BACKGROUND: The criteria established by Light et al in 1972 have been used widely for the differential diagnosis of the pleural effusions in transudates and exsudates. However, in recent years, several reports have agreed that these criteria misclassified an important number of effusions. For this reason, different parameters have been proposed for differentiation the transudates from exudates. Nevertheless, all these alternative parameters have not been better than the past criteria of Light et al. In response the usefulness of two parameters for differentiation pleural transudate from exudates were evaluated : pleural fluid cholinesterase level and pleural fluid to serum cholinesterase ratio. METHODS: A total of forty-three patient with know causes of the pleura effusion by diagnostic thoracentesis were studied. The following criteria for differentiating the pleural effusions in transudates and exsudates were analyzed : Light's criteria, the pleural fluid cholesterol level, the pleural fluid to serum cholesterol ratio. the pleural fluid cholinesterase level, and the pleural fluid to serum cholinesterase ratio. RESULTS: The conditions of forty-three patients were diagnosed. Ten were classified as having transudates and thirty-three as exudates. The percentage of effusions misclassified by each parameter was as follows : Light's criteria, 9.3% ; pleural fluid cholesterol, 2.3% ; pleural fluid to serum cholesterol ratio, 2.3% ; pleural fluid cholinesterase, 4.7% ; and pleural fluid to serum cholinesterase ratio, 2.3%. CONCLUSIONS: The pleural fluid to serum cholinesterase ratio is one of the accurate criteria for differentiating pleural transudates from exudates. If further studies confirm these results, the cholinesterase ratio could be used as the first step in the evaluation of pleural effusion and if evaluated together with the other criteria, the differentiation of pleural transudate from exsudates will become more accurate.
Cholesterol ; Cholinesterases* ; Diagnosis, Differential* ; Exudates and Transudates* ; Humans ; Pleura ; Pleural Effusion

BACKGROUND AND OBJECTIVES: The hyperproliferative character of human cholesteatoma epithelium was confirmed through various hyperproliferation associated antibody expressions. Among the various approaches for evaluating proliferative activity, thrombomodulin (TM) is a cell surface glycoprotein which forms a high affinity non-covalent complex with thrombin and is a differentiation marker for spinous layer keratinocytes. Several animal models have been introduced to study cholesteatoma pathogenesis, among which canal ligation model using Mongolian gerbils is of much interest, because it can potentially provide information on cell differentiation and proliferation of cholesteatoma. In this study, we investigated the hyperproliferative characteristics of canal ligation cholesteatoma by comparing deep meatal skin and retroauricular skin. Another purpose of this study was to provide the morphological basis for further animal studies concerning cholesteatoma pathogenesis. MATERIALS AND METHOD: Using immunohistochemical technique with anti-monoclonal antibody, we investigated TM expression in the canal ligation cholesteatoma, deep meatal skin and retroauricular skin of Mongolian gerbil. RESULTS: Experimental cholesteatoma induced by canal ligation and deep meatal skin showed TM expression especially in the suprabasal layers. TM expression of experimental cholesteatoma is much more intense than that of deep meatal skin. CONCLUSION: Experimental cholesteatoma revealed an altered differentiation in suprabasal layer, suggesting that this animal model can be used for further study in the epithelial differentiation and proliferation of cholesteatoma.
Animals ; Cell Differentiation ; Cholesteatoma* ; Epithelium ; Gerbillinae ; Humans ; Keratinocytes ; Ligation ; Membrane Glycoproteins ; Models, Animal ; Skin ; Thrombin ; Thrombomodulin*

Systemic sclerosis is a multisystemic disorder of unknown etiology characterized by fibrosis of skin, blood vessel, and visceral organ. A 38-week pregnant, 29 year-old woman with systemic sclerosis and migraine was scheduled for cesarean section under lumbar epidural anesthesia because of dyspnea, decreased diffusion lung capacity and Raynaud's phenomenon. She suffered from sudden onset of severe headache, repetitive nausea, vomiting, and hypertension during cesarean section under the epidural anesthesia. The above symptoms did not respond to beta-blocker, vasodilator during the operation period. In the recovery room, the headache and vomiting were relieved by intravenous injection of ketorolac and metoclopramide. She experienced single tonic-clonic generalized seizure and intermittent migraine after operation in the ward, and discharged 7 days after operation.
Adult ; Anesthesia, Epidural ; Blood Vessels ; Cesarean Section* ; Diffusion ; Dyspnea ; Female ; Fibrosis ; Headache ; Humans ; Hypertension ; Injections, Intravenous ; Ketorolac ; Lung Volume Measurements ; Metoclopramide ; Migraine Disorders ; Nausea ; Pregnancy ; Recovery Room ; Scleroderma, Systemic* ; Seizures ; Skin ; Vomiting

