Infection of hepatic cyst is a serious complication of autosomal dominant polycystic kidney disease (ADPKD). Early diagnosis of infected cyst is crucial and usually requires conventional modalities, including ultrasound and computed tomography. However, their contribution is limited because of nonspecific results. We report a case of hepatic cyst infection for which 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) scan allowed the exact localization of the infected cyst and the precise drainage procedure. A 48-year-old woman with ADPKD presented with fever and RUQ pain. Contrast enhanced computed tomography did not show any evidence of complicated or infected cysts in both kidneys and liver. Though she had been treated by antibiotics for 7 days, patient's symptoms were not improved. However, 18F-FDG PET-CT scan revealed infected cyst in the left lobe of liver exactly. After percutaneous drainage based on 18F-FDG PET-CT imaging, the hepatic cyst infection was controlled. Therefore, 18F-FDG PET-CT imaging could be a valuable tool to identify the exact localization of cyst infection, which may contribute to drain the infected cyst. We report this case with a brief review of relevant literature.
Anti-Bacterial Agents ; Drainage ; Early Diagnosis ; Electrons ; Female ; Fever ; Fluorodeoxyglucose F18 ; Humans ; Kidney ; Liver ; Middle Aged ; Polycystic Kidney Diseases ; Polycystic Kidney, Autosomal Dominant ; Positron-Emission Tomography

BACKGROUND AND PURPOSE: Elevated plasma total homocysteine (tHcy) levels are reported to be associated with an increased risk of Alzheimer's disease (AD). However, the mechanism by which homocysteine contributes to the pathogenesis of AD is as yet unknown. The aim of this study was to elucidate the relationship between white matter changes (WMC) and medial temporal lobe atrophy (MTA) on brain magnetic resonance imaging (MRI), and plasma levels of tHcy in AD patients. METHODS: Seventy-two patients with a clinical diagnosis of probable AD were recruited to the study. Plasma tHcy levels, vascular risk factors, and WMC and MTA on brain MRI were evaluated in all patients. The AD patients were classified into two groups: those with no or minimal WMC (69.2+/-8.8 years, mean+/-SD, n=36) and those with moderate-to-severe WMC (74.6+/-4.6 years, n=36) on brain MRI. RESULTS: In a univariate logistic regression analysis, the risk of moderate-to-severe WMC in AD was significantly associated with increasing age, female gender, lower education level, hypertension, high plasma tHcy levels, and lower Mini-Mental State Examination (MMSE) score. Multivariate logistic regression analysis revealed only high plasma tHcy as the independent and significant risk factor for moderate-to-severe WMC [odds ratio (OR; adjusted for age, gender, education level, MMSE score, and hypertension comparing the top tertile - tHcy levels > or =12.9 micromol/L - with the bottom tertile - tHcy levels < or =9.4 micromol/L)=7.35; 95% confidence interval, confidence interval=1.36-39.84; p=0.02], and age as a borderline significant risk factor (OR=1.08, 95% CI=0.99-1.19, p=0.09) in AD patients. Plasma tHcy levels were not correlated significantly with either right or left MTA. CONCLUSIONS: Our results suggest that the vascular pathway mediates the association between elevated plasma tHcy levels and AD.
Alzheimer Disease ; Atrophy ; Brain ; Female ; Glutamates ; Guanine ; Homocysteine ; Humans ; Hypertension ; Leukoaraiosis ; Logistic Models ; Magnetic Resonance Imaging ; Plasma ; Risk Factors ; Temporal Lobe ; Pemetrexed

