We report a 72-year-old female patient with spontaneous rupture of the left external iliac vein. She visited our hospital for abdominal and back pain. She had the abnormal finding of hemoperitoneum. We performed an emergency operation with diagnosis of left ovarian cyst rupture though she suffered from spontaneous rupture of the left external iliac vein. This case provides insight to the experience of spontaneous rupture of the left external iliac vein.
Aged ; Back Pain ; Emergencies ; Female ; Hemoperitoneum ; Humans ; Iliac Vein ; Ovarian Cysts ; Rupture ; Rupture, Spontaneous

Peripheral nervous system involvement is common in systemic vasculitis, occurring most frequently in the polyarteritis nodosa (PAN) group of disorders and in rheumatoid vasculitis. Within the polyarteritis nodosa group of systemic necrotizing vasculitides, three subgroups have been described: classic polyarteritis nodosa, Churg-Strauss syndrome, and an overlap syndrome. Three patients with evidence of systemic vasculitis and peripheral neuropathy were clinically and electrophysiologically investigated. All cases presented clinically with mononeuropathy multiples considered typical pattern of ischemic involvement of the peripheral nerve. The causes included polyarteritis nodosa, its Churg-strauss variant, and the overlap syndrome. Pain and weakness were frequent symptoms. Nerve conduction studies were abnormal In all cases. Necrotizing vasculitis was present as pathologic findings in two cases. All patients were treated with prednisolone alone or in combination with other immunosuppressive agents or with plasmapheresis.
Churg-Strauss Syndrome ; Humans ; Immunosuppressive Agents ; Mononeuropathies* ; Neural Conduction ; Peripheral Nerves ; Peripheral Nervous System ; Peripheral Nervous System Diseases ; Plasmapheresis ; Polyarteritis Nodosa ; Prednisolone ; Rheumatoid Vasculitis ; Systemic Vasculitis ; Vasculitis*

PURPOSE: The laparoscopic approach is thought to reduce postoperative immunologic and metabolic effects after surgery compared to the open approach. This study was designed to compare the systemic immune and metabolic responses after laparoscopic and open surgery in patients with colorectal cancer. METHODS: Forty-four patients with colorectal cancer were prospectively assigned to undergo either a laparoscopic (n=22) or open (n=22) approach. The postoperative immune and metabolic responses were assessed by measuring the serum level of the relative proportion of lymphocytes, the T-cell count, the natural killer cell (NK-cell) count, the human leukocyte antigen-DR (HLA-DR) expression on monocytes, the interleukin-6 (IL-6), and the C-reactive protein (CRP) at specific time intervals. RESULTS: Both approaches resulted in a significant decrease in lymphocyte count, T-cell count, NK-cell count, and HLA-DR expression on monocytes at 2, 24, and 72 hours postoperatively. However, the decrease in HLA-DR expression on monocytes was more significant in open surgery at 2 hour postoperatively (mean level, laparoscopic: 90.9% vs. open: 83.1%, P<0.001). Significant rises in IL-6 and CRP were demonstrated within 72 hour postoperatively in both groups. However, no significant difference between the two groups was seen. CONCLUSIONS: Although both laparoscopic and open surgery in patients with colorectal cancer evoked an alteration of the systemic inflammatory and immune response, our data showed that a HLA-DR expression on monocytes may be less compromised after laparoscopic approach for an immediate postoperative period. However, clearer evidence from large-scaled prospective randomized trials are needed.
C-Reactive Protein ; Colorectal Neoplasms* ; HLA-DR Antigens ; Humans ; Interleukin-6 ; Killer Cells, Natural ; Laparoscopy ; Leukocytes ; Lymphocyte Count ; Lymphocytes ; Monocytes ; Postoperative Period ; Prospective Studies ; T-Lymphocytes

