No abstract available.
Pancreaticoduodenectomy*

It is generally recognized that several chemical mediators are involved in tbe pathogenesis of sunbum; however, the exact mechanism is still to he resolved. Recently, prostaglandin has been found to be one of the inflammatory mediators in sunbum, particularly in the delayed erythema response and several investigators have shown that the nonsteroidal antiinflammatory drugs inhibit the in vivo synthesis of prostaglandin. On the assumption that the nonsteroidal antiinflammatory drugs might exert a beneficial effect on the sunbum through the antiprostaglandin effect, several authors have reported the effect of indomethacin on sunbum. This study was undertaken to evaluate the effect of topical indomethacin on the delayed erythema response induced by artificial sunlamp and sunlight by clinical and histopathological examination. Indomethacin(2. 5% ointment, 2. 5% solution, 5% solution) was applied immediately after 3 MED irradiation of artificial sunlamp to the shaved back skin of 6 healthy albino guinea pigs weighing 550-850gm and 9 human volunteers and the delayed erythema response was observed at 2, 4, 6, 12, 24 and 48 hours after irradiation respectively. Punch biopsies of the skin were performed on 6 guinea pigs at 6, 12, 24 a.nd 48 hours after irradiation and the histologic changes were observed. Four human volunters were exposed t,o 3 MED of sunlight and indomethacin preparations were applied immediately after irradiation. The delayed erythema response was observed at 2, 4, 6, 12, 24 and 48 hours postirradiation and in one volunteer, the skin was biopsied at 24 hour for histologi.c evaluation. The results were as follows: 1. Topical indomethacin in ointment or solution forms delayed and decreased the appearance and degree of erythema induced by sunlight and artificial sunlamp in both human and animal subjects. 2. Histologically, the number of sunbum cells at 24 hour in the epidermis of one human volunteer was decreased on indomethacin applied sites. The dermis showe6 no difference in histologic changes between control and indomethacin sitea. In animal study, however, no detectable difference in epidermal or dermal changes was observed between control and indomethacin applied sites. The autors confirmed that topical indometha,cin was effective in delaying and blanching of the delayed erythema of sunbum in guinea pigs as well as in human volunteers, though there was no difference in histologic changes between indomethacin and control sites in guinea pigs. The mechanism involvel on this aspect is remained to be resolved.
Animals ; Biopsy ; Dermis ; Epidermis ; Erythema ; Guinea Pigs ; Healthy Volunteers ; Humans ; Indomethacin* ; Research Personnel ; Skin ; Sunburn* ; Sunlight ; Volunteers

BACKGROUND AND OBJECTIVES: Studies in patients with mitral valve prolapse syndrome (MVPS) have shown the coexistence of various forms of autonomic dysfunction, and so this is an area that requires further investigation. METHODS AND MATERIALS: The study group consisted of 65 patients (36 men and 29 women), aged 16 to 43 years (mean+/-SD, 28+/-8) with symptomatic, echocardiographically proven mitral valve prolapse (MVPS) who were free of other organic heart diseases and arrhythmias. In a prospective study, heart rate variability (HRV) indexes were calculated from 24-hour Holter recordings obtained during normal daily activity and plasma norepinephine was measured, and then these data were compared among the study group according to clinic heart rate (HR). RESULTS: The study group was divided into below 60 bpm (group 1: n=13), 60 - 80 bpm (group 2: n=36) and over 80 bpm (group 3: n=16) on the basis of clinic HR. These patient groups were matched with respect to age and gender. There were significant difference in SDNNIDX, rMSSD and pNN50 between these groups (p=0.005, 0.009 and 0.002 respectively), and these HRV measures correlated inversely with clinic HR (p<0.01). As clinic HR increased, there was a tendency for plasma norepinephrine concentration to also rise (p<0.05), but there was no statistical significant difference between these groups. CONCLUSION: Our data suggests that MVPS may have subgroups of HRV, reflecting cardiac autonomic modulation, according to clinic HR.
Arrhythmias, Cardiac ; Heart Diseases ; Heart Rate* ; Heart* ; Humans ; Male ; Mitral Valve Prolapse* ; Mitral Valve* ; Norepinephrine ; Plasma ; Prospective Studies

Ovarian tumor in pregnancy is not rare and benign cystic teratoma is most common ovarian tumor in pregnancy. Most ovarian tumor in pregnancy is found at first and second trimester but sometimes found at third trimester and it is difficult to make a decision for management. Moreover physician should consider fetal age and mother's condition, and weigh outcome of operation for complicated ovarian tumor in pregnancy. Torsion of ovarian tumor is not an uncommon complication during first trimester of pregnancy and puerperium but rare occurs during the third trimester of pregnancy. We have experienced a case of torsion of benign cystic teratoma of ovary which occurred at 37 weeks gestation in a 25 year-old woman. So we report this case with a brief review of literature.
Adult ; Female ; Gestational Age ; Humans ; Impetigo* ; Ovary ; Postpartum Period ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Pregnancy* ; Teratoma

