Tuberculoma of the lungs is not an uncommon finding, but an ectopic liver in the lung is extremely rare. Pulmonary tuberculosis presenting as tuberculoma can be diagnosed radiologically, but its definite diagnosis is established by confirmation of the acid-fast bacillus or the unique histology. We report here on a case of tuberculoma of the left lower lobe that was erroneously diagnosed as ectopic liver by ultrasono-guided fine needle aspiration biopsy. An understanding of the normal variants of the liver can prevent a patient from undergoing an unnecessary invasive procedure.
Bacillus ; Biopsy ; Biopsy, Fine-Needle ; Humans ; Liver ; Lung ; Tuberculoma ; Tuberculosis ; Tuberculosis, Pulmonary

Pulmonary Langerhans cell histiocytosis is very rare, especially when accompanied by active pulmonary tuberculosis. A patient was hospitalized due to excessive dyspnea and she was diagnosed with active pulmonary tuberculosis by a sputum AFB smear. The HRCT taken after hospitalization showed multiple micronodules and tiny cysts. An open lung biopsy confirmed the coexistence of pulmonary Langerhans cell histiocytosis.
Biopsy ; Dyspnea ; Histiocytosis ; Histiocytosis, Langerhans-Cell ; Hospitalization ; Humans ; Lung ; Sputum ; Tuberculosis, Pulmonary

A 60-year-old man presented with epigastric pain. The patient had no history of foreign body ingestion and had no symptoms of dysphagia or odynophagia. Chest computed tomography scan showed an esophageal perforation with unknown etiology and an emergency operation for thoracic cavity irrigation and drainage was undertaken, followed by fasting and conservative treatment. Two weeks later, a follow-up chest computed tomography scan revealed a suspicious foreign body in the distal esophagus. Endoscopy revealed a press-through-pack (PTP) that had caused an esophageal perforation. Despite extraction of the PTP and antibiotic administration, the patient died. The present case is important since PTP is commonly used in Korea.
Deglutition Disorders ; Drainage ; Eating ; Emergencies ; Endoscopy ; Esophageal Perforation ; Esophagus ; Fasting ; Follow-Up Studies ; Foreign Bodies ; Humans ; Korea ; Middle Aged ; Thoracic Cavity ; Thorax

PUROPOSE: The efficacy of finasteride in the treatment of hematuria associated with benign prostatic hyperplasia (BPH) is well known. Recent studies have also shown that finasteride reduce angiogenesis and prostatic bleeding associated with BPH. We evaluated that pretreatment with finasteride could decrease perioperative bleeding associated with transurethral resectrion of prostate (TURP) in this way. MATERIAL AND METHODS: A total of 56 patients who underwent TURP due to BPH between January 2004 and August 2006 were evaluated. Of the patients, 30 recieved pretreatment with finasteride 5mg daily (group 1) while 26 did not undergo any pretreatment (control group). In the group 1, 17 had pretreatment period of 3months or more (group 2). In all patients we evaluated the degree of perioperative bleeding, intended as a reduction tendency in hemoglobin (Hb) and hematocrit (Hct) value in the 24 h following TURP. Also, we evaluated the correlation of the preoperative factor and postoperative change of Hb and Hct. RESULTS: Difference of reduction tendency in Hb and Hct between group 1 and control group was not significant (p=0.86, 0.95, respectively). Difference between group 2 and control was not significant (p=0.56, 0.29, respectively). The change of Hb and Hct correlated with prostate volume, significantly (p=0.006, 0.010). Also, operation time was correlated with the change of Hb and Hct (p=0.006, 0.011). CONCLUSIONS: There were no significant difference of the perioperative bleeding according to finasteride medication or medication duration.
Finasteride ; Hematocrit ; Hematuria ; Hemorrhage* ; Humans ; Prostate ; Prostatic Hyperplasia ; Transurethral Resection of Prostate*

