OBJECTIVE: To evaluate magnetic resonance imaging (MRI) observer variability to detect ectopic insertion of the pectoralis minor tendon (EIPMT) and to investigate changes in the rotator interval in patients with EIPMT using MRI. MATERIALS AND METHODS: A total of 507 shoulder MRIs (male:female = 259:248; mean age, 55.4 years) were classified into 1) normal type insertion of the pectoralis minor tendon, 2) complete type EIPMT, and 3) partial type EIPMT independently by two radiologists. Inter-observer agreement was calculated using the kappa coefficient. Thickness of the fibrotic scar tissue in the subcoracoid triangle and humeral side axillary recess was measured. MRIs were reviewed by consensus with regard to the grade of fibrotic scar tissue proliferation in the rotator interval. Comparisons were made between normal and EIPMT and between partial and complete type EIPMT. RESULTS: The incidence of EIPMT was 13.4% (complete type, 7.7%; partial type, 5.7%). Inter-observer agreement was substantial (kappa = 0.775). Fibrotic scar tissue in the subcoracoid triangle was thicker, and the grade of fibrotic scar tissue proliferation in the rotator interval was higher in the EIPMT group than those in the control group. No significant difference was observed in the thickness of humeral side axillary recess. The thicknesses of fibrotic scar tissue in the subcoracoid triangle and humeral side axillary recess as well as the grade of fibrotic scar tissue in the rotator interval were not significantly different between complete and partial type EIPMT. CONCLUSION: MRI enabled detection of EIPMT with substantial observer agreement. Patients with EIPMT show a high tendency for fibrotic scar tissue proliferation in the rotator interval.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Humans ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Rotator Cuff/pathology/*radiography ; Shoulder/pathology/radiography ; Tendons/pathology/*radiography ; Young Adult

Mediastinal teratoma is a rare mediastinal tumor. Patients with mediastinal teratoma are usually asymptomatic and are diagnosed incidentally with chest radiography or CT, but they may develop symptoms via a rupture into adjacent structures, which results in chemical pneumonia, massive hemoptysis, hemothorax, pericardial effusion, or respiratory distress. We report a case of a ruptured teratoma in a 31-year-old female presenting with cough and brown-colored sputum. Chest radiography and computed tomography of the chest showed an inhomogenous anterior mediastinal mass with fat and fluid component. It was successfully treated by surgical resection. Although mature teratomas are rare, we should be familiar with the unique CT features of a ruptured teratoma to make sure of a correct diagnosis.
Adult ; Cough ; Female ; Hemoptysis ; Hemothorax ; Humans ; Mediastinum ; Pericardial Effusion ; Pneumonia ; Rupture ; Rupture, Spontaneous ; Sputum ; Teratoma ; Thorax

OBJECTIVE: The authors have aimed to compare the efficacy of the computed tomography with other study methods, and to investigate if replacement by computed tomography is possible METHODS: From January 1998 to December 2002, 203 cervical cancer patients underwent pre-staging studies including computed tomography. The positive predictive values, negative predictive values, sensitivity, specificity of each method of study were compared. RESULTS: 1. Compared computed tomography with intravenous pyelonephrography. Each values of computed tomography for hydronephrosis or non visualization of kidney were sensitivity 91.7%, specificity 97.8%, positive predictive values 84.6%, negative predictive values 98.9%. 2. Compared computed tomography with cystoscopy. Each values of computed tomography for bladder invasion were sensitivity 90%, specificity 95.8%, positive predictive values 52.9%, negative predictive values 99.4%. 3. Compared computed tomography with sigmoidoscopy. Each values of computed tomography for rectal invasion were sensitivity 80%, specificity 94.4%, positive predictive values 26.6%, negative predictive values 99.4%. CONCLUSION: Rather than routine examination for staging of invasive cervical cancer in all patients, it is more ideal to first take a non invasive technique. then perform on intravenous pyelonephrography, cystoscopy and sigmoidoscopy only in patient showing positive findings of hydronephrosis or non visualization of kidney, bladder or rectal invasion on computed tomography.
Cervix Uteri* ; Cystoscopy ; Female ; Humans ; Hydronephrosis ; Kidney ; Sensitivity and Specificity ; Sigmoidoscopy ; Urinary Bladder ; Uterine Cervical Neoplasms

