Tracheal tumors are uncommon comprising less than 0.1% of all malignancies. Metastatic tracheal tumors, especially form the extrathoracic sites, are exceedingly rare. Ovarian cancer tends to metastasize to the serous cavities and the lymph nodes. One large autopsy study reported tracheal involvement in 1% of patients who had died from ovarian cancer. Other studies have not mentioned tracheal involvement at all. Since the main symptoms of cough, hemoptysis, or wheezing are nonspecific, patients may be initially treated for other conditions including asthma or bronchitis. Here we describe a metastatic tracheal tumor from an overain carcinoma that was initally treated for bronchial asthma.
Asthma ; Autopsy ; Bronchitis ; Cough ; Hemoptysis ; Humans ; Lymph Nodes ; Ovarian Neoplasms ; Respiratory Sounds

There are numerous agents with potential toxic effects on the lung. In particular, cytotoxic drugs constitute the largest and most imprtant group of agents associated with lung toxicity. Bleomycin is commonly used, either alone or in combination with other chemotherapeutic agents, in the treatment of squamous cell carcinoma(head and neck, esophagus, and genitourinary tract), lymphoma, and germ cell tumor. One of the therapeutic advantages of bleomycin is its minimal bone marrow toxicity. However, pulmonary toxicity is one of the most serous adverse side effect. Classically, pulmonary toxicity manifests as a diffuse interstitial process or less commonly as a hypersensitivity reaction. This pulmonary toxicity is generally considered to be dose related and can progress to a fatal fibrosis. It is also possible that bronchiolitis obliterans organizing pneumonia(BOOP) is another manifestation of bleomycin induced toxicity. Bleomycin induced BOOP is less common and has a favorable response to steriod therapy. Here we present a case that demonstrates a BOOP, secondary to a relatively small cumulative dose of bleomycin(225mg/??, may be reversible.
Bleomycin* ; Bone Marrow ; Bronchiolitis Obliterans* ; Bronchiolitis* ; Cryptogenic Organizing Pneumonia ; Esophagus ; Fibrosis ; Hypersensitivity ; Lung ; Lymphoma ; Neck ; Neoplasms, Germ Cell and Embryonal ; Pneumonia*

Adult respiratory distress syndrome(ARDS) is a descriptive term that has been applied to many acute, diffuse infiltrating lung lesions of various etiology when they are accompanied by severe arterial hypoxemis. Despite the various eiology, clinical symptom and nonspecific pathophsiologic derangement, ARDS has a high mortality rate. But early diagnosis and prompt good management including PEEP therapy will decrease the mortality rate. This report described a case of ARDS following anesthesia and also discussed with literature.
Adult* ; Anesthesia* ; Early Diagnosis ; Humans ; Lung ; Mortality ; Respiratory Distress Syndrome, Adult*

The purpose of this study was to evaluate the surface roughness of Ni-Cr-Be alloy(Verabond ~, Aalba Dent Inc. USA) according to electrolyte concentration and etching time. Total of 150 metal specimens (12x 10 X 1.5mm) composed of 5 polisded specimens, 5 sandblasted specimens, 140 etched specimens were prepared. Etched groups were divided into 28 groups by the HC1O4 con= centrations(10, 30, 50, 70%) and etching times(15, 30, 60, 120, 180, 240, 300 seconds). The mean surface roughness(Ra) and the etching depth were measured with Optical 3-dimensional surface roughness measuring machine(Accura 1500M, Intek Engineering Co., Korea) and observed under SEM. The results obtaind were as follows 1. Surface roughness(Ra) and etching depth were affected by the order of etching time, electrolyte concentration, and their interaction (NO.05) . 2. Surface roughness(Ra) and etching depth were increased with etching time in 10%, 30% electrolyte concentrations, but they had no significant difference with etching time in 70%(P<0.05). 3. Surface roughness(Ra) and etching depth decreased in the order of 30, 10, 50, 70% electrolyte concentrations from 120 seconds etching time(p<0.05). 4. The remarkable morphologic changes in etched surface were observed along the grain boundaries in 15, 30 seconds of 10%, 30% concentrations and the morphologic changes could be denoted in the grains themselves as well as along the boundaries with the lapse of time. Even though the noticeable morphologic changes also took place in etched surface with 50% concentration, the degree of changes were less than that of changes with 10%, 30%. However, there were little morphologic changes with 70% concentration regardless of etching time. 5. Surface roughness(Ra) of sandblasting group with 50um A1203 had no significant difference with 30%-30 seconds etched group(p<0.05).
Alloys* ; Edible Grain

