Aniskiasis is caused by the accidental infestation of human by larvae of marine mammals found in saltwater fish and squid. The clinical picture may be severe enough to stimulate an acute surgical abdomen. More commonly, colicky pain, diffuse abdominal tenderness, nausea, vomiting, fever, and leukocytosis are seen. Gastroscopically, 2-to 4-cm larvae can be seen penetrating the mucosa. More characteristically, the larvae burrow into the mucosa of the stomach. Here they produce eosinophilic granulomatous tumors with edema, thickening, and induration which may be mistaken for gastric canceer. The pathalogic changes are thought to be the result of a hypersensitivity reaction. We report a case of chronic gastric anisakiasis, which was diagnosed as submucosal tumor with massive bleeding.
Abdomen ; Anisakiasis* ; Abdominal Pain ; Decapodiformes ; Edema ; Eosinophils ; Fever ; Hemorrhage* ; Humans ; Hypersensitivity ; Larva ; Leukocytosis ; Mammals ; Mucous Membrane ; Nausea ; Stomach ; Vomiting

The complications of bile duct stone are cholangitis, pancreatitis, obstructive jaundice, liver abscess, and secondary biliary cirrhosis. Liver abscess may produce pyothorax, peritonitis, subphrenic abscess, and pyogenic pericarditis. The case studies of pyogenic pericarditis secondary to pyogenic liver abscess are rarely reported. Stones greater than 20mm in diameter are difficult or impossible to remove with a standard basket or balloon after sphincterotomy. There are several nonsurgical treatment options for large bile duct stone: mechanical lithotripsy, endoprosthesis, extracorporeal shock-wave lithotripsy (ESWL), electrohydraulic lithotripsy, contact dissolution therapy, and laser lithotripsy. We experienced a case of large bile duct stone which complicated by pyogenic pericarditis, liver abscess, and pyothorax. He treated with antibiotics, closed thoracostomy, partial pericardiectomy, and removal of bile duct stones by extracorporeal shock-wave and mechanical lithotripsy after endoscopic sphincterotomy and nasobiliary drainage.
Anti-Bacterial Agents ; Bile Ducts* ; Bile* ; Cholangitis ; Drainage ; Empyema ; Empyema, Pleural* ; Jaundice, Obstructive ; Lithotripsy ; Lithotripsy, Laser ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver Cirrhosis, Biliary ; Liver* ; Pancreatitis ; Pericardiectomy ; Pericarditis* ; Peritonitis ; Sphincterotomy, Endoscopic ; Subphrenic Abscess ; Thoracostomy

Phase-partitioning with Triton X-114 (TX114) was applied to the TSP antigen, which may be preferentially associated with the cell wall of M. tuberculosis. The hydrophilic protein components of the TSP antigen were successfully separated from integral hydrophobic macromolecules. To further characterize and examine the cellular immune response of the aqueous fraction of the TSP antigen (TSPa), the in vitro properties of the antigen were measured by lymphoproliferation; surface expression of IL-2 Ra on T lymphocytes was analyzed by flow cytometry; and the cytokine mRNA expression pattern was determined by RT-PCR. Significant lymphoproliferative responses to the TSPa antigen were observed in healthy tuberculin reactive donors after a 5 day in vitro stimulation. TSPa treatment of PBMCs from healthy tuberculin positive subjects for 5 days resulted in progressive augmentation of IFN-r, II 2, and IL-2Ra mRNA expression, as measured by RT-PCR, but considerably reduced IL-4 mRNA expression. In addition, the TSPa antigen stimulated more IL-12 p40 mRNA production than did the PPD antigen, and graduaBy suppressed IL- 10 mRNA expression. Moreover, the CD3' T cells of tuberculin positive subjects displayed a profound increase in their expression of the II 2Ru protein (39.0%) in response to the TSPa antigen. Proliferation was correlated with IL-2 and IL-2Ra mRNAs, but not correlated with distinct IFN-r or IL-12 p40 mRNA production. These findings strongly suggest that the TSPa antigen preferentially evokes the generation of a Thl-like immune response in healthy tuberculin reactors.
Cell Wall ; Flow Cytometry ; Humans* ; Immunity, Cellular* ; Interleukin-12 ; Interleukin-2 ; Interleukin-4 ; Mycobacterium tuberculosis* ; Mycobacterium* ; Neptune ; RNA, Messenger ; T-Lymphocytes ; Tissue Donors ; Tuberculin ; Tuberculosis

