Pneumomediastinum, also referred to as mediastinal emphysema or Hamman's syndrome, is defined as the presence of air or gas within the fascial planes of the mediastinum. Superior extension of air into the cervicofacial subcutaneous space via communications between the mediastinum and cervical fascial planes or spaces occurs occasionally. Pneumomediastinum frequently results from blunt tracheobronchial lesions and esophageal injuries. However, in most cases, the origin of pneumomediastnum remains unclear. In some cases, it is attributed to the Macklin effect. We report a case of patient with pneumomediastinum, that presented with Mackin effect on chest computed tomographic scan.
Humans ; Mediastinal Emphysema* ; Mediastinum ; Thorax*

Primary intimal sarcoma of the pulmonary artery is a rare disease and there has been no report of any case originating from the pulmonary valve. Recently we experienced a 62 year-old female patient who had a primary intimal sarcoma of the pulmonary valve with distal metastasis. She was brought to medical attention due to exertional dyspnea facial edema productive coughing and general weakness for 1 month. Chest CT and echocardi-ography suggest an acute pulmonary thromboembolism or tumor. Exploration showed a large polypoid mass arising from the pulmonary leaflets and multiple masses on distal pulmonary arteries. We replaced the pulmonary valve and reconstructed the pulmonary artery. She received radiotherapy 1 month postoperatively and now 4 months after surgery she has begun receiving chemotherapy.
Cough ; Drug Therapy ; Dyspnea ; Edema ; Female ; Humans ; Middle Aged ; Neoplasm Metastasis ; Pulmonary Artery ; Pulmonary Embolism ; Pulmonary Valve* ; Radiotherapy ; Rare Diseases ; Sarcoma* ; Tomography, X-Ray Computed

No abstract available.
Histiocytoma, Benign Fibrous ; Parotid Gland

The Kawasaki disease has been reported worldwide since the first description in 1967 in Japan. Approximately 20% of the children with untreated Kawasaki disease are believed to develop coronary artery aneurysm of which 2-3% progress to coronary artery stenosis. The Kawasaki disease rarely affects adults and accordingly, there have been only a few cases reported in literatures. The present case describes a successful surgical treatment of a 43-year-old female patient with coronary artery aneurysm and stenosis, which resulted from an episode of the Kawasaki disease that occurred 20 years earlier. The patient was well at 5 months followup.
Adult* ; Aneurysm ; Child ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Disease* ; Coronary Stenosis ; Coronary Vessels ; Female ; Follow-Up Studies ; Humans ; Japan ; Mucocutaneous Lymph Node Syndrome*

A choriocarcinoma is a rapidly invasive, widely metastatic, human chorionic gonadotropin (HCG)-producing neoplasm, which are usually intrauterine and gestational. A primary gastric choriocarcinoma is very rare, and its pathogenesis is still uncertain. A 56-year old man presented with gastrointestinal bleeding and a gastric mass, clinically suspicious of a gastric adenocarcinoma. Thus, a radical subtotal gastrectomy and lymph node dissection, with a reconstruction, was performed. The resected specimen was found to be a Borrmann type I tumor, and a histological examination showed it to be a primary gastric choriocarcinoma, with an associated adenocarcinoma and a syncytiotrophoblast, which was immunostained by human chorionic gonadotropin (HCG). The serum HCG level, on the 7th postoperative day, was found to be 2, 775 mIU/ml. Chemotherapy was administered two months after surgery, as the patient refused chemotherapy during the immediate post operative period. At that time, the tumor rapidly recurred and disseminated to the liver. The patient died three months after the initial diagnosis.
Adenocarcinoma ; Choriocarcinoma* ; Chorionic Gonadotropin ; Diagnosis ; Drug Therapy ; Female ; Gastrectomy ; Hemorrhage ; Humans ; Liver ; Lymph Node Excision ; Pregnancy ; Trophoblasts

