Zollinger-Ellison syndrome is a very rare disease that's caused by tumor having gastrin-producing cells, and this is accompanied by hypergastrinemia leading to gastric acid hypersecretion, peptic ulcer and their complications. A 60-year-old man presented with epigastric pain and soreness he had experienced for 7 days. The endoscopic findings showed reflux esophagitis and multiple active ulcers at the antrum, the duodenal bulb and the 2nd and 3rd portions of the duodenum. The fasting serum gastrin level was markedly elevated above 1,470 pg/mL and this was consistent with the findings of gastrinoma. We confirmed the presence of gastrinoma via the abdomen CT scan and selective intra-arterial calcium injection. This is the first Korean case report of gastrinoma that was localized by selective intra-arterial calcium injection.
Abdomen ; Calcium* ; Duodenum ; Esophagitis, Peptic ; Fasting ; Gastric Acid ; Gastrinoma* ; Gastrins ; Humans ; Middle Aged ; Peptic Ulcer ; Rare Diseases ; Tomography, X-Ray Computed ; Ulcer ; Zollinger-Ellison Syndrome*

BACKGROUND: Postoperative nausea and vomiting (PONV) is a long standing problem in both surgical patients and anesthesiologists, and the treatment of this problem is very important.The purpose of this study was to evaluate the effect of multimodal approach with combination of antiemetics and total intravenous anesthesia (TIVA) on PONV in very high risk patients identified by the Korean predictive model. METHODS: Between March 2008 and February 2009, we evaluated 96 patients who were considered to be at very high risk of PONV according to the Korean predictive model.Among the patients, those who received antiemetic combination of dexamethasone and ondansetron were allocated to treatment group (T) and, those who underwent operation without antiemetics were placed in control group (C).All patients were anesthetized using propofol and remifentanil.We evaluated the incidences of PONV in two groups during the first 24 hours after surgery. RESULTS: The overall incidence of PONV was 14 (29.17%) in C group and 4 (8.33%) in T group, respectively (P = 0.027). CONCLUSIONS: The overall incidence of PONV in T group was significantly lower than that of C group.This study shows that multimodal approach with combination of antiemetics and TIVA was effective in preventing PONV in patients with very high risk.
Anesthesia, Intravenous ; Antiemetics ; Dexamethasone ; Humans ; Incidence ; Ondansetron ; Postoperative Nausea and Vomiting ; Propofol

Small bowel malignancy accounts for approximately 2% of gastrointestinal malignancies. In particular, malignant lymphoma of the small intestine is so rare that it accounts for less than 1% of gastrointestinal malignancies. Initial symptoms are non-specific and diagnosis may be delayed until the patient presents with complications such as intestinal obstruction, hemorrhage, or perforation. A 79-year-old man visited the emergency room with lower abdominal pain. Segmental resection of the small intestine was done and surgery revealed a 9.5x6 cm sized mass with jejunal perforation at 20 cm inferior to the ligament of Treitz. The mass was diagnosed as diffuse large B cell lymphoma. We experienced a case of diffuse large B cell lymphoma which was diagnosed after emergent surgery for jejunal perforation, and report it with a review of literature.
Abdominal Pain ; Aged ; Emergencies ; Hemorrhage ; Humans ; Intestinal Obstruction ; Intestinal Perforation ; Intestine, Small ; Jejunum ; Ligaments ; Lymphoma ; Lymphoma, B-Cell

Intestinal malrotation is a congenital disorder that results from the failure of normal bowel rotation and fixation during the 5th gestational week. The incidence of intestinal malrotation is <0.2%, but prompt diagnosis is important because this anomaly can cause midgut volvulus and lead to fatalities. Compared to infants presenting with acute symptoms, such as abdominal pain, vomiting, or diarrhea, adult patients complain of intermittent self-limited abdominal pain. We present a case of intestinal malrotation complicated by midgut volvulus improved with conservative care in a 70-year-old man. The diagnosis was suggested on the basis of imaging findings.
Aged ; Angiography ; Colonic Diseases/*diagnosis/radiography ; Diagnosis, Differential ; Humans ; Intestinal Volvulus/*diagnosis/radiography ; Male ; Mesenteric Artery, Superior/radiography ; Tomography, X-Ray Computed

No abstract available.

