Fiberoptic bronchoscopy is a valuable diagnostic and therapeutic procedure in many clinical situations and is relatively simple to perform with proper technique. Local anesthetic technique is often preferable to general anesthesia for bronchoscopies since these examinations are mostly undertaken as outpatient procedures. Inhaled topical lidocaine, used to produce anesthesia of the repiratory tract prior to bronchoscopy, may cause anaphylactoid reaction in patients. However lidocaine hypersensitivity reaction is uncommon. We report the case of death due to hypersensitivity to topical lidocaine spray given during routine premedication for this procedure. The possibility of bronchospasm secondary to an adverse reaction to premedication or anesthesia must also be considered.
Anaphylaxis* ; Anesthesia* ; Anesthesia, General ; Bronchial Spasm ; Bronchoscopy* ; Humans ; Hypersensitivity ; Lidocaine* ; Outpatients ; Premedication

PURPOSE: High-fat (HF) feeding induces hypothalamic leptin resistance via the activation of toll-like receptor 4 (TLR4). TLR4 deficiency confers resistance to diet-induced obesity. Udenafil, an anti-impotence drug, inhibits TLR4 in airway epithelial cells in vitro. In this study, we evaluated whether udenafil suppressed the hypothalamic expression of TLR4 and reduced body weight. MATERIALS AND METHODS: The hypothalamic expression of TLR4, phosphodiesterase 5 (PDE5), nuclear factor-κB (NF-κB), and myeloid differentiation primary response gene 88 (Myd88) was analyzed by real-time polymerase chain reaction after treating mice for 2 days with udenafil (0, 12, 120, or 600 µg/d). Furthermore, the hypothalamic expression of TLR4, pro-opiomelanocortin (POMC), and neuropeptide Y (NPY) was analyzed after 9 days' treatment with udenafil and/or leptin. We also measured body weight and food intake following 9 days of udenafil and/or leptin treatment in control- and HF-fed mice. RESULTS: Udenafil suppressed hypothalamic TLR4 mRNA expression dose-dependently. The changes were associated with decreased PDE5, NF-κB, and Myd88 expression. Udenafil treatment for 9 days reduced body weight and caloric intake in HF-fed mice. This may have been associated with the suppression of NPY expression that was elevated by HF feeding. POMC expression was not affected by udenafil. However, udenafil did not augment the effects of leptin on the reduction of body weight and caloric intake in HF-fed mice. CONCLUSIONS: These results suggested that udenafil reduced body weight by suppressing hypothalamic TLR4 mRNA expression in HF-fed mice and the combination effect of udenafil and leptin was additive rather than synergistic.
Animals ; Body Weight ; Cyclic Nucleotide Phosphodiesterases, Type 5 ; Eating ; Energy Intake ; Epithelial Cells ; Hypothalamus ; In Vitro Techniques ; Leptin ; Mice ; Neuropeptide Y ; Obesity ; Pro-Opiomelanocortin ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Toll-Like Receptor 4 ; Toll-Like Receptors

To evaluate the disturbed left ventricular diastolic filling by pulsed Doppler echocardiography in patients with ischemic heart disease who have normal systolic function, 117 subjects (50 angina patients with, 39 myocardial infarction patients with, 28 control subjects without significant coronary arterial narrowing) underwent echocardiographic examination one day before coronary arteriography. Beside analyzing trasmitral flow velocity curve, reconstruction and quantitative analysis of left ventricular filling rate and filling volume curves were made from Doppler trasmitral flow velocity curve, 2-Dimensional mitral annulus diameter and M-Mode mitral valve motion. From reconstructed left ventricular filling rate, filling fraction during early rapid filling or half diastolic rate, ratio of early to atrial peak filling rate, filling fraction during early rapid filling or half diastolic period and diastolic time interval(esp. T1/2 from peak early filling rate to its half valve)were measured. Angina and myocardial infarction group had significantly lower normalized peak early filling rate(4.9+/-0.6, 4.8+/-1.2 vs 6.0+/-1.1 DFV/sec, P<0.005), ratio of early to atrial peak filling rate(103.6+/-29. 4120.6+/-3.5 VS 175.5+/-55.0%, P<0.005), filling fraction during early diastolic period(46.2+/-5.0, 44.4+/-12.6 VS 54.3+/-6.8%, P<0.005) and filling fraction during half diastolic period(56.3+/-5.8, 55.4+/-14.1 VS 66.6+/-7.7%, P<0.005) than those of control group. Angina and myocardial infarction group had significantly higher normalized peak atrial filling rate(4.9+/-1.4, 5.0+/-2.0 VS 3.5+/-0.9 DFV/sec, P<0.005), prologed normalized T1/2 (12.5+/-3.0, 12.0+/-4.0 VS 9.8+/-2.2%, P<0.005) and delayed isovolumic relaxation time(81.7+/-7.8, 95.0+/-13.6 VS 74.3+/-6.9msec, P<0.005) than those of control group. Affecting factors to pseudonormalize left ventricular filling rate and filling volume curves in myocardial infarction group were mitral regurgitation, left ventricular aneurysm and severe impairment of systolic function. In 13 angina group patients who had undergone coronary angioplasty, no difference were found in any noninvasive diastolic filling parameters before and immediately(24 hours and 5 days) after the procedure. Thus, abnormal patterns of left ventricular filling occur in patients with ischemic heart disease and near normal global systolic function. The decreased peak early filling rate and early filling fraction occuring during rapid filling and the increased peak atrial filling rate occuring in late diastolic suggest that the patients with ischemic heart disease have impaired early diastolic filling. These diastolic filling abnormalities are unimproved 24 hour and 5 days after succesful coronary angioplasty. These diastolic filling parameters from left ventricular filling rate and filling volume curves provide useful noninvastive hemodynamic indices for assessment of left ventricular diastolic filling in patients with ischemic heart disease.
Aneurysm ; Angiography ; Angioplasty ; Echocardiography ; Echocardiography, Doppler* ; Echocardiography, Doppler, Pulsed ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Insufficiency ; Myocardial Infarction ; Myocardial Ischemia* ; Relaxation

