Dieulafoy's lesion is a rare condition that may cause intermittent or massive gastrointestinal bleeding. It is characterized by the exteriorization of an arterial vessel into the lumen of the affected organ, generally the upper digestive tract, through an apparently normal mucosa or a small tear or erosion. We report two patients with Dieulafoy's lesions, one in whom the lesion was misdiagnosed as a submucosal tumor and endoscopic biopsy resulted in fatal bleeding.
Autopsy ; Biopsy ; Endoscopy ; Gastrointestinal Hemorrhage* ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Mucous Membrane

Globozoospermia is a rare type of teratozoospermia. It occurs in 0.1% of all andrological patient's and used to be considered sterile. Globozoospermic patient has 100% round headed spermatozoa, but the spermiogram is normal. The spermatozoa show oval-shape head, the lack of a nuclear envelope, acrosome, and post acrosomal sheath. OBJECTIVE: To report that a couple with infertility secondary to globozoospermia received ICSI treatment. MATERIAL AND METHOD: Case report. RESULTS: In the first trial, fertilization was failed. In the second trial, 40% of oocytes were fertilized and all of these embryos were cleaved, but pregnancy did not achieved. In the third trial, sperm injected oocytes were exposed to 10 micrometer calcium ionophore for 15 min. All of the injected oocytes were fertilized and proceeded to develop. Triplet pregnancy was achieved after the transfer of six embryos in their third cycle. One embryo vanished and the remaining twins (female) were delivered at 33 weeks of gestation by Caesarean section. CONCLUSION: This result shows that assisted activation following ICSI may overcome infertility associated with globozoospermia.
Acrosome ; Calcium ; Cesarean Section ; Embryonic Structures ; Female ; Fertilization ; Head ; Humans ; Infertility ; Male ; Nuclear Envelope ; Oocytes* ; Pregnancy* ; Pregnancy, Triplet ; Sperm Injections, Intracytoplasmic ; Spermatozoa* ; Twins

Recently many molecular biologic techniques have been tried to determine a prognostic indicator in various malignancies by evaluating the capacity of cellular differentiation and proliferation and the degree of expression of oncogene products. It is suggested that the activation of EGFR may play a role in normal and abnormal cellular proliferation. Many reports have demonstrated that EGFR is overexpressed in genitourinary, breast, lung, head and neck tumors, and possibly used as tumor marker. In this study we measured EGFR mRNA by in situ hybridization in 64 patients with transitional cell carcinoma of bladder and 14 cases of normal bladder to evaluate its relation to the prognosis. The positive staining of EGFR mRNA by in situ hybridization was observed in 42.8% of normal urothelium and 100% of transitional cell carcinoma of bladder. The strong positive staining of EGFR mRNA was observed in 57.5% of superficial cancer of bladder and 80.6% of invasive one(Ta 25%, T1 62.1%, T2 72.7%, T3 76.9%, T4 100% and Grade I 35%, Grade II 75.9%, Grade III 94.4%, respectively). As tumor stage and grade was increased, the corresponding strong positivity of EGFR mRNA was significant. Progression to invasive cancer occurred in 3 patients with superficial cancer and 2 of them had strong positive EGFR mRNA finding in original specimen. Tumor recurrences occurred in 15 patients with superficial cancer and 8 of them had strong positive EGFR mRNA finding in original specimen. In 20 of the 25 patients(80%) who died of bladder cancer during the study tumors were EGFR mRNA strong positive. The death rate of patients with strong positive EGFR mRNA was significantly greater than that of patient with weak positive EGFR mRNA tumor. In conclusion, The EGFR mRNA expression of transitional cell carcinoma of bladder using in situ hybridization technique may be a useful tumor marker and prognostic indicator.
Breast ; Carcinoma, Transitional Cell* ; Cell Proliferation ; Epidermal Growth Factor* ; Head ; Humans ; In Situ Hybridization* ; Lung ; Mortality ; Neck ; Oncogene Proteins ; Prognosis* ; Receptor, Epidermal Growth Factor* ; Recurrence ; RNA, Messenger ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urothelium

