This is a clinical analysis of 48 patients who had tuberculous peritonitis laparoscopically confirmed at the Gastroenterologic Department of the Korea University Hae Wha Hospital from March 1980 to February 1988, and the results are as fallows: 1) The ratio of male to female was 1:1.7, and the age of the peak incidence was the third decade. 2) The freqeent symptoms were abdominal distension (77.1%), abdominal pain (60.4%), and fever (60.4%); others were indigestion (27.1%), diarrhea (18.8%), weight loss (6.3%), abdominal mass (6.3%), vomiting (6.3%), and dysmenorrhea (2.1%). The freguent physical signs were ascites (93.8%) and abdominal tenderness (45.8%); others were palpable mass (8.3%), hepatomegaly (8.3%), and mild jaundice (4,2%). 3) Hematologic findings in mean value revealed 11.8 g/m% in hemoglobin, 6088/mm in WBC, and 36 mm/hour in ESR, 4) Ascitic analysis revealed 1,031 in specific gravity, 5.2% in protein, and 1700/mm in WBC count with lymphocytic predominance (83%). AFB stain and culture were all negative in the specimens less than 20 ml. 5) On chest X-ray, pulmonary Tuberculosis or associated lesions were noted in 19 patients (39.6%). 6) Studded whitish miliary tubercle, omental change, ad adhesions were noted in a mixed nature. 7) Classifications according to laparoscopic finding revealed wet type in 28 patients (58.3%), mixed type in 13 patients (27.1%), and dry type in 7 patients (14.6%); and laparoscopic type was not related with the duration of symptom up to admission. 8) Microscopic finding of biopsy specimens revealed caseous necrosis or granuloma in 43 patient (89.6%) and nonspecific inflammation in 5 patients. In these 5 patients, characteristic gross findings of tuberculous peritionitis were noted. 9) Intestinal perforation was developed in 2 patients.
Abdominal Pain ; Ascites ; Biopsy ; Classification ; Diarrhea ; Dysmenorrhea ; Dyspepsia ; Female ; Fever ; Granuloma ; Hepatomegaly ; Humans ; Incidence ; Inflammation ; Intestinal Perforation ; Jaundice ; Korea ; Male ; Necrosis ; Peritonitis, Tuberculous* ; Specific Gravity ; Thorax ; Tuberculosis, Pulmonary ; Vomiting ; Weight Loss

Herein, we report a case of multiple myeloma with multiple plasmacytomas of thyroid, lung, lymph nodes and adrenal gland, who presented as upper airway and esophageal obstruction with vocal cord palsy. An 80-year-old women complained of dysphagia, hoarseness and anterior neck mass. Ultrasonography of the neck showed huge inhomogeneous solid mass involving left thyroid lobe and isthmus with several lymphadenopathy along the both upper deep cervical chain. Chest CT scanning revealed 4x3 cm sized, low density mass in posterobasal segment of the right lower lobe with both lower paratracheal lymphadenopathy, and abdominal CT scanning revealed 4.5x4.5 cm sized round low density mass in left adrenal gland. Serum and urine electrophoresis was normal and immunofixation of serum and urine was negative. Bone marrow smear and a bone scintigram revealed no abnormality, but iliac bone marrow biopsy revealed infiltration of abnormal plasma cells. Histologic and immunohistochemical examinations of the thyroid and lung mass revealed monoclonal proliferation of plasma cells of kappa light chain. After local irradiation of the neck with parenteral dexamethasone injection, anterior neck mass was much diminished in size, but 2 weeks later she had a pneumonia with fatal outcome.
Adrenal Glands ; Aged, 80 and over ; Biopsy ; Bone Marrow ; Deglutition Disorders ; Dexamethasone ; Electrophoresis ; Fatal Outcome ; Female ; Hoarseness ; Humans ; Lung ; Lymph Nodes ; Lymphatic Diseases ; Multiple Myeloma* ; Neck ; Plasma Cells ; Plasmacytoma* ; Pneumonia ; Thyroid Gland ; Tomography, X-Ray Computed ; Ultrasonography ; Vocal Cord Paralysis

Solitary osseous plasmacytoma accounts for 3-5% of plasma cell tumor and are assumed to have a fairly good prognosis, with long duration of relapse free survival after local irradiation. A 64 year old woman with a lytic lesion involving left iliac bone was diagnosed as a solitary plasmacytoma, with a negative work-up for coexisting plasma cell disorders. Three months after irradiation of 5,400 cGy, the patient was readmitted with hypercalcemia and mass in left forehead and left gingiva. New multiple osteolytic lesions were developed. A aspiration cytology of forehead mass and curetted specimen of right femur due to pathologic fracture revealed plasmacytoma. MRI of thoracolumbar spine revealed abnormal high signal intensity in the L2 body, T8 and T9 vertebrae. Serum protein electropheresis revealed monoclonal gammopathy of IgG-kappa type. This aggressive case of solitary plasmacytoma, evolving into multiple myeloma after brief duration of remission, is in sharp contrast with the natural course of a solitary plasmacytoma.
Female ; Femur ; Forehead ; Fractures, Spontaneous ; Gingiva ; Humans ; Hypercalcemia ; Magnetic Resonance Imaging ; Middle Aged ; Multiple Myeloma* ; Paraproteinemias ; Plasma Cells ; Plasmacytoma* ; Prognosis ; Radiotherapy ; Recurrence ; Spine