Although ascending aortic aneurysm is a uncommon disease, it has fatal complications such as aortic rupture, dissection, or death. So, experts recommend a preemptive aortic operation. A 77-year-old man with hypertension visited for slow progressive exertional dyspnea and general weakness. Chest X-ray showed deviation of trachea to right, mediastinal widening, cardiomegaly, and bulging of right heart border to right. Transthoracic echocardiography(TTE) and transesophageal echocardiography(TEE) showed marked dilated ascending aorta with wall calcification associated with severe aortic regurgitation and pericardial effusion. Measured diameter of ascending aorta was 12 x 11 cm on Chest Computed Tomography (CT) scan, 8.35 cm on TTE, and 10.2 cm on TEE. Our exam found out the obstructive pneumonia and aortic regurgitation as consequences of complications of huge aneurysm. We report a case of huge ascending aortic aneurysm without any previous aortic operation, aortic complications, trauma, or other etiologic factors.
Aged ; Aneurysm ; Aorta ; Aortic Aneurysm* ; Aortic Rupture ; Aortic Valve Insufficiency ; Cardiomegaly ; Dyspnea ; Heart ; Humans ; Hypertension ; Pericardial Effusion ; Pneumonia ; Thorax ; Trachea

PURPOSE: The aim of this study was to characterize Korean patients with Fanconi anemia (FA), which is a rare but very challenging genetic disease. METHODS: The medical records of 12 FA patients diagnosed at Chonnam National University Hospital from 1991 to 2012 were retrospectively reviewed. RESULTS: The median age at diagnosis was 6.2 years. All patients showed evidence of marrow failure and one or more physical stigmata. Chromosome breakage tests were positive in 9 out of 11 available patients. The median follow-up duration was 69.5 months. The Kaplan-Meier (KM) survival of all patients was 83.3% at 10 years and 34.7% at 20 years, respectively. Seven patients underwent 9 stem cell transplantations (SCTs). Among them, 5 were alive by the end of the study. Ten-year KM survival after SCT was 71.4% with a median follow-up of 3.4 years. All 5 patients treated with supportive treatment alone died of infection or progression at the median age of 13.5 years, except for one with short follow-up duration. Acute leukemia developed in 2 patients at 15.4 and 18.1 years of age. Among 6 patients who are still alive, 3 had short stature and 1 developed insulin-dependent diabetes mellitus. CONCLUSION: We provide information on the long-term outcomes of FA patients in Korea. A nation-wide FA registry that includes information of the genotypes of Korean patients is required to further characterize ethnic differences and provide the best standard of care for FA patients.
Bone Marrow ; Christianity ; Chromosome Breakage ; Diabetes Mellitus, Type 1 ; Diagnosis ; Fanconi Anemia* ; Follow-Up Studies* ; Genotype ; Humans ; Jeollanam-do ; Korea ; Leukemia ; Medical Records ; Retrospective Studies ; Standard of Care ; Stem Cell Transplantation ; Treatment Outcome*

Primary cilia have critical roles in coordinating multiple cellular signaling pathways. Dysregulation of primary cilia is implicated in various ciliopathies. To identify specific regulators of autophagy, we screened chemical libraries and identified mefloquine, an anti-malaria medicine, as a potent regulator of primary cilia in human retinal pigmented epithelial (RPE) cells. Not only ciliated cells but also primary cilium length was increased in mefloquine-treated RPE cells. Treatment with mefloquine strongly induced the elongation of primary cilia by blocking disassembly of primary cilium. In addition, we found that autophagy was increased in mefloquine-treated cells by enhancing autophagic flux. Both chemical and genetic inhibition of autophagy suppressed ciliogenesis in mefloquine-treated RPE cells. Taken together, these results suggest that autophagy induced by mefloquine positively regulates the elongation of primary cilia in RPE cells.
Autophagy* ; Cilia* ; Humans ; Mefloquine ; Retinaldehyde ; Small Molecule Libraries

