Brunner's gland adenoma(or Brunneroma) is clinically relevant tumor-like lesion of the duodenum which is composed of submucosal Brunner's gland tissue. Since the first case by autopsy was described by Cruveihier in l935, there have been less than 190 reports in the world literature, Brunner's gland adenoma is an extremely rare entity that accounts for only 10.6% of benign duodenal tumors, which are themselves relatively rare representing 0.008% of all surgical and autopsy specimens. The clinical manifestation of this tumor are non-specific gastrointestinal complaints, such as bloating or epigastric pain, and tumor often gives rise to melena or obstruction, It is postulated that this tumor are hamartomas rather than true neoplasm. However, they undergo rarely malignant transformation. We report on a case of a large pedunculated Brunner's gland adenoma, which was successfully polypectomized.
Adenoma* ; Autopsy ; Duodenum ; Hamartoma ; Melena

Brunner's gland adenoma(or Brunneroma) is clinically relevant tumor-like lesion of the duodenum which is composed of submucosal Brunner's gland tissue. Since the first case by autopsy was described by Cruveihier in l935, there have been less than 190 reports in the world literature, Brunner's gland adenoma is an extremely rare entity that accounts for only 10.6% of benign duodenal tumors, which are themselves relatively rare representing 0.008% of all surgical and autopsy specimens. The clinical manifestation of this tumor are non-specific gastrointestinal complaints, such as bloating or epigastric pain, and tumor often gives rise to melena or obstruction, It is postulated that this tumor are hamartomas rather than true neoplasm. However, they undergo rarely malignant transformation. We report on a case of a large pedunculated Brunner's gland adenoma, which was successfully polypectomized.
Adenoma* ; Autopsy ; Duodenum ; Hamartoma ; Melena

PURPOSE: The main purpose of this study was to compare the level of satisfaction of patients with nursing care received, and of nurses with nursing care provided to their patients. Another purpose of this study was to identify the relationship between job satisfaction by the nurses and satisfaction with nursing care they provide. METHOD: A self-report questionnaire developed by Yoo & Hong (1999) was used to measure patient and nurse satisfaction. The participants were 147 patients and 133 nurses and data were collected from October 23 to October 30, 2002. Data analysis was done using SPSS WIN 11.0. RESULT: The average score for patient satisfaction was 2.47 (maximum score 5.0) and for nurses, 2.20. This difference was statistically significant. The patients gave high scores on care related personal hygiene, but they gave low scores for critical nursing areas such as following appropriate procedure for administering medications. No significant relationship was found between satisfaction with their nursing care by the nurses and satisfaction with the job. CONCLUSION: Even though the patient scores were significantly higher than nurses', the overall average score was very low and critical nursing actions received the lowest scores. It is necessary to identify areas in need of improvement and develop continuing education programs for nurses.
Education, Continuing ; Humans ; Hygiene ; Job Satisfaction ; Nursing ; Nursing Care ; Patient Satisfaction* ; Surveys and Questionnaires ; Statistics as Topic

The development of glomerular injury in patients with malignancy is considered as paraneoplastic syndrome. The most frequently observed renal lesions associated with malignancies are the membraneous glomerulonephritis on carcinomas and minimal change nephrotic syndrome on Hodgkin's disease. However, glomerular diseases on non-Hodgkin's lymphoma were only occasionally reported. Here we report a case of IgA nephropathy associated with non-Hodgkin's lymphoma. A 53-year-old woman who had complained of gross hematuria and fever was admitted to Wonju Christian Hospital. A urinalysis revealed 2+ proteinuria and red blood cells >30/HPF. A 24-hour urinary protein excretion was 379mg. She was diagnosed as IgA nephropathy on renal biopsy. Subsequently, biopsy of her enlarged neck node was performed for evaluation of fever of unknown origin and it revealed non-Hodgkin's lymphoma (Ki-1 positive anaplastic lymphoma null cell type). Combination chemotherapy was instituted with cyclophosphamide, adriamycin, vincristine and prednisone. After 3 cycles of chemotherapy, she showed no evidence of proteinuria and hematuria with clinical and radiological improvement of malignant lymphoma. Therefore we suggest of certain association between IgA nephropathy and non-Hodgkin's lymphoma by the observation of corresponding disease activity.
Biopsy ; Cyclophosphamide ; Doxorubicin ; Drug Therapy ; Drug Therapy, Combination ; Erythrocytes ; Female ; Fever ; Fever of Unknown Origin ; Gangwon-do ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Hematuria ; Hodgkin Disease ; Humans ; Immunoglobulin A* ; Lymphocytes, Null ; Lymphoma ; Lymphoma, Non-Hodgkin* ; Middle Aged ; Neck ; Nephrosis, Lipoid ; Paraneoplastic Syndromes ; Prednisone ; Proteinuria ; Urinalysis ; Vincristine

