A colonoscopic perforation is rare but can cause a fatal outcome. A perforation can be intraperitoneal or retroperitoneal. Air in the retroperitoneal space by perforation can spread to the mediastinum, pleura, and subcutaneous tissue through the visceral space. Therefore, a colonoscopic perforation may manifest as a pneumomediastinum, a pneumothorax, or subcutaneous emphysema without a peritoneal irritation sign. Although a colonoscopic perforation is treated mainly with an operation, medical treatment may be possible in selected cases, especially for a perforation to the retroperitoneal area or that under peritoneal reflexion. Clipping of a perforation is effective for medical treatment. We experienced a case of pneumothorax, pneumomediastinum, subcutaneous emphysema and pneumoretroperitoneum without peritoneal irritation following a diagnostic colonoscopy, which was diagnosed after 3 days because of atypical symptoms but was successfully managed with medical treatment and clipping.
Colonoscopy ; Fatal Outcome ; Mediastinal Emphysema ; Mediastinum ; Pleura ; Pneumothorax ; Retroperitoneal Space ; Retropneumoperitoneum ; Subcutaneous Emphysema ; Subcutaneous Tissue

Portal vein thrombosis (PVT) is an uncommon cause of presinusoidal hypertension and can result from cirrhosis, malignancy, infection, inflammation, and congenital and acquired thrombophilic states. Infectious and inflammatory causes include pylephlebitis, omphalitis, diverticulitis, pancreatitis, cholecystitis, appendicitis, and inflammatory bowel disease. However, PVT induced by a lung abscess has not been reported. We experienced a 50-year-old male complaining of right upper quadrant pain, fever, and coughing. A lung abscess and PVT were revealed by computed tomography and abdominal Doppler ultrasonography. The PVT resolved, in part, after an 8-day course of antibiotic therapy. We report a case of PVT as a complication of a lung abscess and review the literature.
Appendicitis ; Cholecystitis ; Cough ; Diverticulitis ; Fever ; Fibrosis ; Humans ; Hypertension ; Inflammation ; Inflammatory Bowel Diseases ; Lung ; Lung Abscess ; Male ; Middle Aged ; Pancreatitis ; Portal Vein ; Protein S ; Thrombosis ; Ultrasonography, Doppler

Pegylated interferon alfa-2a (PEG-IFN) and ribavirin combination therapy is the first line treatment for chronic HCV infection. There are four reports of Bell's palsy associated with interferon-alpha (IFN-alpha) and ribavirin therapy. We report here a case of Bell's palsy that occurred in a patient with chronic HCV infection during combination PEG-IFN and ribavirin therapy. The patient was 49-year-old man with chronic hepatitis C for 2 years. The liver biopsy showed grade 1 and stage 1. Therapy with PEG-IFN (Pegasys) 180 microgram/week and ribavirin 1200 mg/day was initiated. After 3 weeks of treatment, the patient showed a loss of muscular tone on the left side of his face. A diagnosis of Bell's palsy was made, and the PEG-IFN and ribavirin therapy was stopped. Prednisolone 45 mg/d was given and then tapered for 8 weeks. His palsy improved over 6 weeks.
Adult ; Antiviral Agents/*adverse effects ; Bell Palsy/*etiology/immunology ; Hepatitis C, Chronic/complications/*drug therapy/virology ; Humans ; Interferon Alfa-2a/*adverse effects/therapeutic use ; Male ; Middle Aged ; Polyethylene Glycols/*adverse effects/therapeutic use ; Ribavirin/administration & dosage/*adverse effects/therapeutic use ; Treatment Outcome

Myoepitheliomas are well-established to occur in the salivary glands, but they have also been described in the breast, upper aerodigestive tract, skin, and soft tissues. We report here on a unique case of primary myoepithelioma that occurred in the right testis of a 28-year-old man. The tumor was entirely confined to the testis and it was clearly separated from the epididymis. Histopathology revealed mixed architectural patterns in which the reticular areas merged into the chondromyxoid stroma. The tumor cells, which were focally immunoreactive to pancytokeratin and S-100 protein, were round to ovoid and spindly arranged in cords, strands, and fascicles. They showed mild nuclear pleomorphism, sparse mitotic figures and a low Ki-67 proliferative index. There was no ductal differentiation in the tumor. To the best of our knowledge, there has been only one case report of a primary testicular myoepithelioma in the English medical literature.
Adult ; Breast ; Epididymis ; Humans ; Male ; Myoepithelioma ; S100 Proteins ; Salivary Glands ; Skin ; Testis

Since patients with intracranial neoplasms usually represent their neurological symptoms rather early in the course of the disease, sudden unexpected death due to intracranial neoplasms is an uncommon event seen only exceptionally in medicolegal autopsy practice. Although meningiom is one of the most common primary intracranial neoplasms, sudden death due to the tumor is an uncommon event. We report a sudden, unexpected death of a 56-year-old female with an undiagnosed olfactory groove meningioma. It is assumed that peritumoral edema is related to the sudden death among the several mechanisms.
Female ; Humans