Chronic pelvic pain in women is a very annoying condition that is responsible for substantial suffering and medical expense. But dealing with this pain can be tough, because there are numerous possible causes for the pelvic pain such as urologic, gynecologic, gastrointestinal, neurologic, or musculoskeletal problems. Of these, musculoskeletal problem may be a primary cause of chronic pelvic pain in patients with a preceding trauma to the low back, pelvis, or lower extremities. Here, we report the case of a 54-year-old female patient with severe chronic pelvic pain after a transcutaneous electrical nerve stimulation (TENS) accident that was successfully managed with image-guided trigger point injections on several pelvic stabilizing muscles.
Female ; Hip Joint* ; Hip* ; Humans ; Lower Extremity ; Middle Aged ; Muscles* ; Pelvic Pain* ; Pelvis* ; Transcutaneous Electric Nerve Stimulation ; Trigger Points

BACKGOUND: The number of ICU beds related to the number of general acute care beds provides a broad measure of intensive care, but it has obvious limitations and underestimates extreme regional differences. As a first step, we evaluated the number of ICU beds or the ratio of ICU beds to hospital beds in university and non-university hospitals in Korea. METHODS: The number of ICU beds and hospital beds, the ratio of the number of ICU beds to hospital beds, and the types of ICU in each range of ICU beds and hospital beds in the university and non-university hospital were analyzed as well. RESULTS: Thirty university hospitals had 1,824 ICU beds out of 25,966 hospital beds, an average of 7.0%. The number of ICU beds ranged from 17 to 159 beds and hospital beds ranged from 400 to 2,000 beds in university hospitals. Fourteen non-university hospitals had 377 ICU beds out of 6,121 hospital beds, an average of 6.2%. In non-university hospitals, the number of ICU beds ranged from 6 to 67 beds with 50 to 700 hospital beds. If there was only one ICU, e.g. multidisciplinary, or more than one, the director of a multidisciplinary and surgical ICU was usually filled by an anesthesiologist, while the directors of other ICUs were usually specialists according to each specific ICU. CONCLUSIONS: There was a large disparity in the number of ICU beds and in the ratio of ICU beds to hospital beds between university and non-university hosptials, and even between university hospitals.
Hospitals, University ; Intensive Care Units* ; Critical Care* ; Korea* ; Specialization

Acute Human immunodeficiency virus (HIV) syndrome should be considered in any patient with possible HIV exposure who presents with acute febrile disease. The diagnosis of acute HIV syndrome is difficult because symptoms are those of common illness. A high index of suspicion and possibility of HIV exposure are important diagnostic clue. Early diagnosis during primary infection permit patient education and treatment that may delay disease progression and improve immune preservation and reconstitution. We report two cases of acute HIV syndrome presenting as an acute febrile disease. The first case had severe illness presenting as acute severe hepatitis and disseminated intravascular coagulation, and the second had relatively mild form of disease. Two cases started the treatment with highly active anti-retroviral therapy (HAART) and have been well now with no other complications.
Acquired Immunodeficiency Syndrome ; Diagnosis ; Disease Progression ; Disseminated Intravascular Coagulation ; Early Diagnosis ; Hepatitis ; HIV Infections ; HIV* ; Humans* ; Patient Education as Topic

OBJECTIVE: To evaluate the value of apparent diffusion coefficient (ADC) histogram analysis for predicting tumor recurrence in patients with uterine cervical cancer treated with chemoradiation therapy (CRT). MATERIALS AND METHODS: Our institutional review board approved this retrospective study and waived informed consent from each patient. Forty-two patients (mean age, 56 +/- 14 years) with biopsy-proven uterine cervical squamous cell carcinoma who underwent both pre-treatment pelvic magnetic resonance imaging with a 3.0 T magnetic resonance scanner and concurrent CRT were included. All patients were followed-up for more than 6 months (mean, 36.4 +/- 11.9 months; range 9.0-52.8 months) after completion of CRT. Baseline ADC parameters (mean ADC, 25th percentile, 50th percentile, and 75th percentile ADC values) of tumors were calculated and compared between the recurrence and no recurrence groups. RESULTS: In the recurrence group, the mean ADC and 75th percentile ADC values of tumors were significantly higher than those of the no recurrence group (p = 0.043 and p = 0.008, respectively). In multivariate analysis, the 75th percentile ADC value of tumors was a significant predictor for tumor recurrence (p = 0.009; hazard ratio, 1.319). When the cut-off value of the 75th percentile ADC (0.936 x 10-3 mm2/sec) was used, the overall recurrence free survival rate above the cut-off value was significantly lower than that below the cut-off value (51.9% vs. 91.7%, p = 0.003, log-rank test). CONCLUSION: Pre-CRT ADC histogram analysis may serve as a biomarker for predicting tumor recurrence in patients with uterine cervical cancer treated with CRT.
Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents/*therapeutic use ; Biopsy ; Carcinoma, Squamous Cell/*diagnosis/drug therapy/radiotherapy ; Chemoradiotherapy ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging/*methods ; Female ; Humans ; Middle Aged ; Neoplasm Recurrence, Local/*diagnosis ; Prognosis ; Retrospective Studies ; Time Factors ; Uterine Cervical Neoplasms/*diagnosis/drug therapy/radiotherapy

