The pleomorphic adenoma is the most common neoplasm involving both the major and minor salivary glands. It is a benign, slowgrowing tumor, but local recurrences can occur. The pleomorphic adenoma gene 1 (PLAG1), which is a novel zinc finger gene, is frequently activated by reciprocal chromosomal translocations involving 8q12 in a subset of salivary gland pleomorphic adenomas. This experimental study was preformed to observe the translocation patterns between PLAG1 gene and the three translocation partner genes. We also have analyzed the presence of PLAG1 transcripts by RT-PCR. CTNNB1/PLAG1 gene fusion was observed in three of nine pleomorphic adnomas. However, LIFR/PLAG1 and SII/PLAG1 gene fusions were not detectable. All of three gene fusions was not detectable in one Warthin's tumor and three inflammatory salivary gland tissues. PLAG1 transcripts were expressed in all inflammatory salivary gland tissues and tumors except for three pleomorphic adenomas. Of particular one pleomorphic adenoma showing CTNNB1/P AG1 gene fusion did not express PLAG1 transcipt. Our data indicate that gene fusion involving PLAG1 is a frequent event in pleomorphic adenoma, but correlation between gene fusion involving PLAG1 and PLAG1 transcription is not definite.
Adenoma, Pleomorphic* ; Gene Fusion ; Recurrence ; Salivary Glands* ; Salivary Glands, Minor ; Translocation, Genetic ; Zinc Fingers

Symptomatic hepatic cysts are infrequently seen. A 82-year-old woman was admitted because of growing abdominal mass and pain. On admission, the mass was palpated on right upper quadrant of the abdomen. Ultrasonography and computed tomography disclosed a huge cystic lesion of the liver. It measured 22.5 x 19.0 x 18.0 cm and had a thick wall that was irregular. Because of the patient's symptoms and the radiologic findings, the decision was made to aspirate the cyst percutaneously under fluoroscopic guidance. Percutaneous drainage yielded approximately 3300 cc of yellow brownish fluid. A cytologic evaluation of the fluid was negative for malignant cells, and a fluid analysis was described as predominantly inflammatory in nature. Cultures revealed a growth of Klebsiella oxytoca. After drainage of the cystic fluid, we instilled contrast medium. No communication between the cyst and bile ducts was seen. Seven days later, the patient was discharged. Four months after treatment, no reaccumulated fluid was observed by ultrasonography. Ten months after treatment, the patient is healthy without abdominal discomfort. We report a case of the infected huge hepatic cyst successfully treated with fluoroscopic-uided percutaneous drainage.
Abdomen ; Aged, 80 and over ; Bile Ducts ; Drainage* ; Female ; Humans ; Klebsiella oxytoca ; Liver ; Ultrasonography

Desmoplastic small round cell tumor (DSRCT) is a distinct clinicopathologic entity that has only recently been described. This aggressive malignant small cell neoplasm tends to occur in adolescents and young adults, who may present with vague abdominal discomfort or distention. We report a case of DSRCT in a 13 year-old girl who presented with intermittent abdominal pain and bulky intra-abdominal mass, accompanied by an increased serum level of a tumor marker CA125. Clinical, pathological, immunohistochemical and radiologic features were compatible with DSRCT. She is under aggressive combination chemotherapy after surgical resection.
Abdominal Pain ; Adolescent ; Desmoplastic Small Round Cell Tumor* ; Drug Therapy ; Drug Therapy, Combination ; Female ; Humans ; Young Adult

The terms "gastrointestinal stromal tumor" (GIST) have been applied to mesenchymal tumos that represent neither typical leiomyoma nor schwannoma. The majority of GISTs are Located in the stomach and small intestine, and only 4% of GISTs are found in duodenum. The most important characteristic is their indolent, slow-growing nature, rendering the most common definitions of malignancy invalid and inapplicable. Clinical and pathological criteria to differentiate benign from malignant GISTs are not well established. Tumor size and mitoic activity are commonly considered as important features, allowing for the prediction of biological behaviour and outcome. The case of a 87-year-old male patient who was presented with melena and acute anemia is herein reported. Esophagogastroduodenoscopy and computed tomography of the abdomen revealed two submucosal tumors in the stomach and duodenum. Histological and immunohistochemical studies on the surgical resection specimen revealed a gastrointestinal stromal tumor of an uncommiteed type, with no evidence of increased mitotic activity. The patient was treated with local excision of the tumors and is now in a favorable state.
Abdomen ; Aged, 80 and over ; Anemia ; Duodenum ; Endoscopy, Digestive System ; Gastrointestinal Stromal Tumors* ; Hemorrhage* ; Humans ; Intestine, Small ; Leiomyoma ; Male ; Melena ; Neurilemmoma ; Stomach

