Spinal anesthesia is a safe anesthetic technique and relative easy to perform, but occasionally neurologic injuries after spinal anesthesia have been reported. A 53-year old female patient visited the emergency room due to abdominal pain and she was diagnosed with acute appendicitis. Thus, an emergent appendectomy was planned. During the preoperative evaluation, we noticed that she had a history of intermittent low back pain for the previous 5 years. However, because her stomach was not fully empty, we decided to administer spinal anesthesia. When the spinal needle passed the subarachnoid membrane, she suddenly complained of severe paresthesia on her right posterior thigh. However the parethesia subsided soon, and 2.2 cc of 0.5% bupivacaine was injected via a spinal needle, and aftewards, an appendectomy was done without any complications. As she recovered from the spinal anesthesia, she started complaining of shooting, stabbing and burning pain on her right buttock and posterior thigh Because a neurologic injury after spinal anesthesia was suspected, we inserted an epidural catheter to the same lumbar vertebral level for administering the mepivacaine and ketamine mixture and we also performed a right second sacral nerve root block and a lumbar sympathetic ganglion block. Magnetic Resonance Imaging showed spondylosis of lumbar spine and associated disc degeneration and a bulging disc at the L3-4, L4-5 and L5-S1 level. After treatments, her symptoms improved gradually. When she was discharged on the 16th hospital day, she complained of only minor discomfort on her right posterior thigh.
Abdominal Pain ; Anesthesia ; Anesthesia, Spinal* ; Appendectomy ; Appendicitis ; Bupivacaine ; Burns ; Buttocks ; Catheters ; Emergency Service, Hospital ; Female ; Ganglia, Sympathetic ; Humans ; Intervertebral Disc Degeneration ; Ketamine ; Low Back Pain ; Magnetic Resonance Imaging ; Membranes ; Mepivacaine ; Middle Aged ; Needles ; Paresthesia ; Spine ; Spondylosis ; Stomach ; Thigh

The purpose of this study is to review the clinical and pathological features of pseudomembranous colitis in Korea. Ten cases of psedomembranous colitis, which were diagnosed by sigmoidoscopy and biopsy at the Seoul National University Hospital from May 1982 to occtober 1985, were analyzed in terms of the age and sex distribution, underlying diseases, presumptive causative antimicrobials, symptomatology, involved site and tratment. 1) The disease was more prevalent above sixth decade with a slight preponderance on the female. 2) The underlying diseases of the patients were the uterine cervix cancer in 3 cases and one case each of the nasal polyp, cataract, degenerative arthritis, tuberculous gradmuloma, SLE with menngitis, CVA and gingival abscess. 3) As for the presumptive causative drugs, cephalosporin were assaciated in 6 cases, aminoglycoside m 7 cases, penlcillin in 3 cases, Bactrim in 3 cases, antituberculosis drugs in 1 case and anticancer drugs in 1 case. 4) As for the anatotmical distribution of the lesion, the rectum was involved in 5 cases, the rectum and sigmoid colon in 4 cases and up to the descending colon in 1 case. 5) All the cases were cured by medical treatment. In 5 cases, discontinuation of the antimicrobial drugs and supportive care only were effective and in other 5 cases, vancamycin and/or metronidazole together vrith cholestyramine were added to the regimen.
Abscess ; Biopsy ; Cataract ; Cervix Uteri ; Cholestyramine Resin ; Colitis ; Colon, Descending ; Colon, Sigmoid ; Enterocolitis, Pseudomembranous* ; Female ; Humans ; Korea ; Metronidazole ; Nasal Polyps ; Osteoarthritis ; Rectum ; Seoul ; Sex Distribution ; Sigmoidoscopy ; Trimethoprim-Sulfamethoxazole Combination ; Trimethoprim, Sulfamethoxazole Drug Combination

