Posterior reversible encephalopathy syndrome (PRES) is a transient condition characterized by altered mental status, seizure, headache, and visual disturbance with typical neuro-imaging findings in the bilateral parieto-occipital regions. Clinicians should be aware of this syndrome because delayed diagnosis and treatment result in irreversible neurologic deficits. We present the case of a 77-year-old male diagnosed with PRES in the setting of postoperative critical illness caused by small-bowel strangulation.
Aged ; Critical Illness* ; Delayed Diagnosis ; Headache ; Humans ; Intensive Care Units ; Male ; Neurologic Manifestations ; Posterior Leukoencephalopathy Syndrome* ; Postoperative Period ; Seizures

Gastric neuroendocrine tumor (GNET) is rare, but increasing in incidence. GNET may be classified into three types on the basis of the background pathology. Type I GNET is related to autoimmune atrophic gastritis and hypergastrinemia. Type II is related to multiple endocrine neoplasia (MEN)-1, Zollinger-Ellison syndrome and hypergastrinemia and sporadic Type III is not related to any background pathology. Type I GNETs can be considered as benign tumors with unusual metastases. However, type II may be related to distant metastases, which is also common in type III GNETs. Type I and type II lesions can be treated by endoscopic excision or somatostatin analogues whereas surgical treatment should be considered for type III lesions. Hypergastrinemia is an essential precondition for the evolution of type I and II lesions, but hypergastrinemia alone is not enough for explanation of tumorigenesis. Furthermore, the pathogenesis of type III neuroendocrine tumors is still poorly understood. Despite improvements in our knowledge of GNET pathogenesis in diagnostic approach and treatment, further investigations and large scale clinical studies are warranted.
Cell Transformation, Neoplastic ; Gastritis, Atrophic ; Incidence ; Multiple Endocrine Neoplasia ; Multiple Endocrine Neoplasia Type 1 ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Somatostatin ; Upper Gastrointestinal Tract ; Zollinger-Ellison Syndrome

We report a case of vesical endometriosis in a 34 year old female patient and review literature. Managements include partial cystectomy, hormonal treatment and radiation. In this case, we select the hormonal treatrnent because the vesical endometriosis was in the fixed portion of the bladder.
Adult ; Cystectomy ; Endometriosis* ; Female ; Humans ; Urinary Bladder

Congenital arachnoid cysts are commonly located at sylvian cistern or middle cranial fossa which are usually asymptomatic and incidentally found. Posterior fossa cysts, however, are usually large when diagnosed, and symptomatic. Three cases of large posterior fossa cysts were recognized on the diagnostic MRI investigation for infantile spasm, developmental delay, and the precocious puberty. Surgical decompression of the cysts by craniectomy, cyst excision and fenestration were performed successfully in two patients with arachnoid cysts in the cerebellopontine cistern and the suprasellar, right cerebellopontine, and prepontine cisterns, but an additional cystoperitoneal shunt was needed in a case with the cyst in the quadrigemial cistern with obstructive hydrocephalus. Infantile spasm was treated with vigabatrin and pyridoxine, and the true precocious puberty was managed with LHRH analogue(Decapeptyl ).
Arachnoid Cysts* ; Arachnoid* ; Cranial Fossa, Middle ; Decompression, Surgical ; Gonadotropin-Releasing Hormone ; Humans ; Hydrocephalus ; Infant ; Infant, Newborn ; Magnetic Resonance Imaging ; Puberty, Precocious ; Pyridoxine ; Spasms, Infantile ; Vigabatrin

An endobronchial metastasis is defined as a subsegmental or a more proximal central bronchial metastasis of a nonpulmonary neoplasm in the bronchoscopically visible range. However, the frequencies of endobronchial metastasis range from 2 to 50% of pulmonary metastases from extrathoracic neoplasms by a different difinition of an endobronchial metastasis. Primary neoplasms of an endobronchial metastasis including breast cancer, colon cancer, renal cell carcinoma, and ovarian cancer are relatively common. However, an endobronchial metastasis arising from thyroid cancer, parotid gland tumor, bone tumor, bladder cancer, and stomach cancer has only rarely been reported in the literature. Here we report a case of an endobrochial metastases from a hepatocellular carcinoma
Breast Neoplasms ; Carcinoma, Hepatocellular* ; Carcinoma, Renal Cell ; Colonic Neoplasms ; Neoplasm Metastasis* ; Ovarian Neoplasms ; Parotid Gland ; Stomach Neoplasms ; Thyroid Neoplasms ; Urinary Bladder Neoplasms

