Both idiopathic pulmonary fibrosis (IPF) and pulmonary involvement of collagen vascular disease(CVD) are well known cause of diffuse interstitial lung disease which lead to fibrosis and honeycombing. We analyzed HRCT findings of 33 patients with IPF and 14 patients with CVD in terms of predominant pattern, site of involvement, mediastinal lymph node enlargement, pleural change and pulmonary volume loss. Criteria of mediastinal lymph node enlargement and pleural thickening were 15mm in long diameter and 3mm, respectively. Volume loss of the lung was measured by using hilar height ratio (apex to hilum/hilum to diaphragmatic dome). Mean age was 61 years for IPF and 46 years for CVD and male: female ratio was 27:6, 4:10, respectively. Predominant HRCT pattern was honeycombing for IPF (63%), and ground-glass opacity for CVD (66%) (p=0.001). Predominantly, subpleural involvement was seen in 90% for IPF and 74% for CVD. Mediastinal lymph node enlargement was seen in 47% of the patient with IPF and 14% with CVD (p=0.004). pleural thickening was seen in 97% of the patients with IPF and 42% with CVD (P=0.002), Pleural effusion was seen in 10% of the patients with IPF and 36% with CVD (P=0.009). Hilar height ratio of more than 1.5 was seen in 84% of the patients with IPF and 29% with CVD. In conclusion, our study shows that patients with IPF are prone to have more progressed stage of pulmonary fibrosis than the patients with CVD on HRCT.
Collagen* ; Female ; Fibrosis ; Humans ; Idiopathic Pulmonary Fibrosis* ; Lung ; Lung Diseases, Interstitial ; Lymph Nodes ; Male ; Pleural Effusion ; Pulmonary Fibrosis

BACKGROUND: High dose fentanyl for cardiac surgery in neonates, infants and children can cause severe bradycardia and chest wall rigidity that result in decreased cardiac output and oxygen desaturation due to fixed stroke volume in pediatric patients. To ameliorate the effects of fentanyl, it is common to administer neuromuscular blocking drugs with wanted cardiovascular side effects. This study was designed to compare the cardiovascular variables and oxygen saturation among different muscular relaxants in high dose fentanyl anesthesia. METHODS: Thirty pediatric cardiac patients were allocated randomly into three muscle relaxant groups treated with 0.2 mg/kg pancuronium (n=10), 0.2 mg/kg vecuronium (n=10) or 0.2 mg/kg pipecuronium (n=10) after receiving an initial bolus dose of 25 g/kg of fentanyl. Changes of heart rate (HR), mean arterial blood pressure (MAP), rate-pressure-product (RPP) and oxygen saturation (SpO2) were observed. The same cardiovascular variables were also observed 1 and 2 minutes after the second bolus dose of 25 g/kg fentanyl and compared to the results among muscle relaxants. RESULTS: HR, MAP and RPP decreased significantly (p<0.05) 1 and 2 minutes after injection of the 1st fentanyl, which returned to levels above the control value after administration of pancuronium, vecuronium or pipecuronium. Among muscle relaxants, pancuronium caused the most rapid and significantly high level compared to the control value in HR and MAP. Next was pipecuronium and then vecuronium. In clinical setting, SpO2 was decreased after the 1st fentanyl injection and increased after the injection of muscle relaxants, but not significant statistically. CONCLUSION: In view of hemodynamic changes, pancuronium is most efficient and rapid in returning the hemodynamic variables that was decreased after high dose fentanyl anesthesia in neonates, infants and children whose cardiac output was dependent on HR due to relatively fixed stroke volume.
Anesthesia* ; Arterial Pressure ; Bradycardia ; Cardiac Output ; Child* ; Fentanyl* ; Heart Rate ; Hemodynamics ; Humans ; Infant* ; Infant, Newborn* ; Neuromuscular Blockade ; Oxygen ; Pancuronium* ; Pipecuronium* ; Stroke Volume ; Thoracic Surgery ; Thoracic Wall ; Vecuronium Bromide*