X-linked agammaglobulinemia is attributed to the genetic defect for Bruton's tyrosine kinase at Xq22 region and the developmental arrest of pre-B lymphocytes. The characteristics of the disease are as follows; 1) male sex, 2) onset in infancy or early childhood, 3) severe panhypogammaglobulinemia, 4) normal cell mediated immunity, 5) recurrent, hardly controlled infection. The most common sites of infection are the respiratory tract and the gastrointestinal tract. The disease must be suspected when the recurrent, hardly controlled infection or the unusual, multiple sites of infection are present. Regular intravenous immune globulin approved the preventive effect against severe infection and fatal complication. But the final outcome remains grave in spite of intensive care. We report an adult case, 20 years old male patient, of X-linked agammaglobulinemia. He has been suffered from recurrent pneumonia and other sites of infection including meningitis and cellulitis. Pseudomonas aeruginosa was cultured from blood. X-linked agammaglobulinemia was diagnosed based on clinical history, severe panhypogammagloblinemia, lack of the gamma-fraction on the serum protein electrophoresis and absence of B-lymphocytes in peripheral blood. The clinical course waxed and waned until intravenous infusion of immune globulin, which dramatically improved pneumonia.
Adult ; Agammaglobulinemia* ; B-Lymphocytes ; Cellulitis ; Electrophoresis ; Gastrointestinal Tract ; Humans ; Immunity, Cellular ; Immunoglobulins, Intravenous ; Infusions, Intravenous ; Critical Care ; Male ; Meningitis ; Pneumonia ; Precursor Cells, B-Lymphoid ; Protein-Tyrosine Kinases ; Pseudomonas aeruginosa ; Respiratory System ; Young Adult

Candida is the most common etiologic agent causing endogenous endophthalmitis resulting due to hematogenous spread from a remote primary focus. Risk factors for the infection include intravenous drug use, hyperalimentation, surgery, malignancy, diabetes, neutropenia, and the use of broad- spectrum antibiotics and immunosuppressive agents, especially corticosteroids. The outcome of candida endophthalmitis is disappointing. One main problem in the management of this infection is that early diagnosis is difficult. Thus, treatment may be delayed and this which often leads to a poor outcome. Candida endophthalmitis, particularly candida guilliermondii endophthalmitis, is extremely rare, although it is becoming more common as the number of chronically debilitated patients and the use of invasive procedures increase. It is an ophthalmologic emergency and commonly takes a tragic course. Therefore, early suspicion and aggressive management are imperative to prevent visual loss. The authors report a case of candida endophthalmitis caused by Candida guilliermondii in a 65-year-old man with mixed gastrointestinal stromal tumor(GIST) and stomach adenocarcinoma.
Adenocarcinoma* ; Adrenal Cortex Hormones ; Aged ; Anti-Bacterial Agents ; Candida* ; Early Diagnosis ; Emergencies ; Endophthalmitis* ; Gastrointestinal Stromal Tumors* ; Humans ; Immunosuppressive Agents ; Neutropenia ; Risk Factors ; Stomach*

