Pyrazinamide (PZA) is an anti-tuberculosis drug and an essential component of the standard four-drug regimen for tuberculosis. Here, we report a case of immediate angioedema secondary to PZA administration intended for pulmonary tuberculosis treatment. A previously healthy 48-year-old woman was diagnosed with pulmonary tuberculosis and tuberculous lymphadenitis. Thirty minutes after taking the first dose of isoniazid, rifampicin, pyrazinamide, and ethambutol, the patient developed facial edema, generalized rash, and dizziness. An oral provocation test was performed on the four drugs, and 1,000 mg pyrazinamide showed a positive result characterized by 50 minutes of urticaria, angioedema, and hypotension. As the prevalence of tuberculosis increases, prescriptions for anti-tuberculosis drugs may increase as well. Clinicians should be aware of the possibility of immediate hypersensitivity as well as delayed hypersensitivity to anti-tuberculosis drugs.
Angioedema* ; Dizziness ; Drug Hypersensitivity ; Edema ; Ethambutol ; Exanthema ; Female ; Humans ; Hypersensitivity, Delayed ; Hypersensitivity, Immediate ; Hypotension ; Isoniazid ; Middle Aged ; Prescriptions ; Prevalence ; Pyrazinamide ; Rifampin ; Tuberculosis ; Tuberculosis, Lymph Node ; Tuberculosis, Pulmonary ; Urticaria*

Acinar cell cystadenoma (ACA) is a very rare cystic lesion of the pancreas. The lining epithelium of ACA is morphologically identical to acinar cells of the pancreas. It is uncertain whether ACA is a benign neoplasm or cystic transformation of acinar glands but it is worthy to consider ACA in the differential diagnosis of other cystic neoplasms of the pancreas. We report here a 25-year old-woman who was operated on for a cystic mass of the pancreas. Grossly, a multilocular cystic mass containing clear serous fluid was observed. There was no communication between the cysts and the pancreatic ducts. Microscopically, cysts of various size were lined by columnar, cuboidal or flattened epithelial cells with a few foci of pseudostratification. The cells had granular apical cytoplasm and basally located nuclei with minimal atypia, the same as normal acinar cells. Metaplastic ossification was noted in the stroma. Immunohistochemically, the lining epithelium was positive for cytokeratin 7, antitrypsin and antichymotrypsin.
Acinar Cells* ; Cystadenoma* ; Cytoplasm ; Diagnosis, Differential ; Epithelial Cells ; Epithelium ; Keratin-7 ; Pancreas* ; Pancreatic Ducts ; Pancreatic Neoplasms

No abstract available.
Humans ; Leiomyosarcoma*

BACKGROUND: Epithelial-mesenchymal transition (EMT) is critical for morphogenesis during embryonic development and is also implicated in the conversion of early-stage tumors into invasive malignancies. Recently, Twist has been identified to play an important role in EMTmediated metastatic progression of several types of human cancer. The present study examined the expression of Twist and evaluated its clinicopathologic significance in urothelial carcinoma of upper urinary tract. METHODS: Immunohistochemical staining for Twist expression was performed on 70 upper urinary tract urothelial carcinomas (UUT-UCs) using tissue microarray. RESULTS: Immunohistochemical staining for Twist was positive in 31/70 cases (44.3%) of UUT-UCs. Twist expression was associated with high-grade and advanced-stage (ISUP grade, p<0.01; stage, p=0.045). The patients with Twist positive-tumors revealed lower disease free survival rate than those with Twist negative-tumors (p<0.01). The overall survival for patients with Twist positive-tumors was slightly worse than the patients with Twist negative- tumors, but the difference was not statistically significant (p=0.12). CONCLUSION: Our results suggest that Twist is a novel marker for advanced UUT-UC.
Carcinoma, Transitional Cell ; Disease-Free Survival* ; Embryonic Development ; Epithelial-Mesenchymal Transition ; Female ; Humans ; Morphogenesis ; Pregnancy ; Twist Transcription Factor ; Urinary Tract*

Anti-LGI1 (leucine-rich glioma inactivated-1) antibody encephalitis is one of autoimmune encephalitis. We report a 66-year-old man who presented with frequent, brief dystonic seizures which involve predominantly ipsilateral face and arm without cognitive impairment. Brain MRI showed normal finding. Serum and CSF tests revealed anti-LGI1 antibody. His symptom was not relieved by antiepileptic drugs, but completely controlled after immunotherapy. This case indicates that recognition of the brief, dystonic seizures should do tests for anti-LGI1 antibodies.
Aged ; Antibodies ; Anticonvulsants ; Arm ; Brain ; Encephalitis* ; Glioma ; Humans ; Immunotherapy ; Magnetic Resonance Imaging ; Potassium Channels, Voltage-Gated ; Seizures*

