No abstract available.
Temporal Bone*

No abstract available.
Humans

The first case of chyle ascites in childhood was reported by Morton in 1683. Its reported incidence varies between 1 in 50,000 to 100,000 in hospital admissions. The clinical picture is similar to that of acute diffuse peritonitis, and is most commonly mistaken as perforated appendicitis. Paracetesis, if performed, is the most useful diagnostic option. Treatment modalities fall into four areas-: Exploratory laparotomy with either direct ligation or drainage, A medium chain triglyceride diet, NPO and hyperalimentation or Venoperitoneal shunting. An 11-years old boy was admitted with RLQ pain. He had diffuse abdominal guarding. The initial diagnosis was perforated appendicitis, and appendectomy was performed. During the operation, the abdomen was found to contain 750cc of a thin, milky fluid. It was later diagnosed as chyle ascites. The small bowel mesentery and transverse colon were thickened and edematous, with a pale white subserosal exudate. The laboratory analysis of the ascites was as follows-: protein 4.6 g/dL, albumin 3.0 g/dL, triglyceride 700 mg/dL, cholesterol 113 mg/dL, glucose 209 mg/dL, LDH 848 U/L, and amylase 32 U/dL, with a pH of 9.0. An appendectomy was performed, and two drains placed in the pelvic cavity. In the postoperative-work-up from the abdominal CT scan, the results were normal. The patient-recovered and was discharged without complication 21 days postoperatively.
Abdomen ; Amylases ; Appendectomy ; Appendicitis* ; Ascites* ; Child ; Cholesterol ; Chyle* ; Colon, Transverse ; Diagnosis ; Diet ; Drainage ; Exudates and Transudates ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Laparotomy ; Ligation ; Male ; Mesentery ; Peritonitis ; Tomography, X-Ray Computed ; Triglycerides

Carcinoid is the most common tumor in the appendix and most often occurs in young patient. A case of mesoappendiceal invasion of carcinoid of appendix in presented and the literature review for indications for right hemicolectomy. A 38-year-old man was admitted to hospital after 3 day with right lower quadrant pain. The appendectomy was performed. At gross pathologic examination the appendix measured 7.5 cm in length and 1.6 cm in diameter. The serosal surface is congested and covered with yellow white fibrinoid material. The cut surface revealed a focal thickening of wall, measured 0.7 x 0.5 cm at 2 cm from tip of the appendix. Light microscopy revealed a typical carcinoid tumors infiltrating periappendiceal fat tissue. The patient was readmitted 4 weeks postoperatively for an elective right hemicolectomy. At exploratory laparotomy, there were no palpable lymph nodes. Exploration of the distal ileum, small bowel, and remaining abdomen did reveal any other carcinoid tumors.
Abdomen ; Adult ; Appendectomy ; Appendix ; Carcinoid Tumor* ; Estrogens, Conjugated (USP) ; Humans ; Ileum ; Laparotomy ; Lymph Nodes ; Microscopy

Acute eosinophilic pneumonia (AEP) represents a clinical entity distinct from chronic eosinophilic pneumonia (CEP). In contrast with CEP, AEP is characterized by duration of symptoms less than 5 days, hypoxemic respiratory failure, no blood eosinophilia at presentation, no atopic background or history of asthma, and no recurrence. However, we report a case of AEP with some features of CEP. A 33-year-old man presented with respiratory symptoms for 4 days. He was diagnosed with AEP based on hypoxemic respiratory failure, diffuse alveolar-interstitial chest X-ray infiltrates, and eosinophilia, lymphocytosis and neutrophilia from bronchoalveolar lavages. However, he had two atopic diseases, asthma and atopic dermatitis. In addition, he presented with blood eosinophilia, which are all features of CEP. Thus, there might be some overlap of clinical features between AEP and CEP. The presence of increased lymphocytes and neutrophils in the bronchoalveolar lavage can be an important finding to help distinguish between AEP versus CEP in difficult cases.
Adult ; Asthma ; Bronchoalveolar Lavage ; Dermatitis, Atopic ; Eosinophilia ; Eosinophils ; Humans ; Lymphocytes ; Lymphocytosis ; Neutrophils ; Pulmonary Eosinophilia ; Recurrence ; Respiratory Insufficiency ; Thorax

