Aortic saddle embolus accounts for approximately 10% of all peripheral arterial emboli. The most common sources of emboli are left atrial thrombi associated with atrial fibrillation and vegetation. A 22-year-old male patient was admitted due to acute onset of orthopnea, tachypea and cough. Transthoracic and transeophageal echocardiography showed huge vegetation (3X2cm) of the posterior mitral valve leaflet which was associated with severe mitral regurgitation. On 14th hospital day, he suffered from sudden onset of weakness, pain, and coldness on both lower extremities. Follow-up echocardiography showed marked size reduction of the original mitral valve vegetation. Angiography showed aortic saddle embolus. The embolectomy of aortic saddle embolus was performed through the transfemoral approach with a Forgarty catheter. At the same time, removal of the infected mitral valve and mitral valve replacement were performed.
Angiography ; Atrial Fibrillation ; Catheters ; Cough ; Echocardiography ; Embolectomy ; Embolism* ; Follow-Up Studies ; Humans ; Lower Extremity ; Male ; Mitral Valve Insufficiency ; Mitral Valve* ; Young Adult

BACKGROUND: Dermatophytoses are infections of keratinized tissues, that is, the epidermis, hair and nails, caused by a group of specialized fungi, the dermatophytes. Laboratory diagnoses of dermatophytes such as Tricophyton, Microsporum and Epidermophyton are made by microscopic examination and in vitro culture but they are either time consuming of lacking specificity. OBJECTIVE: In order to develop and apply more rapid and precise diagnostic tests for fungal pathogens to facilitate the improved identification of dermatophytes, we investigated random amplified polymorphism DNA for classification and identification of dermatophytes. METHODS: Amplification reactions were performed in volumes of 5011 containing 10mM Tris-HCl(pH 8.3), 50mM KCl, 1.5mM MgCl2, 0.01% (w/v), gelatin, 200mM dNTP mixture, 50pM primer, Taq polymerase (0.025 units/ microliter), DNA 0.001 microgram/microliter. The optimal condition to. PCR was 2 cycles (denaturing 94 degrees C 2min, annealing 33 degrees C 2min, extension 72 degrees C 4min), 40 cycles, and extension (72 degrees C 10min). RESULTS: RAPD showed interspecies polymorphism in but it had identical patterns in intraspecies. CONCLUSION: It was confirmed that RAPD PCR analysis with optimal conditions is a fast, economical and reproducible method for identification and classification of dermatophytes isolates.
Arthrodermataceae* ; Classification* ; Clinical Laboratory Techniques ; Diagnostic Tests, Routine ; DNA* ; Epidermis ; Epidermophyton ; Fungi ; Gelatin ; Hair ; Magnesium Chloride ; Microsporum ; Polymerase Chain Reaction ; Sensitivity and Specificity ; Taq Polymerase ; Tinea

OBJECTIVE: To investigate duration of the treatment effect of extracorporeal shockwave therapy (ESWT) on spasticity levels measured with Modified Ashworth Scale (MAS) regardless of the patient group (stroke, multiple sclerosis, and cerebral palsy) and evaluate its spasticity-reducing effect depending on the number of shocks and site of application. METHODS: PubMed, EMBASE, the Cochrane Library, and Scopus were searched from database inception to February 2018. Randomized controlled trials and cross-over trials were included. All participants had spasticity regardless of cause. ESWT was the main intervention and MAS score was the primary outcome. Among 122 screened articles, 9 trials met the inclusion criteria.
Ankle Joint ; Cross-Over Studies ; Elbow ; Fingers ; Humans ; Multiple Sclerosis ; Muscle Spasticity ; Shock ; Wrist

