Cholangiocarcinomas have several histologic types, but intrahepatic cholangiocarcinoma with sarcomatous change is rare. A 71-year-old man was admitted to our hospital because of fever which had lasted two months. Ultrasonography (US) of the upper abdomen demonstrated a huge hepatic mass with central solid and peripheral cystic portions, and computed tomography (CT) revealed a heterogeneous hepatic mass with a central area in which enhancedment was delayed. Magnetic resonance imaging (MRI) disclosed a huge mass of predominantly low signal intensity at T1WI, and peripheral portions of high signal intensity and a central portion of intermediate signal intensity at T2WI. The pathologic diagnosis was cholangiocarcinoma with sarcomatous change.
Abdomen ; Aged ; Cholangiocarcinoma* ; Diagnosis ; Fever ; Humans ; Magnetic Resonance Imaging ; Ultrasonography

We report herein a case of epidermolysis bullosa (Weber-Cockaynetype) in a 22-year-old male soldier. He had tense egg sized bulla on the both feet for about 10 years. The lesions were exacerbated during hot weather but were mild. After entering military service, lesions became severe by mecanical trauma such as prolonged walking or marching. Histopathological findings showed subepidermal bulla and a few inflammatory infiltration in the dermis.
Dermis ; Epidermolysis Bullosa* ; Foot ; Humans ; Male ; Military Personnel ; Ovum ; Transcutaneous Electric Nerve Stimulation ; Walking ; Weather ; Young Adult

In this study of the physical anthropological characteristics of the Akha and Lahu in northern Thailand, whose customs are similar to the Koreans, the authors examined the finger and palm prints of the Akha (male 107, female 114) and Lahu (male 92, female 101) using qualitative methods, and compared them with those of various ethnic groups including Koreans. The results were as follows : The whorl types (Akha 57.7%, Lahu 58.1%) were the most common finger prints, followed by ulnar loop types (Akha 39.7%, Lahu 38.7%), arch types (Akha 2.6%, Lahu 2.8%), and radial loop types (Akha 1.7%, Lahu 1.2%). Of the palm print types, 9-7-5 (Akha 32.7%, Lahu 21.3%) and 7-5-5(Akha 25.4%, Lahu 21.3%) were most common, followed by 11-O-7 (Akha 2.0%, Lahu 11.3%), 9-O-5 (Akha 1.5%, Lahu 10.0%), 11-9-7 (Akha 6.0%, Lahu 5.7%), 7-5-4 (Akha 7.0%, Lahu 2.2%). The finger and palm print patterns of the Akha and Lahu did not correspond closely to the patterns of those classified as White, Negro, or Oriental, although they were closest to the patterns of the latter, particularly Chinese (rather than Korean or Japanese).
African Continental Ancestry Group ; Anthropology ; Asian Continental Ancestry Group ; Dermatoglyphics ; Ethnic Groups ; Female ; Fingers* ; Humans ; Thailand*

Pneumoperitoneum, Pneumomediastinum, subcutaneous emphysema and a pneumothorax are some of the mechanical complications of bronchial asthma. The incidence of pneumoperitoneum during an attack of acute asthma is rare. The pathogenesis is free gas track from the overdistended alveoli, through the bronchovascular sheaths to the mediastinum. If the high pressure is maintained, air can escape retroperitoneally into the abdomen and burst into the peritoneal cavity. A 43-year-old woman was admitted due to a severe asthma attack. She was required endotracheal intubation and AMBU(air mask bag unit) ventilation. Immediately after these procedures, pneumoperiotneum, pneumomediastinum, and subcutaneous emphysema daveloped. She was treated with mechanical ventilation and medical therapy. The pneumoperitoneum was resolved after 27 days. Here, we report this case with the review of the relevant literature.
Abdomen ; Adult ; Asthma* ; Female ; Humans ; Incidence ; Intubation, Intratracheal ; Masks ; Mediastinal Emphysema* ; Mediastinum ; Peritoneal Cavity ; Pneumoperitoneum* ; Pneumothorax ; Respiration, Artificial ; Subcutaneous Emphysema ; United Nations ; Ventilation*

