PURPOSE: To evaluate effectiveness of oblique approach under biplane fluoroscopic guidance in transthoracic fine needle aspiration biopsy. MATERIALS AND METHODS: Fourteen consecutive patients underwent transthoracic fine needle aspiration biopsy for subcarinal lesions. Subcarina was the only accessible biopsy site in 13 patients. Subcarinal biopsy was performed to determine the presence of metastasis in an enlarged subcarinal lymph node in the remaining one patient. Before biopsy, we evaluated the size and location of the lesion on preliminary plain chest X-ray film and CT scan. Under dual projection fluoroscopic guidence, biopsy was performed through right posterior intercostal space with the patient prone by using oblique approach. On 15 degree LAO projection the needle was directed to the area anterior to the spine and advanced to the line extending through the posterior wall of the main bronchus. RESULTS: Cytologic diagnosis was made in 12 out of 14 patients(accuracy 85.7%). The final diagnosis consisted of 5 squamous cell carcinoma, 5 small cell carcinoma, 1 adenocarcinoma and 1 adenosquamous carcinoma. Pneumothorax developed in 2 patients(14%) and was managed by chest tube drainage. Mild hemoptysis was observed in 2. CONCLUSION: Transthoracic fine needle aspiration biopsy using oblique approach under biplane fluoroscopic guidance is a relatively safe and sensitive method for the histologic diagnosis of subcarinal lesion.
Adenocarcinoma ; Biopsy* ; Biopsy, Fine-Needle* ; Bronchi ; Carcinoma, Adenosquamous ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Chest Tubes ; Diagnosis ; Drainage ; Hemoptysis ; Humans ; Lymph Nodes ; Needles ; Neoplasm Metastasis ; Pneumothorax ; Spine ; Thorax ; Tomography, X-Ray Computed ; X-Ray Film

This study was performed to assess the nutritional status of nursing home residents and to assess the effect of nutrition intervention. The subjects were 123 people aged over 60 years from 5 different nursing homes. The nutrition intervention study was carried out by supplementing their diet with multivitamin-minerals for 2 months. The mean intakes of most nutrients did not meet the RDA, Though the nutrient content of the menus provided by the facilities were satisfactory. Nutrients of which intakes fell below 75% of the RDA were protein, Ca, Fe, vitamin A vitamin B1, and vitamin B2. The BMIs of male and female subjects were 22.0 kg/m2 and 24.6 kg/m2 and the WHRs were 0.92 and 0.90, respectively. The percentage of subjects with hypertention (BP> or =140/90 mmHg) and with anemia(Hb< or =13 mg/100ml in men, Hb< or =12 mg/100ml in women) were 34.6% and 41.9%, respectively. The serum cncentrations of albumin, total protein, triglyceride, total cholesterol, HDL-cholesterol, and total lipid fell within normal ranges. However, 27.5% of the subjects showed a high serum cholesterol level of over 250 mg/100ml. The concentration of C3 was 81.2 mg/100ml, IgG, 1343 mg/100ml, and IL-2, 0.766 mg/ml. after 2 months of vitamin-mineral supplementation, the levels of blood glucose and total cholesterol were significantly decreased and triglyceride was significantly increased. The vitamin-mineral supplementation had no effect on the mean levels of vitamin A and E, IgG, IL2, and C3. However, the intervention resulted int he improvement of serum vitamin A and E levels when the subject's serum levels were low before the supplementation.
Blood Glucose ; Cholesterol ; Diet ; Female ; Humans ; Immunoglobulin G ; Interleukin-2 ; Clinical Trial ; Korea* ; Male ; Nursing Homes ; Nutritional Status* ; Reference Values ; Riboflavin ; Thiamine ; Triglycerides ; Vitamin A

PURPOSE: Obstructive voiding difficulties were frequent in the patients with metastatic prostatic cancer, and sometimes acute urinary retention may be developed even though medical treatments. We performed channel transurethral resection of prostate(TURP) as palliative treatment for those patients and reported the results. MATERIALS AND METHODS: Fifteen patients with metastatic prostatic cancer were taken TURP aiming for relief of infravesical obstruction. All patients were under the anti-androgen hormonal therapy and had sudden onset of acute urinary retention. TURP was done under general or epidural anesthesia. After TURP, 30~50 cc ballooning urethral Foley catheter was placed for 4 days. We analyzed voiding parameters comparatively before and 3 months after TURP. RESULTS: The mean age of patients was 75.6+/-5.7 years old. Mean prostatic volume was 47.8+/-1.4 cc. Mean resected prostatic tissue was 6.4+/-2.1 cc. All patients had stage D prostatic cancer. Mean serum PSA was 75.2+/-73.8 ng/ml and mean gleason score was 7.8+/-0.9. After TURP, mean international prostatic symptom score(IPSS) was improved from 25.5+/-2.0 to 13.8+/-2.0, mean quality of life score(QOL) was improved from 4.4+/-0.5 to 2.0+/-0.5, and mean maximum uroflow rate was increased from 5.0+/-1.1 ml/sec to 6.0+/-1.6 ml/sec. All patients did not have any complications according to TURP. CONCLUSION: In patients with metastatic prostatic cancer, channel TURP could be considered as a treatment option to relieve severe obstructive voiding difficulty.
Anesthesia, Epidural ; Catheters ; Humans ; Neoplasm Grading ; Palliative Care ; Prostatic Neoplasms* ; Quality of Life ; Transurethral Resection of Prostate ; Urinary Retention*

