BACKGROUND: Because of the common etiologic factor, such as smoking, lung cancer and chronic obstructive Pulmonary disease are often present in the same patient. The preoperative prediction of remaining pulmonary function after the resectional surgery is very important to prevent serious complication and postoperative respiratory failure. 99mTc-MAA perfusion scan has been used for the prediction of postoperative pulmonary function, but it may be inaccurate in case of large V/Q mismatching. We compared 99mTc-DTPA radioaerosol inhalation scan with 99mTc-MAA perfusion scan in predicting postoperative lung function. METHOD: Preoperative inhalation scan and/or perfusion scan were performed and pulmonary function test were performed preoperatively and 2 month after operation. We predicted the postoperative pulmonary functions using the following equations. Postpneumonectomy FEV1=Preop FEV1x% of total function of lung to remain RESULTS: 1) The inhalation scan showed good correlations between measured and predicted FEV1, FVC and FEF25-75%. (correlation coefficiency; 0.94, 0.91, 0.87 respectively). 2) The perfusion scan also showed good correlations between measured and predicted FEV1, FVC and FEF25-75%. (correlation coefficiency; 0.86, 0.72, 0.97 respectively). 3) Among three parameters, FEV1 showed the best correlations in the prediction by lung scans. 4) Comparison between inhalation scan and perfusion scan in predicting pulmonary function did not show any significant differneces except FVC. CONCLUSION: The inhalation scan and perfusion scan are very useful in the prediction of postoperative lung function and don't make a difference in the prediction of pulmonary function although the former showed a better correlation in FVC.
Humans ; Inhalation* ; Lung ; Lung Neoplasms ; Perfusion* ; Pulmonary Disease, Chronic Obstructive ; Respiratory Function Tests ; Respiratory Insufficiency ; Smoke ; Smoking

PURPOSE: B1 field of birdcage RF (radiofrequency) coil that is used most for brain imaging in magnetic resonance imaging (MRI) decreases toward endring from the coil center. We investigated how much RF B1 homogeneity effect the endcap shield brings form the coil center as it towards to endcap region. MATERIALS AND METHODS: We compared RF B1 field distribution by each finite difference time domain (FDTD) simulations for lowpass, highpass and hybrid birdcage RF coils. We selected the highpass birdcage RF coil that was the highest RF B1 field condition as simulation result, and studied how much RF B1 homogeneity effect was occurred when endcap shield was applied to endring area. RESULTS: B1 field of the highpass birdcage RF coil was higher than other birdcage RF coil types as simulation result. However, the RF B1 homogeneity was lower than other coil types. RF B1 field of highpass birdcage RF coil with endcap shield is similar with RF B1 field of hybrid birdcage RF coil and the overall RF B1 homogeneity in sagittal direction was better. CONCLUSION: In this paper, proposed method can apply improving RF B1 homogeneity of RF coil in clinical examination.
Magnetic Resonance Imaging* ; Neuroimaging

OBJECTIVES: Multiple lung cancers and/or precancerous lesions can be developed because many bronchi are exposed to carcinogens simultaneously according to the concept of 'Field Cancerization'. We had performed a careful bronchoscopic examination and analysed the patients of double bronchial lesions who received the separate pathologic evaluation. METHODS: We studied 21 patients of double bronchial lesions among 1855 patients of bronchoscopic examination from April 1990 to December 1993 in Korea Cancer Center Hospital. We classified the patients into three groups(double malignancies of different histology, double malignancies of same histology, and combination of malignant and benign lesions) and analysed the histologic type, location, radiologic findings, and clinical parameters. RESULTS: Among 21 patients, six patients had double malignancies of different histology, eight had double malignancies of same histology, and seven had combination of malignant and benign lesions. Out of 14 double malignant cases, 11 cases are considered as synchronous multiple primary lung cancers. Combination of squamous cell carcinomas was found in 5 cases, combination of small cell carcinoma and squamous cell carcinoma was found in 4 cases. Combination of adenocarcinoma and squamous cell carcinoma and combination of squamous cell carcinoma and poorly differentiated carcinoma were found in 1 case respectively. All patients of synchronous multiple primary lung cancers were male and had long smoking history(average 40 pack years). Among 21 cases of double bronchial lesions, only one lesion could be detected by prebronchoscopic radiologic examination including chest CT in 15 cases. CONCLUSIONS: The presence of double bronchial lesions including multiple primary lung cancers and the limitation of radiologic examination to detect early bronchial lesions encourage us to examine the whole bronchi carefully and to perform pathologic evaluations.
Adenocarcinoma ; Bronchi ; Bronchoscopy ; Carcinogens ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Humans ; Korea ; Lung Neoplasms ; Male ; Smoke ; Smoking ; Tomography, X-Ray Computed

