Primary Neuroendocrine Tumor of the Breast: Imaging Features

Focal neuroendocrine differentiation can be found in diverse histological types of breast tumors. However, the term, neuroendocrine breast tumor, indicates the diffuse expression of neuroendocrine markers in more than 50% of the tumor cell population. The imaging features of neuroendocrine breast tumor have not been accurately described due to extreme rarity of this tumor type. We present a case of a pathologically confirmed, primary neuroendocrine breast tumor in a 42-year-old woman, with imaging findings difficult to be differentiated from that of invasive ductal carcinoma.

MDCT Findings of Right Circumaortic Renal Vein with Ectopic Kidney

Anomalies of renal vasculature combined with ectopic kidneys were found on a multi-detector CT scan. Knowledge of renal vascular variation is very important for surgical exploration, radiologic intervention and staging for urologic cancer. We present an extremely rare case of a right circumaortic renal vein combined with a right ectopic kidney. The right kidney was located at the level between the third and fifth lumbar vertebra. The right circumaortic renal vein crossed the aorta and returned to the inferior vena cava behind the aorta.

Arachnoid Cyst in Oculomotor Cistern

Oculomotor cistern is normal anatomic structure that is like an arachnoid-lined cerebrospinal fluid-filled sleeve, containing oculomotor nerve. We report a case of arachnoid cyst in oculomotor cistern, manifesting as oculomotor nerve palsy. The oblique sagittal MRI, parallel to the oculomotor nerve, showed well-defined and enlarged subarachnoid spaces along the course of oculomotor nerve. Simple fenestration was done with immediate regression of symptom. When a disease develops in oculomotor cistern, precise evaluation with proper MRI sequence should be performed to rule out tumorous condition and prevent injury of the oculomotor nerve.

Comparison of the Success Rates of Lightwand Tracheal Intubation on the First Attempt When Using the Lightwand at Different Angles

BACKGROUND: It has been recommended that lightwand tracheal intubation be used for cases in which there is difficult airway management. Transillumination of the soft tissue of the neck by the lightwand can lead to successful intubation; however, this depends on skin color, obesity, head position, angle and the bent length of the lightwand. The goal of this study was to compare the success rates of intubation on the first attempt and complications of lightwand orotracheal intubation that occurred when using the lightwand at angles of 60 degrees and 90 degrees. METHODS: One hundred forty eight patients of ASA physical status 1 or 2 were enrolled in this study. Patients in whom intubation had previously been difficult as well as patients who had the potential for difficult intubation were excluded from this study. Patients were randomly assigned to one of two groups: The lightwand bent in 60 degrees (LW60) group and the lightwand bent in 90degrees (LW90) group. Anesthesia was performed using propofol (2 mg/kg), fentanyl (1microg/kg) and rocuronium (0.9 mg/kg), and lightwand orotracheal intubation was attempted 2 minutes after the induction of anesthesia. The success rates of intubation, the number of attempts and their duration, as well as hemodynamic changes, resistance to the tube and complications that occurred during the procedure were recorded. RESULTS: In the LW90 group, resistance to the tube during lightwand intubation occurred in a significant number of patients (P < 0.05), however, there were no significant differences observed between the two groups with regard to the intubation success rates on the first attempt, the duration of intubation, hemodynamic changes and complications. CONCLUSIONS: Their were no significant differences observed between intubation success rates on first attempt and complications when using a lightwand bent to 60 degrees or 90 degrees in patients without any previously known airway abnormalities.

Lumbar Paraspinal Myonecrosis Following Combined Spinal Epidural Anesthesia: A case report / 대한마취과학회지

A 55-year-old woman received a combined spinal epidural anesthesia for total replacement surgery of the left knee. After surgery, the epidural patient controlled analgesia (PCA) device was activated. After the first post-operative day, the patient complained of severe back pain rather than left knee pain in spite of the bolus dose of analgesics via epidural catheter. The epidural catheter was removed and intravenous PCA was initiated. On the 16th post-operative day, the patient's back and knee pain improved; however, the fever did not subside. A blood test revealed increased inflammatory markers in spite of antibiotic therapy. Under the suspicion of epidural abscess, a lumbar magnetic resonance imaging scan was performed and revealed an increase in the signal within left lumbar paraspinal muscle. A prompt debridement and irrigation of the necrotic tissues was performed. The histologic diagnosis was lumbar paraspinal myonecrosis. Subsequent to this corrective procedure, the patient's fever subsided and the inflammatory markers were normalized, except for mild back pain after the surgical repair.