Primary carcinoma of the fallopian tube is a rare malignancy of the female genital tract and infrequently diagnosed before an operation. The majority of patients have extensive disease at the time of diagnosis. We have experienced incidentally a case of a carcinoma of the fallopian tube coexisting with a benign cystic teratoma of the ovary in a 25-year-old woman. We report this case with a brief review of literatures.
Adenocarcinoma, Papillary/pathology* ; Adult ; Case Report ; Fallopian Tube Neoplasms/pathology* ; Female ; Human ; Neoplasms, Multiple Primary/pathology* ; Ovarian Neoplasms/pathology* ; Teratoma/pathology*

BACKGROUND: The loss of resistance technique is the most popular method for identifying the epidural space. Air or liquid is a commonly used medium for this technique. These two media have certain advantages and disadvantages. A liquid filled pressure line connected to an air syringe might have advantages of both air and liquid while preventing the drawbacks of each medium. METHODS: Twenty-five consecutive patients were scheduled to receive an epidural anesthesia for surgery and selected for study. A lidocaine filled pressure line connected to an air syringe allowed for sequential injection of lidocaine and air. The time spent on the procedure, amount of air injected into the epidural space, inadvertent puncture of the dura mater, and rate of anesthetic failure were recorded. RESULTS: The procedure took less than 2 minutes in 22 cases. The average amount of air lost from the syringe during the loss of resistance test was 0.98 +/- 0.23 ml in 22 patients. Volume of the 3-way connected pressure line was 0.95 ml. Therefore, the air volume injected into the epidural space was minimal. In the other 3 cases where previous spinal disease existed, multiple epidural approaches were needed and the procedure took relatively longer with larger injection volumes. There were no complications. CONCLUSIONS: This technique minimized injection of the air into the epidural space during identification but simultaneously, it does not disturb the feel of air compressibility in the syringe.
Anesthesia, Epidural ; Dura Mater ; Epidural Space ; Feasibility Studies ; Humans ; Lidocaine ; Punctures ; Spinal Diseases ; Syringes

"Biliary cast syndrome" describes a cast formed from retained lithogenic material, and this cast is morphologically confined to the bile duct; this develops in 4~18% of liver transplant recipients. The pathogenesis of cast formation is not clearly understood. The proposing etiological factors for biliary cast syndrome include acute cellular rejection, a prolonged cold ischemic time, use of postoperative biliary drainage tubes and biliary infection. These casts are more likely to develop in the setting of hepatic ischemia and biliary stricture. Endoscopic and percutaneous cast extraction might achieve favorable results and this should be attempted before surgical therapy. We report here on a case of biliary cast syndrome that was secondary to orthotopic liver transplantation; this was successfully treated via percutaneous choledochoscopic removal. We also include a review of the literature.
Bile Ducts ; Cold Ischemia ; Constriction, Pathologic ; Drainage ; Humans ; Ischemia ; Liver Transplantation* ; Liver* ; Superior Mesenteric Artery Syndrome ; Transplantation

Nonspecific interstitial pneumonia (NSIP) was first described as a new category of idiopathic interstitial pneumonia in 1994. This is a disease with a more insidious onset and has a chronic course. The histological findings are unusual for other idiopathic interstitial pneumonia cases (usual interstitial pneumonia, diffuse interstitial pneumonia, and acute interstitial pneumonia). In contrast to NSIP, acute interstitial pneumonia (AIP) has an acute onset and a fulminant course with the rapid development of respiratory failure. A pathological examination demonstrated characteristic diffuse interstitial fibrosis, hyaline membranes, thrombi, and architectural derangement. Here we report a 48-year-old woman who was diagnosed pathologically NSIP, but with a rapid progressive course similar to AIP.
Female ; Fibrosis ; Humans ; Hyalin ; Idiopathic Interstitial Pneumonias ; Lung Diseases, Interstitial* ; Membranes ; Middle Aged ; Respiratory Insufficiency

