Giant cell myocarditis(GCM) is a rare inflammatory heart disease which is characterized by multinucleated giant cells and a granulomatous reaction. It usually progresses rapidly and results in a fatal course. We report a patient with giant cell myocarditis who was treated by cardiac transplantation. A 35-year-old male was admitted with dyspnea which had developed 4 months before. On echocardiography, the right and left ventricles were markedly dilated and severe global hypokinesia was noted. He was diagosed with dilated cardiomyopathy with secondary severe mitral regurgitation. His cardiac function deteriorated progressively. He underwent orthotopic heart transplantation. Grossly the heart was enlarged, weighing 420gm and round with a blunt apex. Both right and left ventricles were markedly dilated. There were numerous white patches, measuring up to 4cm, throughout the epi- and myocardium. Microscopically, extensive fibrosis and multiple exuberant granulomas with numerous scattered multinucleated giant cells were seen. Lymphocytes and eosinophils were also frequent. Coronary arteries were unremarkable. Neither microorganisms nor foreign materials were found. By serial endomyocardial biopsies of the transplanted heart, only mild perivascular lymphocytic infiltration was occasionally observed without any evidence of rejection or recurrence of giant cell myocarditis. The patient's postoperative course has been uneventful so far(postoperative 21 months). The etiology of GCM remains to be clarified, although various factors are suspected. No matter what the cause, our experience suggests that this grave disease might be treated well by heart transplantation.
Male ; Humans ; Biopsy

BACKGROUND: Diclofenac is a nonsteroidal anti-inflammatory drug widely used as adjuvants for postoperative pain management with opioid sparing effect. The effect of diclofenac on postoperative opioid analgesia of morphine and meperidine was evaluated in 180 women after cesarean section. METHODS: One hundred eighty parturients were randomly allocated to four groups and each group had 45 women. The parturients were given loading dose of morphine in M group and meperidine in D group using intravenous patient controlled analgesia (PCA) device for up to 48 hours when the parturients awoke and complained abdominal pain. The parturients received diclofenac 75 mg every 12 hours intramuscularly followed by loading dose of morphine in MV group and meperidine in DV group. We evaluated the postoperative opioid requirement, numerical rating pain score, delivery/demand ratio, patient's satisfaction and side effects including respiratory depression, itching, nausea, urinary retention and dizziness. RESULTS: Diclofenac decreased over 40% of morphine or meperidine requirement and also pain score at 1, 2, 3, 6, 12, 24 and 48 hours in the use of PCA morphine and at 6, 12 and 24 hours in the use of PCA meperidine. And the incidence of sedation and itching decreased in MV and DV group. CONCLUSION: We concluded that diclofenac as adjuvant of opioid for postoperative pain after cesarean section could decrease requirement of morphine and meperidine, increase pain relief and decrease sedation and itching.
Abdominal Pain ; Analgesia ; Analgesia, Patient-Controlled ; Cesarean Section* ; Diclofenac* ; Dizziness ; Female ; Humans ; Incidence ; Meperidine* ; Morphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis* ; Pregnancy ; Pruritus ; Respiratory Insufficiency ; Urinary Retention

OBJECTIVE: Oxidative stress may be an important pathogenic mechanism in the obesity and metabolic syndrome. The aims of this study was to assess the possible association between the oxidative stress related Glutathione S-Transferase genes (GST-M1, GST-T1, and GST-P1) variants and the olanzapine-induced weight gain in Korean schizophrenic patients. METHODS: We categorized 78 schizophrenic patients into two groups the more than 7% weight gain from baseline (weight gain > or =7%) and the less weight gain (weight gain <7%) groups according to weight change between before and after long-term olanzapine treatment (440+/-288 days). All participants were genotyped for the GST-M1, GST-T1 and GST-P1 genes. Differences in allele frequencies between cohorts with different body weight changes were evaluated by a chi-square analysis and Fisher's exact test. The multifactor dimensionality reduction (MDR) approach was used to analyze gene-gene interactions. RESULTS: Mean body weight gain was 5.42 kg. There was no difference in the null genotype distribution of GST-M1 and -T1 between subjects with body weight gain > or =7% compared to subjects with body weight gain <7% (p>0.05). No significant difference in GST-P1 genotype and allele frequencies were observed between the groups (p>0.05). MDR analysis did not show a significant interaction between the three GST gene variants and susceptibility to weight gain (p>0.05). CONCLUSION: These findings do not support a relationship between the genetic variants of three GST genes (GST-M1, -T1 and -P1) and weight gain in Korean schizophrenic patients receiving olanzapine treatment.
Benzodiazepines ; Body Weight ; Body Weight Changes ; Cohort Studies ; Gene Frequency ; Genotype ; Glutathione ; Glutathione Transferase ; Humans ; Multifactor Dimensionality Reduction ; Obesity ; Oxidative Stress ; Weight Gain

