Pneumobilia almost always indicates an abnormal communication between the biliary and gastrointestinal systems. Air may occasionally enter the biliary tract in a retrograde fashion through the papilla. Transient incompetence of the sphincter of Oddi, which is produced by the passage of small biliary stones, is one rare mechanism that can explain pneumobilia. We present here a case of spontaneous pneumobilia after sphincter disruption that was presumably caused by the passage of biliary stone. A 37-year-old woman visited our hospital with the symptom of right upper quadrant pain. The pain subsided after she had an episode of severe vomiting. Plain abdominal radiography revealed that air filled the branches of the hepatic ducts, and the common bile duct had a large filling defect. We also include a review of the related literature.
Adult ; Biliary Tract ; Common Bile Duct ; Female ; Hepatic Duct, Common ; Humans ; Radiography, Abdominal ; Sphincter of Oddi ; Vomiting

The drug reaction with eosinophilia and systemic symptom (DRESS) syndrome is a severe adverse drug-induced reaction which includes a severe skin eruption, fever, hematologic abnormalities (eosinophilia or atypical lymphocytes) and internal organ involvement. The most frequently reported drug was anticonvulsants. The diagnosis of DRESS syndrome is challenging because the pattern of cutaneous eruption and the types of organs involved are various. The treatments for DRESS syndrome are culprit drug withdrawal and corticosteroids. Here we report a 71-year-old man with skin eruption with eosinophilia and hepatic and renal involvement that appeared 4 weeks after he had taken anti-tuberculosis drugs (isoniazid, ethambutol, rifampicin, and pyrazinamide), and resolved after stopping anti-tuberculosis drugs and the administration of systemic corticosteroids. DRESS recurred after re-challenging isoniazid, we identified isoniazid was causative drug.
Adrenal Cortex Hormones ; Aged ; Anticonvulsants ; Diagnosis ; Drug Hypersensitivity Syndrome ; Eosinophilia* ; Ethambutol ; Fever ; Humans ; Isoniazid* ; Rifampin ; Skin ; Tuberculosis

There have been several reported cases of acute lymphoblastic leukemia with severe lactic acidosis in adults. In these cases, kidney and liver enlargement that was caused by leukemic infiltration frequently accompanied the acute lymphoblastic leukemia and severe lactic acidosis. Chemotherapy is the only treatment that can rapidly correct the lactic acidosis and normalize the liver and kidney enlargement. We report here on a case of acute lymphoblastic leukemia that was accompanied with severe lactic acidosis and kidney enlargement.
Acidosis, Lactic ; Adult ; Humans ; Kidney ; Leukemic Infiltration ; Liver ; Precursor Cell Lymphoblastic Leukemia-Lymphoma

BACKGROUND/AIMS: The purpose of this study was to evaluate the clinicopathologic characteristics of colon cancers detected at the SOK Sokpeynhan Internal Medical Network, a nationwide system of primary health care institutions. METHODS: We analyzed 579 colon cancer patients diagnosed using colonoscopy at the SOK network from January 2011 through December 2012. Cancers from the rectum to the splenic flexure were classified as left colon cancer. Patients over 65 were classified as senior. RESULTS: The mean age (+/-SD) of subjects was 60.9+/-10.5 years and 61.1% were men. More than one quarter (28.2%) of patients were asymptomatic. The prevalence of left colon cancer was higher (77.9%) than that for right colon cancer. The most frequent macroscopic and histologic types were depressed (58.9%) and moderately differentiated adenocarcinoma (52.2%), respectively. Asymptomatic subjects displayed protruding or well differentiated adenocarcinoma, while symptomatic patients were more likely to display depressed or moderately differentiated adenocarcinoma (P<0.05). The mean age of the right colon cancer group was higher than that for the left colon cancer group (P<0.05). Among symptomatic patients, the most frequent symptoms were bloody stool for patients with left colon cancer and abdominal discomfort for patients with right colon cancer (P<0.05). The prevalence of depressed cancer was higher in older subjects as compared to younger subjects (P<0.05). The prevalence of right colon cancer tended to increase with age, although this difference did not achieve statistical significance (P>0.05). CONCLUSIONS: Study results indicated an increase of colon cancer amongst younger demographics in recent years. The effectiveness of colonoscopy screening was also evident, as asymptomatic patients demonstrated frequent findings of well differentiated adenocarcinomas. Study results also suggested a need for closer examination of older patients, as right colon cancer tended to increase with age.
Adenocarcinoma ; Colon, Transverse ; Colonic Neoplasms* ; Colonoscopy ; Demography ; Humans ; Male ; Mass Screening ; Population Characteristics ; Prevalence ; Primary Health Care* ; Rectum