OBJECTIVES: The myelodysplastic syndromes (MDS) are a group of acquired clonal hematopoietic disorders characterized by peripheral cytopenias and a hypercellular or normocellular dysplastic bone marrow. The mechanisms responsible for development of MDS are not known. We performed this study to evaluate the hematopoietic abnormalities and apoptosis in MDS. METHODS: Long-term bone marrow culture (LTBMC) was performed for colony assays, cobblestone area assay, stromal morphologic changes from 7 patients with MDS and 7 normal controls. In situ nick end labeling (ISNEL) method was performed for detection of apoptosis from LTBMC in 7 patients with MDS and 7 normal controls. ISNEL method also performed in bone marrow cell bloc samples in 36 patients with MI3S. RESULTS: Viability of nonadherent cells from LTBMC of patients with MDS was not decreased compared with normal controls at 1 week, but significantly decreased at 2 and 3 weeks compared with normal controls (P<0.0001). Formation of the cobblestone areas from patients with MDS was slightly decreased compared with normal controls at 1st week, but significantly decreased at 2nd and 3rd weeks compared with normal controls (P<0.0001). Slightly decreased compared with normal controls at 1 week, but significantly decreased at 2 and 3 weeks compared with normal controls (P<0.0001). Stromal layers produced in LTBMC of normal controls and 1 patient with MDS were detected at 1 week and were formed confluent stroma from 3 weeks, but another patients with MDS who did not form a confluent stroma. Patients with MDS had significantly lower colony forming unit granulocyte-macrophage (CFU-GM) compared with normal controls at 1 (P<0.01) and 2 weeks (P<0.001) of LTBMC. Two weeks of LTBMC resulted more profound inhibition of CFU-GM formation than 1 week (P<0.0001). Apoptotic cell death was absent in adherent and non adherent cells from normal controls at 1 and 2 weeks, but massive apoptotic cell death was found in adherent and non adherent cells from patients with MDS at 1 and 2 weeks and the degree of apoptosis was profound at 2 weeks compared with 1 week. Among the 36 patients, fifteen patients demonstrated varying degrees of apoptosis positive cells, 4 having low, 8 intermediates, and 3 high scores. Remaining 21 patients showed absent apoptosis or only occasional positive cells. CONCLUSION: Hematopoietic abnormalities such as a failure of differentiation are caused by the stromal defects and the biologic basis of the apparent paradox of peripheral cytopenias in the face of hypercellular (or normocellular) marrow is related by intramedullary apoptotic cell death of the stromal and hematopoietic cells.
Apoptosis* ; Bone Marrow Cells ; Bone Marrow* ; Cell Death ; Granulocyte-Macrophage Progenitor Cells ; Humans ; In Situ Nick-End Labeling* ; Myelodysplastic Syndromes* ; Stem Cells

Pressure sores are common complications in patients with spinal injuries or cerebrovascular accidents. The management of pressure sores requires prolonged hospitalization and repeated surgical interventions with a high recurrence rate. Particularly osteomyelitis following initial pressure sores persistently complicates wound healing and recovery. Furthermore, it may also ultimately result in serious sepsis; thus an early diagnosis of osteomyelitis in pressure sore patients is crucial along with appropriate surgical and antibiotic therapy. Although many diagnostic methods were reported, there is no single 'gold' standard for early diagnosis of pressure sore-associated osteomyelitis. Authors reviewed pre-operative CBC, plain X-ray, Tc-99m bone scan, and post-operative biopsy results in 37 patients who had received surgical treatment for pressure sores in a 5-year period from September 1991 to August 1996. Based on these reviews, authors compared and analyzed the sensitivity and specificity in diagnosing osteomyelitis.The results were as follows: 1. Of 37 patients studied, 25 cases were confirmed histologically as osteomyelitis. Ischial region revealed the highest incidence of pressure sore-related osteomyelitis(78%, 14 out of 18 cases) while the regional incidence was as following in descending order : ischial, sacral, and greater trochanteric area. 2. Tc-99m bone scan had superior sensitivity(100%) and specificity(83%) to other pre-operative studies in diagnosing osteomyelitis.In conclusion, authors suggest that Tc-99m bone scan is the best diagnostic method because of its high sensitivity and specificity if osteomyelitis is clinically suspected in pressure sore patients. And in case the test result is positive, agressive surgical bone resection and appropriate antibiotic therapy based on bacterial culture from deep bone specimen should be combined to prevent complications or recurrences.
Biopsy ; Early Diagnosis ; Femur ; Hospitalization ; Humans ; Incidence ; Osteomyelitis ; Pressure Ulcer* ; Recurrence ; Sensitivity and Specificity ; Sepsis ; Spinal Injuries ; Stroke ; Wound Healing

