Frequent anomalies causing a left-sided appendix are situs inversus and malrotation. The ectopic position of the appendix frequently causes a delay or error in diagnosis because of atypical symptoms. A physical examination is of limited value unless dextrocardia is present. A left-sided appendix is a rare anomaly, but when other diseases are ruled out, it must be considered especially at the emergency department.
Appendicitis* ; Appendix ; Dextrocardia ; Diagnosis ; Emergency Service, Hospital ; Physical Examination ; Situs Inversus

As an attempt to evaluate any possible effects of dimethylsulfoxide (DMSO) on the phenomena of membrane transport, effects on the short-circuit current (SCC) and potential difference (PD) across the isolated frog skin were studied under the conditions of various bathing medium, Changes of SCC and PD were measured by the method described by Ussing and Zerahn. Addition of DMSO to the inside bathing medium resulted in an initial increase in SCC followed by a secondary decline to pre-DMSO level, while DMSO at outside medium was without effect. Dose-responses(SCC) relationship revealed a linear one from 30 to 60 mM. Substitution of chloride by sulfate ion from bathing medium caused no alteration in the basic pattern and magnitude of response, thus indicating the specificity of DMSO action on the Na transport. Hypertonic solutions of DMSO added to either outer or inner bathing medium evoked a prompt fall in SCC and PD consistently. By isotopic measurement of sodium fluxes with Na24, it was evident that increased sodium influx was entirely responsible for the initial increase in SCC induced by DMSO. Of various parameters concerned with transepithelial Na transport, outer membrane permeability to Na (PoNa) was shown to be the onIy parameter which was significantly elevated by DMSO administration. From these findings, it was postulated that DMSO-induced increment in sodium influx was mediated by its stimulating action on the sodium penctration through the outer permeability barricr after binding to a receptor site different from that for the antidiuretic hormone (ADH.)
Baths ; Dimethyl Sulfoxide* ; Hypertonic Solutions ; Membranes ; Permeability ; Sensitivity and Specificity ; Skin* ; Sodium*

Effect of infusion and bolus injection of lidocaine on the pressure response to the increased intracranial pressure(ICP) was investigated in urethane-anesthetized rabbits. 1) Arterial blood pressure(BP) and ICP were significantly raised by infusing saline(0.05ml/min) into an epidural balloon. 2) Infusing of lidocaine(0.5mg/kg/min) into an ear vein minutely inhibited the elevation of BP and ICP when infusing saline into an epidural balloon. However, infusion of lidocaine(1.5mg/kg/min) markedly inhibited the elevation of BP and ICP. 3) Repeating the infusion of saline into the epidural balloon with intervals, the duration reached to the level of 80-10 mmHg ICP was gradually shortened. Each depressor response to the first, second and third injection of lidocaine(3 mg/kg) was similar. The first injection transiently reduced the elevated ICP, but the second and third injection reduced that significantly and the reducing effect was gradually prolonged according to repeating the lidocaine injection. These results show that lidocaine could delay the elevation of ICP and reduce the previously increased ICP by infusing saline into an epidural balloon.
Ear ; Intracranial Hypertension* ; Lidocaine* ; Rabbits* ; Veins

A fine needle aspiration biopsy specimen of a retroperitoneal mass in a 26-year-old man who had had an orchiectomy for seminoma was submitted for cytologic evaluation. Cytologic features of the specimen included uniform neoplastic cells found singly or in groups of several cells intermingled with lymphocytes in a characteristic foamy, lacelike background. These cells varied from 10 to 20 m in diameter. The nuclei were round to ovoid with fine or reticular chromatin and one or more prominent nucleoli. The poorly defined cytoplasm stained pale-blue or blue with cytoplasmic vacuoles. The cytologic appearance was consistent with seminoma. Documented reports of the cytological appearance of seminoma are rare. The diagnosis of primary gonadal seminoma by fine needle aspiration biopsy is probably not indicated since the treatment of a primary gonadal tumor, regardless of its histogenesis, requires surgical resection. However, fine needle aspiration biopsy is extremely valuable in the diagnosis of extragonadal as well as metastic and recurrent seminoma.
Adult ; Biopsy ; Biopsy, Fine-Needle ; Chromatin ; Cyclosporine* ; Cytoplasm ; Diagnosis ; Endothelin-1* ; Gonads ; Humans ; Liver ; Lymphocytes ; Nephrosis, Lipoid* ; Orchiectomy ; Plasma* ; Seminoma ; Vacuoles