Previously, we have reported that p-chlorophenylalanine (PCPA), a serotonin depletor, profoundly increased pancreatic fluid and bicarbonate secretion but remarkably inhibited pancreatic amylase secretion in anesthetized rats. The present study was performed to verify the detailed effects of PCPA on pancreatic amylase synthesis that is directly related to amylase exocrine secretion. PCPA significantly decreased pancreatic RNA and protein contents as well as the amylase activity. However, pancreatic DNA content, trypsin and chymotrypsin activities were not influenced by the treatment of PCPA. The rate of pancreatic amylase synthesis, which was assessed by the amount of incorporated (35S)-methionine into amylase for 1 h, was also significantly decreased by 44% in PCPA-treated rats. In order to determine whether the PCPA-induced decrease of amylase synthesis resulted from change in the level of amylase mRNA, Northern blot analysis was performed. The mRNA expression level of amylase was also decreased by 48% in the PCPA-treated rats, indicating that the inhibitory effect of PCPA on the synthesis of pancreatic amylase was mainly regulated at a step prior to translation. It was also revealed in SDS-polyacrylamide gel electrophoresis that the qualitative change of amylase was induced by PCPA. The 54 KDa amylase band seems to be degraded into small molecular weight protein bands in PCPA-treated rats, suggesting that the PCPA-induced decrease of amylase may be partly attributed to the degradation of synthesized amylase.
Amylases* ; Animals ; Blotting, Northern ; Chymotrypsin ; DNA ; Electrophoresis ; Fenclonine* ; Molecular Weight ; Pancreas ; Rats* ; RNA ; RNA, Messenger ; Serotonin ; Trypsin

Infectious mononucleosis is an EBV-induced infection, and this is a self-limiting clinical syndrome with such characteristics as fever, pharyngitis, headache, splenomegaly, hepatomegaly and multiple lymphadenopathy among children and young adults. On the other hand, EBV infection-induced gastrointestinal symptoms like anorexia, nausea, vomiting, dyspepsia, abdominal pain, gastric bleeding and diarrhea are non-specific signs and there is less of a chance of EBV infection being involved with gastrointestinal disease. Especially, the relation of gastric cancer and gastric lymphoma with EBV infection is well defined, but other EBV-related gastrointestinal diseases have rarely been reported. Therefore, we report here on a case of acute erosive EBV gastritis that was diagnosed as EBV-induced infectious mononucleosis, and this was confirmed by esophagogastroduodenoscopy with biopsy.
Abdominal Pain ; Anorexia ; Biopsy ; Child ; Diarrhea ; Dyspepsia ; Endoscopy, Digestive System ; Epstein-Barr Virus Infections ; Fever ; Gastritis* ; Gastrointestinal Diseases ; Hand ; Headache ; Hemorrhage ; Hepatomegaly ; Herpesvirus 4, Human* ; Humans ; Infectious Mononucleosis* ; Lymphatic Diseases ; Lymphoma ; Nausea ; Pharyngitis ; Splenomegaly ; Stomach Neoplasms ; Vomiting ; Young Adult

Infectious mononucleosis is an EBV-induced infection, and this is a self-limiting clinical syndrome with such characteristics as fever, pharyngitis, headache, splenomegaly, hepatomegaly and multiple lymphadenopathy among children and young adults. On the other hand, EBV infection-induced gastrointestinal symptoms like anorexia, nausea, vomiting, dyspepsia, abdominal pain, gastric bleeding and diarrhea are non-specific signs and there is less of a chance of EBV infection being involved with gastrointestinal disease. Especially, the relation of gastric cancer and gastric lymphoma with EBV infection is well defined, but other EBV-related gastrointestinal diseases have rarely been reported. Therefore, we report here on a case of acute erosive EBV gastritis that was diagnosed as EBV-induced infectious mononucleosis, and this was confirmed by esophagogastroduodenoscopy with biopsy.
Abdominal Pain ; Anorexia ; Biopsy ; Child ; Diarrhea ; Dyspepsia ; Endoscopy, Digestive System ; Epstein-Barr Virus Infections ; Fever ; Gastritis* ; Gastrointestinal Diseases ; Hand ; Headache ; Hemorrhage ; Hepatomegaly ; Herpesvirus 4, Human* ; Humans ; Infectious Mononucleosis* ; Lymphatic Diseases ; Lymphoma ; Nausea ; Pharyngitis ; Splenomegaly ; Stomach Neoplasms ; Vomiting ; Young Adult

Left ventricular pseudoaneurysm, in which a ventricular free wall rupture is locally contained by adherent pericardium, is a rare complication of myocardial infarction. Compared w'th a true left ventricular aneunsm, a pseudoaneurysm has a greater propensity to sudden rupture, with catastrophic sequelae. Pseudoaneurysm may be surgically curable, a prompt and accurate diagnosis is thus essential. Transthoracic echocardiography has been the procedure of choice in the diagnosis of pseu- doaneurysm. Transesophageal echocardiography can provide more accurate information than transthoracic echocardiography for the evaluation of ventricular pseudoaneurysm located in posterior and inferior wall. We experienced a case of pseudoaneurysm of left ventricle in a 75-year-old female who presented with dyspnea. A large pseudoaneurysm of left ventricle vith narrow neck was de- tected by transesophageal echocardiography.
Aged ; Aneurysm, False* ; Diagnosis ; Dyspnea ; Echocardiography ; Echocardiography, Transesophageal* ; Female ; Heart Rupture ; Heart Ventricles ; Humans ; Myocardial Infarction ; Neck ; Pericardium ; Rupture

