Volvulus of the colon is a twisting of a redundant segment of the colon about it's narrow mesentery and sigmoid volvulus is the most common type. In many developing counteries this disorder is a common cause of obstruction of the intestine and in the western hemisphere it occurs in elderly patients who often have significant coexisting disease. This disorder may spontaneously reduce and recur as a chronic problem, but more frequently it becomes acute by obstruction, which may lead to strangulation and gangrene with high mortality if not treated promptly. Recently We have experienced 5 cases of signmoid volvulus, which were all in their twenties and had surgical operation. They had the triad of abdominal pain, distention, and absolute constipation. Plain abdominal roentgenogram was diagnostic in all cases The first line of treatment was nonoperative decompression with rigid sigmoidoscopy and successful in four of five. One Patient had emergency Hartman operation and other four had elective sigmoid resection with primary anastomosis.
Abdominal Pain ; Aged ; Colon ; Colon, Sigmoid* ; Constipation ; Decompression ; Emergencies ; Gangrene ; Humans ; Intestinal Volvulus* ; Intestines ; Male* ; Mesentery ; Mortality ; Sigmoidoscopy

Drug-induced toxic epidermal necrolysis (TEN) is a bullous erythematous disease that is characterized by the appearance of scaled lesions and large sheets of pilling on the skin. A caseof TEN occured in a 10 month old female patient. The characteristic skin lesions of TEN developed after oral administration of carbamazepine for a partial seizure. Thig case consists of prodrome of malaise, fever, anorexia, and conjunctivity followed by erythema & flaccid bullae formation. Diagnosis was confirmed by histologic findings. This patient was treated with a massive systemic corticosteroid, antibiotics, fluid and electrolytes, and topical measures. Authors experienced an extremely rare case of TEN dur to carbamazepine, So report it with a brief review of literature.
Administration, Oral ; Anorexia ; Anti-Bacterial Agents ; Carbamazepine ; Diagnosis ; Electrolytes ; Erythema ; Female ; Fever ; Humans ; Infant ; Seizures ; Skin ; Stevens-Johnson Syndrome*

No abstract available.
Adrenal Hyperplasia, Congenital*

Lymphoceles are the most frequent surgical complications following kidney transplantation. Symptomatic lymphoceles following kidney transplantation are managed best by surgical marsupialization with intraperitoneal drainage. We performed laparoscopic intraperitoneal drainage in a patient with a large lymphocele and secondary hydronephrosis following a kidney transplant.
Drainage* ; Humans ; Hydronephrosis ; Kidney Transplantation ; Kidney* ; Laparoscopy ; Lymphocele* ; Transplantation

The elimination of most anticholinesterases depends on the kidney, even if the main organ for their metabolism is the liver. Renal excretion of pyridostigmine, edrophonium and neostigmine accounts for 15%, 70% and 50%, respectively. In the absence of renal function, the serum half-life of neostigmine is prolonged, its plasma clearance is decreased However, the pharmacodynamics of neostigmine have not been determined in renal failure. This study was designed to compare the neostigmine dynamics in 18 patients with normal renal function to that in 18 patients with renal failure(Group I & II, respectively). Using the flexor carpi ulnaris EMG via ulnar nerve stimulation with Train-Of-Four(TOF) under the constant infusion of vecuronium to produce about 85%-twitch depression, the responses of neostigmine with three different doses were obtained. The results are follows; 1) The constant infusion rates of vecuronium to maintain sbout 15&-twitch height prior to the administration of neostigmine showed no significant difference between two groups. 2) Immediately prior to each dose of neostigmine, the mean values of twitch heights were 11.7 to 13.7%. 3) There was no significant difference in the onset time, maximum twitch responses and antagonism effects between two groups in respect to each same dose of nesotigmine. 4) The duration of neostigmine with the half of ED only in Group II was significantly longer than that in Group I, even if the durations with the other doses in Group II were not significantly longer than those in Group L These results suggest that the reversal effect of neostigmine to vecuronium-induced block- ade may be outlasted in patients with renal failure and the prolongation of neostigmine effeet may render some benefits to reverse the relaxants which have the limitation of its elimination in this patients.
Cholinesterase Inhibitors ; Depression ; Edrophonium ; Half-Life ; Humans ; Kidney ; Liver ; Metabolism ; Neostigmine* ; Neuromuscular Blockade* ; Plasma ; Pyridostigmine Bromide ; Renal Insufficiency* ; Ulnar Nerve ; Vecuronium Bromide*

Merkel cell carcinoma is a rapidly growing malignant neuroendocrine tumor with a high rate of recurrence and metastasis for which wide excision is recommended. About 10 cases of spontaneous regression have been reported in the world. We report a case of Merkel cell carcinoma which showed spontaneous regression. The patient was a 68-year-old woman with a two-month history of a rapidly enlarging dusky red tumor on her right cheek. Microscopically, the tumor cells were uniform with round to oval shaped nucleus and scanty cytoplasm, and showed trabecular arrangement. Ultrastructually, dense core neurosecretory granules 100 to 200nm in diameter were found in the cytoplasm of tumor cells. As far as we know, this is the first case of the spontaneous regression of the tumor in the country.
Aged ; Carcinoma, Merkel Cell* ; Cheek ; Cytoplasm ; Female ; Humans ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Recurrence

