Hepatocellular carcinoma (HCC) is malignant tumor frequently occurring in Koreans. There have been few reports regarding the cytologic findings of fine needle aspiration (FNA) of HCC. Most have suggested a diagnostic problem in the cytology distinguishing HCC from some benign hepatic lesions-for example, a regeneration nodule in cirrhosis and liver cell adenoma. In spite of its high frequency in Korea, no cytologic study has been reported, concerning the FNA of HCC. In an attempt to achieve cytologic criteria for the diagnosis of HCC, the authors studied retrospectively cytopathologic findings of 247 cases of HCC. These cases were confirmed either by histologic examination including lobectomy, biopsy, or cell block materiai, or, when tissue diagnosis was unavailable, by a high serum alpha-fetoprotein level (over 400 l. U.). All aspiration smears were stained by the Papanicolaou method. In each case, the smears were analyzed for cell patterns and various cytomorphology of the tumor cells. The smear background was assessed for the presence of tumor cell necrosis and inflammatory components and compared to that of metastatic carcinomas. The cell patterns were classified as trabecular, acinar, dispersed, and irregular. The cytologic parameters analyzed included the degree of nuclear atypia and the presence of mitoses, intranuclear cytoplasmic inclusions, nucleolar prominency, endotheiial lining, multinucleated giant cells, eosinophiic globules, bile, and Mallory body.Most of the FNA of HCC showed markedly cellular smears. The tumor cells were most frequently arranged in a trabecular pattern (80.3%). The irregular (12.6%), the acinar (5.5%), and the dispersed patterns (1.7%) followed in decreasing frequency. Individual hepatoma cells were larger than normal liver cells. However, they had morphologic features characteristic of the hepatic cells: the cells were round or polygonal, their cytoplasm was abundant and granular with eosinophilic or amphophilic stainability, and their nuclei were round to oval, located centrally, and tended to have prominent nucleoli. Anaplasia and pleomorphism of tumor cells were generally mild to moderate. These findings existed even in very well differentiated cases. Mitotic figures were present in about 85% of the cases. Prominent nucleoli were observed only in about half the cases. The frequency of other cytologic features was as follows: intranuclear cytoplasmic inclusion in 86.8%; endothelial lining in 56.1%: bile in 19.8%; and giant cells in 60.1%. Clear cells were often present in11.7%, Most aspiration smears of HCC displayed clean background without necrosis or inflammatory material in contrast to the dirty, necrotic background of metastatic cancers and cholangiocarcinomas. Based on the above mentioned features, it is suqqested that the cytologic critieria most important for the diagnosis of HCC include a markedly cellular smear, trabecular pattern, hepatocytoid appearance of tumor cells, endothelial lining, the presence of bile, giant cells, intranuclear cytoplasmic inclusions, and prominent nucleoli, Among these, trabecular pattern, endothelial lining, giant cells and clean smear background are points to be considered in differentiating HCC from metastatic and cholangiocellular carcinoma.
Adenoma, Liver Cell ; alpha-Fetoproteins ; Anaplasia ; Bile ; Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Hepatocellular ; Child* ; Cholangiocarcinoma ; Cytoplasm ; Diagnosis ; Endothelial Cells ; Eosinophils ; Fibrosis ; Giant Cells ; Glomerulonephritis* ; Hepatocytes ; Humans ; Inclusion Bodies ; Korea ; Liver ; Mitosis ; Necrosis ; Regeneration ; Retrospective Studies

No abstract available.

The mucoepidermoid carcinoma is a rare tumor in the lung. A case of bronchial mucoepidermoid carcinoma diagnosed by fine needle aspiration cytology is presented. The smear showed many intermediate cells with occasional mucus-secreting cells. Malignant squamous cells were not present. The cellular arrangement of intermediate cells was overlapping and grouped in ball-like fashion. These cytologic features are unique for diagnosis of this tumor.
Biopsy, Fine-Needle ; Carcinoma, Mucoepidermoid ; Child* ; Diagnosis ; Glomerulonephritis* ; Humans ; Lung ; Mucoepidermoid Tumor

Sirenomelia is a severe form of caudal regression syndrome that results in a fusion of the lower extremities, which is not compatible with life. A various spectrum of anomalies affecting primarily the musculoskeletal, genitourinary and gastrointestinal systems also can occur. This rare malformation has a reported incidence rate of approximately 1 in 60,000 births, with a range of 1 to 1 percent of all malformed infants. We experienced a sirenomelic case with combined anomalies of genitourinary, cardiovascular and gastrointestinal systems. Maternal obstetric history revealed oligohydramnios and intrauterine fetal growth retardation, and the baby was spontaneously delivered at 37 weeks of gestational age, but died I hour after birth.
Infant ; Male ; Female ; Humans ; Incidence

