Malignant fibrous histiocytoma is the most common soft tissue sarcoma in adult life and shows a mixed proliferation of both fibroblsstic & histiocytic cells. We report a case of myxoid malignant fibrous histiocytoma involving right lower leg in a 68-year-old male patient, who presented with a childs palm-sized nodular mass of 3 years duration. Histoapthologically, the tumor had varying proportion of myxoid cellular components. The myxoid areas showed spindle and pleomorphic cells arranged in a vague storiform pattern, abrupt transition between a solidly cellular area and a myxoid area, and lipoblast-like cells. The cellular areas showed spindle cells arranged in a storiform pattern characteritic of the typical pleomorphic malignant fibrous histiocytorna.
Adult ; Aged ; Child ; Histiocytoma, Malignant Fibrous* ; Humans ; Leg ; Male ; Sarcoma

We report two cases of dyschromatosis symmetrica hereditaria. One is a 12-year- old female and her family had five individuals with similar pigmentary disorder through three generation. The other is a 22-yesr-old female who had no family history of similar disease. Fontana-Masson stain revealed increased and decreased melanin granules in the basal cell layers in the pigmented and depigmented lesions respectively.
Female ; Humans ; Melanins

No abstract available.
Keratins*

BACKGROUND: Tourniquet pain is probably mediated by C-fiber. The ability of fentanyl to interrupt this nociceptive conduction was studied by administering either fentanyl or saline intrathecally along with hyperbaric bupivacaine for spinal anesthesia. METHOD: The incidence of tourniquet pain was evaluated in 60 patients having orthopedic surgery of the lower extremities during spinal anesthesia by administering either 30 mcg fentanyl (group 2) or saline (group 1) along with 0.5% hyperbaric bupivacaine 10 mg. We measured the maximal sensory spread of analgesia to pinprick, the incidence of tourniquet pain, and the sensory anesthesia to pinprick at the onset of tourniquet pain. RESULTS: The average maximal sensory spread of analgesia was the same in both groups (T9). The incidence of tourniquet pain was significantly greater in group 1 (33%) than in group 2 (10%). The sensory levels of anesthesia at the onset of tourniquet pain were not different in two groups. CONCLUSIONS: Intrathecal fentanyl was effective against tourniquet pain for 2 hours of the orthopedic surgery of the lower extremities.
Analgesia ; Anesthesia ; Anesthesia, Spinal* ; Bupivacaine* ; Fentanyl* ; Humans ; Incidence ; Lower Extremity ; Orthopedics ; Tourniquets*

BACKGROUND: Propofol and ketamine had been used for anesthesia induction and for total intravenous anesthesia. The nature of any hypnotic interactions occurring between propofol and ketamine are unknown. A comparison of maternal and neonatal effects among propofol-ketamine combination, ketamine and propofol were studied when used for anesthesia induction in Cesarean section. METHODS: Forty five patients in ASA class I or II scheduled for Cesarean section randomly assigned to either propofol 2 mg/kg (n=15), ketamine 1 mg/kg (n=15) or propofol 1 mg/kg - ketamine 0.5 mg/kg combination group (n=15) as an induction agent. Maternal systolic and diastolic blood pressure, heart rate, Apgar score and umbilical blood gas analysis were measured. RESULTS: Before intubation, systolic and diastolic pressure were decreased in propofol group but increased in ketamine and propofol-ketamine combination group. Heart rate were increased in all three groups. But there were no significant differences among three groups (p<0.05). After intubation, there were significant increase in systolic, diastolic pressure and heart rate in three groups but no significant differences among three groups (p<0.05). And there was no significant neonatal depression as assessed by Apgar scores and blood gas analyses. CONCLUSIONS: Propofol-ketamine combination was found to be similar to propofol or ketamine only in the effects on the mother and neonate. But propofol-ketamine gained more stable hemodynamic change than propofol or ketamine before intubation. Therefore propofol-ketamine appears to be a suitable alternatives to propofol or ketamine as an induction agent for anesthesia in Cesarean section.
Anesthesia ; Anesthesia, Intravenous ; Apgar Score ; Blood Gas Analysis ; Blood Pressure ; Cesarean Section* ; Depression ; Female ; Heart Rate ; Hemodynamics ; Humans ; Infant, Newborn ; Intubation ; Ketamine* ; Mothers ; Pregnancy ; Propofol*

The authors present 4 cases of spondylolisthesis, 1 case of spondylolysis and 2 cases of Tbc spondylitis of lower lumbar spine treated by posterior lumbar interbody fusion, with follow-up periods of 3 months to 2 years. All cases had severe low back pain. Other common manifestations were radiating pain to leg. All cases were treated with laminectomy, which included a mesial facetectomy followed by posterior lumbar interbody fusion. The spondylolisthesis was reduced to zero degrees in three cases by the use of vertebral spreader. The fusion rate of intervertebral space in radiological finding was 100%. On case become pain free, 4 cases had mild degree of pain, 1 case had moderate degree of pain and 1 case was not improved. The authors conclude that posterior lumbar interbody fusion is applicable as a surgical treatment of patient with spondylolisthesis and Tbc spondylitis.
Follow-Up Studies ; Humans ; Laminectomy ; Leg ; Low Back Pain ; Spine ; Spondylitis ; Spondylolisthesis ; Spondylolysis

