Pneumomediastinum is a relatively uncommon, infrequently reported entity, In the evaluation of these entity, it is important to exclude pathological causes, including Boerhaave's syndrome which carries a high mortality. Spontaneous pneumomediastinum is related to excessive intraalveolar pressure leading to rupture of perivascular alveoli in the setting of a Valsalva maneuver without communication to gut material. So, it has a benign self-limited course and rarely requires medical intervention. On the contrary, secondary pneumomediastinum caused by instrumental, traumatic, and spontaneous perforation of esophagus. Although the prognosis have been improved since the advent of broad-spectrum antibiotics and nutritional support, pneumomediastinum due to esophageal perforation still has a high morbidity and mortality. The most important prognostic factor is the time interval between perforation and initiation of therapy, and an awareness and a high clinical suspicion is critical in the early diagnosis and treatment. Recently, we have experienced 2 cases of pneumomediastinum, one case was spontaneous pneumomediastinum and the other may be caused by instrumental esophageal perforation. We report the clinical course of the patients with a current literature review.
Anti-Bacterial Agents ; Early Diagnosis ; Esophageal Perforation ; Esophagus ; Fibrinogen ; Humans ; Mediastinal Emphysema* ; Mortality ; Nutritional Support ; Prognosis ; Rupture ; Valsalva Maneuver

Severe irradiation on head may result functional alterations of central nervous system. In this study, the irradiation effect on the cerebellar cortex following heavy X-irradiation on head was studied ultrastructurally. Radiation was produced with the linear accelerator ML-4MV[Mitshubishi Co.], and rats weighing about 200gm each were exposed their heads within the radiation areas of 30cm x 30cm, under the radiation distance of 80cm, and with the radiation depth of 1.2 cm. Radiation doses were 3,000rads or 6,000rads, respectively. Animals were sacrificed on 6 hours, 2 days or 6 days following the radiation. Under anesthesia, animals were perfused with 1% glutaraldehyde-1% paraformaldehyde solution. Two hours after the perfusion, brain were taken out and refixed over night in the perfusion fixative. Small blocks of cerebellar hemispheric cortices were refixed 2 hours in 2% osmium tetroxide solution. Fixed tissues were dehydrated in alcohol, embedded in araldite mixture, and cut with ultratome. Ultrathin sections were contrasted with uranyl acetate and lead citrate solutions, and observed with electron microscope. The results obstained were as follow : 1. On 6th hour following X-irradiations, many cerebellar cortical neurons showed increased electron densities, more complicated nuclear infoldings, depletion of synaptic vesicles, expansion of astroglial territories, etc. 2. On 2nd day following X-irradiations, many organelle-rich cells such as Purkinje cells and Golgi cells were darkly degenerated. Numerous myelin figures formed by the cisternal fusions of Golgi apparatus or granular endoplasmic reticula were observed. Cytoplasmic processes of activated astroglial cells were expanded around capillaries and between granule cells. 3. On 6th day following X-irradiations, morphology of neuropil and neurones in the cerebellar cortex was generally restored, except the expanded territories of astroglial cells. From the above results, it was concluded that the release ofneurotransmitters and transcapillary leakage of blood substance were occurred on 6 hours after heavy X-irradiations. And severe alterations were produced on 2 day after X-irradiation, but the condition was generally restored on 6th day following X-irradiation.
Anesthesia ; Animals ; Brain ; Capillaries ; Central Nervous System ; Cerebellar Cortex* ; Citric Acid ; Cytoplasm ; Golgi Apparatus ; Head ; Myelin Sheath ; Neurons ; Neuropil ; Osmium Tetroxide ; Particle Accelerators ; Perfusion ; Purkinje Cells ; Radiation Effects* ; Rats* ; Synaptic Vesicles

No abstract available.

BACKGROUND: Abdominal pain is one of the most common complaints in the emergency department and the evaluation presents an extraordinary challenge to the emergency physician's skill. C-reactive protein, an acute phase protein which is increased in the presence of inflammation in various clinical conditions, has been proven useful in assessing disease severity, in monitoring the development of complications, and in evaluating the response to specific treatments. So we tried to determine whether CRP offers an advantage over other clinical or laboratory variables for decision-making in the management of acute abdominal pain in the emergency department. METHOD: Patients who came to a University Hospital ED with acute abdominal pain, between september 1, 1998 and November 30, 1998, were included in this study, Data collection included age, sex, duration of symptom, location of pain, and laboratory dta(white blood cell count, portion of neutrophils, ESR, CRP, amylase). RESULT: This study included 85 patients, 34 of whom were men. The mean age was 36.9+/-19.1 years. CRP might be useful to detect the serious condition, sensitivity 81%, but more useful to differentiate normal condition from serious condition in acute abdominal pain patients, specificity 83%. CONCLUSION: CRP is an useful indicator of decision-making to abdominal patients in the emergency department. Hospitalization or operation is very unlikely when CRP value is normal.
Abdominal Pain* ; Acute-Phase Proteins ; Blood Cell Count ; C-Reactive Protein* ; Data Collection ; Emergencies ; Emergency Service, Hospital ; Hospitalization ; Hospitals ; Humans ; Inflammation ; Male ; Neutrophils ; Sensitivity and Specificity

