Subcutaneous emphysema is a complication of the pneumoperitoneum necessary to perform laparoscopy and will be seen more often as laparoscopic techniques are applied to a growing number of intraabdominal procedures. We report a case of subcutaneous emphysema and hypercarbia without pneumothorax or pneumomediastinum during laparoscopic cholecystectomy, which was treated by multiple puncture with 18G needle on emphysematous site. The suspected cause is inadvertent subcutaneous insufflation of carbon dioxide through the trocar sites by increased intra-abdominal pressure for the establishment of pneumoperitoneum. Immediate recognition, evaluation, and treatment of subcutaneous emphysema is necessary since this can be life-threatening complication.
Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Insufflation ; Laparoscopy ; Mediastinal Emphysema ; Needles ; Pneumoperitoneum ; Pneumothorax ; Punctures ; Subcutaneous Emphysema* ; Surgical Instruments

BACKGROUND: Endobroncheal intubation or extubation may occur accidentally when the patient's neck is flexed or extended even in the appropriate endotracheal intubation. The purpose of this study is to examine the effect of fixation or unfixation of the endotracheal tube at the teeth level on the displacement of its distal end when the patient's neck is extended or flexed. METHODS: This study was conducted in 37 patients who underwent endotracheal general anesthesia. The patients with the evidence of pathology in head, neck and chest were excluded from the study. Individual patient's displacement in endotracheal tube tip compared unfixed cases with fixed cases when the change of neck position. The moved distance was measured by fiberoptic bronchoscope. The data were statistically analyzed by Student's paired t-test. RESULTS: The endotracheal tube moved away from the carina when the patient's neck was extended, while it moved toward the carina when flexed in all cases. When the patient's neck was extended the average distance displaced 1.2 0.7 cm in fixed cases and 1.1 0.9 cm in unfixed cases. when the neck was flexed, they were 1.2 0.5 cm and 1.0 0.8 cm respectively. There were not statistically significant between the fixed and the unfixed cases. CONCLUSIONS: It is concluded that the displacement of the endotracheal tube is not related to its fixation or unfixation at the teeth level and therefore, unfixation does not provide any benefits in terms of the displacement of the distal end of the tube in adult trachea.
Adult ; Anesthesia, General ; Bronchoscopes ; Head ; Humans ; Intubation ; Intubation, Intratracheal ; Neck* ; Pathology ; Thorax ; Tooth ; Trachea

OBJECTIVES: This research was performed to identify family violence by male adolescencts, and to examine the characteristics of male adolescent delinquents in terms of domestic viloence. METHODS: We surveyed 677 male adolescents including 238 delinquents from BBS(Big brothers and sisters) in Pusan, 209 criminal adolescents from adolescent correctional institution in Pusan, 230 high school students through questionnaire, MMPI(Minnesota Multiphasic Personality Inventory), and PBI(Parental Bonding Instrument), and then compared these three groups by Chi-square test, T-test, and Anova. RESULTS: In most cases, male delinquent adolescents were placed in poorer socio-economic conditions than those of students, but in better socio-economic conditions than those of criminal adolescents. In general, the assaulters were senior family members, physically stronger than sufferers, and have bad brotherliness. Compared with normal students, the serious problem of violence including violence to the ancestors in delinquent and criminal adolescents. On results of MMPI and PBI test, there were significant difference between violent group and non-violent group on the Sc score and Passive aggressive index in adolescent delinquents and parental overprotection in normal students. CONCLUSION: Generally the characteristics of family violence by male delinquent adolescents were intermediate between those of criminal adolescent and students, these results were same as those of previous socio-psychiatric study, and so the intervention in criminal adolescents is needed for the pre-vention of family violence.
Adolescent* ; Busan ; Criminals ; Domestic Violence* ; Humans ; Male ; MMPI ; Parents ; Surveys and Questionnaires ; Siblings ; Violence

PURPOSE: To investigate the toxicity of a short-term application of timolol maleate, dorzolamide, and benzalkonium chloride (BAC) on human conjunctival epithelial cells in vitro. METHODS: Chang's conjunctival epithelial cell line was treated for 5 min, 15 min, 30 min, and 60 min with various concentrations of timolol, dorzloamide, or BAC, and then examined 4 hrs or 24 hrs later. Cell viabilities were assessed by MTT assay. The expressions of various cytokines by timolol maleate, dorzolamide, and BAC treatment in human conjunctival epithelial cells were evaluated using ELISPOT. RESULTS: BAC significantly decreased survival of conjunctival epithelial cells in a dose and time dependent manner compared with timolol and dorzolamide. Inflammatory cytokines, IL-6 and IL-8, were highly expressed in conjunctival epithelial cells treated with timolol, dorzolamide, and BAC. CONCLUSIONS: The present study suggests that increased expression of inflammatory markers, IL-6 and IL-8 might explain the ocular surface disorder in patients receiving antiglaucoma medication.
Benzalkonium Compounds ; Cell Survival ; Cytokines ; Enzyme-Linked Immunospot Assay ; Epithelial Cells* ; Humans* ; Interleukin-6 ; Interleukin-8 ; Timolol

