Elevation of aspartate aminotransferase (AST), alanine aminotransferase(ALT),and bilirubin levels was noted incidentally in patients who received laparoscopic cholecystectomy(LC). This study was attempted to investigate the elevation of liver enzymes and bilirubin levels after LC and its clinical significance. Twenty patients who showed normal levels of preoperative liver function test were entered into this study, and blood was collected at 24hours, 72hours and 7days after operation for measurement of AST, ALT, alkaline phosphatase(ALP), and bilirubin levels. In AST, a mean 2.76-fold postoperative increase was observed in 18 patients(90%) and 12 patients(60%) showed an elevation rise above normal limits. In ALT, a mean 2.14-fold postoperative increase was observed in 16 patients(80%) and 10 patients(50%) showed an elevation rise above normal limits. A mean 1.42-fold and a mean 2.12-fold increase were observed in total and direct bilirubin level respectively and elevation above normal limits occured in 7 patients(35%) and 4 patients (20%) respectively. The patients with an elevation of AST, ALT and bilirubin levels did not show any related clinical problem, and the elevations were transitory and returned to normal value within several days without any specific treatment.. Although the exact causes of these elevations need further investigation, theys appear to have no obvious clinical significance.
Alanine ; Aspartate Aminotransferases ; Bilirubin* ; Cholecystectomy, Laparoscopic* ; Humans ; Liver Function Tests ; Liver* ; Reference Values

Liposarcoma is one of the most common soft tissue sarcomas in adults and its incidence rate is above 10% of all soft tissue sarcoma. The two common sites of liposarcoma are the extremities, particularly the thigh, and the retroperitoneum, but it developes rarely in spermatic cord, testis, chest wall and breast, mediastinum, omentum and mesentery. Primary solid tumors of omentum are exceedingly rare. Most of them are of mesenchymal origin and about one-half of them are malignant. Primary liposarcoma occurring in the omentum has been reported rarely, and especially round cell type liposarcoma, one of the histologic subtype of liposarcoma, has been known to be extremely rare. Recently, we experienced a patient with round cell liposarcoma arising primarily in the omentum. Herein, we report the clinical case with a consideration of the cytopathologic and ultrastructural features and a review of the literature.
Adult ; Breast ; Extremities ; Humans ; Incidence ; Liposarcoma* ; Mediastinum ; Mesentery ; Omentum* ; Sarcoma ; Spermatic Cord ; Testis ; Thigh ; Thoracic Wall

BACKGROUND: The dominant innervation of airway smooth muscle is parasympathetic fibers which are carried in the vagus nerve. Activation of these cholinergic nerves releases acetylcholine which binds to M3 muscarinic receptors on the smooth muscle causing bronchocontraction. Acetylcholine also feeds back onto neuronal M2 muscarinic receptors located on the postganglionic cholinergic nerves. Stimulation of these receptors further inhibits acetylcholine release, so these M2 muscarinic receptors act as autoreceptors. Loss of function of these M2 receptors, as it occres in animal models of hyperresponsiveness, leads to an increase in vagally mediated hyperresponsiveness. However, there are limited data pertaining to whether there are dysfunctions of these receptors in patients with asthma. The aim of this study is to determine whether there are dysfunction of M2 muscarinic receptors in asthmatic patients and difference of function of these receptors according to severity of asthma. METHODS: We studied twenty-seven patients with asthma who were registered at Pulmonology Division of Korea University Hospital. They all met asthma criteria of ATS. Of these patients, eleven patients were categorized as having mild asthma, eight patients moderate asthma and eight patients severe asthma according to severity by NAEPP Expert Panel Report 2(1997). All subjects were free of recent upper respiratory tract infection within 2 weeks and showed positive methacholine challenge test(PC 20<16mg/ml). Methacholine provocation tests performed twice on separate days allowing for an interval of one week. In the second test, pre-treatment with the M2 muscarinic receptor agonist pilocarpine(180µg) through inhalation was performed before the routine procedures. RESULTS: Eleven subjects with mild asthma and eight aubjects with moderate asthma showed significant increase of PC20 from 5.30±5.23mg/ml(mean±SD) to 20.82±22.56mg/ml(p=0.004) and from 2.79±1.5mg/ml to 4.67±3.53mg/ml(p=0.012) after pilocarpine inhalation, respectively. However, in the eight subjects with severe asthma significant increase of PC20 from 1.76±1.50mg/ml to 3.18±4.03mg/ml(p=0.161) after pilocarpine inhalation was not found. CONCLUSION: In subjects with mild and moderate asthma, function of M2 muscarinic receptors was normal, but there was a dysfunction of these receptors in subjects with severe asthma. These results suggest that function of M2 muscarinic receptors is different according to severity of asthma.
Acetylcholine ; Asthma ; Autoreceptors ; Humans ; Inhalation ; Korea ; Methacholine Chloride ; Models, Animal ; Muscle, Smooth ; Neurons* ; Pilocarpine ; Pulmonary Medicine ; Receptors, Muscarinic* ; Respiratory Tract Infections ; Vagus Nerve

