Gastric carcinoid tumors were previously believed to be rare lesions, representing less than 2% of all carcinoid tumors and less than 1% of all stomach neoplasms. More recent studies have demonstrated that they may constitute as much as l0-30% of carcinoid tumors. We recently experienced a 35-years old businessman with gastric carcinoid tumor who camplained of postprandial epigastric discomfort. Gastrofiberscope showed protruding mass with central depression and erasion which was located on greater curvature of lower body and its size was 1 x 1 cm. Gastroendoscopic biopsy was per formed. It was identified to carcinoid tumor(Argyrophilic tumor). EUS(endoscopic ultrasonography) revealed that the lesion was limited to submucosa without evidence of any metastasis to adjacent lymph node. The carcinoid tumor was successfully removed by endoscopic polypectomy. Gastrofiberscope and EUS 9months after polypectomy showed that the lesion was nearly normal mucosa without submucosal thickening.
Adult ; Biopsy ; Carcinoid Tumor* ; Depression ; Humans ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Stomach Neoplasms

Many patients regard tonsillectomy as a minor operation because it is performed frequently. Although tonsillectomy is considered a relatively safe surgical procedure, numerous complications have been described. The common complications are hemorrhage, infection, and following anesthesia, aspiration, cardiac arrhythmia, and laryngeal trauma. Cervicofacial emphysema and pneumomediastinum are rarely observed sequelae of surgical intervention in the upper aerodigestive tract. Although these complications resolve spontaneously in most cases, a few cases result in tension pneumothorax and other life-threatening conditions. Symptoms include chest pain, neck pain, dyspnea and odynophagia. Treatment involves frequent assessment of the airway and extent of the emphysema. The authors of the present study report of a patient who developed pneumomediastinum shortly after an adenotonsillectomy as well as a review of the related literature.
Anesthesia ; Arrhythmias, Cardiac ; Chest Pain ; Dyspnea ; Emphysema ; Hemorrhage ; Humans ; Mediastinal Emphysema ; Neck Pain ; Pneumothorax ; Subcutaneous Emphysema ; Tonsillectomy

BACKGROUND: The purpose of this study was to evaluate the effect of dexamethasone or dexmedetomidine added to ropivacaine on the onset and duration of ultrasound-guided axillary brachial plexus blocks (BPB). METHODS: Fifty-one ASA physical status I-II patients with elective forearm and hand surgery under axillary brachial plexus blocks were randomly allocated to receive 20 ml of 0.5% ropivacaine with 2 ml of isotonic saline (C group, n = 17), 20 ml of 0.5% ropivacaine with 2 ml (10 mg) of dexamethasone (D group, n = 17) or 20 ml of 0.5% ropivacaine with 2 ml (100 microg) of dexmedetomidine (DM group, n = 17). A nerve stimulation technique with ultrasound was used in all patients. The onset time and duration of sensory blocks were assessed. RESULTS: The duration of the sensory block was extended in group D and group DX compared with group C (P < 0.05), but there was no significant difference between group D and group DX. However, there were no significant differences in onset time in all three groups. CONCLUSIONS: Dexamethasone 10 mg and dexmedetomidine 100 microg were equally effective in extending the duration of ropivacaine in ultrasound-guided axillary BPB with nerve stimulation. However, neither drug has significantly effects the onset time.
Adjuvants, Anesthesia* ; Analgesia ; Brachial Plexus* ; Dexamethasone* ; Dexmedetomidine* ; Forearm ; Hand ; Humans ; Ultrasonography

PURPOSE: To characterize the MR findings of nontumorous focal low attenuated areas around the falciformligament on contrast enhanced CT scan. MATERIALS AND METHODS: MR was used to study twelve patients who oncontrast-enhanced CT scan showed focal low attenuated areas around the falciform ligament. Imaging was carried outwith T1, FSE-T2, fat-suppressed T1, and fat-suppressed FSE T2-weighted pulse sequences at 1.5 T. Dynamic fastlow-angle shot(FLASH) imaging was performed in seven patients and chemical shift images were obtained in five. The findings on contrast enhanced CT scan were compared with those on MR. RESULTS: In five cases, the lesions were slightly hyperintense on T1 and FSE T2-weighted images, hypointense on fat-suppressed images, hyperintense on in-phase image, and presented a considerably diminished signal intensity on opposed-image. Focal hypointensity areas were visualized at 50-75 sec after contrast enhancement in three cases in which a lesion was not depicted oneither T1-or FSE T2-weighted images. CONCLUSION: Nontumorous focal low attenuated areas around the falciformligament were shown on MR imaging as focal fatty infiltrations or pseudolesions.
Humans ; Ligaments* ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed

