ABSTRACT
Acute pancreatitis is one of the most common complications of endoscopic retrograde cholangiopancreatography (ERCP). Prophylactic pancreatic stents are effective for reducing the risk for post-ERCP pancreatitis in high-risk patients. However, an unretrieved pancreatic stent, as a result of proximal migration, can cause pancreatitis. We experienced a case of recurrent acute pancreatitis associated with a pancreatic ductal leak and stricture due to proximal migration of a prophylactic stent in a patient with suspected acute gallstone pancreatitis. We endoscopically retrieved the proximally migrated stent and inserted a new pancreatic stent. Follow-up pancreatic imaging showed that the pancreatitis and pancreatic ductal leak/stricture had resolved.
Subject(s)
Humans , Cholangiopancreatography, Endoscopic Retrograde , Constriction, Pathologic , Follow-Up Studies , Foreign-Body Migration , Gallstones , Pancreatic Ducts , Pancreatitis , StentsABSTRACT
As the clinical and radiological features of pulmonary paragonimiasis are similar to those of pulmonary tuberculosis and lung cancer, the diagnosis of pulmonary paragonimiasis is very difficult and a biopsy is needed for the diagnosis. Transbronchial needle aspiration (TBNA) using conventional bronchoscopy is frequently used for nodal sampling, but its diagnostic accuracy is questionable due to the blind approach for targeting lymph nodes. Endobronchial ultrasound-guided (EBUS)-TBNA has high diagnostic value due to the direct visualization of lymph nodes, and thereby improves nodal diagnosis accuracy. This paper reports the first patient we experienced with pulmonary paragonimiasis mimicking lung cancer diagnosed by EBUS-TBNA.
Subject(s)
Humans , Biopsy , Biopsy, Fine-Needle , Bronchoscopy , Lung , Lung Neoplasms , Lymph Nodes , Needles , Paragonimiasis , Tuberculosis, PulmonaryABSTRACT
Carbon monoxide is a nonirritant, odorless, colorless gas. Its effects are prominent in organs most sensitive to oxygen deprivation, such as the heart, brain, and kidney. Although less frequently, an association between thromboembolic events and carbon monoxide poisoning has been shown in the literatures. In this case, we report a case of atrial thrombus associated with carbon monoxide poisoning.
Subject(s)
Brain , Carbon , Carbon Monoxide , Carbon Monoxide Poisoning , Heart , Heart Atria , Kidney , Oxygen , ThrombosisABSTRACT
Valaciclovir is metabolized to acyclovir after ingestion and thereafter exerts its antiviral activity. Because of its superior pharmacokinetic profile, it has quickly replaced acyclovir in the treatment of herpesvirus infection. Neurotoxicity caused by valaciclovir has been reported, however, among patients with pre-existing impaired renal function. This paper reports a case of neurotoxicity of valaciclovir in a patient with end-stage renal disease who was undergoing continuous ambulatory peritoneal dialysis (CAPD). A 67-year-old female on CAPD took 500 mg of valaciclovir twice for herpes zoster. After she took her second dose orally, she developed confusion and disorientation, along with involuntary movements. Her mental confusion progressed to a coma. Discontinuation of valaciclovir showed no rapid improvement. There- fore, hemodialysis was started. After two sessions of hemodialysis, the patient became alert; and after four sessions of hemodialysis, her neurological abnormalities were completely reversed. In conclusion, valaciclovir can induce life-threatening neurotoxicity, especially in CAPD patients, even with appropriate dose reduction, which can be effectively managed by hemodialysis.
Subject(s)
Female , Humans , Acyclovir , Coma , Dyskinesias , Eating , Herpes Zoster , Herpesviridae Infections , Kidney Failure, Chronic , Neurotoxicity Syndromes , Peritoneal Dialysis , Peritoneal Dialysis, Continuous Ambulatory , Renal Dialysis , ValineABSTRACT
CT and MRI are high-tech devices for medical diagnosis. Their electromechanical function has leaped forward such a fast step, so that their image quality is improved and the time for a whole body scanning is shortened as little as only several minutes. These essential diagnostic tools are tried to apply for the field of forensic medicine in favor of their noninvasiveness and great resolution. These merits could make our postmortem investigation system improve in the aspect of practicality. This presenting study was done for the purpose of expecting what the field of forensic medicine could get or lose, what is needed technically, and what kind of supports are required. In our preliminary study, we gave injuries to the pigs' heads with weapons, scanned the wounds with high-tech devices, and embodied the injuries and the weapons three-dimensionally. These high-tech methods would be expected to play a role in forensic medicine and scientific crime investigation as a new and powerful testimony.
