PURPOSE: We planned to determine the diagnostic capability of focused assessment with sonography for trauma (FAST) in cases of blunt abdominal injury (BAI). METHODS: A retrospective analysis of FAST sheets was performed from April 2002 to December 2004. During the study period, 135 BAI patients were evaluated with FAST at the Emergency Department of Bundang CHA Hospital. Of this group, twenty-eight patients were excluded, leaving 107 patients for analysis. Abdomen CT (computerized tomography) or exploratory laparotomy confirmed the presence of hemoperitoneum. At the secondary survey, patients underwent a three-view FAST examination (LogicQ; General Electric, Waukesha, USA) by an emergency physician, followed within 2 hours by an abdomen CT or exploratory laparotomy. The FAST examination was considered positive if it demonstrated evidence of free intra-abdominal fluid. RESULTS: There were 45 true-positive FAST examination, 57 true-negatives, 1 false-positive, and 4 false negatives (sensitivity 91.8%, specificity 98.3%, positive predictive value 97.8%, negative predictive value 93.4%). The area under the ROC curve was 0.951 for the FAST examination. CONCLUSION: FAST is a highly reliable method for screening patients suspected of having BAI for the presence or absence of hemoperitoneum.
Abdomen ; Abdominal Injuries ; Emergencies ; Emergency Service, Hospital ; Hemoperitoneum ; Humans ; Laparotomy ; Mass Screening ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Tomography, X-Ray Computed

PURPOSE: We planned to determine the diagnostic capability of focused assessment with sonography for trauma (FAST) in cases of blunt abdominal injury (BAI). METHODS: A retrospective analysis of FAST sheets was performed from April 2002 to December 2004. During the study period, 135 BAI patients were evaluated with FAST at the Emergency Department of Bundang CHA Hospital. Of this group, twenty-eight patients were excluded, leaving 107 patients for analysis. Abdomen CT (computerized tomography) or exploratory laparotomy confirmed the presence of hemoperitoneum. At the secondary survey, patients underwent a three-view FAST examination (LogicQ; General Electric, Waukesha, USA) by an emergency physician, followed within 2 hours by an abdomen CT or exploratory laparotomy. The FAST examination was considered positive if it demonstrated evidence of free intra-abdominal fluid. RESULTS: There were 45 true-positive FAST examination, 57 true-negatives, 1 false-positive, and 4 false negatives (sensitivity 91.8%, specificity 98.3%, positive predictive value 97.8%, negative predictive value 93.4%). The area under the ROC curve was 0.951 for the FAST examination. CONCLUSION: FAST is a highly reliable method for screening patients suspected of having BAI for the presence or absence of hemoperitoneum.
Abdomen ; Abdominal Injuries ; Emergencies ; Emergency Service, Hospital ; Hemoperitoneum ; Humans ; Laparotomy ; Mass Screening ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Tomography, X-Ray Computed

OBJECTIVE: To compare motor evoked potential stimulated by round coil with that stimulated by butterfly coil. METHOD: Thirty control subjects were studied using magnetic stimulation by round coil and butterfly coil. Stimulation sites were cortex, cervical spine and lumbar spine. Recording electrodes were located on biceps brachii, abductor digiti minimi and tibialis anterior muscles. RESULTS: There were no significant differences between latencies of motor evoked potentials using round coil and those using butterfly coil in all tested muscles. In all muscles, amplitudes were significantly higher in stimulation with round coil than with butterfly coil. Above results were shown in both cortical and spinal motor evoked potentials. There were significant correlations between latencies of motor evoked potentials, heights, and arm lengths. CONCLUSION: We can record motor evoked potentials more easily with round coil than butterfly coil.
Arm ; Butterflies* ; Electrodes ; Evoked Potentials, Motor* ; Muscles ; Spine