Cutaneous papillomas or acrochorda usually appear after the 4th decade of life in areas with skin folds. Conventional methods of removal are associated with bleeding problems, pain and prolonged sequelae. Thus, acrochorda removal with lasers has gained attention. In this study, we compared the efficacy of two popular laser types with different wavelengths and pulse widths for removal of skin tags. A 60-year-old Korean male noticed skin tags on his neck bilaterally. All tags were treated in a single session, on one side with a picosecond (ps)-domain 532 nm Nd:YAG laser and on the contralateral side with a long-pulsed (LP) 755 nm alexandrite laser. The endpoint for the ps-532 laser was immediate whitening, while that for the LP and quasi-LP (QLP) 755 lasers were visible changes on the surface of the lesion. Antibiotic ointment was applied, dressing was done and clinical photographs were taken. Both lasers effectively removed the skin tags at all settings in a single session without bleeding and with minimal discomfort. Crust formation occurred on both sides with natural shedding within 1 to 2 weeks. Transient erythema lasted longer in the tags treated with the ps-532 laser. At the 5th month of follow-up, residual lesions were detected on the field treated with the ps-532 laser. No persistent side effects such as scarring or postinflammatory hyperpigmentation (PIH) were observed. In conclusion, both the ps-532 nm Nd:YAG and the 755 nm alexandrite lasers ensured safe and effective removal of skin tags in a single session without adverse sequelae.

Breast Cancer in women poses a problem, and it can be difficult at times to evaluate the possibility of the cancer's recurrence in node negative early cancer. Reliable prognostic markers are needed in breast-cancer management to help clinicians identify patient with high risk of recurrence and arrive at more rational decisions for proper treatment. E-cadherin is a glycoprotein that mediates Ca2 -dependent cell-cell adhesion and maintenance of the epithelial cell phenotype. It has been implicated as an invasion-suppressing protein in experimental systems and in human tumors, and alterations in the cadherin function have been implicated in tumor progression in a number of adenocarcinomas. In this study, the expression of E-cadherin was reduced in 35.3% of the case reviewed(12/34), and we could find no clinical relation between the known prognostic factors except tumor stage(p<0.05), and the degree of E-cadherin expression.
Adenocarcinoma ; Breast Neoplasms* ; Breast* ; Cadherins* ; Epithelial Cells ; Female ; Glycoproteins ; Humans ; Phenotype ; Recurrence

This study was designed to evaluated the effects of opioid receptor agonists on the spontaneous alternation behaviour in an animal model of obsessive-compulsive disorder in rats. According to the theory that dopamine is related to the biological etiology of obsessive-compulsive disorder, the effect of the nalbuphine(opioid kappa agonist) and the tramadol(opioid mu agonist), which act as manipulating agents on the inhibition or stimulation of dopamine release, in the spontaneous alternation behaviour were evaluated. 24 hours prior to the experiment, rats were food-deprived. These rats were put into the T-maze, in which white and black goal boxes were baited with small amounts of chocolate milk. Each rat was given 2 set of 7 trials during which it was placed in the start box and allowed to choose the one of the goal boxes for each time. After identifying the stable baseline of spontaneous alternation behaviour, nonselective 5-HT agonist 5-MeODMT(1.25mg/kg/IP) disrupted spontaneous alternation. Rats were stratified into fluoxetine(10mg/kg/IP), nalbuphine(10mg/kg/IP), tramadol(46.4mg/kg/IP), and saline(0.5cc/IP) injection group with experimental drug treatment for 21 days. The effects on the 5-M?DMT(1.25mg/kg/IP) induced disruption of spontaneous alternation behaviour were checked at the next day of discontinuation of drug treatment. The results were as follows : 1) At the day after 21 days of the drug treatment, the nalbuphine treated group and the fluoxetine treated group showed significant difference from the tramadol treated group and the saline treated group in the 5-MeODMT(1.25mg/kg/IP) induced suppression of spontaneous alternation behaviour. 2) Within each drug treatment group, the fluoxetine treated group showed significant difference between before and after the treatment of fluoxetine in the 5-MeODMT(1.25mg/kg/IP) induced suppression of spontaneous alternation behaviour. And also, the nalbuphine treated group showed significant difference between before and after the treatment of nalbuphine in the 5-MeODMT(1.25mg/kg/IP) induced suppression of spontaneous alternation behaviour. There was no difference between the baseline and after the treatment of nalbuphine in the 5-MeODMT(1.25mg/kg/IP) induced suppression of spontaneous alternation behaviour. We indentified that the opioid kappa agonist that act as dopamine release inhibitor affect the spontaneous alternation behaviour which is an animal model of obsessive-compulsive disorder in rat.
Animals ; Cacao ; Dopamine ; Fluoxetine ; Milk ; Models, Animal ; Nalbuphine ; Obsessive-Compulsive Disorder ; Rats* ; Receptors, Opioid ; Serotonin Receptor Agonists ; Tramadol

