A 23 year old female patient swallowed a tooth brush about one month prior to admission. She has been felt discomfort in epigastrium and dull aching pain recently around umbilicus. Upper gastrointestinal X-Ray and gastroduodenoscopic examination disclosed that a full size, yellow tooth brush is lodged transversely in the stomach and duodenal bulb, Endoscopic remova.l was tried and failed because of impaction of the both ends into mucosa. The tooth brush was removed by gastrotomy under general anesthesia. The free end of the brush handle penetrated the duodenal bulb wall and the impaction of the tip prevented the leakage of duodenal contents before removal. Though the primary method of the gastroduodenal foreign body is endoscopic, if sharp end of the forei body seems to be impacted into the gastrointestinal wall, and if it retained same position for long duration, it should not tried to remove by force fo prevention of leakage and resulting peritonitis. Surgical removal may be safer method in these cases.
Anesthesia, General ; Female ; Foreign Bodies* ; Humans ; Mucous Membrane ; Peritonitis ; Stomach ; Tooth ; Umbilicus ; Young Adult

Heterotopic panereas is pancreactie tissue occuring outside its normal anatomical location and without any connection and normal pancreas and it is a developmental anormaly. The most commen site is stomach(esp. greater curvature of the antrum), duodenum and jejunum, In majority of cases heterotopic pancreas does not produce symptoms. When it produces complications, the symptoms depend on the site of lesion and the size of mass. Pathologically, the heterotopic pancreatic tissue is subject to all the lesions found in the normally placed pancreas. Tbe smooth broad base intramural defect with central niche ie typical radiologic fiadings of heterotoPic pancreas. Gastrofiberscopy revealed a small round, submucosal projection with a central umblication. The lesions are frequently confused with polys, lymphoma, in.tramural neoplasm and gastric uleer. Accurate diagnosis may prevent needless surgical procedures. Three cases of heterotopic pancreas of stomach were reported and the pertinent literature were reviewed briefly.
Diagnosis ; Duodenum ; Jejunum ; Lymphoma ; Pancreas* ; Stomach*

Cardiovascular changes induced by a variety of physiological, surgical or emotional stresses are associated with increased sympathetic nervous system activtity. Sympathetic stimulation lowers the ventricular resistance in patients with ischemic heart disease. Thus sympathoadrenal aetivation may play role in sudden cardiac death. We measured the catecholamine levels just before and after fiberoptic gastroscopy, The results were as follows: 1) Though there was no statistical significance, plama catecholamine levels tends to increase during and after fiberoptic gastroscopy. 2) Significant changes in mean blood pressure did not occur during and after fiberoptic gastroscopy. 3) Before fiberoptic gastroscopy, norepinephrine level of three hypertensive patients were lower than the levels of studied patients, But during and after fiberoptic gastroacopy, norepinephrine level increased by 3 times. 4) The highest norepinephrine level was 847 pg/ml and epinephrine level was 110 pg/ml. Though sympathetic response was enhanced by fiberoptic gastroscopy, norepinephrine level did not increase up to the level shown in myocardial infarction or severe exercise.
Blood Pressure ; Death, Sudden, Cardiac ; Epinephrine ; Gastroscopy* ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Norepinephrine ; Stress, Psychological ; Sympathetic Nervous System

