Emergency gastrointestinal tract operation associated with cytomegalovirus infection

Purpose@#Cytomegalovirus (CMV) infection is common in immunocompromised patients. Enterocolitis caused by CMV infection can lead to perforation and bleeding of the gastrointestinal (GI) tract, which requires emergency operation. We investigated the demographics and outcomes of patients who underwent emergency operation for CMV infection of the GI tract. @*Methods@#This retrospective study was conducted between January 2010 and December 2020. Patients who underwent emergency GI operation and were diagnosed with CMV infection through a pathologic examination of the surgical specimen were included. The diagnosis was confirmed using immunohistochemical staining and evaluated by experienced pathologists. @*Results@#A total of 27 patients who underwent operation for CMV infection were included, 18 of whom were male with a median age of 63 years. Twenty-two patients were in an immunocompromised state. Colon (37.0%) and small bowel (37.0%) were the most infected organs. CMV antigenemia testing was performed in 19 patients; 13 of whom showed positive results. The time to diagnose CMV infection from operation and time to start ganciclovir treatment were median of 9 days. The reoperation rate was 22.2% and perforation was the most common cause of reoperation. In-hospital mortality rate was 25.9%. @*Conclusion@#CMV infection in the GI tract causes severe effects, such as hemorrhage or perforation, in immunocompromised patients. When these outcomes are observed in immunocompromised patients, suspicion of CMV infection and further evaluation for CMV detection in tissue specimens is required for proper treatment.

Ca2+ entry through reverse Na+ /Ca2+ exchanger in NCI-H716, glucagon-like peptide-1 secreting cells

Glucagon like peptide-1 (GLP-1) released from enteroendocine L-cells in the intestine has incretin effects due to its ability to amplify glucose-dependent insulin secretion. Promotion of an endogenous release of GLP-1 is one of therapeutic targets for type 2 diabetes mellitus. Although the secretion of GLP-1 in response to nutrient or neural stimuli can be triggered by cytosolic Ca2+ elevation, the stimulussecretion pathway is not completely understood yet. Therefore, the aim of this study was to investigate the role of reverse Na+ /Ca2+ exchanger (rNCX) in Ca2+ entry induced by muscarinic stimulation in NCI-H716 cells, a human enteroendocrine GLP-1 secreting cell line. Intracellular Ca2+ was repetitively oscillated by the perfusion of carbamylcholine (CCh), a muscarinic agonist. The oscillation of cytosolic Ca2+ was ceased by substituting extracellular Na+ with Li + or NMG + . KB-R7943, a specific rNCX blocker, completely diminished CCh-induced cytosolic Ca2+ oscillation. Type 1 Na+ /Ca2+ exchanger (NCX 1 ) proteins were expressed in NCI-H716 cells. These results suggest that rNCX might play a crucial role in Ca2+ entry induced by cholinergic stimulation in NCIH716 cells, a GLP-1 secreting cell line.

Hydrogen peroxide inhibits Ca²⁺ efflux through plasma membrane Ca²⁺-ATPase in mouse parotid acinar cells

Intracellular Ca²⁺ mobilization is closely linked with the initiation of salivary secretion in parotid acinar cells. Reactive oxygen species (ROS) are known to be related to a variety of oxidative stress-induced cellular disorders and believed to be involved in salivary impairments. In this study, we investigated the underlying mechanism of hydrogen peroxide (H₂O₂) on cytosolic Ca²⁺ accumulation in mouse parotid acinar cells. Intracellular Ca²⁺ levels were slowly elevated when 1 mM H₂O₂ was perfused in the presence of normal extracellular Ca²⁺. In a Ca²⁺-free medium, 1 mM H₂O₂ still enhanced the intracellular Ca²⁺ level. Ca²⁺ entry tested using manganese quenching technique was not affected by perfusion of 1 mM H₂O₂. On the other hand, 10 mM H₂O₂ induced more rapid Ca²⁺ accumulation and facilitated Ca²⁺ entry from extracellular fluid. Ca²⁺ refill into intracellular Ca²⁺ store and inositol 1,4,5-trisphosphate (1 µM)-induced Ca²⁺ release from Ca²⁺ store was not affected by 1 mM H₂O₂ in permeabilized cells. Ca²⁺ efflux through plasma membrane Ca²⁺-ATPase (PMCA) was markedly blocked by 1 mM H₂O₂ in thapsigargin-treated intact acinar cells. Antioxidants, either catalase or dithiothreitol, completely protected H₂O₂-induced Ca²⁺ accumulation through PMCA inactivation. From the above results, we suggest that excessive production of H₂O₂ under pathological conditions may lead to cytosolic Ca²⁺ accumulation and that the primary mechanism of H₂O₂-induced Ca²⁺ accumulation is likely to inhibit Ca²⁺ efflux through PMCA rather than mobilize Ca²⁺ ions from extracellular medium or intracellular stores in mouse parotid acinar cells.