BACKGROUND: Oral allergy syndrome (OAS) is an immunoglobulin E (IgE)-mediated hypersensitivity that occurs frequently in older children with pollen sensitization. This study focused on the clinical characteristics of OAS in children with atopic dermatitis (AD) and birch sensitization. METHOD: s: A total of 186 patients aged 2–18 years with AD and birch sensitization were enrolled in this study between January 2016 and March 2017. Their levels of serum total IgE and birch- and ragweed-specific IgE (sIgE) were measured using ImmunoCAP (Thermo Fisher Scientific, Uppsala, Sweden). Information regarding causative foods and symptoms were obtained via interviews. The patients were divided into 3 groups according to their ages (group 1, 2–6 years; group 2, 7–12 years; and group 3, 13–18 years). RESULTS: Eighty-one of the 186 (43.5%) children with AD who were sensitized to birch pollen were diagnosed as having OAS. The prevalence of OAS in group 1 (the children who had AD and birch sensitization aged 2–6 years) was 36.6%. A greater predominance of men was noted in the non-OAS group (77.1%) compared to the OAS group (60.5%). Apples were the most common causative food in group 2 and 3 while kiwis were the most common cause of OAS in group 1. There was a statistically significant correlation between birch-sIgE levels and the prevalence of OAS (P = 0.000). The cut-off value was 6.77 kUA/L with 55.6% sensitivity and 79.0% specificity (area under the curve 0.653). CONCLUSION: In our study, the prevalence of OAS in children with AD and birch sensitization was 43.5%. Even in the preschool age group, the prevalence of OAS was considerable. Patients with high levels of birch-sIgE were more likely to have OAS. Clinicians should therefore be vigilant about OAS in patients with a high degree of sensitization to birch pollen and even young children if they have birch sensitization.
Betula* ; Child* ; Dermatitis, Atopic* ; Humans ; Hypersensitivity* ; Immunoglobulin E ; Immunoglobulins ; Male ; Malus ; Methods ; Pollen ; Prevalence ; Sensitivity and Specificity

OBJECTIVES: Our study aimed to present the distinctive correlates of disorganized speech in patients with schizophrenia, using the Scale for the Assessment of Thought, Language and Communication (TLC scale). METHODS: We compared the formal thought and other clinical characteristics between schizophrenia inpatients with (n=82) and without (n=80) disorganized speech. Psychometric scales including the TLC scale, Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Calgery Depression Scale for Schizophrenia (CDSS) and Word Fluency Test (WFT) were used. The presence or absence of disorganized speech was established using transformed dummy variable of score on the Clinician-Rated Dimension of Psychosis Symptom Severity (CRDPSS). RESULTS: After adjusting the effects of age, sex and total scores on the BPRS, YMRS and WFT, the subjects with disorganized speech presented significantly higher score on the poverty of contents of speech (p=0.001), distractible speech (p<0.0001), tangentiality (p<0.0001), derailment (p<0.0001), incoherence (p<0.0001), ilogicality (p<0.0001), word approximations (p=0.003), loss of goal (p<0.0001), blocking (p=0.006) and self-reference (p=0.002) items than those without disorganized speech. With defining the mentioned item scores as covariates, binary logistic regression model predicted that derailment (p=0.0001) and poverty of contents of speech (p<0.0001) were significant independent-correlates of disorganized speech in patients with schizophrenia. CONCLUSION: Our findings suggest that derailment and poverty of contents of speech are significant correlates of disorganized speech in patients with schizophrenia. Our findings might be used to evaluate disorganized speech in patients with schizophrenia efficiently.
Bipolar Disorder ; Brief Psychiatric Rating Scale ; Depression ; Humans ; Inpatients ; Logistic Models ; Poverty ; Psychometrics ; Psychotic Disorders ; Schizophrenia* ; Weights and Measures