PURPOSE: Traumatic duodenal injury is rare. There is no consensus on what type of repair should be performed for duodenal perforations with respect to their varying severity. As a result, surgeons are confronted with the dilemma of choosing between several diagnostic tests and many surgical procedures. In this study, we report our experience with treating traumatic duodenal injury and also offer a review of the literature. METHODS: Seventeen patients with duodenal injury following abdominal trauma were treated by several methods between January 1992 and October 2006. Based on review of the medical records, we classified the patients as having grade I through V duodenal injury using the scale constructed by the American Association for the Surgery of Trauma (AAST). We also noted clinical features, operative management, and outcome. RESULTS: Among 17 patients, one patient who had a duodenal intramural hematoma was treated by conservative management. Seven patients were treated by duodenojejunostomy, with only one complication. The remaining 9 patients underwent various operations, including primary closure alone (n=3), primary closure with jejunal patch (n=1), primary closure with duodenostomy (n=3), and pancreaticoduodenectomy (n=2). The complication rate among patients who underwent surgery within 24 hours after injury was 1 case among 13. However, complications occurred in all 4 surgical cases undertaken more than 24 hours after injury. CONCLUSION: Early diagnosis (within 24 hours) and thorough inspection during exploration provide the best means toward reducing complications associated with traumatic duodenal injury.
Consensus ; Diagnostic Tests, Routine ; Duodenostomy ; Early Diagnosis ; Hematoma ; Humans ; Medical Records ; Pancreaticoduodenectomy

PURPOSE: Traumatic duodenal injury is rare. There is no consensus on what type of repair should be performed for duodenal perforations with respect to their varying severity. As a result, surgeons are confronted with the dilemma of choosing between several diagnostic tests and many surgical procedures. In this study, we report our experience with treating traumatic duodenal injury and also offer a review of the literature. METHODS: Seventeen patients with duodenal injury following abdominal trauma were treated by several methods between January 1992 and October 2006. Based on review of the medical records, we classified the patients as having grade I through V duodenal injury using the scale constructed by the American Association for the Surgery of Trauma (AAST). We also noted clinical features, operative management, and outcome. RESULTS: Among 17 patients, one patient who had a duodenal intramural hematoma was treated by conservative management. Seven patients were treated by duodenojejunostomy, with only one complication. The remaining 9 patients underwent various operations, including primary closure alone (n=3), primary closure with jejunal patch (n=1), primary closure with duodenostomy (n=3), and pancreaticoduodenectomy (n=2). The complication rate among patients who underwent surgery within 24 hours after injury was 1 case among 13. However, complications occurred in all 4 surgical cases undertaken more than 24 hours after injury. CONCLUSION: Early diagnosis (within 24 hours) and thorough inspection during exploration provide the best means toward reducing complications associated with traumatic duodenal injury.
Consensus ; Diagnostic Tests, Routine ; Duodenostomy ; Early Diagnosis ; Hematoma ; Humans ; Medical Records ; Pancreaticoduodenectomy

BACKGROUND AND OBJECTIVES: Radiofrequency (RF) catheter ablation of the pulmonary vein (PV) can treat drug refractory focal atrial fibrillation (AF). However, high RF energy (RFE) can cause severe PV damage, and the lower limits of effective RFE in PV have not yet been elucidated. This study attempts to evaluate the changes of PV structure after various modes of RFE delivery. MATERIALS AND METHODS: Right heart and transseptal catheterization were performed in 5 anesthetized mongrel dogs. RFE was delivered at the right superior pulmonary vein (RSPV) with 50 watts and 70degreesC and at the left superior pulmonary vein (LSPV) with 20 watts and 50degreesC. After the procedures, the endocardiums of the left atrium and both superior PVs were examined. RESULTS: Total applied RFE in both PVs was 14.2+/-.2 vs. 13.5+/-.6 watts, 46.6+/-.1 vs. 64.5+/-.2degreesC (p<0.05), in LSPV vs. RSPV, respectively. Follow up pulmonary venograms showed that total occlusions of PV branches and severe stenosis of proximal PV (>70% luminal narrowing) developed in 4 dogs with high RFE. Mild stenosis (<50% luminal narrowing) of PV developed in 1 dog with low RFE. Histological examination of the 5 dogs revealed coagulation necrosis over the whole PV layer, including the adventitia and some portion of the myocardial sleeve, and severe hemorrhage and destruction of PVs from high energy treatment, in contrast to intimal damage and swelling of subintimal PV layers in low energy treatment. CONCLUSION: High RF current may result in severe damage of pulmonary veins and sub-structures whereas low RF current may cause suboptimal pulmonary vein damage such as intimal only damage.
Adventitia ; Animals ; Atrial Fibrillation ; Catheter Ablation ; Catheterization ; Catheters ; Constriction, Pathologic ; Dogs ; Endocardium ; Follow-Up Studies ; Heart ; Heart Atria ; Hemorrhage ; Necrosis ; Phenobarbital ; Pulmonary Veins*