BACKGROUND: we have evaluated the association of age, smoking, type of anesthesia, type of operation, duration of surgery, previous history of chronic pulmonary diseases with postoperative pulmonary complications and identified which parameter of preoperative spirometry was a predictor of postoperative pulmonary complications. METHOD: In 270 patients older than 60 years, the postoperative pulmonary complications were evaluated according to age, smoking, type of anesthesia, type of operation, duration of surgery, previous history of chronic pulmonary diseases and the parameters of preoperative spirometry were analyzed. RESULTS: The postoperative pulmonary complications rates were significant higher among patients older than 70 years, and among those with previous chronic pulmonary diseases or their smoking history. The pulmonary complications were increased among patients with general anesthesia or duration of surgery more than 2 hours. The pulmonary complications rates did not differ according to sex, type of operation. The patients with hypercarbia(PaCO2> 45mmHg) have more increased postoperative complications. The preoperative FEVl less than 1 liter, FVC, MMEFR & MVV less than 50% of predicted respectively were predictive of complications. CONCLUSION: Age 70, history of smoking,duration of operation more than 2 hours, general anesthesia, previous chronic pulmonary disease and hypercarbia (> or=45mmHg) on preoperative arterial blood gas analysis were predictivd of pulmonary complications. Among the parameters of spirometry, FEV1, FVC, MMEFR and MVV were indicator of predicting postoperative pulmonary complications.
Aged* ; Anesthesia ; Anesthesia, General ; Blood Gas Analysis ; Humans ; Lung Diseases ; Postoperative Complications ; Smoke ; Smoking ; Spirometry

BACKGROUND AND OBJECTIVES: Antrochoanal polyp (ACP) is a benign maxillary sinus polyp that originates from the mucosa of the maxillary sinus, passes through the sinus ostium, and extends into the choana. Surgical methods employed in the treatment of antrochoanal polyp are simple avulsion, Caldwell-Luc operation, osteoplastic maxillary sinus operation, and endonasal endoscopic removal. In this study, we evaluated the clinical presentation of ACP and compared its surgical outcomes. MATERIALS AND METHODS: We retrospectively reviewed 111 patients who were treated for ACP between January 1995 and May 2008, and analyzed clinical features, radiologic findings, and surgical results. RESULTS: The study group consisted of 111 patients (65 males, 46 females) with a mean age of 20.0 years (range, 4 to 70). Sixty-one cases were accompanied by sinusitis (20 with unilateral sinusitis, 41 with bilateral sinusitis). Endoscopic sinus surgery (ESS) was used to treat 95 cases, and the external approaches of Caldwell-Luc operation or osteoplastic maxillary sinus operation were applied in 12 and four cases, respectively. Among those who received ESS, ACP recurred in 16 cases, whereas none of the patients who received the external approach showed recurrence. CONCLUSION: Endoscopic sinus surgery is a good alternative method for the treatment of ACP. If the antral part of ACP cannot be removed completely, an external approach such as Caldwell-Luc operation or osteoplastic maxillary sinus operation for pediatric patients may be considered to prevent recurrence.
Carbamates ; Humans ; Male ; Maxillary Sinus ; Mucous Membrane ; Organometallic Compounds ; Polyps ; Recurrence ; Retrospective Studies ; Sinusitis

PURPOSE: To examine whether citicoline has a neuroprotective effect on kainic acid (KA) -induced retinal damage. METHODS: KA (6 nmol) was injected into the vitreous of rat eyes. Citicoline (500mg/kg, i.p.) was administered to the rats once before and twice a day after KA-injection for 3- and 7-day intervals. The neuroprotective effects of citicoline were estimated by measuring the thickness of the various retinal layers using hematoxylin-eosin (H and E) staining. In addition, immunohistochemistry was conducted to elucidate the expression of endothelial nitric oxide synthase (eNOS) and neuronal nitric oxide synthase (nNOS). RESULTS: Morphometric analysis of retinal damage in KA-injected eyes showed significant cell loss in the inner nuclear layer (INL) and inner plexiform layer (IPL) of the retinas at 3 and 7 days after KA injection, but not in the outer nuclear layer (ONL). At 3 days after citicoline treatment, no significant changes were detected in the retinal thickness and immunoreactivities of eNOS and nNOS. The immunoreactivities of eNOS and nNOS increased in the retina at 7 days after the KA injection. However, prolonged treatment for 7 days significantly attenuated the immunoreactivities and the reduction of thickness. CONCLUSIONS: The results indicate that citicoline has a neuroprotective effect on KA-induced neurotoxicity in the retina.
Retina/*drug effects/*pathology ; Rats, Sprague-Dawley ; Rats ; Neurotoxins/*pharmacology ; Neuroprotective Agents/*pharmacology ; Male ; Kainic Acid/*pharmacology ; Cytidine Diphosphate Choline/*pharmacology ; Animals

