Respiratory Failure following Tetramine poisoning after Ingestion of Sea Snail: A Case Report

Tetramine toxicity due to sea snail ingestion is generally mild and has a good prognosis. Tetramine toxicity acts on the acetylcholine receptor, affecting the neuromuscular junction and autonomic nervous system. A 78-year-old female patient visited the emergency room with vomiting and dyspnea after eating sea snails. At the time of admission, the vital signs recorded were 140/80 mmHg-105/min-24/min-36.5。C, and 90% oxygen saturation. Arterial blood test revealed hypercapnia (pCO2 58.2 mmHg) and respiratory acidosis (pH 7.213, HCO3 - 22.5 mmol/L), whereas other blood tests showed no specific findings. Due to decreased consciousness and hypoxia, endotracheal intubation and mechanical ventilation were administered to the patient. Successful weaning was accomplished after 12 hrs, and the patient was discharged without any further complications. Although tetramine toxicity rarely results in acute respiratory failure due to paralysis of the respiratory muscle, caution is required whilst treating the patient.

Treatment of the cleft lip and palate patient with few remaining posterior teeth using hybrid telescopic crown denture

For individuals with cleft lip and palate, the removable partial dentures (RPDs) have been an important treatment option. Some modifications from conventional prosthetic treatment may be necessary to achieve satisfactory functional and esthetic results in cleft patients. In case of cleft palate patient with periodontally compromised and only posterior few remaining teeth, removable partial prosthesis connected to telescopic crown can be the alternative treatment option. When connected to the RPD, telescopic crowns increase the prosthetic stability and retention, optimize favorable force transmission to the long dental axis, and improve esthetics. And the cross arch stabilization of double crown denture helps to stabilize both divided maxillary ridges in CLP patient. This case present one adult CLP patient using an RPD connected with hybrid telescopic crowns with friction pins to improve not only retention and stability but also aesthetics.

Modifiers of TGF-beta1 effector function as novel therapeutic targets of pulmonary fibrosis

Pulmonary fibrosis is a fatal progressive disease with no effective therapy. Transforming growth factor (TGF)-beta1 has long been regarded as a central mediator of tissue fibrosis that involves multiple organs including skin, liver, kidney, and lung. Thus, TGF-beta1 and its signaling pathways have been attractive therapeutic targets for the development of antifibrotic drugs. However, the essential biological functions of TGF-beta1 in maintaining normal immune and cellular homeostasis significantly limit the effectiveness of TGF-beta1-directed therapeutic approaches. Thus, targeting downstream mediators or signaling molecules of TGF-beta1 could be an alternative approach that selectively inhibits TGF-beta1-stimulated fibrotic tissue response while preserving major physiological function of TGF-beta1. Recent studies from our laboratory revealed that TGF-beta1 crosstalk with epidermal growth factor receptor (EGFR) signaling by induction of amphiregulin, a ligand of EGFR, plays a critical role in the development or progression of pulmonary fibrosis. In addition, chitotriosidase, a true chitinase in humans, has been identified to have modulating capacity of TGF-beta1 signaling as a new biomarker and therapeutic target of scleroderma-associated pulmonary fibrosis. These newly identified modifiers of TGF-beta1 effector function significantly enhance the effectiveness and flexibility in targeting pulmonary fibrosis in which TGF-beta1 plays a significant role.

Availability of hs-C-reactive protein as Predictive Value of Acute Pyelonephritis with Patient of Urolithiasis

