Esophageal perforation is a rare disease, which require emergent diagnosis and therapeutic procedure. In this paper, we present one case of esophageal perforation by traction of toothbrush which was swallowed during pharyngeal irritation. After the toothbrush was inserted to stomach by gastroscope, gastrostomy was performed for removal of toothbrush and the esophageal perforation was repaired by operation.
Diagnosis ; Esophageal Perforation* ; Gastroscopes ; Gastrostomy ; Rare Diseases ; Stomach ; Traction

When fabricating definitive implant-supported fixed prostheses in upper and lower completely edentulous patients, it is crucial to get information about the vertical dimension, jaw relationship, implants, abutments and gingival contour.In this case, temporary prostheses were used to take the information. The temporary prosthesis was scanned outside of the mouth so that it increased the efficiency of scanning it. During the scan of the prosthesis, a scan zig which connected both posterior parts of the prosthesis was used to minimize the scan errors. We report this case because we obtained satisfactory functional and esthetic results by using the digital technology.

BACKGROUND: Escherichia coli and Klebsiella pneumoniae resistant to 3rd generation cephalosporin have been reported with increasing frequency in tertiary-care hospital in Korea. MicroScan Neg Combo Panel Type 21 (Type 21) contains a 1 microgram/mL cepfodoxime (POD) in addition to other screen wells containing ceftazidime, cefotaxime, ceftriaxone, and aztreonam, which are designed for detecting extended-spectrum beta-lactamase (ESBL)-producing E. coli and Klebsiella species. We evaluated the Type 21 panel for its ability to detect ESBL. METHODS: From November to December in 1998, 496 E. coli and 326 K. pneumoniae strains isolated from clinical specimens were tested with Type 21 panel The isolates flagged as ESBL producers by the panel were confirmed by the double disk synergy test (DDS). To evaluate the specificity of POD, n-lactamases of 54 E, coli and 20 K. pneumoniae strains that were flagged by, POD only from January to May 1999 were analyzed by isoelectric focusing(IEF). RESULTS: 75/496(15%) E. coli and 68/326(21%) K. pneumoniae were flagged as ESBL producers by Type 21 panel. Of those, 94 isolates including 38/75 (51%) of E. coli and 56/68 (82%) of K. pneumoniae were positive for DDS. Among the 94 ESBL producers, all were detected by POD, 84% by cefotaxime, 85% by ceftazidime, 84% by ceftriaxone, and 86% by aztreonam. The 74 strains that were flagged as ESBL producers by POD screen well only were mostly DDS-negative, cefoxitin- resistant and showed beta-lactamases with pls of 5.4 and 7.6 or no band, which could be interpreted as the presence of TEM-1 or SHV-1 type beta-lactamases and/or basal AmpC beta-lactamases, not ESBL. CONCLUSION: MicroScan Neg Combo Panel Type 21 was able to detect a greater number of ESBL producers by inclusion of POD in its screening well. However, the specificity of POD was compromised by flagging a significant number of DDS negative strains. We conclude that the isolates with reduced susceptibility to 3rd generation cephalosporins as well as POD can be reported as ESBL-producers and those resistant to POD only should be confirmed by DDS.
Aztreonam ; beta-Lactamases ; Cefotaxime ; Ceftazidime ; Ceftriaxone ; Cephalosporins ; Escherichia coli ; Klebsiella ; Klebsiella pneumoniae ; Korea ; Mass Screening ; Pneumonia ; Sensitivity and Specificity

Choledochocele is a kind of choledochal cyst and represents a prolapse or herniation of the intramural segment of the distal common bile duct into the duodenal lumen. It is rare congenital anomaly and, easlily overlooked due to non-specific clinical symptoms, signs, and non-characteristic radiologic features. The cause of choledochocele remains uncertain and it was suggested that thete are two distinct types in the pathogenesis of it, i.e., congenital and acquired. Recently, many cases of choledochocele were reported, which diagnosed by ERCP and safely treated with endoscopic unroofing and EST followed by continued observation as well as interval ERCP and/or endoscopic ultrasonography. We present here four cases of symptomaatic choledochoceles that had been managcd by end- oscopic therapy and continucd observation.
Biliary Tract* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochal Cyst* ; Common Bile Duct ; Endosonography ; Pancreas* ; Prolapse

Peritoneal mesothelioma is a rare disease which arises from the mesothelial lining cells in the peritoneum and spreads to the peritoneal wall, omentum and other abdomina1 organs. Aabestos is one etiologic factor and the other factors are genetic cause, radiation, exposure to toxic materials and recurrent yeritonitis. We experienced a case of multiple small nodular peritoneal mesothelioma after exposure to asbestos for over 20 years. He was a sailor and had worked in the engine department of the ship, in which he wrapped up the pipe of engine in asbestos. This person came to our hospital because of inconvenience due to a distended abdomen. Tumor markers were all within normal limits and there was no evidence of tuberculosis in the abdomen and chest. The CT findings of the abdomen were as follows: There was abundant ascites in the abdominal cavity and multiple small nodules on the parietal peritoneum and especially on the lower abdomen. The omentum thickened diffusely. It was difficult to distinguish from peritoneal mesothelioma and peritoneal carcinomatosis or intestinal tuberculosis. The laparoscopic findings were as follows: There were multiple small nodules on the parietal peritoneum and omentum. The small nodules were a gray white color and uneven compared to tuberculous peritonitis. Therefore, we observed the malignant mesothelial cells by means of the light microscope and electron microscope and concluded that this case was peritoneal mesothelioma.
Abdomen ; Abdominal Cavity ; Asbestos ; Ascites ; Carcinoma ; Humans ; Mesothelioma* ; Military Personnel ; Omentum ; Peritoneum ; Peritonitis, Tuberculous ; Rare Diseases ; Ships ; Thorax ; Tuberculosis ; Biomarkers, Tumor