OBJECTIVES: Developments in endoscopic technique and equipments have improved duct clearance rate in patients with extrahepatic bile duct(EHBD) stone. In this study, we reviewed our experience in extracting EHBD stones with standard and more advanced technique and equipments such as mechanical lithotripsy and extra corporeal shock wave lithotripsy. Aims of this study were to determine the overall success rate of endoscopic ex tracting for EHBD stone, to identify risk factors for failed duct clearance at initial and final therapeutic ERCP. METHODS: We retrospectively reviewed 214 consec utive patients who underwent Endoscopic Retrograde Cholangiopancreatography(ERCP) for EHBD stone over 45 months period. Factors evaluated for failed duct clearance included stone size, stone number, stone shape, concomitant stone of gallbladder and intrahepatic duct, presence of distal bile duct stricture, periampullary diverticula(PAD), Billroth-II gastrojejunostomy, and sepsis at admission. RESULTS: The overall success rate of endoscopic treatment for EHBD stone was 93.5% (200/214). The causes of failed duct clearance were failed endoscopic sphincterotomy in 5/214 (2.3%), technical failure of extracting stone in 5/214(2.3%), and aggravation of acute cholecystitis between therapeutic endoscopic sessions in 4/214(1.9%). Risk factors for failed duct clearance with endoscopic extraction of EHBD stone were size and shape of the stone, concomitant stone of gallbladder and intra hepatic duct, and stricture of distal common bile duct. The duct clearance rate with initial therapeutic ERCP was 56.5%(121/200). Risk factors for failed duct clearance with initial therapeutic ERCP were size, shape and number of stone, and sepsis at admission. The com plications of endoscopic treatment for EHBD stone were major bleeding in 5/200 (2.5%), pancreatitis in 18/200 (9.0%), but there was no perforation. CONCLUSION: Eventhough risk for failure of endo scopic treatment for EHBD stone were giant or piston shaped stone, concomitant stone of gallbladder and intra hepatic duct, and stricture of distal common bile duct, we conclude that endoscopic treatment for EHBD stone is safe and effective treatment modality, and choice of treatment.
Bile ; Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystitis, Acute ; Common Bile Duct ; Constriction, Pathologic ; Gallbladder ; Gastric Bypass ; Hemorrhage ; Hepatic Duct, Common ; Humans ; Lithotripsy ; Pancreatitis ; Retrospective Studies ; Risk Factors ; Sepsis ; Shock ; Sphincterotomy, Endoscopic

Atypical hemolytic uremic syndrome (HUS) in adults is a life-threatening disorder characterized by acute renal failure, microangiopathic hemolytic anemia, and thrombocytopenia, which is not related to E. coli. Digital gangrene is one of the grave signs in emergency medicine because it requires prompt evaluation and treatment. We describe a 37 year-old Thailand woman, initially treated for suspected Neisseria septicemia, who went on to develop renal complications, thrombocytopenia and hemolytic anemia, which made the diagnosis of atypical hemolytic uremic syndrome. The patient was complaining of dysesthesia on all extremities and severe pain in both legs. Serologically, she was diagnosed as systemic lupus erythematosus (SLE). She was treated with plasma exchanges using fresh frozen plasma, parenteral steroid, anticoagulant and antibiotics, successfully. This is the first report of digital gangrene complicated by atypical HUS in a patient with SLE in Korea.
Acute Kidney Injury ; Adult ; Anemia, Hemolytic ; Anti-Bacterial Agents ; Emergency Medicine ; Extremities ; Female ; Gangrene ; Hemolytic-Uremic Syndrome ; Humans ; Korea ; Leg ; Lupus Erythematosus, Systemic ; Neisseria ; Paresthesia ; Plasma ; Plasma Exchange ; Sepsis ; Thailand ; Thrombocytopenia

BACKGROUND: The morphological characteristics of hepatocytes transplanted into the spleen have been studied. However few attempts has been made to determine the expression of genes in intrasplenically transplanted hepatocytes. The aim of this study was to explore whether the pattern of expression of albumin gene in intrasplenically transplanted hepatocytes is similar to that in adult liver, resulting in the long-term expression of this hepatocyte-specific gene. METHODS: Hepatocytes isolated from liver of syngeneic Fischer 344 rats and transplanted into the spleen of rats from the same strain survived for 12 months in the absence of immunosuppressive drugs. Microscopic examination of intrasplenic hepatocytes and Northern blotting for albumin gene expression of RNA extracted from liver and spleen was performed. RESULTS: Microscopy demonstrated that hepatocytes attached themselves only in the red pulp of the spleen and isolated hepatocytes preserved the fine structures characteristic of normal hepatic parenchymal cells. Throughout the 12 months period, intrasplenically transplanted hepatocytes expressed albumin mRNA. CONCLUSIONS: Intrasplenically transplanted hepatocytes represent a unique in vivo system of extrahepatic maintenance of hepatocytes. This novel transplantation system could be used to investigate hepatocyte engraft, proliferation and gene expression.
Adult ; Animals ; Blotting, Northern ; Gene Expression* ; Hepatocytes* ; Humans ; Liver ; Microscopy ; Rats ; RNA ; RNA, Messenger ; Spleen