PURPOSE: The aim of this study was to determine early predictive value of acute pyelonephritis and urosepsis in patients with urolithiasis in the emergency department. METHODS: We retrospectively reviewed medical records of patients who visited the emergency department and were diagnosed with urolithiasis by computed tomography for three years. Patients with urolithiasis were grouped according to the presence of computed tomography (CT) findings with acute pyelonephritis. In baseline characteristics, laboratory and CT findings of the two groups were compared. Group 1 was defined as urolithiasis without acute pyelonephritis and group 2 was defined as urolithiasis with acute pyelonephritis. In addition, we compared the sepsis versus non-sepsis and percutaneous nephrostomy (PCN) versus non-PCN group in Group 2 for analysis of the hs-CRP level of each group. RESULTS: The total number of urolithiasis patients was 744. Among the patients, 84 (11.3%) had urolithiasis with acute pyelonephritis in CT findings. Age, sex, history of diabetes, history of urolithiasis, size of stone, duration of symptom, body temperature, blood pressure, heart rate, respiratory rate, leukocyte count, existence of pyuria, and hs-CRP differed significantly between the two groups, respectively. In multivariate logistic regression analysis, age, history of urolithiasis, existence of pyuria, and hs-CRP were shown to be independent predictors affecting acute pyelonephritis in patients with urolithiasis. The area under the receiving operator characteristics (ROC) curve for CRP was 0.820 (95% CI, 0.754-0.886) and leukocyte count was 0.631 [95% confidence interval (CI), 0.542-0.721]. Sepsis and PCN groups showed significantly higher hs-CRP level than non-sepsis and non-PCN groups. CONCLUSION: There were some independent predictive values of urolithiasis with acute pyelonephritis. It can be useful in early detection of acute pyelonephritis or sepsis, and it can be helpful in making treatment plans for patients of urolithiasis.

Platelet Dysfunction in a Patient with Multiple Myeloma: A Case Report with a Literature Review / 대한내과학회지

Multiple myeloma is a monoclonal plasma cell proliferation disorder with various symptoms and signs caused by paraproteinemias. Among these signs, a bleeding tendency is one of the major fatal causes. However, significant severe bleeding is rare in most cases. In this study, we report a case of multiple myeloma in a patient who had a severe recurrent bleeding tendency due to platelet dysfunction caused by paraproteins. After being treated with therapeutic plasma exchange and chemotherapy, the patient's monoclonal protein level decreased and the bleeding stopped.

Deoxypodophyllotoxin Induces a Th1 Response and Enhances the Antitumor Efficacy of a Dendritic Cell-based Vaccine

BACKGROUND: Dendritic cell (DC)-based vaccines are currently being evaluated as a novel strategy for tumor vaccination and immunotherapy. However, inducing long-term regression in established tumor-implanted mice is difficult. Here, we show that deoxypohophyllotoxin (DPT) induces maturation and activation of bone marrow-derived DCs via Toll-like receptor (TLR) 4 activation of MAPK and NF-kappaB. METHODS: The phenotypic and functional maturation of DPT-treated DCs was assessed by flow cytometric analysis and cytokine production, respectively. DPT-treated DCs was also used for mixed leukocyte reaction to evaluate T cell-priming capacity and for tumor regression against melanoma. RESULTS: DPT promoted the activation of CD8+ T cells and the Th1 immune response by inducing IL-12 production in DCs. In a B16F10 melanoma-implanted mouse model, we demonstrated that DPT-treated DCs (DPT-DCs) enhance immune priming and regression of an established tumor in vivo. Furthermore, migration of DPT-DCs to the draining lymph nodes was induced via CCR7 upregulation. Mice that received DPT-DCs displayed enhanced antitumor therapeutic efficacy, which was associated with increased IFN-gamma production and induction of cytotoxic T lymphocyte activity. CONCLUSION: These findings strongly suggest that the adjuvant effect of DPT in DC vaccination is associated with the polarization of T effector cells toward a Th1 phenotype and provides a potential therapeutic antitumor immunity.

A case of early-detected synchronous lung cancer by narrow-band imaging treated with photodynamic therapy / 대한내과학회지

Surgical resection is the treatement of choice for early stage lung cancer. However, it is hazardous for patients with poor pulmonary function, multifocal endobronchial lesions, a previous history of major lung resection, or an important comorbidity. Under such circumstances, bronchoscopic photodynamic therapy could be considered as a treatment option for patients whose tumors are centrally located and bronchoscopically visible and accessible. We present a patient with radiologically occult synchronous non-small cell lung cancer accompanied by esophageal cancer. The esophageal cancer and a tumor in the right lower lobe were surgically removed, and a carcinoma in situ in the left upper lobe was treated with bronchoscopic photodynamic therapy. Nine months later, another tumor was detected in the right middle lobe by narrow-band imaging. The tumor was treated by photodynamic therapy again. In this case, narrow-band imaging played a crucial role in the diagnosis, and photodynamic therapy ensured complete application of the treatment.