BACKGROUND: Histamine is widely distributed in the lung. It increases capillary permeability and the P-selectin expression on vascular endothelial cell surfaces. We studied the role of endogenous histamine on the pathogenesis of endotoxin-induced acute lung injury (ALI) in rats. METHODS: We instilled either normal saline (control group) or lipopolysaccharide (3 mg/Kg, LPS group) to tracheas of Sprague-Dawley rats. H1-receptor blocker (mepyramine, 10 mg/Kg, H1RB group), H2-receptor blocker (ranitidine, 10 mg/Kg, H2RB group), and H3-receptor blocker (thioperamide, 2 mg/Kg, H3RB group) were administered through vein or peritoneum along with intratracheal LPS administration. Statistical significance was accepted at p<0.05. RESULTS: LPS increases the histamine level in BAL fluid significantly at 2 h after the treatment compared with control group. LPS significantly increases protein concentration, PMN cell count in bronchoalveolar lavage (BAL) fluid, and myeloperoxidase (MPO) activity in the lung tissue at 6 h compared to control group. PMN cell count in BAL fluid and MPO activity in lung tissue were significantly lower in H2RB-group compared to LPS-group. However, protein concentration in BAL fluid showed no significant differences between the LPS alone and LPS with histamine receptor blockade. CONCLUSIONS: Endogenous histamine might be involved in the recruitment of PMNs in LPS-induced ALI via H2 receptor. However, its role in ALI would not be significant in this model.
Acute Lung Injury* ; Animals ; Bronchoalveolar Lavage ; Capillary Permeability ; Cell Count ; Endothelial Cells ; Histamine* ; Lung ; P-Selectin ; Peritoneum ; Peroxidase ; Rats ; Rats, Sprague-Dawley ; Receptors, Histamine ; Trachea ; Veins

BACKGROUND: Histamine is widely distributed in the lung. It increases capillary permeability and the P-selectin expression on vascular endothelial cell surfaces. We studied the role of endogenous histamine on the pathogenesis of endotoxin-induced acute lung injury (ALI) in rats. METHODS: We instilled either normal saline (control group) or lipopolysaccharide (3 mg/Kg, LPS group) to tracheas of Sprague-Dawley rats. H1-receptor blocker (mepyramine, 10 mg/Kg, H1RB group), H2-receptor blocker (ranitidine, 10 mg/Kg, H2RB group), and H3-receptor blocker (thioperamide, 2 mg/Kg, H3RB group) were administered through vein or peritoneum along with intratracheal LPS administration. Statistical significance was accepted at p<0.05. RESULTS: LPS increases the histamine level in BAL fluid significantly at 2 h after the treatment compared with control group. LPS significantly increases protein concentration, PMN cell count in bronchoalveolar lavage (BAL) fluid, and myeloperoxidase (MPO) activity in the lung tissue at 6 h compared to control group. PMN cell count in BAL fluid and MPO activity in lung tissue were significantly lower in H2RB-group compared to LPS-group. However, protein concentration in BAL fluid showed no significant differences between the LPS alone and LPS with histamine receptor blockade. CONCLUSIONS: Endogenous histamine might be involved in the recruitment of PMNs in LPS-induced ALI via H2 receptor. However, its role in ALI would not be significant in this model.
Acute Lung Injury* ; Animals ; Bronchoalveolar Lavage ; Capillary Permeability ; Cell Count ; Endothelial Cells ; Histamine* ; Lung ; P-Selectin ; Peritoneum ; Peroxidase ; Rats ; Rats, Sprague-Dawley ; Receptors, Histamine ; Trachea ; Veins

Human babesiosis is a tick-borne infectious disease caused by Babesia species. The clinical diagnosis is difficult because of nonspecific symptoms like flu. Rapid diagnosis of human babesiosis is microscopic examination in peripheral blood smear (Giemsa-stain) which reveals characteristic forms of an intracellular quadruplet parasite. But differentiation between Babesia microti and Plasmodium species can be quite difficult because of the morphologic similarity. We experienced a case of human babesiosis. The patient was a 62-year old Korean male who had been in New Jersey, U.S.A for 2 months. We initially diagnosed as malaria infection because the peripheral blood smear revealed intracellular single ring form organism. But the patient was not improved significantly by the treatment with chloroquine regimen. Finally we confirmed human babesiosis by polymerase chain reaction for Babesia microti. We treated the patient successfully with a regimen of atovaquone and azithromycin which has fewer adverse reactions than a regimen of clindamycin and quinine.
Animals ; Atovaquone* ; Azithromycin* ; Babesia ; Babesia microti ; Babesiosis* ; Chloroquine ; Clindamycin ; Communicable Diseases ; Diagnosis ; Humans* ; Malaria ; Male ; Middle Aged ; New Jersey ; Parasites ; Plasmodium ; Polymerase Chain Reaction* ; Quadruplets ; Quinine