BACKGROUND/AIMS: We measured the brachial artery pulse wave velocity (BaPWV) and intima-media thickness (IMT) of the common carotid artery to evaluate atherosclerosis in young women with systemic lupus erythematosus (SLE) and healthy controls. METHODS: Twenty-one premenopausal female patients with SLE and 21 healthy controls were enrolled. The groups were matched for age, sex, ethnicity, and atherosclerosis risk factors. Smokers and those with the atherosclerosis risk factors hypertension and diabetes were excluded from this study. IMT was measured with high-resolution ultrasonography. BaPWV was measured with volume plethysmography. RESULTS: The mean age was 34.20 years in the SLE group and 36.87 years in the healthy controls. The IMT of the right and left common carotid arteries in the SLE group did not differ significantly from that in the healthy controls. The BaPWV was significantly higher in the right (1.40+/-0.26 vs. 1.17+/-0.09 cm/sec, mean+/-SD; p=0.003) and left (1.41+/-0.26 vs. 1.19+/-0.08 cm/sec, p=0.013) arms in the SLE group than in the healthy controls. There were no significant differences in the ankle-brachial pressure index (ABI), body mass index (BMI), C-reactive protein (CRP), total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, lipoprotein a, and homocysteine between the two groups. CONCLUSIONS: The IMT in premenopausal women with SLE was not significantly different from that in healthy controls, while the BaPWV, which reflects arterial stiffness, was significantly higher than in the healthy controls.
Arm ; Atherosclerosis ; Body Mass Index ; Brachial Artery ; C-Reactive Protein ; Carotid Artery, Common ; Cholesterol ; Female ; Homocysteine ; Humans ; Hypertension ; Lipoprotein(a) ; Lipoproteins ; Lupus Erythematosus, Systemic ; Pulse Wave Analysis ; Risk Factors ; Vascular Stiffness

Systemic sclerosis is a chronic, systemic disease that targets the skin, lungs, heart, gastrointestinal tract, kidneys, and musculoskeletal system. Prominent features are vascular damage, immune activation, and the deposition of extravascular matrix. Scleroderma heart disease manifests as myocardial fibrosis. Intermittent spasm of the blood vessels in patients with systemic sclerosis may result in contraction band necrosis, similar to the changes observed in myocardial infarction in patients with atherosclerotic coronary artery disease. Coronary vasospasm has been demonstrated during attacks of cold-induced Raynaud's disease. However, acute myocardial infarction associated with coronary vasospasm in patients with systemic sclerosis has not been reported. We describe a rare case of acute myocardial infarction due to coronary vasospasm associated with systemic sclerosis in a 43-year-old woman who presented with severe chest pain.
Adult ; Blood Vessels ; Chest Pain ; Contracts ; Coronary Artery Disease ; Coronary Vasospasm ; Female ; Fibrosis ; Gastrointestinal Tract ; Heart ; Heart Diseases ; Humans ; Kidney ; Lung ; Musculoskeletal System ; Myocardial Infarction ; Necrosis ; Raynaud Disease ; Scleroderma, Systemic ; Skin ; Spasm

PURPOSE: To compare the variable inflammatory parameters of acute pyelonephritis patients treated with inpatient therapy at 13 hospitals, according to the age and gender distributions. MATERIALS AND MATHODS: A total of 3,544 medical records of patients with confirmed acute pyelonephritis, and admitted to hospital between January 2000 and December 2005, were retrospectively analyzed. RESULTS: The mean age of the patients was 43.2+/-16.2 years old, with a male:female ratio of 1 : 5.1. The average duration of hospital admission was 7.9+/-5.3 days. Underlying diseases were found in 23.0% (749/3,252 patient), largely due to diabetes (35.1%). Radiological abnormal findings were found in 13.7%. The leukocyte count, ratio of segmented form, erythrocyte sedimentation rate (ESR), c-reactive protein, pyuria, positive blood culture, positive urine culture were 11,014+/-5,778/mm(3), 74.8+/-14.5%, 44.0+/-32.0 mm/hr, 12.4+/-9.3mg/dl, 83.9%, 10.5% and 46.7%, respectively. E. coli grow in 79% of the urine culture positive patients. In a comparison of 3 age groups (<40 years, 40-60 years, >61 years), the elderly patients had a greater number of underlying diseases and more pathogens in cultured blood. When divided into males and females, the elderly male patients had more pathogen in cultured urine, but contrary to the male patients, the elderly female patients had elevated leukocyte count and erythrocyte sedimentation rate. Also, the old patient group had more resistance to ampicillin when they had E. coli as the uropathogen (p=0.021). Patients with higher ESR required longer hospital admission periods. CONCLUSIONS: It was found that variable clinical parameters of acute pyelonephritis patients treated with inpatient therapy differed according to both gender and age group in Korea. Therefore, these factors should be taken into account in the treatment plan.
Aged ; Ampicillin ; Blood Sedimentation ; C-Reactive Protein ; Female ; Humans ; Inpatients ; Korea ; Leukocyte Count ; Male ; Medical Records ; Pyelonephritis* ; Pyuria ; Retrospective Studies

