No abstract available.
Humans ; Trigger Points*

No abstract available.
Zygapophyseal Joint*

We experienced a case of primary hepatic actinomycosis which was initially diagnosed by means of fine needle aspiration. The patient was a 31-year-old emaciated man with a 2-month history of 10 kg weight loss, right upper quadrant pain and flank pain. The liver was palpable and tender on physical examination. Computerized tomography scan of the liver showed two ill-defined hypodense masses in gallbladder fossa and inferior pole of right lobe. Hepatocellular carcinoma was clinically suspected. A CT-guided fine needle aspiration was performed. Microscopically, smears showed numerous radiating clusters of filamentous bacteria with many neutrophils and monocytes in necrotic background. The symptoms were improved by incision and drainage and massive administration of penicillin.
Actinomycosis ; Adult ; Bacteria ; Biopsy, Fine-Needle ; Breast ; Carcinoma, Hepatocellular ; Diverticulum* ; Drainage ; Fibroadenoma ; Flank Pain ; Gallbladder ; Humans ; Infarction ; Liver ; Monocytes ; Neutrophils ; Penicillins ; Physical Examination ; Vesico-Ureteral Reflux* ; Weight Loss

BACKGROUND: External ventricular drainage (EVD) is an important procedure for draining excessive cerebrospinal fluid (CSF) and monitoring intracranial pressure. Generally, EVD is performed in the operating room (OR) under aseptic conditions. However, in emergency circumstances, the operation may be performed in the intensive care unit (ICU) to save neuro-critical time and to avoid the unnecessary transfer of patients. In this study, we retrospectively analyzed the risk of EVD-induced CNS infections and their outcomes according to the operating place (ICU versus OR). In addition, we compared mortalities as well as hospital and ICU days between the CNS infection and non-CNS infection groups. METHODS: We reviewed medical records, laboratory data and radiographic images of patients who had received EVD operations between January, 2013 and March, 2015. RESULTS: A total of 75 patients (45 men and 30 women, mean age: 58.7 +/- 15.6 years) were enrolled in this study. An average of 1.4 catheters were used for each patient and the mean period of the indwelling catheter was 7.5 +/- 5.0 days. Twenty-six patients were included in the ICU group, and EVD-induced CNS infection had occurred in 3 (11.5%) patients. For the OR group, forty-nine patients were included and EVD-induced CNS infection had occurred in 7 (14.3%) patients. The EVD-induced CNS infection of the ICU group did not increase above that of the OR group. The ICU days and mortality rate were higher in the CNS infection group compared to the non-CNS infection group. The period of the indwelling EVD catheter and the number of inserted EVD catheters were both higher in the CNS infection group. CONCLUSIONS: If the aseptic protocols and barrier precautions are strictly kept, EVD in the ICU does not have a higher risk of CNS infections compared to the OR. In addition, EVD in the ICU can decrease the hospital and ICU days by saving neuro-critical time and avoiding the unnecessary transfer of patients. Therefore, when neurosurgeons decide upon the operating place for EVD, they should consider the benefits of ICU operation and be cautious of EVD-induced CNS infection.
Catheter-Related Infections ; Catheters ; Catheters, Indwelling ; Cerebrospinal Fluid ; Drainage* ; Emergencies ; Female ; Humans ; Intensive Care Units* ; Critical Care* ; Intracranial Pressure ; Male ; Medical Records ; Mortality ; Operating Rooms* ; Retrospective Studies ; Ventriculostomy

PURPOSE: We analyzed the appropriateness of the changes regarding the classification of gastric cancer in the fifth edition of the UICC TNMclassification of malignant tumors. MATERIALS AND METHODS: Gastrectomy was performed in 727 patients with gastric cancer between 1990 and 1994. The pN, pM and stage of each patient was reclassified according to the 5th edition. The previous and present pN, pM and stage of each patient were compared. RESULTS: Although ten cases of pNO were reclassified as pNX because the number of dissected regional lymph nodes was less than 15, there revealed a good correlation between old and new pN classification. Survival distribution according to the old pN classification identified significant differences among subgroups of patients. And this was true for the new pN classification. Nine pM1 patients who had involved hepatoduodenal lymph node were reclassified into pMO. Although 97 patients were down-staged and 30 patients were up-staged, comparison of stage according to two classifications revealed good correlation. Both survival distributions according to the new and old stage grouping identified significant differences among subgroups of patients. CONCLUSION: The classification of lymph node metastasis and stage grouping in gastric cancer should be more scientific and rational in future revisions.
Classification* ; Gastrectomy ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Stomach Neoplasms*