A choriocarcinoma is a rapidly invasive, widely metastatic, human chorionic gonadotropin (HCG)-producing neoplasm, which are usually intrauterine and gestational. A primary gastric choriocarcinoma is very rare, and its pathogenesis is still uncertain. A 56-year old man presented with gastrointestinal bleeding and a gastric mass, clinically suspicious of a gastric adenocarcinoma. Thus, a radical subtotal gastrectomy and lymph node dissection, with a reconstruction, was performed. The resected specimen was found to be a Borrmann type I tumor, and a histological examination showed it to be a primary gastric choriocarcinoma, with an associated adenocarcinoma and a syncytiotrophoblast, which was immunostained by human chorionic gonadotropin (HCG). The serum HCG level, on the 7th postoperative day, was found to be 2, 775 mIU/ml. Chemotherapy was administered two months after surgery, as the patient refused chemotherapy during the immediate post operative period. At that time, the tumor rapidly recurred and disseminated to the liver. The patient died three months after the initial diagnosis.
Adenocarcinoma ; Choriocarcinoma* ; Chorionic Gonadotropin ; Diagnosis ; Drug Therapy ; Female ; Gastrectomy ; Hemorrhage ; Humans ; Liver ; Lymph Node Excision ; Pregnancy ; Trophoblasts

The rupture of an acute dissection of the ascending aorta into the space surrounding the pulmonary artery is an uncommon occurrence. No previous cases of transient pulmonary hypertension caused by a hematoma surrounding the pulmonary artery have been documented in the literature. Herein, we report a case of acute aortic dissection presenting as secondary pulmonary hypertension.
Aortic Aneurysm/*complications/diagnosis ; Aortic Rupture/*complications/diagnosis ; Constriction, Pathologic ; Female ; Hematoma/*complications ; Human ; Hypertension, Pulmonary/*etiology ; Middle Aged ; Pulmonary Artery/pathology/radiography ; Tomography, X-Ray Computed

Diagnostic peritoneal lavage is a accurate and safe method confirming the intraabdominal injury with head trauma, unstable multiple injuried patients. But the development of imaging technique and the trend in noninvasive diagnostic value is decreasing now. In the emergency room, the emergency physicians are required the rapidity and accuracy' in intial assessment and the decisions for the operation or not. So emergency physicians have been investigating the diagnostic method for intraabdomial injury that is more rapid, safe and accurate. Many diagnostic tools are developed and now accepted and used widely, among them the diagnostic peritoneal lavage is still the best method for unsatble or head injuries patients. But the positive diagnostic criterias are variable by many authors and still remain imperfectly. So our study was reviewed by medical record of patients who were undertaken the diagnostic peritoneal lavage for the diagnosis intraabdominal injury and statistical analyasis was done compared with many criteria of red blood cell and white blood cell for the more actuate way. A retrospective study of diagnostic peritoneal lavage was done of 90 patients with blunt abdominal trauma during 2 years from January, 1996 to December, 1997 and summerized our experience. The results were as follows; 1) There are 73 males and 17 females in sex. The most common type of injury was the traffic accident. 2) With many variable criteria of RBC and WBC, the accuracy and the false positive and false negative were not different in statistical results. The average accuracy was 80.1%. 3) The operations were done in 30(33.3%) cases, and the most frequent injuried organ was the small bowel, 20 cases(66.7%).
Accidents, Traffic ; Craniocerebral Trauma ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Erythrocytes ; Female ; Humans ; Leukocytes ; Male ; Medical Records ; Peritoneal Lavage* ; Retrospective Studies

Chondroblastoma is an uncommon, benign, cartilaginous neoplasm originating in an epiphysis or apophysis of a long tubular bone. The rib is an unusual site for chondroblastoma. The authors describe a case of chondroblastoma of the rib and present a brief review of the literature.
Bone Neoplasms ; Chondroblastoma* ; Epiphyses ; Ribs*

Catastrophic antiphospholipid syndrome (CAPLS) was diagnosed in a 64-year-old male who was admitted to our hospital with dyspnea. The clinical and radiological examinations showed pulmonary thromboembolism, and so thromboembolectomy was performed. Abdominal distention rapidly developed several days later, and the abdominal computed tomography (CT) abdominal scan revealed thrombus within the superior mesenteric artery with small bowel and gall bladder distension. Cholecystectomy and jejunoileostomy were performed, and gall bladder necrosis and small bowel infarction were confirmed. The anticardiolipin antibody was positive. Anticoagulant agents and steroids were administered, but the patient expired 4 weeks after surgery due to acute respiratory distress syndrome (ARDS). We report here on a case of catastrophic APLS with manifestations of pulmonary thromboembolism, rapidly progressing GB necrosis and bowel infarction.
Antibodies, Anticardiolipin ; Anticoagulants ; Antiphospholipid Syndrome* ; Cholecystectomy ; Dyspnea ; Humans ; Infarction ; Male ; Mesenteric Artery, Superior ; Middle Aged ; Necrosis ; Pulmonary Embolism ; Respiratory Distress Syndrome, Adult ; Steroids ; Thrombosis ; Urinary Bladder