Polyethylene glycol (PEG)-3350 is the most frequently used lavage solution for bowel cleansing prior to colonoscopy or elective surgery because its large molecular weight means that it is poorly absorbed. However, if it leaks into the peritoneal cavity, complications may arise. Few published studies have assessed the absorption, distribution, metabolism and excretion of PEG. Moreover, no published clinical data regarding complications due to the intra-peritoneal leakage of PEG-3350 could be found. We report on an elderly patient who developed the poisoning caused by leaking of PEG-3350 during bowel preparation. It resulted in severe metabolic acidosis, hypernatremia, hyperosmolality and a high anion gap, but it was effectively treated with early continuous renal replacement therapy after surgery.
Absorption ; Acid-Base Equilibrium ; Acidosis ; Aged* ; Colonoscopy ; Humans ; Hypernatremia ; Metabolism ; Molecular Weight ; Peritoneal Cavity ; Poisoning* ; Polyethylene Glycols* ; Renal Replacement Therapy ; Therapeutic Irrigation

The medial collateral ligament is the most commonly injured ligamentous structure of the knee. The management of the medial collateral ligament injuries were divided into surgical and conservative treatment. More recently, many investigators reported that isolated medial collateral ligament injuries did well under non-operative treatment. So, arthroscopic examination of the knee to rule out other intraarticular pathologic conditions such as cruciate ligament injuries, meniscal tear and osteochondral lesion is essential. From October 1993 to April 1995, we treated 45 cases of Grade III medial collateral ligament injuries and arthroscopic finding for cruciate ligament, meniscus, bony structure were analized in these cases. The result were as follows; 1. Anterior cruciate ligament injury:37.5% in +1 degree, 42.8% in +2 degree, 86.7% in +3 degree 2. Posterior cruciate ligament injury:12.5% in +1 degree, 13.4% in +2 degree, 33.3% in +3 degree 3. Meniscal injury:12.5% in +1 degree, 21.3% in +2 degree, 33.4% in +3 degree 4. Medial capsular ligament injury was more frequent and severe in the meniscofemoral ligament than in the meniscotibial ligament, but that finding was not correlated with degree of medial instability.
Anterior Cruciate Ligament ; Collateral Ligaments ; Humans ; Knee ; Ligaments ; Posterior Cruciate Ligament ; Research Personnel ; Rupture ; Tears

PURPOSE: MRI is known to be an effective imaging modality of the aorta and its role is steadily increasing in the evaluation of acquired aortic diseases including aortic dissections and aortic aneurysms. However, differentiation of the aortic dissections with thrombosed false lumen from the aortic aneurysm with mural thrombus in MRI has not been easy. Therefore, the authors tried to find the characteristic MR featrses which would to differentiate the two diseases. MATERIALS AND METHODS: MR images of 6 patients with thrombosed aortic dissection and 7 patients with thrombosed aortic aneurysms were reviewed retrospectively and compared in regand to shape and extent of thrombus, dimension of aorta, and luminal flow signal. RESULTS: Thrombosed aortic dissections showed sharply demarcated crescent shaped aortic wall thickening of even thickness involving long segment of the aorta, whereas thrombosed aortic aneurysms showed irregular aortic wall thickening of uneven thickness localized in the short dilated segment of the aorta. Characteristically aortic aneurysm with mural thrombus showed eccentric intraluminal slow flow signal. In contrast to the signal void of the true lumen in aortic dissections, the residual lumen of the aortic aneurysm with mural thrombus revealed intraluminal signal due to slow flow. CONCLUSION: Familiarity to these MRI findings of thrombosed aortic dissections and aortic aneurysms may lead to the accurate differential diagnosis in majority of cases.
Aorta ; Aortic Aneurysm* ; Aortic Diseases ; Diagnosis, Differential* ; Humans ; Magnetic Resonance Imaging* ; Phenobarbital ; Recognition (Psychology) ; Retrospective Studies ; Thrombosis

