No abstract available.
Lymphadenitis*

Peritonitis is one of the major complications of CAPD(continuous ambulatory peritoneal dialysis). Recently, multidrug-resistant organisms, such as vancomycin-resistant enterococcus (VRE) have been rarely reported by the pathogen as of CAPD-associated peritonitis. But, there is limited information on choices of effective therapy for VRE peritonitis in patients undergoing CAPD. We present a pediatric case of successful treatment of CAPD-associated peritonitis due to VRE with linezolid, and review of the literature.
Acetamides ; Enterococcus ; Humans ; Oxazolidinones ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis

PURPOSE: To evaluate whether CT scanning is useful in differentiating the between endometriomas and other benign complex cystic adnexal masses, and in determining the method of treatment for each mass lesion. MATERIALS AND METHODS: In 54 cases (47 patients), we retrospectively analysed the CT findings of 20 pathologically-proven twenty endometriomas (bilateral in four cases), eight hemorrhagic functional cysts, two tubal ectopic pregnancies, eight tubo-ovarian abscesses (bilateral in two cases), ten serous cystadenomas (bilateral in one case), and six mucinous cystadenomas. Internal attenuation, the hyperdense portion, adhesion, and cul-de-sac obliteration were evaluated by CT scanning. RESULTS: Fourteen endometriomas (70%) showed a hyperdense portion, and in only two of these (10%), was a focal nodular hyperdense portion seen on pre-contrast CT scan (10% sensitivity, 100% specificity). Partial or complete cul-de-sac obliteration was identified in 11 patients (75%), while hemorrhagic functional cysts showed a hyperdense portion in four cases (50%) and were accompanied by partial cul-de-sac obliteration in two (25%). Two unruptured tubal ectopic pregnancies showed CT findings of unilateral hyperdense cystic masses of more than 60 HU. In all cases, tubo-ovarian abscesses were accompanied by thickening of the uterosacral ligament and deviation of thickened mesosalpinx (anterior deviation in 87.5% of patients). Serous and mucinous cystadenomas showed CT findings of hypodense masses (less than 20 HU) without adhesion or cul-de-sac obliteration, and this was helpful in differentiating cystadenomas from other benign cystic adnexal masses, including endometriomas. CONCLUSION: The evaluation by CT scanning of benign complex cystic adnexal masses with respect to the hyperdense portion and the presence or absence of cul-de-sac obliteration was usful in differentiating endometriomas from other lesions, and might be helpful in determining the method of treatment for each mass lesion.
Abscess ; Cystadenoma ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Endometriosis* ; Female ; Humans ; Ligaments ; Pregnancy ; Pregnancy, Ectopic ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUND: Authors have undertaken this study to see if the choice of anesthesia can directly or indirectly provide immunomodulation for cytokines, to determine the relationship of cytokines and hypothalamo-pituitary-adrenal axis in stomach cancer surgery patients, and also to see whether the amount of morphine administration and choice of analgesia can influence cytokine release, and possibly immunity. METHODS: Total 19 gastric cancer surgery patients were randomly assigned in double-blind fashion into two groups. Group-G (n=9) was provided with general anesthesia plus morphine intravenous patient controlled analgesia (IV-PCA), whereas group-GE (n=10) with preemptive epidural and general anesthesia plus continuous epidural analgesia for control of postoperative pain. At predetermined time interval, proinflammatory cytokines and stress hormones were evaluated with visual analog pain scale. Simultaneous assessments of operating and anesthesia time, total morphine doses, the time to recovery of gastrointestinal function and incidences of complications were also made. RESULTS: Demographic data, the durations of operation and anesthesia and recovery of gastrointestinal function were similar in both groups. Total morphine doses were approximately four times greater in group-G. Secretions of interleukin-1 beta , TNF and epinephrine were blocked by preemptive epidural anesthesia, meanwhile, interleukin-6 as well as ACTH and cortisol were not. After 24 hours after skin incision, the differences of cytokines, ACTH and cortisol between two groups were dissipated. In spite of these hormonal findings, visual analog pain scale could not disclose any differences. Incidences of complications were statistically insignificant except that of itching in group-GE. CONCLUSION: Preemptive epidural anesthesia and analgesia can partially block only some of cytokines and stress hormones, and these effects do not have clinically relevant long term influences. The amounts and means of morphine administered by continuous epidural analgesia block or IV-PCA demonstrated no evidence of immunosuppression at clinical dose range.
Adrenocorticotropic Hormone ; Analgesia ; Analgesia, Epidural ; Analgesia, Patient-Controlled ; Anesthesia and Analgesia* ; Anesthesia* ; Anesthesia, Epidural ; Anesthesia, General ; Axis, Cervical Vertebra ; Cytokines ; Epinephrine ; Humans ; Hydrocortisone ; Immunomodulation* ; Immunosuppression ; Incidence ; Interleukin-1beta ; Interleukin-6 ; Morphine ; Pain Measurement ; Pain, Postoperative ; Pruritus ; Skin ; Stomach Neoplasms* ; Stomach*

