Alveolar macrophages participate in the host defense against P. carinii, but the mechanisms in degradation and clearance of the organism from lung has not been well established. We observed the transmission and scanning electron microscopic features and evaluated the expression of TNF-alpha and Surfactant-D in the interaction of P. carinii with alveolar macrophages. Expression of TNF-alpha and Surfactant-D in the experimentally induced P. carinii pneumonia in rat was examined by immunohistochemistry and immunoelectron microscopy. Electron microscopically, the alveolar macrophages phagocytized trophozoites and cysts of P. carinii micro-organisms. Immunohistochemically TNF-alpha was strongly expressed in the cytoplasms of alveolar macrophages. Postembedding immunogold labeling for Surfactant-D protein was expressed on the pellicles of trophozoites and cysts, P. carinii micro-organisms in the cytoplasms of macrophages, free floating surfactant materials and multilamellar bodies of type II epithelial cells. We conclude that alveolar macrophages interacted with P. carinii micro-organisms respond with increased expression of TNF-alpha. TNF-alpha may bind to P. carinii and exert a direct toxic effect upon the micro-organisms. Surfactant-D protein may augment binding of P. carinii to the alveolar macrophages and enhance the clearance of the micro-organisms.
Animals ; Cytoplasm ; Epithelial Cells ; Immunohistochemistry ; Lung ; Macrophages ; Macrophages, Alveolar* ; Microscopy, Immunoelectron ; Pneumocystis carinii* ; Pneumocystis* ; Pneumonia ; Pneumonia, Pneumocystis* ; Rats ; Trophozoites ; Tumor Necrosis Factor-alpha*

PURPOSE: To evaluate the short-term effects of a single intravitreal injection of bevacizumab (Avastin) for the management of new vessels (NV) associated with proliferative diabetic retinopathy (PDR). METHODS: A non-randomized study of 19 PDR patients (20 eyes) who had active NV was analyzed prospectively. Standardized ophthalmic evaluation was performed at baseline and at weeks 1, 4, and 8 after intravitreal injection of 1.25 mg of bevacizumab. The main outcome measures included changes in total area of fluorescein leakage from active NV and best corrected visual acuity (BCVA). RESULTS: Twenty eyes of 19 patients (12 men [63.2%], 7 women [36.8%]) were included and all patients completed the 8-week study follow-up period. The mean age of participants was 47.05+/-12.48 years. At baseline, NV area was 23.02+/-21.80 mm2. The area of active NV decreased significantly to 4.96+/-9.18 mm2, 1.11+/-4.96 mm2 and 4.55+/-5.11 mm2 (p<0.05) at 1, 4 and 8 weeks after injection, respectively. At week 4, no leakage was observed in 19 eyes. The mean logMAR BCVA improved from 0.59+/-0.49 at baseline to 0.56+/-0.47, 0.55+/-0.73 and 0.51+/-0.50 at weeks 1, 4, and 8, respectively. No significant adverse events were observed. CONCLUSIONS: Short-term results suggest that intravitreal injection of bevacizumab is associated with a rapid regression of retinal neovascularization secondary to PDR.
Antibodies, Monoclonal, Humanized ; Diabetic Retinopathy ; Eye ; Female ; Fluorescein ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Male ; Outcome Assessment (Health Care) ; Prospective Studies ; Retinal Neovascularization ; Retinaldehyde ; Visual Acuity ; Bevacizumab

PURPOSE: To report the first case of a solitary eyelid fibrofolliculoma and to review the literature. METHODS: A 37-year-old female patient visited the outpatient department with a lesion in the right upper lid that had been growing steadily for a year. The patient had visited the local clinic, and under the diagnosis of chalazion had received incision and curettage twice, but the lesion had recurred. RESULTS: The 5 x 5 mm lesion was located near the upper lid margin. It was a red, hemispheric, smooth nodule, relatively solid to palpation and not painful. Excision and biopsy were performed, and through a histological exam, the diagnosis of fibrofolliculoma was later confirmed. CONCLUSIONS: Solitary fibrofolliculoma is rare, and to the authors' knowledge, a lesion arising in the eyelid has not yet been reported. Fibrofolliculoma should be included in the differential diagnosis when a localized mass lesion arising in the eyelid is encountered.
Adult ; Chalazion/*diagnosis ; Diagnosis, Differential ; Eyelid Neoplasms/*diagnosis/pathology/surgery ; Female ; Fibroma/*diagnosis/pathology/surgery ; Humans ; Ophthalmologic Surgical Procedures

