Acute limb compartment syndrome (ALCS) is defined as compound symptoms resulting from poor oxygenation and decreased nutrition supply to muscles and nerves in a tightly confined compartment. The most common cause of ALCS is tibia fracture, followed by blunt trauma to soft tissue. However, non-traumatic causes are rare. We report an iatrogenic, non-traumatic ALCS case after venoarterial extracorporeal membrane oxygen (VA-ECMO) therapy. A 14-year-old male received VA-ECMO therapy due to cardiorespiratory failure after drowning. Although he had no symptoms during therapy, leg swelling appeared 10 hours after ECMO treatment. Two days after the leg swelling, the patient underwent a fasciotomy. Unfortunately, nerve conduction studies and electromyography showed multiple neuropathies in the lower leg. Despite 2 weeks of rehabilitation with electrical stimulation, an exercise program, and physical therapy, there was no definite change in muscle strength. To our knowledge, this is the first reported case of non-traumatic ALCS after VA-ECMO therapy in Korea.
Adolescent ; Anterior Compartment Syndrome ; Compartment Syndromes* ; Drowning ; Electric Stimulation ; Electromyography ; Extracorporeal Membrane Oxygenation* ; Extremities* ; Humans ; Korea ; Leg ; Male ; Membranes ; Muscle Strength ; Muscles ; Neural Conduction ; Oxygen ; Rehabilitation ; Tibia

Anti–glomerular basement membrane (GBM) nephritis is characterized by circulating anti-GBM antibodies and crescentic glomerulonephritis (GN) with deposition of IgG along the GBM. In a limited number of cases, glomerular immune complexes have been identified in anti-GBM nephritis. A 38-year-old female presented azotemia, hematuria, and proteinuria without any pulmonary symptoms. A renal biopsy showed crescentic GN with linear IgG deposition along the GBM and mesangial IgA deposition. The patient was diagnosed as concurrent anti-GBM nephritis and IgA nephropathy. Therapies with pulse methylprednisolone and cyclophosphamide administration were effective. Concurrent cases of both anti-GBM nephritis and IgA nephropathy are rare among cases of anti-GBM diseases with deposition of immune complexes. This rare case of concurrent anti-GBM nephritis and IgA nephropathy with literature review is noteworthy.
Adult ; Anti-Glomerular Basement Membrane Disease ; Antibodies ; Antigen-Antibody Complex ; Azotemia ; Basement Membrane ; Biopsy ; Cyclophosphamide ; Female ; Glomerulonephritis ; Glomerulonephritis, IGA ; Hematuria ; Humans ; Immunoglobulin A ; Immunoglobulin G ; Methylprednisolone ; Nephritis ; Proteinuria

Background: Gastric-type endocervical adenocarcinoma (GEA) is unrelated to human papillomavirus (HPV) infection and is clinically aggressive compared with HPV-associated usual-type endocervical adenocarcinoma (UEA). The cytological diagnosis falls short of a definitive diagnosis of GEA and is often categorized as atypical glandular cells (AGCs). To improve cytologic recognition, cytological findings of HPV-independent GEA were analyzed and the results compared with HPV-associated UEA. Methods: Cervical Papanicolaou (Pap) smears from eight patients with a histopathologic diagnosis of GEA and 12 control cases of UEA were reviewed. All slides were conventionally prepared and/or liquid-based prepared (ThinPrep) and stained following the Pap method. A mucinous background, architectural, nuclear, and cytoplasmic features were analyzed and compared with UEA. Results: Preoperative cytologic diagnoses of the eight GEA cases were AGCs, favor neoplastic in three cases, adenocarcinoma in situ in one case, and adenocarcinoma in four cases. Cytologically, monolayered honeycomb-like sheets (p = .002) of atypical endocervical cells with vacuolar granular cytoplasm (p = .001) were extensive in GEA, and three-dimensional clusters (p = .010) were extensive in UEA. Although the differences were not statistically significant, background mucin (p = .058), vesicular nuclei (p = .057), and golden-brown intracytoplasmic mucin (p = .089) were also discriminatory findings for GEA versus UEA. Conclusions Although GEA is difficult to diagnose on cytologic screening, GEA can be recognized based on cytologic features of monolayered honeycomb sheets of atypical endocervical cells with abundant vacuolar cytoplasm and some golden-brown intracytoplasmic mucin. UEA cases are characterized by three-dimensional clusters.