BACKGROUND: Numerous disinfectants are available for disinfection and sterilization in the hospital environment but it is difficult to select an appropriate one. Biospot(R) is a chlorine-based disinfectant that consists of sodium dichloroisocyanurates. We evaluated the bactericidal effect of Biospot(R) against clinical isolates and compared it with that of other disinfectants. METHOD: Biospot(R), Wydex(R), HiCLO-S(R), Vipon(R), 70% ethanol, and 3% boric acid were evaluated. Clinical isolates were cultured from the patients in Kangnam St. Mary's hospital. There were two strains of Escherichia coli, methicillin-susceptible Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Klebsiella pneumoniae, vancomycin-resistant Enterococcus faecium, Pseudomonas aeruginosa, coagulase-negative staphylococcus, Streptococcus pneumoniae, and Bacillus subtilis. One strain of Candida albicans was included. Each strain was exposed to disinfectants for 0.5, 1, 2, 4, 8, and 15 minutes. RESULTS: All the non-spore forming bacteria were killed within 30 seconds in Biospot(R) (30 ppm of sodium dichloroisocyanurate). Wydex(R) (2% glutaraldehyde), HiCLO-S(R) (hypochlorous add 30ppm and electrolyzed oxidized water), Vipon(R) (50ppm of sodium hypochlorite), and 70% ethanol, but not in boric acid. Candida albicans were killed in 30 seconds with 100 ppm of BiOSpot(R) and all of disinfectants except boric acid. Bacillus subtilis, the spore forming bacteria, was killed in 4 minutes with 50 ppm, 2 minutes with 100 ppm of Btospot. Other disinfectants such as Vipon(R) killed Bacillus subtilis in 8 minutes. But Wydex(R), HiCLO-S(R), 70% ethanol, and boric acid could not kill the strain until 15 minutes. CONCLUSIONS: Biospot(R) was an effective and useful disinfectant against most common clinical isolates including fungus and spore forming bacteria.
Bacillus subtilis ; Bacteria ; Candida albicans ; Disinfectants ; Disinfection ; Enterococcus faecium ; Escherichia coli ; Ethanol ; Fungi ; Humans ; Klebsiella pneumoniae ; Methicillin-Resistant Staphylococcus aureus ; Pseudomonas aeruginosa ; Sodium ; Spores ; Staphylococcus ; Staphylococcus aureus ; Sterilization ; Streptococcus pneumoniae

BACKGROUND: Remifentanil efficiently blunts the stress response during endotracheal intubation, but also causes hypotension, especially in geriatric patients. Hence, this study was designed to compare the hemodynamic changes during the induction with propofol or etomidate in geriatric patients. METHODS: Sixty ASA physical status class I or II geriatric patients, who were scheduled for elective surgery, were randomly assigned to two groups (n = 30 each). Induction was performed with either propofol (2 mg/kg mixed with lidocaine 40 mg, Group P) or etomidate (0.2 mg/kg, Group E). Both groups received a bolus dose of remifentanil (1 microg/kg), followed with continuous administration (0.1 microg/kg/min). An additional bolus dose (50 microg) was repeated, if needed. The systolic, diastolic, mean arterial blood pressure, heart rates and cardiac index were measured before induction (baseline vital signs), after propofol or etomidate administration, before intubation, immediately after intubation and at 1, 3, 5 and 10 minutes after intubation. RESULTS: Patient characteristics and baseline vital signs were similar in both groups. Systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and cardiac output were significantly decreased in group P compared with those in group E (P < 0.05). Heart rates decreased after the injection of both propofol or etomidate, but were recovered after intubation. 5 patients in group P and 14 patients in group E needed an additional bolus dose of remifentanil (P < 0.05). CONCLUSIONS: Etomidate can be used safely with remifentanil for the stable induction of anesthesia in geriatric patients.
Anesthesia ; Anesthesia, General* ; Arterial Pressure ; Blood Pressure ; Cardiac Output ; Etomidate* ; Heart Rate ; Hemodynamics ; Humans ; Hypotension ; Intubation ; Intubation, Intratracheal ; Lidocaine ; Propofol* ; Vital Signs