BACKGROUND: The risk for cardiovascular morbidity and mortality is higher in hemodialysis (HD) patients than in general population. Early diagnosis, treatment and prevention of cardiovascular disease (CVD) are the best way to reduce the most important cause of death. However, cardiac geometric and/or functional alterations including left ventricular hypertrophy, atherosclerosis and/or systolic and diastolic dysfunction are not easily known to nephrologist in the sense that diagnostic procedure is limited because cardiac angiography and echocardiography are frequently needed. METHODS: To evaluate the cardiac alteration by non-invasive tools, we measured pre- and post-HD B-type natriuretic peptide levels and performed impedance cardiography (ICG) in 40 HD patients and 10 healthy adults as control. RESULTS: Pre- and post-HD BNP level, cardiac index (CI), cardiac output (CO), stroke volume (SV), systemic vascular resistance index (SVRI), systemic vascular resistance (SVR), acceleration index (ACI), velocity index (VI) and thoracic fluid content (TFC) in patients were significantly higher than those in normal control group (p<0.05). Pre-HD BNP level, stroke index (SI), SV and TFC were significantly different after HD (p<0.05). There were significant differences in pre-HD BNP level, SI, SV and VI between diabetes and non-diabetes groups (p<0.05). Pre-HD BNP level correlated significantly with post- HD BNP level, systolic blood pressure, diastolic blood pressure, CO, SVRI, SVR and TFC (p<0.05). In multiple linear regression analysis, SVR and TFC were positively associated with pre-HD BNP level (R2=0.289). The area under the ROC curve for cardiac alterations was 0.749 for pre-HD BNP level. A cut-point of 560 pg/mL for pre-HD BNP level was 80% sensitive and 72% specific in determining cardiac alterations. CONCLUSION: Even though cardiac alterations of patients were heterogeneous in our study, plasma BNP level and some parameters (SVR, TFC) of ICG seem to be available to nephrologist for detecting and monitoring cardiac conditions in HD patients.
Acceleration ; Adult ; Angiography ; Atherosclerosis ; Blood Pressure ; Cardiac Output ; Cardiography, Impedance* ; Cardiovascular Diseases ; Cause of Death ; Early Diagnosis ; Echocardiography ; Electric Impedance* ; Humans ; Hypertrophy, Left Ventricular ; Linear Models ; Mortality ; Natriuretic Peptide, Brain* ; Plasma ; Renal Dialysis* ; ROC Curve ; Stroke ; Stroke Volume ; Vascular Resistance

Primary malignant melanoma of the vagina is an exceedingly rare entity, accounting for about 3% of all primary vagina1 malignant tumors and 0.3% of all melanoma. The overall 5-year survival in patients with primary vaginal melanoma is notoriously poor, estimated to be between 13% and 19%. A case of primary malignant melanoma of the vagina treated with the wide local excision of vagina and rectum was presented with a brief review of literature.
Humans ; Melanoma* ; Rectum* ; Vagina*

Increasingly aggressive chemotherapy regimens, advances in transplantation technology, and the acquired immunodeficiency syndrome have resulted in a growing number of immunocompromised patients. Infections are a major cause of morbidity and mortality in this population. One of the most ominous complications is the development of typhlitis in this immunocompromised patients. Treatment of this process is controversial, and no consensus has emerged. We report a case of typhlitis who complicated agranulocytosis after exposure to drugs to treat "flu" like illness and recovered completely after two operations of appendectomy and ileocolectomy. Reviewing articles and this case, the favorable outcome seemed to be related to following three factors recognition of the acute surgical abdomen by abdominal CT scan, a prompt return of normal circulating white cells by the use of Granulocyte Colony Stimulating Factor and discontinuation of causative drugs, and an appropriately timed surgical intervention.
Abdomen ; Acquired Immunodeficiency Syndrome ; Agranulocytosis* ; Appendectomy ; Colony-Stimulating Factors ; Consensus ; Drug Therapy ; Granulocytes ; Immunocompromised Host ; Mortality ; Tomography, X-Ray Computed ; Typhlitis*