In removing a huge abdominal mass, we often observe acute hemodynamic changes, For adequate anesthetic management we must carefully observe CVP, MAP, ECG and pulse rate ect. The authons report an an anethetic experience in the removal of huge a ovarian cystic mass. The patient was 29year old female. Under contianous monitoring of CVP, MAP, ECG, pulse rate and fluid administration, the patient tolerated the anesthetic period well. The total weight of the tumor mass was about 34kg, which waa composed of 30L cystic fluid and 4kg of solid maas.
Female ; Humans

Trichilemmal horn(trichilemmal keratosis) is a rare keratinizing tumor that resembles a cutaneous horn. Histologically, it is characterized by an abrupt maturation of keratinocytes into lamellar keratin without the formation of a granular layer. We describe a case of a trichilemmal horn on the right cheek of a 78-year-old woman.
Aged ; Animals ; Cheek ; Female ; Horns* ; Humans ; Keratinocytes

Clinical observation was performed on 23 children with Guillain-Barre syndrome which were hospitalized at the Pediatric ward of Han Yang University Hospital, from July 1975 through May 1991.@ES The results were as follows: 1) The ratio of male patient to female was 2.8:1 and 47.8% of total GBS patients were between the ages 1 to 5 years. 2) The highest seasonal incidence of GBS was seen in summer and there was no significant variation of GBS annually.3) Preceding illness of GBS was found in 60% of the total patients, and upper respiratory infection was the most common (65%). 4) Muscular paralysis or weakness in extremities was the most common chief complaints on admission, and repiratory difficulty, vomiting, diarrhea, swallowing difficulty and myalgia were followed. 5) The sites of paralysis on admission were upper and lower extremities in 14 GBS patients (60.8%), lower extremities in 7 GBS patints (34.8%) and respiratory muscle in 4 GBS patints (17.3%), respectively. 6) The protein content of cerebrospinal fluid was elevated in 18 GBS patients of total (78.3%) on admission and remnant 5 GBS patients showed increased protein later. 7) There was a tendency that recovery time in 5 GBS patients with muscular fibrillation on E.M.G. was longer than in 4 GBS patients without muscular fibrillation. We thought further studies on critical evaluation and better treatment for GBS were needed.
Cerebrospinal Fluid ; Child* ; Deglutition ; Diarrhea ; Extremities ; Female ; Guillain-Barre Syndrome* ; Humans ; Incidence ; Lower Extremity ; Male ; Myalgia ; Paralysis ; Respiratory Muscles ; Seasons ; Vomiting

Small renal masses (SRMs) are defined as radiologically enhancing renal masses of less than 4 cm in maximal diameter. The incidence of renal cell carcinoma (RCC) has increased in recent years, which is mainly due to the rise in incidental detection of localized SRMs. However, the cancer-specific mortality rate is not increasing. This discrepancy may be dependent on the indolent nature of SRMs. About 20% of SRMs are benign, and smaller masses are likely to have pathologic characteristics of low Fuhrman grade and clear cell type. In addition, SRMs are increasingly detected in elderly patients who are likely to have comorbidities and are a high-risk group for active treatment like surgery. As the information about the nature of SRMs is improved and management options for SRMs are expanded, the current role of renal mass biopsy for SRMs is also expanding. Traditionally, renal mass biopsy has not been accepted as a standard diagnostic tool in the clinical scenario because of several issues about safety and accuracy. However, current series on SRM biopsy have reported high diagnostic accuracy with rare complications. Studies of modern SRM biopsy have reported diagnostic accuracy greater than 90% with very high specificity. Also, current series have shown very rare morbid cases caused by renal mass biopsy. Currently, renal biopsy of SRMs can be recommended in most cases except when patients have imaging or clinical characteristics indicative of pathology and in cases in which conservative management is not considered.
Biopsy/adverse effects/methods ; Carcinoma, Renal Cell/*pathology ; Early Detection of Cancer/adverse effects/*methods ; Humans ; Incidental Findings ; Kidney/*pathology ; Kidney Neoplasms/*pathology

Small renal masses (SRMs) are defined as radiologically enhancing renal masses of less than 4 cm in maximal diameter. The incidence of renal cell carcinoma (RCC) has increased in recent years, which is mainly due to the rise in incidental detection of localized SRMs. However, the cancer-specific mortality rate is not increasing. This discrepancy may be dependent on the indolent nature of SRMs. About 20% of SRMs are benign, and smaller masses are likely to have pathologic characteristics of low Fuhrman grade and clear cell type. In addition, SRMs are increasingly detected in elderly patients who are likely to have comorbidities and are a high-risk group for active treatment like surgery. As the information about the nature of SRMs is improved and management options for SRMs are expanded, the current role of renal mass biopsy for SRMs is also expanding. Traditionally, renal mass biopsy has not been accepted as a standard diagnostic tool in the clinical scenario because of several issues about safety and accuracy. However, current series on SRM biopsy have reported high diagnostic accuracy with rare complications. Studies of modern SRM biopsy have reported diagnostic accuracy greater than 90% with very high specificity. Also, current series have shown very rare morbid cases caused by renal mass biopsy. Currently, renal biopsy of SRMs can be recommended in most cases except when patients have imaging or clinical characteristics indicative of pathology and in cases in which conservative management is not considered.
Biopsy/adverse effects/methods ; Carcinoma, Renal Cell/*pathology ; Early Detection of Cancer/adverse effects/*methods ; Humans ; Incidental Findings ; Kidney/*pathology ; Kidney Neoplasms/*pathology

