Pulmonary Multinodular Epithelioid Hemangioendothelioma with Mixed Progression and Spontaneous Regression during a 7-Year Follow-Up: A Case Report and Review of Imaging Findings

Pulmonary epithelioid hemangioendothelioma (PEH) is a rare vascular tumor of borderline or low-grade malignancy, and its prognosis is unpredictable. Herein, we describe the case of a 47-year-old asymptomatic female with a diagnosis of multinodular PEH. During a 7-year followup, the nodules with large size and high 18F-fluorodeoxyglucose uptake in the initial study showed progression with increasing sizes; however, most small nodules (size < 1 cm) demonstrated spontaneous regression with peripheral rim or nodular calcification. The patient underwent surgical resection for an enlarged nodule. Of note, it is unusual for an individual to have mixed progression and regression concomitantly, which may be helpful in predicting the prognosis.

Two Cases of Bronchopulmonary Dysplasia of Similar Appearance in Adult Monozygotic Twin: Pathology and Computed Tomographic Findings / 결핵및호흡기질환

Bronchopulmonary dysplasia (BPD) is related to decreased lung function throughout life. However, the pathology and radiology pattern of BPD of adults are not documented well yet. In this case report, we present BPD case of an adult monozygotic twin showing nearly identical lesions on chest computed tomography (CT). CT images showed mixed areas of ground-glass and reticular opacities in both lungs. They had common histories of pneumonias requiring mechanical ventilations in period of infants. Pulmonary function test of one patient showed a pulmonary insufficiency with airway obstruction. Pathologic findings showed bronchiolar hyperplasia and peribronchiolar fibrosis which was similar to classic BPD patients. Our twin case report might help provide distinguishing pathology and radiology pattern of an adult pulmonary sequelaes of BPD. It might be reasonable to make close follow-up for BPD patients to evaluate the long-term outcomes of BPD survivors.

Bone Mineral Density, Biochemical Bone Turnover Markers and Factors associated with Bone Health in Young Korean Women

PURPOSE: This study was done to assess the bone mineral density (BMD), biochemical bone turnover markers (BTMs), and factors associated with bone health in young Korean women. METHODS: Participants were 1,298 women, ages 18-29, recruited in Korea. Measurements were BMD by calcaneus quantitative ultrasound, BTMs for Calcium, Phosphorus, Osteocalcin, and C-telopeptide cross-links (CTX), body composition by physical measurements, nutrients by food frequency questionnaire and psychosocial factors associated with bone health by self-report. RESULTS: The mean BMD (Z-score) was -0.94. 8.7% women had lower BMD (Z-score or =0) and low-BMD (Z-score<0) women. However, Osteocalcin and CTX were higher in women preferring caffeine intake, sedentary lifestyle and alcoholic drinks. Body composition and Calcium intake were significantly higher in high-BMD. Low-BMD women reported significantly higher susceptibility and barriers to exercise in health beliefs, lower bone health self-efficacy and promoting behaviors. CONCLUSION: Results of this study indicate that bone health of young Korean women is not good. Development of diverse strategies to intervene in factors such as exercise, nutrients, self-efficacy, health beliefs and behaviors, shown to be important, are needed to improve bone health.

Round ligament varicosities mimicking inguinal hernia in pregnancy / 대한외과학회지

Round ligament varicosities during pregnancy are rare, and can easily be mistaken for an inguinal hernia. On physical examination, round ligament varicosities and groin hernia are difficult to distinguish. The diagnosis of round ligament varicosities can be established on gray-scale and color Doppler sonography. We experienced a case of round ligament varicosities in which a 29-year-old woman presented symptoms at 36 weeks gestation. The patient was diagnosed using Doppler sonography, managed with conservative therapy, and had an uncomplicated vaginal delivery at 40 weeks. The symptoms were resolved completely by two weeks postpartum. We report a case of round ligament varicosities that was diagnosed at 36 weeks of gestation with a review of the literature.

