Malignant melanoma of the anorectal region is rare and carries a poor prognosis. The clinical features of pain, bleeding or an external mass are similar to those encountered in many other disorders of the anal canal. We reports a case of anorectal malignant melanoma with regional lymph node involvement who was treated with abdominoperineal resection. Early diagnosis and accurate evaluation is important, as the prognosis was related to tumor size & the thickness. Abdominoperineal resection should be considered in patient without advanced disease.
Anal Canal ; Early Diagnosis ; Hemorrhage ; Humans ; Lymph Nodes ; Melanoma* ; Prognosis

The laparoscopic cholecystectomy is now a standard part of general surgical practice. Conversion from a laparoscopic cholecystectomy to an open cholecystectomy is sometimes required. To identify the factors predisposing to conversion, we retrospectively reviewed all patients undergoing a laparoscopic cholecystectomy from December 1991 to June 1996 at Chosun University Hospital. Factors evaluated were age, sex, history of acute cholecystitis, previous abdominal surgery, associated disease, laboratory findings, and thickened gallbladder wall identified by preoperative ultrasound. Conversion to an open cholecystectomy was required in 42(9.0%) of the 465 patients. The most common reason for conversion was the inability to define the anatomy secondary to inflammation or adhesions. Significant predictors of conversion to an open cholecystectomy were increasing age (age over 60 years), presense of associated disease, a thickened gallbladder wall found by preoperative ultrasound, acute cholecystitis, and increased alkaline phosphatase level. Multivariate analysis found a patients age of over 60 years to be an independent predictor of conversion to an open cholecystectomy. An appreciation for these predictors of conversion will allow appropriate planning by the patients, the institution, and the surgeons. Although data are lacking, increasing experience with laparoscopic cholecystectomy has likely resulted in earlier recognition of the need for conversion to an open cholecystectomy with a resultant decrease in morbidity.
Alkaline Phosphatase ; Cholecystectomy* ; Cholecystectomy, Laparoscopic ; Cholecystitis, Acute ; Gallbladder ; Humans ; Inflammation ; Multivariate Analysis ; Retrospective Studies ; Ultrasonography

The habituation of early (R1) and late response (R2) of blink reflex was investigated in 44 patients with Parkinson's disease (PD) and 19 control subjects. The latency, duration and area of R1 and R2 components of blink reflex in single stimulation, and the percentage recovery of R1 in paired stimulation were not different between patients and control subjects. However, in PD patients, the latency of R2 evoked by test stimuli was shorter than that of conditioning stimuli, and the percentage recovery of R2 habituation was increased as compared to that of control subjects. The degree of early recovery of R2 habituation was slightly more evident in advanced PD patients and nonmedicated patients than that of control subjects. In addition, the early recovery of R2 was present in the test of asymptomatic side of PD patients. Our results suggests that blink reflex may be used as a method of evaluating the clinical status of PD patients.
Blinking* ; Humans ; Parkinson Disease*

Pheochromocytomas are catecholamine-producing tumors that typically cause hypertension. They are rare tumors that can pose problems in diagnosis and detection. Although they usually present classic symptoms, they can at times present symptoms that mimic other clinical conditions. Especially, children have fewer malignant tumors, non-extra-adrenal tumors, and tumors with greater bilaterality and multiplicity. The diagnosis of pheochromocytomas is based upon clinical suspicion and biochemical study. Radiologic localization is obtained before operation because of the variable location of this tumor. The treatment of choice is surgical resection. We reports a case of asymptomatic pheochromocytoma that was treated with tumor excision. To prevent intraoperative and postoperative complications, precise preoperative diagnosis and localization, as well as adequate preoperative management, are necessary.
Child ; Diagnosis ; Humans ; Hypertension ; Pheochromocytoma* ; Postoperative Complications