PURPOSE: Acute appendicitis is one of the most common surgical diseases and the accuracy of diagnosis has been reported to be between 71% and 85%. In this study we tried to determine whether abdominal sonographic examination is critical to the decision to operate and whether its use is essential before surgery of patients with clinically diagnosed or suspected acute appendicitis. METHODS: A total of 552 patients with clinically diagnosed acute appendicitis from January 2000 to December 2001 were enrolled in this study. All patients underwent an abdominal graded compression sonography performed by a staff radiologist. RESULTS: A total of 535 patients (96.9%) with positive findings of appendicitis proceeded to surgery. 17 patients (3.1%) were found to have other diseases. Of the 535 patients undergoing operation, 531 (99.3%) were proved to have appendicitis by pathologic reports. The 17 patients with negative findings in sonography underwent operation or CT examination; 12 (70.6%) were proved to have appendicitis. Abdominal sonography for detecting acute appendicitis had a sensitivity of 97.8%, a specificity of 55.6%, an accuracy of 97.1%, a positive predictive value of 99.3%, and a negative predictive value of 29.4%. CONCLUSION: Abdominal sonography is therefore one of the most useful examinations in diagnosing acute appendicitis before surgery and our experience suggests that patients with clinically suspected acute appendicitis should routinely undergo abdominal sonographic examination.
Appendicitis* ; Diagnosis ; Humans ; Sensitivity and Specificity ; Ultrasonography

Hypoglossal nerve palsy after general anesthesia is an exceptionally rare complication, which has varied etiology. We present a case of unilateral hypoglossal nerve palsy resulting from repeated airway intervention for general anesthesia. A 57-year-old woman was scheduled to undergo modified radical mastectomy. During endotracheal intubation, the patient had Cormack's grade III-a severe airway condition. After the first intubation attempt failed, the intubation was attempted a second time using a stylet inside the endotracheal tube with cricoid pressure; this attempt was successful. In the evening of the operation day, the patient complained of dysarthria and dysphagia. Physical examination revealed deviation of the tongue to the right, which may have been caused by traumatic hypoglossal nerve injury. This case reviews the pathophysiology, prevention, and management of hypoglossal nerve palsy.
Anesthesia, General* ; Deglutition Disorders ; Dysarthria ; Female ; Humans ; Hypoglossal Nerve Diseases* ; Hypoglossal Nerve Injuries ; Hypoglossal Nerve* ; Intubation ; Intubation, Intratracheal* ; Mastectomy, Modified Radical ; Middle Aged ; Paralysis ; Physical Examination ; Tongue

Primary small cell carcinoma of the liver is an extremely rare tumor. Extrapulmonary small cell carcinoma shares many features of pulmonary small cell carcinoma, including the histological appearance, the aggressive clinical behavior and the frequent short-lasting response to either chemotherapy or radiotherapy. We experienced a 56-year-old man with small cell carcinoma that arose in the liver. Abdominal CT scan showed an 8 cm size, low density mass in the segment 4 of the liver and also multiple lymphadenopathies. Chest X-ray showed no abnormal finding, but the chest CT showed a right lower paratracheal lymphadenopathy. The pathological findings showed nests of small round cells with fine granular chromatin, inconspicuous nucleoli and scanty cytoplasm. Distinct and strong immunoreactions were seen for CD56 and c-kit, and sparse immunoreaction was seen for synaptophysin. Thyroid transcription factor-1 showed no immunoreaction. The tumor did not decrease in size despite chemotherapy. We report this case along with a review of the relevant literatures.
Carcinoma, Small Cell/*diagnosis ; English Abstract ; Humans ; Liver Neoplasms/*diagnosis ; Male ; Middle Aged