A Case of Cholethorax Developed by Unknown Cause / 결핵및호흡기질환

Cholethorax is a bilious pleural effusion caused by a pleurobiliary fistula or leakage of bile into the pleural space. Most cases of cholethorax arise from a complication of abdominal trauma, hepatobiliary infection, or invasive procedures or surgery of hepatobiliary system. However, we experienced a case of a patient with cholethorax of unknown origin. There was no evidence of pleurobiliary fistula or leakage of bile from the hepatobiliary system although we examined the patient with various diagnostic tools including chest and abdominal computed tomography, endoscopic retrograde cholangiopancreatography, tubography, bronchofiberscopy, hepatobiliary scintigraphy and video-assisted thoracoscopic surgery. Herein we report a case of cholethorax for which the specific cause was not identified. The patient was improved by percutaneous drainage of pleural bile.

A Case of Anaphylaxis to Trimethoprim-Sulfamethoxazole / 대한내과학회지

Bactrim consists of the sulfonamides trimethoprim and sulfamethoxazole. These induce relatively frequent adverse drug reactions, including allergic reactions ranging from urticaria to anaphylaxis. Either component can be the causative allergen, so it is necessary to determine which has caused an allergic reaction to prevent further allergy. We report the case of a 46-year-old male with chronic renal failure who experienced anaphylactic shock twice after ingesting trimethoprim-sulfamethoxazole, as was proven by the medical history and skin prick testing. Enzyme-linked immunoassays and enzyme-linked allergen inhibition assays for allergen-specific IgE antibody for the five components of Bactrim showed that sulfamethoxazole was the causative allergen.

A Case of Non-Surgical Treatment in Hemodialysis Patient with Spontaneous Splenic Rupture / 대한신장학회지

Spontaneous splenic rupture is a rare disease but can cause a life threatening situation. It can occur under a pathological spleen such as infection, neoplastic, infiltrative and inflammatory disease. Although splenectomy is the treatment of choice for splenic rupture, it is uncertain that the effectiveness of non- surgical treatment in the hemodynamically stable patient. We report a case of a 66-year-old male undergoing hemodialysis for 4 years who presented to the emergency department with abdominal pain and distention. Blood pressure was 130/80 mmHg, heart rate was 108 bpm. White blood cell count was 7,130/mm3, hemoglobin was 6.7 g/dL, platelet was 156,000/mm3. PT INR was elevated up to 2.01 because he had taken warfarin due to splenic infarction. Abdominal CT scan revealed hemoperitoneum due to splenic rupture. We performed angiography but there was no active bleeding. We decided conservative management without embolization because of stable condition and increased bleeding risk in operation. He received 6 pints of packed red blood cell transfusion during continuous renal replacement therapy for 24 hours on ICU. He was discharged with complete recovery on the 21st hospital day. We suggest that non-surgical treatment in splenic rupture also could be considered in hemodynamically stable patients with a high risk of postoperative complication.

The Effect of Autonomic Nerve System on Neurotensin Induced Motility in Isolated, Vascularly Perfused Rat Colon

BACKGROUND/AIMS: Although neurotensin (NT) stimulates colon motility and the passage of intestinal contents, the associated mechanism of action remains unclear. The objective of this study was to investigate the effects of NT on colon motility using isolated rat colon. METHODS: Intraluminal pressure was measured at both the proximal and distal portions of the isolated colon. An isolated rat colon was perfused with Krebs solution via the superior mesenteric artery. After stabilization, NT was administered in concentrations of 14, 28, 138 and 276 pM. After pretreatment with phentolamine, propranolol, hexamethonium, atropine or tetrodotoxin, NT was administered at a concentration of 276 pM, and then the intraluminal pressure was monitored. RESULTS: NT significantly increased colon motility at concentrations of 14, 28, 138, and 276 in the proximal colon (25.1+/-6.5%, 175.4+/-117.0%, 240.8+/-115.1% and 252.3+/-110.6%, respectively) and in the distal colon (35.6+/-11.8%, 97.5+/-35.1%, 132.7+/-36.7% and 212.1+/-75.2%, respectively). The stimulant effect of NT was more potent in the proximal colon, in a concentration-dependent manner (P<0.05). The stimulant effect of NT was significantly inhibited by atropine at both the proximal and distal colon and by tetrodotoxin at the proximal colon, but not by tetrodotoxin at the distal colon and not by propranolol, phentolamine, or hexamethonium at both the proximal and distal colon. CONCLUSIONS: NT increased colon motility at both the proximal and distal portions of the rat colon. The effects were more prominent at the proximal portion. The results of this study suggest that the stimulant action of NT may be mediated by local cholinergic muscarinic receptors.