Subject(s)
Autopsy , Crime , Diagnosis , Diagnostic Imaging , Forensic Medicine , Head , Magnetic Resonance Imaging , Weapons , Whole Body Imaging , Wounds and InjuriesABSTRACT
Most primary spinal abscesses, irrespective of pathogens and anatomical locations, have better prognosis than that of secondary abscesses with spondylitis. We report a 68-year-old man, previously undertaken pulmonary resection due to tuberculosis, presented with paraparesis. Imaging studies showed primary intraspinal abscesses at T-1 and T-3 vertebral levels, semi-invasive pulmonary Aspergillosis and inflammation of the posterior mediastinum. Operative procedure and histopathological examination revealed interdural Aspergillus abscess. Despite chemotherapy, he deteriorated progressively, and spondylitis developed at corresponding vertebrae. He eventually died 6 weeks postoperatively due to pulmonary complication. The authors intended to inform that such an extradural inflammatory lesion of Aspergillus abscess should be treated carefully.
Subject(s)
Aged , Humans , Abscess , Aspergillosis , Aspergillus , Drug Therapy , Inflammation , Mediastinitis , Mediastinum , Paraparesis , Prognosis , Pulmonary Aspergillosis , Spine , Spondylitis , Surgical Procedures, Operative , TuberculosisABSTRACT
OBJECTIVE: Lumbar lordotic curve on L4 to S1 level is important in maintaining spinal sagittal alignment. Although there has been no definite report in lordotic value, loss of lumbar lordotic curve may lead to pathologic change especially in degenerative lumbar disease. This study examines the changes of lumbar lordotic curve after posterior lumbar interbody fusion with wedge shape cage. METHODS: We studied 45patients who had undergone posterior lumbar interbody fusion with wedge shape cage and screw fixation due to degenerative lumbar disease. Preoperative and postoperative lateral radiographs were taken and one independent observer measured the change of lordotic curve and height of intervertebral space where cages were placed. Segmental lordotic curve angle was measured by Cobb method. Height of intervertebral space was measured by averaging the sum of anterior, posterior, and midpoint interbody distance. Clinical outcome was assessed on Prolo scale at 1month of postoperative period. RESULTS: Nineteen paired wedge shape cages were placed on L4-5 level and 6 paired same cages were inserted on L5-S1 level. Among them, 18patients showed increased segmental lordotic curve angle. Mean increased segmental lordotic curve angle after placing the wedge shape cages was 1.96? Mean increased disc height was 3.21mm. No cases showed retropulsion of cage. The clinical success rate on Prolo's scale was 92.0%. CONCLUSION: Posterior lumbar interbody fusion with wedge shape cage provides increased lordotic curve, increased height of intervertebral space, and satisfactory clinical outcome in a short-term period.
Subject(s)
Postoperative PeriodABSTRACT
Pseudomembranous colitis is known to develop with long-term antibiotic administration, but antitubercular agents are rarely reported as a cause of this disease. We experienced a case of pseudomembranous colitis associated with rifampin. The patient was twice admitted to our hospital for the management of frequent bloody, mucoid, jelly-like diarrhea and lower abdominal pain that developed after antituberculosis therapy that included rifampin. Sigmoidoscopic appearance of the rectum and sigmoid colon and mucosal biopsy were compatible with pseudomembranous colitis. The antitubercular agents were discontinued and metronidazole was administered orally. The patient's symptoms were resolved within several days. The antituberculosis therapy was changed to isoniazid, ethambutol and pyrazinamide after a second bout of colitis. The patient had no further recurrence of diarrhea and abdominal pain. We report here on a case of pseudomembranous colitis associated with rifampin.
Subject(s)
Aged , Aged, 80 and over , Humans , Male , Antibiotics, Antitubercular/adverse effects , Diarrhea/etiology , Enterocolitis, Pseudomembranous/chemically induced , Rifampin/adverse effects , Tuberculosis, Pulmonary/drug therapyABSTRACT
Coronary vessel anomaly is a rare disease, with an incidence of about 0.6-1.3% of patients receiving coronary angiography. The ischemia in coronary vessel anomalies is due in most cases to atherosclerosis or compression of the coronary artery by a great vessel, but occasionally spasm of a coronary vessel anomaly is responsible for the pathogenesis of chest pain and myocardial ischemia. A 64-year-old female presented with a one-year history of effort angina. The left circumflex artery originated from the proximal right coronary artery. There was no atherosclerotic lesion in the right and left coronary arteries, but a focal spasm in the right coronary artery by ergonovine. In a patient with chest pain and coronary artery anomaly, if there is no coronary atherosclerosis, abnormal course or compression, the spasm test of the coronary artery should be documented.