PURPOSE: It is sometimes difficult to evaluate the angiographic findings pertaining to spasm of the arteries in the hands and feet in patients with Raynaud's syndrome. The purpose of this study is to investigate the effectiveness of applying a hot bag to the hands and/or feet for the control of vasospasm in patients with Raynaud's syndrome during angiography. MATERIALS AND METHODS: Forty five cases (hands: feet=15:30) in forty patients (M:F=9:31, mean age; 39 years) with Raynaud's syndrome whose conventional angiography demonstrated the presence of vasospasm were included. First, digital subtraction angiography of the extremities was performed at room temperature (20 to 21 degrees Celsius). Then a hot bag was applied for 5 minutes on the hand or foot, and a post-hot bag angiography of the extremity was performed. The angiographic findings were classified into 6 grades in the case of the feet (0; anterior/posterior tibial artery, 1; dorsalis pedis /lateral plantar artery, 2; arcuate artery/plantar arch, 3; metatarsal artery, 4; digital artery, 5; blushing of toe tip) and 5 grades in the case of the hands (0; ulnar/radial artery, 1; palmar arch, 2; common palmar artery, 3; proper palmar artery, 4; blushing of finger tip) according to the level of the visualized vessels on the angiography. The time and the time difference to maximal visualization of the vessels between the measurements taken at room temperature and those taken after the hot bag application were calculated. RESULTS: In all cases, more vessels were visualized after the hot bag application than at room temperature. After the application of the hot bag, the grade of vessel visualization was increased in both the feet (range; 1-4, mean; 2.3) and hands (range; 1-2, mean; 1.4). The time to the maximal visualization of the vessels was faster after the hot bag application than at room temperature. The time difference between the two groups ranged from 1 to 33 seconds (mean; 12.3 seconds) in the feet and 2 to 26 seconds (mean; 11.8 seconds) in the hands. CONCLUSION: Angiography of patients with Raynaud's syndrome showed that the application of a hot bag provides a convenient and effective method of relieving the vasospasm of the vessels of the hands or feet.
Angiography* ; Angiography, Digital Subtraction ; Arteries ; Blushing ; Extremities* ; Fingers ; Foot ; Hand ; Humans ; Metatarsal Bones ; Spasm ; Tibial Arteries ; Toes

Neonatal lupus erythematosus (NLE) is a rare disease characterized by typical clinical features and the transplacental passage of maternal autoantibodies, particularly anti-SSA/Ro. The major clinical manifestations are cutaneous lupus lesions, congenital heart block, hematological disorders, and hepatobiliary diseases. We report a case of NLE presenting with multiple round and oval target-like erythematous skin lesions and abnormal liver function, born to a clinically asymptomatic mother whose diagnosis was made retrospectively only after her newborn's diagnosis. Both the infant and the mother were positive for the anti-SSA/Ro and anti-SSB/La antibodies.
Antibodies ; Autoantibodies ; Heart Block ; Humans ; Infant ; Liver ; Lupus Erythematosus, Systemic ; Mothers ; Rare Diseases ; Retrospective Studies ; Skin

PURPOSE: The aim of this study was to assess clinical correlations with postoperative alteration of p16 DNA methylation, and to clarify whether postoperative changes in the serum DNA methylation status of p16 could be used as a reliable prognostic factor for gastric cancer. MATERIALS AND METHODS: Fifty-three consecutive gastric adenocarcinoma patients who underwent gastric resection (Chung-Ang University Hospital, Seoul, Korea) were included. DNA methylation of p16 was evaluated by methylation-specific polymerase chain reaction using serum DNA preoperatively and at the 10th postoperative day. The correlation between changes in methylation status and patients' prognosis was analyzed. RESULTS: p16 was methylated in 79.2% of preoperative serum DNA and in 54.7% of postoperative serum DNA, respectively. Methylation in p16 disappeared more frequently in patients who underwent standard D2 lymphadenectomy compared to those who underwent modified D1+ lymphadenectomy (P=0.016). Whereas methylation of preoperative serum DNA was not correlated with survival, patients with postoperative disappearance of p16 methylation showed longer survival than those without postoperative disappearance of p16 methylation in the patients who had gastric cancer with lymph node metastasis (P=0.042). CONCLUSIONS: Postoperative disappearance of p16 methylation could be an available prognostic factor for node-positive gastric cancer.
Adenocarcinoma ; DNA ; DNA Methylation ; Genes, p16 ; Humans ; Lymph Node Excision ; Lymph Nodes ; Methylation ; Neoplasm Metastasis ; Polymerase Chain Reaction ; Prognosis ; Stomach Neoplasms