BACKGROUND: Usually fever subsides within one week in over 90% of pulmonary tuberculosis (TBp) patients after the start of short-course anti-tuberculosis therapy, but occasionally it persists over two weeks after treatment. When the fever persists, drug resistance, combined infection, or drug fever, and so on, are considered as an etiology and, in some cases, drugs are changed. But inadvertent discontinuation of a short-course regimen inevitably will extend the duration of treatment, and the treatment completion may be delayed. This study was performed to investigate the causes of prolonged fever (PF) and to identify the predictors of PF in drug-susceptible TBp patients in Korea. METHOD: five hundred-ninety-eight patients, who were admitted to Asan Medical Center from January 1996 to March 1999, diagnosed with TBp and prescribed short-course, anti-tuberculosis treatment, were reviewed. PF was difined as having fever over two weeks despite treatment. The causes of PF were ansalyzed. Drug-susceptible TBp patients who presented no caussp es for PF, except turberculosis itself, were selected(n=22), and they were compared with those who had no fever at diagnosis(n=22) and those who had fever at diagnosis, which had subsided within two weeks after treatment(n=22). Clinical, laboratory, and radiological parameters were compared among the three groups. RESULTS: Twenty-eight(4.8%) of 598 patients showed PF over two weeks despite short-course treatment. the causes of PF were drug fever (n=2), multi-drug resistant tuberculosis (n=3), disseminated Mycobacterium Kansasii infection (n=1), and drug-susceptible tuberculosis itself (n=22). The patients with PF had more risk factors for tuberculosis, long duration of symptoms before treatment, night sweats, weight loss, numerous acid fast bacilli on sputum smear, anemia, hyponatremia, hypoalbuminemia, over three lung cavity numbers and extensive infiltratoion, indicating that they had prolonged and extensive lung diseases. CONCLUSION: The main cause of PF in TBp despite short-course regimen seems to be drug-susceptible but extensive disease in Korea. Any changes to the drug regiment provided for TBp patients with prolonged fever despite treatment should be carefully considered.
Anemia ; Chungcheongnam-do ; Diagnosis ; Drug Resistance ; Fever* ; Humans ; Hypoalbuminemia ; Hyponatremia ; Korea ; Lung ; Lung Diseases ; Mycobacterium kansasii ; Risk Factors ; Sputum ; Sweat ; Tuberculosis ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary* ; Weight Loss

BACKGROUND: We studied the interaction between Succinylcholine (SCh) and mivacurium when mivacurium was administered during early and late recovery from SCh block was investigated. METHODS: Eighty patients undergoing elective surgery under general anesthesia were studied. General anesthesia was induced and maintained with propofol under TCI control. Neuromuscular function was measured in response to TOF stimulation of the ulnar nerve using an electromyographic method. The patients were allocated randomly to the following four groups; group 1 (n = 20): a bolus intravenous injection of 0.08 mg/kg mivacurium; group 2 (n = 20): intravenous injection of 0.08 mg/kg mivacurium after 2 minutes of 1 mg/kg SCh injection; group 3 (n = 20): intravenous injection of 0.08 mg/kg mivacurium after 25% recovery of initial twitch height from twitch height depression induced by 1 mg/kg SCh; group 4 (n = 20): intravenous injection of 0.08 mg/kg mivacurium after 75% recovery of initial twitch height from twitch height depression induced by 1 mg/kg SCh. The onset and duration of neuromuscular blockade, recovery rate and TOF ratio at T75% were measured. RESULTS: The onset of block in groups 3 and 4 were slower than in group 1 (5.2 +/- 0.7 and 2.3 +/- 0.6 vs 2.5 +/- 0.4 min P < 0.05). The clinical duration in groups 2 and 3 were longer than in groups 1 and 4 (12.5 +/- 2.1 min and 11.3 +/- 1.7 min vs 17.0 +/- 3.0 min and 18.5 +/- 2.6 min, p < 0.05). There was no difference in recovery index all groups. The TOF ratio of groups 2, 3 and 4 were smaller than for group 1 (38.2 +/- 5.3, 32.3 +/- 5.6 and 31.5 +/- 4.2 vs 56.0 +/- 7.3, P < 0.05). CONCLUSIONS: The Previous 1 mg/kg SCh injection was affected the time course of action of mivacurium 0.08 mg/kg-induced neuromuscular block.
Anesthesia, General ; Depression ; Humans ; Injections, Intravenous ; Neuromuscular Blockade* ; Propofol ; Succinylcholine* ; Ulnar Nerve

