A case of 26 years old male having horseshoe kidney associated with giant hydronephrosis due to aberrant vessel was presented with a brief review of the literatures. The patient was managed by division of isthmus and nephrectomy with good result.
Adult ; Humans ; Hydronephrosis* ; Kidney* ; Male ; Nephrectomy

BACKGROUND: Tumor necrosis factor(TNF)-alpha and Interleukin(IL)-1beta are thought to play a major role in the pathogenesis of the septic syndrome, which is frequently associated with adult respiratory distress syndrome(ARDS). In spite of many reports for the role of TNF-alpha in the pathogenesis of ARDS, including human studies, it has been reported that TNF-alpha is not sensitive and specific marker for impending ARDS. But there is a possibility that the results were affected by the diversity of pathogenetic mechanisms leading to the ARDS because of various underlying disorders of the study group in the previous reports. The purpose of the present study was to evaluate the roles of TNF-alpha and IL-lbeta as a predictable marker for development of ARDS in the patients with septic syndrome, in which the pathogenesis is believed to be mainly cytokine-mediated. METHODS: Thirty-six patients of the septic syndrome hospitalized in the intensive care units of the Asan Medical Center were studied. Sixteens suffered from ARDS, whereas the remaining 20 were at the risk of developing ARDS(acute hypoxemic respiratory failure, AHRF). In all patients venous blood sample were collected in heparin-coated tubes at the time of enrollment, at 24 and 72 h thereafter. TNF-alpha and IL-lbeta was measured by an enzyme-linked immunosorbent assay (ELISA). All data are expressed as median with interquartile range. RESULTS: 1) Plama TNF-alpha levels: Plasma TNF-beta levels were less than 10pg/mL, which is lowest detection value of the kit used in this study within the range of the mean+/-2SD, in all of the normal controls, 8 of 16 subjects of ARDS and in 8 in 20 subjects of AHRF. Plasma TNF-alpha levels from patients with ARDS were 10.26pg/mL(median;<10-16.99pg/mL, interquartile range) and not different from those of patients at AHRF(10.82, <10-20.38pg/mL). There was also no significant difference between pre-ARDS(<10, <10-15.32pg/mL) and ARDS(<10, <10-10.22pg/mL). TNF-alpha levels were significantly greater in the patients with shock than the patients without shock(12.53pg/mL vs. <10pg/mL) (P<0.01). There was no statistical significance between survivors(< 10, <10-12.92pg/mL) and nonsurvivors(11.80, <10-20.8pg/mL) (P=0.28) in the plasma TNF-alpha levels. 2) Plasma IL-lbeta levels: Plasma IL-1beta levels were less than 0.3ng/mL, which is the lowest detection value of the kit used in this study, in one of each patients group. There was no significant difference in IL-1beta levels of the ARDS(2.22, 1.37-8.01ng/mL) and of the AHRF(2.13, 0.83-5.29ng/mL). There was also no significant difference between pre-ARDS(2.53, <0.3-8.34ng/mL) and ARDS(5.35, 0.66-11.51ng/mL), and between patients with septic shock and patients without shock (2.51, 1.28-8.34 vs 1.46, 0.15-2.13ng/mL). Plasma IL-19 levels were significantly different between survivors(1.37, 0.4-2.36ng/mL) and nonsurvivors(2.84, 1.46-8.34ng/mL). CONCLUSION: Plasma TNF-alpha and IL-1beta level are not a predictable marker for development of ARDS. But TNF-alpha is a marker for shock in septic syndrome. These result could not exclude a possibility of pathophysiologic roles of TNF-alpha and IL-1beta in acute lung injury because these cytokine could be locally produced and exert its effects within the lungs.
Acute Lung Injury ; Adult* ; Chungcheongnam-do ; Enzyme-Linked Immunosorbent Assay ; Humans ; Intensive Care Units ; Interleukin-1beta* ; Lung ; Lymphotoxin-alpha ; Necrosis ; Plasma ; Respiratory Distress Syndrome, Adult* ; Respiratory Insufficiency ; Shock ; Shock, Septic ; Tumor Necrosis Factor-alpha*

No abstract available.

