This study was performed to observe the therapeutic effects of interferon-gamma(IFN-gamma) and gamma-globulin(gamma-globulin) in experimental Pneumocystis carinii pneumonia of immune suppressed mice. After 9 weeks, trimethoprim-sulfamethoxazole(TMP-SMZ; 10-50 mg/mouse/day), mouse IFN-gamma(5 x 10(4) units/mouse/day) and mouse gamma-globulin(20 mg/mouse/day) were administered to the mice for 3 weeks by the experimental group. The therapeutic efficacy was evaluated by body weights, histopathologic and electron microscopic findings of the lungs, and number of P. carinii cysts by Gomori's methenamine silver stain. Body weights of the mice were significantly increased in the group of combination therapy of TMP-SMZ with IFN-gamma or gamma-globulin, and in the group of TMP-SMZ treatment (p < 0.05), however, little effect was found in the group of gamma-globulin alone. Histopathologic findings of P. carinii pneumonia were much improved in the group of combination therapy of TMP-SMZ with IFN-gamma. Treatment with either TMP-SMZ or IFN-gamma significantly reduced the number of cysts in the P. carinii pneumonia, but gamma-globulin alone was ineffective. In electron microscopic findings of P. carinii pneumonia, the number of trophozoites and cysts were reduced by treatment with either TMP-SMZ or IFN-gamma, and most of the cysts were empty or containing one or two intracystic bodies. The present results suggested, that combination therapy of TMP-SMZ with IFN-gamma had synergistic effects in treatment of P. carinii pneumonia in experimental mice.
Drug-Synergism ; Drug-Therapy,-Combination ; English-Abstract ; Gamma-Globulins-administration-and-dosage ; Interferon-Type-II-administration-and-dosage ; Mice- ; Trimethoprim-Sulfamethoxazole-Combination-administration-and-dosage ; *Gamma-Globulins-therapeutic-use ; *Interferon-Type-II-therapeutic-use ; *Pneumonia,-Pneumocystis-carinii-therapy ; Gamma-Globulins ; Trimethoprim-Sulfamethoxazole-Combination ; Interferon-Type-II

Background: Metastatic skin cancers occur when cancer cells metastasize to the skin as the primary cancer progresses, but few studies in Korea have included a large number of patients. Objective: To analyze the clinicopathological characteristics of metastatic skin cancers originating from solid cancers. Methods: A total of 191 patients with metastatic skin cancer diagnosed by skin biopsy from April 2004 to December 2021 were retrospectively analyzed. Data on age, sex, duration, symptoms, clinical manifestations, metastatic sites, and histopathological findings were obtained from medical records and photographs. Results: The mean age of onset was 65.3 years, the male/female ratio was 80:111, and the mean duration was 3.3 months. Most patients were asymptomatic (65.4%), and the most frequent manifestation was nodular lesions (64.4%). Among the 191 metastatic skin cancers, the most common primary cancers were breast cancer (31.9%), lung cancer (25.7%), and melanoma (18.8%). The most common primary cancer in males was lung cancer (52.5%), and that in females was breast cancer (54.1%). The most common sites of metastatic skin cancer were the chest (26.6%), scalp (17.9%), abdomen (10.6%), and back (9.2%). The most common histopathological finding of metastatic skin cancer was adenocarcinoma (53.4%), followed by melanoma (18.8%) and squamous cell carcinoma (14.7%). Conclusion We believe that this study will be helpful in diagnosing metastatic skin cancer in patients with a history of cancer or a newly diagnosed primary cancer.

We report a case of a 36 year old female with coronary artery obstructive disease(Left coronary osteal stenosis), who had been admitted due to severe headache and vomitting. In admission, she was diagnosed as moyamoya disease on cerebral angiogram. She had no history of hypertension, diabetes mellitus, hyperlipidemia, smoking. She had experienced angina for 2 years, and 1 year ago she ws diagnosed as bypass surgery with left main coronary artery angioplasty. In moyamoya disease, several portions of extracranial arteries have been found to be involved, but so far, only one case has been reported the coronary involvement on coronary angiogram in the world. And, there has not been a report about moyamoya disease combined with left main osteal lesion yet. This present case indicates that we need to exam for extracranial vascular system including the heart in moyamoya disease.
Adult ; Angioplasty ; Arteries ; Constriction, Pathologic* ; Coronary Vessels ; Diabetes Mellitus ; Female ; Headache ; Heart ; Humans ; Hyperlipidemias ; Hypertension ; Moyamoya Disease* ; Smoke ; Smoking

