Takayasu's arteritis(TA) is a nonspecific areritis of unknown etiology affecting segmentally the aorta and its main branches, which result in stenosis, occlusion or aneurysm of involved arteries. The clinical manifestations present with a variety of symptoms such as headache, dyspnea on exertion, pain and weakness of extremities, pulse deficit, and hypertension according to involves arteries. Usually it can be managed by medical or surgical treatment, and recently by percutaneous transluminal balloon angioplasty. The type III classified by Lupi-Herrena and associates is the most frequent variety of TA. However the case of type III involving both subclavin arteries and both renal arteries has rarely been reported. We experienced a case of TA involving both subcalvian arteries, and both renal arteries presented with paroxysmal hypertension and right flank pain, in which the stenosis of both subclavian arteries were managed by percutaneous transluminal balloon angioplasty and the stenosis and occlusion of both renal arteries were successfully managed by aorto-renal bypass surgery with autogenous right iliac artery and synthetic vessel(Gortex). The patient was discharged uneventfully.
Aneurysm ; Angioplasty, Balloon ; Aorta ; Arteries* ; Constriction, Pathologic* ; Dyspnea ; Extremities ; Flank Pain ; Headache ; Humans ; Hypertension ; Iliac Artery ; Renal Artery* ; Subclavian Artery ; Takayasu Arteritis*

BACKGROUND AND OBJECTIVES: Squamous cell carcinomas (SCCs) of the head and neck are known for their aggresive growth and propensity to metastasize, which often results in poor prognosis. Tumor cell interaction with the basement membrane has historically been viewed as the crucial step in tumor invasion and future metastasis. The invasive and metastatic process of malignant tumors requires the expression and activation of proteolytic enzymes which facilitate the progression of tumor cells in different ways. Among these proteolytic enzymes, collagenase-3 (matrix metalloproteinase-13) is a recently identified member of the MMP family, and is expressed in breast carcinomas and in articular cartilage from arthritic patients. The substrate specificity of MMP-13 is exceptionally wide as compared to other MMPs. MATERIALS AND METHODS: We performed immunohistochemical stains on 10 normal mucosas and 35 SCCs of the head and neck with anticollagenase-3 antibody and analysed the staining patterns. RESULTS: As a result, the expression of the MMP-13 were detected in 23 of the 35 SCCs (66%), but no expression was detected in any of the 10 normal mucosa. The expression of MMP-13 in most tumors was localized predominantly in neoplastic cells at the invading periphery of the tumor (74%;17/23). A significant correlation was found between MMP-13 expression and local tumor invasion but no correlation was observed between expression and the age, sex of the patients, histological grade, lymph node metastases, recurrence, or the stage of the tumors. CONCLUSION: These findings suggest that MMP-13 expression may contribute to the progression of a significant subset in SCCs of the head and neck. In the future, it is likely that elucidation of the regulatory mechanisms of the MMP-13 in SCCs may prove to be beneficial in developing novel therapeutic modalities for preventing invasion of these neoplastic cells.
Basement Membrane ; Breast Neoplasms ; Carcinoma, Squamous Cell* ; Cartilage, Articular ; Cell Communication ; Coloring Agents ; Head* ; Humans ; Lymph Nodes ; Matrix Metalloproteinase 13 ; Matrix Metalloproteinases ; Metalloproteases ; Mucous Membrane ; Neck* ; Neoplasm Metastasis ; Peptide Hydrolases ; Prognosis ; Recurrence ; Substrate Specificity

Alveolar Process ; Bone Transplantation ; Cleft Lip ; Congenital Abnormalities ; Dentition ; Humans ; Incisor ; Palate ; Retrospective Studies ; Transplants

