The first case report of granular cell tumor was by Abrikossoff in 1926, the tumor has been named with more than 20 different synonyms. It is found usually in the tongue, oral cavity, and the skin. It occurs rarely in the esophagus. Esophageal granular cell tumor is a benign lesion which can be diagnosed by endoscopic biopsy. Large symptomatic lesion can be removed by polypectomy. A 29-year-old female visited our hospital for intermittent epigastric pain and anterior chest discomfort. Endoscopy showed a 0.6 *0.4 cm whitish yellow nodule in the mid-esophagus, 25 cm from the incisor teeth. Endoscopic polypectomy was performed with "O"-type rubber band for endoscopic variceal ligation(EVL). A case of esophageal granular cell tumor conformed by S-100 protein stain is reported with the review of literature.
Adult ; Biopsy ; Endoscopy ; Esophagus* ; Female ; Granular Cell Tumor* ; Humans ; Incisor ; Mouth ; Rubber ; S100 Proteins ; Skin ; Thorax ; Tongue ; Tooth

Intermittent positive pressure ventilation is used as a respiratory support for acute respiratroy failure. Adult respiratory distress syndrome(ARDS) revealed mortality rate of 70% as yet. Hypoxemia is foremost problem in ARDS. Though various ventilatory support is tried on ARDS, extracorporeal membrane oxygenation(ECMO) is to be recommended when hypoxemia and hypercarbia are refractory to conventional treatments. Neonatal venoarterial (VA) ECMO in USA is recognized as a therapeutic modality for neonatal respiratory failure and extracorporeal carhon dioxide removal(ECCO2R) in Europe is used for adult respiratory distress syndome. The partial bypass using the membrane oxygenator aims at lung rest while relieving the hard ventilatory setting on the diseased lung. VA ECMO can provide circulatory support as well but the right internal jugular vein and the right common carotid artery are ligated for the cannulation of draiaage and perfusion catheters. Recent follow up study shows that VA ECMO may not be completely free from neurologic complications such as embolism in the systemic circulation and ill effects due to the reduction of blood supply to the immature lungs. ECCO2R adopts low-flow venovenous(VV) bypass. It has been reported to be valuable for treatment of neonatal respiratory failure. VV bypass provides gas exchange but no cardiac support. Venous drainage and perfusion catheters are placed in the right atrium or vena cavae via the femoral or internal jugular veins. Compared to VA bypass, the consequences of embolizations are potentially fewer, no major artery is sacrificed. Highly oxygenated blood flows into pulmonary eirculatiom which may relieve pulmonary artery hypertension. Total respiratory support may be obtained by VV bypass, VV bypass requires approximately 20-50% more flow for total respiratory sopport due to recirculation of oxygenated blood. Recently VV bypass is chosen for neonatal resyiratoty failure in USA. They alliveate the entry criteria for ECMO using the parameter of oxygenation index(OI). VV ECCO2R using to-and-fro system is tried also for neonatal respiratory failure in Europe. A double lumen tube was developed to reduce the number of veins to be cannulated during VV bypass. It is constructed with the outer drainage cannula( 14 Fr.) and the inner perfusion cannula( 8 Fr.) whose opening is placed on the left side of outer cannula. If perfusion opening is placed on the right atrium facing the right ventricle, the venous blood can be drained from both superior and inferior vena cavae through several drainage opening. To evaluate the effectiveness of ECCO2R with a double lumen tube, we developed an experimental model of acute respiratory failure on 8 mongrel dogs. Under general anesthesia with i.v, pentobarbital, a double lumen tube was introduced via the right internal jugular vein and it was connected with the extracorporeal circuit. Without ventilating the oxygenator during VV bypass, respiratory failure was induced by hypoventilation. After obtaining control hemodynamic and blood gas values under hypoventilation, we proceed to apneic oxygenation(AO), extracorporeal CO2 removal(ECCO2R) and controlled mechanical ventilation(CMV) in that order. Arterial pH in control was 7.180.09(meanSD), and it was increased to 7.33+/-0.08 and 7.28+/-0.08 in ECCO2R and CMV, respectively. PaCO2 in control was 69+/-9mmHg and it was decreased to 41+/-4mmHg and 47+/-7mmHg in ECCO R and CMV respectively. PaCO2 in control was 62+/-15 mmHg and it was increased in AO, ECCO2R and CMV. Mixed venous blood gas analysis showed the same result as arterial blood gas analysis. There was no difference between ECCO2R and CMV. The bypass flow enough to remove CO2 was 30-50% of cardiac output. It is concluded that ECCO2R using a double lumen tube was effective to control the carbon dioxide tension in arterial blood, and a double lumen tube may permit the simplicity of an operation and patient care as well as minimizing the bleeding during extracorporeal respiratory support.
Adult ; Anesthesia, General ; Animals ; Anoxia ; Arteries ; Blood Gas Analysis ; Carbon Dioxide* ; Carbon* ; Cardiac Output ; Carotid Artery, Common ; Catheterization ; Catheters ; Dogs ; Drainage ; Embolism ; Europe ; Extracorporeal Membrane Oxygenation ; Heart Atria ; Heart Ventricles ; Hemodynamics ; Hemorrhage ; Humans ; Hydrogen-Ion Concentration ; Hypertension ; Hypoventilation ; Intermittent Positive-Pressure Ventilation ; Jugular Veins ; Lung ; Membranes ; Models, Theoretical ; Mortality ; Oxygen ; Oxygenators ; Oxygenators, Membrane ; Patient Care ; Pentobarbital ; Perfusion ; Pulmonary Artery ; Respiratory Insufficiency ; Veins ; Vena Cava, Inferior

