No abstract available.
Cytarabine* ; Cytosine* ; Drug Therapy, Combination* ; Idarubicin* ; Leukemia, Myeloid, Acute*

Esophageal perforation continues to be associated with high mortality - 20% to 30% - despite advances in surgical techniques. Traditional surgery has been the mainstay of treatment for perforation, but recent advances in endoscopic closure devices has increased therapeutic options for selected patients. Our patient had a fishbone-induced esophageal perforation. He was treated successfully with endoscopic clipping, antibiotics and parenteral nutrition. We report this case and provide a review of the relevant literature.
Anti-Bacterial Agents ; Esophageal Perforation ; Foreign Bodies ; Humans ; Parenteral Nutrition

BACKGROUND: Nefopam is a centrally acting non-opioid analgesic agent. Its analgesic properties may be related to the inhibitions of monoamine reuptake and the N-methyl-D-aspartate (NMDA) receptor. The antinociceptive effect of nefopam has been shown in animal models of acute and chronic pain and in humans. However, the effect of nefopam on diabetic neuropathic pain is unclear. Therefore, we investigated the preventive effect of nefopam on diabetic neuropathic pain induced by streptozotocin (STZ) in rats. METHODS: Pretreatment with nefopam (30 mg/kg) was performed intraperitoneally 30 min prior to an intraperitoneal injection of STZ (60 mg/kg). Mechanical and cold allodynia were tested before, and 1 to 4 weeks after drug administration. Thermal hyperalgesia was also investigated. In addition, the transient receptor potential ankyrin 1 (TRPA1) and TRP melastatin 8 (TRPM8) expression levels in the dorsal root ganglion (DRG) were evaluated. RESULTS: Pretreatment with nefopam significantly inhibited STZ-induced mechanical and cold allodynia, but not thermal hyperalgesia. The STZ injection increased TRPM8, but not TRPA1, expression levels in DRG neurons. Pretreatment with nefopam decreased STZ-induced TRPM8 expression levels in the DRG. CONCLUSIONS: These results demonstrate that a nefopam pretreatment has strong antiallodynic effects on STZ-induced diabetic rats, which may be associated with TRPM8 located in the DRG.
Animals ; Ankyrins ; Chronic Pain ; Diabetic Neuropathies ; Diagnosis-Related Groups ; Ganglia, Spinal ; Humans ; Hyperalgesia ; Injections, Intraperitoneal ; Models, Animal ; N-Methylaspartate ; Nefopam* ; Neuralgia* ; Neurons ; Rats* ; Streptozocin

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) is associated with dyslipidemia, obesity, and insulin resistance, which are the main features of metabolic syndrome. First, we examined the prevalence of metabolic syndrome among patients with NAFLD. We then compared the prevalence of metabolic syndrome in simple steatosis with that in nonalcoholic steatohepatitis (NASH). Finally, we sought to identify clinical factors associated with the stage of liver fibrosis. METHODS: From November 2002 to March 2004, we enrolled consecutive 25 patients with NAFLD from patients visiting outpatient clinic. The 17 controls were healthy persons who visited our health promotion center. We compared the clinical and biochemical data of the NAFLD group with those of the control group. Using histologic findings, we divided NAFLD into simple steatosis and NASH. We then compared the clinical and biochemical data of the simple steatosis group with those of the NASH group. RESULTS: Fourteen patients (14/25, 56%) had metabolic syndrome in the NAFLD group. There was no difference in the prevalence of metabolic syndrome between the simple steatosis (5/10, 50%) and the NASH group (9/15, 60%). We found significant differences in cardiovascular risk factors between the two groups, but homeostasis model assessment insulin resistance was the only significantly different factor between the simple steatosis group and the NASH group. In addition, no difference in histological features was found between NASH with metabolic syndrome and without metabolic syndrome. CONCLUSIONS: A considerable number of patients with NAFLD had metabolic syndrome. There was a close correlation between NAFLD and metabolic syndrome. We could not find any cardiovascular risk factors that could predict a severe fibrosis.
Adult ; English Abstract ; Fatty Liver/*complications ; Female ; Humans ; Male ; Metabolic Syndrome X/*complications ; Middle Aged

BACKGROUND: Nefopam is a centrally acting non-opioid analgesic agent. Its analgesic properties may be related to the inhibitions of monoamine reuptake and the N-methyl-D-aspartate (NMDA) receptor. The antinociceptive effect of nefopam has been shown in animal models of acute and chronic pain and in humans. However, the effect of nefopam on diabetic neuropathic pain is unclear. Therefore, we investigated the preventive effect of nefopam on diabetic neuropathic pain induced by streptozotocin (STZ) in rats. METHODS: Pretreatment with nefopam (30 mg/kg) was performed intraperitoneally 30 min prior to an intraperitoneal injection of STZ (60 mg/kg). Mechanical and cold allodynia were tested before, and 1 to 4 weeks after drug administration. Thermal hyperalgesia was also investigated. In addition, the transient receptor potential ankyrin 1 (TRPA1) and TRP melastatin 8 (TRPM8) expression levels in the dorsal root ganglion (DRG) were evaluated. RESULTS: Pretreatment with nefopam significantly inhibited STZ-induced mechanical and cold allodynia, but not thermal hyperalgesia. The STZ injection increased TRPM8, but not TRPA1, expression levels in DRG neurons. Pretreatment with nefopam decreased STZ-induced TRPM8 expression levels in the DRG. CONCLUSIONS: These results demonstrate that a nefopam pretreatment has strong antiallodynic effects on STZ-induced diabetic rats, which may be associated with TRPM8 located in the DRG.
Animals ; Ankyrins ; Chronic Pain ; Diabetic Neuropathies ; Diagnosis-Related Groups ; Ganglia, Spinal ; Humans ; Hyperalgesia ; Injections, Intraperitoneal ; Models, Animal ; N-Methylaspartate ; Nefopam ; Neuralgia ; Neurons ; Rats ; Streptozocin