To evaluate the reliability of MR imaging in tissue characterization and depiction of tumor boundaries, we performed MR-pathologic correlation using parosteally implanted VX-2 carcinoma in 17 rabbit thighs. T1-weighted, T2-weighted and Gd-DTPA enhanced T1-weighted axial images were obtained 10-30 days after tumor implantation. After the animals were killed, frozen and sectioned along the MR imaging planes, and histopathologic examinaton were done. For accurate MR-pathologic correlation, rabbits were fixed on the cardboard plate to minimize position change during the procedures. Tumor boundaries depicted on MR images were larger than those depicted on the specimen. Small tumors were surrounded by capsule-like loose connective tissue. Loose connective tissue became compact with tumor growth. This connective tissue showed high signal intensity on both T2-weighted and Gd-DTPA enhanced T1-weighted images. Muscle atrophy with fatty tissue accumulation around the tumor also contributed to the high signal intensity on MR images. Peritumoral edema and inflammatory reaction were not remarkable. Six of 8 cases with bone marrow fibrosis were detected on MR images. We concluded that peritumoral loose connective tissue and muscle atrophy exaggerated the size of experimentally induced malignant musculoskeletal tumors on MR images.
Adipose Tissue ; Animals ; Connective Tissue ; Edema ; Gadolinium DTPA ; Magnetic Resonance Imaging ; Muscular Atrophy ; Primary Myelofibrosis ; Rabbits ; Thigh

BACKGROUND: Recent studies have documented increased release of endothelin(ET) during acute attack of asthma. The purpose of this study is to observe the link between plasma level and urinary excretion of each and changes during acute exacerbation. METHOD: Plasma and 24 hour urine were collected from sixteen asthmatics during acute exacerbation, twice ; first day of symptomatic exacerbation and two weeks after treatment. Controls were ten healthy normal subjects. All patients were treated with corticosteroid and beta-2 adrenergic agonist on admission. ET was determined by radioimmmunoassay and had 100% cross reactivity with ET-1, 67% with ET-2, 84% with ET-3, and 8% with Big-ET. RESULTS: Plasma ETs were significantly elevated during acute attack of asthma compared with those in remission and controls. However, there was no significant changes in urine ET concentrations or total ET amounts in 24 hour urine during exacerbation upto two weeks. Those levels of urine ET in asthmatics were still higher than controls. ET concentrations in plasma or urine were not correlated with pulmonary functional parameters and hypoxemia. CONCLUSION: The findings suggests that increased plasma ETs are related with exaggerated release during acute asthma. Urinary ET excretion is increased in asthma. However, urine ET changes during exacerbation should be observed in a larger and longer scale.
Adrenergic Agonists ; Anoxia ; Asthma* ; Endothelin-2 ; Endothelins* ; Humans ; Plasma*

Background/Aims: We aimed to investigate the silent atherosclerotic burden of cervicocephalic vessels in cirrhotic patients compared with the general population, as well as the relevant risk factors including coronary parameters. Methods: This study included 993 stroke-free patients with liver cirrhosis (LC) who underwent magnetic resonance angiography (MRA) of the head and neck as a pre-liver transplant assessment and 6,099 health checkup participants who underwent MRA examination. The two cohorts were matched for cerebrovascular risk factors, and the prevalence of atherosclerosis in major intracranial and extracranial arteries was compared in 755 matched pairs. Moreover, traditional, hepatic, and coronary variables related to cerebral atherosclerosis were assessed in cirrhotic patients. Results: Overall, intracranial atherosclerosis was significantly less prevalent in the LC group than in the matched control group (2.3% vs. 5.4%, P=0.002), whereas the prevalence of extracranial atherosclerosis was similar (4.4% vs. 5.8%, P=0.242). These results were maintained in multivariate analyses of the pooled samples, with corresponding adjusted odds ratios [ORs] of LC of 0.56 and 0.77 (95% confidence intervals [CIs], 0.36–0.88 and 0.55–1.09). In the LC group, lower platelet count was inversely correlated with intracranial atherosclerosis (adjusted OR, 0.31; 95% CI, 0.13–0.76). Coronary artery calcium (CAC) score ≥100 was the only predictive factor for both intracranial and extracranial atherosclerosis (adjusted ORs, 4.06 and 5.43, respectively). Conclusions LC confers protection against intracranial atherosclerosis, and thrombocytopenia may be involved in this protective effect. High CAC score could serve as a potential surrogate for cervicocerebral vascular screening in asymptomatic cirrhotic patients.

Nasal septal hemangioma is a disease entity which is found most commonly at the anterior part of the nasal septum. The etiology of the nasal septal hemangioma remains controversial. But its development appears to be the result of post-raumatic proliferation of local blood vessels. It is generally an isolated finding, not part of a systemic disorder. In general, the best method of treatment is a wide resection of the tumor with a cuff of underlying mucosa and perichondrium. We present three cases of septal hemangioma which were presented as unilateral epistaxis. They were completely removed with laser photocoagulation under the endoscopic approach. The postoperative course has been gone well without recurrence.
Blood Vessels ; Epistaxis ; Hemangioma* ; Light Coagulation ; Mucous Membrane ; Nasal Septum* ; Recurrence

