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: Despite of numerous researches on the mechanisms and new therapeutic methods of chronic pain, patients are still suffering even with the help of opioids. In recent years, however, with the development of molecular-biology cell transplantation gives us a new chance for treating intractable chronic pain. The major purpose of the present study was to determine if the chromaffin cells have robust analgesic effects in the spinal atlanto-occipital subarachnoid space even without nicotine stimulation. METHODS: In order to determine whether cultured bovine adrenal medullary chromaffin cells transplanted in the spinal cord can produce analgesic effects, we purified adrenal medullary chromaffin cells and implanted them into the subarachnoid space of rats' (n = 10) spinal cord without immunosuppression, and investigated the hot sensitivity of rats' hind-paw by a light-beam test. RESULTS: It was found that compared with the control group, hot response latency of the group which received adrenal medullary chromaffin cells had increased at 14 days and the analgesic efficacy was maintained for at least 3 months. CONCLUSIONS: Adrenal medullary chromaffin cells transplanted in the rats' spinal cord may provide a permanent and locally available source of neuropeptides for the relief of intractable pain. Furthermore, these kinds of analgesic effect even produced without any stimulation such as nicotine.
Analgesics, Opioid ; Animals ; Cell Transplantation ; Chromaffin Cells* ; Chronic Pain ; Humans ; Immunosuppression ; Neuropeptides ; Nicotine ; Pain, Intractable ; Rats* ; Reaction Time ; Spinal Cord* ; Subarachnoid Space ; Transplants

Gastric carcinoid tumors were previously believed to be rare lesions, representing less than 2% of all carcinoid tumors and less than 1% of all stomach neoplasms. More recent studies have demonstrated that they may constitute as much as l0-30% of carcinoid tumors. We recently experienced a 35-years old businessman with gastric carcinoid tumor who camplained of postprandial epigastric discomfort. Gastrofiberscope showed protruding mass with central depression and erasion which was located on greater curvature of lower body and its size was 1 x 1 cm. Gastroendoscopic biopsy was per formed. It was identified to carcinoid tumor(Argyrophilic tumor). EUS(endoscopic ultrasonography) revealed that the lesion was limited to submucosa without evidence of any metastasis to adjacent lymph node. The carcinoid tumor was successfully removed by endoscopic polypectomy. Gastrofiberscope and EUS 9months after polypectomy showed that the lesion was nearly normal mucosa without submucosal thickening.
Adult ; Biopsy ; Carcinoid Tumor* ; Depression ; Humans ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Stomach Neoplasms

Purpose: Primary repair is the standard surgical method for treating duodenal ulcer perforations, with very good results usually anticipated because of the simplicity of the associated surgical techniques. Therefore, this study aimed to analyze the risk factors that affect laparoscopic primary repair outcomes for duodenal ulcer perforation. Methods: Between June 2010 and June 2020, 124 patients who underwent laparoscopic primary repair for duodenal ulcer perforations were reviewed. Early surgical outcomes were evaluated and risk factors for postoperative complications were assessed. Results: All surgeries were performed laparoscopically without open conversion. Multivariate analysis showed that the elderly (over 70 years), and perforations that needed more than 2 stitches for closure were risk factors for overall postoperative complications. Perforations that needed more than 2 stitches and perforations on the superior side of the duodenum were major risk factors for severe postoperative complications. Severe postoperative complications occurred in 6 of the patients, and 1 of them died of multiorgan failure. Conclusion Based on our results, we suggest that laparoscopic primary repair can be safely performed in duodenal ulcer perforation. However, more careful surgery and postoperative care are needed to improve the surgical outcomes of patients who need more than 2 stitches to close their perforation or who have perforations on the superior side of the duodenum.

Methods: Radiograms of the 11 study subjects (six men and five women), aged 22–90 years who visited the outpatients’ clinic for various neck complaints without trauma history were examined. C4–5 synostosis was an incidental finding in all the subjects. Results: All the fused bodies were inwaisted and had anterior caudal breaking but no interior corporal flaring. Adjacent segment disease was not found in eight patients aged <40 years. Disk degeneration was found at C3–4 and C5–6 in three patients each and at C6–7 in two patients. Disk degeneration was limited to the adjacent segments. Conclusions Degenerative disk changes are associated with the natural aging process, and the corporal morphology of the fused vertebral becomes inwaisted similar to that in the single vertebrae.

Purpose: Primary repair is the standard surgical method for treating duodenal ulcer perforations, with very good results usually anticipated because of the simplicity of the associated surgical techniques. Therefore, this study aimed to analyze the risk factors that affect laparoscopic primary repair outcomes for duodenal ulcer perforation. Methods: Between June 2010 and June 2020, 124 patients who underwent laparoscopic primary repair for duodenal ulcer perforations were reviewed. Early surgical outcomes were evaluated and risk factors for postoperative complications were assessed. Results: All surgeries were performed laparoscopically without open conversion. Multivariate analysis showed that the elderly (over 70 years), and perforations that needed more than 2 stitches for closure were risk factors for overall postoperative complications. Perforations that needed more than 2 stitches and perforations on the superior side of the duodenum were major risk factors for severe postoperative complications. Severe postoperative complications occurred in 6 of the patients, and 1 of them died of multiorgan failure. Conclusion Based on our results, we suggest that laparoscopic primary repair can be safely performed in duodenal ulcer perforation. However, more careful surgery and postoperative care are needed to improve the surgical outcomes of patients who need more than 2 stitches to close their perforation or who have perforations on the superior side of the duodenum.

