PURPOSE: We studied CT findings of bronchioloalveolar carcinoma that manifestated varied clinical and radiologic characteristics. MATERIALS & METHODS: We studied presenting radiographic patterns and their characteristics and secondary findings of histologically proven 30 cases of bronchioloalveolar carcinomas on chest CT scan. RESULTS: Bronchioloalveolar carcinoma appeared radiologically as a solitary nodule(19 cases), consolidation (7 cases), and multinodules(4 cases). A solitary nodular type shows irregular or spiculated borders, peripheral or subpleural location, heterogenous density, pleural tags, pseudocavitation, and sometimes rim-enhancement of mass. A consolidation type shows air-brochogram, pseudocavitation and CT anglogram within homogenous low attenuated consolidated lung. Hilar and mediastinal lymphadenopathy as secondary findings of bronchioloalveolar carcioma appeared frequently(43.3%). Even in a solitary nodular form, hilar & mediastinal lymphadenopathy was noted in 36.8% and follow-up study in 6 cases showed lung-to-lung metastasis with 14.7 months in mean metastasis duration. CONCLUSION: It is difficulty in diagnosis of bronchioloalveolar carcioma with clinical or plain radiographic features alone because of theis variability. We found that CT scan can help the diagnosis of this tumor. We also found out that a solitary form of bronchioloalveolar carcioma as well as diffuse form does not have a good prognosis.
Adenocarcinoma, Bronchiolo-Alveolar* ; Diagnosis ; Follow-Up Studies ; Lung ; Lymphatic Diseases ; Neoplasm Metastasis ; Prognosis ; Tomography, X-Ray Computed

An immunohistochemical stain for p53 tumor suppressor gene product was performed in 59 primary lung cancers to study the relation between its expression and type of the tumor, degree of tumor differentiation,clinical stage and smoking. The results were as follows: 1. The expression of mutant p53 protein was noted in 28 of 59 cases(47.5%) of primary lung cancers. The p53 protein was expressed in 21 of 35(60%) squamous cell carcinomas, in 6 of 21(28.6%) adenocarcinomas, and 1 of 1(100%) small cell carcinoma. There was a significant difference in expression of p53 among the different histologic types of lung cancer(p<0.05). 2. The incidence of p53 protein expression did not correlate with the degree of tumor cell differentiation or the clinical stage of lung carcinoma(p>0.05). 3. The incidence of p53 protein expression was higher in smokers(current: 75%, former: 46.2%) than in non-smokers(5.6%) and was increased in direct proportion to the pack years. There was a statistically significant correlation between p53 expression and smoking(p<0.05). The mutation of p53 gene may often be an early event in the development of lung cancer and it is suggested that the smoking known as a risk factor for the development of the lung cancer may be associated with the transformation of p53 tumor suppressor gene into mutant p53 gene or oncogene.
Incidence ; Risk Factors ; Genes, Tumor Suppressor ; Lung Neoplasms

No abstract available.
Nortriptyline* ; Plasma*

A 53-year-old woman presented with dyspnea. She had undergone extended thymectomy for an invasive thymoma two months prior. CT revealed numerous small nodules in the lung. After that, she deteriorated owing to acute respiratory distress syndrome (ARDS), and the vascular surgeon planned veno-venous extracorporeal membrane oxygenation (ECMO). During percutaneous cannulation through the left femoral vein, a vascular injury was suspected, and the patient’s vital signs became unstable. Diagnostic angiography showed a ruptured left common iliac vein, and the bleeding was stopped by placement of a stent-graft. May-Thurner syndrome was diagnosed on abdominal CT. Here, we report a rare case of ECMO-related vascular injury in a patient with an unrecognized anatomical variant, May-Thurner syndrome.

INTRODUCTION: The reconstructions of posterior cruciate ligament (PCL) has been increasing because of increased incidence of insufficiency of the PCL and improved surgical skill Arthroscopic operation is known better than open in cruciate ligamet reconstruction in many respects. Arthroscopic PCL reconstruction, especially using hanstring tendon has some benefits. This study is retrospective study analyzing 20 patients treated by arthroscopically assisted PCL reconstruction using hamstring tendon. ALATERIAL AND METHODS: From November 1993 to June 1996, 20 patients with PCL insufficiency had heen treated by arthroscopically assisted PCL reconstruction using double-looped hamstring (semitendinosus and gracilis) tendon by first author. The isometric point was located slightly posterosuperior than anatomic attachment in femur and 0.8-1.0cm below articular margin in tibia. They were confirmed by intraoperative fluoroscopy. The remnants of intact PCL bundle and meniscofemoral ligaments were preserved and added to the graft. They were nineteen men and one women, with a mean age 31.8 years (range, 15-56 years). RESULTS: The results were as follows; 1. The patients were followed from 13 months to 44 months after operation (average 2years and 2months ). 2. Post operative neurovascular irjuries were not found. 3. No revision case was observed and second operations were made in two cases with posterolateral rotatory instability after primary reconstruction. 4. All patient has no symptom of instability after operation. S. At last follow up, Lyshohn knee scores improved from 62 preoperatively to 89 postoperati.vely on average. CONCLUSION: Arthroscopically assisted PCL reconstruction using double-looped hamstring (semitendinosus and gracilis) tendon is easier and less damage than using bone-patellar tendon-bone graft. It preserves intact meniscofemoral ligament, some intact fibers of PCL bundle and quadriceps mechanism. We think it is a effective treatment for PCL insufficiency patients."
Bone-Patellar Tendon-Bone Grafts ; Female ; Femur ; Fluoroscopy ; Follow-Up Studies ; Humans ; Incidence ; Knee ; Ligaments ; Male ; Posterior Cruciate Ligament* ; Retrospective Studies ; Tendons* ; Tibia ; Transplants

