Two Cases of Rectal Vascular Ectasia in Patients with Liver Cirrhosis and Who Were Treated by Argon Plasma Coagulation / 대한소화기내시경학회지

The term "vascular ectasia" is defined to include angiodysplasia, gastric antral vascular ectasia (GAVE) and telangiectasis, and these are the leading causes of acute or chronic gastrointestinal bleeding. We describe here the first 2 Korean cases of GAVE with rectal vascular ectasia in patients with liver cirrhosis. A 70-year-old woman was admitted to the hospital with hematochezia. The finding on endoscopy showed diffuse nonconfluent spots with oozing bleeding on the antrum and several vascular spots with oozing bleeding on the rectum. The lesions were successfully treated by argon plasma coagulation (APC). We report on another case of rectal vascular ectasia in a patient with liver cirrhosis. A 77-year-old man was admitted to the hospital with hematochezia. The findings on colonoscopy showed diffuse vascular spots with oozing bleeding on the rectum. The lesions were successfully treated by APC. These two patients have had no bleeding since their treatment, and they are currently being evaluated by follow-up studies at the outpatient department.

Genetic Characteristics and Phylogenetic Analysis of Influenza Type B Viruses Isolated from Nasopharyngeal Suction Samples of Korean Patients

To investigate the genetic characteristics of human influenza type B viruses circulating in Chungbuk province, Korea, we tested 510 clinical samples of nasopharyngeal suction from pediatric patients diagnosed with respiratory illness between June 2007 and June 2008. Twelve out of thirty-six isolates were identified as type B influenza virus by RT-PCR and sequencing analysis. Interestingly, genetic characterization of type B viruses isolated in this study revealed that all type B influenza viruses were the Yamagata lineages, a vaccine strains of southern hemisphere during 2007~2008, rather than the Victoria lineage of northern hemisphere during 2007~2008. Furthermore, there were a total of twelve unique mutations (HA: H40Y, D/G230S, V252M and K272R and NA: P3H, P/T/S42Q, N59S) occurred in our type B isolates. These results suggest that relative high prevalence of type B viruses in Korea during 2007~2008 season might be due to the wrong vaccine strains selection. Taken together, the results of this study demonstrate continuous evolutions of human type B viruses by antigenic drift and also highlight the need to closely monitoring of influenza viruses to aid the early detection of potentially pandemic strains as well as underscore the need for new therapeutics.

A Case of Duodenal Intramural Hematoma Treated by Percutaneous External Drainage / 대한소화기학회지

Complicating intramural hematoma is an interesting, relatively unusual condition. Various etiologic factors have been described, with the most common being blunt trauma, anticoagulant therapy, Henoch-Sch nlein purpura and blood dyscrasias. Most intramural hematomas resolve spontaneously with conservative treatment, and the prognosis is good. However, if the abdominal pain or obstruction does not resolve with medical management over seven to ten days, complications such as infarction or peritonitis may occur, and surgical intervention might be required. We report a case of intramural hematoma of duodenum treated with percutaneous drainage and embolization of bleeding focus which was complicated with acute pancreatitis after anticoagulation treatment in a patient with recurrent history of deep vein thrombosis. In addition, we reviewed reports of intramural hematoma of the duodenum and treatment strategies.

Effects of the Specific COX-2 Inhibitor, Celecoxib, on Paclitaxel-Induced Apoptosis in SK-OV-3 Epithelial Ovarian Cancer Cell Line / 대한산부인과학회지

