The enterobiliary fistulas are mostly spontaneous and are caused by biliary disease associated with calculi. Review of many series shows that the most common variety of enterobiliary fistulas is a cholecystoduodenal fistula followed by cholecystocolic, cholecystogastric and choledochoduodenal fistula in that order. But very few cases of choledochocolonic fistulae have been reported. We report a case of choledocholithiasis combined with the absence of gallbladder leading to a choledochocolonic fistula, which was confirmed by endoscopic retrograde cholangiography and abdominal exploration in a 63- year-old male patient with complaint of right upper abdominal pain.
Abdominal Pain ; Calculi ; Cholangiography ; Choledocholithiasis ; Fistula* ; Gallbladder* ; Humans ; Intestinal Fistula ; Male

In two patients with macular hole, retinal detachment in the posterior pole and commotio retinae, we performed pars plana vitrectomy, fluid-air exchange, intravitreal injection and removal of 0.04cc autologous serum, and air-gas exchange. These patients absolutely maintained prone position during the two-week postoperative period. As a result, anatomical and functional success about macular hole was accomplished in both cases through a long term of observation over a year. In traumatic macular hole with retinal detachment, we suppose that anatomical and functional success will be accomplished through pars plana vitrectomy, intravitreal injection and removal of autologous serum and gas injection into the vitreous cavity.
Humans ; Intravitreal Injections ; Postoperative Period ; Prone Position ; Retina ; Retinal Detachment* ; Retinal Perforations* ; Retinaldehyde* ; Vitrectomy

A 62-year-old man with left flank pain and hematuria was shown to have a staghorn stone in left renal pelvis. Grossly, renal pelvis and calyces were markedly dilated with cystic and hemorrhagic degeneration and renal parenchyma was atrophied. A tumor-like mass was located in a hemorrhagic cyst of the renal upper pole. This mass consisted of giant cells and stromal cells mimicking a giant cell tumor of bone. This giant cell tumor-like proliferation may represent a response to hemorrhage into a cystic cavity. Recognition of this finding is important to avoid the over-diagnosis of neoplastic lesions.
Calculi ; Cell Proliferation ; Flank Pain ; Giant Cell Tumor of Bone ; Giant Cell Tumors ; Giant Cells ; Hematuria ; Hemorrhage ; Humans ; Kidney ; Kidney Pelvis ; Middle Aged ; Stromal Cells

BACKGROUND: The accentuated nitric oxide (NO) release that is induced by the systemic inflammatory response associated with infective endocarditis (IE) and cardiopulmonary bypass (CPB) may result in catecholamine refractory hypotension (vasoplegia) and increased transfusion requirement due to platelet inhibition. Methylene blue (MB) is an inhibitory drug of inducible NO. We aimed to evaluate the effect of prophylactic MB administration before CPB on vasopressor and transfusion requirements in patients with IE undergoing valvular heart surgery (VHS). METHODS: Forty-two adult patients were randomly assigned to receive 2 mg/kg of MB (MB group, n = 21) or saline (control group, n = 21) for 20 min before the initiation of CPB. The primary end points were comparisons of vasopressor requirements serially assessed after weaning from CPB and hemodynamic parameters serially recorded before and after CPB. The secondary endpoint was the comparison of transfusion requirements. RESULTS: Two patients in the control group received MB after weaning from CPB due to norepinephrine and vasopressin refractory vasoplegia and were thus excluded. There were no significant differences in vasopressor requirements and hemodynamic parameters between the two groups. The mean number of units of packed erythrocytes transfused per transfused patient was significantly less in the MB group. The numbers of patients transfused with fresh frozen plasma and platelet concentrates were less in the MB group. CONCLUSIONS: In IE patients undergoing VHS, prophylactic MB administration before CPB did not confer significant benefits in terms of vasopressor requirements and hemodynamic parameters, but it was associated with a significant reduction in transfusion requirement.
Adult ; Blood Platelets ; Cardiopulmonary Bypass ; Endocarditis ; Erythrocytes ; Hemodynamics ; Humans ; Hypotension ; Methylene Blue ; Nitric Oxide ; Norepinephrine ; Plasma ; Thoracic Surgery ; Vasoplegia ; Vasopressins ; Weaning

BACKGROUND: Galectin-3 and galectin-7 may play roles in human carcinogenesis. The aim of this study was to investigate the expressions of galectin-3 and galectin-7 in gastric dysplasia and adenocarcinoma. METHODS: We examined the expressions of galectin-3, galectin-7, and P53 in nonneoplastic gastric mucosa, gastric epithelial dysplasia (GED), and adenocarcinoma by immunohistochemistry. Twenty cases of nonneoplastic gastric mucosa, 20 cases of low grade GED, 20 cases of high grade GED, 40 cases of early gastric cancer (EGC), and 60 cases of advanced gastric cancer (AGC) are included for study. RESULTS: In the nonneoplastic tissue, only galectin-3 was expressed in the intestinal metaplasia. Galectin-7 was not stained in the nonneoplastic gastric mucosa. Galectin-3 was expressed in 3 cases of low grade GED (15%), 13 cases of high grade GED (65%), 2 cases of EGC (5%), and 5 cases of AGC (8%), respectively. Galectin-7 was expressed in 2 cases of low grade GED (10%), 3 cases of high grade GED (15%), and 4 cases of EGC (10%), respectively. However, it was not expressed in AGC. CONCLUSIONS: Based on our results, the expressions of galectin-3 and galectin-7 may contribute to the development of gastric epithelial dysplasia and early gastric cancer, rather than contributing to the progression of gastric adenocarcinoma.
Humans ; Adenocarcinoma ; Stomach Neoplasms