BACKGROUND: Hemodynamic derangement during the displacement of the beating heart in off-pump coronary artery bypass graft surgery (OPCAB) might be related with right ventricular (RV) dysfunction. This study evaluated the influence of displacing and stabilizing the heart, for the anastomosis of coronary arteries, on hemodynamic alterations and RV function in patients undergoing OPCAB. METHODS: Twenty patients with triple vessel coronary artery disease underwent OPCAB using single pericardial sutures: a tissue stabilizer was included. The hemodynamic variables and right ventricular ejection fraction (RVEF) were obtained using a right-heart ejection fraction thermodilution pulmonary artery catheter after the induction of anesthesia, before and after anastomosis of each coronary artery and after sternal closure. RESULTS: No significant hemodynamic changes were observed during the displacement of the heart or the placement of a stabilizer on all of the coronary arteries, except the obtuse marginal artery (OM) before anastomosis. RVEF, left ventricular stroke work index (LVSWI), stroke volume index and cardiac index (CI) decreased and mean pulmonary artery pressure increased significantly whist positioning the graft to the OM. Right ventricular volumes were not significantly changed, although central venous pressure and pulmonary capillary wedge pressure increased. Changing CI had a close relationship with LVSWI (r2 = 0.537, P <0.05) but not with RVEF (r2 = 0.118). These hemodynamic compromises recovered to baseline values after sternal closure. CONCLUSIONS: The displacement of the beating heart for positioning during anastomosis of the graft to the OM caused significant hemodynamic instability and LV functional changes in addition to RV functional changes seemed to be responsible for hemodynamic derangements.
Anesthesia ; Arteries ; Catheters ; Central Venous Pressure ; Coronary Artery Bypass, Off-Pump ; Coronary Artery Disease ; Coronary Vessels ; Heart* ; Hemodynamics* ; Humans ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Stroke ; Stroke Volume ; Sutures ; Thermodilution ; Thoracic Surgery* ; Transplants ; Ventricular Function, Right*

Most intussusceptions occur in children under 1 year of age whereas 5%~10% occurs in adults. Although intussusception has an acute occurrence in children, symptoms in adults may be subacute or chronic, and the diagnosis is often delayed. In contrast to adults, intussusception in children is the most common cause of intestinal obstruction, and one of the most frequent causes of surgical emergencies. While idiopathic cases account for more than 90% of those seen in children, many cases in adults are generally related to neoplasm. However, intussusception due to a primary malignant lymphoma of the small intestine is a rare clinical condition. There is little information on the role of colonoscopy in colonic intussusception. Two cases are herein reported, of malignant lymphoma in the ileocecal region causing intussusceptions in which the diagnosis and reduction of intussusception were made by colonoscopy. Colonoscopy plays a useful role in the diagnosis and management of intussusception. The clinical, radiographic, endoscopic, and pathologic findings are described with brief reviews of related literature.
Adult ; Child ; Colon ; Colonoscopy* ; Diagnosis* ; Emergencies ; Humans ; Ileum* ; Intestinal Obstruction ; Intestine, Small ; Intussusception* ; Lymphoma*

