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

Glucagonomas are rare pancreatic tumors of islet ahpha-2 cells. Less than 430 cases have been reported worldwide and 210 cases are malignant tumors. In generally, the tumors typically present with a characteristic constellation of symptoms including necrolytic migratory erythema of the skin, weight loss, non-insulin-dependent diabetes mellitus, anemia, cheliosis, stomatitis, and an increased thrombotic tendency. Since pancreatic glucagonomas are predominantly located in the tail and findings of radiographic or sonographic examination can remain unspecific, patients often present already metastasis when diagnosis is first established, and can be difficult to differentiate from the other pancreatic tumors. We report the case of a 59-year-old woman with an malignant glucagonoma of the pancreas infiltrating already the spleen and presenting metastatic lesion in perirenal lymph nodes, and that the tumor was not assocated with the characteristic skin rash. The pateint with a past history of a diabetes mellitus and hypertension for 9 years was admitted with cramp-like left lower abdominal pain, watery diarrhea, and nausea. A solid tumor of tail of the pancreas revealed by ultrasonography and abdominal computed tomography and distal pancreatectomy, radical nephrectomy, and splenectomy were performed. Immunohistochemial examination of the tumor did show glucagon-reactive tissue and electron microscopy revealed many secretory granules, 180 to 300 nm in diameter in granulated cells. After pancreatic tumor resection, the patient had normalization of plasma glucagon and blood sugar.
Abdominal Pain ; Adenoma, Islet Cell ; Anemia ; Blood Glucose ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Diagnosis ; Diarrhea ; Exanthema ; Female ; Glucagon ; Glucagonoma* ; Humans ; Hypertension ; Lymph Nodes ; Microscopy, Electron ; Middle Aged ; Nausea ; Necrolytic Migratory Erythema ; Neoplasm Metastasis ; Nephrectomy ; Pancreas* ; Pancreatectomy ; Plasma ; Secretory Vesicles ; Skin ; Spleen ; Splenectomy ; Stomatitis ; Tail ; Ultrasonography ; Weight Loss

Medial meniscal root tears have been repaired using various methods. Arthroscopic all-inside repair using a suture anchor is one of the popular methods. However, insertion of the suture anchor into the proper position at the posterior root of the medial meniscus is technically difficult. Some methods have been reported to facilitate suture anchor insertion through a high posteromedial portal, a posterior trans-septal portal, or a medial quadriceptal portal. Nevertheless, many surgeons still have difficulty during anchor insertion. We introduce a technical tip for easy suture anchor insertion using a 25° curved guide and a soft suture anchor through a routine posteromedial portal.
Menisci, Tibial ; Surgeons ; Suture Anchors* ; Sutures* ; Tears

PURPOSE: Invariant natural killer T (iNKT) cells play a critical role in the pathogenesis of asthma. We previously reported the association between circulating Th2-like iNKT cells and lung function in asthma patients and the suppressive effect of Toll-like receptor 5 ligand flagellin B (FlaB) on asthmatic in a mouse model. Thus, we investigated whether FlaB modulates the function of circulating iNKT cells in asthmatic patients. METHODS: Peripheral blood mononuclear cells (PBMCs) were treated with FlaB, and the secreted and intracellular cytokines of iNKT cells were evaluated by using ELISA and flow cytometry, respectively, following stimulation with alpha-galactosylceramide. Foxp3+ iNKT cells were also measured. To determine the effect of FlaB-treated dendritic cells (DCs) on iNKT cells, we co-cultured CD14+ monocyte-derived DCs and T cells from patients with house dust mite-sensitive asthma and analyzed intracellular cytokines in iNKT cells. RESULTS: A reduction of IL-4 and IL-17 production by iNKT cells in PBMCs after FlaB treatment was alleviated following blocking of IL-10 signaling. A decrease in the frequencies of IL-4+ and IL-17+ iNKT cells by FlaB-treated DCs was reversed after blocking of IL-10 signaling. Simultaneously, an increase in Foxp3+ iNKT cells induced by FlaB treatment disappeared after blocking of IL-10. CONCLUSIONS: FlaB may inhibit Th2- and Th17-like iNKT cells and induce Foxp3+ iNKT cells by DCs via an IL-10-dependent mechanism in asthmatic patients. In patients with a specific asthma phenotype associated with iNKT cells, FlaB may be an effective immunomodulator for iNKT cell-targeted immunotherapy.
Animals ; Asthma* ; Cytokines ; Dendritic Cells* ; Dust ; Enzyme-Linked Immunosorbent Assay ; Flagellin* ; Flow Cytometry ; Humans ; Immunotherapy ; Interleukin-10 ; Interleukin-17 ; Interleukin-4 ; Lung ; Mice ; Natural Killer T-Cells* ; Phenotype ; T-Lymphocytes ; Toll-Like Receptor 5

