Central vein catheterization is a common procedure for monitoring the central venous pressure, securing vascular access, administrating vasoactive drugs and removing air embolisms. However, many complications can occur, such as vessel injury, pneumothorax, hydrothorax, nerve injury, arrhythmia and infection at the insertion site. We encountered an unusual complication of a localized right hydrothorax that was initially misinterpreted as an atelectasis after left internal jugular vein catheterization and right lateral positioning for a left lower lobectomy.
Arrhythmias, Cardiac ; Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Pressure ; Embolism, Air ; Glycosaminoglycans ; Hydrothorax ; Jugular Veins ; Pneumothorax ; Pulmonary Atelectasis ; Veins

Various methods of infraclavicular brachial plexus block have been introduced in the past, of which Wilson's coracoid infraclavicular brachial plexus block, a more lateral approach, consequently thought to be easier and safer. While only a few cases of transient ipsilateral phrenic nerve palsy after infraclavicular brachial plexus block have been reported, we describe a rare case of phrenic nerve palsy after Wilson's coracoid infraclavicular brachial plexus block.
Brachial Plexus ; Paralysis ; Phrenic Nerve

Intussusception most commonly occurs in children, and in more than 90% of cases, no cause is found. In contrast, intussusception in adults is relatively rare but over 90% of patients have an organic lesion as the cause. Only 5% of cases of intussusception occur in adults and most involve the small intestine and are benign, whereas colonic intussusceptions are usually malignant. We report here a case of a 70-year-old man with intussusception who was referred with a one-day history of hematochezia and abdominal pain. The intussusception was caused by a sigmoid colonic tumor. The CT findings suggested that we could reasonably proceed to a sigmoidoscopy to confirm the site of obstruction. We speculated that the sigmoid colon tumor induced the anterograde intussusception. As with our patient, it is important to recognize the need to diagnose the primary lesion exactly and promptly.
Abdominal Pain ; Adult ; Aged ; Child ; Colon ; Colon, Sigmoid ; Gastrointestinal Hemorrhage ; Humans ; Intestine, Small ; Intussusception ; Sigmoidoscopes ; Sigmoidoscopy

Bezoars are persistent concretions of indigestible material that are usually found in the stomach. With the significant development of endoscopic techniques, many authors have reported the removal of bezoars using methods such as endoscopic forceps, snares, electrohydraulic lithotripsy, laser. However, there are no reports of using argon plasma to remove a bezoar in Korea. Argon plasma coagulation is a non-contact electrosurgical technique, which is an inexpensive, easily learned, and effective method in gastrointestinal endoscopy. In addition, this method is associated with a decreased risk of perforation and tissue damage by maintaining a controllable depth of coagulation. We report a 71-year-old man with a 11x11x8 cm sized huge gastric phytobezoar found by endoscopy. The bezoar was broken into pieces using the argon plasma coagulator. Endoscopic forceps and a basket were then used to crush and extract its fragments. The bezoar was removed safely without any complications. We report this case with a review of the relevant literature.
Aged ; Argon Plasma Coagulation ; Argon* ; Bezoars ; Endoscopes* ; Endoscopy ; Endoscopy, Gastrointestinal ; Humans ; Korea ; Lithotripsy, Laser ; Plasma* ; SNARE Proteins ; Stomach ; Surgical Instruments

Hepatocellular carcinomas (HCCs) show genomic alterations, including DNA rearrangements associated with HBV DNA integration, loss of heterozygosity, and chromosomal amplification. The genes most frequently involved are those encoding tumor suppressors. The p16INK4A tumor suppressor gene frequently displays genetic alteration in HCC tissues. The present study was performed to examine the incidence of methylated p16INK4A in the sera of liver cirrhosis (LC) and HCC patients, and to evaluate its role as a tumor marker of HCC. The sera of 23 LC patients and 46 HCC patients were examined in this study. The methylation status of p16INK4A was evaluated by methylation-specific PCR of serum samples. Methylated p16INK4A was detected in 17.4% (4/23) of LC patients and in 47.8% (22/46) of HCC patients. No association was demonstrated between p16INK4A methylation and serum AFP level. As the status of p16INK4A methylation was not associated with serum AFP level, it may have a role as a tumor marker of HCC.
Aged ; Carcinoma, Hepatocellular/*genetics ; DNA/metabolism ; *DNA Methylation ; Female ; Fibrosis ; *Genes, p16 ; Human ; Liver/pathology ; Liver Cirrhosis/*genetics ; Liver Neoplasms/*genetics ; Male ; Middle Aged ; Polymerase Chain Reaction ; Predictive Value of Tests ; Protein p16/*blood ; Sensitivity and Specificity ; Time Factors ; Tumor Markers, Biological

