BACKGROUND: Although hypochlorhydria, hypergastrinemia and antiparietal cell antibody have been well documented in the patients with hyperthyroidism, a cause of hypochlorhydria or hypergastrinemia is unknown at the present time. Therefore, in order to clarify an inhibitory mechansim of gastric acid secretion in the patients with hyperthyroidism, interrelationship among hypochlorhydria, hypergastrinemia and antiparietal cell antibody was investigated in this study. METHODS: The gastric secretory function, fasting and postprandial plasma concentrations of gastrin and titer of antiparietal cell antibody in the plasma were determined in the patients with hyperthyroidism and normal subjects. Immunoblot analysis was performed to identify the gastric membrane protein, a possible gastric antigen to antiparietal cell antibody. Using a immunocytochemical technique with electron microscopy, intracellular structure of the parietal cell reacted with antiparietal cell antibody was observed. RESULTS: The basal and pentagastrin-stimulated maximal acid output were reduced in the patients with hyperthyroidism. The fasting and postprandial plasma concentrations of gastrin were markedly elevated in the patients. The plasma gastrin concentration in the patients with the antiparietal cell antibody was higher than that of the norrnal subjects as well as the patients without the antibody not only in the fasting state but also in the postprandial state. However, the plasma gastrin concentration of the patients without the antiparietal cell antibody was elevated in the fasting state only. There was no difference in the gastrin content of the antral mucosa between the norrnal subjects and the patients. The antiparietal cell antibody was detected in 5 (38.5 %) out of 13 patients by using the indirect immunofluorescence method. Patient IgG dose-dependently inhibited rabbit gastric H (+),K (+)-ATPase activity. Among proteins of the rabbit gastric mucosa membrane, four high molecular weight proteins (91, 140, 170 and 210 K dalton) were reacted to the patient IgG. The patient IgG positive peroxidase-antiperoxidase (PAP) activity was electron microscopically detected on the intracellular cannalicular membrane of the parietal cell CONCLUSION: We conclude that hypochlorhydria and hypergastrinemia in the patients with hyperthyroidism are partially related to the antiparietal cell antibody and that the antigen to the antiparietal cell antibody may be H (+),K (+)-ATPase in the intracellular canalicular membrane of the parietal cell.
Achlorhydria ; Fasting ; Fluorescent Antibody Technique, Indirect ; Gastric Acid* ; Gastric Mucosa ; Gastrins ; Humans ; Hyperthyroidism* ; Immunoglobulin G ; Membrane Proteins ; Membranes ; Microscopy, Electron ; Molecular Weight ; Mucous Membrane ; Plasma ; Rabeprazole

No abstract available.
Pregnancy*

No abstract available.
Impetigo*

Coronary stent dislodgement is a rare complication of percutaneous coronary intervention. We report a case of stent dislodgement in the ascending thoracic aorta. The stent was mechanically distorted in the left circumflex artery (LCX) while being delivered to the proximal LCX lesion. The balloon catheter was withdrawn, but the stent with the guide wire was remained in the ascending thoracic aorta. The stent was unable to be retrieved into the guide catheter, as it was distorted. A goose neck snare was used successfully to catch the stent in the ascending thoracic aorta and retrieved the stent externally via the arterial sheath.
Angioplasty, Balloon, Coronary/*adverse effects/*instrumentation ; *Aorta, Thoracic/radiography ; Cardiac Catheterization/*adverse effects/*instrumentation ; Coronary Angiography ; Device Removal/*instrumentation ; Foreign Bodies/etiology/radiography/*therapy ; Humans ; Male ; Middle Aged ; Radiography, Interventional ; *Stents ; Treatment Outcome

No abstract available.
Sarcoma*

We present a patient with type 2 diabetes mellitus and metastatic renal cell carcinoma who developed severe hypoglycemia and metabolic encephalopathy after sunitinib treatment. Sunitinib, a multi-target tyrosine kinase inhibitor, is used to treat metastatic renal cell carcinoma. Sunitinib-induced hypoglycemia has been reported and there are rare case reports of severe hypoglycemia due to sunitinib. Therefore, glycemic control should be monitored closely in diabetic patients treated with sunitinib.
Brain Diseases, Metabolic ; Carcinoma, Renal Cell* ; Coma* ; Diabetes Mellitus, Type 2 ; Humans ; Hypoglycemia ; Protein-Tyrosine Kinases

