Descending necrotizing mediastinitis (DNM) is one of the most lethal form of mediastinitis originating from an oropharyngeal infection. It requires an early and aggressive sugical treatment, but the operative approach and optimal form of mediastinal drainage remains controversial. We report a case of DNM in a 45-year-old male who underwent right cervicomediastinotomy to drain the deep neck space, upper mediastinum and anterior mediastinal drainage was accomplished through a subxiphoid approach. After this procedure, he steadily improved and was dischrged on hospital day 36. We report this case with a brief review of the literature.
Drainage ; Humans ; Male ; Mediastinitis* ; Mediastinum ; Middle Aged ; Neck

BACKGROUND: Although the incidence of colorectal cancer in young adults is low, they seem to show advanced tumors with a poor prognosis at their initial presentation due to diagnostic delay. We evaluated colorectal cancer in young patients with respect to clinical characteristics and prognosis. METHODS: Twelve hundred and seventy-three colorectal cancer patients were evaluated retrospectively. Familial adenomatous polyposis and ulcerative colitis related cases were excluded. We grouped these patients into younger (40 years old) and older (>40 years old) patients. These two groups were compared with respect to sex, tumor location, duration of symptoms and signs, patterns of DNA ploidy, histological differentiations, TNM stage, survival rate, and familial tendency of colorectal cancer. RESULTS: One hundred forty-nine patients (11.7%) were 40 years old or younger. There was no significant difference between the two groups with respect to sex, tumor location, patterns of DNA ploidy, and 5-year survival rate. Histological patterns revealed a higher incidence of mucinous and signet-ring cell tumors in the younger group than in the older group (12.7% vs. 2.7% and 4.0% vs. 0.7%, p<0.05). The duration of the symptoms was shorter in the younger group, being less than 3 months in 56.3% of the younger group and 36.3% of the older group. Colorectal cancer in the younger group seemed to present more advanced lesions, especially those in stage III. Familial clustering of cancers(younger group, 25.5%; older group, 9.3%) and hereditary nonpolyposis colorectal cancer(younger group, 7.4%; older group, 0.7%) were more prevalent in the younger group. CONCLUSION:For colorectal cancer in younger patients with histological shortcomings and familial clustering, every effort is needed to make an earlier diagnosis.
Adenomatous Polyposis Coli ; Adult* ; Colitis, Ulcerative ; Colorectal Neoplasms* ; Colorectal Neoplasms, Hereditary Nonpolyposis ; Diagnosis ; DNA ; Humans ; Incidence ; Mucins ; Ploidies ; Prognosis* ; Retrospective Studies ; Survival Rate ; Young Adult

No abstract available.
Cell Line* ; Glioma*

An experiment was planned to observe the histopathological alteration with administration of the Rheomacrodex and blood pressure changes in induced cerebral infarct after occlusion. Eighty well developed cats, weighing 2.3 to 3.5kg, were used in this experiment. The right MCA was exposed through temporal approach and the proximal part of the MCA was occluded with a silver clip. The animals were divided into 4 groups: The control group was comprised of 20 cats with occlusion of the right MCA alone, Rheomacrodex-treated group was comprised of 20 cats after occlusion of right MCA, induced hypotension and hypertension groups consisted in each 20 cats following occlusion of the MCA. The animals were sacrificed at intervals of 3 hours, 6 hours, 24 hours, 1 week and 2 weeks respectively after occlusion of the MCA. The animals were studied for clinical deficits and histopathological changes of the cerebral infarct according to the time courses. The results obtained were as follows: 1) In the control group, severe contralateral hemiplegia was developed in the early stage following the MCA occlusion, however the neurological deficits were progressively improved to the state of abnormal walking in 24 hours to 2 weeks. The hemorrhagic infarct was involving the basal ganglia, internal capsule and extending to the cortex with mild brain edema in the early stage and the area of the infarct was gradually enlarged from 6 hours to 24 hours following the MCA occlusion. Although the brain edema of surrounding area of the lesion was remained unchanged, the size and distribution of the infarct were decreased in one week to 2 weeks. Extensive ischemic neuronal damage was observed in the control group. 2) In the Rheomacrodex-treated group, mild to moderate neurological deficit was developed in the early stage after MCA occlusion and the deficit was less severe than control group. The clinical deficit was improving in the time course and one case had shown completely normal activity in 2 weeks. The distribution of the infarct was well defined and it was smaller than control group. The infarct mainly involved the basal ganglia and internal capsule. The area of the infarct was gradually enlarged from 6 hours to one week after MCA occlusion, then the extent of the infarct was decreased in 2 weeks. The ischemic neuronal change in this group was less severe than control group. 3) In the induced hypotension group, the early neurological deficit was worse than that of the control group and severe hemiplegia was developed in one week. There was minimal improvement of the neurological deficit in 2 weeks. The area of the infarct was ill-defined and hemorrhagic extending a large portion of the brain with severe brain edema. The infart was involving the basal ganglia, internal capsule, claustrum and the cortex from 3 hours to 24 hours after the occlusion and the area of the infarct was not changed during the observation. Severe ischemic nerve cell change or resolution of the cells was oserved in this group. 4) In the induced hypertension group, the neurological deficit was mild and it was better than that of the control group. The distribution of the infarct was well localized and minimum in extent. The extent of the infarct was not changed during the observation. There was no observable gross brain edema and the ischemic nerve cell changes were not severe.
Animals ; Basal Ganglia ; Blood Pressure* ; Brain ; Brain Edema ; Cats ; Dextrans* ; Hemiplegia ; Hypertension ; Hypotension ; Internal Capsule ; Middle Cerebral Artery* ; Neurons ; Silver ; Walking

