Intestinal malrotation with volvulus is generally presented as a bilious vomiting and acute intestinal obstruction in the newborn period. It could compromise vascular supply of the small bowel secondary to torsion of superior mesenteric artery (SMA) and without urgent surgical management, it could lead to detrimental outcomes such as transmural bowel infarction and sepsis. However, in chronic cases, it is rarely obstructs the vascular supply and propagates to an acute bowel infarction. Rarely, chronic malrotation with midgut volvulus may not reduce the mesenteric blood supply because of collateral vessels, and the chronically stagnated blood flow of the superior mesenteric vein (SMV) favors thrombus formation within the lumen. The recommended treatment is Ladd's procedure and anticoagulation therapy. The authors present an unusual case of intestinal malrotation with chronic volvulus resulting in superior mesenteric vein and portal vein thrombosis in a 28-year-old patient.
Adult ; Humans ; Infant, Newborn ; Infarction ; Intestinal Obstruction ; Intestinal Volvulus ; Mesenteric Artery, Superior ; Mesenteric Veins ; Portal Vein ; Sepsis ; Thrombosis ; Vomiting

No abstract available.
Calcinosis*

PURPOSE: It is well known that cyclooxygenase-2 (COX-2) is associated with carcinogenesis in many human cancers. In thyroid cancers, COX-2 expression in aging patients is known as a powerful prognostic factor of differentiated thyroid cancer. Therefore, in this study, we investigated the expression of COX-2 in cases of papillary thyroid cancer (PTC), as well as its association with other prognostic factors of thyroid cancer. METHODS: A total of 213 cases of papillary thyroid cancer were enrolled in this study and their clinicopathological characteristics were investigated retrospectively by a review of medicalrecords. Immunohistochemical staining for COX-2 was performed in the malignant tissue of the cases and the resultsof were then evaluated to determine if they were associated with other prognostic factors. RESULTS: The mean age of patients was 46 years (Range: 17~77 years old) and the tumor sizesranged from 0.1 to 5 cm (mean 1.2±0.9 cm). The pathological findings were as follows; thyroid capsule invasion in 101 patients (47%), lymph node metastasis in 76 patients (36%), multiplicity in 47 patients (22%), and bilaterality in 36 patients (17%). Positive results of immunohistochemical staining for COX-2 were noted in 131 patients (62%), however, the statistical analyses showed no significant association between COX-2 expression and other prognostic factors of papillary thyroid cancer. CONCLUSION: No association of COX-2 expression and prognostic factors of papillary thyroid cancer were found in this study. However, a larger prospectivestudy with survival analyses would provide a better understanding of thesignificance of COX-2 expression in cases of papillary thyroid cancer.
Aging ; Carcinogenesis ; Cyclooxygenase 2* ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis* ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms*

Conventional treatment of Hirschsprung's disease consists of initial colostomy followed by pull-through operation. But, the treatment of Hirschsprung's disease has been changed along with the development of new surgical technique. Since 1995, endo-GIA has been available at our hospital and one stage Duhamel operation has been performed for neonatal Hirschsprung's disease. Between May 1995 and April 2006, 26 neonates have been treated with one stage pull-through operation by one pediatric surgeon at HanYang University Hospital. The sex ratio was 4.2:1 with male predominance. Clinical findings included abdominal distension (96.2 %), vomiting (50.0 %), delayed passage of meconium (46.2 %), constipation (23.1 %), and enterocolitis (15.4 %). Twenty two cases (84.6 %) were short-segment and 4 cases (15.4 %) were long-segment disease, of which 2 cases were total colon aganglionosis. One of the two patients with total colonic aganglionosis had double transition zones - distal ileum and hepatic flexure of the colon. The average age at operation was 14.56 +/- 8.77 days and the average weight at operation was 3.26+/-0.66 kg. Primary Duhamel operations were performed in 25 patients and Soave-Boley operations was performed in one patient. The endo-GIA 35 (Ethicon, USA) was used from 1995 until 1997, and after that endo-GIA 60 (USSC, USA) was used. The average Duhamel operation time was 88.57 +/- 22.80 minutes. Wound abscess (n = 2) and septum formation (n =1) occurred after Duhamel operation. Bowel function was normalized in 59 % within 3 months and in 95% within 1 year after operation. There was no mortality after one stage pull-through operation in neonate.
Abscess ; Colon ; Colostomy ; Constipation ; Enterocolitis ; Hirschsprung Disease* ; Humans ; Ileum ; Infant, Newborn ; Male ; Meconium ; Mortality ; Sex Ratio ; Vomiting ; Wounds and Injuries

