No abstract available.
Cytomegalovirus Infections*

Mesenteric pseudocyst has a fibrous cystic wall without an endothelial lining. It can develop from an inflammatory reaction or from trauma. This lesion is difficult to diagnose preoperatively, and it is rarely symptomatic except when it is complicated by bleeding, rupture or infection. A 66-year old male presented with generalized abdominal pain for 3 days. In his past medical history, an appendectomy was done forty years ago. Three months after the operation, a mass was palpated in the left lower quadrant and size of the mass had gradually increased. Physical examination revealed a distended abdomen with diffuse tenderness. The non-tender mass, which was about 10 cm in size, was palpated in the left lower abdomen. A simple abdominal x-ray showed a mechanical obstruction of the small bowel. A CT scan showed a 10x9 cm sized cystic mass with a partially enhancing cystic wall. Surgical exploration revealed the 13 cm sized mass in the distal ileum about 40 cm proximal from the ileocecal valve, and the adjacent ileum was obstructed by this mass. The mass was a thick walled cyst that contained a non-clotting bloody material. Histopathological examination indicated that the cyst wall was composed of fibrosis with neutrophil infiltration, but there was no specific endothelial lining. The final pathological diagnosis was a mesenteric pseudocyst. Mesenteric pseudocyst with obstruction is rare and difficult to diagnosis, but it should be included in the differential diagnosis in the case of intestinal obstruction with mass.
Abdomen ; Abdominal Pain ; Aged ; Appendectomy ; Diagnosis ; Diagnosis, Differential ; Fibrosis ; Hemorrhage ; Humans ; Ileocecal Valve ; Ileum ; Intestinal Obstruction* ; Male ; Neutrophil Infiltration ; Physical Examination ; Rupture ; Tomography, X-Ray Computed

OBJECTIVES: Asia sand dust (ASD) is known to cause various human diseases including respiratory infection. The aim of this study was to examine the effect of ASD on inflammatory response in human middle ear epithelial cells (HMEECs) in vitro and in vivo. METHODS: Cell viability was assessed using the cell counting kit-8 assay. The mRNA levels of various genes including COX-2, TNF-a, MUC 5AC, MUC 5B, TP53, BAX, BCL-2, NOX4, and SOD1 were analyzed using semiquantitative realtime polymerase chain reaction. COX-2 protein levels were determined by western blot analysis. Sprague Dawley rats were used for in vivo investigations of inflammatory reactions in the middle ear epithelium as a result of ASD injection. RESULTS: We observed dose-dependent decrease in HMEEC viability. ASD exposure significantly increased COX-2, TNF-a, MUC5AC, and MUC5B mRNA expression. Also, ASD affected the mRNA levels of apoptosis- and oxidative stress-related genes. Western blot analysis revealed a dose-dependent increase in COX-2 production. Animal studies also demonstrated an ASD-induced inflammatory response in the middle ear epithelium. CONCLUSION: Environmental ASD exposure can result in the development of otitis media.
Animals ; Asia ; Asian Continental Ancestry Group* ; Blotting, Western ; Cell Count ; Cell Survival ; Cyclooxygenase 2 ; Dust* ; Ear, Middle* ; Epithelial Cells ; Epithelium ; Gene Expression* ; Humans ; In Vitro Techniques ; Mucins* ; Otitis Media ; Polymerase Chain Reaction ; Rats, Sprague-Dawley ; RNA, Messenger

OBJECTIVE: To devise a new method to measure the amount of soft tissue in pulmonary ground-glass opacity nodules, and to compare the use of this method with a previous volumetric measurement method by use of a phantom study. MATERIALS AND METHODS: Phantom nodules were prepared with material from fixed normal swine lung. Forty nodules, each with a diameter of 10 mm, were made with a variable mean attenuation. The reference-standard amount of soft tissue in the nodules was obtained by dividing the weight by the specific gravity. The imaging data on the phantom nodules were acquired with the use of a 16-channel multidetector CT scanner. The CT-measured amount of soft tissue of the nodules was calculated as follows: soft tissue amount = volume x (1 + mean attenuation value / 1,000). The relative percentage error (RPE) between the CT-measured amount of the soft tissue and the reference-standard amount of the soft tissue was also measured. The RPEs determined with use of the new method were compared with the RPEs determined with the current volumetric measurement method by the use of the paired t test. RESULTS: The CT-measured amount of soft tissue showed a strong correlation with the reference-standard amount of soft tissue (R(2) = 0.996, p < 0.01). The mean RPE of the CT-measured amount of soft tissue in the nodules was -7.79 +/- 1.88%. The mean RPE of the CT-measured volume was 114.78 +/- 51.02%, which was significantly greater than the RPE of the CT-measured amount of soft tissue (p < 0.01). CONCLUSION: The amount of soft tissue measured by the use of CT reflects the reference-standard amount of soft tissue in the ground-glass opacity nodules much more accurately than does the use of the CT-measured volume.
Animals ; Lung Neoplasms/*radiography ; Phantoms, Imaging ; Reference Standards ; Swine ; *Tomography, X-Ray Computed

