The pulmonary cavernous hemangioma is usually from birth and there may be without symptoms until adulthood. Larger or multiple pulmonary angiomata with considerable pulmonary arteriovenous shunts may cause cyanosis, finger clubbing, dyspnea and frequently accompanyingbruit. Recently, we experienced a case of cavernous hemangioma of the lung. A 34-year-old woman was admitted to our hospital for surgical evaluation of a 4 cm solitary, round nodule in the right upper lobe on the chest X-ray and CT scan. She had no symptoms. Laboratory findings are within normal limits except for elevated glucose levels. At surgery, the mass was well encapsulated and easily excised from the peripheral portion of the posterior segment of the right upper lobe. Grossly, it consisted of a 4 cm in diameter, round, soft, sponge-like, hemorrhagic, slightly lobulated mass with a smooth external surface. Microscopically, the mass was composed of vessels, which were thin walled, dilated and filled with blood. The wall of the abnormal vessels was thin and composed of endothelium and fibrous connective tissue with only a little smooth muscle. Immunohistochemically, the wall of the dilated abnormal vessesls showed negative reaction for cytokeratin(low and high) and epithelial membrane antigen but weakly positive reaction for UEA-1 in focal areas.
Adult ; Male ; Female ; Humans ; Hemangioma

No abstract available.
Antibodies, Neutralizing* ; Feces* ; Rotavirus*

PURPOSE: The purpose of this study was to determine the role of CT and MR imagings in the diagnosis aortic dissection and differentiation between the true and false lumen. MATERIALS AND METHODS: We retrospectively studied forty patients with aortic dissection(AD) diagnosed imagings or surgery. Of the forty patients, 19 were examined with only CT, 14 with CT and MR, and 7 with MI~: Our points of view were(1) the classification of AD according to configuration of intimal flap by cross-sectional imaging, (2) differentiation between the true and false lumens, (3) the course of the false lumen, and (4)! detectability of the origin of major branch vessels of the abdominal aorta. RESULTS: The classification by corss-sectional imaging were crescentic(65%), circumferential(15%), flat(12%), and irregular(8%) type, in which false negative diagnosis was made in 1 case of crescentic and circumferential type, respectively. In 2 case of flat type and 1 case of irregular type, the differentiation between the true and false lumen was impossible with CT. The course of the false lumen in descending thoracic aorta revealed countrclock wise rotation(66%), clockwise rotation(5%) or fixed(29%) apperance. MR imaging was superior to CT in the detection of the origin of major branch vessels of the abdominal aorta. The determination of the origin of major branches of abdominal aorta arising from the true and false lumen were impossible in 2 cases in which only CT was done. CONCLUSION: Diagnosis of crescentic and circumferential types of AD with narrow and thrombosed false lumen was problematic in both CT and MR with no difference of diagnostic accuracy between the two modalities. The differentiation between the true and false lumen was difficult in flat and irregular types with only CT. Therefore, when surgical treatment is considered as in type B aortic dissection, MR imaging is recommended in order to determine the origin of major branch vessels.
Aorta, Abdominal ; Aorta, Thoracic ; Classification ; Diagnosis* ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies

Various surgical methods have been used to reconstruct severe soft tissue defects of the finger with exposed critical structures such as tendon, bone, and nerve. Some of these methods include rotation flap, cross finger flap, or regional flap similar to neurovascular island flap. However, there were often difficult situations where a flap could not be applied depending on the remaining surrounding tissue, injured area, and size of defect. As a result, free flap or distant flap may become necessary. However, distant flaps often cause stiffness of the finger joints since the hands need to be immobilized for a long time, while standard free flaps may be too thick to cover the finger and cause problems such as morbidities of the donor site. Since May, 1997, at Anam Hospital, we have performed reconstruction on 6 patients with soft tissue defect using a thin, flexible medial plantar septo-cutaneous free flap similar to the volar aspect of the finger in anatomical characteristics of the skin and subcutaneous tissue covering. The vessels used for this flap were superficial branches of medial division of the medial plantar artery and vena comitantes, or the subcutaneous veins. The mean size of the flaps was 2.75cm x 4.25cm. Primary repair or split-thickness skin graft was performed on the donor site depending on the size. All the flaps survived without significant complications, except one case of venous insufficiency. The composition of the transferred flaps was good with the recovery of pain, touch and temperature sensation. A free medial plantar septo-cutaneous flap has several advantages, e.g., it is small in comparison with other standard free flaps, having two draining venous pathways, good color and texture, and a good recovery of protective sensation. This flap can be used for the reconstruction of soft tissue defect on the heel and foot, as well as the volar aspect of fingers.
Arteries ; Finger Joint ; Fingers ; Foot ; Free Tissue Flaps* ; Hand ; Heel ; Humans ; Sensation ; Skin ; Subcutaneous Tissue ; Tendons ; Tissue Donors ; Transplants ; Veins ; Venous Insufficiency

