No abstract available.
Nocardia Infections*

The pathogenesis, incidence, complication rates, response to acid suppression and Helicobacter pylori (H. pylori) eradication therapy in peptic ulcer associated with chronic disease such as liver cirrhosis, chronic renal failure, diabetes mellitus, and critically ill conditions are different from those with general population, so that the management strategies also should be differentiated. The eradication of H. pylori are not so effective for preventing recurrence of peptic ulcer in liver cirrhosis patients as shown in general population, and conservative managements such as preventing deterioration of hepatic function and decrease in portal pressure are mandatory to reduce the risk of ulcer recurrence. The standard triple therapy for H. pylori eradication are as effective in chronic renal failure patients as in normal population, but the frequency of side effects of amoxicillin is higher in the patients not receiving dialysis therapy. Delay in eradication therapy until beginning of dialysis therapy or modification of eradication regimen should be considered in such cases. High prevalence of asymptomatic peptic ulcers and increased mortality in complicated peptic ulcer disease warrant regular endoscopic surveillance in diabetic patients, especially with angiopathy. The prolongation of duration of eradication therapy also should be considered in diabetic patients with angiopathic complication because of lower eradication rate with standard triple regimens as compared to normal population. Prophylactic acid suppressive therapy is highly recommended in critically ill patients with multiple risk factors. Herein, we propose evidence-based treatment guidelines for the management of peptic ulcer disease in special conditions based on literature review and experts opinion.
Amoxicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Critical Illness ; Diabetes Mellitus/diagnosis/drug therapy ; Helicobacter Infections/diagnosis/drug therapy ; Helicobacter pylori ; Humans ; Kidney Failure, Chronic/diagnosis/therapy ; Liver Cirrhosis/diagnosis/therapy ; Peptic Ulcer/*therapy ; Risk Factors

A hepatic angiosarcoma is a rare primary malignant neoplasm, which accounts for only 2% of all primary hepatic tumors. The prognosis of a hepatic angiosarcoma is very poor, and most patients die within a year of the initial diagnosis. We report a case of a hepatic angiosarcoma in a 57-year-old man. Although a dynamic CT had suggested a carvenous hemangioma 12 months earlier, the tumor size increased and spontaneously ruptured, so surgical resection was mandatory. A pathological examination, including immunohistochemical studies, showed positive staining for CD34 and Factor VIII, which confirmed the diagnosis of an angiosarcoma. Although dynamic CT is an excellent modality for the diagnosis of a cavernous hemangioma of the liver, hepatic angiosarcomas should be ruled out in selected cases, because they may present with very similar CT findings to benign hemangioma.
Diagnosis ; Factor VIII ; Hemangioma ; Hemangioma, Cavernous* ; Hemangiosarcoma* ; Humans ; Liver ; Middle Aged ; Prognosis ; Rupture, Spontaneous

BACKGROUND: Epidural steroid injections (ESI) have been used widely for the treatment of back and radiating extremity pain. Although its effects on the metabolic and endocrine system have been studied, the effects following repeated injections remain to be determined. We studied the effects of three repeated caudal epidural injections of low dose triamcinolone. METHODS: The subjects were 10 elderly women with spinal stenosis. Caudal epidural injections were performed biweekly. Triamcinolone (20 mg), mixed with 15 ml of 0.25% lidocaine, was used as the ESI injectate. The procedures were performed with the patient in the prone position. Blood sampling was performed just before the first injection, and used as the baseline, and then just before each injection on the same day of the 2nd and 4th weeks, with the last samples taken 2 weeks after the third injection. RESULTS: The blood glucose concentrations showed no significant changes. The blood cortisol and ACTH concentrations were significantly decreased after the first injection, but there were no further decreases after each of the subsequent injections. The cortisol concentrations were maintained within the normal range. CONCLUSIONS: Caudal epidural injections, with low dose triamcinolone, suppressed the hypothalamus-pituitary-adrenal (HPA) axis, but no further suppression followed the subsequent repeated injections. Three consecutive caudal injections at 2 week intervals seems to be a safe procedure.
Adrenocorticotropic Hormone* ; Aged* ; Axis, Cervical Vertebra ; Blood Glucose* ; Endocrine System ; Extremities ; Female ; Glucose ; Humans ; Hydrocortisone* ; Injections, Epidural* ; Lidocaine ; Prone Position ; Reference Values ; Spinal Stenosis ; Triamcinolone

