BACKGROUND: The implementation of intraoperative normovolemic hemodilution is a strategy used in an attempt to diminish the need for or obviate allogeneic transfusion and to avert the potential complications. The goal of this study was to evaluate the safety and efficacy of moderate intraoperative normovolemic hemodilution. METHODS: Fifteen patients scheduled for posterolateral spinal fusion underwent intraoperative normovolemic hemodilution with 10% pentastarch to a target hematocrit level of 25% (hemodilution group). All units of blood procured by hemodilution and additional allogeneic blood was transfused in the perioperative period to maintain the hematocrit level of>25%. We investigated the effect of hemodilution on whole blood coagulation as measured by the thromboelastography and, evaluated its efficacy of decreasing the need for allogeneic blood transfusion as compared to the nonhemodilution group, retrospectively. RESULTS: Hemodilution with pentastarch caused a decrease in response and coagulation time (p<0.01) but did not influence on the alpha angle and maximum amplitude on thromboelstogram. Amount of transfusion of allogeneic blood was 4.1 1.7 units for the hemodilution group and 5.0 1.5 units for the nonhemodilution group. Net red blood cell volume ""saved"" from hemodilution was about 120 ml. CONCLUSION: Moderate intraoperative normovolemic hemodilution with pentastarch does not affect the coagulability of whole blood. But its efficacy of decreasing the need for allogeneic blood transfusion is minimal.
Blood Coagulation ; Blood Transfusion ; Erythrocytes ; Hematocrit ; Hemodilution* ; Humans ; Hydroxyethyl Starch Derivatives ; Perioperative Period ; Retrospective Studies ; Spinal Fusion* ; Thrombelastography

Subungual exostosis are not uncommon, however, they are infrequently mentioned in the dermatologic literature. We report herein a rase of subungual exostosis in the great toe of 16-year-old female student which was confirmed by histopathologic and radiologic findings. Histopathologic examination showed that the mass was ooeered by a dense fibrous tissue which merged into a fibrocartilage cap and bone. Computed tomography showed a well defined, oval shaped, radiopacity of bony density capped by a radiolucency.
Adolescent ; Exostoses* ; Female ; Fibrocartilage ; Humans ; Toes

The leiomyoma of the vagina is relatively rare benign solid tumor, and majority of them were not recognized until after operation. Variable opinion exists as to the exact origin of this lesion. The most frequent location is the anterior vaginal wall. Recently we experienced a case of vaginal leiomyoma arising in the anterior vaginal wall and now we present it with a brief review of the literatures.
Leiomyoma* ; Vagina*

PURPOSE: The aim of our study was to identify the CT features helpful in the differential diagnosis of Iobar consolidation. MATERIALS AND METHODS: We evaluated the CT findings in 52 consecutive patients with Iobar consolidation which were proved to be pulmonary tuberculosis(n=24), malignant obstructive pneumonitis due to bronchogenic carcinoma(n=21), and lung abscess(n=7). We retrospectively reviewed CT scans with respect to 1) number of cavities or low attenuation area suggesting necrosis(we described these as cavity), 2) the contour of cavity, 3) enhancement of the cavity wall, 4) enhancement of pleura, 5) small nodules adjacent to the consolidation, 6) similar lesion in other location in lung, 7) air-bronchogram 8) mediastinal lymph node enlargement, and 9) extrapleural change. RESULTS: The helpful CT fingings in the patients with pulmonary tuberculosis were multiple cavities(more than three;79.2%), small nodules adjacent to the Iobar consolidation(75.0%), similar lesion in another lobe or lung(91.7%), air-bronchogram(91.7%), and mediastinal lymph node enlargement(58.3%). Although extrapleural change had low sensitivity it was highly specific for pulmonary tuberculosis(sensitivity, 43.5%;specificity, 91. 7%). Multiple cavities(61.9%) and mediastinal lymph node enlargement(52.4%) were common findings of malignant obstructive pneumonitis. In the patients with lung abscess, the common findings were small number of cavities(one or two, 85.7%) and air-bronchogram(85.7%). However, other findings of pulmonary tuberculosis were rarely seen in the patients with malignant obstructive pneumonitis or lung abscess. CONCLUSION: The CT findings of Iobar consolidation may be used as useful adjuncts in the differential diagnosis of Iobar consolidation.
Diagnosis, Differential ; Humans ; Lung Abscess* ; Lung* ; Lymph Nodes ; Pleura ; Pneumonia* ; Retrospective Studies ; Tomography, X-Ray Computed ; Tuberculosis* ; Tuberculosis, Pulmonary

