positive-Pressure Respiration* ; Respiration

BACKGREOUND: The pneumonectomy may depress the right ventricular (RV) function transiently. The thermodilution ejection/volumetric catheter is known to be most useful method assessing the changes in RV performance during pulmonary resection. The purpose of this study was to examine the RV function during and immediately after pneumonectomy using thermodilution methods. METHODS: 16 patients undergoing pneumonectomy were studied. After induction of anesthesia, a multilumen thermodilution catheter mounted with a rapid response thermister was inserted. Using computer system, RV ejection fraction (RVEF), cardiac output, and RV end-diastolic volume (RVEDV) were measured when the patient was in lateral position (control), after one lung ventilation (OLV) and the main pulmonary artery ligated, and at the completion of resection. Arterial blood gases were analyzed and pulmonary vascular resistance (PVR) was calculated. RESULTS: Systolic pulmonary blood pressure (SPAP)(28.3 +/- 6.2 mmHg) increased compared to the control (24.6 +/- 5.9) without a significant change of PVR. No statistically significant difference was found in either RVEF or RVEDV at each times. CONCLUSIONS: Our study demonstrate the pneumonectomy do not depress the RV function immediately and RVEF do not show any correlation with PVR or RVEDV.
Anesthesia ; Blood Pressure ; Cardiac Output ; Catheters ; Computer Systems ; Gases ; Humans ; One-Lung Ventilation ; Pneumonectomy* ; Pulmonary Artery ; Thermodilution ; Vascular Resistance ; Ventricular Function, Right*

Postoperative atrial arrhythmia after thoracotomy is relatively common, with a reported incidence ranging from 8% to 30%. These arrhythmias may cause hypotension, congestive heart failure and lengthen the period of postoperative hospitalization. The most important precipitating factor is atrial dilation and identified risk factor is an advanced age of the patient. The effect of various prophylactic regimens to reduce atrial arrhythmias is controversial. We report a case of postoperative atrial fibrillation in a 73 year-old female patient undergoing repair of esophageal hiatal hernia.
Aged ; Arrhythmias, Cardiac ; Atrial Fibrillation* ; Female ; Heart Failure ; Hernia, Hiatal* ; Hospitalization ; Humans ; Hypotension ; Incidence ; Precipitating Factors ; Risk Factors ; Thoracotomy

BACKGROUND: Vasoconstricting drugs such as dopamine, phenylephrine (PE) and epinephrine constrict normoxic lung vessels preferentially, thereby disproportionately increasing normoxic lung pulmonary vascular resistance (PVR) and inhibit hypoxic pulmonary vasoconstriction (HPV). In this study, we evaluated the effect of PE on HPV and arterial oxygenation. METHODS: This study was performed on 21 patients undergoing thoracotomy. After induction of anesthesia, Swan-Ganz catheter was inserted. After one lung ventilation was started, systolic blood pressure (SBP) of the patient was reduced to 100 mmHg using inhalation anesthetic agent and then the blood pressure was raised up to 140 mmHg by PE infusion. Hemodynamic variables were measured and arterial blood gas was analyzed at the start of one lung ventilation (control), SBP of 100 mmHg and SBP of 140 mmHg. RESULTS: The mean dose of PE infused was 5.9 +/- 3.8 microgram/kg. Infusion of PE did not increase pulmonary vascular resistant index (PVRI) significantly and did not reduce arterial PO2. There was no statistically significant difference in intrapulmonary shunt fraction (Qs/Qt) between the time of low and high blood pressures. CONCLUSION: Pulmonary vasomotor changes induced by PE are minimal and so should not affect the distribution of blood flow during one lung ventilation. On the basis of this result, PE appears to a reasonable vasoconstrictor to be used in patients undergoing thoracotomy.
Anesthesia ; Blood Pressure ; Catheters ; Dopamine ; Epinephrine ; Hemodynamics ; Humans ; Hypertension ; Inhalation ; Lung ; One-Lung Ventilation* ; Oxygen* ; Phenylephrine* ; Thoracotomy ; Vascular Resistance ; Vasoconstriction*