PURPOSE: Procalcitonin is a well-established biochemical marker for bacterial infection. We conducted this study to analyze the correlation between procalcitonin and Infection Probability Score (IPS), a recently introduced scoring system to predict bacterial infection in intensive care unit patients. The cutoff value of IPS corresponding to procalcitonin cutoff values was determined for procalcitonin-guided antibiotic therapy in emergency department (ED) patients. METHODS: A retrospective observation study was conducted on adult ED patients who simultaneously underwent an IPS-required blood test and procalcitonin treatment from January 1, 2012 to June 30, 2012. Based on their diagnosis at discharge, patients were grouped into a lower respiratory infection group or an "other" diagnosis group. The correlation between IPS and procalcitonin was analyzed by correlation and linear regression analysis. The IPS value corresponded to 0.25 ng/mL procalcitonin (in the lower respiratory infection group) and 0.5 ng/mL (in the other diagnosis group) as inferred by ROC curve analysis. A total of 722 cases (lower respiratory infection group: 258, other diagnosis group: 464) were included in the final analysis. RESULTS: In correlation analysis, the IPS showed a significant correlation with procalcitonin level in both groups (r=0.26, p<0.01, r=0.25, p<0.01, respectively). In ROC curve analysis, IPS 14 could predict procalcitonin> or =0.25 microg/L in the lower respiratory infection group (area under curve: 0.783 [95% CI, 0.724-0.841], sensitivity: 77.8%, specificity: 72.3%). Also, IPS 14 could predict procalcitonin> or =0.5 microg/L in the other diagnosis group (area under curve: 0.764 [95% CI, 0.717-0.810], sensitivity: 70.1%, specificity: 74.2%). CONCLUSION: The IPS had a significant correlation with procalcitonin level and IPS> or =14 corresponded to the procalcitonin cut-off value to predict bacterial infection in ED patients. Thus, IPS> or =14 may be used to predict bacterial infection and can guide early anti-microbial therapy in ED patients when procalcitonin is not readily available.
Adult ; Bacterial Infections ; Biomarkers ; Diagnosis ; Emergencies* ; Hematologic Tests ; Humans ; Intensive Care Units ; Linear Models ; Predictive Value of Tests ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity

PURPOSE: Abdominoperineal resection (APR) has been regarded as the standard procedure for the treatment of distal rectal cancer since Miles first described it in 1908. But because of the better understanding of the patterns of spreading tumor, the pelvic physiology, the development of stapling devices and introduction of total mesorectal excision (TME), the rate of sphincter preserving surgery has been increasing. The aim of this study is to compare the oncologic outcomes after laparoscopic APR and ultra-low anterior resection with handsewn coloanal anastomosis (CAA) for treating distal rectal cancer. METHODS: Between January 2003 and October 2007, 95 patients who were followed up for more than 2 years after curative laparoscopic APR or CAA for distal rectal cancer were included in this study. The clinical characteristics, pathologic findings, postoperative complications and oncologic results were retrospectively analyzed. RESULTS: There were 31 APRs and 64 CAAs. The median follow-up period was 43 (5~79) months. The mean distance between the lower margin of the tumor and the anal verge was 2.1+/-1.2 cm in APR and 3.7+/-1.4 cm in CAA (p<0.001). There were 2 (6.5%) local recurrences and 8 (25.8%) systemic recurrences after APR and 3 (4.7%) local recurrences and 10 (15.6%) systemic recurrences after CAA, respectively (p=0.641, p=0.161). The 3-year disease-specific survival rate was 86.7% in APR and 93.5% in CAA (p=0.407). The 3-year disease free survival rate was 73.7% in APR and 80.1% in CAA (p=0.161) but there were no significant differences in the oncologic results according to the stages between the two groups. CONCLUSION: The operative procedures are changing toward sphincter preservation. Laparoscopic ultra-low anterior resection and hand-sewn coloanal anastomosis is oncologically as safe as laparoscopic APR for treating lower rectal cancer. However, APR should be considered the standard treatment for distal rectal cancer when it invades the anal sphincter or the levator ani.
Anal Canal ; Congenital Abnormalities ; Disease-Free Survival ; Ear ; Follow-Up Studies ; Humans ; Laparoscopy ; Postoperative Complications ; Rectal Neoplasms ; Recurrence ; Retrospective Studies ; Surgical Procedures, Operative ; Survival Rate

