Allergic fungal sinusitis (AFS) is a benign, noninvasive form of fungal sinusitis. Histologically, AFS is characterized by allergic mucin, which consists of eosinophilic mucinous material with occasional laminar deposits of eosinophils. A diagnosis of AFS can be made when there is a demonstration of characteristic allergic mucin and an appearance of fungal hypae scattered within the mucin with no evidence of tissue invasion, or when fungi cultures yield positive results. Until now, no cases of AFS have been reported in Korea, though there have been many cases of mycetomas and a few cases of invasive fungal sinusitis. We present the first two cases of AFS in Korea. The patients demonstrated characteristic allergic mucin, fungal hypae scattered within the mucin, and no evidence of tissue invasion on histopathology. Nasal polyps, involvement of the unilateral sinuses, peripheral eosinophilia, an elevated total IgE, and hyperattenuated masses observed in the CT supported the diagnosis of AFS. The patients recovered and did not display recurrence after surgery and treatment with topical steroids and saline irrigation.
Diagnosis ; Eosinophilia ; Eosinophils ; Fungi ; Humans ; Immunoglobulin E ; Korea ; Mucins ; Mycetoma ; Nasal Polyps ; Recurrence ; Sinusitis* ; Steroids

BACKGROUND AND OBJECTIVES: Nitric oxide (NO) production in the respiratory epithelium and the demonstration of inducible nitric oxide synthase in ciliated epithelium of the upper airway have recently been reported. The aim of this study was to investigate the expression of inducible nitric oxide synthase in the nasal epithelium after capsaicin treatment, which stimulates the substance P innervation. MATERIALS AND METHODS: In vivo treatment -Capsaicin (112 nM) was applied to the nasal cavities of the rat and guinea pig, and 30 nl of normal saline was applied for the control groups. After 2 hours, animals were sacrificed with cardiac perfusion of 4% paraformaldehyde and septal mucosa were removed. The 8 nm serial frozen tissue sections were made, and the expression of inducible nitric oxide synthase was determined using nicotinamide adenine diphosphate-diaphorase histochemistry. In vitro treatment- The nasal septum of the rats and the trachea of the guinea pigs were incubated in DMEM culture media with or without 112 nM capsaicin for experimental or control groups. After 0, 30 or 120 minutes of incubation, the tissues were fixed and processed for nicotinamide adenine diphosphate-diaphorase histochemistry. RESULTS: Both in vivo and in vitro studies demonstrated that the strong positive histochemical reactivity were observed in the respiratory epithelium of the rats and guinea pigs after capsaicin treatment compared to control groups. CONCLUSION: These data imply that capsaicin induces the expression of inducible nitric oxide synthase and that the substance P innervation of the nasal mucosa may have a protective role in the airway defense mechanism through nitric oxide production.
Adenine ; Animals ; Capsaicin* ; Culture Media ; Epithelium* ; Guinea Pigs ; Guinea* ; Mucous Membrane ; Nasal Cavity ; Nasal Mucosa ; Nasal Septum ; Niacinamide ; Nitric Oxide ; Nitric Oxide Synthase Type II* ; Perfusion ; Rats* ; Respiratory Mucosa ; Substance P ; Trachea

PURPOSE: With the increase in the old age population, proximal humerus fractures have been increasing recently. However, complications after operative treatment, such as fixation failure, are common because of osteoporosis. We treated proximal humerus fractures in patients with osteoporosis conservatively, and evaluated the radiographic and functional results by analyzing the factors affecting the results. MATERIALS AND METHODS: Nineteen out of 30 cases for whom the clinical follow-up was over 1 year were included in this retrospective study. There were 17 females and 2 males, and the mean age was 73.2 years. The causes were slip from a short height (18 cases) and a minor car accident (1 case). We evaluated the union period, nonunion, malunion and the Constant score and analyzed several factors affecting the functional result, such as age, fracture pattern, and malunion. RESULTS: Seventeen cases (89.5%) obtained union within 12.8 weeks on average. Neck-shaft angle was 125.3degrees on average, with seven cases of malunion. The Constant score was 84.1 on average, and there were excellent scores in 11 cases, good scores in 4 cases, and fair scores in 2 cases. Fracture pattern, neck-shaft angle, or malunion did not affect the functional outcome, and elderly patients showed poorer shoulder function. CONCLUSION: Proximal humeral fractures with osteoporosis may achieve a high rate of bony union when treated with conservative methods. Despite the common occurrence of malunion, a satisfactory functional outcome may be expected.
Aged* ; Female ; Follow-Up Studies ; Humans ; Humerus* ; Male ; Osteoporosis ; Retrospective Studies ; Shoulder ; Shoulder Fractures

