Traditional surgical management of chylothorax refractory to conservative treatment is thoracic duct ligation through a right open thoracotomy. A new surgical procedure of ligation of the thoracic duct via extrapleural approach is presented. Its advantages are less invasive, no need of a new drainage tube, and easier to expose the thoracic duct than the conventional transthoracic approach. We experienced a new surgical method in the treatment of the chylothorax and report it with literatures.
Chylothorax* ; Drainage ; Ligation* ; Thoracic Duct* ; Thoracotomy

Langerhans cell histiocytosis (LCH), previously called histiocytosis X, refers to a spectrum of disease characterized by idiopathic proliferation of histiocytes producing focal or systemic manifestations. Causes and pathogenesis remain unclear. The basic histopatholgic findings are identical in the three well-established clinical syndromes (eosinophilic granuloma, Hand-Shuller-Christian disease, Letterer-Siwe disease). The disease has a predilection for children, although it may occur in adults. We experienced two cases of adult onset Langerhans cell histiocytosis in the ribs. One case was associated with diabetes insipidus and the other case had a solitary lesion.
Adult* ; Child ; Diabetes Insipidus ; Granuloma ; Histiocytes ; Histiocytosis ; Histiocytosis, Langerhans-Cell* ; Humans ; Ribs*

Reexpansion pulmonary edema is a rare complication of the treatment of lung collapse secondary to pneumothorax, pleural effusion, or atelectasis. But occasionally, severe morbidity and death may result. Reexpansion pulmonary edema occurs when chronically collapsed lung is rapidly reexpanded by evacuation of large amounts of air or fluid. In the treatment of the chronically collapsed lung, physicians must remember the possible events and prevent the complications. When the difference in airway resistance or lung compliance between the two lungs is exaggerated, conventional mechanical ventilation might lead to preferential ventilation with hyperexpansion of one lung and gradual collapse of the other. Differential ventilation has been advocated to avert this problem. By differential lung ventilation, we successfully treated a severe reexpansion pulmonary edema in two patients. Therefore we suggest that differential lung ventilation is the treatment of choice for severe reexpansion pulmonary edema.
Airway Resistance ; Humans ; Lung Compliance ; Lung* ; Pleural Effusion ; Pneumothorax ; Pulmonary Atelectasis ; Pulmonary Edema* ; Respiration, Artificial ; Ventilation*

BACKGROUND: We observed several cases of rare vascular anomalies within the femoral triangle during varicose vein operations. METHODS: From among 2,093 patients who underwent stripping operations of the great saphenous vein between January 2002 and June 2016, 14 cases of rare vascular anomalies were enrolled in this study. RESULTS: Twelve cases of femoral artery and vein transposition (0.57%), 1 case of separate entrance of the great saphenous vein trunk and its tributaries (0.05%), and 1 case of separate entrance with femoral artery and vein transposition (0.05%) were observed. The preoperative diagnosis rate was 71% (10 of 14) using duplex ultrasound. In all cases of femoral artery and vein transposition, the saphenofemoral junction was located at the lateral or posterolateral side of the superficial femoral artery, corresponding to complete or incomplete transposition, respectively. Among the 12 cases of femoral artery and vein transposition, 5 cases were complete transposition and 7 cases were incomplete transposition. In 2 cases of separate entrance of the great saphenous vein trunk and its tributaries, the separated tributaries formed a common trunk before connecting to the femoral vein. CONCLUSION: The anatomy of the saphenofemoral junction may infrequently be altered in some individuals. Detailed preoperative sonographic examinations and meticulous groin dissection during the operation are necessary to prepare for unexpected anatomical variations.
Diagnosis ; Femoral Artery ; Femoral Vein ; Groin ; Humans ; Saphenous Vein ; Ultrasonography ; Varicose Veins* ; Veins

Adult ; Airway Obstruction ; Emphysema ; Female ; Heart Failure ; Humans ; Mediastinal Emphysema ; Mediastinitis ; Mediastinum ; Molar, Third ; Pneumothorax ; Subcutaneous Emphysema ; Thorax ; Tracheostomy