Viral infections can be causative in many glomerular disease, and human immunodeficiency virus (HIV) infection is closely related to a collapsing focal segmental glomerulosclerosis (FSGS). This is known as HIV associated nephropathy (HIVAN) and is characterized clinically by proteinuria, often of sudden onset, with rapidly progressive renal dysfunction resulting in end stage renal disease (ESRD) over several months. Increasingly, other primary renal diseases are being described in HIV infected patients, including IgA nephropathy, an immune complex lupus-like neprhopathy, and tubulonephritis. We observed rare HIVAN case presenting membranous glomerulonephritis with nephrotic syndrome in a woman who was positive for HIV without hepatitis B viral infection. She was treated with Methylprednisolone 60 mg/day, zidovudine 600 mg/day, efavirenz 60 mg/day, and lamivudine 300 mg/day for 5 months. After treatment, proteinuria decreased from 4,092 mg/day to 419 mg/day and CD4 T cell count rose from 594/mL to 1,176/mL. The effectiveness and safety of corticosteroids in the treatment of HIVAN remained controversial but this case showed good response for steroid with triple antiviral therapy about HIVAN especially membranous glomerulonephritis.
Adrenal Cortex Hormones ; AIDS-Associated Nephropathy ; Antigen-Antibody Complex ; Cell Count ; Female ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranous* ; Glomerulosclerosis, Focal Segmental ; Hepatitis B ; HIV Infections* ; HIV* ; Humans ; Kidney Failure, Chronic ; Lamivudine ; Methylprednisolone ; Nephrotic Syndrome ; Proteinuria ; Zidovudine

BACKGROUND: Trichophyton rubrum is the most common dermatophyte isolated from human and has ability to invade the tissues such as stratum comeum, nail and hair. The potential role of proteinases as virulence factors of F rMSrMm has been discussed at length. OBJECTIVE: As a first step towards assessing its virulence role, we report on the purification and characterization of proteinase from T. rubrum isolate culture filtrates. METHODS: An extracellular serine proteinase has been purified from culture filtrates of Trichophyton rubrum HP-9 by ultrafiltration, gel filtration chromatography, and affinity column chromatography. Azocoll and keratin azure were employed as the substrates of enzyme activities. Peak of proteolytic activity was analyzed by gelatin co-polymerized gel electrophoresis. RESULTS: The molecular weight of the purified enzyme was approximately exhibited to 14.0 kDa on sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). The optimum pH and molality of 14.0 kDa proteinase activity was 6.0 and 100mM, respectively. The activity was inhibited by serine proteinase inhibitor, phenylmethylsulfonyl fluoride (PMSF). The proteinase degraded gelatin, collagen type VI, and keratin from human epidermis but not hemoglobin. CONCLUSION: The 14,000 Mr extracellular serine proteinase purified from T. rubrum NP-9 culture filtrates has neutral pH optimum 6.0 and activities against gelatin, collagen type VI, and keratin.
Arthrodermataceae ; Chromatography ; Chromatography, Gel ; Collagen Type VI ; Electrophoresis ; Electrophoresis, Polyacrylamide Gel ; Epidermis ; Gelatin ; Hair ; Humans ; Hydrogen-Ion Concentration ; Molecular Weight ; Peptide Hydrolases ; Phenylmethylsulfonyl Fluoride ; Serine Proteases ; Sodium Dodecyl Sulfate ; Trichophyton* ; Ultrafiltration ; Virulence ; Virulence Factors

Hypertensive pulmonary vascular disease can develop in those cases of congenital cardiac shunt in which critical levels of pulmonary artery pressure and flow are reached and exceeded. We have experienced two cases of plexogenic arteriopathy in complex congenital heart disease and tried to evaluate of distribution of arterial lesions by total mapping of the explanted lung. Case 1 and 2 were 12-year-old boy and 36 year-old man. They were treated with combined heart-lung transplantation. Mapping of the both lungs was done, and graded according to Heath and Edward's grading scheme. The elastic pulmonary artery was tortuous, dilated and aortic configuration. Both lungs showed mostly grade 3. Plexiform lesion or veinlike branches of hypertrophied muscular arteries arosed in a lateral branch of a muscular artery that might be proximal to an area of occlusion. Comprising the right and left lung, the right was more severe than the left. By getting closer to the distal part, the grade tended to increase to 4 to 5. By analyzing the pulmonary lobe, severe pulmonary hypertension of grade 4 or 5 was comparatively disseminated throughout the right lung. On the other hand, in the left lung, the grade of the lower lobe was higher than that of the upper lobe, and within the upper lobe, there was a tendency for the grade of inferior segment to be higher than that of the corresponding apical segment.
Adult ; Arteries ; Child ; Hand ; Heart Defects, Congenital* ; Heart-Lung Transplantation ; Humans ; Hypertension ; Hypertension, Pulmonary ; Lung ; Male ; Pulmonary Artery ; Vascular Diseases

