The diagnosis of dilated cardiomyopathy associated with pheochromocytoma was made in a 24 year old male on the basis of symptoms and signs, measurements of metabolites of catecholamine,echocardiography and radionuclide ventriculography were preformed and demonstrated. The presence of a tumor on both adrenal glands without definite distant metastasis was demonstrated by abdominal ultrasonography, CT scanning and 131I-MIBC scintigraphy. Surgical removal was performed after proper preoperative preparation with a-adrenergic blocker. During the surgery, neither significant arrhythmia nor severe change of blood pressure was observed. After surgery, cardiac function of the patient improved slowly and progressively.
Adrenal Glands ; Arrhythmias, Cardiac ; Blood Pressure ; Cardiomyopathy, Dilated* ; Diagnosis ; Humans ; Male ; Neoplasm Metastasis ; Pheochromocytoma* ; Radionuclide Imaging ; Radionuclide Ventriculography ; Thoracic Surgery ; Tomography, X-Ray Computed ; Ultrasonography ; Young Adult

No abstract available.
Stroke*

Pseudomonas aeruginosa is the most common and the most severe Gram-negative corneal pathogen. Pseudomonas keratitis often arises from the use of a contaminated fluorescein solution or from contaminated medications used either to examine or to treat a corneal abrasion or injury. Pseudomonas keratitis is an acute rapidly progressive corneal ulcer with greenish pus and hypopyon. A 49 year old Korean woman was found to have pseudomonas keratitis whose clinical features. were different from the classic pattern of pseudomonas keratitis.
Corneal Ulcer ; Female ; Fluorescein ; Humans ; Keratitis* ; Middle Aged ; Pseudomonas aeruginosa ; Pseudomonas* ; Suppuration

Alkaline esophagitis is a postoperative complication of a gastrectomy due to gastroesophageal reflux. A lymph-node dissection around the abdominal esophagus, a truncal vagotomy, and dissection to the phrenoesophageal membrane are performed during a radical subtotal gastrectomy, resulting in anatomical and functional changes in the lower esophageal sphincter which is an important structure in the antireflux mechanism. This study evaluated the changes in the esophageal functions and the degree of esophageal reflux before and after a radical subtotal gastrectomy.Ten patients with a relatively early stage of stomach cancer were included, and esophageal manometric studies were performed on all patients before and after the radical subtotal gastrectomy. The pressure and the length of the lower esophageal sphincter and the function of the upper esophageal sphincter were measured. In addition, 24-hour ambulatory esophageal pH monitoring was done before and after the radical subtotal gastrectomy to obtain the percent of the total time for which pH<4, pH>7, and pH>8 and the pre-and post-operative values were compared. There was no significant difference between the pressure and the total abdominal length of the lower esophageal sphincter before the radical subtotal gastrectomy and those after the operation. The pressure in the lower esophageal sphincter was slightly decreased after the operation, but fell within the normal range (pre-op.: 19.7 3.2 mmHg; post-op.: 15.9 5.4 mmHg). There was no increase in the percent of the total time for which pH<4 and pH>8 in the 24-hour ambulatory esophageal pH monitoring. In conclusion, functional changes after a subtotal gastrectomy and alkaline reflux might not be affected by the anatomical derangement due to the surgical procedure itself.
Esophageal pH Monitoring ; Esophageal Sphincter, Lower ; Esophageal Sphincter, Upper ; Esophagitis ; Esophagus ; Gastrectomy* ; Gastroesophageal Reflux ; Humans ; Membranes ; Postoperative Complications ; Reference Values ; Stomach Neoplasms ; Vagotomy, Truncal

No abstract available.
Hyponatremia* ; Hypopituitarism*

BACKGROUND: The aim of this study was to investigate the development of neuropathic pain by radiofrequency thermocoagulation on a rat infraorbital nerve (IoN). METHODS: Male Sprague-Dawley rats (n = 35) were divided into three groups, consisting of the S, T and sham operation. In the experimental groups, rats were thermocoagulated by subjecting them to 70oC for 60 sec (S group, n = 12) or 20 sec (T group, n = 11) on IoN. In the control group (sham operation, n = 12), IoN was not thermocoagulated. The ipsilateral grooming count and escape threshold by von Frey filament (mechanical allodynia) was measured at 1, 3, 5, 7, 9, 11, 13 postoperative days. After two weeks, a 5% formalin solution was injected into the rat upper lips and grooming time was measured for 45 minutes. RESULTS: Grooming count and mechanical allodynia significantly increased in the thermocoalgulation groups (S and T groups) compared to control group (sham operation) for the postoperative days. Nerve injury by radiofrequency thermocoagulation enhanced the grooming time after formalin injection in the rat upper lips. CONCLUSIONS: These results lend support to the hypothesis that thermal injury using radiofrequency thermocoagulation can induce neuropathic pain in rat IoN and this type of nerve injury increases the responsiveness of chemical nocieptive stimuli.
Animals ; Electrocoagulation* ; Formaldehyde ; Grooming ; Humans ; Hyperalgesia ; Lip ; Male ; Neuralgia* ; Rats* ; Rats, Sprague-Dawley ; United Nations

