No abstract available.
Drug Therapy*

Relapsing polychondritis is a rare multisystem rheumatic disease,characterized by recurrent and potentially destructive inflammatory lesions of cartilaginous structures.All types of cartilage & other proteoglycan-rich structures may be involved,resulting in auricular chondritis,laryngotracheal chondritis,ocular symptoms,vasculitis,cardiac abnormalities,skin lesions and glomerulonephritis. The disease may be associated with another connective tissue and autoimmune diseases such as rheumatoid arthritis,systemic lupus erythematosus,Sjogren's syndrome and systemic vasculitis. We experienced a 69-year-old female patient who had been previously diagnosed as Sjogren's syndrome,presenting respiratory tract involvement,episcleritis,auricular chondritis and vestibular dysfunction.
Aged ; Autoimmune Diseases ; Cartilage ; Connective Tissue ; Female ; Glomerulonephritis ; Humans ; Polychondritis, Relapsing* ; Respiratory System ; Sjogren's Syndrome* ; Systemic Vasculitis

PURPOSE: Recent studies have revealed recurrent alterations in the cell adhesion gene FAT4, a candidate tumor suppressor gene, in cancer. FAT atypical cadherin 4 (FAT4) is a transmembrane receptor involved in the Hippo signaling pathway, which is involved in the control of organ size. Here, we investigated the loss of FAT4 expression and its association with clinicopathological risk factors in gastric cancer. MATERIALS AND METHODS: We assessed the expression of FAT4 by using immunohistochemistry on three tissue microarrays containing samples from 136 gastric cancer cases, radically resected in the Soonchunhyang University Cheonan Hospital between July 2006 and June 2008. Cytoplasmic immunoexpression of FAT4 was semi-quantitatively scored using the H-score system. An H-score of > or =10 was considered positive for FAT4 expression. RESULTS: Variable cytoplasmic expressions of FAT4 were observed in gastric cancers, with 33 cases (24.3%) showing loss of expression (H-score <10). Loss of FAT4 expression was associated with an increased rate of perineural invasion (H-score <10 vs. > or =10, 36.4% vs. 16.5%, P=0.015), high pathologic T stage (P=0.015), high tumor-node-metastasis stage (P=0.017), and reduced disease-free survival time (H-score <10 vs. > or =10, mean survival 62.7+/-7.3 months vs. 79.1+/-3.1 months, P=0.025). However, no association was found between the loss of FAT4 expression and tumor size, gross type, histologic subtype, Lauren classification, lymphovascular invasion, or overall survival. CONCLUSIONS: Loss of FAT4 expression appears to be associated with invasiveness in gastric cancer.
Cell Adhesion ; Chungcheongnam-do ; Classification ; Cytoplasm ; Disease-Free Survival ; Genes, Tumor Suppressor ; Immunohistochemistry ; Organ Size ; Risk Factors ; Stomach Neoplasms*

Although DNA damage responses (DDRs) are reported to be involved in nitric oxide (NO) production in response to genotoxic stresses, the precise mechanism of DDR-mediated NO production has not been fully understood. Using a genotoxic agent aphidicolin, we investigated how DDRs regulate NO production in bovine aortic endothelial cells. Prolonged (over 24 h) treatment with aphidicolin increased NO production and endothelial NO synthase (eNOS) protein expression, which was accompanied by increased eNOS dimer/monomer ratio, tetrahydrobiopterin levels, and eNOS mRNA expression. A promoter assay using 5’-serially deleted eNOS promoters revealed that Tax-responsive element site, located at −962 to −873 of the eNOS promoter, was respon-sible for aphidicolin-stimulated eNOS gene expression. Aphidicolin increased CREB activity and ectopic expression of dominantnegative inhibitor of CREB, A-CREB, repressed the stimulatory effects of aphidicolin on eNOS gene expression and its promoter activity. Co-treatment with LY294002 decreased the aphidicolin-stimulated increase in p-CREB-Ser133 level, eNOS expression, and NO production. Furthermore, ectopic expression of dominant-negative Akt construct attenuated aphidicolin-stimulated NO production. Aphidicolin increased p-ATM-Ser1981 and the knockdown of ATM using siRNA attenuated all stimulatory effects of aphidicolin on p-Akt-Ser473 , p-CREB-Ser133 , eNOS expression, and NO production. Additionally, these stimulatory effects of aphidicolin were similarly observed in human umbilical vein endothelial cells. Lastly, aphidicolin increased acetylcholine-induced vessel relaxation in rat aortas, which was accompanied by increased p-ATM-Ser1981 , p-Akt-Ser473 , p-CREB-Ser 133 , and eNOS expression. In conclusion, our results demonstrate that in response to aphidicolin, activation of ATM/Akt/CREB/eNOS signaling cascade mediates increase of NO production and vessel relaxation in endothelial cells and rat aortas.