Subject(s)
Female , Humans , Middle Aged , Angina Pectoris, Variant , Arteries , Atherosclerosis , Chest Pain , Coronary Angiography , Coronary Artery Disease , Coronary Vessel Anomalies , Coronary Vessels , Ergonovine , Incidence , Ischemia , Myocardial Ischemia , Rare Diseases , SpasmABSTRACT
The heart transplantation-associated accelerated graft arteriosclerosis (AGAS) is one of the major causes of cardiac allograft failure. We investigated the early time-course of expresssion patterns of cytokines, transcription factor, and its inhibitor in the intraabdominally transplanted mice hearts that differed only in the D locus of class I histocompatibility antigen. The allograft hearts were harvested at 1-3, 5, 7, 14, 28, and 42 days after the transplantation, and the expressions of NF-kappaB/I-kappaB and cytokines (TNF-alpha , INF-gamma) were examined in these specimens. The expressions of TNF-alpha and INF-gamma were observed on day 1, peaking on day 5 and 7, respectively. Activated NF-kappaB (p65) expression was present on the cytoplasm and perinuclear area in the endothelial cells of coronary arteries on day 1. The peak of translocation of NF-B from cytoplasm to nucleus appeared on day 5 in the endothelial cells, myocytes, and leukocytes within the vessels, and remained elevated until day 42. The I-kappaB expression gradually increased from day 1 until day 5, but a remarkable decrease was detected on day 7. Our data suggest that the increased expressions of NF-kappaB/I-kappaB and cytokines (TNF-alpha, INF-gamma) play an important role in inducing immune responses in the donor allograft heart and hence the blockage of the expressions might be mandatory to avoid a potential graft failure.
Subject(s)
Mice , Animals , Chronic Disease , Coronary Artery Disease/etiology , Cytokines/biosynthesis , Graft Rejection , Heart Transplantation , Histocompatibility Antigens Class I/analysis , Intercellular Adhesion Molecule-1/biosynthesis , Interferon-gamma/biosynthesis , NF-kappa B/biosynthesis , Transplantation, Homologous , Tumor Necrosis Factor-alpha/biosynthesis , Vascular Cell Adhesion Molecule-1/biosynthesisABSTRACT
We experienced a rare clinical manifestation of a digoxin induced catatonic stupor without other features of digoxin toxicity. This case suggests that the neurological manifestation of digoxin toxicity can occur without the usual side effects. Also, a serum digoxin level should be checked in any elderly patient presenting with abnormal cerebral func-tions, irrespective of whether or not the dose of digoxin has been changed. (J Korean Neurol Assoc 19(4):438~439, 2001)
Subject(s)
Aged , Humans , Digoxin , Neurologic Manifestations , StuporABSTRACT
PURPOSE: Mammalian tumor cells differ in their response to ionizing radiation to a degree that some patients are readily curable with conventional doses of radiation, while others are rarely controlled. In experimental systems, it is possible to demonstrate differences between cell lines both in intrinsic radiosensitivity and in the apparent capacity to repair damage. Retinoic acid is a substance that has previously been reported to increase radiosensitivity, but at concentrations likely to have cytostatic effects or induce cellular differentiation. We chose several head and neck cancer cell lines to investigate radiation sensitivity and synergism in combination with retinoic acid. Material and Methods: Seventeen head and neck cancer cell lines (MDA886, P1, P13, A-431, PCI-50, UMSCC-10A, UMSCC-10B, UMSCC-11A, UMSCC-11B, UMSCC-17A, UMSCC-17B, UMSCC-19, UMSCC-22B, UMSCC-30, UMSCC-38, 1YA, 1YB) are irradiated with variable dose of radiation (1 Gy, 5 Gy, 9 Gy) for determination of radiosensitivity of each cell lines. The less radiosensitive cell lines are treated with retinoic acid for evaluation of the effects of retinoic acid on cellular X-ray sensitivity and recovery from X ray-induced potentially lethal damage. RESULTS: Lowest growth inhibition rates are seen UMSCC-11A and 1YA cell lines in 1 Gy, so that we treated with retinoic acid such cell lines. We obtained the following RESULTS: 1) two cell lines appear not inhibitory effect on recovery from X-ray induced potentially lethal damage but growth inhibition synergism when irradiated with retinoic acid in 1 Gy of radiation dose. 2) two cell lines were little effect on radiosensitivity and inhibitory effect on recovery from X-ray damage in 0.5 Gy radiation dose. CONCLUSION: We found that direct radiosensitizing effects of retinoic acid on 1 Gy of radiation dose may act synergistically for cell growth inhibition in vitro study(three cell lines: UMSCC-11A, 1YA, UMSCC-11B). Further in vitro and in vivo experiments are now necessary to evaluate retinoic acid as radiosensitizer for head and neck cancer radiation therapy.