Insulinoma is the most frequent endocrine tumor of the pancreas and the first of the endocrine-secreting tumor of the gut to be recognized by Nicholls in 1902. Recurrent episodes of hypoglycemia is the main cause of the symptoms and signs which were sweating, pallor, dizziness, habitual change, convulsion and coma. In 1935, Whipple and Frants were described so-called “Whipple's triad”: the patient's symptoms occur with fasting or exercise; at the time of symptoms, the serum glucose in 50mg/dl or less; and the symptoms are relieved by the administration of glucose. While these criteria were timely, they proved to be rather nonspecific and may be found in other conditions that result in fasting hypoglycemia. We experienced a 44-year-old female patient who had repeated attacks of convulsion, unconsciousness and coma for 3 years. Although she has been treated with anticonvulsant, the symptoms and signs were not disappeared. At the time of administration, she was a full coma state due to hypoglycemia and was dramatically reversed by intravenous administration of the glucose solution. The preoperative test such as provocative test, abdominal CT and celiac angiography revealed insulinoma and after enucleation the pathologic diagnosis was the same. We like to report an adult female patient with insulinoma and the review of literatures briefly.
Administration, Intravenous ; Adult ; Angiography ; Blood Glucose ; Coma ; Diagnosis ; Dizziness ; Fasting ; Female ; Glucose ; Humans ; Hypoglycemia ; Insulinoma* ; Pallor ; Pancreas ; Seizures ; Sweat ; Sweating ; Tomography, X-Ray Computed ; Unconsciousness

No abstract available.
Blepharoptosis*

No abstract available.
Meconium* ; Peritonitis*

To evaluate the efficacy of the retroperitoneal approach when compared with the transperitoneal approach in elective infrarenal aortoiliac reconstruction, retrospective review of consecutive cases was made with multiple intra-and postoperative parameters. Twenty consecutive cases of infrarenal aortoiliac diseases were performed reconstructive surgery from June 1994 to July 1996 at Department of Surgery, Yeungnam University Hospital. Among these patients, 12 cases underwent aortoiliac reconstruction through the transperitoneal approach(8 cases for infrarenal abdominal aortic occlusion and 4 cases for infrarenal abdominal aneurysm) and 8 cases underwent aortoiliac reconstruction through the retroperitoneal approach (5 cases for infrarenal abdominal aortic occlusion and 3 cases for infrarenal abdominal aortic aneurysm). Both groups had similar associated diseases, such as hypertension, myocardial ischemia and COPD. Intraoperative blood loss was minimal and similar in both groups. The intraoperative crystalloid requirements were not significantly higher for the retroperitoneal approach(4800 ml) than the transperitoneal approach(4400 ml)(p>0.05) and perioperative blood requirements were also similar in both groups. The operation time was not taken significantly longer for the retroperitoneal approach(4.4hr) than the trasperitoneal approach(3.9hr)(p>0.05). Nasogastric intubation and initiation of oral feeding was not significantly prolonged in the transperitoneal group(5 days) when compared with the petroperitoneal group(2.5 days)(p>0.05). Postoperative hospitalization was not considerably prolonged in the transperitoneal approach(19 days) when compared with the retroperitoneal approach(16 days)(p>0.05). There noted significant pulmonary complication in the transperitoneal approach group, whereas wound pain was major complication in the retroperitoneal approach group. These experiences demonstrate that the retroperitoneal approach is a preferable alternative to the transperitoneal route in elective aortoiliac reconstruction.
Aorta, Abdominal ; Hospitalization ; Humans ; Hypertension ; Intubation, Gastrointestinal ; Myocardial Ischemia ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Wounds and Injuries

