No abstract available.
Fever*

No abstract available.
Seroepidemiologic Studies*

BACKGROUND: Pneumoperitoneum for laparoscopic cholecystectomy induces prompt hemodynamic changes. The rapid onset of these changes suggests a neurohumoral response. The present study investigated the effects of pneumoperitoneum on plasma catecholamines and vasopressin during laparoscopic cholecystectomy. METHODS: We studied 18 healthy patients under general anesthesia using a isoflurane and nitrous oxide (50%). In our study, nine patients were selected for Group LC; they underwent the laparoscopic cholecystectomy. The remaining nine patients constituting Group OS served as the control, and underwent minor orthopedic surgery. Venous blood samples were collected 10 minutes after the induction of anesthesia, as well as 10 minutes after the insufflation of pneumoperitoneum or skin incision, and 10 minutes after desufflation of pneumoperitoneum or skin closure. Plasma vasopressin was measured using a radioimmunoassay method. Plasma epinephrine and norepinephrine were measured using the method of high-performance liquid chromatography. RESULTS: In Group LC, the plasma concentration of vasopressin increased remarkably from 2.1 pg/ml to 70.7 pg/ml after insufflation of pneumoperitoneum, and declined to 18.3 pg/ml after desufflation (P < 0.05). Plasma concentrations of epinephrine and norepinephrine also increased significantly after insufflation of pneumoperitoneum (P < 0.05). In Group OS, however, plasma concentrations of vasopressin, epinephrine, and norepinephrine remained stable throughout the operation. CONCLUSIONS: The pneumoperitoneum resulted in a substantial increase of plasma concentrations of vasopressin as well as a signifiant increase in the plasma concentration of epinephrine and norepinephrine during laparoscopic cholecystectomy.
Anesthesia ; Anesthesia, General ; Catecholamines* ; Cholecystectomy, Laparoscopic ; Chromatography, Liquid ; Epinephrine ; Hemodynamics ; Humans ; Insufflation ; Isoflurane ; Nitrous Oxide ; Norepinephrine ; Orthopedics ; Plasma* ; Pneumoperitoneum* ; Radioimmunoassay ; Skin ; Vasopressins*

BACKGROUND: Pneumoperitoneum for laparoscopic cholecystectomy induces prompt hemodynamic changes. The rapid onset of these changes suggests a neurohumoral response. The present study investigated the effects of pneumoperitoneum on plasma catecholamines and vasopressin during laparoscopic cholecystectomy. METHODS: We studied 18 healthy patients under general anesthesia using a isoflurane and nitrous oxide (50%). In our study, nine patients were selected for Group LC; they underwent the laparoscopic cholecystectomy. The remaining nine patients constituting Group OS served as the control, and underwent minor orthopedic surgery. Venous blood samples were collected 10 minutes after the induction of anesthesia, as well as 10 minutes after the insufflation of pneumoperitoneum or skin incision, and 10 minutes after desufflation of pneumoperitoneum or skin closure. Plasma vasopressin was measured using a radioimmunoassay method. Plasma epinephrine and norepinephrine were measured using the method of high-performance liquid chromatography. RESULTS: In Group LC, the plasma concentration of vasopressin increased remarkably from 2.1 pg/ml to 70.7 pg/ml after insufflation of pneumoperitoneum, and declined to 18.3 pg/ml after desufflation (P < 0.05). Plasma concentrations of epinephrine and norepinephrine also increased significantly after insufflation of pneumoperitoneum (P < 0.05). In Group OS, however, plasma concentrations of vasopressin, epinephrine, and norepinephrine remained stable throughout the operation. CONCLUSIONS: The pneumoperitoneum resulted in a substantial increase of plasma concentrations of vasopressin as well as a signifiant increase in the plasma concentration of epinephrine and norepinephrine during laparoscopic cholecystectomy.
Anesthesia ; Anesthesia, General ; Catecholamines* ; Cholecystectomy, Laparoscopic ; Chromatography, Liquid ; Epinephrine ; Hemodynamics ; Humans ; Insufflation ; Isoflurane ; Nitrous Oxide ; Norepinephrine ; Orthopedics ; Plasma* ; Pneumoperitoneum* ; Radioimmunoassay ; Skin ; Vasopressins*

