Abdominal actinomycosis is very rare infectious disease and seldom reported as a cause of abdominal mass. This disease is diagnosed by pathologic findings and culture result but it is very difficult to differentiate with other granulomatous illammatory disease, diverticular disease, malignancy, etc. The radiologic findings were non-specific and CT scan revealed the inflammatory mass with multiple small abscesses and fibrous change. The treatment of choice for actinomycosis is medical treatment with penicillin but surgical intervention may be needed when complication such as obstruction, fistula formation, abscess formation develop. We report a patient with abdominal actinomycosis that presented with transverse colonic obstruction and severe abdominal wall inflammation. This patient had no past operative history but got intrauterine contraceptive devices during last 10 years. We treated this patient by surgical resection and antibiotic therapy.
Abdominal Wall ; Abscess ; Actinomycosis* ; Colon* ; Colon, Transverse ; Communicable Diseases ; Fistula ; Humans ; Inflammation ; Intrauterine Devices ; Penicillins ; Tomography, X-Ray Computed

OBJECTIVES: The purpose of this study was to measure the workload of home visit care activities and their relative values. This study examined also factors that affect the workload of home visit care activities. METHODS: The participants of this study were 126 homehelpers of 50 home visit care agencies at the 2nd Longterm Care Insurance Demonstration Project. The workload of home visit care activities was divided into total work and four dimensions ; physical efforts, mental efforts, stress and time. Home visit care activities consisted of four categories with 24 items. We used magnitude estimation method to measure their relative values of the four dimensions. The participants answered the relative values of each activities based on the reference service. We used the activity for supporting their elderly's evacuation as the reference service. RESULTS: Most of the respondents were over 40 years old female. They consumed most their time supporting elderly's going out. They consumed their highest physical, mental efforts, and stress for activities of coping with emergency situation. The Pearson correlation coefficients showed significant relationships between workload and each dimensions. This study showed that all four dimensions are statistically significant predictors of workload of home visit care activities. Also, we found that the home-helper's career affects the workload of home visit care activities. CONCLUSIONS: The workload of home visit care activities could be explained by physical efforts, mental efforts, stress and time.
Adult ; Female ; Geriatric Nursing/*organization & administration ; Home Care Services ; *House Calls ; Humans ; Korea ; Male ; Middle Aged ; *Workload

Transient hyperkalemia has been reported to occur in eletric burn patients following intravenous administration of succinylcholine. We have studied the origin of the elevated serum K+ concentration after injection of succinylcholine from both the non-burned area and from the burned area in electirc burn patients. Blood samples for serum K+ measurement were drawn 1,2,3,4,5 and 10 minutes after administration of succinylcholine from both the burned are and the non-burned area in 6 electric burn patients. The following results were obtained: 1) Serum K+ levels increased in the burned group in 3 minutes after injection of succinylcholine. 2) The serum K+ concentration of venous samples from the electric burn area were more increased than from the non-burned area injection of succinylcholine.
Administration, Intravenous ; Burns ; Burns, Electric ; Humans ; Hyperkalemia ; Succinylcholine*

No abstract available.

No abstract available.
Blood Transfusion* ; Humans ; Infant*

Bezoars are large conglomerates of vegetable fiber and hair, or concretions of various substances located in the stomach or the intestinal tract. They are classified as trichobezoars, phytobezoars, trichophytobezoars or concretions. The most common site for a bezoar is the stomach, but small-bowel bezoars are occasionally reported. A gastric bezoar can be treated by endoscopic removal or chemical dissolution. Small bowel bezoars are usually discovered due to intestinal obstruction, and surgical removal is the standard treatment method. We report the case of a patient who suffered from an intestinal obstruction due to a phytobezoar about 5 4 3 cm3 size.
Bezoars* ; Hair ; Humans ; Intestinal Obstruction* ; Stomach ; Vegetables

BACKGROUND: The use of choledochoscopy has been increasing lately in open and laparoscopic surgery for bile duct stones. Intraoperative choledochoscopy is useful for assessing the biliary trees and stones and for assisting in the removal of bile duct stones. However, large or impacted bile duct stones are difficult to remove using choledochoscopy alone. Application of electrohydraulic lithotripsy (EHL) seems to be suited for these difficult cases. METHODS: Twenty-six (26) patients with bile duct stones were treated with intraoperative cho ledochoscopic EHL to remove stones which could not be retrieved using stone forceps, a basket, saline flushing, or a Fogarty catheter. We divided the 26 cases into two groups: 12 cases of laparoscopic surgery and 14 cases of open surgery. These cases were further divided into two groups: common bile duct stones and intrahepatic duct stones RESULTS: The indications of EHL in laparoscopic surgery for common bile duct stones were large stones in 2 cases and impacted stones in 4 cases. Eighteen (18) patients with intrahepatic duct stones were treated with EHL for impacted stones. Stone clearence rate was 88.5%, and complications occurred in 3 cases (11.5%). One case of a biliary fistula was managed conservatively, and two cases of mucosal bleeding of the bile duct were spontaneously controlled. CONCLUSION: Intraoperative choledochoscopic electrohydraulic lithotripsy is a safe and effective method for removing large or impacted bile duct stones.
Bile Ducts* ; Bile* ; Biliary Fistula ; Catheters ; Common Bile Duct ; Flushing ; Hemorrhage ; Humans ; Laparoscopy ; Lithotripsy* ; Surgical Instruments