Tetrodotoxin is a neurotoxin produced by about 90 species of puffer fish and causes paralysis of central nervous system and peripheral nerves by blocking the movement of all monovalent cations. Ingestion of tetrodotoxin produces clinical manifestations such as paresthesias(within 10-45 min), vomiting, lightheadedness, salivation, muscle twitching, dysphagia, difficulty in speaking, convulsion and death that expressed by cardiopulmonary arrest with loss of brain stem reflex sometimes. Tetrodotoxin prevents or delays ischemia induced neuronal death by way of following 3 mechanisms. Firstly, it reduces the energy demand of the brain tissues. Secondly, it delays or even prevents anoxic depolarization. Finally, it diminishes ischemia induced cell swelling and cerebral edema. We report a case of puffer fish poisoning which presented with cardiopulmonary arrest and loss of brain stem reflex, but completely recovered by aggressive cardiopulmonary resuscitation.
Brain ; Brain Edema ; Brain Stem ; Cardiopulmonary Resuscitation ; Cations, Monovalent ; Central Nervous System ; Deglutition Disorders ; Dizziness ; Eating ; Heart Arrest ; Ischemia ; Neurons ; Paralysis ; Peripheral Nerves ; Poisoning* ; Reflex ; Salivation ; Seizures ; Tetraodontiformes* ; Tetrodotoxin ; Vomiting

Pseudomembranous necrotizing bronchial aspergillosis (PNBA) is a rare form of invasive aspergillosis with a very poor prognosis. The symptoms are non-specific, and the necrotizing plugs cause airway obstruction. Atelectasis and respiratory failure can be the initial manifestations. Recently, we treated an immunocompromised patient with PNBA, who presented with a sudden onset of atelectasis and acute respiratory failure. There were no preceding signs except for a mild cough and one febrile episode. Bronchoscopy revealed PNBA, and Aspergillus nidulans was cultured from the bronchial wash.
Adult ; Female ; Humans ; Immunocompromised Host ; Invasive Pulmonary Aspergillosis/*complications/*diagnosis ; Leukemia, Myeloid, Acute/complications ; Neutropenia/complications ; Pulmonary Atelectasis/*etiology ; Respiratory Insufficiency/*etiology

Nearly 100% of monochorionic twin pregnancies have vascular anastomoses and a fourth of those has clinical features of twin-to-twin transfusion syndrome. Cerebral palsy, microcephaly, porencephaly, and multicystic periventricular leukomalacia are serious antenatal neurologic complications associated with vascular communications in monochorionic twin gestation. It is most likely that such neurological damage is caused by intrauterine cerebral ischemic necrosis. The intermittent blood flow reversal or sudden hypotension in one twin, or emboli of thromboplastic material originating in the dead fetus could cause in utero cerebral damage in the other twin. In this report, we present a case of antenatal periventricular leukomalacia in monochorionic twin pregnancy complicated with twin-to-twin transfusion syndrome.
Cerebral Palsy ; Female ; Fetofetal Transfusion* ; Fetus ; Humans ; Hypotension ; Infant, Newborn ; Leukomalacia, Periventricular* ; Microcephaly ; Necrosis ; Pregnancy ; Pregnancy, Twin*

Placenta accreta is a rare condition and is associated with considerable maternal morbidity and mortality. Though hysterectomy is a definitive therapy, there are some occasions that conservation of the uterus is desired by the patient and bleeding is not excessive. We report a case successfully treated using methotrexate in patient whose placenta was not detached from the uterus with a brief review of literature.
Hemorrhage ; Humans ; Hysterectomy ; Methotrexate* ; Mortality ; Placenta Accreta* ; Placenta* ; Uterus

OBJECTIVE: To compare clinical results of laparoscopic assisted vaginal hysterectomy for uteri weighing 500 g or more with less than 500 g. And we compared clinical results between laparoscopic coagulation of uterine vessel (LH) and conventional LAVH. METHODS: We reviewed medical records of 296 patient who underwent LAVH from February 2004 to May 2006. They were divided into two groups, uteri weighing greater than 500 g and less than 500 g. And each group was divided into two groups, LH and conventional LAVH. Each groups were compared by operative time, hemoglobin change, complication, transfusion and hospital days. RESULTS: Operation time ,hemoglobin change on the 1st postoperative day and transfusion were significant greater in the uteri > or =500 g group than in the <500 g. However, there was no significant difference in hospital days, hemoglobin change on the 4th postoperative day and complication. In the <500 g group, LH group was lower than conventional LAVH group in operative time, hemoglobin change on the 1st and 4th postoperative day. In the > or =500 g group, there was no signicant difference in hospital days, operative time, hemoglobin change on the 1st postoperative day. However, hemoglobin change was smaller in the LH group than conventional LAVH group on the 4th postoperative day. CONCLUSION: This study demonstrates that despite the increased operating time and blood loss, LAVH can be safely performed for large uterus. However, surgeons need to be aware of high risk of blood transfusion. Modification of surgical method can decrease operating time and blood loss in LAVH.
Blood Transfusion ; Female ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Medical Records ; Operative Time ; Uterus*