BACKGROUND/AIMS: Lamivudine is highly effective in suppressing hepatitis B virus replication and hepatitis B induced necroinflammatory activity. The objective of this study was to evaluate the virological and biochemical responses to lamivudine by patients with HBV associated chronic liver disease. In particular we stressed the importance of lamivudine therapy by patients with decompensated liver cirrhosis. METHODS: We conducted a one-year trial of lamivudine in 80 patients with HBV associated chronic liver disease (chronic hepatitis 44, cirrhosis 36). We classified these patients according to the severity of hepatic dysfunction as chronic B hepatitis (Group A) or liver cirrhosis (Group B). These patients were treated for 12 months with 100 mg daily doses of lamivudine. RESULTS: The seroconversion rate of HBeAg was 23.5% in group A patients and 26.7% in group B patients. The negative conversion of HBV-DNA was sustained for one year in 79.5% of patients in group A and 86.1% in group B. The normalization rates of serum ALT were 90.9% in group A and 88.9% in group B patients. No serious side effect after discontinuance of the treatment was found. There were 12 ALT breakthrough cases and all of them showed mutation of YMDD motif. However, they did not deteriorate clinically in spite of ALT elevation and HBV-DNA reappearance. The Child-Pugh scores improved even in patients with decompensated liver cirrhosis. CONCLUSION: One-year lamivudine treatment resulted in excellent virological and biochemical improvements and was well tolerated in the patients with HBV associated chronic liver disease, even in decompensated cirrhosis. We conclude that lamivudine is relatively safe in chronic hepatitis B and liver cirrhosis treatment.
Fibrosis ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis* ; Humans ; Lamivudine* ; Liver Cirrhosis* ; Liver Diseases ; Liver*

BACKGROUND: Today, blood group antigens are a strong barrier of safe transfusion. We evaluated the change of agglutinability of antibody to RBC surface antigen before and after activated methoxy polyethylene glycol (mPEG) modification. METHODS: We collected blood from healthy volunteers and the blood were treated by activated mPEG (MW 5,000, Sigma, USA). Agglutinability of RBC was measured using anti-sera (Green Cross, Korea) in ABO and Rh(D) groups, and compared the agglutinability changes before and after mPEG treatment. RESULTS: The agglutinability of Rh(D) surface antigen (n=20) was disappeared after mPEG treatment. However, ABO antigens showed variable agglutinability against antisera, some of which showed no change at all. CONCLUSIONS: In the case of Rh(D) antigen, it would be useful to apply mPEG treated RBCs for clinical use, if the safety problem were solved. But in the case of ABO antigen, the more evaluation of the condition of reaction and the concentration of mPEG should be needed.
Antigens, Surface* ; Blood Group Antigens ; Blood Substitutes ; Healthy Volunteers ; Immune Sera ; Polyethylene Glycols* ; Polyethylene*

BACKGROUND: Tetanus toxin selectively blocks inhibitory synapses in the brainstem as well as the spinal cord. Therefore, in contradiction to Stiff Person syndrome, patients with generalized tetanus usually show abnormal masseter silent periods as well as abnormal F/M amplitude or H/M amplitude ratios. This study aimed to verify the characteristics of electrophysiological findings of generalized tetanus. METHODS: The authors retrospectively studied clinical and electrophysiological characteristics of 7 patients with generalized tetanus, who were admitted to the neurology department of Hallym Medical Center from 1995 to 2005. RESULTS: All the seven patients showed abnormal masseter silent periods. Three of them showed somewhat improvement in the silent period at follow-up study as trismus was improving. Full NCSs done in two patients did not show any abnormalities except an increased F/M amplitude ratio. One patient with a wound site in his left finger showed an abnormal F/M amplitude ratio only in the right upper extremity without involvement of other extremities. Another patient showed an increased H/M amplitude ratio without an increased F/M amplitude ratio. (In this patient we did not conduct full NCS tests.) CONCLUSIONS: The Masseter silent period could be used as a diagnostic tool and parameter of clinical improvement in patients with generalized tetanus.
Brain Stem ; Extremities ; Fingers ; Follow-Up Studies ; H-Reflex ; Humans ; Neurology ; Retrospective Studies ; Spinal Cord ; Stiff-Person Syndrome ; Synapses ; Tetanus Toxin ; Tetanus* ; Trismus ; Upper Extremity ; Wounds and Injuries

