No abstract available.
Endoderm* ; Endodermal Sinus Tumor*

Eosinophilic cholecystitis is a rare disease characterized by transmural leukocyte infiltration composed of more than 90% eosinophils. Eosinophilic cholecystitis is clinically indistinguishable from ordinary cholecystitis, and as a rule it leads to cholecystectomy. We report a case of idiopathic eosinophilic cholecystitis treated with steroids. A 75-year-old woman presented with a classic history of acute cholecystitis and a peripheral eosinophilia of 41.8%. There was no evidence of allergy or parasitic infestation. An abdominal ultrasonography and computed tomography (CT) scan showed an edematous, thickened gallbladder wall, but no gallstones. There was no evidence of eosinophilic infiltration in other organs. Cholecystectomy was not performed because the patient refused surgical management. However, fever, abdominal pain, and peripheral eosinophilia persisted despite antibiotic and conservative therapy. Therefore, we attempted treatment with prednisolone. A week later, the symptoms disappeared and the peripheral eosinophilia normalized.
Abdominal Pain ; Aged ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Eosinophilia ; Eosinophils ; Female ; Fever ; Gallbladder ; Gallstones ; Humans ; Hypersensitivity ; Leukocytes ; Prednisolone ; Rare Diseases ; Steroids

Clostridium difficile is the most common nosocomial pathogen of the gastrointestinal tract. Pseudomembranous colitis occurs as a result of a severe inflammatory response to Clostridium difficile toxins. Pseudomembranous colitis is an increasingly frequent cause of morbidity and mortality among elderly hospitalized patients. Diarrhea is the most common manifestation. According to the literature, stools are almost never grossly bloody, and range from soft and unformed to watery or mucoid in consistency. We now report the cases of three patients with pseudomembranous colitis whose main clinical manifestation was hematochezia.
Aged ; Clostridium difficile ; Diarrhea ; Enterocolitis, Pseudomembranous ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Humans

BACKGROUND: Increasing coronary perfusion pressure with phenylephrine is important treatment strategies for right ventricular dysfunction caused by pulmonary hypertension. We compared the effects of phenylephrine on systemic and pulmonary hemondynamics in patients with and without pulmonary hypertension. METHODS: Twenty patients undergoing a valvular replacement were divided into two groups according to pulmonary artery pressure (PAP): control group (mean PAP < 25 mmHg, n = 9) or pulmonary hypertension group (mean PAP > 25 mmHg, n = 11). When systolic blood pressure decreased below 100 mmHg after the induction of anesthesia, phenylephrine was infused to raise systolic blood pressure up to 30% and 50% over baseline. Hemodynamic variables were measured at each time. RESULTS: Phenylephrine failed to raise systolic blood pressure up to 50% above baseline in more than half of the patients with pulmonary hypertension in contrast to successful increases in all patients without pulmonary hypertension. However, the ratio of PAP to systolic blood pressure was significantly reduced in patients whose systolic blood pressure was successfully increased up to 50% over baseline in the pulmonary hypertension group whereas the PAP concomitantly increased as systolic blood pressure was increased in the control group. CONCLUSIONS: Phenylephrine couldn't increase systolic blood pressure in some patients with pulmonary hypertension unlike in control group and it seemed to occur more often in patients with greater the ratio of PAP to systolic blood pressure. The baseline systemic vascular resistance index was high and cardiacoutput was low in the pulmonary hypertension group and these conditions seemed to restrict the effect of phenylephrine.
Anesthesia ; Blood Pressure ; Hemodynamics* ; Humans ; Hypertension, Pulmonary* ; Perfusion ; Phenylephrine* ; Pulmonary Artery ; Vascular Resistance ; Ventricular Dysfunction, Right

