A Rare Case of Coil Migration into the Duodenum after Embolization of a Right Colic Artery Pseudoaneurysm.

Transcatheter arterial embolization is a safe and effective treatment for visceral artery aneurysms; nevertheless, some complications can occur. Coil migration to other organs after embolization is extremely rare, and only 16 cases have been reported previously. We report a rare case of coil migration to the duodenal lumen after embolization of a right colic artery pseudoaneurysm. To the best of our knowledge, this is the first case of coil migration after a right colic artery embolization. The patient exhibited no symptoms and was treated conservatively without any intervention. Some previous reports have demonstrated spontaneous coil passage and successful conservative management. Our case supports conservative treatment as the primary treatment for asymptomatic patients. Clinicians should assess the risks and benefits of coil removal in asymptomatic patients before performing any intervention.

Clinical Interpretation of Elevated CA 19-9 Levels in Obstructive Jaundice Following Benign and Malignant Pancreatobiliary Disease.

BACKGROUND/AIMS: Elevated carbohydrate antigen (CA) 19-9 level may be unable to differentiate between benign and malignant pancreatobiliary disease with obstructive jaundice. The study aims to determine the clinical interpretation and the diagnostic value of CA 19-9 level in pancreatobiliary diseases with coexistent obstructive jaundice. METHODS: We retrospectively reviewed the data of 981 patients who underwent biliary drainage due to obstructive jaundice following pancreatobiliary disease at Sanggye Paik Hospital for 5 years. 114 patients with serial follow-up data for CA 19-9 level were included in this study (80 patients with malignancy and 34 patients with benign diseases). We compared the levels of CA 19-9 levels and the biochemical value before and after biliary drainage. RESULTS: The rate of CA 19-9 elevation (>37 U/mL) was significantly different between the benign group and the malignant group (59% vs. 90%, p=0.001). Despite the decrease in serum bilirubin after biliary drainage, CA 19-9 levels remained elevated in 12% of patients in the benign group and in 63% of patients in the malignant group (p<0.001). Finally, 12% of patients in the benign group turned out to have malignant disease. A receiver operating characteristic analysis provided a cut-off value of 38 U/mL for differentiating benign disease from malignant disease after biliary drainage (area under curve, 0.787; 95% confidence interval, 0.703 to 0.871; sensitivity, 62%; specificity, 88%). CONCLUSIONS: This study suggested that we should consider the possibility of malignant causes if the CA 19-9 levels remain high or are more than 38 U/mL after resolution of biliary obstruction.

Non-umbilical Cutaneous Metastasis of Pancreatic Adenocarcinoma as the First Clinical Manifestation: A Case Report.

Non-umbilical cutaneous metastases from pancreatic adenocarcinomas are extremely rare. Only a few cases have been reported in the literature. An 83-year-old Korean woman, with no previous medical history, presented with a painful nodule on her scalp. Histologic examination of the nodule revealed a metastatic adenocarcinoma, and immunohistochemical staining was positive for cytokeratin (CK) 7 and CK 19. These findings were consistent with a metastatic carcinoma of pancreatic origin. An abdominal computed tomography scan identified a mass on the pancreatic head and multiple enlarged lymph nodes. Pathological examination of an endoscopic ultrasound-guided fine needle biopsy of the pancreatic mass determined that it was a poorly differentiated carcinoma. The patient refused any treatment owing to her old age and short life expectancy. Four months later, the disease progressed rapidly, and the patient died.

Prolonged Motor Weakness With Syringomyelia in Japanese Encephalitis: A Case Study.

Japanese encephalitis (JE) shows characteristic brain lesions, including bilateral thalamus, midbrain, internal capsule, basal ganglia, and occasionally involves an anterior horn cell. We encountered a case of a 44-year-old man who initially presented with encephalitis, which was finally diagnosed as Japanese encephalomyelitis with syringomyelia. The patient showed severe motor weakness followed by delayed recovery of functional motor activities. Cervical magnetic resonance imaging showed syrinx formation at the C5 level suggesting myelitis, and abnormal electromyographic findings were noted. Clinicians should consider the possibility that the spinal cord may be involved; an example would be syringomyelia due to myelitis in a case of JE presenting with severe and prolonged motor weakness.

