Actinomycosis is a chronic, slowly progressive, and suppurative disease caused by filamentous anaerobic bacteria Actinomyces, which results in characteristic sulfur granules. Clinically, actinomycosis can present with a mass-like lesion, and this bacterial nidus has been frequently mistaken for a malignancy. For that reason many patients undergo surgical resection before the correct diagnosis is established. We report a case of a 63-year-old man with a solitary, asymptomatic pancreatic actinomycosis that masqueraded as pancreatic cancer. He did not have any other concurrently infected organs and did not have any signs or symptoms of infection. All radiologic images of the patient favored a malignancy to a great extent rather than an inflammatory mass. He was finally diagnosed with actinomycosis by endoscopic ultrasound (EUS)-guided fine needle aspiration biopsy without surgery. After one month of treatment with antibiotics, the pancreatic head mass was completely resolved on the follow-up computed tomography (CT).
Actinomyces ; Actinomycosis* ; Anti-Bacterial Agents ; Bacteria, Anaerobic ; Biopsy ; Biopsy, Fine-Needle ; Diagnosis ; Follow-Up Studies ; Head ; Humans ; Middle Aged ; Pancreas ; Pancreatic Neoplasms* ; Sulfur ; Ultrasonography

Accurate diagnosis of autoimmune pancreatitis (AIP) is important to clinicians since it is difficult to differentiate AIP from pancreatic malignancies. Furthermore, unlike pancreatic malignancies, AIP has dramatic response to steroids. A 61-years-old man presented with acute pancreatitis. Imaging studies showed two separate pancreatic masses, irregular narrowing of main pancreatic duct, and a renal mass that highly suggested AIP. Endoscopic ultrasound-guided core needle biopsy of the pancreatic masses and ultrasound-guided biopsy of the renal mass revealed peripheral T-cell lymphoma. The patient is currently undergoing chemotherapy. We present a case of pancreatic lymphoma masquerading as AIP with literature review.
Biopsy ; Biopsy, Large-Core Needle ; Diagnosis ; Drug Therapy ; Humans ; Lymphoma* ; Lymphoma, T-Cell, Peripheral ; Pancreatic Ducts ; Pancreatic Neoplasms ; Pancreatitis* ; Steroids

BACKGROUND/AIMS: To evaluate the geographic and demographic variabilities of the quantitative parameters of computed tomography perfusion (CTP) of the left ventricular (LV) myocardium in patients with normal coronary artery on computed tomography angiography (CTA). METHODS: From a multicenter CTP registry of stress and static computed tomography, we retrospectively recruited 113 patients (mean age, 60 years; 57 men) without perfusion defect on visual assessment and minimal (< 20% of diameter stenosis) or no coronary artery disease on CTA. Using semiautomatic analysis software, quantitative parameters of the LV myocardium, including the myocardial attenuation in stress and rest phases, transmural perfusion ratio (TPR), and myocardial perfusion reserve index (MPRI), were evaluated in 16 myocardial segments. RESULTS: In the lateral wall of the LV myocardium, all quantitative parameters except for MPRI were significantly higher compared with those in the other walls. The MPRI showed consistent values in all myocardial walls (anterior to lateral wall: range, 25% to 27%; p = 0.401). At the basal level of the myocardium, all quantitative parameters were significantly lower than those at the mid- and apical levels. Compared with men, women had significantly higher values of myocardial attenuation and TPR. Age, body mass index, and Framingham risk score were significantly associated with the difference in myocardial attenuation. CONCLUSIONS: Geographic and demographic variabilities of quantitative parameters in stress myocardial CTP exist in healthy subjects without significant coronary artery disease. This information may be helpful when assessing myocardial perfusion defects in CTP.
Angiography ; Body Mass Index ; Coronary Artery Disease ; Coronary Vessels ; Cytidine Triphosphate ; Female ; Healthy Volunteers ; Humans ; Male ; Myocardium ; Perfusion* ; Retrospective Studies

Unlike volume models, surface models, which are empty three-dimensional images, have small file size, so that they can be displayed, rotated, and modified in a real time. For the reason, the surface models of liver and neighboring structures can be effectively applied to virtual hepatic segmentectomy, virtual laparoscopic cholecystectomy, and so on. The purpose of this research is to present surface models of detailed structures inside and outside the liver, which promote medical simulation systems. Forty-seven chosen structures were liver structures such as portal triad, hepatic vein, and neighboring structures such as the stomach, duodenum, muscles, bones, and skin. The structures were outlined in the serially sectioned images from the Visible Korean Human to prepare segmented images. From the segmented images, serial outlines of each structure were stacked; on the popular commercial software, advanced surface reconstruction technique was applied to build surface model of the structure. A surface model of the liver was divided into eight models of hepatic segments according to distribution of the portal vein. The surface models will be distributed to encourage researchers to develop the various kinds of medical simulation of the abdomen.
Asian Continental Ancestry Group ; Computer Simulation ; Humans ; *Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Liver/*anatomy & histology ; *Models, Anatomic ; Models, Biological ; Portal Vein/anatomy & histology ; Software ; Tomography, X-Ray Computed

