Pelvic lipomatosis is a rare disease of unknown etiology characterized by overgrowth of mature, nonmalignant fat cells in the pelvis, especially in the perivesical and perirenal space. An overgrowth of fat surrounding the bladder and rectosigmoid colon produces a radiologic picture characterized by 1) radiolucent pelvic densities, 2) elevation and vertical elongation of the bladder, 3) straightening and elevation of the rectosigmoid colon and 4) absence of malignant vessels on pelvic angiography. Cystoscopy has shown a high incidence of cystitic changes: chronic inflammation, cystitis glandularis and cystitis cystica. We report a case of pelvic lipomatosis associated with cystitis glandularis.
Adipocytes ; Angiography ; Colon ; Cystitis* ; Cystoscopy ; Incidence ; Inflammation ; Lipomatosis* ; Pelvis ; Rare Diseases ; Urinary Bladder

PURPOSE: Doxylamine succinate is an over-the-counter drug commonly used in the treatment of insomnia. It is in the ethanolamine class of antihistamine and is frequently involved in intentional overdoses. Seizures are uncommon, but there are potentially serious complications, making early recognition and treatment essential. METHODS: We reviewed retrospectively the medical records of patients admitted for seizures after a doxylamine succinate overdose from Jan. 1, 1992 to Dec. 31, 2008. We evaluated them with respect to age, sex, amount ingested, clinical symptomatology, time from ingestion to seizure, complication, and prognosis. RESULTS: Among the 146 doxylamine overdose patients, 11 patients developed seizures. Females accounted for 9 (81.8%) patients and the number aged between 20 and 40 years was also 9 cases (81.8%). The average time from ingestion to emergency room visit was 170 minutes (60-360). The average time from ingestion to development of seizures was 188 minutes (60-480). The amount of doxylamine succinate ingested was 750-4,750 mg (mean = 2,425 mg). The frequent anticholinergic symptoms were tachycardia (63.6%), vomiting (45.5%), mydriasis (36.4%), and hypertension (36.4%). Rhabdomyolysis and drug induced hepatitis were observed in 7 cases (63.6%) and 6 cases (54.5%), respectively. Primary treatment included administration of benzodiazepine and conservative care. After more than a 6 month follow-up, no patients developed further seizure. CONCLUSIONS: The incidence of seizure after doxylamine succinate overdose is uncommon and prognosis is good. However, other serious symptoms are commonly combined, and we have to be aware that seizures are a potential complication and should be actively investigated and vigorously treated.
Aged ; Benzodiazepines ; Doxylamine ; Eating ; Emergencies ; Ethanolamine ; Female ; Follow-Up Studies ; Hepatitis ; Humans ; Hypertension ; Incidence ; Medical Records ; Mydriasis ; Prognosis ; Retrospective Studies ; Rhabdomyolysis ; Seizures ; Sleep Initiation and Maintenance Disorders ; Succinic Acid ; Tachycardia ; Vomiting

With the introduction of cyclosporine, heart transplantation has become a widely accepted treatment for patients with end-stage heart failure. Number of operation increased steadily during recent 6 years with many postoperative follow up cases. A number of survivors are now presenting for non-cardiac surgery. Cardiac transplanted patients present anesthesiologists with challenging problems related to the infection in immunosuppressed patients, rejection phenomena, denervated heart pathophysiology with altered hemodynamic function of their own and under circumstances of stress and drug therapies. We experienced 2 cases of general anesthesia for noncardiac surgery in heart transplanted patients without important hemodynamic changes. Preoperative evaluation including heart status, rejection, immunosuppressive drug therapy and its complications is mandatory. These patients present few problems during anesthesia if adequate hydration, aseptic technique, selection of proper vasoactive drugs are provided.
Anesthesia* ; Anesthesia, General ; Cyclosporine ; Drug Therapy ; Follow-Up Studies ; Heart Failure ; Heart Transplantation ; Heart* ; Hemodynamics ; Humans ; Survivors