PURPOSE: Angiogenesis plays an important role in the growth, progression and metastasis of solid tumors. Vascular endothelial growth factor (VEGF) was thought to be one such angiogenic factor and was also thought to be a selective mitogen for endothelial cells. The purpose of this retrospective study was to evaluate for prognostic significance of VEGF in stomach cancer. MATERIALS AND METHODS: The sections of formalin-fixed, paraffin embedded from 55 stomach cancer were stained immunohistochemically for VEGF. The rate of VEGF expression and correlation between expression of VEGF and other prognostic factor of stomach cancer were studied. RESULTS: There were 20 cases (36.4%) of VEGF-positive and 35 cases (63.6%) of VEGF- negative. There were no significant difference between VEGF expression and the histologic type, differentiation, depth of invasion of histologic stage, lymph node involvement. The frequency of hepatic recurrence was higher in patients with VEGF-positive tumor than that af patient with negative tumor (p=0.007). The prognosis of the patients with VEGF positive tumor was worse than that of patients with VEGF negative tumor (p=0.0214). CONCLUSION: There was a closely significant between positive expression of VEGF and a high incidence of hepatic metastasis, low survival rate. The expression of VEGF could be considered to be one of useful prognostic factor in human gastric carcinoma
Angiogenesis Inducing Agents ; Endothelial Cells ; Humans* ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Paraffin ; Prognosis ; Recurrence ; Retrospective Studies ; Stomach Neoplasms* ; Stomach* ; Survival Rate ; Vascular Endothelial Growth Factor A*

Rarely, surgical clips can migrate into the biliary tract after laparoscopic cholecystectomy and work as a nidus for biliary stone formation. We report a case of the development of a common bile duct (CBD) stone induced by surgical clip in a 57-year-old man who underwent laparoscopic cholecystectomy 10 years ago. On computed tomography, a CBD stone with a metallic material was found, and endoscopic retrograde cholangiopancreatography (ERCP) revealed a CBD stone including a metallic clip. The stone was removed completely by ERCP, and the surgical clip was found along with the stone.
Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Common Bile Duct* ; Gallstones ; Humans ; Middle Aged ; Surgical Instruments*

PURPOSE: This study investigated the pattern of hematologic profile and eosinophilia for a month after birth in very low birth weight (VLBW) infants. METHODS: The medical records of 141 VLBW infants (birth weight, <1,500 g) admitted to the neonatal intensive care unit (NICU) of Konyang University Hospital. We collected complete blood cell counts (CBC) weekly for 4 weeks and studied hematologic profile and related factors of eosinophilia (> or =700/mm3). RESULTS: Overall, 50.4% of all infants had at least one instance of eosinophilia for a month after birth. There were 50.7% with moderate eosinophilia (1,000-2,999/mm3). White blood cell (WBC) counts and absolute neutrophil count (ANC) climaxed on 7th day of life, whereas eosinophilia mainly occurred on 21st day of life. The demographic data and perinatal characteristics of infants with and without eosinophilia were compared. Prevalence of eosinophilia was associated with gestational age and total parenteral nutrition on 21st day of life; total parenteral nutrition and transfusion on 28th day of life. Eosinophilia was closely associated with transfusion on logistic regression analysis (P<0.05). CONCLUSION: Eosinophilia in VLBW infants occurs mainly on 21st day of life. Eosinophil counts showed a separate trend different from WBC counts and ANC. Transfusion was significantly associated with eosinophilia.
Blood Cell Count ; Eosinophilia ; Eosinophils ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Leukocytes ; Logistic Models ; Medical Records ; Neutrophils ; Parenteral Nutrition, Total ; Parturition ; Prevalence

Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disease characterized by spiking fever, arthralgia, salmon pink rash, neutrophilic leukocytosis, and multi-organ involvement. Although renal involvement may appear in some cases of adult Still's disease, onset over 70 years of age with renal involvement has not been described. We report a 73-years-old woman whose illness manifested with fever of unknown origin, massive proteinuria, and multiple lymph nodes enlargement. With proteinuria of 2,650 mg/day, a renal biopsy was performed, and histopathological evaluation yielded the diagnosis of chronic glomerulonephritis (CGN). After excluding infectious disease, malignancy, and other rheumatic disease, AOSD was diagnosed with symptoms including fever over 39.0degrees C for more than a week, leukocytosis, generalized lymphadenopathy, and negative autoantibodies. Proteinuria and fever were improved markedly by high dose glucocorticoids and methotrexate therapy.
Adult ; Arthralgia ; Autoantibodies ; Biopsy ; Communicable Diseases ; Diagnosis ; Exanthema ; Female ; Fever ; Fever of Unknown Origin ; Glomerulonephritis ; Glucocorticoids ; Humans ; Leukocytosis ; Lymph Nodes ; Lymphatic Diseases ; Methotrexate ; Neutrophils ; Proteinuria ; Rheumatic Diseases ; Salmon ; Still's Disease, Adult-Onset*

PURPOSE: To evaluate the prognostic implication of histopathologic findings on the surgical specimens of N2 positive stage IIIA non-small cell lung cancer (NSCLC) patients who were treated with preoperative concurrent radiochemotherapy (CRCT) and surgery. MATERIALS AND METHODS: From May 1997 to April 2000, 48 patients with N2 positive stage IIIA NSCLC were treated with preoperative CRCT and surgery. Retrospective analyses were performed on 33 patients who underwent surgical resection. The thoracic radiation therapy (TRT) dose was 45 Gy over 5 weeks with a 1.8 Gy daily fraction using 10 MV X-rays. Chemotherapy consisted of two cycles of intravenous cisplatin (100 mg/m2, on days 1 and 29) and oral etoposide (50 mg/m2/day, on days 1~14 and 29~42), concurrently delivered with TRT. Surgery was performed around 4 weeks of the completion of CRCT. The median follow up was 18 months. The histopathologic findings, including the proportions of viable tumor cells, fibrosis, and necrosis, as well as the tumor and nodal statuses on the surgical specimens following the preoperative CRCT, were analyzed. RESULTS: The 3-year overall survival, disease-free survival, and local control rates were 46.1%, 49.5%, and 85.5%, respectively. Post-surgical stages decreased in 18 patients (54.5%), including 3 pathologic complete responses, were unchanged in 13 (39.4%), and increased in two (6.1%). On univariate analyses, the low proportion of the viable tumor cells was the only factor favorably affecting the overall survival rate (p=0.0386), and the histologic type of squamous cell carcinoma was a favorable factor affecting disease free survival rate (p=0.0452). On multivariate analyses, however, no factor affected the overall survival, disease free survival, or local control rates. CONCLUSION: The histopathologic findings of the proportion of viable tumor cells, fibrosis, and necrosis on the surgical specimens following preoperative CRCT had few prognostic implications on uni-and multi-variate analyses. Furthermore, the primary tumor and nodal responses to preoperative CRCT did not influence the outcomes. Longer-term follow-up with a larger number of patients, however, is awaited.
Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Chemoradiotherapy* ; Cisplatin ; Disease-Free Survival ; Drug Therapy ; Etoposide ; Fibrosis ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Necrosis ; Retrospective Studies ; Survival Rate