Methods: Radiograms of the 11 study subjects (six men and five women), aged 22–90 years who visited the outpatients’ clinic for various neck complaints without trauma history were examined. C4–5 synostosis was an incidental finding in all the subjects. Results: All the fused bodies were inwaisted and had anterior caudal breaking but no interior corporal flaring. Adjacent segment disease was not found in eight patients aged <40 years. Disk degeneration was found at C3–4 and C5–6 in three patients each and at C6–7 in two patients. Disk degeneration was limited to the adjacent segments. Conclusions Degenerative disk changes are associated with the natural aging process, and the corporal morphology of the fused vertebral becomes inwaisted similar to that in the single vertebrae.

Erlotinib is accepted as a standard second-line chemotherapeutic agent in patients with non-small cell lung cancer who are refractory or resistant to first-line platinum-based chemotherapy. There has been no previous report of bowel perforation with or without gastrointestinal metastases related to erlotinib in patients with non-small cell lung cancer. The exact mechanism of bowel perforation in patients who received erlotinib remains unclear. In this report, we report the first case of enterocutaneous fistula in a female patient with metastatic non-small cell lung cancer 9 months, following medication with erlotinib as second-line chemotherapy.
Aged ; Antineoplastic Agents/*adverse effects/therapeutic use ; Carcinoma, Non-Small-Cell Lung/complications/*drug therapy ; Female ; Humans ; Intestinal Fistula/*chemically induced/complications/radiography/surgery ; Intestinal Perforation/*chemically induced/complications/radiography/surgery ; Protein Kinase Inhibitors/*adverse effects/therapeutic use ; Quinazolines/*adverse effects/therapeutic use ; Sigmoid Diseases/*chemically induced/complications/radiography/surgery

BACKGROUND/AIMS: After gastrectomy, patients often experience various gastrointestinal symptoms due to the rapid emptying of ingested food into the small intestine. Symptoms of the postgastrectomy syndrome, however, decrease as time passes. The aim of this study is to evaluate the role of sensory function of the small intestine in postgastrectomy patients. METHODS: Liquid meal loading test and balloon distension stimuli test were carried out in 39 postgastrectomy patients and 32 healthy controls. The polyethylene balloon was advanced to intestine, 10 cm apart from anastomosis in patients and 3rd portion of duodenum in controls. Sensory function was assessed by scoring perception for nausea, fullness, and abdominal discomfort or pain during random-order stimulus of 20, 40, and 60 ml of balloon inflation. RESULTS: The maximum tolerable volume of liquid meal intake for postgastrectomy patients was significantly less than that of the controls (p<0.05). Twelve of the 26 patients, who ingested less than normal range, had symptoms of the postgastrectomy syndrome. Total sensation scores after balloon distension stimuli were significantly lower than those of the controls. The type of gastrectomy and the postsurgical duration did not affect the maximum tolerable volume of liquid meal and total sensation scores after balloon distension stimuli. CONCLUSIONS: In comparison to healthy controls, postgastrectomy patients showed an obviously lower maximum tolerable volume of liquid meal, in addition to being significantly less perceptive of small intestine to distension stimuli. This decrease of small intestinal perception is deduced to be part of the adaptation to rapid emptying of ingested food into the small intestine in such patients.
Compliance ; Duodenum ; Gastrectomy* ; Humans ; Inflation, Economic ; Intestine, Small ; Intestines ; Meals ; Nausea ; Polyethylene ; Postgastrectomy Syndromes ; Reference Values ; Sensation

BACKGROUND: Necrotizing fasciitis is a life-threatening infectious disease with rapidly progressive involvement of the affected site. Because of the high mortality rate of this disease, early diagnosis, surgical exploration, and administration of appropriate antibiotics are necessary. The present study aimed to further review the changes in the clinical and microbiological characteristics of necrotizing fasciitis using patients' medical records from consecutive databases of 3 hospitals in Korea. MATERIALS AND METHODS: In this study, we retrospectively reviewed the medical records of patients with necrotizing fasciitis who were clinically diagnosed between May 2001 and February 2012 in 3 university hospitals in Korea. In total, the data of 83 patients were analyzed, including those of 20 patients from our previous study in 2006. An organism found in a blood culture or surgical specimen was regarded as a causative organism. RESULTS: Of the 83 patients, 68(81.9%) had community-acquired infections. Ninety microorganism species were indentifed by culture. Streptococcus was the most commonly identified pathogen. Non-fermentative gram-negative bacteria and Candida species have recently emerged, especially in immunocompromised hosts. CONCLUSIONS: Gram-positive organisms are still the most common pathogens of necrotizing fasciitis. However in our study, various gram-negative bacteria with different levels of susceptibility to antibiotics, as well as Candida species, were responsible for the necrotizing fasciitis. Initial empirical antimicrobial agents for necrotizing fasciitis should be considered depending on the individual patient's condition.
Anti-Bacterial Agents ; Anti-Infective Agents ; Candida ; Communicable Diseases ; Community-Acquired Infections ; Early Diagnosis ; Fasciitis, Necrotizing* ; Gram-Negative Bacteria ; Hospitals, University* ; Humans ; Immunocompromised Host ; Korea* ; Medical Records ; Mortality* ; Retrospective Studies ; Risk Factors* ; Streptococcus