Liver Abscess Caused by Klebsiella oxytoca with Hepatic Artery Pseudoaneurysm:A Case Report

Hepatic artery pseudoaneurysm is a rare but potentially life-threatening condition that usually occurs after trauma. Early recognition and prompt management are essential for preventing catastrophic consequences, such as hemoperitoneum. We report a rare case of liver abscess caused byKlebsiella oxytoca resulting in hepatic artery pseudoaneurysm without iatrogenic injury. The unique feature of the present case is that the abscess cavity itself became a pseudoaneurysm as a result of fistula formation with the hepatic artery. Vascular complications should be considered in patients with unfavorable clinical course even in the absence of iatrogenic injury. Endovascular treatment is safe and effective.

Endovascular Treatment for Arterioureteral Fistula of the Abdominal Aorta: A Case Report and Literature Review

We present a rare case demonstrating successful endovascular management of an arterioureteral fistula involving the abdominal aorta. Arterioureteral fistulas are rare but life-threatening, with mortality rates ranging from 7% to 23%. Early recognition and prompt management are essential for preventing catastrophic consequences, including hypovolemic shock. However, recognition of an arterioureteral fistula requires a high index of clinical suspicion due to its rarity and the lack of a sensitive diagnostic method. Arterioureteral fistulas could be induced by traumatic events in patients who have a history of pelvic surgery, radiation, and prolonged placement of a ureteral stent. Endovascular stent graft placement could be a valid treatment option for arterioureteral fistulas involving the abdominal aorta.

Effectiveness and Influencing Factors of Percutaneous Transluminal Angioplasty for Stenosis of Transposed Brachiobasilic Arteriovenous Fistula

PURPOSE@#To evaluate effectiveness of percutaneous transluminal angioplasty (PTA) for transposed brachiobasilic arteriovenous fistula (tBBAVF), and to analyze the factors influencing patency after PTA.@*MATERIALS AND METHODS@#In 101 patients who underwent operation for tBBAVF from January 2006 to February 2008, we identified 42 patients undergoing PTA. We conducted a retrospective analysis of sequential PTAs in these patients from 2006 to 2017.@*RESULTS@#A total of 100 PTAs were performed. The technical success rate was 93% and the clinical success was 100%. Only ruptures occurred in 12% as minor complications. Primary patency rate was 61%, 29%, 7%, and secondary patency was 91%, 82%, 59% at 6, 12, and 24 months, respectively. Primary patency rate was lower in tBBAVF with rupture (p = 0.024). Secondary patency rate was significantly lower in the diabetes (p = 0.002).@*CONCLUSION@#Repetitive PTAs in tBBAVF are acceptable due to excellent secondary patency. Primary patency of tBBAVF is low in patients with rupture. Diabetes itself has a significant effect on secondary patency.

Spectrum of Multi-Detector Computed Tomography Findings that Alter Pulmonary Artery Diameters in Adults

Abnormalities in the anatomy of pulmonary arteries may have heritable or environmental causes and involve a reduction or enlargement in transverse diameters of the blood vessels eg, congenital and developmental disorders, acquired intrinsic causes, extrinsic compression, and constriction. Pulmonary hypertension, pulmonary artery aneurysm and pseudoaneurysm, and idiopathic dilatation can also increase the diameter of a pulmonary artery. Multi-detector computed tomography (CT) is useful to evaluate each pulmonary artery and to diagnose the conditions that alter the diameter of the pulmonary artery. It is important to be familiar with the CT features of a variety of disorders to allow for accurate diagnoses and appropriate therapeutic management.

Air Embolization after Computed Tomography-Guided Percutaneous Transthoracic Needle Biopsy

Percutaneous transthoracic needle biopsy (PTNB) is an important procedure for diagnosis of pulmonary lesions. PTNB is minimally invasive procedure but sometimes complications can occur. The most common complications include pneumothorax, hemorrhage, and hemoptysis. Air embolism is very rare complication, but it can be a life-threatening if not managed appropriately. So knowledge of air embolism entity may minimize morbidity and mortality after PTNB.