PURPOSE: To report a case of a 9-year-old girl who complained of a floater symptom due to preretinal hemorrhage, subdural hemorrhage and arachnoid cyst. CASE SUMMARY: A 9-year-old girl presented to our clinic with floater symptom in her right eye and a headache. Her corrected visual acuities were 20/20 in both eyes. Preretinal hemorrhage around the optic disc in both eyes was observed. Brain MRI revealed subdural hemorrhage on the frontal, temporal, and parietal lobes, and the arachnoid cyst in the right fronto-temporal lobe. One year later, the preretinal hemorrhages were absorbed. CONCLUSIONS: Arare case of concomitant preretinal and spontaneous subdural hemorrhage with arachnoid cyst was presented. The utilization of brain MRI is recommended to determine underlying causes when fundus examination reaveals retinal hemorrhage without trauma, systemic disease and neurologic symptom.
Arachnoid ; Brain ; Child ; Eye ; Headache ; Hematoma, Subdural ; Hemorrhage ; Humans ; Neurologic Manifestations ; Parietal Lobe ; Retinal Hemorrhage ; Visual Acuity

The thirteen DRB1, 6 DQA1, and 5 DQB1 alleles were defined in 362 healthy Korean controls using reverse dot blot hybridization method. The twenty-four immobilized SSOs for DRB1, 8 for DQA1, and 6 for DQB1 were used for this study. The frequencies of genotypes were DRB104 (17.1'Yo), '09 (13.1%), and '13 (11.6%); DQA1'01 (46.7%), 03 (30.8%), and '05 (11.7%); DQB1*03 (39.5%), '06 '(29.8%), and 05 (16.0%). ...continue...
Alleles* ; Genotype ; Haplotypes* ; HLA-DRB1 Chains

No abstract available.
Brain Neoplasms* ; Brain* ; Tomography, Emission-Computed, Single-Photon*

Moyamoya disease(MMD) is defined as the development of collateral anastomosis pathways, associated with bilateral chronic progressive stenosis of the carotid fork. We have reviewed the types of presentation, angiograms, and single photon emission computed tomographs(SPECT). Ninety-nine patients were divided into three groups (aged below 5 years, between 5 and 15 years, and 16 or over) to investigate whether there were differences in clinical presentation and hemodynamic characteristics between the age groups. Mean age of the 99 patients was 13.6 years and the mean duration of symptoms was 26.2 months. In the 17 children aged less than five, the duration of symptoms was shorter(4.8 months) than in older patients(p<0.05). The former presented mostly with cerebral infarction(59%) with a widespread cerebral perfusion defect(50%). Among 56 children who were 5 to 15 years old, 42 (75%) presented with transient ischemic attacks and 10(18%) with cerebral infarction; the latter was less frequent in this age group than in other age groups. Twelve(46%) out of 26 adult patients had hemorrhage at the initial diagnosis, which was the most frequent presentation in this age group. Stenosis of the posterior cerebral artery was detected in 27% of adult MMD patients, while it was detected in 39% of children. Moreover, no case showed widespread perfusion defects in the adult group. The results suggest that the patterns of presentation and the hemodynamic features differ according to the age at which initial major symptoms occur. Children aged less than five suffer rapid progression of the disease and severe cerebral pefusion defect, and should therefore undergo early surgery. The less frequent involvement of MMD in the posterior circulation and better-preserved cerebral perfusion are characteristic findings of the disease in adults, and this seems to account for its delayed onset.
Adolescent ; Adult ; Cerebral Infarction ; Child ; Constriction, Pathologic ; Diagnosis ; Hemodynamics* ; Hemorrhage ; Humans ; Infarction ; Ischemic Attack, Transient ; Moyamoya Disease* ; Perfusion ; Posterior Cerebral Artery

