Although it is commonly appreciated that there is an inordinately large number of anormalies associated with the excretory ducts of the liver, comparatively little attention has been paid to the position of the orfice of the common bile duct into the duodenum. But, obiviously the site of entrance of the common bile duct into the duodenum becomes of great importance to the endoscopist, radiologist, and surgeon in diseases of the extra-hepatic biliary tract diag-nostically and therapeutically. We report 'a case of anomalous termination of the common bile duct into the duodenal bulb with the gall bladder empyema.
Biliary Tract ; Cholecystitis* ; Common Bile Duct* ; Duodenum ; Liver

PURPOSE: Obesity is related to systemic inflammatory processes causing cardiovascular complications. Intercellular adhesion molecule-1 (ICAM-1), CD40 ligand (CD40L), P-selectin are newly described mediators of inflammation and have a significant effect in atherosclerosis. Adiponectin has shown anti-inflammatory effects in adults. The aim of this study was to evaluate the relationship between adiponectin and inflammatory mediators in children and adolescents. METHODS: Fifty children or adolescents, twenty two with a body mass index (BMI) over 95th percentile, and twenty eight with a BMI below 75th percentile were included in the study. Serum soluble ICAM-1 (sICAM-1), P-selectin, CD40L, lipid profiles, aspartate aminotransferase, alanine aminotransferase, glucose and insulin were measured to evaluate associations with adiponectin. Comparison of these variables was performed between the obese and the nonobese group. RESULTS: We found a adiponectin to be significant lower and sICAM-1 significant higher in the obese group compared to the nonobese group, but there were no significant differences in P-selectin and soluble CD40L. Adiponectin was negatively associated with ICAM-1 and P-selectin in the obese group. CONCLUSION: Negative associations of adiponectin with ICAM-1 and P-selectin in obese children and adolescents suggest that serum adiponectin level may represent the inflammatory status.
Adiponectin* ; Adolescent ; Adult ; Alanine Transaminase ; Aspartate Aminotransferases ; Atherosclerosis ; Body Mass Index ; CD40 Ligand ; Child ; Cytokines* ; Glucose ; Humans ; Inflammation Mediators ; Insulin ; Intercellular Adhesion Molecule-1 ; Obesity ; P-Selectin

Behcet's syndrome has been known as a disease which has the triple symptoms such as recurrent orogenital ulceration and eye inflammation. The syndrome is now recogninized as a multisystem disease involving mucocutaneaous, cardiovascular, central nervous system, renal, articular and gastrointestinal system. The vascular involvement in Behcet's disease has been reported since Mischima first described the case in 1961, four types of vascular lesion are recognized ; arterial occlusion ; aneurysm ; venous occlusion ; and varices. Venous occlusion are frequently observed, most commonly in the inferior or superior vena cava. We report a case of Behcet's disease manifested as superior vena cava syndrome due to thrombus on both brachiocephalic veins.
Aneurysm ; Behcet Syndrome* ; Brachiocephalic Veins ; Central Nervous System ; Inflammation ; Superior Vena Cava Syndrome* ; Thrombosis ; Ulcer ; Varicose Veins ; Vena Cava, Superior*

The Mullerian duct cyst (MDC) occurs due to incomplete focal regression and saccular dilatation of the paramesonephric duct. It is usually found asymptomatic in adults, but it also shows symptoms such as ejaculatory impairment, hematospermia, pelvic pain, urinary retention, and urinary tract infections. MDCs are rare in children. Transrectal ultrasonography, computed tomography, and magnetic resonance imaging are useful for diagnosis. Treatment is based on age, clinical symptoms as well as size and location of the cyst. Here, we report a case of a 19-month-old boy with an infectious MDC that presented with fever. He has improved with antibiotic treatment, not surgical resection.