A 62 year old female patient was transferred to the operating room for open reduction and internal fixation of the left femur fracture under general anesthesia. At 15min. after femur tourniquet application, there were suddenly decreased oxygen saturation, end-tidal CO2 concentration and blood pressure. We suspected a pulmonary embolism, and attempted vigorous emergency treatment and intensive care including ventilator care, vasopressor drug use, pulmonary artery pressure monitoring. At the 5th day after intensive care unit, she was transferred to general ward and she discharged without any sequelae after 17th day postoperatively.
Anesthesia, General ; Blood Pressure ; Embolism ; Emergency Treatment ; Female ; Femur ; Humans ; Critical Care ; Intensive Care Units ; Middle Aged ; Operating Rooms ; Oxygen ; Patients' Rooms ; Pulmonary Artery ; Pulmonary Embolism* ; Tourniquets ; Ventilators, Mechanical

BACKGROUND: The changes of cerebral hemodynamics during syncope have not been fully evaluated. We investigated the changes in the cerebral blood flow velocity during head-up tilt test (HUT) using transcranial Doppler ultrasonogra-phy (TCD) in patients with neurocardiogenic syncope or presyncope. METHODS: Thirty-three patients with a history of recurrent syncope or presyncope of unknown origin were evaluated using HUT for 30 minutes (baseline tilt test), fol-lowed by an infusion of intravenous isoproterenol if needed. Systolic (SV) and diastolic velocities (DV) of middle cere-bral artery were continuously monitored by TCD. Positive responses were defined as presyncope or syncope with hypotension, bradycardia, or both. RESULTS: Five patients had positive responses during baseline tilt and 14 patients dur-ing the isoproterenol infusion. During the baseline tilt test, there was a 86 +/- 23% drop in DV and a 41 +/- 34% drop in SV in patients with positive responses, and mean changes in those were less than 10% in patients with negative responses (p=.00, p=.00). During the HUT with an isoproterenol infusion, the TCD showed an 80 +/- 18% drop in diastolic velocity in patients with positive responses, and a 47 +/- 10% drop in patients with negative responses (p=.00), However, the change in systolic velocity did not differ. TCD showed three patterns during positive responses: loss of all flow, loss of end-diastolic flow, and a decrease in diastolic velocity. Loss of consciousness occurred in patients with loss of all flow or end-diastolic flow during positive responses. CONCLUSIONS: TCD shows different patterns of changes in cerebral hemody-namics during HUT. TCD can be used to investigate the pathophysiology of neurocardiogenic syncope.
Arteries ; Blood Flow Velocity ; Bradycardia ; Hemodynamics ; Humans ; Hypotension ; Isoproterenol ; Syncope* ; Syncope, Vasovagal ; Ultrasonography, Doppler, Transcranial ; Unconsciousness

Primary lymphoma of the spleen is a relatively rare disease entity and is usually defined, although it is still controversial and hard to define, as the lymphoma which involved primarily the spleen and splenic hilar lymph nodes without involvement in any other site, particularly in the liver and in the mesenteric or para-aortic lymph nodes. In laparotomy of patients with non-Hodgkin's lymphoma, splenic involvements are found in 30 to 50% of patients as part of a diffuse pattern of the disease, but primary lymphoma of the spleen accounts for less than 1 % of all lymphoma cases. And it is often difficult to determine during laparotomy whether splenic involvement with lymphoma is primary or the result of a spread from another site. We herein report on a case of primary lymphoma of the spleen which was detected incidentally during evaluation of the cause of right upper quadrant abdominal pain. During the operation, a splenic tumor was found without the evidence of involvement in other sites, and it was confirmed pathologically to be a non-Hodgkin's lymphoma of the spleen. She lives well now without evidence of recurrence 14 months after the operation.
Abdominal Pain ; Humans ; Laparotomy ; Liver ; Lymph Nodes ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Rare Diseases ; Recurrence ; Spleen*

