A case of Kimuras disease was presented. It seemed that this is the first reported case in Korean literature. The patient was 26 years old male having painless slowly growing tumor-like swelling on his left cheek for 5 months. Mild leukocytosis and marked eosinophilia (27%) were noted in routine laboratory tests. Histopathologically numerous well developed lymphoid follicular structures composed of closely packed lymphocytes and histiocytes were seen in the deep dermis and subcutaneous fat tissue. Dense eosinophilic infiltrations in and around the follicles were peculiar picture. The literature was reviewed. Its relation to the similar descriptions in western literature under various diffe'rent headings was discussed;
Adult ; Cheek ; Dermis ; Eosinophilia ; Eosinophils ; Head ; Histiocytes ; Humans ; Leukocytosis ; Lymphocytes ; Male ; Subcutaneous Fat

The present study was designed to estimate the seroprevalence of NLVs among diarrheagenic children and in healthy adults in Seoul and its vicinity with the use of an EIA and an Western blot (WB) based on recombinant Norwalk virus capsid protein (rNV) and crude virus preparations as antigen. Seroconversion was observed in 34 (83%) of 41 tested using the EIA and in 21 (54%) of 39 using the WB, suggesting that the NLVs with epitopes common to rNV are prevalent in Seoul area. Diarrheal children who were known to have been infected with several other strains of the NLVs showed no significant antibody response to the rNV. Infection with rNV occurred earlier in life: primary infections with rNV were common before the age of 6 months and over 91% of children had evidence of infection by that age by the EIA. Since the amount of the NLV antigens available for seroepidemiologic surveys is limited, we tried to detect NLV antibody by using crude virus preparations as antigen. One crude virus preparation of a child whose stool yielded genetically distinct NLV revealed the presence of the plural number of bands upon SDS-PAGE, but precipitated only one band (62 kDa) after the WB with a serum (collected 10 days after the onset of symptoms) of another diarrheal child. The WB assay we present in this report revealed that the NLVs are prevalent among Korean population and that the sera contained antibody to a single major structural protein, with molecular sizes of 58 to 62 kDa, compatible with the sizes reported for the Norwalk virus and Snow Mountain agent proteins, respectively. When the results of the WB were compared with those obtained by the EIA, the EIA antibody assay was sensitive enough to detect an antibody rise of as much as 4096-fold but not as specific as the WB. The WB assay presented in this paper will provide a powerful tool to elucidate not only antigenic structures of the NLVs but also seroepidemiology of the NLV infection. The availability of an unlimited source of antigen will enable a large scale serologic studies that will greatly increase our understanding of the role of NLVs in human enteric illness.
Adult ; Antibody Formation ; Blotting, Western ; Capsid Proteins ; Capsid* ; Child ; Electrophoresis, Polyacrylamide Gel ; Epitopes ; Humans ; Norovirus* ; Norwalk virus* ; Seoul* ; Seroepidemiologic Studies* ; Snow

PURPOSE: The aim of this study was to evaluate the effectiveness of local anesthesia compared to spinal anesthesia and the usefulness of pentothal induction before infiltration of a local anesthetic agent. METHODS: A concurrent non-randomized prospective study was conducted on 52 patients who underwent a hemorrhoidectomy. For the spinal anesthesia (SA) group (n=29), 0.5% heavy bupivacaine (Marcaine(R)), 5 mg (1 ml), was used, and for the local anesthesia (LA) group (n=23), pentothal, 3.3 mg/kg, was administrated intravenously prior to infiltration of a mixture of local anesthetics (2% lidocaine, 14 ml, with 0.5% bupivacaine, 7 ml). RESULTS: There were no differences between the two groups in terms of operating time, postoperative pain, headache, urinary difficulty, nausea or vomiting, pain-free interval after operation, analgesic requirements, and patient's or surgeon's satisfaction. Postoperative ambulation was earlier in the LA group than in the SA group. CONCLUSIONS: Local anesthesia after pentothal induction can be used effectively for a hemorrhoidectomy and may be a safe alternative to spinal anesthesia.
Anesthesia, Local* ; Anesthesia, Spinal* ; Anesthetics, Local ; Bupivacaine ; Headache ; Hemorrhoidectomy* ; Humans ; Lidocaine ; Nausea ; Pain, Postoperative ; Prospective Studies* ; Thiopental* ; Vomiting ; Walking

