A case report of a perforated choledochal cyst with bile peritonitis occurring in a 13-month old girl is presented. The perfortion was identified on the right lateral aspect of the common bile duct. And T-tube drainage was instituted. Episodes of ascending cholangitis followed pooling of the stagnant bile in the biliary system. Reoperation was recommended but in vain.
Bile* ; Biliary Tract ; Cholangitis ; Choledochal Cyst* ; Common Bile Duct ; Drainage ; Female ; Humans ; Infant* ; Peritonitis* ; Reoperation

BACKGROUND: In patients with severe chronic lung diseases even a small pneumothorax can result in life-threatening respiratory distress. It is important to treat the attack by chest tube drainage until the lung expands. Pneumothorax with a persistent air leak that does not resolve under prolonged tube thoracostomy suction is usually treated by open operation to excise or oversew a bulla or cluster of blebs to stop the air leak. Pleurodesis by the instillation of chemical agents is used for the patient who has persistent air leak and is not good candidate for surgical treatment. When the primary trial of pleurodesis with common agent fails, it is uncertain which agent should be used f or stopping the air leak by pleurodesis. It is well known tbat inappropriate drainage of hemothorax results in severe pleural adhesion and thickening. Based on this idea, some reports described a successful treatment with autologous blood instillation for pneumothorax patients with or without residual pleural space. We tried pleurodesis with autologous blood for pneumothorax with persistent air leak and then we evaluated the efficacy and safety. METHODS: Fifteen patients who had persistent air leak in the pneumothorax complicated from the severe chronic lung disease were enrolled. They were not good candidates for surgical treatment and doxycycline pleurodesis failed to stop up their air leaks. We used a mixture of autologous blood and 50% dextrose for pleurodesis. Effect and complications were assessed by clinical outcome, chest radiography and pulmonary function tests. RESULTS: The mean duration of air leak was 18.4 :1:6.16 days before ABP (autologous blood and dextrose pleurodesis) and 5.2 ± 1.68 days after ABP, The mean severity of pain was 2.3 ± 0.70 for DP(doxycycline pleurodesis) and 1.7 ± 0.59 for ABDP (p<0.05). There was no other complication except mild fever. Pleural adhesion grade was a mean of 0.6 ± 0.63. The mean dyspnea scale was 1.7 ± 0.46 before pneumothrax and 2.0 ± 0.59 after ABDP (p>0.05). The mean FEV1 was 1.47 ± 1.01 before pneumothorax and 1.44 ± 1.00 after ABDP (p>0.05). Exɡpt in 1 patient, 14 patients had no recurrent pneumothorax. CONCLUSION: Autologous blood pleurodesis (ABP) was successful for treatment of persistent air leak in the pneumothorax. It was easy and inexpensive and involved less pain than doxycycline pleurodesis. It did not cause complications and severe pleural adhesion. We report that ABP can be considered as a useful treatment for persistent air leak in the pneumothorax complicated from the severe chronic lung disease.
Blister ; Chest Tubes ; Doxycycline ; Drainage ; Dyspnea ; Fever ; Glucose ; Hemothorax ; Humans ; Lung ; Lung Diseases ; Pleurodesis* ; Pneumothorax* ; Radiography ; Respiratory Function Tests ; Suction ; Thoracostomy ; Thorax

PURPOSE: We performed this study to investigate the outcome of surfactant replacement therapy (SRT) in above nearterm neonates who were required mechanical ventilatory care due to meconium aspiration pneumonia (MAP), respiratory distress syndrome (RDS) or other severe pneumonia (PN). METHODS: 48 patients, gestational period 36 weeks, who were admitted in NICU of Dongsan Medical Center, Keimyung University between July 1999 and June 2004 were enrolled. They were divided into three groups, MAP group (15 cases), RDS group (27 cases) and PN group (6 cases). All patients were received SRT and evaluated several clinical data (gestational age, oxygen index, duration of ventilator care) and outcome (complications and mortality rate) between pre-SRT and post-SRT. The mean dose of surfactant (modified bovine surfactant, Newfacten, Yuhan Co., Seoul, Korea) was 120 mg/kg. RESULTS: Among each groups, mean pre-SRT OI was higher in MAP group (213.2) than other groups, mean duration (days) of ventilatory care and oxygen therapy were similar distributions. Compared with pre-SRT values, significant improvements (P<0.05) in mean values for FiO2 and oxygenation index were documented at 12 hours after SRT. Early complications (persistent pulmonary hypertension of newborm, pneumothorax) and survival rate were lower in MAP group. Within RDS group, earlier SRT (given before 12 hours of life) revealed significantly lower early complication rate than later SRT (given after 12 hours of life) (13.3% vs 58.3%, P<0.05) CONCLUSION: Our study suggested that SRT seems to be an effective therapy in above nearterm neonates with severe pulmonary disease, and earlier SRT tends to reduce complications in RDS group than later therapy.
Humans ; Hypertension, Pulmonary ; Infant, Newborn* ; Lung Diseases* ; Meconium Aspiration Syndrome ; Mortality ; Oxygen ; Pneumonia ; Seoul ; Survival Rate ; Ventilators, Mechanical