Several investigators have described an interaction between muscle relaxants and hydrocortisones which have showed different results. The exact mechanism of this action is not clear and ther conflicting results have further confusion. The experimental methods were two ways. In the one of method, a group that vecuronium 0.1mg/kg was given intravenously is control and a group that hydrocortisones of various doses(0.3, 0.5 and 1 mg/kg) were administered into vein when T1 was appeared is compared. In the another of method, a control group was anticholinesterase(pyridostigmine 0.12 mg/kg, robinul 0.004mg/kg) were given at the time when T1 reached 25% and a group treated with hydrocortisone 0.5 mg/kg when T1 was appeared is compared. Neuromuscular blockade was measured by recording the twitch response following ulnar nerve stimulation by EMG(ABM, Datex Co. 2Hz 30mA supramaximal voltage). The recovery time from 25% to 75% recovery of twitch height was measured according to recovery index(RI). The results obtained were as follows: `) The RI of control group treated with vecuronium 0.1mg/kg alone was 40.32+/-20.24 minutes and the group which hydrocortisone 0.5mg/kg was combined, was shorten to 18.79+/-5.17 minutes, but in the group combined with hydrocortisone 1.0mg/kg and 0.3mg/kg, the RI was also tended to short, but not significant. 2) In the RI of vecuronium 0.1mg/kg, anticholinesterases were given, was 8.46+/-5.06 minutes and the group combined with hydrocortisone 0.5mg/kg was shorten to 4.77+/-1.82 minutes significantly. Conclusively, in the small doses of hydrocortisone, there is a effect of antagonism to the vecuronium induced blockade and a potentiated effect to the anticholinesterase activity to the vecuronium.
Cholinesterase Inhibitors ; Humans ; Hydrocortisone* ; Neuromuscular Blockade* ; Research Personnel ; Ulnar Nerve ; Vecuronium Bromide* ; Veins

BACKGROUND: Carolic restriction as a treatment for obesity causes catabolism of body protein stores and produces negative nitrogen balance. GH administration causes acceleration of lipolysis and promotion of nitrogen conservation. We evaluated the effects of GH treatment and caloric restriction on lipolysis, anabolic effects and body composition in obese subjects. METHODS: 24 obese (20% over IBW) subjects (22 women and 2 men; 22-46yr old) were fed a diet of 25kcal/kg IBW with 1.2g protein/kg IBW daily during treatment. The subjects were assigned at random to either treatment with recombinent human GH (n=12, 0.06U/kg IBW every other day) or placebo (n 12, vehicle injection) for 12 weeks. Body fat was assessed by impedence and abdominal fat, visceral fat area at the umbilicus level and muscle area of mid thigh level were measured using computed tomography. RESULTS: Fraction of body weight lost as fat lost was significantly greater in GH treatment than in placebo group (1.21+-0.48%/kg, vs 0.52+-0.28%/kg, p0.05). GH treatment caused significant decrease in visceral fat area (35.3% vs 28.5%, p<0.05). In placebo group, there were significant loss of muscle area (-4.8 +-2.6cm ) and lean body mass (-2.62 +-1.51kg) after treatment. In contrast, GH treatment group had more increase in muscle area (3.5+-2.3cm ) and lean body mass (1.13 +-1.04kg) and positive nitrogen balance (1.81+-4.06g/day). GH injections cuased a 1.6-fold increase in IGF-I, despite caloric restriction. GH responses to L-dopa stimulation were blunted in all subjects and GH responses were increased after treatment. Both group showed hyperinsulinemia during oral glucose tolerance test (OGTT), and after treatment, they had decreased in insulin secretion. However, GH treatmnent group had not significant decrease, because GH might induce insulin resistance. FFA response areas during OGTT markedly decreased after treatment in both group. In GH treatment group, more decrease of FFA responses might result from the antilipolytic effect by higher level of insulin or more decrease in amount of fat. CONCLUSION: This study has demonstrated that in obese subjects fed hypocaloric diet, GH accelerates body fat loss and exerts anabolic effects.
Abdominal Fat ; Acceleration ; Adipose Tissue ; Adult* ; Anabolic Agents ; Body Composition ; Body Weight ; Caloric Restriction ; Diet* ; Female ; Glucose Tolerance Test ; Growth Hormone* ; Humans ; Hyperinsulinism ; Insulin ; Insulin Resistance ; Insulin-Like Growth Factor I ; Intra-Abdominal Fat ; Levodopa ; Lipolysis ; Male ; Metabolism ; Nitrogen ; Obesity ; Thigh ; Umbilicus