PURPOSE: To investigate the relationships between preoperative factors and intraocular pressure (IOP) reduction after phacoemulsification in normal, open-angle glaucoma (OAG) and angle-closure glaucoma (ACG) patients. METHODS: IOP was measured before and 3 months after cataract surgery in 30 normal, 24 OAG and 31 ACG patients. The relationship between IOP reduction after cataract surgery and preoperative parameters including anterior chamber depth (ACD), axial length (AL), preoperative IOP/ACD ratio (PD ratio), preoperative IOP/AL ratio (PL ratio) were investigated in the 3 groups. RESULTS: Significant IOP reduction was observed in all 3 groups after surgery (paired sample t-test; p < 0.05), and IOP reduction was correlated with preoperative IOP level in all 3 groups (Pearson's correlation; p < 0.05). Other preoperative parameters such as ACD and AL were not correlated with IOP reduction, and PD ratio was significantly correlated with IOP reduction only in the OAG group (Pearson's correlation; p < 0.001). PL ratio was significantly correlated with IOP reduction in all 3 groups (Pearson's correlation; p < 0.05) and showed the best sensitivity and specificity to predict significant reduction in IOP after cataract surgery among parameters including preoperative IOP, PD ratio and PL ratio. CONCLUSIONS: PL ratio was significantly correlated with IOP reduction after cataract surgery in all 3 groups and showed a higher predictive value for IOP reduction in the OAG group than in the other groups.
Anterior Chamber ; Biometry ; Cataract ; Glaucoma ; Glaucoma, Angle-Closure ; Glaucoma, Open-Angle ; Growth Hormone ; Humans ; Intraocular Pressure ; Peptide Fragments ; Phacoemulsification ; Sensitivity and Specificity

Subvalvular aortic aneurysms are rare but can be a cause of sudden death. This case report involves a 36-year-old male who died suddenly from rupture of a subvalvular aortic aneurysm with resultant hemopericardium with tamponade. He had a bicuspid aortic valve with acute infective endocarditis. A review of the literature enlightens the association between bicuspid aortic valve and subvalvular aortic aneurysm. The pathogenesis of the diseases of the aortic root will be discussed.
Adult ; Aortic Aneurysm ; Aortic Valve ; Bicuspid ; Death, Sudden ; Endocarditis ; Heart Valve Diseases ; Humans ; Male ; Pericardial Effusion ; Rupture

Neurofibromatosis 1 (NF1) is a common autosomal dominant disorder that causes several systemic diseases. Many studies have reported that NF1 is associated with intrathoracic meningoceles and scoliosis. The incidence of vertebral artery dissection is estimated to be 1-1.5 per 100,000 population. We experienced an autopsy case of massive intrathoracic hemorrhage due to spontaneous vertebral artery dissection in a patient with NF1, who had intrathoracic spinal meningoceles and scoliosis. A 47-year-old man was found dead at his home in the morning. He had a history of NF1 including numerous cutaneous neurofibromas and hyperpigmented macules, scoliosis, and deformity of the leg. The autopsy revealed the dissection and rupture of the left vertebral artery, and a pseudocyst that had formed due to arterial leakage on the wall of the meningocele on the left side. The pseudocyst had eventually ruptured and leaked blood, resulting in a massive hemothorax on the left side. Thus, it was revealed that the patient had suffered from NF1-associated intrathoracic meningoceles and scoliosis, and we concluded that the cause of his death was a massive hemothorax on the left side, caused by the dissection and rupture of the left vertebral artery.
Autopsy* ; Congenital Abnormalities ; Hemorrhage ; Hemothorax ; Humans ; Incidence ; Leg ; Meningocele* ; Middle Aged ; Neurofibroma ; Neurofibromatoses* ; Neurofibromatosis 1* ; Rupture ; Scoliosis* ; Vertebral Artery Dissection* ; Vertebral Artery*

Xanthogranulomatous cholecystitis (XGC) is known to be a rare, variant type of chronic cholecystitis and more frequently found in the adults with a prevalence of 0.7 to 13.2% of all cholecystitis, moreover very rare in children. Clinically, this usually presents as chronic or acute cholecystitis associated with gallstones, but biliary colic is unusual. Although it requires surgery for management, it may accompany some difficulties during cholecystectomy and postoperative complications such as biliary fistula. It could also give rise to higher conversion rates than other diseases of the gallbladder during laparoscopic procedures. We experienced a very rare pediatric case of xanthogranulomatous cholecystitis not associated with gallstones, successfully managed by laparoscopic cholecystectomy and hereby report it with literature reviews.
Adult ; Biliary Fistula ; Child ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Colic ; Gallbladder ; Gallstones ; Granuloma ; Humans ; Postoperative Complications ; Prevalence ; Xanthomatosis

