Choledochocele is a kind of choledochal cyst and represents a prolapse or herniation of the intramural segment of the distal common bile duct into the duodenal lumen. It is rare congenital anomaly and, easlily overlooked due to non-specific clinical symptoms, signs, and non-characteristic radiologic features. The cause of choledochocele remains uncertain and it was suggested that thete are two distinct types in the pathogenesis of it, i.e., congenital and acquired. Recently, many cases of choledochocele were reported, which diagnosed by ERCP and safely treated with endoscopic unroofing and EST followed by continued observation as well as interval ERCP and/or endoscopic ultrasonography. We present here four cases of symptomaatic choledochoceles that had been managcd by end- oscopic therapy and continucd observation.
Biliary Tract* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochal Cyst* ; Common Bile Duct ; Endosonography ; Pancreas* ; Prolapse

Churg-Strauss syndrome(CSS) or the syndrome of allergic granulomatosis and angiitis is a kind of rare systemic vasculitis characterized by bronchilal asthma, peripheral eosinophilia, paranasal sinus abnormality, mono or polyneuropathy, pulmonary infiltrates nonfixed and pathological findings such as prominent eosinophilic infiltration, necrotizing angiitis and extravascular granuloma formation. Clinical features of CSS includes asthma, pulmonary infiltrates, cutaneous lesions, neuropathy, cardiac involvement, gastrointeastinal involvement, renal involvement and musculoskeletal involvement. The diagnosis of CSS is made on the basis of both clinical and pathologic features. We experienced a 30-year-old man who presented peripheral eos'lnophilia, asthma of two year's duration, lower extremity weakness and lung infiltrations. His lung and skin biopsy showed eosinophilic infiltrates and eosinophilic vasculitis. He was diagnosed as Churg-Strauss syndrome based on the clinical manifestations and pathologic finding of lung and skin. He was managed with 3 times of plasmapheresis and methylprednisolone 1.0 g/day of 3 days followed by oral prednisolone 50rag/day and cyclophosphamide 2mg/kg. Clinical symptoms, laboratory and X-ray findings of the patient were improved at 7 days after treatment. After discharge, he has been treated with cyclophosphamide and low dose prednisolone. We report a case CSS with review of the literatures.
Adult ; Asthma ; Biopsy ; Churg-Strauss Syndrome* ; Cyclophosphamide ; Diagnosis ; Eosinophilia ; Eosinophils ; Granuloma ; Humans ; Lower Extremity ; Lung ; Methylprednisolone ; Plasmapheresis ; Polyneuropathies ; Prednisolone ; Skin ; Systemic Vasculitis ; Vasculitis

BACKGROUND: Several factors had been suggested to contribute to the development of hypertension in chronic glomerulonephritis (GN). This study was conducted to find the association of baseline blood pressure (BP) with pathophysiologic findings and later renal progression in chronic GN. METHODS: Clinico-pathological findings including serum creatinine (Cr), proteinuria, pathological findings, and urinary Na excretion were analyzed in a total of 233 patients with IgA nephropathy from The Kyung-Hee Cohort of GN. Glomerular surface area (GSA) was measured by imaging analysis and urine angiotensinogen (AGT) concentrations by human ELISA kits. RESULTS: Systolic BP was ≥130mmHg in 124 patients (53%). Systolic BP was negatively correlated with follow-up eGFR (r=−0.32, p<0.0001) and positively serum uric acid concentrations, while it had no significant relationships with initial serum Cr and eGFR. As compared with patients with systolic BP<130 mmHg, those with ≥130 mmHg were older and showed higher serum Cr, proteinuria, 24 hr urinary Na excretion, mean GSA, and T-I fibrosis, lower follow-up eGFR, and steeper decline in slope of eGFR. The results in patients with normal serum Cr concentrations were comparable to those in whole group. Systolic BP was positively correlated with age, baseline and follow-up proteinuria, serum uric acid concentrations and IgM deposit and negatively with follow-up eGFR. In subgroup analysis, systolic BP was also positively correlated with mean GSA and urinary AGT concentrations. CONCLUSION This study showed that baseline systolic BP is related to urinary Na excretion, glomerulomegaly, T-I fibrosis and later renal progression in patients with IgA nephropathy.

It was reported that cancer in humans and animals infected with microbial pathogens was regressed about 100 years ago. Bacteria are able to trigger apoptosis by a variety of mechanisms including the secretion of protein synthesis inhibitors, pore forming proteins, molecules activating the endogenous death machinery in the infected cell. This study was conducted in order to investigate whether extracellular products of Psuedomonas aeruginosa (EPPA) induce apoptosis in human oral carcinoma cells (OSC9). The EPPA showed cytotoxic effect on OSC9 cells in dose and time-dependent manner. The cell death was demonstrated to be due to apoptosis characterized by chromatin condensation and nuclear fragment. EPPA treatment induced cleavage of caspase-3 and caspase-6. The caspase substrates, PARP, DFF45 and lamin A were cleaved during EPPA-induced apoptosis. Taken together, EPPA induces apoptosis on human oral squamous carcinoma cells in caspase-dependent manner. Our data therefore provide that EPPA contains a novel antitumor agent for human oral squamous carcinoma.
Animals ; Apoptosis* ; Bacteria ; Carcinoma, Squamous Cell* ; Caspase 3 ; Caspase 6 ; Cell Death ; Chromatin ; Humans* ; Lamin Type A ; Protein Synthesis Inhibitors ; Pseudomonas aeruginosa* ; Pseudomonas*

