Complications of tracheal intubation are well documented. However, iatrogenic aspiration of a broken metallic stylet following tracheal intubation has been infrequently reported. A 60-year-old woman, 10 days after shoulder arthroscopic surgery under endotracheal general anesthesia, was admitted to our hospital because of right chest pain. Chest radiographs showed a 8 cm length of metallic foreign body in the lower lobe of the right lung. Attempts at retrieval, including thoracoscopy, were unsuccessful. Open thoracostomy was performed. The removed foreign body was a part of metallic stylet. We report a case of iatrogenic aspiration of a broken metallic stylet.
Anesthesia, General ; Arthroscopy ; Chest Pain ; Female ; Foreign Bodies ; Humans ; Intubation ; Lung ; Middle Aged ; Radiography, Thoracic ; Shoulder ; Thoracoscopy ; Thoracostomy

Primary liposarcoma of the lung is an extremely rare disease. To date, only 14 cases have been reported in the literature. We experienced a case of myxoid liposarcoma of the lung treated by surgery. The tumor was well-defined, solid, lobulated mass measuring 3.5x2 cm, involving the bronchus of the left lower lobe. Microscopically, myxoid liposarcoma was identified. The fluorescence in situ hybridization confirmed the presence of a reciprocal translocation involving DNA damage-inducible transcript 3 (DDIT3) and fused in sarcoma (FUS) genes. The patient is still alive with no recurrence or metastasis at the time of writing this report (on 20 months postoperatively). To our knowledge, this is the first cytogenetic case report of pulmonary myxoid liposarcoma.
Bronchi ; Cytogenetics ; DNA ; Female ; Fluorescence ; Humans ; In Situ Hybridization ; In Situ Hybridization, Fluorescence ; Liposarcoma ; Liposarcoma, Myxoid ; Lung ; Neoplasm Metastasis ; Rare Diseases ; Recurrence ; Sarcoma ; Writing

PURPOSE: This study was performed to evaluate the relation between nodal micrometastasis and tumor angiogenesis, and to assess potential molecular markers pertaining to the development of nodal micrometastasis. MATERIALS AND METHODS: Immunohistochemical studies were performed to evaluate the expression patterns of Phosphatase, and its Tensin homolog, deleted from chromosome TEN (PTEN), and the vascular endothelial growth factor (VEGF) and microvessel density (MVD) in 41 stage I non-small cell lung cancer (NSCLC), using anti-PTEN monoclonal, anti-VEGF polyclonal and anti-CD34 monoclonal antibodies, respectively. The occult micrometastasis in 503 dissected regional lymph nodes were also evaluated using anti-cytokeratin (CK) monoclonal antibody. RESULTS: CK positive cells were identified in 13 (31.7%) of the 41 cases and in 23 (4.6%) of the 503 lymph nodes. There were 19 and 22 cases with positive and negative VEGF expressions, respectively, and 10 (52.7%) and 3 (13.6%) of these, respectively, showed nodal micrometastasis (p<0.05). There were 9 cases with loss of PTEN expression, and 4 of these showed nodal micrometastasis, whereas 9 (21.8%) of 32 positive PTEN expression cases showed nodal micrometastasis (p<0.05). The MVD in the tumors with nodal micrometastasis was 60.4+/-22.6, whereas that in the tumors without nodal micrometastasis was 52.0+/-18.2. The loss of PTEN expression, an increased VEGF expression and a high MVD, within primary tumors, were significantly associated with nodal micrometastasis. CONCLUSION: The results indicate a possible value in using these biological markers, associated with tumor angiogenesis, for predicting the risk of nodal micrometastasis in NSCLC.
Antibodies, Monoclonal ; Biomarkers ; Carcinoma, Non-Small-Cell Lung* ; Humans ; Lymph Nodes* ; Microvessels ; Neoplasm Micrometastasis* ; Vascular Endothelial Growth Factor A

BACKGROUND: This study was performed to examine the significance of the circumferential resection margin (CRM) involvement by a tumor on the postoperative survival after esophageal cancer surgery. METHODS: Fifty nine resected cases of esophageal cancers were retrospectively reviewed. The presence of a tumor either at, or within 1 mm of, the CRM was recorded. By an immunohistochemical study for Ki-67, the Ki-67 differential grades (Ki-67 DG) were defined according to the differences between the Ki-67 labeling indices of the central and of peripheral areas of the tumor nearest to the CRM: Ki-67 DG 0 (< or =10%) and Ki-67 DG 1 (>10%). The CRM involvement was correlated with the clinicopathological factors, Ki-67 DG and survival data. RESULTS: CRM involvement was found in 26 (44.1%) of the 59 cases. There were significant differences in the cases, both with and without CRM involvement of tumor cells, in relation to lymph node metastasis, lymphovascular, perineural invasions and tumor stage (p<0.05). Ten (38.3%) of the 26 with, and 3 (9.1%) of 33 cases without, CRM involvement, showed Ki-67 DG 1 (p=0.007). The 3-year survivals of patients with and without CRM involvement were 26.8 and 61.8%, respectively (p=0.003). CONCLUSIONS: These results show that the CRM involvement status may be used as a predictor of survival after esophageal cancer surgery, and CRM involvement is more an indicator of an advanced disease than of an incomplete resection.
Esophageal Neoplasms* ; Esophagectomy* ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies

We have reviewed 1211 burn patients who had visited our emergency department of Keimyung University Dongsan medical center between April 1995 to March 1997. The following results were obtained; 1) On age and sex distribution, the highest incidence of age group was under 10 year and old in 321 cases(26.5%). Male was affected more frequently than female, the incidence being 847 cases(70.1%) and 364 cases(29.9%). The ratio of male to female was 2.3:1. 2) No monthly and seasonal differences could be recognized. We found winter season having the highest 319 cases(26.3%), followed by autumn, spring and summer. 3) An analysis of causes in burns showed that flame burns were 527 cases(43.1%), scalding burns, 486 cases(40.2%), electrical burns, 96 cases(8.1%) and chemical burns, 48 cases(4.1%). 4) Domestic accidents accounted for 639 cases(52.7%), occupational for 286 cases(23.6%), traffic accidents for 160 cases(13.2%), suicides for 122 cases(10.1%), formentation for 4 cases(0.4%). 5) Most of patients 699 cases(57.7%) were affected with 2nd degree burn in depth, 1st degree for 413 cases(34.1%) and 3rd degree for 99 cases(8.2%). 6) The trunk was the anatomical region most commonly affected followed by upper and lower limbs. 7) 243 cases(20.5%) of all were accompanied by some complications. The main complications were would infection noted in 212 cases(17.5%), pneumonia in 179 cases(14.8%), acute renal failure in 160 cases(13.2), contracture in 155 cases(13.0), urinary tract infection in 24 cases(2.0%), Curling ulcer in 20 cases(1.6%) in order. 8) The over-all mortality rate was 73 cases(6.1%). The mortality rate of the patients with inhalation injury were 33 cases(45.3%). Causes of death were due to sepsis in 54 cases(4.5%), ARDS in 11 cases(0.9%), acute renal failure in 5 cases(0.4%), upper GI bleeding in 2 cases(0.2%), purmonary edema in 1 cases(0.1%).
Accidents, Traffic ; Acute Kidney Injury ; Burns* ; Burns, Chemical ; Cause of Death ; Contracture ; Duodenal Ulcer ; Edema ; Emergency Service, Hospital ; Female ; Hemorrhage ; Humans ; Incidence ; Inhalation ; Lower Extremity ; Male ; Mortality ; Pneumonia ; Seasons ; Sepsis ; Sex Distribution ; Suicide ; Urinary Tract Infections

This study was designed retrospectively to evaluate Ranson's criteria and APACHE II scores as a predictor of mortality in patients with acute pancreatitis. Acute pancreatitis is a common disorder. From mild disease to multiorgan failure, it is a disorder that has numerous causes, an obscure pathogenesis. An accurate history and through physical examination will often raise clinical suspicion of acute pancreatitis in the differential diagnosis of a patient with acute abdominal pain. The retrospective analysis by chart review of 86 cases of acute pancreatitis who visited emergency department of Dongsan hospital from Jan to Dec 1996. The results were as follows. The majority of the patients with acute pancreatitis presented with chief complaints of abdominal pain. The male patient outnumbered female by the ratio of 2.9:1. The highest incidence of age group was between 40 and 50. The majority of our patients had past histories of either chronic alcoholic or gallbladder problems e.g.. the number being 53 cases(61.6%) and 31 cases(36%) respectively. Among 7 patients who had changes in consciousness, 5 were expired. Of those expired, 3 patients had less than 90 mmHg of systolic blood pressure. The overall mortality rate was 10.5%(9 cases). It has been known that acute pancreatitis would be the results of traumatic and non-traumatic causes. The exact mechanism of its pathophysiolgy has not been known yet, but it has been well known that the majority of patients who in forties and fifties had history of alcoholic abuse, the rest being mainly gallbladder problem and, some other diseases implicated too. The relationship of acute pancreatitis with familiar Ranson's criteria was such that 3 patients of the Ranson's out of 9 death were noted to have more than 3 of the criteria, but another 3 had less than 3. Among the 60 patients in whom the required physiologic variables were available out of total 86 patients studied, 9 were expired and 51 survived, average APACHE II scores for the survival and the expired being 6.92+/-3.99 & 18.11+/-5.68 respectively (P<0.05). We concluded that the APACHE II score could be used to better than Ranson's criteria to predict hospital mortality in patients with acute pancreatitis.
Abdominal Pain ; Alcoholics ; APACHE ; Blood Pressure ; Consciousness ; Diagnosis, Differential ; Emergency Service, Hospital ; Female ; Gallbladder ; Hospital Mortality ; Humans ; Incidence ; Male ; Mortality ; Pancreatitis* ; Physical Examination ; Retrospective Studies