Phospholipase C (PLC) plays a role in ligand-mediated signal transduction for cellular activity such as proliferation and differentiation. A recent observation that PLC- gamma1 is highly expressed in some kinds of human cancer tissue supports the view that PLC-gamma1 may be involved in proliferation and carcinogenesis. PLC-gamma2 is known to be involved in B cell differentiation and maturation. However, there have been few studies about the expressions of PLC-gamma1 and gamma2 in human lymphoid malignancy. In the present study, we examined the contents of PLC-gamma1 and gamma2 in 10 cases of B cell, 10 cases of T cell non-Hodgkin's lymphoma and 5 cases of Hodgkin's lymphoma to find out whether these enzymes play any role in the carcinogenesis by immunohistochemistry and immunoprecipitation. Immunoprecipitation analysis revealed that in contrast to increased expression of PLC-gamma2 only in B cell lymphoma, a considerably higher level of PLC-gamma1 was detected in both B and T cell lymphoma. Immunohistochemical finding confirmed this observation. PLC-gamma1 and PLC-gamma2 were expressed in the cytoplasm of most tumor cells. PLC-gamma2 was also expressed in mature B cells, while PLC-gamma1 was not expressed in reactive non-tumor cells. These results suggest that PLC-gamma1 mediated signal transduction implicates a significant role in the carcinogenesis of all types of lymphoid tissue, and PLC-gamma2 may play a role in the carcinogenesis of B cell lymphoma as well as B cell differentiation.
B-Lymphocytes ; Carcinogenesis ; Cell Differentiation ; Cytoplasm ; Hodgkin Disease* ; Humans ; Immunohistochemistry ; Immunoprecipitation ; Lymphoid Tissue ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin ; Lymphoma, T-Cell ; Phospholipases* ; Signal Transduction ; Type C Phospholipases

We report a case of unusual bronchopulmonary foregut malformation composed of a mediastinal bronchogenic cyst with sequestrated lung tissue and communicating tubular esophageal duplication associated with complete pericardial defect. A 18-yrold man, who had suffered from dry cough and mild dyspnea, was admitted because of an incidentally detected chest mass. A computed tomography scan demonstrated a cystic mass with an air fluid level connected with esophagus in the middle mediastinum. The surgically resected mass was a pleural invested accessory lobe of the lung (8.0x7.0x4.5 cm) connected with the esophageal wall by a tubular structure (3.0 cm in length and 2.0 cm in diameter). A complete left pericardial defect was also identified. Histologically, the cystic wall was composed of fibrovascular connective tissue with a smooth muscle layer, mixed seromucous glands and cartilage, and the inner surface of the cyst was lined by ciliated pseudostratified columnar epithelium. The inner surface of the tubular structure was lined by non-keratinizing or keratinizing squamous epithelium, and the wall contained submucosal mucous glands, muscularis mucosa, and duplicated muscularis propria. This case is important in understanding the embryological pathogenesis of the variable spectrum of the bronchopulmonary foregut malformation.
Adolescent ; Bronchogenic Cyst/*complications/*diagnosis ; Digestive System/pathology ; Esophageal Cyst/diagnosis/pathology ; Esophageal Diseases/*complications/*diagnosis ; Esophagus/abnormalities/*pathology ; Humans ; Lung/abnormalities/pathology ; Male ; Pericardium/pathology ; Tomography, X-Ray Computed