PURPOSE: To assess the location and associated findings of fractures of the posterior lumbar vertebral ring apophysis as seen on MRI. MATERIALS AND METHODS: We retrospectively evaluated MR findings in 77 patients (86 lesions) with lumbar apophyseal ring fractures. Their age ranged from ten to 67 (mean 33-1) years. To confirm the presence of verterbral ring fractures, CT was performed in 29 patients (31 lesions) within two weeks of MR imaging. Open laminectomy was performed in ten patients, percutaneous automated nucleotomy in three, and LASER operation in four. RESULTS: The most common location of fractures was the superior margin of L5 (36 lesions 41.9%), next was superior margin of S1 (21 lesions, 24.4%). On CT, a bony fragment was seen in 28 patients (30 lesions); the positive predictive value of MR was 99.7 %. Multiple lesions were seen in nine patients. Associated disc herniation and bulging were noted in 64 (74.4%) and 15 lesions (17.4%), respectively, and a high signal intensity rim aound the bony fragment on T1 weighted image was noted in 33 (38.4%). Other associated findings were spondylolysis in eight patients, retrolisthesis in five, and spondylolisthesis in three. Operative outcomes were variable. The results of open laminectomy were better than those of percutaneous automated laminectomy or LASER operation. CONCLUSION: In patients with lumbar apophyseal ring fractures, their exact location and associated findings could be evalvated by MRI, which was therefore useful in the planning of appropriate surgery.
Humans ; Laminectomy ; Lumbar Vertebrae* ; Magnetic Resonance Imaging* ; Retrospective Studies ; Spondylolisthesis ; Spondylolysis

STUDY DESIGN: The changes of the disc height in patients diagnosed with lumbar disc herniation who underwent a discectomy were subjected to a retrospective study. OBJECTIVES: The goal of this study was to find the relationship between the disc height and degenerative disc changes in patients diagnosed with lumbar disc herniation who underwent a discectomy. SUMMARY OF LITERATURE REVIEW: Disc height changes according to age, degenerative change and the amount of removed disc. MATERIALS AND METHODS: The patients in this study were those diagnosed with HNP who undergone a discectomy in our hospital. The fifty seven observed patients had a discectomy in our hospital between March, 2001 and March, 2003. Patients who had posterior fusion during surgery were excluded. There were 35 males and 22 females, with an average age of 35.9 yrs old (17-55) and a mean follow-up period of 2.7 yrs. The degrees of HNP and degenerative disc were examined with MRI and measured through the T2 MRI, respectively, before the operation. The disc heights were measured before and after surgery, and the anterior, posterior and middle disc heights were measured with a simple lumbar lateral X-ray. There were 6, 20, 25 and 6 cases of degeneration grades II, III, IV and V, respectively. There were also 27, 25 and 5 cases of protruded, extruded and sequestrated discs, respectively. RESULTS: When patients with a lumbar disc herniation underwent a discectomy, the changes of disc height in people of those with a postoperative degenerative disc change were notable, but there was no difference in disc height change with regard to the degree of HNP. CONCLUSION: In lumbar disc herniation patients after a discectomy, the changes of disc height decrease significantly in severe degenerative discs in the short term; therefore, further long term periods of study will be required.
Diskectomy ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; Magnetic Resonance Imaging ; Male ; Retrospective Studies

PURPOSE: Acute appendicitis is one of the most common diseases requiring surgical treatment. Delayed diagnosis, which causes complications like perforation of the appendix, abscess formation, or misdiagnosis, leads to unnecessary surgery. Many scoring systems have been suggested for the diagnosis of acute appendicitis. This study aims to evaluate the clinical value of previous scoring systems. METHODS: This study was conducted with a total of 270 patients who had visited the National Police Hospital (NPH) Emergency Room for acute abdominal symptoms from January to June 2008. The Alvarado and the Ohmann scores were applied retrospectively based on the patients' records. We found 3 criteria which were relatively objective and clinically meaningful; then, we designed a new 10 points scoring system. RESULTS: The sensitivity and the specificity of the Alvarado scoring system were 83.23% and 64.42%, respectively, whereas those of the Ohmann scoring system were 74.85% and 66.35%, respectively. The sensitivity and the specificity of the NPH scoring system were found to be 78.4% and 68.9%, respectively. The Ohmann scoring system showed a little lower sensitivity, and the NPH scoring system showed a little higher specificity, but the differences were not statistically significant. CONCLUSION: Our study indicates that the scoring systems considered are not useful diagnostic methods for primary screening and diagnosis of acute appendicitis.
Abscess ; Appendicitis ; Appendix ; Delayed Diagnosis ; Diagnostic Errors ; Emergencies ; Humans ; Mass Screening ; Police ; Retrospective Studies ; Sensitivity and Specificity ; Unnecessary Procedures