BACKGROUND: Abdominal pain is one of the most common complaints in the emergency department and the evaluation presents an extraordinary challenge to the emergency physician's skill. C-reactive protein, an acute phase protein which is increased in the presence of inflammation in various clinical conditions, has been proven useful in assessing disease severity, in monitoring the development of complications, and in evaluating the response to specific treatments. So we tried to determine whether CRP offers an advantage over other clinical or laboratory variables for decision-making in the management of acute abdominal pain in the emergency department. METHOD: Patients who came to a University Hospital ED with acute abdominal pain, between september 1, 1998 and November 30, 1998, were included in this study, Data collection included age, sex, duration of symptom, location of pain, and laboratory dta(white blood cell count, portion of neutrophils, ESR, CRP, amylase). RESULT: This study included 85 patients, 34 of whom were men. The mean age was 36.9+/-19.1 years. CRP might be useful to detect the serious condition, sensitivity 81%, but more useful to differentiate normal condition from serious condition in acute abdominal pain patients, specificity 83%. CONCLUSION: CRP is an useful indicator of decision-making to abdominal patients in the emergency department. Hospitalization or operation is very unlikely when CRP value is normal.
Abdominal Pain* ; Acute-Phase Proteins ; Blood Cell Count ; C-Reactive Protein* ; Data Collection ; Emergencies ; Emergency Service, Hospital ; Hospitalization ; Hospitals ; Humans ; Inflammation ; Male ; Neutrophils ; Sensitivity and Specificity

The transesophageal echocardiography (TEE) has been used for the assessment of right and left ventricular function, valvular structure and function, regional wall motion abnormalities and localization of intravascular catheters, cannular and prosthesis. We inserted the pulmonary artery catheter (PAC) under the guidance of intraoperative TEE because of the difficulty of placing PAC with the pressure tracing method in two patients. The PAC was inserted from right atrium to right ventricle with the basal four chamber view and advanced to pulmonary artery through pulmonary valve with the longitudinal view of TEE. We observed typical pulmonary arterial wave form to confirm the correct position. We suggest that the TEE can be used for successful placement of a PAC to facilitate manipulation of the catheter as an alternative method in the patients whose PAC can not be positioned with the pressure tracing method.
Catheters* ; Echocardiography, Transesophageal* ; Heart Atria ; Heart Ventricles ; Humans ; Prostheses and Implants ; Pulmonary Artery* ; Pulmonary Valve ; Ventricular Function, Left

BACKGROUND: The purpose of this study was to evaluate the efficacy of suction drain use following arthroscopic rotator cuff repair by comparing early pain score and range of motion (ROM) between groups with and without suction drains. METHODS: The study included 153 patients with rotator cuff tears who underwent arthroscopic repairs at our clinic from April 2014 to March 2015. Following surgery, a suction drain was used in 85 patients (group D) and not used in 68 patients (group ND). There was no statistical difference between the groups in terms of age, gender, or total operation time. The clinical outcome with regard to pain (assessed by pain scores and analgesic requests) and passive ROM was assessed preoperatively and postoperatively. RESULTS: Immediate postoperative analgesic requirement was significantly higher in group D (p=0.001), although there was no difference in pain outcomes between the groups during the 3-month follow-up period. A statistically significant difference in passive ROM was observed at the postoperative 2- and 6-week follow-ups (p=0.036, 0.035, and 0.034 in forward elevation (FE), external rotation at the side (ER) and 90 ER at weeks 2, respectively; 0.045 and 0.009 in FE and ER at weeks 6, respectively); however no significant difference was observed at the end of 3 months. During the study period, no complication was reported in either group. CONCLUSIONS: Use of suction drains after arthroscopic rotator cuff repair provided little benefit in terms of ROM or pain in the early postoperative period (up to 3 months).
Arthroscopy ; Follow-Up Studies ; Humans ; Postoperative Period ; Range of Motion, Articular ; Rotator Cuff* ; Shoulder ; Suction* ; Tears