BACKGROUND: Nitrous oxide may cause distension of the intestine. We studied the influence of nitrous oxide on the recovery of bowel function and the incidence of complications of bowel distension. METHODS: Fifty patients scheduled for abdominal hysterectomy were anesthetized with sevoflurane and oxygen and were randomly assigned to be given 50% nitrous oxide (n = 25) or 50% air (n = 25) in two groups. A surgeon assessed the closing condition. Patients reported pain, nausea and vomiting after surgery. The lapse of time before the passing of flatus was recorded. RESULTS: There was no difference between the two groups with respect to body weight, duration of surgery, alfentanil and atracurium requirements, pain score, nausea and vomiting, and closing condition. The time elapsing before the passing of flatus was significantly greater for the patients that received nitrous oxide. CONCLUSIONS: Our results suggest that avoiding nitrous oxide administration during prolonged intraabdominal surgery shortens the time for recovery of bowel function.
Alfentanil ; Atracurium ; Body Weight ; Flatulence ; Humans ; Hysterectomy ; Incidence ; Intestines ; Nausea ; Nitrous Oxide* ; Oxygen ; Recovery of Function* ; Vomiting

Anomalous origin of a coronary artery is rare and does not generally lead to myocardial infarction and paroxysmal supraventricular tachycardia (PSVT). We report an uncommon case of anomalous origin of the right coronary artery (RCA) originating from the left sinus of Valsalva with PSVT and myocardial ischemia. A 58-year-old man presented with PSVT. After arrhythmia subsided, electrocardiogram showed ST and T wave abnormalities, and transient cardiac enzymes were found to be elevated. Coronary CT angiography confirmed that there was anomalous origin of the RCA originating from the left sinus of Valsalva and no intracoronary stenotic lesion. He was managed with conservative treatment, having no symptoms on clinical follow-up for 4 years.
Angiography ; Arrhythmias, Cardiac ; Coronary Vessel Anomalies ; Coronary Vessels ; Electrocardiography ; Follow-Up Studies ; Humans ; Multidetector Computed Tomography ; Myocardial Infarction ; Myocardial Ischemia ; Sinus of Valsalva ; Tachycardia, Paroxysmal ; Tachycardia, Supraventricular

Anomalous origin of a coronary artery is rare and does not generally lead to myocardial infarction and paroxysmal supraventricular tachycardia (PSVT). We report an uncommon case of anomalous origin of the right coronary artery (RCA) originating from the left sinus of Valsalva with PSVT and myocardial ischemia. A 58-year-old man presented with PSVT. After arrhythmia subsided, electrocardiogram showed ST and T wave abnormalities, and transient cardiac enzymes were found to be elevated. Coronary CT angiography confirmed that there was anomalous origin of the RCA originating from the left sinus of Valsalva and no intracoronary stenotic lesion. He was managed with conservative treatment, having no symptoms on clinical follow-up for 4 years.
Angiography ; Arrhythmias, Cardiac ; Coronary Vessel Anomalies ; Coronary Vessels ; Electrocardiography ; Follow-Up Studies ; Humans ; Multidetector Computed Tomography ; Myocardial Infarction ; Myocardial Ischemia ; Sinus of Valsalva ; Tachycardia, Paroxysmal ; Tachycardia, Supraventricular

No abstract available.
Actinomycosis*

Ginsan, a Panax ginseng polysaccharide that contains glucopyranoside and fructofuranoside, has immunomodulatory effects. Although several biologic studies of ginsan have been performed, its effects on dendritic cells (DCs), which are antigen-presenting cells of the immune system, have not been studied. We investigated the immunomodulatory effects of ginsan on DCs. Ginsan had little effect on DC viability, even when used at high concentrations. Ginsan markedly increased the levels of production by DCs of IL-12 and TNF-alpha, as measured by ELISA. To examine the maturation-inducing activity of ginsan, we measured the surface expression levels of the maturation markers MHC class II and CD86 (B7.2) on DCs. It is interesting that ginsan profoundly enhanced the expression of CD86 on DC surfaces, whereas it increased that of MHC class II only marginally. In 3H-thymidine incorporation assays, ginsan-treated DCs stimulated significantly higher proliferation of allogeneic CD4+ T lymphocytes than did medium-treated DCs. Taken together, our data demonstrate that ginsan stimulates DCs by inducing maturation. Because DCs are critical antigen-presenting cells in immune responses, this study provides valuable information on the activities of ginsan.
Antigen-Presenting Cells ; Dendritic Cells ; Enzyme-Linked Immunosorbent Assay ; Immune System ; Immunomodulation ; Interleukin-12 ; Panax ; Polysaccharides ; T-Lymphocytes ; Tumor Necrosis Factor-alpha