PURPOSE: The purpose of this study was aimed to disclose main affected organisms in patients with perforated appendicitis and to analyze correlations between culture-sensitivity test and infectious complication. METHODS: In 26 of 421 patients who had undergone appendectomy due to acute appendicitis from April 1996 to March 1999, we performed culture-sensitivity test. The clinical records of these patients were collected and reviewed about clinicopathological features and results of culture-sensitivity test, retrospectively. Culture material was collected in BBL transport media with cotton swab and cultured by MacConkey agar plate. The method of MIC by VITEK was used for sensitivity test. RESULTS: Cultured organisms were E. coli (18 cases), Pseudomonas (4), Enterobacter (2), Enterococcus (1), and Proteus (1). In sensitivity test, sensitive antibiotics against all cultured organism were amikacin, ceftriaxone, imipenem and cefotetan. But ampicillin, sulfametoxazole/trimethoprim and piperacillin were mostly resistant. Infectious complications occurred in 11 of 26 patients (42.3%) and consisted of 9 wound infection and 2 intraabdominal abscess. Especially, 13 of 18 cases in which E. coli were isolated, were resistant to ampicillin. And they had infectious complications statistically more than those who were not resistant to ampicillin (p=0.036). CONCLUSIONS: E. coli was a main organism in perforated appendicitis. In case of ampicillin-resistant E. coli, the patients were susceptible to infectious complication such as wound infection and intraabdominal abscess.
Abscess ; Agar ; Amikacin ; Ampicillin ; Anti-Bacterial Agents ; Appendectomy ; Appendicitis* ; Cefotetan ; Ceftriaxone ; Enterobacter ; Enterococcus ; Humans ; Imipenem ; Piperacillin ; Proteus ; Pseudomonas ; Retrospective Studies ; Wound Infection

Von Meyenburg complexes (VMC) have many synonyms such as bile duct hamartomas and biliary hamartoma. These rare benign disorders are considered as congenital diseases caused by malformed differentiation of ductal plate. The diagnosis of VMC by common radiologic modality such as ultrasound and computed tomography was nearly impossible until the emergence of cholangiopancreatography by magnetic resonance imaging (MRCP) and the pathologic examination was the only way to confirm the diagnosis of VMC. But MRCP is now considered as most accurate noninvasive method for diagnosis of VMC. We report a histologically proven case of VMC associated with calculous cholecystitis, cerebral aneurysm and renal cortical cyst. To our knowledge, no comparable case has been reported and this would be the only second reported case of VMC, which was diagnosed by MRCP.
Bile Ducts ; Cholecystitis* ; Diagnosis ; Hamartoma ; Intracranial Aneurysm* ; Magnetic Resonance Imaging ; Ultrasonography

BACKGROUND/OBJECTIVES: Inflammation is associated with various types of acute and chronic alcohol liver diseases. In this study, we examined whether umbelliferone (7-hydroxycoumarin, UF) ameliorates chronic alcohol-induced liver damage by modulating inflammatory response and the antioxidant system. METHODS: Rats were fed a Liber-Decarli liquid diet containing 5% alcohol with or without UF (0.05 g/L) for 8 weeks, while normal rats received an isocaloric carbohydrate liquid diet. RESULTS: Chronic alcohol intake significantly increased serum tumor necrosis factor-alpha (TNF-alpha) and interleukin 6 levels and decreased interleukin 10 level; however, UF supplementation reversed the cytokines related to liver damage. UF significantly suppressed hepatic lipopolysaccharide binding protein, toll-like receptor 4 (TLR4), nuclear factor kappa B, and TNF-alpha gene expression increases in response to chronic alcohol intake. Masson's trichrome staining revealed that UF improved mild hepatic fibrosis caused by alcohol, and UF also significantly increased the mRNA expressions and activities of superoxide dismutase and catalase in liver, and thus, decreased lipid peroxide and mitochondrial hydrogen peroxide levels. CONCLUSIONS: The findings of this study indicate that UF protects against alcohol-induced liver damage by inhibiting the TLR4 signaling pathway and activating the antioxidant system.
Animals ; Antioxidants* ; Carrier Proteins ; Catalase ; Cytokines ; Diet ; Fibrosis ; Gene Expression ; Hydrogen Peroxide ; Inflammation ; Interleukin-10 ; Interleukin-6 ; Liver ; Liver Diseases ; NF-kappa B ; Rats* ; RNA, Messenger ; Superoxide Dismutase ; Toll-Like Receptor 4 ; Tumor Necrosis Factor-alpha

We evaluated the availability of toluidine blue stain in body fluids, such as peritoneal and pleural fluid and urine. Nine hundreds specimens, i.e., 400 pleural and 400 peritoneal fluids and 100 urine samples, respectively, from Jan. 1995 to May 1996 were included. We obtained the result of high sensitivity and high specificity in toluidine blue stained body fluid in comparison with Papanicolaou stained result. Additionally, we found the diagnostically important crystals in chylothorax and some urine samples, which can not be seen in routine Papanicolaou stain. We thought the toluidine blue stain in body fluid is one of very useful diagnostic methods.
Ascitic Fluid ; Body Fluids* ; Chylothorax ; Sensitivity and Specificity ; Tolonium Chloride*