BACKGROUND: Helicobacter pylori colonizes the gastric surface epithelium and the mucus gel layer. It has been known that H. pylori infection decreased the gastric mucin expression. The aim of this study was to determine the effect of H. pylori eradication on mucin expression (MUC5AC, MUC6 and MUC1) in the gastric epithelium. METHODS: This study included 20 patients positive for H. pylori whom successful eradication was performed between March 1998 and December 1999. H. pylori status was determined by histology, rapid urase test and urea breath test. Gastric antral biopsy specimens were examined by immunohistochemistry for mucin (MUC5AC, MUC6 and MUC1) expression. The distribution of epithelial cells expressing MUC5AC was calculated at two sites (surface mucous cells, pyloric glands). Two scores system (weak-strong) was used to assess staining intensity. RESULTS: There was a gradient of MUC5AC expression, higher to lower from the surface to the glands. Increased MUC5AC expression in the surface mucous cell (p=0.013) and in the glands (p=0.008) was found after H. pylori eradication. MUC6 and MUC1 distribution was not changed after H. pylori eradication. CONCLUSION: MUC5AC expression was increased after H. pylori eradication. These results suggest that MUC5AC may relate in the pathogenesis of H. pylori.
Biopsy ; Breath Tests ; Colon ; Epithelial Cells ; Epithelium ; Gastric Mucins ; Helicobacter pylori* ; Helicobacter* ; Humans ; Immunohistochemistry ; Mucins* ; Mucus ; Urea

A 25-year-old male presented with mitral insufficiency, perimembranous type of ventricular septal defect, pulmonary edema and renal insufficiency. The initial serum creatinine level was 16.2mg/dl. Blood cultures were positive for Streptococcus viridans and appropriate antibiotic therapy was initiated. Renal biopsy revealed diffuse proliferative glomerulonephritis with crescents involving all of the glomeruli. Even after adequate duration of treatment with antibiotics, surgical therapy, and high dose steroid therapy, renal function did not recover and the patient ended up with continuous ambulatory peritoneal dialysis. We present a case of crescentic glomerulonephritis associated with bacterial endocarditis with a review of the literature.
Adult ; Anti-Bacterial Agents ; Biopsy ; Creatinine ; Endocarditis, Bacterial* ; Glomerulonephritis* ; Heart Septal Defects, Ventricular ; Humans ; Male ; Mitral Valve Insufficiency ; Peritoneal Dialysis, Continuous Ambulatory ; Pulmonary Edema ; Renal Insufficiency ; Viridans Streptococci

PURPOSE: The present study aimed to investigate the impact of high-sensitivity C-reactive protein (hs-CRP) and renal dysfunction on clinical outcomes in acute myocardial infarction (AMI) patients. MATERIALS AND METHODS: The study involved a retrospective cohort of 8332 patients admitted with AMI. The participants were divided into 4 groups according to the levels of estimated glomerular filtration rate (eGFR) and hs-CRP: group I, no renal dysfunction (eGFR > or =60 mL.min(-1).1.73 m(-2)) with low hs-CRP (< or =2.0 mg/dL); group II, no renal dysfunction with high hs-CRP; group III, renal dysfunction with low hs-CRP; and group IV, renal dysfunction with high hs-CRP. We compared major adverse cardiac events (MACE) over a 1-year follow-up period. RESULTS: The 4 groups demonstrated a graded association with increased MACE rates (group I, 8.8%; group II, 13.8%; group III, 18.6%; group IV, 30.1%; p<0.001). In a Cox proportional hazards model, mortality at 12 months increased in groups II, III, and IV compared with group I [hazard ratio (HR) 2.038, 95% confidence interval (CI) 1.450-2.863, p<0.001; HR 3.003, 95% CI 2.269-3.974, p<0.001; HR 5.087, 95% CI 3.755-6.891, p<0.001]. CONCLUSION: High hs-CRP, especially in association with renal dysfunction, is related to the occurrence of composite MACE, and indicates poor prognosis in AMI patients.
Aged ; C-Reactive Protein/*metabolism ; Coronary Angiography ; Female ; Humans ; Kidney/*physiopathology ; Male ; Middle Aged ; Myocardial Infarction/*metabolism/*radiography ; Retrospective Studies