Endothelial cells are a vital constituent of most mammalian organs and are required to maintain the integrity of these tissues. These cells also play a major role in angiogenesis, inflammatory reactions, and in the regulation of thrombosis. Angiogenesis facilitates pulp formation and produces the vessels which are essential for the maintenance of tooth homeostasis. These vessels can also be used in bone and tissue regeneration, and in surgical procedures to place implants or to remove cancerous tissue. Furthermore, endothelial cell regeneration is the most critical component of the tooth generation process. The aim of the present study was to stimulate endothelial regeneration at a site of acute cyclophosphamide (CP)-induced endothelial injury by treatment with human umbilical cord-derived endothelial/mesenchymal stem cells (hEPCs). We randomly assigned 16 to 20-week-old female NOD/SCID mice into three separate groups, a hEPC (1 x 10(5) cells) transplanted, 300mg/kg CP treated and saline (control) group. The mice were sacrificed on days 5 and 10 and blood was collected via the abdominal aorta for analysis. The alanine transaminase (ALT), aspartate aminotransferase (AST), serum alkaline phosphatase (s-ALP), and albumin (ALB) levels were then evaluated. Tissue sections from the livers and kidneys were stained with hematoxylin and eosin (HE) for microscopic analysis and were subjected to immunohistochemistry to evaluate any changes in the endothelial layer. CP treatment caused a weight reduction after one day. The kidney/body weight ratio increased in the hEPC treated animals compared with the CP only group at 10 days. Moreover, hEPC treatment resulted in reduced s-ALP, AST, ALT levels compared with the CP only group at 10 days. The CP only animals further showed endothelial injuries at five days which were recovered by hEPC treatment at 10 days. The number of CD31-positive cells was increased by hEPC treatment at both 5 and 10 days. In conclusion, the CP-induced disruption of endothelial cells is recovered by hEPC treatment, indicating that hEPC transplantation has potential benefits in the treatment of endothelial damage.
Alanine Transaminase ; Alkaline Phosphatase ; Animals ; Aorta, Abdominal ; Aspartate Aminotransferases ; Blood Vessels ; Cyclophosphamide ; Endothelial Cells ; Eosine Yellowish-(YS) ; Female ; Glycosaminoglycans ; Hematoxylin ; Homeostasis ; Humans ; Hypogonadism ; Immunohistochemistry ; Kidney ; Liver ; Mice ; Mitochondrial Diseases ; Ophthalmoplegia ; Regeneration ; Stem Cell Transplantation ; Stem Cells ; Thrombosis ; Tooth ; Transplants ; Weight Loss

BACKGROUND: Patients with ventilator-associated pneumonia (VAP) in intensive care unit (ICU) have a high mortality rate. The routine surveillance cultures obtained previously or an ATS guideline for hospital-acquired pneumonia was used in selecting initial antimicrobials. The object of this study was to compare the respiratory samples before VAP and bronchoalveolar lavage (BAL) culture. METHODS: 54 patients underwent fiberoptic bronchoscopy to obtain BAL samples. We reviewed microbiologic specimen results of prior respiratory specimens (pre-VAP) and BAL. RESULTS: Among 51 patients with 54 VAP episodes, 52 microorganisms of pre-VAP and 56 BAL samples were isolated. Pre-VAP included 21.2% of MRSA, and 32.6% of multidrug resistant-Acinetobacter baumannii (MDR-AB). BAL samples comprised 25.0% of MRSA, 26.7% of MDR-AB, 14.3% of Stenotrophomonas maltophilia and 3.6% of Klebsiella pneumonia in order. In pre-VAP samples compared to BAL samples, only 35.2% were identical. In BAL samples compared to pre-VAP samples obtained in 5 days before the onset of VAP, only 43.6% were identical. However, among BAL samples compared to pre-VAP samples obtained after more than 5 days, 13.3% were identical (p=0.037). CONCLUSION: Based on these data, pre-VAP samples obtained prior to 5 day onset of VAP may help to predict the causative microorganisms and to select appropriate initial antimicrobials.
Anti-Bacterial Agents ; Bronchoalveolar Lavage ; Bronchoscopy ; Humans ; Critical Care ; Intensive Care Units ; Klebsiella ; Methicillin-Resistant Staphylococcus aureus ; Pneumonia ; Pneumonia, Ventilator-Associated ; Stenotrophomonas maltophilia

The primary cause of hemoptysis is the bronchial artery. However, it should be noted that pulmonary artery and other vessels can cause hemoptysis. If the source of the bleeding is not determined after embolization, other evaluations are needed. Systemic-pulmonary anastomosis and pulmonary artery pseudo-aneurysm are rare vascular abnormalities with varying etiologies. An accurate and rapid diagnosis is needed in hemoptysis, since the cause may be life-threatening. We report a case of a 77-years-old man with persistent hemoptysis due to the right inferior phrenic artery - pulmonary artery anastomosis and pseudoaneurysm. After the embolization of the inferior phrenic artery, the hemoptysis was successfully treated.
Aneurysm, False ; Arteries ; Bronchial Arteries ; Hemoptysis ; Hemorrhage ; Humans ; Pulmonary Artery