OBJECTIVES: Formal thought disorder has been regarded as an essential symptom in the diagnostic criteria for schizophrenia. The aim of our study was to present gender differences in the formal thought disorder among patients with schizophrenia. METHODS: We tested for potential gender differences in the formal thought disorder among 167 inpatients with schizophrenia (86 men and 81 women). The Scale for the Assessment of Thought, Language and Communication (TLC scale), Clinical Language Disorder Rating Scale (CLANG), Brief Psychiatric Rating Scale, Young Mania Rating Scale, and Calgary Depression Scale for Schizophrenia were used for evaluation of thought disorder, language disorder, overall symptoms, manic symptoms, and depressive symptoms, respectively. Using the analysis of covariance for continuous variables and logistic regression analysis for discrete variables, gender differences in the formal thought disorder were evaluated. RESULTS: After adjusting for the effects of marital status and religious affiliation, men showed a significantly higher score on the perseveration (TLC scale ; F=7.538, p=0.007), blocking (TLC scale ; F=8.956, p=0.003), stilted speech (TLC scale ; F=6.921, p=0.009), lack of details (CLANG ; F=7.375, p=0.007), dysfluency (CLANG ; F=21.250, p<0.0001), and dysarthria (CLANG ; F=31.198, p<0.0001) items than women. CONCLUSION: Our study has a virtue of exploring gender differences in the formal thought disorder in patients with schizophrenia. Based on our findings, further study might enlighten regarding neural correlates (namely, cerebral asymmetry/lateralization) for gender-differed patterns of the formal thought disorder in patients with schizophrenia.
Bipolar Disorder ; Brief Psychiatric Rating Scale ; Depression ; Dysarthria ; Female ; Humans ; Inpatients ; Language Disorders ; Logistic Models ; Male ; Marital Status ; Schizophrenia* ; Virtues

Analysis of the T-cell receptor (TCR) repertoire of innate CD4+ T cells selected by major histocompatibility complex (MHC) class II-dependent thymocyte-thymocyte (T-T) interaction (T-T CD4+ T cells) is essential for predicting the characteristics of the antigens that bind to these T cells and for distinguishing T-T CD4+ T cells from other types of innate T cells. Using the TCRmini Tg mouse model, we show that the repertoire of TCRalpha chains in T-T CD4+ T cells was extremely diverse, in contrast to the repertoires previously described for other types of innate T cells. The TCRalpha chain sequences significantly overlapped between T-T CD4+ T cells and conventional CD4+ T cells in the thymus and spleen. However, the diversity of the TCRalpha repertoire of T-T CD4+ T cells seemed to be restricted compared with that of conventional CD4+ T cells. Interestingly, the frequency of the parental OT-II TCRalpha chains was significantly reduced in the process of T-T interaction. This diverse and shifted repertoire in T-T CD4+ T cells has biological relevance in terms of defense against diverse pathogens and a possible regulatory role during peripheral T-T interaction.
Amino Acid Sequence ; Animals ; Antigens, Surface/metabolism ; CD4-Positive T-Lymphocytes/cytology/*immunology/*metabolism ; Cell Communication ; Cell Differentiation/genetics/immunology ; Clonal Evolution ; Histocompatibility Antigens Class II/*immunology ; *Immunity, Innate ; Immunophenotyping ; Lymphocyte Count ; Mice ; Mice, Knockout ; Mice, Transgenic ; Peptide Fragments/chemistry ; Phenotype ; Receptors, Antigen, T-Cell/chemistry/*genetics/metabolism ; Receptors, Antigen, T-Cell, alpha-beta/chemistry/genetics ; Spleen/cytology ; Thymocytes/cytology/immunology/metabolism

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening adverse drug reaction with systemic manifestations. Dapsone is known to be useful for treatment of leprosy and various dermatologic conditions. We report a patient with prurigo pigmentosa who developed DRESS syndrome after dapsone treatment. She presented with lymphadenopathy, fever, eosinophilia, skin rash, and elevated liver enzymes. Initial lymph node and skin biopsy was suggestive of peripheral T-cell lymphoma. Initially, she was treated with chemotherapy. A week later after complete remission of skin symptoms, new skin lesions recurred. TCR-gene rearrangement was examined to show negative results and she was diagnosed as dapsone induced DRESS syndrome. This case emphasizes the importance of differential diagnosis of lymphoma and DRESS syndrome.
Biopsy ; Dapsone ; Diagnosis, Differential ; Drug Hypersensitivity ; Drug Hypersensitivity Syndrome* ; Drug Therapy ; Drug-Related Side Effects and Adverse Reactions ; Eosinophilia ; Exanthema ; Fever ; Humans ; Leprosy ; Liver ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma ; Lymphoma, T-Cell, Peripheral ; Prurigo ; Pseudolymphoma ; Skin