Malignant gastrointestinal stromal tumors (GISTs) are rare non-epithelial, mesenchymal neoplasms of the gastrointestinal tract that metastasize or recur in 30% of patients who undergo surgical resection with curative intent. A 59-year-old man visited our hospital for an examination of a palpable mass in the left abdomen. Fourteen months prior to his visit, the patient underwent gastric wedge resection to remove a GIST of the gastric cardia. At the time of surgery, no evidence of metastatic disease was observed and the pathological interpretation was a high-risk GIST. A follow-up computed tomography scan of the abdomen revealed a partially necrotic solid mass (9.8 x 7.6 cm) and enhancing mass in the spleen (2.3 cm). On exploration, multiple masses were found in the liver, greater omentum, and mesentery. Here, we report a case of recurring GIST of the stomach that metastasized to the spleen. To the best of our knowledge, few reports of metastasis to the spleen exist.
Abdomen ; Cardia ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Liver ; Mesentery ; Middle Aged ; Neoplasm Metastasis ; Omentum ; Spleen ; Stomach

Osteopetrosis is an uncommon hereditary bone disorder whose prominent radiologic feature characterized by increased bone density. The authors reported a 7-year-old male patient who referred from local dental clinic for dental problems such as early exfoliation of deciduous teeth(#54,73,83) and delayed eruption of permanent teeth(#31,41,36,46). The patient appeared as a poorly developed. Dental X-ray films showed early exfoliation of deciduous teeth, delayed eruption of permanent teeth, and rampant caries. Lateral view of skull demonstrated increased opacity of calvarium, facial bones, and skull base. Generally the skeletal density is greatly increased throughout all bones. Facial CT showed poor development of paranasal sinuses and mastoid air cells. No hematopoietic and neurologic complications such as anemia, thrombocytopenia, blindness and deafness were found. Also mental retardation was not found. The final diagnosis of this case was a osteopetrosis tarda. Sometimes patient with osteopetrosis tarda may be developed dental problems prior to severe systemic symptoms. The dentist can be the first clinician to see the patient. It is very important for the dentist to have the knowledge of the osteopetrosis and to care the patient's dental problems to prevent complication such as osteomyelitis of jaws.
Anemia ; Blindness ; Bone Density ; Child ; Deafness ; Dental Clinics ; Dentists ; Diagnosis ; Facial Bones ; Growth Disorders ; Humans ; Intellectual Disability ; Jaw ; Male ; Mastoid ; Osteomyelitis ; Osteopetrosis* ; Paranasal Sinuses ; Skull ; Skull Base ; Thrombocytopenia ; Tooth ; Tooth Eruption ; Tooth, Deciduous ; X-Ray Film

Anti-Bacterial Agents ; Drainage ; Fever ; Humans ; Orthognathic Surgery ; Wound Infection ; Wounds and Injuries

Anti-Bacterial Agents ; Humans ; Mandible ; Maxilla ; Orthognathic Surgery

PURPOSE: Early diagnosis and management of therapeutic interventions are very important in chest trauma. Conventional chest X-rays (CXR) and computed tomography (CT) are the diagnostic tools that can be quickly implemented for chest trauma patients in the emergency department. In this study, the usefulness of the CT as a diagnostic measurement was examined by analyzing the ability to detect thoracic injuries in trauma patients who had visited the emergency department and undergone CXR and CT. METHODS: This study involved 84 patients who had visited the emergency department due to chest trauma and who had undergone both CXR and CT during their diagnostic process. The patients' characteristics and early vital signs were examined through a retrospective analysis of their medical records, and the CXR and the CT saved in the Picture Archiving Communication System (PACS) were examined by a radiologist and an emergency physician to verify whether or not a lesion was present. RESULTS: Pneumothoraxes, hemothoraxes, pneumomediastina, pulmonary lacerations, rib fractures, vertebral fractures, chest wall contusions, and subcutaneous emphysema were prevalently found in a statistically meaningful way (p<0.05) on the CT. Even though their statistical significance couldn't be verified, other disorders, including aortic injury, were more prevalently found by CT than by CXR. CONCLUSION: CT implemented for chest trauma patients visiting the emergency department allowed disorders that couldn't be found on CXR to be verified, which helped us to could accurately evaluate patients.
Contusions ; Early Diagnosis ; Emergencies ; Hemothorax ; Humans ; Lacerations ; Medical Records ; Pneumothorax ; Retrospective Studies ; Rib Fractures ; Subcutaneous Emphysema ; Thoracic Injuries ; Thoracic Wall ; Thorax ; Tomography, X-Ray ; Vital Signs

