No abstract available.
Hemorrhage*

BACKGROUND: This prospective, randomized controlled study was undertaken to compare stress hormone response to open thoracotomy for lung resection at different anesthetic depths, as determined by bispectral index (BIS) monitoring, in patients under propofol-remifentanil anesthesia. METHODS: Forty-eight adult patients scheduled for lung resection surgery using one-lung ventilation were randomly assigned to either a deep anesthesia group (BIS score of 40 +/- 5, n = 24) or a light anesthesia group (BIS score of 60 +/- 5, n = 24) by adjusting propofol infusion rates. Blood norepinephrine, epinephrine, adrenocorticotropic hormone, and cortisol levels were measured before the induction of anesthesia, at the end of surgery, and at 2 hours postoperatively. Blood glucose, hemodynamic, and oxygenation-ventilation variables, and postoperative outcomes were also measured. RESULTS: Norepinephrine and epinephrine levels remained unchanged over time in the deep group, but norepinephrine levels significantly increased in the light group at 2 h after surgery than at baseline (P = 0.007 and 0.004, respectively). Temporal changes in norepinephrine, but not in epinephrine, were significantly different between the two groups (P = 0.036). Plasma glucose levels in the light group increased with time and were significantly higher than in the deep group at the end of surgery (P = 0.002). CONCLUSIONS: A deep level of anesthesia achieved using high propofol infusion rates during lung surgery provided lower perioperative norepinephrine and glucose responses than light level of anesthesia during the early postoperative period but failed to affect immediate postoperative outcomes.
Adrenocorticotropic Hormone ; Adult ; Anesthesia* ; Blood Glucose ; Catecholamines ; Consciousness Monitors ; Epinephrine ; Glucose ; Hemodynamics ; Humans ; Hydrocortisone ; Lung* ; Norepinephrine ; One-Lung Ventilation ; Postoperative Period ; Propofol* ; Prospective Studies ; Pulmonary Surgical Procedures ; Thoracotomy

A pathological study was performed on four cases of infantile hemangioendothelioma of the liver. All the patients were between the age of 1 -5 months and the tumors were typical hemangio-endotheliomas, type 1. The tumors were composed basically of two components; the endothelial cell proliferation and the myxoid matrix. The endothelial cells were cytologically innocuous and formed vascular channels of varying sizes and shapes from capillary to sinusoidal and cavernous vessels. Fibrosis of the matrix, albeit not a major component of the tumor, was found particularly near the center. Immunohistochemically, CD31 was expressed strongly in almost all endothelial cells, in contrast to the stain for von Willebrand factor which was only focally and weakly positive. Alpha-fetoprotein was expressed in hepatocytes within the tumor or in hepatocytes around the tumor. Intratumoral bile duct structures were located mainly at peripheral portion. The results indicated that the type I infantile hemangioendothelioma is a tumor of endothelial cells and myxoid stroma, and that the endothelial cells undergo gradual maturation to form sinusoidal and cavernous vessels in accordance with gradual fibrosis of the myxoid stroma.
Infant ; Male ; Female ; Humans

No abstract available.
Amenorrhea* ; Female

The demand for drug-induced sedation for magnetic resonance imaging (MRI) scans have substantially increased in response to increases in MRI utilization and growing interest in anxiety in children. Understanding the pharmacologic options for deep sedation and general anesthesia in an MRI environment is essential to achieve immobility for the successful completion of the procedure and ensure rapid and safe discharge of children undergoing ambulatory MRI. For painless diagnostic MRI, a single sedative/anesthetic agent without analgesia is safer than a combination of multiple sedatives. The traditional drugs, such as chloral hydrate, pentobarbital, midazolam, and ketamine, are still used due to the ease of administration despite low sedation success rate, prolonged recovery, and significant adverse events. Currently, dexmedetomidine, with respiratory drive preservation, and propofol, with high effectiveness and rapid recovery, are preferred for children undergoing ambulatory MRI. General anesthesia using propofol or sevoflurane can also provide predictable rapid time to readiness and scan times in infant or children with comorbidities. The selection of appropriate drugs as well as sufficient monitoring equipment are vital for effective and safe sedation and anesthesia for ambulatory pediatric MRI.

