Leiomyomas of the vagina is a rare tumor, with 300 cases reported in the world literature. We experienced a case of leiomyoma of the vagina, and present it with a brief review of the literatures.
Leiomyoma* ; Vagina*

BACKGROUND: To visualize adequately the intrathoracic structures, creation of an artificial pneumothorax by carbon dioxide (CO2) insufflation under positive pressures has been advocated during thoracoscopic surgery. We hypothesized that positive-pressure insufflation during thoracoscopy would cause significant hemodynamic and ventilatory compromise. METHODS: Thirty patients underwent general anesthesia with a single lumen endotracheal tube and placement of an arterial line. Noninvasive cardiac output monitoring was done on both the side of the neck and chest. Baseline measurements of hemodynamic indices and arterial blood gas analysis (ABGA) were taken before CO2 insufflation. Data was obtained at 5 minutes after CO2 insufflation. ABGA was taken 5 minutes after CO2 deflation. RESULTS: Insufflation of CO2 resulted in an increase in heart rate (HR), mean arterial pressure (MAP), and systemic vascular resistance index (SVRI). Whereas cardiac index (CI), accelerated contractility index (ACI), PH, and arterial oxygen saturation (SaO2) were decreased. CONCLUSIONS: Positive pressure insufflation of CO2 during thoracoscopy resulted in hemodynamic and arterial blood gas changes. Therefore, we propose that low pressure (< 10 mmHg) insufflation is a safe adjunct to routine thoracoscopic surgical procedures.
Anesthesia, General ; Arterial Pressure ; Blood Gas Analysis ; Carbon Dioxide ; Cardiac Output ; Heart Rate ; Hemodynamics* ; Humans ; Hydrogen-Ion Concentration ; Insufflation* ; Neck ; Oxygen ; Pneumothorax, Artificial ; Thoracoscopy* ; Thorax ; Vascular Access Devices ; Vascular Resistance

A 25-year-old female came in for an explo-laparotomy. The operation was performed under epidural anesthesia. Potassium chloride (40 mEq20 ml) instead of 2% lidocaine mixed with 1:200,000 epinephrine was accidently injected via a Tuohy needle into the epidural space. The patient showed an unexpected prolonged motor and sensory paralysis below the T, cord level for about 8 hours after the epidural injection. The patient recovered without a permanent neurologic sequale after 8 hours. However, the patient developed pulmonary edema resulting from rapid fluid therapy for unusual hypotension which developed 12 hours after the potassium chloride injection. The pulmonary edema was treated by oxygen therapy using a nonrebreathing oxygen mask, a dopamine drip and an intravenous injection of lasix 20 mg. The patient completely recovered from the pulmonary edema on the 3rd postoperative day and went home with no complaints.
Adult ; Anesthesia, Epidural ; Dopamine ; Epidural Space ; Epinephrine ; Female ; Fluid Therapy ; Furosemide ; Humans ; Hypotension ; Injections, Epidural ; Injections, Intravenous ; Lidocaine ; Masks ; Needles ; Oxygen ; Paralysis ; Paraplegia* ; Potassium Chloride* ; Potassium* ; Pulmonary Edema

Primary carcinoma of the fallopian tube is an extremely rare malignancy of the female genital tract. We have experienced two cases of primary carcinoma in the fallopian tube. One case with huge mass which was diagnosed incidentally on the basis of the biopsy findings, and the other case of the 3 years follow-up. We reported the cases with a brief review of the concemed literatures.
Biopsy ; Fallopian Tubes* ; Female ; Follow-Up Studies ; Humans

BACKGROUND: A right thoracoscopic thoracic sympathicotomy involves the removal of T2 and T3 sympathetic chains. Since part of the sympathetic fibers to the heart traverse these two ganglia, we examined the hemodynamic changes during a thoracoscopic thoracic sympathicotomy in primary hyperhidrosis. METHODS: Noninvasive cardiac output monitoring was done on the both side of the neck and chest. A physiograph for measuring of continuous blood flow was taken from the right index finger and a thermometer was placed in the right palm. Following endotracheal intubation was done with double lumen endotracheal tube, anesthesia was maintained with isoflurane. Sympathicotomies were done for T2-3 during one lung ventilation. Heart rate (HR), mean arterial pressure (MAP), systemic vascular resistance index (SVRI), cardiac index (CI), accelerated contractility index (ACI), end-diastolic index (EDI), and temperature were recorded at arrival, before sympathicotomy, after sympathicotomy at 1, 2, 3, 4 and 5 minuets. The blood flow of the right index finger was recorded before and after the sympathicotomy. RESULTS: Concurrent with initiation of the sympathicotomy, MAP and SVRI were reduced, but the CI was elevated. It was accompanied with right palmar temperature elevation and an increase in the blood flow of the right index finger. CONCLUSIONS: A thoracoscopic thoracic sympathicotomy reduces MAP and SVRI and elevates CI, palmar temperature, and blood flow. We concluded that the hemodynamic changes during a thoracoscopic thoracic sympathicotomy seems to be the peripheral vasodilatation.
Adrenergic Fibers ; Anesthesia ; Arterial Pressure ; Cardiac Output ; Fingers ; Ganglia ; Heart ; Heart Rate ; Hemodynamics* ; Hyperhidrosis* ; Intubation, Intratracheal ; Isoflurane ; Neck ; One-Lung Ventilation ; Thermometers ; Thorax ; Vascular Resistance ; Vasodilation

