Duodenal diaphragm is a rare congenital anomaly among the congenital duodenal obstructions. Its symptom and sign usually appear since birth if obstruction is complete. The clinical manifestations of incompletely obstructive duodenal diaphragm are intermittent vomiting, abdominal pain and poor weight gain. Diagnosis may be delayed in this case. Authors experienced a case of incomplete duodenal diaphragm with a central hole. A 29 months old girl presented failure to thrive, intermittent episodes of bloating, abdominal discomfort and occasional vomiting. The patient vomited every 10-14 days, then the abdominal pain and distention were relieved. She overate for about 10 days until the next projectile vomiting. The vomitus frequently contained food ingested several days previously. Plain x-ray films of abdomen showed marked gastric distention. Upper gastrointestinal series revealed marked distention of the duodenum with windsock configuration and radiolucent line at the third portion of the duodenum. On gastroscopic examination, gastric bezoar impacting the pyloric canal and antrum was noted. At operation, we found mucosal membrane in the third portion of the duodenum and bezoar(Chinese cabbage) above the membrane. Side-to-side duodeno-jejunostomy was performed and bezoar was removed. She was discharged on the 13th postoperative day without any complication.
Abdomen ; Abdominal Pain ; Bezoars ; Bulimia* ; Child, Preschool ; Diagnosis ; Diaphragm* ; Duodenal Obstruction ; Duodenum ; Failure to Thrive ; Female ; Humans ; Membranes ; Parturition ; Vomiting ; Weight Gain ; X-Ray Film

Primary breast lymphoma is a rare malignant breast tumor, accounting for <1% of all breast cancers. Among them, diffuse large B-cell lymphoma is the most common histologic subtype.However, primary mucosa-associated lymphoid tissue (MALT) lymphoma is less common and more indolent than diffuse large B-cell lymphoma, and primary MALT lymphoma of the breast is extremely rare. We report a case of bilateral breast cancer in a 62-year-old woman with primary MALT lymphoma in right braest and contralateral invasive breast cancer in left breast. The patient presented with a palpable right breast lump, which appeared as a noncalcified mass on mammography and an indistinct irregular hypoechoic mass with internal vascularity on breast ultrasonography. The mass was pathologically confirmed by excisional biopsy as primary MALT lymphoma. The patient underwent dynamic contrast-enhanced breast MRI, which additionally detected a small suspicious mass in the left breast. This was a clinically and mammographically occult breast cancer diagnosed as invasive ductal carcinoma.

Primary breast lymphoma is a rare malignant breast tumor, accounting for <1% of all breast cancers. Among them, diffuse large B-cell lymphoma is the most common histologic subtype.However, primary mucosa-associated lymphoid tissue (MALT) lymphoma is less common and more indolent than diffuse large B-cell lymphoma, and primary MALT lymphoma of the breast is extremely rare. We report a case of bilateral breast cancer in a 62-year-old woman with primary MALT lymphoma in right braest and contralateral invasive breast cancer in left breast. The patient presented with a palpable right breast lump, which appeared as a noncalcified mass on mammography and an indistinct irregular hypoechoic mass with internal vascularity on breast ultrasonography. The mass was pathologically confirmed by excisional biopsy as primary MALT lymphoma. The patient underwent dynamic contrast-enhanced breast MRI, which additionally detected a small suspicious mass in the left breast. This was a clinically and mammographically occult breast cancer diagnosed as invasive ductal carcinoma.

Primary breast lymphoma is a rare malignant breast tumor, accounting for <1% of all breast cancers. Among them, diffuse large B-cell lymphoma is the most common histologic subtype.However, primary mucosa-associated lymphoid tissue (MALT) lymphoma is less common and more indolent than diffuse large B-cell lymphoma, and primary MALT lymphoma of the breast is extremely rare. We report a case of bilateral breast cancer in a 62-year-old woman with primary MALT lymphoma in right braest and contralateral invasive breast cancer in left breast. The patient presented with a palpable right breast lump, which appeared as a noncalcified mass on mammography and an indistinct irregular hypoechoic mass with internal vascularity on breast ultrasonography. The mass was pathologically confirmed by excisional biopsy as primary MALT lymphoma. The patient underwent dynamic contrast-enhanced breast MRI, which additionally detected a small suspicious mass in the left breast. This was a clinically and mammographically occult breast cancer diagnosed as invasive ductal carcinoma.