Decreased diaphragm excursion in stroke patients with dysphagia as assessed by M-mode sonography.

OBJECTIVE: To record diaphragm excursion via M-mode ultrasonography in stroke patients with dysphagia and determine whether they present reduced diaphragm excursion during voluntary cough compared with stroke patients without dysphagia and healthy subjects. DESIGN: Prospective cross-sectional study. SETTING: University rehabilitation hospital. PARTICIPANTS: Acute stroke patients with dysphagia (n=23), acute stroke patients without dysphagia (n=24), and healthy control participants (n=27) (N=74). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Diaphragm motions during quiet breathing, deep breathing, and voluntary coughing were recorded via ultrasonography using M-mode tracing (mm). Maximum inspiratory and expiratory pressures (cmH2O) and peak cough flow (L/min) during voluntary coughing were measured. RESULTS: The mean diaphragm movement (mm) of the hemiplegic side for all groups during quiet breathing, deep breathing, and voluntary coughing was 14.8±4.3, 17.6±4.8, and 20.9±3.7 (P<.001); 23.8±7.1, 32.7±10.6, and 44.7±10.3 (P<.001); and 16.8±4.8, 28.5±4.9, and 36.0±8.2 (P<.001), respectively. The differences were statistically significant. Differences were observed in the maximum inspiratory (P<.001) and expiratory (P<.001) pressures and peak cough flow (P=.027) among the 3 groups. Forward selection stepwise regression analysis, which was performed to determine variables that help predict diaphragm excursion during voluntary coughing, showed that the presence of dysphagia explained up to 60% (P<.001) of the hemiplegic diaphragm movement during voluntary coughing in patients with stroke. CONCLUSIONS: M-mode ultrasonography showed that stroke patients with dysphagia have decreased diaphragm excursion and compromised respiratory function during voluntary coughing.

Improving Performance of Dye-Sensitized Solar Cell by Multi-Emission Effect of Phosphors.

Generally, the N-719 dye, used in dye-sensitized solar cells (DSSCs), only absorbs visible light in the wavelength range from 400 to 700 nm. Consequently, most of the ultraviolet and infrared rays from the sun are not utilized by this dye. However, ultraviolet and infrared rays can be converted to visible light by upconversion luminescence. Such visible light can then be reabsorbed by the dye, allowing for a larger range of solar irradiation to be utilized in DSSCs. Phosphor (ZnGa2O4, Y2O3:Er(3+)), acting as a luminescence medium, was added to the TiO2 electrode of DSSCs, and owing to the effect of upconversion, it increased their photocurrent density and efficiency. Phosphor (ZnGa2O4, Y2O3:Er(3+)) co-doped TiO2 electrode cells showed better performance than phosphor-free cells. In fact, the highest efficiency observed for a DSSC containing five phosphor layers was 7.03% with a short-circuit current density (Jsc) of 15.62 mA/cm2, an open circuit voltage (Voc) of 0.661 V, and a fill factor (FF) of 68.17%.

Characteristics of wind velocity and temperature change near an escarpment-shaped road embankment.

Artificial structures such as embankments built during the construction of highways influence the surrounding airflow. Various types of damage can occur due to changes in the wind velocity and temperature around highway embankments. However, no study has accurately measured micrometeorological changes (wind velocity and temperature) due to embankments. This study conducted a wind tunnel test and field measurement to identify changes in wind velocity and temperature before and after the construction of embankments around roads. Changes in wind velocity around an embankment after its construction were found to be influenced by the surrounding wind velocity, wind angle, and the level difference and distance from the embankment. When the level difference from the embankment was large and the distance was up to 3H, the degree of wind velocity declines was found to be large. In changes in reference wind velocities around the embankment, wind velocity increases were not proportional to the rate at which wind velocities declined. The construction of the embankment influenced surrounding temperatures. The degree of temperature change was large in locations with large level differences from the embankment at daybreak and during evening hours when wind velocity changes were small.

Analysis of change in the wind speed ratio according to apartment layout and solutions.