PURPOSE: For tachycardic patients not in need of immediate cardioversion, the International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care emphasize specific rhythm diagnosis and avoidance of simplistic overuse of adenosine. The purpose of this study was to identify the rhythms for which adenosine was inappropriately prescribed at the emergency department after the International Guidelines 2000 had been adopted. METHODS: We retrospectively investigated 128 tachycardic patients who had been prescribed adenosine at the emergency department from September 2000 to March 2003. Patients were divided into two groups. The Appropriate Use Group was comprised of patients for whom had been prescribed for narrow QRS-complex tachycardia on the initial ECG. The Inappropriate Use Group was comprised of patients for whom adenosine had been prescribed for atrial fibrillation, atrial flutter, atrial tachycardia, sinus tachycardia, and wide QRS-complex tachycardia of unknown origin on the initial ECG. RESULTS: Of the 128 patients, 31 (24.2%) were in the Inappropriate Use Group. Among them, atrial fibrillation was involved in 15, atrial flutter in 3, atrial tachycardia in 2, sinus tachycardia in 8, and wide QRS-complex tachycardia of unknown origin in 3. CONCLUSION: Approximately 24% of the emergency department patients who were treated with adenosine received the medication unnecessarily for atrial fibrillation, atrial flutter, atrial tachycardia, sinus tachycardia, and wide QRS-complex tachycardia of unknown origin. Additional education on electrocardiographic recognition of tachyarrhythmias, and the Tachycardia Algorithms of Guidelines 2000 may be necessary for residents of emergency department.
Adenosine* ; Atrial Fibrillation ; Atrial Flutter ; Cardiopulmonary Resuscitation ; Diagnosis ; Education ; Electric Countershock ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Retrospective Studies ; Tachycardia ; Tachycardia, Sinus

A 49-year-old man visited our hospital via the emergency room. He had suffered chest trauma by falling down. His chest X-Ray showed pneumomediastinum with pneumopericardium. We checked the Chest CT, and it showed pneumopericardium without any injury to the other organs, the compressed heart and a minimal pneumothorax on the left hemithorax. Closed thoracostomy was then done under local anesthesia. We then performed open pericardiostomy under general anesthesia. We got a good result and so we report on this case.
Anesthesia, General ; Anesthesia, Local ; Emergencies ; Heart ; Humans ; Mediastinal Emphysema ; Middle Aged ; Pericardial Window Techniques ; Pericardium ; Pneumopericardium ; Pneumothorax ; Thoracostomy ; Thorax

STUDY DESIGN: A retrospective study. PURPOSE: To evaluate the prevalence and risk factors of asymptomatic cervical or thoracic lesions in elderly patients who have undergone surgery for lumbar spinal stenosis. OVERVIEW OF LITERATURE: Concurrent multiple spinal lesions have been reported in many studies with a varied prevalence, and described the characteristics of the disease and its treatment options. However, the cervical or thoracic lesions without apparent symptoms in patients with symptomatic lumbar stenosis had not been evaluated. METHODS: A total of 101 elderly patients (aged 65 or more), who had undergone surgery for lumbar spinal stenosis from January 2005 to December 2005, were enrolled in this study. All patients underwent lumbar magnetic resonance imaging (MRI) along with T2-weighted cervical and thoracic sagittal MRI prior to surgery. The concurrent cervical or thoracic lesions were classified according to the disease entity, and the severity of the lesions was graded from grade 0 (no lesion) to grade 4 (any lesion compressing the cord with a signal change). The prevalence of concurrent cervical and thoracic lesions was then analyzed. In addition, the risk factors for the development of concurrent lesions were evaluated, and the risk factors affecting the severity of the concurrent lesion were analyzed individually. RESULTS: Seventy-seven (76.2%) and 30 (29.7%) patients had a concurrent cervical and thoracic lesion, respectively. Twenty-six patients (25.7%) had both a cervical and thoracic lesion. There was a positive correlation between the symptom duration of lumbar stenosis and the prevalence of both cervical (p = 0.044) and thoracic (p = 0.022) lesions. CONCLUSIONS: The incidence of asymptomatic cervical or thoracic lesions is apparently high in elderly patients who have undergone surgery for lumbar spinal stenosis, particularly in those with longer symptom duration. This highlights the need for a preoperative evaluation of the cervical and thoracic spine in these patients.
Aged ; Constriction, Pathologic ; Humans ; Incidence ; Magnetic Resonance Imaging ; Prevalence ; Retrospective Studies ; Risk Factors ; Spinal Stenosis ; Spine