PURPOSE: Although the role of the estrogen receptor alpha (ER alpha, previously called the estrogen receptor) in breast cancer is well established, that of the second human estrogen receptor (ER), estrogen receptor beta (ER beta), remains uncertain. The expression of cyclooxygenase II (COX II) could also be regulated by sex steroids such as estrogen and progesterone. To investigate whether the expressions of the ER beta, ER alpha, and COX II are elevated in more aggressive breast cancers, the expression of the ER beta was studied by immunohistochemical staining in 20 primary breast cancer and original breast cancer tissues from 20 recurrent cancer patients, and its associations with ER alpha and cyclooxygenase (COX) II were evaluated. METHODS: Paraffin tissue sections from 40 breast cancers, surgically excised at the Department of Surgery, the Catholic University of Korea. were obtained. The immunohistochemical analysis was conducted on 20 non-recurrent, and 20 recurrent primary breast cancer tissues, using polyclonal antibodies to ER beta, ER alpha, and the corresponding monoclonal antibodies to COX II. RESULTS: Of the 40 patients, 15 (37.5%) were ER beta-positive, 30 (75%) were ER alpha-positive, and 24 (60%) were COX II-positive. The ER bata status was not related to the tumor size or menopausal status, but was related to the nodal status. The stati of ER alpha and COX II were not related to other clinico-pathological factors. The ER beta positivity was significantly more frequent in the study than the control group. (ER beta, p = 0.0222; ER alpha p = 0.1441; COX II, p = 1.00) The presence of ER beta was significantly related to the expression of ER alpha and COX II (p = 0.0455, p = 0.0381, respectively). CONCLUSION: These results suggest that the expression of ER beta is associated with early recurrence in breast cancer and the expression of COX II in the presence of ER beta implies the possibility of prognostic significance.
Antibodies ; Antibodies, Monoclonal ; Breast Neoplasms* ; Breast* ; Estrogen Receptor alpha* ; Estrogen Receptor beta* ; Estrogens* ; Humans ; Korea ; Paraffin ; Progesterone ; Prostaglandin-Endoperoxide Synthases* ; Recurrence ; Steroids

PURPOSE: Although the role of the estrogen receptor alpha (ER alpha, previously called the estrogen receptor) in breast cancer is well established, that of the second human estrogen receptor (ER), estrogen receptor beta (ER beta), remains uncertain. The expression of cyclooxygenase II (COX II) could also be regulated by sex steroids such as estrogen and progesterone. To investigate whether the expressions of the ER beta, ER alpha, and COX II are elevated in more aggressive breast cancers, the expression of the ER beta was studied by immunohistochemical staining in 20 primary breast cancer and original breast cancer tissues from 20 recurrent cancer patients, and its associations with ER alpha and cyclooxygenase (COX) II were evaluated. METHODS: Paraffin tissue sections from 40 breast cancers, surgically excised at the Department of Surgery, the Catholic University of Korea. were obtained. The immunohistochemical analysis was conducted on 20 non-recurrent, and 20 recurrent primary breast cancer tissues, using polyclonal antibodies to ER beta, ER alpha, and the corresponding monoclonal antibodies to COX II. RESULTS: Of the 40 patients, 15 (37.5%) were ER beta-positive, 30 (75%) were ER alpha-positive, and 24 (60%) were COX II-positive. The ER bata status was not related to the tumor size or menopausal status, but was related to the nodal status. The stati of ER alpha and COX II were not related to other clinico-pathological factors. The ER beta positivity was significantly more frequent in the study than the control group. (ER beta, p = 0.0222; ER alpha p = 0.1441; COX II, p = 1.00) The presence of ER beta was significantly related to the expression of ER alpha and COX II (p = 0.0455, p = 0.0381, respectively). CONCLUSION: These results suggest that the expression of ER beta is associated with early recurrence in breast cancer and the expression of COX II in the presence of ER beta implies the possibility of prognostic significance.
Antibodies ; Antibodies, Monoclonal ; Breast Neoplasms* ; Breast* ; Estrogen Receptor alpha* ; Estrogen Receptor beta* ; Estrogens* ; Humans ; Korea ; Paraffin ; Progesterone ; Prostaglandin-Endoperoxide Synthases* ; Recurrence ; Steroids

