Colorectoanal intussusception is a rare and distinct entity that differs from the more common rectal prolapse. Typically the intussusception occurrs with tumor at the apex of the intussuscepted segment acting as lead point. Here we present a case and review the literature of colorectoanal intussusception. The case presented here is that of an elderly woman with a proximal sigmoid colon cancer at its apex. Anterior resection was electively performed after reduction of the intussusception. It is important to differentiate a colorectoanal intussusception from the more common rectal prolapse because treatment may differ. The anorectum remains in its normal anatomic position in colorectoanal intussusception, whereas the anal canal is effaced with the prolapsed segment of bowel in rectal prolapse. Identification of a tumor at the apex of the intussuscepted bowel should also arouse suspicion that the condition is not a rectal prolapse.
Aged ; Anal Canal ; Colonic Neoplasms ; Female ; Humans ; Intussusception* ; Rectal Prolapse ; Sigmoid Neoplasms

Genes encoding sequence-specific DNA binding proteins have been isolated by screening cDNA libraries constructed in rgt11 expression vector with recognition site DNAs. We isolated a rgt11 recombinant human cDNA clone, designated to C2, using a DNA probe consisted of heptamer of the perfect palindrome (PP; GGGGATTCCCC) of enhancer A (Enh A) of HLA dass I promoter. Sequencing analysis showed that this clone contained a partial cDNA homologous to NF-kB2. Lysogenic E. coli containing the C2 was generated and crude cell extract was prepared. Immunoblot using anti-B-galactosidase antibody showed that this lysogenic E. coli expressed B-galactosidase fusion protein. Electrophoretic mobility shift assay (EMSA) and DNase I footprinting assay were done using crude cell extract and their patterns were compared with nuclear protein extracted from an EBV transformed B lymphoblastoid cell line (BLCL). EMSA showed that crude cell extract prepared from E. coli lysogen speci5cally bound to the PP of Enh A region of HLA class I gene. DNase I footprinting assay showed that the binding sequence of this recombinant B-galactosidase fusion protein was identical to that of nuclear protein extracted from a BLCL. Our data indicate that a Agt11 recombinant cDNA clone was isolated from a human cDNA library using the PP of Enh A of the HLA class I promoter and this clone encoded a B-galactosidase fusion protein capable of binding to the PP and belongs to a NF-xB subunit.
Cell Line ; Clone Cells ; Deoxyribonuclease I ; DNA ; DNA, Complementary* ; DNA-Binding Proteins ; Electrophoretic Mobility Shift Assay ; Gene Library ; Genes, MHC Class I ; Herpesvirus 4, Human ; Humans* ; Mass Screening ; Nuclear Proteins

PURPOSE: Neonatal hyperbilirubinemia has benign courses in most cases, but the possibility of toxicity of hyperbilirubinemia required courses examination of every newborn infant to identify the severity of hyperbilirubinemia progress. This study aims to see how the body surface area of newborns influences the decline rate of serum bilirubin level in conventional phototherapy. METHODS: Based on the charts of the Pediatrics Department, Dae-Dong Hospital from January 2003 to December 2006, we analyzed 168 neonates diagnosed as neonatal hyperbilirubinemia (serum bilirubin > or =15 mg/dL) in retrospective way. We excluded newborn infants under 37 weeks of gestation and under 2,500 g birth weight and classified neonates into four groups by the calculation results of body surface area:males above 75 percentile (group A), males below 25 (group B), females above 75 (group C), and females below 25 (group D). RESULTS: Out of 168 samples, the number of group A, B, C, D was 30, 20, 20, 15 respectively. In conventional phototherapy, the mean decline rates of serum bilirubin of group B and D recording 2.09 mg/dL/day and 1.77 mg/dL/day, were significantly faster than those of group A and C recording 1.63 mg/dL/day and 1.41 mg/dL/day (P<0.01). No significant differences were found in different duration of phototherapy between groups below 25 percentile and those above 75 in both genders. CONCLUSION: In conclusion, body surface area influences of infants the decline rate of serum bilirubin level in conventional phototherapy.
Bilirubin* ; Birth Weight ; Body Surface Area* ; Female ; Humans ; Hyperbilirubinemia ; Hyperbilirubinemia, Neonatal ; Infant ; Infant, Newborn ; Male ; Pediatrics ; Phototherapy* ; Pregnancy ; Retrospective Studies

