Schwannoma or neurilemmoma is an uncommon neoplasm, and it is derived from the peripheral nerve sheath. These tumors most frequently occur in the head, neck and flexor surfaces of the upper and lower extremities, while the porta hepatis and retroperitoneum are rarely implicated. We report here on a case of benign schwannoma in the porta hepatis with compression of the common bile duct, and this was successfully treated by surgical excision. The patient was a 63-year-old woman who had a slow growing upper abdominal mass for 3 years. The abdominal CT scan showed a 12 cm-sized cystic mass with a solid portion, and this was accompanied with intrahepatic bile duct dilatation. Abdominal exploration revealed a yellowish, cystic, encapsulated mass attached to the inferior vena cava, portal vein, the common bile duct and the liver. There has been no evidence of recurrence during 36 months of follow-up.
Bile Ducts, Intrahepatic ; Common Bile Duct ; Dilatation ; Female ; Follow-Up Studies ; Head ; Humans ; Liver ; Lower Extremity ; Middle Aged ; Neck ; Neurilemmoma ; Peripheral Nerves ; Portal Vein ; Recurrence ; Vena Cava, Inferior

Situs inversus refers to a mirror image of the viscera, while situs solitus is defined as the normal anatomical situation. Several cases of successful liver transplantation for situs inversus recipients have been reported, and modifications of the standard surgical techniques were used. We report here on a case of cadaveric liver transplantation in an end-stage liver disease patient with situs inversus. The donor liver was rotated clockwise 90 degrees to the left with the right lobe lying in the left upper quadrant and the left lobe pointing down into the left iliac fossa. The donor's suprahepatic vena cava was oversewn and the infrahepatic vena cava anastomosed end to side to the recipient's inferior vena cava. The postoperative course was good until the postoperative 26th day, when rupture of a hepatic artery pseudoaneurysm occurred. An emergency laparotomy was done and the hepatic artery was ligated. Despite the hepatic artery ligation, the liver function recovered quite well. But sudden intracranial hemorrhage developed on the postoperative 28th day and sadly, the patient expired on the postoperative 30th day. Complete preoperative evaluation of the recipient is essential for the operative planning, and careful donor selection should be attempted to obtain a smaller graft to allow maximum flexibility for placing the donor liver. The use of a reduced-sized graft should be considered in the case for which a smaller graft is not available. In conclusion, adult situs inversus is no longer a contraindication for a liver transplant, although technical difficulties do exist for this procedure.
Adult ; Aneurysm, False ; Cadaver ; Deception ; Donor Selection ; Emergencies ; Hepatic Artery ; Humans ; Intracranial Hemorrhages ; Laparotomy ; Ligation ; Liver Diseases ; Liver Transplantation* ; Liver* ; Pliability ; Rupture ; Situs Inversus* ; Tissue Donors ; Transplants ; Vena Cava, Inferior ; Viscera

PURPOSE: Fournier's gangrene is a rapidly progressive (and aggressive), necrotizing fasciitis of the genitalia and perineum. Despite the use of broad spectrum antibiotics and surgical debridement, morbidity and mortality remain significant. The purpose of this study is to investigate and evaluate the clinical and laboratory characteristics of this disease. METHODS: We reviewed 17 cases of Fournier's gangrene during 10 years from January, 1990 to December, 1999. We retrospectively analyzed these patients and considered several factors, which were age, sex, combined and etiologic factors, symptom and location of infection, duration of admission, operation and its complication, result of bacterial culture and sensitivity of antibiotics, morbidity and mortality. RESULTS: the mean age was 47.4 years with an age range of 3 to 77. The etiologies included unknown (65.7%), anorectal infection (23.5%) and hemorrhoidectomy (11.8%). The combined diseases (predisposing factors) included diabetes mellitus (52.9%), alcohol abuse, steroids or chemotherapy, liver cirrhosis and malignancy. Aggressive surgical debridement with broad spectrum antibiotics therapy was done on 16 patients, 1 patient refused operation. There were 3 colostomy cases, one orchiectomy, one suprapubic cystostomy case. The most common cultured organism was E.coli, 8 cases (53.3%). The mean hospital stay was 32.9 days. 3 patients (17.6%) were died due to sepsis and multiorgan failure. CONCLUSIONS: Our results showed that the early recognition, aggressive debridement of devitalized tissue, antibiotic therapy, search for primary source are considered as the treatment of choice for Fournier's gangrene.
Alcoholism ; Anti-Bacterial Agents ; Colostomy ; Cystostomy ; Debridement ; Diabetes Mellitus ; Drug Therapy ; Fasciitis, Necrotizing ; Fournier Gangrene* ; Genitalia ; Hemorrhoidectomy ; Humans ; Length of Stay ; Liver Cirrhosis ; Mortality ; Orchiectomy ; Perineum ; Retrospective Studies ; Sepsis ; Steroids

