Isolated ACTH deficiency is a uncommon disorder causing secondary adrenocortical insufficiency. Less than 200 cases have been reported in the world. The major clinical manifestations are hypoglycemia, weight loss, hypotension, anemia, weakness, nausea, inability to excrete water load, and hyponatremia. A 56-year-old male was admitted because of weakness, fatigue, nausea and vomiting. He was pallor and not associated with hyperpigmentation. The basal plasma ACTH and cortisol levels were 8.30 pg/ml and 0.6 ug/dl. The serum cortisol did not response to rapid ACTH stimulation test. On combined pituitary stimulation test, the cortisol did not response to insulin-induced hypoglycemia. Other anterior pituitary hormones showed normal responses except elevated prolactin level. Six months after glucocorticoid replacement therapy, the elevated basal prolactin level returned to normal. Brain MRI did not show any anatomic abnormalities of the sellar and suprasella area. We report a case of isolated ACTH deficiency accompanied by hyperprolactineia, which respond to glucocorticoid replacement therapy.
Adrenal Insufficiency ; Adrenocorticotropic Hormone* ; Anemia ; Brain ; Fatigue ; Humans ; Hydrocortisone ; Hyperpigmentation ; Hyperprolactinemia* ; Hypoglycemia ; Hyponatremia ; Hypotension ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nausea ; Pallor ; Pituitary Hormones, Anterior ; Plasma ; Prolactin ; Vomiting ; Water ; Weight Loss

To evaluate the effectiveness of computed tomography for the differential diagnosis of cervical lymphadenopathy, we reviewed CT scans of 26 patients with cervical lymphadenopathy retrospectively. These included 10 patients with tuberculous lymphadenitis, 11 patients with metastasis and 5 patients with lymphoma, We evaluated the CT scans with a special attention to internal nodal density, feature of contrast enhancement and location of lymphadenopathy. Tuberculous lymphadenitis involved multiple nodes unilaterally and showed central low density with even or uneven rim enhancement, usually occurring in young patients (mean: 31.6 years). Two cases with tuberculous lymphadenitis showed calcifications within the lymph nodes. Lymphoma involved unilateral or bilateral nodes and appeared as conglomerated isodense mass with even rim enhancement. Metastasis involved multiple nodes unilaterally and showed focal, diffuse of mixed pattern of central low density with variable rim enhancement, usually occurring in old patients (mean: 59.4 years). Locations of most frequent lymph node involvements were internal jugular group (76%), spinal accessory group (54%) and retropharyngeal group(12%).
Diagnosis, Differential ; Humans ; Lymph Nodes ; Lymphatic Diseases* ; Lymphoma ; Neoplasm Metastasis ; Retrospective Studies ; Tomography, X-Ray Computed ; Tuberculosis, Lymph Node

Periodontal therapy has dealt primarily with attempts at arresting progression of disease, however, more recent techniques have focused on regenerating the periodontal ligament having the capacity to regenerate the periodontium. The effect of chitosan, a carbohydrate biopolymer extracted from chitin, on periodontal ligament regeneration is of particular interest. The purpose of this study was to evaluate the effect of chitosan on the expression of extracellular matrix proteins in primary rat calvarial cells in vitro. In the control group, cells was cultured with BGJb media. In the experimental groups, cells were cultured with chitosan in concentration of 0.01, 0.1, 1.0 and 2.0 mg/ml. Then each group was characterized by examining alkaline phosphatase activity at 3 and 7 days, and the ability to produce mineralized nodules of rat calvarial cells at 14 and 21 days. Synthesis of type I collagen (COL-I), osteocalcin (OCN), bone sialoprotein (BSP) was evaluated by RT-PCR at 14 days. The results were as follows: 1. Alkaline phosphatase activity was significantly higher in the concentration of chitosan 0.01mg/ml, 0.1mg/ml and 1.0mg/ml compared to control (p<0.05). 2. The percentage of mineralized bone nodule was more in the concentration of chitosan 0.1mg/ml and 1.0 mg/ml than the control. 3. At 14 day culture, the expression of OCN was increased by chitosan in concentration of 1.0 mg/ml and 2.0 mg/ml. These results suggested that chitosan in concentration of 0.1 and 1.0 mg/ml stimulate the extracellular matrix of primary rat calvarial cells and may facilitate the formation of bone.
Alkaline Phosphatase ; Animals ; Biopolymers ; Bone Matrix* ; Chitin ; Chitosan* ; Collagen Type I ; Extracellular Matrix ; Extracellular Matrix Proteins ; Integrin-Binding Sialoprotein ; Osteocalcin ; Periodontal Ligament ; Periodontium ; Rats* ; Regeneration

