A trocar site hernia is a rare complication. We report a patient who had an abdominal wall mass at a previous trocar site after laparoscopic distal gastrectomy. It was diagnosed as omental herniation and fat necrosis. We conclude that patients with trocar site masses exhibiting fat density on a computed tomography scan could be followed up without surgery, and that fascial defects located at 10-mm or larger trocar sites should be closed whenever possible to prevent hernia formation.
Abdominal Wall ; Fat Necrosis ; Gastrectomy ; Hernia ; Humans ; Laparoscopy ; Omentum ; Stomach Neoplasms ; Surgical Instruments

BACKGROUNDS/AIMS: Peginterferon alpha-2a or -2b is the standard treatment regimen in chronic hepatitis C. However, there have been few comparative studies of the efficacies of these two types of peginterferon. We evaluated their efficacies in combination with ribavirin as a initial treatment for chronic hepatitis C. METHODS: Ninety-seven patients were treated with peginterferon alpha-2a (180 microgram/week, n=48) or peginterferon alpha-2b (1.5 microgram/kg/week, n=49) plus ribavirin (800 mg/day for 24 weeks in genotype non-1 or 1,000-1,200 mg/day for 48 weeks in genotype 1). Virologic responses including the early virologic response (EVR), end-of-treatment response (ETR), sustained virologic response (SVR), and adverse effects were analyzed retrospectively. RESULTS: The virologic response rates did not differ significantly between peginterferon alpha-2a and -2b: 89.6% and 89.7% for EVR, 79.2% and 79.5% for ETR, 72.9% and 73.5% for SVR, respectively. Analysis of the virologic responses according to genotype also revealed no significant differences in SVR between peginterferon alpha-2a and -2b (59.3% vs. 59.7% for genotype 1 and 90.5% vs. 83.3% for genotype non-1, respectively), or in adverse effects including flu-like symptom, rash, itching, neutropenia, and thrombocytopenia. CONCLUSIONS: We found no significant differences in therapeutic efficacies and adverse effects between the alpha-2a and -2b types of peginterferon as the initial treatment regimen in naive chronic hepatitis C patients.
Adult ; Antiviral Agents/*administration & dosage ; Combined Modality Therapy ; Genotype ; Hepacivirus/drug effects/genetics ; Hepatitis C, Chronic/diagnosis/*drug therapy ; Humans ; Interferon Alfa-2a/*administration & dosage ; Interferon Alfa-2b/*administration & dosage ; Korea ; Middle Aged ; Polyethylene Glycols/*administration & dosage ; Retrospective Studies ; Ribavirin/*administration & dosage ; Risk Factors

In patients undergoing hemodialysis, spontaneous bleedings have been reported in locations such as mediastinum, subdural space, retroperitoneum, pericardial and pleural cavities. A 61 year-old woman had been treated three times a week with maintenance hemodialysis via tunnelled cuffed central venous catheter for 4 months. She had a sudden onset of severe pain on right chest wall 24 hours after maintenance hemodialysis. We found that her right upper chest wall was swollen. Urgent computed tomography revealed a soft tissue mass with high density in right chest wall. The lesion was enhanced by contrast but was not clearly marginated in arterial phase. We did emergent hemodialysis, and did transfusion of packed red blood cells and fresh frozen plasma and compressed locally on her right chest wall. Hematoma was spontaneously resolved only after supportive care. Therapeutic approaches to uremic patients with bleeding disorders include angiography, hemodialysis, peritoneal dialysis, transfusion of packed red cells and fresh frozen plasma, infusion of erythropoietin, desmopressin, conjugated estrogen, etc. In this case, spontaneous bleeding without trauma history can occur in patients with endstage renal disease who underwent hemodialysis using catheter. Therefore, immediate treatment should be followed when evidence of bleeding is found.
Angiography ; Catheters ; Central Venous Catheters ; Deamino Arginine Vasopressin ; Erythrocytes ; Erythropoietin ; Estrogens ; Female ; Hematoma ; Hemorrhage* ; Humans ; Kidney Failure, Chronic ; Mediastinum ; Middle Aged ; Peritoneal Dialysis ; Plasma ; Pleural Cavity ; Renal Dialysis* ; Subclavian Artery* ; Subdural Space ; Thoracic Wall

A venous air embolism is a complication of various venous access procedures such as contrast-enhanced computed tomography (CECT). Although most cases of iatrogenic venous air embolisms during CECT involve a few milliliters of air and are asymptomatic, a massive venous air embolism can be fatal. We report a case of a massive intraventricular air embolism after CECT with a review of the literature regarding the pathophysiology and treatment of air embolisms.
Embolism, Air*

A venous air embolism is a complication of various venous access procedures such as contrast-enhanced computed tomography (CECT). Although most cases of iatrogenic venous air embolisms during CECT involve a few milliliters of air and are asymptomatic, a massive venous air embolism can be fatal. We report a case of a massive intraventricular air embolism after CECT with a review of the literature regarding the pathophysiology and treatment of air embolisms.
Embolism, Air*