PURPOSE: To implant tissue chips in New Zealand rabbits, and thus redurce the frequency with which scattered VX2 carcinoma nodules and early metastasis develop in these animals. MATERIALS AND METHODS: VX2-carcinoma tissue chips of two different sizes were implanted under ultrasonographic guidance. In each of 12 New Zealand rabbits (group 1), there 1-mm tissue chips were implanted in the liver using an 18-gauge needle, and in the same way, one 3-mm chip with an added gelfoam pellet was implanted in the proximal lumen of the liver of each of ten other New Zealand rabbits (group 2). Three weeks after implantation, the animals underwent dvalphase CT scanning and were sacrificed, and the Number and size of tumor nodules, and metastasis were evaluated either macro-or microscopically. RESULTS: In ten rabbits in group I, a total of 21 nodules (16 in the liver, 5 in the peritoneal wall) were observed, which in nine rabbits in group 2, a total of ten nodules-all in the liver-were present. CT scans depicted tumor nodules in 50% of group-I rabbits, and in 29% those in group 2. Mean tumor diameter was 12 +/-9 mm in group 1 and 6.4 +/-3 mm in group 2. Histologic examination indicated the presence of nodular VX2 carcinoma, with varying degrees of central necrosis, a feature more prominent in group 2. CONCLUSION: To provide a well-localized tumor nodule in rabbit liver, tissue chip implantation of VX2 carcinoma, especially with added gelfoam, is a good alternative to intraparenchymal injection of tumor suspension.
Animals ; Gelatin Sponge, Absorbable ; Liver* ; Necrosis ; Needles ; Neoplasm Metastasis ; Rabbits ; Tomography, X-Ray Computed

Effects of thoracentesis on thoracic impedance and cardiac performance were studied in patients with uncomplicated unilateral tuberculous pleural effusion. The speed of the removal of the pleural effusion in thoracentesis was essentially similar to that of a generally used for therapeutic purpose in daily practice. Thoracic impedance was measured in 23 cases before, 4 and 10 minutes after thoracentesis to the amount of pleural effusion aspirated was observed. In 11 cases out of 23, the changes in cardiac performance as assessed by stroke volume, cardiac output, heart rate, heather index and ratio of pre-ejection period to left ventricular ejection time(PEP/LVET) were observed 4 minutes after 150 ml to 1,000 ml of thoracentesis. In these cases, stroke volume, cardiac output, and Heather index were determined from impedance cardiograms, and PEP/LVET from mechanocardiograms recorded simultaneously with the former. A significant increase in thoracic impedance was observed both 4 and 10 minutes after thoracentesis. There was a slight but a significant correlation between the changes in thoracic impedance and the amount of pleural fluid aspirated only 4 minutes after thoracentesis. Thoracentesis showed no consistent influence on cardiac performance as reflected to stroke volume, cardiac output, heart rate, heart index and PEP/LVET. These facts suggest that measurement of thoracic impedance may be a useful method reflecting alterations in pleural fluid volumes, particularly when it occurs in a relatively short period of time, and the effects of thoracentesis of less than one liter on the cardiac functions as determined by the above-mentioned parameters were variable.
Cardiac Output ; Electric Impedance* ; Heart ; Heart Rate ; Humans ; Pleural Effusion ; Stroke Volume

To observe the antihypertensive effects of the angiotensin-converting enzyme inhibitor, enalapril, a daily average dosage of 20mg was administred to 38 patients with essential hypertension for 4 weeks. Changes in blood pressure and heart rate, and the frequencies of adverse reactions during the drug administration were constantly observed. At the end of the 4th week of administration the mean diastolic blood pressure decreased from 104+/-11.3 to 91+/-7.9mmHg(<0.001), and the mean systolic blood pressure from 165+/-16.8 to 142+/-10.6mmHg(P<0.001), An effective antihypertensive action of enalapril was observed in 31 out of 38 cases(82%), and normalization of diastolic blood pressure below 85mmHg was shown in 27 cases(71%). The most remarkable antihypertensive effects were shown at the end of first week, and the effect increased progressively until the end of 4th week of therapy. There were no significant changes in heart rate during the observation period. Adverse reactions occured in only 7 cases(18%). These reactions included headache, dizziness, fatigue, skin rash and facial flushing in the order of frequency. Almost all of these reaction were mild and transient, disappearing spontanously without discontinuation of the medication. In conclusion, enalapril seems to be a safe and effective primary antihypertensive drug for the treatment of essential hypertension.
Blood Pressure ; Dizziness ; Enalapril* ; Exanthema ; Fatigue ; Flushing ; Headache ; Heart Rate ; Humans ; Hypertension

