Synovial sarcoma most commonly affects the extremities, especially the lower thigh and knee region. However, a smaller number develops in a central or axial distribution, an area which encompasses the trunk, orofacial, cervical and parapharyngeal regions. The retroperitoneum is an extremely unusual site and has never been recorded in the literature as primary a site for synovial sarcoma. We investigated a case of retroperitoneal synovial sarcoma in a 40-year-old woman. The specimen consisted of fragmented large bulky multinodular masses separated by slit-like spaces. The tumor was 130 gm in weight. Microscopically, the tumor was composed of nests of plump ovoid to polygonal shaped cells and bundles of spindle shaped cells, which had vesicular nuclei and a small amount of cytoplasm. In some areas, there were cleft like spaces and pseudoglandular structures lined by flat or cuboidal cells. Myxoid change, collagen deposition, foci of calcification and osseous metaplasia were also present. Immunohistochemically, the polygonal cells and some of the spindle cells reacted positively for keratin. The spindle cells, especially in the perivascular area were positive for vimentin. S-100 protein and GFAP were negative in both type of cells.
Female ; Humans

BACKGROUND: Shivering, which occurs in the postanesthetic period, annoys many patients, so we examined the correlation of postanesthetic shivering (PAS) and warming intravenous fluids, the level of sensory blockade, and skin temperature during spinal anesthesia. METHODS: 65 patients undergoing an operation on a lower extremity were randomly allocated to 2 groups. The patients in group 1 and 2 received 500 ml of the unwarmed (ambient temperature) and warmed fluids prior to spinal anesthesia, respectively. All patients were anesthetized with 0.5% bupivacaine in 8% glucose. We measured the decrements of mean blood pressure (MBP) and heart rate, the highest sensory block level, and the increment of skin temperature 30 min after anesthesia, and the operating room temperature. After the operation we also evaluated the PAS by using the 10-mm visual anlalogue scale. RESULTS: The decrement of MBP was higher in group 2 than in group 1 (13 mmHg vs 5 mmHg, P<0.05). The highest sensory block level was higher in group 2 than in group 1 (T6.4 vs T7.6, P<0.05). However, there was no significant difference in heart rate decrement, skin temperature increment, ambient temperature, and PAS between groups. The more the MBP decrement, the less the PAS in all patients (r = 0.326, P = 0.008) and in group 1 (r = 0.480, P = 0.005), but there was no correlation between PAS and MBP decrement in group 2. The more the ambient temperature, the less the PAS in all patients (r = 0.334, P = 0.007), in group 1 (r = 0.386, P = 0.027), and in group 2 (r = 0.394, P = 0.026). The heart rate decrement, skin temperature increment, and sensory blockade level did not correlate with PAS. CONCLUSIONS: PAS lowers as MBP decreases and operating room temperature increases during spinal anesthesia, but warming intravenous fluids, sensory block level, and skin temperature change doesn't affect PAS.
Anesthesia ; Anesthesia, Spinal* ; Blood Pressure ; Bupivacaine ; Glucose ; Heart Rate ; Humans ; Lower Extremity ; Operating Rooms ; Shivering* ; Skin Temperature* ; Skin*

Spontaneous intracranial hemorrhage (ICH) occurs rarely during general anesthesia. We report a case of metastatic brain tumor producing an ICH during general anesthesia. A 47-year-old man was scheduled for the wedge resection of left lower lobe of lung under general anesthesia. He did not show any abnormal neurological sign and coagulation abnormality on arrival in the operating room. But he had a history of right hemiplegia 9 months ago which resolved completely. He was anesthetized for about 2 hours. Until 1 hour after the end of anesthesia and operation he did not regain his consciousness, but responded well to external stimuli. He was expected to be better, but his mentality became worse. Immediate computerized tomogram of brain revealed a left ICH. An emergency craniectomy was performed to remove the hematoma. Pathological investigations demonstrated a metastatic brain tumor from liver cell carcinoma. We presume that this intratumoral bleeding was produced by high intracranial blood pressure relating to general anesthesia or obstruction of jugular venous drainage by abnormal positioning of head.
Anesthesia ; Anesthesia, General* ; Blood Pressure ; Brain Neoplasms* ; Brain* ; Carcinoma, Hepatocellular ; Consciousness ; Drainage ; Emergencies ; Head ; Hematoma ; Hemiplegia ; Hemorrhage ; Humans ; Intracranial Hemorrhages* ; Lung ; Middle Aged ; Operating Rooms

