Leiomyosarcomas of the stomach are unusual tumors, accounting for 1% to 3% of all malignant tumors and 17% to 20% of all smooth muscle tumors of the stomach. It is difficult to diagnosis these tumors preoperatively because of its vague symptoms and signs or producing symptoms only late. Despite their rarity and difficulty in diagnosis, thier diagnosis is important due to more favorable prognosis aasociated with these tumors than that of gastric carcinoma. Recently, endoscopy is being used with increasing frequency, but because these are submucosal lesions the diagnosis of thease tumors cannot be easily made through the endoscope. We experienced a case of relatively full-brown leiomyosarcoma in gastric fundus. Endoscopy showed 6x6cm sized, definite margined, protruding mass on gastric fundus, with central deep ulceration coated with blood clots. The mucosa overlying the mass was intact, smoothly effaced and the bridging fold was also visible. Postoperative ultrasound showed large protruding mixed echogenic solid mass with contral deep excavation due to ulcer, and intact serosa, so suggestive of endogastric tumor. We believed endoscopy combined with endoscopic ultrasound is probably useful method in early diagnosis of gastric submucosal tumors, especially exogastric type or early small tumors
Camellia ; Diagnosis ; Early Diagnosis ; Endoscopes ; Endoscopy ; Gastric Fundus ; Leiomyosarcoma* ; Mucous Membrane ; Prognosis ; Serous Membrane ; Smooth Muscle Tumor ; Stomach* ; Ulcer ; Ultrasonography

There are some emergency situations when untested fresh blood should be transfused. Emergency blood donor tests(EBDT) have been done as an effort to protect these blood recipients from contracting transfusion associated infections in Seoul National University, Hospital. EBDT includes HBsAg, anti-HlV, STS, and ALT test. Anti-HCV test is not included because of the absence of appropriate test kit. A total of 534 tests have been done from June 1993 to August 1995. Among these, 495 tests(92.7%) have been done for blood donor screening, and 39 tests(7.3%) for emergency organ transplantation. Sensitivity and specificiy of the emergency HBsAg test were 69% and 98%, respectively. There were two RPR reactive blood donors, but no anti-HIV positive cases. Among 458 blood donors, 37 donors(8.1%) showed increased ALT level(> 45IU/L). The percent of agreement in HBsAg, elevated ALT and anti-HIV tests between emergent and routine blood donor tests, were 97.0%, 98.9% and 100%, respectively. Although false positive and false negative EBDT result may is useful, although limited, we think that EBDT is useful in protecting blood recipient from transfusion associated infections.
Blood Donors* ; Emergencies* ; Hepatitis B Surface Antigens ; Humans ; Mass Screening ; Organ Transplantation ; Seoul ; Transplants

Purpose: Initial conservative treatment with selective endovascular or surgical intervention has shown successful outcomes in the treatment of spontaneous isolated superior mesenteric artery dissection (SISMAD). However, the benefits of antithrombotic therapy as a part of conservative treatment have not been clarified. This study aimed to investigate the clinical course of SISMAD patients and determine differences in clinical outcomes between the antithrombotic and noantithrombotic groups. Methods: We retrospectively reviewed 79 cases of SISMAD that were treated conservatively from January 2004 to December 2019 at Chonnam National University Hospital. Clinical outcomes, including the length of hospital stay, pain resolution time, image remodeling, and maximal remodeling time, were compared between the antithrombotic and noantithrombotic groups. Results: There were 30 patients in the no-antithrombotic group and 49 patients in the antithrombotic group. There was no significant difference in clinical characteristics between the 2 groups, except for dyslipidemia (P = 0.011). The follow-up period (32.6 months vs. 14.6 months, P = 0.009) and imaging follow-up period (31.6 months vs. 13.9 months, P = 0.011) were longer in the antithrombotic group than in the no-antithrombotic group. The length of hospital stay (5.1 days vs. 7.7 days, P = 0.002) was significantly shorter in the no-antithrombotic group than in the antithrombotic group because patients in the antithrombotic group required longer hospitalization for warfarin titration. Conclusion In patients with SISMAD, conservative treatment without antithrombotic therapy may have clinical benefits such as decreased length of hospital stay compared with conservative treatment with antithrombotic therapy.