The effects of acidosis and alkalosis on vascular smooth muscle contractions were studied. Ring segments(3-4 mm in length) of rabbit abdominal aorta and pulmonary artery were mounted in the tissue bath(for respiratory study) and superfusion device(for metabolic study) for isometric tension recording. Respiratory acidosis and alkalosis were obtained by increasing and lowering the PCO2(80 and 15 mmHg, respectively). Metabolic acidosis and alkalosis were obtained by lowering and increasing the HCO3 concentration(12 and 50 mEq/l, respectively). After precontraction with norepinephrine(10-7 M), Vessels were exposed to acidosis and alkalosis for 30 minutes. The study was done with and without endothelium. The mechanism of vasorelaxation and vasoconstriction were confirmed with Ca2+ activated K+ channel blocker and Ca2+ free Krebs solution. The results were as follows: 1) Respiratory and metabolic acidosis induced significant vasorelaxation in both group of abdominal aorta and pulmonary artery(p<0.05). In endothelium intact group, vasorelaxation was greater than endothelium removed group. especially in respiratory acidosis was statistically significant(p<0.05). 2) Respiratory and metabolic alkalosis induced significant vasoconstriction in both group of abdominal aorta and pulmonary artery(p<0.05). In endothelium intact group, vasoconstriction was lesser than endothelium removed group, but was not statistically significant. 3) Acidosis induced vasorelaxation was blocked by tetraethylammonium(TEA). 4) Alkalosis induced vasoconstriction was blocked by Ca2+ free Krebs solution. These results suggested that: 1) Acidosis induced vasorelaxation. 2) alkalosis induced vasoconstriction 3) Vasorelaxation during acidosis was induced by K+ efflux through the Ca2+ activated K' channel. 4) Vasoconstriction during alkalosis was induced by Ca2+ influx.
Acid-Base Equilibrium* ; Acidosis ; Acidosis, Respiratory ; Alkalosis ; Aorta, Abdominal ; Endothelium ; Muscle, Smooth, Vascular ; Pulmonary Artery ; Vasoconstriction ; Vasodilation

Undifferentiated(embryonal) sarcoma of the liver developing predominantly in the late childhood is extremely rare in malignant hepatic tumors. It has been described by a variety of terms such as malignant mesenchymoma, embryonal sarcoma, fibromyxosarcoma, embryonal rhabdomyosarcoma or primary sarcoma of the liver. The tumor usually presents a huge mass containing solid and sometimes cystic components, and is cmposed of large stellate and spindle cells in an abundant myxoid matrix. The treatment of choice is surgical resection with or without adjuvant chemotherapy and/or radiotherapy, but the prognosis of this disease has been reported extremly poor. We experienced a case of undifferentiated(embryonal) sarcoma of the liver recently which was confirmed by pathological examinations in a 18-year-old boy. He visited our hospital for examination of the progressive growing RUQ abdominal mass detected incidentally. On physical examination, a firm, non-tender, hard, fixed, huge, abdominal mass was palpated in the right upper quadrant of abdomen. Abdominal ultrasonography, computerized tomography and magnetic resonance imaging showed a 10x15cm sized mass confined to the left lobe of the liver, and it was hypovascular mass on angiography. We performed left lobectomy including the tumor and it was confirmed as undifferentiated (embryonal) sarcoma of the liver by pathologic examination. We herein report this case including histologic, electronmicroscopic and flow cytometric results with the review of literatures.
Abdomen ; Adolescent ; Angiography ; Chemotherapy, Adjuvant ; Humans ; Liver* ; Magnetic Resonance Imaging ; Male ; Mesenchymoma ; Physical Examination ; Prognosis ; Radiotherapy ; Rhabdomyosarcoma, Embryonal ; Sarcoma* ; Ultrasonography

Coccidioidomycosis is a disease by airborne exposure of Coccidioides(C.) immitis, and endemic in the Southwest United States. Primary infection site is lung, and dissemination of the disease can occur depending on the host factors: race, immune status, pregnancy, etc. We report a Korean man with coccidioidomycosis disseminated to the skin, presenting the granulomatous papules on the face and trunk in addition to the pulmonary symptoms. Fungal spherules in the dermis were detected on the skin tissue section, and C. immitis were cultured from the skin tissue. The clinical symptoms were gradually improved with the systemic treatment of antifungal agents (amphotericin B and caspofungin). After more than 6 months of treatment, all of the pulmonary and cutaneous lesions were cleared, but fever persisted.
Antifungal Agents ; Coccidioidomycosis* ; Continental Population Groups ; Dermis ; Fever ; Humans ; Lung ; Pregnancy ; Skin ; United States

No abstract available.
Head* ; Killer Cells, Natural* ; Lymphocytes* ; Neck*