PURPOSE: Growth hormone(GH) plays a major role in postnatal longitudinal bone growth. Exogenous growth hormone leads to stimulation of bone resorption as well as formation. The aim of this study is to observe the changes in the indices of bone metabolism and the correlation between growth velocity and changes in the levels of bone markers with GH treatment in children with GH deficiency(GHD). METHODS: Blood samples were collected from 12 patients before and 6 and 12 months after GH therapy. We measured bone-specific alkaline phosphatase(B-ALP), osteocalcin, and carboxy- terminal propeptide of type I collagen(PICP) as markers for bone formation, and cross-linked C-telopeptide of type I collagen(ICTP) as a marker for bone resorption. RESULTS: All patients showed significant increases in both height velocity(P<0.001), and height SD score(P<0.001) with GH therapy. The concentration of B-ALP increased after 12 mos of GH therapy(P<0.05). The maximal osteocalcin levels reached at 6 months of therapy(P<0.05), and decreased to near baseline level afterward. The concentration of PICP and ICTP significantly increased after 12 months of GH therapy(P<0.05). The percent of increase in serum B-ALP level during the first 6 months of GH treatment significantly correlated with increase in height SD score during the first year of GH therapy(P<0.005). CONCLUSION: GH treatment in children with GHD leads to activation of osteoclasts and osteoblasts as evidenced by increased biochemical markers of bone resorption and formation. The changes in the serum level of B-ALP during the first 6 months of therapy appears to be a useful marker for predicting growth responses during the first year of GH therapy.
Biomarkers ; Bone Development ; Bone Resorption ; Child* ; Growth Hormone* ; Humans ; Metabolism* ; Osteoblasts ; Osteocalcin ; Osteoclasts ; Osteogenesis

Laparoscopic cholecystectomy was introduced into Korea in 1990 and has been rapidly replacing open cholecystectomy when the indications were met. In this study a medical utilization and technology was assessed on the selected hospitalized patients with cholelithiasis who underwent open or laparoscopic cholecystectomy from April 1, 1991 to March 31, 1994. The results are as follows. Despite the low reimbursement rate by the health insurance, the number of laparoscopic cases have been steadily increased. The post-operative days before health insurance coverage were significantly shortened from 8.4 days to 4.6 days. The preoperative days before health insurance coverage were significantly shorted from 8.4 days to 4.0 days. The total length-of-stays in the hospital were also significantly shortened from 15.2 days to 10.7 and 9.8 days in laparoscopic cholecystectomy. The laparoscopic cholecystectomy showed low expenses in all aspects expect the average hospital charges per day. For the hospital to have cost containment, it is more effective if length-of-stay is shorter because of high daily inpatient hospital charge. The laparoscopic cholecystectomy also showed shortened anesthesia time and operation time compared with open cholecystectomy that were statistically significant. The mean anesthesia and operation time for open cholecystectomy were 113.2 and 90.2 minutes but those of laparoscopic cholecystectomy were 105.7 and 68.6 minutes. According to this study the laparoscopic cholecystectomy has reduced the medical expenditure and we recommend this procedure over open cholecystectomy. The further discussion on the different morbidity rate between two types of procedure is essential in providing quality medical care, and to educate specialist.
Anesthesia ; Cholecystectomy* ; Cholecystectomy, Laparoscopic* ; Cholelithiasis ; Cost Control ; Health Expenditures ; Hospital Charges ; Humans ; Inpatients ; Insurance, Health ; Korea ; Specialization

Purpose : Shortness is the most frequent and quite disturbing characteristics of patients with Turner syndrome. The aim of this study was to evaluate the factors affecting final adult height(FAH) in these patients. METHODS : The study group was comprised of 19 patients who were diagnosed as Turner syndrome and attained FAH. We analyzed the influences of various factors on FAH in GH treated group with those in GH untreated group. Results : Nineteen patients were enrolled; thirteen received GH treatment and six did not. The mean duration of GH treatment was 24.3 months(range : 9 to 50 months), and the mean dosage of GH was 0.98+/-0.35IU/kg/wk in GH treated group. The mean growth velocity during GH treatment was 5.6+/-1.8 cm/yr, which was significantly higher than that during pretreatment period(P<0.05). In GH treated group, the mean chronological age, bone age, mean height, and height SD score at GH therapy were 13.7+/-1.7yr, 11.3+/-1.9yr, 129.7+/-7.9cm, and -4.1+/-1.1, respectively, which were not statistically different from those at diagnosis of GH untreated group. In GH treated group, the mean FAH and FAH SD score were 144.8+/-5.0cm, and -3.2+/-0.9, respectively, which showed no significant difference compared with those of GH untreated group. Analyzing the factor affecting FAH in all Turner girls of both groups together, parental height, chronological age, bone age, and bone age delay at diagnosis(or at the initiation of GH therapy) were not related to FAH. Height and height SD score at diagnosis(or at the initiation of therapy) were positively related to FAH(P<0.05, r=0.72). CONCLUSION : The results suggest that GH treatment dose not improve FAH in patients with Turner syndrome, despite increased growth velocity during GH treatment, which might come from intermittern GH therapy. This should be remained to be clarified with more Turner patients who attained FAH.
Adult* ; Diagnosis ; Female ; Growth Hormone ; Humans ; Parents ; Turner Syndrome*

