Pulmonary sequestration , defined as loss of connection of the lung tissue with bronchial tree and withpulmonary artery receiving its artery supply from the systemic artery, is very rare cngenital pulmonary disease.It presents as two types, intralobular or extralobular differentiated by its location. 6 cases of pulmonarysequestrations hve been diagnosed in Seoul National University Hospital. 5 cases were confirmed pathologicallyafter lobectomy. 1 case was diagnosed with cardiac cineangiogram only. The results are as follows; 1. 4 cases hadclinical histories of pulmonary sepsis. 2 cases had cardiac problems without suspicion of the lung problem. 2. 4cases are male and 2 cases are female. 3. Ages of the patients are distributed from 2 months of age to 15 years ofage. 4. 4 cases are angiographically confirmed preoperatively. 2 cases had no suspicion of pulmonary sequestrationpreoperatively. 5. 3 cases are associated wtih cardiovascular anomalies such as right sided aortic arch, pulmonarystenosis, complicated heart disease. 6. 5 cases- operatively proven-have intralobar types with cystic change. 7.CT was performed in one case who shows left lower lobe area mass with air bronchogram.
Aorta, Thoracic ; Arteries ; Bronchopulmonary Sequestration ; Female ; Heart Diseases ; Humans ; Lung ; Male ; Seoul ; Sepsis ; Trees

PURPOSE: We performed this study to evaluate the usefulness and the limitation of magnetic resonance angiography in imaging portal vein and hepatic vein. MATERIALS AND METHODS: Magnetic resonance portography was performed in five normal subjects and seven patients with hepatomas, two patients with Budd-Chiari syndromes, one patient with liver cirrhosis and one patient with hepatic metastasis from stomach cancer. Magnetic resonance angiography was done with a 1.5-T Scanner. Breath-hold two-dimensional time-of flight images with spoiled gradient echo technique were acquired. Scan parameters were 34/8/40degrees(TR ms/TE ms/flip angle). The portal vein and the hepatic vein were selectively imaged by applying two presaturation bands. These images were then postprocessed by a maximum intensity projection algorithm. MRA findings were compared with ultrasonography in all cases of the hepatic disease, and conventional angiography (SMA portography) in four cases. RESULTS: In normal subjects, the splenic vein, intrahepatic and extrahepatic portions of the portal vein, and the hepatic veins were well visualized. In the patients with hepatic diseases, the varices (4 cases), the splenorenal shunts (2 cases), and the recanalized umbilical vein (1 case) were demonstrated. There were portal vein thrombosis in the cases of hepatomas and hepatic metastasis. In the cases of Budd-Chiari syndrome, the hepatic veins were not visualized and there were inferior vena cava obstructions with multiple collateral vessels. CONCLUSION: Compared with ultrasonography, MRP may be useful in evaluation of varices, splenorenal shunts, and other collaterals, though less accurate than conventional angiography. MRP can be useful as a noninvasive screening alternative in the evaluation of portal vein and hepatic veins.
Angiography ; Budd-Chiari Syndrome ; Carcinoma, Hepatocellular ; Hepatic Veins ; Humans ; Liver Cirrhosis ; Magnetic Resonance Angiography ; Mass Screening ; Neoplasm Metastasis ; Portal Vein ; Portography* ; Splenic Vein ; Splenorenal Shunt, Surgical ; Stomach Neoplasms ; Ultrasonography ; Umbilical Veins ; Varicose Veins ; Vena Cava, Inferior ; Venous Thrombosis

PURPOSE: The purpose of this study is to evaluate the relationship among psychopathology, family support system and quality of life in patients treated with hemodialysis, peritoneal dialysis and kidney transplantation and provide useful information for therapeutic approach to patients with chronic renal failure. METHODS: The subjects of the present study are 43 patients who have been treated with hemodialysis, 53 patients treated with peritoneal dialysis and 34 patients treated by renal transplantation. Beck Depression Inventory (BDI), Symptom Checklist-90- Revised (SCL-90-R) for psychopathology, Family Adhesion Scale, Family Adaptability and Cohesion Evaluation Scale II (FACES II) for family support system, and World Health Organization Quality of Life Assessment Instrument for quality of life were administered to subjects. To examine these, ANOVAs and Pearson correlation analysis were conducted. RESULTS: The patients who have been treated with hemodialysis or peritoneal dialysis showed higher scores of depression in BDI and SCL-90-R than patients treated with renal transplantation. Depression correlated with family cohesion & adaptability, negatively. Hostility correlated with family adhesion & cohesion, negatively. Somatization, obsessive-compulsive, interpersonal sensitivity, anxiety, phobic anxiety and psychoticism correlated with quality of life, negatively. CONCLUSION: The main findings of this study indicate that psychopathology significantly related with family support system and quality of life of the patients with chronic renal failure. These results suggest that the psychosocial intervention are necessary to promote the mental health, strengthen the family support system, and improve the quality of life in the patients with chronic renal failure.
Anxiety ; Depression ; Hostility ; Humans ; Kidney Failure, Chronic* ; Kidney Transplantation ; Mental Health ; Peritoneal Dialysis ; Psychopathology* ; Quality of Life* ; Renal Dialysis ; World Health Organization

