Acute appendicitis is the most common operative disease in general surgery, but it is not also rate disease to see in other clinical department such as Internal Medicine and Obstetric and Gynecology, because it reqnires to differenciate from many other diseases which have similar symptoms. Expecially, because the clipical aymptoms of acute appendicitis are not typieal in children, elderly, and women, it is hard to be diagnosed as acute appendicitis and it is often misdiagnosed as other disease. We performed colonoscopy due to be interpretated aa one of the colon diseases rather than acute appendicitis. But in colonoscopic findings, there were hyperemie and edematous change on the appendiceal orifice of cecum(cherry or acorn shape). So we report 5 cases of acute appendicitis diagnosed br colonoscopy.
Aged ; Appendicitis* ; Child ; Colon ; Colonoscopy* ; Female ; Gynecology ; Humans ; Internal Medicine

BACKGROUND: Epidural and intravenous administration of opioids had been commonly used for postoperative pain management in thoracoscopic surgery. Recently, interpleural analgesia was frequently used. The aim of this study was to compare the effect of an intravenous continuous infusion of fentanyl (F-IV) with interpleural bupivacaine (B-IP) using a continuous infusion system in the management of post-thoracoscopic pain. METHODS: An interpleural continuous infusion of bupivacaine (B-IP group: basal infusion 7(ng/kg/min) was compared with an intravenous continuous infusion of fentanyl (F-IV group: basal infusion 0.33ng/ kg/hr) in forty patients who had undergone elective thoracoscopic surgery. During the postoperative 48 hours, the visual analogue scale (VAS), Prince-Henry score (PHS), heart rate, respiratory rate and peripheral oxygen saturation were measured. RESULTS: The postoperative heart rate in both groups was significantly higher than the preoperative value (P < 0.05 1 h and 4 h after operation), but there were no differences in the respiratory rate and peripheral oxygen saturation between the two groups. There were significant improvement of the degree of pain in VAS and PHS after administration of the analgesic, but there was no significant differences in the two groups during 48 hours. The incidence of adverse effects such as nausea, vomiting, dizziness, urinary difficulty and respiratory depression was higher in the F-IV than the B-IP group. CONCLUSIONS: The interpleural continuous infusion of local anesthetics and intravenous continuous infusion of fentanyl provided effective analgesia in this study. The side effects were significantly lower in the interpleural continuous infusion of local anesthetics than intravenous continuous infusion of fentanyl. Therefore, interpleural continuous infusion of local anesthetics could be a useful alternative for postoperative analgesia after thoracoscopic surgery.
Administration, Intravenous ; Analgesia ; Analgesics, Opioid ; Anesthetics, Local ; Bupivacaine* ; Dizziness ; Fentanyl* ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Interpleural Analgesia ; Nausea ; Oxygen ; Pain, Postoperative ; Respiratory Insufficiency ; Respiratory Rate ; Thoracoscopy* ; Vomiting

Bizarre parosteal osteochondromatous proliferation (Nora's lesion) is a rare benign tumor and known to be primarily occur in the small tubular bone of the hands and feet. However, it is very unusual to be reported that it occurs in metatarsal bone in Korea. Thus, we report this tumor of metatarsal bone including the literature review because we have experienced this example.
Foot ; Hand ; Korea ; Metatarsal Bones*

Reconstruction of partial ear defects presents a unique and notable challenge to the dermatologist. This is due to the complex architecture of the external ear which is difficult to duplicate surgically. Several procedures are available for correction of defects to the external ear. However, the diversity of external ear shapes shows how difficult it is to achieve a certain solution to this problem. We report a case of auricular squamous cell carcinoma in which the skin defect is reconstructed by a staged supra-auricular interpolation pedicle flap.
Carcinoma, Squamous Cell ; Ear* ; Ear, External ; Skin