BACKGROUND/AIMS: Chronic obstructive pulmonary disease (COPD) is characterized by an incompletely reversible airflow limitation. Pulmonary function test (PFT) has been considered the gold standard test for diagnosis and severity evaluation in COPD. However, PFT by spirometry does not provide information about exercise performance in COPD patients. Therefore, the present study was performed to compare pulmonary function determined by spirometry with exercise function determined by cardiopulmonary exercise test (CPET) for grading of COPD. METHODS: A total of 105 patients with airway obstruction were examined. The patients' mean age was 65 years, and the mean smoking history was 27 pack-years. The patients underwent spirometry and CPET. The results were analyzed by categorical statistical comparison, based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and American Thoracic Society guidelines. RESULTS: The two methods agreed on the classification of only 44 patients (42%). Of the remaining patients, 21 (20%) were found to be less severe according to CPET than according to PFT, whereas 40 (38%) were more severe. Those who were more severe according to CPET had significantly low maximal minute ventilation, low anaerobic threshold, low oxygen pulse, and high breathing reserve. CONCLUSIONS: The present study revealed the large disagreement between the results of resting and exercise pulmonary function tests, and therefore suggests the need for a novel approach or guideline. Additional cardiological evaluation may be needed in patients classified as more severe according to CPET, who are assumed to have a greater degree of impairment of cardiovascular function.
Airway Obstruction ; Anaerobic Threshold ; Bacterial Toxins ; Exercise Test ; Humans ; Oxygen ; Pulmonary Disease, Chronic Obstructive ; Respiration ; Respiratory Function Tests ; Smoke ; Smoking ; Spirometry ; Ventilation

Good's syndrome (GS) is a rare cause of acquired combined B- and T-cell immunodeficiency in adults. GS is also known as a rare form of paraneoplastic syndrome of thymoma that may persist after thymectomy. Some reported GS cases have been related to various diseases as a result of humoral immunodeficiency, but no report to date has related GS to cytomegalovirus (CMV) retinitis in Korea. We report two cases of CMV retinitis as a manifestation of GS with severe cellular immunodeficiency. In the first case, a 61-year-old woman was diagnosed with GS manifesting as CMV retinitis combined with coincident pulmonary tuberculosis and soft-tissue tuberculosis. In the second case, a 56-year-old man had CMV retinitis and CMV pneumonia. Both patients had a history of thymoma and had received total thymectomies, and were diagnosed with GS a few years thereafter.
Adult ; Cytomegalovirus ; Cytomegalovirus Retinitis ; Female ; Humans ; Immunologic Deficiency Syndromes ; Korea ; Middle Aged ; Paraneoplastic Syndromes ; Pneumonia ; Retinitis ; T-Lymphocytes ; Thymectomy ; Thymoma ; Tuberculosis ; Tuberculosis, Pulmonary

PURPOSE: Pancreatic cystic neoplasm is a rare disease. It should be resected regardless of the presence of symptoms due to the possibility of malignancy. Standard pancreatic resection such as PPPD or distal pancreatectomy accompanies the loss of a significant amount of normal pancreatic parenchyma and may cause an impairment of normal pancreatic functions. On the contrary, pancreatic enucleation is known to have risks of pancreactic fistula or abscess. The aim of this study is to elucidate whether segmental resection of the pancreas is a safe and effective treatment in cystic neoplasms in the head and neck of the pancreas. METHODS: We reviewed the medical records of seven patients treated with central segmental resection of the pancreas for cystadenoma at Ewha Womans University Mokdong Hospital from December 2000 to April 2001. All lesions were located at the head and neck of the pancreas. A cephalic stump was sutured for closure of minute pancreatic ductal leakage and hemostasis, and the distal stump was anastomosed with a Roux-en-Y jejunal loop. Postoperative pancreatic functions, complications, and follow up results were analysed. RESULTS: The mean age of the patients was 48.14 (+/-9.55) years old. The pathological diagnoses were 4 cases of serous cystadenoma and 3 cases of mucinous cystadenoma. The mean size was 2.03 (+/-0.7) cm. The average operating time was 299.3 (+/-44.2) minutes. There were two cases of minor complications that were mild pancreatic fistulas without symptoms. There was no operative mortality, impairment of pancreatic function, or recurrence. The mean postoperative hospital stay was 23.6 days. CONCLUSION: Segmental resection of the pancreas can be a rational therapeutic option for cystic neoplasms in the head and neck of the pancreas in terms of the potential benefit of preserving pancreatic function.
Abscess ; Cystadenoma ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Diagnosis ; Female ; Fistula ; Follow-Up Studies ; Head* ; Hemostasis ; Humans ; Length of Stay ; Medical Records ; Mortality ; Neck* ; Pancreas* ; Pancreatectomy ; Pancreatic Cyst ; Pancreatic Ducts ; Pancreatic Fistula ; Rare Diseases ; Recurrence