BACKGROUND: Controversy exists as to whether or not inhalation anesthetics and intravenous anesthetics impair arterial oxygenation (PaO2) during one lung ventilation (OLV). Accordingly, we examined the effect of enflurane and propofol on PaO2 and pulmonary vascular resistance (PVR) during OLV. METHODS: Forty patients, who had prolonged periods of OLV anesthesia with minimal trauma to the nonventilated lung were studied in a cross over design. Patients were randomized to four groups; Group 1 received 1 MAC of enflurane and oxygen from induction until the first 20 min after complete lung collapse, then were switched to propofol 100 g/kg/min (P100). In group 2, the order of the anesthetics was reversed. Group 3, Group 4 received the same order of the anesthetics as Group 1, Group 2, respectively but received propofol 200 g/kg/min (P200). RESULTS: During OLV, the PaO2 values were lower than those with two lung ventilation (TLV), there were no significant differences among each groups and between propofol and enflurane in PaO2, but in the selected patients (n=10, PaO2<120 mmHg during OLV), PaO2 in propofol group was higher than that of enflurane group (p<0.05). Conversion from TLV to OLV caused a significant increase in PVR, but there were no difference in PVR between propofol and enflurane group. CONCLUSIONS: These results suggest that the usual clinical dose of propofol affords no advantage over 1 MAC of enflurane anesthesia except low PaO2 patients during OLV. Propofol might be of value in risk patients of hypoxemia during thoracic surgery when OLV is planned.
Anesthesia ; Anesthetics ; Anesthetics, Inhalation ; Anesthetics, Intravenous ; Anoxia ; Cross-Over Studies ; Enflurane* ; Humans ; Lung ; One-Lung Ventilation* ; Oxygen* ; Propofol* ; Pulmonary Atelectasis ; Thoracic Surgery ; Vascular Resistance ; Ventilation

PURPOSE: To elucidate the mechanism of neoangiogenesis of human retinal pigment epithelium (HRPE) under hypoxia. METHODS: HRPE cells were cultured for 2 and 24 hours in a hypoxic chamber. Expression and production of the angiogenic factor, vascular endothelial growth factor (VEGF) and the anti-angiogenic factor, pigment epithelium-derived factor (PEDF) were analyzed by RT-PCR and Western blot, respectively. Neoangiogenesis was induced by adding culture supernatant harvested from cells exposed to hypoxic conditions. Neoangeogenesis was measured with a tube formation assay that uses ECV 304 cells and with a migration assay that uses human dermal microvascular endothelial cells. RESULTS: Competitive RT-PCR showed that the expression of the PEDF gene in HRPE cells under hypoxic state decreased compared to normoxic state (p<0.01) but the expression of the VEGF gene increased (p<0.01) when exposed to hypoxic conditions. These results corresponded to those of the Western blot analysis which revealed a significant increase of VEGF production (p<0.01) and a decrease of PEDF production (p<0.01). Moreover, the tube formation and migration assays demonstrated that angiogenesis was increased by exposure to hypoxic stress. Taken together, HRPE cells under hypoxic stress produce more VEGF and less PEDF, which lead to neoangiogenesis. CONCLUSIONS: These results suggest that the subretinal neovascularization that occurs under hypoxic stress might be caused by an imbalance of angiogenesis-related factors in HRPE cells.
Angiogenesis Inducing Agents ; Anoxia* ; Blotting, Western ; Endothelial Cells ; Epithelial Cells* ; Humans ; Retinal Pigment Epithelium ; Retinaldehyde* ; Vascular Endothelial Growth Factor A