Tuberculosis is a common chronic infectious disease, although the spleen is an uncommon organ to harbor tubercle bacilli. Immunocompromised subjects are primarily prone to miliary tuberculosis and in them the spleen is invaded by Mycobacterium tuberculosis. Spleen tuberculosis is manifested commonly as a miliary form. The basic pathology is granulomatous inflammation. The CT finding of splenic tuberculosis are multiple, well-defined, roung or ovoid, low-density masses. Lymphadenopathy in the abdomen and mediastinum and pleural effusion can be found. We report two cases with tuberculosis of the spleen proved by computed tomography and histologic identification. One paitient did not improve following antituberculous medication, so splenectomy was performed. The other patient has been treated with antituberculous medication.
Abdomen ; Communicable Diseases ; Humans ; Inflammation ; Lymphatic Diseases ; Mediastinum ; Mycobacterium tuberculosis ; Pathology ; Pleural Effusion ; Spleen* ; Splenectomy ; Tuberculosis* ; Tuberculosis, Miliary ; Tuberculosis, Splenic

OBJECTIVE: It is not unusual to decompress two consecutive disc levels in treating patients with multiple radiculopathy or uncertain level diagnosis. However, the controversy over whether to use corpectomy or bisegmental diskectomy for anterior cervical fusion is still largely unsettled. The aim of this study is to define the properties of these two surgical options. PATIENTS AND METHODS: We performed a retrospective review of radiological data and clinical records only in patients whom the follow up period is longer than 12 months. Functional outcome, fusion rate, complication rate, and duration of anesthesia were analyzed in both groups. RESULTS: In total of 61 cases, corpectomy was performed in 34 and the bisegmental diskectomy in 27 patients. Mean follow-up periods were over 24 months in both groups. Anesthesia time was shorter in corpectomy patients(280 minutes vs. 300 minutes in segmental diskectomy). However, the bisegmental diskectomy group was better in achieving good clinical outcome(92.6% vs. 82%). Overall fusion rate in bisegmental diskectomy was 100%. Hardware failure rate was lower in bisegmental diskectomy group(11% vs. 18%). Revision was needed in 6% of corpectomy group. CONCLUSIONS: In conclusion, although the anesthesia time is slightly longer in bisegmental fusion, we believe the method of bisegmental diskectomy is better in accomplishing higher fusion rate and lower complication rate.
Anesthesia ; Diagnosis ; Diskectomy* ; Follow-Up Studies ; Humans ; Radiculopathy ; Retrospective Studies

No abstract available.
Chondromatosis, Synovial* ; Knee Joint* ; Knee* ; Osteoarthritis*

Infectious complications such as wound infection and intra-abdominal abscess are rarely fatal, but perplexing to both patients and surgeons, and still remain asserious problem after appendectomy in about 5% of the patients. To be helpful to reduce post-appendectomy complications, authors retrospectively analyzed 229 cases of appendectomy performed during the period of one year, from January 1 through December 31, 1995, to find out contributing factors to the post-appendectomy infectious complications such as wound infection or intra-abdominal abscess. The results were as follows. 1) Infectious complications are more common in patients with four or more days of symptom. 2) Infectious complications are more common in patients with complicated appendicitis such as gangrenous or perforated appendicitis. 3) Preoperative antibiotics are helpful to prevent infectious complications in cases of complicated appendicitis. 4) There is no difference in the incidence of infectious complications between the immediate operations and overnight delayed operations in patients who were admitted in the late evening or at night. 5) There is no difference in the incidence of infectious complications between operators: staff surgeons who exclusively operated on patients with complicated appendicitis and residents(with or without supervision of staff surgeons) who mostly operated on patients with simple appendicitis. This means technical superiority has its role in preventing infectious complications. Early diagnosis and operation before the gangrenous change or perforation are warranted. Preoperative antibiotics are effective in cases of complicated appendicitis, but not in cases of simple appendicitis. But the lack of objective criteria to decide complicated appendicitis before the operation remains problem, and prospective study to solve this problem is needed. Technical perfectness is required to protect the wound and to remove the appendix without contamination. Preventive measures are also important to prevent the infectious complications in cases of inevitably contaminated wounds or inta-abdominal spaces.
Abdominal Abscess ; Anti-Bacterial Agents ; Appendectomy ; Appendicitis ; Appendix ; Early Diagnosis ; Humans ; Incidence ; Organization and Administration ; Retrospective Studies ; Wound Infection ; Wounds and Injuries