BACKGROUND: Patients undergoing cardiac surgery employing cardiopulmonary bypass frequently require transfusion of homologous blood products and, therefore, are exposed to the risk of transfusions. A administration of autologous platelet-rich plasma may reduce homologous transfusion and attendant risks. This study was designed to investigate the effect of preoperative collection of platelet-rich plasma on the requirement of homologous transfusion and postoperative blood loss in patients undergoing open heart surgery. METHODS: Twenty seven patients undergoing cardiac surgery were divided into control group(n=11) and autologous platelet-rich plasmaphereris(PRP) group(n=16). Autologous platelet-rich plasma was retransfused after offbypass. Hematocrit, platelet count, PT(prothrombin time), PTT(partial thromboplastin time), postoperative blood loss and transfusion requirement were measured. RESULTS: There was no statistical significance between control and PRP group in homologous transfusion and postoperative blood loss. There was no difference in hemoatocrit, platelet count, PT or PTT on immediate post surgery or on day 1. CONCLUSIONS: Autologous platelet-rich plasma did not reduce postoperative blood loss or transfusion reguirements in cardiac surgery.
Cardiopulmonary Bypass ; Hematocrit ; Humans ; Platelet Count ; Platelet-Rich Plasma* ; Postoperative Hemorrhage* ; Thoracic Surgery* ; Thromboplastin

BACKGROUND: Air trapped in left ventricle(LV) after cardiopulmonary bypass(CPB) is a major source of air embolism. We tried to measure the length of time(T) to remove the air bubbles from release of aortic cross clamp(ACC) and to find the factors affecting the length of time. METHODS: With Institutional Review Board(IRB) approval, 125 patients undergoing valvular replacement and repair of atrial septal defect(ASD) were included in this prospective study. After induction of anesthesia, a 5-MHz phased-array transesophageal echocardiographic(TEE) probe was inserted into the esophagus and then connected to the TEE system. TEE was continuously monitored from the time of release ACC to the end of operation. And the length of time from release of ACC to disappearance of the air bubbles in LV was recorded. RESULTS: The mean T was 27.5+/-12.0 minutes and was statistically longer in patients undergoing mitral valve replacement than in patients with ASD. There was significant difference in T between surgeon 1 and surgen 2. In patients with atrial fibrillation(A-fib) the air bubbles were removed more slowly than in patients with normal sinus rhythm preoperatively and there was negative correlation between preoperative ejection fraction(EF) and the length of time to remove air bubbles(r= 0.23). CONCLUSIONS: Careful management to remove the air bubbles from the LV after release of ACC is required in patients with low EF or A-fib preoperatively and surgeon's attention is required because they are the important factor affecting the length of time to remove the air bubble.
Anesthesia ; Cardiopulmonary Bypass* ; Echocardiography* ; Echocardiography, Transesophageal ; Embolism ; Embolism, Air ; Esophagus ; Heart Ventricles* ; Humans ; Mitral Valve ; Prospective Studies

BACKGROUND/AIMS: The prevalence of colonic diverticulosis in Korea is increasing in conjunction with the adoption of western dietary pattern, extension of lifespan, and advances in diagnostic modalities. The clinical characteristics of colonic diverticulosis seem to be gradually becoming similar to those of Western societies. Therefore, factors associated with the clinical characteristics of colonic diverticulosis in Korea were investigated. METHODS: The data of 200 patients diagnosed with colonic diverticulosis using colonoscopy between May 2010 and April 2012 at Inje University Seoul Paik Hospital (Seoul, Korea) were prospectively collected. Clinical parameters acquired through a questionnaire include age, body mass index, waist circumference, exercise, diet, smoking, drinking habits, etc. Correlation between these factors and the clinical features of diverticulosis were analyzed. RESULTS: Mean age of the patients was 54.9+/-11.9 (range 17-79) years and male to female ratio was 2.2:1. Most diverticula were located on the right side of the colon (83%) and the mean number of diverticulum was 4.07+/-3.9. Factor associated with the location of diverticulum on the left side was age (p=0.001). There was a positive correlation between the waist circumference and the number of diverticulum (partial correlation coefficient r'=0.143, p=0.047). Diverticulitis occurred more frequently in younger patients than in older patients (p=0.002). CONCLUSIONS: Colonic diverticulosis in older patients is found more frequently on the left colon, and the number of diverticulosis is associated with central obesity.
Adolescent ; Adult ; Age Factors ; Aged ; Alcohol Drinking ; Body Mass Index ; Colonoscopy ; Diverticulosis, Colonic/complications/*diagnosis/epidemiology ; Exercise ; Female ; Hemorrhage/etiology ; Humans ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Republic of Korea/epidemiology ; Risk Factors ; Smoking ; Waist Circumference ; Young Adult