No abstract available.
Drug Therapy* ; Humans ; Immunotherapy*

Granulocytic sarcoma is a rare localized tumor composed of granulocytic precusor cells. Granu-locytic sarcoma occurs in a variety of clinical conditions and it is often misdiagnosed histologically. Differential diagnosis frorh lymphoma or nonhematopoietic malignancies such as undifferentiated carcinoma or sarcoma is difficult in the routing histologic examination. An evaluation of clinical and histopathologic features was done on 4 cases of granulocytic sarcoma which were diagnosed at Pusan Paik Hospital from 1988 to 1992. During the period, 282 cases of myelogenous leukemia were diagnosed. Immunohistochemical reaction for lysozyme, myelopero-xidase, leukocyte common antigen, epthelial membrane antigen and cytokeratin was assessed comparing to lymphoma and undifferentiated carcinoma. The histologic features of the granulocytic sarcoma revealed thin nuclear membrane, fine chromatin pattern and one or two small nucleoli. It also often involved the vascular wall and infiltrated the native structures without destruction. Immunohistochemical stain revealed that all(4 cases) of granulocytic sarcoma showed diffuse and strong positivity for myeloperoxidase, and partial but strong positivity for lysozyme. One case of granulocytic sarcoma was negative and 3 cases revealed focal positive reaction for LCA, and all 4 cases was negative for cytokeratin and EMA. In summary, careful observation under light microscopy with immunohistochemical stain for myeloperoxidase, lysozyme, and LCA is helpful in the differential diagnosis of granulocytic sarcoma from malignant lymphoma and cytokeratin and EMA is useful for differential diagnosis from undifferentiated carcinoma.
Diagnosis, Differential

Tourniquets are often used for surgery on the extremities to provide a bloodless surgical field. However, inflation of tourniquet can cause hypertension, and deflation can cause hypotension. Decrease in arterial pH and PaCO2, and increase in PaCO2 immediately following tourniquet deflation have been documented. In 25 patients for the operation on the lower extremity with spinal anesthesia, we examined the changes of arterial blood pressure, heart rate, arterial blood gases (pH, PO2, PCO2, HCC3 ), and serum electrolytes (Na(+), K(+). Cl(+) ) just before inflation of tourniquet and at 5 minutes after deflation of it. The results were as follows ; 1) Systolic blood pressure decreased by 5.8 mmHg (p<0.05), and diastolic blood pressure decresed by 3.8 mmHg after release of tourniquet. But heart rate did not change, significantly. 2) PaCO2 increased bY 2.4 mmHg after deflation of tourniquet, but it was not significant statistically. Arterial pH, PaCO2, and concentration of bicarbonate all showed insignificant changes. 3) All of serum electrolytes showed too small and insignificant changes.
Anesthesia, Spinal* ; Arterial Pressure ; Blood Pressure ; Electrolytes* ; Extremities ; Gases ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hypertension ; Hypotension ; Inflation, Economic ; Lower Extremity ; Tourniquets*

Malignant transformation of benign cystic teratomas of the ovary is rare, with an incidence rate of 1-3%. The most common malignancy associated with benign cystic teratoma of the ovary is squamous cell carcinoma, which represents 90% of malignant transformations, followed by adenocarcinoma and carcinoid. Primary malignant neuroectodermal tumor in a mature cystic teratoma is extremely rare and microscopically can be subclassified as differentiated, primitive, and anaplatic. We experienced a case of primitive neuroectodermal tumor (PNET) associated with mature cystic teratoma of the ovary in a 11-year-old girl. Grossly, the ovary was a unilocular cyst which contained sebum material and disclosed several large, yellow to gray-tan polypoid excresences attached to the inner cystic wall. Except a large, fish-flesh, soft mass, the other polypoid masses were covered with sebum and contained small pieces of cartilage and tooth, and microscopically represented as mature teratoma. The large, fish-flesh, soft mass disclosed sheets and lobules of closely packed small cells with thin fibrovascular septa, which frequently replacing and encroaching the mature cystic teratoma. The small tumor cells were uniform and made up of round to oval nuclei with coarse chromatin and prominent nucleoli, very similar to those of PNET of the central nervous system.
Incidence ; Cysts ; Adenocarcinoma

No abstract available.
Exostoses*

No abstract available.
Animals ; Lordosis*

This study tested how S/N (Signal to Noise Ratio) ratios and ADC (apparent diffusion coefficient) values vary with different T-scores in a group of patients with osteoporosis. Based on DEXA (Dual Energy X-ray Absorptiometry) T-scores for L1?L4 for two groups of subjects consisting of 30 healthy people without osteoporosis and 30 patients who came for treatment of waist (lumbar or low back) pain and were suspected to have osteoporosis as judged from the simple X-ray findings, this study classified every spine into two groups of osteoporosis and osteopenia. Signal intensity measurements were made in the four regions of L1 to L4 on diffusion-weighted MR images obtained using 1.5T MR scanner, while ADC measurements were obtained from ADC map images. As an approach for quantitative analysis, the comparison of the variances in S/N ratios and ADC values for varying T-scores in the selected regions of interest was carried out based on averaged T-scores, S/N ratios, and ADC values. Also, the variances in S/N ratios and ADC values for each of the groups of osteoporosis and osteopenia, which were classified into by T-scores, were compared. For qualitative analysis, a careful naked eye examination of signal intensity differences in the area of L4 was made on T1-weighted sagittal images for each of the healthy (normal), osteopenia, and osteoporosis groups. In the qualitative analysis, it was found that for both the osteopenia group and the osteoporosis group, as T-scores deceased, the S/N ratios on diffusion-weighted MR images also decreased, with the greatest decrease in the S/N ratio found in the osteoporosis group. Additionally, among the three groups, the lowest S/N ratio was found in the osteoporosis group. With respect to ADC map, it was found that for both the osteopenia group and the osteoporosis group, as T-scores deceased, the ADC values on diffusion-weighted MR images also decreased, with the greatest decrease in the ADC values found in the osteoporosis group. Additionally, among the three groups, the lowest ADC value was found in the osteoporosis group. On the other hand, in the qualitative analysis, the osteoporosis group showed the highest signal intensity. Additionally, among the three groups, the lowest signal intensity was found in the healthy (normal) group. It was found that as osteoporosis progressed, S/N ratio and ADC decreased, whereas signal intensity increased on T1-weighted images. Also, in diagnosing osteoporosis, MRI tests turned out to be (more) effective.
Bone Diseases, Metabolic ; Diffusion ; Eye ; Hand ; Humans ; Noise ; Osteoporosis ; Porphyrins ; Spine