Actinomycosis still poses a problem for correct clinical and radiologic diagnosis. We retrospectively analyzed CT findings in 7 patients with pathologically proven abdominal actinomycosis. Involved areas were the pelvis (n=3), greater omentum (n=2), liver (n=1), and kidney (n=1). CT confirmed the infiltrative nature of the disease with a tendency to invade across tissue plane and boundary. Five of seven cases were predominantly solid mass (pseudotumor) with focal low-attenuation areas while two were predominantly cystic mass with thickened wall. Contrast-enhanced CT showed dense, inhomogeneous contrast enhancement in the wall and/ or solid components of the masses in five. Minimal lymphadenopathy was noted in one case. CT is useful in demonstrating the extent and characteristics of this disease. Despite nonspecific findings, actinomycosis should be included in the differential consideration when CT shows an infiltrative mass with unusual aggressiveness and dense inhomogeneous contrast enhancement in patients with fever, leukocytosis, or long-term use of intrauterine contraceptive devices.
Actinomycosis* ; Diagnosis ; Fever ; Humans ; Intrauterine Devices ; Kidney ; Leukocytosis ; Liver ; Lymphatic Diseases ; Omentum ; Pelvis ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: Aminoglycoside antibiotics are widely used for the treatment of infection caused by Gram-negative bacilli, but prolonged exposure to it can cause permanent hearing loss since are reported to interrupt the function of medial olivocochlear bundle. This study was designed to explore the effects of several aminoglycoside antibiotics on acetylcholine, the neurotransmitter of medial olivocochlear bundle, and how it affects potassium currents of the guinea pig outer hair cells. MATERIALS AND METHOD: Using extracted outer hair cells from Guinea pigs, potassium currents induced by acetylcholine were recorded using the whole-cell patch clamp technique. The effects of different aminoglycoside antibiotics on the potassium current were also studied. RESULTS: Acetylcholine increased the potassium currents of outer hair cells. All of aminoglycoside antibiotics tested such as neomycin, streptomycin, gentamicin, and amikacin decreased the acetylcholine-induced potassium current. CONCLUSION: These experimental results suggest that aminoglycoside antibiotics have effects on the membrane potential of outer hair cells regulated by acetylcholine, which is thought to be one of the mechanisms of aminoglycoside ototoxicity.
Acetylcholine ; Amikacin ; Aminoglycosides ; Animals ; Anti-Bacterial Agents* ; Gentamicins ; Guinea Pigs ; Hair* ; Hearing Loss ; Membrane Potentials ; Neomycin ; Neurotransmitter Agents ; Potassium* ; Streptomycin