PURPOSE: We wanted to evaluate the diverse distribution and relation of the hepatic segments, as divided by the portal venous territories, on the isotropic multi-planar reformatted (MPR) CT images and we wanted to find their correlation to the intrahepatic venous structures. MATERIALS AND METHODS: Fifty adult patients who underwent portal phase CT images and who had the normal liver contours at CT were included in our study. The portal phase images were obtained with a slice collimation and reconstruction interval of 1.25 mm, and they were reformatted in the coronal and sagittal planes with a slab thickness of 3 mm. For analysis of these MPR images, various terms were newly defined according to the portal venous territories (e.g., three vertical planes [right, middle and left] and one transverse plane and their plane angles, the transverse and longitudinal angles). Also, the dominant segments of the right lobe were newly divided into the S7- and S8-dominant types by comparing the transverse angles. The imaging analysis was then conducted for the following: (1) the diversity of the three vertical planes and the one transverse plane and their plane angles, (2) the proportion of the dominant segments of the right lobe and their relation with the plane angles, and (3) the correlation between the dominant segments and the intrahepatic venous structures. RESULTS: The number of the S7- and the S8-dominant types was 21 and 29, respectively. The vertical and transverse planes were undulating and diverse according to the dominant segments as follows: the plane angles of the right vertical and middle vertical planes were more vertical in the S7-dominant type than in the S8-dominant type (p < 0.001). The right transverse plane angle was more horizontal in the S8-dominant type (p < 0.05). The left transverse plane angle seemed to be rather vertical than horizontal. For the intrahepatic venous structures, despite of our limited data, the anomalous intrahepatic venous structures might have some correlation with the dominant segments. CONCLUSION: According to our results, we suggest that the isotropic MPR images could successfully depict the vertical and transverse planes of the real hepatic segments, as divided by the portal venous territories, which were diverse according to their dominant types.
Adult ; Humans ; Liver

BACKGROUND: PM10(Particulate matter with a diameter < 10micrometer), which is characterized by different environmental conditions, is a complex mixture of organic and inorganic compounds. The Asian dust event caused by meteorological phenomena can also produce unique particulate matter in affected areas. This study investigated the cytokine produced by A549 epithelial cells exposed to particles collected during both the Asian dust pfenomenon and ambient air particles in a non-dusty period. METHOD: Air samples were collected using a high volume air sampler(Sibata Model HV500F) with an air flow at 500l/min for at least 6 hours. The cytokine messenger RNA(mRNA) was measured using a reverse transcriptase polymerase chain reaction(RT-PCR). The A549 cells were exposed to 10 to 500microgram/microliter of a suspension containing PM10 for 24 hours. Each was compared with those in the non-exposed control cells. RESULT: The mRNA levels of interleukin(IL)-1alpha, IL-Ibeta , IL-8, and the granulocyte macrophage colony stimulating factor(GM-CSF) increased after veing exposed to PM10 in the ambient air particles, compared with those in the non-exposed control cells. The increase in IL-1alpha and IL-8 were dose dependent at a PM10 concentration between 100microgram/microliter and 500microgram/microliter. The mRNA level of IL-8 in the A549 epithelial cells was higher during the in the Asian dust period(500microgram/microliter) than during the non dust period. CONCLUSION: A549 cells exposed to the PM10 collected during the Asian dust period produce more proinflammatory cytokine than during non-dusty period. This cytokine enhances the local inflammatory response in the airways and can also contribute to the systemic component of this inflammatory process.
Asian Continental Ancestry Group* ; Dust* ; Epithelial Cells* ; Granulocytes ; Humans ; Interleukin-8 ; Macrophages ; Particulate Matter* ; RNA, Messenger ; RNA-Directed DNA Polymerase

