Contrast-induced encephalopathy after cerebral angiography is a rare complication and until now, only few cases have been reported. This paper reports on contras-induced encephalopathy mimicking meningoencephalitis after cerebral angiography by using iodixanol, an iso-osmolar non-ionic contrast agent. A 58-year-old woman underwent cerebral angiography for the evaluation of multiple intracranial aneurysms. A few hours later, she had persistent headache, vomiting, fever, and seizures. Brain computed tomography (CT) showed sulcal obliteration of right cerebral hemisphere and cerebrospinal fluid profile was unremarkable. The next day, she developed left side hemiparesis, sensory loss, and left-sided neglect with drowsy mentality. Brain magnetic resonance imaging (MRI) showed cerebral swelling with leptomeningeal enhancement in the right parieto-occipital lobe without sign of ischemia or hemorrhage. The patient was managed with intravenous dexamethasone, mannitol and anticonvulsant. There was a progressive neurological improvement with complete resolution of the symptoms at day 6. This observation highlights that contrast-induced encephalopathy can be caused by an iso-osmolar non-ionic contrast agent. This rare entity should be suspected if neurologic deterioration after cerebral angiography is not explained by other frequent causes such as acute infarction or hemorrhage.
Angiography ; Brain ; Brain Diseases* ; Cerebral Angiography* ; Cerebrospinal Fluid ; Cerebrum ; Dexamethasone ; Female ; Fever ; Headache ; Hemorrhage ; Humans ; Infarction ; Intracranial Aneurysm ; Ischemia ; Magnetic Resonance Imaging ; Mannitol ; Meningoencephalitis ; Middle Aged ; Paresis ; Seizures ; Vomiting

Metatarsal head and neck fractures are injuries that often result from a direct blow of a heavy objects to the metatarsal head. The head is often impacted or displaced to the plantar aspect that if not treated may cause malunion which later induces painful plantar calluses. If the fracture fragment is large enough, closed reduction may be successfully performed, but when the fragment is small or closed reduction is unsuccessful, open reduction is needed. We present our reduction and fixation technique for the metatarsal head and neck fractures using antegrade intramedullary Kirschner wire (K-wire) without opening the fracture site or infringing the metatarsophalangeal (MTP) joint which allows immediate motion of the joint and partial weight bearing in a stiff soled shoe.
Bony Callus ; Head ; Joints ; Metatarsal Bones ; Neck ; Shoes ; Weight-Bearing

Keloids are benign fibrcus growths which extend beyond the original wound and rarely regress. Available methods of treatment include surgical excision, radiotherapy, intralesional steroid injection, cryotherapy, systemie. chemotherapy, zinc tape strapping, pressure, silicon gel and combined therapy. Postoperative irradiation is a useful and effective method of eradication or prevent.ion of keloid. We describe two cases of the prevention of keloids associated with postoperative irradiation.
Cryotherapy ; Drug Therapy ; Keloid* ; Radiotherapy ; Silicone Gels ; Wounds and Injuries ; Zinc

PURPOSE: This study was done to determine the usefulness of serum pepsinogen (PG) levels as a screening method for gastric cancer, and to assess the relationships between serum PG and clinicopathologic factors of gastric adenocarcinoma. MATERIALS AND METHODS: Serum PG concentrations were measured in 94 subjects who were classified into (a) a control group (50 subjects) without abnormal endoscopic finding on a health checkup, or (b) a gastric cancer group (44 subjects) who had surgery at Daegu Catholic University Hospital between Nov. 2008 and May 2009. Receiver operator characteristic curves were utilized to select the most suitable test. Using different cutoff points, sensitivity and specificity were calculated. We compared preoperative serum PG levels with several clinicopathologic findings for patients with gastric adenocarcinoma. RESULTS: The Serum PG I:II ratio was the most useful as a screening test. The sensitivity and specificity of PG screening for gastric cancer were, respectively, 81.8% and 82%. The cut off point correlated with the type of intestinal cancer (Lauren classification; P=0.003), tumor stage (P=0.001), and gastric adenocarcinoma with peritumoral chronic atrophic gastritis (P=0.036). CONCLUSION: Serum PG levels were found to be a potentially useful screening test and to correlate with clinicopathologic factors in gastric cancer patients. But, in order to use serum PG found in a health checkup for gastric cancer as a clinical application a large scale study is recommended.
Adenocarcinoma ; Gastritis, Atrophic ; Humans ; Intestinal Neoplasms ; Mass Screening ; Pepsinogen A ; Sensitivity and Specificity ; Stomach Neoplasms

