Invasive aspergillosis (IA) is most commonly seen in patients with risk factors, such as cytotoxic chemotherapy, prolonged neutropenia, corticosteroids, transplantation and acquired immune deficiency syndrome. IA commonly occurs in the respiratory tract. Extrapulmonary aspergillosis is usually a part of a disseminated infection, and primary invasive intestinal aspergillosis is very rare. Herein, we report a case of an immunocompetent 53-year-old male who suffered recurrent septic shock in the intensive care unit (ICU) and was finally diagnosed as invasive intestinal aspergillosis without dissemination. IA is rarely considered for patients who do not have an immune disorder. Thus, when such cases do occur, the diagnosis is delayed and the clinical outcome is often poor. However, there is a growing literature reporting IA cases in patients without an immune disorder, mostly among ICU patients. Primary intestinal aspergillosis should be considered for critically ill patients, especially with severe disrupted gastrointestinal mucosal barrier.
Acquired Immunodeficiency Syndrome ; Adrenal Cortex Hormones ; Aspergillosis* ; Critical Illness ; Diagnosis ; Drug Therapy ; Gastrointestinal Diseases ; Humans ; Immune System Diseases ; Immunocompromised Host* ; Intensive Care Units ; Male ; Middle Aged ; Neutropenia ; Respiratory System ; Risk Factors ; Shock, Septic

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No abstract available.
Acceleration* ; Lasers, Semiconductor* ; Wound Healing* ; Wounds and Injuries*

Chordoma is relatively uncommon tumor comprising 1~4% of primary malignant bone tumors, and believed to arise from the remnants of notochordal tissue. Because of its occurrence in the thoracic spine, we report a case of chordoma in volving the thoracic spine. A 45-year-old male was suffered from chest pain radiating to the back. Chest CT showed a well marginated, round huge mass with multiseptated enhancement at the thoracic spine from T5 to T8 level, After percutaneous needle aspiration, piecemeal resection of the tumor was done. On cytologic smears. two types of neoplastic cells were arranged in sheets and cords in mucinous background. One type of cells consisted of medium sized cells with pink cytoplasm and round nuclei. The other type had voluminous bubbly or clear cytoplasm divided by intracytoplasmic septae imparting a feathery or basket-like appearance. Histologically, the tumor showed lobulated feature divided by fibrous septae and the tumor cells were pink eosinophilic or physaliphorous in morphology. Immunohistochemically, the tumor cells revealed strong positivity for low(AE1) and high (AE3) molecular weight cytokeratins.
Chest Pain ; Chordoma* ; Cytoplasm ; Eosinophils ; Humans ; Keratins ; Male ; Middle Aged ; Molecular Weight ; Mucins ; Needles ; Notochord ; Spine* ; Tomography, X-Ray Computed

Malignant peripheral nerve sheath tumors (MPNSTs) have rarely been reported to occur in the adrenal gland and all of the reported cases were associated with neurofibromatosis, pheochromocytoma or ganglioneuroma. We present here a case of MPNST in the bilateral adrenal glands without any history of neurofibromatosis or combined tumor. Histologic examination showed the tumor cells had a spindle to ovoid shape, they were arranged in sweeping fascicles and there were frequent mitotic figures. The immunohistochemical and ultrastructural features of the tumor are also presented. To the best of our knowledge, this is the first report in the English medical literature about MPNSTs in the bilateral adrenal glands without any history of neurofibromatosis or combined tumor.
Adrenal Glands ; Ganglioneuroma ; Nerve Sheath Neoplasms ; Neurofibromatoses ; Pheochromocytoma