PURPOSE: Sulphomucin is secreted by immature foveolar cells of the stomach and is expressed in gastric adenocarcinomas. Carcinoembryonic antigen (CEA) is well known to be expressed in gastric adenocarci nomas and is correlated with the cellular differentiation of gastric adenocarcinomas. However, at the moment, there are no conclusions about the relationships between the expression of sulphomucin and pathological classifications. METHODS: This study was designed to determine the significance of expression of sulphomucin and CEA in advanced gastric adenocarcinomas. Also, these two factors were compared with established clinicopathological prognostic factors. Thirty-two paraffin-embedded surgical specimens of gastric adenocarcinomas were obtained from January 1993 to December 1995 and were selected for study. The expressions of sulphomucin and CEA were studied by using the Spicer method and immunohistochemical staining with CEA 2-7 monoclonal antibody. RESULTS: The expressions of sulphomucin and CEA were positive in 9 (28%) cases and 25 (78%) cases, respectively. There was a significant correlation between sulphomucin expression and histologic differentiation (p<0.05). However, the expression of CEA was correlated with neither clinopathological factors nor sulphomucin expression. CONCLUSION: These results suggest that expressions of sulphomucin are well correlated with cellular differentiations of advanced gastric adenocarcinomas.
Adenocarcinoma* ; Carcinoembryonic Antigen ; Classification ; Noma ; Stomach

PURPOSE: Sulphomucin is secreted by immature foveolar cells of the stomach and is expressed in gastric adenocarcinomas. Carcinoembryonic antigen (CEA) is well known to be expressed in gastric adenocarci nomas and is correlated with the cellular differentiation of gastric adenocarcinomas. However, at the moment, there are no conclusions about the relationships between the expression of sulphomucin and pathological classifications. METHODS: This study was designed to determine the significance of expression of sulphomucin and CEA in advanced gastric adenocarcinomas. Also, these two factors were compared with established clinicopathological prognostic factors. Thirty-two paraffin-embedded surgical specimens of gastric adenocarcinomas were obtained from January 1993 to December 1995 and were selected for study. The expressions of sulphomucin and CEA were studied by using the Spicer method and immunohistochemical staining with CEA 2-7 monoclonal antibody. RESULTS: The expressions of sulphomucin and CEA were positive in 9 (28%) cases and 25 (78%) cases, respectively. There was a significant correlation between sulphomucin expression and histologic differentiation (p<0.05). However, the expression of CEA was correlated with neither clinopathological factors nor sulphomucin expression. CONCLUSION: These results suggest that expressions of sulphomucin are well correlated with cellular differentiations of advanced gastric adenocarcinomas.
Adenocarcinoma* ; Carcinoembryonic Antigen ; Classification ; Noma ; Stomach

BACKGROUND: The purpose of this study was to determine whether the injection rate affects the spread of spinal anesthesia in cesarean sections. METHODS: Spinal anesthesia was performed on 45 parturients in a cesaren section. Dural puncture was performed in the sitting position with a 27-gauge Whitacre needle. All patients received a mixture of 10 mg hyperbaric bupivacaine and 15 microgram fentanyl. Twenty five (Group I) patients received rapid injections (about 0.2-0.3 ml/sec) and twenty (Group II) received slow injections (about 0.1 ml/sec). Anesthetic levels, time to T4 sensory block, maximal height sensory block and incidence of hypotension were measured. RESULTS: There was significantly rapid T4 sensory block in group I but no differences in maximal height of sensory block and incidence of hypotension between the two groups. CONCLSIONS: We conclude that injection rate (about 0.1-0.3 ml/sec) has a statistically insignificant influence on the maximal height sensory block and incidence of hypotension.
Anesthesia, Spinal* ; Bupivacaine* ; Cesarean Section* ; Female ; Fentanyl ; Humans ; Hypotension ; Incidence ; Needles ; Pregnancy ; Punctures