Ca(2+)-induced Ca2+ Release from Internal Stores in INS-1 Rat Insulinoma Cells

The secretion of insulin from pancreatic beta-cells is triggered by the influx of Ca2+ through voltage-dependent Ca2+ channels. The resulting elevation of intracellular calcium ([Ca2+]i) triggers additional Ca2+ release from internal stores. Less well understood are the mechanisms involved in Ca2+ mobilization from internal stores after activation of Ca2+ influx. The mobilization process is known as calcium-induced calcium release (CICR). In this study, our goal was to investigate the existence of and the role of caffeine-sensitive ryanodine receptors (RyRs) in a rat pancreatic beta-cell line, INS-1 cells. To measure cytosolic and stored Ca2+, respectively, cultured INS-1 cells were loaded with fura-2/AM or furaptra/AM. [Ca2+]i was repetitively increased by caffeine stimulation in normal Ca2+ buffer. However, peak [Ca2+]i was only observed after the first caffeine stimulation in Ca2+ free buffer and this increase was markedly blocked by ruthenium red, a RyR blocker. KCl-induced elevations in [Ca2+]i were reduced by pretreatment with ruthenium red, as well as by depletion of internal Ca2+ stores using cyclopiazonic acid (CPA) or caffeine. Caffeine-induced Ca2+ mobilization ceased after the internal stores were depleted by carbamylcholine (CCh) or CPA. In permeabilized INS-1 cells, Ca2+ release from internal stores was activated by caffeine, Ca2+, or ryanodine. Furthermore, ruthenium red completely blocked the CICR response in permeabilized cells. RyRs were widely distributed throughout the intracellular compartment of INS-1 cells. These results suggest that caffeine-sensitive RyRs exist and modulate the CICR response from internal stores in INS-1 pancreatic beta-cells.

Matrixplasty for the Treatment of Pincer Nail with Nail Growth Plate Deformity / 대한족부족관절학회지

PURPOSE: The purpose of this study was to introduce the 'Matrixplasty' for the treatment of a severely incurved toenail with growth plate deformity and to report our results treating this disease entity. MATERIALS AND METHODS: Between January 2010 and May 2010, 48 consecutive patients (62 cases) underwent treatment of symptomatic incurved toenails with the 'matrixplasty'. The mean period of time at last follow-up was 14.0+/-1.3months. The recurrence rate and complication rate were evaluated. An American Orthopedic Foot and Ankle Society (AOFAS) forefoot hallux score was assigned and patients were evaluated at pretreatment and the last follow-up meeting. For evaluation of improvement in toenail shape, the center to edge angle of the toenail was measured at pretreatment and last follow-up. RESULTS: All ingrown toenails healed and the nail deformity was corrected within 3 weeks after the procedure. Among the 62 cases, four cases had recurred by the last follow-up. The mean pretreatment AOFAS forefoot hallux score was 73.1+/-12.8, and it improved to 98.7+/-1.1 by the last follow-up (p<0.01). The mean center to edge angle of the toenail improved from 53.3+/-12.9 degrees to 18.2+/-7.4 degrees by the last follow-up (p<0.01). Minor paronychia, which was managed with local wound dressing and oral antibiotics, was identified in eight cases. CONCLUSION: Matrixplasty showed excellent clinical results in the treatment of severe incurved toenail (pincer nail) and this procedure also showed great improvement of the deformed toenail and its growth plate.