BACKGROUND: Owing to increase in elderly population, the importance of geriatric health is accentuated strongly. We surveyed cancer patients aged 60 years or more to investigate the common cancers, time trend to compare with whole cancer patients. METHODS: We analyzed the data of cancer patients aged 60 years or more who were admitted cancer patients, diagnosed by pathologic biopsy, received radiotherapy, registered as cancer patients on death certification and diagnosed by the other methods in a university hospital from January, 1987 to December, 1995. RESULTS: We analyzed at intervals of three year, from 1987 to 1989. The order of common cancer sites were stomach(30.1% ), lung(19.9% ), liver and intrahepatic(11.4% ), bladder (6.2% ), colon(5.5% ), gallbladder and extrahepatic(4.9%), rectosigmoid(4.2% ), pancreas (3.2%), cervix(2.9%), esophagus(2.8%) and the number of patients was 1025. From 1990 to 1992, the order of common cancer sites were stomach(23.5%), lung(19.3% ), liver and intrahepatic(10.3% ), gallbladder and extrahepatic(4.4% ), rectosigmoid(4.2% ), pancreas (3.9%), cervix(3.7%), colon(3.5% ), esophagus(2.7%) and the number of patients was 1470. From 1993 to 1995, the order of common cancer sites were stomach(19.5%), lung(17.2%), liver and intrahepatic(11% ), rectosigmoid(5.1% ), colon(4.5% ), gallbladder and extrahepatic(4.5% ), bladder(4.1% ), cervix (3.8% ), pancreas(3.7% ), esophagus(2.0% ) and the number of patients was 1519. CONCLUSIONS: Stomach, lung, and hepatic cancers were decreasing and rectosigmoid and pancreatic cancers were increasing in triannual frequency of cancer patients aged 60 years or more, The proportion of elderly patients in all age cancer patients was increasing except gallbladder and extrahepatic cancer. According to the prolongation of life span, cancer frequency increased in old age.
Aged ; Biopsy ; Certification ; Cervix Uteri ; Female ; Gallbladder ; Humans ; Life Support Care ; Liver ; Liver Neoplasms ; Lung ; Pancreas ; Pancreatic Neoplasms ; Radiotherapy ; Stomach ; Urinary Bladder

BACKGROUND: There is considerable experimental evidence to indicate that tumor growth is dependent on angiogenesis. To investigate how tumor angiogenesis correlates with clinical factors and prognosis in breast carcinoma, we counted microvessels (capillaries and venules) and graded the density of micro vessels within the invasive ductal carcinomas of 59 patients. METHODS: Using light microscopy, we highlighted the vessels by staining their endothelial cells immu nohistochemically for rabbit antihuman factor-VIII related antigen (Dako L1809, USA). The microvessels were carefully counted (per 200 field) in the most active areas of neovascularization without knowledge of either the outcome in the patient or the clinical variables. RESULTS: The mean age was 47.8 years. There was no statistical correlation between angiogenesis and either estrogen receptor status or age. However, there was a statistical correlation with tumor size (p< or =0.05). There was a statistical difference between lymph-node-metastasis positive group and negative group (p= 0.006). Angiogenesis correlated statistically with TMN stage (microvessels count:stage I= 31.27, stage II= 40.74, and stage III= 78.9)(p= 0.001). There was a statistical correction between angiogenesis and follow-up results (microvessels counts:disease free group= 42.11, living metastatic group= 63.64, and expired group= 73.60)(p= 0.031). CONCLUSIONS: In this study, the degree of angiogenesis (the number of microvessels per 200 field in the area of most intensive neovascularization) may have a predictive value in invasive breast carci nomas. Therefore, assessment of tumor angiogenesis may give us useful information for selecting thera peutic and follow-up plan for patients with breast carcinomas.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Endothelial Cells ; Estrogens ; Follow-Up Studies ; Humans ; Microscopy ; Microvessels ; Noma ; Prognosis

