The diagnosis of insulinoma is made primarily by the detection of an inappropriately elevated serum insulin level in the presence of a low blood glucose level. The successful resection of insulin-secreting islet cell turnors is greatly facilitated by accurate preoperative localization. But, the modalities of ultrasonography, computer tomography, magnetic resonance imaging and selective arteriography often fail to detect insulinoma smaller than 1.5 cm in diameter. In this report, we describe a patient with an insulinoma successfully localized by percutaneous transhepatic portal vein sampling but not by abdominal ultrasonography, computer tomography and selective arteriography. Percutaneous transhepatic portal vein catheterization with insulin sampling showed sudden step-up of insulin concentrations near 6 cm from distal splenic vein. During operation, a 1×1.3cm sized tumor was found at the junction of body and tail of pancreas, so distal pancreatectomy was performed, We propose that preoperative percutaneous transhepatic portal vein catheterization with measurement of radioimmunoactive insulin concentration is a safe and reliable method and plays an important role to localize insulinoma that are considered occult after conventional diagnostic studies have been negative.
Angiography ; Blood Glucose ; Catheterization ; Catheters ; Diagnosis ; Humans ; Insulin ; Insulinoma ; Islets of Langerhans ; Magnetic Resonance Imaging ; Methods ; Pancreas ; Pancreatectomy ; Portal Vein ; Splenic Vein ; Tail ; Ultrasonography

Sparganosis is a parasitic infestation which is manifested principally in the cats or dogs, but many human infestations have not been reported uncommonly. In Korea, the reported cases of human sparganosis are more than 20 cases till now Moreover the urogenital infestation of sparganosis is rarely observed. We have experienced one case of sparganosis in scrotum, which would often be confused with the sperm granuloma.
Animals ; Cats ; Dogs ; Granuloma ; Humans ; Korea ; Scrotum* ; Sparganosis* ; Spermatozoa

BACKGROUND: Stereotactic thalamotomy and pallidotomy for Parkinson's disease or essential tremor have been performed under local anesthesia. But some neurosurgeons have been reluctant to utilize this technique because of patient discomfort and neurological complications. So we used the propofol that provides excellent sedation and rapid and smooth recovery of mental abilities with minimal side effects. METHODS: After the patients were placed into the Leksell's stereotactic frame, anesthesia was induced by continuous infusion of propofol at the rate of 150 mcg/kg/min and then maintained at the rate of 50 mcg/kg/min. We investigated the hemodynamic changes, ABGA, total dose of propofol, time to loss of consciousness, recovery time from the end of infusion to eyes opening and side effects. RESULTS: The blood pressure decreased significantly at infusion start 15 min and 30 min (p<0.05) and heart rate decreased significantly at infusion start 30 min (p<0.05). The PaCO2 increased significantly at infusion start 15 min and 30 min (p<0.05). Total dose of propofol was 202.4+/-59.8 mg, time to loss of consciousness was 13.0+/-4.4 min, recovery time was 9.0+/-4.7 min and side effects were pain on infusion (2 cases) and postoperative nausea (1 case). CONCLUSIONS: Stereotactic thalamotomy and pallidotomy for Parkinson's disease or essential tremor were performed by infusion of propofol with minimal side effects and no neurological complications.
Anesthesia* ; Anesthesia, Local ; Blood Pressure ; Essential Tremor ; Heart Rate ; Hemodynamics ; Humans ; Movement Disorders* ; Pallidotomy ; Parkinson Disease ; Postoperative Nausea and Vomiting ; Propofol* ; Unconsciousness

Adenosquamous carcinomas of the intestine are rare tumors, especially when they occur in the small bowel. We report a case of primary adenosquamous carcinoma of the proximal jejunum in a 66 year old woman with no underlying pathologic condition. The tumor mainly consisted of well differentiated squamous cell carcinoma showing keratin pearl and conspicuous intercellular bridges, and minor portion revealed well differentiated adenocarcinoma. The tumor seemed to have originated from the mucosal epithelium, invading the entire wall and metastasizing to the regional lymph nodes. Previous reports of adenosquamous carcinoma of the small intestine have been associated with metastatic disease from distant sites or intestinal duplication. In the colon, squamous cell differentiation have been seen in about 0.05% of adenocarcinomas and in 0.4% of adenomata. The pathogenesis of squamous cell carcinoma of the intestine is unknown, but some possible mechanisms are proposed. :1)malignant transformation of squamous cell epithelium in the submucosa, 2)aberrant differentiation of stem cells to squamous cell with subsequent malignant change, 3)squamous metaplasia of glandular cells with subsequent malignant change, 4)transformation of an adenosquamous into an epidermoid carcinoma.
Adenocarcinoma ; Aged ; Carcinoma, Adenosquamous* ; Carcinoma, Squamous Cell ; Cell Differentiation ; Colon ; Epithelium ; Female ; Humans ; Intestine, Small ; Intestines ; Jejunum* ; Lymph Nodes ; Metaplasia ; Stem Cells