BACKGROUND: Combined spinal epidural anesthesia (CSE) often produces a more extensive spinal block than expected. This study was designed to evaluate the effects of CSE on subarachnoid block in patients undergoing lower extremity surgery. METHODS: Thirty-three patients who undergone lower extremity surgeries were randomly allocated to three groups of 11 patients each. Using needle through needle technique, all patients received a subarachnoid injection of hyperbaric 0.5% bupivacaine 1.6~2.0 ml through a 25G Whitacre spinal needle. Group 1 received no extradural injection for 25min, but group 2 and 3 received extradural saline 10 ml and bupivacaine 10 ml 5min after the subarachnoid injection, respectively. Levels of sensory and motor block were assessed at 4, 6, 8, 10, 15, 20, and 25 min after subarachnoid injection. RESULTS: The median values of maximum sensory block level were T7 in all groups. Levels of sensory blockade and the time to onset of maximum sensory blockade were similar among the three groups. There was no significant difference in the degree of motor block among three groups. CONCLUSIONS: This study suggests that extradural saline 10 ml or 0.5% bupivacaine 10 ml which injected 5min after subarachnoid injection does not significantly influence the level of subarachnoid block in lower extremity surgical patients. However, further study is required to declare the safety or optimal dose of extradural injection during CSE.
Anesthesia, Epidural* ; Bupivacaine ; Humans ; Injections, Epidural ; Lower Extremity* ; Needles

OBJECTIVE: To investigate the response of hyperplastic endometrium to Medroxyprogesterone acetate according to the histologic types such as simple typical, complex typical and atypical hyperplasia. METHODS: A total of 79 patients with histologically proved endometrial hyperplasia were enrolled into this prospective study between March 1996 and May 1998. Patients without atypia were placed on a regimen of cyclic therapy with 10mg MPA orally, each day for 14days per month for 3 months. In the cases in which hyperplasia did not regress , MPA was increased to 20mg. Patients with atypical hyperplasia received continuous MPA therapy, 20mg orally each day for 3 month. All patients were followed up for a minimum of 3 months and a maximum of 1 year(mean 7 months). RESULTS: In patients with simple typical hyperplasia, 45 patients(80.4%) had regression, 11 patients(19.6%) had persistence and none had progression. In patients with complex typical hyperplasia, 10 patients(83.3%) had regression, 2 patients(16.7%) had persistence and none had progression. But, in patients with atypical hyperplasia 5 patients(45.4%) had regression, 4 patients(36.4%) had persistence and 2(18.2%) patients had well differentiated endometrial adenocarcinoma. There was no recurrence during the follow up. CONCLUSION: This data suggest that most women with typical hyperplasia respond to progestin therapy, but there is high failure rate of response to progestin therapy and risk of endometrial cancer in patients with atypical hyperplasia. If the young patient desires to preserve her fertility, then progestin therapy may be considered as primary treatment in patients with atypical hyperplasia. But older patients in whom fertility is not an issue, hysterectomy should be selected as treatment of choice for atypical lesion.
Adenocarcinoma ; Endometrial Hyperplasia* ; Endometrial Neoplasms ; Endometrium ; Female ; Fertility ; Follow-Up Studies ; Humans ; Hyperplasia ; Hysterectomy ; Medroxyprogesterone Acetate ; Medroxyprogesterone* ; Prospective Studies ; Recurrence

Hunter syndrome is one of the mucopolysaccharidoses, characterized by abnormal accumulation and deposition of mucopolysaccharides in the tissues of several organs which are known to complicate anaesthetic and airway management. We experienced a case of pulmonary edema which developed during induction of general anesthesia of Hunter syndrome after several attempts of intubation and airway obstruction.
Airway Management ; Airway Obstruction ; Anesthesia, General ; Glycosaminoglycans ; Intubation ; Intubation, Intratracheal* ; Mucopolysaccharidoses ; Mucopolysaccharidosis II* ; Pulmonary Edema*

