Nonparasitic true splenic cyst is a rare disease and the epidermoid cyst accounts for the majority of the cases. And the epidermoid cyst producing CA19-9 is extremely rare. We present a case of true splenic cyst with high cystic fluid CA19-9 level. A 26-year-old woman complained left upper quadrant abdominal pain. Abdominal ultrasonography and CT depicted a 17 x 13 cm sized cystic lesion in the left upper abdomen. The aspirated cystic fluid showed high concentration of CA19-9, but serum CA19-9 level was normal. Spleen with huge unilocular cyst was removed surgically. The cyst was lined with single layered cuboidal epithelial cells and negative for immunohistochemical staining with anti-CA19-9 antibody.
Abdomen ; Abdominal Pain ; Adult ; Epidermal Cyst ; Epithelial Cells ; Female ; Humans ; Rare Diseases ; Spleen* ; Splenic Diseases ; Ultrasonography

BACKGROUND AND OBJECTIVES: This study investigated the surgical methods and their results according to the subtypes of zygomatic fractures. SUBJECTS AND METHOD: Medical records of 99 zygomatic fractures treated between March 1997 and December 2006 were reviewed regarding fracture type, surgical method and time of operation from the initial trauma. RESULTS: Overall, operations were performed in 70 out of 99 cases. For zygomatic arch fractures, facial asymmetry and trismus in all 14 of 20 cases after surgery by Gillies incision were improved, and one revision procedure was performed. For tetrapod and multifragment fractures, one revision procedure was performed because of displacement of repaired bone fragment following surgery in 60 cases. Considering location and replacement of fractures, surgery was performed through one of incisions below: Gillies, lateral canthal, gingivobuccal, and subcilliary incision. All preoperative symptoms were improved. CONCLUSION: For zygomatic arch fractures, Gillies approach would be an optimal method, while for displaced tetrapod and multifragment fractures, two or more point fixation points would achieve satisfactory results.
Displacement (Psychology) ; Facial Asymmetry ; Medical Records ; Trismus ; Zygoma ; Zygomatic Fractures

Lymphatic malformation is a congenital abnormality of the lymphatic system, which manifests frequently at birth or before 2 years of age. Lymphatic malformations are classified as macrocystic or microcystic. Microcystic lesions typically occur above the level of mylohyoid muscle and need conservative treatment rather than surgical resection because of the high rate of incomplete excision and recurrence. We report our experience with two cases of radiofrequency ablation of lymphatic malformation in the oral cavity recently seen in our practice.
Congenital Abnormalities ; Lymphatic System ; Mouth ; Muscles ; Parturition ; Recurrence

BACKGROUND AND OBJECTIVES: Since chronic E-tube dysfunction is believed to play an important role in the development of otitis media, it is necessary to evaluate the function of the E-tube clinically. Recently, the endoscopic techniques have been used more frequently to directly inspect the E-tube orifice. In this study, I evaluated the morphologic and dynamic motion of the E-tube orifice with 4 mm 30 degrees videoendoscope and compared with the other existing tests of the E-tube function. SUBJECTS AND METHOD: 101 E-tubes with chronic otitis media were selected. I performed the transnasal 4 mm 30 degrees videoendoscopic examination of the pharyngeal E-tube orifice when patients were swallowing, and classified morphologic and dynamic findings of the E-tube orifice into three categories as follows: Type A, the E-tube is opened widely on swallowing with normal mucosa (normal); Type B, the E-tube is not opened with normal mucosa (functional blockage) and Type C, the E-tube is not opened with pathologic mucosa (mechanical blockage). Throughout the study, the control group was 60 E-tubes that were free of ear pathologies. RESULTS: There were more type As in the control group than in the otitis media group according to videoendoscopic findings of the E-tube orifice. The videoendoscopic analysis of the E-tube orifice had a close correlations with the results of inflation deflation test and with the classification of otitis media, but had no significant relationship with the degree of mastoid pneumatization. CONCLUSION: The morphologic and dynamic examination of the E-tube orifice with videoendoscopic techniques may be an important and useful method to examine the tubal function as well as its dysfunction.
Classification ; Deglutition ; Ear ; Endoscopy ; Eustachian Tube* ; Humans ; Inflation, Economic ; Mastoid ; Mucous Membrane ; Otitis Media ; Pathology

