No abstract available.
Female ; Leiomyosarcoma* ; Ovary*

No abstract available.
Germ Cells* ; Neoplasms, Germ Cell and Embryonal*

Folliculosebaceous cystic hamartoma (FSCH) is a recently-recognized cutaneous hamar- toma composed of follicular, sebaceous and mesenchymal elements. We describe an unusual case of FSCH in a 61-year-old male, who had a relatively large, 3x2.5cm sized, smooth subcutaneous nodule on the occipital area of the scalp, an uncommon location for FSCH.
Hamartoma* ; Humans ; Male ; Middle Aged ; Scalp

OBJECTIVE: The exact position of the lesion during the pallidotomy is critical to obtain the clinical improvement of parkinson's disease without damage to surrounding structure. Ventriculogrphy, CT(computed tomograpy) or MRI(magnetic resonance imaging) have been used to determine the initial coordinates of stereotactic target for pallidotomy. The goal of this study was to determine whether microelectrode recording significantly improves the neurophysiologic localization of the target obtained from MRI. METHODS: Twenty patients were studied. They underwent a unilateral pallidotomy. Leksell frame was applied and T1 axial images parallel to the AC-PC(anterior commissure-posterior commissure) plane using a 1.5 Tesla MRI with 3mm slice thickness were obtained. Anteroposterior coordinate of target was chosen at 2mm in front of the midcommissural point and lateral coordinate between 19 and 22mm from the midline. The vertical coordinate was calculated on coronal slice using a fast spin echo inversion recovery sequence(FSEIR) related to the position of the choroidal fissure and ranged over 4-5mm below the AC-PC plane. Confirmation of the anatomical target was done on axial slices using the same FSEIR sequence. Microrecording was done at the pallidum contralateral to the symptomatic side using an electrode with a tip diameter of 1nm diameter tip and 1.1-1.4 mOhm impedance at 1000Hz. Electrophysiologic localization of the target was also confirmed intraoperatively by macrostimulation. RESULTS: Microrecording techniques were reliable to define the transition from the base of the pallidum which was characterized by the disappearance of spike activity and by the change of the audible background activity. Signals from high amplitude neurons firing at 200-400Hz were recorded in the pallidal base. X, Y and Z coordinates of target obtained from the MRI were within 1mm from the X, Y, Z coordinates obtained with microrecording in 16 patients (80%), 15 patients(75%), 10 patients(50%) respectively. The difference of Y coordinate between on MRI and on microrecording was 4mm in only one patient. CONCLUSION: The MRI was accurate to localize the target within 1mm of the error from microrecording target in 70% of the patients. 4mm discrepancy was observed only once. We conclude that MRI alone can be used to determine the target for pallidotomy in most patients. However, microrecording technique can still be extremely valuable in patents with aberrant anatomy or unusual MRI coordinates. We also consider physiologic confirmation of the target using macrostimulation to be mandatory in all cases.
Choroid ; Electric Impedance ; Electrodes ; Fires ; Humans ; Magnetic Resonance Imaging* ; Microelectrodes ; Neurons ; Pallidotomy* ; Parkinson Disease*

BACKGROUND: The tourniquet is associated with severe hemodynamic changes and tourniquet-induced hypertension (T-HTN). Propofol is preferred as an anesthetic agent for rapid induction and recovery, and less nausea and vomiting. The aim of this study was to find the difference in hemodynamic changes and the T-HTN in patients with total knee replacement arthroplasty receiving enflurane or propofol anesthesia. METHODS: One hundred patients underwent total knee replacement arthroplasty were divided into four groups; enflurane-control (n = 22), enflurane-elderly (n = 28), propofol-control (n = 22), propofol-elderly (n = 28). Mean arterial blood pressure (MAP), heart rate (HR) and end-tidal CO2 (PETCO2) were recorded throughout the operations of each group. Statistical analysis was done using repeated measures of ANOVA, chi-square test (P < 0.05). RESULTS: MAP increased in the propofol group during the tourniquet inflation period compared to the period before tourniquet inflation. The incidence of T-HTN in the propofol group (58%) was higher than that of the enflurane group (36%). HR increased in the enflurane group just after tourniquet inflation. PETCO2 decreased during 20 60 minutes after tourniquet inflation in the propofol group (P < 0.05). MAP decreased and PETCO2 increased during the 1, 5 minutes after tourniquet deflation in all groups. There were minimal HR changes after tourniquet deflation in all groups. CONCLUSIONS: T-HTN occurrence and MAP were shown to be higher in the propofol anesthesia and both enflurane and propofol can be used as an anesthetic agent for total knee replacement arthroplasty without complications.
Anesthesia ; Anesthesia, General* ; Arterial Pressure ; Arthroplasty* ; Arthroplasty, Replacement, Knee* ; Enflurane* ; Heart Rate ; Hemodynamics ; Humans ; Hypertension* ; Incidence ; Inflation, Economic ; Nausea ; Propofol* ; Tourniquets* ; Vital Signs* ; Vomiting

