On the contrary to congenital anomalies of intestinal rotation in pediatric patients, those in adults are generally nonsymptomatic and of little consequence. Occasionally, however, an adult may have midgut nonrotation and complain of chronic or recurrent abdominal pain. Intestinal nonrotation can be divided into complete or partial failure of rotation and into abnormalities affecting the proximal segment, the distal segment or both. We report herein a 43-year old female patient with symptomatic partial, cecocolic nonrotation.
Abdominal Pain ; Adult* ; Female ; Humans

Closed thoracostomy with UWSD* which is the most utilized procedure in chest surgery applies general thoracic disorders, trauma and after-thoracic surgery. The University hospital was involved on operating 2341 cases of closed thoracostomy with UWSD except chest tubing after-thoracic surgery for a full six years from January, 1991 to December, 1996. The rate of men and women out of the total 2341 cases was 3.5 : 1, the distribution by age showed that men were 36.6+/-21.0 years old, women were 47.0+/-20.2 years old and so that the total were 40.0+/-20.5 years old. As for indication, spontaneous, secondary and traumatic pneumothorax were the most common, in addition to hemothorax, hemopneumothorax, hydrothorax, hydropneumothorax, empyema, chylothorax. The most indwelling period of chest tubing is between eight and fourteen days for 974 cases and the average is 13.7+/-6.3 days, The average drainage amount immediately after thoracostomy was 537+/-88ml, and in 694 cases(46.0%), the drain amount was 201~500 ml. The rate of right and left tubing was 52.4 : 47.6, in 2071 cases(88.5%), the thoracostomy was the first chance and 2210 cases(94.4%) were treated with a single tube drainage. Almost all the patients complained of tube site pain, besides tube site infection, intercostal neuralgia, loss of tube function by the pleural adhesion, intrathoracic infection, incomplete reexpansion of defective lung, hemorrhage caused by the rupture of a blood vessel, subcutaneous emphysema, lung parenchymal rupture, diaphragmatic and intraabdominal trauma, reexpansionary pulmonary edema of one side lung and cellulitis were relapsed. 84.6% of all patients recovered with only closed thoracostomy and the rest of patient needed additional some necessary managements and so on to have successful results. There were two deaths(0.1%), caused by reexpansionary pulmonary edema, the cellulitis were complicated by thoracostomy with UWSD on an empyema patients to come to death(due to sepsis). * UWSD = under water seal drainage.
Blood Vessels ; Cellulitis ; Chylothorax ; Drainage ; Empyema ; Female ; Hemopneumothorax ; Hemorrhage ; Hemothorax ; Humans ; Hydropneumothorax ; Hydrothorax ; Lung ; Male ; Neuralgia ; Pneumothorax ; Pulmonary Edema ; Rupture ; Subcutaneous Emphysema ; Thoracostomy* ; Thorax

A benign cecal ulcer is an uncommon lesion. The etiology remains unknown, and there are no pathognomonic lesions or symptoms. Lower gastrointestinal tract hemorrhage secondary to benign cecal ulcer is the most common complication. Herein, the case of a 24-year-old man with a benign cecal ulcer presenting with a massive lower gastrointestinal tract hemorrhage requiring transfusion until a exploratory laparotomy and right hemicolectomy, is reported with a review of the literature. Surgical intervention is warranted if malignancy is suspected or if the patient has signs of uncontrollable hemorrhage, perforation, or peritonitis.
Hemorrhage* ; Humans ; Laparotomy ; Lower Gastrointestinal Tract* ; Peritonitis ; Ulcer* ; Young Adult

Melanoma is a malignant neoplasm of melanocytes most frequently arising from the skin, but primary melanoma can also arise from the mucosa of the gastrointestinal tract. Gastrointestinal melanomas are most commonly metastases from a cutaneous melanoma. Primary melanoma of the stomach is rare and carries a poor prognosis. Reported here is the case of a 75-year-old man with a primary gastric melanoma who presented with a melena, abdominal pain, and weight loss. Most cases of melanoma are treated by excision of the primary tumor. Patients with melanoma have been treated with adjuvant chemotherapy, radiation therapy, and immunotherapy. None of these modalities has been demonstrated to prolong the survival rate. To improve long-term disease-free survival, early diagnosis and surgical intervention are very important.
Abdominal Pain ; Aged ; Cardia* ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Early Diagnosis ; Gastrointestinal Tract ; Humans ; Immunotherapy ; Melanocytes ; Melanoma* ; Melena ; Mucous Membrane ; Neoplasm Metastasis ; Prognosis ; Skin ; Stomach* ; Survival Rate ; Weight Loss

