BACKGROUND: The large volume of blood products are required during orthotopic liver transplantation. Any preoperative and intraoperative factors may influence the intraoperative blood products usage. METHODS: We retrospectively reviewed the demographic information, coagulation screens, thrombelastographic variables, and intraoperative blood requirements in 952 adult patients, who underwent orthotopic liver transplantation at the University of Pittsburgh Medical Center between January 1992 and December 1995. A preoperative coagulation abnormality score (CAS) was calculated by assigning one point of each abnormal result of the coagulation tests (PT, aPTT, platelet count) and thrombelastographic variables (reaction time, alpha angle, maximal amplitude, clot lysis index). Intraoperatively, blood products and pharmacologic coagulation therapy were administered based on thrombelastographic and hemodynamic data. RESULTS: Underlying liver disease, retransplantation one month after the first transplantation, poor preoperative coagulation profiles were predictive of intraoperative blood usage. Age, preoperative PT >15 sec, and CAS were not predictive of intraoperative blood usage. The severe fibrinolysis during operation occurred. More blood products were required in patients with severe fibrinolysis. CONCLUSIONS: The understanding of preoperative and intraoperative factors affecting blood product requirements can help the management of blood component therapy during liver transplantation.
Adult ; Blood Platelets ; Fibrinolysis ; Hemodynamics ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Retrospective Studies ; Risk Factors*

BACKGROUND: Since the demonstration of the fact that vascular relaxation by acetylcholine(Ach) results from the release of relaxing factor from the endothelium, the identity and physiology of this endothelium-derived relaxing factor(EDRF) has been the target for many researches. EDRF has been identified as nitric oxide(NO). With the recent evidences that EDRF is an important mediator of vascular tone, there have been increasing interests in defining the role of the EDRF as a potential mediator of hypoxic pulmonary vasoconstriction. But the role of EDRF in modulating the pulmonary circulation is not compeletely clarified. To investigate the endotbelium-dependent pulmonary vasodilation and the role of EDRF during hypoxic pulmonary vasoconstriction, we studied the effects of N(G)-monornethyl-L-arginine(L-NMMA) and L-arginine on the precontracted pulmonary arterial rings of the rat in normoxia and hypoxia. METHODS: The pulmonary arteries of male Sprague Dawley(300~350g) were dissected free of surrounding tissue, and cut into rings. Rings were mounted over fine rigid wires, in organ chambers filled with 20ml of Krebs solution bubbled with 95 percent oxygen and 5 percent carbon dioxide and maintained at 37℃. Changes in isometric tension were recorded with a force transducer(FT. 03 Grass, Quincy, USA). RESULTS: 1) Precontraction of rat pulmonry artery with intact endothelium by phenylephrine(PE, 10(-6)M) was relaxed completely by acetylcholine(Ach, 10(-9) -10(-5)M) and sodium nitroprusside (SN, 10(-9) -10(-5)M), but relaxing response by Ach in rat pulmonary artery with denuded endothelium was significantly decreased. 2) L-NMMA(10-4M) pretreatment inhibited Ach(10(-9) -10(-5)M)-induced relaxation, but L-NMMA(10-4M) had no effect on relaxation induced by SN(10(-9) -10(-5)M). 3) Pretreatment of the L-arginine(10(-4)M) significantly reversed the inhibition of the Ach(10(-9) -10(-5)M)-induced relaxation caused by L-NMMA(10(-4)M). 4) Pulmonary arterial contraction by PE(10(-6)M) was stronger in hypoxia than normoxia but relaxing response by Ach(10(-9) -10(-5)M) was decreased. 5) With pretreatment of L-arginine(10(-4)M), pulmonary arterial relaxation by Ach(10(-9) -10(-5)M) in hypoxia was reversed to the level of relaxation in normoxia. CONCLUSION: It is concluded that rat pulmonary arterial relaxation by Ach is dependent on the intact endothelium and is largely mediated by NO. Acute hypoxic pulmonary vasoconstriction is related to the suppression on NO formation in the vascular endothelium.
Animals ; Anoxia ; Arginine ; Arteries ; Carbon Dioxide ; Endothelium ; Endothelium, Vascular ; Humans ; Male ; Nitric Oxide* ; Nitroprusside ; omega-N-Methylarginine ; Oxygen ; Physiology ; Poaceae ; Pulmonary Artery ; Pulmonary Circulation ; Rats* ; Relaxation* ; Vasoconstriction* ; Vasodilation