OBJECTIVE: In vitro studies have revealed that treatment of various human cancer cell lines with specific cyclooxygenase 2 (COX-2) inhibitors induces apoptotic cell death. The goal of this article is to investigate the benefits of combining COX-2 inhibitors with existing treatment modalities in the management of ovarian cancer. METHODS: In this study we sought to determine the effects of combining paclitaxel and the COX-2 inhibitor celecoxib on apoptosis of epithelial ovarian cancer (EOC) cells. SK-OV-3 cells were exposed to increasing concentrations of paclitaxel (10(-7) M, 10(-6) M and 10(-5) M) and celecoxib (10(-8) M, 10(-7) M, 10(-6) M, 10(-5) M and 10(-4) M) as well as a combination of both drugs. The activity of apoptosis was evaluated by the morphologic examination and the MTT assay. The pattern of apoptosis was also assessed by the caspase-3 activity and the fraction of cleaved PARP (poly ADP-ribose polymerase) protein. RESULTS: Single application of both drugs could significantly increase the rate of apoptosis after 24 hours of continuous exposure. But concomitant treatment of SK-OV-3 EOC cell line with paclitaxel and celecoxib resulted in marked impairment of paclitaxel-induced apoptosis. The pattern of apoptosis induced by paclitaxel on SK-OV-3 EOC cell line was caspase-3 independent. CONCLUSION: Combining COX-2 inhibitors and paclitaxel does not have an additive or synergistic tumoricidal effect. On the contrary, celecoxib treatment markedly inhibited the apoptotic effects of paclitaxel in SK-OV-3 EOC cell line.

In Vitro Responses of SK-OV-3 Ovarian Cancer Cell Lines to Tamoxifen and Celecoxib / 대한산부인과학회지

OBJECTIVE: There are some evidences that some epithelial ovarian cancer cells respond to hormonal therapy. And in vitro studies have revealed that treatment of various human cancer cell lines with selective cyclooxygenase 2 (COX-2) inhibitors induces apoptotic cell death. The goal of this article is to evaluate the effects of tamoxifen and celecoxib, a selective COX-2 inhibitor, on the ovarian cancer cells and the benefits of combining these agents in the management of ovarian cancer. METHODS: SK-OV-3 epithelial ovarian cancer cells were exposed to increasing concentration of tamoxifen (10(-8) M, 10(-7) M, 10(-6) M, 10(-5) M and 10(-4) M) and celecoxib (10(-8) M, 10(-7) M, 10(-6) M, 10(-5) M and 10(-4) M) as well as a combination of both drugs. The activity of apoptosis was evaluated by the morphologic examination and the MTT assay. The pattern of apoptosis was also assessed by the caspase-3 activity and the fraction of cleaved PARP (poly ADP-ribose polymerase) protein. RESULTS: Single application of both drugs could significantly increase the rate of apoptosis after 24 h of continuous exposure. Concomitant treatment of SK-OV-3 cells with tamoxifen and celecoxib induced significant increase in apoptosis, comparing with single drug exposure. The pattern of apoptosis induced by these agents on SK-OV-3 cells seemed to be caspase-3 dependent. CONCLUSION: Our data suggest that combining tamoxifen with selective COX-2 inhibitor seems to have at least an additive tumoricidal effect. A more definitive role for this combination therapy in clinical settings in ovarian cancer will need to be defined through the conduct of clinical trials.

Primary Peripheral T-Cell Lymphoma of the Stomach and Duodenum / 대한소화기내시경학회지

About 90% of primary gastrointestinal lymphomas originate from the B-cell and less than 10% from the T-cell. In respect of anatomical location, the stomach is the most common site of gastrointestinal lymphomas followed by the ileum, colon, and rectum. However, esophagus and duodenal lymphomas are infrequently involved. Primary T-cell lymphoma of the duodenum is not common and peripheral T-cell lymphoma of the duodenum is very rare. In Korea, there has been no case report of peripheral T-cell lymphoma which simultaneously involved the stomach and duodenum. In this report, we present a case of primary peripheral T-cell lymphoma of the duodenum and stomach. A 63-year-old man was hospitalized complaining of weight loss of 15 kg and dyspepsia for 2 months. Esophagogastroduodenoscopy showed a large annular infiltrative lesion in the descending portion of the duodenum. At the posterior side of the upper body of the stomach, an ill-defined, broad, flat, and infiltrative lesion was also noted. Microscopic examination of the biopsy specimen showed that atypical bizzare lymphocytes infiltrated the mucosa of the duodenum and stomach. The lymphocyte was positive for CD3, CD5 and negative for CD20, CD23, and CD56 by immunohistochemistry. We made a diagnosis of primary peripheral T-cell lymphoma of the stomach and duodenum. We report a case of peripheral T-cell lymphoma of the stomach and duodenum with a review of the literature.