To compare the regenerative effect of direct end-to-end suture, nerve graft and sutureless fibrin glue repair in the rat sciatic model, forty rats were divided into 4 groups: normal control group(NC-G, n=6), direct end-to-end suture group(DS-G, n=12), nerve graft group(NG-G, n=10) and sutureless fibrin glue group(FG-G, n=12). One half of each group except NC-G was sacrificed 4 weeks later and the other half was sacrificed 14 weeks later. The repair site was assessed by nerve conduction studies and quantitative morphometry. Regeneration index (RI) was defined as a total number of remyelinated axons in one quarter of 3X5 inch sized microphotograph. The comparison among groups was analyzed statistically by Kruskal-Wallis 1-way ANOVA and Mann-Whitney test. Nerve conduction study done 14 weeks later revealed that latency was 1.7ms+/-0.18(DS-G), 2.4ms+/-0.35(NG-G), 2.4ms+/-0.17(FG-G) and amplitude was 20.1mV+/-2.89(DS-G), 12.0mV+/-2.47(NG-G), 13.7mV+/-2.95(FG-G). RI was 281+/-37.5(DS-G), 227+/-14.4(NG-G) and 217+/-22.2(FG-G). There was a statistical difference in the latency, amplitude and RI between three groups(p<0.05), but there was no statistical difference in the latency, amplitude and RI between FG-G and NG-G(p>0.05). Regenerative effect of fibrin glue is not different from that of nerve graft, therefore fibrin glue repair can facilitate inaccessible nerve repairs in skull base or spinal surgery.
Animals ; Axons ; Fibrin Tissue Adhesive* ; Fibrin* ; Neural Conduction ; Rats* ; Regeneration ; Sciatic Nerve* ; Skull Base ; Sutures ; Transplants

Bilateral chylothorax as a complication of modified radical neck dissection is extremely rare, but it is potentially serious and sometimes fatal. Early diagnosis and proper management is very important. We report here on a case of bilateral chylothorax following left modified radical neck dissection that was successfully treated with conservative management.
Chylothorax* ; Early Diagnosis ; Lymph Node Excision* ; Lymph Nodes* ; Neck Dissection ; Neck* ; Thyroid Neoplasms

PURPOSE: Although the diagnostic accuracy of thyroid cancer by fine needle aspiration cytology (FNAC) is increasing, there are some nodules for which ultrasonography and FNAC show indeterminant. The purpose of this study was to determine the usefulness of thyroid ultrasonography by the surgeon prior to operation METHODS: Forty-nine patients who underwent thyroid operations between June 2006 and January 2007 were selected for this study. Thyroid ultrasonography was performed on each patient.And we recorded and analyzed the shape and the margin of the nodule, internal echogeneiety, heterogeneiety, the presence of microcalcification, height versus width, and the presence of level VI lymph node larger than 3 mm, assigning each a score of 1, 2 or 3. RESULTS: The average score was 17.1. Assuming an average score over 14 is considered to be malignant, the sensitivity, specificity, positive predictive value, and negative predictive value were 95.6%, 88.9%, 91.7%, 94.1% respectively. Statistically significant characteristics of malignancy were the shape and the margin of the nodule, internal echogeneiety, microcalcification, taller than wide shape and the presence of enlarged VI lymph nodes. The heterogeneiety had no significant P value. CONCLUSION: When malignancy cannot be confirmed even after repeated FNAC, preoperative ultrasonograpy performed by surgeons can be a reliable test and helpful for operations.
Biopsy, Fine-Needle ; Humans ; Lymph Nodes ; Sensitivity and Specificity ; Surgeons* ; Thyroid Gland* ; Thyroid Neoplasms ; Ultrasonography*

