The authors describe a case of tuberculous abscess of the cerebellum that originating probably from pulmonary lesion. The development of such a lesion indicates a persistence of infection and an immunological breakdown which may party have been due to unsatisfactory chemotherapy and protein malnutrition. Tuberculous brain abscess, an encapsulated collection of pus containing viable tubercle bacilli, is quite rare and it is different from tuberculoma in several points. Only five cases of tuberculous abscess have been fully documented and bacteriologically confirmed. The clinical, laboratory, and histopathological findings of those reported cases and the author's have been discussed.
Abscess ; Brain Abscess* ; Brain* ; Cerebellum* ; Drug Therapy ; Malnutrition ; Suppuration ; Tuberculoma

The purpose of this study was taken after transplantation of fetal serotonin and substance-P containing raphe nuclei into the transected thoracic spinal cord (T9-10) of adult rats, a suspension of cells derived from the mesencephalic and medullary raphe nuclei of 13~15 days embryonic rats were injected upper and lower the transected spinal cord. After survival periods of 15 days to 1 year, the animals were sacrificed and the spinal cord, processed for the localization of serotonin and substance-P immunoreactive neurons in the transplanted spinal cord, was studied using ABC immunocytochemistry. Immunocytochemical analysis revealed the presence of many serotonin and substance-P immunoreactive neurons in the transplants. In the mesencephlic implants, however, the serotonin and substance-P immunoreactive neurons were not co-localized with the same neurons. The serotonin and substance-P nerve fibers were densely distributed in lamina I and II of the dorsal horn and in lamina VIII and IX of the ventral horn of all segments of the spinal cord. The nontransplanted control, spinal cord of the rats showed a total absence of serotonin and substance-P immunoreactive fibers below the section. Immunoelctronmicroscopic anlysis demonstrated the presence of numerous synaptic contacts formed by serotonin and substance-P containing boutons which are most likely emanated from the grafted serotonin and substance-P.
Adult ; Animals ; Axons* ; Horns ; Humans ; Immunohistochemistry ; Nerve Fibers ; Nerve Tissue* ; Neurons ; Raphe Nuclei ; Rats* ; Serotonin* ; Spinal Cord* ; Transplants

BACKGROUND AND AIMS: In the management of patients with extrahepatic bile duct carcinoma, histologic diagnosis is crucial to determine therapeutic modalities, to predict their outcomes, and to avoid an unnecessary operation. Though various methods were developed, none of them yielded satisfactory results. A combination of those methods was reported to yield superior sensitivity and specificity to a single method. To evaluate the diagnostic efficacy, endoscopic transpapillary biopsy (ETPB) and exfoliative bile aspiration cytology (BAC) was performed in 40 patients with extrahepatic bile duct carcinoma. METHODS: After visualization of the biliary tree and the lesion by endoscopic retrograde cholangiopancreatography (ERCP), ETPB (n=40) and BAC (n=28) was done in one session with or without endoscopic sphincterotomy (EST) and the results of two methods were analyzed. RESULTS: The final diagnoses were made by surgical pathology and by clinical follow-ups of more than a year. The locations of the 40 bile duct carcinomas were in the upper area in 25, the middle in 14 and the lower in 1. ETPB was performed in all patients and BAC in 28 patients. The overall sensitivity of the ETPB was 65.0% (26/40). According to the morphology and location, the sensitivity of ETPB was 65.6% (11/32) for sclerotic, 60.0% (3/5) for papillary, and 66.7% (2/3) for the protruding type, and 68.0% (17/25) for the upper bile duct lesion, 64.3% (9/14) for the middle, and 0% (0/1) for the lower. The overall sensitivity of the BAC was 71.4% (20/28). According to the morphology and location, the sensitivity of BAC was 80.0% (16/20) for sclerotic, 20% (1/5) for papillary, and 100% (3/3) for the protruding type, and 82.4% (14/17) for the upper bile duct lesion and 54.5% (6/11) for the middle bile duct lesion. When the two tests were combined, the sensitivity rose to 96.4% (27/28). CONCLUSIONS: A combination of ETPB and BAC is useful in making a histologic diagnosis in patients with bile duct carcinoma.
Bile Duct Neoplasms* ; Bile Ducts* ; Bile Ducts, Extrahepatic ; Bile* ; Biliary Tract ; Biopsy* ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis* ; Follow-Up Studies ; Humans ; Pathology, Surgical ; Sensitivity and Specificity ; Sphincterotomy, Endoscopic

