Aged ; Geriatric Assessment ; Homes for the Aged ; Humans ; Nursing Homes ; Quality of Health Care ; Singapore

The bronchopulmonary sequestration is a rare congenital malformation of the lung, concerning about the abnormal feeding systemic artery, needed for invasive angiography for definite diagnosis. This case report is described that patient diagnosed by multi-detectional computed tomography (MDCT) without angiography and combined with aspergillosis within an intralobar seqestration. He was 43-year old male patient with left submandibular mass. On chest PA, abnormal cystic lesion was shown in left lower lung field. There were multiple cysts with internal air-fluid level in left lower lobe on computed tomography. By useing MDCT, we could reconstruct internal structures and feeding artery, arising from thoracic aorta. We could confirm the intralobar bronchopulmonary sequestration. Lobectomy of the left lower lobe was done. On histologic finding, there was intralobar type pulmonary seqestration with chronic inflammation with hyphae of aspergillus species focally.
Adult ; Angiography ; Aorta, Thoracic ; Arteries ; Aspergillosis* ; Aspergillus ; Bronchopulmonary Sequestration* ; Diagnosis ; Humans ; Hyphae ; Inflammation ; Lung ; Male ; Thorax

We investigated proprotein convertase subtilisin/kexin type 9 (PCSK9) concentrations in individuals with normoglycemia, impaired fasting glucose (IFG), and impaired glucose tolerance (IGT). This was a pilot, cross-sectional study including 92 individuals who had not been diagnosed with or treated for diabetes. We measured PCSK9 levels in three groups of subjects; namely, normoglycemia (n=57), IFG (n=21), and IGT (n=14). Individuals with IFG and IGT showed higher PCSK9 concentrations than those in the normoglycemic group, with the highest serum PCSK9 concentrations found in individuals with IGT (55.25±15.29 ng/mL for normoglycemia, 63.47±17.78 ng/mL for IFG, 72.22±15.46 ng/mL for IGT, analysis of variance P=0.001). There were no significant differences in high- or low-density lipoprotein cholesterol among groups. Serum PCSK9 levels are increased in patients with prediabetes compared to subjects with normoglycemia.

Ginseng has been believed to be a powerful tonic by oriental people for a long time and is one of the most popular folk medicine in oriental countries. Intraperitoneal injection of ginseng into rats and mice has been reported to Increase the rates of hepatic RNA and protein synthesis, increase proliforation of rough RES of liver, and enhance alcohol metabolism. We have carried out a study to see the effects of red ginseng powder and extract on in vivo and in vitro metabolism of enflurane and methoxyflurane in male Fisher 344 rats. Red ginseng powder was dissolved in deionized water and dosed for two weeks ad libitum in rats. Hepatic microsomes were prepared and oxidative defluorination of enflurane and methoxyflurane were measured in vitro. Using red ginseng extract, studies were done of both acute and chronic treatment in rats. In chronic experiments, they were dosed with several dosages three times a day for three days; on the fourth day enflurane was administered i.p. and one hour later fluoride levels were mesured in plasma and hepatic microsomes were prepared for in vitro studies as above. In the acute experiment enflurane was administered intraperitoneally eighteen hours after single oral dosage of ginseng and plasma defluorination was measured. There were no statistically significant differences in hepatic microsomal cytochrome P-450 content or defluorination of enflurane and methoxyflurane between control and experimental groups using either red ginseng extract or powder. The results showed that ginseng ingestion did not affect the metabolism of enflurane and methoxyflurane.
Animal ; Enflurane/metabolism* ; Male ; Methoxyflurane/metabolism* ; Panax/metabolism* ; Plants, Medicinal* ; Rats ; Rats, Inbred F344

Enflurane* ; Metabolism* ; Methoxyflurane* ; Panax*

Exudative pleural effusion can arise from pneumonia, tuberculosis, cancer, etc. Early drainage is needed for prevention of complications such as pleural fibrosis, thickening, bronchopleural fistulae and decline of lung function. Intrapleural Instillation of fibrinolytic enzymes has been used for 50years as an adjunct in the removal of fibrous material, hematoma and pus from the thoracic cavity. By the local fibrinolytic effect on fibrinous exudates within the pleural space, fibrinolytic agent has improved results of chest tube or pig tail drainage. But there were no controlled randomized studies, so significant controversy exists concerning the efficacy of this therpy, especially tuberculous pleurisy. Furthermore about complication, severe spontaneous bleeding has not been reported with intrapleural urokinase. Intrapleural fibrinolytic enzymes has shows no systemic complication. When it is administrated intravenously, not into intrpleural space, major bleeding is reported about 1-3% of patient, especially they had systemic disease, such as coagulation abnormalities. This case report presents a patient who suffered major hemothorax induced hypovolemic shock following the administration of 100,000 units of urokinase intrapleurally. He was 25-year old male with tuberculosis pleurisy without systemic illness demonstraion.
Adult ; Chest Tubes ; Drainage ; Exudates and Transudates ; Fibrin ; Fibrosis ; Fistula ; Hematoma ; Hemorrhage ; Hemothorax* ; Humans ; Hypovolemia* ; Lung ; Male ; Pleural Effusion ; Pleurisy ; Pneumonia ; Shock* ; Suppuration ; Thoracic Cavity ; Tuberculosis ; Tuberculosis, Pleural ; Urokinase-Type Plasminogen Activator*