Apartment complexes in various forms are built in downtown areas. The arrangement of an apartment complex has great influence on the wind flow inside it. There are issues of residents' walking due to gust occurrence within apartment complexes, problems with pollutant emission due to airflow congestion, and heat island and cool island phenomena in apartment complexes. Currently, the forms of internal arrangements of apartment complexes are divided into the flat type and the tower type. In the present study, a wind tunnel experiment and computational fluid dynamics (CFD) simulation were performed with respect to internal wind flows in different apartment arrangement forms. Findings of the wind tunnel experiment showed that the internal form and arrangement of an apartment complex had significant influence on its internal airflow. The wind velocity of the buildings increased by 80% at maximum due to the proximity effects between the buildings. The CFD simulation for relaxing such wind flows indicated that the wind velocity reduced by 40% or more at maximum when the paths between the lateral sides of the buildings were extended.

Intractable abdominal pain in a patient with spinal cord injury: a case report.

Patients with spinal cord injury (SCI) may experience several types of chronic pains. Abdominal pain in patients with SCI has gained limited attention and little is yet known about its characteristics and mechanisms. It often has been regarded as visceral pain associated with constipation and distention. Neuropathic pains localized in the abdomen have rarely been reported. We experience a case of intractable abdominal pain in a patient with SCI, neither of visceral pathology nor of musculoskeletal origin. The nature of pain fulfilled the diagnostic criteria for neuropathic pains. The pain was therefore regarded as neuropathic and managed accordingly. The first- and second-line oral drugs available were being performed, unfortunately, adequate pain control was not achieved. We tried an intrathecal lidocaine injection as another treatment option, and the injection had considerable effects.

Management of severe bilateral ptosis in a patient with midbrain infarction: a case report.

Ptosis could be caused by oculomotor nerve palsy in the midbrain infarction. Bilateral ptosis has been reported in several reports, which focused on clinical characteristics of midbrain infarction. Little research attention has been paid to the treatment of patients with bilateral ptosis in midbrain infarction. We experienced a case of severe bilateral ptosis occurring after midbrain infarction. The patient could not open her eyes, perform basic activities or achieve effective rehabilitation. Neurogenic ptosis can improved after the underlying cause is treated. However, in this case, bilateral ptosis was not improved after conservative care for 6 months and the patient remained limited in activities of daily living and mobility. Surgical correction of bilateral ptosis was done by the resection of both Muller's muscles. After surgical correction, the bilateral ptosis was much improved and the effect persisted for at least 6 months.

Nano-structured biogenic calcite: a thermal and chemical approach to folia in oyster shell.

The thin sheets of calcite in oyster shell in Crassostrea gigas are termed folia and comprise much of the oyster shell. The folia are covered by a layer of discrete globules that has been proposed to consist of aggregations of an organic matrix and minerals. A continuous organic framework divides each tablet into nanograins. Their shape is globular with a mean extension from 30 to 40 nm. Chemical and thermal treatments to correlate between the organic matrix and the minerals are considered using spectrometers, thermal analyzers, and electron microscopes. After treatment, the nanograins of the foliar and organic matrix are clearly identified. The organic matrix plays a key role in the thermal stability and material properties of this biological composite. From analysis of the FT-IR results, it is identified that the organic matrix in folia is composed of proteins and polysaccharides.

Primary structure of myostracal prism soluble protein (MPSP) in oyster shell, Crassostrea gigas.

Soluble protein (MPSP, myostracal prism soluble protein) obtained from myostracum in oyster shell (Crassostrea gigas) was characterized using biochemical and molecular biological techniques. From an analysis of secondary protein structure, it was shown that beta-structure was predominant in MPSP. And via in vitro assays, the relation of MPSP to biomineral phase and morphology was studied. SDS-PAGE revealed one major protein band of 20 kDa. An amino acid sequence of 160 amino acids was deduced for myostracum by characterization of the complementary DNA encoding the protein. The deduced protein was composed of a high proportion of Gly and Asp, typifying a calcium-binding protein for shell formation, and a relatively high proportion of Val, Ala and Ile, typifying an adhesive protein. In contrast to prevailing expectations, (Gly-Asp)n-type sequence motifs exist in MPSP, demanding a revision of previous theories of protein-mineral interactions. The cDNA sequence of myostracum is elucidated for the first time.