OBJECTIVES: Our purpose was (1) to determine whether amniotic fluid concentrations of interleukin-6 are of value in the diagnosis of histologic chorioamnionitis of preterm placenta and in the prediction of significant perinatal morbidity and mortality in patients with preterm premature rupture of membranes and (2) to compare the diagnostic performance of amniotic fluid interleukin-6 with that of amniotic fluid microbial culture for these outcome variables. METHOD: The relation among placental histologic finding, perinatal outcome, amniotic fluid culture, and amniotic fluid interleukin-6 concentrations were examined in 65 patients with preterm premature rupture of membranes who delivered preterm neonates within 72 hours after transabdominal amniocentesis. Interleukin-6 level was determined by enzyme-linked immunosorbent assay. Receiver-operator characteristic curve, Mann-Whitney U test, and Fisher's exact test were used for analysis. RESULTS: 1) Patients with acute histologic chorioamnionitis had significantly higher median amniotic fluid interleukin-6 concentrations than those without histologic chorioamnionitis (median 12.6 ng/ml, range 0.03 to 142.2 ng/ml vs median 0.5 ng/ml, range 0.03 to 16 ng/ml; P < 0.0001). 2) Amniotic fluid having interleukin-6 concentrations higher than 3.2 ng/ml had a sensitivity of 78% (35/45) and specificity of 95% (19/20) in the diagnosis of acute histologic chorioamnionitis and sensitivity of 74% (25/34) and specificity of 65% (20/31) in the prediction of significant neonatal morbidity and mortality. 3) These sensitivities were significantly higher than those of amniotic fluid culture, but there were no significant difference in specificities between amniotic fluid interleukin-6 and culture (histologic chorioamnionitis: 78% vs 51%, p<0.01; significant neonatal morbidity and mortality: 74% vs 47%, p<0.01, respectively). CONCLUSIONS: Test of amniotic fluid interleukin-6 is of value and more sensitive than amniotic fluid culture for the antenatal diagnosis of histologic chorioamnionitis and for the prediction of perinatal outcome in patients with preterm premature rupture of membranes.
Amniocentesis ; Amniotic Fluid* ; Chorioamnionitis ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Infant, Newborn ; Interleukin-6* ; Membranes* ; Mortality ; Placenta ; Pregnancy ; Prenatal Diagnosis* ; Rupture* ; Sensitivity and Specificity

PURPOSE: To report the clinical manifestations and computed tomography (CT) findings of patients with a trapdoor type medial orbital wall blowout fracture.METHODS: From March 2009 to October 2016, the clinical records and computed tomography findings of patients who underwent surgical treatment for a trapdoor type medial orbital wall blowout fracture were retrospectively analyzed.RESULTS: A total of eight patients (six males and two females) were enrolled with a combined mean age of 14.4 years. Clinical manifestations were eyeball movement limitation (abduction and adduction) and ocular motility pain (eight patients, 100%), diplopia (seven patients, 87.5%), and nausea and vomiting (four patients, 50%). On CT, the distance from the orbital apex to the fracture site was an average of 22.0 mm and occurred in the middle position of the entire wall. Two patients had missed rectus completely dislocated into the ethmoid sinus through the fracture gap and six patients had definite involvement in the fracture gap and edema of the medial rectus muscle. The medial rectus muscle cross-sectional area was 47.7 mm² which was edematous compared to the contralateral eye (40.1 mm²). Orbital wall reconstruction was performed an average of 4.1 days after the injury. In all patients with oculocardiac reflex-like nausea and vomiting immediately improved after surgery. Six out of eight patients who had eyeball movement limitations (abduction and adduction) preoperatively showed adduction limitation after surgery. The eyeball movement limitation and diplopia disappeared 11.7 days and 46.7 days after surgery, respectively.CONCLUSIONS: Patients with trapdoor type medial wall blowout fracture showed characteristic computed tomographic findings and clinical manifestations such as eyeball movement limitation, ocular motility pain, diplopia, and oculocardiac reflex. An understanding of clinical findings and quick surgical treatment are therefore required. The type of eyeball movement limitation was abduction and adduction limitation preoperatively and adduction limitation postoperatively.
Diplopia ; Edema ; Ethmoid Sinus ; Humans ; Male ; Nausea ; Orbit ; Reflex, Oculocardiac ; Retrospective Studies ; Vomiting

