Submucosal infiltration and the topical application of epinephrine as a vasoconstrictor produce excellent hemostasis during surgery. The hemodynamic effects of epinephrine have been documented in numerous studies. However, its metabolic effects (especially during surgery) have been seldom recognized clinically. We report two cases of significant metabolic effects (including lactic acidosis and hyperglycemia) as well as hemodynamic effects in healthy patients undergoing orthognathic surgery with general anesthesia. Epinephrine can induce glycolysis and pyruvate generation, which result in lactic acidosis, via β2-adrenergic receptors. Therefore, careful perioperative observation for changes in plasma lactate and glucose levels along with intensive monitoring of vital signs should be carried out when epinephrine is excessively used as a vasoconstrictor during surgery.
Acidosis, Lactic* ; Administration, Topical ; Anesthesia, General ; Anesthesia, Local ; Epinephrine ; Glucose ; Glycolysis ; Hemodynamics ; Hemostasis ; Humans ; Lactic Acid ; Orthognathic Surgery* ; Plasma ; Pyruvic Acid ; Vital Signs

BACKGROUND: The late results of repair of tetralogy of Fallot(TOF) are favorable in most patients. Some portion of the patients with tetralogy, however, require reoperation for residual lesions or result in late death. The outcome of patients after tetralogy repair performed during the past 13 years was studied, with an emphasis on postrepair survival and problems including reoperations. MATERIAL AND METHOD: A retrospective review of clinical, echocardiographic and catheterization data was performed in 569 of 775 patients with TOF who underwent corrective repair between 1983 and 1995 at Sejong General Hospital, Buchon, Korea. RESULT: Of 28(4.9%) early deaths(defined as 30 days postrepair), 12 deaths(42.9%) were <1 year of age, with an operative mortality of 15.4%. The surviving 541 patients(age 2.8 months to 43.4 years, median 23 months) have been followed up from 1 month to 12.6 years(median 35 months) postoperatively. Most patients were in good functional class and had normal right ventricular(RV) function. Postrepair results were compared between the transatrial-transpulmonary approach and the conventional right ventriculotomy. The former technique provided a lesser incidence of significant pulmonary regurgitation(p<0.001) and alesser degree of RV dysfunction(p<0.05) compared with those in the latter. There were 10(1.8%) late deaths during the follow-up period and 6 of the deaths were directly related to reoperation or ventricular dysfunction. The 10-year actuarial survival rate was 96.7%. There were 44 reoperations(8.1%) in 39 patients(7.2%), with an operative mortality of 10.3%. The main indications or reoperation included residual ventricular septal defect(VSD) (n=6), pulmonary stenosis(PS) (n=11), VSD with PS(n=17), pulmonary regurgitation(n=7), and tricuspid regurgitation(n=2). The 5- and 10-year freedom from reoperation were 89.4% and 76.1%, respectively. CONCLUSION: Although the majority of patients with repaired TOF are clinically well, with a high rate of survival, approximately 7% of patients have residual lesions that require surgical therapy. Therefore, the timely and meticulous corrective repair is mandatory to avoid reoperation, and continued close surveillance is also needed for the early detection of residual problems.
Catheterization ; Catheters ; Echocardiography ; Follow-Up Studies ; Freedom ; Hospitals, General ; Humans ; Incidence ; Korea ; Mortality ; Reoperation ; Retrospective Studies ; Survival Rate ; Tetralogy of Fallot* ; Ventricular Dysfunction

BACKGROUND: Famciclovir and valacyclovir are antiviral agents commonly used to treat herpes zoster. These medications not only reduce the time to complete cessation of zoster-associated pain, but also aid in the healing of the herpes zoster skin lesions. However, only few studies have compared these antiviral agents. OBJECTIVE: We conducted a randomized clinical trial to evaluate the extent of pain relief and wound healing, and the rate of postherpetic neuralgia associated with these drugs during 4 weeks of treatment. METHODS: The study included 69 immunocompetent adult inpatients diagnosed with herpes zoster randomly divided into 2 groups based on the antiviral agent administered. Patient age, date of visit from rash onset, and rash severity at baseline were recorded. Famciclovir or valacyclovir were administered orally for 7 days. Patients reported pain levels through a visual analog scale (VAS) score, and pain durations were assessed on days 1, 3, and 7, and at weeks 2, 3, and 4. Crust formation and reepithelialization times of skin lesions were also recorded. RESULTS: VAS scores, pain durations, ratios of patients undergoing postherpetic neuralgia, and skin lesion healing rates did not differ significantly between the 2 groups. However, rash severity independently correlated with the extent of pain experienced. CONCLUSION: Famciclovir and valacyclovir are comparable to each other in resolving zoster-associated pain, postherpetic neuralgia, and zoster wound healing. Early antiviral treatment before expansion of the skin lesion would be helpful for rapid relief of herpes zoster pain.
Adult* ; Antiviral Agents ; Exanthema ; Herpes Zoster* ; Humans ; Inpatients ; Neuralgia, Postherpetic ; Skin ; Visual Analog Scale ; Wound Healing