BACKGROUND: Recently, ultrasound guidance in clinical procedures including brachial plexus block has gained popularity. This method has been considered to be an efficient and a useful method with real-time visualization. Many reports have showed the usefulness of ultrasound-guided brachial plexus block. We evaluated the usefulness of ultrasound guidance in infraclavicular brachial plexus block compared with nerve stimulation. METHODS: Thirty patients were randomized into two groups of US group (ultrasound-guided block) and NS group (nerve stimulation). Blocks were performed with mepivacaine 2% and bupivacaine 0.5% with epinephrine 1:200,000 (total volume 40 ml). Block execution time, onset time, success rate, patient's discomfort and complications were measured and statistically evaluated for the comparison. RESULTS: Block execution time were 88.3 +/- 48.1 sec in US group and 172.7 +/- 103.1 sec in group NS, respectively (P = 0.017). Onset time were 16.0 +/- 6.9 min and 17.7 +/- 7.8 min (P = 0.434). Success rates were 93.3% and 80.0% (P = 0.283). Patient's discomfort was not significantly different. Pain in patients with fractured arm was significantly lower in US group (P = 0.004). CONCLUSIONS: An ultrasound-guided infraclavicular brachial plexus block is useful with less time consumption and less discomfort in patients with fracture of arm. Success rate and onset time were acceptable.
Arm ; Brachial Plexus ; Bupivacaine ; Epinephrine ; Humans ; Mepivacaine

BACKGROUND AND OBJECTIVES: It is known that patients with malignant tumor often have depressed antitumor immunity. Much information has been generated about a biologically-based therapy, which can induce or activate antitumor cytotoxic T lymphocytes (CTL) capable of recognizing the antigens associated with the major histocompatibility complex molecules (MHC). Optimal induction of CTL seems to require contact with antigenic peptides presented by antigen presenting cell (APC). Dendritic cells (DC) are currently considered to be the most effective and professional APC. MATERIALS AND METHODS: With an injection of SCC cells (1x105) to the back of C3H mouse, a consistent and immunocompetent experimental animal tumor model was achieved. DCs were successfully cultured from the bone marrow of C3H mouse, and phenotypically they expressed high levels of co-stimulatory molecules and abundant MHC. Cultured DCs were intraperitoneally injected into the tumor-established mouse. RESULTS: In the treated group, tumor sizes were smaller, infiltration to the adjacent structures were limited. T cells extracted from the spleen of the treated group showed better proliferative and cytolytic activity toward tumor cells. The results of this study suggest that DCs have an effect to suppress the growth of tumors and to induce higher T cell reactivity toward tumor cells. CONCLUSION: These results may help in proceeding further immunologic approaches to reduce the morbidity and mortality in patients with the head and neck SCC.
Animals ; Bone Marrow* ; Carcinoma, Squamous Cell* ; Dendritic Cells* ; Head ; Humans ; Immunotherapy, Adoptive* ; Major Histocompatibility Complex ; Mice ; Mice, Inbred C3H ; Mortality ; Neck ; Peptides ; Spleen ; T-Lymphocytes ; T-Lymphocytes, Cytotoxic

BACKGROUND: Autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), primary biliary cirrhosis (PBC), and autoimmune cholangiopathy (AIC) are major classes of liver diseases currently considered autoimmune. We investigated the clinical, biochemical, and immunologic findings in Korean patients with these disease entities. METHODS: We retrospectively analyzed 47 patients with AIH, 27 with PBC, 3 with Overlap syndrome, 15 with AIC, and 5 with PSC. RESULTS: About 90% of the patients were women, while 40% in PSC. The mean age of onset ranged from 47 to 57 years, while it was 28 years in PSC. Fatigue and jaundice were the most frequent manifestations at diagnosis. In AIH, 13% of patients had an acute onset and 1 died of fulminant hepatic failure. The serum level of IgG was elevated in 67.5%, and antinuclear antibody and anti-smooth muscle antibody were detected in 95.7% and 43.2%. Fifty eight per cent of the patients who received immunosuppressive therapy showed a complete response. In patients with PBC, the level of IgM was elevated in 75% and all of the patients were positive for anti-mitochondrial antibody. Biochemical remission was observed in 37% on ursodeoxycholic acid therapy. Except for the negative anti-mitochondrial antibody, the clinical and biochemical features in AIC were not different from those in PBC. CONCLUSION: Autoimmune liver diseases are not rare in Korea. Considering that these entities are potentially treatable diseases, a high index of suspicion is needed, especially in patients negative for the serologic markers of viral hepatitis.
Age of Onset ; Antibodies, Antinuclear ; Cholangitis ; Cholangitis, Sclerosing ; Diagnosis ; Fatigue ; Female ; Hepatitis ; Hepatitis, Autoimmune ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Jaundice ; Korea* ; Liver Cirrhosis ; Liver Cirrhosis, Biliary ; Liver Diseases* ; Liver Failure, Acute ; Liver* ; Retrospective Studies ; Ursodeoxycholic Acid

A hemorrhoid is the most common cause of acute lower gastrointestinal (LGI) bleeding. Diverticulosis, angiodysplasia and ischemic colitis can also cause LGI bleeding. Acute LGI bleeding from the appendix is very rare. We experienced a case of a 33-year-old woman with acute LGI bleeding from the appendix. Colonoscopy demonstrated an active hemorrhage from the orifice of the appendix. The patient was treated with a appendectomy, and a histological examination showed the presence of a small ulcer with inflamed granulation tissue in the mucosa and submucosa.
Adult ; Angiodysplasia ; Appendectomy ; Appendix ; Colitis, Ischemic ; Colonoscopy ; Diverticulum ; Female ; Granulation Tissue ; Hemorrhage ; Hemorrhoids ; Humans ; Mucous Membrane ; Ulcer