No abstract available.
Germ Cells* ; Neoplasms, Germ Cell and Embryonal* ; Prognosis*

PURPOSE: The determine the chest CT findings in breast cancer patients who have undergone postoperative irradiation. MATERIALS AND METHODS: The chest CT findings in 36 female patients who underwent breast surgery and radiotherapy between May 1996 and March 2000 were retrospectively analysed. Prior to radiotherapy, baseline chest CT depicted normal parenchyma in all cases. In 11 patients, the ipsilateral breast and chest wall were irradiated using opposed tangential fields, while 25 were treated by the four fields method (opposed tangential fields plus anterior and posterior supraclavicular/high axillary fields), with a total dose of 5040-5400 cGy for 5-9 weeks. RESULTS: CT after radiotherapy demonstrated reticular opacity (n=24), perpendicular linear opacity (n=15), traction bronchiectasis (n=7), consolidation (n=6), ground glass attenuation (n=3), pathologic rib fractures (n=3), pleural effusion (n=2), and pleural thickening (n=1), while in five patients no abnormality was observed. In addition, in the anterolateral lung area of 23 (64%) of 36 patients who underwent tangential beam irradiation, CT demonstrated peripheral opacities. When supraclavicular and axillary portals were used, radiation-induced lung changes mostly occurred at the apex of the lung (n=24). Chest radiographs were abnormal in 26 patients and normal in ten; in five of these ten, CT demonstrated reticular opacity. CONCLUSION: Depending on the irradiation CT findings of radiation-induced lung injury in breast cancer include areas of increased opacity with or without fibrosis, in apical and/or anterior subpleural regions. CT may help differentiate radiation-induced parenchymal change from superimposed or combined lung disease.
Breast Neoplasms* ; Breast* ; Bronchiectasis ; Female ; Fibrosis ; Glass ; Humans ; Lung ; Lung Diseases ; Lung Injury ; Pleural Effusion ; Radiography, Thoracic ; Radiotherapy ; Retrospective Studies ; Rib Fractures ; Thoracic Wall ; Thorax* ; Tomography, X-Ray Computed* ; Traction

BACKGROUND: Patients with major burns require replacement of intravascular volume. Hydroxyethyl starch (HES) solutions are widely used to replace intravascular volume. Dilution with crystalloids or colloids and corresponding platelet dysfunction are known causes of perioperative bleeding tendencies. The aim of the current study was to evaluate the effect of crystalloid and colloid solutions on platelet function in patients with major burns. METHODS: Forty patients scheduled for burn surgery were divided into 4 groups. The infusion was started with a Hartman solution infusion (group 1) from 7 A.M. until surgery. HES (6%, Voluven(R)) was infused in the following concentrations: 7 ml/kg (group 2), 10 ml/kg (group 3), and 15 ml/kg (group 4). The bleeding time (BT), prothrombin time (PT), prothrombin time international ratio (PT INR), activated partial thromboplastin time (aPTT), hemoglobin (Hb), platelet function analyzer-100 closing time (PFA CT), and platelet count (Plt) were measured. RESULTS: Hartmann solution and HES had no significant effect on the BT, PT, PT INR, a PTT, Hb, and Plt. The post-operative PFA CT was significantly higher in group 4 than in group 3. In group 4, the PFA CT was significantly higher post-operatively compared to pre-operatively. CONCLUSIONS: The use of high dose HES may increase the risk of bleeding tendencies in burn patients.
Bleeding Time ; Blood Coagulation ; Blood Platelets ; Burns ; Colloids ; Hemoglobins ; Hemorrhage ; Hetastarch ; Humans ; International Normalized Ratio ; Isotonic Solutions ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time

Purpose: Eosinophil-derived neurotoxin (EDN) is not the only a marker for eosinophil activation, but also acts as an alarm protein.Very few studies have examined the potential role of eosinophils in the development of bronchopulmonary dysplasia (BPD). This study aims to address the roles of eosinophil and EDN in the early phase of BPD development. Methods: Patients were preterm neonates with respiratory distress syndrome (RDS) born at 36 weeks of gestation or less. Blood and urine samples were collected to measure total eosinophil count in the blood, serum eosinophil cationic protein (ECP), serum EDN, and urinary EDN during the first week of life. Results: Fifty-two preterms were recruited, of whom 43 infants were analyzed. Comparisons were made between the RDS (n = 16) and non-RDS groups (n = 27) and between the BPD (n = 6) and non-BPD groups (n = 26). There were no differences between RDS and non-RDS group in total eosinophil count, serum ECP, serum EDN, or urinary EDN, except when compared by gestational age, birth weight and prenatal dexamethasone use. Urinary EDN was increased significantly in the BPD group compared to the non-BPD group. Conclusion We demonstrated the roles of eosinophil and EDN in the development of BPD and suggest that urinary EDN may be utilized as a noninvasive factor predicting the development of BPD.