The frequencies of multiple synchronous carcinomas of the colon and the rectum have been reported to range from 2.1 to 6.3%. Currently, the frequency is higher in colorectal cancer patients, and the diagnosis is better due to the many diagnostic tools that have been developed. There are a few reported cases of five cancers in a patient at the same time. We report here on the case of five synchronous cancers arising from the colon and the rectum in a patient without a familial history of colon cancer or of genetic predisposing factor. The patient was a 62-yr-old woman who presented with frequently loose stool for six months and intermittent abdominal pain for two months. Colonoscopic examination revealed two adenocarcinomas, one each at the sigmoid colon and the rectum; the cancer in the sigmoid colon was obstructed at nearly 40 cm above the anal verge. Computed tomographic colonoscopy revealed many other polyps and masses in the colon and a metastatic mass at segment 8 in the liver. A total proctocolectomy and ileostomy were performed. Histologic evaluation revealed the five lesions to be adenocarcinomas invading the pericolic fat; 1 out of 30 lymph nodes was invaded by the cancer cells.
Abdominal Pain ; Adenocarcinoma ; Colon ; Colon, Sigmoid ; Colonic Neoplasms ; Colonoscopy ; Colorectal Neoplasms ; Female ; Humans ; Ileostomy ; Liver ; Lymph Nodes ; Polyps ; Rectum

ProSeal(TM) laryngeal mask airway (PLMA) was developed to be more effective especially with glottic airway sealing and is suppose to be an improved device over the classic laryngeal mask airway (cLMA). The PLMA's cuff is bulkier, softer, and more pliable than the cLMA. We reviewed a case were a patient had hand surgery under general anesthesia using the PLMA. After having the hand surgery, the patient suffered from dyspnea and had difficulty with their respirations at a supine position. The problems with dyspnea and respiration after surgery resulted because of difficulties from inserting PLMA No.5 into the patient. We suspect from this case that the problems in dyspnea and respiration were due to the folded cuff and incomplete placement of the PLMA, which resulted in lacerations of the mucosa in the soft palate of the patient. In this paper, we considered the probable causes for lacerations of the mucosa in the soft palate and reviewed all of the relevant literature, especially about the proper placement of the PLMA.
Anesthesia, General ; Dyspnea ; Hand ; Humans ; Lacerations ; Laryngeal Masks ; Mucous Membrane ; Palate, Soft ; Respiration ; Supine Position

PURPOSE: Laparoscopic cholecystectomy (LC) has replaced open cholecystectomy (OC) for the treatment of gallbladder disease. However certain cases still require conversion to open procedures. Identifying these patients at the risk of conversion remains difficult. This study evaluated risk factors that may predict conversion from a laparoscopic to an open procedure. METHODS: From January 1994 to December 2004, a total of 582 laparoscopic cholecystectomies were performed at Seoul Medical Center. A retrospective analyses of clinical parameters including patient demographics, clinical histories, laboratory data, ultrasound results, intraoperative details and postoperative pathologic findings were performed. RESULTS: A total of 30 patients (5.2%) had their cholecystectomies converted to an open procedure. Causes for conversion were inability to correctly identify the anatomy of surgical field due to adhesion and inflammation (56.7%), bile duct injury (13.3%), bleeding (13.3%) and others (16.7%). Univariate analysis showed that ASA (the classification of American Society of Anesthesiologists, p = 0.034), previous abdominal operation history (p = 0.008), RUQ tenderness(right upper quadrant tenderness, p = 0.002), acute cholecystitis (p < 0.001) and time elapsing between diagnosis and operation (p = 0.013) to be risk factors. Multivariate analysis revealed that acute cholecystitis (4.2 greater odds ratio [OR] of conversion, p = 0.002) and previous abdominal operation history (3.6 greater odds ratio [OR] of conversion, p = 0.003) were positive independent predictive factors for conversion to open cholecystectomy. CONCLUSION: Although laparoscopic cholecystectomy is a safe and beneficial procedure in the management of patients with gallbladder disease, there are still many chances of conversion of laparoscopic to open cholecystectomy. In this study, patients with acute cholecystitis and previous abdominal operation histories were more likely to require conversion to an open procedure. These two positive independent predictive factors can help operators to make early decision and to counsel patients undergoing laparoscopic cholecystectomy with regards to the posibility of conversion to an open procedure.
Bile Ducts ; Cholecystectomy* ; Cholecystectomy, Laparoscopic ; Cholecystitis, Acute ; Classification ; Conversion to Open Surgery ; Demography ; Diagnosis ; Gallbladder Diseases ; Hemorrhage ; Humans ; Inflammation ; Multivariate Analysis ; Odds Ratio ; Retrospective Studies ; Risk Factors ; Seoul ; Ultrasonography