We report a case of renal sarcoidosis accompanied by hypercalcemia and renal insufficiency. A 52-year-old woman presented to hospital with nausea, pruritus, general weakness and weight loss. Laboratory tests revealed a serum creatinine was 3.6mg/dL, calcium ll.lmg/dL(ionized calcium 5.6mg/dL), hemoglobin 10.2g/dL, parathyroid hormone <3.0pg/mL, 24 hour urinary protein 1,127mg/day and 24 hour urinary calcium 489mg/day. Chest X-ray showed normal and both kidneys were within normal size with mild increased echo-genicity on renal ultrasound. Renal biopsy showed interstitial nephritis with mononuclear cell infiltration and mild interstitial fibrosis. Non-caseating granuloma with epitheloid and giant cells were seen. Following corticosteroid therapy, renal function and hypercalcemia were dramatically improved. Within 1 month, calcium level was normal and the creatinine level fell to 2.0mg/dL and subsequently remained stable while corticosteroid was progressively tapered off. She has been followed up for 11 months with normal seum calcium level and the creatinine level of 1.9mg/dL.
Acute Kidney Injury* ; Biopsy ; Calcium ; Creatinine ; Female ; Fibrosis ; Giant Cells ; Granuloma ; Humans ; Hypercalcemia* ; Kidney ; Middle Aged ; Nausea ; Nephritis, Interstitial ; Parathyroid Hormone ; Pruritus ; Renal Insufficiency ; Sarcoidosis* ; Thorax ; Ultrasonography ; Weight Loss

PURPOSE: The aim of this study was to compare the coordinates of anatomical landmarks on cone-beam computed tomographic (CBCT) images in varied head positions before and after reorientation using image analysis software. MATERIALS AND METHODS: CBCT images were taken in a normal position and four varied head positions using a dry skull marked with 3 points where gutta percha was fixed. In each of the five radiographic images, reference points were set, 20 anatomical landmarks were identified, and each set of coordinates was calculated. Coordinates in the images from the normally positioned head were compared with those in the images obtained from varied head positions using statistical methods. Post-reorientation coordinates calculated using a three-dimensional image analysis program were also compared to the reference coordinates. RESULTS: In the original images, statistically significant differences were found between coordinates in the normal-position and varied-position images. However, post-reorientation, no statistically significant differences were found between coordinates in the normal-position and varied-position images. CONCLUSION: The changes in head position impacted the coordinates of the anatomical landmarks in three-dimensional images. However, reorientation using image analysis software allowed accurate superimposition onto the reference positions.
Anatomic Landmarks ; Cone-Beam Computed Tomography ; Gutta-Percha ; Head* ; Imaging, Three-Dimensional ; Orthodontics ; Skull