Splenic artery pseudoaneurysm (SAP) is a very rare case, postoperatively. SAP originates from many causes such as complication of chronic pancreatitis in adults and blunt abdominal trauma in children. SAP related to surgery may result from direct tissue injury during operation. Urgent angiography is helpful in diagnoses and life-saving procedures as the endovascular embolization simultaneously. However, endovascular management is not a definite treatment modality in patients previously operated on because the blood supply of remaining organs will be insufficient after embolization. In this paper, we report a rare case that is proximal splenic artery pseudoaneurysm after radical subtotal gastrectomy in a 63-year-old male patient with early gastric cancer, as well as a brief review.
Adult ; Aneurysm, False ; Angiography ; Child ; Gastrectomy ; Humans ; Male ; Middle Aged ; Pancreatitis, Chronic ; Splenic Artery ; Stomach Neoplasms

Acute peripheral facial palsy usually manifests Bell's palsy of unknown cause, and rarely lacunar infarct which located in facial nucleus can mimic peripheral facial palsy. A 73 year-old man with isolated facial asymmetry diagnosed with lacunar infarction which selectively involve the facial fascicles which lie in inferolateral aspect of pons. Clinicians should take into account the possibility of central lesion and brain stem infarction, even when patients present with isolated peripheral type facial palsy.
Bell Palsy ; Brain Stem Infarctions ; Facial Asymmetry ; Facial Nucleus ; Facial Paralysis* ; Humans ; Pons ; Stroke, Lacunar

BACKGROUND AND OBJECTIVES: Some patients with Kawasaki disease (KD) present with fever and cervical lymphadenopathy alone. The purpose of this study was to characterize the clinical features of these unusual KD patients and determine whether this is a severe form of KD associated with increased risks of intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs). SUBJECTS AND METHODS: A total of 146 children with KD were reviewed retrospectively, and classified into two groups according to initial clinical features. Those presenting with only fever and cervical lymphadenopathy (LKD) were classified as LKD patients. Other-KD patients included all except the LKD patients. RESULTS: Among 146 KD patients, 13 (8.9%) were classified as LKD patients. The LKD patients were significantly older and admitted earlier. The duration between fever onset and KD diagnosis was significantly longer in the LKD patients (5.9 days vs. 4.9 days, p=0.023). The frequency of IVIG resistance was not different between the two groups., In the LKD patients, the incidence of CALs was significantly higher in the acute phase, and without significant difference in the convalescent phase. The percentage of neutrophils and C-reactive protein, albumin, and total bilirubin levels were significantly higher in LKD patients. CONCLUSION: Even though LKD patients were older, admitted earlier, and had higher inflammatory marker levels, they did not have a greater risk of CALs or IVIG resistance. However, echocardiography may be helpful in the acute stage if patients have only fever and cervical lymphadenopathy and are unresponsive to empirical antibiotics.
Anti-Bacterial Agents ; Bilirubin ; C-Reactive Protein ; Child ; Coronary Vessels ; Diagnosis ; Echocardiography ; Fever* ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Incidence ; Lymphatic Diseases* ; Mucocutaneous Lymph Node Syndrome* ; Neck ; Neutrophils ; Retrospective Studies

BACKGROUND/AIMS: Transient elastography is a new noninvasive tool for measuring liver stiffness that accurately predicts significant fibrosis and cirrhosis. However, several studies have indicated that liver stiffness can be significantly influenced by major changes in aminotransferase in patients with chronic viral hepatitis. The aim of this study was to determine the factors influencing liver stiffness in patients with chronic liver disease. METHODS: We studied 158 patients with chronic liver disease who underwent transient elastography and liver biopsy sampling. Histologic findings on fibrosis and necroinflammatory activity in the biopsy specimens were evaluated according to the Korean Society of Pathologists Scoring System. Routine biochemical tests were performed according to standard methods. RESULTS: Liver stiffness was strongly correlated with liver fibrosis stage (Spearman coefficient=0.636, P<0.001), lobular activity (Spearman coefficient=0.359, P<0.001), and portoperiportal activity grade (Spearman coefficient=0.448, P<0.001). Liver stiffness was significantly associated with serum levels of total bilirubin (P=0.025), direct bilirubin (P=0.049), gamma-glutamyl transpeptidase (P=0.014), platelet count (P=0.004), albumin (P<0.001), and international normalized ratio (P<0.001). Multivariate analysis showed that fibrosis stage (B 3.50, P=0.009) and lobular activity grade (B 3.25, P=0.047) were independently associated with liver stiffness. CONCLUSIONS: Liver stiffness as measured by transient elastography is associated with the grade of necroinflammatory activity and the stage of fibrosis, irrespective of serum ALT levels.
Adult ; Aged ; Bilirubin/blood ; Biopsy ; Chronic Disease ; Elasticity ; *Elasticity Imaging Techniques ; Female ; Hepatitis B, Chronic/*complications ; Hepatitis C, Chronic/*complications ; Humans ; International Normalized Ratio ; Liver Cirrhosis/etiology/pathology/*ultrasonography ; Male ; Middle Aged ; Platelet Count ; Risk Factors ; Severity of Illness Index ; gamma-Glutamyltransferase/blood

Pneumatosis intestinalis (PI) is an imaging phenomenon that represents air in the bowel wall. The cause of PI is variable, although specific etiologic factors remain unknown. It is an infrequent complication in leukemia patients and is associated with several medical and surgical conditions. PI often represents a benign condition, but it can also require surgery. Therefore, the assessment of PI with or without complications can be difficult. Herein, we report on an unusual case of a 63 year-old woman with refractory acute precursor B-cell lymphoblastic leukemia-lymphoma who presented with PI resulting from the leukemic process, and finally expired due to sepsis.
Female ; Humans ; Leukemia ; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma ; Precursor Cells, B-Lymphoid ; Sepsis

Renal artery pseudoaneurysm after blunt renal trauma is an uncommon complication of delayed hemorrhage, and diagnostic difficulties are experienced due to its rarity. Delayed hemorrhage after renal trauma is a lifethreatening complication. Angiography is considered the gold standard to diagnose a traumatic renal artery pseudoaneurysm. We report here a case of delayed bleeding from a renal artery pseudoaneurysm that was diagnosed at 17 days after the injury and that was managed successfully with selective renal artery embolization without medical complication.
Aneurysm, False ; Angiography ; Hemorrhage ; Kidney ; Morphinans ; Renal Artery