Endoscopic treatment of chronic pancreatitis by stent insertion is an accepted procedure, but various complications can be induced, including proximal migration of the stent. Many techniques are used to retrieve proximally migrated, pancreatic stents. We here report a case of a proximally migrated stent into the dorsal duct of a pancreas divisum, which was retrieved endoscopically by using a mini-snare. A 39-year-old female patient had chronic pancreatitis with divisum. A stent was inserted into the dorsal duct to relieve the chronic pain. After two months, sudden epigastric pain developed due to proximal migration of the stent. The pancreatic stent was retrieved successfully with one endoscopic attempt using a mini-snare. The epigastric pain resolved after retrieval of the stent. Our observation is that pancreatic stent migration may cause severe abdominal pain and that endoscopic retrieval is possible.
Abdominal Pain ; Adult ; Chronic Pain ; Female ; Humans ; Pancreas* ; Pancreatitis, Chronic ; Stents*

PURPOSE: Chlormadinone acetate (CMA) therapy for benign prostatic hyperplasia (BPH) may lower the serum prostate specific antigen (PSA) level. However, little is known about the effect of CMA on the total or free serum PSA levels of PSA. Such information would be important since PSA testing is useful for prostate cancer screening. Thus, we prospectively studied the effect of CMA therapy on the total and free serum PSA levels. MATERIALS AND METHODS: The patients with lower urinary tract symptoms (LUTS) and BPH who were aged over 50 years were treated with 50mg CMA for 6 months. Men with a PSA level greater than 10ng/ml were excluded to reduce the likelihood of including cases of occult prostate cancer. Those with suspicious findings on the digital rectal examination and serum PSA testing were biopsied to rule out prostate cancer. alpha- blocking agents were permitted to treat the men with LUTS. Serum levels of the total and free PSA were measured at the study baseline and after approximately 3 and 6 months. The prostate volume (PV) was assessed by transrectal ultrasonography. RESULTS: The analysis included 170 patients with a mean age of 67.9 years, a baseline PV of 47.3ml and a baseline total PSA of 4.1ng/ml. The total PSA levels declined from 4.1ng/ml at baseline to 2.0ng/ml after 6 months of treatment (50.7% decrease, p<0.01). The mean percent free PSA (21% to 22% at baseline) was not significantly altered by CMA treatment. The PSA levels and PV at baseline did not affect the rate of decline of PSA. CONCLUSIONS: The total PSA serum levels decreased by an average of 50% during CMA therapy, but the percent free PSA did not change significantly. This information is potentially useful in the interpretation of the PSA data that's used for early detection of prostate cancer in the men receiving CMA.
Chlormadinone Acetate* ; Digital Rectal Examination ; Humans ; Lower Urinary Tract Symptoms ; Male ; Mass Screening ; Prospective Studies ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Hyperplasia* ; Prostatic Neoplasms ; Ultrasonography