Bis (Bag-3, CAIR), a Bcl-2-interacting protein, promotes the anti-apoptotic activity of Bcl-2 and increased levels of Bis have been observed in several disease models. The involvement of Bcl-2 and some Bcl-2-binding proteins in differentiation has recently been reported. However, the relevance of Bis to cellular differentiation remains unknown. The findings herein show that Bis expression is up-regulated during the differentiation of HL-60 cells. To investigate the effect of Bis expression on differentiation, we established Bis-overexpressing HL-60 cells (HL-60-bis). HL-60-bis cells have a low nuclear: cytoplasmic ratio and indented nucleus in Wright- Giemsa staining, and an increased expression of CD11b in immunofluorescence study, indicating the promotion of differentiation. The overexpression of Bis also resulted in a retarded cell growth rate, accompanied by the accumulation of HL-60 cells at the G0/G1 phase of the cell cycle, which was sustained during the differentiation process. Western blot analysis revealed that the expression of p27, a representative inducer of cell cycle arrest at the G1 phase, was increased 2.5-fold in HL-60-bis cells compared to HL-60-neo cells. These results suggest that the Bis induced growth inhibition of HL-60 cells promotes G0/G1 phase arrest via up-regulation of p27, which seems to be a prerequisite for differentiation. Further studies will be required to define the exact roles of Bis on cellular differentiation more precisely.
Carrier Proteins/*metabolism ; *Cell Differentiation ; Cell Proliferation ; Cell Shape ; Cells, Cultured ; Cyclin-Dependent Kinase Inhibitor p27/*metabolism ; Flow Cytometry ; Gene Expression ; HL-60 Cells ; Humans ; Research Support, Non-U.S. Gov't ; *Up-Regulation

Duodenal varices are a serious complication of portal hypertension. Bleeding from duodenal varices is rare, but when bleeding does occur, it is massive and can be fatal. Unfortunately, the optimal therapeutic modality for duodenal variceal bleeding is unclear. This paper presents a patient with duodenal variceal bleeding that was managed successfully using percutaneous trans-splenic variceal obliteration (PTVO). A 56-year-old man with a history of alcoholic cirrhosis presented with a 6-day history of melena. Emergency esophagogastroduodenoscopy revealed a large, bluish mass with a nipple sign in the second portion of the duodenum. Coil embolization of the duodenal varix was performed via a trans-splenic approach (i.e., PTVO). The patient no longer complained of melena after treatment. The duodenal varix was no longer visible at the follow-up esophagogastroduodenoscopy performed three months after PTVO. The use of PTVO might be a viable option for the treatment of duodenal variceal bleeding.

Duodenal varices are a serious complication of portal hypertension. Bleeding from duodenal varices is rare, but when bleeding does occur, it is massive and can be fatal. Unfortunately, the optimal therapeutic modality for duodenal variceal bleeding is unclear. This paper presents a patient with duodenal variceal bleeding that was managed successfully using percutaneous trans-splenic variceal obliteration (PTVO). A 56-year-old man with a history of alcoholic cirrhosis presented with a 6-day history of melena. Emergency esophagogastroduodenoscopy revealed a large, bluish mass with a nipple sign in the second portion of the duodenum. Coil embolization of the duodenal varix was performed via a trans-splenic approach (i.e., PTVO). The patient no longer complained of melena after treatment. The duodenal varix was no longer visible at the follow-up esophagogastroduodenoscopy performed three months after PTVO. The use of PTVO might be a viable option for the treatment of duodenal variceal bleeding.

BACKGROUND/AIMS: The multidetector computed tomography (MDCT) scanning frequently leads to the incidental discovery of bowel wall thickening. The aim of this study was to determine the utility of gastroscopy and colonoscopy in the management of patients who had incidental discovery of bowel wall thickening on MDCT. METHODS: From May 2006 to March 2008, the abdominal MDCT reports of all patients in Chungbuk National University Hospital were reviewed. Cases with any bowel thickening was selected and then patients who received gastroscopy or colonoscopy after abdominal MDCT were re-selected. RESULTS: Gastroscopy revealed abnormal findings in 22 (95.7%) out of 23 patients, and 10 patients (43.5%) had stomach cancers. Colonoscopy revealed abnormal findings in 35 (85.4%) out of 41 patients, and 12 patients (29%) had malignant tumors. In the patients who had lymph node enlargement (p<0.001), dirty fat infiltration (p=0.025), and irregular wall thickening (p<0.001) on MDCT malignancy was observed more frequently. CONCLUSIONS: We recommend gastroscopy and colonoscopy to patients who had incidentally found bowel wall thickening on MDCT, especially those with lymph node enlargement, dirty fat infiltration, and irregular wall thickening.
Adult ; Aged ; Aged, 80 and over ; Colonic Neoplasms/radiography ; Endoscopy, Gastrointestinal ; Female ; Humans ; Intestines/cytology/*radiography ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms/radiography ; Tomography, X-Ray Computed/*methods