Candida albicans is a saprophytic organism that frequently resides in the mouth, skin, gastrointestinal and vaginal mucosa. It is also an opportunistic pathogen in immune compromised individuals, alcoholics, and debilitated subjects treated with antibiotics, steroids, or antineoplastic drugs. Although the most common site of gastrointestinal involvement is the esophagus, gastric candidiasis may occur in immune suppressed patients and is rarely apparent in healthy individuals. Symptoms are nonspecific; indigestion, abdominal pain, fever and weight loss have been described. The diagnosis can usually be established by visualizing yeast and/or mycelial forms in endoscopic biopsy or in mucosal brushings of the lesions. A case of gastric candidiasis presented with bleeding was experienced in a 69-year-old female with chronic renal failure due to diabetic nephropathy. She underwent orthopedic surgery because of intertrochanteric fracture of her femur. On the 6th day of the postoperative period, the patient began suffering from a large amount of melena. Endoscopic findings revealed multiple whitish or central necrotic plaques in the body and antrum of the stomach. Endoscopic biopsy revealed budding yeast and pseudohyphae infiltrating through the ulcerated stomach wall. After the patient was treated with mycostatin for 7 days, endoscopic and pathologic findings did not show any evidence of the candidiasis. The case is herein reported of gastric candidiasis presented with gastric bleeding, along with a review of corresponding literature.
Abdominal Pain ; Aged ; Alcoholics ; Anti-Bacterial Agents ; Antineoplastic Agents ; Biopsy ; Candida albicans ; Candidiasis* ; Diabetic Nephropathies ; Diagnosis ; Dyspepsia ; Esophagus ; Female ; Femur ; Fever ; Hemorrhage* ; Humans ; Kidney Failure, Chronic ; Melena ; Mouth ; Mucous Membrane ; Nystatin ; Orthopedics ; Postoperative Period ; Saccharomycetales ; Skin ; Steroids ; Stomach ; Ulcer ; Weight Loss ; Yeasts

Infliximab, a tumor necrosis factor-alpha (TNF-alpha) inhibitor, has been approved for the treatment of a variety of inflammatory illnesses, including Crohn's disease. However, infliximab can increase the risk of reactivation of latent tuberculosis (Tbc) infection by affecting host immune responses. Therefore, a screening test should be performed before the initiation of infliximab therapy, and patients with evidence of latent infection should be treated with prophylactic anti-Tbc therapy. Here, we report a case of multifocal disseminated tuberculosis after treatment with infliximab in a patient diagnosed with Crohn's disease who had no past history of Tbc and showed a negative screening test.
Antibodies, Monoclonal ; Crohn Disease ; Humans ; Latent Tuberculosis ; Mass Screening ; Tuberculosis ; Tumor Necrosis Factor-alpha ; Infliximab