Gastric mucosal calcinosis (GMC) is a very rare condition that is characterized by the nodular deposition of calcium salts in the gastric mucosa. It has been associated with renal failure, gastric cancer, ingestion of aluminum- containing antacids and the use of sucralfate in organ transplant patients. The etiology of this condition is uncertain, but several theories have been proposed; the condition is due secondarily to hyperparathyroidism in renal failure and to the alkalinization of the gastric mucosa. We report here on two patients who had long-term use of bismuth and/or aluminum-containing antacids to treat their gastro-esophageal reflux symptoms. The esophagogastroduodenoscopy revealed acute gastritis patterns, and GMC was confirmed histologically with biopsy. When one patient stopped ingesting bismuth-containing antacid solution, the follow-up esophagogastroduodenoscopy and the biopsy revealed a completely improved state. We report here on these interesting cases and we include a brief review of the literature.
Antacids ; Biopsy ; Bismuth ; Calcinosis* ; Calcium ; Eating ; Endoscopy, Digestive System ; Follow-Up Studies ; Gastric Mucosa ; Gastritis ; Gastroesophageal Reflux ; Humans ; Hyperparathyroidism ; Renal Insufficiency ; Salts ; Stomach Neoplasms ; Sucralfate ; Transplants

Extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma) is usually indolent. Although it was reported recently that about 20-30% cases of MALT lymphoma presented with a disseminated disease at diagnosis, it was described as a disease localized at diagnosis and remaining stable for a prolonged period. However, only a few cases of MALT lymphoma involved the lung and gastrointestinal tract all at once. We report a case of a 73-year-old man with disseminated MALT lymphoma. He presented with non-productive cough, initial chest radiograph showed a nodule in the right lower lobe. The diagnosis of stage IV MALT lymphoma was made by CT scan, video-assisted thoracoscopic excisional biopy, gastrofiberscopic biopsy and bone marrow biopsy. The lymphoma involved the lung, stomach and bone marrow at the time of diagnosis. Because he refused chemotherapy, he discharged after Helicobacter pylori eradication without chemotherapy. Regular follow-up examination did not show any evidence of disease progression over 22 months.
Aged ; Biopsy ; Bone Marrow ; Cough ; Diagnosis ; Disease Progression ; Drug Therapy ; Follow-Up Studies ; Gastrointestinal Tract ; Helicobacter pylori ; Humans ; Lung ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Radiography, Thoracic ; Solitary Pulmonary Nodule* ; Stomach ; Tomography, X-Ray Computed

PURPOSE: To evaluate the diagnostic utility and predictors for determinate results of an enzyme-linked immunospot assay using induced sputum cells (IS ELISPOT) for a rapid diagnosis of pulmonary tuberculosis (TB). MATERIALS AND METHODS: Subjects suspected of pulmonary TB who had either sputum acid fast bacilli smear-negative or not producing sputum spontaneously were prospectively enrolled. ELISPOT assay was performed using cells from induced sputum. RESULTS: A total of 43 subjects, including 25 with TB (TB group) and 18 with non-TB disease (non-TB group) were enrolled. Results of IS ELISPOT were determinate in only 17/43 (39%) subjects, but all of determinate results were consistent with the final diagnosis. Of the 43 sputum samples, 11 (26%) were inadequate to perform IS ELISPOT. Of 32 adequate sputum samples, the proportion of determinate results was significantly higher in the TB group (75%, 15/20) than in the non-TB group (17%, 2/12) (p=0.002). The status of active TB was a unique predictor but smear positivity was not a significant predictor for determinate results. In addition, sensitivity of IS ELISPOT (75%, 9/12) in smear negative TB was higher than that of TB-polymerase chain reaction (25%, 3/12). CONCLUSION: IS ELISPOT showed relatively high diagnostic value and accuracy in the TB group, independent of smear positivity. IS ELISPOT may provide additional diagnostic yield for microbiological tools in the rapid diagnosis of smear-negative TB.
Adult ; Aged ; *Enzyme-Linked Immunospot Assay ; Female ; Humans ; Immunologic Tests/*methods ; Male ; Middle Aged ; Mycobacterium tuberculosis/*isolation & purification ; Predictive Value of Tests ; Prospective Studies ; Reproducibility of Results ; Risk Factors ; Sensitivity and Specificity ; Sputum/*microbiology ; Tuberculosis, Pulmonary/*diagnosis/microbiology