Gall bladder wall varices are unusual manifestations of protal hypertention. Authors report 4 cases of gall bladder wall varices which were easily detected in IV bolus CT. All of our cases showed main portal vein obstruction but preserved intrahepatic portal flows with development of cavernous transformation. We could easily identify tortous and tubular structures with strong contrast enhancement in the gall bladder wall, compatible with gall bladder wall varices, at the early phase of IV bolus CT. Comparing with Doppler sonography, IV bolus CT is an easy and useful method for detection of gall bladder wall varices even in case of no prior information for portal vein abnormality.
Diagnosis* ; Methods ; Portal Vein ; Urinary Bladder* ; Varicose Veins

Henoch-Schonlein purpura or Anaphylactiod purpura is rare syndrome in adults characterized by a symmetrical, non traumatic, nonthrombocytopenic, painless purpuric rash, arthritis, nephritis, gastrointestinal manifestation. G-I tract involvement is characterized by abdominal pain, G-I bleeding. Although the small bowel is more frequently involved, cases of esophageal, gastroduodenal and colorectal localization have been rarely reported. Recently, we have experienced a case of Henoch-schonlein purpura with renal, skin, extensive gastrointestinal involvement in a 53 year-old male patient who complained of pain, purpura, generalized abdominal pain, dyspnea. The endoscopic findings of duodenum and colon in a patient with Henoch-Schonlein purpura are presented.
Abdominal Pain ; Adult ; Arthritis ; Colon ; Colon, Sigmoid ; Duodenum ; Dyspnea ; Exanthema ; Hemorrhage ; Humans ; Male ; Middle Aged ; Nephritis ; Purpura* ; Purpura, Schoenlein-Henoch ; Skin

Henoch-Schonlein purpura or Anaphylactiod purpura is rare syndrome in adults characterized by a symmetrical, non traumatic, nonthrombocytopenic, painless purpuric rash, arthritis, nephritis, gastrointestinal manifestation. G-I tract involvement is characterized by abdominal pain, G-I bleeding. Although the small bowel is more frequently involved, cases of esophageal, gastroduodenal and colorectal localization have been rarely reported. Recently, we have experienced a case of Henoch-schonlein purpura with renal, skin, extensive gastrointestinal involvement in a 53 year-old male patient who complained of pain, purpura, generalized abdominal pain, dyspnea. The endoscopic findings of duodenum and colon in a patient with Henoch-Schonlein purpura are presented.
Abdominal Pain ; Adult ; Arthritis ; Colon ; Colon, Sigmoid ; Duodenum ; Dyspnea ; Exanthema ; Hemorrhage ; Humans ; Male ; Middle Aged ; Nephritis ; Purpura* ; Purpura, Schoenlein-Henoch ; Skin

Xanthogranulomatous cholecystitis is an uncommon inflammatory disease of the gall baldder characterised by a focal or diffuse destructive inflammatory process. The pathogenesis is uncertain, but an inflammatory response to extravasated bile due to acute inflammation and obstruction is likely. Macroscopically, the gall bladder wall is invariably thickened, and extensive adhesions to adjacent organs are frequent. Clinically, xanthogranulomatous cholecystitis can mimic gall bladder carcinoma and radiologic differential diagnosis is extremely difficult. Fistula to skin and duodenum was reported. We report the first case of cholecysto-colonic fistula due to xanthogranulomatous cholecystitis.
Bile ; Cholecystitis* ; Diagnosis, Differential ; Duodenum ; Fistula* ; Inflammation ; Skin ; Urinary Bladder

Aortic regurgitation in the pediatrics who had previous cardiac surgery is increased with their improved longterm survival rate and their complexity of heart disease. So the need of aortic valve surgery in pediatrics is also on the increase. A 10-year old boy was admitted for progressive cyanosis and dyspnea on exertion(DOE). The patient had been underwent lateral tunnel Fontan operation before. Echocardiography and cardiac catheterization study revealed hepatic vein drained to pulmonary atrium via intrahepatic collaterals, moderate atrioventricular regurgitation, and severe aortic regurgitation due to aortic root dilation. We report a case who had aortic root reconstruction, valvuloplasty of the atrioventricular valve, and hepatic vein ligation successfully. Cyanosis and DOE was dramatically improved after the operation
Aortic Valve ; Aortic Valve Insufficiency ; Cardiac Catheterization ; Cardiac Catheters ; Child ; Cyanosis ; Dyspnea ; Echocardiography ; Fontan Procedure* ; Heart Diseases ; Hepatic Veins ; Humans ; Ligation ; Male ; Pediatrics ; Survival Rate ; Thoracic Surgery