Peutz-Jeghers syndrome is a rare autosomal dominant disorder defined by harmatomatous polyps of the gastrointestinal tracts and the occurrence of melanin spots on the lips(oral mucosa), hands and feet. This syndrome is associated with a variety of gastrointestinal and extraintestinal neoplasms, both benign and malignant. A 28-year old male was admitted to our hospital with abdominal pain and nausea for two months. He had melanin spots involving his lips, buccal mucosa, hands and feet. A small bowel series showed luminal obstruction at the forth portion of the duodenum. And abdominal CT scan showed target-like mass suggesting intussusception on the small bowel. On laparotomy, there was an annular constricting mass adherent to retroperitoneum with metastasis to preaortic lymph nodes. Palliative duodeno-jejunostomy was performed. The histologic finding disclosed signet-ring cell type adenocarcinoma.
Abdominal Pain ; Adenocarcinoma* ; Adult ; Duodenum ; Foot ; Gastrointestinal Tract ; Hand ; Humans ; Intestinal Obstruction ; Intussusception ; Laparotomy ; Lip ; Lymph Nodes ; Male ; Melanins ; Mouth Mucosa ; Nausea ; Neoplasm Metastasis ; Peutz-Jeghers Syndrome ; Phenobarbital ; Polyps ; Tomography, X-Ray Computed

To study the effect of extracranial-intracranial(EC/IC) bypass on symptomatic patients with hemodynamic cerebral ischemia, we prospectively reviewed 14 patients who underwent EC/IC bypass surgery. A series of 14 patients treated in a 2 years period met the following criteria, 1) symptomatic internal carotid artery(ICA) or middle cerebral aetery(MCA) obstruction or stenosis over 80M, 2) decrease in basal cerebral blood flow(CBF) over 10%, 3) hyporeactivity to acetazolimide of CBF Amomg these, the type of ischemic episode was transient ischemic attack(TIA) or reversible ischemic neurological deficit(RIND) in 4, minor stroke in 8, and major stroke in 2. Of these, 10 patients had multiple episode of ischemic attack. CT or MRI were showed infarction of the MCA territory in 3, border zone infarction in 5, basal ganglia infarction in 2 and multiple lacunar infarction in 4. Based on our criteria, superficial temporal artery(STA)-MCA anastomosis was performed in 13 cases and EC-IC bypass grafting using radial artery in one. Average follow up period was 24 months. Postoperative course was uneventful in 12 patients. One patient suffered a postoperative stroke with complete recovery and another suffered operative wound infection. Of the 14 patients 12(85.7 % ) have had an excellent to good outcome with complete resolution or significant improvement of preoperative neurologic symptom, remaining two show no improvement of preoperative neurologic deficit. Bypass patency was confirmed by postoperative angiography in all cases except for one. Postoperative follow up studies of the basal CBF and response to the acetazolamide of the CBF showed significant increased CBF activity to acetazolamide in 12 cases(85. 7%) while the basal CBF was essentially unchanged in all cases except for two. In view of these finding, the authors suggest that EC-IC bypass surgery to be considered as an appropritate therapy for improvement of the cerebrovascular reserve capacity in patients with hemodynamic cerebral ischemia, defined using the strict selection criteria employed in this study.
Acetazolamide ; Angiography ; Basal Ganglia ; Brain Ischemia* ; Constriction, Pathologic ; Follow-Up Studies ; Hemodynamics* ; Humans ; Infarction ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Patient Selection ; Prospective Studies ; Radial Artery ; Stroke ; Stroke, Lacunar ; Transplants ; Wound Infection

BACKGROUND AND OBJECTIVES: Several studies have utilized physical models or casts of the nasal cavity in an effort to understand the relationship between nasal anatomy and the distribution of inspired or expired airflow. This paper deals with the evaluation of nasal airflow characteristics during physiologic breathing in normal conditions. MATERIALS AND METHOD: The choana of a nasal model casting by a combination of rapid prototyping and solidification of clear silicone was connected to a pump that simulated physiological pressure in the upper airway system. Glycerin-water mixture was used as medium. The airstream was marked with polyvinyl spherical particles, and was observed through an solidificated clear silicone and analyzed with particle image velocimetry. RESULTS: Turbulence is clearly visible at the level of the head of the middle turbinate. The maximal velocity was recorded at the superior meatus. The flow rate was highest at the middle meatus. CONCLUSION: This model allows the investigation of airflow distribution and velocity under physiologic conditions. The main flow stream passes through the middle meatus.
Head ; Nasal Cavity ; Polyvinyls ; Respiration ; Rheology* ; Rivers ; Silicones ; Turbinates