We describe a 28-year old man in otherwise apparently good health, in whom pain in his left knee joint caused by avascular necrosis led to a diagnosis of polyarteritis nodosa (PAN). The angiogram showed multiple microaneurysmal and thrombotic lesions, notably in the renal, mesenteric and tibial arteries. A skin biopsy of the upper dermis of the left thigh with an erythematous skin rash showed the infiltration of mononuclear leukocytes in the perivascular area. During hospitalization, he was diagnosed with chronic hepatitis B, and was treated with lamivudine, and corticosteroid, azathioprine to control the PAN. The knee joint pain improved progressively, and the patient could walk normally after several months. This case is an unusual presentation because the initial manifestation of PAN was avascular necrosis.
Azathioprine ; Biopsy ; Dermis ; Exanthema ; Hepatitis B, Chronic ; Hospitalization ; Humans ; Knee Joint ; Lamivudine ; Leukocytes, Mononuclear ; Necrosis ; Osteonecrosis ; Polyarteritis Nodosa ; Skin ; Thigh ; Tibial Arteries

Primary malignant tumor of trachea is rare and often extensive at presentation and frequently causes life threatening airway obstruction. Primary extranodal lymphomas comprise about 10% of all malignant lymphomas. However, the primary malignant lymphoma of trachea is extremely rare. We presented here a case of 62-year-old male, was diagnosed as a primary extranodal lymphoma arising in the trachea with review of literature.
Airway Obstruction ; Humans ; Lymphoma* ; Male ; Middle Aged ; Trachea*

Effects of egg york containing IgY specific for Helicobacter pylori on the bacterial growth and intragastric infection were investigated in comparison with a proton-pump inhibitor pantoprazole. For in vitro anti-bacterial activity test, H. pylori (1x108 CFU/mL) was incubated with a serially diluted IgY for 3 days. As a result, IgY fully inhibited the bacterial growth at 16 mg/mL, which was determined to a minimal inhibitory concentration. In vivo elimination study, male C57BL/6 mice were infected with the bacteria by intragastric inoculation (1x108 CFU/mouse) 3 times at 2-day intervals, and 2 weeks later, orally treated twice a day with 50, 100, 200 or 500 mg/kg IgY for 18 days. After the final administration, biopsy sample of the gastric mucosa was assayed for the bacterial identification via urease, oxidase, catalase, nitrate reduction and H2S tests in addition to microscopic examination for mucosal inflammation. In CLO kit test, 75, 50, 12.5 and 12.5% of the animals revealed positive reaction following treatment with 50, 100, 200 and 500 mg/kg IgY, respectively, resulting in a superior efficacy at 200 mg/kg than 30 mg/kg pantoprazole that displayed 75% elimination. The CLO test results were confirmed by bacterial identification. Microscopic examination revealed that H. pylori infection caused severe gastric mucosal inflammation, which were not observed in the CLO-negative mice following treatment with IgY or pantoprazole. Taken together, IgY inhibited the growth of H. pylori, and improved gastritis and villi injuries by eliminating the bacteria from the stomach. The results indicate that IgY could be a good candidate overcoming tolerance of antibiotics for the treatment of H. pylori-mediated gastric ulcers.
2-Pyridinylmethylsulfinylbenzimidazoles ; Animals ; Anti-Bacterial Agents ; Bacteria ; Biopsy ; Catalase ; Gastric Mucosa ; Gastritis ; Helicobacter pylori ; Humans ; Immunoglobulins ; Inflammation ; Male ; Mice ; Ovum ; Oxidoreductases ; Stomach ; Stomach Ulcer ; Urease