OBJECTIVE: To investigate the feasibility of a rat model on hindlimb ischemia induced by embolization from the administration of polyvinyl alcohol (PVA) particles or N-butyl cyanoacrylate (NBCA). MATERIALS AND METHODS: Unilateral hindlimb ischemia was induced by embolization with NBCA (n = 4), PVA (n = 4) or surgical excision (n = 4) in a total of 12 Sprague-Dawley rats. On days 0, 7 and 14, the time-of-flight magnetic resonance angiography (TOF-MRA) and enhanced MRI were obtained as scheduled by using a 3T-MR scanner. The clinical ischemic index, volume change and degree of muscle necrosis observed on the enhanced MRI in the ischemic hindlimb were being compared among three groups using the analysis of variance. Vascular patency on TOF-MRA was evaluated and correlated with angiographic findings when using an inter-rater agreement test. RESULTS: There was a technical success rate of 100% for both the embolization and surgery groups. The clinical ischemic index did not significantly differ. On day 7, the ratios of the muscular infarctions were 0.436, 0.173 and 0 at thigh levels and 0.503, 0.337 and 0 at calf levels for the NBCA, PVA and surgery groups, respectively. In addition, the embolization group presented increased volume and then decreased volume on days 7 and 14, respectively. The surgery group presented a gradual volume decrease. Good correlation was shown between the TOF-MRA and angiographic findings (kappa value of 0.795). CONCLUSION: The examined hindlimb ischemia model using embolization with NBCA and PVA particles in rats is a feasible model for further research, and muscle necrosis was evident as compared with the surgical model.
Animals ; *Disease Models, Animal ; Embolization, Therapeutic/*adverse effects ; Enbucrilate/administration & dosage/*toxicity ; Feasibility Studies ; Hindlimb/*blood supply ; Injections, Intra-Arterial ; Ischemia/*chemically induced/diagnosis ; Magnetic Resonance Angiography/*methods ; Male ; Polyvinyl Alcohol/administration & dosage/*toxicity ; Rats ; Rats, Sprague-Dawley ; Tissue Adhesives/administration & dosage/toxicity

Purpose: : This study aims to investigate the status of delirium intervention in adult intensive care unit (ICU) patients and the perception of this delirium by medical staff. Methods: : This retrospective study involves 185 patients, whereas, a descriptive survey is conducted with 197 medical staff members. Results: : The delirium group includes 100 patients (54.1%). The incidence of delirium is 64.9% in the medical ICU, 65.9% in the surgical ICU, 42.4% in the neuro ICU, and 46.5% in the cardiac ICU. The percentages of delirium prevention intervention differs between the two groups: 65.0% in the delirium group and 95.3% in the non-delirium group. The medical staff recognize that delirium is a common problem in the ICU (100.0%) and requires active medical intervention (98.5%). Conclusion : The length of stay at the ICU is longer in the delirium group than in the non-delirium group. It is necessary to standardize delirium prevention and treatment protocols to be equally applicable to all ICU patients.

The diagnosis of hepatocellular carcinoma (HCC) is based on imaging studies particularly in high-risk patients without histologic confirmation. This study evaluated the prevalence and characteristics of false-positively diagnosed HCC in a liver resection cohort for HCC. A retrospective review was performed of 837 liver resection cases for clinically diagnosed HCC between 2005 and 2010 at our institute. High-risk patients with tumors > 1 cm with one or two image findings consistent with HCC and tumors < 1 cm with two or more image findings consistent with HCC with persistently increased serum alpha-fetoprotein (AFP) levels above the normal range with underlying inhibited hepatitis activity underwent liver resection. The false-positive rate was 2.2% (n = 18). Of the 18 patients, 7 patients (0.8%) were diagnosed with benign conditions (one each of hemangioma, inflammation, cortical adenoma, dysplastic nodule, angiomyolipoma, bile duct adenoma, and non-neoplastic liver parenchyme) and 11 patients (1.3%) were diagnosed with malignancies (cholangiocarcinoma [n = 6], hepatoblastoma [n = 2], and one each of lymphoepithelioma-like carcinoma, ovarian cystadenocarcinoma, and nasopharynx carcinoma metastasis). The clinical characteristics of pathologically diagnosed HCC patients were similar (P > 0.05) compared to non-HCC patients except for higher rate of history of alcoholism (P < 0.05) observed in non-HCC patients. Four of 18 non-HCC patients (22.2%) showed diagnostic discordance on the dynamic imaging study. Despite the recent progression in diagnostic imaging techniques, 2.2% of cases were false-positively diagnosed as HCC in a liver resection patient cohort; and the final diagnosis was benign disease in 0.8% of liver resection patients clinically diagnosed with HCC.
Adenoma ; Adenoma, Bile Duct ; Alcoholism ; alpha-Fetoproteins ; Angiomyolipoma ; Carcinoma, Hepatocellular* ; Cohort Studies ; Cystadenocarcinoma ; Diagnosis* ; Diagnostic Imaging ; Hemangioma ; Hepatitis ; Hepatoblastoma ; Humans ; Inflammation ; Liver* ; Nasopharynx ; Prevalence ; Reference Values ; Retrospective Studies