The rectal prolapse syndome is a disease entity includes rectocele and rectal prolapse, presenting prolapse(procidentia) of rectum. In rectocele, rectum is prolapsed anteriorly into the vagina, whereas in procidentia, inferiorly out of the anus. This study was aimed at analyzing pathogenesis and adequacy of surgical treatment in rectocele and rectal prolapse. Twenty-one patients with rectocele and 18 patients with rectal prolapse were assessed pre- and post-operatively in respect to symptoms and signs, pathogenesis, defecography, and manometry. In analysis of symptoms and sings, constipation was the commonest in both diseases(86% of rectocele and 67% of rectal prolapse) and incontinence was not infrequently found in both diseases as well(14% of rectocele and 33% of rectal prolapse). In analysis of the underlying causes, two patients with rectal prolapse had prolapse from childhood. Defecography showed anorectal angle of rectal prolapse in rest and push period. They were significantly wider than those of rectocele(p<0.05). The perineal descent of rectal prolapse was longer than that of rectocele. In analysis of the associated factors, average number of delivery was more than three times in both diseases(3.5 of rectocele and 5.1 of rectal prolapse). We could easily find previous operation history in both diseases. Among them, hysterectomy was the most frequent, especially in patients with rectocele. The hemorrhoids was associated more common in rectocele than in rectal prolapse(p<0.05). Preoperative maximal resting pressure of rectal prolapse was more significantly decreased than that of rectocele(p<0.05). The sensation of fullness was significantly decreased in patients with rectal prolapse postoperatively(p<0.05). Patients with rectocele underwent levator plication by transrectal or vaginal approach. Patients with rectal prolapse underwent posterior rectopexy in 11 patients, resection and rectopexy in 3 patients, Delorme's operation and Thiersch operation in 2 patients each. Constipation was significantly improved in patients with rectocele postoperatively(p<0.05). Incontinence was markedly improved in patients with rectal prolapse postoperatively(p<0.05). At the interview about subjective improvement of symptom, 95% of patients with rectocele and 89% of patients with rectal prolapse were satisfied with surgery. In conclusion, rectocele and rectal prolapse can be categorized as rectal prolapse syndrome because both diseases have anatomical derangements caused by similar pathogenesis such as altered bowel habits, anatomical factor, delivery, past history of hysterectomy, and hemorrhoids. Levator plication and posterior rectopexy seem to be useful surgical methods of anatomical repair for the respective disease.
Anal Canal ; Constipation ; Defecography ; Hemorrhoids ; Humans ; Hysterectomy ; Manometry ; Prolapse ; Rectal Prolapse* ; Rectocele ; Rectum ; Sensation ; Vagina

No abstract available.

No abstract available.
Adrenocorticotropic Hormone* ; Hydrocortisone* ; Transcutaneous Electric Nerve Stimulation*

BACKGROUND: Although an oxidants and antioxidants imbalane has been considered in the pathogenesis of chronic obstructive pulmonary disease (COPD), there is a paucity of reports focussing on the smoking-induced changes of oxidants and antioxidants in COPD. METHOD: The concentration of antioxidants (ascorbic acid, uric acid, retinol, and α- &γ-tocopherol) was measured in the serum and induced sputum of 30 healthy controls and 34 stable COPD patients using high performance liquid chromatography (HPLC). The inhibition of lipid peroxidation as an index of antioxidant capacity was measured in the serum by a TBA assay. RESULTS: The serum concentration of ascorbic acid, α-tocopherol, and retinol were significantly lower in the patients with COPD than in healthy controls (484.8±473.3 vs 1497.8±819.2 pmol/L, p<0.001, 48.38±17.34 vs 73.96±26.29 pmol/L, p<0.001, and 9.51±8.33 vs 15.01±5.88 pmol/L, p<0.05, respectively, mean±SD). However, there were little differences in the ascorbic acid and uric acid concentrations in the induced sputum between the COPD patients and the controls. The induced sputum to serum ratio of ascorbic acid was significantly higher in COPD patients compared with healthy control (0.375 vs 0.085, p<0.05). In the normal controls, the serum ascorbic acid concentration was lower in smokers than in nonsmokers (1073±536 vs 1757±845 pmol/L, p<0.05), but the level was still higher than that of the COPD patients (p<0.05). The serum retinol levels were correlated with FEV1 in COPD patients (r=0.58, p<0.05). The products of lipid peroxidation were increased in normal smokers and COPD compared with normal nonsmokers (115.56±19.93 and 120.02±24.56 vs 91.87±20.71 µmol/µmol Pi of liposome, p<0.05). CONCLUSION: Cigarette smoking may induce the depletion of serum antioxidants and this depletion of antioxidants is suggested to play a role in the pathogenesis of COPD.
Antioxidants* ; Ascorbic Acid ; Chromatography, Liquid ; Humans ; Lipid Peroxidation ; Liposomes ; Oxidants ; Pulmonary Disease, Chronic Obstructive* ; Smoking ; Sputum* ; Uric Acid ; Vitamin A

Motor neuropathy of a lower extremity is well recognized potential complication of procedures performed on patients in a lithotomy position. Mechanisms of nerve injury are unclear but the incidence of perioperative nerve injuries can be reduced if anesthetists are aware of their causes and pathophysiolgies. It is important to note that reduced duration in lithotomy position may reduce the risk of lower extremity neuropathies. We experienced two case of common peroneal nerve palsy after lithotomy positioning. Diagnosis was based on history, a clinical examination and electrophysiologic studies. A neurologic examination revealed hypersthesia over the dorsum of the left foot with inability to perform active dorsiflexion. Electrophysiologic studies showed delayed latency and low amplitude of nerve action potential.
Action Potentials ; Diagnosis ; Foot ; Humans ; Incidence ; Lower Extremity ; Neurologic Examination ; Paralysis* ; Peroneal Nerve*