PURPOSE: To evaluate the results of using minimally invasive reduction techniques in patients with femoral subtrochanteric fracture. MATERIALS AND METHODS: We retrospectively analyzed 40 patients (41 cases) with subtrochanteric fracture who underwent using minimally invasive reduction techniques. The mean age was 61.4 years (15-89 years), and the mean follow-up period was 32.7 months (12-66 months). Clinical results were assessed using the Parker-Palmer mobility score and the Salvati-Wilson hip functional score. Radiographic results were evaluated using bone union time and femur neck-shaft angle. RESULTS: No significant difference was observed in the pre- and postoperative Parker-Palmer mobility score. Salvati-Wilson hip functional score showed more than good grade in 37 cases (90%) at the last follow-up. Union was achieved in all 41 cases at an average of 22.5 weeks (18-30 weeks). The mean femoral neck-shaft angle immediately postoperatively was 128.8 degrees (120-140 degrees), and the mean difference versus contralateral sides was 2.5 degrees varus (-6-13 degrees). CONCLUSION: Fixation of femoral subtrochanteric fracture using minimally invasive reduction techniques showed excellent clinical and radiographic results and low complication rate.
Femur ; Follow-Up Studies ; Hip ; Humans ; Retrospective Studies

Somatostatin analogue octreotide is commonly used for the treatment of carcinoid syndrome. Octreotide also has an antiproliferative effect in neuroendocrine tumors and has demonstrated tumor reduction in patients having advanced carcinoid tumor. This is a case report of a patient who had metastatic liver carcinoid tumor and showed marked regression of liver metastasis after octreotide therapy.
Carcinoid Tumor* ; Humans ; Liver ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Octreotide* ; Somatostatin

In this study, characteristics and immuno-modulatory effects of Weissella cibaria JW15 isolated from Kimchi, traditional Korean fermented food, were examined for investigation of the capacity of potentially probiotic strains. We measured acid, bile, and heat tolerance, adhesive properties to intestinal epithelial cells, and inhibitory activity against pathogens. JW15 could survive at pH 3.0 for 2 hr, but not at pH 2.0. JW15 also showed tolerance to 0.3% oxgall bile salt, and heat tolerance at 70degrees C and 80degrees C for 5 min, respectively. Adhesive ability to Caco-2 cells was similar to that of Lactobacillus rhamnosus GG (LGG), a well-known commercial probiotic. JW15 exhibited antimicrobial activities to pathogenic bacteria such as Escherichia coli, Listeria monocytogenes, Staphylococcus aureus, and Salmonella enteritidis. The immuno-modulatory effects of JW15 were compared with those of LGG, a well-known immune enhancer. For analysis, production of nitric oxide (NO), NF-kappaB (Nuclear factor kappaB), Interleukin-1beta (IL-1beta), and tumor necrosis factor-alpha (TNF-alpha) was measured. The concentration of NO induced by JW15 was higher than that by LGG at low concentration (1 x 10(7) cfu/mL). Low and high (5 x 10(7) CFU/mL) concentration of JW15 induced statistically higher production of NF-kappaB, IL-1beta, and TNF-alpha than that produced by LGG, respectively. In conclusion, Weissella cibaria JW15 had ability as a probiotic strain, including acid, bile, and heat tolerance, adhesive properties to intestinal epithelial cells, and inhibitory activity against pathogens. In addition, JW15 showed better immuno-modulatory effects than LGG when NO, NF-kappaB, IL-1beta, and TNF-alpha were measured. According to these results, the characteristics and immunomodulating activity of Weissella cibaria JW15 are suitable for consideration as a potential probiotic.
Adhesives ; Bacteria ; Bile ; Caco-2 Cells ; Epithelial Cells ; Escherichia coli ; Hot Temperature ; Humans ; Hydrogen-Ion Concentration ; Interleukin-1beta ; Korea* ; Lactobacillus rhamnosus ; Listeria monocytogenes ; NF-kappa B ; Nitric Oxide ; Probiotics* ; Salmonella enteritidis ; Staphylococcus aureus ; Tumor Necrosis Factor-alpha ; Weissella*

BACKGROUND: Myocardial contractile dysfunction is often noticed without myocardial infarction, it may be due to myocardial stunning or hibernation. There are several case reports of myocardial stunning in patients with variant angina, but effect of recurrent myocardial spasm on myocardial contratile function in human is not well established. METHODS: To evaluate the effect of recurrent spasm-induced myocardial ischemia on myocardial contractile function, we analyzed the ejection fraction(by area-length method) and regional wall motion(by centerline method) at before and after intracoronary nitroglycerin in variant angina group and control group. Variant angina group consisted of 15 patients(LAD ; 10 patients, RCA ; 5 patients) and normal control group consisted of 6 patients. RESULTS: Ejection fraction increment after nitroglycerin infusion was not significant in normal control group, but that in variant angina group was significant(p<0.05). Pre-NG shortening fraction of LAD territory on both RAO and LAO view in patients with spasm in LAD was significantly lower than that in patients without spasm in LAD(RAO ; p<0.05, LAO ; p<0.01). On LAO view pre-NG shortening fraction of LAD territory in 6 patients with spasm and without significant fixed lesion was lower than that in patients without spasm in LAD(p<0.05). Shortening fraction increment after nitroglycerin infusion in LAD territory on both RAO and LAO view was significant in patients with spasm in LAD(RAO ; 0.05, LAO ; p<0.01), but that in LCX or RCA territory and that in LAD territory of patients without spasm in LAD was not significant. Shortening fraction increment after nitroglycerin infusion in RCA territory on LAO view was significant in patients with spasm in RCA(p<0.05), but that in LAD or LCX territory and that RCA territory of patients without spasm in RCA and was not significant. CONCLUSION: These observations suggest that recurrent coronary artery spasm results in reversible dysfunction of the ventricular global and regional contractility, and myocardial stunning may be the cause of this phenmenon.
Coronary Vessels* ; Hibernation ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Myocardial Stunning ; Nitroglycerin ; Spasm*