Herein we wish to report a case of pernicious anemia and myasthenia gravis occurred after treatment with removal of an invasive thymoma and irradiation. Nine years ago, the male patient was visited due to chest pain, and was found a mediastinal mass at his age of 55. He received open thoracotomy and was found stage III invasive thymoma which infiltrated phrenic nerve and pericardium. After removal of thymoma, he received 4,500cGy of radiation. Two years later, he complained of left eyelid drooping and diagnosed as myasthenia gravis with tensilon test. His myasthenic eye symptom was controled with Mestinon. After 9 years from thymectomy, he complained of dizziness and dyspnea on exertion. Bone marrow smear revealed megaloblastic anemia and serum vitamin B12 level was 42.24pg/ml. Gastric juice analysis revealed achlorhydria with positive anti-intrinsic factor antibody. 6 weeks after treatment with parenteral vitamin B12, hematologic findings were normalized.
Achlorhydria ; Anemia, Megaloblastic ; Anemia, Pernicious* ; Bone Marrow ; Chest Pain ; Dizziness ; Dyspnea ; Edrophonium ; Eyelids ; Gastric Juice ; Humans ; Male ; Myasthenia Gravis* ; Pericardium ; Phrenic Nerve ; Pyridostigmine Bromide ; Thoracotomy ; Thymectomy* ; Thymoma* ; Vitamin B 12

The Gerbode shunt, known as the left ventricle to the right atrial communication, is a rather rare finding, following surgical closure of septal defects. Even though the surgical closure is accepted as a treatment of choice, we report a successful percutaneous transcatheter closure of the Gerbode shunt in a 3-months old baby who weighed 3 kilograms.
Heart Septal Defects ; Heart Ventricles ; Humans ; Septal Occluder Device

PURPOSE: The purpose of this study was to evaluate the differences in survival rates between primary gastric and intestinal gastrointestinal non-Hodgkin's lymphoma (NHL) and to investigate risk factors for survival. MATERIALS AND METHODS: We reviewed survival rates and risk factors in 60 cases with stage I and II primary gastrointestinal lymphomas treated at Keimyung University Hospital between January 1972 and August 1999. RESULTS: No differences in sex, age, histology, stage, or percentage of curative resection were observed between primary gastric and intestinal lymphoma. The overall 10-year survival rates of gastric and intestinal NHL were 68.1% and 39.6%, respectively (p<0.05). The overall 10-year survival rates in stage I gastric and intestinal NHL were 66.7% and 70.0%, respectively, while those in stageII were 65.1% and 23.7%, respectively (p<0.001). A multivariate analysis of risk factors for survival revealed that the site of origin (5.68, CI=1.8-17.5) and stage (4.22, CI= 1.19-14.85) were significantly correlated with prognosis (p<0.05). There was no significant difference in the expression of bcl-2 and p53 between gastric and intestinal NHL. Furthermore bcl-2 and p53 expressions were not correlated with the prognosis. CONCLUSION: This study indicates that stage II primary intestinal lymphoma has lower survival rate than gastric lymphoma.
Lymphoma* ; Lymphoma, Non-Hodgkin* ; Multivariate Analysis ; Prognosis ; Risk Factors ; Survival Rate*

No abstract available.
Drug Therapy* ; Lung*

No abstract available.

No abstract available.
Cisplatin* ; Humans ; Nausea* ; Ondansetron* ; Vomiting*

BACKGROUND: Initial symptoms for esophageal perforation have not been clarified, but when there is no early diagnosis and proper treatment to follow immediately after the diagnosis, it is fatal for the patients. Therefore, this study attempted to discover the factors that influence the prognosis of esophageal perforation to contribute to the improvement of the treatment result. MATERIAL AND METHOD: The subjects of this study are 32 patients who came to the hospital with esophageal perforation from October, 1984 to June, 2000. This study examined the items for clinical observation such as patients' sex, age, cause of the perforation, perforation site, the time spent until the beginning of the treatment, symptoms caused by the perforation and its complication, and treatment methods. This study tried to find out the relationship between the survival of patients and each item. RESULT: There were 24 male and 8 female patients and their mean age was 49.7 +/- 16.4. For the causes of perforation, there were 14 cases(43%) of iatrogenic perforation, which ranked first, caused by the medical instrument operation and surgical damage. As for the perforation sites, thoracic esophagus was the most common site(26 cases of 81.2%) and chest pain was the most frequent symptom. The complication caused by esophageal perforation showed the highest cases in the order of mediastinitis, empyema, sepsis and peritonitis. After the treatment, there were 23 cases of survival and 9 cases of mortality. The total mortality rate was 28.1% and the main causes of mortality were sepsis and acute respiratory distress syndrome(ARDS). As for the treatment, 8 cases(25.0%) treated the perforation successfully using conservative treatment only. As for the surgical treatment, there were 5 cases(15.6%) of cervical drainage, 7 cases (21.8%) of primary repair and 12 cases(37.5%) of esophageal reconstruction after performing an exclusion-diversion. There were 18 cases(56.2%) of complete treatment of esophageal perforation at its initial treatment and in 14 cases(43.8%) of treatment failure at its initial treatment, patients were completely cured in the next treatment stage or died during the treatment. The cases of perforation in thoracic esophagus, complication into severe mediastinitis or sepsis and the cases of failure at initial treatment showed a statistically significant mortality rate (p<0.05). CONCLUSION: Based on the above results, it is thought that a proper choice for initial treatment choice depending on the perforation site and the prevention of serious complication such as mediastinitis or sepsis can shorten the treatment period for the patients with esophageal perforation and improve the convalescence.
Chest Pain ; Convalescence ; Diagnosis ; Drainage ; Early Diagnosis ; Empyema ; Esophageal Perforation* ; Esophagus ; Female ; Humans ; Male ; Mediastinitis ; Mortality ; Peritonitis ; Prognosis ; Sepsis ; Treatment Failure