Perigraft seroma is uncommon complication of polytetrafluoroethylene(PTFE) grafts applied as an arteriovenous shunt for hemodialysis. It is a collection of clear, sterile fluid confined to nonsecretory fibrous pseudomembrane, most commonly localized around the middle and distal portion of graft. The possible etiologic factors of perigraft seroma include poor graft incorporation, mechanical graft damage caused by alcohol and povidone-iodine, intraoperative streching of the graft, variations in quality control at the time of manufacture and contributing factors such as anemia and coagulopathy in uremia. The best strategy for management of perigraft seroma is not clear. spiration or drainage alone is not effective, and some authors advocate graft removal. We report a case of perigraft seroma around arterial end of PTFE graft along with a brief review of the literatures.
Anemia ; Drainage ; Humans ; Polytetrafluoroethylene ; Povidone-Iodine ; Quality Control ; Renal Dialysis* ; Seroma* ; Transplants ; Uremia

BACKGROUND: The external jugular vein (EJV) is a useful intravenous (IV) cannulation site for anesthesiologists, although it has a relatively high failure rate. Unlike other central veins, visualization of the EJV is important during IV cannulation, and the Valsalva maneuver distends the jugular venous system. However, the relationship between the maneuver and EJV visibility remains unknown. This study compared EJV visibility before and after the Valsalva maneuver. METHODS: This was a prospective observational study that included 200 participants. After the induction of anesthesia, EJV visibility grade, depth from the skin to the EJV superficial surface (EJV depth), and EJV cross-sectional area (CSA) before the Valsalva maneuver were measured. The same parameters were measured after the Valsalva maneuver was performed. The EJV visibility grade was defined as grade A: good appearance and good palpation, grade B: poor appearance and good palpation, and grade C: poor appearance and poor palpation. RESULTS: Patient body mass index and EJV depth affected the EJV visibility grade before the Valsalva maneuver (p < 0.05), although EJV CSA did not. The Valsalva maneuver distended EJV CSA and reduced EJV depth, although these changes were not correlated with EJV visibility grade. With regard to EJV visibility, 34.0% of grade B cases and 20.0% of grade C cases were improved by the Valsalva maneuver. CONCLUSIONS: Although the Valsalva maneuver improved EJV CSA and EJV depth, it did not greatly affect EJV visibility grade.
Anesthesia ; Body Mass Index ; Catheterization ; Humans ; Jugular Veins* ; Observational Study ; Palpation ; Prospective Studies ; Skin ; Ultrasonography ; Valsalva Maneuver* ; Veins

No abstract available.
Humans ; Infant, Newborn*

PURPOSE: To compare image quality of storage phosphor digital radiography(DR) with film-screen radiography in portable chest imaging, and to assess the minimum X-ray dose that can be applied to DR in adults without image degradation, and also to compare image qualities of low dose and standard dose DR. Materials and Methalos: A geometrical phantom similar to the human thorax was imaged by a portable radiographic unit with fixed kVp and variable m^s in both film-screen and DR systems. Three radiologists scored the images by four grades in four categories of 1) contrast between mediastinum and lung, 2) definition of the nodule in the lung, 3) definition of another nodule through the mediastinal shadow, and 4) grainess(noise : assessed only in DR). Additionally, portable chest images were obtained in 10 patients in a intensive care unit by film-screen, standard dose and half dose DR in consecutive days. The same readers scored the images by four grades in six categories of 1) the lungs and hila, 2) the mediastinum, 3) subphrenic area. 4) musculoskeletal shadow, 5) tubes and lines, and 6) grainess (only in DR). The images with superior quality were assessed by paired t-test. RESULTS: In phantom study, the minimum dose of digital images scored 3 or more by all readers was 39% of the standard dose. In patient study, DR was superior to film-screen radiography in all categories except tube and line. Low dose DR was not inferior to standard dose DR in five categories other than grainess to two readers or more. CONCLUSION: In portable chest imaging, storage phosphor DR image was superior to conventional film-screen radiography and half dose DR was comparable to standard dose DR despite of more noise.
Adult ; Humans ; Intensive Care Units ; Lung ; Mediastinum ; Noise ; Radiographic Image Enhancement* ; Radiography ; Thorax*