The complications of bile duct stone are cholangitis, pancreatitis, obstructive jaundice, liver abscess, and secondary biliary cirrhosis. Liver abscess may produce pyothorax, peritonitis, subphrenic abscess, and pyogenic pericarditis. The case studies of pyogenic pericarditis secondary to pyogenic liver abscess are rarely reported. Stones greater than 20mm in diameter are difficult or impossible to remove with a standard basket or balloon after sphincterotomy. There are several nonsurgical treatment options for large bile duct stone: mechanical lithotripsy, endoprosthesis, extracorporeal shock-wave lithotripsy (ESWL), electrohydraulic lithotripsy, contact dissolution therapy, and laser lithotripsy. We experienced a case of large bile duct stone which complicated by pyogenic pericarditis, liver abscess, and pyothorax. He treated with antibiotics, closed thoracostomy, partial pericardiectomy, and removal of bile duct stones by extracorporeal shock-wave and mechanical lithotripsy after endoscopic sphincterotomy and nasobiliary drainage.
Anti-Bacterial Agents ; Bile Ducts* ; Bile* ; Cholangitis ; Drainage ; Empyema ; Empyema, Pleural* ; Jaundice, Obstructive ; Lithotripsy ; Lithotripsy, Laser ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver Cirrhosis, Biliary ; Liver* ; Pancreatitis ; Pericardiectomy ; Pericarditis* ; Peritonitis ; Sphincterotomy, Endoscopic ; Subphrenic Abscess ; Thoracostomy

Dieulafoy lesion is very small and easily overlooked as a course of massive, often recurrent hemorrhage that results from the crosion of a submucosal artery, typically in the gastric cardia or fundus. The clinical picture of Dieulafoy lesion is quite uniform: patients commonly present with massive hemorrhage and melena without any relevant history. The diagnostic procedure of choice in patients with severe gastrointestinal bleeding is emergency endoscopy. The lesion is rare but potentially life threatening source of upper gastrointestinal bleeding. Before the endoscopic era, the prognosis for patients with these lesions was quite poor. However, recent reports have described the success of endoscopic therapy in the management of Dieulafoy lesion. We performed emergency endoscopy in 3 patients who had massive or recurrent episode of upper gastrointestinal bleeding, identified to the Dieulafoy lesion. We tried to Endoscopic "0" band ligation, successfully in hemostasis and prevention of recurrence.
Arteries ; Cardia ; Emergencies ; Endoscopy ; Gastrointestinal Hemorrhage ; Hemorrhage ; Hemostasis ; Humans ; Ligation* ; Melena ; Prognosis ; Recurrence

Endoscopic sphincterotomy(EST) is now an established therapeutic procedure for various disorder of the pailla of Vater, the biliary tract, and the pancreas. From November 1992 to September l993, 123 cases of E.S.T were performed in our hospital. The success rate of EST was 97.8%, and choledocholithiasis was the indication for EST in 63. 4% of cases. Among 78 cases of choledocholithiasis, 47 cases were presence of gall bladder with stone (16 cases) or without stone (31 cases), especially 46 cases were assisted with needle type papillotome and 23 cases were assisted with guidewire. EST hae relatively low complications and is the therapy of choice for choledocholithiasis and various diisease of biliary tract. Guidewire assisted stanard papillotome probable reduce the use of needle type papillotome in the difficult cases that EST with pull type papillotome was impossible.
Biliary Tract ; Choledocholithiasis ; Needles ; Pancreas ; Sphincterotomy, Endoscopic* ; Urinary Bladder

Aniskiasis is caused by the accidental infestation of human by larvae of marine mammals found in saltwater fish and squid. The clinical picture may be severe enough to stimulate an acute surgical abdomen. More commonly, colicky pain, diffuse abdominal tenderness, nausea, vomiting, fever, and leukocytosis are seen. Gastroscopically, 2-to 4-cm larvae can be seen penetrating the mucosa. More characteristically, the larvae burrow into the mucosa of the stomach. Here they produce eosinophilic granulomatous tumors with edema, thickening, and induration which may be mistaken for gastric canceer. The pathalogic changes are thought to be the result of a hypersensitivity reaction. We report a case of chronic gastric anisakiasis, which was diagnosed as submucosal tumor with massive bleeding.
Abdomen ; Anisakiasis* ; Abdominal Pain ; Decapodiformes ; Edema ; Eosinophils ; Fever ; Hemorrhage* ; Humans ; Hypersensitivity ; Larva ; Leukocytosis ; Mammals ; Mucous Membrane ; Nausea ; Stomach ; Vomiting