A Case of Myxedema Coma with Severe Hypoventilation / 대한내분비학회지

A myxedema coma, representing the extreme feature of hypothyroidism is rare. Despite early vigorous treatment, a myxedema coma is associated with a mortality rate as high as 60%. Herein, a case of a myxedema coma, with severe hypoventilation, is described. When the patient arrived at the emergency room, she complained of dyspnea and general weakness, and was of a drowsy mental status. 7 days after admission, she was more confused and disoriented, and respiratory insufficiency had developed. Although levothyroxine was continued and her respiration improved, she still had a confused mentality and seizure developed. Despite medication her consciousness did not improve, so was discharged in despair by her family members. The respiratory abnormality with a myxedema coma is a depressed ventilatory response to hypercapnea, resulting in a decrease in alveolar ventilation, with progressive CO2 retention. An upper airway obstruction, especially during sleep, and neuromuscular dysfunction in breathing may be shown in hypothyroidism. Therefore, a myxedema coma, accompanied by severe hypoventilation, should be intensively treated with thyroid hormone replacement therapy and mechanical ventilatory support

A Case of Nonspecific Interstitial Pneumonitis Improved After Cyclosporin Therapy / 결핵

Idiopathic interstitial pneumonia is a group of lung disease classified by clinical, radiological and pathologic findings. Steroid is described in many reports as an effective treatment for the idiopathic interstitial pneumonitis. For the treatment of steroid non-responders, immuno-suppressive or cytotoxic agents are used as second line drug of choice. We experienced a case of nonspecific interstitial pneumonitis who was treated initially with glucocorticoid and antibiotics without effects, but later did respond to cyclosporin treatment. This 63 year-old patient was admitted due to dyspnea, cough, and sputum production. He was started on glucocorticoid and antibiotics after he was diagnosed as having nonspecific interstitial pneumonitis by open lung biopsy. The initial steroid treatment was not effective, however, after cyclosprin treatment, the patient showed clinical and radiologic improvements.

Clinical Characteristics of 10 Cases of Korean Osteogenesis Imperfecta / 대한내분비학회지

Osteogenesis Imperfecta (OI) is a relatively rare hereditary disease, which is characterized by multiple bone fractures and spine scoliosis, due to the fragility of bone, and is often associated with blue sclerae, deafness and dentinogenesis imperfecta. Four types of OI can be distinguished, according to the clinical findings. Although mutations affecting type I collagen are responsible for the disease in most patients, the mechanism by which the genetic defects cause abnormal bone development remains to be fully understood. Here, the clinical characteristics of 10 OI patient cases are reported, with a review of the literature. All the cases, including 4 type I, 4 type III and 2 type IV, inherited OI as an autosomal dominant trait. All the subjects had multiple old fractures and decreased bone densities. In this study, the biochemical marker of bone formation, serum alkaline phosphatase, was found to be increased only in the pediatric OI patients, while the biochemical marker of bone resorption, urinary deoxypyridinoline, was increased in all cases. The mobility score was found to correlate with the severity of the type on diagnosis.

H+ -ATPase Pump Defects of Distal Renal Tubular Acidosis as Initial Manifestation of Systemic Lupus Erythematosus / 대한신장학회잡지

Systemic lupus erythematosus (SLE) is a multisystem disease with marked variability in its manifestation. Tubulointerstitial involvement is well recognized in SLE. But usually the tubular dysfunction is latent and usually presents after diagnosis of SLE. We report a 20 years old female whose initial symptom of SLE was distal renal tubular acidosis (RTA). She presented with severe muscle weakness at emergency room with laboratory fingding consistent with distal RTA. After several months she developed fever, arthritis, serologic fingding which was compatible to diagnose SLE. We report a case whose initial symptom of SLE had been distal RTA.