High tension electrical burns affecting the wrist are likely to produce full thickness necrosis of the skin and to damage deep vital structures beneath the eschar, affecting he local tendons, nerves, vessels, even bones and joints which result in serious dysfunction of the hand. An aggressive approach to the treatment of these severe wounds and adequate wound coverage are essential for the successful result. From October 1997 to February 2000, we had treated 23 electrical wrist injuries in 20 patients with free flaps. Among these, 13 anterolateral thigh flaps, 5 forearm flaps, 2 scapular flaps, 2 parascapular flaps, and 1 medial leg flap were executed. About 2-4 weeks after initial injury, we tried free flaps. Preoperative debridement was not carried out. At the time of surgery, debridement of all nonviable tissue was done, but nerves, tendons, and bones were left in place with minimal or no debridement when they had anatomic continuity, regardless of their appearance of viability. In all cases, successful soft tissue coverage and wound healing were achieved, and we obtained the following conclusions. 1. Flap coverage should be executed before damage of the tendons, nerves, vessels. 2. As long as the free flap survives, the infected tendons, nerves, and denuded bone can be salvaged. 3. For later reconstruction of the wrist, fasciocutaneous flap should be preferred to promise tendon gliding and endure several operative procedures.
Burns* ; Debridement ; Forearm ; Free Tissue Flaps* ; Hand ; Humans ; Joints ; Leg ; Necrosis ; Skin ; Surgical Procedures, Operative ; Tendons ; Thigh ; Wound Healing ; Wounds and Injuries ; Wrist Injuries ; Wrist*

An inflammatory myofibroblastic tumor (IMT) is a rare disease and can occur in nearly every site of the body. The usual intrathoracic sites where an IMT has been recorded are the lung and bronchus. An IMT originating from the mediastinum has been rarely reported. A patient with a posterior mediastinal mass that was noticed incidentally on a chest X ray underwent mass extirpation. The pathologic diagnosis was an inflammatory myofibroblastic tumor. The tumor was positive for tuberculosis as determined by PCR. Tuberculosis can be thought to be the causative factor of the IMT in this case.
Bronchi ; Humans ; Lung ; Mediastinal Neoplasms ; Mediastinum ; Myofibroblasts ; Polymerase Chain Reaction ; Rare Diseases ; Thorax ; Tuberculosis

PURPOSE: The purpose of this study was to evaluate the effects of estrogen on detrusor contraction and the expression of muscarinic receptors in ovariectomized rats. MATERIALS AND METHODS: 24 Sprague-Dawley female virgin rats(12 weeks old) were separated into three groups of 8 rats each. Group I served as a control group, group II was the ovariectomized only rats(Ovx group) and Group III was given estradiol benzoate(0.8mg/kg/day) subcutaneously for 7 consecutive days, beginning 1 week after ovariectomy(Ovx+E group). At the end of the experimental period, each rat was sacrificed and the urinary bladder was removed for contractile studies. The expressions of M2 and M3 receptors in the bladder epithelium and the muscle layer were investigated by performing immunofluorescent staining. RESULTS: The Ovx group showed a significantly decreased bladder contractile function on the KCl and carbachol-induced contractile tests, whereas the Ovx+E group showed increased contractility(p<0.05). The Ovx+E group showed an increase of smooth muscle compared to the other groups. Ovariectomy induced a significant increase in the M3 receptors density in the bladder body, as compared to the control group(p<0.05) but there was no significant difference between the Ovx group and the Ovx+E group. CONCLUSIONS: Bladder dysfunction of menopausal women is thought not to be related with the changes of muscarinic receptors. Our results suggest that the detrusor contractility of menopausal women might be improved after estrogen replacement therapy.
Animals ; Contracts ; Epithelium ; Estradiol ; Estrogen Replacement Therapy ; Estrogens ; Female ; Humans ; Muscle Contraction ; Muscle, Smooth ; Muscles ; Ovariectomy ; Rats ; Receptors, Muscarinic ; Urinary Bladder