BACKGROUND: Residual muscle paralysis after anesthesia is reduced with the advent of intermediate-acting neuromuscular blocking drugs, yet the incidence is as high as about 10 percent. Opioids in patient-controlled analgesia (PCA) may cause respiratory depression and other problems after anesthesia. The purpose of this study is to evaluate the influence of PCA on the SPO2, TOF ratio, head-lift and tongue protrusion during recovery room stay following intraoperative muscle relaxants. METHODS: 120 patients aged from 20 to 65 in ASA class I and II were divided into control or PCA groups. All patients received rocuronium (0.9 mg/kg) or atracurium (0.5 mg/kg) for tracheal intubation, and maintenance of relaxation was done with atracurium 0.2 mg/kg/hr during inhalation anesthesia. Reversal of block was done with pyridostigmine 0.15 mg/kg and glycopyrrolate 0.2 mg. SpO2, TOF ratio, 5 sec-head lift, tongue protrusion tests were evaluated in the recovery room. RESULTS: IV-PCA did not influence the incidence of residual block, SPO2, TOF ratio during recovery room stay for 20 minutes, but influenced negatively 5 sec-head lift test, tongue protrusion test only immediately after arrival at the recovery room. CONCLUSIONS: Since IV-PCA decreased the ability to perform head-lift and tongue protrusion early postoperatively, it is recommended that patients with IV-PCA should be carefully managed against the risk of aspiration or upper respiratory obstruction during their early recovery room stay.
Analgesia, Patient-Controlled* ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Inhalation ; Atracurium ; Glycopyrrolate ; Humans ; Incidence ; Intubation ; Neuromuscular Blockade ; Paralysis ; Passive Cutaneous Anaphylaxis ; Pyridostigmine Bromide ; Recovery Room ; Relaxation ; Respiratory Insufficiency ; Tongue

BACKGROUND AND OBJECTIVES: Follicular tumors can present a difficult diagnostic challenge for cytological evaluation and ultrasound findings. Therefore, new methods which could help distinguish follicular adenoma from follicular carcinoma simply and accurately are greatly desired. This study investigated the usefulness of immnunohistochemical expression of CXC chemokine receptor 4 (CXCR4) and galectin-3 as marker of differentiated thyroid carcinomas. MATERIALS AND METHODS: Expression of CXCR4 and galectin-3 were examined immunohistochemically in the 60 paraffin embedded tissues which were already diagnosed as follicular adenoma (n=20), follicullar carcinoma (n=20), and papillary carcinoma (n=20) of thyroid. RESULTS: Galatin-3 was expressed significantly high in follicular carcinoma than follicular adenoma (p=0.022). CXCR4 was also expressed significantly high in follicular carcinoma than follicular adenoma (p=0.027). The sensitivity of CXCR4 and galectin-3 was 70% and 80% and specificity, 65% and 60% for differential diagnosis of follicular tumors. CONCLUSION: An immunohistochemical panel, including galatin-3 and CXCR4, could be useful in the differential diagnosis between follicular adenoma from follicular carcinoma.
Adenoma ; Carcinoma, Papillary ; Diagnosis, Differential ; Galectin 3 ; Paraffin ; Receptors, CXCR ; Receptors, CXCR4 ; Sensitivity and Specificity ; Thyroid Gland

Hepatoblastoma is a primary embryonic liver tumor usually found in children. It extremely rarely occurs in adults. We report a case of hepatoblastoma in a 56 year old man with chronic hepatitis B of 10years duration. Laboratory investigation of the patient on admission showed a marked elevation of alpha-fetoprotein in serum. Ultrasonography and Computerized tomography scan revealed a primary tumor, 6x7cm in size, in the right lobe. The tumor removed by a right lobectomy. Complete removal of the tumor is the treatment which is potentially curative provided that lesion is confined within the liver capsule. The literature revealed and a case of this tumor reviewed.
Adult* ; alpha-Fetoproteins ; Child ; Hepatitis B, Chronic ; Hepatoblastoma* ; Humans ; Liver ; Middle Aged ; Ultrasonography

Large intestinal Lipohyperplasia (LPH) is a poorly recognized lesion characterized by adipose tissue infiltration in the submucosal layer of the colon. Most of all, LPH developed at Ileoceal valve, especially upper lip which was called by ileocecal valve syndrome. For endoscopists and radiologists, it has often remained difficult to make a distinction from malignant neoplasia. We report here the case of a mild obese, 51-year-old man who had polypoid lipohyperplasia of the colon associated with extreme hyperplasia of the appendix. His chief complaint was recurrent intermittent abdominal pain. The colonoscopic finding was a submucosal tumor-like polypoid mass originating from appendix with smooth surface, But ileocecal valve was intact. Abdominal CT finding was 2.5 cm sized round heterogeneous low density mass like lesion with intratumoral fatty density of cecal tip area with enhancement of peripheral portion. In barium enema study, after retrograde filling of contrast, smooth extrinsic indentation of cecal tip with partial filling of appendix was seen. Histological exemination revealed infiltration of mature adipose tissue in the submucosal layer. Because of recurrent abdominal pain, ileocecal resection was performed at operation. We discuss the case and review the literatures on this subject.
Abdominal Pain ; Adipose Tissue ; Appendix* ; Barium ; Colon ; Enema ; Humans ; Hyperplasia ; Ileocecal Valve ; Lip ; Middle Aged ; Tomography, X-Ray Computed