To achieve safe airway management, it is essential first to predict whether there will be difficulties in intubating or ventilating the patient's airway. An enlarged thyroid mass can produce a tracheal obstruction by compression or intraluminal invasion or both. We report two patients with thyroid cancer that obstructed the trachea by compression or invasion. There was no difficulty in endotracheal intubation of the patients with marked thyroid enlargement or in securing passage of the endotracheal tube through the compressed or narrowed portion of the trachea.
Airway Management ; Humans ; Intubation, Intratracheal ; Thyroid Gland ; Thyroid Neoplasms ; Trachea

BACKGROUND: Therapeutic approaches using monoclonal antibodies (mAbs) against complement regulatory proteins (CRPs:i.e.,CD46,CD55 and CD59) have been reported for adjuvant cancer therapy. In this study, we generated a recombinant 1E8 single-chain anti-CD59 antibody (scFv-Fc) and tested anti-cancer effect.by using complement dependent cytotoxicity (CDC). METHODS: We isolated mRNA from 1E8 hybridoma cells and amplified the variable regions of the heavy chain (VH) and light chain (VL) genes using reverse-transcriptase polymerase chain reaction (RT-PCR). Using a linker, the amplified sequences for the heavy and light chains were each connected to the sequence for a single polypeptide chain that was designed to be expressed. The VL and VH fragments were cloned into the pOptiVEC-TOPO vector that contained the human CH2-CH3 fragment. Then, 293T cells were transfected with the 1E8 single-chain Fv-Fc (scFv-Fc) constructs. CD59 expression was evaluated in the prostate cancer cell lines using flow cytometry. The enhancement of CDC effect by mouse 1E8 and 1E8 scFv-Fc were evaluated using a cytotoxicity assay. RESULTS: The scFv-Fc constructs were expressed by the transfected 293T cells and secreted into the culture medium. The immunoreactivity of the secreted scFv-Fc construct was similar to that of the mouse 1E8 for CCRF-CEM cells. The molecular masses of 1E8 scFv-Fc were about 120 kDa and 55 kDa under reducing and non-reducing conditions, respectively. The DNA sequence of 1E8 scFv-Fc was obtained and presented. CD59 was highly expressed by the prostate cancer cell line. The recombinant 1E8 scFv-Fc mAb revealed significantly enhanced CDC effect similar with mouse 1E8 for prostate cancer cells. CONCLUSION: A 1E8 scFv-Fc construct for adjuvant cancer therapy was developed.
Animals ; Antibodies, Monoclonal ; Base Sequence ; Cell Line ; Centers for Disease Control and Prevention (U.S.) ; Clone Cells ; Complement System Proteins ; Flow Cytometry ; Humans ; Hybridomas ; Light ; Mice ; Polymerase Chain Reaction ; Prostatic Neoplasms ; Proteins ; RNA, Messenger

BACKGROUND/AIMS: The majority of foreign body ingestions occur in pediatric population. We assessed the characteristics and endoscopic treatment outcome of esophageal foreign bodies in adults. METHODS: Medical records of consecutive 257 patients who received trial of endoscopic treatment for esophageal foreign bodies, from January 1998 through November 2003 in Gyeongsang National University Hospital, were analyzed retrospectively. RESULT: Among 257 cases, 132 were male. The incidence was highest in 5th decade, and mean age was 54.6 years. Most common location was upper esophagus (84.6%). Accidental ingestion accounted for 92.2%. Twenty cases (7.8%) of voluntary ingestion were all prisoners or in psychiatric problems. Fish bone was the most common type. Endoscopic treatment was successful in 253 cases (98.4%) and 4 were managed with rigid esophagoscopy. Four cases who complicated by acute mediastinitis or pneumomediastinum at presentation had sharp-pointed or long objects lodged in upper esophagus, and almost presented at 48 hours after the ingestion. Full esophagogastroduodenoscopy could find 37 organic lesions in 35 cases. CONCLUSIONS: Majority of esophageal foreign bodies in adults developed accidentally during meals. Voluntary ingestion of foreign bodies was not related to meals, and developed by prisoners or psychiatric patients. The sharp-pointed or long objects lodged in upper esophagus with delayed presentation may cause complication. Endoscopic treatment is safe and beneficial, and a full endoscopic evaluation should be recommended for the evaluation of a synchronous organic disease.
Adult* ; Eating ; Endoscopy, Digestive System ; Esophagoscopy ; Esophagus ; Foreign Bodies* ; Humans ; Incidence ; Male ; Meals ; Mediastinal Emphysema ; Mediastinitis ; Medical Records ; Prisoners ; Prisons ; Retrospective Studies ; Treatment Outcome