Typhlitis is a life threatening necrotizing enterocolitis of the cecum, ascending colon and terminal ileum seen in severely neutropenic patients, however its pathogenesis is not identified up to this time.The incidence of typhlitis in leukemic patient is 10~12%, estimated by postmortem examination, and 46% in induction chemotherapy of leukemia. Recently, entity incidence is more high due to increasing challenges to high dose chemotherapy in solid tumors.We experienced four cases of typhlitis, one was developed in the circumstance of neutropenia induced by induction chemotherapy for acute myelocytic leukemia and others in neutropnia due to primary diseases without chemotherapy, ig, chronic myelocytic leukemia, acute lymphocytic leukemia, myelodysplastic syndrome.All cases were treated with high dose broad spectrum antibiotics in early phase of disease and its outcome was good, so that, early diagnosis of typhlitis is essential, then prompt treatment with high dose antibiotics and intravenous fluid before onset of transmural necrosis is associated with lower morbidity and mortality than surgical resection.
Anti-Bacterial Agents ; Autopsy ; Cecum ; Colon, Ascending ; Drug Therapy ; Early Diagnosis ; Enterocolitis, Necrotizing ; Humans ; Ileum ; Incidence ; Induction Chemotherapy ; Leukemia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukemia, Myeloid, Acute ; Mortality ; Necrosis ; Neutropenia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Typhlitis*

Metastatic tumor of the epididymis is a rare tumor. There are around 31 cases in the literature until now. The primary tumor was from the prostate in 18 cases, large and small intestine in 6 cases, kidney in 4 cases, stomach in 2 cases and pancreas in 1 case. We recently experienced a case of metastatic carcinoma to the epididymis from a primary cancer in the sigmoid colon and the other case of metastatic carcinoma to the testis and the liver from a sigmoid adenocarcinoma.
Adenocarcinoma ; Colon, Sigmoid* ; Colonic Neoplasms ; Epididymis ; Intestine, Small ; Kidney ; Liver ; Male ; Neoplasm Metastasis ; Pancreas ; Prostate ; Stomach ; Testis

PURPOSE: Important advances in the treatment of acute myelogenous leukemia have been made with the introduction of cytosine arabinoside (ara-C) and anthracyclines (daunorubicin) over the past 20 years. Currently, 60 to 80% of patients with acute myelogenous leukemia achieve complete remission with induction chemotherapy consisting of ara-C and daunorubicin (adriamycin) AD ("7+3"). The one-fourth of complete responders will have extended long-term survival and may be cured. Therefore wetreated patients with acute myelogenous leukemia admitted to our hospital with AD ("7+3") regimen. METHODS: Induction therapy; Thirty four patients with previously untreated acute myelogenous leukemia received AD ("7+3") regimen (ara-C, 200 mg/m2/d by continuous infusion for seven days, and daunorubicin, 45 mg/m2/d for 3 days). The second course of therapy was AD ("5+2"), if the patients failed to enter remission. Consolidation therapy; three cycles of consolidation chemotherapy were administered with at least 4 week interval following remission. Course 1; ara-C at 100 mg/m2 by subcutaneous injection every 12 hour for seven days, 6-thioguanine at every 12 hour 100 mg/m2 orally every 12 hour for 7 days). Course 2; ara-C (same as course 1) at 100 mg/m2 by subcutaneous injection every 12 hour for seven days, vincristine at 1.5 mg/m2 (maximum 2 mg) by bolus injection for 1 day, prednisolone at 40 mg/m2 (maximum 60 mg) orally for 7 days. Course 3; ara-C (same as course 1) daunorubicin at 45 mg/m2 by 1 hour infusion for 3 dyas. RESULTS: Sixty-eight percent of the 34 patients entered complete remission. The remission duration for all patients in complete remission ranged from 4 weeks to 3122+ weeks, with the median of 50 weeks. The median duration of survival in complete responder group was 62 weeks. Twenty-Six percent of patients with complete remission are alive at 5 years. Cases with extramedullary leukemic involvement were found in four patients; M2 with orbital mass, M3 and M4 with CNS leukemia, M5a with subcutaneous nodules. Among the potential prognostic variables including age, initial WBC count, percent of blast in peripheral blood,none was statistically related to prognosis. CONCLUSION: Combination chemotherapy with cytosine arabinoside and daunorubicin is a effective regimen for acute myelogenous leukemia as much as other regimen. Futher clinical trials for effective treatment regimen and method are necessary to raise the complete remission rate.
Anthracyclines ; Consolidation Chemotherapy ; Cytarabine* ; Cytosine* ; Daunorubicin* ; Drug Therapy ; Drug Therapy, Combination* ; Humans ; Induction Chemotherapy ; Injections, Subcutaneous ; Leukemia ; Leukemia, Myeloid, Acute* ; Orbit ; Prednisolone ; Prognosis ; Thioguanine ; Vincristine