BACKGROUND AND OBJECTIVES: Various surgical techniques have been tried to relieve nasal obstruction in patients who have hypertrophic inferior turbinate. Recently, coblators and microdebriders are the favored surgical procedure. This study is aimed at evaluating the long term efficacy of posterior resection of inferior turbinate performed on patients for whom the previous inferior turbinate surgery had not relieved the symptoms of nasal obstruction. SUBJECTS AND METHOD: We selected 27 patients who have had previous inferior turbinate surgery, but were not relieved of the symptom for nasal obstruction. Under local or general anesthesia, hypertrophied posterior part of inferior turbinate was removed. The symptom changes of nasal obstruction and patients satisfaction were checked pre and postoperatively at 1, 2, 3, 6, 12 month by Visual Analogue Scale (VAS) score. The minimal cross-sectional area of second notch and volume of nasal cavity were measured at 1, 2, 3, 6, 12 month after operation. RESULTS: There were significant improvement in the VAS score of nasal obstruction and patient satisfaction after the operation. The minimal cross-sectional area of second notch did not change significantly after surgery, but the nasal cavity volume was significantly improved after surgery. CONCLUSION: This study suggests that posterior resection of inferior turbinate is an effective surgical procedure for patients who have hypertrophic inferior turbinate especially on the posterior part.
Anesthesia, General ; Humans ; Nasal Cavity ; Nasal Obstruction* ; Nasal Surgical Procedures ; Patient Satisfaction ; Rhinitis ; Turbinates*

BACKGROUND AND OBJECTIVES: The study aimed to evaluate the long term efficacy of micro-debrider assisted inferior turbinoplasty (MAIT) compared to coblation assisted inferior turbinoplasty (CAIT) for hypertrophic inferior turbinates. SUBJECTS AND METHOD: From January 2008 to December 2008 inclusively, 96 patients with persistent hypertrophic inferior turbinates mucosa refractory to medical therapy were enrolled into this study. All patients were suffering from nasal obstruction and related symptoms. Overall, 56 patients were treated with microdebrider assisted inferior turbinoplasty (MAIT group) and 40 patients were treated with coblation assisted inferior turbinoplasty (CAIT group). Postoperative changes in degree of nasal obstruction, sneezing, rhinorrhea, minimal cross sectional area (MCA), and nasal volume from the nostril to 7 cm posteriorly (V7), operation time, duration of crust formation, intraoperative bleeding and delayed bleeding were compared between the two surgical methods prospectively in the 1st and 6 months, and in the 1st and 2nd years after the procedure. Also patient's satisfaction with procedure was evaluated. RESULTS: The nasal obstruction and related nasal symptoms improved significantly in MAIT group and persisted within the periods of 2 years after surgery, while in CAIT group the significant improvements took place in the 1st and 6th months after surgery but no significant improvements from 1 to 2 years after were noted. Nasal patency (MCA and V7) also showed more improvement and persistence in MAIT group than CAIT group. There were no significant differences in operation time and intraoperative bleeding and delayed bleeding but the duration of crust formation was significantly shorter in MAIT group. And patient satisfaction in the MAIT group was higher than that in the CAIT group. CONCLUSION: From the analysis of this study, it can be said that MAIT is more effective and satisfactory for the long term relief of nasal obstruction, related nasal symptoms and reduction of hypertrophic inferior turbinate mucosa than CAIT.
Hemorrhage ; Humans ; Hypogonadism ; Mitochondrial Diseases ; Mucous Membrane ; Nasal Obstruction ; Ophthalmoplegia ; Patient Satisfaction ; Prospective Studies ; Sneezing ; Stress, Psychological ; Turbinates

BACKGROUND: Tuberculosis is more prevalent in dialysis patients than in the general population, and more difficult to make a diagnosis, and often leads to death, Moreover, extra-caution is needed in prescribing anti-tuberculosis medications as dose modification is frequently needed in patients with renal insufficiency. Several pharmacokinetic studies have been performed for antimycobacterial regimens in patients with renal insufficiency, including under hemodialysis. However, the anti-mycobacterial regimens of patients on peritoneal dialysis have been made based on empirical methods because of few pharmacokinetic studies. METHODS: To elucidate the pharmacokinetic profiles of anti-mycobacterial regimens for peritoneal dialysis, we measured both plasma and peritosol concentrations of anti- tuberculous drugs including isoniazide, rifampin and pyrazinamide in 9 patients maintained on chronic ambulatory peritoneal dialysis(CAPD). RESULTS: After a conventional oral dose of anti-tuberculosis medication, their plasma concentrations were in the therapeutic range, but the peritosol concentration of rifampin was below the therapeutic range. CONCLUSION: No dose adjustments are required for isoniazid, rifampin and pyrazinamide for the treatment of systemic or peritoneal tuberculosis in CAPD patients. On the contrary, oral rifampin is not expected to be effective in the treatment of tuberculous peritonitis, because of its low peritosol concentration.
Diagnosis ; Dialysis ; Humans ; Isoniazid ; Peritoneal Dialysis* ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis, Tuberculous ; Pharmacokinetics* ; Plasma ; Pyrazinamide ; Renal Dialysis ; Renal Insufficiency ; Rifampin ; Tuberculosis