Xanthogranulomatous pyelonephritis in childhood is a rare chronic pyelonephritis often assodiated with calculi of urinary tract obstruction, with a clinical presentation of renal mass. A 3-year old boy was admitted to Korea University Hospital complaining of intermittent fever and palpable mass at right upper quadrant of the abdomen. The CBC revealed increased ESR and the finding of iron deficientcy anemia. Proteus mirabilis was cultured from the urine. We found the idiopathic hypercalciuria was affected also. Intravenous pyelogram. ultrasonogram and abdominal computerized tomogrhapy demonstrated a multiple cystic lesion with renal calculi at upper and lower pole of right kidney. Right nephrectomy was performed under the suspicion of the renal abscess with renal stone. Postoperatively microscopic examination revealed parenchymal destruction with infiltration of foamy phagocytes, giant cells, and plasma cells. In conclusion, we experienced a case of xanthogranulomatous pyelonephritis with idiopathic hypercalciuria in a child. So, we report it with a review of literature.
Abdomen ; Abscess ; Anemia ; Calculi ; Child* ; Child, Preschool ; Fever ; Giant Cells ; Humans ; Hypercalciuria* ; Iron ; Kidney ; Kidney Calculi ; Korea ; Male ; Nephrectomy ; Phagocytes ; Plasma Cells ; Proteus mirabilis ; Pyelonephritis ; Pyelonephritis, Xanthogranulomatous ; Ultrasonography ; Urinary Tract

Even though some authors have reported on the advantages of early total correction of complex heart disease, for low birth weight premature neonates, most surgeons prefer a multi-step approach to early total correction due to the many problems, such as the technical problems, the cardiopulmonary bypass management and etc. We report here on a successful case of early one-stage total repair of coarctation of the aorta and a ventricular septal defect in a 1,250 gram premature neonate.
Aortic Coarctation ; Cardiopulmonary Bypass ; Heart Diseases ; Heart Septal Defects, Ventricular ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Thoracic Surgery

BACKGROUND: Peritoneal CO2 insufflation results in elevation of PaCO2 and decreased respiratory compliance. Respiratory mechanics can be measured with flow interrupter technique. This study was designed to evaluate the effect of increased intra-abdominal pressure and positions on respiratory mechanics during laparoscopic surgery. METHODS: Female patients undergoing cholecystectomy (10 degrees head-up group, n=9) and gynecologic operation (10 degrees head-down group, n=9) under laparoscopy were studied. The upper limit of intra-abdonimal pressure was set to 12 mmHg. We measured airway flow and airway pressure of patients at preoperation, during insufflation, during positioning, and postoperation. Respiratory data were obtained from D-lite(R)sensor on-line. RESULTS: After increased intra-abdominal pressure and positioning, dynamic compliances in both groups were significantly decreased by 31~35%, static compliances by 39~43%. There was no difference of compliance between positions. The elastic tissue resistance of head-up group was significantly elevated compared with after operation. After operation, the respiratory parameters returned nearly to control levels. CONCLUSIONS: This result suggests that the respiratory mechanics should be monitored under laparoscopy continuously. Further studies on clinical condition such as ascites, hemorrhage, and pregnancy were needed.
Ascites ; Cholecystectomy ; Compliance ; Elastic Tissue ; Female ; Hemorrhage ; Humans ; Insufflation ; Laparoscopy* ; Pregnancy ; Respiratory Mechanics*