Thirty cases of gastric adenocarcinoma were examined immunohistochemically for expression of transforming growth factor-beta(TGF-beta) in order to analyze significant correlation with clinical stage and pathologic grade of gastric adenocarcinoma. Specific immunostaining was clearly detected in the cytoplasm of the neoplastic cells. The TGF-,6 expression in the gastric adenocarcinoma is closely related to the depth of invasion, the degree of invasiveness and the presence of metastasis. Thus, we observed the stronger immunohistochemical. expression of TGF-beta in the deeper portion of invasion and in the invasive gastric adenocarcinomas with the lymph nodal metastasis than in the superficial portion of invasion and in those without the lymph nodal metastasis. There results suggest that the transforming growth factors expression in carcinoma cells may play an important role in the carcinomatous invasion resulting in metastasis.
Adenocarcinoma ; Neoplasm Metastasis

BACKGROUND: Caudal administration of local anesthetics, opioids, and the alpha2 adrenergic agonists is effective for postoperative pain. Intrathecal and epidural opioids may commonly result in urinary retention. The purpose of this study was to evaluate the effects of fentanyl or clonidine on postoperative analgesia and urinary retention. METHODS: Forty patients undergoing a hemorrhoidectomy were randomly assigned to receive 20ml of 2% lidocaine and 1 : 200,000 epinephrine plus clonidine 100 microgram (group C100, n = 10), clonidine 150 microgram (group C150, n = 10), fentanyl 50 microgram (group F50, n = 10), or fentanyl 100 microgram (group F100, n = 10) for caudal anesthesia. Mean arterial pressure (MAP) and heart rate (HR) were measured before anesthesia and immediately postanesthesia, and every 5 min after caudal administration for 30 min. The following variables were recorded: onset time, analgesic time, voiding time, and urinary retention. RESULTS: The MAP at 20, 25, and 30 min in group C150 (91 +/- 7, 91 +/- 6, and 90 +/- 7 mmHg, respectively) was less than in group F50 (99 +/- 4, 101 +/- 6, and 101 +/- 5 mmHg, respectively) (P < 0.05). There was no difference in HR and onset time of anesthesia among the groups. Analgesic times in groups C150, F50, and F100 (270 +/- 22, 265 +/- 23, and 323 +/- 82 min, respectively) were longer than in group C100 (207 +/- 59 min), (P < 0.05). The number of patients using a urinary catheter to void was much higher in group F100 (7 patients) than in the groups C100, C150, or F50 (4, 5, and 3 patients, respectively) (P < 0.05). The voiding time was longer in group C150 than in group C100 (369 +/- 122 min vs 266 +/- 83 min, P < 0.05). No side effects were reported. CONCLUSIONS: We conclude that clonidine 150 microgram is adequate to provide effective analgesia and a low incidence of urinary retention during caudal anesthesia.
Adrenergic Agonists ; Analgesia* ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Caudal* ; Anesthetics, Local ; Arterial Pressure ; Clonidine* ; Epinephrine ; Fentanyl* ; Heart Rate ; Hemorrhoidectomy ; Humans ; Incidence ; Lidocaine ; Pain, Postoperative ; Urinary Catheters ; Urinary Retention*

BACKGROUND AND OBJECTIVES: Despite marked advances in the design of percutaneous coronary intervention hardware, total occlusion remains associated with a low primary success rate. The most common cause of failure is the inability to cross the lesion with a guidewire. We report the results of a non-randomized single-center investigation using a hydrophilic coated guidewire (Crosswire NT). SUBJECTS AND METHODS: We analyzed the angiographic results of 92 patients (68 males, 24 females, age 58.8+/-9.7 years-old) who underwent angioplasty utilizing Crosswire NT for either total (TIMI flow 1) or subtotal occlusion at Chonnam National University Hospital between December 2000 and July 2001. RESULTS: Clinical diagnoses of the studied subjects revealed 40 cases of acute myocardial infarction, 15 of myocardial infarction, 29 of unstable angina and 8 of stable angina. The primary success rate was 79.3% (73/92), the success rate in total occlusion was 69.0% (40/58), and that of the chronic total occlusion cases among the total occlusion group was 64.3% (18/28). The success rates in the use of Crosswire NT as the first and second choice were 85.7% and 78.8%, respectively. The abrupt occlusive lesions, complex lesions more than type B 2, and presence of collateral circulation were all associated with a lower success rate. Coronary artery perforation occurred in one case. CONCLUSION: The new nitinol hydrophilic wire, Crosswire NT, is a safe and effective tool for the recanalization of total occlusive coronary lesion.
Angina, Stable ; Angina, Unstable ; Angioplasty ; Angioplasty, Balloon, Coronary ; Collateral Circulation ; Coronary Disease ; Coronary Vessels* ; Diagnosis ; Female ; Humans ; Jeollanam-do ; Male ; Myocardial Infarction ; Percutaneous Coronary Intervention*