No abstract available.
Edema* ; Hydrops Fetalis*

BACKGROUND: Monocytes/macrophages play a central role in determining the host response during Gram-negative infection through secretion of a variety of mediators after stimulation of LPS. Even though cytokine production has been shown to play an important role in host defense during sepsis cytokine release may also lead to tissue injury. Thus, regulation of macrophage response to LPS is critical for host survival during Gram-neg-alive sepsis. In animals exposed to nonlethal doses of endotoxin a characteristic hyporesponsiveness to subsequent administration of endotoxin has been observed. This phenomenon was knowm as 'LPS tolerance'. However, little information is availavble regarding the underlying mechanism of U)S tolerance. METHOD: Peripheral blood monocyte(PBMC) was isolated from peripheral blood of normal volunteers by adhesion purification method. To evaluate conditions to obtain LPS tolerance. preculture was carried out with LPS at 10ng/ml for 24 hours. For stimulation culture plates were washed two times and were stimulated with LPS at 1ng/ml for 4, 6 and 26 hours. To assess the underlying mechanisms of LPS tolerance, autologous serum, PMA, anti-CD14 Ab, Indomethacin or PGF2 were added to preculture solution respectively. Cytokine concentrations in culture supernatants were measured using ELISA for TNF-α and IL-8 and mRNA of TNF-α and IL-8 were determined by Northern blot analysis. RESULTS: The exposure of PBMC to low dose of LPS suppressed the cytokine production and mRNA expression of TNF-α, but not IL-8. Anti-CDl4 Ab partially recovered production of TNF-α which was suppressed by preculture with low dose LPS. The preculture with PMA induces US tolerance, as preculture with low dose LPS. CONCLUSION: LPS tolerance to TNF-α is regulated pretranslationally and is influenced by protein kinase C pathway and CD14.
Animals ; Blotting, Northern ; Dinoprost ; Enzyme-Linked Immunosorbent Assay ; Healthy Volunteers ; Indomethacin ; Interleukin-8* ; Macrophages ; Monocytes* ; Protein Kinase C ; RNA, Messenger ; Sepsis ; Tumor Necrosis Factor-alpha*

A 58-year-old man underwent laparoscopy-assisted distal gastrectomy (LADG) with Billroth I gastroduodenostomy due to early gastric cancer. During surgery, the perigastric vessels were ligated with Hem-o-Lok clips. Esophagogastroduodenoscopy (EGD) 6 months later showed a fungating mass at the anastomosis site. Repeat EGD 1 year after LADG showed a Hem-o-Lok clip at the fungating mass lesion. Because the patient was asymptomatic, with no major abnormalities on clinical examination, and endoscopic removal of the clip would have been difficult due to the presence of adhesions and inflammation, no attempt was made to remove the clip. The patient remained well after the exposed Hem-o-Lok clip was identified. A third EGD 6 months later showed that the clip had disappeared from the anastomosis site, and that this site was covered with normal mucosa surrounding the scar.
Cicatrix ; Endoscopy, Digestive System ; Foreign-Body Migration ; Gastrectomy ; Gastroenterostomy ; Humans ; Inflammation ; Middle Aged ; Mucous Membrane ; Postoperative Complications ; Stomach Neoplasms ; Surgical Instruments

BACKGROUND: Diverticulosis of the cecum and ascending colon is a rare disease in Western countries, it is more common in the Orient. Making the diagnosis preoperatively could be difficult, and the intraoperative assessment and decision of optimal treatments are difficult. METHODS: Therefore, we reviewed the patient's charts of diverticulosis of the cecum and ascending colon at our hospital from 1992 to 1997. RESULTS: During the past 5 years, a total of 53 cases of diverticulosis of the cecum and ascending colon had been treated at this hospital. Mean age was 41.8 years (range 20-70). The male to female ratio was 1.8 : 1. Frequent complaints were abdominal pain (46 cases, 86.8%), followed by diarrhea (5 cases, 9.3%), indigestion (4 cases, 7.5%), and bowel habits change (2 cases, 3.8%). Mean duration of illness was 3.5 days(range 24 hours~15 days). In non-surgical cases, diagnoses were established with barium enema, CT scan, or ultrasonography. The accuracy of these methods was 91%, 75%, and 25%. In surgical cases, the preoperative diagnoses were appendicitis(13 cases, 50.1%), diverticulitis (7 cases, 31.8%), and abscess (2 cases, 9.1%). Treatments of the cecum and ascending colon diverticulitis were conservative management (3 teases,58.5%) and surgical treatment (22 cases,41.5%). The operative procedures were right hemicolectomies (2 cases), ileocecal resections (2 cases), diverticulectomies (6 cases) and appendectomies only (11 cases). CONCLUSION: These results suggest that correct diagnosis of the diverticulitis of the cecum and ascending colon made before treatment is very important because correct assessment of diverticulitis intraoperatively is difacut. Liberal use of diagnostic modalities could facilitate to make correct diagnosis to set a proper plan for treatment.
Abdominal Pain ; Abscess ; Appendectomy ; Barium ; Cecum* ; Colon, Ascending* ; Diagnosis ; Diarrhea ; Diverticulitis ; Diverticulum* ; Dyspepsia ; Enema ; Female ; Humans ; Male ; Rare Diseases ; Surgical Procedures, Operative ; Tomography, X-Ray Computed ; Ultrasonography