BACKGROUND: Inguinal hernia is one of the most common surgical diseases in pediatric patients. We reviewed pediatric inguinal hernia cases retrospectively to analyze the clinical characteristics. METHODS: We reviewed 200 herniorrhaphies in 194 patients who were under the age of 15 and who were operated on at Chungbuk National University Hospital from January 1992 to July 1997. RESULTS: 1) All of the cases were indirect inguinal hernias. Sliding hernias were noticed in 6 cases. High ligations were performed in all cases except 2 cases of Bassini operations. 2) Boys were affected 3.4 times more often than girls. 56.2% of the hernias occurred on the right side, 35.0% on the left side, and 8.8% bilaterally. Bilateral inguinal hernias occurred more often in girls (13.6%) than in boys (7.3%). 3) Hernias were noticed under the age of 1 year (47.9% of the cases). In most of those cases, operations were delayed. Especially, the operations were delayed more than 3 months for 82.1% of patients with hernias and under the age of 6 months. 4) On admission, most patients complained of inguinal or scrotal swelling and inguinal pain or discomfort. 5) Hospitalization occurred in 20.6% of the cases, 3 of which needed emergency operations. Hospitalization occurred in 47.5% of the cases under the age of 1 year; in those cases, hernias were noticed within the first 6 months, and in most of those cases, operations were delayed more than 3 months. 6) Postoperative complications occurred in 9 cases, i.e., 8 cases of scrotal swelling and 1 case of scrotal hematoma. There were no recurrent cases after operation (average follow-up of 33 months). 7) After unilateral inguinal hernia repairs, contralateral hernias developed in 10 patients including 4 patients who had had received their first hernia operations at other hospitals. The sex ratio was 9:1. Laterality of the first hernias were right in 5 cases and left in 5 cases. Contralateral hernias developed within an average of 4.8 months after the first operation; however, 6 cases developed within 6 months after the first operation. CONCLUSIONS: Education for early operation to prevent complications of hernias and careful evaluation of contralateral inguinal hernias in unilateral hernias are needed in the treatment of pediatric inguinal hernias.
Chungcheongbuk-do ; Education ; Emergencies ; Female ; Follow-Up Studies ; Hematoma ; Hernia ; Hernia, Inguinal* ; Herniorrhaphy ; Hospitalization ; Humans ; Ligation ; Postoperative Complications ; Retrospective Studies ; Sex Ratio

A case of transient neonatal diabetes mellitus combined with congenital adrenal hyperplasia(CAH) is described. A female infant was born by cesarean delivery due to fetal distress, she had sunken eyeball and anterior fontanelle, large protruded tongue and thin subcutaneous tissues. She had large clitoris and progressive pigmentation on whole body was observed since 10th day of birth. Hyperglycemia and glycosuria was noted at 3rd day of birth. Level of insulin and C-peptide was 3.0 mU/L and 0.35 ng/mL respectively. Serum ACTH was 870.4 pg/mL and 17-hydroxyprogesterone was increased to 20,000 ng/dL. Serum Na was 124 mEq/L, K 5.6 mEq/L. Abdominal MRI showed no abnormality. Chromosomal study showed 46,XX. Genetic analysis with polymorphic DNA markers for chromosome 6 showed paternal uniparental isodisomy at D6S276, D6S1704 and DNA analysis of CYP 21 gene showed mutation at P435S. She required insulin therapy for 8 months after birth. Hydrocortisone and florinef was needed for the control of CAH.
17-alpha-Hydroxyprogesterone ; Adrenal Hyperplasia, Congenital* ; Adrenocorticotropic Hormone ; C-Peptide ; Chromosomes, Human, Pair 6 ; Clitoris ; Cranial Fontanelles ; Diabetes Mellitus* ; DNA ; Female ; Fetal Distress ; Genetic Markers ; Glycosuria ; Humans ; Hydrocortisone ; Hyperglycemia ; Infant ; Insulin ; Magnetic Resonance Imaging ; Parturition ; Pigmentation ; Subcutaneous Tissue ; Tongue ; Uniparental Disomy

Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.
Adult ; Anesthesia, General ; Cesarean Section ; Emergencies ; Female ; Heart Arrest* ; Hemorrhage ; Humans ; Hypothermia ; Hypothermia, Induced* ; Hysterectomy* ; Maternal Mortality ; Placenta Accreta ; Postpartum Hemorrhage* ; Postpartum Period* ; Pregnancy ; Pregnant Women ; Resuscitation

No abstract available.
Female ; Pregnancy ; Pregnancy, Abdominal*

We performed anorectal physiologic studies to evaluate the pelvic floor musculature and its innervation in 73 pregnant women(35 primiparous, 38 multiparous) who had been recruited into a study of pudendal nerve damage and its recovery in vaginal delivery as part of a prospective investigation. These women had all delivered by vaginal route with pros terolateral episiotomy. Pudendal nerve terminal motor latency was significantly increased 2~3 days after delivery but substantial recovery occurred in the first 2 months after delivery nearly to the pre-delivery value. Maximum average resting pressure was not affected by delivery. In contrast, maximum average squeeze pressure was decreased significantly 2~3 days after delivery and some recovery occurred in the first 6 months after delivery, which still remained significantly low relative to pre-delivery value. Perineal descent was significantly increased 2~3 days after delivery but substantial recovery occurred in the first 2 months after delivery, which still remained significantly low relative to pre-delivery value and thereafter no significant recovery was found. These results suggest pudendal nerve damage occurrs during vaginal delivery which recovers in the first 2 months after delivery but functional disturbance in pelvic floor sphincter muscuature persists thereafter, and we support avoidance of further vaginal delivery after previous damage to the innervation of pelvic floor sphincter musculature.
Episiotomy ; Female ; Humans ; Pelvic Floor ; Prospective Studies ; Pudendal Nerve*

No abstract available.
Ultrasonography*

BACKGROUND: Nitric Oxide (NO) has been discovered to be an important endothelium-derived relaxing factor. The exogenous inhaled NO may diffuse from the alveoli to pulmonary vascular smooth muscle and produce pulmonary vasodilation, but any NO that diffuses into blood will be inactivated before it can produce systemic effects. To examine the effects of NO on pulmonary and systemic hemodynamics, NO was inhaled by experimental dogs in an attempt to reduce the increase in pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) induced by hypoxia in dogs. METHODS: Eight mongrel dogs were studied while inhaling 1)50% O2 (baseline), 2)12% O2 in N2 (hypoxia), 3)followed by the same hypoxic gas mixture of O2 and N2 containing 20, 40 and 80 ppm of NO, respectively. RESULTS: Breathing at FIO2 0.12 nearly doubled the pulmonary vascular resistance from 173 56dyn sec cm-5 to 407 139dyn sec cm-5 and significantly increased the mean pulmonary artery pressure from 16 3mmHg to 22 4mmHg. After adding 20~80 ppm NO to the inspired gas while maintaining the FIO2 at 0.12, the mean pulmonary artery pressure decreased (p<0.05) to the level when breathing oxygen at FIO2 0.5 while the PaO2 and PaCO2 were unchanged. The pulmonary vascular resistance decreased significantly and the right ventricular stroke work index returned to a level similar to breathing at FIO2 0.5 by addition of NO into the breathing circuit. Pulmonary hypertension resumed within 3~5 minutes of ceasing NO inhalation. In none of our studies did inhaling NO produce systemic hypotension and elevate methemoglobin levels. CONCLUSIONS: Inhalation of 20~80 ppm NO selectively induced pulmonary vasodilation and reversed hypoxic pulmonary vasoconstriction without causing systemic vasodilation and bronchodilation. Methemoglobin and NO2 were within normal limit during the study.
Animals ; Anoxia ; Dogs ; Endothelium-Dependent Relaxing Factors ; Hemodynamics* ; Hypertension, Pulmonary ; Hypotension ; Inhalation* ; Methemoglobin ; Muscle, Smooth, Vascular ; Nitric Oxide* ; Oxygen ; Pulmonary Artery ; Respiration ; Stroke ; Vascular Resistance ; Vasoconstriction* ; Vasodilation