BACKGROUND: rhGM-CSF has been shown to enhance the migration and proliferation of endothelial cells and to promote keratinocyte growth. This study was tried to evaluate the effect of rhGM-CSF dressing on the uninfected wounds. METHODS: Thirty Sprague-dawley white mice(250-300g) were selected in this study . The number of wound with the diameter of 5 mm, was 3 in left and 3 in right at the symmetric sites, respectively . The site of rhGM-CSF dressing was decided by a randomization. rhGM-CSF(Leucogen (r)) was diluted in the distilled water(5 micro gram/mL). The experimental wound group was dressed by l mL of distilled water mixed with rhGM-CSF and control wound group was dressed by l mL of distilled water. The dressing was done, every 24 hours. The criteria of comparison were the duration of wound healing duration, histologic findings and the bacterial culture of wound sites. RESULTS: The duration of wound healing was 10.3+/-1.7 days in experimental group and 10.2+/-2.8 days in control group, without significant difference. There was no specific difference of histologic findings between both groups. The pathogen was not found, at all. CONCLUSION: It seems to be that rhGM-CSF has no prominent effect on the uninfected wound healing in the mice without immune suppression.
Animals ; Bandages ; Endothelial Cells ; Keratinocytes ; Mice ; Random Allocation ; Rats, Sprague-Dawley ; Water ; Wound Healing ; Wounds and Injuries*

Emphysematous gastritis is a rare infection of the stomach wall with high mortality rate. It is caused by gas forming organisms and may arise by local spread through the mucosa or hematogenous dissemination from distant focus. Clinical manifestation includes acute abdomen with systemic toxicity, and diagnosis is based on radiologic demonstration of gas within the gastric wall. Treatment should be aimed to cover gram-negative organisms and anaerobes using wide-spectrum intravenous antibiotics, and sometimes surgical management may be needed in order to enhance survival. Herein, we report a case of emphysematous gastritis in a patient with end stage renal disease on hemodialysis.
Anti-Bacterial Agents/therapeutic use ; Emphysema ; Female ; Gastritis/complications/*diagnosis/radiography ; Gastroscopy ; Humans ; Kidney Failure, Chronic/complications/*diagnosis ; Klebsiella pneumoniae/isolation & purification ; Middle Aged ; Renal Dialysis ; Sputum/microbiology ; Tomography, X-Ray Computed

No abstract available.
DNA* ; Humans ; Lung Neoplasms* ; Lung* ; Microsatellite Repeats*

PURPOSE: The aim of this study was to assess the involvement of several organs patients with Marfan syndrome in Korea. Also the clinical features in childhood patients with Marfan syndrome were assessed. METHODS: Thirty-eight cases of Marfan syndrome were enrolled in this study. Clinical evaluations of the musculoskeletal, cardiovascular and occular system were performed in all cases. RESULTS: The musculoskeletal system was involved in 32 cases (84.2%) and occular system in 24 cases (63.1%). Cardiovascular abnormalities were found in 19 cases (50.0%) at initial evaluation. Family history was involved in 21 cases (55.2%). Ectopia lentis was found in 17 cases (70.8%). Severe myopia and iris abnormalities were also present in 14 cases (58.2%). The ascending aorta was dilated in 13 cases (34.2%). Emergency operation was performed in 3 cases (7.9%) because of a dissecting aorta. Mitral regurgitation and prolapse were found in 29 cases (76.4%) and other valve insufficiency was accompainied in 5 cases (13.1%). Of the 38 cases, 29 patients (79.3%) were less than 15 years of age and their major manifestations were occular problems in 23 cases (79.3%), and family history in 17 cases (58.6%). In one infant, severe heart failure was the predominant clinical feature. CONCLUSION: The clinical features of Korean patients with Marfan syndrome were summarized in this report. Heart failure was the main manifestaton in infantile Marfan syndrome. Early treatment with beta-blocker and valvular replacement can prevent fatality, i.e. aortic dissection, in this disease, concern and management should be advocated in the early detection of Marfan syndrome.
Aorta ; Cardiovascular Abnormalities ; Ectopia Lentis ; Emergencies ; Heart Failure ; Humans ; Infant ; Iris ; Korea ; Marfan Syndrome* ; Mitral Valve Insufficiency ; Musculoskeletal System ; Myopia ; Prolapse