PURPOSE: The aim of this study was to define the capsules of synchronous multicentric small hepatocellular carcinomas (HCCs) with use of high-frequency intraoperative ultrasonography (IOUS). METHODS: Among the 131 consecutive patients undergoing hepatic resection and high-frequency IOUS for HCC, 16 synchronous multicentric small HCCs in 13 patients were histologically diagnosed in the resected specimens. High-frequency IOUS and pathologic findings of these lesions were compared, with particular focus on the presence and appearance of the capsule in or around each lesion. RESULTS: Synchronous multicentric small HCCs were pathologically classified into distinctly nodular (n=12) or vaguely nodular (n=4) types. All 12 distinctly nodular HCCs including six subcentimeter lesions showed detectable capsules on high-frequency IOUS and pathology. The capsules appeared as a hypoechoic rim containing hyperechoic foci (n=6), hypoechoic rim (n=5), or hyperechoic rim (n=1) with varying degrees of coverage around each lesion. Histologically, the capsules were composed of a combination of one to four layers consisting of a fibrous capsule, peritumoral fibrosis, prominent small vessels, and entrapped hepatic parenchyma. CONCLUSION: Synchronous multicentric small HCCs with distinctly nodular type, even at subcentimeter size, can show capsules with varying coverage and diverse echogenicity on high-frequency IOUS.
Capsules ; Carcinoma, Hepatocellular* ; Fibrosis ; Humans ; Liver Neoplasms ; Pathology ; Ultrasonography*

PURPOSE: This clinical research was performed to determine the safety of laparoscopic appendectomy using a 5 mm scope by comparing the outcomes with open appendectomy. METHOD: We examined the medical records of 441 patients that underwent either laparoscopic appendectomy (LA) or open appendectomy (OA) from March 2005 to August 2007. We retrospectively reviewed the clinical data and compared: age, gender, days of hospitalization, operation time, time to oraldiet, complications, and readmission, between the LA and OA groups. RESULTS: Among the 441 patients that were diagnosed with appendicitis, LA was attempted in 332 patients; 325 (73.7%) of them received the procedure. One hundred-nine patients (24.7%) received an OA. There were no differences in operation time (p=0.072), length of hospitalization, and complication or re-admission rates; however the time to oral diet (p=0.025) was earlier in patients in the LA group. There were no differences in the outcomes of patients that had an uncomplicated appendicitis and received LA or OA; however patients diagnosed with complicated appendicitis had a shorter length of hospitalization after a LA compared to those that had an OA (p=0.03). CONCLUSION: There was no difference in safety between the laparoscopic appendectomy using a 5 mm scope and an open appendectomy. Laparoscopic appendectomy using a 5 mm scope provided a better cosmetic outcome.
Appendectomy ; Appendicitis ; Cosmetics ; Diet ; Hospitalization ; Humans ; Medical Records ; Retrospective Studies

A laparoscopic cholecystectomy is the gold standard for symptomatic gallbladder stones. Reports of a pseudoaneurysm following a cholecystectomy have recently increased. Herein, the case of a 36-year-old man, who had an unusual complication following a routine laparoscopic cholecystectomy for gallbladder stones, is reported. On postoperative day 6, the patient was readmitted via the emergency room with severe abdominal pain and right shoulder pain. A selective hepatic angiography revealed a pseudoaneurysm of the branch of the right hepatic artery, which was treated with transarterial embolization. A pseudoaneurysm is an uncommon complication of a laparoscopic cholecystectomy. If any suspicion of a pseudoaneurysm is presented, prompt attention and angiography are necessary, as the condition can cause life-threatening bleeding.
Abdominal Pain ; Adult ; Aneurysm, False* ; Angiography ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Emergency Service, Hospital ; Gallbladder ; Hemorrhage ; Hepatic Artery* ; Humans ; Shoulder Pain

Low grade MALT lymphoma of stomach is associated with H. pylori infection in more than 90% of cases, and eradication of H. pylori leads to regression of the low grade MALT lymphoma in 60~90% of cases. On the contrary, high grade MALT lymphoma is thought to be independent from H. pylori for growth and usually is thought to require antitumor chemotherapy. However, there have been recent reports of high grade MALT lymphoma regressing after H. pylori eradication. We experienced and are reporting a case of high grade MALT lymphoma arising in the background of low grade MALT lymphoma that showed complete regression after H. pylori eradication.
Drug Therapy ; Helicobacter pylori* ; Helicobacter* ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Stomach

We report two cases of gingival plasma cell granuloma in a 34-yr-old and 40-yr-old two male renal transplant recipients with cyclosporine A (CsA)-induced gingival overgrowth (GO). Histologically, these lesions were composed of mature plasma cells, showing polyclonality for both lambda and kappa light chains and fibrovascular connective tissue stroma. In addition to the fact that CsA-induced plasma cell granuloma is rare, the salient features of our cases were the secretion of interleukin-6 and overexpression of phospholipase C-gamma1 of the tumor cells, which may explain the mechanisms of CsA- induced GO.
Cyclosporine/adverse effects ; Female ; Gingival Diseases/*chemically induced/enzymology/immunology/pathology ; Granuloma, Plasma Cell/*chemically induced/enzymology/immunology/pathology ; Humans ; Immunohistochemistry ; Immunosuppressive Agents/adverse effects ; Interleukin-6/metabolism ; Kidney Transplantation ; Male ; Middle Aged ; Phospholipase C gamma ; Type C Phospholipases/metabolism