The occurrence of lung cancer in patients suffering with pneumothorax is very rare, especially in the absence of any radiological changes that would suggest neoplasia after the pulmonary reexpansion. We have experienced a case of a 60-year-old male who presented with lung cancer that was discovered by chance after an operation for his pneumothorax. The resected lung tissue showed a 0.3 cm-sized, peripheral squamous cell carcinoma associated with a bulla. The tumor was not macroscopically detected on the first thoracotomy that was performed for the treatment of the pneumothorax. The micronodular cancer was diagnosed after the histological examination of the resected bulla. The patient has been doing well with no evidence of tumor recurrence during the fifteen months follow-up. This case shows that we should always be vigilant for associated lung cancer when we examine the lung tissue after the operation for pneumotherax.
Carcinoma, Squamous Cell* ; Follow-Up Studies ; Humans ; Lung Neoplasms ; Lung* ; Male ; Middle Aged ; Pneumothorax* ; Recurrence ; Thoracotomy

PURPOSE: We conducted a comparative evaluation in the ease of endotracheal intubation when using the Macintosh laryngoscope (ML) versus the new Disposcope endoscope(R) (DE) (Disposcope Taiwan, Hsinchuang city, Taiwan), a video-laryngoscope, during simulated normal airway and manual in-line stabilization of suspected cervical spine injury patients. METHODS: Forty-three medical interns participating in an endotracheal intubation training program used both the DE and the ML as part of their lessons. In each of the two simulated patient scenarios, endotracheal intubation was performed using each endoscope, in random order. The rate of successful intubation, time required for visualizing the glottis, time to complete endotracheal intubation, results of a modified Cormack & Lehane classification (CL grade), and a measure of dental injury were all recorded and analyzed. RESULTS: In the normal airway scenario, there was no difference in the rate of successful completion of intubation (both 100%) between the two endoscopes. Time to complete endotracheal intubation using the DE was shorter than that with the ML (10.7 versus 12.6 sec; p=0 010). In the trauma scenario, despite similar success rates (95.3% in ML versus 100% in DE), the time required to complete endotracheal intubation using the DE was shorter than that with the ML (17.6 versus 24.1 sec; p=0.010). Rate of dental injury using the DE was significantly less than that observed with the ML (0.0% versus 30.2%; p<0.0001). In both scenarios, the DE provided higher achievement of CL grade 1 (93% versus 67.4% in normal airway; p=0.006 and 55.8% versus 0% in trauma airway; p<0.0001). CONCLUSION: Compared to the ML, the DE provided a better view of the glottis, provided decreased dental trauma, and offered faster completion time for endotracheal intubation.
Achievement ; Endoscopes ; Glottis ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopes ; Manikins ; Spine ; Taiwan

BACKGROUND: DNA methylation and histone modification are dynamically linked in the epigenetic control of gene silencing and they play an important role in tumorigenesis. METHODS: To evaluate the role of histone deacetylase 1 (HDAC1) in the development of lung cancer and the relationship between a HDAC1 overexpression and p16INK4a hypermethylation, we performed immunohistochemical staining for HDAC1 in 76 lung cancer specimens (39 squamous cell carcinomas and 37 adenocarcinomas) that had been previously evaluated for their p16INK4a methylation status by real-time quantitative polymerase chain reaction. RESULTS: A HDAC1 overexpression (>50% of HDAC1 immunoreactive cells) was detected in 65 (85.5%) out of the 76 cases and it was more frequently seen in the squamous cell carcinomas (97.4%) than in the adenocarcinomas (73.0%) (p=0.002). The incidence of HDAC1 overexpression tended to be higher in the heavy smokers with more than 20 pack-years (p=0.067). Although there was no statistical significance, the frequency of p16INK4a hypermethylation in the cases with a HDAC1 overexpression (27.7%) tended to be higher than that in the cases without a HDAC1 overexpression (9.0%) (p=0.175). CONCLUSIONS: A HDAC1 overexpression might be involved in lung carcinogenesis, and especially in a subgroup of smoking and squamous cell carcinoma patients, and a HDAC1 overexpression may be associated with p16INK4a hypermethylation.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Cell Transformation, Neoplastic ; Cyclin-Dependent Kinase Inhibitor p16 ; DNA Methylation ; Epigenomics ; Gene Silencing ; Genes, p16 ; Histone Deacetylase 1 ; Histone Deacetylases ; Histones ; Humans ; Incidence ; Lung ; Lung Neoplasms ; Methylation ; Polymerase Chain Reaction ; Smoke ; Smoking

No abstract available.
Chondrosarcoma, Mesenchymal* ; Mediastinum*