Erythema nodosum is a reactive dermatosis that occurs in response to various stimuli, such as bacterial, fungal and viral infections, drugs and malignancies. Lesions of erythema nodosum usually appear symmetrically on the extensor aspects of the legs with occasional involvement of the thighs or forearms. Unilateral or plantar involvement uncommonly occurs. A 26-year-old man presented with bilateral, painful, multiple, confluent, erythematous, firm nodules confined to the both plantar skin for 7 days. Histopathologic examination revealed fibrosis of and a lymphohistiocytic infiltrate within the septae of fat lobules, consistent with erythema nodosum. We, herein, report an unusual case of plantar erythema nodosum, which was successfully treated with nonsteroidal antiinflammatory drugs for 2 weeks.
Adult ; Erythema Nodosum* ; Erythema* ; Fibrosis ; Forearm ; Humans ; Leg ; Skin ; Skin Diseases ; Thigh

Onychomycosis is the invasion of the healthy nail plate by species of dermatophytes, as well as a variety of non-dermatophytes (yeasts and moulds) which may cause nail infection, particularly after tissue damage by trauma or disease. Candida albicans and C. parapilosis are the most commonly isolated yeasts from abnormal toenails. The patient was a 20-year-old woman who presented with a thickened and crumbly nail plate of the right second finger for 4 months. Initially, a tiny yellowish macule appeared under the nail plate, which gradually involved the entire nail plate, resulting in complete deformity of the nail. She was diagnosed with diabetes mellitus 4 months ago and her blood sugar level was controlled with subcutaneous insulin injections. Direct microscopic examination of the scrapings prepared with potassium hydroxide revealed fungal elements. Repeated cultures on Sabouraud dextrose agar showed cream to white colored, semi-glossy, flat colonies, which were findings consistent with C. albicans. Complete extraction of the involved nail with meticulous curettage of the nail bed was made. She has been taking 150 mg of oral fluconazole weekly since August 2003 and showed substantial improvement.
Agar ; Arthrodermataceae ; Blood Glucose ; Candida albicans* ; Candida* ; Congenital Abnormalities ; Curettage ; Diabetes Mellitus* ; Female ; Fingers ; Fluconazole ; Glucose ; Humans ; Insulin ; Nails ; Onychomycosis* ; Potassium ; Yeasts ; Young Adult

Insulin autoimmune syndrome (IAS) is characterized by fasting hypoglycemia, endogenous hyperinsulinemia, and the presence of autoantibodies to insulin or insulin receptor in patients that have never been exposed to exogenous insulin. This syndrome is occasionally accompanied by several autoimmune disorders. There is no reported case of concurrent IAS with Hashimoto's thyroiditis. A 52-year-old female was diagnosed with Hashimoto's thyroiditis and was treated with 25 microg/d levothyroxine for 3 years. Recently, she experienced recurrent fasting hypoglycemic symptoms that disappeared rapidly with a carbohydrate-rich diet, although she had no history of diabetes or insulin use. Blood analysis showed hypoglycemia and elevated serum levels of insulin and C-peptide. Imaging studies did not reveal a mass lesion in the pancreas, and selective calcium-stimulated venous sampling also gave a negative result. However, anti-insulin antibody titer was high and assay for anti-insulin receptor antibody was positive. Here, we report a case of IAS concomitant with Hashimoto's thyroiditis.
Autoantibodies ; C-Peptide ; Diet ; Fasting ; Female ; Humans ; Hyperinsulinism ; Hypoglycemia ; Insulin* ; Middle Aged ; Pancreas ; Receptor, Insulin ; Thyroid Gland* ; Thyroiditis* ; Thyroxine

Metronidazole is an antimicrobial agent widely used for the treatment of trichomoniasis, giardiasis, amebiasis, and anaerobic bacterial infections. It has been reported that metronidazole-induced neurotoxicity is associated with responsible lesions on brain MRI. We report 2 patients with metronidazole-induced neurotoxicity, who had no responsible lesions on brain MRI for their neurological deficits. The pathogenic mechanisms are discussed.
Amebiasis ; Bacterial Infections ; Brain ; Giardiasis ; Humans ; Magnetic Resonance Imaging ; Metronidazole