BACKGROUND: Helicobacter pylori (H. pylori) can now be eradicated in the majority of patients with 7 days of treatment with OAC (omeprazole+amoxicillin+clarithromycin) regimen. It is unclear if additional acid-suppressing treatment should be continued beyond 7 days in patients with active gastric or duodenal ulcers. METHODS: Ninety two patients with endoscopically proven active peptic ulcers who were H. pylori positive were randomized to receive either omeprazole 20 mg plus amoxicillin 1.0g plus clarithromycin 500mg ; twice daily for 1 week alone (OAC group) or same regimen followed by 3 weeks of omeprazole (OACP group). Endoscopy and UBT (urea breath test) were performed 8 weeks after the initiation of treatment. RESULTS: Forty four of forty five (97.8%) of OAC group and forty four of forty seven (93.6%) of OACP group were noted to have healed ulcer at week 8. CONCLUSION: In patients with H. pylori infection and peptic ulcers, one week of OAC therapy without further need for PPI may heal the ulcers. Following an l week course of H. pylori eradication therapy by OAC for peptic ulcers, further 3 weeks of acid-suppressing therapy with PPI was not proven to promote ulcer healing rate.
Amoxicillin ; Clarithromycin ; Duodenal Ulcer ; Endoscopy ; Helicobacter pylori* ; Helicobacter* ; Humans ; Omeprazole ; Peptic Ulcer* ; Ulcer

Isolated rectal tuberculosis commonly involves sigmoid, ascending, or transverse colon. Rectal involvement in tuberculosis is uncommon and poorly characterized. Isolated rectal tuberculosis was defined as focal lesions of rectum in the abscence of demonstrable lesions in the small and large bowel. Diagnosis of rectal tuberculosis was based on characteristic endoscopic appearance of lesions, histopathologic feature of tuberculosis in biopsy material and response to antitubercular therapy. Three patients with isolated rectal tuberculosis were seen at Kwak's hospital. The lesions observed was classified according to macroscopic morphology as follows: ulcerative, hypertrophic and ulcero-hypertrophic. Clinical manifestations were non-specific and consists of rectal bleeding, fever, weight loss, constipation and abdominal pain. One of the three patients had coexisting tuberculous pleurisy. Response to antitubercular chemotherapy was good.
Abdominal Pain ; Biopsy ; Colon, Sigmoid ; Colon, Transverse ; Constipation ; Diagnosis ; Drug Therapy ; Fever ; Hemorrhage ; Humans ; Rectum ; Tuberculosis* ; Tuberculosis, Pleural ; Ulcer ; Weight Loss