BACKGROUND: General anesthesia alters autonomic nervous system activity. Evaluation of the autonomic nervous system activity using heart rate variability and so, evaluating the anesthetic depth was tried. METHODS: In thirty patients undergoing gynecological surgery under general inhalational anesthesia with enflurane, a 10-minute EKG was perioperatively acquired during main incidents. The heart rate variability was analyzed and expressed as 5-minute signals. RESULTS: In an analysis of the frequency area adopting the heart rate variability, both low and high frequencies represented the effects of the autonomic nervous system, but the low and high frequencies, their ratio and 1/f noise were not valuable in estimating the depth of anesthesia before, during and after the operation. The detrended fluctuation analysis also proved unsuitable for the estimation of the anesthetic depth during an operation. CONCLUSIONS: The signal using heart rate variability reflects the parameter of the autonomic nervous system during operations.
Anesthesia* ; Anesthesia, General ; Autonomic Nervous System ; Electrocardiography ; Enflurane ; Female ; Gynecologic Surgical Procedures ; Heart Rate ; Humans ; Noise

PURPOSE: We investigate the effect of osteoprotegerin (OPG) on activation of osteoclastogenesis and NF-kappaB activation by PMMA (Polymethyl methacrylate) particles in osteoclast precursor cells. MATERIALS AND METHODS: Osteoclast precursor cells (CSF-1 dependent) were obtained from whole bone marrow of C57BL mouse. Four experiments included 1) different dose of RANKL (Receptor Activator of NF-kappaB ligand) treatment (0, 1, 10, 40 ng/ml) 2) PMMA treatment +/- RANKL 3) PMMA treatment with different dose of RANKL 4) PMMA treatment +/- OPG. After treatments, cultured cells were stained with TRAP (Tartrate resistant alkaline phosphatase). The activity of NF-kappaB DNA nuclear translocation was detected by EMSA (electrophoretic mobility shift assay). RESULTS: The experiments with RANKL on osteoclast precursors differentiation demonstrated a dose-dependent stimulation of osteoclastogenesis (p<0.05). Control cultures without RANKL had no osteoclasts, while maintenance in 1 ng/ml of RANKL results in low level osteoclast formation. PMMA particles activated osteoclastogenesis in RANKL-primed osteoclast precursor cells. And the effect of particles on osteoclastogenesis were dependent on RANKL concentration (p<0.03). OPG treatment significantly decreased osteoclast formation and NF-kappaB DNA binding activity by PMMA particles in osteoclast precursor cells. CONCLUSION: OPG inhibits activation of osteoclast formation and NF-kappaB DNA binding activity by PMMA particles through RANK-RANKL pathway.
Animals ; Bone Marrow ; Cells, Cultured ; DNA ; Electrophoretic Mobility Shift Assay ; Mice ; Mice, Inbred C57BL ; NF-kappa B* ; Osteoclasts* ; Osteoprotegerin ; Polymethyl Methacrylate*

Saponin has been known to be a major antioxidant component in panax ginseng. Recent experimental study suggests that some antioxidant materials prevent Parkinson's disease caused by 1-methyl-4-phenyl-1,2,3,6- tetrahydropyridine (MPTP) in an animal model. The present study was performed to demonstrate the effect of ginseng saponins in the Parkinson's disease model induced by MPTP. To verify the effect of ginseng saponin on dopaminergic neurons in the mice brain, the tyrosine hydroxylase-immunoreactive (TH-ir) neurons were observed by immunohistochemical stain and immunoelectron microscopy (preembedding method). Also, in order to estimate the immunoreactivity of dopaminergic neuropils, they were quantified by image analysis. The number of TH-ir neurons of substantia nigra was significantly increased in the high-dose (0.46 mg/kg) ginseng saponin group compared with the MPTP injected group. The immunoreactivity of TH-ir neuropils in striatum was significantly increased in both high and low-dose (0.1 mg/kg) ginseng saponin groups compared with the MPTP injected group. In immunoelectron microscopic observation, TH-ir neurons of the control and both ginseng saponin injected group showed normal nuclei and well preserved cytoplasmic organelles. In the MPTP injected group, dying dopaminergic neurons showed destroyed nuclei and cytoplasmic organelles. These results suggest that ginseng saponin has a protective effect on the Parkinson's disease model induced by MPTP.
1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine ; Animals ; Brain ; Cytoplasm ; Dopaminergic Neurons* ; Mice* ; Microscopy, Immunoelectron ; Models, Animal ; Neurons ; Neuropil ; Organelles ; Panax* ; Parkinson Disease* ; Saponins* ; Substantia Nigra ; Tyrosine ; Tyrosine 3-Monooxygenase