PURPOSE: The aim of this study is to determine whether the serum apolipoprotein A1(apoA1) level, as measured at different time points after hepatectomy and liver transplantation, can predict the synthesis ability of the liver and the nutritional status. We also investigated the usefulness of regions of interest(ROIs) as an indicator of the recovery status of the liver after liver transplantation. METHODS: 93 patients (21: laparoscopic cholecystectomy, 53: partial hepatectomy, 19: liver transplantation) were operated on under general anesthesia. The serum levels of apoA1, prealbumin, albumin, aspartate aminotransferase and alanine aminotransferase and the prothrombin time were measured at pre- and post-operation. The liver conditions were a normal liver (50 cases), hepatitis (16 cases) and liver cirrhosis (28 cases). The mean hepatic attenuation was calculated by averaging the ROI values that were obtained at different hepatic segments. RESULTS: The serum apoA1 level was minimally changed during the perioperative period in the laparoscopic cholecystectomy group. Yet in most cases, the serum apoA1 level after partial hepatectomy and liver transplantation was decreased on postoperative days (PODs) 1 and 7, but it nearly recovered to the preoperative level on POD 30. There were significant differences in the values of apoA1 between the normal liver and co-existent liver disease at the various time points. The ROI value after transplantation gradually increased and it reached a normal level by POD 30. CONCLUSION: The serum apoA1 level can be an indicator of liver's ability to synthesize protein and the nutritional status after partial hepatectomy. In addition, ROIs of the unenhanced CT image can reflect the recovery status of the liver after transplantation.
Alanine Transaminase ; Anesthesia, General ; Apolipoprotein A-I ; Apolipoproteins ; Aspartate Aminotransferases ; Cholecystectomy, Laparoscopic ; Hepatectomy ; Hepatitis ; Humans ; Liver ; Liver Cirrhosis ; Liver Diseases ; Liver Transplantation ; Nutritional Status ; Perioperative Period ; Prealbumin ; Prothrombin Time ; Transplants

PURPOSE: To study the fundus findings in the peripheral retina using examination under general anesthesia in patients showing vitreoretinopathy in the unilateral posterior pole of the eye. METHODS: The records of 27 patients showing vitreoretinopathy in the unilateral posterior pole of the eye were retrospectively reviewed. Analysis of the records for the fundus finding was performed using indirect ophthlamoscopy at the outpatient clinic, fundus findings and results of fluorescein angiography during examination under general anesthesia. RESULTS: The viteroretinopathies in the unilateral posterior poles were retinal vascular and vitreous abnormality including avascular area in seven eyes (16%), retinal dragging in 14 eyes (32%), retinal folding in 21 eyes (48%), and total tractional retinal detachment in two eyes (5%). The final clinical diagnoses were familial exudative vitreoretinopathy in 33 patients, incontinentia pigmenti in four eyes, and idiopathic vitreoretinopathy in seven eyes. Abnormal findings in the peripheral retina of the contralateral eye were observed in 27 eyes (61%) when examined under general anesthesia. Leakage in fluorescein angiography was found in 17 contralateral eyes (39%). The treatment including diode laser photocoagulation and cryotherapy was performed in eyes showing active leakage. CONCLUSIONS: Examination of the bilateral fundus is important in patients showing vitreoretinopathy in the unilateral posterior pole. The examination under anesthesia was helpful for diagnosis, evaluation and treatment in patients showing vitreoretinopathy in the unilateral posterior pole of the eye.
Ambulatory Care Facilities ; Anesthesia ; Anesthesia, General ; Cryotherapy ; Eye ; Fluorescein Angiography ; Humans ; Incontinentia Pigmenti ; Lasers, Semiconductor ; Light Coagulation ; Retina ; Retinal Detachment ; Retinaldehyde ; Retrospective Studies ; Traction

Tendon disorders commonly cause wrist and hand disability and curtail the performance of work-related tasks. Sonography allows for cost-effective, noninvasive, and dynamic evaluation of soft tissue structures, thus representing a valuable tool for ruling out musculoskeletal disorders of the wrist and hand. Because of the complexity of the wrist joint, sonographic training and familiarity with normal and variant anatomy are needed to avoid misdiagnosis and improper treatment. The purpose of this article is to demonstrate the structures representing normal findings during sonographic evaluations of the wrist and hand. The main reviews the gross anatomy and procedures that are recommended to assess the soft tissue structures of the wrist and hand, with particular emphasis given to tendons, nerves, and ligaments. In conclusion, sonography is effective in assessing the tendons of the hand and wrist and related disorders and represents a valuable tool for diagnosis.