We present a 17-year-old man who underwent brain magnetic resonance imaging and laboratory exams for uncontrolled seizure. Patients with an autistic disorder require deep sedation or, occasionally, general anesthesia even for radiologic exams or simple procedures. The anesthetic management of an obese, violent patient with a severe autistic disorder and mental retardation can be challenging to anesthesiologists and requires a more careful approach in selecting adequate anesthetics and doses. This case emphasizes the importance of having a detailed plan to ensure the smooth process of premedication, anesthetic induction, maintenance, emergence and safe discharge of incorporated patients in the event of unexpected situations. A 5% lidocaine patch to relieve the pain from the intramuscular injection and intravenous cannulation, intramuscular midazolam as premedication, and propofol for the maintenance of sedation can be a good sedation protocol in incorporated patients.
Adolescent* ; Anesthesia, General ; Anesthetics ; Animals ; Autistic Disorder* ; Brain* ; Catheterization ; Comb and Wattles* ; Deep Sedation ; Humans ; Injections, Intramuscular ; Intellectual Disability ; Lidocaine* ; Magnetic Resonance Imaging* ; Midazolam* ; Obesity ; Premedication ; Propofol* ; Seizures

Miliary tuberculosis is quite a rare but serious cause of acute respiratory distress syndrome (ARDS). Therefore, the early detection of military tuberculosis as the underlying cause of ARDS is very important for the prognosis and survival of the patient. We report a case of military tuberculosis mimicking ARDS. A female patient was admitted due to repeated fever and dyspnea. The initial chest CT scan showed diffuse ground glass opacity, without a miliary pattern. The case was considered to be ARDS caused by pneumonia. She showed improvement after being treated with levofloxacin. However, she was re-admitted with fever seven days after discharge. The follow up chest CT scan showed micronodules in both lungs. An open lung biopsy confirmed the diagnosis of military tuberculosis.
Biopsy ; Dyspnea ; Female ; Fever ; Follow-Up Studies ; Glass ; Humans ; Injections, Intravenous ; Lung ; Military Personnel ; Ofloxacin ; Pneumonia ; Prognosis ; Respiratory Distress Syndrome, Adult ; Thorax ; Tuberculosis ; Tuberculosis, Miliary

Staphylococcus aureus is a well-known pathogen involved inright-sided endocarditis with predisposing factors, and the clinical course may be acute and rapidly progressive. Intravenous drug abuse, pacemakers or central vascular catheters, and congenital heart diseases are well-known predisposing factors. However, right-sided endocarditis as a result of S. aureus infection is very rare in patients without these predisposing factors. Here, we report the case of a previously healthy 25-year-old male with native tricuspid valve infective endocarditis by methicillin-sensitive Staphylococcus aureus, complicating multiple septic pneumonia and septic pulmonary artery thrombosis. The patient was treated with antibiotics and surgical thromboembolectomy with tricuspid valve repair.
Adult ; Anti-Bacterial Agents ; Endocarditis ; Heart Diseases ; Humans ; Male ; Pneumonia ; Pulmonary Artery ; Staphylococcus ; Staphylococcus aureus ; Substance Abuse, Intravenous ; Thrombosis ; Tricuspid Valve ; Vascular Access Devices

The use of high throughput screening (HTS) in drug development is principally for the selection new drug candidates or screening of chemical toxicants. This system minimizes the experimental environment and allows for the screening of candidates at the same time. Umbilical cordderived stem cells have some of the characteristics of fetal stem cell and have several advantages such as the ease with which they can be obtained and lack of ethical issues. To establish a HTS system, optimized conditions that mimic typical cell culture conditions in a minimal space such as 96 well plates are needed for stem cell growth. We have thus established a novel HTS system using human umbilical cord derived-mesenchymal stem cells (hUC-MSCs). To determine the optimal cell number, hUC-MSCs were serially diluted and seeded at 750, 500, 200 and 100 cells per well on 96 well plates. The maintenance efficiencies of these dilutions were compared for 3, 7, 9, and 14 days. The fetal bovine serum (FBS) concentration (20, 10, 5 and 1%) and the cell numbers (750, 500 and 200 cells/well) were compared for 3, 5 and 7 days. In addition, we evaluated the optimal conditions for cell cycle block. These four independent optimization experiments were conducted using an MTT assay. In the results, the optimal conditions for a HTS system using hUC-MSCs were determined to be 300 cell/well cultured for 8 days with 1 or 5% FBS. In addition, we demonstrated that the optimal conditions for a cell cycle block in this culture system are 48 hours in the absence of FBS. In addition, we selected four types of novel small molecule candidates using our HTS system which demonstrates the feasibility if using hUC-MSCs for this type of screen. Moreover, the four candidate compounds can be tested for stem cell research application.
Cell Count ; Cell Culture Techniques ; Cell Cycle ; Fetal Stem Cells ; Humans ; Hydrazines ; Mass Screening ; Mesenchymal Stromal Cells ; Seeds ; Stem Cell Research ; Stem Cells ; Umbilical Cord