Bronchial defects in neonates are known to occur very rarely as a complication of mechanical ventilation or intubation. This causes persistent air leakage that may form massive pneumomediastinum or pneumothorax, leading to cardiac tamponade or cardiorespiratory deterioration. Early diagnosis and treatment of bronchial defects are essential, as they can be accompanied by underlying severe lung parenchymal diseases, especially in preterm infants. We encountered an extremely low birth weight infant with an air cyst cavity in the posterior mediastinum that displaced the heart anteriorly, thereby causing cardiopulmonary deterioration. During exploratory-thoracotomy, after division of the air cyst wall (mediastinal pleura), we found a small bronchial defect in the posterior side of the right main bronchus. The patient had shown respiratory distress syndrome at birth, and she was managed by constant low positive pressure ventilation using a T-piece resuscitator after gentle intubation. As the peak inspiratory pressure was maintained low throughout and because intubation was successful at the first attempt without any difficulty, we think that the cause of the defect was not barotrauma or airway injury during intubation. The fact that the margin of the defect was very clear also suggested a congenital origin. To our knowledge, this is the first case of congenital bronchial defect in English literature.
Barotrauma ; Bronchi ; Cardiac Tamponade ; Early Diagnosis ; Heart ; Humans ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Intubation ; Lung ; Mediastinal Emphysema* ; Mediastinum ; Parturition ; Pneumothorax ; Positive-Pressure Respiration ; Respiration, Artificial

Desmoid tumors are defined as aggressive overgrowth of fibrous sheets and musculoaponeurotic structures. Although desmoid tumors are generally known as a benign neoplasm, it's aggresive local invasiveness and frequent recurrence indicate it's position lying between the benign and malignancy. The association of desmoid tumor and familial adenomtous polyposis(FAP) was first made in 1923 by Nichols. In 1951, Gardner reported the familial occurrence of intestinal polyposis, osteomas, fibromas, and epidermal or sebaceous cyst. Desmoid tumors are common in patients with FAP and Occur in 3.5~29% of patients with FAP whereas the incidence in the gerenal population is 2~5/1,000,000 person years. Surgical resection of desmoids in patients with FAP has been controversial because unresectability and recurrence are more common than cure. Palliative and curative resections have a high morbidity. Surgery should be reserved for those patients with symptomatic mesenteric desmoids. If a small mesenteric desmoid is encountered incidentally and is easily resectable, it should be resected. If surgery has been less than satisfactory in the treatment of these patients, several different medical approaches can be combined with or without surgical resection with mixed result. Authors report a case of unresectable mesenteric desmoid tumor, developing after surgery of FAP and literatures were reviewed
Deception ; Epidermal Cyst ; Fibroma ; Fibromatosis, Aggressive* ; Humans ; Incidence ; Intestinal Polyposis ; Osteoma ; Recurrence

Sunitinib is multitargeted tyrosine kinase inhibitor, and this drug was approved for use to treat gastrointestinal stromal tumor and advanced renal cell carcinoma. It has also been shown to be efficacious in treating neuroendocrine, colon and breast cancer. Sunitinib therapy is often complicated by cutaneous adverse effects such as hand-foot syndrome, hair depigmentation, subungal splinter hemorrhage, xerosis, alopecia and seborrheic dermatitis- like reactions. But there have been no reports on patients presenting with a bullous fixed drug eruption associated with sunitinib administration. We report here on a case of a bullous fixed drug eruption and hand-foot syndrome, and these maladies were caused by this agent.
Alopecia ; Breast Neoplasms ; Carcinoma, Renal Cell ; Colon ; Drug Eruptions ; Gastrointestinal Stromal Tumors ; Hair ; Hand-Foot Syndrome ; Hemorrhage ; Humans ; Indoles ; Protein-Tyrosine Kinases ; Pyrroles