BACKGROUND AND OBJECTIVES: Pharyngoesophageal musculature plays an important role in swallowing, and prevents aspiration and supraesophageal reflux. These muscles are closed during the resting state and opens with swallowing to allow the passage of food. In this study, the histochemical characteristics of the upper esophageal sphincter muscles in human were investigated. MATERIALS AND METHODS: Muscle samples from the inferior pharyngeal constrictor, cricopharyngeus, upper esophageal muscle and sternocleidomastoid (SCM) muscle were obtained from the healthy portion of nine laryngectomized specimen. We used the H&E staining for identifying the gross anatomy of these muscles, and the myofibrillar ATPase staining and the NADH-TR staining for differentiating the muscle fiber type. RESULTS: Analysis of the muscle fiber types of the upper esophageal sphincter muscle revealed a predominance of type I in the cricopharyngeus (78.9%) and the upper esophageal muscle (85.2%), and type II in the inferior pharyngeal constrictor muscle (80%). In the SCM muscle, the percentage of each fiber type was almost the same. The proportion of oxidative fibers within these muscles correlated well to that of the type I fibers. CONCLUSION: The distribution of the type I fibers tended to be higher in the upper esophageal muscle than in the inferior pharyngeal constrictor. These findings about fiber types represents well the physiological features of each muscle, i.e. the inferior pharyngeal constrictors are capable of short rapid contraction and the upper esophageal muscles are capable of slow rhythmic movement.
Adenosine Triphosphatases ; Deglutition ; Esophageal Sphincter, Upper* ; Histocytochemistry ; Humans* ; Muscles ; Pharyngeal Muscles

BACKGROUND AND OBJECTIVES: Pilomatricoma, also known as calcifying epitheliomas of Malherbe is uncommon, benign skin neoplasm that arise from outer root sheath cell of hair follicle or hair follicle of sebaceous glands. In more than half of the cases, pilomatricoma typically involves the head and neck followed by upper extremities and trunk, with the majority occurring in children. The purpose of this study is to analyze the data from the author's experience with head and neck pilomatricoma and to discuss diagnostic and therapeutic management. SUBJECTS AND METHOD: A retrospective analysis of the patients of pilomatricoma treated between 1994 and 2004 revealed 21 cases of head and neck pilomatricoma. RESULTS: The typical clinical manifestation of pilomatricoma was non-tender, firm, subcutaneous, and nodular mass. The age range was from 9 months to 62 years (mean 17.4 years). The male-to-female ratio was 4 : 3. The common sites of occurrence were the neck (33%), cheek (24%), suboccipital (14%), preauricular (14%). The size of the mass ranged from 0.5 cm to 3 cm, and the mean was 1.1 cm. CT with contrast enhancement scans revealed densely calcified, mild enhancing and well circumscribed soft tissue densities in subcutaneous tissues. Additionally, MRI with gadolinum enhancement scans revealed partially enhanced, well demarcated and intermediate signal intensity mass lesions. Surgical excision was curative in all cases. CONCLUSION: Pilomatricoma is cutaneous neoplasms that occur commonly in the head and neck region. Even if the preoperative diagnosis may be difficult in some cases, pilomaticoma must be considered in the differential diagnosis of a superficial head and neck mass.
Carcinoma ; Cheek ; Child ; Diagnosis ; Diagnosis, Differential ; Hair Follicle ; Head and Neck Neoplasms ; Head* ; Humans ; Magnetic Resonance Imaging ; Neck* ; Pilomatrixoma* ; Retrospective Studies ; Sebaceous Glands ; Skin Neoplasms ; Subcutaneous Tissue ; Upper Extremity

Renal oncocytomas account for approximately 5% of renal parenchymal tumors. Usually it has unilateral solitary oncocytic nodule, but bilateral multifocal renal oncocytomasis is rare. The term renal oncocytoma should be used to characterize a well-differentiated renal epithelial tumor with eosinophilic granular cytoplasm that has benign behavior and favourable progress. Also, multiple oncocytoma distributed diffusely in both kidneys is termed renal oncocytomatosis Because of the benign nature, multicentricity, possible bilaterality and absence of pathognomonic radiographic features, renal oncocytomas should be considered in differential diagnosis of solid masses, especially renal cell carcinoma. We report a patient with bilaleral multifocal renal oncocytomatosis, who had progressive renal failure. Renal oncocytomatosis was diagnosed pathologically after bilateral nephrectomy.
Adenoma, Oxyphilic ; Carcinoma, Renal Cell ; Cytoplasm ; Diagnosis, Differential ; Eosinophils ; Humans ; Kidney ; Kidney Failure, Chronic* ; Nephrectomy ; Renal Insufficiency