The diagnosis of insulinoma is made primarily by the detection of an inappropriately elevated serum insulin level in the presence of a low blood glucose level. The successful resection of insulin-secreting islet cell turnors is greatly facilitated by accurate preoperative localization. But, the modalities of ultrasonography, computer tomography, magnetic resonance imaging and selective arteriography often fail to detect insulinoma smaller than 1.5 cm in diameter. In this report, we describe a patient with an insulinoma successfully localized by percutaneous transhepatic portal vein sampling but not by abdominal ultrasonography, computer tomography and selective arteriography. Percutaneous transhepatic portal vein catheterization with insulin sampling showed sudden step-up of insulin concentrations near 6 cm from distal splenic vein. During operation, a 1×1.3cm sized tumor was found at the junction of body and tail of pancreas, so distal pancreatectomy was performed, We propose that preoperative percutaneous transhepatic portal vein catheterization with measurement of radioimmunoactive insulin concentration is a safe and reliable method and plays an important role to localize insulinoma that are considered occult after conventional diagnostic studies have been negative.
Angiography ; Blood Glucose ; Catheterization ; Catheters ; Diagnosis ; Humans ; Insulin ; Insulinoma ; Islets of Langerhans ; Magnetic Resonance Imaging ; Methods ; Pancreas ; Pancreatectomy ; Portal Vein ; Splenic Vein ; Tail ; Ultrasonography

No abstract available.
Cryptococcosis* ; Humans

Granular cell tumor is a relatively uncommon and usually benign neoplasm of the soft tissue. Most cases are benign, and only over 40 cases of malignant granular cell tumors were reported by the presence of metastases in the world literature. A 54-year-old woman with cough, mild exertional dyspnea and abnormal chest radiography was admitted to our hospital. Four years ago, the patient underwent a surgical excision of the mass at the left thigh. The lesion was diagnosed as a granular cell tumor. Chest and abdominal CT scans showed multiple variable sized pulmonary and hepatic nodules. Multiple osteoblastic and osteolytic bone lesions were also noted on chest and abdominal CT scans. Ultrasonography-guided biopsy of the pulmonary and hepatic nodule were done. The histologic examination revealed a tumor growing in nests and sheets. Tumor cells contained abundant eosinophilic granular cytoplasm which was PAS-positive and resistant to diastase digestion. After histologic examination, we diagnosed as a malignant granular cell tumor. We report a case of malignant granular cell tumor with multiple pulmonary, bone and hepatic metastases.
Amylases ; Biopsy ; Cough ; Cytoplasm ; Digestion ; Dyspnea ; Eosinophils ; Female ; Granular Cell Tumor* ; Humans ; Middle Aged ; Neoplasm Metastasis ; Osteoblasts ; Radiography ; Soft Tissue Neoplasms ; Thigh ; Thorax ; Tomography, X-Ray Computed

