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

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

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

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*

PURPOSE: To investigate the influences of preoperative bladder outlet obstruction(BOO) to be adjusted by age and prostate volume on improvement of storage symptoms in patients who underwent transurethral resection of prostate(TURP) in a long term follow up. MATERIALS AND METHODS: We performed retrospective study of 75 patients with benign prostatic hyperplasia(BPH) who had undergone TURP and preoperative urodynamics from July 2004 to December 2006. 18 patients of them were lost follow up in this period, so we analyzed 57 patients in this study. The degrees of BOO were measured by the Abrams-Griffiths (AG) number calculated according to the preoperative urodynamic data. International Prostate Symptom Score(IPSS) questionnaire were used to evaluate improvement of symptoms. Especially IPSS questions number 2, 4 and 7 were used to evaluate storage symptoms. Partial correlation analysis was done between the AG numbers and the degree of storage symptoms improvement, adjusted by the age and the prostate volume. RESULTS: There were significant decreases of the IPSS(p=0.029), storage symptom score(p=0.024) and frequency score(p=0.017) in BOO group compared to the non-BOO group. The changes of IPSS(gamma=-0.338, p=0.012), storage symptoms score(gamma=-0.292, p=0.031) and frequency symptom score (gamma=-0.305, p=0.023) were significantly correlated with AG number. CONCLUSIONS: These results suggested that the preoperative AG number derived from urodynamics was an important factor in predicting the postoperative results. It would be expected that the patients with high AG numbers might be more improved storage symptom after TURP.

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

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

Endometrial cancer is the most common malignancy of the female genital tract. The cancer spreads by direct extension, transtubal dissemination, lymphatic dissemination, and/or by hematogenous spread, usually results in lung metastasis, but may less commonly involve liver, brain, and bone. Here, we describe a patient with stage IA endometrial cancer who developed liver recurrence 17 months after surgery.
Brain ; Endometrial Neoplasms ; Female ; Humans ; Liver ; Lung ; Neoplasm Metastasis ; Recurrence

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