Cronkhite-Cadana syndrome is a rare non-familial disease. This syndrome is characterized by multiple hamartomatous polyps on the entire gastrointestinal tract except esophagus, nail dystrophy, alopecia and hyperpigmentation. Taste disturbance, abdominal pain, diarrhea and weight loss are common symptoms of it. The pathogenesis and causes of Cronkhite-Canada syndrome remain unknown until now. Although various treatment strategies including steroid therapy have been tried, their prognosis is poor. We report a 68 years old man who were diagnosed Cronkhite-Canada syndrome with esophageal candidiasis. After using combination of steroids and anti-fungal drugs, both Cronkhite-Canada syndrome and esophageal candidiasis were cured.
Abdominal Pain ; Alopecia ; Candidiasis ; Diarrhea ; Esophagus ; Gastrointestinal Tract ; Hyperpigmentation ; Intestinal Polyposis ; Nails ; Polyps ; Prognosis ; Steroids ; Weight Loss

Embryo implantation and development are critically dependent upon the regulation of angiogenesis and adequate immunologic acceptance. These local angiogenesis and vascular permeability are regulated by the interaction between fetal trophoblast, uterine decidua, and endothelial cells through the key mediator, vascular endothelial growth factor (VEGF). PROBLEM: The mechanism through which VEGF regulation occurs at the feto-maternal interface is poorly understood. The Th1 type cytokines are known to be harmful to the successful maintenance of early pregnancy at the feto-maternal interface. OBJECTIVE: To clarify whether the Th1 type cytokines could be involved in the regulation of VEGF secretion at the feto-maternal interface. Method of Study : we investigated the effects of Th1 type cytokines on VEGF secretion in human first trimester trophoblast cell-line by using reverse transcription polymerase chain reaction(RT-PCR)and enzyme-linked immunosorbent assay (ELISA). RESULTS: The trophoblast cells expressed VEGF constitutively and the main isoforms were VEGF121 and VEGF165. When cultured in the presence of IFN-gamma or IL-2, VEGF secretion was most significantly increased by IFN-gamma treatment but not affected by IL-2 treatment. The level of intracellular VEGF was also increased by IFN-gamma treatment. CONCLUSION: These results suggest that IFN-gamma, despite of harmful Th1 type cytokine to the maint enance of early pregnancy, may regulate the production of VEGF in early gestational trophoblasts.
Capillary Permeability ; Cell Line* ; Cytokines* ; Decidua ; Embryo Implantation ; Endothelial Cells ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans* ; Interleukin-2 ; Pregnancy ; Pregnancy Trimester, First* ; Protein Isoforms ; Reverse Transcription ; Trophoblasts* ; Vascular Endothelial Growth Factor A*

This prospective randomized study was conducted to evaluate the efficacy of two common analgesic techniques, thoracic epidural patient-controlled analgesia (Epidural PCA), and intravenous patient-controlled analgesia (IV PCA), in patients undergoing lobectomy by the video-assisted thoracic surgical (VATS) approach. Fifty-two patients scheduled for VATS lobectomy were randomly allocated into two groups: an Epidural PCA group receiving an epidural infusion of ropivacaine 0.2%+fentanyl 5 microg/mL combination at a rate of 4 mL/hr, and an IV PCA group receiving an intravenous infusion of ketorolac 0.2 mg/kg+fentanyl 15 microg/mL combination at a rate of 1 mL/hr. Pain scores were then recorded using the visual analogue scale at rest and during motion (VAS-R and VAS-M, 0-10) for five days following surgery. In addition, we measured the daily morphine consumption, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), satisfaction score, and the incidence of side effects. Thirty-seven patients out of 52 completed the study (18 in the Epidural PCA group, 19 in the IV PCA group). There were no differences in the pain scores, analgesic requirements, pulmonary function, satisfaction score, and the incidence of side effects between groups. This indicates that IV PCA and Epidural PCA are equally effective to control the postoperative pain after VATS lobectomy, which suggests that IV PCA may be used instead of Epidural PCA.
Adult ; Aged ; Amides/therapeutic use ; Analgesia, Epidural/methods ; Analgesia, Patient-Controlled/*methods ; Analgesics, Opioid/therapeutic use ; Anesthesia, Intravenous/methods ; Anesthetics, Local/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Female ; Fentanyl/therapeutic use ; Humans ; Ketorolac/therapeutic use ; Male ; Middle Aged ; Pain Measurement ; Pain, Postoperative/*drug therapy/prevention & control ; Prospective Studies ; Thoracoscopy