No abstract available.
Pregnancy*

Phase-partitioning with Triton X-114 (TX114) was applied to the TSP antigen, which may be preferentially associated with the cell wall of M. tuberculosis. The hydrophilic protein components of the TSP antigen were successfully separated from integral hydrophobic macromolecules. To further characterize and examine the cellular immune response of the aqueous fraction of the TSP antigen (TSPa), the in vitro properties of the antigen were measured by lymphoproliferation; surface expression of IL-2 Ra on T lymphocytes was analyzed by flow cytometry; and the cytokine mRNA expression pattern was determined by RT-PCR. Significant lymphoproliferative responses to the TSPa antigen were observed in healthy tuberculin reactive donors after a 5 day in vitro stimulation. TSPa treatment of PBMCs from healthy tuberculin positive subjects for 5 days resulted in progressive augmentation of IFN-r, II 2, and IL-2Ra mRNA expression, as measured by RT-PCR, but considerably reduced IL-4 mRNA expression. In addition, the TSPa antigen stimulated more IL-12 p40 mRNA production than did the PPD antigen, and graduaBy suppressed IL- 10 mRNA expression. Moreover, the CD3' T cells of tuberculin positive subjects displayed a profound increase in their expression of the II 2Ru protein (39.0%) in response to the TSPa antigen. Proliferation was correlated with IL-2 and IL-2Ra mRNAs, but not correlated with distinct IFN-r or IL-12 p40 mRNA production. These findings strongly suggest that the TSPa antigen preferentially evokes the generation of a Thl-like immune response in healthy tuberculin reactors.
Cell Wall ; Flow Cytometry ; Humans* ; Immunity, Cellular* ; Interleukin-12 ; Interleukin-2 ; Interleukin-4 ; Mycobacterium tuberculosis* ; Mycobacterium* ; Neptune ; RNA, Messenger ; T-Lymphocytes ; Tissue Donors ; Tuberculin ; Tuberculosis

BACKGROUND: Cancer that tends to metastasize to other internal organs also involves the skin with various clinical features. OBJECTIVE: We studied the clinical and histopathological findings of metastatic skin cancer and primary lung cancer. METHODS: We reviewed the clinical features and histopathological findings in 7 patients with metastatic skin cancer from the lung cancer. We performed routine hematoxylin-eosin stain and immunohistochemical staining with monoclonal antibody to cytokeratin, neuron specific enolase, S-100, leukocyte common antigen, and epithelial membrane antigen using the formalin-fixed paraffin embedded skin tissue of cutaneous metastatic and primary lung cancer. RESULTS: All patients are men ranging from 44 to 72 years in age(mean, 63.0 years). Cutaneous lesions were nodule, tumor, and sclerotic plaque. Skin lesions appeared on all parts of body. The neck, chest, and scalp were the most common locations of metastases. Pathologic findings were squamous cell carcinoma in 5 patients, adenosquamous cell carcinoma in 2 patients. We found some different immunophenotypes in cutaneous metastatic lesion and lung cancer. Mean survival time from the diagnosis of lung cancer was 10.4 months, and 8.4 months from the diagnosis of skin metastasis. CONCLUSION: We conclude that patients with cutaneous metastasis of lung cancer reflect progressive, terminal stage, and poor prognosis of the disease.
Antigens, CD45 ; Carcinoma, Squamous Cell ; Diagnosis ; Humans ; Keratins ; Lung Neoplasms* ; Lung* ; Male ; Mucin-1 ; Neck ; Neoplasm Metastasis ; Paraffin ; Phosphopyruvate Hydratase ; Prognosis ; Scalp ; Skin ; Skin Neoplasms ; Survival Rate ; Thorax

Background/Aims: To select appropriate empirical antibiotics, updates on the changes in pathogens are essential. We aimed to investigate the changes in pathogens and their antibiotic susceptibility in acute cholangitis (AC) with bacteremia over a period of 15 years. Furthermore, the efficacy of empirical antibiotic therapies and the risk factors predicting antibiotic-resistant pathogens (ARPs) were analyzed. Methods: A total of 568 patients with AC and bacteremia who were admitted to Daegu Catholic University Medical Center from January 2006 to December 2020 were included. Their medical records were retrospectively reviewed. In addition, the data were grouped and analyzed at 3-year intervals under the criteria of Tokyo Guideline 2018. Results: During the study period, 596 pathogens were isolated from blood cultures of 568 patients. The three most common pathogens were Escherichia coli (50.5%), Klebsiella species (24.5%), and Enterococcus species (8.1%). The proportion of vancomycin-resistant Enterococci (VRE) has increased since the mid-2010 (0.0% to 4.3%, p=0.007). There was emergence of carbapenem-resistant Conclusions The proportion of VRE has increased and CRE has emerged in AC. In addition, healthcare-associated infection, history of previous biliary intervention, and the severity of AC were independent risk factors predicting ARP. For patients with these risk factors, the administration of imipenem or piperacillin-tazobactam should be considered.