BACKGROUND: The specificity of HBsAg enzyme immunoassay (EIA) has been previously reported between 95% and 100% for blood donor screening in Korea. Considering that Korea is highly endemic in HBV infection, it is highly recommended that blood donors showing true positive for HBsAg were permanently deferred from donation. Identification of false-positive results by a confirmation assay would be a necessary step for this purpose. This study was intended to evaluate LG HBsAg Confirm (LG Chemicals Corp., Seoul, Korea) kit as a confirmation test and know the positive predictive value for HBsAg screening results. METHODS: LG HBsAg Confirm reactivities were evaluated in 279 patients and 185 blood donor samples, all of which were positive in HBsAg EIA. Patients samples were positive in both HBsAg EIA and HBV DNA. Confirm positive was determined according to the following 2 step criteria: (1) the percent neutralization is 50% or more (first-step neutralization), or (2) if not, the percent neutralization after 1:1,000 dilution of original sample is 50% or more (second-step neutralization). RESULTS: LG HBsAg Confirm kit confirmed all 279 patients~ sera as positive. All of 185 blood donor samples showed true positive results. First-step neutralization confirmed 157 sera (33.8%) as positive and second-step neutralization confirmed 307 sera (66.2%) among 464 samples. CONCLUSION: Performance of LG HBsAg Confirm was so excellent that all the samples showing positive in both HBsAg EIA and HBV DNA tests could be determined as confirm positive.
Blood Donors ; DNA ; Hepatitis B Surface Antigens* ; Humans ; Immunoenzyme Techniques ; Korea ; Mass Screening ; Neutralization Tests ; Sensitivity and Specificity ; Seoul

Behcet's disease is a chronic inflammatory symptom complex consisting of recurrent aphthous sttomatitis, nonspectific ulcerative lesions of the genital area, and uveitis. Skin, cardiovascular, arthritic, central nerve system and gastrointestinal involvement have been reported in association with the major triad. Intestinal involvement in Behcets disease most commonly affects the ileocecal region as ulceration. Intestinal ulcers give rise to abdominal pain, perforation, melena, and tumor in order of frequency. A 36-year-old female patient was addmitted to this hospital because of right upper quadrent abdominal pain and mass. There was a history of recurrent aphthous stomatitis and vaginal ulcers. Barium enema showed that the terminal ileum was irregularly indented with multiple nodular filling defects and the proximal ascending colon around ileocecal valve had several round shaped filling defects. Colonoscopy showed that the terminal ileum was irregularly marginated geographic ulcer, surrounded with hyperemic edematous mucosa, extended to ileoeecal valve. And the proximal ascending colon around ileocecal valve revealed several discreted whitish patched ulcers with apparently normal intervening mucosa. She was operated with right hemicolectomy and end to end ileotransverse colostomy under the impression of inttinal-Behcets disease. About 1 year after operation, right upper quardrent abdominal pain was reappeared. Colonoscopy was performed and revealed a recurred ulcer at anastomotic site. We report a case of Behcet's disease with multiple ileocecal ulcers, recurred after operation.
Abdominal Pain ; Adult ; Barium ; Colon, Ascending ; Colonoscopy ; Colostomy ; Enema ; Female ; Humans ; Ileocecal Valve ; Ileum ; Melena ; Mucous Membrane ; Skin ; Stomatitis, Aphthous ; Ulcer* ; Uveitis

Traumatic aortic transection after blunt chest injury is highly lethal and has high operative mortality. Recently, the diagnostic and therapeutic method of this injury is advanced, especially in spinal cord protection during aortic cross-clamping. We have experienced two cases of traumatic aortic transection with left hemothorax after blunt chest injury, which was diagnosed in operative field. The transected aorta was primarily repaired with clamp and sew method and postoperative paraplegia had not occured. The patients were dischraged without any significant complications. We report these cases with a review of literature.
Aorta ; Hemothorax ; Humans ; Mortality ; Paraplegia ; Spinal Cord ; Thoracic Injuries

Although attachments have been utilized for a retainer of removable prostheses during several decades, there is little information on the force distribution by the attachments. This study was undertaken to evaluate the stress patterns developed by partial dentures employing rigid attachments on the supporting structures. Four types of the mandibular removable partial dentures were designed depending upon the position of the rigid attachment and the existency of lingual bracing. Under 100N of vertical and 25N of lateral loads on the 1st and 2nd lower molar of partial denture, stress distribution patterns and displacement were analysed with three dimensional finite element method by ANSYS version 5.3. 1. The highest stresses were concentrated on the distal alveolar crest of posterior abutment and the second stresses on the apical region of posterior abutment in the models. 2. The greatest displacement were shown on the distal alveolar crest of posterior abutment and the second displacement on the distal alveolar crest of anterior abutment in the models. 3. There was little difference between the models with intraoral attachment and those with extracoronal attachment. 4. There was little difference between the models with and without the lingual bracing.
Braces ; Denture, Partial* ; Denture, Partial, Removable ; Molar ; Prostheses and Implants

