Use of recombinant tissue plasminogen activator (rt-PA) for the treatment of acute cerebral infarction secondary to aortic dissection is challenging because of a narrow time window and potential life-threatening complications. An 80-year-old woman with right middle cerebral artery infarction was treated with rt-PA. Although she had no history, symptoms, or sign of aortic dissection, carotid CT angiography revealed aortic arch dissection. Mediastinal widening, which did not show on initial chest X-ray, developed on follow-up chest X-ray. This observation indicates that physicians should monitor patient symptoms for signs of aortic dissection during thrombolysis and perform chest X-ray or carotid angiography immediately after thrombolysis even if the patient has no symptoms or signs of aortic dissection on onset of acute cerebral infarction.
Aged, 80 and over ; Angiography ; Aorta, Thoracic ; Cerebral Infarction* ; Female ; Follow-Up Studies ; Humans ; Infarction, Middle Cerebral Artery ; Thorax ; Thrombolytic Therapy ; Tissue Plasminogen Activator

No abstract available.
Circumcision, Male* ; Female ; Male ; Sensation*

No abstract available.
Mitral Valve*

No abstract available.
Adult ; Humans ; T-Lymphocytes

No abstract available.
Acrylic Resins ; Breast ; Hydrogel

Sulfasalazine, one of disease modifying anti-rheumatic drugs, is widely used in various rheumatic diseases. Very rarely, sulfasalazine causes drug-associated hypersensitivity syndrome that resembles infectious mononucleosis. Clinical signs include fever, lymphadenopathy, maculopapular skin rash and multivisceral involvement which appear 2 to 5 weeks after administration of drug. Atypical lymphocytosis, liver dysfunction and splenomegaly are also frequently observed. Severe infectious mononucleosis-like syndrome in sulfasalazine treated patients can be caused by reactivation of viruses such as human herpes virus-6, that often result in hypersensitivity syndrome. We report a case of patient who developed infectious mononucleosis-like syndrome after administration of sulfasalazine for the treatment of rheumatoid arthritis. This case warrents careful observation for infectious mononucleosis-like syndrome after sulfasalazine treatment.
Antirheumatic Agents ; Arthritis, Rheumatoid ; Exanthema ; Fever ; Humans ; Hypersensitivity ; Infectious Mononucleosis ; Liver Diseases ; Lymphatic Diseases ; Lymphocytosis ; Rheumatic Diseases ; Splenomegaly ; Sulfasalazine*

Insulinoma with hyperproinsulinemia and normal serum insulin level is a rare disease. Because of the neuroglycopenic symptoms, the initial diagnosis tends to be made as epilepsy or as psychosis. A 43-year-old man was admitted to our hospital because of recurrent confusional episodes. Symptoms are intermittent and consist of staring, confusion, amnesia, and bizarre behavior. Vital signs during the episode were normal but the serum glucose level was 27 mg/dl. The serum level of insulin during the episode was lower than normal and those of proinsulin and growth hormone were higher than normal. Solitary pancreatic mass was found by abdominal CT, measuring 15 mm in diameter. Pathologic evaluation showed islet cell tumor. This suggests that the serum level of proinsulin should be checked when insulinoma with neuroglycopenic symptom is suspected.
Adenoma, Islet Cell ; Adult ; Amnesia ; Blood Glucose ; Diagnosis ; Epilepsy ; Growth Hormone ; Humans ; Insulin ; Insulinoma* ; Proinsulin ; Psychotic Disorders ; Rare Diseases ; Seizures* ; Tomography, X-Ray Computed ; Vital Signs

OBJECTIVE: Cell therapy has been extensively studied as a gene complementation approach in muscular dystrophy including Duchenne muscular dystrophy (DMD), and adipose tissue has recently been identified as a uniquely abundant and adequately accessible source of pluripotent cells. In the present work, we investigated myogenic potentials of adipose-derived stem cells (ADSCs) depending on culture media and isolation with using surface markers. METHOD: Human ADSCs were obtained by liposuction and cultured in two different media; control and myogenic media. In addition we attempted to isolate ADSCs by utilizing surface markers: CD45 and CD133. The following observations were made to evaluate myogenic differentiation as the expression of myogenic regulatory factors (MyoD, Myf-5 and Myf-6) and desmin by RT-PCR and immunoflurescence study. RESULTS: Conversion of ADSCs to myogenic phenotype was observed by indirect immunoflurescence study of MyoD and Myf-5 in regardless of media type and isolation method. In addition mRNA of MyoD and Myf-5 were positive in both culture media, and there were no differences of MyoD and Myf-5 responses between CD45- and CD45-CD133-ADSCs. However, secondary myogenic regulatory factor (Myf-6) was not expressed constantly, and desmin were negative in all cultural condition. CONCLUSION: Our findings suggest that human ADSCs might have myogenic potentials. However, further studies are needed to express the secondary myogenic regulatory factors and proteins in myoblasts.
Adipose Tissue ; Complement System Proteins ; Culture Media ; Desmin ; Genes, vif ; Humans ; Lipectomy ; Muscular Dystrophies ; Muscular Dystrophy, Duchenne ; Myoblasts ; Myogenic Regulatory Factors ; Phenotype ; Proteins ; RNA, Messenger ; Stem Cells ; Tissue Therapy

