BACKGROUND: Pulmonary hypertension (PH) associated with end stage liver disease is rare but the risk of hemodynamic deterioration during liver transplantation may be high. This study was done to characterize the pulmonary hemodynamics during liver transplantation and to seek the relationship between pulmonary artery pressure (PAP) and other hemodynamic variables. METHODS: One hundred patients undergoing liver transplantation were chosen and we divided patients into normal and PH groups (mean pulmonary artery pressure [MPAP] > 25 mmHg). Hemodynamic data was collected throughout the surgery. Studied variables between groups were analyzed with an unpaired t-test. The relationship between MPAP and other hemodynamic variables was analyzed with a linear regression test. Survival analysis was performed by cumulative survival analysis (Logrank test). RESULTS: Incidence of PH during liver transplantation was 34%, and true PH (pulmonary vascular resistance index [PVRI] > 150 dyne.sec/cm5/m2, MPAP > 25 mmHg) was 7%. MPAP, systemic vascular resistance index, cardiac index, right ventricular ejection fraction, maximum elastance, central venous pressure (CVP), pulmonary artery occlusion pressure (PAOP), and right ventricular end-diastolic volume index were significantly higher in the PH group. In the PH group, right ventricular function curve was abnormal. MPAP correlated significantly with PAOP, and CVP (P < 0.01). One year survival rate showed no significant difference between groups (Logrank test P = 0.49). CONCLUSIONS: Episodes of increased pulmonary artery pressure during liver transplantation was not infrequent. PAP was more dependent on preloads. In patients with high PAP, RV diastolic dysfunction was usually observed. Early mortality rate after liver transplantation was not associated with PH.
Central Venous Pressure ; End Stage Liver Disease ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary ; Incidence ; Linear Models ; Liver Transplantation* ; Liver* ; Mortality ; Pulmonary Artery* ; Stroke Volume ; Survival Rate ; Vascular Resistance ; Ventricular Function, Right

We report a case of a 53-year-old woman with squamous cell carcinoma with lymph node metastasis who has had a recurrent painful bleeding papule on the right toe nail bed with resultant nail plate shedding over the past two years. X-ray and computer tomography examinations showed nearly total destruction of the distal phalanx of the right fifth toe and right inguinal lymph node enlargemet it. A nail bed biopsy specimen disclosed invading tumor masses composed of atypical squamous cells and multiple horn pearls. While squamous cell carcinoma of the nail bed is not usually aggresive and local removal is usually adequate, the possibility that metastasis or invasion of the adjacent phalanx or joint can occur should be kept in mind.
Animals ; Biopsy ; Carcinoma, Squamous Cell* ; Female ; Hemorrhage ; Horns ; Humans ; Joints ; Lymph Nodes* ; Middle Aged ; Neoplasm Metastasis* ; Toes

Moyamoya disease is characterized by progressive stenosis of internal carotid artery and shows unique angioraphic findings. Its etiology is still unknown, and theories of immunophysiologic and inflammatory mechanisms remain unproven. These patients show various neurologic symptons by cerebral ischemia, infarction and gemorrhage. and they also show various ophthalmologic symptoms. We experienced that a 21-year-old female who was diagnosed to have moyamoya disease presented with a suddenly developed occipital headache and neurologic deficit. The etiology of her characteristic fundus findings was thought to be retinal vascular insufficiency.
Brain Ischemia ; Carotid Artery, Internal ; Constriction, Pathologic ; Female ; Financial Management* ; Headache ; Humans ; Infarction ; Moyamoya Disease* ; Neurologic Manifestations ; Retinaldehyde* ; Young Adult