Leaf Spot of Yam Caused by Pseudophloeosporella dioscoreae in Korea

Leaf spot symptoms were frequently observed on yam plants grown in the Yeoju area in Korea during a disease survey in 2008. A total of five isolates of Pseudophloeosporella sp. were obtained from the infected leaves of yam plants. All of the isolates were identified as Pseudophloeosporella dioscoreae based on their morphological and cultural characteristics. A phylogenetic tree derived from the internal transcribed spacer sequences of the fungal isolates showed that the fungus is distinctly separated from species in other related genera. P. dioscoreae isolates caused very tiny spots on leaves of yam plants two weeks after artificial inoculation which were similar to those observed in the field. This is the first report that Pseudophloeosporella dioscoreae causes leaf spot in yams in Korea.

Caffeine and 2-Aminoethoxydiphenyl Borate (2-APB) Have Different Ability to Inhibit Intracellular Calcium Mobilization in Pancreatic Acinar Cell

Inositol 1,4,5-trisphosphate receptors (InsP3Rs) modulate Ca2+ release from intracellular Ca2+ store and are extensively expressed in the membrane of endoplasmic/sarcoplasmic reticulum and Golgi. Although caffeine and 2-aminoethoxydiphenyl borate (2-APB) have been widely used to block InsP3Rs, the use of these is limited due to their multiple actions. In the present study, we examined and compared the ability of caffeine and 2-APB as a blocker of Ca2+ release from intracellular Ca2+ stores and Ca2+ entry through store-operated Ca2+ (SOC) channel in the mouse pancreatic acinar cell. Caffeine did not block the Ca2+ entry, but significantly inhibited carbamylcholine (CCh)-induced Ca2+ release. In contrast, 2-APB did not block CCh-induced Ca2+ release, but remarkably blocked SOC-mediated Ca2+ entry at lower concentrations. In permeabilized acinar cell, caffeine had an inhibitory effect on InsP3-induced Ca2+ release, but 2-APB at lower concentration, which effectively blocked Ca2+ entry, had no inhibitory action. At higher concentrations, 2-APB has multiple paradoxical effects including inhibition of InsP3-induced Ca2+ release and direct stimulation of Ca2+ release. Based on the results, we concluded that caffeine is useful as an inhibitor of InsP3R, and 2-APB at lower concentration is considered a blocker of Ca2+ entry through SOC channels in the pancreatic acinar cell.

The Computerized Measurement for the Radiological Severity of Hallux Valgus / 대한족부족관절학회지

PURPOSE: To study the reliability of intra- and interobserver reliability in angular measurement of hallux valgus deformity by assessing hallux valgus angle (HVA) and the 1st to 2nd intermetatarsal angle (1-2 IMA) through using computerized system. MATERIALS AND METHODS:20 cases of moderate to severe hallux valgus patients were included in this study. With the standing anteroposterior view of foot, the HVA and 1-2 IMA were calculated by computerized measurement system of Infinity cooperation, called phi-view, with its software tools. Using the statistical software program, SPSS (version 12th), we interpreted the results which were measured by two independent observers. RESULTS:In the intraobserver measurement, the HVA of observer A showed reliability (32.5 degrees +/-6.9 and 33.1 degrees +/-6.8)(p005). In the results of observer B, HVAs were measured as 35.7 degrees +/-7.6 and 36.2 degrees +/-7.7, and were not reliable (p>005). 1-2 IMA in observer B was not reliable as well (17.0 degrees +/-0.8 and 20.8 degrees +/-1.5)(p>005). In the interobservers' measurements, the first and the second results of HVA were 3.2 degrees +/-3.6 and 3.1 degrees +/-3.1, reliable within the 95% confidence interval (p005). CONCLUSION: In the angular measurement of the hallux valgus by computerized system, the HVA and 1-2 IMA showed less error range in the interobserver's results, compared with the previous studies about the manual measurement. However, our results failed to show the statistical reliability of intra- and interobserver's measuring. Therefore, even the computerized angular measurements in the severity of hallux valgus require development of the measuring methods and software tools.

