A Case of Primary Endobronchial Neurilemmoma Without Intraspinal Extension / 영남의대학술지

Neurilemmoma is a benign and slowly growing neurogenic tumor. Intrathoracic neurilemmoma often develops in the chest wall and posterior mediastinum, but endobronchial neurilemmoma is extremely rare. The diagnosis of endobronchial neurilemmoma with preoperative imaging findings is challenging and is usually made via postoperative pathological examination. These authors encountered a case of primary endobronchial neurilemmoma in a 52-year-old woman who had no symptoms. A 3.0 x 2.6 cm mass in the right lower lobe projecting into the mediobasal segmental bronchus was shown in the results of the contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) of the chest. Benign neurilemmoma was confirmed via bronchoscopic biopsy, and surgical resection (sleeve bronchial excision and end-to-end anastomosis) was performed.

The Ultrasound Diagnosis of Round Ligament Varices That Mimicked Inguinal Hernias During Pregnancy: A Case Report

Round ligament varices during pregnancy are an important part of the differential diagnosis of inguinal hernia as they may cause symptoms and clinical features that are similar to those of inguinal hernia. When this condition is correctly diagnosed, an unnecessary operation may be prevented. The diagnosis of round ligament varices should be considered for pregnant women who present with a palpable mass in the groin. We describe here a case of round ligament varices that presented during pregnancy and this was readily diagnosed with Doppler sonography.

The Occurrence of a Branchial Cleft Cyst in the Anterior Mediastinum: A Case Report

Branchial cleft cysts and branchial anomalies develop from the branchial cleft apparatus that persists after fetal development. The most common anatomical site for the occurrence of branchial cleft cysts is in the cervical area, generally anterior to the sternomastoid muscle in the upper or middle portion of the neck. A mediastinal branchial cleft cyst is extremely rare and few cases have been reported. We report the case of branchial cleft cyst found in the anterior mediastinum with literature review.

The Effect of the Cost Exemption Policy for Hospitalized Children under 6 Years Old on the Medical Utilization in Korea / 예방의학회지

OBJECTIVES: The Korean government in January 2006 instigated an exemption policy for hospitalized children under the age of six years old. This study examines how this policy affected the utilization of medical care in Korea. METHODS: A total of 1,513,797 claim records from the Health Insurance Review Agency were analyzed by complete enumeration methods. The changes of medical utilization were compared from 2005 to 2006. In addition, the changes of medical utilization between 2004 and 2005 were compared as a pseudocontrol group. RESULTS: The admission rate increased 1.14-fold from 15.20% in 2004 to 17.32% in 2005, and this further increased 1.08-fold to 18.65% in 2006. The increase of patients with a common cold (1.2-fold) was higher than that of both the general patients (1.08-fold) and the patients with the top 10 fatal diseases (0.91-fold). The average length of stay per case for clinics showed the highest increase rates (1.06-fold). The rates of patients with the common cold showed a higher increase (1.05-fold) than that of the general patients. The average medical expense per case was increased by 1.10-fold from 2005 to 2006, which was higher than that from 2004 to 2005 (1.04-fold). The increase rate for patients with the common cold was higher at 1.18-fold than that of the general patients. CONCLUSIONS: The cost exemption policy has especially led to an increase in the utilization of clinics and the utilization by patients with a common cold.

Hepatic Metastasis of Thymoma: A Case Report

Thymoma is the most common neoplasm in the anterior mediastinum, and extrathoracic involvement is rare. Moreover, cystic liver metastasis is extremely rare; few cases have been reported in the literature to date. We report here on a case of cystic liver metastasis of thymoma treated with surgical resection, describing the ultrasonography, CT and MRI findings.

Adventitial Cystic Disease of the Left External Iliac Vein: A Case Report

Adventitial cystic disease (ACD) is a rare, but well-characterized vascular disease. It is most commonly seen in the popliteal artery, but it has also been reported in the venous system. The most commonly involved segment has been the common femoral vein; the disease resulted in luminal compromise and extremity swelling. We report here on a case of adventitial cystic disease of the left external iliac vein that was initially misdiagnosed as deep vein thrombosis in a 68-year-old man who presented with a painless swelling of his left leg.

Pulmonary Cryptococcosis: Report of 2 cases / 대한흉부외과학회지

Cryptococcus neoformans is a ubiquitous fungus found worldwide, particularly in soil contaminated by pigeon droppings. Pulmonary cryptococcosis occurs rarely in immunocompetent individuals. The risk of cryptococcal infection increases with the degree of immunal compromise, in human immunodeficiency virus infection especially. Pulmonary cryptococcosis is most frequently encountered as asymptomatic single or multiple pulmonary nodules found by routine chest x-ray examination. The diagnosis is most often made in these situations by the histology of the resected lesion. Acute progressive pneumonia may occur, with symptoms of cough, sputum production, fever, and weakness. The clinical picture is not pathognomonic. The yeasts are stained well by any of the special stains for fungi. Treatment is now indicated for all cases given a diagnosis of cryptococcosis, even if the diagnosis has been made by resecton of a solitary, asymptomatic pulmonary nodule.