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome-also known as drug-induced hypersensitivity syndrome-is an uncommon disease entity that manifests as fever, skin rash, blood cell abnormalities, lymphadenopathy, and often coagulopathy. Tigecycline is an antibiotic that is selectively used to treat complicated intra-abdominal and soft-tissue infections. Recently, a few cases of tigecycline-induced coagulopathy have been reported. Herein, we report a case of tigecycline-induced coagulopathy in a patient with DRESS syndrome. Both prothrombin time and activated partial thromboplastin time were abruptly exceeded beyond 180 seconds on day 6 of tigecycline treatment and normalized after discontinuation of tigecycline.
Blood Cells ; Drug Hypersensitivity Syndrome ; Eosinophilia* ; Exanthema ; Fever ; Humans ; Hypersensitivity ; Lymphatic Diseases ; Partial Thromboplastin Time ; Prothrombin Time

Macrophage activation syndrome (MAS) is a secondary hemophagocytic lymphohistiocytosis caused by autoimmune diseases, such as systemic lupus erythematosus (SLE). It is characterized by fever, cytopenia, coagulopathy, hepatosplenomegaly, elevated liver enzyme, and high ferritin, typically combined with hemophagocytic histiocyte proliferation in the bone marrow. Here, we report a case of MAS in a patient with SLE treated successfully by tocilizumab. She was transferred to our hospital due to persistent fever of unknown origin. Initial blood tests revealed cytopenia, elevated liver enzyme, and high ferritin. Bone marrow histology revealed the presence of hemophagocytic histiocytes. The patient was initially treated with high dose corticosteroids; however, fever and cytopenia were not controlled. Additional treatments with cyclosporine, intravenous immunoglobulin, and rituximab were applied consecutively, but the fever and cytopenia persisted. Symptom resolution was finally achieved following treatment with tocilizumab, resulting in rapid improved of fever, and resolution of pancytopenia within 2 months.
Adrenal Cortex Hormones ; Autoimmune Diseases ; Bone Marrow ; Cyclosporine ; Ferritins ; Fever ; Fever of Unknown Origin ; Hematologic Tests ; Histiocytes ; Humans ; Immunoglobulins ; Liver ; Lupus Erythematosus, Systemic* ; Lymphohistiocytosis, Hemophagocytic ; Macrophage Activation Syndrome* ; Macrophage Activation* ; Macrophages* ; Pancytopenia ; Rituximab

Crohn`s disease is a severe chronic inflammation that is treated mainly by immunosuppression, which often has serious side effects. There is a need to develop new drugs for treating this disease that have few side effects. Heme oxygenase-1 (HO-1) has immunosuppressive properties, but the mechanism of its anti-inflammatory actions is unclear. We investigated the protective effects of HO-1 on trinitrobenzene sulfonic acid (TNBS)-induced colitis in mice. An HO-1 inducer, cobalt protoporphyrin IX (CoPPIX), dramatically improved the clinical and histopathological symptoms in TNBS-induced colitis. CoPPIX suppressed tumor necrosis factor-alpha and interleukin-1beta expression and down-regulated the nuclear transcription factor kappa B activity caused by TNBS. The vehicle copper protoporphyrin IX (CuPPIX) failed to duplicate the protective effects seen with CoPPIX. Moreover, an inhibitor of HO-1 activity-zinc protoporphyrin IX-reversed the protective effects of CoPPIX on TNBS-induced colitis. In conclusion CoPPIX protects against TNBS-induced colonic damage by inducing HO-1, which might be an important target in the treatment of Crohn`s disease.
Animals ; Cobalt ; Colitis* ; Colon ; Copper ; Heme Oxygenase-1 ; Immunosuppression ; Inflammation ; Interleukin-1beta ; Mice ; Transcription Factors ; Tumor Necrosis Factor-alpha

BACKGROUND: Generation of perfluorocarbon-exposed sonicated dextrose albumin (PESDA), the custom-made contrast agent, is performed under certain conditions that have been proposed by its original developer. We doubted whether the known composition and manufacturing method of PESDA is ideal and if there is an optimal method of storing batches of PESDA for a significant time duration. METHODS: PESDA was generated with several different composition of ingredients (5% human serum albumin, 5% dextrose water, and perfluorocarbon (PFC) gas), where various ratios of each were used. Sonication was performed for various durations. After manufacturing, the mean size and concentration of the microbubbles were evaluated by hemocytometer and compared. The generated PESDA was stored for 48 hours under 4 degrees C or -20 degrees C and changes in size and concentration of microbubbles were evaluated and compared. RESULTS: The best concentration of microbubbles was found with a mix ratio of albumin: PFC: dextrose of 1:1:1 and sonication time of 90 sec. The microbubble concentration of the optimal PESDA was not different to that of the conventionally manufactured one (9.47+/-1.70 x 10(8) /mL vs. 8.34+/-0.87 x 10(8) /mL, p>0.05) but the mean microbubble size was significantly smaller (1.22+/-0.31 um vs. 1.66+/-0.32 um, p<0.01). After 48 hours, the concentration of microbubbles was reduced by 34+/-3% (p=NS) and 55+/-0.2% (p<0.05) and the size increased by 77+/-25% and 108+/-41% (p=NS in both) in the 4 degrees C -stored and -20 degrees C -stored PESDA, respectively. CONCLUSION: The optimal composition of PESDA ingredients is 1:1:1 for albumin, PFC, and dextrose water, and the best duration of sonication is 90 seconds. Refrigeration under 4 degrees C may be the best way for storage of PESDA for 48 hours.
Echocardiography ; Glucose* ; Humans ; Microbubbles ; Refrigeration ; Serum Albumin ; Sonication ; Water