Kasabach-Merritt phenomenon does not occur with common hemangioma, rather it is associated with the more aggressive Kaposiform hemangioendothelioma and rarely with other vascular neoplasm. We report the case of an adult who was diagnosed as Kaposiform hemangioendothelioma complicated by Kasabach-Memtt phenomenon. This is the first report in Korea of an adult with Kasabach-Merritt phenomenon who has osteolytic changes of femur, pelvic bone, and lumbar spine.
Adult* ; Femur ; Hemangioendothelioma* ; Hemangioma ; Humans ; Kasabach-Merritt Syndrome ; Korea ; Pelvic Bones ; Spine ; Vascular Neoplasms

There was no specific criteria of white cell count to determine the therapy of hyperleukocytosis in chronic myelogenous leukemia (CML). Therapeutic leukapheresis usually indicated in acute myelogenous leukemia with over 100,000/mm3 of white blood cell, leukocyte infiltration and leukostasis with over 100,000/mm3 of white blood cell, and hairy cell leukemia with no response to drug and splenectomy. Leukapheresis can reverse the hyperleukocytic syndrome rapidly, be used immediately without having to wait for the result of allopurinol to reduce the risk of uric acid nephropathy and decrease the tumor cell mass so as to minimize the extent of cytolysis- induced hyperuricemia, hyperkalemia and hyperphosphatemia. We report a case of 56-year-old man presented right lower leg pain, gait disturbance who was diagnosed CML 4 years before. He showed right popliteal artery obstruction in doppler sonogram and immediatly started leukapheresis. After two therapeutic leukapheresis, symptoms were improved and popliteal blood flow was improved by follow-up doppler sonogram. As a result, we consider that leukapheresis without use of anticoagulant or thrombolytic agents is effective therapy in CML associated leukocytosis and vascular obstruction.
Allopurinol ; Arteries* ; Cell Count ; Fibrinolytic Agents ; Follow-Up Studies ; Gait ; Humans ; Hydroxyurea* ; Hyperkalemia ; Hyperphosphatemia ; Hyperuricemia ; Leg* ; Leukapheresis* ; Leukemia, Hairy Cell ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Leukemia, Myeloid, Acute ; Leukocytes ; Leukocytosis ; Leukostasis ; Middle Aged ; Popliteal Artery ; Splenectomy ; Uric Acid

No abstract available.
Lung Neoplasms* ; Lung* ; Lymph Nodes* ; Needles*

The Truncus arteriosus is a congenital malformation in which only one great artery arises from the base of the heart and gives origin to the systemic, pulmonary and coronary arteries proximal to the aortic arch. Pulmonary blood flow is governed by the size of the pulmonary arteries and the pulmonary vascular resistance. In infancy, pulmonary blood flow is usually excessive because pulmonary vascular resistance is not greatly increased. Thus, despite an obligatory admixture of systemic and pulmonary venous blood in the common trunk, only minimal cyanosis is present. Rarely pulmonary blood blood flow is restricted by hypoplastic or stenotic pulmonary arteries arising from the truncus. The prognosis in persistent truncus arteriosus is very poor. the median age of survival of the 94 patients with the disease reported up to 1962 was only five weeks. The longest survival reported is the case of the man described by Carr et al who lived to the age of 36 years and 2 months. We report the case of a man with persistent truncus arteriosus who lives to the age of 29 years.
Aorta, Thoracic ; Arteries ; Coronary Vessels ; Cyanosis ; Heart ; Humans ; Prognosis ; Pulmonary Artery ; Truncus Arteriosus ; Truncus Arteriosus, Persistent* ; Vascular Resistance