From January, 1984 to January, 1985 twelve patients with unstable fracture and fracture-dislocation of the thoraco . lumbar spine with neurologic deficits were treated with Harrington Instrument. Fixation by Harrington Instrumentation appeared to provide stabilization, reduction and return of neural function. Author performed Harrington Instrumentation with experience of 12 cases of unstable thoraco . lumbar spine fructure and fracture-dislocation with neurologic deficits. Results were as follows : 1) Spinal fracture and fracture-dislocation were most common in thoraco . lumbar Junction. 2) Harrington Instrumentation was very effective for keeping the spine stability in unstable fracture. 3) Six cases (50%) had a complete neurologic deficit and six cases (50%) had a incomplete neurologic deficit, two cases of the six patients with complete neurologic deficits recovered slightly but two cases with incomplete neurological deficit gained complete recovery. 4) During the postoperative period, early ambulation was possible and average admission period were 71 days. 5) Correction of spinal deformity. A. Average value of kyphotic angle (12.5 degrees). B. Average value of Iw(Index of weding) (1.32). C. Displacement was completely corrected in eight patients (100%).
Congenital Abnormalities ; Early Ambulation ; Humans ; Neurologic Manifestations ; Postoperative Period ; Spinal Fractures ; Spine*

OBJECTIVE: Nitric oxide and endothelin-1 are two endothelium derived relaxing and constricting factors probably involved in the pathogenesis of cerebral vasospasm after subarachnoid hemorrhage. The aim of this study is to ascertain the effects of nitric oxide donor(nitroglycerine) to reverse endothelin-1 induced cerebral vasoconstriction in vivo, when administered to the adventitial side of the basilar artery exposed through a transclival approach and common carotid artery exposed through a transcervical approach. METHODS: The exposed arteries were subjected to pharmacological manipulations and direct observation of the changes of their sizes under surgical microscope. Measurements of blood pressure, pulse rate and cerebral blood flow using thermal diffusion flowmetry during the drug infusion were done. RESULTS: 1) Nitroglycerine rapidly and completely reversed endothelin-1-induced vasoconstriction. The average value for maximal vasoconstriction by endothelin-1/synthetic cerebrospinal fluid was 58.3% of baseline arterial diameter and occurred within 30 minutes. 2) The nitroglycerine administered via adventitial side of the blood vessel was not associated with any changes in systemic blood pressure nor other vital signs. 3) Same changes occurred in the common carotid artery, although the severity of the occurrence and reversal of vasospasm were not significant compared to those of basilar artery. CONCLUSION: Intrathecally administered nitroglycerine was effective in reversing cerebral vasoconstriction without causing systemic hypotension. These findings provides the potential for the development of targeted therapy to reverse cerebral vasospasm after subarachnoid hemorrhage using nitric oxide donors.
Arteries ; Basilar Artery ; Blood Pressure ; Blood Vessels ; Carotid Artery, Common ; Cerebrospinal Fluid ; Endothelin-1* ; Endothelium ; Heart Rate ; Hypotension ; Nitric Oxide ; Nitric Oxide Donors ; Nitroglycerin* ; Rheology ; Subarachnoid Hemorrhage ; Thermal Diffusion ; Vasoconstriction ; Vasospasm, Intracranial ; Vital Signs

To formulate treatment strategies for poor-grade patients after aneurysmal subarachnoid hemorrhage(SAH), medical records were analyzed for 166 patients who were in Hunt and Hess grade IV or V among 588 consecutive aneurysmal SAH patients admitted during the past 5 years. Causes for unfavorable outcome(poor or dead) in these 166 patients were carefully evaluated to improve the management outcome. Overall management results were favorable(good or fair) in 71(42.8%), and unfavorable in 95(78 dead, 17 poor). Direct clipping was performed in 90 patients, and the surgical results were favorable in 69(76.7%) and unfavorable in 21(23.3%). Surgery was not performed in 76 patients because of moribund state on arrival in 41, neurological deterioration due to rebleeding in 15, massive brain swelling in seven, serious medical illness in five, severe delayed ischemic deficit in one, and massive cerebral infarction following angiography in one, and refused surgery in six. Seven patients survived from non-surgery group(2 fair, 5 poor). Direct effects of aneurysm rupture(34.8%) and early rebleeding(34.8%) were the causes of unfavorable outcome in grade IV patients, while it was direct effect of aneurysm rupture(91.8%) in grade V patients. It is suggested that since rebleeding is the only preventable factor of unfavorable outcome, urgent management seems necessary to prevent rebleeding, especially for grade IV patients. Grade IV patients should be treated aggressively with direct clipping for non-complex aneurysms or for patients with hematoma, and with coil embolization for complex aneurysms without hematoma.
Aneurysm ; Angiography ; Brain Edema ; Cerebral Infarction ; Embolization, Therapeutic ; Hematoma ; Humans ; Intracranial Aneurysm* ; Medical Records

Penetrating brain stem injury is rare, and complete recovery is seldom expected. This case report presents exceptional cases of penetrating brain stem injury with a metal chopstick. The patients were a three-year-old boy and a 60-year-old man, and both patients made a complete recovery after surgical removal of the chopstick.
Brain Stem ; Foreign Bodies* ; Head Injuries, Penetrating* ; Humans ; Male ; Middle Aged