BACKGROUND: Cerebral microbleeds (CMBs) reflect cerebral small vessel disease and has a pathological role in Alzheimer's disease (AD) and stroke according to their distribution. We investigated to determine whether association of CMBs distribution in Korean patients with AD and cerebral infarction by susceptibility weighted imaging (SWI) which is a most sensitive magnetic resonance imaging technique for enhanced detection and localization of CMBs. METHODS: Seventy-one patients (AD 30, recent cerebral infarction 21, control 20) were included and 1.5 Tesla SWI was used to image. The Microbleed Anatomical Rating Scale (MARS) was used to localize each CMBs distribution (lobar versus basal ganglia/thalamus [deep], and infratentorial). RESULTS: The prevalence of CMBs was higher in AD and cerebral infarction than controls (p=0.004). Predilection of the total CMBs (n=71) were in order of lobar, basal ganglia/thalamus (deep), and infratentorial region (p=0.029). There was only significant predilection of CMBs in basal ganglia/thalamus (deep) region in cerebral infarction compared with AD (p=0.037) and controls (p=0.011). However, predilection of CMBs in lobar region than infratentorial region (p=0.019) in AD, and predilection of CMBs in basal ganglia/thalamus (deep) region than infratentorial region (p=0.033) in cerebral infarction were significant. Hypertension, a strong risk factor for hypertensive angiopathy was not significant in contributing CMBs prevalence in three groups even though the incidence of hypertension was higher in cerebral infarction than AD and controls. CONCLUSION: Characteristic predilection pattern of CMBs distribution between AD and cerebral infarction through SWI might provide an imaging biomarker for differentiation between dementia due to cerebrovascular disease and cerebral degenerative disorders.
Alzheimer Disease* ; Cerebral Infarction* ; Cerebral Small Vessel Diseases ; Cerebrovascular Disorders ; Dementia ; Humans ; Hypertension ; Incidence ; Magnetic Resonance Imaging* ; Prevalence ; Risk Factors ; Stroke

Asphyxiating thoracic dysplasia(ATD;Jeunes's syndrome) is a rare variety of short limb dwarfism. It is characterized by an extremely small thorax when compared to the ab-dominal circumference, which frequently results in respiratory distress. Other anomalies as-sociated with Jeune's syndrome are pelvic bone malformations and renal dysplasia. It was first described and namely by Jeune et al. in 1954. Jeune's syndrome is an autosomal rece-ssive trait and has a 25% recurrence risk. These patients died at early age due to respirat-ory insufficiency. Death due to uremia has occurred in number of children surviving infan-cy, following progressive renal failure, hypertension and hepatic failure. About 50 cases have been reported in the world literature. We experienced a case of small thorax with short limb dwarfism on antenatal ultraso- und examination and then the baby was delivered by cesarean section. The diagnosis was confirmed to Asphyxiating thoracic dysplasia by clinical features, radiological findings and pathological findings. We reported a case of Asphyxiating thoracic dysplasia with review of literatures.
Cesarean Section ; Child ; Diagnosis ; Dwarfism ; Extremities ; Female ; Humans ; Hypertension ; Liver Failure ; Pelvic Bones ; Pregnancy ; Recurrence ; Renal Insufficiency ; Thorax ; Uremia

No abstract available.
Endometrium* ; Female ; Humans

Acute aortic dissection is the most common catastrophic illness of the aorta. Left untreated, about 75% of patients with dissections involving the ascending aorta die within 2 weeks of an acute episode, but survival may be significantly improved by the timely institution of diagnostic modalities and appropriate medical and surgical therapy. But, approximately 10-20% of patients with acute aortic dissection present with a clinical picture of acute myocardial infarction. This sometimes can not only delay the diagnosis and adequate treatment of acute aortic dissection but also inappropriately treat with thrombolytic agents and anticoagulants which result in rapid deterioration of clinical condition of patient. We report a case of acute aortic dissection with dynamic ST changes in electrocardiogram which resulted in delay of accurate diagnosis and adequate treatment of acute aortic dissection.
Anticoagulants ; Aorta ; Catastrophic Illness ; Diagnosis ; Electrocardiography* ; Fibrinolytic Agents ; Humans ; Myocardial Infarction

We describe a case of cavitary metastasis to the lungs from a small angiosarcoma of the scalp, in which themetastatic lesions were complicated by pneumothorax and pulmonary hemorrhage. On high-resolution CT, the lesionssimulated the findings of Langerhans cell histiocytosis. Thin-walled cavitary metastatic lesions were similar tothose of thin walled air cysts in Langerhans cell histiocytosis. Ground-glass opacity simulated the findings ofsmoke r's respiratory bronchiolitis in Langerhans cell histio-cytosis but histologically represented hemorrhageduring metastasis of the angiosarcoma.
Bronchiolitis ; Hemangiosarcoma* ; Hemorrhage ; Histiocytosis, Langerhans-Cell ; Lung* ; Neoplasm Metastasis ; Pneumothorax ; Sarcoma ; Scalp