PURPOSE: We investigated the prevalence of lower urinary tract symptoms (LUTS), and the inconvenience of each symptom, using an ICS-male Questionnaire (ICS-mQ) in Korean man. We also evaluated the relationships between symptoms, prostate volume and urodynamic parameters of a bladder outlet obstruction (BOO). MATERIALS AND METHODS: 180 male LUTS patients, from 7 urological institutions, were enrolled in this study. The ICS-mQ was used to measure the severity of the symptoms, with a bothersomeness scale. Transrectal sonography and urodynamic studies, including Schaefer linear passive urethral resistance relation (L-PURR), were performed. RESULTS: The 5 most frequent symptoms were voiding symptoms, such as reduced stream, terminal dribbling, incomplete emptying, intermittency and hesitancy, in that order. However, the 5 most bothersome symptoms included 2 voiding, and 3 storage, symptoms, such as incomplete emptying, urge incontinence, pain in bladder, nocturnal incontinence and hesitancy. 34.4% of the nocturia patients felt quite, or severely, bothered, but only 1.1% felt no problem. The mean value of estimated prostate volume, by sonography, was 29.8+/-14.1ml. There were no correlations between the severity of symptoms and the prostate size. There were also little, or no, correlations between a wide range of symptoms and the urodynamic parameters of BOO. CONCLUSIONS: The most frequent symptoms of male patients with LUTS are voiding symptoms, but they suffered more from storage, than from voiding, symptoms. The severities of the symptoms, or the bothersomeness, were not correlated with the prostate size or the urodynamic parameters of a bladder outlet obstruction. Therefore, the relief of a bladder outlet obstruction is not crucial to relieve the symptoms.
Humans ; Korea* ; Lower Urinary Tract Symptoms* ; Male ; Nocturia ; Prevalence ; Prostate ; Surveys and Questionnaires* ; Rivers ; Urinary Bladder Neck Obstruction* ; Urinary Bladder* ; Urinary Incontinence, Urge ; Urodynamics

PURPOSE: We investigated the prevalence of lower urinary tract symptoms (LUTS), and the inconvenience of each symptom, using an ICS-male Questionnaire (ICS-mQ) in Korean man. We also evaluated the relationships between symptoms, prostate volume and urodynamic parameters of a bladder outlet obstruction (BOO). MATERIALS AND METHODS: 180 male LUTS patients, from 7 urological institutions, were enrolled in this study. The ICS-mQ was used to measure the severity of the symptoms, with a bothersomeness scale. Transrectal sonography and urodynamic studies, including Schaefer linear passive urethral resistance relation (L-PURR), were performed. RESULTS: The 5 most frequent symptoms were voiding symptoms, such as reduced stream, terminal dribbling, incomplete emptying, intermittency and hesitancy, in that order. However, the 5 most bothersome symptoms included 2 voiding, and 3 storage, symptoms, such as incomplete emptying, urge incontinence, pain in bladder, nocturnal incontinence and hesitancy. 34.4% of the nocturia patients felt quite, or severely, bothered, but only 1.1% felt no problem. The mean value of estimated prostate volume, by sonography, was 29.8+/-14.1ml. There were no correlations between the severity of symptoms and the prostate size. There were also little, or no, correlations between a wide range of symptoms and the urodynamic parameters of BOO. CONCLUSIONS: The most frequent symptoms of male patients with LUTS are voiding symptoms, but they suffered more from storage, than from voiding, symptoms. The severities of the symptoms, or the bothersomeness, were not correlated with the prostate size or the urodynamic parameters of a bladder outlet obstruction. Therefore, the relief of a bladder outlet obstruction is not crucial to relieve the symptoms.
Humans ; Korea* ; Lower Urinary Tract Symptoms* ; Male ; Nocturia ; Prevalence ; Prostate ; Surveys and Questionnaires* ; Rivers ; Urinary Bladder Neck Obstruction* ; Urinary Bladder* ; Urinary Incontinence, Urge ; Urodynamics