Laparoscopic cholecystectomy (LC) is considered as the gold standard operation for the removal of a nonmalignant, diseased gallbladder. With the increasing number of LCs, a number of gallbladder carcinomas have been unexpectedly found either during or following this procedure. The removal of unexpected gallbladder carcinomas by LC can cause also a new complication, port site metastasis (PSM), which is developed by the implantation of tumor cells into the abdominal wall at the port site. We report a rare case of PSM of gallbladder carcinoma which was unsuspected at the time of LC. A 65-year-old man underwent LC at another hospital for calculous cholecystitis. The histologic examination revealed an adenocarcinoma of the gallbladder infiltrating the muscle wall. Despite the surgeon's advice, the patient refused any additional treatment. Ten months after surgery, he visited our hospital because of a painful and palpable subcutaneous mass at the scar of the periumbilical trocar incision. The mass was biopsed and histological examination confirmed metastasis from the gallbladder carcinoma.
Abdominal Wall ; Adenocarcinoma ; Aged ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cicatrix ; Gallbladder* ; Humans ; Neoplasm Metastasis* ; Surgical Instruments

OBJECTIVE: To evaluate the frequency distribution and causes of death according to number of days after stroke. METHOD: We reviewed in 158 cases of the stroke patients who had died in hospitalization from January 2000 to June 2002 by medical records retrospectively. We evaluated the correlations between the frequency of death and causes of death by frequency analysis. RESULTS: Mean age was 65.8 11.5 years old and average survival days after stroke were 16.2 24.1 days. The proportion of stroke subtypes were infarct (51.3%), intracranial hemorrhage (36.7%), and subarachnoid hemorrhage (12.0%). The frequency of death at 7 days and 30 days after stroke onset were 52.5% and 89.2%, respectively. The most frequent cause of death was respiratory arrest due to transtentorial herniation or brain stem lesion (48.1%), followed in frequency by pneumonia (22.2%), cardiac origin (10.8%), and vasospasm (6.3%). Within the first 30 days, the leading cause of death was respiratory arrest due to transtentorial herniation or brain stem lesion. After the first 30 days, the most frequent cause of death was pneumonia. CONCLUSION: The results of this study are valuable as basic data of mortality and causes of death after stroke during an acute stroke management and early rehabilitation.
Brain Stem ; Cause of Death* ; Hospitalization* ; Humans ; Intracranial Hemorrhages ; Medical Records ; Mortality ; Pneumonia ; Rehabilitation ; Retrospective Studies ; Stroke* ; Subarachnoid Hemorrhage

We have experienced a case of aortic dissecting aneurysm in pregnant woman. She felt initially severe chest pain which was radiated to the neck on the 3days before delivery. Thereafter dyspnea and generalized edema were developed for 1 month after delivery. She was diagnosed as aortic dissectLn, Debakey type-II. During cardiopulmonary bypass, the selective cerebral perfusion was done through the right and left commom carotid arteries. Aortic replacement with Hemashield vascular graft and reimplantation of innominate artery, resuspension of aortic valve, repair of intimal tear were performed. The postoperative course was uneventful.
Aneurysm, Dissecting ; Aortic Valve ; Brachiocephalic Trunk ; Cardiopulmonary Bypass ; Carotid Arteries ; Chest Pain ; Dyspnea ; Edema ; Female ; Humans ; Neck ; Perfusion ; Pregnant Women* ; Replantation ; Tears ; Transplants

PURPOSE: A decline in the circulating levels of estrogen impairs vaginal engorgement, which leads to histopathological changes in the vaginal tissues. The aim of this study was to evaluate the effect of delayed estrogen replacement on the vagina structure in castrated rabbits. Materials and Methods: New Zealand White female rabbits were randomly divided into three groups; two groups (the castration and castration estrogen replacement groups) were castrated: the control group underwent sham operations. Nine weeks after surgery, the estrogen replacement group received subcutaneous injections of estrogen (50microgram/kg/day) for 4 weeks. Vaginal tissue was processed for histology with Masson's trichome stain. The expressions of e-NOS and n-NOS were examined by immunohistochemistry and Western blot. RESULTS: From the histology, marked thinning of the vaginal epithelial layers, and decreased smooth muscle content and submucosal microvasculatures were evident, but with no increase in the collagen fibers in the castrated group was noted. The vaginal tissue of the estrogen replaced animal showed similar morphological features to those in the control rabbits. From the histomorphometry, the percentage of vaginal smooth muscle in the castrated group was significantly decreased compared to those in the control and estrogen replaced groups. The expression and signal intensity of e-NOS were decreased in the vagina of the castrated animals compare to those in the control group. In the estrogen replaced group, the expression of e-NOS was normalized. CONCLUSIONS: Delayed estrogen replacement showed structural restoration of vaginal tissues. These results suggest that delayed estrogen replacement therapy could improve the sexual function in menopausal women.
Animals ; Blotting, Western ; Castration ; Collagen ; Estrogen Replacement Therapy* ; Estrogens* ; Female ; Humans ; Immunohistochemistry ; Injections, Subcutaneous ; Menopause ; Muscle, Smooth ; New Zealand ; Rabbits ; Trichomes ; Vagina