Acute appendicitis is the most common operative disease in general surgery, but it is not also rate disease to see in other clinical department such as Internal Medicine and Obstetric and Gynecology, because it reqnires to differenciate from many other diseases which have similar symptoms. Expecially, because the clipical aymptoms of acute appendicitis are not typieal in children, elderly, and women, it is hard to be diagnosed as acute appendicitis and it is often misdiagnosed as other disease. We performed colonoscopy due to be interpretated aa one of the colon diseases rather than acute appendicitis. But in colonoscopic findings, there were hyperemie and edematous change on the appendiceal orifice of cecum(cherry or acorn shape). So we report 5 cases of acute appendicitis diagnosed br colonoscopy.
Aged ; Appendicitis* ; Child ; Colon ; Colonoscopy* ; Female ; Gynecology ; Humans ; Internal Medicine

PURPOSE: To evaluate the efficacy of the combination therapy of intravitreal bevacizumab injection and photodynamic therapy in neovascular age-related macular degeneration associated with large retinal pigment epithelial detachment. METHODS: A total of 13 eyes were reviewed, with 9 eyes diagnosed with definite choroidal neovascularization (CNV) and 4 eyes diagnosed with CNV or polypoidal choroidal vasculopathy (PCV) becausethe exact type could not be determined. Photodynamic therapy was performed within 1 week after bevacizumab injection according to indocyanine green angiography (ICGA). Additional bevacizumab injections were performed within a 4 to 6 week interval. Additional photodynamic therapy was performed within 4 months. RESULTS: The visual acuity on final examination had improved in 3 eyes (23.1%), was maintained in 7 eyes (53.8%), and decreased in 3 eyes (23.1%). The change of the PED before and after treatment showed regression in 5 eyes (38.5%), recurrence after regression in 2 eyes (15.4%), persistence in 4 eyes (30.8%), and retinal pigment epithelial tear in 2 eyes (15.4%). The maintained or improved visual acuity rate was 66.7% (6/9) and 100% (4/4) in the CNV and CNV or PCV group, respectively. CONCLUSIONS: The combination therapy in neovascular age-related macular degenerationassociated with large retinal pigment epithelial detachment is a viable alternative treatment in the stabilization and improvement of vision. However, further studies with long-term follow up and controlled studies with anti-vascular endothelial growth factor antibody monotherapy are required.
Angiography ; Antibodies, Monoclonal, Humanized ; Choroid ; Choroidal Neovascularization ; Endothelial Growth Factors ; Eye ; Follow-Up Studies ; Indocyanine Green ; Macular Degeneration ; Photochemotherapy ; Recurrence ; Retinal Detachment ; Retinaldehyde ; Vision, Ocular ; Visual Acuity ; Bevacizumab

BACKGROUND: According to several studies investigating the relationship between muscle activity and electroencephalogram results, reversal of neuromuscular blockade (NMB) may affect depth of anesthesia indices. Therefore, we investigated the effect of pyridostigmine on these indices via spectral entropy. METHODS: Fifty-six patients scheduled for thyroidectomy or parotidectomy were included in this study and randomized into two groups. At the start of skin suturing, the desflurane concentration was adjusted to 4.2 vol% in both groups. Following this, the pyridostigmine group (group P, n = 28) was administered pyridostigmine 0.2 mg/kg mixed with glycopyrrolate 0.04 mg/kg, while the control group (group C, n = 28) received normal saline. Entropy values (response entropy [RE] and state entropy [SE]), train of four (TOF) ratio, and end-tidal desflurane concentration were recorded from point of drug administration to 15 minutes post-drug administration. RESULTS: Mean RE values at 15 minutes, when the maximum effect of pyridostigmine was anticipated, showed a statistically significant difference between groups (53.8 ± 10.5 in group P and 48.0 ± 8.8 in group C; P = 0.030). However, mean SE at 15 minutes showed no significant difference between the two groups (P = 0.066). At 15 minutes, there were significant differences in the TOF ratio between the two groups (P < 0.001). CONCLUSIONS: NMB reversal by pyridostigmine significantly increased RE values but not SE values. This finding suggests that spectral entropy may be a useful alternative tool for monitoring anesthetic depth during recovery from anesthesia in the presence of electromyogram activity.
Anesthesia* ; Electroencephalography ; Electromyography ; Entropy* ; Glycopyrrolate ; Humans ; Neuromuscular Blockade* ; Prospective Studies* ; Pyridostigmine Bromide* ; Skin ; Thyroidectomy

Xanthogranulomatous cholecystitis is an uncommon inflammatory disease of the gall baldder characterised by a focal or diffuse destructive inflammatory process. The pathogenesis is uncertain, but an inflammatory response to extravasated bile due to acute inflammation and obstruction is likely. Macroscopically, the gall bladder wall is invariably thickened, and extensive adhesions to adjacent organs are frequent. Clinically, xanthogranulomatous cholecystitis can mimic gall bladder carcinoma and radiologic differential diagnosis is extremely difficult. Fistula to skin and duodenum was reported. We report the first case of cholecysto-colonic fistula due to xanthogranulomatous cholecystitis.
Bile ; Cholecystitis* ; Diagnosis, Differential ; Duodenum ; Fistula* ; Inflammation ; Skin ; Urinary Bladder

No abstract available.
Cell Line, Tumor* ; Gonadal Steroid Hormones* ; Gonadotropin-Releasing Hormone* ; Gonads*