We report cases of two patients with acute generalized exanthematous pustulosis(AGEP). One patient had localized cutaneous infection and the other rhinoplasty. Both were being treated with ampicillin and developed intense erythemas followed by generalized subcorneal pustulation associated with fever and a neutrophilic leukocytosis. Histopathological findings were subcorneal spongiform pustules showing preponderance of polymorphonuclear leukocytes. Generalized pustular psoriasis, subcorneal pustular dermatosis, impetigo and pemphigus foliaceus should be differentiated from AGEP. The causative drug in both of our cases was ampicillin and fast resolution of pustules was observed with a low dosage of systemic steroid within 5 days.
Acute Generalized Exanthematous Pustulosis* ; Ampicillin* ; Erythema ; Fever ; Humans ; Impetigo ; Leukocytosis ; Neutrophils ; Pemphigus ; Psoriasis ; Rhinoplasty ; Skin Diseases, Vesiculobullous

BACKGROUND: To study the prognosis of patients with lung cancer, many investigators have reported the methods to detect cell proliferation in tissues including PCNA, thymidine autoradiography, flow cytometry and Ki-67. PCNA, also known as cyclin, is a cell related nuclear protein with 36KD intranuclear polypeptide that is maximally elevated in S phase of proliferating cells. In this study, PCNA was identified by paraffin-embedding tissue using immunohistochemistry which has an advantage of simplicity and maintenance of tissue architecture. The variation of PCNA expression is known to be related with proliferating fraction, histologic type, anatomic(TNM) stage, degree of cell differentiation, S-phase fraction and survival rate. We analyzed the correlation between PCNA expression and S-phase fraction, survival. METHODS: To investigate expression of PCNA in primary lung cancer, we used immunohistochemical stain to paraffin-embedded sections of 57 resected primary non-small cell lung cancer specimen and the results were analyzed according to the cell type, cell differentiation, TNM stage, S-phase fraction and survival. RESULTS: PCNA expression was dMded into five group according to degree of staging(-, +, ++, +++,++++). Squamous cell type showed high positivity than in adenocarcinoma. Nonsignificant difference related to TNM stage was noticed. Nonsignificant difference related to degree of cell differentiation was noticed. S-phase fraction was increased wit advance of PCNA positivity, but t could not reach the statistic significance. The 2 year survival rate and median survival time were -50% 13 months, +75% 41.3 months, ++73% 33.6 months, +++67% 29.0 months, ++++25% 9 months with statistic significance (P<0.05, Kaplan-Meier, generalized Wilcox). CONCLUSION: From this study. PCNA expression was high positive n squamous cell cancer. And, there was no relationship between PCNA positivity and TNM stage, cellular differentiation or S-phase fraction. But, the patients with high positive PCNA staining showed poor survival rate than the patients with lower positive PCNA. It was concluded that PCNA immunostaining is a simple and useful method for survival prediction in paraffin embedded tissue of non-small cell lung cancer.
Adenocarcinoma ; Autoradiography ; Carcinoma, Non-Small-Cell Lung* ; Cell Differentiation ; Cell Proliferation ; Cyclins ; Flow Cytometry ; Humans ; Immunohistochemistry ; Lung Neoplasms ; Neoplasms, Squamous Cell ; Nuclear Proteins ; Paraffin ; Prognosis ; Proliferating Cell Nuclear Antigen* ; Research Personnel ; S Phase ; Survival Rate* ; Thymidine

