Antiphospholipid antibody syndrome (APS) has been considered as a distinct clinical entity, usually associated with systemic lupus erythematosus (SLE) or with other connective tissue disease. Prominent clinical features include venous thrombosis, arterial occlusions, thrombocytopenia, hemolytic anemia, recurrent fetal loss, livedo reticularis and neurologic manifestations. Antiphospholipid antibodies (aPL) represent a spectrum of phospholipid-binding antibodies, including the lupus anticoagulant(LA), anticardiolipin antibody (aCL), and the biologic false-positive serologic test for syphilis (BFP-STS). Primary antiphospholipid syndrome (PAPS) which has been recently described is a complication of autoimmune aPL with lack of serologic and clinical features of SLE. We present a young female patient with PAPS who showed progressive dementia, diffuse cerebral atrophy, renal arteriolar occlusions, livedo reticularis, and valvular heart disease. To our knowledge, our patient is the first described with the clinical and mangetic resonance imaging(M-RI) findings in this entity.
Anemia, Hemolytic ; Antibodies ; Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Atrophy* ; Brain* ; Connective Tissue Diseases ; Dementia* ; Female ; Heart Valve Diseases ; Humans ; Livedo Reticularis ; Lupus Erythematosus, Systemic ; Neurologic Manifestations ; Serologic Tests ; Syphilis ; Thrombocytopenia ; Venous Thrombosis

A 48 year-old man was admitted with the chief complaint of epigastric pain for 10 days. With upper gastrointetinal series and gastrofiberscopy, there noted a round hemispherical submucosal tumar at lesser curvature side of stomach. Because of continuous epigastric pain and large submucosal mass with mucosal ulceration the patient undewent operation. After subtotal gastrectomy, we found the round well-demarcated tumor with mucosal ulceratian and hemarrhage, which located at muscular layer. Microscopically, dominent cells of tumor are round or polygonal epithelioid cells, which cytoplasm was lightly eosinophilic and was tightly coadenced about nucleus so that the bulk of the cell appeared clear. In the immunohistochemistry with desmin, the tumor cells are positive. Histological diagnosis was leiomyoblastoma of stomach. In 1960 Martin et al. described six cases of unusual round cell myogenic tumor of stomach. In 1962, Stout report a series of 69 similar cases and he proposed the term leiomyoblastoma'. Until recent, leiomyoblastoma are rare and largely misdiagnosed as leiomyoma or leiomyosarcoma. A careful histological study is recommended in case of smooth muscle cell tumor of stomach
Cytoplasm ; Desmin ; Diagnosis ; Eosinophils ; Epithelioid Cells ; Gastrectomy ; Humans ; Immunohistochemistry ; Leiomyoma ; Leiomyoma, Epithelioid ; Leiomyosarcoma ; Middle Aged ; Myocytes, Smooth Muscle ; Stomach ; Ulcer

Primary adenosquamous carcinoma of the liver is generally considered as an extremely rare subtype of cholangiocarcinoma. It has been reported mostly in a form of case studies. As far as we know, there was only one case report on tumor related with biliary fistula. Recently, we experienced a case of primary adenosquamous carcinoma of liver with a formation of tumor-colonic fistula. A 54-year-old man was transferred to our hospital due to liver mass detected by abdominal ultrasonogram. Dynamic computed tomogram of liver showed a large irregular hypodense mass without rim enhancement in right lobe of liver and also suggested a fistula formation between the tumor and hepatic flexure of right colon. Colonoscopic examination showed a large colonic wall defect in hepatic flexure and a friable, nodular mucosa around the defected colonic wall. Extended right lobectomy and right hemicolectomy were done. Microscopically, the tumor was composed of squamous cell carcinoma mainly with foci of the adenocarcinoma component.
Carcinoma, Adenosquamous/*pathology/radiography/surgery ; Colonic Diseases/*pathology ; Colonoscopy ; Humans ; Intestinal Fistula/*pathology ; Liver Neoplasms/*pathology/radiography/surgery ; Male ; Middle Aged ; Tomography, X-Ray Computed

