The occurrence of a fistula between the duodenum and the colon is very rare, although these two structures commonly lie in intimate relationship to each other. It is not uncommon for tumor of the right colon and proximal transverse colon to involve the duodenum by continuity, but fistulous connection between the duodenum and colon are infrequent In most of the reported malignant cases, the fistulas follow carcinomas of the transverse colon or the hepatic flexure of the colon. We report a rare case of malignant duodenocolic fistula which was first suspected by endoscopic examination and confirmed by operation.
Colon ; Colon, Transverse ; Duodenum ; Endoscopy* ; Fistula*

We are report on three cases of typical clinical characterstics and treatment response in neuroleptic maligant syndrome(NMS), and reviewed the literatures of NMS. NMS was first recognized as a life-threatening complication of dopamine receptor antagonists, and defined as a catatonic-like states associated with fever, obtundation, muscle rigidity, and unstable vital sign in patients taking neuroleptic agents. Concepts of NMS have changed because medications other than classic neuroleptic drugs have been implicated as triggering agents and syndromes identical to NMS have been observed in other conditions. The important neurochemical features are probably functional dopamine deficiency and ensuing hyperactivity of excitatory amino and neurotransmission in the basal ganglia and hypothalamus. Recognition of NMS and early discontinuation of neuroleptics are the most important step in its management. Supportive care includes management of hyperthermia and fluid replacement. Contraversial therapeutic measures include the application of dopamine receptor agonists, excitatory amino acid antagosists, or dantrolene. Psychiatric patients with a history on NMS and psychotic relapse necessitating antipsycotics do not commonly redevelop NMS.
Antipsychotic Agents ; Basal Ganglia ; Dantrolene ; Dopamine ; Dopamine Agonists ; Dopamine Antagonists ; Excitatory Amino Acids ; Fever ; Humans ; Hypothalamus ; Muscle Rigidity ; Neuroleptic Malignant Syndrome* ; Recurrence ; Synaptic Transmission ; Vital Signs

No abstract available.
Embryonic Structures* ; Head* ; Humans* ; Neck*

BACKGROUND: We investigated the effectiveness of fibular strut allograft augmentation of proximal humerus fractures to prevent varus deformity in patients over the age of 65 years with insufficient medial support. METHODS: We analyzed the clinical and radiological outcomes of locking plate fixation with adjunct fibular strut allograft augmentation in 21 patients with proximal humeral fractures. The inclusion criteria were age (65-year-old or older); presence of severe medial comminution; inadequate medial support; and those who could participate in at least a one year follow-up. The average age was 76.4 years. We analyzed each patient's Constant score, our indicator of clinical outcome. As radiological parameters, we analyzed time-to-bone union; restoration of the medial hinge; difference between the immediately postoperative and the last follow-up humeral neck-shaft angles;; and anatomical reduction status, which was assessed using the Paavolainen method. RESULTS: A successful bone union was achieved in all patients at an average of 11.4 weeks. We found that the average Constant score was 74.2, showing a satisfactory outcome. The average difference in the humeral neck-shaft angles between the immediately postoperative time-point and at the final follow-up was 3.09°. According to the Paavolainen method, the anatomical reduction was rated excellent. The medial hinge was restored in 14 of 21 patients. Although we did not find evidence for osteonecrosis, we found that a single patient had a postoperative complication of screw cut-out. CONCLUSIONS: Fibular strut allografting as an adjunct treatment of proximal humeral fractures may reduce varus deformity in patients with severe medial comminution.
Allografts ; Congenital Abnormalities* ; Follow-Up Studies ; Humans ; Humerus* ; Methods ; Osteonecrosis ; Postoperative Complications ; Shoulder Fractures ; Transplantation, Homologous