Neuropathic pain is a complex state showing increased pain response with dysfunctional inhibitory neurotransmission. The TREK family, one of the two pore domain K+ (K2P) channel subgroups were focused among various mechanisms of neuropathic pain. These channels influence neuronal excitability and are thought to be related in mechano/thermosensation. However, only a little is known about the expression and role of TREK-1 and TREK-2, in neuropathic pain. It is performed to know whether TREK-1 and/or 2 are positively related in dorsal root ganglion (DRG) of a mouse neuropathic pain model, the chronic constriction injury (CCI) model. Following this purpose, Reverse Transcription Polymerase Chain Reaction (RT-PCR) and western blot analyses were performed using mouse DRG of CCI model and compared to the sham surgery group. Immunofluorescence staining of isolectin-B4 (IB4) and TREK were performed. Electrophysiological recordings of single channel currents were analyzed to obtain the information about the channel. Interactions with known TREK activators were tested to confirm the expression. While both TREK-1 and TREK-2 mRNA were significantly overexpressed in DRG of CCI mice, only TREK-1 showed significant increase (~9 fold) in western blot analysis. The TREK-1-like channel recorded in DRG neurons of the CCI mouse showed similar current-voltage relationship and conductance to TREK-1. It was easily activated by low pH solution (pH 6.3), negative pressure, and riluzole. Immunofluorescence images showed the expression of TREK-1 was stronger compared to TREK-2 on IB4 positive neurons. These results suggest that modulation of the TREK-1 channel may have beneficial analgesic effects in neuropathic pain patients.
Animals ; Blotting, Western ; Constriction* ; Diagnosis-Related Groups ; Fluorescent Antibody Technique ; Ganglia, Spinal* ; Humans ; Hydrogen-Ion Concentration ; Mice* ; Neuralgia* ; Neurons ; Polymerase Chain Reaction ; Reverse Transcription ; Riluzole ; RNA, Messenger ; Spinal Nerve Roots* ; Synaptic Transmission

PURPOSE: Human papilloma viruses (HPVs) play a central role in the pathogenesis of neoplastic lesions of the uterine cervix. The viral oncoprotein HPV E6 degrades the p53 protein, and the HPV E7 protein inactivates pRB and increases the expression of the CDK inhibitor, p16(INK4A). We investigated the usefulness of p16(INK4A) as a biologic marker for the cervical dysplastic and neoplastic cells. MATERIALS AND METHODS: We examined the expression of p16(INK4A) and cytokeratin in a mixed population of normal peripheral blood mononuclear cells (PBMC) and the cervical cancer cell lines (HeLa, SiHa, and CasKi) using flow cytometry. RESULTS: The DNA indices of the HeLa, SiHa and CasKi cell lines were 1.89, 1.53 and 1.75, respectively, indicating that these cells are aneuploid cells. Furthermore, the positive rate of p16(INK4A) expression was 86.7% for the HeLa mixed population, 85.6% for the SiHa mixed population, and 92.2% for the CasKi mixed population. According to the FL3A vs FL3W histogram, electrical gating of the HeLa, SiHa and CasKi mixed populations showed the expression levels of both cytokeratin and p16(INK4A) to be identical, at 86.6%, 84.8% and 85.0%, respectively. These findings revealed that almost all cells selected through electrical gating were cervical cancer cells originating from the epithelium and which expressed cytokeratin and p16(INK4A). On the other hand, when each mixed population was electrically gated for normal PBMC, we found that the PBMCs expressed neither cytokeratin nor p16(INK4A). CONCLUSION: Using flow cytometry, we observed the enhanced expression of p16(INK4A) in cervical cancer cell lines. These RESULTS suggest the usefulness of p16(INK4A) for the selective detection of cervical dysplastic and cancer cells in the liquid-based samples, which are taken from the cervices and contaminated with blood and stromal cells.
Aneuploidy ; Biological Markers ; Cell Line* ; Cervix Uteri ; Cyclin-Dependent Kinase Inhibitor p16* ; DNA ; Epithelium ; Female ; Flow Cytometry ; Hand ; Humans ; Keratins ; Papilloma ; Stromal Cells ; Uterine Cervical Neoplasms*