To differentiate the postoperative changes from the recurrence of tumor and to evaluate MR imaging of early postoperative leptomeningeal seeding in medulloblastoma, We have retrospectively analysed 34 cases of MR images of 17 patients who were confirmed as medulloblastoma by histopathology. Noncontrast and postcontrast T1 weighted MR images were obtained in all patients. In 11 patients follow-up MR was done more than once (average:1.5 times) and average interval of MR imaging was 6 months. The timing of 34 MR images was as follow: 6 case within 2 months, 9 cases between 2 months and 1 year, 19 cases more than 1 year after surgery respectively. MR images within 2 month after surgery revealed contrast enhancement at operation site and adjacent meninges, hemorrhage, residual tumor. In patients who had no evidence of tumor recurrence, these early postoperative changes were markedly decreased within 6 month after sugery. MR images obtained more than 1 year after sugery showed no abnormal contrast enhancement or mild focal dural enhancement at operation site. Diffuse moderate dural enhancement was noted in one patient who had the history of post-surgical subdural hemorrhage. In six patients with tumor recurrences which were detected from as early as 9months to 6 years after surgery, the findings of recurrence included leptomeningeal enhancement of brain stem and cerebellar surface at early stage, variable sized enhancing leptomeningeal nodules, linear or irregular sulcus obliterating enhancing lesions, enhancing mass at primary or metastatic site. We have concluded that leptomeningeal enhancement detected after 6 months of surgery is an important MR finding suggesting the possibility of tumor recurrence. Small nodular and linear enhancement of leptomeninges at brainstem or cerebellar surface is considered as the early manifestation of intracranial tumor seeding.
Brain Stem ; Follow-Up Studies ; Hematoma, Subdural ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Medulloblastoma* ; Meninges ; Neoplasm, Residual ; Recurrence ; Retrospective Studies

Double outlet left ventricle (DOLV), even defined as origins of both great vessels from left ventricle,implies varieties of morphology in concern with loop pattern, location of ventricular septal defect, conotruncalanatomy, and presence or adsence of pulmonary stenosis. With the improvement of surgical tenchnique, correctivesurgery of DOLV became possible, and preoperative diagnosis and determination of the accurate anatomicalrelaltionship between great vessels, ventricular septal defect, and ventricles is very important in surgicalimplication. Authors have recently experienced two cases of DOLV. The one is with subpulmonic conus, subpulmonicventricular septal defect, patent ductus arteriosus, and preductal type coarctation of aorta. The other is withbilateral coni and subaortic ventricular septal defect. Loop patterns are [S,D,D] in both cases.
Aortic Coarctation ; Conus Snail ; Diagnosis ; Ductus Arteriosus, Patent ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Pulmonary Valve Stenosis

It is known that the painful sensation of diabetic peripheral neuropathy (DPN) results in sleep problems in type 2 diabetes mellitus (T2DM). However, it is not known that the painless DPN also is associated with poor sleep quality in T2DM. The purpose of the current study was to investigate the association between painless DPN and poor sleep quality in T2DM.

It is known that the painful sensation of diabetic peripheral neuropathy (DPN) results in sleep problems in type 2 diabetes mellitus (T2DM). However, it is not known that the painless DPN also is associated with poor sleep quality in T2DM. The purpose of the current study was to investigate the association between painless DPN and poor sleep quality in T2DM.

PURPOSE: To evaluate the inter observer variation in interpretation of the mammographic findings suggesting malignancy. MATERIALS AND METHODS: Sixty-two mammograms of proven breast cancer were retrospectively analyzed by5 radiologists based on the 15 findings that suggest malignancy. Using kappa value, the degree of interobserver agreement was calculated. RESULTS: There were fair to excellent interobserver agreements for 5 findings which were clustered microcalcifications(k=0.7642), ductal calcifications (k=0.5463), lobulated mass(k=0.4539), asymmetric breast parenchyma (k=0.4487) and nipple retraction(k=0.4061). The finding in which kappa value was lessthan 0.2 were intramammary lymph node(k=0.1572), duct ectasia(k=0.1453), phleomorphic calcifications(k=0.1309), architectural distortion(k=0.1247) and stellate mass(k=0.0200). CONCLUSION: The most reliable finding suggesting breast cancer was clustered microcalcifications.
Breast ; Breast Neoplasms ; Nipples ; Observer Variation* ; Retrospective Studies