BACKGROUND: Esmolol is a short acting sympathetic beta receptor antagonist, and it was successfully applied to induced hypotension. Esmolol lowers blood pressure by decreasing cardiac output, and does not cause vasodilation. This property of esmolol may help to decrease bleeding during induced hypotension. In this study, we tried to elucidate the effect of esmolol on induced hypotension for total hip arthroplasty. METHOD: Twenty patients receiving total hip arthroplasty were randomly divided to two groups. Esmolol group (10 patients) received esmolol as a hypotensive agent, and sodium nitroprusside (SNP) group (10 patients) received SNP as a hypotensive agent. We measured arterial blood gas analysis, vital sign, amounts of bleeding, amounts of transfusion and administered fluid, and various laboratory findings. RESULTS: Induced hypotension was successfully performed in either esmolol and SNP group. Heart rate increased by SNP, and decreased by esmolol. There were no statistically significant differences between the two groups in amounts of bleeding, amounts of transfusion or administered fluid, and laboratory findings. Arterial oxygen tension was relatively constant in esmolol group, but decreased in SNP group. CONCLUSION: Esmolol can be used as a single hypotensive agent during induced hypotension without significant side effects during total hip arthroplasty.
Arthroplasty, Replacement, Hip* ; Blood Gas Analysis ; Blood Pressure ; Cardiac Output ; Heart Rate ; Hemorrhage ; Humans ; Hypotension* ; Nitroprusside* ; Oxygen ; Sodium* ; Vasodilation ; Vital Signs

Splenosis is the autotransplantation of fragmented splenic tissue that occurs as a result of traumatic splenic rupture or a routine splenectomy. Generally, splenic implants are numerous and located within the peritoneal cavity; peritoneum, omentum and abdominal viscera, and occasionally on extra-abdominal surfaces. Splenic implants are rarely clinically significant and are incidental found during an abdominal operation, but occasionally mimics primary or metastatic tumors, as seen on radiological studies. Herein, the case of a patient in whom multiple abdominal masses were identified as splenosis, but the initial radiographic finding was that of carcinomatosis peritonei.
Autografts ; Carcinoma* ; Humans ; Omentum ; Peritoneal Cavity ; Peritoneum ; Splenectomy ; Splenic Rupture ; Splenosis* ; Stomach Neoplasms* ; Viscera

PURPOSE: The present study assessed the diagnostic significance of digital infrared thermal imaging (DITI) in determining the inflammatory state of patients with nonspecific orbital inflammation. METHODS: The present study included 11 patients diagnosed with nonspecific orbital inflammation between December 2009 and March 2011 and who were followed-up for more than 6 months. All patients were all diagnosed based on computed tomography (CT), magnetic resonance image (MRI) and tissue biopsy. The grade of eyelid swelling was classified as 5 and severe compared with the temperature of location. The temperature of the upper eyelid, caruncle, medial conjunctiva, lateral conjunctiva, lower eyelid, cornea and lateral orbit were measured with DITI. RESULTS: When comparing the normal eye with the diseased eye in patients with nonspecific orbital inflammation, the temperature of the upper eyelid and cornea were statistically significant (p = 0.003, p = 0.038, respectively, Mann-Whitney test). The correlation between the grade of eyelid swelling and the temperature of location was most highly related in the temperature of the upper eyelid (Spearman's correlation coefficient, r = 0.55, p = 0.008) and cornea (Spearman's correlation coefficient, r = 0.45, p = 0.037). CONCLUSIONS: DITI may aid in evaluating the inflammatory state of nonspecific orbital inflammation. In particular, the temperature of the upper eyelid and cornea can be very useful indicator. Future studies, including larger study population are necessary in order to confirm DITI as a diagnostic tool which can assess the results of medical treatment by comparing temperature before and after treatment.
Biopsy ; Conjunctiva ; Cornea ; Eye ; Eyelids ; Humans ; Inflammation ; Magnetic Resonance Spectroscopy ; Orbit

A choriocarcinoma is a rapidly invasive, widely metastatic, human chorionic gonadotropin (HCG)-producing neoplasm, which are usually intrauterine and gestational. A primary gastric choriocarcinoma is very rare, and its pathogenesis is still uncertain. A 56-year old man presented with gastrointestinal bleeding and a gastric mass, clinically suspicious of a gastric adenocarcinoma. Thus, a radical subtotal gastrectomy and lymph node dissection, with a reconstruction, was performed. The resected specimen was found to be a Borrmann type I tumor, and a histological examination showed it to be a primary gastric choriocarcinoma, with an associated adenocarcinoma and a syncytiotrophoblast, which was immunostained by human chorionic gonadotropin (HCG). The serum HCG level, on the 7th postoperative day, was found to be 2, 775 mIU/ml. Chemotherapy was administered two months after surgery, as the patient refused chemotherapy during the immediate post operative period. At that time, the tumor rapidly recurred and disseminated to the liver. The patient died three months after the initial diagnosis.
Adenocarcinoma ; Choriocarcinoma* ; Chorionic Gonadotropin ; Diagnosis ; Drug Therapy ; Female ; Gastrectomy ; Hemorrhage ; Humans ; Liver ; Lymph Node Excision ; Pregnancy ; Trophoblasts