No abstract available.
Gonadotropin-Releasing Hormone* ; Humans

BACKGROUND: Midazolam or propofol has been used for the procedural sedation in children. However, the combined use of remifentanil have not been widely investigated. The purpose of this study was to evaluate the effectiveness and safety of remifentanil infusion with intravenous anesthetics during the central venous catheterization in children. METHODS: After institutional review board approval and written informed consent from patients' parent, 20 children planned central venous catheterization for chemotherapy were randomly assigned into two groups. All patients were infused with remifentanil 0.1microng/kg/min. In M group, 0.3 mg/kg of midazolam bolus was injected and 0.1 mg/kg bolus were injected intermittently if the sedation was inadequate. In P group, 1.0 mg/kg of propofol bolus and 150microng/kg/min were infused. 0.5 mg/kg of propofol was given intermittently if the sedation was inadequate. Hemodynamic variables, end-tidal CO2 (EtCO2), bispectral index score (BIS) were monitored throughout the procedure. RESULTS: There were no significant differences in hemodynamic variables, sedation and recovery times. Oxygen saturation (SpO2) in P group was significantly lower than that of M group at 15 min after the start of infusion. EtCO2 in P group was significantly higher than that of M group at 10 min after the start of infusion. Hypoxemia (SpO2< 90%) were occurred in three patients of P group. There was no significant difference in BIS among the groups. CONCLUSIONS: The combined infusion of remifentanil 0.1microng/kg/min with midazolam provided successful sedation without airway assistance during the central venous catheterization in children.
Anesthetics, Intravenous ; Anoxia ; Catheterization, Central Venous* ; Central Venous Catheters* ; Child* ; Drug Therapy ; Ethics Committees, Research ; Hemodynamics ; Humans ; Informed Consent ; Midazolam* ; Oxygen ; Parents ; Propofol*

BACKGROUND: Remifentanil is an ultra-short acting opioid, and its use has been known to be related to acute opioid withdrawal or tolerance. This study was performed to compare the hemodynamic response, recovery characteristics, and postoperative pain response after sevoflurane-remifentanil or sevoflurane anesthesia in subtotal gastrectomy patients. METHODS: Sixty patients scheduled for gastrectomy were randomly allocated into two groups. Thoracic epidural catheterization was performed before anesthesia. Anesthesia was maintained with sevoflurane-remifentanil (SR group) or sevoflurane (SN group). We compared hemodynamic variables during surgery and recovery, the pain and sedation score during recovery, and the pain score and analgesic requirements during the postoperative period. RESULTS: Intraoperative blood pressure and heart rates in the SR group were lower than in the SN group. There was no significant difference in extubation time and recovery time between patients in the two groups. The patients in the SN group showed more prompt recovery at 15 minutes after extubation. The VAS scores and analgesic demand of the SR group were greater than in the SN group. CONCLUSIONS: Intraoperative use of remifentanil with sevoflurane may be related to increased postoperative pain.
Analgesia, Epidural* ; Anesthesia ; Anesthesia, Epidural ; Blood Pressure ; Catheterization ; Catheters ; Gastrectomy* ; Heart Rate ; Hemodynamics ; Humans ; Pain, Postoperative ; Postoperative Period

PURPOSE: To report a case of acute endophthalmitis associated with 23-gauge transconjunctival sutureless vitrectomy and gas tamponade for macular hole surgery. CASE SUMMARY: A 66-year-old female patient who presented with a macular hole in the left eye was treated with 23-gauge transconjunctival sutureless vitrectomy. On postoperative day 2, the patient developed acute endophthalmitis and was treated with gas-fluid exchange, lensectomy and intravitreal antibiotic injection. Staphylococcus epidermidis was detected in the vitreous fluid of the operated eye. Intraoperative fundus findings showed severe retinal hemorrhage, vascular occlusion and fibrous membranes due to inflammatory response. After treatment, the patient's fundus findings markedly improved and the inflammatory response was controlled. CONCLUSIONS: Acute endophthalmitis after sutureless vitrectomy performed via intraocular gas injection may quickly result in inflammation and disease due to infection. Immediate reoperation and intravitreal antibiotic injections are recommended in such cases.
Aged ; Endophthalmitis ; Eye ; Female ; Humans ; Inflammation ; Membranes ; Reoperation ; Retinal Hemorrhage ; Retinal Perforations ; Staphylococcus epidermidis ; Vitrectomy

BACKGROUND: allergic disease is an inflammatory disease, whose main inflammatory cells are eosinophils, mast cells, and T lymphocytes. From that point, new therapeutic targets on allergic inflammation focusing on them are under investigation. We extracted four isoflavonoids from sophorica japonica such as sophi, orobol, genistin and genistein which are known PTK antagonists. We documented that these iso-flavonoids except genistein had an antagonism on IL-5 and IL-3 in vitro eosinophil activation and also in allergic mouse model sensitized by OA(ovualbumin). Their common action is due to the common beta chains. GM-CSF also share common beta chains, through which it activates eosinophils. OBJECTIVES: From the above results, We observed the antagonistic effects of these compounds on GM-CSF using eosinophil activation in vitro. METHODS: LTC4 which was detected by RIA and ECP by UniCAP were activation markers. RESULTS: Among those compounds, sophi was the most potent antagonist on GM-CSF induced LTC4 release and even on degranulation and orobol and genistin also had antagonism on them but genistein an antagonist of PTK did not show any antagonistic effects. CONCLUSION: From these results, We concluded these three iso-flavonoids were GM-CSF antagonists and the mechanism might not be through PTK signaling.
Animals ; Eosinophils ; Genistein ; Granulocyte-Macrophage Colony-Stimulating Factor ; Inflammation ; Interleukin-3 ; Interleukin-5 ; Leukotriene C4 ; Mast Cells ; Mice ; T-Lymphocytes