OBJECTIVE: The aim of this study was to measure circulating levels of nitric oxide metabolites (nitrites) in the uteroplacental, fetoplacental, and peripheral circulation in women with normal pregnancy and preeclampsia. METHODS: Two groups of pregnant women were included : 20 patients with preeclampsia and 18 normotensive women. At cesarean, blood samples were taken from the antecubital vein and uterine vein draining the placental site before delivery of the baby, and the umbilical vein after delivery of the baby. Plasma nitric oxide concentrations were determined with the Griess reaction by measuring combined oxidation products of nitric oxide, plasma nitrite and nitrate after reduction with nitrate reductase. RESULTS: Significantly higher serum nitrite concentrations were found in umbilical (46.53+/-22.01 vs. 17.51+/-7.43 M/L, p<0.05), uterine (51.78+/-14.19 vs. 21.23+/-11.6 M/L, p<0.05) and antecubital (66.41+/-20.87 vs. 21.26+/-9.54 M/L, p<0.05) venous plasma in the preeclamptic group compared with the control group. CONCLUSION: We observe higher levels of nitirc oxide metabolites in the uteroplacental, fetoplacental, and peripheral circulation in women with preeclampsia than in normal pregnancy. These results support the hypothesis that increased nitric oxide production may be a compensatory response to improve blood flow and offset the pathologic effects of preeclampsia.
Female ; Humans ; Nitrate Reductase ; Nitric Oxide* ; Plasma* ; Pre-Eclampsia* ; Pregnancy ; Pregnant Women ; Umbilical Veins ; Veins

We experienced a case of primary gastric tuberculosis presented with melena. A 61-year-old male was admitted with epigastric pain and melena. Upper endoscopy revealed an irregular shaped gastric ulcer on the posterior wall of the body. Histological examination of endoscopic specimen revealed chronic inflammation with fibrosis, granulomas and acid-fast bacilli. Cultures for acid-fast bacilli subsequently grew Mycobacterium tuberculosis. There was no evidence of the tuberculous lesion anywhere else. Primary gastric tuberculosis remains an extremely uncommon clinical entity; the definitive diagnosis is made by biopsy and positive culture for the organism. We report a case of primary gastric tuberculosis with review of the literature.
Biopsy ; Diagnosis ; Endoscopy ; Fibrosis ; Granuloma ; Humans ; Inflammation ; Male ; Melena* ; Middle Aged ; Mycobacterium tuberculosis ; Stomach Ulcer ; Tuberculosis*

Diffuse esophageal spasm, an uncommon esophageal motility disorder, has recently been defined using high-resolution manometry. Patients with distal esophageal spasm usually complain of chest pain or dysphagia. The etiology and pathophysiology of this disorder are poorly known, and treatment options are limited. However, some options to improve symptoms are available, including endoscopic injection of botulinum toxin. Nevertheless, few reports have described the effects of endoscopic injection of botulinum toxin in patients with symptomatic diffuse esophageal spasm with clear endoscopic and high-resolution manometry images. Here, we report a case of diffuse esophageal spasm diagnosed with high-resolution manometry and treated by endoscopic injection of botulinum toxin with good results at the 7-month follow-up.
Aged ; Anti-Dyskinesia Agents/*therapeutic use ; Botulinum Toxins/*therapeutic use ; Endoscopy, Digestive System ; Esophageal Spasm, Diffuse/radiography/*therapy ; Female ; Humans ; Manometry ; Tomography, X-Ray Computed

Melatonin has been reported to protect neurons from a variety of neurotoxicity. However, the underlying mechanism by which melatonin exerts its neuroprotective property has not yet been clearly understood. We previously demonstrated that melatonin protected kainic acid-induced neuronal cell death in mouse hippocampus, accompanied by sustained activation of Akt, a critical mediator of neuronal survival. To further elucidate the neuroprotective action of melatonin, we examined in the present study the causal mechanism how Akt signaling pathway is regulated by melatonin in a rat primary astrocyte culture model. Melatonin resulted in increased astrocytic Akt phosphorylation, which was significantly decreased with wortmannin, a specific inhibitor of PI3K, suggesting that activation of Akt by melatonin is mediated through the PI3K-Akt signaling pathway. Furthermore, increased Akt activation was also significantly decreased with luzindole, a non-selective melatonin receptor antagonist. As downstream signaling pathway of Akt activation, increased levels of CREB phoshorylation and GDNF expression were observed, which were also attenuated with wortmannin and luzindole. These results strongly suggest that melatonin exerts its neuroprotective property in astrocytes through the activation of plasma membrane receptors and then PI3K-Akt signaling pathway.
Androstadienes ; Animals ; Astrocytes ; Cell Death ; Cell Membrane ; Glial Cell Line-Derived Neurotrophic Factor ; Hippocampus ; Melatonin ; Mice ; Neurons ; Phosphorylation ; Rats ; Receptors, Melatonin ; Tryptamines