Two cases of post-traumatic arterial priapism diagnosed with duplex and color Doppler ultrasonography showed pseudoaneurysm and increased peak systolic and diastolic velocity of the inflowing cavernosal artery(low resistance index). An autologous blood clot successfully controlled tumescence and was comfortable and secure in preventing necrosis and impotence.
Aneurysm, False ; Embolization, Therapeutic* ; Erectile Dysfunction ; Male ; Necrosis ; Priapism* ; Ultrasonography, Doppler, Color

A 54-year-old woman presented with vaginal bleeding. On gynecologic and radiologic examinations, bilateral cystic ovarian tumors were suspected. A laparoscopic examination revealed multiple cysts involving both the uterine horns and the posterior surface of the uterus. These were removed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. Microscopically, multiple cysts were identified in the subserosal layer of the uterus, and they were lined with benign tubal type epithelium surrounded by a smooth muscle wall. These features were consistent with "florid cystic endosalpingiosis". Considering the location of the lesion, the lesion has to be distinguished from other benign cystic lesions of the uterus and adnexa, including multicystic mesothelioma, serous cystadenoma and mucinous cystadenoma. Awareness of this lesion will facilitate a correct diagnosis by both the clinician and pathologist.
Female ; Humans ; Cysts

BACKGROUND: Mitral stenosis (MS) and mitral regurgitation (MR) have different pathophysiologies and left ventricular function after miral valve replacement (MVR) in both diseases has been well known. However, there has been no report comparing the change of right ventricular (RV) function immediately after MVR. We evaluated the change of RV function following MVR in MS and MR using a RV ejection fraction (RVEF) thermodilution catheter. METHODS: With IRB approval, 27 patients with MS and 22 patients with MR undergoing MVR were included. Patients with tricuspid regurgitation were excluded. A RVEF catheter was inserted before the induction of anesthesia. Hemodynamic parameters were measured after anesthesia (T1, control), immediately after the termination of cardiopulmonay bypass (T2) and after the sternum was closed (T3). RESULTS: Pulmonary capillary wedge pressure (PCWP) and end systolic and end diastolic RV volume index (RVESVI and RVEDVI) were higher in MS than in MR and there was no difference in RVEF at T1. Heart rate increased and mean pulmonary artery pressure (mPAP), PCWP, and pulmonary vascular resistance significantly decreased at T2 in both groups. RVEF increased and RVESV and RVEDV decreased significantly only in MS after MVR versus that at T2. There was no difference in hemodynamic parameters between both groups at T2 and T3. CONCLUSIONS: RV function was significantly improved in MS but not in MR after MVR. However, there was no significant hemodynamic difference between MS and MR after MVR, though they are known to have different preoperative pathophysilogies and postoperative left heart functions.
Anesthesia ; Catheters ; Ethics Committees, Research ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Mitral Valve* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Sternum ; Thermodilution ; Tricuspid Valve Insufficiency ; Vascular Resistance ; Ventricular Function, Left ; Ventricular Function, Right*

Coccidioidomycosis, which results from inhaling the spores of Coccidioides species, is endemic in the southwestern United States. The primary infection site is the lung, and dissemination of the disease can occur. We report a case of cutaneous coccidioidomycosis in a 79-year-old Korean woman who presented with purpura on both lower extremities, but no pulmonary symptoms and no history of visiting an endemic area. Microscopically, skin biopsy showed multiple aggregates of granulomas in the dermis. Numerous multinucleated giant cells were associated with the granulomas. Mature and immature fungal spherules, which were 20 to 30 micrometer in diameter, were present inside and outside the multinucleated giant cells.
Female ; Humans ; Biopsy

There have been a few reported cases of pancreatic pseudocyst with involvement of adjacent structures including the stomach, duodenum, and even the mediastinum. An intrasplenic pancreatic pseudocyst is an uncommon complication of acute or chronic pancreatitis. We report a case of pancreatic pseudocyst with splenic involvement in a 69-year-old man with a review of literatures. Abdominal CT revealed a 4 cm sized cyst at the pancreatic tail which was extending into the splenic hilum and splenic parenchyma. Distal pancreatectomy and splenectomy was performed. Pathologic findings demonstrated a pseudocyst of pancreatic tail which communicated with the infacted splenic parenchyma. Also vasculitis, endothelial hyperplasia and medial calcification of the splenic artery were observed.
Male ; Humans