The clinical investigation for determining the etiology of bronchial anthracofibrosis / 대한내과학회지

BACKGROUND: The bronchial anthracofibrosis has been thought to be a unique clinical syndrome caused by a fibrotic response to active or old tuberculous infection, but recent studies suggest that long-term exposure to woodsmoke may be the cause of the development of bronchial anthracofibrosis and the tuberculosis is thought to be a disease frequently associated with bronchial anthrocofibrosis, not the main etiology. The purpose of this study was to elucidate the relationship between the bronchial anthracofibrosis and the long-term exposure to woodsmoke and tuberculosis through analyses of the clinical features of patients with bronchial anthracofibrosis. METHODS: 166 patients having bronchial anthracofibrosis confirmed by bronchoscopy were included in this study. They were 23 males and 143 females, having mean sge 72.4 years, ranging from 56 to 91. The epidemiologic features, distinctive clinical features, physiologic findings, radiologic findings and bronchoscopic findings were analyzed retrospectively. RESULTS: All the patients living in rural area (129 of 166) had experienced long-term exposure to woodsmoke. The history of tuberculosis was obtained in 52 patients without history of occupational exposure to dust. The predominant chest CT findings were atelectasis, bronchial stenosis and calcified or noncalcified lymph node enlargements. The most common abnormality of pulmonary function was obstructive pattern, observed in 47.8%. The bronchoscopic examination disclosed multifocal anthracotic plaques mostly at the bifurcation of lobar or segmental bronchi, particularly in upper lobe. The bronchial stenosis was frequently observed in right middle and upper lobe. The associated diseases were obstructive airway disease in 56, obstructive pneumonia in 40, active tuberculosis in 36, and lung cancer in 11 patients. CONCLUSION: The bronchial anthracofibrosis, in the patient who has long-term experience to woodsmoke inhalation without any history of environmental exposure to dust, is one of the manifestation of lung disease related to woodsmoke inhalation, and is frequently associated with various pulmonary diseases, including tuberculosis.

Elastofibroma Dorsi: A case report / 대한흉부외과학회지

Elastofibroma dorsi, a rare, noncapsulated benign entity is characterized by the proliferation of fibrous tissue with elastin and occurs most often in the infrascapular area of elderly women. It is a relatively slowly growing lesion and no reports of malignant transformation exist. Which is overlooked easily because it rarely causes symptoms such as tenderness, pain, or restriction of movement. The diagnosis of elastofibroma is established by typical histopathologic findings. Radiographic evaluation may lead to a presumptive diagnosis. We experienced a case of elastofibroma dorsi in a 48-year-old woman and report this case with a review of the literature.

Effects of Dimethyl Sulfoxide (DMSO) on the Contraction of the Rat Iris Muscle

PURPOSE: To evaluate the effects of DMSO on the iris muscle contractility and to compare DMSO with other detergents(ethanol and triton-x 100). METHODS: After anesthesizing rats with an intraperitoneal injection of pentobarbital sodium, each animal was fixed under microscope. The pupil response to the drugs was examined by CCD camera and the video edge motion detector was used for measurement of alteration of the pupil size. The pupil response to the drugs was recorded by MacLab chart(version 3.6/s). RESULTS: Miosis induced by DMSO was initiated after 5 minutes, peaked at around 30 minutes and maintained until 3 hours after instillation. Miotic effect of DMSO was in a dose dependent manner ranging 0.01%-10% and was not reversed after washout. All detergents used in the present experiment induced miosis, however, DMSO elicited the strongest miotic response. After pretreatment with atropine, DMSO-induced miotic response was not affected, showing similar changes with control group. CONCLUSIONS: Taken together, it is concluded that DMSO induces miosis by inducing relaxation of iris dilator muscle.