PURPOSE: There is growing evidence that thrombosis and inflammation are closely interrelated and that the inflammatory response may play a role in the development of the syndrome of post-thrombotic, chronic venous insufficiency. A thrombus contains biologically active factors that stimulate cellular and structural alterations and lead to post-thrombotic venous abnormalities. Prolonged exposure to thrombus may result in the development of more severe pathologic conditions. To assess the effect of prolonged thrombus exposure on the development of secondary venous wall changes, the level of D-dimer test and the microscopic findings of thrombosed vein were analyzed in a rat venous thrombosis model. METHOD: The left iliac vein of male Sprague-Dawley rats weighing of 250 to 300 gm were thrombosed by means of either proximal ligation or temporary 24-hour occlusion with a microvascular clamp. The rats were divided into three groups: control group (n=10), thrombosis model by proximal ligation of the iliac vein only; group A (n=10), thrombosis model by proximal ligation of the iliac vein with treatment of low molecular weight heparin (LMWH; Clexane(r) 0.5 mg/kg, s.c.b.i.d); and group B (n=10), thrombosis model by temporary 24-hours clamp of the iliac vein without treatment of LMWH. The vein located 2 cm below from the initial ligation was harvested at time intervals of 7 and 14 days after ligation or clamp. Thrombi were identified by gross findings and indirectly quantitated with D-dimer test. RESULT: The levels of D-dimer test on days 7 and 14 after ligation or occlusion were significantly higher in the control group than in groups A and B (P<0.05). However, gross findings of intraluminal thrombosis were not present only in group B. These findings suggest that injection of LMWH did not prevent the development of thrombi around the ligation area. The neutrophilic infiltration of the perivascular area was evaluated microscopically (Hematoxylin-Eosin stain, x100). Severe perivascular neutrophilic infiltration was found in the control group and group A, whereas in group B neutrophilic infiltration was decreased to a mild or moderate degree. The vein wall thickness was evaluated by counting cells on representative sections through the mid vein area and by direct measuring of the vein wall usinga scale bar. The rat vein walls on days 7 and 14 were significantly thicker in the control group and group A than in group B (P<0.05). CONCLUSION: These results suggest that prolonged exposure of thrombus plays a major role in the development of secondary venous wall changes. However, the injection of LMWH did not prevent the development of secondary venous wall changes during the prolonged exposure of thrombus.
Animals ; Heparin, Low-Molecular-Weight ; Humans ; Iliac Vein ; Inflammation ; Ligation ; Male ; Neutrophils ; Rats* ; Rats, Sprague-Dawley ; Thrombosis* ; Veins ; Venous Insufficiency ; Venous Thrombosis*

Noninvasive techniques of antenatal detection of the fetal development and well-being such as biophysical profile, non-stress and stress remain major challenges in modern obstetric practice. To obtain and analyze umbilical artery velocity waveform by pulsed-wave doppler ultrasound, a total of 160 determinations were carried out on 157 normal pregnant women between 16th to 41st week gestation. The ratio of peak systolic to end-diastolic flow velocity (S/D ratio), pulsatility index and resistance index were measured as indices of the resistance in feto-placental circulation. The results were as follows: As gestation advances, the mean values for peak systolic and end-diastolic velocities raised progressively. As gestation advances, the mean values for the S/D ratio declined progressively, exhibiting high diastolic flow velocity caused by low resistance. Pulsatility index, and resistance index were also declined progressively, as gestation advances. The analysis of umbilical artery blood flow velocity waveforms provides a new noninvasive technique to evaluate fetal development and well-being, and may be expected a reliable method for assessment of fetal life.
Blood Flow Velocity* ; Female ; Fetal Development ; Humans ; Methods ; Pregnancy* ; Pregnant Women ; Ultrasonography ; Umbilical Arteries*