Anesthetic management of renal cell carcinoma that extended into the right atrium through the inferior vena cava: A case report

Renal cell carcinoma (RCC) rarely extends to the cardiac chambers, and the presence of an extension of tumor thrombus to the inferior vena cava or the right atrium has not been shown to determine the survival of patients with RCC.Although an aggressive surgical approach remains the primary treatment for RCC, the anesthetic management remains a difficult intraoperative challenge.We report here on a case of performing cavoatrial tumor thrombectomy and radical nephrectomy in a patient with RCC with an intracardiac extension, and we used cardiopulmonary bypass and intraoperative trans-esophageal echocardiography to assess and treat this tumor.

Ischemic postconditioning may not influence early brain injury induced by focal cerebral ischemia/reperfusion in rats / 대한마취과학회지

BACKGROUND: Experimental studies have shown that ischemic postconditioning can reduce neuronal injury in the setting of cerebral ischemia, but the mechanisms are not yet clearly elucidated. This study was conducted to determine whether ischemic postconditioning can alter expression of heat shock protein 70 and reduce acute phase neuronal injury in rats subjected to transient focal cerebral ischemia/reperfusion. METHODS: Focal cerebral ischemia was induced by intraluminal middle cerebral artery occlusion for 60 min in twenty male Sprague-Dawley rats (250-300 g). Rats were randomized into control group and an ischemic postconditioning group (10 rats per group). The animals of control group had no intervention either before or after MCA occlusion. Ischemic postconditioning was elicited by 3 cycles of 30 s reperfusion interspersed by 10 s ischemia immediately after onset of reperfusion. The infarct ratios, brain edema ratios and motor behavior deficits were analyzed 24 hrs after ischemic insult. Caspase-3 reactive cells and cells showing heat shock protein 70 activity were counted in the caudoputamen and frontoparietal cortex. RESULTS: Ischemic postconditiong did not reduce infarct size and brain edema ratios compared to control group. Neurologic scores were not significantly different between groups. The number of caspase-3 reactive cells in the ischemic postconditioning group was not significantly different than the value of the control group in the caudoputamen and frontoparietal cortex. The number of cells showing heat shock protein 70 activity was not significantly different than the control group, as well. CONCLUSIONS: These results suggest that ischemic postconditioning may not influence the early brain damage induced by focal cerebral ischemia in rats.

Ischemic postconditioning may not influence early brain injury induced by focal cerebral ischemia/reperfusion in rats / 대한마취과학회지

BACKGROUND: Experimental studies have shown that ischemic postconditioning can reduce neuronal injury in the setting of cerebral ischemia, but the mechanisms are not yet clearly elucidated. This study was conducted to determine whether ischemic postconditioning can alter expression of heat shock protein 70 and reduce acute phase neuronal injury in rats subjected to transient focal cerebral ischemia/reperfusion. METHODS: Focal cerebral ischemia was induced by intraluminal middle cerebral artery occlusion for 60 min in twenty male Sprague-Dawley rats (250-300 g). Rats were randomized into control group and an ischemic postconditioning group (10 rats per group). The animals of control group had no intervention either before or after MCA occlusion. Ischemic postconditioning was elicited by 3 cycles of 30 s reperfusion interspersed by 10 s ischemia immediately after onset of reperfusion. The infarct ratios, brain edema ratios and motor behavior deficits were analyzed 24 hrs after ischemic insult. Caspase-3 reactive cells and cells showing heat shock protein 70 activity were counted in the caudoputamen and frontoparietal cortex. RESULTS: Ischemic postconditiong did not reduce infarct size and brain edema ratios compared to control group. Neurologic scores were not significantly different between groups. The number of caspase-3 reactive cells in the ischemic postconditioning group was not significantly different than the value of the control group in the caudoputamen and frontoparietal cortex. The number of cells showing heat shock protein 70 activity was not significantly different than the control group, as well. CONCLUSIONS: These results suggest that ischemic postconditioning may not influence the early brain damage induced by focal cerebral ischemia in rats.