The vertical ground reaction force (GRF) parameters in a sit-to-stand movement are useful for measuring lower-limb muscle strength and power in older adults. The purpose of this study was to examine which GRF parameters would be more strongly associated with a person's physical functioning, history of falls, fear of falling and mobility limitations, all of which are known to be related to lower-limb muscle strength and power. We performed cross-sectional analyses on 363 community-dwelling older adults, which included 160 men and 203 women, aged 65-85 years (73.4 ± 5.3 years). Five parameters were measured: peak reaction force, two rate of force development and two time-related parameters. Their rate of force development was relatively higher correlated with results from timed “up and go” tests, standing times from a long sitting position and 4-way choice reaction times (partial r = -0.37 ∼ -0.52); these tests were accompanied with a dynamic movement of lower-limb; than their peak reaction force and time-related parameters. The rate of force development were poorer in subjects reporting falls, a fear of falling or a mobility limitation compared with those reporting no falls, fear of falling or mobility limitation. These results suggest that measuring the rate of force development in a sit-to-stand movement provide a better assessment of lower-limb muscle strength and power.

BACKGROUND: Total intravenous anesthesia (TIVA) is by definition a technique involving the induction and maintenance of the anesthetic state with intravenous drugs alone. In particular, propofol and opioid and muscle relaxants allow enhanced control of the state of anesthesia for the entire duration of the surgical procedure. We evaluated the clinical usefulness of TIVA with fixed fentanyl concentration 3 ng/ml using isoconcentration nomogram and titrated propofol for coronary artery bypass graft. METHODS: Anesthesia was induced using 1% propofol mixed with lidocaine 0.5 mg/kg and ephedrine 10 mg (150 ml/hr) until loss of consciousness in 19 patients undergoing coronary artery bypass graft. Infusion rate of propofol was adjusted in response to blood pressure and pulse rate. To achieve constant fentanyl concentration, infusion rate of fentanyl was changed timely according to isoconcentration nomogram. Infusion of propofol and fentanyl was discontinued 15 and 30 min before predictable end of surgery, respectively. Intraoperative hemodynamics, recovery profile and postoperative analgesic requirements were checked. RESULTS: Overall intraoperative hemodynamics including cardiac index and PCWP showed no significant changes compared with preinduction control value except during CPB period. Average flow rate of propofol and fentanyl was 3.4 0.2 mg/kg/hr and 2.8 0.4 g/kg/hr, respectively. Spontaneous eye opening time was 96.4 min after discontinuation of fentanyl. More than 80% (16/19) of patients did not require any analgesic during first postoperative 24hrs for pain relief. CONCLUSIONS: TIVA with propofol and fentanyl (3 ng/ml) could be a suitable and safe anesthetic technique for coronary artery bypass graft.
Anesthesia ; Anesthesia, Intravenous* ; Blood Pressure ; Coronary Artery Bypass* ; Coronary Vessels* ; Ephedrine ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Lidocaine ; Nomograms ; Propofol ; Transplants ; Unconsciousness

PURPOSE: To evaluate by means of MR arthrography the causal relationship between anterior capsularattach-ment type and anterior instability of the glenohumeral joint. MATERIALS AND METHODS: Sixty-five patients (M:F=64:1; mean age, 23 years), who had undergone shoulder MR arthrography were retrospectively reviewed. There wasno history of traumatic dislocation, and medical records relating to anterior instability were available. Physicalexamination revealed anterior instability in 25 patients(Group A), while in 40 (Group B), this was eithersuspicious or absent. With the aid of general anesthe-sia, 32 patients who had undergone surgery were physicallyexamined. Anterior instability was evident in 16 patients(Group C), and suspicious or absent in the remaining 16(Group D). All images were obtained after in-traarticular injection of Gd-DTPA. Fat-suppressed T1 axial imagingwas used to evaluate anterior capsular at-tachment type at mid and distal three-fourths levels of the glenoidfossa. The causal relationship between ante-rior capsular attachment types and anterior instability was analyzedusing the x2 test RESULTS: In group A, type I was most common at distal three-fourths level, and types I and IIwere equal and more common than type III at mid level. In group B, type I anterior capsular attachment type wasmost com-mon at both mid and distal three-fourths level. In these groups, no statistical significance was notedbetween anterior capsular attachment type and anterior instability (p value 0.611: 0.567). In group C, types I andII were equal and more common than type III at both mid and distal three-fourths level, while in group D, type IIwas most common at mid level, and type I was most common at distal three-fourths level. In these groups, nostatistical significance was noted between anterior capsular attachment type and anterior instability (p val-ue,0.772). CONCLUSION: There was no statistically significant difference between anterior capsular attachment typeand anterior instability of the shoulder joint.
Arthrography* ; Dislocations ; Gadolinium DTPA ; Humans ; Medical Records ; Retrospective Studies ; Shoulder ; Shoulder Joint*