Lung cancer is the most common fatal malignant lesion in both sexes. Detection of the solitary pulmonary nodule is important because surgical series up to a third of solitary pulmonary nodules are bronchogenic carcinoma. Bronchioloalveolar cell carcinoma is a rare primary lung cancer and surgery is treatment of choice in brochioloalveolar cell carcinoma. We experienced a case of broschioloalveolar cell carcinoma in solitary pulmonary nodule with cavitary lesion in chest CT scan, which is an uncommon finding in brochioloalveolar cell carcinoma.
Carcinoma, Bronchogenic ; Lung Neoplasms ; Solitary Pulmonary Nodule ; Tomography, X-Ray Computed

Thyroid tuberculosis is rare. We experienced case of a 50-year-old woman with tuberculosis of the thyroid associated with miliary tuberculosis. She complained of chronic cough and weight loss. She was clinically and biochemically euthyroid. Thyroid sonogram demonstrated 3 2 cm sized heterogenous echogenic mass on upper pole of the left lobe of thyroid with calcification. Fine needle aspiration biopsy showed epithelioid granuloma in the caseous necrosis and acid-fast bacilli. She took antituberculous agents. One month later, radiologic finding improved and thyroid mass decreased also.
Biopsy ; Biopsy, Fine-Needle ; Cough ; Diagnosis* ; Female ; Granuloma ; Humans ; Middle Aged ; Necrosis ; Thyroid Gland* ; Tuberculosis* ; Tuberculosis, Miliary* ; Weight Loss

Thyroid tuberculosis is rare. We experienced case of a 50-year-old woman with tuberculosis of the thyroid associated with miliary tuberculosis. She complained of chronic cough and weight loss. She was clinically and biochemically euthyroid. Thyroid sonogram demonstrated 3 2 cm sized heterogenous echogenic mass on upper pole of the left lobe of thyroid with calcification. Fine needle aspiration biopsy showed epithelioid granuloma in the caseous necrosis and acid-fast bacilli. She took antituberculous agents. One month later, radiologic finding improved and thyroid mass decreased also.
Biopsy ; Biopsy, Fine-Needle ; Cough ; Diagnosis* ; Female ; Granuloma ; Humans ; Middle Aged ; Necrosis ; Thyroid Gland* ; Tuberculosis* ; Tuberculosis, Miliary* ; Weight Loss

PURPOSE: Survival outcome of locally advanced pancreatic cancer has been poor and little is known about prognostic factors of the disease, especially in locally advanced cases treated with concurrent chemoradiation. This study was to analyze overall survival and prognostic factors of patients treated with concurrent chemoradiotherapy (CCRT) in locally advanced pancreatic cancer. MATERIALS AND METHODS: Medical records of 34 patients diagnosed with unresectable pancreatic cancer and treated with definitive CCRT, from December 2003 to December 2012, were reviewed. Median prescribed radiation dose was 50.4 Gy (range, 41.4 to 55.8 Gy), once daily, five times per week, 1.8 to 3 Gy per fraction. RESULTS: With a mean follow-up of 10 months (range, 0 to 49 months), median overall survival was 9 months. The 1- and 2-year survival rates were 40% and 10%, respectively. Median and mean time to progression were 5 and 7 months, respectively. Prognostic parameters related to overall survival were post-CCRT CA19-9 (p = 0.02), the Eastern Cooperative Oncology Group (ECOG) status (p < 0.01), and radiation dose (p = 0.04) according to univariate analysis. In multivariate analysis, post-CCRT CA19-9 value below 180 U/mL and ECOG status 0 or 1 were statistically significant independent prognostic factors associated with improved overall survival (p < 0.01 and p = 0.02, respectively). CONCLUSION: Overall treatment results in locally advanced pancreatic cancer are relatively poor and few improvements have been accomplished in the past decades. Post-treatment CA19-9 below 180 U/mL and ECOG performance status 0 and 1 were significantly associated with an improved overall survival.
Chemoradiotherapy* ; Follow-Up Studies ; Humans ; Medical Records ; Multivariate Analysis ; Pancreatic Neoplasms* ; Survival Rate

