We reported a case of postoperative pulmonary embolism associated with pelvic lymphadenectomy for staging prostatic carcinoma. A 66-year-old man was admitted to our hospital complaining of dysuria. Transperineal prostatic biopsy under transrectal ultrasonographic guidance revealed evidence of malignancy. Abdominal CT and whole body scan demonstrated no abnormal findings. Staging pelvic lymphadenectomy was performed safely under general anesthesia. On the 6th postoperative day, the patient had sudden dyspnea and chest pain. EKG showed sinus tachycardia. Chest A-P showed some elevation of left diaphragm. Pulmonary perfusion scan revealed multiple cold area throughout both lung fields. A diagnosis of pulmonary embolism was made. Shock treatment and anticoagulant therapy were successfully performed. This case suggests that attention should be directed to pulmonary embolism as one of the postoperative complication of staging pelvic lymphadenectomy.
Aged ; Anesthesia, General ; Biopsy ; Chest Pain ; Diagnosis ; Diaphragm ; Dyspnea ; Dysuria ; Electrocardiography ; Humans ; Lung ; Lymph Node Excision* ; Perfusion ; Postoperative Complications ; Prostatic Neoplasms ; Pulmonary Embolism* ; Shock ; Tachycardia, Sinus ; Thorax ; Tomography, X-Ray Computed ; Whole Body Imaging

Even though prostatitis remains a complex, often puzzling disease, studies during the last decade have clarified many of its features. Much of the prevailing confusion concerning prostatitis is attributable is attributable to imprecise methods of diagnosis. We measured the immunologic response of the EPS using radial immunodiffusion method in 14 bacterial prostatitis cases, 39 nonbacterial prostatitis cases and 24 normal volunteer controls. The results obtained in this study are as follows: 1. Among the 14 cases of chronic bacterial prostatitis, gram negative bacterias were cultured from VB, and/or EPS specimens in 12 cases (85.8%) , and gram positive bacterias in 2 cases (14.2%). 2. In normal group, the mean+/-S.D. of IgG, IgA and IgM an serum was 1,235+/-203.78mg/dl, 192.0+/-50.16mg/dl, 172.0+/-32.11mg/dl respectively, in chronic bacterial prostatitis 1,171.5+/-241.O6 mg/dl, 163.1+/-67.61mg/dl, 137.1+/-51.88mg/dl, in nonbacterial prostatitis 1,258.3+/-313.47 mg/dl, 205.0+/-78.37 mg/dl, l35.0+/-48.78mg/dl. There was no significant difference among the normal control group, chronic bacterial and nonbacterial prostatitis patients. 3. In the normal group, the mean+/-S.D. of lgG, IgA and IgM was 1.5+/-0.74 mg/dl 0.82+/-0.06mg/dl, 2.7+/-1.37mg/dl, in chronic bacterial prostatitis 9.1+/-6.39mg/dl, 6.1+/-5.09mg/dl, 3.3+/-1.37mg/dl, in chronic nonbacterial prostatiti 2.8+/-1.99mg/dl, 2.7+/-3.05mg/dl, 2.2+/-1.56mg/dl. The levels of IgG. 4. The ratio of IgG and IgA in prostatic secretion to immunoglobulin in serum was increased in chronic bacterial prostatitis significantly more than the normal control group(P < 0.05). and IgA in prostatic secretion were more increased in chronic bacterial prostatitis than the normal control group(P< 0.05) but there was no significant elevation of EPS immunoglobulin in non-bacterial prostatitis.(P> 0.05) 5. After antimicrobial therapy the level of IgG and IgA in prostatic secretion was progressively decreased in chronic bacterial prostatitis but there was no definite change in chronic nonbacterial prostatitis.
Diagnosis ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Healthy Volunteers ; Humans ; Immunodiffusion ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Immunoglobulins* ; Prostatitis*

The pathogenesis of bladder and cloacal exstrophy is an abnormal development of the cloacal membrane. The incidence of each is one in l0,000-50,000 and 200,000-400,000 live births. Male is more commonly affected than female. We experienced two cases of bladder exstrophy and one cloacal. First case was one-day-old girl who was referred to our department because of urine leakage through defected abdominal wall. We performed primary bladder closure with paraexstrophy skin flap urethroplasty, approximation and traction of pubis without osteotomy and application of hip-spica cast. The second was seven-day-old boy visited our department because of urine and stool leakage. We performed primary bladder closure, bilateral orchiectomy and ileostomy. He recurred bladder exstrophy due to infection of operation site. The third was twenty-day-old boy visited our department because of urine leakage. We recommended admission and treatment, but his parents refused further evaluation.
Abdominal Wall ; Bladder Exstrophy* ; Cloaca ; Female ; Humans ; Ileostomy ; Incidence ; Live Birth ; Male ; Membranes ; Orchiectomy ; Osteotomy ; Parents ; Skin ; Traction ; Urinary Bladder*

Chordoid meningioma, an uncommon subtype of meningioma, occurs rarely in the spine. In this case report, the authors present a case of spinal chordoid meningioma in a young female patient, and include a detailed description of imaging findings and a literature review.
Female ; Humans ; Meningioma ; Spine

