The extent of excision and necessity of hepatectomy in type IVa choledochal cyst has not been clarified. We performed left lobectomy of the liver for complete excision of the cyst in a thirty-year-old male patient with type IVa choledochal cyst. Postoperative recovery was untroubled and outcome was satisfactory. Complete excision of the cyst including hepatectomy is an acceptable operative management for patients with type IVa choledochal cyst. This procedure can eliminate the possibility of subsequent cancer arising from remaining cyst.
Choledochal Cyst* ; Hepatectomy ; Humans ; Liver ; Male

A case of myxoma of the breast was reported. A 25-year-old woman showed a lump in the left breast which was suddenly enlarged after the delivery of a baby. A tumor measuring 73.53cm was located in the upper outer quadrant of the breast. Fine needle aspiration cytology revealed scattered benign spindle shaped mesenchymal cells with abundant myxoid material. On excision, the tumor was partly solid, partly cystic and multilocular. Each nodule consisted of an abundant mucoid material with a few spindle or stellate mesenchymal cells. Pleomorphism and mitosis were absent. The mesenchymal cells showed immunoreactivities for S-100 protein, smooth muscle actin, and CD34. The myxoid stroma was positively stained with alcian blue and mucicarmine. These findings suggest that constituent cells derive from totipotential primitive mesenchymal cells.
Actins ; Adult ; Alcian Blue ; Biopsy, Fine-Needle ; Breast* ; Female ; Humans ; Mitosis ; Muscle, Smooth ; Myxoma* ; S100 Proteins

BACKGROUND: Endobroncheal intubation or extubation may occur accidentally when the patient's neck is flexed or extended even in the appropriate endotracheal intubation. The purpose of this study is to examine the effect of fixation or unfixation of the endotracheal tube at the teeth level on the displacement of its distal end when the patient's neck is extended or flexed. METHODS: This study was conducted in 37 patients who underwent endotracheal general anesthesia. The patients with the evidence of pathology in head, neck and chest were excluded from the study. Individual patient's displacement in endotracheal tube tip compared unfixed cases with fixed cases when the change of neck position. The moved distance was measured by fiberoptic bronchoscope. The data were statistically analyzed by Student's paired t-test. RESULTS: The endotracheal tube moved away from the carina when the patient's neck was extended, while it moved toward the carina when flexed in all cases. When the patient's neck was extended the average distance displaced 1.2 0.7 cm in fixed cases and 1.1 0.9 cm in unfixed cases. when the neck was flexed, they were 1.2 0.5 cm and 1.0 0.8 cm respectively. There were not statistically significant between the fixed and the unfixed cases. CONCLUSIONS: It is concluded that the displacement of the endotracheal tube is not related to its fixation or unfixation at the teeth level and therefore, unfixation does not provide any benefits in terms of the displacement of the distal end of the tube in adult trachea.
Adult ; Anesthesia, General ; Bronchoscopes ; Head ; Humans ; Intubation ; Intubation, Intratracheal ; Neck* ; Pathology ; Thorax ; Tooth ; Trachea

Subcutaneous emphysema is a complication of the pneumoperitoneum necessary to perform laparoscopy and will be seen more often as laparoscopic techniques are applied to a growing number of intraabdominal procedures. We report a case of subcutaneous emphysema and hypercarbia without pneumothorax or pneumomediastinum during laparoscopic cholecystectomy, which was treated by multiple puncture with 18G needle on emphysematous site. The suspected cause is inadvertent subcutaneous insufflation of carbon dioxide through the trocar sites by increased intra-abdominal pressure for the establishment of pneumoperitoneum. Immediate recognition, evaluation, and treatment of subcutaneous emphysema is necessary since this can be life-threatening complication.
Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Insufflation ; Laparoscopy ; Mediastinal Emphysema ; Needles ; Pneumoperitoneum ; Pneumothorax ; Punctures ; Subcutaneous Emphysema* ; Surgical Instruments

No abstract available.
Liver*

No abstract available.
Malaria*

To elucidate a possible prognostic factor, we studied 91 cases of breast carcinoma for the expression of n-tn23 protein using an immunohistochemical method, and compared these results with the known prognostic parameters of the breast carcinoma. The mn23 protein was intensely stained in the cytoplasm and/or the nucleus of carcinoma cells in 82 cases(90.1%). There were two patterns of cytoplasmic staining; heterogeneous pattern and homogeneous pattern. Among the positive cases, 43 cases(47.2%) were heterogeneous while 39 cases(42.8%) were homogeneous. Axillary lymph node metastases(p<0.005) was found more frequently in the heterogeneous pattern group(79.0%) than in the homogeneous pattern group(41.0%). There was no significant correlation between nm23 protein expression and other parameters such as patient age, tumor size, estrogen receptor, histopathologic grade, and p53 overexpression. Although axillary lymph node metastasis was correlated with the disease free status(p<0.0005) and patient survival (p<0.05), they showed no correlation with nin23 expression. Multivariate analysis showed that axillary lymph node metastasis was the only prognostic indicator(p<0.05), and the expression of nm23 protein was of borderline significance. The results suggest that the homogeneous and/or granular cytoplasmic expression of mn23 protein plays a role in the suppression of nodal metastasis in breast carcinoma and might contribute in predicting patient survival.
Neoplasm Metastasis

Two cases of synovial hemangioma have been experienced at the Department of Orthopedic surgery, Seoul National University Hospital. In the first case, synovial hemangioma about 1.5cm in diameter was found to be attached to the anterior aspect of the medial condyle of the left femur, which was excised completely with good follow-up result. In another case, cavernous hemangioma was observed diffusely invading tendon sheaths, lower one third of the tibia and also synovium of the ankle joint. Because of diffuse involvement, complete removal was not possible. After partial removal, a total 800 r Roentgen therapy was taken.
Ankle Joint ; Femur ; Follow-Up Studies ; Hemangioma ; Hemangioma, Cavernous ; Orthopedics ; Seoul ; Synovial Membrane ; Tendons ; Tibia

No abstract available.
Humans ; Organophosphate Poisoning* ; Respiratory Insufficiency*

This report is of 81 anesthetic experiences of renal homotransplantation performed under general anesthesia from December 1984 to April 1988 at Kosin Medical Center. Our anesthetic procedures in the recipients were as follows: 1) Preanesthetic preparation with dialysis. 2) Premedication with Robinul and Demerol. 3) Thiopental and succinylcholine for anesthetic induetion. 4) N2O-O2-relaxant (pancuronium and/or norcuron) with halothane or enflurane for maintenance. 5) Antagonism against the relaxant with neostigmine or pyridostigmine. 6) Transfusion and fluid infusion with which CVP was maintained around 10 cm H2O. These patients had several common problems of significance to anesthesiologists, including anemia, coagulopathies, electrolyte imblance, acidosis, hytertension with associated therapy, previous therapy with steroids and immunosuppressants, and dialysis etc. As well as the problems listed above, we experienced a case of protrusion of a grafted kidney due to inadequate relaxation, several cases of bradycardia which did not respond to intravenous atropine during anesthesia, and 5 cases of delayed recovery of respiration.
Acidosis ; Anemia ; Anesthesia ; Anesthesia, General ; Atropine ; Bradycardia ; Dialysis ; Enflurane ; Halothane ; Humans ; Immunosuppressive Agents ; Kidney ; Kidney Transplantation* ; Meperidine ; Neostigmine ; Premedication ; Pyridostigmine Bromide ; Relaxation ; Respiration ; Steroids ; Succinylcholine ; Thiopental ; Transplants