PURPOSE: The aim of this study is to investigate the usefulness of intestinal ultrasonography (US) and upper gastrointestinal endoscopy in the early diagnosis of Henoch-Schonlein purpura (HSP) with the gastrointestinal (GI) symptoms preceding the emergence of the skin lesion. METHODS: The clinical, intestinal US and upper gastrointestinal endoscopic records of 85 patients (88 cases) with GI symptoms relating to HSP presenting between January 1999 and April 2001 were reviewed. RESULTS: 1) GI symptoms were observed in 52 cases (59%) and skin, joint, renal and scrotal manifestations were observed in 88 (100%), 64 (73%), 15 (17%), 3 cases (3%) respectively. 2) Out of 52 cases with GI symptoms, abdominal pain was observed in all cases (100%). Positive stool occult blood, nausea and vomiting, abdominal tenderness, melena or tarry stool, diarrhea, hematemesis, rebound tenderness and rigidity were observed in 28 (50%), 17 (33%), 17 (33%), 12 (23%), 6 (12%), 4 (8%), 1 (2%) and 1 case (2%) respectively in order of frequency. 3) Intestinal US examination was performed in 27 cases with HSP and GI symptoms (52 cases). Out of 27 sonographic examinations 22 showed abnormal findings. Thickening of the duodeno-jejunal wall was observed in 16 cases (73%). Free peritoneal fluid, enlarged mesenteric lymph node, ileus and abnormal gall bladder were seen in 8 (36%), 8 (36%), 4 (18%) and 1 case (5%) respectively. In three cases of HSP without GI symptoms, those changes were absent. 4) In all of five cases with HSP and GI symptoms, endoscopic study showed mucosal edema and multiple hemorrhagic erosions especially at the second portion of the duodenum. Biopsy specimens from the duodenum of 2 cases out of 5 endoscopic examinations showed acute inflammatory infiltrates in the mucosa with hemorrhage. 5) Both intestinal US and endoscopic studies were performed in 4 cases with HSP and GI symptoms simultaneously. Out of 4 those cases, 3 cases showed the thickened duodeno-jejunal wall on the intestinal US, which suggested erosive hemorrhagic duodenitis by endoscopic findings. CONCLUSION: The typical but nonpathognomonic intestinal US findings including the thickening of the duodeno-jejunal wall and upper gastrointestinal endoscopic findings including hemorrhagicerosive duodenitis, in children with GI symptoms, should be considered a manifestation of HSP, even in the absence of skin lesion.
Abdominal Pain ; Ascitic Fluid ; Biopsy ; Child ; Diarrhea ; Duodenitis ; Duodenum ; Early Diagnosis ; Edema ; Endoscopy ; Endoscopy, Gastrointestinal ; Hematemesis ; Hemorrhage ; Humans ; Ileus ; Joints ; Lymph Nodes ; Melena ; Mucous Membrane ; Nausea ; Occult Blood ; Purpura, Schoenlein-Henoch* ; Skin ; Ultrasonography ; Urinary Bladder ; Vomiting

Sarcopenia-related falls and fractures are increasing worldwide due to the aging population. The purpose of this study was to 1) evaluate anthropometric characteristics related to hip fracture in Korean patients, 2) investigate sarcopenia prevalence in hip fracture (HF) and non-hip fracture (NF) groups, and 3) investigate the correlation between sarcopenia and osteoporosis. This case-control study examined 359 HF and 1,614 NF normal populations using Korea National Health and Nutrition Examination Survey data. We performed whole-body dual energy X-ray absorptiometry to analyze body composition using the skeletal muscle mass index (SMI: lean mass/height2) and bone mineral density (BMD). In the HF group, using the AWGS definition, the prevalence of sarcopenia in women and men was 44.3% and 68.2%, respectively; in the NF group, it was 7.1% and 16.1%, respectively. Lower appendicular SMI (P < 0.001), leg muscle mass (P < 0.001), and higher prevalence of sarcopenia (P < 0.001) were observed in the HF group after adjustment for age and gender. In multivariate analysis, sarcopenia (OR = 6.52; 95% CI = 4.67-9.09), age (OR = 1.15; 95% CI = 1.13-1.17), and osteoporosis (OR = 1.87; 95% CI = 1.35-2.58) were associated with the occurrence of a hip fracture. This study showed a higher prevalence of sarcopenia in patients with hip fractures compared with a normal population, and higher prevalence of sarcopenia in men.
Absorptiometry, Photon ; Accidental Falls ; Aging ; Body Composition ; Bone Density ; Case-Control Studies* ; Female ; Hip Fractures ; Hip* ; Humans ; Korea ; Leg ; Male ; Multivariate Analysis ; Muscle, Skeletal ; Nutrition Surveys ; Osteoporosis ; Prevalence* ; Sarcopenia*