Transvenous implantation of an implantable cardioverter defibrillator in patients with a prosthetic valve in the tricuspid position is difficult because a defibrillator lead cannot be implanted into the right ventricle through the prosthetic valve. Hence, there are three options: epicardial implantation, subcutaneous implantable cardioverter defibrillator implantation, and cardiac vein implantation. Here, we report the transvenous implantation of an implantable dual-chamber cardioverter defibrillator in a patient who had undergone tricuspid valve replacement with a prosthetic valve. The patient was a 70-year-old female with a prosthetic valve in the tricuspid position who had experienced two events of sudden cardiac arrest. We successfully performed the procedure by implanting the defibrillator lead into the middle cardiac vein.
Aged ; Death, Sudden, Cardiac ; Defibrillators* ; Defibrillators, Implantable ; Female ; Heart Ventricles ; Humans ; Tricuspid Valve* ; Veins

BACKGROUND: Gallstone is one of the most common cause of acute abdominal pain and is increasingly managed by laparoscopic cholecystectomy. Silent gallstones are usually managed expectantly and are considered for surgery only if the characteristic biliary pain occurs. If predictors of stone-related complications such as acute cholecystitis, pancreatitis, and cholangitis can be identified, patients at high risk can be selectively referred for treatment regardless of symptoms development, while those at lower risk may be safely observed. The purpose of this study was to find out the predictors of stone-related complication or biliary pain in patients with gallbladder stones. METHODS: We collected clinical data retrospectively on patients who were diagnosed with gallstone at Asan Medical Center. Total gallstone number was classified into 1, 2~4, over 5. Diameter of the gallstones were subdivided into 20 mm. Statistical analysis was performed using SAS program (Ver 6.11). RESULTS: 918 patients (432 men and 486 women) were included in the analysis. The mean age was 54.3 years; that of men was 55 years and women was 53.8 years. Stone-related complications developed in 201 patients of acute cholecystitis, 78 patients of acute gallstone pancreatitis and 80 patients of acute cholangitis. Biliary pain was occurred in 568 patients. 658 patients were experienced cholecystectomy (158 patients open cholecystectomy and 500 patiens LLC). 377 patients were experiened ERCP, and 289 persons of that were experienced EST. Acute gallstone pancreatitis and acute cholangitis were significantly more frequent in older age and patients experiencing biliary pain. Their gallstone size was significantly smaller and the number was significantly more numerous in the univariate analysis. But, in the multiple logistic regression analysis, only age and the smallest stone size were independent risk factors. Patients who experiencing biliary pain were older and had significantly smaller and multiple gallstones in the univariate analysis. However in the multiple logistic regression analysis only age and stone number were independent variables. Acute cholecystitis was significantly more frequent in the old age group and patients with biliary pain. CONCLUSION: In the multiple logistic regression analysis, old age and small gallstones were predictors of acute gallstone pancreatitis and acute cholangitis. Old age and multiple gallstones were associated with biliary pain. Old age and biliary pain were predictors of acute cholecystitis, but the gallstone size and number were not associated in this study. We suggest that a well-designed prospective study is necessary in the future.
Abdominal Pain ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Chungcheongnam-do ; Female ; Gallbladder ; Gallstones* ; Humans ; Logistic Models ; Male ; Pancreatitis ; Retrospective Studies ; Risk Factors

BACKGROUND/AIMS: CD11c is a dendritic cell marker in humans, which potentially induces a cytotoxic effect on lymphoma cells. Forkhead boxP3 (FOXP3) is a regulator of T lymphocyte in the microenvironment of the lymphoma. The principal objective of this study was to determine whether the tumors' microenvironment expressions of CD11c and FOXP3 are predictive of clinical outcomes in diffuse large B-cell lymphoma (DLBCL) patients receiving treatment with rituximab, cyclophosphamide, anthracycline, vincristine, and prednisone (R-CHOP) combination chemotherapy. METHODS: The study population consisted of 100 patients with DLBCL. The CD11c and FOXP3 expression in primary tumors' microenvironment were evaluated using an immunohistochemistry (IHC). RESULTS: CD11c and FOXP3 expression positivity in microenvironment were 25% and 35%, respectively. Each one counted for 1 point. In CD11c and FOXP3 stain, positive was counted as 0 and negative was 1. The points were separated into low risk (0 to 1) and high risk (2) groups. Only the extranodal DLBCL patient group analysis conveyed significant differences of progression-free survival (p = 0.019) and overall survival (p = 0.039) between the two groups. CONCLUSIONS: We can achieve possible clinical significance of lymphoma tumor microenvironments through CD11c and FOXP3 IHC stains in extranodal DLBCL patients receiving R-CHOP therapy.
B-Lymphocytes* ; Coloring Agents ; Cyclophosphamide* ; Dendritic Cells ; Disease-Free Survival ; Drug Therapy, Combination* ; Humans ; Immunohistochemistry ; Lymphocytes ; Lymphoma ; Lymphoma, B-Cell* ; Lymphoma, Large B-Cell, Diffuse ; Prednisone* ; Rituximab* ; Tumor Microenvironment* ; Vincristine*