PURPOSE: To evaluate CT findings which may help differentiate benign from malignant parotid tumors. MATERIALS AND METHODS: The CT findings of seventy-one cases with surgically-proven parotid tumors were retrospectively analysed for size, location, margin, internal density, adjacent tissue plane and lymphadenopathy. RESULTS: The margin of the mass was smooth and sharp in most benign tumors (89.5%), and irregular or indistinct in twelve which were malignant (75%, p<0.01). With regard to internal density, 70.2% of benign tumors were homogeneous (similar to muscle) and 81.3% of malignant tumors were heterogeneous (p<0.01). When analysing low density patterns within the mass, focal low densities in benign tumors (11/17) and diffuse or scattered multifocal low densities in those which were maligant (8/13) were frequently seen. Three malignant tumors invaded adjacent muscles, the parapharyngeal space, and bones, each in one case, and twelve malignant and one benign tumor infiltrated the adjacent fascia or subcutaneous fat layer. In five patients with a malignant tumor, obliteration by the mass of the fat plane between the mastoid tip and styloid process was noted, suggesting facial nerve invasion, while in three cases of malignancy, lymphadenopathy greater than 1cm was seen. CONCLUSION: In differentiating malignant and benign parotid tumors, the presence of irregular or indistinct margin of the mass, and invasion of adjacent structures, are important. Lymph node enlargement greater than 1cm and diffuse internal low densities, which may suggest necrosis or cystic change were also helpful in differential diagnosis.
Diagnosis, Differential* ; Facial Nerve ; Fascia ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Mastoid ; Muscles ; Necrosis ; Retrospective Studies ; Subcutaneous Fat

PURPOSE: We investigated the efficacy of transurethral injection of Macroplastique bulking agent (Uroplasty) for male stress urinary incontinence (SUI) after prostate surgery. MATERIALS AND METHODS: This retrospective review included men with SUI treated by transurethral injection for symptoms resulting from prostate surgery. Patients were evaluated at 1 month and 6 months after injection by determining the number of pads used per day and changes in incontinence symptoms. Treatment success was defined as use of 1 pad or fewer per day combined with subjective symptom improvement. RESULTS: The study population comprised 30 men with a mean age of 66.1+/-5.3 years. Of the 30 patients, 24 (80.0%) underwent prostate cancer surgery and the remaining 6 (20.0%) underwent surgery for benign prostatic hyperplasia. The preinjection pad number was 2.9+/-1.9 pads per day. After injection treatment, the mean follow-up period was 9.3+/-12.7 months and the success rate was 43% (13/30) at 1 month and 32% (6/19) at 6 months. Injection was more likely to result in a successful outcome in patients with no preinjection radiation treatment history and higher abdominal leak point pressure (ALPP) than in those with a previous history of radiation treatment and lower ALPP, although this result was not statistically significant. Acute urinary retention occurred in 5 patients (17%). CONCLUSIONS: Transurethral Macroplastique injection treatment is a relatively non-invasive treatment method for male SUI with a success rate of 43% at 1 month and 32% at 6 months. Patients with a higher ALPP and no previous history of radiation therapy may experience better treatment outcomes.
Dimethylpolysiloxanes ; Follow-Up Studies ; Humans ; Male ; Methods ; Prostate ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Retrospective Studies ; Urethra ; Urinary Incontinence ; Urinary Retention