Gastric bezoars are concretion of undigested material in the gastrointestinal tract. In the past, gastric bezoars were generally treated with surgical management. Recently, the efficacy of oral intake or endoscopic injection therapy with Coca-Cola has been reported. We report a case of a 47-year-old-man with huge gastric bezoar (4x2.5 cm) that was successfully removed by endoscopic fragmentation with Coca-Cola injection. Compared with a single endoscopic fragmentation therapy, the combination therapy with Coca-Cola injection shortened the procedure time and reduced the complication associated with fragmented bezoar.
Bezoars ; Cola ; Endoscopy ; Gastrointestinal Tract

BACKGROUND: The objectives of this study were to assess propofol as sedative agents for colonoscopy in the safety and efficacy, compared with midazolam plus meperidine. METHODS: 120 patients undergoing colonoscopy in a prospective study were randomly assigned to one of three medication regimens. Patients in group A (n=42) received i.v. 25 mg of meperidine and 2.5 mg of midazolam. Patients in group B (n=41) received i.v. a median dose of 96.59 mg of propofol (range 40-180) and patients in group C (n=37) received i.v. 25 mg of meperidine and a median dose of 77.03 mg of propofol (range 40-150), administered by a nurse with endoscopist supervision. Endpoints were patient satisfaction, procedure and recovery times and complications. RESULTS: The mean time to sedation was much faster in 2 groups using propofol (group A: 152+/-105.9 sec, group B: 52.9+/-46.5 sec, group C: 56+/-63.7sec; p<0.001). The mean time to reach the cecum was not different among the 3 groups. There were total 3 episodes of oxygen desaturation to <90%, as one in each group, but the patients were spontaneously recovered with only increasing O2 concentration and arousal. Patients in group C expressed better overall mean satisfaction than patients in group A (p=0.049), but difference was not found between group A and group B. The amnestic effect was better in two groups using propofol than group A (p=0.017) The mean dose of propofol was lower in the patients who received propofol combined with low dose of meperidine than those with propofol only (77.03 mg vs 96.59 mg, p=0.009). CONCLUSION: Nurse-administered propofol sedation with endoscopist supervision is believed to be safe and useful for colonoscopy with careful monitoring.
Arousal ; Cecum ; Colonoscopy ; Conscious Sedation* ; Humans ; Meperidine ; Midazolam ; Organization and Administration ; Oxygen ; Patient Satisfaction ; Propofol* ; Prospective Studies*

Sudden manhood death syndrome (SMDS) is a disorder found in southeast Asia, particularly Thailand, Philippines and Japan, which causes sudden cardiac death during sleep. In Korea, SMDS cases have been occasionally encountered in forensic autopsy practice. However, the incidence and pathogenesis has been rarely studied. This study to review chronologically the proposed pathogenesis of SMDS; pathology of cardiac conduction system, sleeping and breathing disorder, K+ and thiamine deficiency, mental stress, testosterone, hyperlipidemia, and narrow circumference of coronary artery. Brugada syndrome and SMDS are phenotypically, genetically and functionally the same disorder and Brugada syndrome has been a subject of intensive study since its early description in 1992. While Brugada syndrome is an inherited cardiac disorder caused by mutations in the SCN5A gene encoding the cardiac sodium channel alpha-subunit. less than 20% of its patients are known to be associated with SCN5A mutations. Moreover, the postmortem molecular screening of SCN5A mutations on formalin fixed paraffin embbeded cardiac tissues from SMDS cases has not been rewarding due to technical problems. The role of structural heart disease and sodium channel dysfunction in the induction of electrical instability in SMDS and Brugada syndrome is still debatable.
Asia, Southeastern ; Autopsy ; Brugada Syndrome ; Coronary Vessels ; Death, Sudden, Cardiac ; Formaldehyde ; Heart Diseases ; Humans ; Hyperlipidemias ; Incidence ; Japan ; Korea ; Mass Screening ; Paraffin ; Philippines ; Respiration ; Reward ; Sodium Channels ; Testosterone ; Thailand ; Thiamine Deficiency

Gastric carcinoids usually appear as a single polypoid tumor or yellowish rounded submucosal tumor in the fundus or body of the stomach. Multiple gastric carcinoids are associated with pernicious anemia, chronic atrophic gastritis and Zollinger-Ellison syndrome. These are believed to be due to hypergastrinemia. In Korea, carcinoids usually appear as single round-based submucosal tumor or sessile polyps. Multiple pedunculated polypoid carcinoids were rarely reported. A 27-year old woman was admitted to our hospital due to melena. The endoscopy revealed multiple pedunculated polypoid lesions in the fundus and body, predominantly in Yamada type III and IV. The histopathologic examination revealed the diagnosis of gastric carcinoid tumors. Serum fasting gastrin level was normal. We report a case of multiple pedunculated polypoid gastric carcinoids without atrophic gastritis or hypergastrinemia with a review of relevant literatures.
Female ; Humans

Endoscopic thoracoscopic sympathicotomy (ETS) for treatment of hyperhidrosis is usually considered as a simple and safe procedure. The complication of ETS is low and no death following ETS has ever been reported in the literature without anecdotal fatal cases. Recently, we experienced two cases of intraoperative cardiac arrest and death. Two patients are suffered from sudden cardiac arrest after transection of the left sympathetic nerve trunk by the thoracoscopic method. Vigorous cardiopulmonary resuscitations were performed but both patients are not recovered. Autopsy examinations are performed and there are no remarkable pathology.