Life-threatening Hemobilia following Removal of a Biliary Stent in a Patient with a Bile Leak / 대한췌담도학회지

Biliary plastic stent induced life-threatening hemobilia is very rare. In this case, hemobilia seriously worsened following removal of a biliary stent, which had been placed for treatment of a postoperative bile leak in a patient who had undergone lateral liver segmentectomy for abdominal trauma. Following placement of the biliary stent, the bile leak improved, but hemobilia and cholangitis developed five days later. To manage the stent malfunction, we removed the biliary stent. However, life-threatening hemobilia developed immediately after removal. Endoscopic hemostasis was impossible; therefore, emergency angiographic embolization and stent graft were performed successfully. In such cases, angiographic embolization and stent-graft placement are effective diagnostic and therapeutic alternatives. When a patient develops hemobilia or cholangitis after biliary stent placement, endoscopists should pay special attention to remove the stent, which might exacerbate hemobilia.

Congenital Intrahepatic Portosystemic Shunts

Intrahepatic portosystemic shunts are an anomalous connection between the portal vein and hepatic vein/IVC, which may be either congenital or acquired secondary to liver cirrhosis or portal hypertension. Cases of congenital intrahepatic shunts are usually encountered in children and may spontaneously resolve. We report 5 cases of congenital intrahepatic portosystemic shunts in neonates and an adult.

A Randomised, Double-Blind, Parallel, Placebo-Controlled Study of the Efficacy and Safety of Tadalafil Administered On-Demand to Men with Erectile Dysfunction in Korea / 대한비뇨기과학회지

PURPOSE: Tadalafil is a phosphodiesterase type 5 inhibitor that is used for the treatment of erectile dysfunction (ED). Previous clinical trials have assessed its efficacy and safety in Western populations, but this drug has not been investigated in a large clinical trial involving Korean men with ED. Thus, the aim of this study was to assess the efficacy and safety of 20 mg tadalafil in comparison to placebo when it is taken on demand by Korean men suffering with ED over a study period of 12 weeks. MATERIALS AND METHODS: Men more than 18 years of age with mild to severe ED of various etiologies were randomized to receive placebo or tadalafil 20 mg that was taken as needed (maximum once daily). Efficacy assessments included the International Index of Erectile Function (IIEF), the Sexual Encounter Profile (SEP) diary and Global Assessment Questions (GAQ). RESULTS: Tadalafil significantly improved erectile function, as measured by the erectile function domain of the IIEF, compared to placebo (p<0.001). At the endpoint, the patients receiving tadalafil 20mg reported a greater mean per-patient percentage of successful intercourse attempts (SEP3: 71% compared to 31% for placebo) and a greater proportion of improved erections (GAQ: 80% compared to 44%). The most common treatment emergent adverse events were headache (16.3%), flushing (5%) and eye pain (5%), and most of the adverse events were mild or moderate in severity. CONCLUSIONS: Tadalafil was an effective, well-tolerated therapy for Korean men suffering with ED of broad-spectrum severity and etiology.

Antitumor immunity induced by tumor cells engineered to express a membrane-bound form of IL-2

Transduction of cytokine gene into tumor cells is a promising method of tumor therapy, but the value is limited by accompanying side effects. To focus antitumor immune response to tumor antigen-specific CTL, we developed an antitumor vaccine by transfecting modified IL-2 gene in a membrane-bound form (mbIL-2) into B16F10 melanoma cells. The mbIL-2 clone showed reduced tumorigenicity and metastatic ability, and inhibited metastasis and prolonged the survival of mice against B16F10 cells. The inhibition of B16F10 metastasis by mbIL-2 was accompanied by the increment of CD8+ T cells. The metastasis of mbIL-2 clone was significantly increased in the CD8+ T cell-depleted mice, but not in CD4+ T cell depleted mice. Spleen cells immunized with the mbIL-2 clone showed higher CTL activity towards B16F10 cells than those immunized with control cells. The size of CD8+ T cell population in the lung of mice injected with the mbIL-2 clone was markedly greater than that of mice injected with B16F10 cells, but there was no detectible change in CD4+ and CD8+ T cell populations of lymph nodes and spleen. These results suggest that when the mbIL-2 clone is introduced into the blood stream, it migrates mainly to lung and activates CD8+ T cells in situ, possibly by direct priming. Such a tumor vaccine may ameliorate the toxic side effects encountered with conventional cytokine gene therapy.