No abstract available.
Microvascular Decompression Surgery*

Transforming growth factor-beta (TGF-beta) has been suspected as a possible gene therapy candidate for orthopedic diseases. We demonstrated that the TGF-beta gene therapy can be applicable to orthopedic patients. After transfection of TGF-beta cDNA sequence to myoblasts [C2 (280)] and fibroblasts (NIH 3T3), stable cell lines with TGF-beta mRNA expression were selected by Northern analysis. To evaluate the possibility of clinical application of these cells to orthopedic diseases, the cells were injected into rabbit achilles tendon. Intratendinous injection was done to evaluate the viability of the cells and to determine the optimal concentration for in vivo expression. At 6 weeks after injection, the injected tendon was thickened with newly formed collagen. The results from this experiment indicates that these cells survived and stimulated matrix formation in rabbit achilles tendon. We concluded that TGF-beta cDNA transfected cells can be useful in the evaluation of TGF-beta biology in vivo.
Achilles Tendon* ; Biology ; Cell Line* ; Collagen ; DNA, Complementary ; Fibroblasts* ; Genetic Therapy ; Humans ; Myoblasts* ; Orthopedics ; RNA, Messenger ; Tendons ; Transfection ; Transforming Growth Factor beta*

A 78-year-old male presented with an asymptomatic pinkish multi-nodular mass on his frontal scalp. The lesion had recurred twice after incomplete surgical excision. Initial punch biopsy was diagnosed with cylindroma. He revisited after one year with exophytic enlargement of the mass, and two staged Mohs micrographic surgery identified well-differentiated malignant cylindroma. Histopathology in the lower dermis and periosteal layer showed atypical cells with mitosis and hyperchromatic nucleoli with increased Ki-67 index of 10% to 30%. The postoperative wound was successfully treated with negative wound pressure therapy (NPWT) and secondary intentional healing. We report this case showing malignant transformation of solitary cylindroma, and good result for secondary intention healing using NPWT for postoperative defect.

Radionuclide scrotal scintigraphy with 99m Tc-pertechnetate is an easy, well established, sueful and readilyavailable technique for evaluation of acute scrotum. We studied 41 cases of radionuclide scrotal scintigraphy andthe results were as follows; 1. The over all diagnostic accuracy of scrotal scintigraphy waas 93%(38/41 cases). 2.Scrotal scintigraphy was very useful and accurate in differential diagnosis of epididymo-orchitis and testiculartorsion in patient with acute scrotal pain and swelling, while there was some limitation in differential diagnosisof hematoma from acute epididymo-orchitis or torsion. 3. scintigraphy of epididymoorchitis showed increasedperfusion and radiocativity in the epididymis and/or testis and its diagnostic accuracy was 90%(19/21 cases) 4.Acute testicular torsion showed normal flow in perfusion and cold defect occupying affected testis in staticimage, while missed torsion showed slightly increased flow in perfusion image and cold defect surrounded by anuniform rim of hyperactivity (halo sign). Diagnostic accuracy of testicular torsion was 86%(6/7 cases).
Diagnosis, Differential ; Epididymis ; Hematoma ; Humans ; Male ; Perfusion ; Radionuclide Imaging ; Scrotum ; Spermatic Cord Torsion ; Testis

The authors have studied the findings of radionuclear scanning, inferior vena cavography and ultrasonographyin 2 cases of Budd-chiari Sundrome experienced diffuse inhomogeneous uptake throughout enlarged liver without colddefects. Slightly increased activity in the central portion of liver in case I and markedly increased activity inthe caudate lobe in case II were observed. In inferior vena cavography, the dilated hepatic veins formingintrahepatic collaterals were seen in enlarged caudate lobe. Marked stenosis of I.V.C. at the level of confluenceto right atrium, intraluminal thrombosis of I.V.C., partial obstruction of hepatic veins by thrombi at theconfluent portion and systemic collaterals were noted in case I. In case II, abrupt conical obstruction of I.V.C.at the orgin of hepatic segment, which is consistent with membrane or web. was seen. Prominent systemiccollaterals were developed through the serpinginous margedly dilated azygos and hemiazygos veins, and splenorenalshunt. In ultrasonography, diffuse narrowing and obstruction of hepatic veins at eh confluent level by echogenicnodules were seen in 2 cases. Prominent intrahepatic venous collaterals were observed in case II.
Budd-Chiari Syndrome ; Constriction, Pathologic ; Heart Atria ; Hepatic Veins ; Hepatomegaly ; Liver ; Membranes ; Thrombosis ; Ultrasonography ; Veins

Inducible nitric oxide synthase (iNOS) expression of several organs on the lipopolysaccharides (LPS)-injected rats and on excisional wound was observed by immunohistochemical methods to investigate iNOS-positive cells during inflammation. iNOS expression was induced in response to LPS in the brain and these reactions were observed in the choroidal epithelium, ependymal cells and a few of nerve cells and fiber. A more intensive reaction of nerve cell and fiber was mainly observed in the corpus callosum and hypothalamus. Induction of iNOS of the lung was observed in alveolar macrophage, smooth muscle, pneumocytes and inflammatory cells infilterated in the alveolar septum. iNOS expression of the liver was detected in Kupffer cells, hepatocytes, bile duct and inflammatory cells of spotty necrosis. The cardiac muscle and endothelial cell of the heart showed positive iNOS expression. In the excisional wound, inflammatory cells including macrophages, neutrophil and fibrobast showed iNOS expression and mainly detected necrobiotic layer. Collectively, iNOS expression was induced in the several cell types during inflammatory process. So for better understanding the function of iNOS, more research should be done in relation to each cell type of organ.
Animals ; Bile Ducts ; Brain ; Choroid ; Corpus Callosum ; Endothelial Cells ; Epithelium ; Heart ; Hepatocytes ; Hypothalamus ; Inflammation ; Kupffer Cells ; Lipopolysaccharides ; Liver ; Lung ; Macrophages ; Macrophages, Alveolar ; Muscle, Smooth ; Myocardium ; Necrosis ; Neurons ; Neutrophils ; Nitric Oxide Synthase Type II* ; Pneumocytes ; Rats* ; Shock* ; Wound Healing* ; Wounds and Injuries*