BACKGROUND: An antioxidant, probucol, prevents endothelial dysfunction and low density lipoprotein oxidation and also inhibits the secretion of interleukin-1 by macrophages. These effects of probucol may result in decreased production of matrix metalloproteinases by smooth muscle cells and thus modify remodeling of the extracellular matrix. METHODS AND MATERIALS: We analyzed clinical events at 1 month and 6 months in 337 patients with 363 coronary arterial lesions after coronary stenting at Chonnam National University Hospital between January 1998 and May 1999. The patients were assigned to following four modalities: 500 mg of tilcipidine daily (Group I), 200 mg of cilostazol daily (Group II), 500 mg of probucol in addition to 500 mg of ticlipidine daily (Group III), and 500 mg of probucol in addition to 200 mg of cilostazol daily (Group IV). All patients received aspirin. RESULTS: Group I comprised of 149 (104 M, 45 F, 62+/-10 years), Group II 96 (73 M, 23 F, 60+/-10 years), Group III 50 (32 M, 18 F, 61+/-10 years), and Group IV 42 (32 M, 10 F, 62+/-10 years) patients. Clinical diagnosis was not different among four groups. Major adverse cardiac events, including myocardial infarction, cardiac death, and repeated intervention, at 1 month were 7 (4.7%) in Group I, 2 (2.1%) in Group II, 0 (0%) in Group III, 2 patients (4.8%) in Group IV, and those at 6 months were 29 (19.5%) in Group I, 17 (17.7%) in Group II, 9 (18.0%) in Group III, and 6 patients (14.3%) in Group IV. CONCLUSIONS: Probucol combined with aspirin and cilostazol has a tendency reducing the major cardiac events compared with aspirin and ticlopidine or cilostazol after stenting.
Aspirin ; Death ; Diagnosis ; Extracellular Matrix ; Humans ; Interleukin-1 ; Jeollanam-do ; Lipoproteins ; Macrophages ; Matrix Metalloproteinases ; Myocardial Infarction ; Myocytes, Smooth Muscle ; Probucol* ; Stents* ; Ticlopidine

Background/Aims: The protective effects of vitamin D and calcium on colorectal neoplasms are known. Bone mineral density (BMD) may be a reliable biomarker that reflects the long-term anticancer effect of vitamin D and calcium. This study aimed to evaluate the association between BMD and colorectal adenomas including high-risk adenoma. Methods: A multicenter, cross-sectional, case-control study was conducted among participants with average risk of colorectal cancer who underwent BMD and screening colonoscopy between 2015 and 2019. The main outcome was the detection of colorectal neoplasms. The variable under consideration was low BMD (osteopenia/osteoporosis). The logistic regression model included baseline demographics, components of metabolic syndrome, fatty liver disease status, and aspirin and multivitamin use. Results: A total of 2,109 subjects were enrolled. The mean age was 52.1±10.8 years and 42.6% were male. The adenoma detection rate was 43%. Colorectal adenoma and high-risk adenoma were both more prevalent in subjects with low BMD than those with normal BMD (48.2% vs 38.8% and 12.1% vs 9.1%). In the univariate analysis, old age, male sex, smoking, metabolic components, fatty liver, and osteoporosis were significantly associated with the risk of adenoma and high-risk adenoma. In the multivariate analysis, osteoporosis was independently associated with risk of colorectal adenoma (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.11 to 2.46; p=0.014) and high-risk adenoma (OR, 1.94; 95% CI, 1.14 to 3.29; p=0.014). Conclusions Osteoporosis is an independent risk factor of colorectal adenoma and high-risk adenoma