BACKGROUND: The emergence of multi-drug resistant Gram-positive cocci, such as MRSA, VRE, and VRSA, necessitated to develop new antibiotics, which could replace the glycopeptide. As a result, a new antibiotics named linezolid was developed. Linezolid is different line of oxazolidinones with a good oral bioavailability, compared to other antibiotics. Since appropriate oral antibiotics are not presently available for MRSA, which is a major cause of nosocomial and community acquired infections, the introduction of linezolid will have favorable effect on treatment of infections such as pneumonia or skin infections. In this study, we investigated the antibiotic effect of linezolid on MRSA and VRE isolated from patients who were treated in Korea University Guro Hospital. MATERIAL AND METHODS: By using broth microdilution and agar dilution method we measured minimum inhibitory concentration (MIC) with sixty S. aureus, forty three Enterococcus spp., and twenty five S. pneumoniae isolates from patients who were diagnosed as skin, soft tissue, respiratory, and urinary infections in Korea University Guro Hospital from January, 1998 to December, 2002. RESULTS: All of S. aureus used in this study were MRSA, and MIC90 of linezolid was below 2 microgram/ml (MIC ranged between 1-2 microgram/ml). All of Enterococcus spp. were VRE, and had MIC90 of 2 microgram/ml (MIC ranged between 1 to 4 microgram/ml). One of the VRE showed intermediate susceptibility with MIC of 4 microgram/ml. However, none was resistant with MIC breakpoint above 8 microgram/ml. All of S. pneumoniae were resistant to penicillin, but they were susceptible to linezolid with MIC90 of 1 microgram/ml(MIC range 0.5-1 microgram/ml). CONCLUSION: In conclusions, linezolid has an excellent in vitro antibiotic effect on multi-drug resistant Gram-positive cocci, such as MRSA, PRSP, and VRE.
Agar ; Anti-Bacterial Agents ; Biological Availability ; Community-Acquired Infections ; Enterococcus ; Gram-Positive Cocci ; Humans ; Korea ; Linezolid ; Methicillin-Resistant Staphylococcus aureus ; Microbial Sensitivity Tests ; Oxazolidinones ; Penicillins ; Pneumonia ; Skin

BACKGROUND: The emergence of multi-drug resistant Gram-positive cocci, such as MRSA, VRE, and VRSA, necessitated to develop new antibiotics, which could replace the glycopeptide. As a result, a new antibiotics named linezolid was developed. Linezolid is different line of oxazolidinones with a good oral bioavailability, compared to other antibiotics. Since appropriate oral antibiotics are not presently available for MRSA, which is a major cause of nosocomial and community acquired infections, the introduction of linezolid will have favorable effect on treatment of infections such as pneumonia or skin infections. In this study, we investigated the antibiotic effect of linezolid on MRSA and VRE isolated from patients who were treated in Korea University Guro Hospital. MATERIAL AND METHODS: By using broth microdilution and agar dilution method we measured minimum inhibitory concentration (MIC) with sixty S. aureus, forty three Enterococcus spp., and twenty five S. pneumoniae isolates from patients who were diagnosed as skin, soft tissue, respiratory, and urinary infections in Korea University Guro Hospital from January, 1998 to December, 2002. RESULTS: All of S. aureus used in this study were MRSA, and MIC90 of linezolid was below 2 microgram/ml (MIC ranged between 1-2 microgram/ml). All of Enterococcus spp. were VRE, and had MIC90 of 2 microgram/ml (MIC ranged between 1 to 4 microgram/ml). One of the VRE showed intermediate susceptibility with MIC of 4 microgram/ml. However, none was resistant with MIC breakpoint above 8 microgram/ml. All of S. pneumoniae were resistant to penicillin, but they were susceptible to linezolid with MIC90 of 1 microgram/ml(MIC range 0.5-1 microgram/ml). CONCLUSION: In conclusions, linezolid has an excellent in vitro antibiotic effect on multi-drug resistant Gram-positive cocci, such as MRSA, PRSP, and VRE.
Agar ; Anti-Bacterial Agents ; Biological Availability ; Community-Acquired Infections ; Enterococcus ; Gram-Positive Cocci ; Humans ; Korea ; Linezolid ; Methicillin-Resistant Staphylococcus aureus ; Microbial Sensitivity Tests ; Oxazolidinones ; Penicillins ; Pneumonia ; Skin