PURPOSE: This study evaluated the benefit of radiation therapy in high-risk breast cancer patients who have received immediate transverse rectus abdominis myocutaneous (TRAM) flap reconstruction. The evaluation involved examining the effect of radiation therapy on postmastectomy flap fat necrosis and tumor recurrence. METHODS: A retrospective review was performed on 102 patients who underwent mastectomy and immediate TRAM flap reconstruction between 1996 and 2001 at the Asan Medical Center (Seoul, Korea). The mean patient age was 41 years, and the median follow-up time was 33 months. Skin-sparing mastectomy was con ducted in 82 patients (80.4%) and classical mastectomy in 20 patients (19.6%). Of the 21 high-risk patients needing postmastectomy radiation therapy, nine received it. RESULTS: Moderate or severe TRAM flap fat necrosis occurred more frequently in patients receiving radiation therapy than those not receiving radiation therapy (55.6% vs. 19.4%, P=0.026). In the group with high-risk patients, two tumor recurrences occurred (one-locoregional and one-systemic). Among the 102 patients, thirteen had recurrences, including only two high-risk patients, with almost of them being systemic recurrences except four locoregional recurrences. CONCLUSION: Our findings showed that radiation therapy increased flap fat necrosis in high-risk patients underwent immediate TRAM flap reconstruction. Such necrosis can result in poor outcomes for reconstruction. We recommend careful consideration prior to using radiation therapy on high-risk breast cancer patients after immediate TRAM flap reconstruction, where clinicians need to balance the possible positive effects on recurrence with the possible negative effects on flap tissue.
Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Fat Necrosis* ; Follow-Up Studies ; Humans ; Mastectomy* ; Necrosis ; Rectus Abdominis ; Recurrence ; Retrospective Studies

PURPOSE: A skin-sparing mastectomy (SSM) with immediate reconstruction can give psychological and cosmetic benefits to patients requiring a mastectomy, but a risk of pulmonary thromboembolism (PTE) also exists due to longer operative time. The purpose of this study was to evaluate the clinical characteristics of symptomatic PTE following a SSM with immediate reconstruction. METHODS: Of 216 breast cancer patients underwent a SSM with immediate reconstruction at the Asan Medical Center, between December 2003 and July 2005, 7 in whom postoperative symptomatic PTE developed were included in this study. The ventilation/perfusion scan, embolism CT and serum D-dimer level were checked for those suspected of PTE. RESULTS: The prevalence of symptomatic PTE was 3.2% (7/216). Mean patient age and BMI were 41 years and 24.9 kg/m2, respectively. All patients had undergone TRAM reconstruction, with mean operative time of 562.1 minutes. Postoperative bleeding developed in 4 cases. The pathological stages included 0, I and IIA, which were observed in 1, 4 and 2 cases, respectively. Most common symptom of PTE was dyspnea, which developed in all patients on the second or third postoperative day; followed by chest discomfort and tachypnea. The ventilation/perfusion scans showed 6 with high probabilities. All seven patients were diagnosed as PTE on embolism CT. One patient had DVT on the lower extremities. The most common site of PTE was the superior lobar artery and the segmental branches of the right pulmonary artery. All patients recovered, or were recovering, after the LMWH and warfarin treatment. CONCLUSION: This study has shown that SSM with immediate reconstruction possesses a considerable risk of postoperative PTE. Further study on preoperative prophylaxis and the risk factors is warranted to prevent PTE.
Arteries ; Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Dyspnea ; Embolism ; Hemorrhage ; Heparin, Low-Molecular-Weight ; Humans ; Lower Extremity ; Mastectomy* ; Operative Time ; Prevalence ; Pulmonary Artery ; Pulmonary Embolism* ; Risk Factors ; Tachypnea ; Thorax ; Warfarin