Growth factors are polypeptide molecules that regulate cell growth and function by binding with high affinity to specific receptor molecules in the plasma membrane and stimulating receptor mediated action of intracellular signal transduction pathway.Epidermal growth factor(EGF) and their receptors(EGFR) regulate normal cellular growth, proliferation, and differentiation of various cells in vivo and in tissue cultures. And also may contribute directly to oncogenesis.Overexpression of EGFR and autocrine stimulation of growth involving this receptor system has been identified in several types of human neoplasia. There is evidence that the EGF and receptor system is involved in the regulation of follicular cell growth in the thyroid gland especially with immunohistochemical technic. But there was a challenge about the validity of previously performed immunohistochemical studies.In the study we investigated the relationship between EGFR mRNA expression and tumorigenesis by rapid in situ hybridization method. Formalin-fixed, paraffin embedded tissue sections of 10 normal, 17 nodular hyperplasia, 6 follicular adenoma, and 15 papillary cancer were examined. The results were as follows:1) EGFR mRNA positivity were 20%(2/10) in normal thyroid, 70%(12/17) in nodular hyperplasia, and 100% in follicular adenoma and papillary cancer.2) There was a significantly increased EGFR mRNA expression in papillary cancer compare to normal and nodular hyperplasia(p<0.05). But no difference was found with papillary cancer and follicular adenoma.3) There was a significantly increased EGFR mRNA expression in follicular adenoma compare to normal (p<0.05). But no difference was found with follicular adenoma and nodular hyperplasia. These results suggest that an overexpression of EGFR mRNA may play an important role in the tumorigenesis of thyroid tissue.
Adenoma ; Carcinogenesis ; Cell Membrane ; Epidermal Growth Factor ; Humans ; Hyperplasia ; In Situ Hybridization ; Intercellular Signaling Peptides and Proteins ; Methods ; Paraffin ; Receptor, Epidermal Growth Factor ; RNA, Messenger ; Signal Transduction ; Thyroid Gland

PURPOSE: Control of bleeding and preservation of liver function are still major keys for successful liver resection. We applied right hemihepatic vascular exclusion (RHVE) in patients with a right lobe liver tumor to verify the usefulness and safety of RHVE. METHODS: Between March 1998 and August 2002, 12 patients (Control group) underwent right liver surgeries without inflow occlusion, and 22 patients (RHVE group) underwent right liver surgeries under RHVE. Hemodynamic changes during the operation, amount of transfusion, and post- operative liver function were compared between the two groups. RESULTS: The mean duration of RHVE was 32.3+/-13.9 (15~60) minutes. The mean arterial pressure of the control group and the RHVE group after liver resection were reduced, but these changes were not statistically significant. The amount of transfusion in the RHVE group (2.66+/-1.4 unit) was significantly lower (P<0.05) than that of the control group (4.56+/-3.3 unit). AST/ALT level of the RHVE group were significantly higher on POD#1, but there were no statistically significant differences on POD#3, 5 and 7. Also, the differences in the changes of total bilirubin and IL-6 after liver resection were not significant. Cirrhotic patients in both groups were compared with the same analysis. Only the amounts of transfusion in the RHVE group were significantly lower (P<0.05) than that of the control group. CONCLUSION: RHVE is a safe and useful procedure for right liver surgery with minimal blood loss, but without significant hemodynamic alteration and functional deterioration. These characteristics are shown especially in cirrhotic liver and non-anatomical resection of metastatic cancer.
Arterial Pressure ; Bilirubin ; Carcinoma, Hepatocellular ; Hemodynamics ; Hemorrhage ; Humans ; Interleukin-6 ; Liver*

Dermatomyositis is a systemic inflammatory disease affecting the skin, skeletal muscle, and occasionally, other organs, such as the lung. Interstitial lung disease (ILD) is a serious lung complication, which can occur in patients with dermatomyositis. It affects the prognosis of the disease and requires a more aggressive therapeutic approach. Interstitial lung disease (ILD) may be associated with systemic inflammatory disorders and autoantibody production. In particular, anti Jo-1 antibody has long been recognized as an important predictive factor in systemic manifestations of ILD in dermatomyositis. We report here a case of a 42 year old woman with cutaneous lesions typical of dermatomyositis, showing clinical features of antisynthetase syndrome, which showed rapid progression to acute respiratory distress syndrome.
Antibodies, Antinuclear ; Dermatomyositis ; Female ; Humans ; Lung ; Lung Diseases, Interstitial ; Muscle, Skeletal ; Myositis ; Prognosis ; Respiratory Distress Syndrome, Adult ; Skin