BACKGROUND: This study was designed to investigate the correlation between pain and non-pain sensation of the cutaneous nociceptors in healthy adults use 250 Hz and 5 Hz evoking neuroselective sinusoidal current to A delta and C-fiber separately. METHODS: Fifty healthy adult volunteers who have no history of neurological illness were examined. Twenty-five of them were male, and twenty-five were female. Their ages ranged from 20 to 46 years, with a mean equal to 29.5 years old. The thresholds for both current perception and nociceptive perception were measured bilaterally in volar aspect of wrist using a Neurometer CPT/C (Quantitative Sensory Nerve Testing Device). The manual mode for current perception threshold and the staircase method for nociceptive current perception threshold was performed individually. RESULTS: The mean values of the threshold for perception evoked by 250 Hz were 0.30 mA in left and 0.31 mA in right, 0.17 mA in left and 0.14 mA in right at 5 Hz respectively. The mean values of the nociception threshold were 0.52 mA in both site at 250 Hz and from 0.35 mA to 0.32 mA at 5 Hz (Table 1). There were no differences between left and right wrist (Fig. 1). Also a significant positive correlation between current perception and nociception thresholds was found (p<0.05) (Fig. 2, 3). There appeared to be different between genders in perception threshold evoked by 250 Hz and nociception threshold evoked by 5 Hz in left (p<0.05) (Table 2). CONCLUSIONS: There exists a meaningful correlation between both sensations of non-pain and pain perception thresholds obtained from all subjects. The measurement of the current perception threshold is considered to be a unique and valuable resource in evaluation of patient with neurologic condition, as well as in serial evaluation of patient to assess the outcome of therapeutic intervention.
Adult* ; Female ; Humans ; Male ; Nociception* ; Nociceptors ; Pain Perception ; Sensation ; Volunteers ; Wrist

We report the case of a 56-year-old man with a prostatic mass that extended into the rectal mucosa. He experienced constipation and anal bleeding for 6 months. He underwent surgical ablation for an approximately 5-cm, benign, subepithelial cystic mass in the rectum, which was adjacent to a 5-cm solid mass located on the prostatic gland seen on computed tomography and magnetic resonance imaging (MRI) of the pelvis. One year after the surgery, the patient had recurrent anal bleeding with difficulty defecating. The pelvic MRI scan showed a solid mass with heterogeneous enhancement that was compressing the rectum. The sigmoidoscopic exam showed a 4-cm mass protruding through the anterior rectal mucosa 7-cm above the anal verge. Ultra-low anterior resection with ileostomy and prostatectomy was performed for curative resection of the mass with extension into the rectum. However, the pathologic report showed massive benign prostatic hyperplasia involving the rectum, but not penetrating into the rectal mucosa. The patient did not complain of any symptoms including constipation and anal bleeding, until 18 months after the surgical resection. This is the first reported case of benign prostatic hyperplasia mimicking a rectal submucosal tumor in a patient presenting with anal bleeding and constipation.
Constipation ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Ileostomy ; Magnetic Resonance Imaging ; Middle Aged ; Mucous Membrane ; Pelvis ; Prostatectomy ; Prostatic Hyperplasia* ; Rectal Neoplasms ; Rectum

BACKGROUND: The literature on variations of rib is limited. Very little has been written in the radiological journal of this country on the subject. It seemed of interest to investigate the nature and incidence of congenital variations in a series of routine chest roentgenograms. The topic of rib variations has not been covered extensively in the radiological journals in Korea. This has presented an opportunity to investigate the nature, type, shape and incidences of congenital rib variations in normal Korean adults from a series of routine roentgenograms. METHODS: Chest radiographs of 5,000 adults (,) who visited our hospital for a routine check-up or for employment physical examinations from January 1996 to September 1998, were consecutively reviewed. The sex distribution consisted of 2,827 male males and 2,173 females (ratio of 1.3:1) with the age range between 19 and 65 years (mean age: 34.6 years). The chest PAs was were analyzed for the presence, type, location, and shape of the rib variations (.) From this data, and we the incidence of each type of variations was calculated. RESULTS: Seventy-six of the 5000 adults (1.52%), 63 male (2.23%) and 13 female (0.6%), showed 88 cases of rib variation (Table 1). Bifid rib (n=35) was the The most common variation was the bifid rib (n=35), followed by hypoplasia of the rib (n=22), flaring of the rib (n=18), bridging of the ribs (n=7), cervical ribs (n=3), and fusion of between ribs (n=3) (Table 2). (New paragraph)Bifid The bifid rib (Table 1) was found most frequent in the right fourth rib (12/35, 34.3%), followed by the left fifth rib (6/35, 17.1%) and right third rib (6/35, 17.1%). Hypoplasia of the rib was common in first rib (20/22, 90.9%). Flaring of the rib was common at fourth rib (8/18. 44.4%, right and left combined) (,) and bridging between ribs was common between first and second rib (3/7, 42.9%). CONCLUSION: The percentage of incidence of rib variations in adults was 1.52%. Bifid rib was the most common variation, followed by hypoplasia, flaring, bridging, cervical rib, and fusion of ribs(,) in decreasing order.
Adult ; Cervical Rib ; Employment ; Female ; Humans ; Incidence* ; Korea ; Male ; Physical Examination ; Radiography ; Radiography, Thoracic* ; Ribs* ; Sex Distribution ; Thorax*