Effect of Hypoxia on Antegrade and Retrograde Atrioventricular Conduction in Isolated Perfused Heart

PURPOSE: Cyanotic congenital heart diseases patients are in a state of hypoxia since birth. In general, hypoxia delays atrioventricular conduction. The atrioventricular node in such a hypoxic condition would have a different function, and some possibility for arrhythmia. The authors studied atrioventricular nodal function during hypoxia to elucidate the relationship between hypoxia and arrhythmia, including atrioventricular node in terms of cardiac tissue level. METHODS: After extraction of an adult rabbit heart under pentobarbital anesthesia, the heart was retrogradely perfused through the aorta with graded hypoxic Krebs' solution(100, 70, and 50% oxygen). The intracardiac electrocardiograms were obtained by a custom-made programmed stimulation at basic cyde length 40ms antegradely and retrogradely. All the data was analysed at His-electrogram and conduction time. Refractory periods and Wenckebach cycling length were determined. RESULTS: During antegrade conduction, the fast AV nodal conduction was prolonged and the slow conduction shortened, resulting in decreased compliance of the AV nodal conduction with graded hypoxia. The His-Purkinje system also showed a similar result. Among the refractory periods, only the AV nodal effective refractory period was prolonged with hypoxia. Wenckebach cycle length was sensitive to hypoxia, especially for retrograde conduction. CONCLUSION: Because the AV conduction during hypoxia was characterized by decreased AV conduction compliance, prolonged AV nodal effective refractory period, and sensitive Wenckebach cyding length, hypoxia would not seem to be a special risk for arrhythmia, including AV node.

The Analysis of Risk Factors and Significance of Tumor Necrosis Factor(TNF)-a in Henoch-Schonlein Nephritis

A mediastinal mass was aspirated by fluoroscope-guided fine needle aspiration biopsy in a 47 years old female patient. The first aspiration smears were not diagnostic, because of hemorrhagic background and cell paucity. On the second aspiration, the smears were composed of some clusters of benign epithelial cells in hemorrhagic background. Cells were arranged in mostly solid sheets and tended to form glandular lumina in part. Their nuclei were round and vesicular. Nucleoli were not prominent. These findings were suggestive of benign glandular tissue, which was finally confirmed as mediastinal thyroid gland by open thoracotomy specimen.

A Case of Tuberous Sclerosis with Hydrocephalus and Multiple Cardiac Tumors in Neonatal Period

Several different tumors in different tissues(including the central nervous system, heart, kidney, liver, bone, and soft tissues) are found to be associated with tuberous sclerosis. In the brain, this tumor characteristically arises from the floor of the lateral ventricle and often occluded the foramen of Monro. Cardiac tumor is among the earliest signs of tuberous sclerosis and occurs in over half of affected patients, but symptomatic primary heart tumors are rare in newborn. Thus, early detections are rare in asymptomatic cases. We experienced a case of tuberous sclerosis, in a 2-day-old female newborn who presented with dilatation of lateral ventricle detected by fetal ultrasonography. Diagnosis was confirmed by brain MRI and echocardiogram demonstrated multiple cardiac tumor. Brief review and related literatures were also presented.

bcl-2 and bax Expression in Prostate Carcinoma / 대한비뇨기과학회지

PURPOSE: Proteins encoded by bcl-2 family as regulators of apoptosis appear to have significant cellular effects such that when abnormally expressed, they may render certain cells more susceptible to aberrant proliferation. The ratio of anti-apoptotic to pro-apoptotic bcl-2 family proteins appears to control the relative sensitivity or resistance of cells to apoptotic stimuli. The primary goal of this study is to determine the expression pattern of bcl-2 and bax in prostate carcinoma and to correlate them with Gleason score, T stage, and PSA to determine their prognostic potential. MATERIALS AND METHODS: We examined the cellular expression of bcl-2 and bax proteins using immunohistochemical metod in a total 35 patients with untreated prostatic carcinoma. All tissues were scored for overall tissue expression as follows: bcl-2(0,50%), bax(1+,75%). RESULTS: Of the 35 cases, 16(45.7%) contained at least 1% bcl-2 positive tumor cells. The bcl-2 positive cases included 1(7.7%) Gleason 2 to 4 grade tumors, 8(66.7%) Gleason 5 to 7 tumors, 7(70.0%) Gleason 8 to 10 tumors. bcl-2 protein expressed more frequently in higher grade(p<0.05) and in higher PSA level(p<0.05) of tumors. bax immunostaining was positive for all 35(100%) and 1+ was 16(45.7%), 2+ was 14(40.0%), 3+ was 5(14.3%). But statistically significant differences in bax expression among grade, T stage, and PSA were not observed. The bcl-2 protein was present mainly in the basal cells, but bax was in both basal and secretory cells of prostate. CONCLUSIONS: bcl-2 protein have some potential role in progression of prostate carcinoma. Therefore, studies that evaluate the expression of these bcl-2 family genes in varoius time during progression of tumors correlate with the state of hormone dependency, response to therapy and duration of response are needed.

