PURPOSE: There are a number of conditions that can lead to a hypercoagulable state, however, protein C and S deficiencies are frequently described as causes of the hypercoagulable states. The aim of this study was to evaluate the clinical features and prognosis of vascular diseases associated with protein C and/or S deficiencies and to determine an adequate treatment modality for such cases. METHODS: We prospectively evaluated 7 cases with vascular disease caused by protein C and/or S deficiencies confirmed with serologic tests. RESULTS: Four patients showed venous thrombosis, 1 peripheral arterial insufficiency, 1 cerebral venous thrombosis and peripheral arterial insufficiency, and 1 portal vein thrombosis. Surgical intervention was required in 5 patients. Full anticoagulation with heparin sodium followed by warfarin sodium was done in all patients. CONCLUSION: Protein C and S deficiencies may influence clinical management. Patients presenting with atypical vascular involvement without evidence of other risk factors should be evaluated for a hypercoagulable state. Once the diagnosis is made, patients should be treated with full anticoagulation.
Diagnosis ; Heparin ; Humans ; Prognosis ; Prospective Studies ; Protein C* ; Risk Factors ; Serologic Tests ; Vascular Diseases* ; Venous Thrombosis ; Warfarin

BACKGROUND: Tracheal intubation may be difficult in many patients with sleep apnea syndrome because of anatomical abnormalities in their upper airway. METHODS: For 30 patients with obstructive sleep apnea syndrome, we evaluated two classifications; Samsoon-Young and Cormack-Lehane, and five airway examinations; interincisors' distance on mouth opening (DI), angle on cervico-occipital extension (ACO), thyromental distance (TD), and existence of edentulous with atrophic mandible and prominent maxillary incisor. RESULTS: 20 patients (67%) belonged to class III or IV according to the Samsoon-Young classification and 22 patients (73%) to grade III or IV according to the Cormack-Lehane classification. The incidence rate for DI less than 40 mm, ACO less than 160o, TD less than 60 mm, atrophic mandible and prominent maxillary incisor were 30%, 37%, 50%, 13% and 27% respectively. CONCLUSIONS: According to our results, we concluded that most patients with obstructive sleep apnea syndrome are difficult for anesthesiologists to intubate. Therefore, we suggest that anesthesiologists must prepare variable methods for ventilation if there is any suspicion of difficult intubation in those patients.
Classification ; Humans ; Incidence ; Incisor ; Intubation ; Intubation, Intratracheal* ; Mandible ; Mouth ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Ventilation

BACKGROUND: The neuromuscular blocking effects of a nondepolarizing neuromuscular blocker (NDNM) during a nitroglycerin (NTG) infusion were significantly potentiated and prolonged. NTG reduced the requirement of a NDNM in surgical patients. We investigated the influence of a NTG single bolus injection on a mivacurium nuromuscular blockade. METHODS: We studied 36 adult surgical patients, ASA physical status I or II, between 15 and 53 years old. Neuromuscular monitoring was measured by TOF-GUARD (Biometer Co., Denmark). Anesthesia was induced by thiopental sodium 3-5 mg/kg and fentanyl 3 microgram/kg, and maintained with 3 L/min N2O, 2 L/min O2 and 1 vol.% isoflurane. Patients were randomly assigned to 3 groups: 1) Control group (mivacurium 0.16 mg/kg), 2) N100 group (mivacurium 0.16 mg/kg, NTG 100 microgram), 3) N200 group (mivacurium 0.16 mg/kg, NTG 200 microgram). We measured the train-of-four (TOF) response from the beginning of recovery to the complete regaining of muscle twitch. RESULTS: NTG produced a prolongation of the neuromuscular blocking effect by mivacurium. T1 (contro group: 12.1 +/- 0.5, N100 group: 15.8 +/- 0.4 and N200 group: 11.6 +/- 0.4 min), T25 (16.4 +/- 0.4, 20.5 +/- 0.5 and 14.9 +/- 1.0 min), T75 (22.5 +/- 0.9, 29.4 +/- 0.7 and 20.1 +/- 1.0 min), T95 (27.3 +/- 0.6, 39.6 +/- 0.7 and 24.6 +/- 1.5 min) and the recovery index (6.1 +/- 0.6, 9.0 +/- 0.4 and 5.3 +/- 0.7 min) were significantly prolonged in the N100 and N200 groups (P < 0.05). CONCLUSION: These results suggest that a NTG bolus injection prolonged the neuromuscular blocking effect of mivacurium, dose relatively.
Adult ; Anesthesia ; Fentanyl ; Humans ; Isoflurane ; Middle Aged ; Neuromuscular Blockade ; Neuromuscular Monitoring ; Nitroglycerin* ; Thiopental

