No abstract available.
Bacteremia*

Fiberoptic bronchoscopy is a valuable diagnostic and therapeutic procedure in many clinical situations and is relatively simple to perform with proper technique. Local anesthetic technique is often preferable to general anesthesia for bronchoscopies since these examinations are mostly undertaken as outpatient procedures. Inhaled topical lidocaine, used to produce anesthesia of the repiratory tract prior to bronchoscopy, may cause anaphylactoid reaction in patients. However lidocaine hypersensitivity reaction is uncommon. We report the case of death due to hypersensitivity to topical lidocaine spray given during routine premedication for this procedure. The possibility of bronchospasm secondary to an adverse reaction to premedication or anesthesia must also be considered.
Anaphylaxis* ; Anesthesia* ; Anesthesia, General ; Bronchial Spasm ; Bronchoscopy* ; Humans ; Hypersensitivity ; Lidocaine* ; Outpatients ; Premedication

Pulmonary embolism is the impaction of material into branches of the pulmonary arterial bed. It usually occurs in patients with primary hypercoagulable states or secondary hypercoagulable states like cancer, preganancy, and estrogen replacement therapy. We report a case of a pulmonary embolism in a patient with positive lupus anticoagulant who received estrogen replacement therapy. The patient was referred due to suddenly developed shortness of breath and echogenic mass densities in the right atrium on 2 dimensional echocardiography. The patient was markedly improved with intravenous urokinase and subsequent oral anticoagulant therapy. Related articles are also reviewed.
Dyspnea ; Echocardiography ; Estrogen Replacement Therapy* ; Estrogens* ; Female ; Heart Atria ; Humans ; Lupus Coagulation Inhibitor* ; Pulmonary Embolism* ; Urokinase-Type Plasminogen Activator

Testicular granulosa cell tumor(GCT) is a rare neoplasm. We report here on an incidentally discovered testicular granulosa cell tumor in a 36-year-old man. The serum tumor markers were within the normal limits. The ultrasonographic findings revealed a mass with a heterogenous hypoechoic echotexture, including multiple variable sized cystic components. The histology on the orchiectomy specimen demonstrated a gonadal stromal tumor with granulosa cell features. Testicular granulosa cell tumor of the adult type is a very rare tumor, and there have been several isolated case reports and small serial studies described in the literature.
Adult ; Female ; Gonads ; Granulosa Cell Tumor ; Granulosa Cells ; Humans ; Orchiectomy ; Testicular Neoplasms ; Testis ; Biomarkers, Tumor

Midurethral slings are increasingly popular for the surgical treatment of stress urinary incontinence. They are relatively simple to implant and shorten operating time, hospital stay, and recovery time. Tension free vaginal tape (TVT) and Intravaginal slingplasty (IVS) mesh are both polypropylene mesh. TVT is a type I totally macroporous mesh which, because of pores larger than 75 microns, admits bacteria, macrophages, and fibroblasts into the pores. IVS is a type III mesh with microporous components which admits bacteria but not macrophages. So anterior IVS appear to be more at risk of infection or vaginal erosion than other monofilament mesh. We report our experience with a patient who underwent anterior IVS and developed erosion of the mesh through vagina, creating pelvic abscess.
Abscess* ; Bacteria ; Fibroblasts ; Humans ; Length of Stay ; Macrophages ; Polypropylenes ; Suburethral Slings ; Surgical Mesh ; Urinary Incontinence* ; Vagina

BACKGROUND: The nutritional status of critical-ill patients is important for recovering from the disease itself. Therefore, this present study was designed to assess the biochemical and nutritional parameters of Intensive-Care Unit (ICU) patients on mechanical ventilation. METHODS: We retrospectively reviewed the medicial records of 126 patients (male/female=72/54) who were on mechanical ventilationin the ICU. The nutritional parameters such as serum total protein, albumin, hemoglobin, hematocrit, calcium, phosphorus, total cholesterol, % lymphocytes, blood urea nitrogen (BUN), and creatinine (Cr) were measured at the beginning of mechanical ventilation. We also measured the outcome variables such as the duration of mechanical ventilation, the ICU length of stay and the hospitalization period. We analyzed the relationship between the nutritional parameters and the outcome variables of ICU patients on mechanical ventilation. RESULTS: The level of hemoglobin was negatively correlated with the outcome variables; the ICU length of stay (p<0.05), the hospitalized period (p<0.01), and the duration of mechanical ventilation (p<0.01). The creatinine level was positively correlated with the outcome variables; the ICU length of stay (p<0.01), the hospitalized period (p<0.01) and the duration of mechanical ventilation (p<0.05). On the multiple regression analysis, the serum total protein, albumin, calcium, inorganic phosphorus, BUN and creatinine were independent factors affecting the duration of mechanical ventilation. CONCLUSIONS: These findings indicate that ICU patients with mechanical ventilation have a risk for malnutrition and anemia. So, an adequate nutritional intervention is required for these patients in order to decrease the prevalence of malnutrition and anemia.
Anemia ; Blood Urea Nitrogen ; Calcium ; Cholesterol ; Creatinine ; Hematocrit ; Hospitalization ; Humans ; Length of Stay ; Lymphocytes ; Malnutrition ; Nutrition Assessment ; Nutritional Status ; Phosphorus ; Prevalence ; Regression Analysis ; Respiration, Artificial* ; Retrospective Studies

