The laparoscopic cholecystectomy, performed for the first time in France in 1987, has been accepted as in many countries the method of choice when performing a cholecystectomy. The trend toward minimally invasive surgery has prompted general surgeons to try it instead of open cholecystectomy. We performed 1000 laparoscopic cholecystectomies at the Department of General Surgery of Eulji Medical College Hospital from January 1992 to April 1997. The outcome data have been analyzed retrospectively. Moreover, we have compared the case histories of 13 patients who received cholecystostomy with those of 43 patient who did not. We also present preliminary results for an interval laparoscopic cholecystectomy which was a preceded by percutaneous cholecystostomy. The results are as follows: 1) The mean age was 54.3 years ranging from 17 to 86; there were 402 males and 598 females. 2) Of the 1000 patients, 123 patients (12.3%) had a history of abdominal surgery. 3) More than half of the patients(560 patients, 56.0%) underwent operations within 6 months of the onset of symptoms. 4) A preoperative endoscopic retrograde cholecystoscopy was performed on 220 patients (22.0%), and of these, 93 patients received endoscopic sphincterotomies because of bile duct stones. 5) The majority of patients(744 patients, 74.4%) had laparoscopic cholecystectomies which lasted 40 minutes or less. 6) More than half (54%) of the removed gallbladders showed grade II inflammation. 7) Drains were used in 142 patients (14.2%). 8) Postoperative complications were encountered in 48 patients (4.8%). 9) Postoperative oral intake was resumed within 24 hours in most patients. 10) Most patients(854 patients, 85.4%) were discharged within 3 days of the operation. 11) The pathologic diagnosis was chronic nonspecific inflammation in most cases (823 cases, 82.3%). 12) The most common microorganism in the bile was E. coli. 13) Patients who received a cholecystostomy had many benefits: a shorter operation time, a low rate of open cholecystectomy, early oral intake. 14) For the 1160 patients who underwent a cholecystectomy during the same period, the rate of open cholecystectomy was 13.8%.
Bile ; Bile Ducts ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystostomy* ; Diagnosis ; Female ; France ; Gallbladder ; Humans ; Inflammation ; Male ; Postoperative Complications ; Retrospective Studies ; Sphincterotomy, Endoscopic ; Surgical Procedures, Minimally Invasive

PURPOSE: To describe the sonographic features of angioleiomyoma arising from superficial soft tissue. MATERIALS AND METHODS: A retrospective study of the sonographic findings of 11 pathologically proven angioleiomyomas was performed. We evaluated the location, layer, size, shape, margin, echotexture, echogenicity, internal content, presence of calcification, and relationship to adjacent structures on gray scale sonography. We evaluated the presence, degree, and distribution pattern of vascularity within the mass on color Doppler sonography. RESULTS: All tumors were located in the subcutaneous layers of the extremities (5 in hand, 2 in elbow, 2 in knee, 1 in foot, 1 in calf). The sizes ranged from 8 to 30 mm, with an average size of 15.5 mm. All lesions were relatively homogeneous and hypoechoic, with well-defined margins and oval to round shape. There were no intratumoral calcifications or cystic portions in any of the masses. Vascularity was not detected in any patient (type 1), but was easily detected in 10 other patients. The degree of vascularity was mild (type 2) in 1 patient, moderate (type 3) in 4, and abundant (type 4) in 5. CONCLUSION: Although angioleiomyoma is an uncommon entity, our study suggests that it must be included in the differential diagnosis of well-defined, hypoechoic, vascular subcutaneous tumors in the extremities.
Angiomyoma ; Diagnosis, Differential ; Elbow ; Extremities ; Foot ; Hand ; Humans ; Knee ; Retrospective Studies