Cytomegalovirus infections (CMV) of the gastrointestinal tract (GI) are common, and most often seen in patients with acquired immunodeficiency syndrome (AIDS), inflammatory bowel disease, or those receiving immunosuppressive therapy. CMV enteritis is uncommon in an immunocompetent individual. A CMV infection of the small bowel accounts for 4.3% of all CMV infections of the GI tract. The GI manifestations of CMV include: diarrhea, bleeding, obstruction and perforation, all of which are usually secondary to discrete erosions or ulceration. High mortality rates have been reported for CMV enteritis. Here, a rare case of CMV enteritis, resulting in segmental ileal ischemia, is reported in a 47-year old man following a traffic accident. On the 17th hospital day, he developed melena, watery diarrhea, fever and abdominal pain. An abdominal computed tomography (CT) on the 23rd hospital day showed an enlarged appendix with mild periappendiceal infiltration and segmental wall thickening in the terminal ileum. An ileocecal resection was performed. Pathological evaluation of the operative specimen revealed CMV inclusion bodies, with ulcerations. The patient was treated with ganciclovir therapy for 3 weeks after which his symptoms improved. If a CMV infection is highly suspected in multiply injured trauma victims, the earlier recognition of potential small bowel involvement can hopefully decrease the incidence of bleeding, ischemic demage to the bowel and perforation, which are usually fatal events.
Abdominal Pain ; Accidents, Traffic* ; Acquired Immunodeficiency Syndrome ; Appendix ; Cytomegalovirus Infections* ; Cytomegalovirus* ; Diarrhea ; Enteritis ; Fever ; Ganciclovir ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Ileum ; Incidence ; Inclusion Bodies ; Inflammatory Bowel Diseases ; Ischemia* ; Melena ; Middle Aged ; Mortality ; Multiple Trauma* ; Ulcer

BACKGROUND/AIMS: Hepatitis A is increasing during the recent years in Korea, and sporadic cases of hepatitis E are not rare. We investigated the etiology of acute viral hepatitis, including 27 cases of coinfection with hepatitis A and E, during the last 3 years. METHODS: Retrospective analysis of one hundred eleven patients with acute viral hepatitis at Chung-Ang University Hospital was done from January 2005 to July 2007. The patients were positive for any one of the following tests: IgM anti-HAV, IgM anti-HBc, HCV RNA and IgM anti-HEV. RESULTS: The proportions of acute viral hepatitis A, B and C were 94.6% (105/111), 4.5% (5/111) and 0.9% (1/111), respectively. Among the patients with hepatitis A, 27 patients (24.3%) were positive for IgM anti-HEV. We analyzed 105 patients with either hepatitis A only or they had coinfection of hepatitis A and E. The mean age, the duration of the hospital stay, the mean levels of serum transaminase, bilirubin and albumin and the protrombin time were similar between the patients with hepatitis A only and those with coinfection of hepatitis A and E. All the patients were discharged without serious complication such as fulminant hepatic failure. The biochemical liver function tests were normalized in all patients within 8 weeks. CONCLUSIONS: The most common etiology of acute viral hepatitis in Koreans was the hepatitis A virus. Patients coinfected with hepatitis A and E were observed. The patients with coinfection of hepatitis A and E showed no significant difference in their clinical features and laboratory parameters, as compared to the patients with hepatitis A only.
Bilirubin ; Coinfection ; Hepatitis ; Hepatitis A ; Hepatitis A Antibodies ; Hepatitis A virus ; Hepatitis E ; Humans ; Immunoglobulin M ; Korea ; Length of Stay ; Liver Failure, Acute ; Liver Function Tests ; Retrospective Studies ; RNA

A 14-yr-old male presented with a hemoperitoneum caused by a spontaneous rupture of a primary splenic cyst. The laparotomy showed a ruptured spleen at the lower pole from one of the multiple cyst-like lesions, measuring approximately 2 cm in diameter. After the splenectomy, a microscopic examination confirmed the diagnosis of a primary splenic cyst lined with a mature, well-differentiated squamous epithelium. A hemoperitoneum caused by a spontaneous rupture of a primary splenic cyst is a rare but potentially lethal complication, because most patients with a splenic rupture present with some degree of hypovolemia.
Diagnosis ; Epithelium ; Hemoperitoneum* ; Humans ; Hypovolemia ; Laparotomy ; Male ; Rupture ; Rupture, Spontaneous* ; Spleen ; Splenectomy ; Splenic Rupture