BACKGROUND: Cat scratch disease (CSD) is an emerging disease worldwide and is mainly caused by Bartonella henselae, a gram-negative bacterium. The most common clinical manifestation is regional lymphadenopathy, though clinical recognition may be difficult, as atypical manifestations occur. The condition can be complicated by neuroretinitis, endocarditis, and sometimes fatal encephalopathy. The reservoir of B. henselae is the cat, and the prevalence rates of B. henselae infection in cat populations range from 4 to 70%. The prevalence of Bartonella infection in Korea has not been studied, thus, in this study Bartonella infection was investigated in cats captured in the Inchon and Ansan areas. METHODS: Twenty wild cats were captured and their livers and spleens were examined by polymerase chain reaction (PCR), bacterial culture, and histopathologically. PCR used two primers: Cat (sense:5'-GAT TCA ATT GGT TTG AA(G/A) GAG GCT-3', antisense:5'-TCA CAT CAC CAG G(A/G)C GTA TTC- 3') and Barto (sense:5'-(C/T) CT TCG TTT CTC TTT CTT CA-3', antisense:5'-AAC CAA CTG AGC TAC AAG CC-3'). Culture was performed by inoculating sliced spleen and liver into the ECV304 cell line and bacterial growth was observed over a period of 3 weeks. If no visible bacterial growth was identified, the presence of bartonella was examined by DNA staining, indirect immunofluorescent staining, and PCR. Liver and spleen were stained with H&E and scrutinized under the light microscope. RESULTS: Nine pairs of culture cells inoculated with liver and spleen were examined by indirect immunofluorescent staining and PCR; no positive case was found. In addition, no positive case was identified by PCR in the liver and spleen specimens of eleven cats. Spleen and liver specimens of eleven cats were examined by light microscopy and none showed granuloma. CONCLUSION: This preliminary study suggests that the Bartonella infection is probably uncommon in the cat population of the Inchon and Ansan areas. Further studies should be undertaken to detail the prevalence of Bartonella infection in other areas and in human.
Animals ; Bartonella henselae* ; Bartonella Infections ; Bartonella* ; Cat-Scratch Disease ; Cats* ; Cell Line ; DNA ; Endocarditis ; Granuloma ; Gyeonggi-do ; Humans ; Incheon ; Korea ; Liver ; Lymphatic Diseases ; Microscopy ; Polymerase Chain Reaction ; Prevalence* ; Retinitis ; Spleen

Streptococcal myositis is an extremely uncommon infectious disease caused by Group A streptococcus (GAS). GAS infection spreads rapidly and diffusely through the muscle, resulting in edema and necrosis. Consequently, it results in streptococcal toxic shock syndrome having extremely high mortality. We report a 42 year-old female patient with systemic lupus erythematosus accompanying with streptococcal myositis who initially presented with fever, severe pain, and tenderness on the calf. Her systemic toxic symptoms were aggravated and finally she died of the disease in spite of aggressive management.
Adult ; Communicable Diseases ; Edema ; Female ; Fever ; Humans ; Lupus Erythematosus, Systemic* ; Mortality ; Myositis* ; Necrosis ; Shock, Septic ; Streptococcus

Hyperplasia of Brunner's glands is considered an uncommon finding; its wide range of morphological variation has led to confusing identifying terminology which includes: hyperplasia, adenoma, and hamartoma. Some investigators have suggested that hyperplasia of Brunner's glands is hamartomatous in nature, whereas others have favored a causative relationship that results from gastric acid hypersecretion. Although most commonly an incidental finding, that appears as multiple small submucosal sessile nodules, usually located in the duodenal bulb, it can lead to clinically significant symptoms including gastrointestinal bleeding, abdominal pain, and intestinal obstruction. Here, we report a case of hyperplasia of multiple cystic Brunner's glands on the duodenal bulb in a patient with acute pancreatitis; they were discovered incidentally on abdominal CT and duodenoscopy. This is the first report of hyperplasia of Brunner's glands with these morphological characteristics.
Abdominal Pain ; Adenoma ; Brunner Glands ; Duodenoscopy ; Gastric Acid ; Hamartoma ; Hemorrhage ; Humans ; Hyperplasia* ; Incidental Findings ; Intestinal Obstruction ; Pancreatitis ; Research Personnel ; Tomography, X-Ray Computed