Purpose: This study aimed to investigate changes in cytokine levels after intravitreal bevacizumab injection in patients with chronic central serous chorioretinopathy (CSC). Methods: In a prospective interventional trial, 12 eyes from 12 patients with chronic CSC and six eyes from six patients who underwent cataract surgery were included as controls. Patients diagnosed as with CSC received a single intravitreal injection of bevacizumab (1.25 mg/0.05 mL). Aqueous humor samples were collected from the patients and controls. Best-corrected visual acuity and foveal thickness were evaluated, and aqueous samples were obtained before and 4 weeks after injection. The aqueous concentrations of interleukin (IL)-6, IL-8, interferon-induced protein (IP)-10, monocyte chemotactic protein (MCP)-1, platelet-derived growth factor (PDGF)-AA, and vascular endothelial growth factor (VEGF) were measured using a multiplex bead assay. Results: After injection, the foveal thickness decreased significantly from 328.08 μm (range, 210–477 μm) to 283.91 μm (range, 168–356 μm; p = 0.048), but the best-corrected visual acuity was not significantly different (p = 0.066). The aqueous levels of IL-8 increased significantly from 3.3 pg/mL (range, 1.5–8.3 pg/mL) to 4.7 pg/mL (range, 2.2–11.6 pg/mL) at 4 weeks after the injection (p = 0.046). The aqueous levels of VEGF decreased significantly from 31.4 pg/mL (range, 17.0–53.3 pg/mL) to 15.2 pg/mL (range, 7.7–21.5 pg/mL; p < 0.01). No significant changes in levels of IL-6 (p = 0.455), IP-10 (p = 0.055), MCP-1 (p = 0.076), and PDGF-AA (p = 0.339) were noted 4 weeks after injection. Conclusions In this study we found intravitreal bevacizumab injection decreased VEGF and increased IL-8 in the eyes of patients with chronic CSC. This study suggests the possibility that the pathogenesis of CSC may be related to abnormal circulation of the choroidal blood vessels through VEGF and IL-8 cytokine level changes.

Transfusion associated graft-versus-host disease is a rare but fatal disease reported after open heart surgeries mainly in Asian people.It can be prevented by pretransfusion gamma irradiation of the fresh whole blood. In this presentation,we report a case of transfusion associated graft-versus-host disease following coronary artery bypass surgery in a 61 year-old male patient.Postoperatively the patient was transfused urgently with 2 units of fresh whole blood from his two sons. He was discharged on postoperative 10 day with only symptom of mild diarrhea.Two days after discharge,he was readmitted because of persistent diarrhea,systemic erythema and high fever.On laboratory examinations,he showed findings of failure in liver,kidney, gastrointestinal tract,and bone marrow.Hemodynamically he deteriorated acutely and died of multiple organ failure on 17th postoperative day. This has been our first experience since we started open heart program at our hospital and we changed our policy for the transfusion of the fresh whole blood after this event.
Asian Continental Ancestry Group ; Blood Transfusion ; Coronary Artery Bypass ; Erythema ; Graft vs Host Disease* ; Heart* ; Humans ; Male ; Middle Aged ; Multiple Organ Failure ; Thoracic Surgery*

The mutations that occur in the p53 tumor suppressor gene have been studied in various human malignant tumors. However, little is known about this gene in meningiomas. To investigate the relationship and frequency of p53 gene mutations, the p53 polymerase chain reaction-single stranded conformational polymorphism (PCR-SSCP) and immunohistochemical study were performed on the 41 intracranial meningiomas (21 benign, 11 atypical, and 9 malignant). The higher the p53 protein expression rate, the poorer the histologic grade (9.5%, 72.7%, and 88.9% in benign, atypical and malignant meningioma, respectively) (p=0.000). The p53 protein expression rate was higher in recurrent meningioma (71.4%) than in nonrecurrent meningioma (10.5%) (p=0.002). PCR-SSCP method was performed in positive p53 protein immunoreactivity cases. p53 gene mutation rate was higher in the atypical (62.5%) and malignant (25%) meningiomas than in the benign meningioma (0%) (p=0.232). Also, the rate was higher in recurrent menigioma (20%) than in nonrecurrent meningioma (0%) (o=0.495). Among five to eight exons of the p53 gene, the mutation was observed on exon 7 more frequently. In conclusion, p53 immunoreactivity and p53 gene mutation are closely correlated with histologic grade and histologic atypia of intracranial meningiomas. p53 gene mutation would be considered as a useful marker to detect the progression of intracranial meningiomas.
Brain Neoplasms/pathology ; Brain Neoplasms/genetics* ; Human ; Meningioma/pathology ; Meningioma/genetics* ; Mutation* ; Neoplasm Invasiveness ; Protein p53/genetics*