A 17-year-old girl was admitted to our hospital due to mild generalized edema. Laboratory tests revealed a serum creatinine was 0.7mg/dL, protein/albumin 6.7/3.5g/dL, cholesterol 190mg/dL, hemoglobin 10.0g/dL, and 24 hour urinary protein 4,40mg/day. Chest X-ray and renal ultrasound were normal. There were no clinical or serologic evidences of paraproteinemia, cryoglobulinemia, light chain disease or systemic lupus erythematosus. Renal biopsy showed membranoproliferative glomerulonephritis-like pattern with lobular accentuation, hypercellularity and diffuse GBM thickening by light microscope. Congo red staining was negative. Granular IgG and C3 deposits were found along the glomerular capillary wall and mesangium by immunofluorescence microscope. Ultrastructurally, abundant subendothelial and mesangial fibrillary deposits were found associated with thickening and wrinkling of GBM. These fibrils, measured about 20-30nm in diameter, were nonbranching and randomly arranged without either periodicity or an organized structure. These findings were compatible with those of fibrillary glomerulonephritis. Thus we report a case of idiopathic fibrillary glomerulonephritis, which is a rare cause of nephrotic syndrome.
Adolescent ; Biopsy ; Capillaries ; Cholesterol ; Congo Red ; Creatinine ; Cryoglobulinemia ; Edema ; Female ; Fluorescent Antibody Technique ; Glomerulonephritis* ; Humans ; Immunoglobulin G ; Lupus Erythematosus, Systemic ; Nephrotic Syndrome ; Paraproteinemias ; Periodicity ; Thorax ; Ultrasonography

Aspergilloma and Allergic Bronchopulmonary Aspergillosis (ABPA) are different types of spectrum of pulmonary aspergillosis. ABPA results from hypersensitivity reaction to Aspergillus species and is known to be usually associated with bronchial asthma and cystic fibrosis. Aspergilloma results from simple colonization of this fungus within cavitary lung lesion or bronchiectasis. But rarely some patients can present together with ABPA and aspergilloma. We experienced a case of ABPA associated with aspergilloma in a 38 year-old male. The diagnosis was confirmed by asthma, immediate cutaneous reactivity to A. fumigatus, IgG antibody to A. fumigatus, elevated total and specific IgE antibodies to A. fumigatus, central bronchiectasis and peripheral eosinophilia coincident with radiographic infiltrates. During follow-up management with steroid, left pneumonectomy was done because of spontaneous pneumothorax with persistent air-leak and multidrug resistance pulmonary tuberculosis in association with aspergilloma. His respiratory symptoms and ABPA activity was much more improved after removal of aspergilloma. These findings suggest that surgical resection of aspergilloma can be considered to reduce antigenic source of colonized fungi in ABPA patients when associated with aspergilloma.
Adult ; Antibodies ; Aspergillosis, Allergic Bronchopulmonary* ; Aspergillus ; Asthma ; Bronchiectasis ; Colon ; Cystic Fibrosis ; Diagnosis ; Drug Resistance, Multiple ; Eosinophilia ; Follow-Up Studies ; Fungi ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulin G ; Lung ; Male ; Pneumonectomy ; Pneumothorax ; Pulmonary Aspergillosis ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: Previous studies have demonstrated that enalapril or lovastatin seems to ameliorate the renal injury in several animal models with glomerulonephritis. The aim of this study was to examine whether enalapril or lovastatin was still beneficial in tubulointerstitial injury induced by protein-overload proteinuria in rats. METHODS: Enalapril(200mg/L in the drinking water) or lovastatin(16mg/kg, subcutaneously) was administered to uninephrectomized rats which received a daily intraperitoneal injections of bovine serum albumin(BSA, 1/100g body weight)(each n=6). Six rats were served as normal control. After 2 weeks, renal cortical pathologic findings, including immunohistochemistry for macrophage were examined and renal cortical osteopontin, MCP-1, endothelin-1, TGF-beta and procollagen alpha1(I) mRNA expression were examined by Northern blot analysis. RESULTS: Renal cortex in rats with protein-overload proteinuria showed infiltration of inflammatory cells including macrophages, tubular dilatation and atrophy. Renal cortical mRNA expression of osteopontin, MCP-1 and endothelin-1 were increased in rats with protein-overload proteinuria. There were no changes in TGF-beta and procollagen alpha1(I) mRNA expression. Enalapril decreased the macrophage infiltration significantly and inhibited the mRNA expression of osteopontin, MCP-1 and endothelin-1. However, lovastatin had no significant effects on the macrophage infiltration and cortical mRNA expression. CONCLUSION: Enalapril showed beneficial effects in tubulointerstitial injury induced by protein-overload proteiuria in rats by inhibition of macrophage infiltration and the cortical mRNA expression of osteopontin, MCP-1 and endothelin-1. However, lovastatin had no significant effects.
Animals ; Atrophy ; Blotting, Northern ; Dilatation ; Drinking ; Enalapril* ; Endothelin-1 ; Glomerulonephritis ; Immunohistochemistry ; Injections, Intraperitoneal ; Lovastatin* ; Macrophages ; Models, Animal ; Osteopontin ; Procollagen ; Proteinuria* ; Rats* ; RNA, Messenger ; Transforming Growth Factor beta

