The epiphyseal fracture-separation of the distal humerus is extremely rare injury in neonates. It is frequently misdiagnosed as a elbow dislocation owing to the invisible cartilagenous portion of the distal humerus in roentgenograms. We described a case, 9-day-old neonate with finally diagnosed the Salter-Harris type 1 injury of the distal humeral epiphysis. He was referred for further evaluation of 'refusal to use the left arm' from a local clinic. The injury had initially misdiagnosed as normal roentgenograms by a locaorthopedic specialist, so we preferentially give an impression of the brachial plexus injury or the hemiplegic cerebral palsy. But electromyography and brain magnetic resonance imaging were negative findings. A neonate was referred to the pediatric orthopedic subspecialist and properly diagnosed. He was treated with the closed reduction and the percutaneous pinning. No complication has occurred.
Brachial Plexus Neuropathies ; Brachial Plexus* ; Brain ; Cerebral Palsy ; Dislocations ; Elbow ; Electromyography ; Epiphyses ; Humans ; Humerus* ; Infant, Newborn ; Magnetic Resonance Imaging ; Orthopedics ; Specialization

No abstract available.
Child* ; Hernia, Diaphragmatic* ; Humans

Changes in nitric oxide production in spinal cord or dorsal root ganglion have been known to contribute to allodynia after nerve injury. However, regulation of nNOS expression was also reported not to be responsible for the development and/or maintenance of neuropathic allodynia. The aim of this study was to elucidate role of nNOS expression in the sensory nervous system in neuropathic pain. Von Frey and acetone tests were performed in a model of peripheral neuropathy, ligation of 5th lumbar and 6th lumbar spinal nerves, in wild type and nNOS (-/-) mice. The effect of nNOS inhibitor was evaluated in neuropathic pain behavior in the mice. Mechanical allodynia was slightly reduced in nNOS (-/-) mice compared with wild type mice after peripheral neuropathy. nNOS inhibitor, L-NAME, reduced minimally mechanical allodynia, not cold allodynia, but gabapentin reduced remarkably neuropathic pain behavior (mechanical and cold allodynia) in both wild type and nNOS (-/-) mice. These results suggested that nNOS expression in the sensory nervous system may be partially associated with development and/or maintenance of mechanical allodynia in a mouse model of peripheral neuropathy.
Acetone ; Animals ; Ganglia, Spinal ; Hyperalgesia ; Ligation ; Mice ; Mice, Knockout* ; Nervous System ; Neuralgia* ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Peripheral Nervous System Diseases ; Spinal Cord ; Spinal Nerves

BACKGROUND: Hepatolithiasis is rarely associated with a cholangiocarcinoma and the etiologic relationship between them has not been proved. Hepatolithiasis is a risk factor for cholangiocarcinoma. Accurate preoperative diagnosis remains low, and the survival outcome is still dismal, despite improvements in imaging studies. METHODS: Eighteen cases of intrahepatic cholangiocarcinomas among the 522 cases undergoing treatments from Jan. 1984 to May 1998 for hepatolithiasis at the Department of Surgery, Kyung Hee University Hospital were reviewed. RESULTS: The patients had a significantly long duration of symptoms, a high incidence of previous biliary surgery, and a lower rate of preoperative diagnosis. The eighteen cases accounted for 3.4% of the hepatolithiasis cases and 8.5% of the cholangiocarcinomas. There were 17 women and 1 man, and the most prevalent age group was in the 5th and the 6th decades. HBsAg was positive in one case who had chronic hepatitis, 3 patients had clonorchiasis, and 2 patients had liver cirrhosis. CEA and CA19-9 were elevated in 42.9% (3/7) and 27.3% (3/11) of the patients. Various imaging studies, including ultrasonography, CT, choangiography, angiography, and ERCP were performed for diagnosis. The malignant lesions could not be detected preoperatively in 9 patients, and the presence of a coexisting malignant tumor was confirmed by frozen section or by permanent tissue pathology. The operative methods were as follows; a lobectomy in 4 patients, a segmentectomy in 4 patients, and a CBD resection for palliation or explo-laparotomy only in 4 patients because of multiple hepatic metastases. During the operation, the exact location of the stones and the gross pathology of the tumor were recorded in each case. The left side was more prevalent than the right. The mean survival was 15 months for resection group and 9 months for non resection group. CONCLUSIONS: The lower survival rates may be attributed to delayed diagnosis, lower diagnostic accuracy, and relatively fewer curative resections in the patients with stone-containing cholangiocarcinomas. Hepatolithiasis is one of the risk factors of a cholangiocarcinoma. During the diagnostic and operative procedures, we should not overlook a cholangiocarcinoma which can coexist with hepatolithiasis, and we should examine tumor markers, the results of imaging studies and tissue examinations, and the operative findings.
Angiography ; Biomarkers, Tumor ; Cholangiocarcinoma* ; Cholangiopancreatography, Endoscopic Retrograde ; Clonorchiasis ; Delayed Diagnosis ; Diagnosis ; Female ; Frozen Sections ; Hepatitis B Surface Antigens ; Hepatitis, Chronic ; Humans ; Incidence ; Liver Cirrhosis ; Mastectomy, Segmental ; Neoplasm Metastasis ; Pathology ; Risk Factors ; Surgical Procedures, Operative ; Survival Rate ; Ultrasonography