PURPOSE: The aim of the study was to evaluate the long-term safety profile and efficacy of Alfuzosin 10 mg once daily in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH), under daily practice conditions in Korea. MATERIALS AND METHODS: In this 6-months, open-label, multicenter, noncomparative, observational study, 511 men were enrolled. International Prostate Symptom Score (IPSS), IPSS 8th question (bother score), maximum flow rate (Qmax), Danish Prostate Symptom Score (DAN-PSS) were evaluated at baseline and after 3, 6 months of treatment. Safety was analyzed in all patients exposed to alfuzosin (n=480). Analysis was performed at end-point in the intent to treat population (n=368). RESULTS: Of the 511 enrolled patients in the study, 218 patients (42.7%) dropped out. With alfuzosin, IPSS and bother score significantly improved from baseline by -6.7+/-6.4 (-31.9%, p<0.001) and -1.2+/-1.2 (-29.3%, p<0.001), respectively. Nocturia also significantly improved from 2.3+/-1.3 at baseline to 1.8+/-1.0 at end-point (-0.6+/-1.1, p<0.001). In the subgroup of patients likely to be obstructed (Qmax <10 ml/sec at baseline), Qmax improved from 8.3+/-1.2 at baseline to 13.7+/-6.1 at end-point (+5.4+/-5.8, p=0.001). In patients with pain/discomfort on ejaculation, weighted score significantly improved from 2.4+/-2.2 at baseline to 1.5+/-1.9 at end-point (-31%, p=0.002). There were no clinically relevant changes in sitting systolic BP and diastolic BP at endpoint. CONCLUSIONS: Alfuzosin 10 mg once daily administered for 6-months is effective in improving LUTS and quality of life, and is well tolerated from a sexual and cardiovascular perspective, including in elderly men and those receiving anti-hypertensive co-medication.
Aged ; Ejaculation ; Humans ; Korea ; Lower Urinary Tract Symptoms ; Male ; Nocturia ; Prostate ; Prostatic Hyperplasia ; Quality of Life ; Quinazolines

PURPOSE: In Korea, there was no specific guidelines for the management of benign prostatic hyperplasia (BPH). We reviewed the practice patterns of Korean urologists in the management of BPH and aimed to describe the need to develop specific guidelines. MATERIALS AND METHODS: A probability sample was taken from the Korean Urological Association Registry of Physicians, and a structured questionnaire, that explored practice patterns in the management of BPH, was mailed to a random sample of 251 Korean urologists. RESULTS: For the initial evaluation of BPH, most urologists routinely performed prostatic specific antigen (PSA) (96.4%), digital rectal exam (94.4%), international prostate symptom score (IPSS) (83.2%) and transrectal ultrasound (79.2%). Symptom assessment (36.4%) followed by transrectal ultrasound of prostate (TRUS) (20.0%) was considered as the most important diagnostic examination affecting the decision about individual treatment options. Almost all urologists (92.2%) chose medical treatment as the first-line treatment option for uncomplicated BPH with moderate symptoms. Of the respondents, 57.2% had prescribed alpha blocker and 41.6% alpha blocker plus 5-alpha reductase inhibitors as the medical treatment option for BPH. The prescription of 5-ARIs was dependent on the size of the prostate and the severity of symptoms. CONCLUSION: The results of our current survey provide useful insight into variations in the clinical practice of Korean urologists. They also indicate the need to develop further practical guidelines based on solid clinical data and to ensure that these guidelines are widely promoted and accepted by the urological community.
Adrenergic alpha-Antagonists/therapeutic use ; Cholestenone 5 alpha-Reductase/antagonists & inhibitors ; Data Collection ; Humans ; Korea ; Male ; Prostatic Hyperplasia/*diagnosis/*drug therapy ; Urology/statistics & numerical data