Identification of Differentially Expressed Radiation-induced Genes in Cervix Carcinoma Cells Using Suppression Subtractive Hybridization / 대한방사선종양학회지

PURPOSE: A number of genes and their products are induced early or late following exposure of cells to ionizing radiation. These radiation-induced genes have various effects on irradiated cells and tissues. Suppression subtractive hybridization (SSH) based on PCR was used to identify the differentially expressed genes by radiation in cervix carcinoma cells. MATERIASL AND METHODS: Total RNA and poly (A)+ mRNA were isolated from irradiated and non-irradiated HeLa cells. Forward- and reverse-subtracted cDNA libraries were constructed using SSH. Eighty-eight clones of each were used to randomly select differentially expressed genes using reverse Northern blotting (dot blot analysis). Northern blotting was used to verify the screened genes. RESULTS: Of the 176 clones, 10 genes in the forward-subtracted library and 9 genes in the reverse-subtracted library were identified as differentially expressed radiation-induced genes by PCR-select differential screening. Three clones from the forward-subtracted library were confirmed by Northern blotting, and showed increased expression in a dose-dependent manner, including a telomerase catalytic subunit and sodium channel-like protein gene, and an ESTs (expressed sequence tags) gene. CONCLUSION: We identified differentially expressed radiation-induced genes with low-abundance genes with SSH, but further characterization of theses genes are necessary to clarify the biological functions of them.

Detection of RTP801, a Gene That is Differentially Expressed in Irradiated HeLa Cells / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: To quantify the effects of irradiation on the expression levels of a differentially expressed gene, RTP801, in HeLa cells. MATERIALS AND METHODS: Total RNA was isolated from irradiated and non-irradiated HeLa cells. A subtraction library was constructed, from which 88 random clones were screened. The expression patterns of one clone, detected by reverse Northern blotting, were quantified by real time RT-PCR, using CYBR green I dye. RESULTS: RTP801, a hypoxia-inducible factor-I-responsive gene, was identified as a differentially expressed gene in HeLa cells exposed to X-ray. Real time RT-PCR showed that the mRNA levels of RTP801 were greatly diminished by radiation. CONCLUSIONS: These results suggest that down-regulation of hypoxia-inducible factor-I-responsive genes, such as RTP801, in irradiated HeLa cells may result in reductions in the radiotherapy resistance of tumor cells.

Comparison of Burch Colposuspension, Pubovaginal Sling Operation and Tension-Free Vaginal Tape for Surgical Treatment of Stress Urinary Incontinence In Women / 대한산부인과학회잡지

OBJECTIVE: The object of this study was to compare the cure rate and confirm the clinical efficacy of three most frequent surgical procedures for stress urinary incontinence (Burch colposuspension, pubovaginal sling operation, tension-free vaginal tape). MATERIALS AND METHODS: We collected datas from the records of ninety-one patients who were diagnosed as stress urinary incontinence from Jan. 1999 to May 2001. Burch colposuspension was performed by department of gynecology, Severance hospital in thirty-three patients, pubovaginal sling operation was performed by department of urology in twenty-eight patients, and tension-free vaginal tape was performed by department of urology in thirty-one patients. We investigated the characteristics of patients, preoperative urodynamic study results, cure rates and complication rates for the result, and compared them by x2-test. RESULTS: There were statistically no significant differences between the cure rate of each operation after 3, 6 month of operation but after 12 months of follow up, the cure rate of pubovaginal sling operation was significantly higher than that of Burch operation and tension-free vaginal tape. CONCLUSION: The cure rate of pubovaginal sling operation was significantly higher after 12 months of follow up after surgery. There was no significant difference between cure rates of Burch operation and tension- free vaginal tape. We propose randomized prospective study with larger population in the future.