Silver Spike PintElectro-Therapy(SSPET) means passing electric current through the skin surface with the triangle spike silver coated metal electrode. Transcutaneous Electrical Nerve Stimulation(TENS) for chronic pain management was first reported by Shealy in 1972. Since 1975, Vanderark and Mograth reported that TENS has had a analgesic effect for the relief of acute postoperative pain. SSPET was reported by Hyoto and Kitade at Edinburg, Scotland. 3rd World Congress on Pain in 1981; It has a number of advantages over traditional narootic medication in postoperative pain management. It does not depress the cardiovascular, respiratory of metabolic system and has no apparent effect on the sensorium. Furthermore it is noninvasive, nontoxic, simple in its application and can be used continuously or intermittently. This study was undertaken to investigate recent reports concerning the use of Silver Spike Point Electro-therapy for the relief of postoperative pain. Sisyt patients undergoing elective Cesarean section were subjected to a standard perianesthetic proctocol by the Department of Anesthesiology at Hanyang University Hospital from March, 1st to August, 31, 1984. The patients were divided into three groups of twenty, designed control, SSP and sham SSP. Postoperative analgesic requirements for each group were compared. The results are as follows; 1) The age distribution ranged from 21 years to 36 yearts. Mean age was 25 years and the body weight ranged from 45kg to 68kg. The mean body weight was 52kg. 2) The incisional area of the Cesarean section was 23 cases (38.3%) of low midline incision and 37 cases(81.7%) of Pfannenstiel incision. 3) There were no remarkable changes in the blood pressure, pulse rate or respiratory rate during before and after SSP administration. 4) The total number of intramuscular doses of Demerol given to the patients in the ward was: control group 94 doses, SSP group 31 doses and sham SSP group 89 doses. The SSP group was statistical different from the other 3 groups when compared by the Student's T-test. 5) In the subjective assessment of each group, their statements were markedly varied. Nevertherless SSP has shown that the analgesic requirement was considerably less than that of the other group. This result means that SSP can be used for the relief of acute postoperative pain. Despite a number of diffidulties encountered during this study, we were primarily concerned with the action mechanism, subjective measurement of pain and standards in the requirment of Demerol. We considered that further investigation should be done in the use of SSP for postoperative analgesia and pain. SSP for postoperative pain management is a useful method that is simple, non-invasive, non-toxic and obtains safe analgesia.
Age Distribution ; Analgesia ; Anesthesiology ; Blood Pressure ; Body Weight ; Cesarean Section ; Chronic Pain ; Electrodes ; Female ; Heart Rate ; Humans ; Meperidine ; Pain Management* ; Pain, Postoperative ; Pregnancy ; Respiratory Rate ; Scotland ; Silver* ; Skin ; Transcutaneous Electric Nerve Stimulation

Reiter's syndrome is a clinical triad of urethritis, conjunctivitis, and arthritis, but the characteristic mucocutaneous lesion occurs very frequently. Therefore, Reiters syndrome in fact might better be considered a tetrad, consisting in its complete form of urethritis, arthritis, conjunctivitis, and mucocutaneous lesions. In initial stage of the disease, the arthritis usually appear after the urethritis and conjunctivitis have been made. The arthritis is usually of subacute onset, reaching its full intensity within a few weeks in most cases. Additionally a man with Reiters syndrome who developed aortic insufficiency with no evidence of syphilis or rheumatic heart disease has been reported. Two cases of Reiters syndrome are presented with the review of the literature: the first case was a 60 years old male who had non-gonococcal urethritis with mucous purulent discharge, conjunctivitis, polyarthritis, and aortic insufficiency; the second case was a young man aged 21 years who had the characteristic conjunctivitis and a past history of urethritis, and he also has had obvious keratodermia blenorrhagica and polyarthritic symptoms and signs.
Arthritis ; Conjunctivitis ; Humans ; Male ; Rheumatic Heart Disease ; Syphilis ; Urethritis

The hand is an organ of both motion and sensibility. Motion is necessary for the highly adaptive functions of pinch, grasp, and hook. When a major muscle is paralyzed, the balance of the hand is disrupted. The objective of reconstructive procedure is to achieve a limited but balanced functional performance by means of redistributing assets rather than creating new motor and sensory units. Among the variable methods of treatment, the tendon transfer is a useful method in restoring the lost functions of the paralyzed hand. Authors reviewed 3 cases of paralyzed hands: the first one had an impairment of the opposition and flexion of the thumb caused by brachial plexus injury; the second one had an adducted thumb and a flexion contracture of the index and middle fingers due to a severe compression injury to forearm; the third one was a quadriplegics due to the C5-6 fracture-dislocation, but fortunately had a function of active flexion in ring and little fingers. They were treated by Omer's technique plus other reconstructive procedures for the paralysis at the Department of Orthopaedics, Catholic Medical Center from 1978 to 1981. By this procedure gratifying results such as restoration of pinching and grasping function were obtained.
Brachial Plexus ; Contracture ; Fingers ; Forearm ; Hand Strength ; Hand ; Methods ; Muscles ; Paralysis ; Tendon Transfer ; Thumb