PURPOSE: Therapeutic hypothermia is an important treatment strategy for control of the overwhelming inflammatory reactions of cardiac arrest patients. Rapid rewarming is related to poor outcome, however the kinds of inflammatory processes that occur during the rewarming period are not well understood. Our aim in the current study was to evaluate the changes in inflammatory cytokine levels during cardiac arrest patients' rewarming period. METHODS: This study was conducted in an emergency intensive care unit of a tertiary referral hospital. Blood samples were collected on admission (0 h) and 24, 26, 28, and 32 h after return of spontaneous circulation. Eight inflammatory cytokines (E-selectin, soluble ICAM, interleukin-10, interleukin-1ra, interleukin-6, interleukin-8, monocyte chemotactic protein-1, and tumor necrosis factor-α) were measured. RESULTS: Twenty-eight patients were enrolled and completed a protocol of 24 h hypothermia and 8h rewarming. Eight patients were of the good cerebral performance category (CPC) and 20 of the bad. The IL-1Ra level in the good CPC group was statistically changed at 26 (p=0.039) and 28 (p=0.003) but not at 32 h (p=0.632) when compared with the 24 h level. The IL-10 levels of the bad CPC group were decreased at 26 (p=0.017) and 28h (p=0.013) but not at 32 h (p=0.074) when compared with 24 h. None of the other cytokines showed meaningful differences during the rewarming period. CONCLUSION: Change in inflammatory-cytokine-level change during the rewarming period is not significant.
Chemokine CCL2 ; Cytokines* ; Emergencies ; Heart Arrest ; Humans ; Hypothermia ; Hypothermia, Induced* ; Intensive Care Units ; Interleukin 1 Receptor Antagonist Protein ; Interleukin-10 ; Interleukin-6 ; Interleukin-8 ; Necrosis ; Prognosis ; Rewarming* ; Tertiary Care Centers

PURPOSE: The thoracic aortic rupture due to a blunt thoracic trauma is a fatal condition and majority of affected patients die before arriving at the hospital. The purpose of this study was to report our experiences of the traumatic thoracic aortic rupture. METHOD: Between January 1998 and September 2002, 6 patients with traumatic aortic rupture were experienced at out institute. All the patients had been involved in a traffic accident. There were 5 males and a female with mean age 29.8+/-7.0 years, ranging from 18 to 36 years. Preoperative chest CT and aortography confirmed the thoracic aortic rupture around the aortic isthmus in all patients. One patient died while waiting for an operation. The records of the remaining 5 patients that undergone an urgent operation were retrospectively reviewed. RESULT: There was no operative mortality. The mean aortic cross clamp time was 67.6+/-14.7 minutes. The injured portion of the thoracic aorta was just below the aortic isthmus in all cases which was resected and replaced with an artificial vascular graft. Various kinds of distal perfusion technique were employed: left atrial to femoral artery bypass in 3, Gott's shunt in 1, and femoro-femoral bypass with hypothermic circulatory arrest also in 1 patient. No signs of spinal cord injury developed postoperatively. All patients are in good clinical condition for 4 to 47 months postoperatively. CONCLUSION: Favorable outcomes could be anticipated in patients with a descending aortic rupture due to blunt thoracic trauma, if prompt diagnostic work up and surgical treatment are applied. The surgical results are thought to be improved with the employment of the distal perfusion technique, thus avoiding distal ischemia.
Accidents, Traffic ; Aorta, Thoracic ; Aortic Rupture* ; Aortography ; Employment ; Female ; Femoral Artery ; Humans ; Ischemia ; Male ; Mortality ; Perfusion ; Retrospective Studies ; Spinal Cord Injuries ; Tomography, X-Ray Computed ; Transplants

Sunitinib as a multitarget tyrosine kinase inhibitor is one of the anti-tumor agents, approved by the United States Food and Drug Administration to use treat gastrointestinal stromal tumor and metastatic renal cell carcinoma. The agent is known to commonly induce adverse reactions such as fatigue, nausea, diarrhea, stomatitis, esophagitis, hypertension, skin toxicity, reduciton in cardiac output of left ventricle, and hypothyroidism. However, it has been reported to rarely induce adverse reactions such as nephrotic syndrome and irreversible reduction in renal functions, and cases of intestinal perforation or pneumatosis interstinalis as such reactions have been consistently reported. In this report, a 66-year old man showing abdominal pain had renal cell carcinoma and history of sunitinib at a dosage of 50 mg/day on a 4-weeks-on, 2-weeks-off schedule. Seven days after the third cycle he was referred to the hospital because of abdominal pain. Computed tomography showed pneumoperitoneum with linear pneumatosis intestinalis in his small bowel. The patient underwent surgical exploration that confirmed the pneumatosis intestinalis at 100 cm distal to Treitz's ligament. We report a rare case of intestinal perforation with pneumatosis intestinalis after administration of sunitinib to a patient with metastatic renal cell carcinoma.
Aged ; Antineoplastic Agents/adverse effects/*therapeutic use ; Carcinoma, Renal Cell/*drug therapy ; Drug Administration Schedule ; Humans ; Indoles/adverse effects/*therapeutic use ; Intestinal Perforation/*diagnosis/etiology/surgery ; Kidney Neoplasms/*drug therapy ; Lung/radiography ; Male ; Pneumatosis Cystoides Intestinalis/*diagnosis/etiology ; Positron-Emission Tomography ; Pyrroles/adverse effects/*therapeutic use ; Tomography, X-Ray Computed