The effects of gabapentin pretreatment on brain injury induced by focal cerebral ischemia/reperfusion in the rat / 대한마취과학회지

BACKGROUND: Experimental studies have shown that gabapentin can reduce neuronal injury in the setting of cerebral ischemia, but the mechanisms have not yet been clearly determined. This study was conducted to determine whether gabapentin pretreatment altered expression levels of heat shock protein 70 and reduced acute phase neuronal injury in rats subjected to transient focal cerebral ischemia/reperfusion. METHODS: Forty male Sprague-Dawley rats (260-300 g) were randomly assigned to one of four groups (saline-treated, or 0.1, 0.5, or 5 mg/kg gabapentin group). In all animals, focal cerebral ischemia was induced by intraluminal middle cerebral artery occlusion for 1 hour. The animals of the gabapentin groups were pretreated with a single intravenous administration of gabapentin 20 minutes before ischemic insults. The infarct volume, brain edema and motor behavior deficits were analyzed 24 hours after ischemic insult. Caspase-3-reactive cells and cells showing Hsp70 activity were counted in the caudoputamen and fronto-parietal cortex. RESULTS: The infarction ratio was significantly decreased in the 5 mg/kg gabapentin group (P < 0.05) and brain edema ratios were significantly reduced in the 0.1 mg/kg, 0.5 mg/kg, and 5 mg/kg gabapentin groups 24 hours after ischemia/reperfusion injury (P < 0.05). There were more Hsp70-reactive cells in the 5 mg/kg gabapentin group than in the saline group in both the caudoputamen and fronto-parietal cortex (P < 0.05). CONCLUSIONS: These results indicate that gabapentin may have a neuroprotective effect and can reduce early neuronal injury caused by focal cerebral ischemia/reperfusion; this may be mediated by expression of Hsp70. However, gabapentin pretreatment did not prevent caspase-dependent apoptosis.

The effects of gabapentin pretreatment on brain injury induced by focal cerebral ischemia/reperfusion in the rat / 대한마취과학회지

BACKGROUND: Experimental studies have shown that gabapentin can reduce neuronal injury in the setting of cerebral ischemia, but the mechanisms have not yet been clearly determined. This study was conducted to determine whether gabapentin pretreatment altered expression levels of heat shock protein 70 and reduced acute phase neuronal injury in rats subjected to transient focal cerebral ischemia/reperfusion. METHODS: Forty male Sprague-Dawley rats (260-300 g) were randomly assigned to one of four groups (saline-treated, or 0.1, 0.5, or 5 mg/kg gabapentin group). In all animals, focal cerebral ischemia was induced by intraluminal middle cerebral artery occlusion for 1 hour. The animals of the gabapentin groups were pretreated with a single intravenous administration of gabapentin 20 minutes before ischemic insults. The infarct volume, brain edema and motor behavior deficits were analyzed 24 hours after ischemic insult. Caspase-3-reactive cells and cells showing Hsp70 activity were counted in the caudoputamen and fronto-parietal cortex. RESULTS: The infarction ratio was significantly decreased in the 5 mg/kg gabapentin group (P < 0.05) and brain edema ratios were significantly reduced in the 0.1 mg/kg, 0.5 mg/kg, and 5 mg/kg gabapentin groups 24 hours after ischemia/reperfusion injury (P < 0.05). There were more Hsp70-reactive cells in the 5 mg/kg gabapentin group than in the saline group in both the caudoputamen and fronto-parietal cortex (P < 0.05). CONCLUSIONS: These results indicate that gabapentin may have a neuroprotective effect and can reduce early neuronal injury caused by focal cerebral ischemia/reperfusion; this may be mediated by expression of Hsp70. However, gabapentin pretreatment did not prevent caspase-dependent apoptosis.

Anesthetic management of a patient with prune-belly syndrome : A case report

Prune-belly syndrome is characterized by absent abdominal wall musculature with wrinkled overlying skin, urinary tract dilatation and cryptorchidism. Prune-belly syndrome is also associated with diseases of the respiratory, cardiovascular, skeletal, gastrointestinal and central nervous system. Because the congenital disease is uncommon, it is difficult to collect the information of anesthetic management of prune-belly syndrome. We report a case of 4 year-old-boy with prune-belly syndrome who underwent abdominoplasty and Mitrofanoff operation under general anesthesia.

