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

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

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

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: The 5-hydroxytryptamine 3 receptor (5-HT3R) is a member of a superfamily of ligand-gated ion channels which has structural similarities and common evolutionary origin to those of the nicotinic acetylcholine receptor (nAChR). 5-hydroxytryptamine (5-HT) and muscle relaxants may have cross reaction. Rocuronium is a non-depolarizing neuromuscular blocking agent which has a rapid onset. The aim of this study was to examined the effects of 5-HT on rocuronium-induced neuromuscular blockade in a rat phrenic nerve-hemidiaphragm preparation. METHODS: Institutional approval was obtained for the experimental procedure. Fifty male Sprague-Dawley rats (150-200 g) were divided into 5 groups; the control, and 0.1, 1, 10, and 20microgram/ml of 5-HT. The animals were injected with phentobarbital at 40 mg/kg into the peritoneal cavity. The hemidiaphragm with the phrenic nerve was dissected and then mounted in a bath containing 100 ml Krebs solution at room temperature. The phrenic nerve was stimulated at the supramaximal intensity using a Grass(R) S88 stimulator via an SIU5 isolation unit. The twitch height was measured and recorded using a precalibrated Grass(R) FT88 force displacement transducer and recorded with a Grass(R) 79 polygraph, respectively. In the cumulative dose-response study, the rocuronium 100microgram/dl and each dose of 5-HT were administered simultaneously administered, with additional 50microgram/dl incremental doses of rocuronium were added to obtain grteater than 95% neuromuscular twitch inhibition. The ED5, ED50, ED90, and ED95 of rocuronium in each group were calculated using a probit model. RESULTS: The ED50, ED90, and ED95 of rocuronium were significantly reduced in 5-HT 20microgram/ml group (P < 0.05), but no differences were observed with the other 5-HT groups compared to the control groups. CONCLUSIONS: 5-HT at 20microgram/ml enhanced the neuromuscular blockade of rocuronium.
Animals ; Baths ; Cross Reactions ; Humans ; Ligand-Gated Ion Channels ; Male ; Neuromuscular Blockade* ; Peritoneal Cavity ; Phrenic Nerve ; Rats* ; Rats, Sprague-Dawley ; Receptors, Nicotinic ; Serotonin* ; Transducers

BACKGROUND:Rocuronium is a non depolarizing muscle relaxant of rapid onset and of intermediate action duration. It is particularly suitable for short operation and rapid control airway. But, intravenous rocuronium cause pain and a withdrawal movement. The purpose of this study was to evaluate the effect of intravenous lidocaine on pain and withdrawal movement in patients receiving rocuronium. METHODS: The study was approved by our institutional review board, and informed consent was obtained from all patients. One hundred and twenty patients, ASA physical status 1-2 undergoing general anesthesia for elective surgery were randomly enrolled. Allergy history to trial drug, chronic pain, pregnancy, patient on analgesics, difficult vein access and deeply sedated patients were excluded. Patients were not premedicated, and had a 20-18 G intravenous catheter inserted into a hand dorsum before operation. On arrival in the operation room, routine non-invasive monitors were placed and the free flow of intravenous fluid without edema, redness or hardness was confirmed. A subparalyzing dose of rocuronium 0.06 mg/kg (RS group) or vecuronium 0.01 mg/kg (VS group) was administered after 2 ml of 0.9% NaCl in one group, and a subparalyzing dose of rocuronium 0.06 mg/kg (RL group) or vecuronium 0.01 mg/kg (VL group) was administered after 2 ml of 2% lidocaine injection in a second group. All patients then received 5 mg/kg of 2.5% thiopental sodium and 0.6 mg/kg rocuronium (RS and RL group) or 0.1 mg/kg of vecuronium (VS and VL group). Muscle relaxant-induced pain and withdrawal movements were assessed using 4-grade scales (0-3). Vein redness was measured just after administration and vein hardness five minutes after intubation using 4-grade scales (0-3). RESULTS: Incidence of pain (8.2 times) and withdrawal movement (6.2 times) was more frequent in the rocuronium group than in the vecuronium group (P< 0.01). Lidocaine pretreatment decreased the incidence of pain significantly (5.7 times, P < 0.01). CONCLUSIONS: Rocuronium causes more pain and withdrawal movements than vecuronium. Lidocaine pretreatment significantly reduced the incidence and severity of pain, and withdrawal movements in both groups.
Analgesics ; Anesthesia, General ; Catheters ; Chronic Pain ; Edema ; Ethics Committees, Research ; Hand ; Hardness ; Humans ; Hypersensitivity ; Incidence ; Informed Consent ; Intubation ; Lidocaine* ; Pregnancy ; Thiopental ; Vecuronium Bromide ; Veins ; Weights and Measures

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*