BACKGROUND: Mycobacterium tuberculosis is one of the most clinically significant infectious agents. Especially during mass outbreaks, accurate identification and monitoring are required. The proportion of Beijing family members is very high among infecting strains, and spoligotyping is not suitable for strain typing. Therefore, we studied the homogeneity of isolates using the mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR) method and identified its utility for carrying out molecular epidemiologic analysis. METHODS: Eighty-one clinical M. tuberculosis isolates that had previously been analyzed by spoligotyping were used in this study. We used the 12 standard MIRU loci and further four exact tandem repeat (ETR) loci (ETR-A, -B, -C, and -F). Four strains each of randomly selected Beijing and Beijing-like families were subjected to IS6110- restriction fragment length polymorphism analysis. RESULTS: All 81 samples showed amplification products of all VNTR loci, and all of them showed differences in at least one locus. The calculation of the Hunter-Gaston diversity index (HGDI) for MIRU-VNTR gave the value of 0.965. Discriminatory index in the six loci (MIRU-10, -16, -26, -31, -39, and ETR-F) were found to be highly discriminated (HGDI >0.6). Beijing and Beijing-like family isolates were discriminated into different MIRU-VNTR types. CONCLUSIONS: MIRU-VNTR analysis by using well-selected loci can be useful in discriminating the clinical M. tuberculosis isolates in areas where the Beijing family is predominant.
Bacterial Typing Techniques/*methods ; DNA, Bacterial/analysis ; Genotype ; Humans ; *Minisatellite Repeats ; Mycobacterium tuberculosis/*classification/genetics/isolation & purification ; Polymerase Chain Reaction ; Republic of Korea ; Tuberculosis/diagnosis/*microbiology

PURPOSE: This study evaluated the benefits of adjuvant chemotherapy on elderly patients with advanced gastric cancer (AGC) using meta-analysis of well-designed randomized controlled clinical studies. MATERIALS AND METHODS: PubMed, Embase, and Cochrane were searched to retrieve clinical studies evaluating the benefits of adjuvant chemotherapy in the elderly with AGC. Hazards ratios (HRs) with 95% confidence intervals (CIs) were pooled across studies using a fixed-effects model. RESULTS: Two studies were included in this meta-analysis to estimate HR for the overall survival (OS), and relapse-free survival (RFS) between adjuvant chemotherapy and surgery in elderly and non-elderly patients. HR for OS in the elderly and non-elderly was 0.745 (95% CI, 0.552 to 1.006, p=0.055) and 0.636 (95% CI, 0.522 to 0.776; p < 0.001), respectively, which showed no heterogeneity regarding HR between the two groups (p(interaction)=0.389). HR for RFS in the elderly and non-elderly was 0.613 (95% CI, 0.466 to 0.806; p < 0.001) and 0.633 (95% CI, 0.533 to 0.753; p < 0.001), respectively (p(interaction)=0.846). CONCLUSION: Meta-analysis suggests that the benefit of adjuvant chemotherapy to the elderly is not big enough to reach statistical significance while the HR for OS is less than 1 (0.745) and no heterogeneity are observed regarding the HR between the elderly and non-elderly patients.
Aged* ; Chemotherapy, Adjuvant* ; Humans ; Population Characteristics ; Stomach Neoplasms*

BACKGROUND: With a rapidly aging population, more elderly patients are being hospitalized than before. Thus, a comprehensive geriatric assessment medium is needed to carefully evaluate geriatric patients. The author's university hospital has a geriatric medicine team to where patients are referred for comprehensive evaluations. Their services will be introduced here. METHODS: From December 2010 to January 2012, the team performed comprehensive geriatric assessments comprising of a thorough review of systems, physical examination, and surveys, and reviewed past medical records of the elderly hospitalized patients aged 65 or over, referred from the Department of Orthopedics. RESULTS: Of total 58 patients, 4 patients (6.9%) had severe dysfunction in the activities of daily living with the score of 16 or higher. Twenty-two patients (73.3%) had cognitive impairment or dementia upon assessing cognitive function after excluding those previously diagnosed with dementia or those within 5 days after surgery, thus predisposed to delirium who had tested mini mental state examination for cognitive function level test. Fifteen patients (31.3%) had mild depression, while four (8.3%) had moderate depression; and 37 patients (67.3%) were at moderate risk and five (9.1%) were at high risk for developing delirium. CONCLUSION: A comprehensive evaluation of the functional status of elderly hospitalized patients was helpful in detecting medical problems other than the initial diagnosis. A significant proportion of the elderly patients we assessed were suspected to have cognitive impairment.
Activities of Daily Living ; Aged* ; Aging ; Delirium ; Dementia ; Depression ; Diagnosis ; Geriatric Assessment* ; Humans ; Inpatients* ; Medical Records ; Orthopedics* ; Physical Examination