Candida is the most common etiologic agent causing endogenous endophthalmitis resulting due to hematogenous spread from a remote primary focus. Risk factors for the infection include intravenous drug use, hyperalimentation, surgery, malignancy, diabetes, neutropenia, and the use of broad- spectrum antibiotics and immunosuppressive agents, especially corticosteroids. The outcome of candida endophthalmitis is disappointing. One main problem in the management of this infection is that early diagnosis is difficult. Thus, treatment may be delayed and this which often leads to a poor outcome. Candida endophthalmitis, particularly candida guilliermondii endophthalmitis, is extremely rare, although it is becoming more common as the number of chronically debilitated patients and the use of invasive procedures increase. It is an ophthalmologic emergency and commonly takes a tragic course. Therefore, early suspicion and aggressive management are imperative to prevent visual loss. The authors report a case of candida endophthalmitis caused by Candida guilliermondii in a 65-year-old man with mixed gastrointestinal stromal tumor(GIST) and stomach adenocarcinoma.
Adenocarcinoma* ; Adrenal Cortex Hormones ; Aged ; Anti-Bacterial Agents ; Candida* ; Early Diagnosis ; Emergencies ; Endophthalmitis* ; Gastrointestinal Stromal Tumors* ; Humans ; Immunosuppressive Agents ; Neutropenia ; Risk Factors ; Stomach*

PURPOSE: The aim of this study was to determine a more appropriate method for follow-up of carotid stenting by comparing the efficiency of US and CT angiography. MATERIALS AND METHODS: Eleven carotid arteries of seven patients(men: 5, women: 2, mean age: 56.4years) who underwent stent placement and percutaneous transluminal angioplasty(PTA) because of carotid stenosis were studied. The follow-up periods ranged from three to eleven(mean, five) months, and US and CT angiography were performed in one day. Color duplex sonography was performed with a 10 MHz linear array transducer. After spiral CT scan were obtained, MPR images were reconstructed on a workstation. Retrospective imaging analysis specifically focused on [1] stent configuration, [2] the accuracy of internal diameter measurement, [3] the detection of blood flow and the measurement of blood flow velocity, [4] the presence of atheroma and intraluminal thrombi, [5] the measurement of stent location, and [6] artifacts. RESULT: US was more accurate than CT angiography for measuring internal diameter. In all cases, US and CT angiography were able to detect the blood flow at carotid artery, and utilizing the Doppler spectrum, flow velocity was measured. US showed atheromas in all cases but CT angiography demonstrated calcified atheromas in three cases only. In six cases, US failed to determine stent location, though in this respect CT angiography was successful in all cases. Artifacts of US were small reverbe ration artifact(11/11) of the stent and a defective color Doppler signal caused by acoustic shadowing of atheroma calcification(3/11). Artifacts of CT angiogrpahy were hard-beam artifact of the stent(11/11) and motion artifact(3/11). CONCLUSION: US was superior to CT angiography in accuracy of measuring stent diameter, hemodynamic assessment, high-resolution views of the luminal state of the stent and minimal artifacts for the non-inva s i ve follow-up studies of carotid stenting.
Acoustics ; Angiography* ; Angioplasty* ; Artifacts ; Blood Flow Velocity ; Carotid Arteries ; Carotid Stenosis ; Female ; Follow-Up Studies* ; Hemodynamics ; Humans ; Phenobarbital ; Plaque, Atherosclerotic ; Retrospective Studies ; Shadowing (Histology) ; Stents* ; Tomography, Spiral Computed ; Transducers ; Ultrasonography*