PURPOSE: There has been much reported data showing that breast reconstruction surgery does not result in reduced patient survival if the accepted principles of cancer surgery are closely followed. The proper reconstructive technique can be selected according to diverse factors, but breast size and the site of tumor are mostly important. The latissimus dorsi musculocutaneous flap (LDMCF) is one of the most commonly used techniques for early breast cancer patients who have small breasts. But, it has difficulties for supplying enough tissues to the widely excised tumor site. Especially for ptosis patients, reduction mammoplasty by itself is not enough to achieve symmetry of the breast. We suggest that the pectoralis major myomammary flap (PMMF) is a useful technique for the patients with ptosis. METHODS: Seventeen patients with ptosis were treated with breast conserving surgery with PMMF reconstruction. A quadrantectomy rather than lumpectomy was performed through a planned skin incision, and axillary lymph node dissection was performed according to the results of sentinel lymph node biopsy. The PMMF is carefully harvested without perforating branch injury to the internal thoracic artery. Reconstruction was done via the PMMF through the medial tunnel between both breasts. RESULTS: Among the seventeen patients, seroma occurred in two patients and no necrosis occurred at all. The cosmetic result was fair in 15 patients and poor in two patients, based on the four-point scoring system of breast cosmetics. CONCLUSION: After performing enough quadrantectomy to adhere to the accepted principles of cancer surgery, PMMF was quite useful to supply enough proper tissues for breast reconstructions, and especially for the ptosis patients.
Breast ; Breast Neoplasms ; Cosmetics ; Female ; Humans ; Lymph Node Excision ; Mammaplasty ; Mammary Arteries ; Mastectomy, Segmental ; Necrosis ; Nitriles ; Pyrethrins ; Sentinel Lymph Node Biopsy ; Seroma ; Skin

Intussusception can develop at any age but about 95% of patients are children under 2 years-old. Adult intussusception is a rare condition. Unlike children, nearly all adults with intussusception have a lead point such as benign or malignant small bowel tumors, intestinal tuberculosis, or Meckel's diverticulum. First case is a 48-year-old male who was admitted with 2 days of diffuse abdominal cramping pain and no other associated gastrointestinal symptoms. Barium enema revealed ileocolic intussusception with a round cecal mass after barium reduction. An ileocecectomy was performed electively. The pathologic report was cecal cyst, which was an intraluminal structure with an epithelial lining of colonic mucosa. The second case, a 53-year-old male, was admitted with 1 week of diffuse abdominal cramping pain and watery diarrhea. Barium enema revealed ileocecal intussusception. Emergency surgery (ileocecectomy), revealed a polypoid small bowel mass. The pathologic report was lipoma. Recently, we experienced two cases of adult intussusception and report these cases with a brief review of the literature.
Adult* ; Barium ; Child ; Child, Preschool ; Colic ; Colon ; Diarrhea ; Emergencies ; Enema ; Humans ; Intussusception* ; Lipoma ; Male ; Meckel Diverticulum ; Middle Aged ; Mucous Membrane ; Tuberculosis

BACKGROUND: Currently, the incidence of hepatitis A is on the increase in Korea. Although there is emphasis on contact precautions, the nosocomial outbreak of hepatitis A virus (HAV) in healthcare personnel has increased within endemic areas because these workers inevitably come in close contact with patients and work under suboptimal hygiene conditions. In this study, we evaluated the necessity of immunization against HAV for healthcare personnel. METHODS: We investigated the seropositivity of serum immunoglobulin G (IgG) anti-HAV antibody (Ab) in 672 healthcare personnel on the basis of their age-group, sex, and occupation in Soon Chun Hyang University Hospital and Soon Chun Hyang University Bucheon Hospital. RESULTS: The subjects were divided into 6 groups on the basis of their ages to identify differences among the various age groups in the number of cases with HAV Ab seropositivity. Significant intergroup differences were noted in this respect: 21-25 years, 2/152 (1.3%); 26-30 years, 33/245 (13.5%); 31-35 years, 70/148 (47.3%); 36-40 years, 52/79 (65.8%); >40 years, 44/48 (91.7%). CONCLUSION: The number of seropositive cases was low among young healthy personnel: low seropositivity is an emerging risk for vulnerable population. With the increase in the incidence of hepatitis A, healthcare personnel have become a risk population for hepatitis A, as are community residents. Therefore, for healthcare personnel working in hospitals, immunization against HAV should be recommended for personnel younger than 30 years, and serological testing for older personnel.
Delivery of Health Care ; Hepatitis ; Hepatitis A ; Hepatitis A Antibodies ; Hepatitis A Vaccines ; Hepatitis A virus ; Humans ; Hygiene ; Immunization ; Immunoglobulin G ; Incidence ; Korea ; Occupations ; Serologic Tests ; Vulnerable Populations