PURPOSE: Hemorrhoidal tissues are normal anatomic structures present in every individual, and they act as cushions and are anchored to the internal anal sphincter by a connective tissue system. When the anchoring connective tissues undergo bears degenerative changes, the hemorrhoids not only bulge but also descend into the lumen of the anal canal. The veins also become distended. The previous hemorrhoidectomy methods (excision and ligation methods) tend to remove excessive amounts of hemorrhoidal tissues, possibly causing incontinence or stenosis. This study introduces a modified hemorrhoidectomy method. METHODS: A retrospective study was done with 650 patients (358 males, 292 females) who underwent hemorroidectomies from Jan. 1997 to Jan. 2000. Under saddle-block anesthesia, the patient was placed in a prone jack-knife position. After narrow incisions on the mucosa of the selected pile, a bilateral submucosal dissection was performed. The pedicle was ligated by transfixing sutures 2 or 3 times with 2-0 chromic catgut to lift up the mucosa. RESULTS: The mean operation time per hemorrhoidal pile was 12.7 minutes, and the mean hospital-stay was 4.3 days. Acute and delayed postoperative anal bleeding occurred in 7 (1.1%) and 3 (0.5%) patients, respectively. The symptoms of both subsided spontaneously. Ninety-three (93) patients (14.3%) reguired nelaton catheterization for voiding difficulty, and one patient (0.2%) showed mild anal stenosis. The most frequent complaint was skin-tag formation (148 cases, 22.8%). In 140 cases, the skin tag was removed under local anesthesia. CONCLUSIONS: It is desirable to keep the normal structure of the anal canal by removing as little of the cushions as possible. Our 'lift-up submucosal hemorrhoidectomy' shows good results and is an easy operative method when compared with Parks' original method.
Anal Canal ; Anesthesia ; Anesthesia, Local ; Catgut ; Catheterization ; Catheters ; Connective Tissue ; Constriction, Pathologic ; Hemorrhage ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Ligation ; Male ; Mucous Membrane ; Retrospective Studies ; Skin ; Sutures ; Veins

Exercise-induced anaphylaxis can be associated with ingestion of a specific food. We experienced a case of exercise-induced anaphylaxis followed by ingestion of parsely. A 22- year old female patient was presented with angioedema of the face and chest tightness induced by running after ingestion of parsley within 15 minutes. She had suffered from allergic rhinitis. She had positive reactions to mugwort pollen and parsely extract on skin prick test in a dose dependent manner. Although the oral provocation test with parsely could not induce bronchoconstriction, we could diagnosed as parsely dependent exercise induced anaphylaxis based upon skin prick test and history.
Anaphylaxis ; Angioedema ; Artemisia ; Bronchoconstriction ; Eating ; Female ; Humans ; Petroselinum ; Pollen ; Rhinitis ; Running ; Skin ; Thorax