Human babesiosis is a tick-borne infectious disease caused by Babesia species. The clinical diagnosis is difficult because of nonspecific symptoms like flu. Rapid diagnosis of human babesiosis is microscopic examination in peripheral blood smear (Giemsa-stain) which reveals characteristic forms of an intracellular quadruplet parasite. But differentiation between Babesia microti and Plasmodium species can be quite difficult because of the morphologic similarity. We experienced a case of human babesiosis. The patient was a 62-year old Korean male who had been in New Jersey, U.S.A for 2 months. We initially diagnosed as malaria infection because the peripheral blood smear revealed intracellular single ring form organism. But the patient was not improved significantly by the treatment with chloroquine regimen. Finally we confirmed human babesiosis by polymerase chain reaction for Babesia microti. We treated the patient successfully with a regimen of atovaquone and azithromycin which has fewer adverse reactions than a regimen of clindamycin and quinine.
Animals ; Atovaquone* ; Azithromycin* ; Babesia ; Babesia microti ; Babesiosis* ; Chloroquine ; Clindamycin ; Communicable Diseases ; Diagnosis ; Humans* ; Malaria ; Male ; Middle Aged ; New Jersey ; Parasites ; Plasmodium ; Polymerase Chain Reaction* ; Quadruplets ; Quinine

BACKGROUND: Additional tests ordered by doctors after checking abnormal routine test results for inpatients are usually delayed for one day or more, which in turn delays diagnostic and therapeutic procedures and prolongs length of stay (LOS) for the patients. We at Department of Laboratory Medicine, Asan Medical Center (AMC), established a "secondary order system for laboratory tests without additional blood sampling" to improve the conventional reflexive tests. METHODS: Oracle 8.0 (Oracle Co., Belmont, CA, USA) was used for data base software and Powerbuilder (Powersoft, Burlington, UK) for client development tool. Specimens subjected to "reflexive tests by doctors without additional blood sampling" were SST tubes for routine chemistry and EDTA for routine hematology requested in the morning of additional requests of the laboratory tests. RESULTS: Programs of registration and request for "reflexive tests by doctors without additional blood sampling" and bar code printing were developed for clinicians to check the routine test results and to order additional tests, if necessary, and for laboratory to perform the requested tests using the same samples used for routine chemistry and hematology tests in the morning. Additionally requested tests were done by finding the SST and EDTA samples, putting newly printed bar code, and processing them as usual. In February 2004, right after introducing reflexive tests by doctors without additional blood sampling, 75 additional requests were made for 50 patients, but they increased gradually up to 1,020 tests for 698 patients in December 2004. In 2005, the monthly average number of tests was 1,035 for 742 patients. CONCLUSIONS: The reflexive tests by doctors without additional blood sampling developed at AMC helped establish a rapid reporting of test results, which in turn reduced LOS related to laboratory. It also increased patient satisfactory indices by reducing repeated blood sampling and would also contribute to the financial health of the hospital.
Automatic Data Processing ; Chemistry ; Chungcheongnam-do ; Edetic Acid ; Hematology ; Humans ; Inpatients ; Length of Stay ; Reflex

Primary non-Hodgkin's lymphoma of the liver, an organ normally devoid of a native lymphoid tissue, is very rare. We report a case of primary hepatic T-cell lymphoma in a 18-year-old girl, with review of literature. The pateint admitted with fever for 5 months. The ultrasonography revealed a 10 x 7 cm sized mass in the left lobe of the liver. On abdominal CT, the mass was poorly enhancing and low attenuated. On MRI, the signal intensity of the mass was low in T1 weighted image, heterogeneously high in T2 weighted image, and peripherally enhanced in contrast enhancing T1 weighted image. The biopsy specimen obtained by laparatomy showed anaplastic tumor. The malignant cells were positive for T-cell lineage (CD3, CD44, CD45RO). There was no evidence of the lymphoma in other regions. The patient was treated with CHOP (cyclophosphamide, adriamycin, vincristine and prednisolone) chemotherapy without objective response. The patient died of sudden cardiogenic shock.
Adolescent ; Biopsy ; Doxorubicin ; Drug Therapy ; Female ; Fever ; Fever of Unknown Origin ; Humans ; Liver* ; Lymphoid Tissue ; Lymphoma ; Lymphoma, Non-Hodgkin ; Lymphoma, T-Cell* ; Magnetic Resonance Imaging ; Shock, Cardiogenic ; T-Lymphocytes ; Tomography, X-Ray Computed ; Ultrasonography ; Vincristine