PURPOSE: The accurate identification of renal cortical defects in children with urinary tract infection is essential in reducing subsequent morbidity. Imaging of the kidneys with 99mTc-dimercaptosuccinic acid (DMSA) has been demonstrated as the sensitive method available for identification of renal cortical defects. Single photon emission computerized tomography (SPECT) has been suggested as a method by which the accuracy of identification of renal cortical defects can be improved. The aim of this study was to assess the diagnostic value of the 99mTc-DMSA SPECT, comparing the detection rate of cortical defects identified from planar imaging and SPECT data. METHODS: 99mTc-DMSA SPECT, planar imaging and voiding cystourethrogram (VCUG) were performed in 76 patients diagnosed urinary tract infection at the department of pediatrics, Kyung Hee University Hospital, from March, 1994 to Feburary, 1995. Follow-up 99mTc-DMSA SPECT was done in 7 patients. RESULTS: 1) Overall detection rate of 99mTc-DMSA SPECT imaging was 32.9% (25/76), but, planar imaging showed cortical defects in 21.1% (16/76). 2) The patients with renal cortical defects in planar imaging showed all definite or more additional cortical defects in 99mTc-DMSA SPECT imaging. 3) Seven patients presented improvement in 4, no change in 2, and aggrevation in 1 on follow-up studies. 4) Incidence of renal cortical defects was higher in patients with vesicoureteral reflux (VUR); the detection rate was 83.3% (10/12). But, those of without VUR also presented high detection rate as 23.4% (19/60). 5) There is no correlation between renal cortical defects and urine culture findings. CONCLUSIONS: 99mTc-DMSA SPECT imaging is superior to planar imaging, thus 99mTc-DMSA SPECT is a useful initial diagnostic tool in children suggesting urinary tract infection, irrespective of VUR, to identify patients who need more extensive radiological studies and early treatment.
Child* ; Follow-Up Studies ; Humans ; Incidence ; Kidney ; Pediatrics ; Technetium Tc 99m Dimercaptosuccinic Acid* ; Tomography, Emission-Computed, Single-Photon* ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

The hepatopulmonary syndrome is defined as the triad of liver disease, an increased alveolar-arterial gradient while breathing room air, and evidence of intrapulmonary dilatation. Other cardiopulmonary abnormalities(such as pleural effusion or decreased lung volumes) are common and may coexist in patients with the hepatopulmonary syndrome. An abnormal dilatation of intrapulmonary capillaries is evidenced by Tc 99m-MAA perfusion scan, contrast-enhanced echocardiography, and pulmonary angiography. We have experienced a case of hepatopulmonary syndrome in a fi7 year old woman with liver cirrhosis who complained of severe dyspnea and cyanosis. Her arterial blood gas analysis (ABGA) showed severe hypoxemia(PaO2 59mmHg), suggesting the hepatopulmonary syndrome, which was confirmed with the contrast-enhanced echocardiography. It showed delayc4 opacification of left side chambers during agitated saline injection', thus, intrapulmonary shunt was confirmed. So we report a case of hepatopulmonary syndrome with a rewiew of literature.
Angiography ; Blood Gas Analysis ; Capillaries ; Cyanosis ; Dihydroergotamine ; Dilatation ; Dyspnea ; Echocardiography ; Female ; Hepatopulmonary Syndrome* ; Humans ; Liver Cirrhosis* ; Liver Diseases ; Liver* ; Lung ; Perfusion ; Pleural Effusion ; Respiration

OBJECTIVE: To analyze the methylenetetrahydrofolate reductase (MTHFR) mutation in patients with recurrent spontaneous abortion. MATERIAL AND METHOD: The blood samples of patients with recurrent spontaneous abortion were tested by PCR-RFLP method. RESULTS: Of 51 cases of study group, 14 (27.5%) were normal, 25 (49.0%) were heterozygosity, and 12 (23.5%) were homozygosity. Of 58 cases of control group, 20 (34.5%) were normal, 30 (51.7%) were heterozygosity, and 8 (13.8%) were homozygosity. But the difference between two groups was not significant (p=0.190). CONCLUSION: Hyperhomocysteinemia due to MTHFR mutation is a cause of recurrent spontaneous abortion. Therefore, the study for MTHFR mutation should be included in the workup of recurrent spontaneous abortion.
Abortion, Spontaneous* ; Female ; Humans ; Hyperhomocysteinemia ; Methylenetetrahydrofolate Reductase (NADPH2)* ; Pregnancy