A 56-year-old man who had suffered from intermittent right upper quadrant abdominal pain for 6 months and jaundice for 2 months was admitted for evaluation. Endoscopic retrograde cholangio-pancreatography showed filling defect which suggested tumor. Peroral choledo-choscopy was performed which showed polypoid tumor of the common hepatic duct and biopsy reported as papiilary adenocarcinoma. So segmental resection of the bile duct including removal of tumor with Roux-en Y hepaticojejunostomy was performed successfully.
Abdominal Pain ; Adenocarcinoma ; Adenocarcinoma, Papillary* ; Bile Ducts ; Biopsy ; Hepatic Duct, Common* ; Humans ; Jaundice ; Middle Aged

A 56-year-old man who had suffered from intermittent right upper quadrant abdominal pain for 6 months and jaundice for 2 months was admitted for evaluation. Endoscopic retrograde cholangio-pancreatography showed filling defect which suggested tumor. Peroral choledo-choscopy was performed which showed polypoid tumor of the common hepatic duct and biopsy reported as papiilary adenocarcinoma. So segmental resection of the bile duct including removal of tumor with Roux-en Y hepaticojejunostomy was performed successfully.
Abdominal Pain ; Adenocarcinoma ; Adenocarcinoma, Papillary* ; Bile Ducts ; Biopsy ; Hepatic Duct, Common* ; Humans ; Jaundice ; Middle Aged

Influences of intracerebroventricular(icv) ouabain on cardiovascular system and on pressor response to raised intracranial pressure(ICP) were investigated in urethane-anesthetized rabbits. Intravenous(iv) 40 microgram/kg ouabain did not affect blood pressure of rabbit. Icv ouabain(5, 10, 20 microgram/kg) and digoxin(6.25, 12.5 microgram/kg) produced dose-dependent pressor responses and marked decrease of heart rate. After bilateral vagotomy, the bradycardiac effect of ouabain disappeared, while the pressor effect was significantly potentiated. The ouabain-induced pressor effect was not affected by iv and icy phentolamine or propranolol, and significantly inhibited by icy infusion of lidocaine(0.1 mg/kg/min) and diazepam(0.025 mg/kg/min). The pressor response to raised ICP was not affected by iv 40 microgram/kg ouabain but disappeared by icy 10 microgram/kg ouabain and 6.25 microgram/kg digoxin. These data suggests that ouabain causes pressor effect through direct interaction with a site(s) in central nervous system and bradycardiac effect by direct activation of vagal center, and ouabain blocks central sympathetic stimulation by increase of ICP in rabbits.
Blood Pressure ; Cardiovascular System* ; Central Nervous System ; Digitalis* ; Digoxin ; Heart Rate ; Intracranial Pressure ; Ouabain ; Phentolamine ; Propranolol ; Rabbits* ; Vagotomy

Undifferentiated sarcoma is one of the rare primary malignant tumor of the liver typically occur ring in later childhood. It has also been referred to embryonal sarcoma or malignant mesenchymoma. In Korea, three child and two adult cases have been reported to date in liter ature. We experienced a case of undifferentiated sarcoma in a 65- year- old female who presented with abdominal pain and right upper quadrant mass . Contrast-enhanced abdominal CT scan revealed a well demarcated mass with low at tenuation and sept ation at left lobe of the liver and the mass showed hypovas cular pattern on hepatic angiography. On cross section, the tumor was well demarcated from the adjacent liver by afibr ouspseudocapsule and showed cystic degener ation. Pathologically, the tumor was consistent with an undifferentiated sarcoma of the liver.
Abdominal Pain ; Adult* ; Angiography ; Child ; Female ; Humans ; Korea ; Liver* ; Mesenchymoma ; Sarcoma* ; Tomography, X-Ray Computed