Anterior cervical osteophytes are commonly found in elderly patients, but rarely produce symptoms. When symptoms occur, they can range from mild symptoms of dysphagia, dysphonia, and foreign body sensation to severe symptoms of airway obstruction due to compression of the pharynx or larynx. We report the case of a 59-year-old man who underwent brain tumor surgery, and developed post-operative respiratory difficulty due to progressive pharyngo-laryngeal edema, requiring urgent endotracheal intubation, secondary to the presence of a previously asymptomatic anterior cervical osteophyte. It is paramount to recognize that asymptomatic anterior cervical osteophytes are a potential cause of life-threatening post-operative respiratory complications that can rapidly progress to life-threatening airway obstruction after surgeries in the prone position, especially in elderly patients.
Aged ; Airway Obstruction ; Brain Neoplasms* ; Brain* ; Deglutition Disorders ; Dysphonia ; Edema ; Foreign Bodies ; Humans ; Intubation, Intratracheal ; Larynx ; Middle Aged ; Osteophyte* ; Pharynx ; Prone Position ; Sensation

BACKGROUND: Recently a report was published about the cross-inhibitory effect of post ganglionic neuron between upper extremities. We tried to find the existence of the same effect in all extremities by comparing the changes of skin temperature (ST) of all extremities during and after sympathicotomy for palmar hyperhidrosis. METHODS: Twenty patients with palmar hyperhydrosis underwent bilateral video-assisted thoracoscopic sympathicomy. Right side T3 sympathicotomy was performed first, then left side T3 sympathicotomy was done. The ST of both hands and feet were compared with the ST before the surgery at 2, 4, 6, 10 minutes after first (right) sympathicotomy, 10 minutes after second (left) sympathicotomy and 4 hours after both sympathicotomy in the post anesthetic care unit (PACU) of our one-day surgery center. RESULTS: At 10 minutes after completion of first (right) sympathicotomy, ipsilateral increase of the ST (right hand, 2.73 +/- 2.01oC) and contralateral decrease of the ST (left hand, - 0.65 +/- 0.88oC) were observed (P < 0.05). After the second (left) sympathicotomy was done, the ST of both feet decreased (right, - 1.24 +/- 0.81oC and left, - 1.31+/- 0.77oC, P < 0.05) and the ST of both hands increased (right, 3.34 +/- 2.40oC and left, 2.11+/- 1.91oC, P < 0.05). There were increases of the ST in both hands (right, 4.93 +/- 2.51oC and left, 4.63 +/- 2.19oC) and decreases of the ST in both feet (right, - 3.38 +/- 1.85oC and left, - 3.09 +/- 2.03oC, P < 0.05) in the PACU. CONCLUSIONS: There may be a cross-inhibitory effect by the post ganglionic neurons innervating the blood vessels of the all extremities. Sympathicotomy causes the relief of the cross-inhibitory effect and result in vasoconstriction and a decrease of ST of contralateral hand and both feet.
Blood Vessels ; Extremities ; Foot* ; Ganglion Cysts ; Hand* ; Humans ; Hyperhidrosis* ; Neurons ; Skin Temperature ; Upper Extremity ; Vasoconstriction

BACKGROUND: Recently a report was published about the cross-inhibitory effect of post ganglionic neuron between upper extremities. We tried to find the existence of the same effect in all extremities by comparing the changes of skin temperature (ST) of all extremities during and after sympathicotomy for palmar hyperhidrosis. METHODS: Twenty patients with palmar hyperhydrosis underwent bilateral video-assisted thoracoscopic sympathicomy. Right side T3 sympathicotomy was performed first, then left side T3 sympathicotomy was done. The ST of both hands and feet were compared with the ST before the surgery at 2, 4, 6, 10 minutes after first (right) sympathicotomy, 10 minutes after second (left) sympathicotomy and 4 hours after both sympathicotomy in the post anesthetic care unit (PACU) of our one-day surgery center. RESULTS: At 10 minutes after completion of first (right) sympathicotomy, ipsilateral increase of the ST (right hand, 2.73 +/- 2.01oC) and contralateral decrease of the ST (left hand, - 0.65 +/- 0.88oC) were observed (P < 0.05). After the second (left) sympathicotomy was done, the ST of both feet decreased (right, - 1.24 +/- 0.81oC and left, - 1.31+/- 0.77oC, P < 0.05) and the ST of both hands increased (right, 3.34 +/- 2.40oC and left, 2.11+/- 1.91oC, P < 0.05). There were increases of the ST in both hands (right, 4.93 +/- 2.51oC and left, 4.63 +/- 2.19oC) and decreases of the ST in both feet (right, - 3.38 +/- 1.85oC and left, - 3.09 +/- 2.03oC, P < 0.05) in the PACU. CONCLUSIONS: There may be a cross-inhibitory effect by the post ganglionic neurons innervating the blood vessels of the all extremities. Sympathicotomy causes the relief of the cross-inhibitory effect and result in vasoconstriction and a decrease of ST of contralateral hand and both feet.
Blood Vessels ; Extremities ; Foot* ; Ganglion Cysts ; Hand* ; Humans ; Hyperhidrosis* ; Neurons ; Skin Temperature ; Upper Extremity ; Vasoconstriction