Background: /Aim: The aim of this study was to compare clinical features of hypertriglyceridemia-induced acute pancreatitis (HTGAP) with those of biliary acute pancreatitis (BAP) and alcoholic acute pancreatitis (AAP), respectively. Methods: Medical records of patients with acute pancreatitis (AP) who were admitted to our institution from January 2014 to December 2018 were retrospectively reviewed. Disease severity and local complications were evaluated according to the 2012 Revised Atlanta Classification. Systemic complications were evaluated according to the Modified Marshall Scoring System. Results: Of the total 610 patients with AP, those with BAP, AAP, and HTGAP were 310 (50.8%), 144 (23.6%), and 17 (2.8%), respectively. Compared with BAP, HTGAP showed higher proportion of moderately severe acute pancreatitis (MSAP) (64.7% vs. 28.1%, p<0.001) and severe acute pancreatitis (SAP) (17.6% vs. 5.5%, p <0.001). And HTGAP showed more local complications (76.5% vs. 26.8%, p<0.001) and higher recurrence rate (52.9% vs. 6.5%, p <0.001), but there was no significant difference in systemic complications (23.5% vs. 11.6%, p =0.140). Contrarily, there was no significant difference between HTGAP and AAP with respect to disease severity (64.7% vs. 63.9% in MSAP and 17.6% vs. 6.9% in SAP, p =0.181), local complications (76.5% vs. 67.4%, p =0.445), recurrence rate (52.9% vs. 32.6%, p =0.096), and systemic complications (23.5% vs. 11.5%, p =0.233). Conclusions HTGAP showed higher disease severity, more local complications, and higher recurrence rate than BAP. However, there was no significant difference in clinical features between HTGAP and BAP.

To classify the causes of hypogonadotropic hypogonadism in Korean patients, and to improve the endocrinologic evaluation for the disease, we retrospectively studied the clinical findings and result of combined pituitary stimulation test in 35 patients with hypogonadotropic hypogonadism. The following results were obtained.1) The ratio of male to female was 1.3:1, and the 50% of male patients was under 20 years of age and the 20% of female patients in 30th decades. 2) The chief complaints of male patients on the admission were the failure of secondary sexual characteristics(95.0%) and loss of hair(5.0%), those of female patients were amenorrhea(46.7%), infertility(26.7%), failure of secondary characteristics(13.3%) and loss of hair(13.3%). 3) The causes of male hypogonadotropic hypogonadism were craniopharyngioma(35.0%), idiopathic(30.0%), Kallmann's syndrome(15.0%), pituitary adenoma(10.0%) and germinoma(5.0%), and those of female hypogonadotropic hypogonadism were prolactinoma(13.3%), Sheehan's syndrome(26.6%), pituitary adenoma(6.7%), tuberculous granuloma(6.7%), germinoma(6.7%), idiopathic hypogonadotropic hypogonadism(40.0%).4) The responses of LH and FSH to GnRH test were absent or markedly blunted in diffuse pituitary diseases such as pituitary tuberculous granuloma, pituitary macroadenomas, Sheehan's syndrome. However those were also absent or blunted in Cushing's disease and hypothalamic disease such as Kallmann's syndrome, germinoma, craniopharyngioma, idiopathic hypogonadotropic hypogonadism. 5) The responses of LH, FSH increased after repeated injection of GnRH in a patient with germinoma. 6) In diffuse destructive pituitary diseases such as Sheehan's syndrome, nonfunctioning macroadenomas, tuberculous granuloma, large prolactinoma, the combined deficiency of pituitary hormones other than gonadotropins was observed. 7) In many cases with hypothalamic diseases, the combined defects of pituitary hormone response were also seen.These data suggest that GnRH test is not always useful to localize the lesion between pituitary and hypothalamus, and combined pituitary stimulation test revealed defects of pituitary hormones other than gonadotropin in various hypothalamic diseases.Therefore repeated GnRH test would be useful for the differential diagnosis, and CRH test and GRH test would be necessary to demonstrate whether pituitary abnormality is present.
Craniopharyngioma ; Diagnosis, Differential ; Female ; Germinoma ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Granuloma ; Humans ; Hypogonadism ; Hypopituitarism ; Hypothalamic Diseases ; Hypothalamus ; Kallmann Syndrome ; Male ; Pituitary Diseases ; Pituitary Hormones ; Prolactinoma ; Retrospective Studies

OBJECTIVE: We investigated gender differences in event-related potential (ERP) responses to subliminally presented threat-related stimuli. METHODS: Twenty-four participants were presented with threat-related and neutral pictures for a very brief period of time (17 ms). To explore gender differences in ERP responses to subliminally presented stimuli, we examined six ERP components [P1, N170, N250, P300, Early Posterior Negativity (EPN) and Late Positive Potential (LPP)]. RESULTS: The result revealed that only female participants showed significant increases in the N170 and the EPN in response to subliminally presented threat-related stimuli compared to neutral stimuli. CONCLUSION: Our results suggest that female participants exhibit greater cortical processing of subliminally presented threat-related stimuli than male participants.
Evoked Potentials ; Female ; Humans ; Male ; Masks