OBJECTIVE: A dichotomous Thl and Th2 cytokine profile has been associated with reproductive failure and success, respectively. The purpose of our study was to determine the levels of Thl cytokine (IFN- y ) secreted by peripheral blood mononuclear cells (PBMCs) form women with unexplained recurrentabortion (URA) and fertile controls in response to trophoblast antigen. METHODS: PBMCs were isolated from 30 nonpregnant women with URA and from 10 nonpregnant fertile controls. Following 4 days of culture (1 * 10(6) cells/mL) with and without a protein extract derived from a trophoblast cell line (30 ug/mL, protein). None of the women had allergies, atopy or recent infection. Cytokines were measured in supernatants with enzyme-linked immunosorbent assay (ELISA) kits. IFN- r kit was obtained from BOISOURCE (lower limit of sensitivity, 15.6 pg/mL for IFN- r ). All values below the lowest limit of sensitivity as determined by test kit standards were considered negative. The cytokine stimulation test is considered positive if the IFN- r concentration increases by 200% or more with the trophoblast antigen stimulation. Datas are presented as mean+ SEM. Nonparametric testing (Mann-Whitney U) was used for analysis with P<0.05 considered statistically significant. RESULTS: The Thl-type cytokine (IFN- r ) was detected in 20(67%) of 30 supernatants from women with URA. In contrast, 2 (20%) of trophoblast-activated PBMC culture supernatants from the 10 parus women with normal reproductive histories was detected IFN- r and but were significantly lower than levels in women with URA who had secreted IFN- r upon trophoblast stimulation (99.80+ 18.17 pg/mL versus 166.47 + 36.96 pg/mL, p<0.05). Spontaneous secretion of IFN- r was significantly higher in culture supernatants from women with URA than in supernatants from women with successful reproductive histories (41.36.09+6.99 pg/mL versus 25.89+9.34 pg/mL, p<0.05). CONCLUSION: These data indicate that there are significant differences between women with URA and women with normal reproductive histories in their regulation of the Thl-cytokine (IFN- r) in response to trophoblast. Thl-type immunity to trophoblast is associated with URA and may play a role in reproductive failure.
Abortion, Spontaneous* ; Cell Line ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Hypersensitivity ; Pregnancy ; Reproductive History ; Trophoblasts*

No abstract available.
Arthritis, Psoriatic* ; HLA-B27 Antigen ; Korea* ; Prevalence* ; Psoriasis ; Spondylitis

Symptomatic muscular rings are extremely rare, and some authors have even disputed their existence. The lower esophageal muscular ring, or A ring, located about 2cm proximal to the squamocolumnar junction and are covered by squamous epithelium. These rings consist of an annular narrowing of hypertrophic muscular tissue in the esophageal body. Recently, we experienced 2 cases of symptomatic muscular ring of the esophagus and the findings. Case 1) A 52 year-old male with dysphagia, chest pain and regurgitation for several years, had esophagogram, endoscopy, esophageal motility studies and chest CT. Under the diagnosis of esophageal muscular ring, the patient had pneumatic baUoon dilatation (3.0 cm in diameter, Rigiflex), under which the patient experienced perforation of the lower esophagus and required surgery. We confirmed muscular ring of the esophagus as shown by a thickened muscularis propria layer, without other pathologic findings. Case 2) A 60 year-old male complaining of intermittent dysphagia, had esophagogram, endoscopy, esophageal motility studies and EUS. Under the diagnosis of esophageal muscular ring, he is now being treated with calcium channel blocker and nitrate, and has experienced minimal symptom improvement. We report 2 cases of symptomatic muscular ring of low esophagus with review of literature.
Calcium Channels ; Chest Pain ; Deglutition Disorders ; Diagnosis ; Dilatation ; Endoscopy ; Epithelium ; Esophagus* ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed

BACKGROUND: Deep burns of the elbow lead to soft tissue necrosis and infection, with exposure of deep structures. Adequate wound coverage of this area requires thin, pliable, and durable tissue, while optimal functional recovery requires early coverage and functional rehabilitation. We have found 3 types of island flaps that provide reliable coverage for the elbow. METHODS: A retrospective study was performed on all patients who underwent flap coverage of an elbow defect at our hospital. The patients' data including age, sex, cause of injury, wound dimensions, timing of flap coverage, postoperative elbow motion, and complications were investigated. RESULTS: Between 2001 and 2012, 16 patients were treated at our hospital. The mean age was 53.3 years. Three kinds of flaps were performed: 9 latissimus dorsi flaps, 4 lateral arm flaps, and 4 radial forearm flaps. The average defect size was 183.5 cm2 (range, 28 to 670 cm2). Wound coverage was performed at mean duration of 45.9 days (range, 14 to 91 days). The mean postoperative active elbow flexion was 98degrees (range, 85degrees to 115degrees). Partial flap failure occurred in 1 latissimus dorsi flap. Minor complications included partial flap loss (11.8%), hematoma (23.5%), seroma (35.3%), and wound infection (5.9%). CONCLUSIONS: Flap selection for elbow reconstruction is determined by the defect size and the extent of the adjacent tissue injury. Elbow reconstruction using an island flap is a single-staged, reliable, and relatively simple procedure that permits initiation of early rehabilitation, thereby improving a patient's functional outcome.
Arm ; Burns ; Elbow ; Forearm ; Hematoma ; Humans ; Necrosis ; Retrospective Studies ; Seroma ; Surgical Flaps ; Wound Infection

