Femoral head and neck fractures during the course of avascular necrosis are rare with only few reports in the English literature. Moreover, there are very few reports on an analysis of the patterns of these fractures. Four cases of femoral head fracture caused by minor trauma, which were quite different from the crescent fractures during the course of avascular necrosis were analyzed in regard to the underlying disease, causes, sites, types, directions, pattern of fractures and the injury mechanism of the fractures. The results are reported with special regard to the pattern of the stress fracture of the femoral head and neck during the course of avascular necrosis.
Fractures, Stress ; Head* ; Neck* ; Necrosis*

PURPOSE: To report a rare case of primary mucinous adenocarcinoma arising from a sweat gland in the eyelid. CASE SUMMARY: A 68-year-old male presented to our hospital with a painless, superficial nodular lesion over the skin of the right lateral canthus that had slowly grown over the past two years. The patient had a history of surgical excision for three nodular lesions at the same site 5 years ago, and an excisional biopsy was mucinous adenocarcinoma with a positive margin. A systemic evaluation, including whole-body Positron Emission Tomography scan (PET), chest computerized tomography, gastrointestinal endoscopy, and colonoscopy, revealed no other abnormal lesions. Therefore, the eyelid lesion was considered a primary mucinous adenocarcinoma of the skin. CONCLUSIONS: Primary mucinous adenocarcinoma of the eyelid can rarely metastasize. Therefore, a systemic examination is warranted to discriminate primary and metastatic adenocarcinoma and also to monitor the long-term follow-up for the evaluation of local recurrence.
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Aged ; Biopsy ; Colonoscopy ; Endoscopy, Gastrointestinal ; Eyelids ; Humans ; Male ; Mucins ; Organothiophosphorus Compounds ; Positron-Emission Tomography ; Recurrence ; Skin ; Sweat Glands ; Thorax

Carcinoid tumor of stomach continue to interest clinician because of the rarity and difficulty in diagnosis clioically with infrequent classical carcinoid syndrome. Recently, we experienced a case of gastric carcinoid with hemetemesis and melena. We feel that this case is an instructive example of the fascinating variety of entities which can result in massive upper gastrointestinal bleeding. So we present this case with s review of relevant literatures.
Carcinoid Tumor* ; Diagnosis ; Hemorrhage* ; Melena ; Stomach

OBJECTIVESThe mechanism of the adverse health effects of ambient particulate matter on humans has not been well-investigated despite many epidemiologic association studies. Measurement of personal exposure to particulate pollutants and relevant biological effect markers are necessary in order to investigate the mechanism of adverse health effects, particularly in fragile populations considered to be more susceptible to the effects of pollutants.

METHODSWe measured personal exposure to PM(2.5) and examined oxidative stress using urinary malondialdehyde three times in 51 preschoolers and 38 elderly subjects. A linear mixed-effects model was used to estimate PM(2.5) effects on urinary MDA levels.

RESULTSAverage personal exposure of the children and elderly to PM(2.5) was 80.5 +/- 29.9 and 20.7 +/- 12.7 mug/m(3), respectively. Mean urinary MDA level in the children and the elderly was 3.6 +/- 1.9 and 4.0 +/- 1.6 mumol/g creatinine. For elderly subjects the PM(2.5) level was significantly associated with urinary MDA after adjusting for age, sex, BMI, passive smoking, day-care facility site, alcohol consumption, cigarette smoking, and medical history (heart disease, hypertension and bronchial asthma). However, there was no significant relationship for children.

CONCLUSIONSThe elderly were more susceptible than young children to oxidative stress as a result of ambient exposure to PM(2.5). Identification of oxidative stress induced by PM(2.5) explains the mechanism of adverse health effects such as cardiovascular or respiratory diseases, particularly in the elderly.

Biliary drainage can improve the quality of life in a patient with obstructive jaundice caused by malignancy. Biliary metal stent insertion is a very useful method because it drains the bile physiologically and patients have little discomfort with the procedure. It has a few complications such as restenosis, liver perforation, bowel perforation, fistula formation and stent dislocation. Perforation and fistula formation are caused by pressure due to the self expanding characteristics of the metal stent. We report here on a case of duodenobiliary fistula that was caused by a biliary metal stent in a patient suffering with hepatocellula carcinoma, and we also include a review of the relevant literature.
Bile ; Carcinoma, Hepatocellular ; Dislocations ; Drainage ; Fistula ; Humans ; Jaundice, Obstructive ; Liver ; Quality of Life ; Stents ; Stress, Psychological