Arthrodesis Of The First Metsatarophalangeal Joint For Rheumatoid Arthritis And Hallux Valgus / 대한정형외과학회잡지

PURPOSE: We reviewed the result of metatarsophalangeal arthrodesis of the great toe in rheumatoid arthritis and severe hallux valgus. MATERIALS AND METHODS: From February 1994 to March 1997, 68 patients were operated on. The follow up averaged 2.8 years. We evaluated the subjective improvement with respect to pain, ability to stand and walk and shoe wear, the radiologic improvement with respect to hallux valgus angle, intermetatarsal angle and dorsiflexion angle. RESULTS: Arthrodesis of the first metatarsophalangeal joint was resulted in a good functional improvement in 91% of hallux valgus and 94% of rheumatoid arthritis with respect to pain relief. Preoperative hallux valgus angle in rheumatoid arthritis was 42.5o, and the postoperative hallux valgus angle 10.1o. Preoperative hallux valgus angle in severe hallux valgus was 38.2o, postoperative hallux valgus 8.7o. CONCLUSION: Arthrodesis of the first metatarsophalangeal joint was an excellent operation for correction of the rheumatoid arthritis and severe hallux valgus, and there were no different result between these two groups.

A Clinical Evaluation of Urethral Topical Anesthetics for Urological Procedures / 대한비뇨기과학회지

In order to find a more satisfactory pain relieving agent for endoscopic examinations and other urological procedures, various urethral topical anesthetics and analgesics were evaluated clinically on a total of 147 male patients. Mean age of three patients was 46 years old with range of 16~78. The procedures performed in this study were: Cystoscopy in 50; cystoscopy and panendoscopy. 77: panendoscopy only 1; cystoscopy and ureteral catheterization, 15; cystoscopy and lithorapaxy, 1 and urethral dilatation, 3. The anesthetics and analgesics used in this study were as follow: Group 1 consisted of 7 patients with intramuscular injection of 50mg of demerol 30 minutes before the procedure and urethral lubrication with surgical jelly, Group II. 10 patients, urethral instillation of 2% procaine solution for 10 minutes and urethral lubrication with surgical jelly. Group III. 13 patients, urethral instillation of 2% lidocaine solution for 10 minutes and urethral lubrication with surgical jelly. Group IV. 112 patients, urethral instillation of 2% lidocaine jelly only for 10 minutes and Group V, 5 patients, urethral instillation of 2% lidocaine jelly with intravenous injection of 50mg of demerol 10 minutes before the procedure. Degree of pain after exposure of the anesthetics was recorded as the following 5 different categories: +++: severe pain, intolerability of the procedures ++ : moderate pain tolerance of the procedures + : mild pain, tolerance of the procedures +/- : slight pain with discomfort - : no pain with only discomfort Tentative criteria of judging effectiveness of anesthetics were as follows: + ~ +++ : unsatisfactory results - ~ +/- : satisfactory results The effectiveness of the anesthetics used for various urological endoscopic procedure was summarized as follows : The satisfactory results were obtained in 20% group II, in 23% group III, it 65% of group IV, and in 80% of group V.

Clinical Investigation on Localization of Urinary Tract Infection by Total Urinary LDH Activity and Isoenzyme Pattern / 대한비뇨기과학회지