PURPOSE: Since the pandemic (H1N1) 2009 virus has been a seasonal flu which still poses great human health concerns worldwide, vaccination would be considered as the most effective strategy to control the influenza virus spreading. Here, we assessed adjuvant efficacy of modified outer membrane vesicle (mOMV) towards the pandemic H1N1 split antigen. MATERIALS AND METHODS: For this study, mice were vaccinated twice with various amount of antigen (0.05, 0.1, and 0.5 microg/dose hemagglutinin [HA]) that were mixed with mOMV, aluminum hydroxide (alum), and MF59, as well as the combined adjuvant comprising the mOMV plus alum. RESULTS: We found that all the adjuvanted vaccines of A/California/04/09 (CA04, H1N1) containing HA antigen more than 0.1 microg/dose protected effectively from lethal challenge (maCA04, H1N1) virus, compared to the antigen only group. Furthermore, vaccinated mice received as low as 0.05 microg/dose of the split vaccine containing the combined adjuvant (10 microg of mOMV plus alum) showed a full protection against lethal challenge with H1N1 virus. Taken together, these results suggest that mOMV can exert not only the self-adjuvanticity but also a synergy effect for the vaccine efficacy when combined with alum. CONCLUSION: Our results indicate that mOMV could be a promising vaccine adjuvant by itself and it could be used as a vaccine platform for development of various vaccine formulations to prepare future influenza pandemic.
Aluminum Hydroxide ; Animals ; Hemagglutinins ; Humans ; Influenza A virus ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; Membranes ; Mice ; Orthomyxoviridae* ; Pandemics ; Seasons ; Vaccination ; Vaccines

OBJECTIVE: To evaluate the efficacy and safety of balloon-occluded retrograde transvenous obliteration (BRTO) with sodium tetradecyl sulfate (STS) liquid sclerotherapy of gastric varices. MATERIALS AND METHODS: Between February 2012 and August 2014, STS liquid sclerotherapy was performed in 17 consecutive patients (male:female = 8:9; mean age 58.6 years, range 44-86 years) with gastric varices. Retrograde venography was performed after occlusion of the gastrorenal shunt using a balloon catheter and embolization of collateral draining veins using coils or gelfoam pledgets, to evaluate the anatomy of the gastric varices. We prepared 2% liquid STS by mixing 3% STS and contrast media in a ratio of 2:1. A 2% STS solution was injected into the gastric varices until minimal filling of the afferent portal vein branch was observed (mean 19.9 mL, range 6-33 mL). Patients were followed up using computed tomography (CT) or endoscopy. RESULTS: Technical success was achieved in 16 of 17 patients (94.1%). The procedure failed in one patient because the shunt could not be occluded due to the large diameter of gastrorenal shunt. Complete obliteration of gastric varices was observed in 15 of 16 patients (93.8%) with follow-up CT or endoscopy. There was no rebleeding after the procedure. There was no procedure-related mortality. CONCLUSION: BRTO using STS liquid can be a safe and useful treatment option in patients with gastric varices.
Adult ; Aged ; Aged, 80 and over ; Balloon Occlusion ; Contrast Media/*chemistry ; Demography ; Embolization, Therapeutic ; Endoscopy, Digestive System ; Esophageal and Gastric Varices/*therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Portal Vein/radiography ; Sclerotherapy ; Sodium Tetradecyl Sulfate/*chemistry ; Tomography, X-Ray Computed

The remnant cystic duct or gallbladder neck calculus may rarely result in post-cholecystectomy Mirizzi syndrome. Various managements have been proposed for the treatment of post-cholecystectomy Mirizzi syndrome. Some previous cases of post-cholecystectomy Mirizzi syndrome have been managed with open cholecystectomy and endoscopically. We report a case of a laparoscopic stone removal of post-cholecystectomy Mirizzi syndrome that developed 7 months after laparoscopic cholecystectomy. To our knowledge, this is the first case of laparoscopic management of post-cholecystectomy Mirizzi syndrome. The mechanism, diagnosis and treatment of post-cholecystectomy Mirizzi syndrome are discussed.
Calculi ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cystic Duct ; Gallbladder ; Gallstones ; Mirizzi Syndrome ; Neck

Tuberculous peritonitis is one of the most common extrapulmonary tuberculosis. The presenting signs and symptoms, together with the carbohydrate antigen (CA) 125 status and imaging findings may resemble the primary peritoneal carcinoma or ovarian carcinoma. We herein report a case on a 71-year-old woman who is presented with abdominal distension, abdominal pain, nausea, anorexia. Abdomino-pelvic computed tomography scans reveal large amounts of ascites and mottled omentum with diffuse nodular masses, and the serum CA 125 level is elevated. The initial clinical diagnosis is the primary peritoneal carcinoma, but the final histological diagnosis confirms the tuberculous peritonitis. Thus, we discuss the differential diagnosis of tuberculous peritonitis from primary peritoneal carcinoma and also the problems especially found in old aged patients. In conclusion, although the elderly patients are suspected with malignancy, we should keep in mind the possibility of curable diseases and perform laparoscopic biopsy during the early stage aggressively.
Abdominal Pain ; Aged ; Anorexia ; Ascites ; Biopsy ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Nausea ; Omentum ; Peritonitis, Tuberculous* ; Tuberculosis