The leiomyoma of the uterus is most common benign genital tumor in women of reproductive age but occurs in the vagina rarely and may be confused with a variety of vaginal tumors. A preoperative diagnosis is seldom made. Recently we experienced a case of vaginal leiomyoma arising in the anterior vagina wall and concomitant uterine leiomyoma, so we report this case with a brief review of literature.
Diagnosis ; Female ; Humans ; Leiomyoma* ; Uterus ; Vagina*

BACKGROUND/AIMS: The cytosolic host protein nucleotide binding oligomerization domain 1 (Nod1) has emerged as a key pathogen recognition molecule for innate immune responses in epithelial cells. The purpose of the study was to elucidate the mechanism by which Helicobacter pylori infection leads to transepithelial neutrophil migration in a Nod1-mediated manner. METHODS: Human epithelial cell lines AGS and Caco-2 were grown and infected with H. pylori. Interleukin (IL)-8 mRNA expression and IL-8 secretion were assessed, and nuclear factor kappaB (NF-kappaB) activation was determined. Stable transfections of AGS and Caco-2 cells with dominant negative Nod1 were generated. Neutrophil migration across the monolayer was quantified. RESULTS: Cytotoxin-associated gene pathogenicity island (cagPAI)(+) H. pylori infection upregulated IL-8 mRNA expression and IL-8 secretion in AGS and Caco-2 cells compared with controls. NF-kappaB activation, IL-8 mRNA expression and IL-8 secretion by cagPAI knockdown strains were reduced compared with those infected with the wild-type strain. NF-kappaB activation, IL-8 mRNA expression and IL-8 secretion in dominant-negative (DN)-Nod1 stably transfected cells were reduced compared with the controls. The transepithelial migration of neutrophils in DN-Nod1 stably transfected cells was reduced compared with that in controls. CONCLUSIONS: Signaling through Nod1 plays an essential role in neutrophil migration induced by the upregulated NF-kappaB activation and IL-8 expression in H. pylori-infected human epithelial cells.
Adult Stem Cells/physiology ; Caco-2 Cells ; Cell Line ; Epithelial Cells/*metabolism/microbiology ; Gene Expression ; Genomic Islands ; Helicobacter Infections/*genetics ; *Helicobacter pylori ; Humans ; Interleukin-8/genetics/secretion ; NF-kappa B/metabolism ; Neutrophils/*physiology ; Nod1 Signaling Adaptor Protein/*physiology ; RNA, Messenger/metabolism ; Signal Transduction ; Transendothelial and Transepithelial Migration/*physiology ; Up-Regulation

BACKGROUND: It is well known that when macrophages are stimulated with endotoxin, they produce a wide variety of cytokine mediators, including TNF-α and IL-1β. However, there is an alterationnin the macrophages responsiveness when they are challenged with repeated bouts of endotoxin, termed 'endotoxin tolerance' which is regarded as a self-protective phenomenon from continuous stimulation. In this study, endotoxin tolerance in the peripheral blood monocytes of sepsis patients was evaluated. METHODS: Fourteen patients with organism-documented sepsis were included. The severity of illness was evaluated by APACHE IIscore. Peripheral blood monocytes were isolated from the patients and diluted to 1×105/well. After stimulation with endotoxin(LPS of E. coli O114:B4, 100 ng/ml), they were incubated at 37℃ in 5% CO2 incubator for 24 hours. Supernatant was collected for the measurement of TNF-αand IL-1β with ELISA method. Peripheral blood monocytes of seven healthy volunteers were used as control. RESULTS: The APACHE IIscore(mean±SD) of the patients at the time of blood sampling was 12.2±5.7. The primary infection foci were urinary tract infection, pneumonia, subacute bacterial endocarditis, and catheter related infection, etc. The causative organisms were gram negative rods(10 cases), gram positive cocci(6 cases) with two cases of mixed infection. Serum TNF-α could be measured in 4 cases with 29.9±27.7 pg/ml. Serum IL-1β was measureable in only one patient. The TNF-α level of supernatant of cultured peripheral blood monocytes was 2,703±2,066 pg/ml in patients and 2,102±1,914 pg/ml in controls. The IL-1β level of supernatant was 884±1,050 pg/ml in patients and 575±558 pg/ml in controls. There was no difference of TNF-α and IL-1β level between patients and controls. CONCLUSION: We cannot prove the phenomenon of endotoxin tolerance in this study. Future study needs to be focused on the more severe sepsis patients who were taken for sampling earlier. Addition of serum to the culture medium could be an another valuable option for the success of this study.
APACHE ; Catheters ; Coinfection ; Endocarditis, Subacute Bacterial ; Enzyme-Linked Immunosorbent Assay ; Healthy Volunteers ; Humans ; Incubators ; Macrophages ; Monocytes ; Pneumonia ; Sepsis* ; Tumor Necrosis Factor-alpha* ; Urinary Tract Infections