Recent studies have demonstrated that human periodontal ligament cells express receptor activation of nuclear factor kappaB ligand (RANKL) which enhances the bone resorbing activity of osteoclasts differentiated from hematopoietic preosteoclasts. The purpose of this study is to determine the effects of p38 MAPK and JNK kinase upon regulating RANKL and OPG in response to IL-1beta(1 ng/ml) in rat periodontal ligament cells. Soluble RANKL was measured by immunoassay. The effects of p38 MAPK on RANKL and OPG expression was determined by RT-PCR. The results were as follows: 1. Periodontal ligament cells which stimulated by IL-1beta increased soluble RANKL synthesis by dose-dependent pattern. 2. p38 MAP kinase inhibitor (SB203580) showed regulation of soluble RANKL expression by dose-dependent manners. 3. p38 MAP kinase inhibitor (SB203580) regulated the expression of RANKL, but it dose regulate the expresseion of OPG. 4. JNK (c-jun NH2-terminal kinase) inhibitor (PD98059) did not regulate mRANKL and mOPG. These results suggested that p38 MAPK play a significant role in RANKL gene expression.
Animals ; Gene Expression ; Humans ; Immunoassay ; MAP Kinase Kinase 4 ; Osteoclasts ; p38 Mitogen-Activated Protein Kinases* ; Periodontal Ligament* ; Rats*

Respiratory infections, which are caused by airborne pathogens, are the most common disease of all ages worldwide. This study was conducted to characterize the airborne respiratory pathogens in the public facilities in Busan, South Korea. A total of 260 public facilities were investigated in 2017, 52 seasonal indoor air from 2 hospitals and 208 indoor air samples from 208 randomly selected daycare centers. Among respiratory pathogen, 8 viral pathogens including human adenovirus (HAdV), human bocavirus (HBoV), human rhinovirus (HRV), human parainfluenza virus (HPIV), human respiratory syncytial virus (HRSV), human metapneumovirus (HMPV), human coronavirus (HCoV) and influenza virus (IFV), and 3 bacterial pathogens including Mycoplasma pneumoniae, Bordetella pertussis, and Chlamydophila pneumoniae, were investigated by multiplex real-time reverse transcription polymerase chain reaction. Pathogens were detected in 9 cases (3.4%). Among 9 positive samples, 6 (2.3%) cases were positive for HBoV and 3 (1.2%) cases were positive for IFV. All the positive cases were detected in daycare centers. Additionally, the concentration of HBoV was determined. In HBoV-positive samples, the cycle threshold (Ct) values of HBoV were 29.73~36.84, which are corresponding to the viral concentration of 4.91 × 10⁰ ~ 9.57 × 10² copies/ml. Serotype distribution of isolated HBoV was analyzed by sequencing of VP1/VP2 gene. All of the HBoV isolates were identified as HBoV type 1 with a high similarity among the isolates (>97%). No bacterial pathogen was identified in indoor air samples. Although virus concentration was not high in public facilities (daycare center), the presence of respiratory viral pathogens has been identified. Effective ventilation and air purification strategies are needed to reduce the indoor concentration of respiratory pathogens. A long-term and ongoing surveillance plan for respiratory pathogen management should be established.
Adenoviruses, Human ; Bordetella pertussis ; Busan ; Chlamydial Pneumonia ; Chlamydophila pneumoniae ; Coronavirus ; Human bocavirus ; Humans ; Korea ; Metapneumovirus ; Mycoplasma pneumoniae ; Orthomyxoviridae ; Paramyxoviridae Infections ; Pneumonia, Mycoplasma ; Polymerase Chain Reaction ; Public Facilities* ; Respiratory Syncytial Virus, Human ; Respiratory Tract Infections ; Reverse Transcription ; Rhinovirus ; Seasons ; Serogroup ; Ventilation

Benign intracranial hypertension (BIH) is very rare and its cause is unclear. Raised intracranial pressure in the absence of an intracranial mass or hydrocephalus (BIH or pseudotumor cerebri) has been described in association with many conditions including SLE. Several pathogenic pathways tie BIH with SLE as thrombotic obliteration of cerebral arteriolar and venous systems and immune complex deposition within the arachnoid villi that are responsible for cerebrospinal fluid (CSF) absorption. The diagnosis of BIH was confirmed by increased intracranial pressure in the absence of any abnormal radiological findings of the brain. We report a young woman with SLE and autoimmune thrombocytopenia complicated by BIH which resolved with corticosteroid therapy and osmotic diuretics.
Absorption ; Antigen-Antibody Complex ; Arachnoid ; Brain ; Cerebrospinal Fluid ; Diagnosis ; Diuretics, Osmotic ; Female ; Humans ; Hydrocephalus ; Intracranial Pressure ; Lupus Erythematosus, Systemic* ; Pseudotumor Cerebri* ; Purpura, Thrombocytopenic, Idiopathic