PURPOSE: There have been few case reports regarding treatment plans for long-term, neglected scalp defects and calvarial defects with subdural abscess. The purpose of this case report is to present our experience with a free latissimus dorsi musculocutaneous flap for scalp and calvarial defects and to discuss flap options in comparison with a literature review. METHODS: A 60-year-old man who fell down from a four-story-height that resulted in a craniotomy in 1979; he visited our outpatient clinic for a chronic, purulent scalp and calvarial defects with unidentified artificial bone. The artificial bone was removed by a neurosurgeon and reconstructed with a free latissimus dorsi musculocutaneous flap. The deep temporal artery was used as a recipient artery. The postoperative flap status was excellent until the 6th day post-operation when the patient experienced a seizure, and an arterial insufficiency occurred at the flap probably due to an arterial spasm. Emergency exploration with arterial re-anastomosis was performed and the flap status was stabilized. RESULTS: Complete wound healing was achieved after 3 weeks without infectious and systemic postoperative complications. During the 6 month follow-up period, there were no complications. CONCLUSION: We suggest the latissimus dorsi myocutaneous free flap as a good treatment option for a chronic, purulent, complicated scalp with calvarial defect, as a well as treatment for an acute traumatic defect.
Abscess ; Ambulatory Care Facilities ; Arteries ; Craniotomy ; Emergencies ; Follow-Up Studies ; Free Tissue Flaps ; Humans ; Middle Aged ; Postoperative Complications ; Scalp ; Seizures ; Spasm ; Temporal Arteries ; Wound Healing

This experiment was performed to evaluate the morphological responses of the cecal mucosa of the mouse, inoculated with Ehrlich carcinoma cells in the inguinal area, following administration of 5-fluorouracil, mitomycin C or adriamycin. Healthy adult ICR mice weighing 25 gm each were divided into normal and experimental groups. In the experimental groups, each mouse was inoculated with 1 x 10(7) Ehrlich carcinoma cells subcutaneous in the inguinal area. From next day, 0.2 mL of saline, 5-fluorouracil (30 mg/kg), mitomycin C (400 microgram/kg) or adriamycin (2 mg/kg) were injected subcutaneously to the animals every other day, respectively. The day following the 7th injection of anticancer drugs, each mouse was injected with a single dose of 0.7 micro Ci/gm of methyl-3H-thymidine (25Ci/mmol, Amersham Lab, England) through tail vein. Seventy minutes after the thymidine injection, animals were sacrificed. The number of the labeled epithelial cells of the cecal crypts (mean number of labeled epithelial cells per 3.5 mm length of mucosa) were observed and evaluated. On histological study, in the experimental control and mitomycin C-treated mice, general morphology of the cecal mucosae was similar. And in the 5-fluorouracil-treated mice, slightly swelled epithelial cells and expanded lumen of the intestinal crypts were observed. But in the adriamycin-treated groups, slightly disrupted intestinal crypts, a large number of basophilic epithelial cells and the expanded lumen of the intestinal crypts were observed. On autoradiographic study, number of the labeled cells of normal control, experimental control, 5-fluorouracil treated, mitomycin C-treated, or adriamycin-treated groups were 362.2+/-56.12, 350.7+/-71.13, 215.7+/-80.55, 144.2+/-34.60 and 125.0+/-37.45, respectively. In the adriamycin and mitomycin C-treated groups, poorly-labeled cells containing only a few silver grains were observed more frequently than in those of the normal and experimental control groups. From the above results, adriamycin and mitomycin C suppressed the DNA synthesis of the epithelial cells of the cecal mucosa more severely as compared with 5-fluorouracil did. Especially, adriamycin was more harmful than mitomycin C and 5-fluorouracil on the cecal mucosae.
Adult ; Animals ; Antineoplastic Agents* ; Basophils ; Edible Grain ; DNA* ; Doxorubicin ; Epithelial Cells ; Fluorouracil ; Humans ; Mice* ; Mice, Inbred ICR ; Mitomycin ; Mucous Membrane* ; Silver ; Thymidine ; Veins

PURPOSE: Electrocardiography is a non-invasive tool for use in prediction of reperfusion and outcome of acute myocardial infarction. We attempted to determine initial electrocardiographic findings associated with failed resolution of ST-segment elevation (STE) among patients with ST-segment Elevation Myocardial Infarction (STEMI) treated with a thrombolytic agent. METHODS: This retrospective study included patients with STEMI who were treated with a thrombolytic agent at the emergency department between October 2008 and March 2011. During the study period, among 331 patients with STEMI, 43 patients were enrolled. Resolution of STE was evaluated by comparison of initial electrocardiography (ECG) with follow-up ECG, taken 90 minutes after thrombolytic therapy. Determination of success or failure of resolution of STE was based on the electrocardiographic criteria of the American College of Cardiology and the American Heart Association (ACC/AHA). Patients were divided into two groups according to these criteria, and initial electrocardiographic findings were compared for the two groups. RESULTS: Of a total of 43 patients, 22(55.16%) demonstrated failed resolution of STE after thrombolytic therapy. The risk of failed resolution of STE was approximately nine times higher in the anterior location of STE, compared to the inferior location of STE (OR 9.09, 95% CI, 1.46-94.69, p<0.01). In addition, the absence of reciprocal ST depression was associated with a six times higher risk of failed resolution of STE, compared with the presence of reciprocal ST depression (OR 6, 95% CI, 1.17-39.23, p=0.01). However, other electrocardiographic findings, including abnormal Q-wave, wide QRS complex, and QTc prolongation did not differ statistically between the two groups. CONCLUSION: Failed STE resolution after thrombolytic therapy was more frequent in STEMI patients with ST elevation in an anterior location or without reciprocal ST depression.
American Heart Association ; Cardiology ; Depression ; Electrocardiography ; Emergencies ; Follow-Up Studies ; Humans ; Myocardial Infarction ; Reperfusion ; Retrospective Studies ; Thrombolytic Therapy

No abstract available.
Lower Extremity ; Ulcer

No abstract available.
Lower Extremity ; Ulcer

No abstract available.
Adolescent ; Humans