Precise location of the site of infection is the most important step to determine the proper management of patients with urinary tract infection. Since lower tract infection, i. e., cystitis, is associated with almost no long-term morbidity or mortality, treatment does not need to be intensive or prolonged. Conversely, upper tract infection, or pyelonephritis, is a serious clinical problem with a definite risk of immediate and long-term complications. Accordingly, most urologist want to find a reliable, noninvasive technique to localize the site of urinary tract infection. We herein made clinical study of level of total urinary LDH activity and its isoenzyme pattern to localize the site of infection on 13 renal infection patients (6 males and 7 females). 12 bladder infection patients (5 males and 7 females), and 11 normal control group (9 males and 2 females). The results obtained in this clinical study the as follows; 1. Normal control group; Range of total urinary LDH activity was 0-12 IU/1 and mean value was 3.8 IU/1. Urinary LDH isoenzyme 1 and 2 (fast zone) predominated. (84.1% of total urinary LDH activity) 2. Renal infection group; Range of total urinary LDH activity was 20-85 IU/1 and mean value was 45.1 IU/1. Urinary LDH isoenzyme 4 and 5(slow zone) highly increased in 10 cases (77%). 3. Bladder infection group; Range of total urinary LDH activity was 8-75 IU/1 and mean value was 31.5 IU/1. Total urinary LDH activity in bladder infection patients was higher than in normal control group but lower than in renal infection patients. In two bladder carcinoma patients with bladder infection, urinary LDH isoenzyme 5 highly increased. 4. In urinary tract infection, total urinary LDH activity highly increased. Level of total urinary LDH activity in renal infection was higher than in bladder infection and its isoenzyme patterns revealed slow zone predominance. In patients with bladder infection, the isoenzyme patterns varied but fast zone slightly increased than slow zone. Localization of urinary tract infection by total urinary LDH activity and its isoenzyme patterns the most reliable, noninvasive, quickly available and easy to perform technique.

The Role of Lymphography in the Management of the Genitourinary Tract Tumors / 대한비뇨기과학회지

This paper is presented to report the results of urinary quantitative culture and drug sensitivity tests for isolated micro-organisms in this study. Studies were done on 172 cases from the department of Urology, Eul Ji General Hospital during the period from Jan. 1979 up to Dec. 1980. 1. Quantitative urine culture in 172 cases were performed and of these, 89 cases grew micro-organism wile the remaining 83 cases showed no growth. Among the 89 cases, 67 cases (75.2%) revealed significant bacteriuria with colony count over 10 5/ml in urine while 22 cases (24. 8%) were below 105/ml. Radio of Male: Female is 29: 38 2. 55 cases (82.1%) among the 67 cases with significant bacteriuria could the bacteria be identified on a smear and Gram stain. 54 cases (80.6%) of the 67 significant bacteriuria casts revealed pyuria of more than 5/HPF while 13 cases (19.4%) were below 5/HPF 3. 60 cases(89. 6%) of the 67 cases significant bacteriuria has Gram (-) bacilli while 7 cases(10.4 %) were Gram (+) cocci by direct smear. The frequency of isolated organism were as following E. coli 33 cases (49. 3%). Pseudomonas 11 cases(16.4%) Enterobactor 6 cases(9.0%) Proteus and stapbylo. Aureus 4 cases(5.8%) respectively. 4. On the whole, all isolated micro-organisms showed considerable susceptibility to panimycin (82. 7%) and then frequency of susceptible drug were and then the frequency of susceptible drug were Cefamezine, Kedacillin, Gentamicin.

Clinical Observation of Normal Uroflowmetry and Urethral Pressure Profilometry / 대한비뇨기과학회지

Uroflowmetry and Urethral Pressure Profilometry were made on 4 cases and 6 cases respectively who visited our Department of Urology during the period of March 1980 to July 1980. The results were summarized as follows; 1. On 2 women cases, uroflowmetry with anal sphincter electromyography revealed: Maximum flow rate; 30ml/sec, voided volume: 500ml-750ml. Time to Maximum flow rate; 4.8 sec~10.8 sec. Voiding time; 40 sec~84 sec., average flow rate; 5.9ml/sec~18.7ml/sec., residual urine ;0 Detrusor-sphincter dyssynergia did not appear. 2. On 2 men cases, uroflowmetry with anal sphincter EMG revealed: M.F.R.; 25ml/sec., V.V.: 500ml, Time to MFR; 1.7 sec.~6 sec. V.T. 43.2 sec.~48 sec., A.F. R.; 10.4ml/sec.~11.6ml/sec. R.U.; 0. Detrusor-sphincter dyssynergia did not appear. 3. On 2 women cases, urethral pressure profilometry with EMG revealed: Functional profile length; 2.8cm~3cm. Maximum urethral closure pressure ; 50cmH2O~80cmH20. Maximum urethral pressure; 70cmH2O~90cm H2O The maximum EMG sensitivity appeared on the midurethra. 4. On 4 men cases, urethral pressure profilometry with EMG revealed: F.P.L. ; 4.5cm~6cm, M.U.C.P.; 60cm 11,0~140cm H.O. M.U.P. 80cmH2O~160cm H20. Prostatic length: 2.5cm~3.8cm. The maximum EMG sensitivity appeared on the external sphincter. 5. We concluded that urodynamic study was the important method to diagnose the lower urinary tact lesions in addition to previous method (excretory urography, cystoscopy, panendoscopy etc.).