PURPOSE: To confirm the effect of the frog leg lateral radiographs for determining the clinical indication of total hip arthroplasty for high riding dislocation and to discuss its theoretical background. MATERIALS AND METHODS: A consequent series of reconstructive THA were studied in 28 recent tuberculous hips. Twenty-three hips (17patients) with developmental dysplastic hip were compared. Preoperatively, frog-leg lateral radiographs were performed in all the patients, which were enhanced using a 2-dimensional computer model to predict the reattachment of the greater trochanter. RESULTS: The modified scores of Merle d'aubigne and Postel improved from a mean of 2.6 points preoperatively to a mean of 5.1 points. Sciatic nerve palsies occurred in three cases. In two cases, they fully recovered, but in one case, it did not. We confirmed that old high dislocation of the hip could be adopted in type 1 and 2 categories of frog leg lateral position. The reconstruction of hip was relatively simple in type 3, however, further study is necessary in type 5 due to unsuitable abduction contracture. CONCLUSION: We confirm that frog leg lateral radiography is effective for determining the operative indication of high riding dislocation. However irreducible frog leg lateral position is absolutely contraindirated for total hip arthroplasty.
Arthroplasty* ; Arthroplasty, Replacement, Hip ; Computer Simulation ; Contracture ; Dislocations* ; Femur ; Hip* ; Humans ; Leg ; Radiography ; Sciatic Neuropathy

A 62-year-old female was adrnitted to the Catholic University Hospital of Taegu-Hyosung with an intracerebral hemorrhage. She was operated on successfully, but developed bacterial pneumonia. She was then treated with sulperazone, tobramycin, and metronidazole for 1 month. After the antibiotic treatment, she suffered from a fever and bloody, mucoid diarrhea for 3 days, and was examined with a sigmoidoscope. The sigmoidoscopic examination revealed yellow patches of ulcerations and swelling covered with thick sero- sanguinous exudate in the distal transverse colon and sigmoid colon. A latex agglutination test for C. was performed on her stool, whereby difficile cytotoxin was negative, however, metronidazole resistant C. perfringens was isolated from anaerobic culture of the biopsied colon tissue. She recovered with 15 days using oral vancomycin treatment. The possibility of C. perfringens as a causative organism of pseuclomernbraneous colitis was discussed.
Cerebral Hemorrhage ; Clostridium perfringens* ; Clostridium* ; Colitis* ; Colon ; Colon, Sigmoid ; Colon, Transverse ; Diarrhea ; Exudates and Transudates ; Female ; Fever ; Humans ; Latex Fixation Tests ; Metronidazole ; Middle Aged ; Pneumonia, Bacterial ; Sigmoidoscopes ; Tobramycin ; Ulcer ; Vancomycin

Idiopathic mesenteric phlebosclerosis (IMP) is a rare disease of chronic mesenteric ischemia characterized by a thickening of the colonic wall with fibrosis and calcification of the affected veins, which causes ischemic colitis. While the pathogenesis of IMP is unknown, characteristic radiographic, colonoscopic and histologic findings are evident. We report a case of IMP presenting with right lower abdominal pain and diarrhea in a 69-year-old woman. A plain abdominal radiograph revealed thread-like calcification in the colon. Colonoscopy showed dark purple-colored edematous mucosa and erosions in the colon. Histologic examination showed calcification in and around the submucosa and vascular wall. A barium enema demonstrated narrowing and thumb-printing from the ascending to the transverse colon. Abdominal CT disclosed a thickened colonic wall with intramural calcification and calcified mesenteric veins in the colon.
Abdominal Pain ; Aged ; Barium ; Colitis, Ischemic ; Colon ; Colon, Transverse ; Colonoscopy ; Diarrhea ; Enema ; Female ; Fibrosis ; Humans ; Ischemia ; Mesenteric Veins ; Mucous Membrane ; Rare Diseases ; Vascular Diseases ; Veins