BACKGROUND: Previous studies have demonstrated that enalapril or lovastatin seems to ameliorate the renal injury in several animal models with glomerulonephritis. The aim of this study was to examine whether enalapril or lovastatin was still beneficial in tubulointerstitial injury induced by protein-overload proteinuria in rats. METHODS: Enalapril(200mg/L in the drinking water) or lovastatin(16mg/kg, subcutaneously) was administered to uninephrectomized rats which received a daily intraperitoneal injections of bovine serum albumin(BSA, 1/100g body weight)(each n=6). Six rats were served as normal control. After 2 weeks, renal cortical pathologic findings, including immunohistochemistry for macrophage were examined and renal cortical osteopontin, MCP-1, endothelin-1, TGF-beta and procollagen alpha1(I) mRNA expression were examined by Northern blot analysis. RESULTS: Renal cortex in rats with protein-overload proteinuria showed infiltration of inflammatory cells including macrophages, tubular dilatation and atrophy. Renal cortical mRNA expression of osteopontin, MCP-1 and endothelin-1 were increased in rats with protein-overload proteinuria. There were no changes in TGF-beta and procollagen alpha1(I) mRNA expression. Enalapril decreased the macrophage infiltration significantly and inhibited the mRNA expression of osteopontin, MCP-1 and endothelin-1. However, lovastatin had no significant effects on the macrophage infiltration and cortical mRNA expression. CONCLUSION: Enalapril showed beneficial effects in tubulointerstitial injury induced by protein-overload proteiuria in rats by inhibition of macrophage infiltration and the cortical mRNA expression of osteopontin, MCP-1 and endothelin-1. However, lovastatin had no significant effects.
Animals ; Atrophy ; Blotting, Northern ; Dilatation ; Drinking ; Enalapril* ; Endothelin-1 ; Glomerulonephritis ; Immunohistochemistry ; Injections, Intraperitoneal ; Lovastatin* ; Macrophages ; Models, Animal ; Osteopontin ; Procollagen ; Proteinuria* ; Rats* ; RNA, Messenger ; Transforming Growth Factor beta

Objectives: . Using tissue-engineered materials for esophageal reconstruction is a technically challenging task in animals that requires bioreactor training to enhance cellular reactivity. There have been many attempts at esophageal tissue engineering, but the success rate has been limited due to difficulty in initial epithelialization in the special environment of peristalsis. The purpose of this study was to evaluate the potential of an artificial esophagus that can enhance the regeneration of esophageal mucosa and muscle through the optimal combination of a double-layered polymeric scaffold and a custom-designed mesenchymal stem cell-based bioreactor system in a canine model. Methods: . We fabricated a novel double-layered scaffold as a tissue-engineered esophagus using an electrospinning technique. Prior to transplantation, human-derived mesenchymal stem cells were seeded into the lumen of the scaffold, and bioreactor cultivation was performed to enhance cellular reactivity. After 3 days of cultivation using the bioreactor system, tissue-engineered artificial esophagus was transplanted into a partial esophageal defect (5×3 cm-long resection) in a canine model. Results: . Scanning electron microscopy (SEM) showed that the electrospun fibers in a tubular scaffold were randomly and circumferentially located toward the inner and outer surfaces. Complete recovery of the esophageal mucosa was confirmed by endoscopic analysis and SEM. Esophagogastroduodenoscopy and computed tomography also showed that there were no signs of leakage or stricture and that there was a normal lumen with complete epithelialization. Significant regeneration of the mucosal layer was observed by keratin-5 immunostaining. Alpha-smooth muscle actin immunostaining showed significantly greater esophageal muscle regeneration at 12 months than at 6 months. Conclusion . Custom-designed bioreactor cultured electrospun polyurethane scaffolds can be a promising approach for esophageal tissue engineering.