BACKGROUND: Epidural morphine has been commonly used to provide postoperative pain relief, but it has many side effects such as nausea, vomiting, respiratory depression, and pruritus. The purpose of this study was to evaluate the analgesic efficacy and side effects by combination use of epidural morphine and butorphanol. METHODS: Forty five patients were randomly divided into 3 groups. For group I, a bolus of 4.7 ml of saline and 3 mg of morphine were administered. For group II, a bolus of 4.2 ml of saline and 3 mg of morphine and 1 mg of butorphanol were administered. For group III, a bolus of 3.2 ml of saline and 3 mg of morphine and 3 mg of butorphanol were administered. Continuous epidural analgesia were administered for all groups; group I (saline 99.4 ml and morphine 6 mg), group II (saline 98.4 ml, morphine 6 mg, and butorphanol 2 mg), group III (saline 96.4 ml, morphine 6 mg, and butorphanol 6 mg) by two day infuser, 2 ml/hr. We compared the side effects and analgesic effect of the three groups for 2 days. RESULTS: The incidence of pruritus, nausea and vomiting was reduced significantly in the group II and III, but the incidence of somnolence increased in the group III. There were no significant differences in analgesic effect and the other side effects among the three groups. CONCLUSION: Above results suggest that the addition of butorphanol to morphine in epidural infusion reduce the incidence of pruritus, nausea and vomiting, but increase the incidence of somnolence.
Analgesia* ; Analgesia, Epidural ; Anesthesia, Epidural* ; Butorphanol* ; Humans ; Incidence ; Morphine* ; Nausea ; Pain, Postoperative ; Pruritus ; Respiratory Insufficiency ; Vomiting

BACKGROUND: Epidural morphine has been commonly used to provide postoperative pain relief, but it has many side effects such as nausea, vomiting, respiratory depression, and pruritus. The purpose of this study was to evaluate the analgesic efficacy and side effects by combination use of epidural morphine and butorphanol. METHODS: Forty five patients were randomly divided into 3 groups. For group I, a bolus of 4.7 ml of saline and 3 mg of morphine were administered. For group II, a bolus of 4.2 ml of saline and 3 mg of morphine and 1 mg of butorphanol were administered. For group III, a bolus of 3.2 ml of saline and 3 mg of morphine and 3 mg of butorphanol were administered. Continuous epidural analgesia were administered for all groups; group I (saline 99.4 ml and morphine 6 mg), group II (saline 98.4 ml, morphine 6 mg, and butorphanol 2 mg), group III (saline 96.4 ml, morphine 6 mg, and butorphanol 6 mg) by two day infuser, 2 ml/hr. We compared the side effects and analgesic effect of the three groups for 2 days. RESULTS: The incidence of pruritus, nausea and vomiting was reduced significantly in the group II and III, but the incidence of somnolence increased in the group III. There were no significant differences in analgesic effect and the other side effects among the three groups. CONCLUSION: Above results suggest that the addition of butorphanol to morphine in epidural infusion reduce the incidence of pruritus, nausea and vomiting, but increase the incidence of somnolence.
Analgesia* ; Analgesia, Epidural ; Anesthesia, Epidural* ; Butorphanol* ; Humans ; Incidence ; Morphine* ; Nausea ; Pain, Postoperative ; Pruritus ; Respiratory Insufficiency ; Vomiting

We experienced a case of adenocarcinoma arising in sacrococcygeal teratoma. The patient was a 52-year-old woman. She was admitted due to one month of sacral pain. She had a sacral mass since birth. On physical examination, anal fistula was present at the perianal area and pus drainage was noted. MR image showed multiple variable-sized cysts with inhomogeneous density. Resected specimen, mesuring 12.5 7.0 cm in diameter, showed multiple variable-sized cystic lesions admixed with grayish solid portion. The cysts contained mucoid material. The microscopic examination showed mature teratoma composed of cysts lined by pseudostratified ciliated columnar epithelium, intestinal mucosa, mature cartilage, bone, and fat tissue. A moderately differentiated adenocarcinoma developed from the cystic area in the mass.
Adenocarcinoma* ; Adult ; Cartilage ; Drainage ; Female ; Humans ; Intestinal Mucosa ; Middle Aged ; Mucous Membrane ; Parturition ; Physical Examination ; Rectal Fistula ; Suppuration ; Teratoma*