BACKGROUND: Studies in animals suggest that pipecuronium dose not induce hemodynamic chan-ges related to histamine release or to an effect on the autonomic nervous system. Therefore the effects of bolus administration of large doses of pipecuronium, up to 0.20 mg/kg, on the intubation condition, onset and duration of neuromuscular blockade, heart rate and blood pressure were studied during fentanyl- nitrous oxide anesthesia. METHOD: Forty adults were randomly assigned to receive a bolus injection of either 0.05, 0.10, 0.15, 0.20 mg/kg of pipecuronium. Neuromuscular blockade was measured using mechanomyographic activity of the adductor pollicis muscle after supramaximal stimulation of the ulnar nerve. Four subgroups of 10 patients received pipecuronium doses of 0.05, 0.10, 0.15 and 0.20 mg/kg, respectively, as an intubating dose. RESULTS: The times of onset and clinical duration (mean sem) after each dose were as follows: 0.05 mg/kg, 2.98 0.42 and 41.5 2.42 min; 0.10 mg/kg, 1.54 0.06 and 82.9 7.48 min; 0.15 mg/kg, 1.41 0.14 and 124.8 13.1 min; 0.20 mg/kg, 1.12 0.05 and 187.1 12.8 min. The intubation condition, time of onset and duration after doses of 0.05 mg/kg were significantly different from values after the higer doses. The duration was increased with dose-increments. No dose-related changes in heart rate or blood pressure were observed. CONCLUSION: The authors conclude that dose of 0.10 mg/kg and over has good intubation condition clinically and large bolus dose of pipecuronium can be safely used with a significantly prolonged duration of action without hemodynamic change.
Adult* ; Anesthesia ; Animals ; Autonomic Nervous System ; Blood Pressure ; Heart Rate ; Hemodynamics ; Histamine Release ; Humans ; Intubation ; Intubation, Intratracheal* ; Neuromuscular Blockade ; Nitrous Oxide ; Pipecuronium* ; Ulnar Nerve

PURPOSE: A charcoal filter attached within the anesthetic circuit has been shown to efficiently adsorb halothane or isoflurane, thus hastening anesthetic recovery in low or minimal flow system. This study was intended to demonstrate whether the charcoal filter enhances the recovery time from sevoflurane anesthesia using a semi-closed circuit system. MATERIALS AND METHODS: Thirty healthy patients scheduled for elective surgery under sevoflurane anesthesia were randomly assigned to the charcoal filter or control group. Upon completion of surgery, the end-tidal concentration of sevoflurane was maintained at 2.0 vol%. A charcoal filter was attached to the expiratory limb of the breathing circuit of charcoal filter group subjects. After sevoflurane was discontinued, ventilation was controlled with the same minute volume as the intra-operative period at a fresh gas flow rate of 5 L.min(-1) with 100% O2. The elimination kinetics of sevoflurane from end-tidal concentration, Bispectral index and times of eye opening and extubation were obtained. RESULTS: The exponential time constant (tau) of alveolar sevoflurane concentration in the charcoal filter group was significantly shorter than that in the control group (1.7+/-0.5 vs. 2.5+/-1.1 min, p=0.008). The charcoal filter hastened rapid eye opening (11.1+/-3.8 vs. 14.8+/-3.0 min, p=0.007) and extubation (11.9+/-3.9 vs. 15.3+/-3.2 min, p=0.014), compared to the control group. CONCLUSION: A charcoal filter enhances the recovery from sevoflurane anesthesia with a semi-closed rebreathing circuit.
Adult ; Anesthesia/methods ; *Anesthesia Recovery Period ; Anesthesiology/instrumentation ; Anesthetics, Inhalation/chemistry/*pharmacology ; Charcoal/*chemistry ; Filtration/*methods ; Humans ; Methyl Ethers/chemistry/*pharmacology ; Middle Aged ; Time Factors

BACKGROUND AND OBJECTIVE: Percutaneous transluminal coronary angioplasty of chronic total occlusion has been limited by a relatively low success rate and a high restenosis rate. This study investigated procedural outcome, factors predictive of procedural success and safety of coronary angioplasty for chronic total coronary occlusion. MATERIALS AND METHODS: The study population was composed of 45 lesions attempting PTCA with or without stent implantation for recanalization of chronic total coronary occlusion between January 1997 and July 1999. The clinical and angiographic data of the 45 lesions were reviewed. The results of successful PTCA in 28 lesions were compared with those in 17 lesions whose PTCA was failed. RESULTS: The overall success of balloon angioplasty and stenting was achieved in 28 lesions (62.2%) and did not differ significantly by clinical variables. The most common cause of failure of balloon angioplasty was inability to pass the guide wire across the occlusion( 14 of 23 lesions, 61%). Procedural success was more common in patients with occlusions with a tapered entry configuration(77.2% vs. 47.8%, p=.042), with lesions without side branches(82.3% vs. 50%, p=.03). Multiple logistic regression analysis identified the absence of side branch(p<0.01) and the presence of a tapered entry configuration(p<0.05) as independent predictors of procedural success. One case(2.2%) needed emergency coronary bypass surgery after failure to recanalize the occluded vessel. There was no Q wave acute myocardial infarction, death. CONCLUSIONS: The favorable cases(>60%) of chronic total coronary occlusions can be successfully dilated by balloon angioplasty with or without stent implantation, with a major complication rate of 2.2%. Therefore, with careful patient selection, we need to try the aggressive recanalization for chronic total coronary occlusion.
Angioplasty ; Angioplasty, Balloon ; Angioplasty, Balloon, Coronary* ; Coronary Occlusion ; Emergencies ; Humans ; Logistic Models ; Myocardial Infarction ; Patient Selection ; Stents