PURPOSE: We evaluated the clinical and radiological outcomes of double-bundle anterior cruciate ligament (ACL) reconstruction using an outside-in technique with a follow-up of two- to six-years, especially in terms of the sports activity level and radiological degeneration. MATERIALS AND METHODS: Sixty-seven patients who were available for a minimum two-year follow-up after double-bundle ACL reconstruction using an outside-in technique were retrospectively evaluated. The mean follow-up period was 43.7 months. The knee function and stability were evaluated before the operation, one year after the operation (short-term follow-up), and more than two years after the operation (last follow-up). RESULTS: Regarding the knee function, the Lysholm score, International Knee Documentation Committee (IKDC) evaluation, and hop test showed significant improvement. Regarding the stability, the Lachman test, pivot shift test, KT-2000 arthrometer data, and anterior drawer radiographs using Telos showed significant improvement. Regarding the sports activity level, the patients who returned to pre-injury level activity was 68.7% according to the Tegner activity score and 76.1% according to the Cincinnati sports activity scale score. The incidence of aggravated degeneration or development of greater than IKDC grade A degeneration after surgery was 10.4%. CONCLUSIONS: Double-bundle ACL reconstruction using an outside-in technique showed favorable clinical and radiological outcomes with respect to the knee function and stability, joint degeneraion, and, especially, return to pre-injury sports activity.
Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction ; Follow-Up Studies ; Humans ; Humulus ; Incidence ; Joints ; Knee ; Retrospective Studies ; Sports

BACKGROUND: Supraglottic airway devices can be used to maintain stable hemodynamics during intubation, to secure a difficult airway and to administer muscle relaxants at reduced levels for brief operation. We investigated the insertion success rates, hemodynamic stabilities after insertion, intraoperative ventilatory parameters, and postoperative laryngopharyngeal discomforts of three supraglottic airway devices: the ProSealTM laryngeal mask airway (PLMA), the laryngeal tube (LT), and the PAxpressTM (PAX). METHODS: After induction with thiopental 5 mg/kg with fentanyl 1microgram/kg and rocuronuim 0.6 mg/kg as muscle relaxants, manual control ventilation was done with N2O : O2 (1 : 1) and sevoflurane 5-6 vol% for 2 minutes. The supraglottic airway devices were inserted into 94 adult ASA physical status I and II patients. Unblinded observers collected the intraoperative data, and blinded observers collected the postoperative data. RESULTS: The success rates of first-attempts were similar (PLMA: 96.9%, LT: 93.1%, PAX: 96.8%). The time to achieve effective ventilation was shorten for PLMA. Peak inspiratory pressure (PIP) was significant higher for PAX than PLMA. Cuff pressure significantly increased in LT at 60 and 90 minutes after insertion. LT provided the tightest seal for positive ventilation. The incidence of blood-tinged and sore throat was highest for PAX. CONCLUSIONS: These three supraglottic airway devices can be used successfully and effectively without gastric insufflation. We suspected that the incidences of airway complications were proportional to PIP and cuff pressure and that they are dependent upon insertion skill.
Adult ; Fentanyl ; Hemodynamics ; Humans ; Incidence ; Insufflation ; Intubation ; Laryngeal Masks* ; Pharyngitis ; Thiopental ; Ventilation

BACKGROUND: Three isoforms of the neuronal acetylcholine receptors (AChRs) have been described in muscle epsilonAChRs, gammaAChRs and alpha7AChRs. The adult neuromuscular junctions are composed of epsilonAChRs. During immobilization, new AChRs with subunit compositions of gammaAChRs and alpha7AChRs appear in the perijunctional and extrajunctional area. This study evaluated the contribution of these isoforms to neurotransmission during immobilization, by using waglerin-1 which selectively blocks the epsilonAChRs. METHODS: Male mice (n = 20) were used and each group was divided into sham operated or immobilized. A leg was immobilized in mice for 14 days by pinning, after which nerve-evoked twitch tension was examined under anesthesia in tibialis muscle of both legs, with the contralateral leg serving as control. Neuromuscular transmission was monitored by using a peripheral nerve stimulator with the tibialis muscle and sciatic nerve. Electrical stimuli of 0.2 msec duration were applied to sciatic nerve 2 Hz for 2 sec every 30 sec. After administration of waglerin-1, the evoked twitch was recorded. The percent depression of T1 relative to baseline was transformed to probit scale to determine the effective dose of waglerin-1 for 5%, 50%, and 95% twitch depression. RESULTS: The twitch tension in the control group was higher than immobilized group, confirming the efficacy of immobilization. Waglerin-1 produced 99% twitch suppression on the control group. But on the immobilized group, waglerin-1 produced only 70% twitch suppression even at 37 pg. CONCLUSIONS: The functional role of epsilonAChRs in neurotransmission decreases during immobilization while that of gammaAChRs and alpha7AChRs increases.
Adult ; Anesthesia ; Animals ; Depression ; Hindlimb ; Humans ; Immobilization ; Leg ; Male ; Mice ; Muscles ; Neuromuscular Junction ; Neurons ; Peripheral Nerves ; Protein Isoforms ; Receptors, Cholinergic ; Salicylamides ; Sciatic Nerve ; Synaptic Transmission