A case of gallbladder perforation without cholecystitis or trauma is described herein. The patient was a 74-year-old woman who initially presented with right lower quadrant pain of the abdomen. A laparotomy was performed with the impression of an acute appendicitis at a local clinic. However, the appendix was normal and a large amount of bile was noted in the peritoneal cavity. The patient was referred to our hospital. An exploratory laparotomy was performed with the suspicion of a hollow viscous perforation. A pin point perforation of the gallbladder fundus was identified. There were no gallstones or definite inflammation of the gallbladder wall. Although gallbladder perforation without cholecystitis or trauma is rare, gallbladder perforation without cholecystitis should be considered in elderly patients with bile peritonitis of unknown etiology.
Abdomen ; Aged ; Appendicitis ; Appendix ; Bile ; Cholecystitis ; Female ; Gallbladder ; Gallstones ; Humans ; Inflammation ; Laparotomy ; Peritoneal Cavity ; Peritonitis

A case of cystic lymphangioma of the lesser omentum is described herein. The patient was a 46-year-old man who initially presented with an abdominal mass. Abdominal computed tomography (CT) detected an 11.6x4 cm, lobulated, contoured, low density lesion on the lesser sac. Excision of the mass, including the lesser omentum, and pyloroplasty were performed. The mass was semitranslucent and cystic, and it measured 10x9x2.5 cm in size. The external surface was smooth, but partly enclosed within adipose tissue. The oligolocular cysts contained clear and milky fluid. To our knowledge, this is the first case of lymphangioma of the lesser omentum in the Korean literature. A brief review of the literature is presented following the case report.
Adipose Tissue ; Humans ; Lymphangioma ; Lymphangioma, Cystic* ; Middle Aged ; Omentum* ; Peritoneal Cavity

A case of cystic lymphangioma of the lesser omentum is described herein. The patient was a 46-year-old man who initially presented with an abdominal mass. Abdominal computed tomography (CT) detected an 11.6x4 cm, lobulated, contoured, low density lesion on the lesser sac. Excision of the mass, including the lesser omentum, and pyloroplasty were performed. The mass was semitranslucent and cystic, and it measured 10x9x2.5 cm in size. The external surface was smooth, but partly enclosed within adipose tissue. The oligolocular cysts contained clear and milky fluid. To our knowledge, this is the first case of lymphangioma of the lesser omentum in the Korean literature. A brief review of the literature is presented following the case report.
Adipose Tissue ; Humans ; Lymphangioma ; Lymphangioma, Cystic* ; Middle Aged ; Omentum* ; Peritoneal Cavity

Patients with early gastric cancer (EGC) may be associated with an increased risk of having a second primary cancer. Metachronous primary malignancies may have an influence on the long term prognosis of these patients. We report here on two cases of bile duct cancer after performing subtotal gastrectomy for EGC. A 59-year-old man underwent pylorus preserving pancreaticoduodenectomy (PPPD) under the diagnosis of bile duct cancer, and this was done 5 years after he had undergone gastrectomy. The pathological specimens were different between the EGC and bile duct cancer according to their morphology and immunohistochemical staining, and this case was determined to be metachronous double cancer. The second case was a 39-year-old man who received PPPD for bile duct cancer 4 years after undergoing gastrectomy. Double primary malignancies of bile duct cancer and gastric cancer are very rare.
Adult ; Bile ; Bile Duct Neoplasms ; Bile Ducts ; Gastrectomy ; Humans ; Middle Aged ; Neoplasms, Second Primary ; Pancreaticoduodenectomy ; Prognosis ; Pylorus ; Stomach Neoplasms