Post-TIPS Change of Esophagogastric Variceal Size on Endoscopy

PURPOSE: To evaluate the relationship between endoscopic change in esophagogastric varices and post transjugular intrahepatic portosystemic shunt (TIPS) portal pressure reduction, and to study any difference in post-TIPS endoscopic change between esophageal and gastric varices. MATERIALS AND METHODS: Sixty four patients who had undergone pre- and post- TIPS endoscopic examination were analysed. They were divided into two groups, Group 1 (n = 40) and Group 2 (n = 24), according to whether they had not or had, respectively, undergone post-TIPS residual variceal embolization. The varices were classified as either esophageal (n = 54) or gastric (n = 60). Post TIPS endoscopic change was evaluated as Grade 1 (complete disappearance), Grade 2 (partial disappearance), or Grade 3 (no change). Mean pressure reduction between the pre and post TIPS portosystemic pressure gradient was checked, and statistical correlation between mean portal pressure reduction and endoscopic change in Group 1 and Group 2 was evaluated using the ANOVA test. By means of the x2 test, post-TIPS endoscopic change between esophageal and gastric varices was also evaluated. RESULTS: In Group I, a significant statistical relationship was found between endoscopic change and mean portal pressure reduction (p0.05). No significant statistical difference was found between endoscopic change in esophageal and in gastric varices (p> 0 . 0 5 ). CONCLUSION: In patients who had not undergone post-TIPS residual variceal embolization, endoscopicf change in gastroesophageal varices correlated significantly with post-TIPS portal pressure reduction. With regard to post-TIPS endoscopic change, these was no significant difference between esophageal and gastric varices.

P revalence of Lattice Degeneration and Its Relation to Axial Length

We studied the relationship between the prevalence of lattice degeneration and the axial length in patients with myopia who had undergone photorefractive keratectomy(PRK). 355 eyes of 186 myopic patients with axial length of 22.99mm~30.67mm were evaluated by using A-scan axial length measurements and fundus examination. The myopic patients with posterior staphyloma did not undergo PRK.Eyes were classified into three groups on the basis of axial length:mild(28mm)axial myopia.The prevalence of lattice degeneration was then studied according to axial length group. The highest prevalence of lattice degeneration(13 of 35 eyes, 37.1%)was found among eyes of axial length 28 mmor greater;the lowest prevalence of lattice degeneration(10 of 174 eyes, 5.7%)was found among eyes of axial length under 26 mm. We could find statistically significant association between the prevalence of lattice degeneration and axial length(X2 27.356 P-value<0.005). Unless the axial myopia is related to posterior staphyloma, this may explain the observation that lattice degeneration has been noted more commonly among patients with severe than mild or moderate axial myopia. As lattice degeneration is recognized as a frequent cause of retinal detachment, we recommend peripheral fundus examination be done carefully before PRK or LASIK.

Induced Astigmatism after Rabbit Cataract Surgery Using Tissue Adhesive

In order to compare the amount of surgically induced astigmatism among sutureless group(Group 1),10-0 nylone suture group(Group 2),and using tissue adhesive group(Group 3),we analysed a series of rabbit cataract surgery cases in these three groups. We performed cataract surgery on 30 eyes of 15 rabbits by Irrigation and aspiration technique. After cataract surgery,10 eyes by sutureless technique,10 eyes were closed by conventional 10-0 nylon suture technique, and 10 eyes by tissue adhesive(Beriplast) technique.We collected keratometric data before and after surgery(At 1,2,4,8 weeks).In postoperative astigmatic change,three groups had the distinct features in the evolution for postoperative astigmatism.The group 1 showed early against-the-rule(ATR)astigmatism,which advanced ATR and showed about 0.5D astigmatic change at 8 weeks.The group 2 showed early with-the-rule(WTR)astigmatism about 1.13D,which advanced toward ATR from 1week.The group 3 showed little ATR about 0.2D,which was minimal change in astigmatism.At 8 weeks after operation,there was no signifi-cant difference in the astigmatic change among the three groups(P>0.05), which were no complications observed. In this study,the tissue adhesive(Beriplast)seem to be a simple,effective and less induced astigmatic changing corneoscleral suture technique than other suture techniques

Transjugular Intrahepatic Portosystemic Shunt in Patients with Active Variceal Bleeding Due to Portal Hypertension and Portal Vein Thrombosis

PURPOSE: To evaluate the feasibility and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in patients with active variceal bleeding due to liver cirrhosis and pre-existing portal vein thrombosis. MATERIALS AND METHODS: Of a total of 123 patients who underwent TIPS, 14 patients with intractable variceal bleeding due to portal hypertension and portal vein thrombosis were included in this study. Noncavernomatous portal vein occlusion was seen in eight patients, and complete portal vein occlusion with cavernomatous transformation in six. For all patients, the methods used for TIPS placement were the same as those used in patients with patent portal veins. In seven of eight patients with noncavernomatous occlusion, right hepatic vein-right portal vein shunting was performed; in one with noncavernomatous occlusion, a shunt was created between the right hepatic and left portal vein. In five of six patients with cavernomatous occlusion, the right hepatic and main portal vein were connected via a collateral vein. RESULTS: The procedures were technically successful in all except one patient. Immediate hemostasis was achieved after all technically successful procedures, and no significant complications were encountered. Minor complications were noted in six patients (three biliary tree punctures, one transperitoneal puncture, one splenic vein perforation, one hepatic subcapsular hematoma). CONCLUSION: TIPS is a technically feasible and hemodynamically effective procedure, even in patients with active variceal bleeding due to cirrhosis and complete portal vein occlusion.