Paraduodenal hernia is a rare congenital anomaly caused by abnormal rotation of the midgut in embryonic stage, with part of the small intestine becoming trapped posterior to the mesocolon. Right and left paraduodenal hernias are distinct and separate entities, varying not only in anatomical structure but also in embryological origin. Paraduodenal hernia is a rare cause of acute intestinal obstruction. Careful clinical evaluation is needed for prompt surgical treatment. Because it is difficult to diagnose before exploration, and since paraduodenal hernia may cause potentially lethal complications such as obstruction, gangrene or bowel perforation, the possibility of internal hernia should be considered in any patient with acute intestinal obstruction who has no previous abdominal operation or external hernia. If paraduodenal hernia is suspected to be the cause of acute intestinal obstruction, the recommended tool for diagnosis is abdominal computed tomography. We experienced three cases of paraduodenal hernia, one case was right paraduodenal hernia while the others were left paraduodenal hernia.
Diagnosis ; Gangrene ; Hernia* ; Humans ; Intestinal Obstruction ; Intestine, Small ; Mesocolon

PURPOSE: This study was performed to evaluate the value of repeated CT scans for the non-operative management of patients with clinically stable blunt splenic trauma. METHODS: 49 consecutive patients with blunt splenic trauma were prospectively studied. Of these, 29 (59.2%) were initially managed non-operatively according to their clinical status and initial CT findings. A repeat CT scan was obtained within 7 days of admission. RESULTS: Of the 29 non-operatively managed patients, 5 (17.2%) required delayed surgical intervention: 3 presented with a change in thier clinical status, whereas the other 2 did not. In all 5 patients, a repeat CT scan revealed a deteriorating appearance of the splenic injury: active bleeding or an increased hematoma in 3, with splenic artery pseudoaneurysms in the other 2. CONCLUSION: This initial experience suggests that a repeat CT scan can provide valuable clinical information in selected cases on the diagnosis and management of a splenic injury to document the healing or progression of the injury.
Aneurysm, False ; Diagnosis ; Hematoma ; Hemorrhage ; Humans ; Prospective Studies ; Spleen ; Splenic Artery ; Tomography, X-Ray Computed*

Torsion of the gallbladder is a rare entity that is difficult to diagnose preoperatively. The condition occurs most often in the elderly. Although its etiology is unknown, a constant finding is the presence of the gallbladder on a mobile mesentery (floating gallbladder). Torsion, or volvulus, of the gallbladder occurs when it twists axially, with the subsequent occlusion of bile and/or blood flow. Herein, a case of torsion of the gallbladder is presented where preoperative computed tomographic scan and laparoscopy were successfully used to diagnose and treat this condition without the usual requirement of open exploration. Given the possibility of laparoscopic cholecystectomy and the increasing incidence with which torsion of the gallbladder is being witnessed today, the importance of a preoperative computed tomographic scan is emphasized when there is a high index of clinical suspicion.
Torsion/radiography/surgery ; Tomography, X-Ray Computed ; Humans ; Gallbladder Diseases/pathology/*radiography/*surgery ; Female ; Cholecystectomy, Laparoscopic ; Aged, 80 and over

Hepatocellular carcinoma has a great tendency to invade blood vessels, particularly the portal vein. Invasion into the biliary lumen has been considered to be a rather rare event. Ultrasonogram and endoscopic retrograde cholangiopancreatography of the patient, a 65-year-old man presenting with obstructive jaundice, revealed an obstructing mass at the common hepatic duct and dilatation of the intrahepatic bile ducts. Abdominal computed tomography and hepatic angiogram showed no abnormal mass and abnormal staining in the liver. Obstructive jaundice due to Klatskin's tumor was suspected preoperatively. During operation, although no tumor was palpable in the liver, an intraductal tumor measuring 3.5X3.0 cm was found in the common hepatic duct. Bile duct resection was performed in a patient. Histologically, the tumor, a hepatocellular carcinoma showing abundant eosinophilic cytoplasm, was structurally arranged in a solid and trabecular pattern. We report a case of hepatocellular carcinoma mainly presenting as Klatskin tumor.
Aged ; Bile Ducts ; Bile Ducts, Intrahepatic ; Blood Vessels ; Carcinoma, Hepatocellular* ; Cholangiopancreatography, Endoscopic Retrograde ; Cytoplasm ; Dilatation ; Eosinophils ; Hepatic Duct, Common ; Humans ; Jaundice, Obstructive ; Klatskin's Tumor* ; Liver ; Portal Vein ; Ultrasonography