Effect of Pelvic Floor Magnetic Stimulation Therapy on the Patient with Female Stress Urinary Incontinence / 대한비뇨기과학회지

Purpose: Pulsed magnetic technology has been developed for pelvic floor muscle strengthening in the treatment of stress urinary incontinence (SUI). This report includes a prospective multi-center study of pelvic floor magnetic stimulation (PMS) for SUI. Materials and Methods: Sixty-four women, with demonstrable SUI, were studied. Fifty-six completed the PMS therapy and were available for analyzed. Evaluations, both before and 6 weeks after treatment included bladder diaries, 1-hour pad weight test, perineometry and a quality-of-life survey. For the treatments the patients were seated, fully clothed, in a PMS system, with a magnetic field therapy head in the seat. The treatment sessions were for 20 minutes, twice a week, for 6 weeks. To compare the results, the patients were divided into pure SUI and mixed urinary incontinence groups. Results: Of the 56 patients, 13 were completely dry (23.2%). The mean weight of the used pad was reduced from 15.26 to 2g (p8 times/day) was also reduced from 10.55 to 8.14/day following the treatment (p<0.001). The pressure of the pelvic muscle contractions increased from 30.3 to 36.95cmH2O (p<0.001). Forty-five patients (80.35%) were satisfied with the results of the PMS. At the baseline, the number of incontinence episodes, weight of used pads and pressure of the pelvic muscle contractions were significantly higher in the mixed incontinence (n=17) than in the pure SUI (n=39) group. There were no differences in the treatment results between the pure SUI and mixed urinary incontinence groups. No adverse events were reported during the study period. Conclusions: PMS therapy is effective for both stress and mixed urinary incontinence. A longer follow-up will be required to determine how long the benefits of treatment last, and whether retreatment will be required.

Sensory Neuronal Change after Intravesical Electrical Stimulation in Spinailized Rat

The clinical benefits of intravesical electrical stimulation (IVES) in patients with increased residual urine or reduced bladder capacity have been reported. However, studies on the underlying mechanism of IVES has been limited to the A delta afferent and parasympathetic neurons. This study investigated the changes in the calcitonin gene-related peptide (CGRP), substance P (SP), and nitric oxide synthase (NOS) expression in the thoracolumbar and lumbosacral dorsal root ganglia (DRG) of spinalized rats to determine the effect of IVES on the C fiber afferent nerve. Forty Sprague-Dawley rats were divided into normal controls (n=10); IVES treated normal rats (n=10), spinalized rats (n=10), and IVES treated spinalized rats (n=10). IVES was performed for 2 weeks (5 days a week). IVES was started 3 weeks after spinalization in the spinalized animals. All animals had the DRG removed at the thoracolumbar (T13-L2) and lumbosacral (L5-S1) level. Changes in the CGRP, SP and n-NOS levels at the DRG were measured by western-blot analysis. The relative density of the CGRP and SP following spinalization was significantly higher compared to the controls in both the T13-L2 and L5-S1 DRG. However, IVES in the spinalized rat significantly decreased the relative density of the CGRP and SP compared to the rats with spinalization alone. A significant increase in the relative density of n-NOS was detected in the L5-S1 DRG following spinalization. However, the density of n-NOS was significantly lower after IVES in both the T13-L2 and L5-S1 DRGs. In conclusion, IVES significantly reduced the CGRP, SP and n-NOS levels in the DRG of spinalized rats. CGRP, SP and n-NOS are the main factors that contribute to the hyperexcitability of the micturition reflex after spinal cord injury. These results suggest that the bladder C fiber afferent is also involved in modulating the micturition reflex by IVES.