A 44-year-old man was cutting an outer plate of a ship, at a depth of 25 m below sea level. Following a sudden explosion, he was discovered unconscious and was carried to the surface by other divers. There was no evidence of vital signs upon arrival at the hospital. Postmortem computed tomography, which was performed prior to autopsy, revealed massive pneumocephalus in the brain, pneumohemothorax, diffuse lung contusions with multiple traumatic lung cysts, air-fluid level in the cardiac chamber of the chest, and pneumoperitoneum in the abdomen. Postmortem external examination showed a circular abrasion on the jaw, diffuse subcutaneous emphysema, and contusion in the right upper arm. An internal examination revealed intravascular air bubbles in all four chambers of the heart, and diffuse pulmonary trauma including contusion, laceration, and multiple traumatic cysts. Blast injury to the chest, and air embolism due to the underwater explosion were established as the underlying cause of death.
Abdomen ; Adult ; Arm ; Autopsy ; Blast Injuries ; Brain ; Cause of Death ; Contusions ; Diving ; Embolism, Air ; Explosions* ; Heart ; Humans ; Jaw ; Lacerations ; Lung ; Pneumocephalus ; Pneumoperitoneum ; Ships ; Subcutaneous Emphysema ; Thorax ; Vital Signs

BACKGROUND: Intrathecal gabapentin is effective on nociceptive states evoked by tissue injury. In addition, gabapentin interacts synergistically with clonidine at the spinal level, suggesting that a mechanism of gabapentin may be related to spinal adrenoceptors. However, it has not been established whether this drug is associated with cholinergic receptors. The aim of this study was to examine the role of spinal adrenergic and cholinergic receptors on the antinociceptive action of intrathecal gabapentin. METHODS: Rats were implanted with lumbar intrathecal catheters. For a nociceptive test, 50nl of 5% formalin solution was injected into the hindpaw. The effect of intrathecal gabapentin, administered 10 min before the formalin injection, was assessed. Next, antagonistic effects of intrathecal prazosin, yohimbine, atropine and mecamylamine for the action of intrathecal gabapentin were evaluated. RESULTS: Formalin injection caused a biphasic incidence of flinching of the injected paw. Intrathecal gabapentin produced a dose-dependent suppression of only the phase 2 flinching response in the formalin test. Intrathecal atropine, but not prazosin, yohimbine nor mecamylamine, reversed the antinociception of intrathecal gabapentin. CONCLUSIONS: The antinociceptive effect of intrathecal gabapentin on facilitated states may be mediated through the muscarinic receptor but by neither the nicotinic receptor nor the adrenergic receptor at the spinal level.
Animals ; Atropine ; Catheters ; Cholinergic Antagonists* ; Clonidine ; Formaldehyde ; Incidence ; Mecamylamine ; Nociception ; Pain Measurement ; Prazosin ; Rats ; Receptors, Adrenergic ; Receptors, Cholinergic ; Receptors, Muscarinic ; Receptors, Nicotinic ; Spinal Cord ; Yohimbine

Parvovirus B19 has been recently identified as the cause of various diseases such as erythema infectiosum, transient aplastic crisis in patients with chronic hemolytic anemias, hydrops fetalis, bone marrow suppression in immunocompromised hosts, and lastly acute and chronic arthropathy mimicking rheumatoid arthritis (RA) and occasionally, systemic lupus erythematosus (SLE). We describe a female patient who presented with fever, chills, polyarthralgia, serologic and PCR evidence of presence of Parvovirus B19, and expression of antinuclear antibody, anti- Ro/SSA and anti-La/SSB. There has been no clinical findings suggestive or diagnostic of any diffuse connective tissue diseases in this patient. Although there has been reports of Parvovirus B19 infection mimicking RA and SLE with manifestations of various autoimmune antibodies including rheumatoid factor, antinuclear antibody, anti-dsDNA, antilymphocyte antibody, and antiphospholipid antibody, there has not been any report of anti-Ro/SSA and anti-La/SSB expression in the setting of parvoviral arthropathy and this is the first case report.
Anemia, Hemolytic ; Antibodies ; Antibodies, Antinuclear* ; Antibodies, Antiphospholipid ; Antilymphocyte Serum ; Arthralgia ; Arthritis, Rheumatoid ; Bone Marrow ; Chills ; Connective Tissue Diseases ; Erythema Infectiosum ; Female ; Fever ; Humans ; Hydrops Fetalis ; Immunocompromised Host ; Lupus Erythematosus, Systemic ; Parvovirus* ; Polymerase Chain Reaction ; Rheumatoid Factor