No abstract available.
Lung Neoplasms* ; Lung* ; Lymph Nodes* ; Needles*

PURPOSE: Differential diagnosis of acute abdominal pain of the childbearing age woman is a difficult challenge to the emergency physician. Clinical scoring systems for pelvic inflammatory disease (PID) and acute appendicitis have already been introduced. We want to validate these scoring systems externally. METHODS: This study was conducted at a single urban teaching hospital emergency department from May 2011 to September 2013. Retrospective analysis of a prospectively collected registry for reproductive-aged women was performed. RESULTS: A total of 1432 patients were registered. Among them, 322 patients diagnosed as PID (177 patients) or acute appendicitis (145 patients) were finally analyzed in this study. Among the PID and acute appendicitis scored, lower and higher cut-off points were 3 and 8 for PID risk score, and 6 and 10 for appendicitis risk score. PID risk score of PID patients was 7.0 (+/-1.9), acute appendicitis patients was 4.3 (+/-2.1), and other patients was 4.0 (+/-2.2) (p<0.001). Appendicitis risk score of PID patients was 5.7 (+/-1.9), acute appendicitis patients was 9.0 (+/-2.1), and other patients was 5 (+/-1.6) (p<0.001). The areas under the receiver operating characteristic curves were 0,832 and 0,950 for diagnosis of PID with PID risk score and acute appendicitis with appendicitis risk score, respectively. CONCLUSION: These scoring systems have appropriate diagnostic power for diagnosis of PID and acute appendicitis.
Abdominal Pain* ; Appendicitis* ; Diagnosis ; Diagnosis, Differential ; Emergencies ; Emergency Service, Hospital* ; Female ; Hospitals, Teaching ; Humans ; Pelvic Inflammatory Disease* ; Prospective Studies ; Retrospective Studies ; ROC Curve

PURPOSE: Hemorrhoidal tissues are normal anatomic structures present in every individual, and they act as cushions and are anchored to the internal anal sphincter by a connective tissue system. When the anchoring connective tissues undergo bears degenerative changes, the hemorrhoids not only bulge but also descend into the lumen of the anal canal. The veins also become distended. The previous hemorrhoidectomy methods (excision and ligation methods) tend to remove excessive amounts of hemorrhoidal tissues, possibly causing incontinence or stenosis. This study introduces a modified hemorrhoidectomy method. METHODS: A retrospective study was done with 650 patients (358 males, 292 females) who underwent hemorroidectomies from Jan. 1997 to Jan. 2000. Under saddle-block anesthesia, the patient was placed in a prone jack-knife position. After narrow incisions on the mucosa of the selected pile, a bilateral submucosal dissection was performed. The pedicle was ligated by transfixing sutures 2 or 3 times with 2-0 chromic catgut to lift up the mucosa. RESULTS: The mean operation time per hemorrhoidal pile was 12.7 minutes, and the mean hospital-stay was 4.3 days. Acute and delayed postoperative anal bleeding occurred in 7 (1.1%) and 3 (0.5%) patients, respectively. The symptoms of both subsided spontaneously. Ninety-three (93) patients (14.3%) reguired nelaton catheterization for voiding difficulty, and one patient (0.2%) showed mild anal stenosis. The most frequent complaint was skin-tag formation (148 cases, 22.8%). In 140 cases, the skin tag was removed under local anesthesia. CONCLUSIONS: It is desirable to keep the normal structure of the anal canal by removing as little of the cushions as possible. Our 'lift-up submucosal hemorrhoidectomy' shows good results and is an easy operative method when compared with Parks' original method.
Anal Canal ; Anesthesia ; Anesthesia, Local ; Catgut ; Catheterization ; Catheters ; Connective Tissue ; Constriction, Pathologic ; Hemorrhage ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Ligation ; Male ; Mucous Membrane ; Retrospective Studies ; Skin ; Sutures ; Veins

PURPOSE: To evaluate of the role in carcinogenesis of p53 over-expression and bcl-2 inhibition in early gastric and advanced gastric cancers, we investigated the immunohistochemical tissue status of 31 primary early gastric-cancer patients and 31 primary advanced gastric-cancer patients. METHODS: DO7, the monoclonal antiserum to the P53 protein, and clone 124, the monoclonal antibody to the bcl-2 protein, were used for the immunohistochemical analysis of the 31 surgically resected primary early gastric cancer specimens and the 31 surgically resected advanced gastric-cancer specimens. The expressions were scored and divided into negative, positive, low expression, and overexpression. RESULTS: The clinicopathologic parameter; tumor depth of invasion, histologic type, and differentiation, were not related with the expression status of p53 or bcl-2. Of the 31 primary early gastric-cancer patients, 14 exhibited p53 overexpression and 16 showed negative the bcl-2 expression; 5 cases had both p53 overexpression and negative bcl-2 expression. Of the 31 advanced gastric cancer patients, 19 showed the p53 overexpression, and negative bcl-2 expression, 15 exhibited both p53 overexpression and negative bcl-2 expression. CONCLUSION: These results suggest that cell cycle alteration and apoptosis control by p53 and bcl-2 may play roles in the carcinogenesis of gastric cancer. However, there are many other mediators that may facilitate carcinogenesis. This study proved that bcl-2 is a valuable prognostic factor.
Apoptosis ; Carcinogenesis ; Cell Cycle ; Clone Cells ; Humans ; Stomach Neoplasms*