BACKGROUND: A sizable percentage of tuberculous pleurisy patients are known to have residual pleural thickening(RPT) despite adequate anti-tuberculous chemotherapy. But, the predictive factors related to the development of RPT is not well known. Therefore, we studied to determine which factors are related to the development of RPT after completion of therapy. METHODS: By retrospective review of medical records, fifty-eight patients initially diagnosed as having tuberculous pleurisy between March 1995 and January 1998 were separated into two groups: 27 patients in group 1 had RPT on simple chest radiography, while 31 patients in group 2 had no RPT after 6 month of anti-tuberculous chemotherapy. The clinical characteristics, radiologic findings and pleural fluid findings of the two group were compared at the time of diagnosis and during the course of therapy. RESULTS: 1) 47% of patients had RPT after 6 month of chemotherapy, and RPT was more common in man than in women(54% vs 29%,p=0.092). 2) In group 2 patients, complete resorption of pleural lesion occurred rather late stage of therapy(1-2 month : 26%, 3-4 month :29%, 5-6 month : 45%). 3) Group 1 patients had increased percentage of loculated pleural lesion(26% vs 19%) and increased white blood cell and lymphocyte count, lactate dehydrogenase level in pleural fluid (3527+/-5652 vs 2467+/-2201/ml, 2066+/-2022 vs 1698+/-1835/ml and 1636+/-1143 vs 1441+/-923IU/ml, respectively) than group 2 at the time of diagnosis, but statistically insignificant. 4) Duration of symptom prior to treatment, size of pleural effusion, presence of parenchymal lung lesion, level of total protein, glucose and adenosine deaminase(ADA) activity in pleural fluid were similar in both group. CONCLUSION: 53% of tuberculous pleurisy patients showed slow but complete resorption of pleural lesion after 6 month of chemotherapy. But, no clinical, radiological and pleural fluid findings are predictive for the development of RPT.
Adenosine ; Diagnosis ; Drug Therapy ; Glucose ; Humans ; L-Lactate Dehydrogenase ; Leukocytes ; Lung ; Lymphocyte Count ; Medical Records ; Pleural Effusion ; Radiography ; Retrospective Studies ; Thorax ; Tuberculosis, Pleural*

Emphysema is characterized by air space enlarge?ment and alveolar destruction. The mechanism responsible for the development of emphysema was thought to be protease/antiprotease imbalance and oxidative stress. A very recent study shows that alveolar cell apoptosis causes lung destruction and emphysematous changes. Thus, this study was per?formed to support the evidence for the role of apoptosis in the development of emphysema by characterizing cigarette smoke extract (CSE)-induced apoptosis in A549 (type II pneumocyte) lung epithelial cells. CSE induced apoptosis at low concentration (10% or less) and both apoptosis and necrosis at high concentration (20%). Apoptosis was demonstrated by DNA fragmentation using FACScan for subG1 fraction. Discrimination between apoptosis and necrosis was done by morphologic analysis using fluorescent microscopy with Hoecst 33342/propium iodide double staing and electron microscopy. Cy?tochrome c release was confirmed by using immuno?fluorescence with monoclonal anti-cytochrome c antibody. However, CSE-induced cell death did not show the activation of caspase 3 and was not blocked by caspase inhibitors. This suggests that CSE-induced apoptosis might be caspase-independent apoptosis. CSE-induced cell death was near com?pletely blocked by N-acetylcystein and bcl-2 over?expression protected CSE-induced cell death. This results suggests that CSE might induce apoptosis through intracellular oxidative stress. CSE also activated p53 and functional knock-out of p53 using stable overexpression of HPV-E6 protein inhibited CSE-induced cell death. The characterization of CSE-induced cell death in lung epithelial cells could support the role of lung cell apoptosis in the patho?genesis of emphysema.
Apoptosis ; Caspase 3 ; Caspase Inhibitors ; Cell Death* ; Discrimination (Psychology) ; DNA Fragmentation ; Emphysema ; Epithelial Cells* ; Lung* ; Microscopy ; Microscopy, Electron ; Necrosis ; Oxidative Stress ; Smoke* ; Tobacco Products*