BACKGROUND/AIMS: Patients undergoing Billroth II (B II) gastrectomy are at higher risk of perforation during endoscopic retrograde cholangiopancreatography (ERCP). We assessed the success rate and safety of forward-viewing endoscopic biliary intervention in patients with B II gastrectomy. METHODS: A total of 2,280 ERCP procedures were performed in our institution between October 2008 and June 2011. Of these, forward-viewing endoscopic biliary intervention was performed in 46 patients (38 men and 8 women with B II gastrectomy). Wire-guided selective cannulations of the common bile duct using a standard catheter and guide wire were performed in all patients. RESULTS: The success rate of afferent loop entrance was 42 out of 46 patients (91.3%) and of biliary cannulation after the approach of the papilla was 42 out of 42 patients (100%). No serious complications were encountered, except for one case of small perforation due to endoscopic sphincterotomy site injury. CONCLUSIONS: When a biliary endoscopist has less experience and patient volume is low, ERCP with a forward-viewing endoscope is preferred because of its ease and safety in all patients with prior B II gastrectomies. Also, forward-viewing endoscope can be used to improve the success rate of biliary intervention in B II patients.
Catheterization ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Endoscopes ; Female ; Gastrectomy ; Gastroenterostomy ; Humans ; Male ; Sphincterotomy, Endoscopic

Primary cardiac tumors are extremely rare and can originate within the heart or be the result of tumor spread from other sites. We report a female patient with a pulmonary vein tumor extending into the left atrium that had a suspicious primary malignant origin with a sacral metastatic carcinoma. The patient was admitted complaining of pain in her buttock area as a result of a sacral tumor. It was believed that the sacral tumor was a metastasis from the imaging study and clinical manifestation. The primary malignant origin was evaluated. The chest CT showed a left atrium thrombus-like lesion without a pulmonary abnormality. After a transesophageal echocardiogram, the patient was diagnosed with a pulmonary vein tumor extending to the left atrium. The patient was given palliative radiotherapy for the sacral pain. Initially, the clinical impression was a metastatic sacral tumor with a thromboembolism of the left atrium. However, this patient was finally diagnosed with a pulmonary vein tumor with a left atrium extension by a transesophageal echocardiogram.
Vascular Neoplasms/*diagnosis/pathology ; Thromboembolism/diagnosis ; Sacrococcygeal Region/pathology ; Pulmonary Veins/*pathology ; Palliative Care ; Humans ; Heart Neoplasms/*diagnosis/pathology ; Heart Atria/*pathology ; Female ; Diagnosis, Differential ; Aged

BACKGROUND/AIMS: Gastric cancer is one of the most widespread cancers and the second leading cause of cancer-related death worldwide. Although Helicobacter pylori (H. pylori) has been classified as a type I carcinogen for gastric cancer, the exact pathway has remained indistinct. In this study, we investigated the effects of H. pylori on oncogenic proteins (epidermal growth factor receptor [EGFR], CEA), tumor suppressor (p53) and cell-cycle regulator (p16) expression, using immunohistochemical stains, in gastric neoplasias. MATERIALS AND METHODS: From April 2007 until July 2009, 166 patients with consecutive gastric neoplasias resected were retrospectively enrolled; 35 gastric dysplasias, 70 early gastric cancers and 60 advanced gastric cancers. We examined the relationship of clinicopathologic features of gastric neoplasias such as age, sex, p16, p53, EGFR, tissue CEA, TNM stage, Lauren classification, location, histologic type of neoplasia to H. pylori infection status. RESULTS: H. pylori infection detected in the samples of gastric dysplasia, early gastric cancer (EGC) and advanced gastric cancer (AGC) were 15 (41.7%), 38 (54.3%) and 33 (55.0%) samples. p53, CEA and EGFR stains expression were associated with cancer stage (P<0.05). There was no relation between the immunohistochemical stains (p16, p53, CEA, EGFR) and H. pylori infection. CONCLUSIONS: This study failed to show any relation of immunohistochemical markers of p16, p53, EGFR, CEA expressions to H. pylori infection in gastric dysplasia as well as gastric cancer. Further study is necessary to investigate the effect of H. pylori infection on p16, p53, CEA, EGFR expressions in precancerous lesions such as atrophic gastritis and intestinal metaplasia.
Coloring Agents ; Cyclin-Dependent Kinase Inhibitor p16 ; Gastritis, Atrophic ; Helicobacter ; Helicobacter pylori ; Humans ; Metaplasia ; Proteins ; Retrospective Studies ; Stomach Neoplasms