BACKGROUND: Because of wide individual variations in response to sedative and the level of sedation desired by different patients, inadequate sedation is frequent during surgery. Patient-controlled sedation is a logical extension of patient-controlled analgesia to find and maintain their own steady-state of sedation by self-administration of sedatives during surgery. The purpose of this study was to evaluate the feasibility of patient-controlled sedation compared with anesthesiologist-controlled sedation during surgical spinal anesthesia. METHODS: Unpremedicated forty adult patients who received spinal anesthesia for lower extremity surgery were randomly allocated into two groups (n=20 for each group). After selection of target state of sedation according to sedation scale, patient-controlled sedation (PCS) group self-administered 0.5 mg (1 ml) intravenous midazolam in increments using a Walkmed PCA infusor and anesthesiologist- controlled sedation (ACS) group administered by the anesthesiologist as the same manner to achieve previously selected sedation state. Sedation score, vital signs, SpO2 were checked 5, 10, 20, 30, 40min after start of drug injection. RESULTS: The sedation scores patient desired were 4.4 +/- 0.8 in PCS group and 4.3 +/- 0.7 in ACS group. These scores were achieved 20min after start of injection in PCS group and 40 min in ACS grou p (p<0.05). Degree of satisfaction was higher in PCS group compared with ACS group (1.5 +/- 0.6 vs 2.1 +/- 0.8, p<0.05). No complications were detected in two groups. CONCLUSIONS: PCS using midazolam was better than ACS in terms of early achievement of sedation state patient desired and degree of satisfaction.
Adult ; Analgesia, Patient-Controlled ; Anesthesia, Spinal ; Humans ; Hypnotics and Sedatives ; Infusion Pumps ; Logic ; Lower Extremity ; Midazolam* ; Passive Cutaneous Anaphylaxis ; Vital Signs

Ubiquitin-positive neuritic threads (UNTS) in the hippocampal CA 2-3 region are reported to occur exclusively in association with so-called diffuse Lewy body disease (DLBD). hi order to assess the association between the occurrence of Lewy bodies (LBs) and that of the UNTs, an immunohistochemical study on the hippocampus including the parahippocampal gyrus with antiubiquitin antibody (Chemicon Co., California, U.S.A.) was perfon-ned in four groups of patient's brains. All brains were selected from the large pool of brains referred to the Neuropadiology Laboratory of the University of Minnesota for studies of Alzheimer's disease. Group 1 consisted of 34 cases (20 male and 14 female) with LBs widespread in the frontal and temporal cortex and the brain stem nuclei (basal nucleus, substantia nigra, locus ceruleus and dorsal vagal nucleus) associated with varying degrees of degeneration of the substantia nigra; 21 (11 male and 10 female) combined with and 13 (9 male and 4 female) without Alzheimer's disease (AD) pathology. Group 2 included 12 cases (9 male and 3 female) in which LBs were observed only in the brain stem nuclei; 7 with and 4 without AD pathology. Group 3 consisted of 30 cases (9 male and 21 female) without LBs but with AD pathology and degeneration of the substantia nigra. Group 4 included 23 cases (11 male and 12 female) with neither LBs nor AD pathology but with degeneration of the substantia nigra. Ages of the patients varied among the groups. In the 46 cases in the first two groups with LBs. The mean age in the 28 cases with AD pathology was 77.3+/-8.9 and in the 18 cases without AD pathology it was 71.6+/-8.8 (P<0.05). In the 53 cases in groups 3 and 4 without LBs, which served as the controls, the mean ages were 80.8+/-7.7 and 74.0+/-9.7 respectively. UNTs were encountered in all (100%) of 34 cases of group I with widespread LBs which met the histological criteria of DLBD regardless of combined AD pathology. In 12 cases of group 2 with LBs confined to the brain stem, UNTs occurred in 3 (25%), 1 with and 2 without AD pathology. hi the group 3 cases with only AD pathology, UNTs occurred in 4 (13%) of 30 cases, while no UNTs were encountered in the 23 cases of group 4 without AD pathology or LBs. In conclusion, UNTs in the hippocampal CA 2-3 region occur invariably but not exclusively in association with widespread LBs, frequently when LBs are confined to the brain stem, and infrequently with AD pathology. It seems, therefore, that the UNTs are closely related to LBs and increase in ftequency as LBs spread beyond the brain stem with time, but the pathogenesis of the UNTs is little understood.
Female ; Male ; Humans