The endoscopic fine needle aspiration cytology may add to the diagnostic accuracy of endoscopic biopsy and brush cytology. It is also of particular value in submucosal, infiltrative and ulceronecrotic tumors. Endoscopic fine needle aspiration cytology was done with sclerotherapy needle(23 gauge) in. the 17 patients with submucosal tumor(18 cases), extrinsic compression(2 cases), infiltrative gastric cancer(one case) and cancer of the ampulla of Vater(one case) on the upper gastrointestinal endoscopy. Endoscopic fine needle aspiration cytology established the diagnosis in 6 cases(submucosal tumor of the stomach; 2 cases, submucosal tumor of the duodenum; one case, extrinsic mass of the duodenum; one case, infiltrative cancer of the stomach; one case, and the cancer of ampulla of Vater; one case) of 17 cases. There were negative results for malignancy in 7 cases and material insufficiency in 4 cases. Five cases of the positive results with endoscopic fine needle aspiration cytology were not diagnosed with endoscopic forceps biopsies. There was no complication. We conclude that endoscopic fine needle aspiration cytology is a simple and safe technique and is of particular value in submucosal tumor, extrinsic compression of the upper gastrointestinal tract by tumor, and infiltrative gastric cancer.
Ampulla of Vater ; Biopsy ; Biopsy, Fine-Needle* ; Diagnosis* ; Duodenum ; Endoscopy, Gastrointestinal ; Humans ; Sclerotherapy ; Stomach ; Stomach Neoplasms ; Surgical Instruments ; Upper Gastrointestinal Tract

No abstract available.
Lymphoma, Large-Cell, Anaplastic

Ocular disturbances related to cranial nerve lesion or increased intracranial pressure are well known in cryptococcal meningitis, but internuclear ophthaloplegia is very rare and only two cases have been reported to our knowledge. We report the third patient of internuclear ophthalmoplegia in cryptococal meningitis. The internuclear ophthalmoplegia in our case persisted for one year with a demonstrable lesion in brain MRI, in contrast to the other cases in which intranuclear ophthalmoplegia was transient and no responsible lesion was observed.
Brain ; Cranial Nerves ; Cryptococcosis* ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Meningitis ; Meningitis, Cryptococcal ; Ocular Motility Disorders ; Ophthalmoplegia

BACKGROUND: The recovery of spontaneous ventilation is delayed in elderly patients in whom muscle relaxants has been administered for general anesthesia. We evaluated the appropriateness of microscopic cataract surgery without using muscle relaxants in elderly patients. METHODS: Forty two ASA physical status I and II patients for cataract surgery were randomly assigned to two groups. Glycopyrrolate 0.2 mg, fentanyl 2 mcg/kg and propofol 2 mg/kg were administered intravenously followed by vecuronium 1 mg/kg iv in group I and 10% lidocaine 1.5 mg/kg spray into oropharynx in group II. Laryngeal mask (LMA) was inserted for airway management and anesthesia was maintained by only propofol infusion in both groups. Whether the patient moved during the surgery, whether ephedrine was administered and the propofol infusion rate were recorded. RESULTS: Six patients of group I and 1 patient of group II were moved during surgery. Only in group II, 7 patients received intravenously ephedrine administration. Mean infusion rate of propofol was 0.114 mg/kg/min in group I and 0.159 mg/kg/min in group II. CONCLUSION: In general anesthesia for microscopic cataract surgery, the combination of fentanyl 2 mcg/kg, propofol 2 mg/kg and infusion, 10% lidocaine spray and laryngeal mask without muscle relaxants is a good alternate method of keeping airway.
Aged ; Airway Management ; Anesthesia* ; Anesthesia, General ; Cataract* ; Ephedrine ; Fentanyl ; Glycopyrrolate ; Humans ; Laryngeal Masks ; Lidocaine ; Oropharynx ; Propofol ; Vecuronium Bromide ; Ventilation

BACKGROUND: The recovery of spontaneous ventilation is delayed in elderly patients in whom muscle relaxants has been administered for general anesthesia. We evaluated the appropriateness of microscopic cataract surgery without using muscle relaxants in elderly patients. METHODS: Forty two ASA physical status I and II patients for cataract surgery were randomly assigned to two groups. Glycopyrrolate 0.2 mg, fentanyl 2 mcg/kg and propofol 2 mg/kg were administered intravenously followed by vecuronium 1 mg/kg iv in group I and 10% lidocaine 1.5 mg/kg spray into oropharynx in group II. Laryngeal mask (LMA) was inserted for airway management and anesthesia was maintained by only propofol infusion in both groups. Whether the patient moved during the surgery, whether ephedrine was administered and the propofol infusion rate were recorded. RESULTS: Six patients of group I and 1 patient of group II were moved during surgery. Only in group II, 7 patients received intravenously ephedrine administration. Mean infusion rate of propofol was 0.114 mg/kg/min in group I and 0.159 mg/kg/min in group II. CONCLUSION: In general anesthesia for microscopic cataract surgery, the combination of fentanyl 2 mcg/kg, propofol 2 mg/kg and infusion, 10% lidocaine spray and laryngeal mask without muscle relaxants is a good alternate method of keeping airway.
Aged ; Airway Management ; Anesthesia* ; Anesthesia, General ; Cataract* ; Ephedrine ; Fentanyl ; Glycopyrrolate ; Humans ; Laryngeal Masks ; Lidocaine ; Oropharynx ; Propofol ; Vecuronium Bromide ; Ventilation