Adenosquamous carcinoma of the papilla of Vater is a rare tumor and only a few cases have been reported so far. Here, we report a case of adenosquamous carcinoma in a 76-year-old male who presented with jaundice and right upper quadrant abdominal pain. Ultrasonography and enhanced abdominal CT scans showed dilated common bile duct (CBD) and intrahepatic bile duct (IHD) with a suspicious obstructing mass in distal CBD. On endoscopy, obstructing and ulcerated mass was noted on the papilla of Vater. Histopathological inspection of the biopsied specimens from mass showed adenosquamous cell carcinoma of the papilla of Vater. Since the patient refused operation, we inserted a self-expandable metallic stent in distal CBD. This is the first case report on adenosquamous carcinoma of the papilla of Vater in Korea.
Aged ; Ampulla of Vater/*pathology ; Carcinoma, Adenosquamous/*diagnosis/pathology/surgery ; Cell Differentiation ; Humans ; Immunohistochemistry ; Male ; Tomography, X-Ray Computed

PURPOSE: Few studies have examined acute prostatitis in Korea. To initiate the investigation of this topic, a multi-center retrospective analysis of acute prostatitis was conducted. MATERIALS AND METHODS: The clinical records of 335 patients from 13 hospitals, diagnosed with acute prostatitis, between January of 1994 and October of 2004, were reviewed. For each patient, the urine culture, changes in the PSA (prostate-specific antigen) value and the prostate volume, the incidence of prostate abscess, the use of antibiotics, and whether the disease went into remission or progressed to chronic prostatitis were analyzed. RESULTS: The mean age of the patients, time from the onset of symptom to admission and number of days of admitted were 54.9+/-15.1 (16-85) years, 2.4+/-3.4 (16-85) days and 7.5+/-3.9 (1-25) days, respectively. The chief symptoms of the patients were high fever, dysuria and urinary frequency. Routine urinalysis found pyuria in 82% and hematuria in 70% of patients. The causative organisms of 43.0% of the patients were cultured, with the chief organisms found to be E. coli (67%) and P. aeruginosa (13%), et al. The mean PSA and prostate volume on initial diagnosis were 24.6+/-30.2ng/ml and 45.8 +/-17.4ml, respectively, and a prostate abscess was found in 4 patients (3.1%). The antibiotics injected during patient admission were: cephalosporin family (68%), aminoglycosides (70%) and quinolone family (43%). An additional alpha blocker was used in 49% of cases. Oral quinolone (91%), cephalosporin (9%) and alpha blocker (44%) were prescribed for a mean 32.5 (2-180) days after discharge. 259 (77%) of the patients were available for follow-up. Of these, 21% took antibiotics over an 8 week treatment period, and 8% over a 12 week period. The disappearance of pyuria after treatment was observed in a mean of 13 days after the end of treatment. After 13 weeks of treatment, 11 (50%) of the 22 patients who received prostate massage (4.2% of all follow up patients) were found to have chronic prostatitis. The mean PSA and prostate volume declined during follow up, to 6.13+/-10.38ng/ml and 37.5+/-13.5ml, respectively. CONCLUSIONS: In our study, the most common chief symptom of acute prostatitis was a high fever, with the most common causative organism being E. coli. Patients were admitted for approximately one week, and treated with antibiotic for about one month, after which time PSA elevation was observed in 80% of patients. Although all acute prostatitis patients were treated with proper antibiotics, progression to chronic prostatitis was observed in 4.2% of patients.
Abscess ; Aminoglycosides ; Anti-Bacterial Agents ; Diagnosis ; Dysuria ; Fever ; Follow-Up Studies ; Hematuria ; Humans ; Incidence ; Korea ; Massage ; Patient Admission ; Prostate ; Prostate-Specific Antigen ; Prostatitis* ; Pyuria ; Retrospective Studies ; Urinalysis

Anesthesia, Local ; Bite Force ; Dental Implants ; Epistaxis ; Humans ; Mandible ; Maxilla ; Maxillary Sinus ; Maxillary Sinusitis ; Molar ; Oroantral Fistula ; Osteotomy ; Recurrence ; Splints ; Tooth