A Case of Sarcoidosis with Pancytopenia as Resulting from Bone Marrow Involvement / 결핵및호흡기질환

Sarcoidosis is a granulomatous disease that can involve any organ, although it primarily involves the lungs, intrathoracic lymph nodes, skin, and eyes. We present a case of sarcoidosis with pancytopenia, resulting from bone marrow involvement. A 35-year-old man was admitted to hospital for chronic cough and blurred vision. On chest computed tomography, there were multiple pulmonary nodules and mediastinal lymph nodes enlargement. As the patient also showed pancytopenia, we performed a bone marrow biopsy, as well as a transbronchial lung biopsy. Both biopsies showed non-caseating granulomas. We diagnosed the patient with sarcoidosis with pulmonary, bone marrow, uvea, liver and spleen involvement. After oral steroid therapy, the patient's symptoms as well as his pancytopenia improved. We present this case to demonstrate the significance of bone marrow biopsy in cases of sarcoidosis with pancytopenia, as well the possibility of clinical improvement with steroid treatment.

A Case of Miliary Tuberculosis in a Patient with Behcet's Disease and Uveitis Receiving Infliximab / 결핵및호흡기질환

Infliximab, a TNF-alpha antagonist, has been used to treat refractory rheumatoid arthritis, ankylosing spondylitis, Crohn's disease and Behcet's disease. Tuberculosis (TB) is a well-known opportunistic infection in patients receiving infliximab. Therefore, patients should be screened and treated for latent or active TB infection before being administered infliximab. Recently, we encountered a case of military TB during infliximab therapy in a patient suffering from Behcet's disease and uveitis. We report this case with a review of the relevant literature.

A Case of Miliary Tuberculosis in a Patient with Behcet's Disease and Uveitis Receiving Infliximab / 결핵및호흡기질환

Infliximab, a TNF-alpha antagonist, has been used to treat refractory rheumatoid arthritis, ankylosing spondylitis, Crohn's disease and Behcet's disease. Tuberculosis (TB) is a well-known opportunistic infection in patients receiving infliximab. Therefore, patients should be screened and treated for latent or active TB infection before being administered infliximab. Recently, we encountered a case of military TB during infliximab therapy in a patient suffering from Behcet's disease and uveitis. We report this case with a review of the relevant literature.

A Clinical Study on Adnexal Tumors in Pregnancy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinicopathologic features and clinical outcomes of adnexal tumors in pregnancy. METHODS: After review of charts of 51 patients managed at Kyungpook National University Hospital from January 1996 to June 2002, data including clinical findings, treatments and outcomes were analyzed. RESULTS: The mean age of pregnant women with adnexal tumors was 28.5 years old and the adnexal tumors were more common in nulliparous pregnant women (74.5%) than parous those. There were asymptomatic or no signs in 40 cases (78.4%), lower abdominal pain in 9 cases (17.6%), vaginal bleeding in 1 case (2.0%) and palpable mass by patient herself in 1 case (2.0%). The surgical treatments were performed at first trimester in 9 cases (19.1%), second trimester in 31 cases (66.0%) and third trimester in 7 cases (14.9%). Postoperative histopathologic diagnoses of adnexal tumors were 22 cases (43.1%) of benign cystic teratoma, 7 cases (13.8%) of functional cyst, 6 cases (11.8%) of serous cystadenoma, 4 cases (7.8%) of mucinous cystadenoma, 4 cases (7.8%) of endometrioma, 3 cases (5.9%) of parovarian cyst and 4 cases (7.8%) of malignancy including 2 cases of mucinous cystadenocarcinoma and 2 cases of mucinous tumor, borderline. The complication resulting from adnexal tumors was torsion of 6 cases (11.8%). The outcome of pregnancy was available in 30 cases, term delivery in 25 cases (83.3%), preterm delivery in 3 cases (10%) and spontaneous abortion in 2 cases (6.7%). CONCLUSION: Although the incidence of adnexal tumors with pregnancy is variable according to the reports, the detection rate is more and more increasing due to a widespread application of ultrasound. Thus, obstetricians must always consider adnexal tumors combined with pregnancy and try to minimize the complications of surgery during pregnancy to prevent adverse fetal outcome and maternal morbidity.