A Case of Pulmonary Hemorrhage Associated with Henoch-Schonlein Purpura / 결핵및호흡기질환

Henoch-Schonlein purpura (HSP) is an immunologically mediated systemic vasculitis of small blood vessels that primarily involves the skin, gastrointestinal tract, joints and kidneys. HSP is a common vasculitic syndrome in children who, in most cases, achieve complete recovery. Pulmonary hemorrhage is a very rare manifestation of HSP. The authors present a case of a 46-year-old male presenting with pulmonary hemorrhage and renal involvement and the diagnosis of HSP. The patient responded to prednisolone therapy.

The Effects of Superior Cervical Sympathetic Ganglion Block on the Acute Phase Injury and Long Term Protection against Focal Cerebral Ischemia/Reperfusion Injury in Rats / 대한통증학회지

BACKGROUND: Cerebral blood vessels are innervated by sympathetic nerves from the superior cervical ganglia (SCG), and these nerves may influence the cerebral blood flow. The purpose of the present study was to evaluate the neuroprotective effect of superior cervical sympathetic ganglion block in rats that were subjected to focal cerebral ischemia/reperfusion injury. METHODS: Eighty male Sprague-Dawley rats (270-320 g) were randomly assigned to one of two groups (the ropivacaine group and a control group). In all the animals, brain injury was induced by middle cerebral artery (MCA) reperfusion that followed MCA occlusion for 2 hours. The animals of the ropivacaine group received 30microl of 0.75% ropivacaine, and their SCG. Neurologic score was assessed at 1, 3, 7 and 14 days after brain injury. Brain tissue samples were then collected. The infarct ratio was measured by 2.3.5-triphenyltetrazolium chloride staining. The terminal deoxynucleotidyl transferase mediated dUTP-biotin nick-end labeled (TUNEL) reactive cells and the cells showing caspase-3 activity were counted as markers of apoptosis at the caudoputamen and frontoparietal cortex. RESULTS: The death rate, the neurologic score and the infarction ratio were significantly less in the ropivacaine group 24 hr after ischemia/reperfusion injury. The number of TUNEL positive cells in the ropivacaine group was significantly lower than those values of the control group in the frontoparietal cortex at 3 days after injury, but the caspase-3 activity was higher in the ropivacaine group than that in the control group at 1 day after injury. CONCLUSIONS: The study data indicated that a superior cervical sympathetic ganglion block may reduce the neuronal injury caused by focal cerebral ischemia/reperfusion, but it may not prevent the delayed damage.

Spontaneous Massive Hemothorax Associated with Solitary Posterior Mediastinal Neurilemmoma / 결핵및호흡기질환

Neurogenic tumors are common in posterior mediastinal tumors and neurilemmoma represents approximately 40% of neurogenic tumors arising in the mediastinum. It is usually asymptomatic, and is generally diagnosed incidentally. In some cases, they presented with symptoms of nerve or airway compression. However, a solitary neurilemmoma, particularly not associated with von Recklinghausen disease, with spontaneous hemothorax is quite rare. We report a case of spontaneous massive hemothorax associated with a solitary neurilemmoma.

A Case of Non-Specific Interstitial Pneumonia Associated with Primary Lung Adenocarcinoma / 결핵및호흡기질환

Idiopathic pulmonary fibrosis (IPF) is strongly associated with lung cancer compared with the general population. However, other types of idiopathic interstitial pneumonia (IIP) are rarely associated with lung cancer. We describe a case of a primary lung cancer associated with IIP other than IPF, which was considered to be nonspecific interstitial pneumonia (NSIP), and NSIP disappeared spontaneously after treating the primary lung cancer.