A prospective study was carried out to evaluate the validity of TROPT troponin T rapid assay in early diagnosis of acute myocardial infarction(AMI) in patients with ischemic chest pain, in comparison with conventional diagnostic tools such as serum troponin T(c-TnT) level, creatine Kinase(CK), CK-MB level and initial EKG finding. The study was performed at the emergency department(ED) of Yong Dong Severance hospital from March 1st 1996 to February 28th 1997. One hundred eighty one patients visiting ED with chief complaint of atraumatic chest pain within 24 hours of visit were eligible for the study. Those who lacked enough data collection and those who had chest paint of noncardiac origin and EKG of PSVT were excluded from the study. The overall study population was a total of 131 patients. Initial EKG, TROPT rapid assay, CK, CK-MB and c-TnT level were obtained simultaneously. Diagnosis of AMI was made according to the international diagnostic criteria for AMI. Of the 131 patients 61 patients(46.6%) were diagnosed as AMI. Within 4 hours of their symptom onset, initial EKG showed the highest sensitivity(63.2%) whereas the sensitivities of TROPT rapid assay, c-TnT, CK and CK-MB were poor(0-0.7%). From 4-8 hours, the sensitivities of c-TnT, CK and CK-MB were higher than that of TROPT rapid assay(80% vs. 30%). The sensitivites of TROPT rapid assay, c-TnT, CK and CK-MB rose over time and reached 100% after 8 hours symptom onset. The specificities of the TROPT rapid assay, c-TnT, CK & CK-MB and EKG were all 100% within 8 hours after symptom onset. Discrepancy between TROPT rapid assay and c-TnT was noted in nine patients(6.9%). In this study TROPT rapid assay was valuable in the diagnosis of AMI after 8 hours of symptom onset.
Chest Pain* ; Creatine ; Data Collection ; Diagnosis ; Early Diagnosis ; Electrocardiography ; Emergencies ; Humans ; Paint ; Prospective Studies ; Thorax* ; Troponin ; Troponin T

No abstract available.
Sternotomy*

The term pseudolymphoma is not specific, and a variety of infl; m atory reactions may simulate clinically and histopat,hologically a cutaneous malignant lymphomas udolymphoma induced by drug therapies, especially anticonvulsants, have been reportecl. These pseidayrnphornas most commonly appear as single lesions. Characteristically, few localized lesions disappear after discontinuing therapy with the offending drug. Multiple and generalized tumors are very rate. We report a case of generalized cutaneous pseudolymphoma assocated with phenytoin therapy in a 52-year old male patient.
Anticonvulsants ; Drug Therapy ; Humans ; Lymphoma ; Male ; Middle Aged ; Phenytoin* ; Pseudolymphoma*

Until recently, the cervical pregnancy have been treated with surgery, usually hy- sterectomy, because of uncontrollable heavy vaginal bleeding. The development of sophisticated ultrasound which allows early diagnosis of cervical pregnancy and methotrexate chemotherapy opened up new therapeutic options in the management of this unusual but potentially life threatening complication of pregnancy which have been always a nightrnare for the gynecologist. We are reporting a case of cervical pregnancy diagnosed in 12 weeks of gestation. The patient was successfully treated with alternative administration of methotrexate (1 mg/kg, intramuscularly) and leucovorin (0.1 mg/kg, intramuscularly) without surgical intervention, in order to preserve both the uterus and fertility. Follow up was done with serum beta hCG and pelvic ultrasonography. Complete resolution of the cervical pregnancy was obtained at 50 days after starting methotrexate treatment. This case gave us the opportunity to review the recent literature on cervical pregnancy.
Drug Therapy ; Early Diagnosis ; Fertility ; Follow-Up Studies ; Humans ; Leucovorin* ; Methotrexate* ; Pregnancy* ; Ultrasonography ; Uterine Hemorrhage ; Uterus

No abstract available.
Lipoma*

It has been widely accepted that complete surgical resection of hepatoblastoma is essential for long-term survival. But unfortunately less that 50% of hepatic tumors in children can be totally removed at the time of diagnosis. This report is to present the experience of successful resection of hepatoblastoma after concurrent radiotherapy with transarterial chemoinfusion in a child. We believe this modality of treatment enables complete resection of unresectable hepatoblastoma, which is resistant to the systemic chemotherapy.
Child ; Diagnosis ; Drug Therapy ; Hepatoblastoma* ; Humans ; Radiotherapy*