BACKGROUND: Postprimary pulmonary tuberculosis is located mainly in upper lobes. The tuberculous lesion involving the lower lobes usually arises from the upper lobe cavity through endobronchial spread. When tuberculosis is confined to the lower lung field, it often masquerades as pneumonia, lung cancer, bronchiectasis, or lung ahscess. Thus the correct diagnosis may be sometimes delayed for a long time. METHODS: We carried out, retrospectively, a clinical study on 50 patients confirmed with lower lung field tuberculosis who visited the Department of Pulmonary Medicine at Hanyang University Hospital from January 1992 to December 1994. The following results were obtained. RESULTS: Lower lung field tuberculosis without concomitant upper lobe disease occurred in fifty patients representing 6.9% of the total admission with active pulmonary tuberculosis over a period of 3 years. It occurred most frequently in the third decade but age distribution was relatively even. The mean age was 43 years old. Female was more frequently affected than male (male to female ratio 1:1.9). The most common symptom was cough(68%), followed by sputum(52%), fever(38%), and chest discomfort(30%). On chest X-ray of the S0patients, consolidation was the most common finding in 52%, followed by solitary nodule(22%), collapse(16%), cavitary lesion(l0%), in decreasing order. The disease confined to the right side in 25 cases, left side 20 cases, and both sides 5 cases. Endobronchial tuberculosis (1) Endobronchial involvement was proved by bronchoscopic examination in 20 of S0patients. (2) Mean age was 44years old and female was more affected than man (male to female ratio 1 : 3). Sputum AFB stain and Mycobacterium tuberculosis culture were positive only in 50% of cases unlikely upper lobe tuberculosis, additional diagnostic methods were needed. In our study, bronchoscopic examination and percutaneous fine needle aspiration biopsy increased diagnostic yield by 18% and 32%, respectively. The most common associated condition was diabetes mellitus(18%) and others were anemia, anorexia nervosa, stomach cancer, and systemic steroid usage. CONCLUSION: When we find a lower lung field lesion, we should suspect tuberculosis if the patient has diabetes mellitus, anemia, systemic steroid usage, malignancy or other immune suppressed states. Because diagnostic yield of sputum AFB smear & Mycobacterium tuberculosis culture was low, additional diagnostic methods such as bronchoscopy and fine needle aspiration biopsy were needed.
Adult ; Age Distribution ; Anemia ; Anorexia Nervosa ; Biopsy ; Biopsy, Fine-Needle ; Bronchiectasis ; Bronchoscopy ; Diabetes Mellitus ; Diagnosis ; Female ; Humans ; Lung Neoplasms ; Lung* ; Male ; Mycobacterium tuberculosis ; Pneumonia ; Pulmonary Medicine ; Retrospective Studies ; Sputum ; Stomach Neoplasms ; Thorax ; Tuberculosis* ; Tuberculosis, Pulmonary

We report a case of plaque stage of dermatofibrosarcoma protuberans(DFSP). A 36-year-old female visited our clinic with a 10-year history of solitary deep seated palpable erythematous plaque on right anterior chest. There was no history of previous trauma at the site of the lesion. Histopathologic findings are characterized by a flat surface, lower cellularity and slender spindle-shaped neoplastic cells diffusely infiltrated dermis and subcutaneous tissue. The slender neoplastic cells have uniform nuclei with no evidence of cytologic atypia. Especially earlier plaque or nonprotuberans stage of the DFSP could be confused with benign lesions such as dermatofibroma or diffuse neurofibroma. Because plaque areas are strongly positive for CD34, this antibody is very helpful in differentiating other benign tumors.
Adult ; Dermatofibrosarcoma* ; Dermis ; Female ; Histiocytoma, Benign Fibrous ; Humans ; Neurofibroma ; Subcutaneous Tissue ; Thorax

Pseudoxanthoma elasticum (PXE) is a heritable disorder of elastic tissue and it has many systemic manifestations. PXE is a systemic disorder that most markedly affects the elastic tissues in the skin, retina and blood vessels. Defects in the ABCC6 gene lead to calcification of elastic tissue. We herein report on two cases of pseudoxanthoma elasticum that presented with focal involvement on the skin of the neck without marked wrinkling.
Blood Vessels ; Elastic Tissue ; Neck ; Pseudoxanthoma Elasticum ; Retina ; Skin

Approximately 1% of all the meningiomas arise from the extradural space. Intradiploic meningiomas constitutes only a very small percentage of this figure. Because of its rarity, it is often confused preoperatively with primary bone tumors of the skull. The intradiploic meningioma of the orbital wall may be considered as a subgroup of intradiploic ectopic meningioma. The following is our report of a recently observed case of intradiploic meningioma of the orbital wall without intracranial or intraorbital involvement. The preoperative tentative diagnosis was osteoma of the orbital wall. Nomenclature and histogenesis of this type of meningioma are discussed.
Diagnosis ; Meningioma* ; Orbit* ; Osteoma* ; Skull