Reticulated pigrnented anomalies of the flexures is a pigmentary disorder bearing genetic back ground, also known as Dowling Degos disease or dark dot disease. It is characterized reticulated brownish black macules on the flexural areas with the histological features of filiform pigmented epidermal downward proliferation and the presence of intraepidermal keratin containing cysts. We report 34-year-old housewife who showed brawnish black reticulated macules on her axillae, anterior neck and genitocural folds. Pigmented comedones were also found at the marginal areas of the axillae. Biopsy specimen revealed the presence of intraepidermal keratin containing cysts and basilar hyperpigmentation.
Adult ; Axilla ; Biopsy ; Humans ; Hyperpigmentation ; Malignant Atrophic Papulosis ; Neck ; Pigmentation

Pemphgus vulgaris (PV), Bullus pemphigoid (BP), and Epidermolysis bullous acqusita (EBA) are autoimmune bullous dermatoses, characterized by circulating IgG autoantibodies. These antibodies react with antigens located at the intercellular substance (ICS) of epidermis, basement membrane zone (BMZ), and subepidermal anchoring fibril zone (AFZ), respectively. The subclass distribution of IgG autoantibodies, and the properties and degrees of complement fixing activities of these autoantibodies in each of the above diseases have not been well understood. Indirect immunofluorescence and in vitro complement stainings were performed for the titration of subclasses of IgG antibodies and for the immunofluorescence staining reactivities of complement components C3, C4, C5b-9, H, C4bp, and S. Each serum specimen from five cases of PV, five cases of BP. and three cases of EBA was tested. The findings of multistep technique with monoclonal and polyclonal antibodies are as follows : All four subclasses of IgG antibodies were identified at the antigenic sites in these group, however there were some differences in the antibodies titers. In PV and BP the dominant subclass of highest antibody titer was IgG1 and/or IgG4. In EBA only IgG4 was dominant in all three cases. The results of complement component stainings, in most of the cases of PV, showed positive for C3 and C4 but were negative for the other components or inhibitor proteins at the ICS of epidermis. In BP most of the cases revealed positive staining reactivities at the BMZ for C3, C4, C5b-9, H, and C4bp-9 with no staining reactivities for the inhibitor proteins No significant relevancy was found between the titers of complement fixing IgG subclasses and the numbers of positive complement staining reactivities for complement components. The results suggest that the complement system may contribute more strongly to the formation of bullous lesions in BP and EBA than in PV.
Antibodies ; Autoantibodies ; Basement Membrane ; Blister ; Complement Membrane Attack Complex ; Complement System Proteins ; Epidermis ; Epidermolysis Bullosa Acquisita* ; Epidermolysis Bullosa* ; Fluorescent Antibody Technique ; Fluorescent Antibody Technique, Indirect ; Immunoglobulin G ; Pemphigoid, Bullous* ; Pemphigus* ; Skin Diseases, Vesiculobullous

The status of DNA synthesis and the effect of UV radiation on the DNA synthesis were studied in mouse skin by microautoradiography. Mice exposed to 100mJ/cm of UVB were injected intradermally with tritiated thymidine, 5 minutes, 2, 6 and 24 hours after irradiation and biopsies were processed for light microscopic autoradiography, A total of 25 ICR female albino haired mice were used as subjects. We compared heavily labeled cells(>10 grains/nucleus) and sparsely labeled cells (3-10 grains/nucleus) in UVL irradiated skin with nonirradiated control skin. 1. Within 5 minutes after UVL exposure an apparent depression in the number of heavily labeled cells occurred. This reduction was statistically significant and remained so for at least six hours post,irradiation. By 24 hours after UVL exposure, the reduction was recovered to nearly control level. 2. By five minutes after UVL exposure, sparsely labeled cells were observed in basal cell layer and differentiated cell layer. The nurriber of sparsely labeled cells appeared highest at five minutes after UVL exposure and then tended to fall to nearly control level at 24 hours. This aberrant type of TdR H incorporation is thought to represent unscheduled DNA synthesis to repair pyrimidine dimers formed in UVL injured DNA molecules,
Animals ; Autoradiography* ; Biopsy ; Depression ; DNA* ; Female ; Hair ; Humans ; Mice* ; Pyrimidine Dimers ; Skin* ; Thymidine ; Ultraviolet Rays