Alpha-lipoic acid (ALA) is a naturally occurring antioxidant and has been previously used to treat diabetes and cardiovascular disease. However, the autophagy effects of ALA against oxidative stress-induced dopaminergic neuronal cell injury remain unclear. The aim of this study was to investigate the role of ALA in autophagy and apoptosis against oxidative stress in the SH-SY5Y human dopaminergic neuronal cell line. We examined SH-SY5Y phenotypes using the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide assay (cell viability/proliferation), 4′,6-diamidino-2-phenylindole dihydrochloride nuclear staining, Live/Dead cell assay, cellular reactive oxygen species (ROS) assay, immunoblotting, and immunocytochemistry. Our data showed ALA attenuated hydrogen peroxide (H2O2)-induced ROS generation and cell death. ALA effectively suppressed Bax up-regulation and Bcl-2 and BclxL down-regulation. Furthermore, ALA increased the expression of the antioxidant enzyme, heme oxygenase-1. Moreover, the expression of Beclin-1 and LC-3 autophagy biomarkers was decreased by ALA in our cell model. Combined, these data suggest ALA protects human dopaminergic neuronal cells against H2O2-induced cell injury by inhibiting autophagy and apoptosis.

Alpha-lipoic acid (ALA) is a naturally occurring antioxidant and has been previously used to treat diabetes and cardiovascular disease. However, the autophagy effects of ALA against oxidative stress-induced dopaminergic neuronal cell injury remain unclear. The aim of this study was to investigate the role of ALA in autophagy and apoptosis against oxidative stress in the SH-SY5Y human dopaminergic neuronal cell line. We examined SH-SY5Y phenotypes using the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide assay (cell viability/proliferation), 4′,6-diamidino-2-phenylindole dihydrochloride nuclear staining, Live/Dead cell assay, cellular reactive oxygen species (ROS) assay, immunoblotting, and immunocytochemistry. Our data showed ALA attenuated hydrogen peroxide (H2O2)-induced ROS generation and cell death. ALA effectively suppressed Bax up-regulation and Bcl-2 and BclxL down-regulation. Furthermore, ALA increased the expression of the antioxidant enzyme, heme oxygenase-1. Moreover, the expression of Beclin-1 and LC-3 autophagy biomarkers was decreased by ALA in our cell model. Combined, these data suggest ALA protects human dopaminergic neuronal cells against H2O2-induced cell injury by inhibiting autophagy and apoptosis.

Patients with hemophilia generally have a reduced frequency of coronary artery disease compared to the general population. As advances in the management of hemophilia have increased their life expectancy, the prevalence of coronary artery disease also has increased. However, there are no standard treatment guidelines for coronary artery disease in patients with hemophilia, especially in the field of coronary intervention. We report the case of a patient with severe hemophilia A who presented with acute coronary syndrome and was successfully treated with percutaneous coronary intervention.
Acute Coronary Syndrome ; Angioplasty ; Coronary Artery Disease ; Hemophilia A ; Humans ; Life Expectancy ; Percutaneous Coronary Intervention ; Prevalence

BACKGROUND AND OBJECTIVES: A higher neutrophil to lymphocyte ratio (NLR) has been associated with poor clinical outcomes in various cardiac diseases. However, the clinical availability of NLR in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) has not been known. We evaluated the availability of NLR to predict clinical outcomes in patients with STEMI undergoing primary PCI. SUBJECTS AND METHODS: We analyzed 326 consecutive STEMI patients treated with primary PCI. The patients were divided into tertiles according to NLR: NLR< or =3.30 (n=108), 3.316.53 (n=110). We evaluated the incidence of major adverse cardiac events (MACE), a composite of all causes of death, non-fatal MI, and ischemic stroke at the 12-month follow-up. RESULTS: The high NLR group was associated with a significantly higher rate of 12-month MACE (19.1% vs. 3.7%, p<0.001), 12-month death (18.2% vs. 2.8%, p<0.001), in-hospital MACE (12.7% vs. 2.8%, p=0.010) and in-hospital death (12.7% vs. 1.9%, p=0.003) compared to the low NLR group. In the multivariable model, high NLR was an independent predictor of 12-month MACE {hazard ratio (HR) 3.33 (1.09-10.16), p=0.035} and death {HR 4.10 (1.17-14.46), p=0.028} after adjustment for gender, left ventricular ejection fraction, creatinine clearance, angiographic parameters and factors included in the Thrombolysis in Myocardial Infarction risk score for STEMI. There was a significant gradient of 12-month MACE across the NLR tertiles with a markedly increased MACE hazard in the high NLR group (log rank test p=0.002). CONCLUSION: The NLR is a useful marker to predict 12-month MACE and death in patients with STEMI who have undergone primary PCI.
Cause of Death ; Creatinine ; Heart Diseases ; Humans ; Incidence ; Lymphocytes ; Myocardial Infarction ; Neutrophils ; Percutaneous Coronary Intervention ; Stroke ; Stroke Volume