BACKGROUND/OBJECTIVES: Nelumbo leaves have been used in traditional medicine to treat bleeding, gastritis, hemorrhoids, and halitosis. However, their mechanisms have not been elucidated. MATERIALS/METHODS: The present study prepared two Nelumbo leaf extracts (NLEs) using water or 50% ethanol. Inflammatory response was induced with LPS treatment, and expression of pro-inflammatory mediators (inducible nitric oxide synthase, cyclooxygenase-2, tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, and IL-6 and nitric oxide (NO) and prostaglandin E₂ (PGE₂) productions were assessed. To determine the anti-inflammatory mechanism of NLEs, we measured nuclear factor-κB (NF-κB) activity. Major metabolites of NLEs were also analyzed and quantified. RESULTS: NLEs effectively reduced the expression and productions of pro-inflammatory mediators such as IL-1β, IL-6, TNF-α, PGE₂, and NO. NLEs also reduced NF-κB activity by inhibiting inhibitor of NF-κB phosphorylation. Both extracts contained catechin and quercetin, bioactive compounds of NLEs. CONCLUSIONS: In this study, we showed that NLEs could be used to inhibit NF-κB-mediated inflammatory responses. In addition, our data support the idea that NLEs can ameliorate disease conditions involving chronic inflammation.
Catechin ; Cyclooxygenase 2 ; Dinoprostone ; Ethanol ; Gastritis ; Halitosis ; Hemorrhage ; Hemorrhoids ; Inflammation ; Interleukin-6 ; Interleukins ; Macrophages ; Medicine, Traditional ; Metabolomics ; Necrosis ; Nelumbo* ; Nitric Oxide ; Nitric Oxide Synthase ; Phosphorylation ; Quercetin ; Water

PURPOSE: Hepatolithiasis results in septic cholangitis, biliary stricture, hepatic atrophy, hepatic abscess, irreversible liver cirrhosis, and cholangiocarcinoma. Hepatic resection for hepatolithiasis is regarded as a more effective treatment for achieving complete removal of stones and preventing recurrence. The purpose of this study was to determine the surgical outcome of hepatic resections for hepatolithiasis. METHODS: From March 2001 to December 2006, 54 patients underwent hepatic resections for hepatolithiasis at the Department of Surgery, Eulji University Hospital. A retrospective review of the surgical outcome was carried out. RESULTS: The hepatolithiasis was located in the left intrahepatic duct (34 cases), right intrahepatic duct (7 cases) or both (13 cases). The operative procedures were as follows: a left hepatectomy in 34 patients, a left lateral sectionectomy in eight, a right posterior sectionectomy in three, a left trisectionectomy in three, a right hepatectomy in five, and a segmentectomy in 1. The postoperative complications were intraabdominal abscess in 10 patients, wound infection in 4, pleural effusion in 3, internal bleeding in 2, T-tube site leakage in 2, hepatic failure and pneumonia in 1. The factors that affect these complications were analyzed. Preoperative percutaneous transhepatic biliary drainage (PTBD) and operative hepaticojejunostomy increased the frequency of postoperative complications; these findings were statistically significant (p=0.035, p=0.006, respectively). Two patients were diagnosed with cholagiocarcinoma. Five patients had remaining stones and five patients had recurrent stones. CONCLUSION: Hepatic resection is a safe and effective procedure for treating hepatolithiasis. If possible, bypass procedures such as hepaticoenterostomy should be avoided to reduce postoperative complications.
Abscess ; Atrophy ; Cholangiocarcinoma ; Cholangitis ; Constriction, Pathologic ; Drainage ; Hemorrhage ; Hepatectomy ; Humans ; Liver Abscess ; Liver Cirrhosis ; Liver Failure ; Mastectomy, Segmental ; Pleural Effusion ; Pneumonia ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Surgical Procedures, Operative ; Wound Infection

BACKGROUND: The purpose of this study is to evaluate the patients' general perception about the analgesics and the effects of the preoperative education about analgesics and patient-controlled analgesia (PCA). METHODS: One hundred patients scheduled for elective gastrectomy were randomly allocated into two groups. In control group (n = 50), patients were given conventional preanesthetic visit with questionnaire survey on PCA one day before operation. In study group (n = 50), patients were sufficiently explained about postoperative analgesia and PCA by anesthesiologist and given precise explanation sheet about PCA. Total amounts of drug used in PCA as well as rescue analgesics, the pain scores, and side effects were compared. RESULTS: 62.2% of patients had much information from various sources that analgesics effects positively in the recovery phase, but actually 73.7% of patients considered that analgesics do not seem to have any influence on the recovery after operation. There was no difference between the amounts of total PCA used, rescue analgesics, and the pain scores. However, the educated patients complained less dizziness at postoperative days (POD) one. Also, the number of patients excluded from study due to the PCA discontinuation secondary to related side effects was less in educated patients (P = 0.025). CONCLUSIONS: Preoperative education about analgesics and PCA failed to demonstrate significant decrease in the amount of analgesics and of pain scores. However, it lowered the incidence of PCA discontinuation due to side effects.
Analgesia ; Analgesia, Patient-Controlled* ; Analgesics* ; Dizziness ; Education* ; Gastrectomy ; Humans ; Incidence ; Passive Cutaneous Anaphylaxis ; Postoperative Care