Sarcoidosis is a multisystem granulomatous disorder commonly affecting young adults. Diagnosis is confirmed by evidence of non-caseating granuloma in more than one organ. A case is presented where the diagnosis was made on a bone marrow biopsy, the first case in Korea. A 54-year-housewife was admitted because of multiple variable sized, skin papules and macules, who showed pancytopenia and evidence of liver cirrhosis on ultrasound. We performed skin biopsy and bone marrow biopsy, which showed non-caseating granulomas. The chest CT, opthalmologic examination was performed and showed the involvement of sarcoidosis of mediastinal lymph nodes and uvea. Multiple joints of both hands and feet also seemed to be involved in view of simple X-ray. By this case, we emphasize the significance of bone marrow biopsy in the sarcoidosis with pancytopenia.
Biopsy ; Bone Marrow* ; Diagnosis ; Foot ; Granuloma ; Hand ; Humans ; Joints* ; Korea ; Liver Cirrhosis ; Liver* ; Lymph Nodes ; Pancytopenia ; Sarcoidosis* ; Skin* ; Tomography, X-Ray Computed ; Ultrasonography ; Uvea* ; Young Adult

PURPOSE: Blepharoptosis can result from either congenital or acquired causes. Blow out fracture or facial bone fracture including blow out fracture can be one of the causes. Authors experienced 3 cases of severe blepharoptosis after blow out fracture treated only with observation after reduction of associated fracture. METHODS: Reconstruction of orbital wall was conducted on all cases diagnosed as blow out fracture using 3 dimensional computed tomography, and conservative treatment was done on accompanying severe blepharoptosis. RESULTS: At the time of injury, all cases showed severe blepharoptosis requiring frontalis muscle transfer for correction. But blepharoptosis was recovered in an average of 18 weeks without any surgical procedure except reconstruction of orbital wall. CONCLUSION: Once Blepharoptosis occurred after blow out fracture, thorough evaluation must be done at first. If definitive cause of blepahroptisis cannot be found as authors' cases, injury of oculomotor nerve may result in blepharoptosis. So, as for blepharoptosis after blow out fracture, conservative treatment following reconstruction of fractured orbital wall can be one of good management.
Blepharoptosis ; Facial Bones ; Muscles ; Oculomotor Nerve ; Orbit

PURPOSE: The aim of this study was to compare ESD only and subsequent Laparoscopy-assisted gastrectomy (LAG) patients for EGC through propensity score matching analysis. METHODS: This study was a retrospective review of the records of 46 consecutive patients with gastric cancer who underwent LAG after ESD from 2009, September to 2014, September, and propensity matching analysis was performed with 92 patients who underwent LAG without ESD as a control group. Subgroup analysis was performed with the interval of subsequent laparoscopic gastrectomy and endoscopic resection (within 2 weeks, 2~4 weeks, above 4 weeks). RESULTS: There were no significant differences in age, gender, body mass index, comorbidity, previous abdominal surgery, and location of the lesion or clinical stage between the two groups. Early postoperative outcomes including postoperative complications and postoperative hospital stay were not significantly different between the two groups. According to subgroup analysis with the interval of laparoscopic gastrectomy and endoscopic resection, there were no significant differences in early outcomes in three groups. However, only early postoperative complication rate was significantly higher in patients who received LAG more than 4 weeks after ESD (0 versus 4.76 versus 40 per cent; p=0.0032). CONCLUSION: We analyzed the influence of ESD on subsequent LAG using propensity score matching to reduce the bias. However, we found that ESD might induce inflammation for a significant duration, but ESD had little influence on early postoperative outcome of LAG.
Bias (Epidemiology) ; Body Mass Index ; Comorbidity ; Gastrectomy ; Humans ; Inflammation ; Length of Stay ; Postoperative Complications ; Propensity Score ; Retrospective Studies ; Stomach Neoplasms*