Comparison of the Clinical Effectiveness of the CobraTM Perilaryngeal Airway and the ProSealTM Laryngeal Mask Airway during Anesthesia with Controlled Ventilation

BACKGROUND: Supraglottic airway devices are currently available. We compared the efficacy of the Cobra perilaryngeal airway (CobraPLATM) and the ProSealTM laryngeal mask airway (PLMA) during anesthesia with controlled ventilation for the insertion success rate, hemodynamic stability after insertion, intraoperative ventilatory parameters, and postoperative laryngeal discomfort. METHODS: Forty-three patients received either a CobraPLATM or a PLMA after induction with thiopental 5 mg/kg, fentanyl 1microg/kg and rocuronium 0.6 mg/kg, and manual controlled ventilation with N2O: O2 (1:1) and sevoflurane 5-6 vol% for 2 minutes. Unblinded observers collected the intraoperative data, and blinded observers collected the postoperative data. RESULTS: The two devices were similar for hemodynamic stability after insertion, and for the intraoperative ventilatory parameters. The success rates of first-attempts were similar, but the insertion time was longer for the CobraPLATM. The cuff volume and pressure changes were significantly higher for the PLMA than the CobraPLATM. The cuff pressure was significantly higher for the CobraPLATM than the PLMA from insertion to 10 minutes after insertion, but at 30, 60 and 90 minutes after the insertion, there was no significant difference for the two devices. There were no differences with respect to the incidence of adverse events. CONCLUSIONS: During anesthesia with controlled ventilation, these two devices can be used successfully and effectively. We suggest that the CobraPLATM could be used an alternative device for airway management and further investigation is required.

Synchronous Double Primary Cancers of Lung and Liver / 결핵및호흡기질환

Although reports of multiple primary malignant tumors have increased recently, cases of synchronous double primary tumors of lung and liver are rare. A 73-year-old man suffered from chronic cough. His chest x-ray showed segmental atelectasis of the right upper lobe. Bronchoscopy revealed a mass occluding the orifice of the anterior segmental bronchus of the right upper lobe, and a biopsy showed a squamous cell carcinoma. A synchronous hepatic mass was found by ultrasonography. However, F18-FDG-PET showed no evidence of a distant metastasis. The liver biopsy revealed a hepatocellular carcinoma. A right upper lobe lobectomy and a sleeve resection were performed for the lung cancer, and radiofrequency ablation was performed for the hepatocellular carcinoma.

Studies on the Proper Storage Period and Change of -20 degrees C Cryopreserved Adipocyte

The use of autologous fat grafts has questionable clinical value due to unreliable grafts survival. For the purpose of improved graft survival, re-implantation of cryopreserved adipocytes is developed. The purpose of study is to analyze the changes of freeze-preserved adipocytes and to find out efficient long-term storage period. After centrifugation of aspirated abdominal tissues, 10ml of packed adipocytes were freezed at -20 degrees C (n=70). For 6 months, each 10 frozen samples were taken and analyzed at 1 month interval. Significant volume changes were observed in cryopreservation for 3 months (p < 0.05). The profiles of total lipid and FFA were not changed and no significant difference in saturated fatty acid ratio with gas chromatography. No histologic changes were observed, independent of the freezing period with H & E stain. The reduction of mitochondrial enzymatic activity was observed independent of time interval but activity of mitochondrial dehydrogenase was reduced less than 50% in XTT assay. On the basis of these data, -20 degrees C freezing for 6 months has no adverse effect to adipocytes, but frigile adipocytes, damaged cell membrane during harvest procedure, were disrupted within 1month and the maximum volume reduction were followed less than 3 months. These results demonstrate that tissue preparation cells with no cell membrane damage have the greatest viability level and cryopreservation less than 3 months has great volume effect.

Exacerbation of Sarcoidosis Following Interferon-alpha Therapy for Chronic Active Hepatitis C / 결핵및호흡기질환

Interferon alpha is an immunomodulator that is used as an antiviral agent to treat chronic active viral hepatitis C. However, interferon can induce or exacerbate sarcoidosis. We report a case of 42-year-old man with an exacerbation of pulmonary sarcoidosis after the cessation of interferon and ribavirin therapy for chronic hepatitis C. The patient's sarcoidosis improved spontaneously and he continues to be monitored regularly without steroid therapy.