A 12-day-old female baby underwent a Norwood procedure for hypoplastic left heart syndrome. The left superior vena cava (LSVC), which was found incidentally during the operation, was divided to facilitate surgical exposure. After the operation, she developed signs of low cardiac output and died 7 hours afterward. Autopsy findings showed that the coronary sinus was atretic at the orifice without unroofing into both atria, rendering the LSVC the sole route of coronary sinus drainage. In patients with incidentally-found LSVC during surgery, special care should be taken to leave the LSVC intact because the LSVC may be the exclusive drainage vein of the coronary venous system.
Autopsy ; Cardiac Output, Low ; Coronary Sinus ; Drainage ; Female ; Humans ; Hypoplastic Left Heart Syndrome ; Norwood Procedures ; Veins ; Vena Cava, Superior

Myocardial bridging is defined that short segments of coronary artery descend into the myocardium for a variable distance and each systolic contraction of these fibers can cause narrowing of the artery. Systolic narrow-ing may rarely be caused by connective tissue such as fibrous band. Myocardial ischemia, infarction and sudden death may be seen in some patients with myocardial bridging. Myocardial infarction in association with isolated myocardial bridges with systolic narrowing is uncommon. We report a case of Q wave myocardial infarction in a patient with angiographic systolic narrowing at the middle segment left anterior descending coronary artery which was caused by fibrous band.
Arteries ; Connective Tissue ; Coronary Vessels ; Death, Sudden ; Humans ; Infarction ; Myocardial Bridging* ; Myocardial Infarction* ; Myocardial Ischemia ; Myocardium

OBJECTIVE: The objective of this study was to evaluate the ultrasonographic appearance of suspected fetal cardiac tumor and their evolution until delivery and in the postnatal period, and to document the associated problems including tuberous sclerosis. METHODS: We retrospectively reviewed the medical records of all cases born in Yonsei University Health System, Seoul, Korea, between September 1996 and August 2006, and diagnosed as fetal cardiac tumor prenatally. RESULTS: 10 cases were found in all medical records. The mean age of the mothers on delivery was 30.2+/-2.4 and the mean gestational age on diagnosis was 30.6+/-5.4 weeks. The cardiac tumors were single in five cases and multiple in the other five cases. The size ranged from 7 to 34mm. Most of the tumors were located in right ventricle (RV, n=9), left ventricle (LV, n=6), but they also located in interventricular septum (IVS, n=4), right atrium (RA, n=1). In one case, fetal arrhythmia was found, which was normalized in two days after birth, and in another case, mild intracardiac flow obstruction was noted. The duration of postnatal follow-up ranged from 2 months to 36 months (mean, 18.9+/-13.1 months). In most cases the tumor masses decreased after birth (n=6), but had no change in utero (n=5). Three of them were diagnosed as tuberous sclerosis after birth, and none of them needed surgical intervention. CONCLUSION: Fetal cardiac tumors and their effect on the fetal cardiac function could be well evaluated by two-dimensional and Doppler echocardiography. The fetal cardiac tumors may have little effect on the fetal well being both prenatally and postnatally from the cardiovascular standpoint in most affected fetuses, but are important in the early diagnosis of tuberous sclerosis and in suggesting careful follow-up and management.
Arrhythmias, Cardiac ; Early Diagnosis ; Echocardiography, Doppler ; Fetus ; Follow-Up Studies ; Gestational Age ; Heart Atria ; Heart Neoplasms ; Heart Ventricles ; Humans ; Korea ; Medical Records ; Mothers ; Parturition ; Prenatal Diagnosis ; Retrospective Studies ; Tuberous Sclerosis