PURPOSE: To evaluate the findings of subchondral cyst of the humeral head, as seen on shoulder MRarthrography MATERIALS AND METHODS: Sixty-three patients( M:F=62:1 ; mean age 23 years) who underwent shoulder MRarthrography between September 1996 and May 1998 were retrospectively reviewed. No patient had a history of eithershoulder dislocation or certain diseases known to be commonl accompanied by subchondral cysts. All MR images wereobtained using a 1.5 Tesla unit after intraarticular injection of 20ml of diluted contrast material. T1 andT2-weighted axial, oblique coronal, and oblique sagittal images were analysed for the presence, location, number,shape, size, and connection to the joint cavity of subchondral cysts. RESULTS: We identified 58 subchondral cystsin 43(71.7%) of 63 cases. All were located in the posterolateral portion of the humeral head, and on the physealline. Twenty-eight patients(65.1%) had one cyst, and 15(34.9%) had two. Thirty-four cysts(58.6%) were round orovoid in shape and, 2-8mm in diameter(average, 3.9mm) ; 24(41.4%) were lobulated and 3-10mm in diameter(average5.3mm). Fifty-three cysts(91.4%) were connected to the joint cavity. CONCLUSIONS: In symptomatic patients, the incidence of subchondral cyst of the humeral head was 71.7%. All were located in the posterolateral portion, andon the physeal line. Most subchondral cysts were connected with the joint cavity.
Bone Cysts* ; Dislocations ; Humans ; Humeral Head* ; Incidence ; Injections, Intra-Articular ; Joints ; Magnetic Resonance Imaging* ; Retrospective Studies ; Shoulder

Osteochondroma is a benign bone tumor that is most commonly found in the extremities and is prevalent in adolescents, with a peak incidence before the age of 20 years. Herein, we present a rare case of a 33-year-old man with an asymptomatic tumor on the right anterior rib that was pathologically confirmed to be a rib osteochondroma after surgical excision. We describe the computed tomography and magnetic resonance imaging (MRI) procedures and highlight the importance of MRI as a critical diagnostic tool for osteochondroma.

BACKGROUND: Propofol is a useful induction agent, but it can cause hypotention and bradycardia. Meanwhile, ephedrine has alpha-vasoconstriction and beta-cardiac stimulant effect. The purpose of this study was to assess the hemodynamic effects of adding various doses of ephedrine to propofol to obtund adverse hemodynamic response and to determine the optimal dose. METHODS: Unpremedicated 120 ASA physical status I adult patients (20~50yrs) scheduled for elective surgery were randomly allocated into four groups according to the doses of ephedrine added to propofol (1%, 20 ml). Group 1 (control group) was given propofol alone and 10, 15 and 20 mg of ephedrine was added to propofol in Group 2, 3 and 4, respectively (n=30 for each group). Propofol was loaded at 150 ml/hr using a syringe pump and no response to verbal command was ascertained as the end-point of induction. Vital signs and SpO2 were checked every 1 min during the induction period. RESULTS: In group 1, there was a significant decrease in both systolic and diastolic pressure prior to intubation. Group 2 and 3 showed relatively stable hemodynamic changes and significant systolic or diastolic changes occured only in the pre or post 1 min periods of intubation. But, in pulse rate, group 3 showed significant change 1 and 2 min after intubation, in contrary to group 2. Group 4 showed significant changes in systolic and diastolic pressure 1 and 2 min after intubation, and in pulse rate throughout the postintubation period. CONCLUSIONS: Ephedrine 10mg may be safely employed to reduce the hemodynamic changes during induction preiod with propofol.
Adult ; Anesthesia* ; Blood Pressure ; Bradycardia ; Ephedrine* ; Heart Rate ; Hemodynamics* ; Humans ; Intubation ; Propofol* ; Syringes ; Vital Signs