The Results of Renal Transplantation after Lymphocyte Cross-match Negative Conversion by Combination Therapy with Plasmapheresis, Intravenous Gamma Globulin and Potent Immunosuppresants in Patients with Positive LCM / 대한이식학회지

PURPOSE: It is well-known that kidney transplantation cannot be done if recipient has circulating antibodies showing positive lymphocyte cross-match (LCX) to organ donor. In the United States and European countries, the incidence of positive LCX to cadaveric donors in patients who are on the waiting list is up to 20~40%. Unfortunately, these patients also show high rate of positive LCX to live donors when they have donor candidates in their family members and have to be on dialysis until compatible donor comes up. Recently, Eugene J Schweitzer and his associates at the University of Maryland used the combination therapy with plasmapheresis, intravenous gamma globulin and potent immunosuppression to induce negative conversion of LCX in patients who were LCX positive to their living donors and reported the good results after the trial. We did the combination therapy in patients who had positive LCX to their living donors and reported the results. METHODS: Seven patients, four women and three men who showed positive LCX to their living donors, underwent the conversion trials between January 1 and July 31, 2002. The mean age of patients was 43.86 (35~60) and the duration of dialyses varies from 9 to 120 months. We used combination therapy with plasmapheresis, intravenous gamma globulin injection, tacrolimus, mycophenolate mofetil (MMF) and steroids. Plasmapheresis had been done on every other day up to 6 times to induce negative conversion of LCX. If patient continue to show positive LCX to donor after 6 times of plasmapheresis, we stopped the therapy. The numbers of plasmapheresis varies from two to six times. Kidney transplantations were preformed immediately after negative conversion of LCX as a semi-elective procedures. Five to ten day courses of ATG (or OKT3) were used as an induction immunosuppression after transplantation and tacrolimus, MMF, and steroids were used as a maintenance immunosuppression. RESULTS: We could achieve negative conversion of LCX in six out of seven patients, and kidney transplantations were performed in these 6 patients successfully. There was no hyperacute rejection during the operations, but three patients developed acute rejection episodes during their early postoperative periods. Steroid pulse therapies were used as a primary therapy to treat acute rejection and all three patients showed complete recovery of their graft function after the treatments. Baseline serum creatinine level varies from 1.0 mg/dl to 1.9 mg/dl with 3 to 6 months follow-up periods after transplantations. We could not induce negative conversion in one patient and he remained on hemodialysis. CONCLUSION: We did successful kidney transplantations in six patients who achieved negative conversion of LCX to their donors after the combination therapy with plasmapheresis and potent immunosuppression. All patients showed excellent graft function since their operations and did not have any significant complications except three reversible acute rejection episodes. According to the results, although it is preliminary, we recommend the use of the combination therapy in patient who has LCX positive living donor. Further long-term study with more numbers of patients is needed for the evaluation of the efficacy of this trial.

Urethral Diverticulo-Rectal Fistula in AIDS

A 41-year-old heterosexual African man was evaluated for persistent urethral discharge, pneumaturia and watery diarrhea. Radiographic and endoscopic procedures established the diagnosis of a rectourethral fistula. The differential diagnosis of an acquired rectourethral fistula and the significance of AIDS are discussed.

The Differentially Expressed Genes by Radiotherapy in the Patients with Uterine Cervix Cancer / 대한방사선종양학회지

PURPOSE: To detect differentially expressed genes in the patients with uterine cervical cancer during the radiation therapy. MATERIALS AND METHODS: In patients with biopsy proven uterine cervical cancer, we took a tumor tissue just before radiation therapy and at 40 minutes after external irradiation of 1.8 Gy. Total RNAs isolated from non-irradiated and irradiated tumor tissue samples were analyzed using the differential-display reverse transcription-polymerase chain reaction (DDRT-PCR). Complementary DNA (cDNA) fragments corresponding to differentially expressed messenger RNAs(mRNAs) were eluted, and cloned. The differential expression of the corresponding mRNAs was confirmed by reverse northern blot. Differentially expressed cDNA bands were sequenced. Nucleotide sequence data were analyzed in the Gene Bank and EMBL databases via the BLAST network server to identify homologies to known genes or cDNA fragments. Expression pattern of down-regulated clone was examined using RT-PCR in 5 patients undergoing radiotherapy. RESULTS: We identified 18 differentially expressed bands by DDRT-PCR, which were eluted and cloned. There were 10 up-regulated clones and 1 down-regulated clone in reverse northern blot. One cDNA fragment had homology to chemokine receptor CXCR4, four were identified as Human ESTs in the EMBL database in EST clones. Down-regulated CxCa-11 was also down regulated in all patients. CONCLUSION: Using the DDRT-PCR, we have identified 10 up-regulated and 1 down-regulated clone(s) in the patients with uterine cervix cancer during the radiation therapy. The clinical relevance and the functions of these genes will be further investigated.