OBJECTIVE: To evaluate the prevalence of sleep disturbance in Korean patients with ankylosing spondylitis (AS), and its association with disease activity and depression. METHODS: Forty patients with AS and eighty healthy controls were included in this study. Sleep quality was assessed using the Korean version of Pittsburgh sleep quality index (PSQI). Depression was assessed by the Korean version of Beck depression inventory second edition (BDI-2). Ankylosing spondylitis disease activity score-C-reactive protein (ASDAS-CRP) was used to evaluate disease activity. Patients were dichotomized into a good sleeper group (PSQI< or =5) and a poor sleeper group (PSQI>5). RESULTS: The mean total PSQI score of patients with AS was 7.23+/-3.84. It was higher than that of the control subjects. AS patients had higher scores in all of the PSQI components, except for the use of sleep medication. Sixty percent of the AS patients were classified as poor sleepers. The mean BASDAI, ASDAS-CRP, and BDI-2 scores of the poor sleeper group were higher than that of the good sleeper group. Significantly, higher disease activity according to ASDAS-CRP was associated with poor sleep quality and depression. Multiple regression analysis revealed that the duration of morning stiffness and depression were independent risk factors that influenced poor sleep quality. CONCLUSION: Sleep disturbances are prevalent amongst Korean patients with AS. Lower quality of sleep is significantly associated with higher disease activity and depression. Therefore, optimal management to improve sleep quality in patients with AS is important.
Depression ; Humans ; Prevalence ; Risk Factors ; Spondylitis, Ankylosing*

BACKGROUND: Tsutsugamushi, leptospirosis and hemorrhagic fever with renal syndrome (HFRS) are the prevalent diseases among the acute febrile illnesses in Korea. Pulmonary involvement in the patients with these diseases remains poorly recognized in endemic regions, and this is despite reports of recent outbreaks and epidemic episodes. Pulmonary involvement and a higher CRP level as clinical manifestations show a more severe form of infection. The aim of this study is to analyze the correlation of pulmonary involvement and the CRP level in patients with acute febrile illnesses. METHODS: We retrospectively reviewed the clinical records of 105 patients who were diagnosed with tsutsugamushi, HFRS and leptospirosis from January 2002 to May 2008 in Chuncheon Sacred Heart Hospital. The radiographic images were retrospectively analyzed by two radiologists. We analyzed the pulmonary complications of the patients with these febrile diseases and we checked the CRP level at admission. RESULTS: The study included 105 patients who were diagnosed with febrile diseases. Of these patients, 32 patients had hantaan, 10 patients had leptospirosis and 63 patients had tsutsugamushi disease. 42 (40%) patients had pulmonary complications, 20 patients had pulmonary edema, 20 patients had pleural effusion and 2 patients had interstitial pneumonitis. The patients with pulmonary involvement showed a more severe form of infection and a higher CRP level than that of those patients without pulmonary involvement (p=0.0073). CONCLUSION: Pulmonary involvement in patients with acute febrile diseases might be correlated with a higher CRP level. Identification of this factor on admission might provide useful selection criteria for the patients who need early intensive care.
C-Reactive Protein ; Disease Outbreaks ; Heart ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Incidence ; Critical Care ; Korea ; Leptospirosis ; Lung Diseases, Interstitial ; Patient Selection ; Pleural Effusion ; Pulmonary Edema ; Retrospective Studies ; Scrub Typhus

PURPOSE: Hepatolithiasis results in septic cholangitis, biliary stricture, hepatic atrophy, hepatic abscess, irreversible liver cirrhosis, and cholangiocarcinoma. Hepatic resection for hepatolithiasis is regarded as a more effective treatment for achieving complete removal of stones and preventing recurrence. The purpose of this study was to determine the surgical outcome of hepatic resections for hepatolithiasis. METHODS: From March 2001 to December 2006, 54 patients underwent hepatic resections for hepatolithiasis at the Department of Surgery, Eulji University Hospital. A retrospective review of the surgical outcome was carried out. RESULTS: The hepatolithiasis was located in the left intrahepatic duct (34 cases), right intrahepatic duct (7 cases) or both (13 cases). The operative procedures were as follows: a left hepatectomy in 34 patients, a left lateral sectionectomy in eight, a right posterior sectionectomy in three, a left trisectionectomy in three, a right hepatectomy in five, and a segmentectomy in 1. The postoperative complications were intraabdominal abscess in 10 patients, wound infection in 4, pleural effusion in 3, internal bleeding in 2, T-tube site leakage in 2, hepatic failure and pneumonia in 1. The factors that affect these complications were analyzed. Preoperative percutaneous transhepatic biliary drainage (PTBD) and operative hepaticojejunostomy increased the frequency of postoperative complications; these findings were statistically significant (p=0.035, p=0.006, respectively). Two patients were diagnosed with cholagiocarcinoma. Five patients had remaining stones and five patients had recurrent stones. CONCLUSION: Hepatic resection is a safe and effective procedure for treating hepatolithiasis. If possible, bypass procedures such as hepaticoenterostomy should be avoided to reduce postoperative complications.
Abscess ; Atrophy ; Cholangiocarcinoma ; Cholangitis ; Constriction, Pathologic ; Drainage ; Hemorrhage ; Hepatectomy ; Humans ; Liver Abscess ; Liver Cirrhosis ; Liver Failure ; Mastectomy, Segmental ; Pleural Effusion ; Pneumonia ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Surgical Procedures, Operative ; Wound Infection