OBJECTIVE: To compare gadoxetic acid injection rates of 0.5 mL/s and 1 mL/s for hepatic arterial-phase magnetic resonance (MR) imaging. MATERIALS AND METHODS: In this prospective study, 101 consecutive patients with suspected focal liver lesions were included and randomly divided into two groups. Each group underwent dynamic liver MR imaging using a 3.0-T scanner after an intravenous injection of gadoxetic acid at rates of either 0.5 mL/s (n = 50) or 1 mL/s (n = 51). Arterial phase images were analyzed after blinding the injection rates. The signal-to-noise ratios (SNRs) of the liver, aorta, portal vein, hepatic vein, spleen, and pancreas were measured. The contrast-to-noise ratios (CNRs) of the hepatocellular carcinomas (HCC) were calculated. Finally, two experienced radiologists were independently asked to identify, if any, HCCs in the liver on the images and score the image quality in terms of the presence of artifacts and the proper enhancement of the liver, aorta, portal vein, hepatic vein, hepatic artery, spleen, pancreas, and kidney. RESULTS: The SNRs were not significantly different between the groups (p = 0.233-0.965). The CNRs of the HCCs were not significantly different (p = 0.597). The sensitivity for HCC detection and the image quality scores were not significantly different between the two injection rates (p = 0.082-1.000). CONCLUSION: Image quality and sensitivity for hepatic HCCs of arterial-phase gadoxetic acid-enhanced MR were not significantly improved by reducing the contrast injection rate to 0.5 mL/s compared with 1 mL/s.
Adult ; Aged ; Aged, 80 and over ; Artifacts ; Carcinoma, Hepatocellular/*radiography ; Contrast Media/*administration & dosage/*diagnostic use ; Dose-Response Relationship, Drug ; Female ; Gadolinium DTPA/*administration & dosage/*diagnostic use ; Hepatic Artery ; Humans ; Liver Neoplasms/*radiography ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Prospective Studies ; Sensitivity and Specificity ; Signal-To-Noise Ratio

BACKGROUND: Nefopam has been known as an inhibitor of the reuptake of monoamines, and the noradrenergic and/or serotonergic system has been focused on as a mechanism of its analgesic action. Here we investigated the role of the spinal dopaminergic neurotransmission in the antinociceptive effect of nefopam administered intravenously or intrathecally. METHODS: The effects of intravenously and intrathecally administered nefopam were examined using the rat formalin test. Then we performed a microdialysis study to confirm the change of extracellular dopamine concentration in the spinal dorsal horn by nefopam. To determine whether the changes of dopamine level are associated with the nefopam analgesia, its mechanism was investigated pharmacologically via pretreatment with sulpiride, a dopaminergic D2 receptor antagonist. RESULTS: When nefopam was administered intravenously the flinching responses in phase I of the formalin test were decreased, but not those in phase II of the formalin test were decreased. Intrathecally injected nefopam reduced the flinching responses in both phases of the formalin test in a dose dependent manner. Microdialysis study revealed a significant increase of the level of dopamine in the spinal cord by intrathecally administered nefopam (about 3.8 fold the baseline value) but not by that administered intravenously. The analgesic effects of intrathecally injected nefopam were not affected by pretreatment with sulpiride, and neither were those of the intravenous nefopam. CONCLUSIONS: Both the intravenously and intrathecally administered nefopam effectively relieved inflammatory pain in rats. Nefopam may act as an inhibitor of dopamine reuptake when delivered into the spinal cord. However, the analgesic mechanism of nefopam may not involve the dopaminergic transmission at the spinal level.
Analgesia ; Animals ; Dopamine ; Microdialysis ; Nefopam* ; Pain Measurement ; Rats* ; Spinal Cord ; Spinal Cord Dorsal Horn ; Sulpiride ; Synaptic Transmission