Intestinal malrotation is usually asymptomatic and most often is found during abdominal exploration for other surgical diseases. However, a serious complication of intestinal malrotation, midgut volvulus is a true surgical emergency of childhood. The clinical findings, diagnostic procedures, treatment, and prognosis of midgut volvulus were reviewed by a retrospective study. Between 1980 and 2005, 29 patients with midgut volvulus ranging in age from 1 day and 15 years were treated at HanYang University Hospital. Seventy-nine percent of the patients presented before 1 month of age. Midgut volvulus occurred 2 times more frequently in male. The clinical findings were bilious vomiting (96.6 %), irritability (34.5 %), abdominal distention (13.8 %), abdominal pain (10.3 %), and palpable abdominal mass (6.9 %). The diagnosis was made by abdominal simple x-ray (17.2 %), upper gastro-intestinal contrast study (37.9 %), abdominal sonogram (20.7 %), abdominal CT (3.4 %), and abdominal exploration (20.7 %). Among the 29 patients, 5 patients developed gangrene of small intestine due to strangulation and underwent resection of bowel. Two patients died due to sepsis.
Abdominal Pain ; Diagnosis ; Emergencies ; Gangrene ; Humans ; Intestinal Volvulus* ; Intestine, Small ; Male ; Prognosis ; Retrospective Studies ; Sepsis ; Tomography, X-Ray Computed ; Vomiting

Biliary atresia (BA) is the result of fibrosing destructive inflammatory process affecting intrahepatic and extrahepatic bile ducts, which lead to cirrhosis and portal hypertension. Kasai portoenterostomy has been the standard operative procedure in biliary atresia. Recently, there has been remarkable increase in the survival rate in cases of BA. However, long-term survivors are not clearly evaluated in Korea. To define long-term prognosis factors of patients who underwent surgery for BA, a retrospective study was undertaken of 10 (37 %) patients surviving more than 10 years among 27 patients who underwent one of Kasai procedures between 1981 and 1995. Hepatomegaly was present in 4 and splenomegaly in 7 patients. Serum bilirubin was normalized at 1 year after operation. Aspartate aminotransferase (AST, GOT), Alanine aminotransferase(ALT, GPT) were normalized at 12 years and alkaline phosphatase(ALP) was normalized at 13.5 years. Cholangitis developed mainly within 5 years after operation so close follow up is needed. Life long follow-up is needed because of progressive deterioration of liver function even after 10 years.
Alanine ; Aspartate Aminotransferases ; Bile Ducts, Extrahepatic ; Biliary Atresia* ; Bilirubin ; Cholangitis ; Fibrosis ; Follow-Up Studies ; Hepatomegaly ; Humans ; Hypertension, Portal ; Korea ; Liver ; Prognosis ; Retrospective Studies ; Splenomegaly ; Surgical Procedures, Operative ; Survival Rate ; Survivors

Thelaziases in human is an opportunistic infection. The worms usually lie in the conjunctival sac or in the lacrimal apparatus, causing foreignbody sensation, tearing and conjunctival irritation, In most cases, patients find the worms themselves and visit the hospital. Having experienced and confirmed 5 cases of human subconjunctival infestation of Thelazia callipaeda, we report these with literature review.
Humans* ; Lacrimal Apparatus ; Opportunistic Infections ; Parasites ; Sensation ; Thelazioidea