Phytobezoars in the Small Intestine: CT and US Appearances

PURPOSE: To describe CT and ultrasound(US) appearances of phytobezoar in the small intestine. MATERIALS AND METHODS: During the past two years, CT and US scans of six patients with phytobezoars of the small intestine were retrospectively reviewed. All patients presented symptoms of bowel obstruction, and four had a history of gastric surgery. Four phytobezoars were found in the jejunum and two in the ileum at surgery. We evaluated CT and US findings of phytobezoar and compared these with CT images of the removed phytobezoars. RESULTS: In three patients, US studies showed a curvilinear echogenic mass within the lumen of the dilated small bowel, with a clear posterior acoustic shadow. In six, CT scans revealed an intraluminal mass seen as having a thin soft tissue rim at the periphery and numerous aggregated low attenuation areas representing gas in the central portion. CT findings of the specimens were the same as those of phytobezoars in vivo. CONCLUSION: US and CT appearances of small intestinal phytobezoars are sufficiently distinctive to advocate the preoperative routine use of US and CT for diagnosing this entity.

Percutaneous Insertion of Inferior Vena Cava Filter: Clinical Results of 8 patients

PURPOSE: To evaluate the efficacy and clinical results of percutaneous insertion of inferior vena cava(IVC) filter. MATERIALS AND METHODS: Over a two year period, eight IVC filters were placed in eight patients with pulmonary thromboembolism resulting from deep vein thrombosis of the legs. The indications for placement were contraindication to anticoagulation(3), and recurrent pulmonary embolism during anticoagulant therapy(5). Both femoral(7) and jugular(1) routes were used for percutaneous transvenous insertion. To delineate the caval anatomy and to ensure placement just caudal to the renal vein, a cavogram was obtained before filter placement. Bird's Nest (7) and Greenfield (1) filters were inserted. Follow-up information was obtained by means of duplex sonography, CT scan, abdominal radiograph, and perfusion scan of the lungs, followed by clinical evaluation. RESULTS: In all cases, procedures were technically successful. Placement complications occurred in three patients. In one, the filter was inadvertently placed above the iliac bifurcation; in the other two, prolapse of the Bird's Nest filter wire occurred. Occlusion of IVC occurred in two patients, and recurrent pulmonary embolism was suspected in one, who suffered from chest pain and shortness of breath. In the other patients, there was no clinical evidence of recurrence of the pulmonary embolism. CONCLUSION: Insertion of an inferior vena cava filteris a safe and effective method for the prevention of pulmonary embolism when anticoagulant therapy is either ineffective or contraindicated.

Teleradiology: Detectability of Pneumothorax and Miliary Tuberculosis

PURPOSE: To evaluate the clinical utility of the teleradiology system using the information super highway communication network. MATERIALS AND METHODS: Two radiologists selected 101 cases of pneumothorax and 20 cases ofmiliary tuberculosis. There were scanned and transmitted to our hospital at a speed of 640 Kbps and displayed on avideo monitor with a resolution of 1280 pixels/line x 1024 lines. Four radiologists divided into three groups :read the images group A read the images without image processing ; group B read the images with image processing, group C read the radiographic films on the view box. The authors compared sensitivity and specificity between thegroups and checked their statistical significance using the Chi-square test. According to the location of thepleural line, we divided the pneumothorax into four types : continve on this live type 1, pleural line confined tothe apex ; type 2, to the upper half ; type 3, to the lower half ; type 4, to the upper through lower half. We then compared sensitivity between the Three groups. RESULTS: In the pneumothorax group, the average sensitivity of group A, B and C was 79%, 90% and 96%, and average specificity was 99%, 99% and 94%, respectively. There were statistically significant differences in seasitivity between group A and B and between group B and C (p<0.017). There were no statistically significant difference in specificity between group A and B or between group B and C.In the miliary tuberculosis group, the average sensitivity of group A, B and C was 73%, 78% and 90%, and average specificity was 95%, 95% and 100%, respectively. With regard to sensitivity and specificity, there was no statistically significant difference between group A and B or between group B and C but there was a statistically significant difference between group A and C (p<0.017). According to the location of the pneumothorax, for alltypes, the sensitivity of group A was less than that of group B and group B was less than that of group C. CONCLUSION: All groups showed reduced observer performance in the detection of pneumothorax and miliary tuberculosis when reading a transmitted image on the monitor-workstation compared with reading conventional radiographs on the view box. To improve the clinical utility of the teleradiology system, a higher resolution workstation and adequate image processing are required.