Reports of osteomyelitis in the proximal humerus with pyogenic glenohumeral arthritis of adjacent joints mostly involve pediatric patients. Nowadays, osteomyelitis that is secondary to adjacent pyogenic glenohumeral arthritis is extremely rare, even more so in adults than in pediatrics. We report a rare case of the pyogenic glenohumeral arthritis followed by osteomyelitis of the proximal humerus in an elderly patient. Initially, we diagnosed a case of pyogenic glenohumeral arthritis only, which, despite arthroscopic synovectomy, did not resolve and severe pain continued. Subsequent radiological imaging, performed after our suspicion of a secondary involvement, allowed us to diagnose osteomyelitis combined with the pyogenic glenohumeral arthritis, which we had overlooked because of the extreme rarity of the condition in adults since the antibiotic era began.
Adult ; Aged* ; Arthritis* ; Arthritis, Infectious ; Humans ; Humerus* ; Joints ; Osteomyelitis* ; Pediatrics ; Shoulder

Small cell osteosarcoma is a rare form of osteosarcoma and the histological differential diagnosis from other small round cell tumors (SRCTs) is difficult. The immunohistochemical stain for MIC2 has been considered an useful diagnostic marker for Ewing's sarcoma and primitive neuroectodermal tumors but recently, other SRCTs such as malignant lymphoma and embryonal rhabdomyosarcoma also showed positive reaction. Therefore, the usefulness of MIC2 must still be proven. We experienced a case of small cell osteosarcoma of the mandible in a 25-year-old man. Histologically, the tumor consisted of small round cells that resembled those of Ewing's sarcoma. Immunohistochemically, the tumor cells expressed diffuse strong positive reaction for MIC2 gene products. However, the scanty foci of lacy osteoid material between the tumor cells seemed to be diagnostic of osteosarcoma. The histologic and immunohistochemical findings of this case suggest close relationship between small cell osteosarcoma and Ewing's sarcoma.
Adult ; Diagnosis, Differential ; Humans ; Lymphoma ; Mandible ; Neuroectodermal Tumors, Primitive ; Osteosarcoma* ; Rhabdomyosarcoma, Embryonal ; Sarcoma, Ewing*

The influence of intravesica1 pressure on urine for-mation was studied in dogs and rabbits prepared with ureteral fistulae and in man following ureteral cathe-terization. Reduction of urinary output following distension of the bladder occurred in all except two dogs. The mean rate of reduction in sixteen dogs was 37.3 +/- 4.9 per cent. The response was not blocked by tetracaine applied to the bladder mucosa or by systemic hexamethonium. The renal blood flow showed a significant reduction following distension of the bladder. After denervation or celiac ganglionectomy, the reduction of urinary output or of renal blood flow was prevented in the ipsilateral kidney. Coloring of the renal cortex by intravenously injected indigo carmine does not occur in animals with distended bladders. Adrenaline and serotonin produced and enhanced the effect on the urinary response of the distended bladder. The injection of a small amount of blood or urine from animals with distended bladders into undistended animals produced a significant decrease in urine formation in the recipients. In five human subjects, a marked reduction of urine flow was noted following bladder distension. We conchlde that the intravesical pressure may regulate the formation of urine through a short vesico-renal reflex mediated by the celiac ganglion and through a long vesico-hypothalamic reflex which releases the antidiuretic hormone.
Animals ; Denervation ; Dogs ; Epinephrine ; Fistula ; Ganglia, Sympathetic ; Ganglionectomy ; Hexamethonium ; Humans ; Indigo Carmine ; Kidney ; Mucous Membrane ; Rabbits ; Reflex ; Renal Circulation ; Serotonin ; Tetracaine ; Ureter ; Urinary Bladder