Purpose: Indocyanine green (ICG) is a promising agent for intraoperative visualization of tumor tissues and sentinel lymph nodes in early-stage gynecological cancer. However, it has some limitations, including a short half-life and poor solubility in aqueous solutions. This study aimed to enhance the efficacy of near-infrared (NIR) fluorescence imaging by overcoming the shortcomings of ICG using a nano-drug delivery system and improve target specificity in cervical cancer. Materials and Methods: ICG and poly(lactic-co-glycolic acid) (PLGA) conjugated with polyethylenimine (PEI) were assembled to enhance stability. Hyaluronic acid (HA) was coated on PEI-PLGA-ICG nanoparticles to target CD44-positive cancer cells. The manufactured HA-ICG-PLGA nanoparticles (HINPs) were evaluated in vitro and in vivo on cervical cancer cells (SiHa; CD44+) and human dermal cells (ccd986sk; CD44-), respectively, using NIR imaging to compare intracellular uptake and to quantify the fluorescence intensities of cells and tumors. Results: HINPs were confirmed to have a mean size of 200 nm and a zeta-potential of 33 mV using dynamic light scattering. The stability of the HINPs was confirmed at pH 5.0–8.0. Cytotoxicity assays, intracellular uptake assays, and cervical cancer xenograft models revealed that, compared to free ICG, the HINPs had significantly higher internalization by cervical cancer cells than normal cells (p<0.001) and significantly higher accumulation in tumors (p<0.001) via CD44 receptor-mediated endocytosis. Conclusion This study demonstrated the successful application of HINPs as nanocarriers for delivering ICG to CD44-positive cervical cancer, with improved efficacy in NIR fluorescence imaging.

Purpose: Indocyanine green (ICG) is a promising agent for intraoperative visualization of tumor tissues and sentinel lymph nodes in early-stage gynecological cancer. However, it has some limitations, including a short half-life and poor solubility in aqueous solutions. This study aimed to enhance the efficacy of near-infrared (NIR) fluorescence imaging by overcoming the shortcomings of ICG using a nano-drug delivery system and improve target specificity in cervical cancer. Materials and Methods: ICG and poly(lactic-co-glycolic acid) (PLGA) conjugated with polyethylenimine (PEI) were assembled to enhance stability. Hyaluronic acid (HA) was coated on PEI-PLGA-ICG nanoparticles to target CD44-positive cancer cells. The manufactured HA-ICG-PLGA nanoparticles (HINPs) were evaluated in vitro and in vivo on cervical cancer cells (SiHa; CD44+) and human dermal cells (ccd986sk; CD44-), respectively, using NIR imaging to compare intracellular uptake and to quantify the fluorescence intensities of cells and tumors. Results: HINPs were confirmed to have a mean size of 200 nm and a zeta-potential of 33 mV using dynamic light scattering. The stability of the HINPs was confirmed at pH 5.0–8.0. Cytotoxicity assays, intracellular uptake assays, and cervical cancer xenograft models revealed that, compared to free ICG, the HINPs had significantly higher internalization by cervical cancer cells than normal cells (p<0.001) and significantly higher accumulation in tumors (p<0.001) via CD44 receptor-mediated endocytosis. Conclusion This study demonstrated the successful application of HINPs as nanocarriers for delivering ICG to CD44-positive cervical cancer, with improved efficacy in NIR fluorescence imaging.

Ischemic ventricular rupture is one of the most fatal complications following myocardial infarction, and this requires prompt diagnosis and operation. A 75-year-old female was admitted to the ER in a semicomatous mentality with cyanotic extremities. Cardiac echography was carried out in the ER, and a 1.5~2 cm thickness of effusion in the pericardium was seen. Because the patient's heart had declined to 35 times per min, an emergency operation was started while giving cardiac massage. After observing a 1 cm rupture on the right ventricular wall and a necrotic hemorrhagic scar with a rupture on the left ventricular apical wall, repair of the ruptured areas with a large Satinsky clamp was carried out to control bleeding without cardiopulmonary bypass. On the 28th day after surgery, she was discharged home with a minimal degree of dyspnea.
Aged ; Cardiac Tamponade ; Cardiopulmonary Bypass ; Cicatrix ; Emergencies ; Extremities ; Female ; Heart ; Heart Massage ; Hemorrhage ; Humans ; Infarction ; Myocardial Infarction ; Pericardium ; Rupture