PURPOSE: To compare image quality of storage phosphor digital radiography(DR) with film-screen radiography in portable chest imaging, and to assess the minimum X-ray dose that can be applied to DR in adults without image degradation, and also to compare image qualities of low dose and standard dose DR. Materials and Methalos: A geometrical phantom similar to the human thorax was imaged by a portable radiographic unit with fixed kVp and variable m^s in both film-screen and DR systems. Three radiologists scored the images by four grades in four categories of 1) contrast between mediastinum and lung, 2) definition of the nodule in the lung, 3) definition of another nodule through the mediastinal shadow, and 4) grainess(noise : assessed only in DR). Additionally, portable chest images were obtained in 10 patients in a intensive care unit by film-screen, standard dose and half dose DR in consecutive days. The same readers scored the images by four grades in six categories of 1) the lungs and hila, 2) the mediastinum, 3) subphrenic area. 4) musculoskeletal shadow, 5) tubes and lines, and 6) grainess (only in DR). The images with superior quality were assessed by paired t-test. RESULTS: In phantom study, the minimum dose of digital images scored 3 or more by all readers was 39% of the standard dose. In patient study, DR was superior to film-screen radiography in all categories except tube and line. Low dose DR was not inferior to standard dose DR in five categories other than grainess to two readers or more. CONCLUSION: In portable chest imaging, storage phosphor DR image was superior to conventional film-screen radiography and half dose DR was comparable to standard dose DR despite of more noise.
Adult ; Humans ; Intensive Care Units ; Lung ; Mediastinum ; Noise ; Radiographic Image Enhancement* ; Radiography ; Thorax*

Ulcerative colitis, one of the inflammatory bowel disease, is primarily managed medically with combinations of 5-ASA and steroids. However, this chronic disease requires surgical management if symptoms persist or complications develop despite medical management. The clinical course, the indications and outcome for surgical management of pediatric ulcerative colitis patients were studied from medical records retrospectively. Twenty-one patients under the age of 15 who were endoscopically diagnosed with ulcerative colitis at the Seoul National University Children's Hospital between January, 1988 and January, 2003 were subjected to the study. Mean follow up period was 3 years and 10 months. The mean age was 10.3 years old. All patients received medical management primarily after diagnosis and 8 patients (38%) eventually required surgical management. Of 13 patients who received medical management only, 7 patients (53%) showed remission, 4 patients are still on medical management, and 2 patients expired due to congenital immune deficiency and hepatic failure owing to sclerosing cholangitis respectively. In 8 patients who received surgical management, 1 patient underwent surgery due to sigmoid colon perforation and 7 patients due to intractability of medical management. The perforated case received colon segmental resection and the other 7 patients recieved total protocolectomy with ileal pouch-anal anastomosis. One patient expired postoperatively due to pneumonia and sepsis. One patient is still on medical management because of mild persistent hematochezia after surgery. The other operated patients are showing good prognosis without any management. Pediatric ulcerative colitis patients can be surgically managed if the patient is intractable to medical management or if complications such as perforation is present. Total protocolectomy & ileal pouch-anal anastomosis is thought to be the adequate surgical method.
Child* ; Cholangitis, Sclerosing ; Chronic Disease ; Colitis, Ulcerative* ; Colon ; Colon, Sigmoid ; Diagnosis ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; Humans ; Inflammatory Bowel Diseases ; Liver Failure ; Medical Records ; Pneumonia ; Prognosis ; Retrospective Studies ; Seoul ; Sepsis ; Steroids ; Ulcer*

The secretion of melatonin exhibits a circadian rhythm entrained with the sleep-wake cycle. An alteration of this secretory rhythm has been found in various psychiatric disorders. This review summarizes the regulation of melatonin and its relationship to the circadian rhythm, major depressive disorder, bipolar disorder, seasonal affective disorder, Alzheimer's disease and autism. The review also looks at the effect of melatonin and melatonin agonist on sleep and symptoms of depression, bipolar disorder and seasonal affective disorder. In Alzheimer's disease, the circadian rhythm alterations are associated with the change of melatonin levels and melatonin receptors. It has been reported that melatonin and melatonin synthetic enzyme levels decrease in autism spectrum disorder.
Alzheimer Disease ; Autistic Disorder ; Bipolar Disorder ; Child ; Autism Spectrum Disorder ; Circadian Rhythm ; Depression ; Depressive Disorder, Major ; Melatonin* ; Receptors, Melatonin ; Seasonal Affective Disorder