No abstract available.
Osteoporosis*

Cerebral somatosensory evoked potentials(SEPs) produced by stimulation of peripheral nerves provide a useful diagnostic index of conduction in somatosensory pathways to the cortex. Thus the integrity of both the dorsal column-medial lemniscus pathway and primary sensorimotor area has been considered an essential requirement to record a normal SEP. There are suggestions that SEPs contain several components arising from different neuronal sources, the early short latency potentials corresponding to the lemniscus-mediated responses and the late waves to the diffuse spino-thalamic projections. The present work analyses the influence on SEPs of focal brain lesions, using the computerized tomography in detecting and localizing brain lesions. Somatosensory evoked potentials were recorded in 20 patients with focal brain lesions recognized by computerized tomography. 1) Patients with primary sensorimotor area(PSMA) damages(group I) had a very abnormal of the early component(No, Po, Nl, Pl) in 100% on the lesion side. 2) Patients presented supratentorial lesions, sparing PSMA(group II), 87.5% showing abnormal SEPs in early components and characterized by increment of amplitude in late components. 3) Brainstem damage(group III) produced a distortion of the early components especially N11, N20msec in latency. 4) In incomplete spinal cord injuries, the SEPs is indeed signal of functional recovery, of posterior column, and incorrespondance with clinical improvement.
Brain Stem ; Brain* ; Evoked Potentials, Somatosensory* ; Humans ; Neurons ; Peripheral Nerves ; Spinal Cord Injuries

BACKGROUND: When patients with chronic respiratory symptoms have a normal spirometry result, it is not always easy to consider bronchial asthma as the preferential diagnosis. Forced expiratory flow between 25% and 75% of vital capacity (FEF(25~75%)) is known as a useful diagnostic value of small airway diseases. However, it is not commonly used, because of its high individual variability. We evaluated the pattern of bronchodilator responsiveness (BDR) and the correlation between FEF25~75% and BDR in patients with suspicious asthma and normal spirometry. METHODS: Among patients with suspicious bronchial asthma, 440 adult patients with a normal spirometry result (forced expiratory volume in one second [FEV1]/forced vital capacity [FVC] > or =70% & FEV1% predicted > or =80%) were enrolled. We divided this group into a positive BDR group (n=43) and negative BDR group (n=397), based on the result of BDR. A comparison was carried out of spirometric parameters with % change of FEV1 after bronchodilator (DeltaFEV1%). RESULTS: Among the 440 patients with normal spirometry, FEF(25~75%)% predicted were negatively correlated with DeltaFEV1% (r=-0.22, p<0.01), and BDR was positive in 43 patients (9.78%). The means of FEF(25~75%)% predicted were 64.0+/-14.5% in the BDR (+) group and 72.9+/-20.8% in the BDR (-) group (p<0.01). The negative correlation between FEF(25~75%)% predicted and DeltaFEV1% was stronger in the BDR (+) group (r=-0.38, p=0.01) than in the BDR (-) group (r=-0.17, p<0.01). In the ROC curve analysis, FEF(25~75%) at 75% of predicted value had 88.3% sensitivity and 40.3% specificity for detecting a positive BDR. CONCLUSION: BDR (+) was not rare in patients with suspicious asthma and normal spirometry. In these patients, FEF(25~75%)% predicted was well correlated with BDR.
Adult ; Asthma ; Bronchodilator Agents ; Humans ; ROC Curve ; Spirometry ; Vital Capacity

BACKGROUND: Surgical correction of partial anomalous pulmonary venous connection to the superior vena cava has been associated with postoperative venous obstruction and sinus node dysfunction. In this paper we describe our current approach and its short-term results. MATERIAL AND METHOD: Between April 1999 and January 2000, 5 consecutive patients, ranging from 2 months to 66 years old, underwent corrective operation for partial anomalous pulmonary venous connection to the superior vena cava at Sejong General Hospital and Daegu Catholic University Medical Center. Surgical correction involved diversion of the pulmonary venous drainage to the left atrium using a right atrial flap(2 patients) or prosthetic patch(3 patients) with division of the superior vena cava superior to the entrance site of the pulmonary veins and reimplantation on the right atrial appendage to restore systemic venous drainage. RESULT: All patients were discharged between postoperative day 9 and 15 without complications. One Russian boy returned to his country, therefore, he was lost to follow-up after discharge. Remaining 4 patients were asymptomatic and in normal regular sinus rhythm at a mean follow-up of 17.75+/-4.27 months. Follow-up echocardiographic study (range, 12 to 24 months) revealed no incidence of narrowing of the venous pathways or of residual shunt. CONCLUSION: Our current approach is relatively simple and reproducible in achieving unobstructive pulmonary venous and SVC pathways. By avoiding incision across the cavoatrial junction, surgical injury to the sinus node and its artery may be minimized. The presented surgical technique can be safely and effectively applied to the selected patients.
Academic Medical Centers ; Aged ; Anastomosis, Surgical ; Arteries ; Atrial Appendage ; Daegu ; Drainage ; Echocardiography ; Follow-Up Studies ; Heart Atria ; Hospitals, General ; Humans ; Incidence ; Intraoperative Complications ; Lost to Follow-Up ; Male ; Pulmonary Veins ; Replantation ; Sick Sinus Syndrome ; Sinoatrial Node ; Vena Cava, Superior*