BACKGROUND: Endotoxin is a complex lipopolysaccharide molecule situated within the outer membrane of Gram-negative bacteria. Sepsis and acute respiratory failure (ARDS) can be induced by endotoxin. In order to introduce and develop the experimental model of ARDS in sepsis, we induced sepsis with the endotoxin and investigated the change of respiratory pathophysiology during sepsis using a multiple inert gas elimination technique (MIGET). METHODS: Ten New Zealand white rabbits were anesthetized and ventilated with a Harvard apparatus. In 5 rabbits, 2 mg/kg of lipopolysaccaride from E. coli was infused intravenously for 30 min (Toxin group). At 1, 2, 3, and 4 hours after endotoxin infusion, arterial blood gas, and hemodynamic profiles were checked. To perform the MIGET, six inert gases (SF6, krypton, desflurane, enflurane, diethyl ether, acetone) of widely varying solubility were infused peripherally and the excretion and retention data was determined from measurements of inert gas tensions in pulmonary arterial, systemic arterial blood samples and mixd expiratory gas sampling of pre and post septicemia using gas chromatography. We transformed and analysed the data into a V/Q distribution curve to find out the change of V/Q distribution curve. After the experiments, the animals were dissected and the lungs were extracted for wet/dry weight ratio (WW/DW) and microscopic examination. RESULTS: In the Toxin group, the pulmonary arterial pressures were increased and arterial oxygen tensions were decreased after the endotoxin infusion. The lung WW/DW were increased and inflammatory findings were seen in microscopic examination. In the MIGET, shunt, deadspace and log SDQ were increased in the toxin group, though there were wide V/Q distributions in the control group. CONCLUSIONS: We developed a successful endotoxin induced septic animal model, V/Q distribution curve and data using MIGET. The accomplishment of the experiment will not only allow us to better understand pulmonary pathophysiology of endotoxin induced sepsis using MIGET, but it will also contribute to other pulmonary physiology experiments associated with sepsis.
Animals ; Arterial Pressure ; Chromatography, Gas ; Enflurane ; Ether ; Gram-Negative Bacteria ; Hemodynamics ; Krypton ; Lung ; Membranes ; Models, Animal ; Models, Theoretical ; Noble Gases ; Oxygen ; Physiology ; Rabbits ; Respiratory Insufficiency ; Sepsis ; Solubility ; Ventilation-Perfusion Ratio*

Changes in the scotopic electroretinogram (ERG) and oscillatory potentials (Ops) were examined in patients who had rhegmatogenous retinal detachment within 3 days before and also at regular intervals after a successful reattachment operation. Electroretinograms were recorded in 38 patients (age 10 to 62 years) for the recent 5 year period. The amplitudes of the scotopic a-wave and b-wave in the detached eye were significantly decreased compared to the fellow normal eye preoperatively. Statistically significant differences were found between the preoperative and the postoperative recordings of the diseased eye. However, postoperative interocular differences in the amplitude of the a-wave between the reattached and normal fellow eye were not statistically significant. The amplitudes of the a-wave and b-wave were inversely related to the extent of the retinal detachment area, the duration of the detachment, and the extent of the buckles that were applied. Significant interocular differences in the b/a wave amplitude ratio and the Ops amplitude were observed. These results strongly suggest that the retinal function, even after successful reattachment surgery, might be compromised mainly by an inner retinal malfunction rather than from a photoreceptor dysfunction.
Adolescent ; Adult ; Child ; *Electroretinography ; Human ; Middle Age ; Oscillometry ; Postoperative Period ; Retinal Detachment/etiology/*physiopathology/*surgery ; Retinal Perforations/*complications

BACKGROUND: The treatment for multi-drug resistant tuberculosis(MDRTB) is encountered to be important clinically, but there are still a few reports about it all over the world. So, we evaluated the outcomes of only chemotherapy for the pulmonary MDRTB retrosptctively. METHOD: We reviewed the clinical courses of 63 patients with pulmonary disease due to M.tuberculosis resistant to rifampin and isoniazid who were under follow-up between March 1996 and June 1996 after hospitalization at our hospital between January 1993 and January 1996. We performed cohort retrospective study for all these patient's records. Their regimens were selected individually and preferably included four medications that they had not been given previously and to which the strain was fully susceptible. RESULTS: The 63 patients(mean age, 43.2 years) had previously received a median 5.1drugs. Fifty two(82.5%) patients responded to chemotherapy(as indicated by negative sputum cultures for at least three consecutive months); eleven patients(17.5%) had no response, as shown by continually positive cultures. In a univariate analysis, an unfavorable response was significantly associated with greater number of resistant drugs before the current courses of therapy(relative risk 21.5; 95 percent confidence interval, 1.2-3.0; p<0.05). The mean period of follow-up was seventeen months. There was no relapse subsequently among the patients with responses. There was no death related to tuberculosis. CONCLUSION: In this report from National Masan Tuberculosis Hospital in Korea, multi-drug resistant pulmonary tuberculosis responded relatively well to carefully selected regimens.
Cohort Studies ; Drug Therapy* ; Follow-Up Studies ; Hospitalization ; Hospitals, Chronic Disease ; Humans ; Isoniazid* ; Korea ; Lung Diseases ; Recurrence ; Retrospective Studies ; Rifampin* ; Sputum ; Tuberculosis ; Tuberculosis, Pulmonary*