STUDY DESIGN: This is a prospective study OBJECTIVES: The purpose of this study is to describe the technique for reconstruction of the iliac crest graft donor site and to determine the clinical results of its application. Summary of literature REVIEW: An iliac crest tricortical bone graft is frequently used for anterior interbody fusion of the spine. For preventing iliac crest graft donor site morbidity (pain, skin dimpling, etc), various graft materials have been used, for example, rib, cement, ceramic and so on. However, the rib needs another incision for lumbar or cervical fusion, the cement sometimes causes the wound infection, and the bioactive ceramic spacer has not had its long term results confirmed. MATERIALS AND METHODS: We prospectively analyzed 28 patients who underwent iliac crest reconstruction with a 1/3 tubular plate after bone harvesting between 1998 and 2004. Pain at postoperative 1 month, 6 months and 1 year was checked by the visual analogue scale (VAS). The cosmetic appearance, foreign body sense, overall satisfaction (according to the methods of Ito et al), complications and the radiologic evaluations were all analyzed as indicators of the outcome. RESULTS: The mean visual analogue scale was 3.5 and 0.1 at postoperative 1 and 12 months, respectively. For the cosmetic appearance, among the 28 patients, 24 patients felt a smooth and satisfactory outline (Excellent). 25 patients couldn't feel any foreign body sense. One patient experienced wound infection. No plate breakage or screw loosening were observed. CONCLUSIONS: Reconstruction of the iliac crest with a one-third tubular plate after tricortical bone graft harvest could be a favorable method. the screws during the consolidation of PMMA.
Ceramics ; Foreign Bodies ; Humans ; Polymethyl Methacrylate ; Prospective Studies ; Ribs ; Skin ; Spine ; Tissue Donors* ; Transplants ; Wound Infection

PURPOSE: Macrophage migration inhibitory factor (MIF) may serve as a general marker for systemic inflammation in septic and nonseptic acute critical illness. Additionally, our previous experiment has demonstrated that immunosuppressant Prostaglandin E2 (PGE2) lowered MIF levels and inhibited T-cells proliferation when compared to control levels. The addition of hypertonic saline (HTS) increased MIF production as compared with PGE2-stimulated T-cells in concordance with restore PGE2-suppressed T-cells proliferation. Generally, HTS has been well known for its anti-inflammatory effect so far. Therefore, the experiments were conducted to evaluate MIF after stimulating lipopolysaccharide (LPS) either in the presence or absence of HTS in monocyte, in response to early phase injury. METHODS: Human acute monocytic leukemic cell line (THP-1) cells were cultured in RPMI media, to a final concentration of 1 x 10(6) cells/mL. The effect of HTS on LPS-induced MIF was evaluated in monocyte with 1 microg/mL LPS. HTS at 10, 20 or 40 mmol/L above isotonicity was added. MIF concentrations of the supernatant were determined by enzyme-linked immunosorbent assay, and cell lysates were used for Western blots analysis to determine the MIF expression. RESULTS: MIF concentrations in the cell supernatant increased in LPS-induced cells compared to control cells. Also, levels of MIF protein expression were higher in LPS stimulating cells. However, the addition of HTS to LPS stimulated cell restored MIF concentrations and MIF expression. CONCLUSION: The role of HTS in maintaining physiological balance in human beings, at least in part, should be mediated through the MIF pathway.
Anti-Inflammatory Agents ; Blotting, Western ; Cell Line ; Critical Illness ; Dinoprostone ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunosuppression ; Inflammation ; Lipopolysaccharides ; Macrophage Migration-Inhibitory Factors ; Macrophages ; Monocytes ; Saline Solution, Hypertonic ; T-Lymphocytes

BACKGROUND/AIMS: Encapsulating peritoneal sclerosis (EPS) is an often-fatal complication of long-term peritoneal dialysis (PD). We here report the clinical features of EPS in Korean PD patients from a single university center. METHODS: The data were collected retrospectively from 606 PD patients at Kyungpook National University Hospital, between August 2001 and August 2011. The diagnosis of EPS was based on clinical signs and symptoms, and confirmed by radiological findings. RESULTS: Eight patients (1.3%, four males) were diagnosed with EPS. The mean age of the patients was 48.5 years (range, 33 to 65). The mean duration of PD was 111.8 months (range, 23 to 186). All patients except for one had three or more episodes of peritonitis. Seven patients were diagnosed with EPS after stopping PD, and only one stayed on PD after initial diagnosis and treatment. Total parenteral nutrition and corticosteroids, in addition to tamoxifen therapy, were used to treat most of the patients, and one patient underwent surgery (adhesiolysis). The overall mortality rate was 50%. CONCLUSIONS: EPS is a serious, life-threatening complication in patients on long-term PD. To reduce the incidence and mortality rate of EPS, careful monitoring and early diagnosis is needed.
Adrenal Cortex Hormones/therapeutic use ; Adult ; Aged ; Female ; *Hospitals, University ; Humans ; Male ; Middle Aged ; Parenteral Nutrition, Total ; Peritoneal Dialysis/*adverse effects/mortality ; *Peritoneal Fibrosis/diagnosis/etiology/mortality/therapy ; *Peritonitis/diagnosis/etiology/mortality/therapy ; Republic of Korea ; Retrospective Studies ; Tamoxifen/therapeutic use ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome

During radiotherapy of cancer, neighboring normal cells may receive sub-lethal doses of radiation. To investigate whether such low levels of radiation modulate normal cell responses to death stimuli, primary cultured human fibroblasts were exposed to various doses of gamma-rays. Analysis of cell viability using an exclusion dye propidium iodide revealed that the irradiation up to 10 Gy killed the fibroblasts only to a minimal extent. In contrast, the cells efficiently lost their viability when exposed to 0.5-0.65 mM H2O2. This type of cell death was accompanied by JNK activation, and was reversed by the use of a JNK-specific inhibitor SP600125. Interestingly, H2O2 failed to kill the fibroblasts when these cells were pre-irradiated, 24 h before H2O2 treatment, with 0.25-0.5 Gy of gamma-rays. These cytoprotective doses of gamma-rays did not enhance cellular capacity to degrade H2O2, but elevated cellular levels of p21Cip/WAF1, a p53 target that can suppress H2O2-induced cell death by blocking JNK activation. Consistently, H2O2-induced JNK activation was dramatically suppressed in the pre-irradiated cells. The overall data suggests that ionizing radiation can impart normal fibroblasts with a survival advantage against oxidative stress by blocking the process leading to JNK activation.
Antioxidants/pharmacology ; Cell Death ; Cells, Cultured ; Enzyme Activation/radiation effects ; Fibroblasts/enzymology/radiation effects ; *Gamma Rays ; Heat-Shock Proteins/metabolism ; Humans ; JNK Mitogen-Activated Protein Kinases/*antagonists & inhibitors ; Oxidative Stress/*radiation effects ; Research Support, Non-U.S. Gov't ; Water/pharmacology

PURPOSE: To examine the clinical utility of lactic acidosis as a predictor of in-hospital mortality and as an early therapeutic marker in severe sepsis and septic shock patients. METHODS: We conducted a prospective observational study. Patients visiting the emergency department from January 2005 to October 2006 who were suspected to have severe sepsis and septic shock were candidates for enrollment. Therapies in the emergency department consisted of early goal-directed resuscitation and employed central venous access, antibiotics, fluid resuscitation, mechanical ventilation, vasoactive agent, and inotropes as required. We measured hemodynamic variables, arterial blood gases, and serum lactate at presentation (0 hours) and at four hours. The SAPS II at emergency department and SOFA score at 0 hours, 4 hours, 24 hours, 48 hours and 72 hours were recorded. RESULTS: A total of 102 patients were enrolled during the study period. Data were presented as mean+/-SD. Thirtyfour patients died in the hospital, eighteen patients of them within 72 hours after admission. Septic shock was encountered in 44 patients. Non-survivors had significantly lower pH, higher serum lactate level, higher SAPS II scores, lower mean arterial blood pressure, higher heart rates, and lower PaO2/FiO2 values at 0 and 4 hours than did survivors. During the first four hours, persistent lactic acidosis and high SAPS II scores were independently associated with mortality. Although most patients achieved the therapeutic goals, excepting central venous oxygen saturation in nonsurvivors, patients with persistent lactic acidosis at 0 and 4 hours had significantly high in-hospital mortality and early overall mortality than other patients (80.0%, p=0.000, 65.0%, p=0.000, respectively). Patients recovering from lactic acidosis at 4 hours showed lower in-hospital mortality and early overall mortality than patients with persistent lactic acidosis (50.0% vs. 80.0%, p=0.070, 14.3% vs. 65.0%, p=0.004). CONCLUSION: Persistent lactic acidosis was found to be an independent variable for predicting mortality and morbidity. Persistent lactic acidosis may be used as a prognostic and treatment indicator during the resuscitation of patients with severe sepsis and septic shock in an emergency department.
Acidosis ; Acidosis, Lactic* ; Anti-Bacterial Agents ; Arterial Pressure ; Emergency Service, Hospital ; Gases ; Heart Rate ; Hemodynamics ; Hospital Mortality ; Humans ; Hydrogen-Ion Concentration ; Lactic Acid ; Mortality ; Observational Study ; Oxygen ; Prospective Studies ; Respiration, Artificial ; Resuscitation ; Sepsis* ; Shock, Septic* ; Survivors