Adenosquamous carcinoma of the pancreas is a rare tumor but demonstrated an aggressive biologic behavior. A 60-year- old man with huge cystic mass in epigastrium was admitted complaining of abdominal discomfort. Initially the cystic mass was diagnosed to pancreatic pseudocyst. An abdominal computed tomography on 1 month later demonstrated a more enlarged mass in the body of the pancreas with central necrosis, which was infiltrating posterior wall of the stomach. Near total pancreatectomy, splenectomy and total gastrectomy were done. The resection specimen composed of squamous cell carcinoma components with a small area of adenocarcinoma. The patient died of cachexia 4 months after the operation. We reported an unusual case of adenosquamous carcinoma of the pancreas which was a giant cystic mass with central degeneration and gastric infiltration.
Adenocarcinoma ; Cachexia ; Carcinoma, Adenosquamous* ; Carcinoma, Squamous Cell ; Gastrectomy ; Humans ; Necrosis ; Pancreas* ; Pancreatectomy ; Pancreatic Pseudocyst ; Splenectomy ; Stomach

Cavernous hemangioma is the most common benign tumor of the liver. This tumor is mostly small and asymptomatic, but giant cavernous hemangioma can produce symptoms and complications including abdominal pain, palpable mass and hemorrhage due to spontaneous or traumatic rupture. The authors encountered exceptionally large hemangioma with abdominal pain and anemia, and performed successful right hemihepatectomy, and present the case with the brief review of the literature.
Abdominal Pain ; Anemia ; Hemangioma ; Hemangioma, Cavernous* ; Hemorrhage ; Liver* ; Rupture

Carcinoma, Squamous Cell ; Cell Differentiation ; Humans ; Immunohistochemistry ; Korea ; Lymph Nodes ; Mouth Neoplasms ; Neoplasm Metastasis ; Peptide Hydrolases ; Prognosis ; Radiotherapy ; Saints ; Tissue Inhibitor of Metalloproteinase-1 ; Tongue

Atlantoaxial subluxation in undifferentiated spondyloarthropathy is extremely rare and has not been reported. We describe a case of 27-year-old man who was diagnosed as undifferentiated spondyloarthropathy with atlantoaxial subluxation with an initial complaint of painful swelling of right 1st metatarsophalangeal joint and posterior neck pain. Roentgenograms showed sclerotic change and increased hazziness in right 1st metatarsophalangeal joint. Magnetic resonance images and roentgenograms of the cervical spine showed inflammation of odontoid process and atlantoaxial subluxation. Bone scan showed hot uptakes in left sacroiliac joint, right 1st & 4th metacarpophalangeal joints and 1st metatarsophalangeal joint. HLA-B27 gene was positive. Spontaneous atlantoaxial subluxation and undifferentiated spondyloarthropathy was diagnosed and conservatively treated with oral medication. Currently, there is no definite neurological sign. Early recognition and awareness of potential clinical complications is important in preventing compressive damage on central nervous system.
Adult ; Central Nervous System ; HLA-B27 Antigen ; Humans ; Inflammation ; Magnetic Resonance Spectroscopy ; Metacarpophalangeal Joint ; Metatarsophalangeal Joint ; Neck Pain ; Odontoid Process ; Sacroiliac Joint ; Spine ; Spondylarthropathies

PURPOSE: The isoflavones in soy are likely to contribute to the historically low incidence of breast cancer among Asian women that consume traditional diets. A possible role of isoflavones in controlling the expression of cyclooxygenase-2 (Cox-2) has not previously been explored. In this study, the ability of the isoflavone, genistein, to regulate the expression of Cox-2 in breast cancer cells was evaluated. METHODS: The effects of genistein and NS-398, a Cox-2 inhibitor, were examined on the expression of Cox-2 at the mRNA level using the MDA-MB 231, and MCF-7 breast cancer cell-lines. RESULTS: In the MCF-7 cells, the Cox-2 mRNA could not be detected using RT-PCR. In the MDA-MB-231 cells, NS-398 and genistein were found to inhibit the Cox-2 mRNA expressions by 50 and 35~40%, respectively. CONCLUSION: These studies suggest that dietary isoflavonoids may contribute to the prevention or inhibition of breast cancer by inhibiting the Cox-2 expression.
Asian Continental Ancestry Group ; Breast Neoplasms* ; Breast* ; Cyclooxygenase 2* ; Diet ; Female ; Genistein* ; Humans ; Incidence ; Isoflavones ; MCF-7 Cells ; RNA, Messenger

BACKGROUND: Laparoscopic cholecystectomy (LC) has become the treatment of choice for patients with symptomatic gallbladder (GB) stones. About 10% of patients with symptomatic GB stones may have common duct (CD) stones at the same time. For patients with symptomatic GB stones and suspected CD stones, an endoscopic retrograde cholangiopancreaticography (ERCP) should be performed. The preferred approach to these patients is an ERCP, an endoscopic sphincterotomy (EST), and removal of the CD stones, followed by a LC. The aims of this study were to test the safety and to evaluate the efficacy of the endoscopic and laparoscopic procedure in patients with symptomatic GB stones associated with CD stones. MATERIAL AND METHODS: A retrospective review was conducted on 522 patients who had been treated surgically for GB stones with or without CD stones between Jul. 1994 and Jun 1997. Among them, an ERCP followed by a LC was performed in 57 (67.1%) of the 85 patients who had CD stones, a LC in 377, an open cholecystectomy in 60, and an open cholecystectomy and CD exploration in 28. RESULTS: There were significant differences in operation times, hospital stays, and postoperative complications between the group with an EST followed by a LC and the group with an open cholecystectomy and CD exploration, but no significant differences between the LC group and the group with an EST followed by a LC. CONCLUSIONS: An EST followed by a LC is a good and safe treatment mordality for patients with symptomatic GB stones associated with CD stones.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Choledocholithiasis* ; Gallbladder ; Humans ; Length of Stay ; Postoperative Complications ; Retrospective Studies ; Sphincterotomy, Endoscopic*