The Mullerian duct cyst (MDC) occurs due to incomplete focal regression and saccular dilatation of the paramesonephric duct. It is usually found asymptomatic in adults, but it also shows symptoms such as ejaculatory impairment, hematospermia, pelvic pain, urinary retention, and urinary tract infections. MDCs are rare in children. Transrectal ultrasonography, computed tomography, and magnetic resonance imaging are useful for diagnosis. Treatment is based on age, clinical symptoms as well as size and location of the cyst. Here, we report a case of a 19-month-old boy with an infectious MDC that presented with fever. He has improved with antibiotic treatment, not surgical resection.

PURPOSE: To evaluate the imaging findings of endometrial stromal sarcoma (ESS) according to histopathologic grade. MATERIALS AND METHODS: Six patients with pathologically proven ESS were included in this study. The histopathologic diagnosis was low-grade ESS for three patients and high-grade ESS for the three others. Preoperative CT or MR images were evaluated in terms of tumor size, location, growth pattern, the presence of hemorrhage or necrosis, status of the endometrial cavity, and invasion of surrounding structures. The imaging features of ESSs, which varied according to their histopathologic grade, were compared. RESULTS: The mean maximal diameter of low-and high-grade ESSs was 6 cm and 11.2 cm, respectively. All three low-grade ESSs were located mainly in the myometrium, but two high-grade ESSs were situated in the endometrial cavity and associated with focal tumor extension into the myometrium. One high-grade ESS had completely replaced the uterus. Low-grade ESSs were relatively well-defined, but high-grade ESSs had an irregular and lobulated margin. Intratumoral hemorrhage and necrosis were, respectively, found in two and three high-grade ESSs. Widening of the endometrial cavity was noted in all three high-grade ESSs, and lymph node metastasis had occurred in one. CONCLUSION: The imaging findings of ESS vary from a well-defined intramural mass to a bulky infiltrating mass, and depend on their histopathologic grade.
Animals ; Diagnosis ; Female ; Hemorrhage ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging* ; Mice ; Myometrium ; Necrosis ; Neoplasm Metastasis ; Sarcoma ; Sarcoma, Endometrial Stromal* ; Uterine Neoplasms ; Uterus

PURPOSE: To compare 2-year clinical outcomes of Descemet's stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) in patients with bullous keratopathy. METHODS: A retrospective chart review was performed to obtain 2 years of follow-up data of DSAEK or PK at a single center from March 2009 to September 2012. The study comprised 15 eyes of DSAEK and 11 eyes of PK. Outcome measures included best-corrected visual acuity (BCVA), spherical and keratometric changes, central corneal thickness, endothelial cell density, intraocular pressure, and postoperative complications. Graft survival rate was assessed by Kaplan-Meier survival analysis. RESULTS: There were no differences in patient baseline characteristics between the two groups. At postoperative 2 years, better BCVA of 0.69 ± 0.51 logarithm of the minimum angle of resolution (logMAR) was found after DSAEK compared to 0.88 ± 0.48 logMAR after PK. Refractive cylinder in DSAEK and PK was −2.60 ± 1.53 and −6.00 ± 1.05 diopters (D), respectively, and keratometric cylinder was 3.27 ± 3.70 and 6.34 ± 3.51 D, respectively, at postoperative 2 years. The difference of mean spherical equivalents between postoperative 1 month and 2 years was 0.84 D after DSAEK and 2.05 D after PK. A hyperopic shift of 1.17 D was present after 2 years of DSAEK. The mean endothelial cell density at postoperative 2 years was 1,548 ± 456 cells/mm² for DSAEK and 1,052 ± 567 cells/mm² for PK, with a cell loss of 19.96% vs. 52.38%, respectively when compared to postoperative 1 month. No significant difference in central corneal thickness was found between DSAEK and PK (592 ± 75 vs. 563 ± 90 µm, respectively). Finally, the 2-year survival rate did not differ significantly between DSAEK and PK (93.3% vs. 81.8%, respectively, p = 0.344). CONCLUSIONS: Compared to PK, DSAEK provided more stable refractive errors with better visual outcome, lower endothelial cell loss, and a lower rate of graft rejection at postoperative 2 years in patients with bullous keratopathy.
Cornea/diagnostic imaging/*surgery ; Corneal Diseases/diagnosis/*surgery ; Descemet Stripping Endothelial Keratoplasty/*methods ; Female ; Follow-Up Studies ; Graft Survival ; Humans ; Keratoplasty, Penetrating/*methods ; Male ; Middle Aged ; *Refraction, Ocular ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Visual Acuity