PURPOSE: Red cell distribution width (RDW) was introduced as a new biomarker for the prognosis of sepsis patients. In addition, the definition of sepsis has changed recently to sepsis-3 criteria. The aim of this study was to compare the efficacy of RDW as a prognostic factor for sepsis-3 patients in the emergency department. METHODS: We conducted a retrospective study of patients who were suspected of having sepsis between October, 2015 and April, 2016. The demographic data, comorbidities, blood test results, including RDW, lactate, C-reactive protein, and procalcitonin at admission, as well as the Mortality in Emergency Department Sepsis score were compared between the 30-day survivors and nonsurvivors. Analysis compared the areas under the receiver operator characteristic curves for 30-day mortality. Multivariate Cox proportional hazards regression analysis was performed to determine the risk factors for mortality. RESULTS: A total of 222 patients were included. The mean age was 75, 51.8% of the patient population was male, and the overall mortality rate was 16.7%. The non-survival group had higher RDW levels than the survivor group (14.5% vs 13.4%). The area under the receiver operating characteristic curve of RDW to predict mortality was 0.724. In a Cox proportional hazards analysis, RDW had 1.292 hazard ratio. Setting the RDW cutoff value to 14.3, we found that sensitivity and specificity of predicting mortality was 75.1% and 70.3%, respectively. CONCLUSION: It may be possible to use RDW to predict mortality in sepsis-3 patients.
C-Reactive Protein ; Comorbidity ; Emergencies* ; Emergency Service, Hospital* ; Erythrocyte Indices* ; Erythrocytes ; Hematologic Tests ; Humans ; Lactic Acid ; Male ; Mortality ; Prognosis ; Retrospective Studies ; Risk Factors ; ROC Curve ; Sensitivity and Specificity ; Sepsis ; Survivors

Granulosa cell tumor is a rare ovarian neoplasm. It's indolent growth leads to large tumor at time of diagnosis. It is characterized by variable and long interval to recurrence in pelvic and peritoneal cavities, but solitary retroperitoneal recurrence is very rare. At laparotomy, a 52-years-old woman was found to have an oval shaped cystic tumor near left renal hilar region. Ten years ago, she had total hysterectomy with bilateral salpingo-oophorectomy due to left ovarian granulosa cell tumor. Histological features of the retroperitoneal tumor were granulosa cell tumor. We report a rare case of solitary retroperitoneal recurrence of granulosa cell tumor with a review of relevant literatures.
Diagnosis ; Female ; Granulosa Cell Tumor* ; Granulosa Cells* ; Humans ; Hysterectomy ; Laparotomy ; Ovarian Neoplasms ; Recurrence*

BACKGROUND AND OBJECTIVES: In head and neck reconstructive surgery, the stability of vital signs is important for patient recovery and flap outcome. We aimed to determine the better sedation protocol by comparing two protocols, namaely, midazolam/morphine (MM)-based and remifentanil (RF)-based sedation protocols, in the immediate postoperative settings of head and neck reconstructive surgery. SUBJECTS AND METHOD: We retrospectively reviewed the medical data of patients who underwent reconstructive surgery after the ablation of head and neck cancer involving MM sedation (n=34) or RF sedation (n=28). Parameters related to vital signs, flap outcomes, occurrence of delirium, length of stay and nursing burden were compared between the groups. RESULTS: The length of stay at the intensive care unit and flap outcomes were similar in the two groups. However, blood pressure as measured by frequency of variation was more stable in the RF group than in the MM group. In addition, the number of medical calls from the attending nurse due to the fluctuation of vital signs was less in the RF group than in the MM group. CONCLUSION: RF-based sedation for the postoperative intensive care unit care after head and neck reconstructive surgery is more effective in cases where vital signs are less stable. This type of sedation may decrease the nursing burden for these patients.
Blood Pressure ; Delirium ; Free Tissue Flaps ; Head and Neck Neoplasms ; Head* ; Humans ; Intensive Care Units* ; Critical Care* ; Length of Stay ; Neck* ; Nursing ; Postoperative Care ; Retrospective Studies ; Vital Signs

OBJECTIVE: While the optic nerve sheath diameter (ONSD) is measured by computed tomography and ultrasonography as an indicator of an elevation in the intracranial pressure (ICP), it is unclear which ONSD measurement is useful for predicting an increased ICP. This study examined the comparability between the ONSD measured by computed tomography and ultrasonography. METHODS: A prospective study of 150 patients in the emergency center was performed. The ONSD was measured 3 mm behind the globe of all patients by computed tomography and ultrasonography. The receiver operator characteristic (ROC) curve was analyzed to determine the diagnostic utility of detecting ICP through ONSD. RESULTS: A total of 150 patients were enrolled. Thirty-three patients (22.0%) were found to have an increased ICP. The ONSD in patients with increased ICP was significantly higher than that of normal ICP patients measured by computed tomography and ultrasonography. Moreover, computed tomography and ultrasonography revealed an area under the ROC curve value of 0.886 and 0.933, respectively. The ONSD measurement by computed tomography and ultrasonography produced similar results (P=0.256). CONCLUSION: The ONSD measured by computed tomography and ultrasonography is a valuable indicator of an ICP elevation. Therefore, either of the two diagnostic methods for monitoring the ICP can be used in patients with a critical care and resource-limited setup.
Critical Care ; Emergencies ; Humans ; Intracranial Pressure ; Optic Nerve ; Prospective Studies ; ROC Curve ; Ultrasonography