OBJECTIVE: To compare the clinical effectiveness of transvaginal radiofrequency myolysis of the patients with leiomyomas and the patients with adenomyosis which have similar clinical symptoms. METHODS: From May 2005 to May 2006 at Eulji university hospital, 108 women who were diagnosed of leiomyoma and adenomyosis had undergone transvaginal radiofrequency myolysis. Before and after the procedure size, number of uterine myomas, location and the volume of the leiomyomas and adenomyosis were measured by ultrasound. And on every visit after the procedure improvement of the symptom was checked by questionnaire of the symptom and life quality. Using Wilcoxon signed ranked test, the statistical significance was proved and the P value lower than 0.05 was judged to be significant. RESULTS: 76 women with leiomyoma who had undergone transvaginal radiofrequency myolysis, were followed up 1 month, 3 months, 6 months and 9 months after the procedure. The average maximal diameter of the myoma was decreased by 14.6%, 23.3%, 30.6%, 33.6% respectively, and the average volume was decreased by 35.7%, 53.3%, 67.3%, 72.2% respectively. 32 women with adenomyosis who had undergone transvaginal radiofrequency myolysis were followed up, at the same period after the procedure. The average maximal diameter of the adenomyosis was decreased by 8.9%, 13.6%, 14.6%, 11.9% respectively, and the average volume was decreased by 22.6%, 30.0%, 32.3%, 28.4% respectively. Before and after the procedure the symptom score was 62.3, 52.2, 40.6, 32.6, 28.6 respectively, and the quality of life score was 68.9, 78.1, 82.9, 85.7, 87.3 respectively in the leiomyoma group. In the adenomyosis group, before and after the procedure the symptom score was 77.7, 37.6, 30.6, 54.4, 67.5 respectively, and the quality of life score was 48.1, 76.5, 85.5, 66.5, 55.1 respectively. CONCLUSION: Transvaginal radiofrequent myolysis had benefits in conserving the uterus, and was less invasive, and had great effect on the reducing the size of the leiomyoma and improving the symptoms, and also returning to normal life pattern was earlier. But in women with adenomyosis the symptoms were worsened after approximately 6 to 9 months after the procedure. Therefore additional research and follow-up is required and a strict criterion is needed.
Adenomyosis ; Female ; Follow-Up Studies ; Humans ; Leiomyoma ; Myoma ; Quality of Life ; Surveys and Questionnaire ; Uterus

Persistent cloaca is a very rare congenital anomaly with a single common perineal opening for the genital urinary and gastrointestinal tract, which is caused by abnormal formation of the urorectal septum. It has an incidence of 1 in 50,000 to 1 in 125,000 births and is much more common in females and in twin pregnancies. Pathologic findings of persistent cloaca include dilated bowel, hydrocolpos, urethral obstruction, hydronephrosis and oligohydramnios caused by obstruction of the bladder, vagina and intestine. Failure of the paired m llerian ducts to fuse also usually results in duplication of the uterus and vagina. Currently, the diagnosis depends on the prenatal sonography but the diagnosis may be very difficult due to the complex nature of the anomaly and variable appearances. We present a case of persistent cloaca with one opening confirmed by autopsy after therapeutic termination which was initially diagnosed by prenatal sonography.
Autopsy ; Cloaca* ; Diagnosis ; Female ; Gastrointestinal Tract ; Humans ; Hydrocolpos ; Hydronephrosis ; Incidence ; Intestines ; Oligohydramnios ; Parturition ; Pregnancy ; Pregnancy, Twin ; Urethral Obstruction ; Urinary Bladder ; Uterus ; Vagina