PURPOSE: To evaluate the radiological findings and clinical courses of the complications arising after nonbiliary laparoscopic gastrointestinal surgery (NLGS). MATERIALS AND METHODS: We retrospectively reviewed the clinical records of 131 patients who underwent NL-GS (83 cases involving colorectal surgery, 18 splenectomies, 14 appendectomies, ten adrenalectomies, three lumbar sympathectomies, two Duhamel 's operation, and one peptic ulcer perforation repair) over a four-year period. Among these 131 patients, the findings of fifteen in whom postoperative complications were confirmed were analysed. The radiologic examinations these patients underwent included CT (n = 8), barium enema and fistulography (n = 4), ultrasonography (n = 3), ascending venography of the lower legs (n = 2), and penile Doppler sonography (n = 1). We evaluated the radiologic findings and clinical courses of early (within 2 weeks) and late (after 2 weeks) postoperative complications. RESULTS: Sixteen cases of postoperative complications developed in fifteen patients ; in 14 (17%) after colorectal surgery and in one (6%) after splenectomy. Eleven of the sixteen cases (69%) involved early complications, consisting of an abscess in three, ischemic colitis in two, hemoperitoneum in one, perforation of the colon in one, pancreatitis in one, recto-vaginal fistula in one, deep vein thrombosis after colorectal surgery in one, and abscess after splenectomy in one. The remaining five cases (31%) involved late complications which developed after colorectal surgery, comprising anastomosic site stricture in two, abdominal wall (trocar site) metas-tasis in one, colo-cutaneous fistula in one, and impotence in one. Among the 16 cases involving postoperative complications, recto-vaginal fistula, colon perforation, and abdominal wall metastasis were treated by surgery, while the other thirteen cases were treated conservatively. CONCLUSION: Various postoperative complications develop after NLGS, with a higher rate of these being noted in cases involving colorectal surgery than in other cases.
Abdominal Wall ; Abscess ; Adrenalectomy ; Appendectomy ; Barium ; Colitis, Ischemic ; Colon ; Colorectal Surgery ; Constriction, Pathologic ; Enema ; Erectile Dysfunction ; Fistula ; Hemoperitoneum ; Humans ; Laparoscopy ; Leg ; Male ; Neoplasm Metastasis ; Pancreatitis ; Peptic Ulcer Perforation ; Phlebography ; Postoperative Complications ; Retrospective Studies ; Splenectomy ; Sympathectomy ; Ultrasonography ; Venous Thrombosis

Chronic eosinophilic pneumonia is characterized by multiple and dense areas of consolidation on chest radiographs and computed tomographic scans, persistent symptoms, a requirement for steroid therapy and possible relapses. The finding of increased BAL eosinophils is most helpful in diagnosis of patients presenting with chronic eosinophilic pneumonia. Therefore, although biopsy remains the gold standard for diagnosis of chronic eosinophilic pneumonia, it is usually not required if the clinical findings are characteristic and if the response to a trial of corticosteroids is rapid and complete. The male patient, aged 40years, presented with cough, chest pain, weight loss and peripheral infiltration of right middle lobe on the chest radiograph and chest computed tomographic scans. We confirmed chronic eosinophilic pneumonia with bronchoalveolar lavage analysis and transbronchial lung biopsy. We herein report a lobal type of chronic eosinophilic pneumonia with a brief review of literature.
Adrenal Cortex Hormones ; Biopsy ; Bronchoalveolar Lavage ; Chest Pain ; Cough ; Diagnosis ; Eosinophils* ; Humans ; Lung ; Male ; Pulmonary Eosinophilia* ; Radiography, Thoracic ; Recurrence ; Thorax ; Weight Loss

PURPOSE: To report the arteriovenous (AV) adventitial sheathotomy for the treatment of macular edema associated with branch retinal vein occlusion (BRVO). METHODS: Seven eyes of seven patients with best corrected visual acuity of less than 20/200 secondary to BRVO received pars plana vitrectomy and AV adventitial sheathotomy, and were followed postoperatively for 1, 2, and 4 months. RESULTS: Intraoperative decompression of the AV crossing was achieved in all 7 patients. All patients showed clinical improvement as determined by fundus examination, optical coherent tomography, and fluorescein angiography. Postoperative visual acuity was better in 6 of the 7 patients (86%) with an average of two lines of vision being gained. CONCLUSIONS: AV adventitial sheathotomy may be beneficial for selected patients with poor vision secondary to BRVO.
Decompression ; Fluorescein Angiography ; Humans ; Macular Edema* ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Visual Acuity ; Vitrectomy