Complications after a median sternotomy incision, which is used currently in most open heart surgery, are serious, although it is infrequent. Reconstruction of the sternal defect resulting from dehiscence of median sternotomy is still big challenge to the most plastic surgeons. Since vascularized greater omentum was transposed to eliminate mediastinal wound problems, many vascularized regional muscle flaps became mainstay in reconstruction of median sternotomy wound. We treated 13 patients with median sternotomy dehiscence between October of 1993 and March of 1998. In two patients, the wound problems were so confined to superficial tissue that debrided and closed primarily. Eleven patients with deep wound infection were managed with vigorous debridement of all necrotic tissues and resultant defects were covered with regional muscle flaps: rectus myocutaneous flap(3) and bilateral pectoralis advancement flap(8). We used the pectoralis major advancement flaps without counter incision at humeral insertion site and the dissections were limited only medial to the anterior axillary line to preserve the axillary fold. In five patients with larger defects, we elevated muscle and cutaneous flaps separately to make these flaps more mobile. Large portion of two rectus abdominis flaps could not survive, whereas pectoralis advancement flaps had mo special wound problems. Only one patient developed fistula due to remained wire, regardless to flap surgery.
Debridement ; Fistula ; Humans ; Omentum ; Rectus Abdominis ; Sternotomy* ; Thoracic Surgery ; Wound Infection ; Wounds and Injuries

BACKGROUND: Our study aimed to make a comparative analysis of clinical outcomes of arthroscopic decompression for rotator cuff calcific tendinitis by location of calcific deposits and by its size. METHODS: We enrolled a total of 38 patients, comprising 39 affected shoulders, who underwent arthroscopic decompression for calcific tendinitis. As our clinical scores, we evaluated the UCLA, the ASES, and the VAS scores and analyzed them by calcific location, by calcific deposit size, by the presence or absence of calcific remnants, and by whether concomitant cuff repair was performed. RESULTS: The clinical scores of those whose calcific deposit had an area greater than 77.0 mm2 and of those whose calcific deposit had an area smaller than 77.0 mm2 did not significantly differ (p=0.21 in ASES; p=0.19 in UCLA; p=0.17 in VAS). Nor did the clinical scores significantly differ with respect to the location of calcification (p=0.23). Further, the clinical scores did not significantly differ between those who had calcific remnants and those who did not and between those who received additional cuff repair and those who did not. CONCLUSIONS: We found that the clinical outcomes after arthroscopic decompression of calcific tendinitis were not significantly associated with the cuff tendon in which the calcium deposits are found; the location of the calcium deposits in the supraspinatus tendon (if found in this tendon); the size of calcific deposits; the presence of calcific remnants; and concomitant cuff repairs.
Calcium ; Decompression ; Humans ; Rotator Cuff ; Shoulder* ; Tendinopathy* ; Tendons

Most of the malignant tumors of the pancreas are adenocarcinomas arising from the ductal epithelium. Primary leiomyosarcoma of the pancreas, even though it is the most common sarcoma of the pancreas, is very rare. We present a case of leiomyosarcoma of the pancreas, probably primary, with metastases to the stomach, lymph nodes, and abdominal wall. A 52-year-old woman visited the hospital with vague right upper abdominal pain and weigh loss of 6 kg for 2 months. The radiological and endoscopic examination revealed that she had a large heterogeneous mass, 11 cm in size, in the pancreatic body and tail, a 4 cm-sized mass in the paraaortic area, and a 3 cm-sized polypoid mass in the stomach. Histologically, they were all similar to one another and composed of markedly pleomorphic cells. Immunohistochemical and electron microscopic studies showed definite smooth muscle differentiation of the tumor cells. Two months later, the patient underwent an excision of a new 3 cm mass in the right lower abdominal wall, showing features of well differentiated leiomyosarcoma.
Abdominal Pain ; Abdominal Wall ; Adenocarcinoma ; Epithelium ; Female ; Humans ; Leiomyosarcoma* ; Lymph Nodes ; Middle Aged ; Muscle, Smooth ; Neoplasm Metastasis ; Pancreas* ; Sarcoma ; Stomach

Cloeortolone (9-a-chloro-6-a fluoro-11-B 21 digydroxy-16 methyl preganl,4-diene) is a newly synthesized corticonsteroid which has been found to have potent antinflammatory action and good tolerance through animal experiment. Several investigators reported its therapeutic affect in various dermatoses by topical application. The present was undertaken to evaluate the therapeutic effect of 0.1% clocortolone cream (Purantix-Sandoz) in patients with eczematous dermatoses and with psoriasis and to compare its effect with that of I% hydrocortisone. Eleven patients with contact dermatitis, 10 with psoriasis entered this study durtin the period of 6 months from January to june, 1977 at the Department of Dermatology, Seoul National University Hospital. All patients were instructed to apply 0.1% Clocortolone cream on one side of their lesion and 1%hydrocortisone cream on the opposite site for two weeks. After wo weeks' period of observation the status of the lesion was evaluated clinically and the tesults were as follows. 1. Ninety one percent of patiens with contact dermatitis, 70% of atopic dermatitis, 60% of nenrodermatitis, 67% of nummular eczema and 60% of psoriasis responded very effectively or moderately effectively. The therapeutic responses were generally similar to that of 1% hydrocortisone. 2. During the ovservation period, there was no systemic of local side effect of 0.1% Clocortolone cream.
Animal Experimentation ; Dermatitis, Atopic ; Dermatitis, Contact ; Dermatology ; Eczema ; Humans ; Hydrocortisone ; Psoriasis ; Research Personnel ; Seoul ; Skin Diseases*