PURPOSE: Craniospinal neurenteric (NE) cysts are rare developmental non-neoplastic cysts of the central nervous system with diverse MR imaging findings. The purpose of this study was to evaluate various MR imaging findings of intracranial and intraspinal NE cysts. MATERIALS AND METHODS: We retrospectively reviewed the MR imaging findings of six NE cysts that were confirmed by pathology. We evaluated anatomic location, signal intensity, size and enhancement pattern of NE cysts. RESULTS: Two intracranial lesions were located extra-axially in the cerebellopontine angle and quadrigeminal cisterns. Three spinal lesions were intraduralextramedullary cysts, located ventral to the spinal cord, but one thoracic lesion was an intramedullary cyst. The signal intensity of the cysts was hyperintense on T1-weighted images as compared with the cerebrospinal fluid (CSF) for two intracranial lesions and one cervical lesion. In addition, all intracranial lesions showed diffusion restriction. For the remaining three spinal lesions, the signal intensity was nearly the same as the signal intensity of the CSF as seen on both T1- and T2-weighted images. On contrast-enhanced studies, two intracranial cysts showed a small nodular enhancement and one thoracic spinal lesion showed rim enhancement. CONCLUSION: NE cysts have various locations, signal intensities, and possible focal nodular or rim enhancement. Therefore, NE cysts can be included in the differential diagnosis of various craniospinal cystic or tumorous cystic lesions.
Central Nervous System ; Cerebellopontine Angle ; Diagnosis, Differential ; Diffusion ; Neural Tube Defects ; Retrospective Studies ; Spinal Cord

Multiple trichoepithelioma is a benign adnexal neoplasm characterized by the presence of many small papules that appear predominantly on the face. Clinical improvement have been demonstrated after several treatments such as carbon dioxide laser, cryotherapy, dermabrasion, and argon laser. However, these destructive methods have various disadvantages. We report a case of multiple trichoepithelioma treated with an intralesional bleomycin injection. Fewer lesions without scars and cosmetic improvements were observed. Bleomycin is a cytotoxic antitumor antibiotic that can be injected intralesionally by transcutaneous administration and displays excellent results for treating malignancies including skin tumors. We believe that intralesional bleomycin injection is an effective treatment option for this condition, and an easy method to conduct at the outpatient clinic.
Administration, Cutaneous ; Ambulatory Care Facilities ; Argon ; Bleomycin ; Cicatrix ; Cosmetics ; Cryotherapy ; Dermabrasion ; Lasers, Gas ; Skin

PURPOSE: The early detection of breast cancer by screening mammography is important to reduce breast cancer mortality rate. The purpose of this study was to investigate the characteristics of breast cancer patients detected by screening mammography. MATERIALS AND METHODS: Surgically treated 1,265 patients at Asan Medical Center from Jul. 1989 to Dec. 1997 were evaluated. Among them, 119 patients (9.4%) were detected by screening mammography. These patients were compared with clinically detected symptomatic breast cancer group. RESULTS: The characteristics of breast cancer patients detected by screening mammography were as follows: The most common finding of mammography was microcalcifications (62.2%); The less invasive or more conservative minimal and non-destructive surgical treatments such as breast conserving surgery (21.0%), simple mastectomy (8.4%), breast reconstruction (8.4%) were performed more frequently; The median tumor size of invasive cancers was 16 mm; Node-negative cancers (83.2%) were more frequent; The early breast cancer of stage 0 and I was 70.6%; DCIS (29.4%) was highly proportionated; and The 5-year overall (95.8%) and 5-year disease-free survival rate (92.0%) were significantly higher than in clinically detected symptomatic breast cancer patients. CONCLUSION: The screening mammography was significant for detecting non-palpable, early stage breast cancer. Ultrasonography was needed as an adjunct for the accurate detection in dense breast or young women. According to early detection, the 5-year survival rate was high.
Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Chungcheongnam-do ; Disease-Free Survival ; Female ; Humans ; Mammaplasty ; Mammography* ; Mass Screening* ; Mastectomy, Segmental ; Mastectomy, Simple ; Mortality ; Survival Rate ; Ultrasonography

Squamous cell carcinoma commonly originates from recalcitrant wound sites, including burn scars, pressure sores, stasis ulcers, osteomyelitis, and sites of frostbite. A 62-year-old male was referred to the dermatology department for skin necrosis of his right great toe and walking difficulty. He had a history of smoking, drinking alcohol, and frostbite of his right great toe 9 years prior, which deteriorated into osteomyelitis due to poor care. Although a skin biopsy was recommended before amputation, the two procedures were performed simultaneously due to a lack of toe function due to severe osteolysis. Biopsy of the amputated toe tip showed many lobules consisting of atypical keratinocytes with hyperchromatic nuclei, and severe dermal pleomorphism. After evaluation for distant metastasis, including a (99m) Tc-MDP bone scan, 18F-FDG positron emission tomography scan, computed tomography, and ultrasound, no metastasis was detected.
Amputation ; Biopsy ; Burns ; Carcinoma, Squamous Cell* ; Cicatrix ; Dermatology ; Drinking ; Fluorodeoxyglucose F18 ; Frostbite ; Humans ; Keratinocytes ; Male ; Middle Aged ; Necrosis ; Neoplasm Metastasis ; Osteolysis ; Osteomyelitis* ; Positron-Emission Tomography ; Pressure Ulcer ; Skin ; Smoke ; Smoking ; Toes ; Ultrasonography ; Varicose Ulcer ; Walking ; Wounds and Injuries