BACKGROUND: In contrast to childhood intussusception, the clinical features in adults are not typical, and the incidence of adult intussusception is low. This study was to evaluate the clinical features, diagnosis, and management of adult intussusception. METHODS: Thirty-seven cases of adult intussusception occurring between 1981 and 1996 in individuals older than 16 were investigated retrospectively. RESULTS: The most common age was in the 3rd decade (24.3%). Abdominal pain, nausea and vomiting, abdominal tenderness and palpable abdominal mass were common symptoms and physical findings in order of frequency. The duration of symptoms was less than 7 days in 54% of the cases. Correct preoperative diagnosis was made in 13.3% from 1981 to 1990 versus 72.7% from 1991 to 1996. This difference was caused by common use of abdominal ultrasound (US) and computed tomography (CT) during recent years. On exploration there were 27 cases of enteric (73%) and 10 cases of colonic (27%) intussusceptions and there were underlying lesions in 30 cases (81%). Two manual reductions only, 7 manual reductions and resections, including one reoperation after manual reduction only, 28 resections without manual reduction, and 1 ileocolostomy were performed. While only 2 cases (7.4%) of malignancy were identified among the enteric intussusceptions, there were 7 cases (70%) of malignancy among the colonic intussusceptions. CONCLUSIONS: With the advance of abdominal US and CT, preoperative diagnosis of adult intussusception was not so difficult. Because of high prevalence of underlying lesions in adult intussusception, operative management is mandatory. Resection without reduction is the most common method of operation and is recommended in edematous and ischemic enteric intussusceptions and in all colonic intussusceptions which have high malignant rate.
Abdominal Pain ; Adult* ; Colon ; Diagnosis* ; Humans ; Incidence ; Intussusception* ; Nausea ; Prevalence ; Reoperation ; Retrospective Studies ; Ultrasonography ; Vomiting

BACKGROUND: There has been a general feeling among surgeons that recurrence or metastasis following a curative gastric resection is a hopeless surgical proposition. This study was conducted to evaluate the clinical features and significance of relaparotomy following a gastrectomy for gastric cancer. METHODS: Fifty-six cases of relaparotomies following resection for 53 gastric cancer patients, which were performed over a nine-year period, were investigated retrospectively. On preoperative diagnosis, there were 17 cases of remnant and anastomotic recurrence, 15 cases of intestinal obstruction, 7 cases of cholecystitis, 7 cases of rectosigmoid obstruction, 5 cases of E-loop obstruction and 5 cases of other diseases. RESULTS: Of all the laparotomies eleven cases (19%) were non-recurrence, benign diseases and forty-six (81%) were recurrence. In the 17 cases of remnant and anastomotic recurrence, re-resection was possible in 13 (76%) and major postoperative complications developed in 4 cases with 2 cases of death within one month. Also 6 of 7 re-resected cases which was stage I at first operation were still alive well. In 15 cases of mechanical obstruction, 5 cases were non-recurrence and 10 cases involved recurrence, of which 6 had a bypass or enterostomy and 4 an exploration only. All cholecystitis cases had a cholecystectomy; metastasis was found in 2 cases. Rectal obstruction and E-loop obstruction all involved recurrence and a palliative resection was possible in only one case of each type of obstruction. CONCLUSIONS: In a relaparotomy of remnant and anastomotic recurrence, most of the survival-improving re-resection cases were in stage I at the first operation. In late-onset cholecystitis tumor recurrence should be suspected and a relaparotomy of the malignant obstruction, with bypass and ostomy procedure, can be justified for symptomatic relief.
Cholecystectomy ; Cholecystitis ; Diagnosis ; Enterostomy ; Gastrectomy ; Humans ; Intestinal Obstruction ; Laparotomy ; Neoplasm Metastasis ; Ostomy ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Stomach Neoplasms*

A 63-year-old woman was admitted to the hospital with abdominal pain and nausea. Her abdomen was distended with obstructive bowel sounds on exam. There was diffuse abdominal tenderness but no palpable masses. Abdominal computed tomography (CT) scan revealed a large gallstone in the ileum. Surgical intervention was deferred given patient's known significant liver cirrhosis (Child-Pugh class B). Instead colonoscopy was performed and a large gallstone was found to be impacted at the ileocecal valve. The gallstone was fragmented using electrohydraulic lithotripsy (EHL) and then retrieved with snare and forceps. The patient made a full recovery and was eventually discharged home. This is the first reported case of an impacted gallstone at the ileocecal valve with successful colonoscopic treatment using electrohydraulic lithotripsy in Korea. This case highlights the potential therapeutic benefits for colonscopic retrieval of a gallstone impacted at the ileocecal valve in well selected individuals.
Abdominal Pain/radiography ; Colonoscopy ; Female ; Gallstones/*diagnosis/therapy ; Humans ; Ileus/*diagnosis/therapy ; Intestinal Obstruction/diagnosis/therapy ; Lithotripsy/*methods ; Middle Aged ; Tomography, X-Ray Computed

Piriformis syndrome (PS) is an uncommon neuromuscular disorder caused by the piriformis muscle (PM) compressing the sciatic nerve (SN). The main symptom of PS is sciatica, which worsens with certain triggering conditions. Because the pathophysiology is poorly understood, there are no definite diagnostic and therapeutic choices for PS. This case report presents a young woman who mainly complained of bilateral leg weakness. Electromyography revealed bilateral sciatic neuropathy and magnetic resonance imaging confirmed structural lesions causing entrapment of the bilateral SNs. After a laborious diagnosis of bilateral PS, she underwent PM releasing surgery. Few PS cases present with bilateral symptoms and leg weakness. Therefore, in such cases, a high level of suspicion is necessary for accurate and prompt diagnosis and treatment.
Diagnosis ; Electromyography ; Female ; Humans ; Leg* ; Magnetic Resonance Imaging ; Muscle Weakness ; Piriformis Muscle Syndrome* ; Sciatic Nerve ; Sciatic Neuropathy ; Sciatica