BACKGROUND: Insulin resistance has been identified as one of the risk factor of atherosclerosis. Hypertension, obesity, glucose intolerance and dyslipidemia could induce atherosclerosis through mechanism of insulin resistance. And there are some reports that hyperinsulinemia itself could induce coronary artery disease(CAD). Then we planed to investigate relationship between CAD and insulin resistance. And smoking is also known as one major risk factor of CAD. So we also investigated the relationship between smoking and insulin resistance in the CAD patients. METHODS: Among 36 subjects in whom coronary angiography was done, we grouped 25 subjects who had stenotic coronary artery as a CAD group and 11 subjects without stenosis as control group. We compared insulin and glucose response to oral glucose load(75g), serum lipid concentrations, blood pressure, and degree of obesity between two groups. We also divided CAD group into smoking and nonsmoking subgroups, compared the above parameters. RESULTS: 1) There were no significant difference in body mass index, blood pressure, creatinine, cholesterol, HDL-cholesterol, between the CAD group and the control group. There were significantly higher incidence of smokers in CAD group. 2) Insulin concentration at 120 minutes after glucose load were significantly higher in the CAD group than the control group. 3) In the CAD group, fasting plasma insulin concentration insulin area, peak plasma insulin concentration and insulin concentration at 60,90,120 minutes after glucose load were significantly higher in non-smoking group. CONCLUSION: Enhanced insulin reponse such as higher insulin concentration 60 minutes after glucose load in the CAD group suggests that insulin resistance is a risk factor of CAD. And insulin response was more pronounced in the non-smoker subgroup than smoker subgroup in the CAD patients. Thus role of insulin resistance in provoking coronary artery disease is more important in the non-smoker.
Atherosclerosis ; Blood Pressure ; Body Mass Index ; Cholesterol ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Creatinine ; Dyslipidemias ; Fasting ; Glucose ; Glucose Intolerance ; Humans ; Hyperinsulinism ; Hypertension ; Incidence ; Insulin Resistance* ; Insulin* ; Obesity ; Plasma ; Risk Factors ; Smoke ; Smoking

BACKGROUND: The reduction in the plasma cholinesterase (PChE) level results in slow to hydrolysis of succinylcholine (SCC) and mivacurium (MIV). The factors altering the level of the normal enzyme in human could be considered under the several conditions. We investigated in the present study whether the drugs induced decreases in normal PChE activity after administration of various muscle relaxants during anesthesia are evident and how these results should be influenced to the time course of neuromuscular blockade produced by SCC and MIV. METHODS: Young adult patients of ASA class I or II scheduled for elective surgery requiring muscle relaxation were premedicated and anesthesia was maintained with nitrous oxide in oxygen with increment of thiopentone or fentanyl as required. In the neuromuscular monitoring, surface electrodes were applied on the ulnar nerve at wrist. Supramaximal transcutaneous single twitch stimulation (1 Hz) during onset and 0.1 Hz during recovery of neuromuscular blockade induced by various muscle relaxants delivered by a peripheral nerve stimulator was applied. Twitch response of thumb adductor was measured mechanomyographically using 2 kg Load Cell Strain Gauge with thumb piece modification. Recordings were made on a Gould recorder. PChE levels were measured by the modified Garry method after induction of anesthesia and, at 3, 10, 20 and 30 min following administration of 2 x ED95 of pancuronium (PAN), vecuronium (VEC) and atracurium (ATR). Neuromuscular recordings were measured with onset time defined as lag time and manifest time, and recovery time defined as clinical duration, recovery index and total duration. RESULTS: The levels of PChE were significantly reduced after administration of PAN and VEC (p<0.05). Onset times were significantly shorten but recovery time in the group given MIV pretreated by small dose of PAN was significantly prolonged (p<0.05). And there were a evidence to prolong recovery time in the group pretreated by small dose of VEC but not significant. CONCLUSIONS: It is concluded that aminosteroidal derivative neuromuscular blocking agents have presumably evidence induced decreases in PChE activity rather than benzylisoquinolinium derivative neuromuscular blocking agents.
Anesthesia ; Atracurium ; Cholinesterases* ; Electrodes ; Fentanyl ; Humans ; Hydrolysis ; Muscle Relaxation ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Neuromuscular Monitoring ; Nitrous Oxide ; Oxygen ; Pancuronium ; Peripheral Nerves ; Plasma* ; Succinylcholine ; Thiopental ; Thumb ; Ulnar Nerve ; Vecuronium Bromide ; Wrist ; Young Adult

Peutz-Jeghers syndrome is an autosomal dominant inherited disorder characterized by multiple gastrointestinal hamartomatous polyps and mucocutaneous pigmentation. Peutz-Jeghers syndrome has an incidence of approximately 1 in 25,000 to 300,000 births. Crohn's disease is a chronic inflammatory bowel disease that typically manifests as regional enteritis with its incidence ranging from 3.1 to 14.6 cases per 100,000 person-years in North America. Herein, we report a case of a 30-year-old male patient who had both Peutz-Jeghers syndrome and Crohn's disease. We believe that this is the first case in Korea and the second report in the English literatures on Peutz-Jeghers syndrome coincidentally accompanied by Crohn's disease.
Adult ; Crohn Disease/complications/*diagnosis/pathology ; Endoscopy, Gastrointestinal ; Humans ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Intestinal Polyps/pathology/surgery ; Male ; Peutz-Jeghers Syndrome/complications/*diagnosis/genetics ; Protein-Serine-Threonine Kinases/genetics