PURPOSE: To investigate the courses leading to bilateral enucleation in bilateral retinoblastoma patients. METHODS: Medical records of 5 bilateral retinoblastoma patients who underwent bilateral enucleation were reviewed for patient information, history, change of tumor state during the treatment and the cause of bilateral enucleation. RESULTS: Out of 48 bilateral retinoblastoma patients, both eyes were saved in 6 children, 1 eye was saved in 37 children, and the remaining 5 children lost both eyes. All patients who underwent bilateral enucleation were female and had no family history of retinoblastoma. At diagnosis, 3 children were 4 months old and the remaining 2 patients were 1 year and 1.5 years old each. Out of 10 eyes, 8 eyes were in Reese Ellsworth group V and the remaining 2 eyes were in group III. The initial treatment was enucleation of 1 eye followed by chemotherapy in 3 patients, and chemotherapy alone in 2 patients. Additional treatment included laser photocoagulation, cryotherapy, external beam radiation therapy and proton beam irradiation. Vitreous seeding, development of new tumors, and increase in tumor size despite of intensive, conservative treatment resulted in second enucleation. CONSLUSION: Most patients who underwent bilateral enucleation were 1 year old or younger at diagnosis of retinoblastoma. All patients had a progressed disease status at presentation and showed poor response to intensive, conservative treatment.
Child ; Cryotherapy ; Diagnosis ; Drug Therapy ; Female ; Humans ; Infant ; Light Coagulation ; Medical Records ; Protons ; Retinoblastoma*

PURPOSE: To investigate the courses leading to bilateral enucleation in bilateral retinoblastoma patients. METHODS: Medical records of 5 bilateral retinoblastoma patients who underwent bilateral enucleation were reviewed for patient information, history, change of tumor state during the treatment and the cause of bilateral enucleation. RESULTS: Out of 48 bilateral retinoblastoma patients, both eyes were saved in 6 children, 1 eye was saved in 37 children, and the remaining 5 children lost both eyes. All patients who underwent bilateral enucleation were female and had no family history of retinoblastoma. At diagnosis, 3 children were 4 months old and the remaining 2 patients were 1 year and 1.5 years old each. Out of 10 eyes, 8 eyes were in Reese Ellsworth group V and the remaining 2 eyes were in group III. The initial treatment was enucleation of 1 eye followed by chemotherapy in 3 patients, and chemotherapy alone in 2 patients. Additional treatment included laser photocoagulation, cryotherapy, external beam radiation therapy and proton beam irradiation. Vitreous seeding, development of new tumors, and increase in tumor size despite of intensive, conservative treatment resulted in second enucleation. CONSLUSION: Most patients who underwent bilateral enucleation were 1 year old or younger at diagnosis of retinoblastoma. All patients had a progressed disease status at presentation and showed poor response to intensive, conservative treatment.
Child ; Cryotherapy ; Diagnosis ; Drug Therapy ; Female ; Humans ; Infant ; Light Coagulation ; Medical Records ; Protons ; Retinoblastoma*

Subdural abscess is relatively rare compared with epidural abscess, but it can rapidly progress to complete paraplegia with a poorer outcome. In particular, the occurrence of widespread subdural abscess is extremely rare. We experienced a case of widespread thoracolumbar subdural abscess with infectious spondylodiscitis in the thoracic spine. We report this rare case with a review of relevant literatures.
Abscess* ; Discitis* ; Empyema ; Epidural Abscess ; Paraplegia ; Spine