The complement system is known to be involved in the pathogenesis of the skin lesions in pernphigus vulgaris, bullous pemphigoid, dermatitis herpetiformis, epidermolysis bullosa acquisita, and systemic lupus erythematosus. Authors examined the skin specimens of each disease cases, who did not show any evidence of complement deficiency, to determine the deposition of complement components(C4, C3, Chb-9) and their inhibitors(C4bp, Factor H, S-protein) by modified direct immunofluorescence. We also looked at the staining pattern and localization, for further insights of their pathobiologic contributions in each disease. The findings of deposits of complement components up to C9, as well as inhibitor proteins at the primary histopathologic sites, in the majority of those cases, may indicate that the complement system, to certain extent, involves the inflamrnatory reactions in these diseases. The co-localization of C5b-9 and S-protein could be regarded as the consequence of in situ formation of SC5b-9 complexs or as the result of non-lytic adsorbed complexes of fluid phase SC5b-9. The pathologic role of the complement seems to depend mostly on the complement-fixing biologic property and the amount of the tissue bound immune complexes, which are often heterogeneous to different diseases and among different patients.
Antigen-Antibody Complex ; Complement Factor H ; Complement Membrane Attack Complex ; Complement System Proteins* ; Dermatitis Herpetiformis ; Epidermolysis Bullosa Acquisita ; Fluorescent Antibody Technique, Direct ; Humans ; Lupus Erythematosus, Systemic ; Pemphigoid, Bullous ; Skin ; Skin Diseases*

In order to know the species and frequency of human parasitic infection diagnosed by biopsy, 149 cases (0.18%) of parasitic infection were reviwed, which were selected from 80,947 biopsied materials submitted for routine histopathological examination during a period of 10 years from 1980 to 1989 at Department of Pathology, Chonnam National University Hospital. They consisted of 112 cases of cysticercosis, 17 paragonimiasis, 7 clonorchiasis, 4 amebiasis, 1 sparganosis, 1 enterbiasis, 1 aniskiasis, and 1 fascioliasis respectively. Based on morphological preservation of cysticercus, they could be divided into mild (20.2%), morderate (40.4%), and severe (39.4%) degeneration. Except 2 cases biopsied at the lungs, 15 cases of ectopic paragonimiasis were located at abdominal cavity (8 cases) and central nervous system (7 cases). One case of intrahepatic fascioliasis was observed. This is the 13th human fascioliasis reported in Korea. From the above results, the frequency of parasitic infections found in biopsied specimens was on the decrease as the cysticercosis and ectopic paragonimiasis.
parasitology-helminth-cestoda-nematoda-trematoda ; biopsy ; histopathology ; tissue parasite ; cysticercose ; ectopic ; Enterobius vermicularis ; Taenia solium ; Paragonimus westermani ; Clonorchis sinensis ; Entamoeba histolytica ; Anisakis ; Fasciola sp. ; paragonimiasis ; fascioliasis

Microvascular anastomosis has become an essential technique in reconstructive surgery. A lot of techniques have been developed to improve patency rate and reduce operation time. But interrupted suture technique is still most widely used because of limited indication and inconvenience of other methods. A comparative study was undertaken to evaluate new microvasular anastomosis technique using fibrin glue. In this report 40 femoral arteries of Sprague-Dawley rats were anastomosed by utilizing four stay sutures which were placed 90 degrees apart and the intervals covered with fibrin glue, and by conventional eight suture method served as control. The patency rate(immediate postoperative, postoperative two weeks), time needed for vascular anastomosis, and microscopic evaluation were compared to those of conventional microvascular suture technique. Postoperative patency rate was 100% and 85% by fibrin glue technique compared to 100% and 90% by conventional technique at immediate postoperative and postoperative two weeks. Less time consumed with fibrin glue technique by 16 minutes compared to conventional technique by 21 minutes. Microscopically reendothelization was complete with smooth and less injured inner lining and also less inflammatory response by fibrin glue technique compared to conventional technique.
Femoral Artery ; Fibrin Tissue Adhesive* ; Fibrin* ; Rats, Sprague-Dawley ; Suture Techniques ; Sutures