BACKGROUND: Cigarette smoking is an important modifiable cardiovascular risk factor, which is known to acutely increase arterial stiffness. But the chronic effects of smoking on arterial stiffness are still controvertial. We studied the effects of chronic cigarette smoking on arterial stiffness in Korean subjects. METHODS: Our subjects included those >18 years of age (n=2685, 991 females) who had undergone a pulse wave velocity from July 2004 to June 2008. They were classified into two groups, smokers (n=641) and non-smokers (n=2044). In addition to the pulse wave velocity (PWV), we reviewed the highly sensitive C-reactive protein levels in a random manner when it was available. RESULTS: Males were predominant in the smokers group. Smokers had significantly higher heart-femoral PWVs than non-smokers (1083.6+/-264.1 cm/sec vs. 1041.3+/-257.3 cm/sec; p<0.001). There was no linear relationship between smoking duration and PWV (r= -0.225, p=0.506) even after adjusting for age, sex, and body mass index. Furthermore, there was no difference in the ankle-brachial index between the two groups. On the multivariate regression analysis, age, male gender, hypertension, and diabetes were independent predictors of increased arterial stiffness. CONCLUSION: In this study, chronic cigarette smoking increased central arterial stiffness in Korean subjects.
Ankle Brachial Index ; Body Mass Index ; C-Reactive Protein ; Humans ; Hypertension ; Korea ; Male ; Pulse Wave Analysis ; Risk Factors ; Smoke ; Smoking ; Tobacco Products ; Vascular Stiffness

Oxaliplatin is a third-generation platinum compound that is used as a single agent and in combination with fluorouracil (5-FU) to treat colorectal and gastric carcinoma. The patients treated with oxaliplatin may develop hypersensitivity and idiosyncratic reactions, although these complications are known to be rare. We report here on two patients who suffered with metastatic colorectal cancer and who underwent palliative combination chemotherapy with oxaliplatin; they then developed hypersensitivity reactions to oxaliplatin. The first case had an anaphylatic reaction immediately after the beginning of the 7(th) to 8(th) cycle infusion of oxaliplatin. The second case developed repeated febrile episodes from the 4th to 8th cycles of oxaliplatin infusion. With the increasing use of oxaliplatin in clinical practice, we are now encountering an increasing incidence of suspected hypersensitivity reactions. Physicians should keep their eyes wide open and carefully observe for the clinical manifestations of these hypersensitivity reactions.
Colorectal Neoplasms ; Drug Therapy ; Drug Therapy, Combination ; Fluorouracil ; Humans ; Hypersensitivity* ; Incidence ; Platinum

Intussusception primarily occurs in children and is uncommon in adults. Moreover, intussusception caused by intestinal tuberculosis is very rare. We report a case of intussusception induced by intestinal tuberculosis. A 53-year-old man presented to our hospital with complaints of cough and sputum for 2 weeks. We started anti-tuberculosis medication as the patient's sputum acid-fast staining was positive. After 4 days of treatment, the patient developed abdominal cramping pain. Imaging studies showed ileo-ileal type intussusception. The patient underwent segmental resection of the small bowel and intestinal tuberculosis was confirmed on histological examination. He recovered after surgery and was discharged on anti-tuberculosis medication.
Adult ; Child ; Colic ; Cough ; Humans ; Intussusception ; Middle Aged ; Sputum ; Tuberculosis ; Tuberculosis, Gastrointestinal

Intussusception primarily occurs in children and is uncommon in adults. Moreover, intussusception caused by intestinal tuberculosis is very rare. We report a case of intussusception induced by intestinal tuberculosis. A 53-year-old man presented to our hospital with complaints of cough and sputum for 2 weeks. We started anti-tuberculosis medication as the patient's sputum acid-fast staining was positive. After 4 days of treatment, the patient developed abdominal cramping pain. Imaging studies showed ileo-ileal type intussusception. The patient underwent segmental resection of the small bowel and intestinal tuberculosis was confirmed on histological examination. He recovered after surgery and was discharged on anti-tuberculosis medication.
Adult ; Child ; Colic ; Cough ; Humans ; Intussusception ; Middle Aged ; Sputum ; Tuberculosis ; Tuberculosis, Gastrointestinal