Endoscopic injection sclerotherapy(EIS) has been shown to be the most effective simple method for control of bleeding and eradication of varices. This method has been aceepted widely as a standard treatment of bleeding esophageal varices. However, EIS may be associated with undesirable local and systemic complications. (continue...)
Esophageal and Gastric Varices* ; Hemorrhage* ; Ligation* ; Varicose Veins

Aniskiasis is caused by the accidental infestation of human by larvae of marine mammals found in saltwater fish and squid. The clinical picture may be severe enough to stimulate an acute surgical abdomen. More commonly, colicky pain, diffuse abdominal tenderness, nausea, vomiting, fever, and leukocytosis are seen. Gastroscopically, 2-to 4-cm larvae can be seen penetrating the mucosa. More characteristically, the larvae burrow into the mucosa of the stomach. Here they produce eosinophilic granulomatous tumors with edema, thickening, and induration which may be mistaken for gastric canceer. The pathalogic changes are thought to be the result of a hypersensitivity reaction. We report a case of chronic gastric anisakiasis, which was diagnosed as submucosal tumor with massive bleeding.
Abdomen ; Anisakiasis* ; Abdominal Pain ; Decapodiformes ; Edema ; Eosinophils ; Fever ; Hemorrhage* ; Humans ; Hypersensitivity ; Larva ; Leukocytosis ; Mammals ; Mucous Membrane ; Nausea ; Stomach ; Vomiting

Weber-Christian disease (WCD) is a rare inflammatory disease of adipose tissue, which is characterized by painful cutaneous nodules and constitutional symptoms. Although any area of the body containing fat can be affected by WCD, the involvement of retrobulbar fat is uncommon and proptosis is a rare presenting manifestation. We report a case who presented with proptosis of the right eye which is accompanied by painful subcutaneous nodules, high fever and myalgia. Biopsies of retrobulbar tissue and suprapubic nodule showed lobular panniculitis with mixed cellular infiltration, mainly composed of histiocytes and lymphocytes. He responded well to high-dose glucocorticoid.
Adult ; Biopsy ; Case Report ; Exophthalmos/pathology* ; Exophthalmos/etiology* ; Exophthalmos/drug therapy ; Glucocorticoids/administration & dosage ; Human ; Magnetic Resonance Imaging ; Male ; Panniculitis, Nodular Nonsuppurative/pathology* ; Panniculitis, Nodular Nonsuppurative/drug therapy ; Panniculitis, Nodular Nonsuppurative/complications*

Weber-Christian disease (WCD) is a rare inflammatory disease of adipose tissue, which is characterized by painful cutaneous nodules and constitutional symptoms. Although any area of the body containing fat can be affected by WCD, the involvement of retrobulbar fat is uncommon and proptosis is a rare presenting manifestation. We report a case who presented with proptosis of the right eye which is accompanied by painful subcutaneous nodules, high fever and myalgia. Biopsies of retrobulbar tissue and suprapubic nodule showed lobular panniculitis with mixed cellular infiltration, mainly composed of histiocytes and lymphocytes. He responded well to high-dose glucocorticoid.
Adult ; Biopsy ; Case Report ; Exophthalmos/pathology* ; Exophthalmos/etiology* ; Exophthalmos/drug therapy ; Glucocorticoids/administration & dosage ; Human ; Magnetic Resonance Imaging ; Male ; Panniculitis, Nodular Nonsuppurative/pathology* ; Panniculitis, Nodular Nonsuppurative/drug therapy ; Panniculitis, Nodular Nonsuppurative/complications*

Cytomegalovirus(CMV) rarely causes cutaneous rnanifestations. But since the recent development of organ transplants and the increased prevalence of AIDS, various skin manifestations of CMV infection such as varicelliform eruptions, perineal hulcerations, papular, purpurc and vesiculobllous lesions are increasing in immunocompromised subjects, Perineal ulceration is a typical cytomegalovirus-induced skin manifestation which exhibits similar morphology to herpes simplex viral infection. We describe a case of CMV-induced ulcer on labia majora in an AIDS patient, proven by histologic findings and immunohistochemistry. The patient was treated with ganciclovir and the lesion improved two months later.
Cytomegalovirus* ; Ganciclovir ; Herpes Simplex ; Humans ; Immunohistochemistry ; Prevalence ; Skin Manifestations ; Transplants ; Ulcer*