A fifty year old Korean female was admitted with a few months history of general malaise. On admission, positive HBs Ag, negative HBs Ab and HBe Ag was negative. The liver function tests showed AST 274 U/L, ALT 126 U/L, CEA 1.87 ng/ml. With the clinical impression of chronic hepatitis B, abdominal CT and ERCP were performed and demonstrated a narrowing of the distal common bile duct suggesting a malignant etiology. The Whipple's procedure was done. The intraoperative finding revealed neoplastic involvement of the distal 1 cm of the common bile duct with severe narrowing and proximal dilatation. Microscopic findings demonstrated cystically dilated ductular structures and intervening irregular hypertrophic smooth muscle bundles.
Adenomyoma* ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct* ; Dilatation ; Female ; Hepatitis B, Chronic ; Humans ; Liver Function Tests ; Muscle, Smooth ; Tomography, X-Ray Computed

No abstract available.
Rho(D) Immune Globulin*

BACKGROUND: It is believed that stimulation of the P6 acupoint minimizes nausea and vomiting, and has been used to prevent and treat nausea and vomiting in various situations. The present study was undertaken to investigate whether the transcutaneous electrical stimulation of the P6 acupoint prevents postoperative nausea and vomiting (PONV) in female patients undergoing laparoscopic cholecystectomy. METHODS: In this prospective, randomized, double-blind, placebo-controlled study, we investigated 59 ASA I or II female patients who underwent laparoscopic cholecystectomy under general anesthesia using isoflurane or enflurane. We used a ReliefBand(R) unit (NSTTM 600, Woodside Biomedical Inc, USA) for the transcutaneous electrical stimulation of the P6 acupoint. Patients were randomly divided into two groups; in the P6 group (n = 29) the activated ReliefBand(R) was placed at the P6 acupoint; and in the placebo group (n = 30) the inactivated ReliefBand(R) was placed at the P6 acupoint. The ReliefBand(R) was applied 10 min before the end of surgery and remained in place for 24 h. We evaluated the incidence and severity of PONV, and need for rescue antiemetics during the first 6 h and 24 h after surgery. RESULTS: No differences in age, weight, previous PONV history, or duration of anesthesia were present between groups. The incidence of PONV was significantly lower (34%) in the P6 group than in the placebo group (63%) during the first 24 h after surgery. The severity of nausea and vomiting was also significantly lower in the P6 group than in the placebo group. However, the need for rescue antiemetics was similar in the two groups. CONCLUSIONS: Transcutaneous electrical stimulation of the P6 acupoint significantly reduces the incidence and severity of PONV in female patients undergoing laparoscopic cholecystectomy during the first 24 h after surgery.
Acupuncture ; Acupuncture Points* ; Anesthesia ; Anesthesia, General ; Antiemetics ; Cholecystectomy, Laparoscopic* ; Enflurane ; Female ; Humans ; Incidence ; Isoflurane ; Nausea ; Postoperative Nausea and Vomiting* ; Prospective Studies ; Transcutaneous Electric Nerve Stimulation* ; Vomiting

BACKGROUND: Because moving means can be easily shiftable according to their crude data, we made a selective expected ranges to calculate the moving means. Bull's mean (exponential factor, P=0.50) and Exponentially Adjusted Moving Mean (EAMM, P=0.66) were assessed. we studied to determine appropriately expected range and exponential factor. METHODS: We made the target values from RBC indices being measured with H-2 hematology autoanalyzer from 800 patients and the expected range from red cell indices data of additional 600 patients. Both moving means using this expected ranges were calculated. The % difference of Bull's mean and EAMM was compared and total mean of (deltaBull's mean/deltaBatch mean) and (deltaEAMM/deltaBatch mean) was compared. RESULTS: The target values were MCV: 90.6 fL, MCH: 29.8 pg. MCHC: 32.8 g/dL. The expected ranges were within +/-6% of their target values. Among the 20 batches obtained from expected range, there were no above +/-3% difference of red cell indices in both moving means. The comparison between % difference of Bull's mean and that of EAMM showed no difference. Total mean of (deltaEAMM/deltaBatch mean) was higher than that of (deltaBull's mean/deltaBatch mean). CONCLUSIONS: The % difference results of Bull's mean and EAMM were basically similiar within the expected range but EAMM method was more sensitive than Bull's mean method under the aspect of specimen effects, so EAMM was more detectable than Bull's mean on the quality control of red cell indices.
Erythrocyte Indices* ; Hematology ; Humans ; Quality Control

Objectives: ：Clozapine has been known to increase the possibility of developing cardio/cerebrovascular diseases, and the platelet activation has been deemed to be related to the occurrence of them. In author’s previous study, we observed the increase of platelet activity with short-term clozapine administration. This study was conducted, as a follow-up study, to investigate the effect of clozapine on the platelet activity when administered continuously for long-term period of time of 1 year. Methods: ：The medical records of the patients with schizophrenia or schizoaffective disorder who were treated with clozapine for 1 year were retrospectively reviewed. The degree of platelet activation was assessed by measuring the mean platelet component. Results: ：Total of 24 patients were enrolled. 9 of them (37.5%) were male and 15 of them (62.5%) were female. In the Wilcoxon sign-ranks test, no significant change was observed between the mean platelet factor values at the beginning and at the end of one year. Conclusions ：No significant changes of mean platelet activity were observed after continued administration of clozapine for 1 year. Considering the author’s previous findings that observed a prominent decrease of mean platelet component after short-term clozapine administration, the result of this study suggests the possibility that the activity of the platelet may change depending on the duration of the clozapine administration.