No abstract available.
Pleura* ; Rhabdomyosarcoma*

Cytokines such as interleukin 10 (IL10) may play an important role in the process of inflammation. The aim of this study was to analyze the association between IL10, IL10RA and IL10RB single nucleotide polymorphisms (SNPs), and benign prostate hyperplasia (BPH) in Korean population. All patients with BPH were divided into two groups according to international porostate symptom score (IPSS), prostate specific antigen (PSA) level, Qmax, and prostate volume. We selected two IL10 SNPs (rs1518111 and rs1554286), three IL10RA SNPs (rs2256111, rs4252243, and rs2228054), and two IL10RB SNPs (rs999788 and rs2834167). Genotypes of seven SNPs were determined through direct sequencing. The G/G genotype of IL10RB polymorphism (rs2834167) was associated with a high PSA level compared with the A/G + A/A genotypes (P = 0.009). Of IL10 SNP, the A/A genotype of rs1518111 and T/T genotype of rs1554286 were associated with small prostate volume, respectively (P = 0.011, P = 0.014). Moreover, the T/T genotype of IL10RB polymorphism (rs999788) was associated with high prostatic volume compared with the T/C + C/C genotypes (P = 0.033). The linkage disequilibrium (LD) blocks were formed in IL10 and IL10RA. However, haplotypes in the LD block were not associated with BPH. It is concluded that there is a strong association between the IL10 and IL10RB SNPs, and BPH in Korean population.
Aged ; *Genetic Predisposition to Disease ; Genotype ; Humans ; Inflammation ; Interleukin-10/*genetics ; Interleukin-10 Receptor alpha Subunit/*genetics ; Interleukin-10 Receptor beta Subunit/*genetics ; Linkage Disequilibrium ; Male ; Middle Aged ; *Polymorphism, Single Nucleotide ; Prostate-Specific Antigen/blood/genetics ; Prostatic Hyperplasia/*genetics ; Republic of Korea ; Sequence Analysis, DNA

Inflammatory myofibroblastic (IMF) tumor is a rare solid tumor that often affects children. IMF tumors occur primarily in the lung, but the tumor may affect any organ system with protean manifestations. A 22-year-old woman was evaluated for palpable low abdominal mass that had been increasing in size since two months prior. Abdominal computed tomography showed a lobulated, heterogeneous contrast enhancing soft tissue mass, 6.5 x 5.7 cm in size in the ileal mesentery. At surgery, the mass originated from the greater omentum laying in the pelvic cavity and was completely excised without tumor spillage. Histologically, the mass was a spindle cell lesion with severe atypism and some mitosis. Immunohistochemistry for anaplastic lymphoma kinase-1 revealed that the lesion was an IMF tumor. Because of its local invasiveness and its tendency to recur, this tumor can be confused with a soft tissue sarcoma. Increasing physician awareness of this entity should facilitate recognition of its clinical characteristics and laboratory findings.
Child ; Female ; Humans ; Immunohistochemistry ; Lung ; Lymphoma ; Mesentery ; Mitosis ; Myofibroblasts ; Omentum ; Sarcoma ; Young Adult

The incidence of traumatic rupture of the tracheobronchial tree has been increased considerably with advent of widespread mechanization and high speed era. Rupture of the bronchus is an unusual result of nonpenetrating trauma to chest. Early diagnosis and primary repair not only restore normal lung function but also avoid difficulties and complications associated with delayed diagnosis and repair. These complications are pneumonia, atelectasis and lung abscess secondary to the bronchial obtruction. We experienced a case of partial rupture on left main bronchus caused by nonpenetrating blunt chest trauma with rib fractures 1 year ago. He was suffered from progressively developing dyspnea on exercise and treated as bronchial asthma at other hospital. Bronchoscopic finding was the narrowed lumen of left main bronchus at 1cm from carina by web-like membrane. We confirmed by bronchogram and repaired by end to end anastomosis, which is rare delayed finding in bronchial rupture without pulmonary complications. We report a case of nonpenetrating traumatic bronchial rupture, manifested by bronchial web in bronchoscopy.
Asthma ; Bronchi ; Bronchoscopy* ; Delayed Diagnosis ; Dyspnea ; Early Diagnosis ; Incidence ; Lung ; Lung Abscess ; Membranes ; Pneumonia ; Pulmonary Atelectasis ; Rib Fractures ; Rupture* ; Thorax* ; Trees