A Case of Battered Child Syndrome with Subdural hemorrhage / 대한소아신경학회지

The diagnosis of a Battered Child Syndrome is made by the pediatrician, surgeon and the radiologist because almost parents deny the diagnosis or refuse to answer the doctor's questions. The imaging modalities play a key role in the investigation and documentation of the battered child syndrome, because of the high frequency of the typical skeletal lesion. Although physical abuse is denied by parents, the recognition of this entity is possible by the primary diagnostic imaging study in the suspected child abuse. The imaging studies are either a bone scan and x-ray series or a complete radiolographic skeletal survey by X-ray series. In an expected intracranial injury, a CT scan of the head is mandatory We experienced a case of Battered Child Syndrome in a 6 month-old male infant who had subdural hemorrhage and fractures of skull and ribs in different stages of healing and repair. The brief review of the literature was made.

Huge Seminal Vesicle Cyst Associated with Ipsilateral Renal Agenesis / 대한남성과학회지

We report a case of huge seminal vesicle cyst associated with ipsilateral renal agenesis in a 49-year-old man with frequency, urethral discomfort with a full bladder, and tenesmus as complaints.

Two Cases of Post-Traumatic Arterial High-Flow Priapism / 대한남성과학회지

type presents as a prolonged painful erection and is characterized by ischemia and pooling of blood within the corpora cavernosa. The less common form, high-flow priapism, is characterized by absence of pain and ischemia. We report two cases of high-flow priapism caused by rupture of the cavernosal artery following blunt perineal trauma. The patients complained of painless and persistent penile erection. By trauma history, cavernosal blood gas analysis, and color Doppler sonography, arterial high-flow priapism was confirmed, In both cases, left cavernosal artery leakage was revealed by internal pudendal selective angiography. The cavernosal artery was embolized with coils in both patients, and penile detumescence was achieved.

Two Cases of Post-Traumatic Arterial High-Flow Priapism / 대한남성과학회지

type presents as a prolonged painful erection and is characterized by ischemia and pooling of blood within the corpora cavernosa. The less common form, high-flow priapism, is characterized by absence of pain and ischemia. We report two cases of high-flow priapism caused by rupture of the cavernosal artery following blunt perineal trauma. The patients complained of painless and persistent penile erection. By trauma history, cavernosal blood gas analysis, and color Doppler sonography, arterial high-flow priapism was confirmed, In both cases, left cavernosal artery leakage was revealed by internal pudendal selective angiography. The cavernosal artery was embolized with coils in both patients, and penile detumescence was achieved.