Gastrointestinal lipomas are benign adipose tumors that are usually submucosal, and most commonly found in the colon. However, they have also been discovered in the small bowel, stomach and very rarely in the esophagus. Although most of gastrointestinal lipomas are asymptomatic and are found incidentally at time of endoscopy, surgery or autopsy, large lipomas can cause acute abdominal pain, bowel habit changes, gastrointestinal bleeding, intussusception or bowel obstruction. Lipomas can be diagnosed by colonoscopy, abdominal CT, barium series and endoscopic ultrasonography (EUS). Large lipomas need to be treated using various techniques. However, the best treatment modality for large lipomas has not yet been established. A surgical resection of lipomas should be considered for a giant lipoma >2 cm in diameter due to the risk of perforation or hemorrhage. Currently, endoscopic snare polypectomy or endo-loop ligation is used to treat symptomatic lipomas, which may reduce the risk of complications associated with endoscopic treatment. We report a case of giant colonic lipoma that was diagnosed successfully with EUS and treated safely using an endoscopic unroofing technique, endoloop ligation and snare polypectomy in phases.
Abdominal Pain ; Autopsy ; Barium ; Colon ; Colonoscopy ; Endoscopy ; Endosonography ; Esophagus ; Hemorrhage ; Intussusception ; Ligation ; Lipoma ; SNARE Proteins ; Stomach

The aim of this study was to develop and evaluate a triage method to prevent unnecessary emergency department visits of out-of-hospital poisoned patients. From October 2003 to September 2004, the calls that lay persons gave to the Seoul Emergency Medical Information Center to seek advices on the out-of-hospital poisoned patients were enrolled. We designed a triage protocol that consisted of five factors and applied it to the patients. According to the medical outcomes, we classified the patients into two groups, the toxicity-positive and the toxicity-negative. We arranged the factors on the basis of the priority that was determined in order of the odds ratio of each factor for the toxicity-positive and made a flow chart as a triage method. Then we calculated a sensitivity, specificity, positive predictive value and negative predictive value of the method. We regarded the specificity as the ability of the method and the sensitivity as the safety. A total of 220 patients were enrolled in this study. The method showed a sensitivity, specificity, positive predictive value, and negative predictive value of 99.2%, 53.4%, 76.2%, and 97.9%, respectively. Our triage method prevented 53.4% of the unnecessary emergency department visits of outof-hospital acutely poisoned patients, safely.
Triage/methods/*organization & administration ; Telephone ; Telemedicine/methods/*organization & administration ; Severity of Illness Index ; Sensitivity and Specificity ; Risk Factors ; Risk Assessment/*methods ; Reproducibility of Results ; Prognosis ; Poisoning/*diagnosis/*therapy ; Male ; Korea ; Humans ; Female ; Emergency Medical Services/methods/*organization & administration ; Decision Trees ; *Decision Support Techniques ; Child, Preschool ; Child ; Adult ; Adolescent

Boerhaave's syndrome, spontaneous esophageal rupture, is very rare but fatal disease and commonly associated with alcohol induced vomiting. Polyethylene glycol solution is useful for colonic bowel preparation necessary for colonic examination or surgery. There was no report on polyethylene glycol solution associated Boerhaave's syndrome. We report a case of Boerhaave's syndrome, a patient who present chest pain, fever, and dyspnea after several violent vomitings during colonic bowel preparation with polyethylene glycol solution, and review the relevant literature.
Chest Pain ; Colon ; Dyspnea ; Esophagus ; Fever ; Humans ; Polyethylene Glycols ; Rupture ; Vomiting