PURPOSE: One of the most difficult problems in the care of children with nephrotic syndrome remains the occurrence of relapses, despite initial response to steroids. Constantinescu reported that rapidity of initial response to steroid therapy could predict fewer relapses in the first year. So we evaluated the changes in serum lipid abnormalities in children with corticosensitive nephrotic syndrome before steroid treatment and the correlation between serum lipid levels and renal function, days to remission. METHODS: We analyzed the medical records of children who were managed by us between October 1994 and August 2000. In 33 patients with corticosensitive nephrotic syndrome, we evaluated the correlation between serum lipid levels and renal function [Creatinine clearance(Ccr)] and proteinuria before steroid treatment, and days to remission defined as the third day when the patient`s urine becomes protein free. RESULTS: There were 21 males and 12 females. Median age at presentation was 6.4 years (range: 1.8-17.3 years). Median days to remission were 15.4 days (range 4-42 days) on Prednisolone 60mg/m2 daily. The increased levels of triglyceride, total cholesterol, LDL cholesterol, apolipoprotein B, total cholesterol/HDL cholesterol, Lipoprotein(a) were observed. But the level of HDL cholesterol was not increased. Serum albumin was decreased and proteinuria was increased before steroid treatment. But Ccr was not decreased. There were negative correlation between serum albumin and total cholesterol (r = -0.5157, P<0.005), LDL cholesterol (r = -0.5543, P<0.005), total cholesterol/HDL cholesterol (r = -0.4506, P<0.01), lipoprotein(a) (r = -0.4570, P<0.025), apolipoprotein B (r = -0.5297, P<0.025), apolipoprotein B/apolipoprotein A1 (r = -0.5851, P<0.01), apolipoprotein B/HDL cholesterol (r = -0.4961, P<0.05) before steroid treatment. There was no correlation between proteinuria and serum lipid profiles. Also Ccr and serum lipid profiles were not correlated. There was positive correlation between days to remission and HDL cholesterol (r = +0.4511, P<0.05), apolipoprotein B (r = +0.5190, P<0.05), apolipoprotein B/HDL cholesterol (r = +0.7169, P<0.005). CONCLUSIONS: This results reveal that HDL cholesterol, apolipoprotein B and apolipoprotein B/HDL cholesterol can be used as a predictive factor in corticosensitive nephrotic syndrome. We could not determine the significant level of these lipids for insufficient patients number, but these level may predict future relapses of corticosensitive nephrotic syndrome patients and thus may allow to better management and treatment protocols. More data and long term follow up studies should be needed.
Apolipoproteins ; Child ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Female ; Follow-Up Studies ; Humans ; Hyperlipidemias* ; Lipoprotein(a) ; Male ; Medical Records ; Nephrotic Syndrome* ; Prednisolone ; Proteinuria ; Recurrence* ; Serum Albumin ; Steroids ; Triglycerides

A 56 year old female was admitted because of the right upper quadrant mass for 4 days. She complained of intermittent colicky RUQ pain, fever and chills. So diagnostic procedures was performed: Blood chemistry testings. Ultrasonography. Barium enema, Liver scan, Hepatobiliary scan, ERCP and Abdomen CT, which diagnosed as gall bladder carcinoma. So explolaparotomy was performed and gross operative finding was gall bladder carcinoma with metastatic lymph node and cystic duct stone. So cholecystectomy, hemigastrectomy and anterior segmentectomy of right liver was done. But the biopsy result was cystic duct stone, cholecystitis and gall bladder empyema.
Abdomen ; Barium ; Biopsy ; Chemistry ; Chills ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystitis* ; Cystic Duct* ; Enema ; Female ; Fever ; Humans ; Liver ; Lymph Nodes ; Mastectomy, Segmental ; Middle Aged ; Ultrasonography ; Urinary Bladder