Mucosal bridge, endoscopically observed as a cord-like mucosal connection across the lumen, looking like a bridge, may infrequently arise anywhere from the esophagus to the colon. Mucosal bridges have been more frequently reported in the colon than in the esophagus, stomach, and duodenum. The causes of the mucosal bridge are congenital origin or acquired origin as the inflammatory diseases. We experienced a 49-year-old male patient who had multiple esophageal diverticula with mucosal bridges. We report this case with a review of relevant literatures.
Colon ; Diverticulum ; Diverticulum, Esophageal* ; Duodenum ; Endoscopy ; Esophagus ; Humans ; Male ; Middle Aged ; Stomach

BACKGROUND AND PURPOSE: Compression of the anterior optic pathway results in visual deficits that can lead to the detection of unruptured aneurysms in the internal carotid artery (ICA). The general types of treatment modalities for aneurysms and visual deficits include surgery and endosaccular coiling. This study retrospectively analyzed and compared the resolution of visual deficits following surgery or endosaccular coiling. METHODS: We reviewed data on 33 patients with unruptured ICA aneurysms who presented with visual field deficits caused by mass effects over the anterior optic pathway. Statistical analyses were performed to identify the variables associated with the recovery of visual symptoms. RESULTS: Eighteen patients underwent aneurysm clipping, 2 underwent bypass surgery with endovascular trapping, and 2 underwent endovascular trapping without bypass surgery (group A). Ten patients received endosaccular coiling (group B). The visual outcomes included the following: in group A, 17 patients (73.9%) demonstrated improvement and 6 patients (26.1%) demonstrated no changes or worse outcomes; in group B, 2 patients (20.0%) demonstrated improvement and 8 patients (80.0%) demonstrated no changes or worse outcomes. Group A was associated with a higher rate of favorable outcome than group B (P = 0.007). According to the multivariate analysis, treatment without endosaccular coiling (group A) was the only variable significantly associated with improvement of visual outcome (P = 0.005; OR = 28.523; 95% CI = 2.683-303.171). CONCLUSIONS: Treatment modality was the only predictor of improvement in visual deficits. Treatment without endosaccular coiling resulted in visual improvement significantly more often in comparison with endosaccular coiling.
Aneurysm* ; Carotid Artery, Internal* ; Humans ; Multivariate Analysis ; Retrospective Studies ; Visual Fields

PURPOSE: As the Korean life style is becoming westernized at a rapid pace, the rate of breast cancer is growing at the same time. So, the case of breast reconstruction after mastectomy increases, too. Points of breast reconstruction are symmetry, scar, size, and shape. Especially symmetry and scar are more important than others for Korean. This study is aimed to identify the method of breast reconstruction that accomplished the best results in terms of symmetry and scar. METHODS: A total 15 patients were operated on from March of 2005 to July of 2009. The 5 patients were reconstructed by mammoreduction method after periareolar incision, the 7 patients were reconstructed by pectoralis-major transfer with implant after periareolar incision, and 3 patient were reconstructed by both breast augmentation. RESULTS: Follow up period was 20.2 months on average and no complications such as breast deformity were observed. In symmetry of breast, the satisfaction score of periareolar approach is 4.4 and the satisfaction score of other approaches are 4.2(p>0.05). But in scar of breast, the satisfaction score of periareolar approach is 4.6 and the satisfaction score of other approaches is 3.4(p<0.05). CONCLUSION: In conclusion, Author's method of breast reconstruction after removal of breast cancer through periareolar incision is effective method in patients who care about aesthetic result after mastectomy.
Breast ; Breast Neoplasms ; Cicatrix ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Life Style ; Mammaplasty ; Mastectomy

Dog bites are common in many countries and the most common type of animal bites. Despite the high rates, genital trauma, especially scrotal trauma, caused by dog bite is rare, with few cases reported in the literature. We report the successful treatment of testicular rupture due to dog bite. Treatment consisted of orchiectomy with surgical debriment and antibiotics. The diagnosis and management of scrotal injury caused by dog bite are discussed.
Animals ; Anti-Bacterial Agents ; Bites and Stings ; Diagnosis ; Dogs* ; Orchiectomy ; Rupture* ; Scrotum