BACKGROUND AND OBJECTIVES: QT dispersion (QTd) is defined as the difference between the maximum and minimum QT interval in any of the 12 leads of the surface ECG. QTd has been shown to reflect regional variations in ventricular repolarization. Ischemic dilated cardiomyopathy (DCM) may lead to more spatial and temporal dispersion in ventricular repolarization than idiopathic DCM. The purpose of this study was to determine the difference of QTd between patients who had ischemic and idiopathic DCM. MATERIALS AND METHODS: The study population included 30 patients with ischemic DCM and 30 with idiopathic DCM. All standard 12-lead ECGs were examined prospectively by two observers who were unware of the patient's details. RESULTS: QTd in ischemic DCM was significantly higher than that in idiopathic DCM (63+/-32 vs. 44+/-26 msec, p=0.012) and JTd in ischemic DCM was significantly higher than that in idiopathic DCM (48+/-21 vs. 36+/-22 msec, p=0.036). Results did not change when Bazett's QTc and JTc was substituted for QT (QTcd:69+/-33 vs. 52+/-28 p=0.039) and JT (JTcd:56+/-21 vs. 41+/-25 p=0.043). CONCLUSION: Ischemic DCM has increased spatial inhomogeneity of repolarization probably due to more regional myocardial damages compared with idiopathic DCM. The value of QT dispersion as an easily accessible, non-invasive method in predicting the risk of life threatening arrhythmia and overall mortality in patients with dilated cardiomyopathy must be confirmed in prospective trials.
Arrhythmias, Cardiac ; Cardiomyopathy, Dilated* ; Electrocardiography ; Heart Failure ; Humans ; Mortality ; Prospective Studies

Purpose: The transforming growth factor-beta (TGF-beta) is a peptide that has diverse biologic actions in human tissue and is thought to contribute to tumor development and progression. Increased TGF-beta1 levels were found in several types of malignant tumors. TGF-beta1 expression in RCC and adjacent normal kidney tissues was examined to determine the TGF-beta1 in renal cell carcinoma (RCC). MATERIALS AND METHODS: The TGF-beta1 protein levels in cancer and a normal portion of a specimen were analyzed in 61 radical nephrectomized clear cell type RCC by an enzyme-linked immunosorbent assay (ELISA), with the results compared with the clinicopathological characteristics. Immunohistochemical staining was performed to localize their expression. RESULTS: Compared with non-tumor kidney specimens, primary renal cell carcinoma demonstrated a significantly higher TGF-beta1 protein level (p<0.001). There were significant differences in the TGF-beta1 level among the histological grade (p<0.01). The tissue TGF-beta1 level was the highest in T4 stage, but there was no statistical significance between the T stages. Immunohistochemical analysis demonstrated that TGF-beta1 was localized to the tumor cytoplasm and their intensity reflected the protein expression level in these tissues. CONCLUSIONS: These results suggest that enhanced TGF-beta1 expression contributes to carcinogenesis and tumor progression in the later stages of renal cell carcinoma.
Carcinogenesis ; Carcinoma, Renal Cell* ; Cytoplasm ; Enzyme-Linked Immunosorbent Assay ; Humans ; Kidney ; Transforming Growth Factor beta1

No abstract available.