We investigated the effects of prolonged exposure in hot environmental condition and ingestion of fluid on various physiological variables including plasma glucose, lactate, the rating of perceived exertion (RPE), and heart rate as well as golf putting performance. Six male professional golfers were voluntarily participated in three different putting trials which were separated by seven days of time interval period. Three different putting trials were conducted at either 20degrees C or 32degrees C, or 32degrees C + Fluid ingestion. Performing 32degrees C + Fluid ingestion trial, all subject ingested sport drink as much as their body mass was decreased. For each experiment, all subjects were undertaken total 48 putting, which separated by four x 12 putting in four different time points (i.e., Rest, 1 hr, 2 hr, and 3 hr). Plasma glucose concentration was significantly decreased with hot ambient condition but it was almost fully recovered by fluid ingestion. Plasma lactate concentration was significantly higher when subjects were exposed in hot environmental condition, and it did not change with fluid ingestion. There was a no different in putting performance and psychological fatigue level (performed by GRID test) at any environmental conditions. The RPE, commonly used for evaluating of physical fatigue level, was significantly dropped by fluid ingestion which indicates lower physical fatigue level. In addition to this, heart rate (HR) was also significantly decreased after fluid ingestion. Based on these results, it was concluded that the ingestion of fluid during prolonged exposure in hot ambient condition decrease the degree of physical fatigue levels and heart rate, which will possibly improve the golf performance when exposed in extreme weather condition in summer.
Blood Glucose ; Eating* ; Fatigue* ; Golf ; Heart Rate* ; Heart* ; Humans ; Lactic Acid ; Male ; Plasma ; Sports* ; Weather

OBJECTIVES: We report a case of pure epidural cavernous hemangioma located at the thoracolumbar spine in a 53-year-old woman that mimicked a neurogenic tumor on magnetic resonance imaging (MRI).SUMMARY OF LITERATURE REVIEW: A pure spinal epidural cavernous hemangioma without bony involvement is a very rare lesion about which limited information is available in the literature. MATERIALS AND METHODS: A 53-year-old woman visited our clinic for hypoesthesia with a tingling sensation in the left anterolateral thigh that had begun a month ago. No other neurologic symptoms or signs were present upon a neurologic examination. MRI from an outside hospital showed a 2.0×0.5 cm elongated mass at the T11-12 left neural foramen. The tumor was completely removed in piecemeal fashion. RESULTS: The histopathologic examination revealed a cavernous hemangioma, which was the final diagnosis. The outcome was favorable in that only operation-related mild back pain remained, without any neurologic deficits, after a postoperative follow-up of 2 years and 3 months. No recurrence was observed on MRI at 2 years postoperatively. CONCLUSION Pure epidural spinal cavernous hemangioma is very rare, and it is very difficult to differentiate from other epidural lesions. However, we believe that it should be included in the differential diagnosis of spinal epidural tumors due to its favorable prognosis.

STUDY DESIGN: Case report. OBJECTIVES: We report a case of pure epidural cavernous hemangioma located at the thoracolumbar spine in a 53-year-old woman that mimicked a neurogenic tumor on magnetic resonance imaging (MRI). SUMMARY OF LITERATURE REVIEW: A pure spinal epidural cavernous hemangioma without bony involvement is a very rare lesion about which limited information is available in the literature. MATERIALS AND METHODS: A 53-year-old woman visited our clinic for hypoesthesia with a tingling sensation in the left anterolateral thigh that had begun a month ago. No other neurologic symptoms or signs were present upon a neurologic examination. MRI from an outside hospital showed a 2.0×0.5 cm elongated mass at the T11-12 left neural foramen. The tumor was completely removed in piecemeal fashion. RESULTS: The histopathologic examination revealed a cavernous hemangioma, which was the final diagnosis. The outcome was favorable in that only operation-related mild back pain remained, without any neurologic deficits, after a postoperative follow-up of 2 years and 3 months. No recurrence was observed on MRI at 2 years postoperatively. CONCLUSION: Pure epidural spinal cavernous hemangioma is very rare, and it is very difficult to differentiate from other epidural lesions. However, we believe that it should be included in the differential diagnosis of spinal epidural tumors due to its favorable prognosis.
Back Pain ; Diagnosis ; Diagnosis, Differential ; Epidural Neoplasms ; Female ; Follow-Up Studies ; Hemangioma, Cavernous ; Humans ; Hypesthesia ; Magnetic Resonance Imaging ; Middle Aged ; Neurologic Examination ; Neurologic Manifestations ; Prognosis ; Recurrence ; Sensation ; Spine ; Thigh ; Thoracic Vertebrae