Choriocarcinoma is a HCG-producing epithelial neoplasm derived from either trophoblastic or totipotential germ cells. It is a highly malignant tumor, which is rapidly invasive and widely metastatic, and in most cases develops within the uterus after a normal or abnormal gestation, including ectopic pregnancy. Non-gestational choriocarcinoma rarely occur as a primary neoplasm in the gonads or in the extragonadal midline locations such as mediastinum, retroperitoneum, and pineal gland. It also has been reported very rarely to arise in parenchymal organs such as the prostate, lung, breast, brain, liver, kidney, bladder, vagina, and gastrointestinal tract. A 58-year old man was admitted to our hospital with symptoms of tarry stool and epigastric discomfort. The endoscopic biopsy specimen initially revealed pooly differentiated carcinoma of stomach with regional lymph node metastasis. Patient underwent distal gastrectomy with Billroth II anastomosis. Choriocarcinoma of stomach with well differentiated tubular adenocarcinoma was diagnosed by the surgical biopsy specimen, and the serum level of beta-HCG was 2,775 mIU/mL.In three months after operation, the patient presented with pain on right upper quadrant abdomen, and the CT scan revealed multiple liver metastasis. Bleomycin, etoposide, and cisplatin (BEP) combination chemotherapy were administered, but he died three months after the initial diagnosis.
Abdomen ; Adenocarcinoma* ; Biopsy ; Bleomycin ; Brain ; Breast ; Choriocarcinoma* ; Choriocarcinoma, Non-gestational ; Cisplatin ; Diagnosis ; Drug Therapy, Combination ; Etoposide ; Female ; Gastrectomy ; Gastroenterostomy ; Gastrointestinal Tract ; Germ Cells ; Gonads ; Humans ; Kidney ; Liver ; Lung ; Lymph Nodes ; Mediastinum ; Middle Aged ; Neoplasm Metastasis ; Neoplasms, Glandular and Epithelial ; Pineal Gland ; Pregnancy ; Pregnancy, Ectopic ; Prostate ; Stomach ; Tomography, X-Ray Computed ; Trophoblasts ; Urinary Bladder ; Uterus ; Vagina

BACKGROUND: Cancer pain impacts the patient and improved pain management increases the quality of life (QOL) for the patient and entire family. One tablet of Ultracet(R) is composed of 37.5 mg of tramadol hydrochloride and 325 mg acetaminophen. Mechanism of action of Ultracet(R) is multiple blocking to pain transmission with 3 synergistic actions. Ultracet(R) shows high performance analgesic efficacy with good tolerability and fast onset in previous studies. METHODS: From February 2003 to January 2004, we treated 97 patients who had cancer pain. Brief pain inventory, WHO QOL-BREF, and EORTC QLQ-C30 were evaluated before, and after median duration of treatment of 17.9 days with Ultracet(R). RESULTS: Among 97 patients, male was 59 (61%) and female was 38 (39%). Mean age was 60.3+/-12.0 (range: 25-81 years). Stomach cancer was in 19, lung cancer in 14, lymphoma in 11, unknown primary carcinoma in 8, colorectal cancer in 7, in order of frequency. Pre/post treatment visual analogue scale (VAS) score was 6.43/4.46 (p=0.000). Mild pain in 11 patients and pre/post treatment VAS score of 2.09/1.91 (p=0.875), moderate pain in 33 and 5.21/3.64 (p=0.000), and severe pain in 53 and 8.09/5.51 (p=0.000). Change of QOL after pain management was significant in emotion (65.9/72.1, p=0.012) in functional scales, and pain in symptom scales (62.0/50.9, p=0.000), sleep disturbance (p=0.018), and constipation (p=0.038) in symptom scales. We compared a QOL scales of 3 groups by response to Ultracet(R); improvement (67), no change (17), and aggravation (13). Global health (p=0.000). fatigue (p=0.019), and sleep disturbance (p=0.003) were statistically different among 3 groups. CONCLUSION: Ultracet(R) is effective in moderate to severe cancer pain and contribute an improvement of quality of life (QOL) of cancer patients.
Acetaminophen ; Analgesics ; Colorectal Neoplasms ; Constipation ; Fatigue ; Female ; Humans ; Lung Neoplasms ; Lymphoma ; Male ; Pain Management ; Quality of Life* ; Stomach Neoplasms ; Tramadol ; Weights and Measures