PURPOSE: We attempted to determine the frequency of the type of anterior diaphragm and diaphragmatic abnormalities, and to ascertain whether these two may be correlated with respiration and patient's age. MATERIALS AND METHODS: Two hundred abdominal CT scans that were obtained at end expiration and 150 chest CT scans that were obtained at end inspiration were retrospectively reviewed for the evaluation of anterior diaphragmatic appearance, diaphragmatic defect, pseudotumor, and undulation. We evaluated the frequency of these findings and the differences of diaphragmatic appearance between the group above 60 years and the group under 59 years. RESULTS: The most common type of anterior diaphragm was lower(50.0%) on chest CT scans and superior (32.5%) on abdominal CT scans;thus, a significant relationship with respiration was observed. Diaphragmatic defect, pseudotumor, and undulation were found in 15.1%, 16.0%, 22.6% of all 350 patients, respectively. Diaphragmatic defect did not change significantly with the respiration or the type of anterior diaphragm. Pseudotumor and undulation, which were more common on chest CT scans and the lower type of anterior diaphragm, demonstrated a trend to change with respiration. Diaphragmatic defect, pseudotumor, and undulation were more common in older age above 60 years(26.4%, 23.6%, 36.8%, respectively) than in under 59 years(7.3%, 10.7%, 12.6%, respectively). CONCLUSION: Anterior diaphragmatic appearances may not be constant but may change with respiration. Respiration and aging process may be the main causes of diaphragmatic abnormalities.
Aging ; Diaphragm* ; Humans ; Respiration ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUND: Diagnosis of tuberculous pleurisy is sometimes difficult using conventional diagnostic methods. We have investigated the utility of pleural fluid cell IFN-gamma production assay in the diagnosis of tuberculous pleurisy. METHODS: We prospectively performed pleural fluid cell IFN-gamma production assay in 39 patients with tuberculous pleural effusions (TPE) and in 26 patients with nontuberculous pleural effusions (NTPE) (13 malignant pleural effusions and 13 parapneumonic effusions). Pleural fluid cells were cultured in DMEM media and stimulated with purified protein derivatives (PPD), and phytohemagglutinin (PHA) for 24 hr. The amount of IFN-gamma released in the culture supernatant was quantitated by IFN-gamma ELISA assay. We have also measured adenosine deaminase (ADA) activities and IFN-gamma concentrations in the pleural fluid. RESULTS: 1) The pleural fluid levels of ADA activity and IFN-gamma concentrations were significantly higher in TPE than NTPE (p<0.01). 2) IFN-gamma production in TPE cells stimulated by PPD (755,266+/-886,636 pg/ml) was significantly higher than NTPE cells (3,509+/-6,980 pg/ml) (p<0.01). By considering the fact that IFN-gamma concentrations over 10,000 pg/ml is a criteria for the diagnosis of TBE, sensitivity and specificity of the test were 97.4 and 92.3%, respectively. 3) The ratios of IFN-gamma production by the stimulation with PPD and PHA (PPD/PHA) were significantly higher in TPE cells (59+/-85) than NTPE cells (5+/-18)(p<0.01). Considering the criteria for the diagnosis of TBE as PPD/PHA ratio over 5, sensitivity and specificity of the test were 76.9 and 92.3%, respectively. CONCLUSION: Pleural fluid cell IFN-gamma production assay may be useful for the diagnosis of tuberculous pleurisy.
Adenosine Deaminase ; Diagnosis* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Pleural Effusion ; Pleural Effusion, Malignant ; Pleurisy ; Prospective Studies ; Tuberculosis ; Tuberculosis, Pleural*

BACKGROUND: Preoxygenation is routine prior to rapid sequence induction of general anesthesia for a cesarean section. The aim of this study was to evaluate the preoxygenation techniques of tidal volume breathing (TVB) and deep breathing (DB) for a cesarean section. METHODS: One hundred twenty ASA I and II patients scheduled for a cesarean section under general anesthesia participated in the study. Preoxygenation was performed with 5, 7, and 10 L/min 100% oxygen. The following techniques were tested: 1) normal TVB for a 5-min period (TVB/5 min) and 2) DB for a 2-min period (4 DB/0.5 min, 8 DB/min, 12 DB/1.5 min and 16 DB/2 min). Inspired (FIO2) and end-tidal oxygen fraction (FETO2), end-tidal carbon dioxide pressure (ETCO2) and oxygen saturation (SpO2) were measured at 0.5-min intervals. RESULTS: During TVB, FETO2 increased rapidly between 0.5 and 3.5 min and plateaued by 3.5 min at 78.5%, 83.3% and 90.8% with 5, 7 and 10 L/min 100% oxygen, respectively. Four DB/0.5 min increased FETO2 to 64.7%, 67.2% and 72.3% at 5, 7, and 10 L/min 100% oxygen, respectively. As compared with four DB/0.5 min, the values of FETO2 with TVB/1.5 min and TVB/2 min were high at 7, 10 and 5 L/min 100% oxygen. CONCLUSIONS: We concluded that TVB/2 min was more effective than four DB/0.5 min in achieving preoxygenation but eight DB/min could be used in case of an emergent operation.
Anesthesia, General ; Carbon Dioxide ; Cesarean Section* ; Female ; Humans ; Oxygen ; Pregnancy ; Respiration* ; Tidal Volume*