PURPOSE: To evaluate the MR imaging findings of chondrosarcomas by correlation with pathologic classificationand grade. MATERIALS AND METHODS: We performed MR imaging-pathologic correlation of nineteen chondrosarcomas. Conventional chondrosarcomas accounted for 15 cases (grade I : 6, II : 6, III : 3) and the mesenchymal and dedifferentiated types each accounted for two. MR signal intensity (SI) of the tumor on T1- and T2-weighted images(T1WI and T2WI, respectively), was classified as homogeneous or heterogeneous low-, iso- or high SI, and enhancing pattern as marginal, marginal and septal, marginal and nodular, or diffuse enhancement. RESULTS: Eighteen cases of chondrosarcomas (95%) showed homogeneous or heterogeneous low- or iso SI on T1WI and high SI on T2WI. Low gradeconventional chondrosarcomas showed marginal and septal (n=8/10) or marginal (n=2/10) enhancement on Gd-enhanced MR images. Grade III conventional chondrosarcomas showed marginal or marginal and nodular enhancement. Dedifferentiated and mesenchymal chondrosarcomas showed marginal and nodular or diffuse enhancement. CONCLUSION: Chondrosarcomas showed iso- or low SI on T1WI and high SI on T2WI. Marginal and septal enhancement was demonstrated on Gd-enhanced MR images of grade I and II conventional chondrosarcomas. If a tumor showed amarginal and nodular or diffuse enhancing pattern, this suggested it was a of high grade chondrosarcoma.
Chondrosarcoma* ; Chondrosarcoma, Mesenchymal ; Classification* ; Gadolinium ; Magnetic Resonance Imaging*

No abstract available.

BACKGROUND: The purpose of this study was to determine the possibility and safety of performing carotid endarterectomy under cervical plexus block. METHODS: Carotid endarterectomy was performed in 30 cases with deep and superficial cervical plexus block, to monitor the patient for cerebral ischemia in the awake state. The toy horn was placed in the contralateral hand in each case and was activated by the patient on command and patients had counted ten repeatedly during carotid clamping. Patients who had not been experienced in the change of mental status or motor response had been operated without a shunt. RESULTS: Cerebral ischemia requiring shunt was observed in one case (3.3%). There were no permanent neurologic deficit and major cardiovascular complication and mortality. CONCLUSIONS: Carotid endarterectomy under cervical plexus block allows direct and precise observation of the patient's central nervous system function during the operation.
Animals ; Brain Ischemia ; Central Nervous System ; Cervical Plexus* ; Constriction ; Endarterectomy, Carotid* ; Hand ; Horns ; Humans ; Mortality ; Neurologic Manifestations ; Play and Playthings

We evaluated the effects of previous pulmonary tuberculosis (TB) on the risk of obstructive lung disease. We analyzed population-based, the Second Korea National Health and Nutrition Examination Survey 2001. Participants underwent chest X-rays (CXR) and spirometry, and qualified radiologists interpreted the presence of TB lesion independently. A total of 3,687 underwent acceptable spirometry and CXR. Two hundreds and ninty four subjects had evidence of previous TB on CXR with no subjects having evidence of active disease. Evidence of previous TB on CXR were independently associated with airflow obstruction (adjusted odds ratios [OR] = 2.56 [95% CI 1.84-3.56]) after adjustment for sex, age and smoking history. Previous TB was still a risk factor (adjusted OR = 3.13 [95% CI 1.86-5.29]) with exclusion of ever smokers or subjects with advanced lesion on CXR. Among never-smokers, the proportion of subjects with previous TB on CXR increased as obstructive lung disease became more severe. Previous TB is an independent risk factor for obstructive lung disease, even if the lesion is minimal and TB can be an important cause of obstructive lung disease in never-smokers. Effort on prevention and control of TB is crucial in reduction of obstructive lung disease, especially in countries with more than intermediate burden of TB.
Adolescent ; Adult ; Aged ; Female ; Humans ; Lung Diseases, Obstructive/*etiology ; Male ; Middle Aged ; Odds Ratio ; Questionnaires ; Radiography, Thoracic ; Republic of Korea/epidemiology ; Respiratory Function Tests ; Risk Factors ; Spirometry ; Tuberculosis, Pulmonary/*complications/*epidemiology/pathology ; Young Adult