Two cases of clear cell syringoma are reported in the women who were 39 ad 54 years old, respectively. They had had asymptomatic, ricegrain-sized skin colored to yellowish pink papules on the face, particularly on he lower eyelid for several years. Interestingly, both of them had suffered from diabetes mellitus for more than a decade and been placed on irregular antidiabetic medications. Routine laboratory findings in the elder patient(case 2), unfortunately not checked in the younger patient(cases 1) due to her refusal, were within normal limits except marked glucosuria. Histologic examination revealed numerous various-sized, well-defined tumor nests composed largely of clear cells with polygonal cellular boundary and eccentric nucleus. Special stain with Periodic acid-Schiff disclosed existance of glycogen in the clear cells, but other special stains such as alcian blue showed negative findings. Electron microscopic examination of the elder patient revealed many multivesicular bodies suggestive of lysosomes, and numerous droplets of glycogen dispersed between them in villi-rich periluminal cell.
Alcian Blue ; Coloring Agents ; Diabetes Mellitus ; Disulfiram ; Eyelids ; Female ; Glycogen ; Humans ; Lysosomes ; Middle Aged ; Multivesicular Bodies ; Skin ; Syringoma*

Dermoid cysts develop from sequestration of epithelium along lines of embryonic fusion.The most common locations are the lateral third of the eyebrows, nose, and scalp. These cysts are located in the subcutis; they are often adherent to periosteum, and may invade or erode underlying bane. A 34-year-old female presented with a solitary, skin colored, dome-shaped, child fistsized, subcutaneous mass on her right occiput. At operation, keratinous material was discharged and tufts of hair projected from opening of the cyst wall.The base of the cyst was firmly adherent to periosteum and diffuse depression with focal deep erosions of the outer table of skull was found.
Adult ; Child ; Cytochrome P-450 CYP1A1 ; Depression ; Dermoid Cyst* ; Epithelium ; Eyebrows ; Female ; Hair ; Humans ; Nose ; Periosteum ; Scalp ; Skin ; Skull*

BACKGROUND: Although one hair usually arises from a single follicular opening in normal healthy subjects, we can see two or more hairs emerging from the single opening through close inspection. The latter is called "compound hair", described by Lowenthal in 1946, however, few reports on this have been made since. Histopatholoigcally two or more hairs which have an independant external root sheath arise from one follicular opening like its clinical appearance. We examined the distribution and density of compound hair in order to define its difference according to anatomical sites and aging process. OBJECTIVE AND METHOD: We counted the number of hairs in the circle(2 cm in diameter) at te frontal, temporal and occipital scalp of 24 old young men(22.5+/-2.0 years old) and 24 old men(64.4+/-12.9 years old), respectively. RESULTS: The summated number of grouped hair, which was mostly regarded at compound hair, was greater in the young group than in old group in the frontal area, but was smaller in young group than in old group in from the temporal and occipital areas. The proportion of grouped hair to total hair in the older group was lower in the frontal area, but higher in the temporal and occipital areas(p<0.05, p<0.01) according to aging process, however, no significant change was seen between the frontal area and the sum of single hair to compound hair was significantly decreased in the temporal and occipital areas(p<0.05, p<0.01) according to aging process, however, no significant change was seen between the frontal area and the sum of the three tested areas. CONCLUSION: Compound hairs are observed frequently on the scalp of normal healthy subjects and are most frequently seen on the occipital scalp in both of the young and old.
Aging ; Hair* ; Scalp* ; Tuberculosis, Cutaneous

We report a patient with pachydermoperiostosis accompanied by hypertrophic gastritis. A 26-year-old man showed deep folds and furrows of the face and scalp, and terminal spade-like expansion of fingers and toes. Physical examination revealed no abnormalities except a grotesque appearance. Results of routine laboratory tests were unremarkable. Mild periosteal reactoins of both femurs and humeri were noted on long bone series, and hypertrophic gastritis on fibroscopic examination drew our attention. The relationship between pachydermoperiostosis and hypertrophic gastritis is uncertain. However it is probable that hypertrophic gastritis may be the endodermal counterpart of the ectodermal manifestations of pachydermoperiostosis.
Adult ; Ectoderm ; Endoderm ; Femur ; Fingers ; Gastritis, Hypertrophic* ; Humans ; Osteoarthropathy, Primary Hypertrophic* ; Physical Examination ; Scalp ; Toes