A preduodenal portal vein is a rare anomaly. A left-sided gallbladder is also a rare anatomical variant that may be occasionally combined with a preduodenal portal vein. We report here a patient with multiple biliary stones whose preduodenal portal vein was discovered at operation. The anomaly was a preduodenal portal vein associated with a left-sided gallbladder, which is very rare. This is the first case reported in Korea. An abnormal location of the round ligament to the right side can make the gallbladder appear to be a left-sided gallbladder. Our case belongs to this category. This patient had multiple biliary stones in the intrahepatic duct, the common bile duct, and the gallbladder. We treated him with a cholecystec tomy, choledochotomy, and choledochoscopic stone extraction using a basket, and electrohydraulic lithotripter. All procedures were done using a laparoscopic method. The patient was treated well with no complication.
Common Bile Duct ; Gallbladder* ; Humans ; Korea ; Portal Vein* ; Round Ligament of Uterus ; Round Ligaments

We report 2 cases of serotonin syndrome with variable symptoms after being treated with antidepressants. A 57-year-old woman developed agitation, diaphoresis, and tremor after combination therapy with fluoxetine and trazodone. The second patient, a 76-year-old female woman, became partially disoriented and developed brief, jerky myoclonus of all extremities after discontinuation of sertraline and consecutive imipramine treatment. These two patients rapidly improved with supportive care. The serotonin syndrome is not always easy to diagnose and sometimes causes a serious and fatal event. For this reason, if possible, the practice of multiple serotonergic drugs should be avoided because of the risk for potential serious pharmacodynamic drug interactions. Clinicians should not view the serotonin syndrome as an idiosyncratic reaction, but rather, as a predictable one with a variability in occurrence and severity among patients. Heightened awareness by clinicians will help to minimize pharmacodynamically mediated interactions that may occur between prescribed drugs and, ideally avoid this syndrome.
Aged ; Antidepressive Agents ; Dihydroergotamine ; Drug Interactions ; Extremities ; Female ; Fluoxetine ; Humans ; Imipramine ; Middle Aged ; Myoclonus ; Serotonin Agents ; Serotonin Syndrome* ; Serotonin* ; Sertraline ; Trazodone ; Tremor

BACKGROUND: E-cadherin, one of the best known cell adhesion molecules plays an important role in embryonic cell development and architectural maintenance of adult tissues. This molecule is a calcium- dependent glycoprotein and is expressed in most normal epithelial tissues. Selective loss of E-cadherin has been observed in many carcinomas of various origins, and this phenomenon is thought to be an induction point for depression of cell adhesiveness and for metastasis. This study was conducted to evaluate the significance of E-cadherin expression as a prognostic factor in breast cancer and to examine the relationship between E-cadherin expression and clinicopathologic factors. METHODS: Surgical specimens were obtained from 73 patients with breast carcinoma from September 1993 to August 1996 in the Department of Surgery, Mok-Dong Hospital, Ewha Womans University. The immunohistochemical staining was performed by using the paraffin embedded tissues. These results were compared with previously known important clinicopathologic characteristics such as age, tumor location, chief complaint, mass size, tumor stage, lymph node invasion, mitosis, nuclear and histologic grades. RESULTS: The expression status of E-cadherin was normal in 41 cases (56%), reduced in 23 cases (32%), lost in 9 cases (12%). When compared with clinicopathologic variables, loss of E-cadherin expression was found in high nuclear and histologic grade, high stage, and severe lymph node invasion cases. However, there was no significant difference in survival rate according to E-cadherin expression. CONCLUSION: This study suggests that E-cadherin expression may be related with the histologic and nuclear grades, the stage and lymph node invasiveness, so it can be used as predictive factor for metastasis.
Adhesiveness ; Adult ; Breast Neoplasms* ; Breast* ; Cadherins* ; Cell Adhesion Molecules ; Depression ; Female ; Glycoproteins ; Humans ; Lymph Nodes ; Mitosis ; Neoplasm Metastasis ; Paraffin ; Survival Rate