Gastroduodenal Crohn's Disease (CD), which is uncommon in adults, involves the gastric antrum and proximal duodenum in most cases, and results in epigastric pain, weight loss, and gastric outlet obstruction, raising initial suspicion that it may be peptic ulcer disease or a malignancy. On upper endoscopy, aphthous ulcers are typical in the early stages but linear or stellate ulcers with a cobblestone appearance and luminal narrowing can be found in advanced diseases. Multiple mucosal biopsies are helpful for diagnosis despite the fact that granulomas are seen in less than one third of all cases. Gastroduodenal CD requires oral sulfasalazine therapy or systemic corticosteroid therapy in advanced cases. A case of gastroduodenal CD in a 37-year-old man admitted with epigastric pain, anorexia, vomiting and weight loss is herein reported. Malignancy was suspected as a result of the patient's clinical manifestations and endoscopic findings. An endoscopic biopsy revealed an active inflammation in the mucosa and lamina propria. The patient's condition improved with oral sulfasalazine and prednisolone therapy.
Adult ; Anorexia ; Biopsy ; Crohn Disease* ; Diagnosis ; Duodenum ; Endoscopy ; Gastric Outlet Obstruction ; Granuloma ; Humans ; Inflammation ; Mucous Membrane ; Peptic Ulcer ; Phenobarbital ; Prednisolone ; Pyloric Antrum ; Stomatitis, Aphthous ; Sulfasalazine ; Ulcer ; Vomiting ; Weight Loss

BACKGROUND: Korean women are known to have a very low smoking rate. However, the actual smoking rate among Korean women is higher than 10% and may continue to increase gradually. In addition, some Korean women use extreme weight control methods that have potentially harmful effects. This study was conducted to elucidate weight control methods related to cotinine-verified smoking among Korean adult women. METHODS: This cross-sectional study involved 4,189 women aged > or =19 years who had attempted weight control during the past 1 year from the Korea National Health and Nutrition Examination Survey, 2008-2011. Smoking status was assessed using both self-report questionnaires and assays of urinary cotinine, and weight control methods were investigated using self-report questionnaires. RESULTS: The smoking rate based on the measurement of urinary cotinine was 12.4% +/- 0.8% among Korean women. Cotinine-verified smokers were more likely to attempt fasting (odds ratio, 2.19; 95% confidence intervals, 1.03 to 4.67), taking prescription diet-pills (odds ratio, 2.37; 95% confidence intervals, 1.47 to 3.82), and taking nonprescription diet-pills (odds ratio, 3.46; 95% confidence intervals, 1.71 to 6.98), and were less likely to attempt eating less food or modifying dietary patterns (odds ratio, 0.71; 95% confidence intervals, 0.51 to 0.99) compared to non-smokers. CONCLUSION: Korean adult women's smoking is independently related to a high likelihood of using weight control methods with potentially harmful effects, such as fasting and taking diet-pills, and a low likelihood of choosing weight control methods, including dietary modification, that require constant effort for a prolonged time.
Adult* ; Body Weight ; Cotinine ; Cross-Sectional Studies ; Eating ; Fasting ; Female ; Food Habits ; Humans ; Korea ; Nutrition Surveys* ; Prescriptions ; Surveys and Questionnaires ; Smoke* ; Smoking* ; Weight Loss