It was reported that use of aprotinin in elderly patients undergoing hypothermic circulatory arrest was associated with an increased risk of renal dysfunction, and myocardial infarction as a result of intravascular coagulation. We reviewed 20 patients who received high-dose aprotinin under deep hypothermic circulatory arrest with(NP group, n=11) or without selective cerebral perfusion(SP group, n=9). The activated clotting time was exceeded 750 seconds in all but 1 patient. After opening aortic arch, retrograde low flow perfusion was maintained through femoral artery to prevent air embolization to the visceral arteries. Four patients among 20 died during hospitalization due to bleeding, coronary artery dissection, pulmonary hemorrhage and multiple cerebral infarction. Postoperatively, cerebrovascular accidents occurred in two patients; one with preoperative carotid artery dissection and the other with unknown multiple cerebral infarction. In conclusion, use of aprotinin in young patients undergoing hypothermic circulatory arrest did not increase the risk of renal dysfunction or intravascular coagulation if ACT during circulatory arrest is maintained to exceed 750 seconds with low-flow perfusion.
Acute Kidney Injury ; Aged ; Aorta, Thoracic ; Aprotinin* ; Arteries ; Carotid Arteries ; Cerebral Infarction ; Circulatory Arrest, Deep Hypothermia Induced ; Coronary Vessels ; Femoral Artery ; Hemorrhage ; Hospitalization ; Humans ; Myocardial Infarction ; Perfusion ; Stroke

The skin is an uncommon site of distant metastasis from any internal malignancy, and the incidence of metastatic skin lesions as the first symptom of disease is only 0.8% in patients with all systemic malignancies. Furthermore, cutaneous metastasis from adenocarcinoma of the stomach has been found to be extremely rare. A 35-year-old female patient was admitted due to multiple cutaneous nodules in her chest, abdomen, and back. A gastroendoscopic examination and biopsy was made according to the results of skin pathologic findings. Stomach and skin biopsy results revealed a signet ring cell type of adenocarcinoma. A case of gastric adenocarcinoma in which metastatic skin nodules appeared as the first sign of disease, is here in reported with a review of related literature.
Abdomen ; Adenocarcinoma* ; Adult ; Biopsy ; Female ; Humans ; Incidence ; Neoplasm Metastasis* ; Skin* ; Stomach ; Stomach Neoplasms ; Thorax

To determine the best concentration of lidocaine for caudal anesthesia under supplementary general inhalation anesthesia via faee mask, 85 children aged 1 month to 12 years scheduled for inpatients or outpatients inguinal herniorraphy were randomiaed to receive caudal anesthesia with lidocaine in one of four concentrations(0.5, 0.75, 1.0 or 1.5%) mixing l: 200,000 epinephrine. After incision, gradual reduction in inspired halothane resulted, if tolerated by subject, in an inspired concentration of 0.5% at 10 minutes after incision. Percents of patients who received more than 0.5% of endtidal halothane concentration at hernia sac ligation were 30.0, 28.6, 16.7 and 20.0% in the subjeets receiving 0.5, 0.75, 1.0 and 1.5% lidocaine, respectively. There was no significant differences among groups in pain/discomfort scores and caudal effectiveness scores. A subject receiving 1.5 % lidocaine complained of leg weakness and another of retching. About ninety percents of all subjects could gain the analgesic levels at T dermatome although most of subjects receiving 0.5% lidocaine had the short duration less than 1 hour. Postoperative analgesic effects in the subjects receiving 1.0% lidocaine were superior to those receiving 0.5 and 0.75% solution. Although all concentrations were effective for combined general-caudal anesthesia in children, we conclude that 1.0% lidocaine offers the best combination of effectiveness, postoperative analgesia, adequate anesthetic levels and less complication for pediatric inguinal herniorraphy.
Analgesia ; Anesthesia ; Anesthesia, Caudal* ; Anesthesia, Inhalation ; Child ; Epinephrine ; Halothane ; Hernia ; Humans ; Inpatients ; Leg ; Lidocaine* ; Ligation ; Masks ; Outpatients