PURPOSE: The ictal perfusion patterns of cerebellum and basal ganglia have not been systematically investigated in patients with temporal lobe epilepsy (TLE). Their ictal perfusion patterns were analyzed in relation with temporal lobe and frontal lobe hyperperfusion during TLE seizures using SPECT subtraction. MATERIALS AND METHODS: Thirty-three TLE patients had interictal and ictal SPECT, video-EEG monitoring, SPGR MRI, and SPECT subtraction with MRI co-registration. RESULTS: The vermian cerebellar hyperperfusion (CH) was observed in 26 patients (78.8%) and hemispheric CH in 25 (75.8%). Compared to the side of epileptogenic temporal lobe, there were seven ipsilateral hemispheric CH (28.0%), fifteen contralateral hemispheric CH (60.0%) and three bilateral hemispheric CH (12.0%). CH was more frequently observed in patients with additional frontal hyperperfusion (14/15, 93.3%) than in patients without frontal hyperperfusion (11/18, 61.1%). The basal ganglia hyperperfusion (BGH) was seen in 11 of the 15 patients with frontotemporal hyperperfusion (73.3%) and 11 of the 18 with temporal hyperperfusion only (61.1%). In 17 patients with unilateral BGH, contralateral CH to the BGH was observed in 14 (82.5%) and ipsilateral CH to BGH in 2 (11.8%) and bilateral CH in 1 (5.9%). CONCLUSION: The cerebellar hyperperfusion and basal ganglia hyperperfusion during seizures of TLE can be contralateral, ipsilateral or bilateral to the seizure focus. The presence of additional frontal or basal ganglia hyperperfusion was more frequently associated with contralateral hemispheric CH to their sides. However, temporal lobe hyperperfusion appears to be related with both ipsilateral and contralateral hemispheric CH.
Basal Ganglia* ; Cerebellum* ; Epilepsy, Temporal Lobe* ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; Perfusion ; Seizures ; Temporal Lobe* ; Tomography, Emission-Computed, Single-Photon

OBJECTIVES: The present study was performed to investigate whether estrogen and progesterone induce the change of vascular tone in endothelium-denuded human uterine artery and vascular reactivity may be mediated by intracelluar calcium modulation through receptor- and voltage-dependent calcium channels. METHODS: The uterine arteries were obtained at the time of hysterectomy from 28 women followed by denudation of endothelium. After confirmation of functional integrity of endothelium-denuded uterine artery, vascular reactivity was measured by using isometric force transducer and recorded by physiograph. Contraction was induced by 10-6 M norepinephrine and 35mM high concentrated potassium chloride solution which activated receptor-dependent calcium channel and voltage-dependent calcium channel, respectively.Thereafter estradiol of 4 different concentrations from 3x10-11M to 3x10-8M was administered. Progesterone was also administered to endothelium-denuded uterine artery which was contracted by 10-6M norepinephrine and high potassium chloride solution. To evaluate the effect of additional progesterone on vascular smooth muscle relaxation effect of estrogen,4 different progesterones in concentrations from 3x10-8M to 3x10-5M were given to vascular smooth muscle which was initially pretreated with norepinephrine followed by relaxation of estradiol. RESULTS: Estradiols from 3x10-11M to 3x10-8M showed in significant dose-dependent vascular relaxation. Progesterones result in significant decrease in vascular contraction in concentration dependent manner. Additional progesterone on estrogenic effects also results in significant decrease in vascular contraction. CONCLUSION: Estradiol may have endothelium independent vasorelaxation effect in human uterine artery. These vasorelaxant effects may be mediated through antagonistic action for receptor-and voltage-dependent calcium channels in vascular smooth muscle. Progesterone also bring about vasorelaxation by same action in endothelium-denuded vascular smooth muscle. On estrogen induced vascular relaxation, progesterone results in additional vasorelaxation.
Calcium ; Calcium Channels ; Endothelium ; Estradiol ; Estrogens* ; Female ; Humans* ; Hysterectomy ; Muscle, Smooth, Vascular ; Norepinephrine ; Potassium Chloride ; Progesterone* ; Relaxation ; Transducers ; Uterine Artery* ; Vasodilation

Osteomalacia is a disorder in which the mineralization of the organic matrix of the skeleton is defective. Proximal muscular weakness is a common symptom of osteomalacia. A 27-year-old woman reported the gradual onset of gait disturbance and bone pain in the thigh. Her height shortened during 10 months. On neurological examinations, proximal muscular weakness of the extremities was disclosed. Serum phosphorus was 1.8 mg/dl (normal 2.5~4.5), alkaline phosphatase was 1045 IU/L (normal 70~290), and 1,25 (OH)2 vitamin D3 was 18 pg/ml (normal 20~60). On roentgenography, multiple pseudofracture lines of the rib and erosion of the head of the right femur were demonstrated. A bone scan showed multiple hot spots on the ribs and right femur. She was medicated with calcitriol and phosphorus and she recovered most of her strength and experienced decreased bone pain after 3 months. We report a case that confirms osteomalacic myopathy by an endocrinological test in patients who experienced gradual proximal muscular weakness and bone pain.
Adult ; Alkaline Phosphatase ; Calcitriol ; Cholecalciferol ; Extremities ; Female ; Femur ; Gait ; Head ; Humans ; Muscle Weakness ; Muscular Diseases* ; Neurologic Examination ; Osteomalacia ; Phosphorus ; Radiography ; Ribs ; Skeleton ; Thigh