Insertion of indwelling arterial catheter has become a valuable procedure for blood pressure monitoring and for measurement of blood gas tension during anesthesia. A 34-year-old man with chronic alcoholism and diabetes mellitus was admitted to the hospital because of hyperosm-olar coma. On the first hospital day, percutaneous left radial artery cannulation was carried out for hemodynamic monitoring and arterial blood gas analysis after a modified Allen's test appear-ed to be positive. On the eleventh hospital day, the catheter was removed because of fever and sign of infection at the insertion site. Treatment with vancomycin by sensitivity test was begun on day 13, after continued for 2 weeks. On day 34 a pulsatile mass was noted at the insertion site. During surgery, a pseudoaneurysm of 1X1.2 cm size was found, and liquified hematoma and necrotic material were noted. The aneurysm was removed and end to end anastomosis was successfully completed. We suggest that risk factors for pseudoaneurysm may include abnormal state of vessel wall, multiple attempts at cannulation, increased duration of catheterization, adva-nced age, prolonged hospitalization, hematoma and infection at cannulation site.
Adult ; Alcoholism ; Anesthesia ; Aneurysm ; Aneurysm, False* ; Blood Gas Analysis ; Blood Pressure Monitors ; Catheterization* ; Catheters ; Coma ; Diabetes Mellitus* ; Fever ; Hematoma ; Hemodynamics ; Hospitalization ; Humans ; Radial Artery* ; Risk Factors ; Vancomycin

Epstein-Barr virus (EBV)-encoded small non-coding RNAs (EBERs) are abundantly expressed in various EBV-associated malignancies, and play critical roles in cell proliferation, tumorigenesis, and apoptosis resistance. However, the mechanism how EBERs regulate cell function awaits further clarification. In this study, we investigated the effect of EBERs on the expression of cellular microRNA (miRNA) and mRNA expression. To test the effect of EBERs while unaffected by other EBV genes, we used EBERs-deleted recombinant EBV infected Burkitt's lymphoma cell line (Akata(+)EBERs(-)) as well as EBV-infected (Akata(+)) and EBV uninfected (Akata(-)) cell lines. They all have the same genetic backgrounds. First, 15 different cellular miRNAs which have reverse complementary sequences to EBERs and have reported targets were selected by bioinformatics analysis. When RT-PCR was carried out for the 16 miRNAs using RNAs from Akata(+), Akata(-), and Akata(+)EBERs(-) cells, hsa-miR-7-5p was the only one showing down-regulated expression in Akata(+) than in Akata(-) and Akata(+)EBERs(-) cells. Bioinformatics and mRNA microarray analyses for Akata(+), Akata(-), and Akata(+)EBERs(-) cell lines were then carried out to predict putative targets of hsa-miR-7-5p. Among the 6 predicted targets of hsa-miR-7-5p, only low density lipoprotein receptor-related protein 6 (LRP6) was up-regulated in EBERs-expressing cells when tested by RT-PCR and Western blot. However, luciferase reporter assay showed that the 3'-UTR of LRP6 was not directly targeted by hsa-miR-7-5p. Our data suggest that both hsa-miR-7-5p and LRP6 are regulated by EBERs in Akata cells, and these genes may partly mediate the tumorigenic function of EBERs in Burkitt's lymphoma.
Apoptosis ; Blotting, Western ; Burkitt Lymphoma* ; Carcinogenesis ; Cell Line* ; Cell Proliferation ; Computational Biology ; Herpesvirus 4, Human ; Low Density Lipoprotein Receptor-Related Protein-6 ; Luciferases ; MicroRNAs ; RNA* ; RNA, Messenger ; RNA, Small Untranslated

Congenital pericardial defects are rare and asymptomatic for both partial and complete defects. However, some patients can experience syncope, arrhythmia, and chest pain. When a patient experiences a symptom, it may be caused by herniation and dynamic compression or torsion of a heart structure including the coronary arteries. Diagnosis of a congenital pericardial defect may be difficult, especially in old patients with concomitant coronary artery disease. The clinical importance of congenital pericardial defect has not been stressed and congenital pericardial defects are regarded as benign, but in this case, pericardial defect was responsible for myocardial ischemia. The authors report a case of partial congenital pericardial defect causing herniation and dynamic compression of the coronary arteries, presenting as an acute coronary syndrome in an old man, with an emphasis on the unique features of the coronary angiogram that support the diagnosis of partial pericardial defects.
Acute Coronary Syndrome* ; Arrhythmias, Cardiac ; Chest Pain ; Coronary Artery Disease ; Coronary Vessels ; Diagnosis ; Heart ; Heart Defects, Congenital ; Humans ; Myocardial Ischemia ; Pericardium ; Syncope