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

Patients with early gastric cancer (EGC) may be associated with an increased risk of having a second primary cancer. Metachronous primary malignancies may have an influence on the long term prognosis of these patients. We report here on two cases of bile duct cancer after performing subtotal gastrectomy for EGC. A 59-year-old man underwent pylorus preserving pancreaticoduodenectomy (PPPD) under the diagnosis of bile duct cancer, and this was done 5 years after he had undergone gastrectomy. The pathological specimens were different between the EGC and bile duct cancer according to their morphology and immunohistochemical staining, and this case was determined to be metachronous double cancer. The second case was a 39-year-old man who received PPPD for bile duct cancer 4 years after undergoing gastrectomy. Double primary malignancies of bile duct cancer and gastric cancer are very rare.
Adult ; Bile ; Bile Duct Neoplasms ; Bile Ducts ; Gastrectomy ; Humans ; Middle Aged ; Neoplasms, Second Primary ; Pancreaticoduodenectomy ; Prognosis ; Pylorus ; Stomach Neoplasms

No abstract available.
Gonadotropin-Releasing Hormone* ; Humans

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*

A case of gallbladder perforation without cholecystitis or trauma is described herein. The patient was a 74-year-old woman who initially presented with right lower quadrant pain of the abdomen. A laparotomy was performed with the impression of an acute appendicitis at a local clinic. However, the appendix was normal and a large amount of bile was noted in the peritoneal cavity. The patient was referred to our hospital. An exploratory laparotomy was performed with the suspicion of a hollow viscous perforation. A pin point perforation of the gallbladder fundus was identified. There were no gallstones or definite inflammation of the gallbladder wall. Although gallbladder perforation without cholecystitis or trauma is rare, gallbladder perforation without cholecystitis should be considered in elderly patients with bile peritonitis of unknown etiology.
Abdomen ; Aged ; Appendicitis ; Appendix ; Bile ; Cholecystitis ; Female ; Gallbladder ; Gallstones ; Humans ; Inflammation ; Laparotomy ; Peritoneal Cavity ; Peritonitis

OBJECTIVES: The aim of this study was to evaluate the risk of recidivism in sex offenders according to the sociodemographic factors, IQ, diagnosis by using Static-99 and KSORAS. METHODS: A total of 48 sex offenders were enrolled. Among them, 44 offenders were rated by Static-99, 41 offenders were evaluated by KSORAS. All the information was collected by reviewing medical records and written records of prosecutors or police retrospectively. RESULTS: In Static-99 and KSORAS, young adults tend to commit more recidivism than late adults. Single offenders have high rates of recidivism than married offenders in Static-99. In KSORAS, mental retardation patients have a tendency to commit more recidivism than schizophrenia patients. CONCLUSION: We should not overlook that specific condition of sex offenders (young adults, single, mental retardation) can have more possibility of recidivism.
Adult ; Criminals ; Humans ; Intellectual Disability ; Medical Records ; Police ; Schizophrenia ; Young Adult

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*

PURPOSE: Acute kidney injury (AKI) is a common, serious complication in rhabdomyolysis patients. Early recognition and adequate therapy in rhabdomyolysis-related AKI are essential to reducing mortality. However, existing biomarkers, such as plasma creatinine, have several limitations for early detection of AKI. Novel parameters have recently been studied for greater reliability in prediction and staging of AKI in critically ill patients in the emergency department. The aim of this study is to evaluate the role of certain parameters for early prediction and staging of AKI in adults with acute non-traumatic rhabdomyolysis. METHODS: Eighty eight patients with adult non-traumatic rhabdomyolysis, who were admitted to the emergency intensive care unit (ICU) from Dec 2013 to Nov 2014, were enrolled in this observational cohort study. AKI was defined according to the Acute Kidney Injury Network (AKIN) criteria. Diagnostic characteristics of initial laboratory parameters were analyzed using the area under the receiver operating characteristic (ROC) curve. RESULTS: Of the 88 patients, 60 patients (68.2%) developed AKI during the ICU stay. The ROC curve for plasma neutrophil gelatinase-associated lipocalin (NGAL) showed the highest sensitivity (81.7%) and specificity (78.6%) among initial parameters. In pairwise comparison, the areas under the curve (AUCs) for plasma NGAL and serum creatinine were 0.868 (95% confidence interval [CI]: 0.779-0.931) and 0.765 (95% CI: 0.662-0.849), respectively. A statistically significant difference was observed in both (p=0.047). Plasma NGAL levels increased significantly as the stage of AKI progressed, using AKIN criteria (p<0.001). CONCLUSION: Plasma NGAL can be a reliable parameter for early prediction and approximate staging of AKI in adult non-traumatic rhabdomyolysis in the emergency department.
Acute Kidney Injury* ; Adult ; Biomarkers ; Cohort Studies ; Creatinine ; Critical Illness ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intensive Care Units ; Lipocalins ; Mortality ; Neutrophils ; Plasma ; Rhabdomyolysis* ; ROC Curve ; Sensitivity and Specificity