A choriocarcinoma is a rapidly invasive, widely metastatic, human chorionic gonadotropin (HCG)-producing neoplasm, which are usually intrauterine and gestational. A primary gastric choriocarcinoma is very rare, and its pathogenesis is still uncertain. A 56-year old man presented with gastrointestinal bleeding and a gastric mass, clinically suspicious of a gastric adenocarcinoma. Thus, a radical subtotal gastrectomy and lymph node dissection, with a reconstruction, was performed. The resected specimen was found to be a Borrmann type I tumor, and a histological examination showed it to be a primary gastric choriocarcinoma, with an associated adenocarcinoma and a syncytiotrophoblast, which was immunostained by human chorionic gonadotropin (HCG). The serum HCG level, on the 7th postoperative day, was found to be 2, 775 mIU/ml. Chemotherapy was administered two months after surgery, as the patient refused chemotherapy during the immediate post operative period. At that time, the tumor rapidly recurred and disseminated to the liver. The patient died three months after the initial diagnosis.
Adenocarcinoma ; Choriocarcinoma* ; Chorionic Gonadotropin ; Diagnosis ; Drug Therapy ; Female ; Gastrectomy ; Hemorrhage ; Humans ; Liver ; Lymph Node Excision ; Pregnancy ; Trophoblasts

Objective: The objective of this study is to assess the efficacy and safety of repeated sodium polynucleotide (Conjuran Ⓡ ) treatments in patients with knee osteoarthritis. Methods: The study was conducted by retrospectively examining 45 patients who repeated the treatment course of 5 injections of Conjuran Ⓡ twice within 6 months. For each course, pain reduction by the change of 100-mm Weight-Bearing-Pain Visual-Analog-Scale was compared with before administration until 6 months after administration. Improvement by Clinical Global Impression (CGI) and Patient Global Impression (PGI) were also investigated, as well as adverse reactions. Results: Pain analysis after administration of Conjuran Ⓡ confirmed that VAS decreased by 51.6% until 6 months (p＜0.001), and after that the effect was lost and was repeat for the 2 nd course. In the 2 nd , VAS continued to decrease by 58.7% compared to before the 1 st course (p＜0.001). Analysis of CGI, 88.9% of patients improved after the 1 st and 84.4% of patients improved after the 2 nd . In the PGI results, symptoms improved in 86.7% of patients after the 1 st and 82.2% after the 2 nd . No significant adverse event was reported. Conclusion The safety and efficacy results of patients receiving Conjuran Ⓡ for 2 nd treatment courses were similar to those for 1 st treatment course. In addition, the effect lasts for up to 6 months after administration, and the pain reduction effect is lost thereafter, so it is recommended to apply it at 6-month intervals if additional treatment is needed. Conjuran Ⓡ is an intra-articular injection that is effective in reducing knee pain and can be used repeatedly without adverse reactions.