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by overproduction of myeloid white blood cells. Philadelphia chromosome is an essential finding for CML diagnosis. Generally, a clinical diagnosis of essential thrombocythemia (ET) can be established from isolated marked thrombocytosis in peripheral blood. However, Philadelphia chromosome-positivity or bcr/abl rearrangement with isolated thrombocytosis should be diagnosed as CML, not ET, according to World Health Organization diagnostic criteria. Therefore, CML should not be excluded before confirming the presence of the Philadelphia chromosome or bcr/abl rearrangement in cases of isolated thrombocytosis in peripheral blood. We report a case of CML with clinical features of ET in a patient successfully treated with imatinib.
Bone Marrow* ; Diagnosis ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Leukocytes ; Philadelphia Chromosome ; Thrombocythemia, Essential* ; Thrombocytosis ; World Health Organization ; Imatinib Mesylate

The term electrosurgery refers to the passage of high-frequency alternating electrical current through the tissue, to achieve a specific surgical effect. It is used in everyday dermatologic practice for various purposes, including tissue dissection, bleeding control, and the removal of common skin lesions such as viral warts, melanocytic nevi, and cherry angiomas. Considering the nature of the device, adverse effects including skin burn and scarring can occur at any stage of the procedure. Therefore, it is essential that electrosurgery be performed by skilled and well-trained physicians. In this paper, we introduce a brief history of electrosurgery and present its categories and their clinical uses. In addition, the possible adverse effects and safety measures of electrosurgery are addressed.
Burns ; Cicatrix ; Dermatology* ; Electrosurgery* ; Hemangioma ; Hemorrhage ; Nevus, Pigmented ; Skin ; Warts

PURPOSE: We prospectively evaluated the prostate cancer detection rate and pathologic characteristics of patients with a serum prostate-specific antigen (PSA) level of 3.0 to 4.0ng/ml and we compared this with the patients who had a PSA level in the range of 4.1 to 10.0ng/ml. MATERIALS AND METHODS: We analyzed the data of patients who had PSA levels of 3.0 to 10.0ng/ml, benign findings on digital rectal examination (DRE) and no specific lesion identified on transrectal ultrasound. The clinical characteristics, cancer detection rate and pathologic findings of the biopsy and prostatectomy specimen were compared between the low (3.0 to 4.0ng/ml) and intermediate (4.1 to 10.0ng/ml) PSA groups. RESULTS: A total of 370 patients met our criteria and so they were included in the study. Sixty five and 305 patients had low or intermediate PSA levels, respectively. The mean age and the number of prostate biopsy cores were not different between the two groups. Prostate cancer was diagnosed in 26% of the low PSA group and in 20% of the intermediate PSA group. No significant difference was found between the two groups on the pathologic findings of the biopsy and on the pathology findings of the prostatectomy specimens, including the mean Gleason score, the percentage of patients with a Gleason score 7 or higher, the pathologic stage and the percentage of insignificant prostate cancer. CONCLUSIONS: No statistically significant difference was found in the incidence of prostate cancer or pathological characteristics on comparison between the low and intermediate PSA groups. These results suggest that a lower PSA cutoff should be considered as an indication for a prostate biopsy in the Korean population.
Biopsy ; Digital Rectal Examination ; Humans ; Incidence ; Neoplasm Grading ; Pathology ; Prospective Studies ; Prostate* ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms* ; Ultrasonography