PURPOSE: Dexmedetomidine, a full agonist of alpha2B-adrenoceptors, is used for analgesia and sedation in the intensive care units. Dexmedetomidine produces an initial transient hypertension due to the activation of post-junctional alpha2B-adrenoceptors on vascular smooth muscle cells (SMCs). The aims of this in vitro study were to identify mitogen-activated protein kinase (MAPK) isoforms that are primarily involved in full, alpha2B-adrenoceptor agonist, dexmedetomidine-induced contraction of isolated rat aortic SMCs. MATERIALS AND METHODS: Rat thoracic aortic rings without endothelium were isolated and suspended for isometric tension recording. Cumulative dexmedetomidine (10(-9) to 10(-6) M) dose-response curves were generated in the presence or absence of extracellular signal-regulated kinase (ERK) inhibitor PD 98059, p38 MAPK inhibitor SB 203580, c-Jun NH2-terminal kinase (JNK) inhibitor SP 600125, L-type calcium channel blocker (verapamil and nifedipine), and alpha2-adrenoceptor inhibitor atipamezole. Dexmedetomidine-induced phosphorylation of ERK, JNK, and p38 MAPK in rat aortic SMCs was detected using Western blotting. RESULTS: SP 600125 (10(-6) to 10(-5) M) attenuated dexmedetomidine-evoked contraction in a concentration-dependent manner, whereas PD 98059 had no effect on dexmedetomidine-induced contraction. SB 203580 (10(-5) M) attenuated dexmedetomidine-induced contraction. Dexmedetomidine-evoked contractions were both abolished by atipamezole and attenuated by verapamil and nifedipine. Dexmedetomidine induced phosphorylation of JNK and p38 MAPK in rat aortic SMCs, but did not induce phosphorylation of ERK. CONCLUSION: Dexmedetomidine-induced contraction involves a JNK- and p38 MAPK-mediated pathway downstream of alpha2-adrenoceptor stimulation in rat aortic SMCs. In addition, dexmedetomidine-induced contractions are primarily dependent on calcium influx via L-type calcium channels.
Adrenergic alpha-2 Receptor Agonists/*pharmacology ; Animals ; Anthracenes/pharmacology ; Aorta/cytology ; Dexmedetomidine/*pharmacology ; Enzyme Inhibitors/pharmacology ; Extracellular Signal-Regulated MAP Kinases/antagonists & inhibitors/physiology ; Flavonoids/pharmacology ; Imidazoles/pharmacology ; JNK Mitogen-Activated Protein Kinases/antagonists & inhibitors/*physiology ; Male ; *Muscle Contraction ; Muscle, Smooth, Vascular/drug effects/enzymology/*physiology ; Protein Isoforms/antagonists & inhibitors/physiology ; Pyridines/pharmacology ; Rats ; Rats, Sprague-Dawley ; p38 Mitogen-Activated Protein Kinases/antagonists & inhibitors/physiology

A patient with mucin hypersecreting papillary adenocarcinoma of intrahepatic bile duct had jaundice and symptoms of cholangitis. Radiologic evaluations-ultrasonography and computerized tomographyrevealed passage disturbance of bile at the level of the distal common bile duct or ampulla of Vater. But, primary lesion was located at left intrahepatic duct proximal to the ductal dilatation. This peculiar phenomenon confused clinicians. A 59-year-old man was referred to our hospital for evaluation of recurrent cholangitis. Ultrasonogram, computerized tomogram and endoscopic retrograde cholangiography disclosed dilatation and amorphous filling defect extending from left intrahepatic bile duct to common bile duct suggesting choledochal cyst(type IVa). Preoperative endoscopic examination showed spillage of mucin through duodenal papilla. Abdominal exploration revealed mucin hypersecreting papillary adenocarcinoma of left intrahepatic duct and dilated distal common bile duct filled with tenacious mucin. Left hepatic lobectomy and Roux-en-Y hepaticojejunostomy were performed.
Adenocarcinoma ; Adenocarcinoma, Papillary* ; Ampulla of Vater ; Bile ; Bile Ducts, Intrahepatic ; Cholangiography ; Cholangitis ; Common Bile Duct ; Dilatation ; Humans ; Jaundice ; Middle Aged ; Mucins* ; Ultrasonography