Phagocytosis of serum- and IgG-opsonized zymosan (SOZ and IOZ, respectively) particles into J774A.1 macrophages induced apoptosis of the cells, accompanied by the expression of p21(WAF1), one of cyclin-dependent protein kinase (CDK) inhibitors. Furthermore, phagocytosis of SOZ and IOZ particles into macophages induced superoxide formation. Tat-superoxide dismutase (SOD), which is readily transduced into the cells using Tat-domain, protected the cells from the apoptosis induced by phagocytosis of SOZ and IOZ particles. lipopolysaccharide (LPS)/interferon-gamma (IFN-gamma) also caused the apoptosis of the cells. However, Tat-SOD could not protect the cells from LPS/IFN-gamma induced apoptosis, suggesting that apoptosis mechanisms involved are different from each other. In the present study, we determined the amounts of nitric oxide (NO) produced by SOZ, IOZ, and LPS/IFN-gamma, and found that SOZ and IOZ did not induce the generation of NO in macrophages, whereas LPS/ IFN-gamma did. The apoptosis due to phagocytosis was accompanied with the release of cytochrome c from mitochondrial membrane to cytosolic fraction. Furthermore, SOZ and IOZ induced the cleavage of procasapase-3 (35 kDa) to give rise to an active caspase-3 (20 kDa), which was blocked by Tat- SOD but not by 2-phenyl-4,4,5,5-tetramethylimidazoline-1-oxyl 3-oxide (PTIO), a scavenger of NO. On the other hand, LPS/IFN-gamma caused the activation of procaspase-3, which was blocked by PTIO but not by Tat-SOD. Taken together, phagocytosis of SOZ and IOZ particles induced apoptosis through superoxide but not NO in macrophages, accompanied with the release of cytochrome c and the activation of caspase-3.
Apoptosis/*immunology ; Caspases/metabolism ; Cell Line ; Cyclins/biosynthesis ; Cytochromes c/metabolism ; Immunoglobulin G/*immunology ; Interferon Type II/pharmacology ; Lipopolysaccharides/pharmacology ; Macrophages/*immunology/metabolism ; Nitric Oxide/*metabolism ; Opsonins/immunology ; Phagocytosis/*physiology ; Superoxide Dismutase/metabolism ; Superoxides/*metabolism ; Zymosan

A 67-year-old male patient was admitted with an abrupt sudden cardiac death. He represented with an extreme electrical storm of 30 times of ventricular fibrillation (VF) episodes on one day. External shocks were performed to terminate VF. Transient J-wave in the inferior-lateral leads and Brugada electrocardiography pattern on the right precordial leads appeared during the electrical storm. And J-wave disappeared after the termination of electrical storm. We report a case of the appearance of J-wave during electrical storm in a patient with Brugada syndrome.
Brugada Syndrome ; Death, Sudden, Cardiac ; Electrocardiography ; Humans ; Male ; Shock ; Ventricular Fibrillation

Common variable immunodeficiency (CVID) is the most common symptomatic primary antibody deficiency syndrome and has a high prevalence of gastrointestinal complications. We report the case of a 36-year-old male with CVID who presented with chronic intractable diarrhea and malabsorption. A comprehensive evaluation revealed no secondary causes of his symptoms. He was treated symptomatically without improvement. After receiving systemic steroid treatment, his symptoms improved, but returned soon after tapering the steroid. When he was subsequently administered oral budesonide, his symptoms and quality of life improved; this effect lasted for 20 months without unacceptable side effects.
Adult ; Budesonide* ; Common Variable Immunodeficiency* ; Diarrhea* ; Humans ; Immunologic Deficiency Syndromes ; Male ; Prevalence ; Quality of Life

Multiple symmetric lipomatosis (MSL) is a rare disease characterized by the presence of diffuse, non-tender, symmetric deposits of adipose tissue on the neck, back and upper part of the trunk. It has been reported that this disease could be associated with various metabolic abnormalities such as impaired glucose tolerance, hyperuricemia, alcohol consumption, type 4 hyperlipidemia, renal tubular acidosis and thyroid disorder. We present a case of type 2 MSL with pulmonary thromboembolism. He suffered sudden dyspnea and decreased urine output. The causes of dyspnea and acute renal failure (ARF) in this case were dehydration and hemodynamic disturbance due to pulmonary thromboembolism. After thrombolytic and fluid therapy, his condition was improved. He was discharged on warfarin medication and has remained asymptomatic for 12 months.
Acidosis, Renal Tubular ; Acute Kidney Injury* ; Adipose Tissue ; Alcohol Drinking ; Dehydration ; Dyspnea ; Fluid Therapy ; Glucose ; Hemodynamics ; Hyperlipidemias ; Hyperuricemia ; Lipomatosis, Multiple Symmetrical* ; Neck ; Pulmonary Embolism* ; Rare Diseases ; Thyroid Gland ; Warfarin