Change of Cerebral Blood Flow and EEG in Premature Infants with PDA / 대한소아신경학회지

PURPOSE: Studies conducted on both animal and adult human subjects have demonstrated that a decrease in cerebral blood flow (CBF) causes cerebrocortical dysfunction resulting in an abnormal electroencephalogram (EEG). Although it is assumed that in premature infants with patent ductus arteriosus (PDA), the shunt will decrease CBF and alter the cerebrocortical function thus resulting in an abnormal EEG, this has yet to be firmly established. This comparative study, therefore, measures EEG as effected by CBF before and after PDA closures. Furthermore, in order to observe the effect of PDA on CBF and EEGs, the results were compared against a control group made up of premature infants without PDA. METHOD: All subjects were premature infants admitted to the neonatal intensive care unit of Chungbuk National University Hospital between February and August of 1997, were under gestational age (GA) 36 weeks, and weighed less than 2 kilograms: PDA group (group I consisted of 8 with PDA and respiratory distress syndrom (RDS); group II of 5 with PDA but without RDS) and Control group (group III of 6 without PDA but with RDS; group IV of 12 with neither PDA nor RDS). Studies were performed on the third and seventh day after birth and continued weekly throughout the period of study. Using Acuson 128XP/10c Doppler Echo cardiography, we measured the peak systolic velocity (PVS), the end-diastolic velocity (EDV) and the area under the velocity curve (AUVC) of the anterior cerebral artery (ACA), the blood flow of the left carotid artery and the descending aorta, calculated the LA/Ao ratio and conducted EEG's. RESULTS: 1) Birth weight and gestational age There was a significant difference between group I and group IV. However, when contrasting the two control groups overall, we found no significant variation. 2) In the PDA group, the infants were treated as follows: four infants were performed PDA ligations and seven were administrated indomethacine, resulting in 5 successful closures. Two infants had PDA which closed naturally without any treatment.3) PSV, DV, AUVC in the PDA group before and after closureThe incidence of decreased cerebral blood flow tended to increase after the PDA closure; however, the variation was not significant. In the groupes with RDS, on the other hand, the increase of CBF was significant after treatment, especially in group III.4) Incidence of abnormal EEGsThe preliminary EEG was abnormal for the above infants, with the background EEG appearing as suppressed or sharp and spike wave discharges. There was no significant difference in the results of the two groups and all EEG's were normalized in subsequent examinations. CONCLUSION: The decreased cerebral blood flow in premature infants with PDA increased following closure of the shunt; however, this increase was not significant. In groupes with RDS, the decreased cerebral blood flow significantly increased as the RDS improved, especially in group III. Nonetheless, despite the observed changes in CBF, we were unable to detect a corresponding change in the EEGs of the newborns in this study.

Intraoperative Bupivacaine Irrigation for Analgesia after Inguinoscrotal Surgery in Children / 대한비뇨기과학회지

Postoperative pain is a major problem that may restrict early mobilization and hospital discharge of surgical patients and it may cause psychologic trauma in pediatric patients, so effective postoperative analgesia is important especially in pediatric surgery. A study was undertaken to test the effect of intraoperative wound irrigation with bupivacaine for postoperative analgesia in pediatric inguinoscrotal surgery and the analgesic effect was measured with postoperative analgesics requirement and pain score. A total of 149 patients of 5 months to 13 years old were enrolled in our study. In comparison of analgesics requirement a total of 69 patients were enrolled and assigned to 2 groups. Group 1 was treated with wound irrigation with 0.21 ml/kg 0.25 % bupivacaine solution before closure of the inguinal canal and before suturing the subcutaneous layer. Group 2 was treated with normal saline instead of bupivacaine. Postoperatively 3 mg/kg phenobarbital was administered intramuscularly on complaint of pain. And the total number of doses of phenobarbital administered during first 24 hours of postoperative period was recorded. Drug administration and patient evaluation were double-blinded. In comparison of pain score a total of 80 patients were enrolled and assigned to 2 groups as same method as above and score according to the Oucher pain scale was recorded by nursing staff to assess the efficacy of intraoperative bupivacaine irrigation. The children in the bupivacaine group required significantly less postoperative medication for analgesia than those in the control group. The average number of doses of phenobarbital in the bupivacaine group was 0.189 +/- 0.065 compared to 0.594 +/- 0.109 in the control group (p=0.002). On the Oucher pain scale the bupivacaine group reported less pain than the control group (score 27.69 +/- 6.04 versus 37.56 +/- 5.18, respectively, p=0.01). We concluded that bupivacaine irrigation effectively decreases postoperative pain and narcotic drug requirement, and the irrigation of wounds with bupivacaine should be a routine procedure in elective inguinoscrotal surgery in children.