BACKGROUND: The heat shock proteins (HSPs) are stress-responsive genes present in all species and play a major role in many cellular processes. These proteins are highly conserved molecules whose expression is induced in eukaryotic cells by a variety of environmental stresses. These proteins can also be expressed in virally transformed cells and cancer cells. Especially, HSP70 is found at a higher level in growing cells than in resting cells. Sulphomucin is secreted by immature foveolar cells of stomach and expressed in gastric adenocarcinomas. Also, it is known that the population of sulphomucin-producing cells increases with long-lasting stress. The purpose of this study was to determine HSP70 and sulphomucin expressions in gastric adenocarcinoma and the significance of expressions. METHODS: Thirty-one paraffin-embeded surgical specimens of gastric adenocarcinomas were obtained from April 1992 to March 1995 and were selected for analysis. The expressions of HSP70 and sulphomucin were analyzed by immunohistochemical staining with HSP70 monoclonal antibody and the Spicer (HID) method. RESULTS: The expressions of HSP70 and sulphomucin were positive in 13 (42%) cases and 11 (35%) cases, respectively. The expression of HSP70 correlated with neither clinopathological factors nor sulphomucin expression. There was a significant correlation not only between sulphomucin expression and histologic differentiation (p=0.001) but also between disease-free survival and sulphomucin expression. CONCLUSIONS: Sulphomucin expression in gastric adenocarcinoma may be useful as a prognostic factor of gastric adenocarcinomas.
Adenocarcinoma* ; Disease-Free Survival ; Eukaryotic Cells ; Heat-Shock Proteins* ; Hot Temperature* ; HSP70 Heat-Shock Proteins* ; Stomach

PURPOSE: A traumatic diaphragmatic rupture (TDR) is a diagnostic challenge and the associated injuries determine the outcome in those diagnosed early. A TDR has long been considered to be a marker of the severity of injury with an average reported Injury Severity Score (ISS) between 31 and 50. This report reviewed the TDR cases in order to emphasize the method and timing of the diagnosis, associated injuries and the outcome. METHODS: A retrospective analysis was performed on 30 patient treated for TDR between August 1998 and september 2002. RESULTS: The mean age of the patients was 33.4 years and the injury predomiantly affected males (male: female=2: 1). Blunt trauma by TA was the most common cause of the TDR (25 patients). The ruptured sites were on the left in 22 cases and on the right in 8 cases. The most common symptom was chest pain (23 cases) followed dyspnea (21 cases). Liver injuries and a pneumo-hemothorax were the most common associated injuries. The mean CRAMS scale was 6.47 and Injury Severity Score (ISS) was 18.93. Eighteen TDR cases were suspected based on the abnormal chest X-ray findings. Nineteen cases underwent surgery within 6 hours after the trauma (early diagnosis). Although many complications occurred in 11 cases, there were no lethal complications. The mean size of the diaphragmatic rupture was 9.77 cm and an intraabdominal organ herniation had not occurred in ruptures smaller than 6 cm. Surgical repair of the diaphragm was performed via a laparotomy in 20 cases and thoracotomy in 7 cases. A left side TDR was preferred to a laparotomy whereas a right sided TDR was preferred to a thoracotomy. Pulmonary complications (atelectasis, pneumonia, pleural effusion) occurred in 14 cases postoperatively. CONCLUSION: The patient's complaints and physical findings were not a reliable indicator of the diagnosis, but usually a manifestation of the associated injuries. A suspicion and routine chest X-ray was the most reliable diagnostic tool, even though the chest X-ray was normal in 12 cases. A high rate of early diagnosis can be achieved using an aggresive investigation protocol, suspicion and a combined radiologic evaluation in multiple trauma patients. Although pulmonary complications occurred in the early diagnosed cases, lethal complications and long term sequela were directly related to the time of diagnosis. The higher ISS had many complications (11 cases) but there were no lethal complications, long term sequela.
Chest Pain ; Diagnosis ; Diaphragm ; Dyspnea ; Early Diagnosis ; Humans ; Injury Severity Score ; Laparotomy ; Liver ; Male ; Multiple Trauma ; Pneumonia ; Retrospective Studies ; Rupture ; Thoracotomy ; Thorax