OBJECTIVE: Patient-controlled-analgesia (PCA) using intravenous (IV) opioids is recognized a safe and effective method for pain control. However, postoperative analgesia with opioids is associated with a high incidence of postoperative nausea and vomiting (PONV) exceeding 30%. The 5-hydroxytryptamine receptor 3 (5-HT3) antagonists alleviate nausea and vomiting. This study aims to compare the effectiveness of ramosetron and ondansetron in preventing PONV following laparoscopic hysterectomy for benign uterine diseases under general anesthesia. METHODS: The medical records of 1483 patients who underwent laparoscopic hysterectomy between January 2005 and May 2009 were reviewed. Of the 1483 patients, 1184 patients who received IVPCA with ramosetron 0.3 mg (n=761) or ondansetron 8 mg (n=423) were analyzed. Fentanyl-based IVPCA was administered for 48 hours after surgery. The overall incidence of postoperative nausea and vomiting, bowel ileus, Levin tube insertion for severe bowel ileus, additional usage of pain killers and discontinuation of the IVPCA infusion with PCA-related severe nausea and vomiting were assessed for 48 hours after surgery. The amount of time until bowel gas passage resumption after surgery was measured. RESULTS: There was a significant difference between the two groups regarding the duration until post-operative bowel gas passage resumption (1.78+/-0.79 days in the ramosetron group, and 2.23+/-0.83 days in the ondansetron group; p=0.005); however, there were no significant differences found in other aspects. CONCLUSION: Ramosetron is superior to ondansetron in terms of faster recovery in bowel mobility, with similar effects in preventing the incidence of PONV.
Analgesia ; Analgesia, Patient-Controlled ; Analgesics, Opioid ; Benzimidazoles ; Humans ; Hysterectomy ; Ileus ; Incidence ; Medical Records ; Nausea ; Ondansetron ; Postoperative Nausea and Vomiting ; Serotonin ; Uterine Diseases ; Vomiting

PURPOSE: The role of the Ferric Uptake Regulator (FUR) in the acid resistance of Helicobacter pylori (H. pylori) has been thought to be independent of urease. However, we demonstrated in this study that Fur influences urease activity. MATERIALS AND METHODS: A fur knockout mutant of H. pylori was constructed by replacing the Fur gene with a kanamycin resistant marker gene. The wild-type H. pylori and fur mutant were compared for survival. The integrity of the inner membrane of the bacteria was evaluated by confocal microscopy using membrane-permeant and -impermeant fluorescent DNA probes. Urease activity of intact H. pylori was measured between pH 3 and 8. Real time PCR of both strains was performed for urease genes including ureI, ureE, ureF, ureG, and ureH. RESULTS: The fur deletion affected the survival of H. pylori at pH 4. The urease activity curve of the intact fur mutant showed the same shape as the wild-type but was 3-fold lower than the wild-type at a pH of less than 5. Real time PCR revealed that the expression of all genes was consistently down-regulated in the fur mutant. CONCLUSION: The results of this study showed that fur appears to be involved in acid resistant H. pylori urease activity.
Bacterial Proteins/genetics/*physiology ; Helicobacter pylori/*enzymology/genetics ; Hydrogen-Ion Concentration ; Microscopy, Confocal ; Models, Biological ; Mutation ; Repressor Proteins/genetics/*physiology ; Urease/*metabolism

BACKGROUND: The aims of this national survey were to determine the views of Korean people regarding the specialty of anesthesiology and the role of anesthesiologists and to consider the ways in which individual anesthesiologists and the Korean Society of Anesthesiologists inform the public. METHODS: This off-line national survey was conducted by a professional research organization to obtain exact and reliable data. The questionnaire included structured questions to identify perceptions of the specialty of anesthesiology and the role of anesthesiologists inside and outside the operating room, people's desire for explanation of anesthesia by anesthesiologists, and their opinion about the best way to raise awareness about anesthesia and anesthesiologists. RESULTS: Of the respondents, 25.2% did not know that anesthesiologists are in charge of anesthesia during surgery. Furthermore, even respondents who knew that had very little knowledge of anesthesiologists' actual roles inside and outside the operating room. Respondents wanted their anesthesiologist to inform them about their anesthesia. CONCLUSIONS: The public's awareness regarding the role of anesthesiologists seems to be inadequate. To improve this awareness, in hospitals, each anesthesiologist should provide patients with more exact and detailed information. Simultaneously, the National Society of Anesthesiology should provide systematic information reflecting the public's thoughts.
Anesthesia ; Anesthesiology* ; Surveys and Questionnaires ; Humans ; Operating Rooms ; Physician's Role ; Public Opinion