There are many kinds of herbal medication available in Korea, and some of them have been reported to be related with renal failure. However, the simultaneous occurrence of toxic hepatitis and acute renal failure associated with herbal medicine has rarely been reported. A 26-year-old male was admitted with a sudden onset of jaundice and generalized weakness after taking two doses of herbal medication. A physical examination revealed no abnormalities other than scleral icterus. The patient's blood chemistry demonstrated a blood urea nitrogen level of 91 mg/dL, a creatinine level of 13 mg/dL, an AST of 212 IU/L, an ALT of 1,528 IU/L and a bilirubin level of 8.5 mg/dL. Renal biopsy showed interstitial edema and an infiltration of neutrophils and lymphocytes with preserved glomeruli and vascular structure; these findings were consistent with administering medical supportive care without renal replacement therapy. He was discharged on the 8th hospital day. This case provides the possibility of development of hepatitis and renal failure due to herbal medication. We propose that a meticulous history taking for determining the herbal medications a patient has taken should be done for those cases of simultaneous toxic hepatitis and renal failure that are without any obvious cause in Korea.
Acute Kidney Injury ; Adult ; Bilirubin ; Biopsy ; Blood Urea Nitrogen ; Chemistry ; Creatinine ; Drug-Induced Liver Injury* ; Edema ; Hepatitis ; Herbal Medicine ; Humans ; Jaundice ; Korea ; Lymphocytes ; Male ; Neutrophils ; Physical Examination ; Renal Insufficiency ; Renal Replacement Therapy

Granulosa cell tumors are relatively low-grade malignancies accounting for about 1 to 2% of all primary ovarian neoplasms and have an indolent growth pattern. There are two types of tumors, adult type granulosa cell tumor (AGCT) and juvenile type granulosa cell tumor (JGCT), and each tumor reveals different clinical or histopathological features. The clinical manifestations are mostly associated with estrogen produced by tumor, which are vaginal bleeding or menstrual irregularity in AGCT and precocious puberty in JGCT. Although most patients are diagnosed in early stage with favorable prognosis, some recur after several years. So, continuous follow up is required. Recently, we experienced two cases of adult type granulosa cell tumor and report with a brief review of literatures.
Adult ; Estrogens ; Female ; Follow-Up Studies ; Granulosa Cell Tumor* ; Granulosa Cells* ; Humans ; Ovarian Neoplasms ; Ovary* ; Prognosis ; Puberty, Precocious ; Uterine Hemorrhage

46,X,inv(Y)/45,X mosaicism is a extremely rare sex chromosomal disorder. We experienced an unusual mosaic Turner syndrome case in a 29-years old Korean woman with a phenotypic female, primary amenorrhea and immature secondary sexual characteristics. Cytogenetic analysis including GTG banding revealed 46,X,inv(Y)(q11.2q12?)[15]/45,X[35] mosaicism, and X/Y chromosome Fluorescence in situ hybridization (FISH) analysis result was ish (SRY-,DYZ3-)[16]/ ish der(Y)del(Y)(q12)inv(Y)(p11.3q12)(SRY sp, DYZ3-)[4] and its meaning was coexistence of microdeletion and inversion of Y chromosome. To our knowledge, this karyotype may be a very rare variant of Turner syndrome, and we report this case with brief review of related literature.
Adult ; Amenorrhea ; Chromosome Disorders ; Cytogenetic Analysis ; Female ; Fluorescence ; Humans ; In Situ Hybridization ; Karyotype* ; Mosaicism ; Turner Syndrome* ; Y Chromosome*

The mature cystic teratoma of the omentum is a very rare tumor. It is generally believed that autoamputation and reimplantation of an ovarian tumor is the most common etiology of omental teratoma. Abdominal pain is the main presenting symptom of these tumors. A 41-year-old woman was admitted for pelvic mass. At laparotomy, a 8.5 x 7.0 x 7.5 cm mass was found in the pelvic cavity, attached to the omentum with adhesion to bladder. The histopathologic diagnosis was mature cystic teratoma in conjunction with the cyst wall is diffusely necrotic and calcified with hairs. The absence of the left ovary suggested that the tumor underwent autoamputation and reimplantation on the omentum. We report the case with a brief review of literature.
Abdominal Pain ; Adult ; Diagnosis ; Female ; Hair ; Humans ; Laparotomy ; Omentum* ; Ovary ; Replantation ; Teratoma* ; Urinary Bladder

The present study evaluated the effects of guided tissue regeneration using xenograft material(deproteinated bovine bone powder), with and without Calcium sulfate membrane in beagle dogs. Contralateral fenestration defects (6 x 4 mm) were created 4 mm apical to the buccal alveolar crest of maxillary premolar teeth in 5 beagle dogs. Deproteinated bovine bone powders were implanted into fenestration defect and one randomly covered Calcium sulfate membrane (experimental group). Calcium sulfate membrane was used to provide GTR. Tissue blocks including defects with soft tissues which were harvested following four & eight weeks healing interval, prepared for histo-phathologic analysis. The results of this study were as follows. 1. In control group, at 4 weeks after surgery, new bony trabecular contacted with interstitial tissue and osteocytes like cell were arranged in new bony trabecule. Bony lamellation was not observed. 2. In control gruop, at 8 weeks after surgery, scar-like interstitial tissue was filled defect and bony trabecule form lamellation. New bony trabecular was contacted with interstitial tissue but defect was not filled yet. 3. In experimental group, at 4 weeks after surgery, new bony trabecular partially recovered around damaged bone. But new bony trabecule was observed as irregularity and lower density. 4. In experimental group, at 8 weeks after surgery, lamella bone trabecular developed around bone cavity and damaged tissue was replaced with dense interstitial tissue. In conclusion, new bone formation regenerated more in experimental than control groups and there was seen observe more regular bony trabecular in experimental than control groups at 4 weeks after surgery. In control group, at 8 weeks after surgery, the defects was filled with scar-like interstitial tissue but, in experimental group, the defects was connected with new bone. Therefore xenograft material had osteoconduction but could not fill the defects. We thought that the effective regeneration of periodontal tissue, could be achieved using GTR with Calcium sulfate membrane.
Animals ; Bicuspid ; Bone Regeneration ; Calcium Sulfate* ; Calcium* ; Dogs* ; Furcation Defects* ; Guided Tissue Regeneration ; Heterografts ; Membranes* ; Osteocytes ; Osteogenesis ; Powders ; Regeneration* ; Tooth