The purpose of this study was firstly, to evaluate the efficacy of coronary stenting in ESRD patients compared with non uremic patients and secondly, to compare the perioperative mortality of coronary artery bypass grafting(CABG) in ESRD patients with that in non-uremic patients exhibiting a similar degree of left ventricular function. We examined the clinical restenosis of coronary stenting and 30 day mortality rate after CABG in this retrospective, case-controlled study. The case histories of twenty-five ESRD patients with ischemic heart disease(IHD) and twenty-five non-uremic IHD patients matched for age, sex, ejection fraction and number of implanted stents, who had undergone first, elective, primarily successful coronary stenting were reviewed. The case of histories of another sixteen ESRD patients with IHD and sixteen non-uremic IHD patients matched for age, sex, ejection fraction and number of grafted vessels, who had undergone first elective CABG were also reviewed. Clinical restenosis developed in nine of the twenty-five ESRD patients and in eight of the twenty-five non-uremic patients after coronary stenting within follow up periods of 16.9+/-14.5 months and 17.6+/-14.6 months, respectively. There was no significant difference in the cumulative clinical restenosis free curves between the two groups(p=0.79). Three out of sixteen for the ESRD patients and one out of sixteen for the non-uremic patients died in 30 days after CABG, follow up periods being 11.3+/-9.6 months and 11.1+/-8.9 months, respectively. The perioperative mortality did not differ between the two groups(p=0.28). We conclude that coronary stenting in ESRD patients is as effective as in non-uremic patients regarding initial coronary revascularization and perioperative mortality rate of CABG in ESRD patients is not significantly higher compared with non-uremic patients when Left ventricular function is matched.
Case-Control Studies ; Coronary Artery Bypass* ; Coronary Vessels* ; Follow-Up Studies ; Heart ; Humans ; Kidney Failure, Chronic ; Mortality ; Myocardial Ischemia* ; Retrospective Studies ; Stents* ; Transplants ; Ventricular Function, Left

Nowadays, tumor necrosis factor-alpha (TNF-alpha) blockers are used for treatment of rheumatoid arthritis, inflammatory bowel diseases, ankylosing spondylitis, psoriatic arthritis, and psoriasis. Paradoxically, there are some reports on the appearance of psoriasis after administration of TNF-alpha blockers. Here, we report on a patient with monoarthritis in a knee joint who experienced psoriasis after TNF-alpha blocker therapy (adalimumab and etanercept). Oral medication was not a treatment option due to patient intolerance; thus, we tried ustekinumab, an anti-interleukin (IL)-12/23 monoclonal antibody used for treatment of psoriasis. Following ustekinumab injection, psoriatic skin lesions and joint symptoms were much improved. However, in the following period, joint pain and swelling became aggravated and synovial fluid cytokine levels including IL-6 and IL-17 were elevated. The treatment was changed to tocilizumab, a humanized monoclonal antibody against IL-6 receptor. After injection, knee joint swelling rapidly subsided without worsening of psoriatic skin lesions.
Arthralgia ; Arthritis, Psoriatic ; Arthritis, Rheumatoid ; Humans ; Inflammatory Bowel Diseases ; Interleukin-17 ; Interleukin-6 ; Joints ; Knee Joint ; Psoriasis* ; Receptors, Interleukin-6 ; Skin ; Spondylitis, Ankylosing ; Synovial Fluid ; Tumor Necrosis Factor-alpha* ; Ustekinumab