No abstract available.
Humans ; Subclavian Vein*

Bleeding from pancreatic pseudocyst is a rare complication. Furthermore, massive upper gastrointestinal (GI) bleeding from gastro-cystic fistula formation and intracystic bleeding are both extremely rare and are also potentially fatal. A 53-year-old male was referred to the emergency room with melena and hematemesis. An urgent endoscopy revealed a massive gastric hematoma but showed no specific bleeding focus. Gastrocystic fistula formation and intracystic bleeding leakage to the stomach were suspicious in the follow-up endoscopy. A contrast-enhanced computed tomography scan demonstrated splenic artery pseudoaneurysm and extravasation of contrast media into the cyst that was abutted to the greater curvature side of the stomach. A splenic artery embolization was performed and no further bleeding occurred after embolization. Upper GI bleeding from gastro-cystic fistula and intracystic bleeding are rare but possible. Therefore, this possibility should be considered in the unknown cause of an upper GI bleeding in a patient with pancreatic pseudocyst.
Aneurysm, False ; Emergency Service, Hospital ; Endoscopy ; Extravasation of Diagnostic and Therapeutic Materials ; Fistula* ; Follow-Up Studies ; Hematemesis ; Hematoma ; Hemorrhage* ; Humans ; Male ; Melena ; Middle Aged ; Pancreatic Pseudocyst* ; Splenic Artery ; Stomach

PURPOSE: To assess the value of positional shifting to a gravity-dependent area, as revealed by HRCT, in differ-entiating pulmonary edema (PE) from other conditions. MATERIALS AND METHODS: Sixteen consecutive patients in whom plain radiographs suggested the presence of pulmonary edema but the clinical findings were indefinite underwent HRCT of the lung. For initial scanning they were in the supine position, and then in the prone position. Findings of ground-glass opacity, interlobular septal thickening and peribronchovascular interstitial thickening were analyzed in terms of the presence and degree of shifting to a gravity-dependent area, a grade of high, intermediate or low being assigned. RESULTS: PE was diagnosed in 8 of 16 cases, the remainder being designated as non-pulmonary edema (NPE). Ground-glass opacity was observed in all 16, while the degree of positional shifting was found to be high in ten (PE:NPE=6:4), intermediate in four (PE:NPE=2:2), and low in two (PE:NPE=0:2). There was no significant difference between the two groups (p > 0.05). Interlobular septal thickening was observed in all but two NPE cases; the degree of shifting was high in six (PE:NPE=6:0), intermediate in one (PE), and low in seven (PE:NPE=1:6). Shifting was significantly more prominent in PE than in NPE cases (p<0.05). Peribronchovas-cular interstitial thickening was positive in all PE cases and one NPE case, with no positional shifting. CONCLUSION: Positional shifting of interlobular septal thickening to a gravity-dependent area, as demonstrated by HRCT, is the most specific indicator of pulmonary edema.
Edema ; Humans ; Lung ; Prone Position ; Pulmonary Edema* ; Supine Position

Esophageal tubular duplication is a rare congenital anomaly. We experienced a patient with esophageal tubular duplication who presented with a swallowing difficulty which was aggravated after a gastrofiberscopic examination. Preoperative diagnosis was intramural hematoma of the esophagus due to trauma caused by endoscopy. Surgical specimen revealed that hematoma was located within a duplicated lumen of the esophagus. The radiologic and endoscopic findings are discussed in correlation with its pathology.
Aged ; Case Report ; Deglutition Disorders/etiology+ACo- ; Esophageal Diseases/etiology+ACo- ; Esophagus/surgery ; Esophagus/injuries ; Esophagus/abnormalities+ACo- ; Gastroscopy/adverse effects+ACo- ; Hematoma/etiology+ACo- ; Human ; Male

Esophageal tubular duplication is a rare congenital anomaly. We experienced a patient with esophageal tubular duplication who presented with a swallowing difficulty which was aggravated after a gastrofiberscopic examination. Preoperative diagnosis was intramural hematoma of the esophagus due to trauma caused by endoscopy. Surgical specimen revealed that hematoma was located within a duplicated lumen of the esophagus. The radiologic and endoscopic findings are discussed in correlation with its pathology.
Aged ; Case Report ; Deglutition Disorders/etiology+ACo- ; Esophageal Diseases/etiology+ACo- ; Esophagus/surgery ; Esophagus/injuries ; Esophagus/abnormalities+ACo- ; Gastroscopy/adverse effects+ACo- ; Hematoma/etiology+ACo- ; Human ; Male