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An 84-year-old man was admitted to our hospital with fever, jaundice, and itching. He had been diagnosed previously with chronic renal failure and diabetes, and had been taking allopurinol medication for 2 months. A physical examination revealed that he had a fever (38.8ºC), jaundice, and a generalized maculopapular rash. Azotemia, eosinophilia, atypical lymphocytosis, elevation of liver enzymes, and hyperbilirubinemia were detected by blood analysis. Magnetic resonance cholangiography revealed multiple cysts similar to choledochal cysts in the liver along the biliary tree. Obstructive jaundice was suspected clinically, and so an endoscopic ultrasound examination was performed, which ruled out a diagnosis of obstructive jaundice. The patient was diagnosed with DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) syndrome due to allopurinol. Allopurinol treatment was stopped and steroid treatment was started. The patient died from cardiac arrest on day 15 following admission. (Clin Mol Hepatol 2014;20:71-75)
<P>Laparoscopic gastric surgeries are routinely performed with use of a nasogastric tube to decompress the upper gastrointestinal tract. A distended upper gastrointestinal tract can complicate successful laparoscopic gastric surgery as the distention compromises not only the visual field but also the laparoscopic manipulation of the stomach. Since nasogastric intubation is not without risks, we have attempted laparoscopic-assisted gastric cancer surgeries without nasogastric tubes. In this article we describe a simple method of aspirating gastric contents using a 9 cm long 19-gauge needle inserted percutaneously during laparoscopic-assisted gastrectomy. First, a 9 cm long 19-gauge disposable needle was introduced through the abdominal wall. This needle was then introduced to the stomach through the anterior wall and the stomach gases and fluids were aspirated by connecting the needle to suction. Thus, a collapsed upper gastrointestinal tract was easily obtained. We performed this procedure instead of nasogastric decompression on twenty-two patients with gastric cancer who underwent laparoscopic-assisted distal subtotal gastrectomy with lymph node dissection. The results were good with only one patient experiencing wound infection (4.5%) and one patient with postoperative acalculus cholecystitis (4.5%). There were no patients with either intraabdominal infection or anastomotic leakage and none of the patients needed postoperative nasogastric decompression, except the patient who experienced acaculus cholecystitis. Percutaneous needle aspiration is a very simple and efficient technique with little risk of postoperative complications. It can be used as an alternative to nasogastric tube decompression of the gastrointestinal tract for laparoscopic-assisted gastrectomy.</P>
A practical simplified model has been developed for design analysis of electroosmotic flow in microfluidic channels. The height of channel is greater than O(1㎛) and much smaller than horizontal dimensions. The flow of an electrolyte solution is driven by pressure difference and electroosmosis. The thickness of electric double layer is negligible in comparison to channel height and the Reynolds number is less than O(1). Under these constraints, scaling analysis has been performed to disclose that the flow could be interpreted as a linear combination of the Poiseuille flow and the ideal elctroosmotic flow. The vertically-averaged flow field could be represented by two Laplace equations. Numerical tests have been conducted to illustrate the applicability and usefulness of this model for a typical dilution process of sample in a cross channel.
<P>Although numerous operative approaches have been utilized for gastric submucosal tumors, laparoscopic wedge resection has been regarded as the treatment of choice in recent years. As widespread use of diagnostic endoscopy has exposed a number of gastric submucosal tumors, the laparoscopic wedge resections are being performed with increased frequency. Many reports have been published which describe the technique of laparoscopic wedge resection of gastric submucosal tumors, and by far most of them were about the techniques for masses located at the posterior wall or esophagogastric junction. Generally, wedge resection for tumors on the anterior wall is regarded as an easy procedure especially when the mass is extraluminal mass. However, when the tumor is huge and intraluminal, it is very difficult to resect without compromising the gastric lumen as wedge resection of a huge intraluminal mass in situ inevitably includes a wide portion of normal gastric wall. In this article, we describe a successfully performed laparoscopic wedge resection of a huge intraluminal gastric submucosal tumor while preserving the volume of residual stomach without compromising the gastric lumen using the Eversion method through gastrotomy made with laparoscopic ultrasound guidance. J. Surg. Oncol. 2005;89:95–98. © 2005 Wiley-Liss, Inc.</P>
( Hyung Wook Kim ), ( Su Hyun Kim ), ( Young Ok Kim ), ( Dong Chan Jin ), ( Ho Chul Song ), ( Euy Jin Choi ), ( Yong Lim Kim ), ( Yon Su Kim ), ( Shin Wook Kang ), ( Nam Ho Kim ), ( Chul Woo Yang ), ( Yong Kyun ) 대한내과학회 2014 The Korean Journal of Internal Medicine Vol.29 No.6
Background/Aims: The effect of high-flux (HF) dialysis on mortality rates could vary with the duration of dialysis. We evaluated the effects of HF dialysis on mortality rates in incident and prevalent hemodialysis (HD) patients. Methods: Incident and prevalent HD patients were selected from the Clinical Research Center registry for end-stage renal disease (ESRD), a Korean prospective observational cohort study. Incident HD patients were defined as newly diagnosed ESRD patients initiating HD. Prevalent HD patients were defined as patients who had been receiving HD for > 3 months. The primary outcome measure was all-cause mortality. Results: This study included 1,165 incident and 1,641 prevalent HD patients. Following a median 24 months of follow-up, the mortality rates of the HF and low- flux (LF) groups did not significantly differ in the incident patients (hazard ratio [HR], 1.046; 95% confidence interval [CI], 0.592 to 1.847; p = 0.878). In the prevalent patients, HF dialysis was associated with decreased mortality compared with LF dialysis (HR, 0.606; 95% CI, 0.416 to 0.885; p = 0.009). Conclusions: HF dialysis was associated with a decreased mortality rate in prevalent HD patients, but not in incident HD patients.
Complex regional pain syndrome (CRPS) is a chronic progressive illness that presents in combination with sensory, autonomic, trophic, and motor abnormalities. Replacing the hypersensitive painful skin with healthy tissue with the free-flap surgery can be one of the treatment methods for the type II CRPS. A 39-year-old patient developed complex regional pain syndrome of the foot dorsum due to repeated ankle surgeries. For the management of intractable pain, we decided to perform wide excision and free-flap surgery. After excision of hypersensitive skin and subcutaneous tissue, we covered the skin defect with healthy tissue using anterolateral thigh perforator flap. We performed additional vein wrapping around the superficial peroneal nerve also. Microscopic examination of the skin and subcutaneous tissue obtained from the painful site revealed more axons than normal tissue. Allodynia and pain of the foot almost disappeared immediately until 6 months after surgery. At the three years follow up after flap surgery, allodynia at the flap site disappeared. The patient could tolerate walking and was satisfied with the results of our flap surgery. Replacing the hypersensitive skin with healthy tissue with the free-flap surgery can be one of the treatment methods for the type II CRPS.