PURPOSE: Gastric carcinoma tissues release high level of prostaglandin E2 (PGE2) when compared to non-neoplastic mucosa, and cyclooxygenase-2 (COX-2), which is the rate-limiting enzyme in prostaglandin (PG) biosynthesis, is often overexpressed in gastric carcinomas and during gastric carcinogenesis. However, little is known about the expression of 15-hydroxyprostaglandin dehydrogenase (15-PGDH), the key enzyme responsible for the biological inactivation of PG, in gastric carcinomas. MATERIALS AND METHODS: We investigated the expression of 15-PGDH in 28 cases of advanced gastric carcinomas by Western blot analysis and also the relation between its expression and the gene promoter methylation. RESULTS: 15-PGDH expression was significantly decreased in gastric carcinomas compared to corresponding non-neoplastic tissues and inversely correlated with the expression of proliferating cell nuclear antigen in gastric carcinomas. However, there was no correlation between 15-PGDH expression and pathological findings such as nodal metastasis and vascular invasion. Promoter hypermethylation of 15-PGDH gene was not detected in carcinomas, with only a negligible expression of the enzyme. CONCLUSION: Our results suggested that 15-PGDH has tumor suppressor activity in gastric carcinomas.
Aged ; Base Sequence ; DNA Methylation ; DNA Primers/genetics ; DNA, Neoplasm/genetics ; Female ; Humans ; Hydroxyprostaglandin Dehydrogenases/genetics/*metabolism ; Male ; Middle Aged ; Promoter Regions, Genetic ; Stomach Neoplasms/*enzymology/genetics

Basaloid squamous cell carcinoma occurs in various organs including the upper respiratory tract, the base of the tongue, pharynx, larynx, breast, uterine cervix and anus. It is a rare tumor, but it must be distinguished from other malignancies because of its aggressive clinical behavior. Many cases present in the advanced stage at the time of diagnosis. We present here a case of esophageal basaloid squamous cancer that was diagnosed in 75-year-old male patient who had dysphagia and throat pain, and this was accompanied by squamous cell cancer of the tongue base, as was determined by laryngoscopic and esophagogastroscopic examination.
Aged ; Anal Canal ; Breast ; Carcinoma, Squamous Cell* ; Cervix Uteri ; Deglutition Disorders ; Diagnosis ; Esophagus ; Female ; Head and Neck Neoplasms ; Humans ; Larynx ; Male ; Neoplasms, Squamous Cell ; Pharynx ; Respiratory System ; Tongue*

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare and fatal cancer-related pulmonary complication leading to severe pulmonary hypertension, right heart failure, and death. Few cases of PTTM have been diagnosed antemortem. A 62-year-old male showing complete remission of gastric cancer presented with exertional dyspnea. Transthoracic echocardiography showed marked dilation of the right atrium, right ventricle, and the small left ventricle with normal left ventricular function. Right heart catheterization also showed mild to moderate pulmonary hypertension. A chest computed tomography scan revealed no evidence of acute pulmonary thromboembolism, but it showed consolidations with subpleural nodules in both lower lobes, and a lung perfusion scan showed multifocal, non-segmental perfusion defects. Finally, a diagnostic lung biopsy with video-assisted thoracoscopic surgery was performed, and the pathologic findings were compatible with PTTM. Here, we report a case of gastric cancer-related PTTM that was diagnosed antemortem.
Biopsy ; Cardiac Catheterization ; Cardiac Catheters ; Dyspnea ; Echocardiography ; Heart Atria ; Heart Failure ; Heart Ventricles ; Humans ; Hypertension, Pulmonary ; Lung ; Male ; Middle Aged ; Perfusion ; Pulmonary Embolism ; Stomach Neoplasms* ; Thoracic Surgery, Video-Assisted ; Thorax ; Thrombotic Microangiopathies* ; Ventricular Function, Left