The Magnetic Relaxation Properties of DTPA-bis(4-carboxycyclohexyl) amide Paramagnetic Gd-chelates

PURPOSE: To evaluate the NMR relaxation properties of newly developed high performance paramagnetic. MATERIALS AND METHODS: 4-aminomethylcyclohexane carboxylic acid (0.63 g, 4 mmol) was mixed with the suspension solution of DMF (15 mL) and DTPA-bis-anhydride (0.71 g, 2 mmol) to synthesize the ligand. The ligand was then mixed with Gd2O3 (0.18 g, 0.5 mmol) to synthesize Gd-chelate. For the measurement of magnetic relaxivity of paramagnetic compounds, the compounds were diluted to 1mM and then the relaxation times were measured at 1.5T(64 MHz). Inversion-recovery pulse sequence was employed for T1 relaxation measurement and CPMG(Carr-Purcell-Meiboon-Gill) pulse sequence was employed for T2 relaxation measurement. Using MATLAB(Version 7.1) program, T1 magnetic relaxation map, R1 map, T2 magnetic relaxation map and R2 map were developed to represent magnetic relaxation time and magnetic relaxivity as image. RESULTS: Compared to R1=4.9 mM(-1) sec(-1) and R2= 4.8 mM(-1) sec(-1) of Omniscan (Gadodiamide), which is commercially available paramagnetic MR agent, R1 of SUK090(Gd-C32H74N5O24) was 12.46 mM(-1) sec(-1) and R1 of SUK091(Gd-C34H78N5O24) was 12.77 mM(-1) sec(-1). However, R1 of SUK092(Gd-C30H56N5O17) was decreased to 2.09 mM(-1) sec(-1). In case of R2, SUK090(Gd-C32H74N5O24) was 8.76 mM(-1) sec(-1) and SUK091(Gd-C34H78N5O24) was 7.60 mM(-1) sec(-1) whereas SUK092(Gd-C30H56N5O17) CONCLUSION: Among three new paramagnetic complexes, SUK090(Gd-C32H74N5O24) and SUK091(Gd-C34H78N5O24) showed higher T1, T2 magnetic relaxation rates than that of commercially available paramagnetic MR agent and thus expected to have more contrast enhancement effect.

Effect of Smoking and Carotenoid-rich Food Consumption on Lipid Peroxidation and Antioxidant Status

This study was performed to determine the effect of carotenoid-rich food consumption and smoking on the lipid peroxidation and antioxidant status in human. The subjects consisted of the health 210 middle-aged adults who visited health care center in the Inha University hospital. The blood and urine samples of the subjects were taken to analyze serum lipid profiles, plasma TBARS, total antioxidant status (TAS) and urinary 8-isoprostanes concentration. The anthropometric indices of the subjects were measured. The nutritional intake and the frequency of carotenoid-rich food consumption was determined by semi-quantitative food frequency questionnaire survey. HDL-cholesterol level of the smoking subjects was significantly lower than that of the non-smoking subjects in men. In the analysis of the carotenoid-rich food consumption, the frequency of pepper and tomato consumption of the non-smoking subjects was significantly higher than that of the smoking subjects in men. In women, the Sequency of pear and peach consumption of the non-smoking subjects was significantly higher than that of the smoking subjects. HDL-cholesterol level of the high carotenoid rich food consumption group was significantly higher than that of medium and low group in women. TAS of the high carotenoid rich food consumption group was significantly higher than that of medium and low group. In conclusion, carotenoid intakes seemed to be effective to reduce lipid peroxidation and increase antioxidant status in the body. The frequency of the carotenoid-rich food consumption seemed to be lower in the smokers than in the non-smokers. However, further researches consisted of large-scaled and randomized clinical trials are required to determine whether carotenoids have any other beneficial effect in human.