BACKGROUND AND AIMS: Long term results of an endoscopic sphincterotomy (EST) have still been poorly estimated. The aim of this study was to assess late complications of EST. METHODS: The rate of late complications were retrospectively evaluated in with 91 patients (mean age, 59.1 years; range, 28~86 years; M:F, 44:47), who underwent EST for choledocholithiasis. RESULTS: Forty six patients (50.5%) had their gallbladder in situ, and 45 patients (49.5%) underwent cholecystectomy. Early complications (<30 days) such as hemorrhage, pancreatitis, and perforation occurred in 7 patients (7.7%). During a mean period of 53.4 months (range, 24~134 months), 26 patients (28.0%) developed late complications, including a recurrence of CBD stones in 20 patients (22.0%) (8-gallbladder in situ, 12-cholecystectomized). An univariate analysis of risk factors for stone recurrence revealed dilated ducts, stone sizes, and stone numbers which were not related with stone recurrence. The history of choledocholithotomy with cholecystectomy was significantly related to stone recurrence. CONCLUSIONS: After EST for bile duct stones, late complications occurred in a significant proportion of patients and it was determined that a history of choledocholithotomy with cholecystectomy was significantly correlated with stone recurrence.
Bile Ducts ; Cholecystectomy ; Choledocholithiasis ; Gallbladder ; Hemorrhage ; Humans ; Pancreatitis ; Recurrence* ; Retrospective Studies ; Risk Factors ; Sphincterotomy, Endoscopic

PURPOSE: Development of a standardized guideline and assessment tool is necessary. Therefore, the aim is to investigate the current state of enteral feeding management and to develop a basis for a standardized guideline. METHODS: From July 1, 2010 through June 30, 2011, this study was conducted retrospectively for 100 patients who had enteral feeding more than once only in the Intensive Care Unit, after General Surgery at Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. The analysis was based on the following factors; age, diagnosis, name of the operation, period of start and the end of enteral feeding, method of injection, flushing method, residual volumes of the stomach, location and the size of the tube, medication through tubing, and complications related to enteral feeding. RESULTS: The mean age of the patients was 60.5, 65 men and 35 women. There were 30 malignant tumors of the hepatobiliary system and pancreas, 8 gastric and duodenal cancer, 4 colon and rectal cancer, 11 peritonitis, hemoperitoneum, and bowel obstruction, and 47 others. The average period of performing enteral feeding was 11.7 days and the locations of enteral feeding tube were stomach 56%, jejunum 39%, duodenum 3%, and undescribed 2%. The methods of enteral feeding were as follows; continuous feeding 19%, cyclic feeding 75%, intermittent and bolus feeding 3%, respectively. Only 1% of patients were on flushing and 16% on stomach residual. The most common complication of enteral feeding was clogging of the tube (5%). CONCLUSION: Due to the lack of detailed charting related to enteral feeding, we were unable to analyze the statistics on the relevance of complication which was the primary endpoint. As a result, development of a standardized protocol on charting enteral feeding is suggested for optimal enteral nutritional support.
Colon ; Diagnosis ; Duodenal Neoplasms ; Duodenum ; Enteral Nutrition* ; Female ; Flushing ; Hemoperitoneum ; Humans ; Intensive Care Units ; Jejunum ; Korea ; Male ; Nutritional Support ; Pancreas ; Peritonitis ; Rectal Neoplasms ; Residual Volume ; Retrospective Studies ; Seoul ; Stomach