The serine/threonine kinase Akt has been shown to play a role of multiple cellular signaling pathways and act as a transducer of many functions initiated by growth factor receptors that activate phosphatidylinositol 3-kinase (PI3K). It has been reported that phosphorylated Akt activates eNOS resulting in the production of NO and that NO stimulates soluble guanylate cyclase (sGC), which results in accumulation of cGMP and subsequent activation of the protein kinase G (PKG). It has been also reported that PKG activates PI3K/Akt signaling. Therefore, it is possible that PI3K, Akt, eNOS, sGC, and PKG form a loop to exert enhanced and sustained activation of Akt. However, the existence of this loop in eNOS-expressing cells, such as endothelial cells or astrocytes, has not been reported. Thus, we examined a possibility that Akt phosphorylation might be enhanced via eNOS/sGC/PKG/PI3K pathway in astrocytes in vivo and in vitro. Phosphorylation of Akt was detected in astrocytes after KA treatment and was maintained up to 72 h in mouse hippocampus. 2 weeks after KA treatment, astrocytic Akt phosphorylation was normalized to control. The inhibition of eNOS, sGC, and PKG significantly decreased Akt and eNOS phosphorylation induced by KA in astrocytes. In contrast, the decreased phosphorylation of Akt and eNOS by eNOS inhibition was significantly reversed with PKG activation. The above findings in mouse hippocampus were also observed in primary astrocytes. These data suggest that Akt/eNOS/sGC/PKG/PI3K pathway may constitute a loop, resulting in enhanced and sustained Akt activation in astrocytes.
Animals ; Astrocytes ; Cyclic GMP-Dependent Protein Kinases ; Endothelial Cells ; Guanylate Cyclase ; Hippocampus ; Kainic Acid ; Mice ; Nitric Oxide ; Phosphatidylinositol 3-Kinase ; Phosphorylation ; Phosphotransferases ; Receptors, Growth Factor ; Transducers

Background: Migraine patients have a higher frequency of suicidality than people without migraine. The aim of this study was to identify suicidality and its risk factors in migraine patients. Methods: We enrolled 358 migraine patients from 11 hospitals. We collected data regarding their clinical characteristics and the patients completes the questionnaires. We also interviewed patients with the Mini International Neuropsychiatric Interview (MINI)plus version 5.0.0 to identify their suicidality. The International Classification of Headache Disorders, third edition, beta version was used in headache diagnosis. Results: The frequency of suicidality in migraine patients was 118 (33.0%). Migraine patients with suicidality were more likely to have a major depressive disorder or generalized anxiety disorder than those without suicidality. Among variables, risk factors for suicidality in migraine patients were female (odds ratio [OR], 4.110; 95% confidence interval [CI], 1.55310.878; p=0.004), attack duration (OR, 2.559; 95% CI, 1.2105.413; p=0.011), Patient Health Questionnaire9 (OR, 1.111; 95% CI, 1.0381.189; p=0.002), and Generalized Anxiety Disorder7 (OR, 1.194; 95% CI, 1.1011.294; p<0.001). Conclusions Suicidality in migraine patients is common. Therefore, clinicians who take care of migraine patients should be concerned about suicidality and its risk factors such as female gender, attack duration, depression or anxiety.

OBJECTIVE: To compare the conventional Pap smear with the ThinPrep Pap smear in detecting HSIL and invasive cervical cancer and to determine the clinical value of ThinPrep Pap smear. METHODS : We evaluated the Pap smear results of 2933 patients. These subjects were selected from women having visited the early cancer clinic of the department of Obstetrics and Gynecology, Chonnam University Hospital, from Jan. 1998 to Dec. 2000. Of 2933 patients, conventional Pap smear and ThinPrep Pap smear were performed in 1594 and 1339 cases respectively. According to the results, sensitivity, specificity, positive predictability and negative predictability of both tests were compared and analyzed. RESULTS: In detecting HSIL and invasive cervical cancer, the conventional Pap smear examinations showed sensitivity 62.0%, specificity 96.5%, positive predictability 87.7%, and negative predictability 86.3%, while ThinPrep Pap smear did sensitivity 85.1%, specificity 98.3%, positive predictability 97.4% and negative predictability 89.7%. CONCLUSION: ThinPrep Pap smear makes it possible to obtain better specimen by reducing probable mistakes in sampling, and which can result in decreasing the rate of false negativity of Pap smear and increasing the accuracy of the Pap smear examination. Therefore, ThinPrep pap smear is a useful method in raising detection rate of HSIL and invasive cervical cancer.
Cervix Uteri* ; Female ; Gynecology ; Humans ; Jeollanam-do ; Obstetrics ; Sensitivity and Specificity ; Uterine Cervical Neoplasms*