PURPOSE: Laparoscopy-assisted distal gastrectomy (LADG) has become a viable alternative treatment for patients suffering with early gastric cancer. Surgeons have long thought that obesity might increase the rate of intraoperative or postoperative complications. This study was performed to evaluate the impact of obesity, according to the learning curve, in patients who underwent laparoscopy assisted distal gastrectomy for gastric cancer. METHODS: We retrospectively reviewed 100 patients who had undergone LADG for gastric cancer between September 2004 and May 2007 at Keimyung University Dongsan Medical Center. We measured the degree of obesity by using the body mass index (BMI: kg/m(2)), and we compared the surgical outcomes between the low BMI group (BMI < 25 kg/m(2), n=72) and the high BMI group (BMI >25 kg/m(2), n=28). We further subdivided the patients into the surgeons' number of cumulative LADG cases, the early learning curve group (from the first patient to the 50th patient) and the late learning curve group (from the 51th patient to the 100th patient). We analyzed them in terms of the operation time, the amount of intraoperative bleeding, the number of retrieved lymph nodes, the rate of operative morbidity and the length of the postoperative hospital stay. RESULTS: There no significant differences between the high and low BMI groups in terms of the patients' clinicopathologic characteristics and surgical outcomes, but there was a statistically significant difference in the operation times between the high BMI (303.3 min) and low BMI groups (269.3 min, P=0.029). The postoperative morbidity was not different between the high BMI (25%) and low BMI groups (12.5%, P=0.12). However, when we subdivided the patients by the learning curve, there was a statistically significant difference for the operation time (360 vs 297 minutes, respectively), postoperative morbidity (41.7 vs 10.5%, respectively) and the postoperative hospital stay (15.5 vs 8.6 day, respectively) between the high BMI and low BMI groups at the early learning curve period. Especially for male patients, the early learning curve period showed significant differences in the operation time, the postoperative morbidity and the postoperative hospital stay between the high BMI and low BMI groups, but in case of the female patients, there was no difference in postoperative morbidity and the length of the postoperative hospital stay. At the late learning curve period, there was no difference according to gender and obesity. CONCLUSION: Obesity itself does not increase operative morbidity when performing LADG in patients with gastric cancer. However, at a surgeon's initial period of performing LADG, a careful approach seems to be required for male obese patients.
Body Mass Index ; Female ; Gastrectomy ; Hemorrhage ; Humans ; Laparoscopy ; Learning ; Learning Curve ; Length of Stay ; Lymph Nodes ; Male ; Obesity ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms ; Stress, Psychological

PURPOSE: To report the clinical results of a planned vitrectomy, laser photocoagulation and gas tamponade for the treatment of serous macular detachment associated with optic disc pit. However, laser photocoagulation was performed on a postoperative outpatient basis for subretinal fluid. CASE SUMMARY: A 13-year-old women presented with central visual disturbance in the left eye. Her best-corrected visual acuity (BCVA) was 0.16. On ophthalmic examination, the patient was diagnosed with optic disc pit combined with serous macular detachment. After 3 months, the serous macular detachment increased and visual acuity decreased to 0.1. Pars plana vitrectomy combined with complete posterior vitreous detachment was performed. After intravitreal injection of perfluorodecalin, internal drainage of the subretinal fluid using the back flush needle around the optic disc pit was performed, but the fluid was not drained. The planned intraoperative photocoagulation was not performed due to a large serous macular detachment. Gas tamponade was performed and a facedown position was maintained for 1 week followed by laser photocoagulation. The subretinal fluid was completely absorbed and visual acuity was improved. In addition, recurrence was not observed throughout the follow-up period.
Adolescent ; Drainage ; Eye ; Female ; Fluorocarbons ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Light Coagulation ; Needles ; Outpatients ; Recurrence ; Subretinal Fluid ; Visual Acuity ; Vitrectomy ; Vitreous Detachment

Several reports have described the usefulness of tumor markers detected in pancreatic juice for diagnosis of pancreatic cancer. We performed this study to evaluate the usefulness of tumor markers in pure pancreatic juice collected by duodenoscopic cannulation of pancreatic duct before and after injection of secretin. From April 1993 to July 1995, 8 cases of pancreatic cancer, 5 cases of benign pancreatic lesions, and 5 cases of benign biliary diseases without pancreatic lesion were involved. CEA and CA 19-9 immunoreactivity were measured by radioimmunoassay. Concentrations of CA 19-9 in pure pancreatic juice were significantly higher in patients with pancreatic cancer(median value; 3582, range 88.4-10410 IU/ml) than in control patients(median value 231, range 30.4-682 IU/ml)(p<0.05). Concentrations of CEA in pure pancreatic juice were not significantly different between patients with pancreatic cancer(median value: 6,5, range 1.0-152ng/ml) and control patients(median value: 4.0, range 1-17.2 ng/ml)(p>0.05). There was no significant correlation between levels of CA19-9, CEA in pancreatic juice and those levels in serum. The amounts of juice collected by duodenoscopic cannulation in patients with pancreatic cancer were 1.5+/- 0.9ml during 5 minutes before infusion of secretin, 11.3+/- 3.9ml, 10.8+/- 4.0ml, 10.6+/- 4.0ml in 5 minute interval after infusion of secretin. These results indicated that measurement of CA19-9 in pure pancreatic juice may be used as a marker for pancreatic cancer. Adequate amount of pancreatic juice was collected by duodenoscopic cannulation for evaluation of tumor marker, enzyme studies and cytology.
Catheterization ; Diagnosis ; Humans ; Pancreatic Diseases ; Pancreatic Ducts ; Pancreatic Juice* ; Pancreatic Neoplasms ; Radioimmunoassay ; Secretin ; Biomarkers, Tumor