The Role of Epithelial-mesenchymal Transition in the Gastroenterology / 대한소화기학회지

The epithelial-mesenchymal transition (EMT) plays physiologic roles in the embryogenesis, wound healing, and tissue regeneration. In terms of pathological direction, it causes organ fibrosis, cancer development, progression, metastasis, and chemoresistance. Recently, the underlying mechanism of EMT and many kinds of EMT regulators have been identified. Pharmaceutical treatment strategies which target EMT pathway could be applied for the prevention of tissue fibrosis and cancer progression. In the field of gastroenterology, profuse evidences have been collected about the critical roles of EMT in cancers of the gastrointestinal tract, liver, and pancreas and hepatic fibrosis. However, EMT varies widely among cancer types, and much remains to be identified about the main regulators of EMT in a specific disease. In this review, we present recent research results regarding the roles of EMT in cancers and organic fibrosis, especially in the area of gastroenterology.

Effects of Cadmium on Superoxide Radical, Superoxide Dismutase, Catalase and ATPase Activity in Liver, Kidney and Testicle of Rats in Vtm and in Vivo / 예방의학회지

Production of free radicals of superoxide anion in tissues by cadmium, activities of superoxide dismutase and catalase to protect tissue damages caused by the free radicals and ATPase that plays an important role in energy metabolism at cellular level were investigated. Experiments in viro were conducted with liver, kidney and testicle tissue homogenates of rats adding 0.05~0.50 mM cadmium chloride, and in vivo experiments administering single dose of 5mg of cadmium/kg of body weight in 0.1% cadmium chloride solution intraperitoneally 48 hours prior to evisceration. Production of superoxide radicals in liver and testicle increased with addition of cadmium in vitro, but not in kidney. In vivo experiments, however superoxide radicals slightly increased in liver and kidney but not in testicle. Superoxide dismutase (Cu, Zn-SOD and Mn-SOD), catalase and ATPase (total, (Mg++)- & (Na+)- (K+)-) activity decreased in the presence of cadmium in dose dependent manner. Reduction of these enzyme activities varied not only with dosage of cadmium but also with type of tissue and between in vitro and in vivo experiment.

A Case of Horseshoe Kidney with Single Renal Stone and Hydronephrosis / 대한비뇨기과학회지

The horseshoe kidney is one of the most common type of fusion anomaly and a non fatal anomaly of renal development. It is characterized by fusion of either the upper or the lower poles of the kidneys. We report a case of horseshoe kidney with renal stone and hydronephrosis in a 24 year old man and the literatures are reviewed.

Urological Observation on Abdominal Masses in Infants and Children / 대한비뇨기과학회지

A series of 57 infants and children presenting with palpable abdominal masses which performed surgery from Jan. 1. 1972 to Dec. 31. 1978 has been reviewed. Masses such as distended bladder, abdominal distension, intussusception, intestinal obstruction, abscess, hematoma, as well as hepatospleaomegaly which not performed a surgical operation, were not included. There were 29 children with non-urological conditions, and 28 with urological lesions. The study was limited to the latter group. The groupings by age at presentation and type of urologic lesion enable us to make certain genera statements. About one-half of surgical abdominal masses were of urologic origin, and about one-third were renal origin. Since legions of renal origin are the predominant cause of abdominal masses in infants and children, an I. V. P. and other urological examination should be obtained as soon as possible on all children patients with abdominal masses.