Clinical Review on Urolithiasis (III) / 대한비뇨기과학회지

A statistical observation was made on 841 cases of urolithiasis among the l.004 cases which were seen during the 15 years period from January 1963 to December. 1977. 1. The incidence of the patients with urolithiasis was 1.85 % of total urological patients and 19.2 % of the inpatients. 2. The incidence of the patients with urolithiasis did not increase in spite of increasing annual incidence of inpatients. 3. They consisted of 266 patients with kidney stone (29 %) . 573 patients with ureter stone (61 %). 68 patients with bladder stone (7%) .and 26 patients with urethral stone (3%) The ratio of upper urinary tract stones to lower urinary tract stones was 9 to I. Among the 266 cases of the kidney stone, 21 cases were staghorn calculi. 4. The most favored predilection of ureter stones was lower 1/3 of ureter in 61% of these. 5. Seasonal variation of urolithiasis was not distinct, but the summer was the most favored season. 6. They were most commonly found between the ages of 20 to 50 (82 %). The causes were not found in all cases of childhood urolithiasis ( 8 cases) under the ages of 10. 7. The ratio of males to females was 2.7 to 1, however, the staghorn calculi were more commonly found in female. The ratio of males to females under age of 25 years was 1.8 to 1. 8. The upper urinary tract calculi occurred both in the right and left side with approximately equal frequency. 9. Multilocated stones were found in 10.7 % of all cases and bilateral stones were found in the 8.4% of the all cases. 10. The clinical symptoms of upper urinary tract calculi were flank pain in 85%, hematuria in 27.7 %, frequency in 17.8 %, nausea and vomiting in 10.4 %, and fever in 7.2%. The clinical symptoms of lower urinary tract calculi were painful urination in 78.7%, frequency in 48.8%, hematuria in 33%, and sudden stoppage in 33%. 11. The microscopic hematuria was found in 68.2% and pyuria in 47.7%. 12. Treatment consisted of surgical intervention in 70.3%, rnknown or expectant therpay in 14.4%, spontaneous expelling in 8.5%, and instrumental manipulation in 6.9%. 13. Definite histor of recurrent calculi was found in 27 cases (3.2%) and average duration of recurrence was 2.5 years.

Overall Clinical Statistics in the Urology Department of Seoul National University Hospital for the Past 24 Years (1954~1977) / 대한비뇨기과학회지

A clinical and statistical observation was made on out-patients and in-patients admitted to the Department of Urology, Seoul National University Hospital for the past 24 years from 1954 to 1977. The observations were summarized as follows. 1. During the period, the total number of out-patients was 63,438 and that of in-patients, 6,028. 2. In the out-patients, lower urinary tract infections such as urethritis and prostatitis were the most common diseases regardless of the time period. 3. In the in-patient, the frequency of the disease has been changed with the lapse of time in the order of the occurrence. The interesting changes of the disease order related to the time period were noted as follows. 1954-1960 : genitourinary tuberculosis, urolithiasis, tumor, injury and congenital anomaly. 1961-1970 : urolitiasis, tumor, genitourinary tuberculosis, injury, infection and congenital anomaly. 1971-1977 : tumor. urolithiasis, genitourinary tuberculosis, congenital anomaly, injury and infection. 4. In 1977, 10 major diseases were tumor, ureteral stone, infertility, renal tuberculosis, B. P. H. hypospadias, varicocele, renal stone, scrotal injury and renal tumor 5. Major operations were performed on 4,122 cases during the period. Nephrectomy and ureterolithotomy were the most common operations. Recently, total cystectomy with ileal loop diversion, transurethral procedure and vasovasostomy, which require more skillful techniques, are increasing in number.