Proximal Migration of Ureteral Stent after Extracorporeal Shock Wave Lithotripsy / 대한비뇨기과학회지

Double-pigtail ureteral stent has been used to prevent the ureteral obstruction from calculi and to pass the urine easily after extracorporeal shock wave lithotripsy (ESWL). One of the complications in stent indwelling is the migration of the stent. Especially the proximal migration of double-pigtail ureteral stents is rare. One of the several theories that have been proposed to account for cephalad migration is a stent movement in conjunction with kidney movement during respiration. The reason is that the respiration makes the kidney move in both upward and downward directions while the stent, held by fragemented ureteral stone, moves only in upward direction. We call this cause of the proximal migration of the stent, 'Jack' phenomenon. Therefore, if the residual calculi remain after ESWL with ureteral stent, we need close observation.

Technical Refinement of 99mTc-RBC Scrotal Scan for Evaluating Varicocele / 대한남성과학회지

PURPOSE: The association of varicoceles and subfertility has been well documented. Although varicoceles remain the most common surgically correctable cause of male infertility the subjective diagnosis of varicocele, especially the small ones remains a challenge. MATERIALS AND METHODS: We evaluated 40 young men (16 volunteers, 24 varicocele patients) with scrotal blood pool scan using 99mTc RBC. RESULTS: Complete correlation between physical findings and the scrotal scan was found. The postoperative scans of 12 patients with surgically corrected high grade varicoceles demonstrated symmetrical photon accumulation in the scrotum. The technique which most accurately correlated the clinical grade was the varicocele index using total count at Valsalva maneuver. CONCLUSIONS: We believe that the 99mTc RBC scrotal scan with technical refinement is a useful procedure in the objective diagnosis and followup of varicoceles.

Penile vibratory threshold changes with various doses of SS-cream in patients with primary premature ejaculation

SS-cream made with extracts from natural products is a topical agent for treating premature ejaculation (PE). In order to elucidate the penile vibratory threshold changes and clinical effects of various doses of SS-cream, 53 patients with primary PE were investigated in a double-blind randomized placebo-controlled study. The mean age was 37.3 +/- 6.4 years and mean ejaculatory latency was 1.37 +/- 0.52 minutes. Neither the patients nor their sexual partners were satisfied with their sexual lives. Vibratory threshold at the glans penis, penile shaft, scrotum and index finger were measured using a biothesiometer twice during the screening period and three times one hour after the application of respective creams (SS-cream 0.05, 0.10. 0.15, 0.20 gm and placebo 0.10 gm) on the glans penis according to the order of the allocation table in a randomized fashion. The efficacy of SS-cream was defined as when the vibration threshold increased by more than 4 microns compared to the value tested during the screening period. The vibratory thresholds at the glans penis increased significantly in a dose-dependent manner after the application of various doses (0.05, 0.10, 0.15, 0.20 gm) of SS-cream (p < 0.001), and the efficacy of SS-cream on the penile vibration threshold increased according to the increased dosage (penile shaft: 48.4, 51.6, 54.8, 64.5%, glans penis: 58.1, 67.7, 77.4, 83.9%, respectively). With these results, we concluded that SS-cream increased the penile sensory threshold dose dependently, and therefore it is clinically effective for treating the heightened penile sensory response in patients with PE.