OBJECTIVE: In order to facilitate total removal with preservation of the facial nerve, the authors applied presigmoid(PS) approach in some patients with recurrent acoustic neurinoma(AN) patients who had undergone previous retrosigmoid(RS) approaches. The surgical outcomes of PS approach were retrospectively analyzed and compared to those of RS approaches and we suggest the indication of PS approach for recurrent AN. METHODS: From 1989 to 1999, twenty-one of 183 operated AN patients underwent re-operation due to regrowth of the residual tumors. Nine of the 21 recurrent tumors were removed by PS approach and 12 cases underwent RS approach. The surgical extent of removal and the facial nerve preservation rate were compared between the two different approaches. RESULTS: In PS approaches, the total removal was achieved in four patients(44%) and the facial nerve could be identified and preserved anatomically in all patients. Among 12 cases who underwent RS approaches, the rate of total removal was 44% and the facial nerve identified and preserved in only 5 cases (42%). The rate of facial nerve preservation was significantly different between two modes of approaches (p=0.0007). CONCLUSION: PS transpetrosal approach is recommended in recurrent AN patients who had underwent RS approach previously and already lost the hearing. Early identification of the facial nerve and easy removal of the tumors can be achieved using the PS approach.
Acoustics* ; Facial Nerve ; Hearing ; Humans ; Neoplasm, Residual ; Neuroma, Acoustic* ; Recurrence ; Retrospective Studies

BACKGROUND/AIMS: This study was designed to evaluate the dose-effect relationship of statins in patients with ischemic congestive heart failure (CHF), since the role of statins in CHF remains unclear. METHODS: The South koreAn Pitavastatin Heart FaIluRE (SAPHIRE) study was designed to randomize patients with ischemic CHF into daily treatments of 10 mg pravastatin or 4 mg pitavastatin. RESULTS: The low density lipoprotein cholesterol level decreased by 30% in the pitavastatin group compared with 12% in the pravastatin (p < 0.05) group. Left ventricular systolic dimensions decreased significantly by 9% in the pitavastatin group and by 5% in the pravastatin group. Left ventricular ejection fraction (EF) improved significantly from 37% to 42% in the pitavastatin group and from 35% to 39% in the pravastatin group. Although the extent of the EF change was greater in the pitavastatin group (16% vs. 11%) than that in the pravastatin group, no significant difference was observed between the groups (p = 0.386). Exercise capacity, evaluated by the 6-min walking test, improved significantly in the pravastatin group (p < 0.001), but no change was observed in the pitavastatin group (p = 0.371). CONCLUSIONS: Very low dose/low potency pravastatin and high dose/high potency pitavastatin had a beneficial effect on cardiac reverse remodeling and improved systolic function in patients with ischemic CHF. However, only pravastatin significantly improved exercise capacity. These findings suggest that lowering cholesterol too much may not be beneficial for patients with CHF.
Aged ; Biological Markers/blood ; Cholesterol, LDL/*blood ; Down-Regulation ; Dyslipidemias/blood/diagnosis/*drug therapy/epidemiology ; Exercise Tolerance/drug effects ; Female ; Heart Failure/diagnosis/*drug therapy/epidemiology/physiopathology ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/*administration & dosage/adverse effects ; Male ; Middle Aged ; Myocardial Ischemia/diagnosis/*drug therapy/epidemiology/physiopathology ; Pravastatin/*administration & dosage/adverse effects ; Prospective Studies ; Quinolines/*administration & dosage/adverse effects ; Recovery of Function ; Republic of Korea ; Stroke Volume/drug effects ; Time Factors ; Treatment Outcome ; Ventricular Function, Left/drug effects ; Ventricular Remodeling/drug effects

PURPOSE: Arteriovenous fistulas (AVF) are crucial for hemodialysis in patients with end stage renal disease. However, the lack of suitable forearm cephalic veins has led the surgeons to perform alternative procedures, such as transposition of basilic vein or prosthetic A-V graft. To increase the use of the autologous vein in AVF, we tried a technique of basilic venous transposition of the forearm. METHOD: From 2005.1.1 to 2006.6.30, Six patients had AVFs created with a transposed basilic vein of the forearm. We estimated postoperative clinical outcomes such as primary patency rate and operative complications. RESULT: Three of six patients were male and the mean age was 66.2 yr. Two patients were having their first AVF operation, and the others were having their second AVF operation. The mean follow-up period was 14.8 months. Early graft failure was occurred in one (16.7%). The 1-year primary and secondary patency rates were 66.7%, 83.3%, respectively. CONCLUSION: Autologous AVF formation with basilic vein transposition of the forearm was a feasible surgical technique by increasing the chances autologous AVF formation, this procedure could save the vessels on the upper arm for later AVF creation, and so it avoids using artificial grafts. However, this technique needs further study of more detailed clinical outcomes in large series including the long term patency rate, surgical complications, and comparative results to other AVF formation techniques.
Arm ; Arteriovenous Fistula* ; Follow-Up Studies ; Forearm* ; Humans ; Kidney Failure, Chronic ; Male ; Ocimum basilicum* ; Renal Dialysis ; Transplants ; Veins*