We report two cases of atypical teratoid/rhabdoid tumor(AT/RT) in the central nervous system. Primary central nervous system AT/RT is an extremely rare malignant tumor affecting infants and young children. These tumors have been diagnosed previously as primitive neuroectodermal tumors(PNETs) because AT/RT contains fields indistinguishable from classic PNETs. Separation of these two tumor types is crucial because the prognosis for AT/RT is poor even when treatment includes surgery with or without radiation therapy and/or chemotherapy. Clinical, radiological and histopathological features of AT/RT are presented.
Central Nervous System* ; Child ; Drug Therapy ; Humans ; Infant ; Neural Plate ; Neuroectodermal Tumors, Primitive ; Prognosis

A 53-year-old woman presented with left mandibular area pain, trismus, and facial numbness that had persisted for 4 years. Physical examination revealed a 3x5 cm, hard, non-tender, and round mass on the left mandibular area. Computed tomography and magnetic resonance imaging revealed an expansile tumor involving the left mandibular ramus and temporomandibular joint area with bone destruction, extending to the base of middle cranial fossa and left zygomatic bone. The mass at the segment of left mandible and zygomatic bone, and base of middle cranial fossa was removed. Pathological examination of the mass revealed a giant cell tumor. The defect was reconstructed with iliac bone for the mandible and temporal bone and fascia for the cranial bone and dura. The case is described along with a review of the literature.
Cranial Fossa, Middle ; Fascia ; Female ; Giant Cell Tumors ; Giant Cells ; Humans ; Hypesthesia ; Magnetic Resonance Imaging ; Mandible ; Middle Aged ; Physical Examination ; Skull ; Temporal Bone ; Temporomandibular Joint ; Trismus

No abstract available.
Hemorrhagic Fever with Renal Syndrome* ; Pregnancy*

PURPOSE: To evaluate the characteristic sequential MRI findings of cortical laminar necrosis. MATERIALS AND METHODS: We retrospectively reviewed the MRI findings of 11 patients with clinical signs of hypoxic brain damage who showed findings of cortical laminar necrosis with definite time of onset. Three were men and eight were women; they were aged between 27 and 74 (mean 59.3)years. All patients underwent imaging with a 1.0-T MagnetomImpact(Siemens) ; follow-up MR examinations were performed in five. RESULTS: The watershed zones in the parietooccipital, frontoparietal and temporoparietal cortex were involved in eight cases, whereas the other areas involved were the frontal lobe in two cases and the temporal lobe in one. In one case, MRI obtained two days latershowed brain swelling demonstrating obliteration of cortical sulci and high signal intensity of subcortical whitematter on T2WI. In five cases, MRI obtained between two and three weeks later showed gyriform high signalintensity along the cortex on T1WI, cortical high and subcortical low signal intensities on T2WI in four cases,and gyriform enhancement on gadolinium-enhanced scans in three cases. MRI obtained between three and four weeks later in three cases showed subcortical high signal intensity on T2WI in two cases and gyriform cortical highsignal intensities on T1WI and gyral enhancement in all cases. MRI obtained after 50 days in four cases includingtwo of follow-up MR, showed cortical gyriform high signal intensity on T1WI in all cases and subcortical high signal intensity on T2WI and mild gyriform enhancement on gadolinium-enhanced scans in three cases. In twofollow-up studies, the lesions had become more discrete and larger. CONCLUSION: Cortical laminar necrosis due tohypoxic brain damage shows relatively characteristic MR findings according to the stage. Therefore, MR imaging seems to be useful diagnostic tool for the evaluation of cortical laminar necrosis due to hypoxic brain damage.
Brain ; Brain Edema ; Female ; Follow-Up Studies ; Frontal Lobe ; Humans ; Hypoxia, Brain ; Magnetic Resonance Imaging* ; Male ; Necrosis* ; Retrospective Studies ; Temporal Lobe

BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) is a widely-performed procedure for patients undergoing enteral feeding. Due to frequent complications, careful management after the PEG is required. In this study, we investigated the risk factors associated with early exchange of PEG tube. MATERIALS AND METHODS: We did a retrospective survey of 72 patients who received a PEG between January 2009 and April 2014. All patients underwent a tube exchange or removal after the first PEG. Patients who had an exchange within 6 months were defined as 'early exchange' group and the others, as 'late exchange' group. We analyzed the relationship between early exchange and pre-PEG status. RESULTS: Mean age of patients was 67.5+/-18.3 years. The most frequent mental status and performance status before the first procedure, was 'alert' (n=48, 66.7%) and Eastern Cooperative Oncology Group (ECOG) score was 4 (n=28, 39.8%). Mean BMI was 20.2+/-3.7 kg/m2 and the majority of PEG cause was cerebrovascular accidents (n=23, 31.9%). Many patients had a tube exchange (or removal) because of tube dysfunction (n=32, 44.4%). The 'early exchange' group showed a lower BMI than 'late exchange' group (19.7+/-3.57 kg/m2 vs. 22.4+/-3.87 kg/m2, P value 0.009). 'Underweight' (BMI less than 18.5 kg/m2) group was more frequently observed in 'early exchange' group. There was no significant difference in pre-PEG status and post-PEG complication between the 2 groups. CONCLUSIONS: A lower BMI was associated with early exchange of PEG. Health providers should pay attention to the nutritional status of PEG patients.
Body Mass Index ; Endoscopy ; Enteral Nutrition ; Gastrostomy* ; Humans ; Nutritional Status ; Retrospective Studies ; Risk Factors* ; Stroke