OBJECTIVE: This study was designed to investigate the effect of different sites of recording electrodes on auditory evoked potentials (AEPs) in healthy adults and to analyse these potentials properly. METHOD: Eleven healthy adults, 7 males and 4 females, without any history of disease or conditions causing hearing difficulties were selected. AEPs were performed on these subjects with 4 different methods, i.e. different recording sites, Cz-Ai, Cz-Fpz, Ai-Ac, and Ai-Cs7. Auditory stimulation was given by rarefaction clicks of 75dB intensity and 11.1 Hz frequency, and responses were recorded with surface electrodes. RESULTS: The amplitudes of peak I and V were larger with vertical recordings, that is the vertex-auricle (Cz-Ai) or vertex-7th cervical spine (Cz-Cs7) recordings, compared to horizontal recordings of both auricle (Ai-Ac) or extracephalic electrodes. The largest amplitude ratio of peak V/I was with vertex-7th cervical spine (Cz-Cs7) recording. CONCLUSION: Changes in AEPs with respect to the sites of recording and reference electrodes are thought to be due to the vector of brain stem auditory nuclei and pathways. It might be helpful to consider these changes in the evaluation of brain stem lesions.
Acoustic Stimulation ; Adult* ; Brain Stem ; Electrodes* ; Evoked Potentials, Auditory* ; Female ; Hearing ; Humans ; Male ; Spine

OBJECTIVE: Botulinum toxin works at the neuromuscular junction by inhibiting the release of acetylcholine from the presynaptic membrane. It has been indicated for limb spasticity in patients with upper motor neuron lesions. The paralytic effect of this toxin usually lasts for 3 to 4 months, and repeated injections are needed to maintain the effect. This study was performed to investigate whether electrical stimulation can prolong the paralytic effect induced by botulinum toxin type A. METHOD: Ninety male Sprague-Dawley rats, 30 for control and 60 for experimental, were studied. Botulinum toxin type A (Dysport ) was injected into the gastrocnemius muscle in the experimental groups (10 units for group 1 and 5 units for group 2), and normal saline 0.05 ml was injected into the same muscle in the control group. Thirty minutes of electrical stimulation was applied to the injected muscle with surface-stimulating electrodes. The stimulation was given once a day for 3 times in subgroup E1 and once every other day for 6 times in subgroup E2. No electrical stimulation was applied to subgroup N. Amplitudes of action potentials were measured serially on the injected muscles. At the third week, hematoxylin-eosin stained sections and synaptophysin immunohistochemical stained sections were examined. RESULTS: 1) At the second week after the toxin injection, amplitudes of action potentials maximally declined to 2.1~3.7% in group 1 and to 4.0~5.3% in group 2, compared to the initial amplitude. The amplitudes were beginning to recover from the third week. 2) Electrically stimulated groups demonstrated significantly more depressed amplitudes than non-stimulated group N. These effects lasted till week 2~4. 3) Hematoxylin-eosin staining for muscle sections showed degenerative changes of muscle fibers. Synaptophysin immunoreactivity in the muscle demonstrated multiple synaptophysin-positive areas in a muscle fiber of the toxin injected muscle. CONCLUSION: Transient electrical stimulation to the botulinum toxin injected muscles seems to enhance the paralytic effects of the toxin.
Acetylcholine ; Action Potentials ; Botulinum Toxins* ; Botulinum Toxins, Type A* ; Electric Stimulation* ; Electrodes ; Extremities ; Humans ; Male ; Membranes ; Motor Neurons ; Muscle Spasticity ; Muscle, Skeletal ; Muscles ; Neuromuscular Junction ; Paralysis* ; Rats, Sprague-Dawley ; Synaptophysin