OBJECTIVE: Locking of the knee is usually attributed to a tear of meoiscus, or to a loose body that rnechanically obstructs the motion of joint. A less frequently recognized cause of a locked knee is a partial tear of the ACL. The purpose of this study is to report that the partial tear of,the ACL at the femoral attachment site of posterolateral bundle provided a mechanical obstruction in the knW, and it is convicted the injury mechanism of isolated ACL. MATEIRALS AND METHODS: The author presents 16 cases in which the torn ACL was observed knee locking under arthroscopy fram February 1993 to June 1996. Patients ages ranged from 22 to 54 years. The mechanism of injuries were 6 sports activity (Ski 4, Soccer 1, Badminton 1), 4 slip down, 3 pedestrian car accidents and 3 unknown causes with especially low velocity injuries. Although the chief complain in each case was knee pain, all had locking knee that, on physical examination, locked from 5 to 20 of full extension, and 4 locked full flexion. The positive Lachman test was obtained 3 of the 16 paiients. Associated intraarticular injuries were 2 tears of the medial meniscus, 1 lateral meniscus. RESULTS: The average time to arthroscopy was 3 nonths with a range of 1 month to 10 rnonths. An arthroscopic diagnosis and treatment were performed and meniscal tears were ruled out as the cause of locking in all patients. The injury mechanism of isolated ACL was the hyperextensioo of the knee with leg I/R and especially low velocity injuries. The ACL was found to have a partial tear at the site of femoral attachment of an estimated P-L bundle. The torn segment of the ACL to become interposed between the lateral femoral condyle and the latera1 tibial condyle and to act as mechanical block was demcinstrated. CONCLUSION: In all cases, the torn portion of the ACL was excised under arthroscopy and knee locking was resolved.
Arthroscopy ; Diagnosis ; Humans ; Joints ; Knee* ; Leg ; Menisci, Tibial ; Physical Examination ; Racquet Sports ; Soccer ; Sports

One of the most basic function in brachial plexus injury is the recovery of elbow flexion. So the important purpose in nerve surgery of brachial plexus injury is the recovery of the function of the musculocutaneous nerve. However, failure of the recovery of function of the biceps through surgery or in cases of neglected nerve surgery of more than 1 year needs the consideration of tendon transfer or free vascularized muscle graft. In these failed or neglected brachial plexus injury, flexorplasty is more often indicated because of associated surrounding muscle weakness or paralysis. We analyzed the functional results in brachial plexus injured 12 patients who underwent elbow flexorplasty between June, 1987 and Aug. 1994. In 2 patients, the elbow flexorplasty was augmented by a glenohumeral arthrodesis. The mean length of the follow-up was 52 months. The mean are of active flexion following flexorplasty was 81 degrees. The postoperative active Supination and loss of elbow extension was 40 and 28 degree respectively. At final objective evaluation, 6 patients were judged to have excellent; 2 good; 1 poor; 3 failure. At final subjective evaluation, 3 patients were judged to have excellent; 3 good; 3 failure.
Arthrodesis ; Brachial Plexus ; Elbow ; Follow-Up Studies ; Humans ; Muscle Weakness ; Musculocutaneous Nerve ; Paralysis ; Recovery of Function ; Supination ; Tendon Transfer ; Transplants

No abstract available.
Brain Edema* ; Brain* ; Decompressive Craniectomy*

The foreign bodies in the upper GI tract are produced chiefly by accidental swallowing and rarely produce symptoms. But it is recommended to remove the foreign bodies if they produce symptoms or retained in GI tract for long duration, and if they have the possibilities of producing complications. Nowadays the development of therapeutic endoscopy enables the removal of the foreign bodies easily. We have reviewed 88 cases of foreign bodies diagnosed by endoscopy from January, 1980 to July 1990 and had the following results. 1) The most common foreign bodies were coins and bezoars, common with the ages under 10 years and over 50 years. 2) The foreign bodies were found in the upper gastrointestinal tract in the order of stomach, esophagus and duodenum. 3) The esophageal stricture especially by lye was the most common underlying cause of upper gastrointestinal foreign bodies. 4) The symptoms and complications were more common with esophageal foreign bodies. 5) By therapeutic endoscopy, the success rate for removal of foreign bodies was 98%.
Bezoars ; Deglutition ; Duodenum ; Endoscopy* ; Esophageal Stenosis ; Esophagus ; Foreign Bodies* ; Gastrointestinal Tract ; Lye ; Numismatics ; Stomach ; Upper Gastrointestinal Tract*

No abstract available.
Nortriptyline* ; Pharmacokinetics*