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

Bacteriophages were induced from staphylococcus intermedius isolates from dogs and used for a phage typing. Mitomycin C induction was performed on 60 strains of S. intermedius and all phages were reacted with the strains. Twenty-eight strains (46.7%) were found to be lysogenic. Based on host ranges, eight phages were selected. By using the eight phages, 129 strains isolated from canine clinical specimens were subjected to the phage typing at the routine test dilution (RTD) and 100xRTD. Typability of the phage set was 78.3%, yielding 40 phage patterns. The phage set was considered useful for differentiating S. intermedius strains isolated from dogs. None of 50 strains of S. aureus, 2 (3.6%) of 56 S. simulance strains, 13 (24.5%) of 53 S. chromogenes strains and 46 (28.1%) of 164 S. hyicus strains were typable by the phages at 100xRTD.
Animals ; Bacteriophage Typing* ; Bacteriophages* ; Dogs ; Host Specificity ; Mitomycin ; Staphylococcus intermedius* ; Staphylococcus*

PURPOSE: This research used mathematical modeling to project the supply and demand of emergency physicians over the next decade in Korea. METHODS: A model was used to project the annual emergency physicians (EP) workforce supply and demand through the year 2015. The mathematical equations used were as follows: Supply = number of emergency physicians at the beginning of the year plus annual residency graduates minus annual attrition; Demand formula I = 5.29 fulltime equivalent positions/emergency department (ED) x the number of hospital EDs, Demand formula II = annual ED visits/(4,700visits/EP/year), Demand formula III = (11 to 16 EP per major referral ED) + (6 to 8 EP per urban district/ regional hospital ED). RESULTS: While the most conservative demand projection was 1,505 EPs in the year 2015, the most aggressive supply estimate with a yearly supply of 120 new EPs and a 1% attrition rate was 1,362 EPs in that year. CONCLUSIONS: In Korea, emergency physicians will remain in short supply for the next ten years, even at the present levels of EM residency output.
Emergencies* ; Emergency Medicine ; Hospitals ; Internship and Residency ; Korea* ; Models, Theoretical ; Referral and Consultation

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