BACKGROUND: The solitary pulmonary nodule(SPN) presents a diagnostic dilemma to the physician and the patient. Many clinical characteristics(i.e. age, smoking history, prior history of malignancy) and radiological characteristics(i.e. size, calcification, growth rate, several findings of computed tomography) have been proposed to help to determine whether the SPN was benign or malignant. However, most of these diagnostic guidelines are based on the data collected before computed tomography(CT) has been introduced and lung cancer was not as common as these days. Moreover, it is not well established whether these guidelines from western populations could be applicable to Korean patients. METHODS: We had a retrospective analysis of the case records and radiographic findings in 114 patients presenting with SPN from Jan. 1994 to Feb. 1995 in Seoul National University Hospital, a tertiary referral hospital. RESULTS: We observed the following results ; (1) Out of 113 SPNs, the etiology was documented in 94 SPNs. There were 34 benign SPNs and 60 malignant SPNs. Among which, 49 SPNs were primary lung cancers and the most common histologic type was adenocarcinoma. (2) The average age of patients with benign and malignant SPNs was 49.7+/-12.0 and 58.1 +/-10.0 years, respectively(p=0.0004), and the malignant SPNs had a striking linear propensity to increase with age. (3) No significant difference in the history of smoking was noted between the patients with benign SPNs(13.0+/-17.6 pack-year) and those with malignant SPNs(18.6+/-25.1 pack-year) (p=0.2108). (4) 9 out of 10 patients with prior history of malignancy had malignant SPNs. 5 were new primary lung cancers with no relation to prior malignancy. (5) The average size of benign SPNs (3.01+/-1.20cm) and malignant SPNs(2.98+/- 0.97cm) was not significantly different(p=0.8937). (6) The volume doubling time could be calculated in 22 SPNs. 9 SPNs had the volume doubling time longer than 400 days. Out of these, 6 were malignant SPNs. (7) The CT findings suggesting malignancy included the lobulated or spiculated border, air-bronchogram, pleural tail, and lymphadenopathy. In contrast, calcification, central low attenuation, cavity with even thickness, well-marginated border, and perinodular micronodules were more suggestive for benign nodule. (8) The diagnostic yield of percutaneous needle aspiration and biopsy was 57.6%(19/33) of benign SPNs and 81.0%(47/58) of malignant SPNs. The diagnostic value of sputum analysis and bronchoscopic evaluations were relatively very low. (9) 42.3%(ll/26) of SPNs of undetermined etiology preoperatively turned out to be malignant after surgical resection. Overall, 75.4%(46/61) of surgically resected SPNs were malignant. CONCLUSIONS: We conclude that the likelihood of malignant SPN correlates the age of patient, prior history of malignancy, some CT findings including lobulated or spiculated border, air-bronchogram, pleural tail and lymphadenopathy. However, the history of smoking, the size of the nodule, and the volume doubling time are not helpful to determent whether the SPN is benign or malignant, which have been regarded as valuable clinical parameters previously. We suggest that aggressive diagnostic approach including surgical resection is necessary in patient with SPNs.
Adenocarcinoma ; Biopsy ; Humans ; Lung Neoplasms ; Lymphatic Diseases ; Needles ; Retrospective Studies ; Seoul ; Smoke ; Smoking ; Solitary Pulmonary Nodule* ; Sputum ; Strikes, Employee ; Tail ; Tertiary Care Centers

Pulmonary sequestration is a rare congenital anomaly of the lung in which it is separately supplied from the aorta or one of its branches. Bilateral pulmonary sequestration is very rare, particularly in adults. In bilateral pulmonary sequestration, resection of both sides is usually recommended if both sides are infected and symptomatic. We report the case of a 37-year-old female patient with bilateral intralobar pulmonary sequestration treated by staged bilateral lower lobectomy.
Adult ; Aorta ; Bronchopulmonary Sequestration ; Female ; Humans ; Lung ; Lung Abscess

The Cerebro-oculo-facio-skeletal (COFS) syndrome is a rare autosomal recessive disorder characterized by multiple abnormalities that involve the brain, face, eyes, and extremities. COFS syndrome is regarded as a degenerative disorder of the brain and spinal cord caused by a mutation of the DNA repair genes. We report on an 8-month-old girl with COFS syndrome who exhibited growth and developmental delay, hypotonia, microcephaly, nystagmus, cleft palate, widely separated nipples, inguinal hernia, camptodactyly, and rocker-bottom feet with vertical talus.
Abnormalities, Multiple ; Brain ; Cleft Palate ; Cockayne Syndrome ; DNA Repair ; Extremities ; Eye ; Foot ; Growth and Development ; Hernia, Inguinal ; Humans ; Infant ; Microcephaly ; Muscle Hypotonia ; Nipples ; Spinal Cord ; Talus