Primary tumors of the heart are rare and the most are benign. Malignant tumors constitute less than 25% of primary cardiac tumors and angiosarcomas are the most commonly reported histologic type. At least 160 cases have been reported in the world, but no previous report in Korea. We reported a case of primary cardiac angiosarcoma located in right atrium.
Heart ; Heart Atria ; Heart Neoplasms ; Hemangiosarcoma* ; Korea

Lamotrigine is an anticonvulsant drug used to treat partial and generalized seizure disorders. Hypersensitivity to lamotrigine usually causes mild symptoms such as fever, rash, and slight invasion of internal organs. However, a 33-year-old male patient who was admitted with Stevens-Johnson syndrome after taking lamotrigine for 15 days experienced hepatic failure and died 5 days after admission. This case demonstrates the importance of realizing that lamotrigine can lead to fatal hepatic failure, and that tests for the normal liver function should be performed when administering lamotrigine.
Adult ; Alanine Transaminase/blood ; Anticonvulsants/*adverse effects/therapeutic use ; Aspartate Aminotransferases/blood ; Drug Hypersensitivity/complications/*diagnosis ; Humans ; Liver/enzymology/metabolism ; Liver Failure/*etiology ; Male ; Stevens-Johnson Syndrome/diagnosis/drug therapy ; Triazines/*adverse effects/therapeutic use

PURPOSE: To evaluate the usefulness and diagnostic accuracy of turbo spin-echo(TSE) proton-density andT2-weighted images of meniscal tears of the knee. MATERIALS AND METHODS: We retrospectively evaluated thesensitivity, specificity, and accuracy of TSE proton density and T2-weighted images of meniscal tears confirmedarthroscopically or surgically in 47 patients(98 menisci). The routine TSE parameters used in all patients werethe dual echo sequence with sagittal proton density and T2-weighed images(4000/16, 90/5/2 [TR/effectiveTE/ETL/NEX]), and fat-suppressed coronal proton density and T2-weighted images. The chi-square test was used forstatistical analysis. RESULTS: The sensitivity, specificity, and accuracy of TSE proton density images for thedetection of meniscal tears were 93.9%, 93.8%, and 93.9%, respectively, in the medial meniscus, and 92.9%, 91.4%,and 91.8% in the lateral. On T2-weighted images the corresponding figures were 87.9%, 93.8%, and 89.8%,respectively, in the medial meniscus, and 64.3%, 91.4%, and 83.7 % in the lateral. CONCLUSION: With regard tosensitivity and accuracy, TSE proton density images of meniscal tears were superior to TSE T2-weighted images.
Humans ; Knee* ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Protons ; Retrospective Studies ; Sensitivity and Specificity

No abstract available.
Lutein* ; Lymphangioma, Cystic*

We report here on a case of a recurrent left anterior neck infection and focal left suppurative thyroiditis that were associated with a congenital pyriform sinus fistula (PSF) in an 18-year-old male. Acute suppurative thyroidits is a very rare clinical condition and it is usually caused by infection that's derived from infected perithyroidal tissue or a congenital internal fistula. The PSF can lead to recurrent episodes of neck inflammation and abscess, and it is the most common cause of acute suppurative thyroiditis in young man. In this current case, the CT scan showed an air-containing tract of a PSF from the left pyriform sinus to the left thyroid gland and the perithyroidal soft tissue. The CT scan also showed a neck inflammatory infiltration or abscess along the course of the sinus tract. The focal low density of the thyroid parenchyma was seen and this was suggestive of suppurative thyroiditis. Barium esophagography demonstrated the fistulous tract in the PSF. We performed laryngoscopy, and the internal opening of the pyriform sinus fistula was successfully cauterized with AgNO3 and the post procedure course was fair. When an air-containing tract and a recurrent inflammatory infiltration or abscess are present at the left anterior neck with including the thyroid and perithyroidal soft tissue, a PSF should be strongly suspected.
Abscess ; Adolescent ; Barium ; Fistula* ; Humans ; Inflammation ; Laryngoscopy ; Male ; Neck ; Pyriform Sinus* ; Soft Tissue Infections* ; Thyroid Gland* ; Thyroiditis ; Thyroiditis, Suppurative ; Tomography, X-Ray Computed