Miliary tuberculosis is quite a rare but serious cause of acute respiratory distress syndrome (ARDS). Therefore, the early detection of military tuberculosis as the underlying cause of ARDS is very important for the prognosis and survival of the patient. We report a case of military tuberculosis mimicking ARDS. A female patient was admitted due to repeated fever and dyspnea. The initial chest CT scan showed diffuse ground glass opacity, without a miliary pattern. The case was considered to be ARDS caused by pneumonia. She showed improvement after being treated with levofloxacin. However, she was re-admitted with fever seven days after discharge. The follow up chest CT scan showed micronodules in both lungs. An open lung biopsy confirmed the diagnosis of military tuberculosis.
Biopsy ; Dyspnea ; Female ; Fever ; Follow-Up Studies ; Glass ; Humans ; Injections, Intravenous ; Lung ; Military Personnel ; Ofloxacin ; Pneumonia ; Prognosis ; Respiratory Distress Syndrome, Adult ; Thorax ; Tuberculosis ; Tuberculosis, Miliary

Obesity hypoventilation syndrome (OHS) is characterized by severe obesity, excessive daytime sleepiness, hypoxemia and hypercapnea. Because OHS mimics pulmonary hypertension or cor pulmonale, clinicians should recognize and treat this syndrome appropriately. A 58-year-old female visited the emergency room because of dyspnea. She was obese and had kyphoscoliosis. The patient also experienced snoring, recurrent choking during sleep and daytime hypersomnolence which worsened after gaining weight in the recent year. The arterial blood gas analysis showed she experienced hypoxemia and hypercapnea not only during nighttime but also daytime. We suspected OHS and the patient underwent polysomnography to confirm whether obstructive sleep apnea was present. During the polysomnography test, sleep obstructive apnea was observed and apnea-hypopnea index was 9.2/hr. The patient was treated with bilevel positive airway pressure therapy (BiPAP). After BiPAP for 4 days, hypoxemia and hypercapnia were resolved and she is currently well without BiPAP. We report a case successfully treated with clinical improvement by presuming OHS early in a patient who had typical OHS symptoms, even while having other conditions which could cause hypoventilation.
Airway Obstruction ; Anoxia ; Apnea ; Blood Gas Analysis ; Disorders of Excessive Somnolence ; Dyspnea ; Emergency Service, Hospital ; Female ; Humans ; Hypercapnia ; Hypertension, Pulmonary ; Hypoventilation ; Middle Aged ; Obesity Hypoventilation Syndrome* ; Obesity, Morbid ; Polysomnography ; Pulmonary Heart Disease ; Sleep Apnea, Obstructive ; Snoring

Fetus in fetu is a poorly understood and rare congenital malfomation. This is a rare form of monozygotic twin that asymmetric twin becomes internalized in the other twin thus acting endoparasitically. Fetus in fetu can be distinguised from teratoma, because of vertebral column, skeletal axis, and well-differentiated internal organs. We present the findings in the two cases of fetus in fetu that were diagnosed with prenatal ultrasonography. After birth, we removed fetus-like structures and confirmed by pathologic examination. Fetus-like structures were consisted of vertebral column, extremities, and other well-developed internal organs.
Axis, Cervical Vertebra ; Extremities ; Fetus* ; Humans ; Parturition ; Spine ; Teratoma ; Twins, Monozygotic ; Ultrasonography, Prenatal*

With the progress of computed tomography (CT), the detection of small pulmonary nodules has been increased. The conventional diagnostic modalities for tissue confirmation, such as bronchoscopic biopsy or transthoracic needle biopsy, may not be successful in some cases. Too small a nodule or the nodules located far from the pleural surface can be marked and localized with device preoperatively and then this tissue can be obtained surgically. CT-guided hook wire fixation is useful in marking pulmonary nodules and there are few complications with this procedure. We report here on a case of double primary lung cancer that was diagnosed by percutaneous localization with using a hook wire
Biopsy ; Biopsy, Needle ; Lung ; Lung Neoplasms