Unroofed coronary sinus with persistent left superior vena cava is an extremely rare congenital anomaly. It can be suspected by the presence of a markedly dilated coronary sinus and can be confirmed by injection of agitated saline into the left antecubital vein during echocardiography. Agitated saline contrast echocardiography can easily visualize the flow in the persistent left superior vena cava communicating with the unroofed coronary sinus hereby creating a shunt into the left atrium. An agitated saline contrast echocardiography may be performed with a low risk of transient complication. We demonstrate the case of a 32-year-old pregnant woman with unroofed coronary sinus and persistent left superior vena cava, confirmed by agitated saline contrast echocardiography.
Adult ; Coronary Sinus* ; Dihydroergotamine* ; Echocardiography* ; Female ; Heart Atria ; Humans ; Pregnant Women ; Veins ; Vena Cava, Superior*

Amyloidosis is a disorder of protein metabolism that leads to extracellular deposition of amyloid in tissues and organs. Multiple organ dysfunction can be induced by deposition of amyloid. Diagnosis is established by histologic demonstration of amyloid protein in involved tissue using Congo red staining. A 72 year-old woman was admitted due to mild abdominal pain, diarrhea and hematochezia. Duodenoscopic and colonoscopic findings were nonspecific, however, multiple biopsies showed amyloid deposits characterized by green birefringence under polarized light. The findings of small bowel series and abdominal CT were compatible with amyloidosis. We experienced a case of amyloidosis with involvement of the whole bowel.
Abdominal Pain ; Aged ; Amyloid ; Amyloidosis* ; Biopsy ; Birefringence ; Congo Red ; Diagnosis ; Diarrhea ; Female ; Gastrointestinal Hemorrhage* ; Humans ; Metabolism ; Plaque, Amyloid ; Tomography, X-Ray Computed

Portal hypertension often leads to the development of several collateral vessels that shunt blood flow from the portal to the systemic circulation. The rupture of intra-abdominal varix is an unusual complication of portal hypertension that can lead to life-threatening hemoperitoneum. If the patient is hemodynamically unstable due to massive intra-abdominal bleeding, exploratory laparotomy should be performed on the patient. There are several reported cases of intra-abdominal variceal bleeding such as paraumbilical varix, the varix from the small intestine and proximal colon etc. Spontaneous hemoperitoneum caused by the rupture of gastroepiploic vein varix, however, has not been reported in Korea, to the best of our knowledge. We will discuss a patient with portal hypertension due to liver cirrhosis who presented with acute intra-abdominal bleeding. During the laparotomy, he was found to have a rupture of the gastroepiploic vein. The vessel was ligated, and the patient recovered uneventfully by operative variceal ligation.
Alcoholics* ; Colon ; Esophageal and Gastric Varices ; Hemoperitoneum* ; Hemorrhage ; Humans ; Hypertension, Portal ; Intestine, Small ; Korea ; Laparotomy ; Ligation ; Liver Cirrhosis ; Liver Cirrhosis, Alcoholic* ; Rupture* ; Varicose Veins ; Veins*

A 34-year-old woman was admitted to the hospital because of recently aggravated right heart failure without angina for 5 months. When she was 25 years old, patch repair with Polytetrafluoroethylene (PTFE) was performed for the secondum type of atrial septal defect (ASD) with moderate pulmonary hypertension. The chest PA, echocardiography and cardiac catheterization at current admission revealed Eisenmenger syndrome without intracardiac shunt. Chest CT scan with contrast revealed markedly dilated pulmonary trunk, both pulmonary arteries and concave disfigurement of the left side of the ascending aorta suggesting extrinsic compression, as well as total occlusion of the ostium of the left main coronary artery that was retrogradly filled with collateral circulation from the right coronary artery. The coronary angiography showed normal right coronary artery and the collaterals that come out from the conus branch to the mid-left anterior descending artery (LAD) and that from distal right coronary artery to the left circumflex artery (LCX) and to the distal LAD, respectively. On aortography, the left main coronary artery was not visualized with no stump, suggestive of total occlusion of the ostium of the left main coronary artery. From our experience, it is possible to say that the occlusion of the ostium of the left main coronary can be induced by the dilated pulmonary artery trunk due to ASD with pulmonary hypertension and that, if the ASD closure was too late, the narrowing or obstruction of the left coronary artery could not be resolved even after operation owing to irreversible pulmonary hypertension.
Adult ; Case Report ; Constriction, Pathologic/etiology/radiography ; Coronary Disease/*etiology/radiography ; Dilatation, Pathologic/etiology ; Eisenmenger Complex/diagnosis ; Female ; Heart Septal Defects, Atrial/*complications ; Human ; Hypertension, Pulmonary/*complications ; *Pulmonary Artery/radiography