OBJECTIVE: Notch receptors are heterodimeric transmembrane proteins that regulate cell fate, such as differentiation, proliferation, and apoptosis. Dysregulated Notch pathway signaling has been observed in glioblastomas, as well as in other human malignancies. Nerve growth factor (NGF) is essential for cell growth and differentiation in the nervous system. Recent reports suggest that NGF stimulates glioblastoma proliferation. However, the relationship between NGF and Notch1 in glioblastomas remains unknown. Therefore, we investigated expression of Notch1 in a glioblastoma cell line (U87-MG), and examined the relationship between NGF and Notch1 signaling.METHODS: We evaluated expression of Notch1 in human glioblastomas and normal brain tissues by immunohistochemical staining. The effect of NGF on glioblastoma cell line (U87-MG) was evaluated by 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. To evaluate the relationship between NGF and Notch1 signaling, Notch1 and Hes1 expression were evaluated by reverse transcription polymerase chain reaction (RT-PCR) and Western blot analysis, respectively. To confirm the effects of NGF on Notch1 signaling, Notch1 and Hes1 small interfering RNAs (siRNAs) were used.RESULTS: In immunohistochemistry, Notch1 expression was higher in glioblastoma than in normal brain tissue. MTT assay showed that NGF stimulates U87-MG cells in a dose-dependent manner. RT-PCR and Western blot analysis demonstrated that Notch1 and Hes1 expression were increased by NGF in a dose-dependent manner. After transfection with Notch1 and Hes1 siRNAs, there was no significant difference between controls and 100 nM NGF-β, which means that U87-MG cell proliferation was suppressed by Notch1 and Hes1 siRNAs.CONCLUSION: These results indicate that NGF stimulates glioblastoma cell proliferation via Notch1 signaling through Hes 1.
Apoptosis ; Blotting, Western ; Brain ; Cell Line ; Cell Proliferation ; Glioblastoma ; Humans ; Immunohistochemistry ; Nerve Growth Factor ; Nervous System ; Polymerase Chain Reaction ; Receptor, Notch1 ; Receptors, Notch ; Reverse Transcription ; RNA, Small Interfering ; Transfection

Impaction of an ingested foreign body in the colon is uncommon but surgical or endoscopic intervention is occasionally needed when serious complications such as perforation, obstruction or hemorrhage occur. Several factors may predispose a patient to ingestion and subsequent impaction of lower intestinal foreign body. It is more common in the elderly who wear dentures, in the mentally infirm, in chronic alcoholics or rapid eating. The majority of impaction occurs at narrowing and angulation such as ileocecal valve or rectosigmoid junction. The diagnosis of lower intestinal foreign body should be considered, among more common conditions, in the differential diagnosis of elderly patients who present with altered bowel habits. We report the case with a literature review that successfully endoscopically removed the fish bones impacted in the rectosigmoid colon complicated by rectal bleeding.
Aged ; Alcoholics ; Colon* ; Dentures ; Diagnosis ; Diagnosis, Differential ; Eating ; Foreign Bodies ; Hemorrhage ; Humans ; Ileocecal Valve

The prevalence of intestinal tuberculosis has been markedly decreased with the development of antituberculous chemotherapy, improved economic conditions, preventive medicine and early detection and treatment of pulmonary tuberculosis. An even more impressive resurgence of pulmonary and extrapulmonary tuberculosis has been seen in recent years among persons infected with the human immunodeficiency virus. The most common site of intestinal tuberculosis is the ileocecal region, and duodenum is a rare site. Symptoms and signs of duodenal tuberculosis are nonspecific. The gross pathologic appearance of the duodenal tuberculous lesions has to its traditional categorization into three forms: 1) ulcerative, 2) hypertrophic, and 3) ulcerohypertrophic (mixed). Hypertrophic lesions of the duodenal tuberculosis should be differentiated from duodenal adenocarcinoma and lymphoma. We herein report a case of duodenal tuberculosis presenting as intraluminal protruding mass in gastroduodenoscopy and multiple intraabdominal lymphadenopathy on abdominal CT. We have confirmed the duodenal tuberculosis by endoscopic biopsy, and review the current literatures.
Adenocarcinoma ; Biopsy ; Drug Therapy ; Duodenal Neoplasms* ; Duodenum ; HIV ; Humans ; Lymphatic Diseases ; Lymphoma ; Prevalence ; Preventive Medicine ; Tomography, X-Ray Computed ; Tuberculosis* ; Tuberculosis, Pulmonary ; Ulcer