A Clinical Study on Adnexal Tumors in Pregnancy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinicopathologic features and clinical outcomes of adnexal tumors in pregnancy. METHODS: After review of charts of 51 patients managed at Kyungpook National University Hospital from January 1996 to June 2002, data including clinical findings, treatments and outcomes were analyzed. RESULTS: The mean age of pregnant women with adnexal tumors was 28.5 years old and the adnexal tumors were more common in nulliparous pregnant women (74.5%) than parous those. There were asymptomatic or no signs in 40 cases (78.4%), lower abdominal pain in 9 cases (17.6%), vaginal bleeding in 1 case (2.0%) and palpable mass by patient herself in 1 case (2.0%). The surgical treatments were performed at first trimester in 9 cases (19.1%), second trimester in 31 cases (66.0%) and third trimester in 7 cases (14.9%). Postoperative histopathologic diagnoses of adnexal tumors were 22 cases (43.1%) of benign cystic teratoma, 7 cases (13.8%) of functional cyst, 6 cases (11.8%) of serous cystadenoma, 4 cases (7.8%) of mucinous cystadenoma, 4 cases (7.8%) of endometrioma, 3 cases (5.9%) of parovarian cyst and 4 cases (7.8%) of malignancy including 2 cases of mucinous cystadenocarcinoma and 2 cases of mucinous tumor, borderline. The complication resulting from adnexal tumors was torsion of 6 cases (11.8%). The outcome of pregnancy was available in 30 cases, term delivery in 25 cases (83.3%), preterm delivery in 3 cases (10%) and spontaneous abortion in 2 cases (6.7%). CONCLUSION: Although the incidence of adnexal tumors with pregnancy is variable according to the reports, the detection rate is more and more increasing due to a widespread application of ultrasound. Thus, obstetricians must always consider adnexal tumors combined with pregnancy and try to minimize the complications of surgery during pregnancy to prevent adverse fetal outcome and maternal morbidity.

Clinical Comparisons of Laparoscopic Assisted Vaginal Hysterectomy and Total Abdominal Hysterectomy in the Huge Uterine Myoma / 대한산부인과학회잡지

OBJECTIVE: This study is to evaluate the effectiveness and the value of laparoscopic assisted vaginal hysterectomy (LAVH) and the possibility of replacing total abdominal hysterectomy (TAH) to LAVH. METHODS: Retrospective study of 25 cases of LAVH and 157 cases of TAH for huge uterine myoma (uterus weight 500 gram) in Dept. of OB/GYN, Kyungpook National University Hospital from Jan. 1998 to May. 2000 was carried out and postoperative results were compared between 2 methods. Statistical analysis was performed using x2 test and Student t-test as appropriate. Statistical significance was defined as p0.05). The mean operating time was 126+/-53 (range 53-240) min vs 109+/-29 (range 60-250) min (p>0.05). The mean weight of uterus was 719+/-389 (range 500-2414) gram vs 791+/-541 (range 500- 4700) gram (p>0.05). The mean of hospital stay was 4.3+/-1.1 (range 3-8) days vs 6.9+/-3.4 (range 4-25) days (p0.05). Postoperative hospital stay was significantly shorter in LAVH than TAH. CONCLUSION: Even though fewer cases have been done, there was no episode of changing the surgery from LAVH to TAH in huge uterine myoma operation. For the more, neither was increase of morbidity compared to TAH. In huge uterine myoma operation, LAVH may replace the role of TAH in limited number of cases we have experienced. The advantages of LAVH are cosmetic superiority and early hospital discharge. In hands of experienced laparoscopic operator, huge uterine myoma is not an absolute contraindication of LAVH.