BACKGROUND: Patients with prolonged empirical broad spectrum antibiotics for febrile neutropenia (FN) with cancer, inevitably have increased risk of invasive fungal infections owing to the altered endogenous microbial environment. OBJECTIVE: The purpose of this study is to evaluate the impact of empirical antifungal therapy on occurrence of invasive fungal infections (IFIs) during FN with cancer. METHODS: We retrospectively reviewed medical records of patients with FN after cytotoxic chemotherapy due to cancer from July, 2003 to June, 2007. RESULTS: We identified 91 patients with FN after cytotoxic chemotherapy. Most common underlying conditions were lymphoma (20/91, 22%) and leukemia (20/91, 22%). IFIs occurred in 10% (9/91). In a comparison of patients with empirical antifungal therapy with no antifungal therapy, the duration of neutropenia was significantly increased with IFIs (p=0.09). The mortality of IFIs was 55.5% (5/9). CONCLUSION: We found that the duration of FN than empirical antifungal therapy affected occurrence of IFIs.
Anti-Bacterial Agents ; Antifungal Agents ; Humans ; Leukemia ; Lymphoma ; Medical Records ; Neutropenia ; Retrospective Studies

Candidal infection is recently reported to increase in certain predisposing condition, although isolated candidiasis from larynx is infrequently recognized and reported. Iisolated whitish lesions of vocal cord may be confused with precancerous lesions, squamous cell carcinoma, or verrucous carcinoma. A 62-year-old male visited our department for continuous hoarseness. Flexible laryngoscopy disclosed a whitish irregular exophytic mucosal lesion in right true vocal cord, which extended to anterior commissure and subglottis. Laryngeal microscopic surgery was done because of a concern regarding the possibility of glottic cancer. A pathologic biopsy revealed distorted and septated hypae and yeasts, scattered in moderate dysplasia. The patient was treated with itraconazole for 4 weeks, and followed up without any recurrence of candidiasis or dysplasia.
Biopsy ; Candidiasis* ; Carcinoma, Squamous Cell ; Carcinoma, Verrucous ; Hoarseness ; Humans ; Itraconazole ; Laryngoscopy ; Larynx ; Male ; Middle Aged ; Recurrence ; Vocal Cords* ; Yeasts

BACKGROUND: Infections are the second leading cause of morbidity and mortality in hemodialysis patients. Vascular access is a major risk factor for infection-related hospitalization and mortality. This study aimed to characterize the presenting features and outcome of vascular access infection in hemodialysis patients. MATERIALS AND METHODS: Between May 2003 and March 2010, 224 patients admitted to a 750 bed tertiary care hospital for treatment of vascular access infection were retrospectively analyzed. Vascular access infections were defined by local infection signs (pus or redness) at the vascular access site or by a positive blood culture with no known source other than the vascular access. RESULTS: Of the 224 patients, 179 (79.7%) had an arteriovenous (AV) graft, 28 (12.5%) had a tunneled cuffed catheter, 12 (5.4%) had AV fistulas, and five (2.2%) had a temporary central catheter. The mean+/-SD time between the creation of each type of vascular access and onset of infection were as follows: temporary central catheter 46.6+/-36.9 days, tunneled cuffed catheter 180.3+/-168.8 days, AV fistulas 928.6+/-1,299.7 days, and AV graft 1,066.3+/-1321.1 days (P value=0.006). The most common causative organism was Staphylococcus aureus (62.5%; methicillin-susceptible 35.2%, methicillin-resistant 27.3%) followed by coagulase negative staphylococci (17.0%) and gram negative bacilli (15.9%). The involved vascular accesses in infected cases were: temporary central catheter (4/5, 80%), tunneled cuffed catheter (13/27, 48%), AV graft (68/179, 38%) and AV fistulas (4/12, 33%). The complications of vascular access infection included septic pulmonary embolism (n=9, 4%), pneumonia (n=9, 4%), endocarditis (n=6, 2.7%), osteomyelitis (n=3, 1.3%) and abdominal abscess (n=2, 0.9%). A multivariable analysis showed that Staphylococcus aureus was a risk factor of septic pulmonary embolism and osteomyelitis. The all-cause mortality was 8.4%, 30-day mortality was 2.2% and infection-related mortality was 5.4%. CONCLUSIONS: Staphylococcus was responsible for 79.5% of infections, with methicillin-susceptible S. aureus being the most commonly implicated strain. Temporary accesses have the potential to become infected earlier. Septic pulmonary embolism and pneumonia were common complications. Efforts should be focused on prevention and early detection of VA infection with pulmonary complications.
Abdominal Abscess ; Catheter-Related Infections ; Catheters ; Coagulase ; Endocarditis ; Fistula ; Hospitalization ; Humans ; Methicillin Resistance ; Osteomyelitis ; Pneumonia ; Pulmonary Embolism ; Renal Dialysis ; Retrospective Studies ; Risk Factors ; Sprains and Strains ; Staphylococcus ; Staphylococcus aureus ; Tertiary Healthcare ; Transplants