Contralateral exploration in children with unilateral inguinal hernia is controversial. This study was done to identify risk factors for the development of contralateral inguinal hernia in patients with unilateral inguinal hernia. The clinical experience of 4,206 inguinal hernias repaired by one pediatric surgeon on 3,358 children at HanYang University Hospital from September 1979 to December 2002 was analyzed. 1,868 (55.6%) hernias occurred on right side, 1,190 (35.4%) on left side, and 300 (8.9%) were bilateral. 2,702 children were boys and 656 were girls (M:F=4.1:1). 170 children of 3,058 children with unilateral hernias (5.6%) developed contralateral inguinal hernia at 1 day to 95 months after herniotomy. 146 children were boys and 24 were girls (M:F=6.1:1). The patients who had had herniotomy before 1 year of age developed contralateral hernia in 17.4%, compared with 5.6% overall average. The earlier the first herniotomy was performed, the more frequently contralateral hernia developed. The occurrence of contralateral inguinal hernia was more frequent in boys (146 of 2,460, 5.9%) than girls (24 of 598, 4.0%) and more frequent after left herniotomy (80 of 1,190, 6.7%) than after right herniotomy (90 of 1,868, 4.8%), but statistically not significant. 52.9% of contralateral inguinal hernia developed within 1 year after hernia repair, and 87.6% developed within 3 years. Routine exploration on contralateral side in children is not necessary.
Child* ; Female ; Hernia ; Hernia, Inguinal* ; Herniorrhaphy ; Humans ; Risk Factors

PURPOSE: Stress, depending on its intensity and duration, results in either adaptive or maladaptive physiological and psychological changes in humans. Also, it was found that stressful experiences increase the signs of behavioral despair in rodents. On the other hand, exercise and melatonin treatment is believed to have many beneficial effects on health. Thus, this study was designed to evaluate the anti-depressant effects of physical activity and melatonin against chronic stress-induced depression in rats. METHODS: Adult male Sprague-Dawley(SD) rats(200-250g, 7 weeks of age) were subjected to depression induced by chronic stress. Chronic depression was induced with forced-swim stress (FSS) and repeated change of light-dark cycle for 4 weeks. In the last 2 weeks, some rats were confined in a cage enriched with a running wheel, seesaw and chewed a ball from 19:00 to 07:00 every day. Melatonin was injected intra-peritoneally (I.P), and the rats received intraperitoneal injections of melatonin (15 mg/kg). The Forced Swim Test (FST) was performed to evaluate the immobility behaviors of rats for a 5 min test. RESULTS: It was found that, the immobility time in FST was significantly (p<.05) lower in physical exercise (M=58.83+/-22.73) and melatonin (M=67.33+/-37.73) than in depressive rats (M=145.93+/-63.16) without physical activity. Also, TPH positive cell in dorsal raphe was significantly (p<.05) higher in exercise (M=457.38+/-103.21) and melatonin (M=425.38+/-111.56) than in depressive rats (M=258.25+/-89.13). CONCLUSION: This study suggests that physical activity and melatonin produces antidepressant-like effect on stress-induced depression in rats. So, physical exercise and melatonin may be a good intervention in depression patients.
Adult ; Animals ; Depression* ; Exercise ; Hand ; Humans ; Injections, Intraperitoneal ; Male ; Melatonin* ; Models, Animal* ; Motor Activity* ; Photoperiod ; Rats* ; Rodentia ; Running

Diaschisis is classically defined as a sudden inhibition of function, produced by an acute focal disturbance in a remote area which is anatomically connected through fiber tracts. Transhemispheric diaschisis can underlie some diffuse symptoms of acute supratentorial stroke such as agitation, confusion, and coma. We experienced a patient with right middle cerebral artery infarction, presenting a quadriparesis and hypoesthesia at sensory level. This case suggests the diaschisis exacerbate the initial focal deficit such as weakness and sensory loss.
Coma ; Dihydroergotamine ; Humans ; Hypesthesia ; Infarction, Middle Cerebral Artery* ; Quadriplegia* ; Stroke