BACKGORUND: infusion of propofol by a target-controlled infusion (TCi) system is effective in achieving conscious sedation for anxious patients presenting for dental surgery. However, there is no report of conscious sedation for mandibular fracture patients using propofol TCi. The objective of this study was to evaluate the appropriation of a conscious sedation using propofol for mandibular fracture patients. METHODS: Twenty patients with a mandibular fracture undergoing an open reduction and miniplate insertion operation were analyzed. We anesthetized patients using a propofol infusion by a TCi system (Diprifusor :Master TCi:Pilot Anesthesia is, France) with local anesthesia using lidocaine. The BiS score was evaluated continually during surgery using a microcomputer (A-2000 BiS monitor , Aspect Medical System, USA). We set the infusion machine at a target concentration 2mug/ml, and adjusted the propofol concentration for a BiS score range of 80-85. infusion rate, total dosage, duration of induction, recall of operative procedure and cooperation scores were checked. BiS, heart rate, noninvasive arterial blood pressure, and SpO2 were recorded during the operation. RESULTS: The mean BiS score was 82.95, the mean target concentration of propofol was 2.645mug/ml, the mean infusion rate was 136.3mug/kg/min, and the mean cooperation score was 2.5, the patients were cooperative. The score of amnesia was 0.2, almost patients did not recall the intraoperative event. The mean duration of stay in the recovery room was 22.2 minutes, and the most frequent side effect was pain on injecion of propofol. CONCLUSiONS: Conscious sedation with propofol TCi is an effective anesthesia method substitute for general anesthesia with quick emergence, few side effects, and safety for mandibular fracture patients.
Amnesia ; Anesthesia ; Anesthesia, General ; Anesthesia, Local ; Arterial Pressure ; Conscious Sedation* ; Heart Rate ; Humans ; Lidocaine ; Mandibular Fractures* ; Microcomputers ; Propofol* ; Recovery Room ; Surgical Procedures, Operative

PURPOSE: To evaluate injury patterns of facet joints and associated soft tissue injuries in patients withacute traumatic cervical facet joint injuries. MATERIALS AND METHODS: From among patients with cervical spinetrauma, 27 with facet joint injuries, as seen on CT and MRI, were chosen for this study. CT scans were analyzedwith regard to the location of facet joint injury, the presence or absence of facet dislocation or fracture, andother associated fractures. MR images were analyzed with regard to ligament injury, intervertebral disc injury,intervertebral disc herniation, and spinal cord injury. RESULTS: The most common location of facet joint injurywas C6-7 level(n=10), followed by C5-6(n=8). Among these 27 patients with facet joint injuries, 12(44%) hadbilateral injuries and 15(56%) unilateral injuries. Facet fractures were present in 17 cases(63%) and the fractureof inferior facet was more frequent than superi-or. Patterns of fracture were vertical, transverse, or comminuted,but vertical fracture was the most common. Various degrees of dislocation were observed in patients with facetfractures. Fractures other than facet includ-ed pillar(n=11), lamina(n=6), transverse process(n=14), body(n=13),and spinous process(n=3). On MR im-ages, anterior longitudinal ligament injury was found in 8 patients(30%),posterior longitudinal ligament injury in 4(15%), and interspinous ligament injury in 20(74%). Twelvepatients(44%) had spinal cord injuries includ-ing edema(n=8) and hemorrhage(n=4). Among patients with discabnormalities, 11(41%) had intervertebral disc injuries, and traumatic disc herniations were found in nine. CONCLUSION: Traumatic cervical facet joint injuries were manifested as various patterns and frequentlyassoci-ated with other fractures or soft tissue injuries. Analysis of CT and MR findings of these injury patternshelped formulate a therapeutic plan and determine of prognosis.
Dislocations ; Humans ; Intervertebral Disc ; Ligaments ; Longitudinal Ligaments ; Magnetic Resonance Imaging* ; Prognosis ; Soft Tissue Injuries ; Spinal Cord Injuries ; Spine* ; Tomography, X-Ray Computed ; Zygapophyseal Joint*

Reversible cerebral vasoconstriction syndrome (RCVS) has several trigger factors, including physical exertion, pregnancy, and the intake of vasoconstrictive agents. These triggers activate the sympathetic nervous system and induce vasoconstriction, thereby leading to an ischemic or hemorrhagic stroke. In this study, we describe case of RCVS in a 73-year-old woman who complained of sudden bilateral leg weakness after taking cyclophosphamide for anti-neutrophil cytoplasmic antibody associated vasculitis. She was diagnosed with concurrent cerebral hemorrhage and cerebral infarction with multiple intracranial vasoconstrictions on imaging analyses.

Reversible cerebral vasoconstriction syndrome (RCVS) has several trigger factors, including physical exertion, pregnancy, and the intake of vasoconstrictive agents. These triggers activate the sympathetic nervous system and induce vasoconstriction, thereby leading to an ischemic or hemorrhagic stroke. In this study, we describe case of RCVS in a 73-year-old woman who complained of sudden bilateral leg weakness after taking cyclophosphamide for anti-neutrophil cytoplasmic antibody associated vasculitis. She was diagnosed with concurrent cerebral hemorrhage and cerebral infarction with multiple intracranial vasoconstrictions on imaging analyses.

Isolated splenic abscess of spleen is very rare, which is increasingly recognized with immunosuppressed states due to the use of chemotherapy to malignancy, immunosuppression for transplantation and AIDS recently. The most fre-quent cause of splenic abscess is septic embolism arising from bacterial endocarditis. While splenic abscess can be seen rarely in healthy men, it has a high rate of mortality when it is diagnosed lately. A healthy 66-year-old male patient who presented with a 7 month history of intermittent spiking fever, toothache was admitted to the emergency room with clinical and biochemical signs of sepsis. Vital sign were 90/60-112-20-38.9 degrees C. He had left subcostal tenderness, a 15 cm palpable spleen and no medical history except toothache. The laboratory values were as follows: leukocyte 289,200/mm(3)(segmented neutrophil 94.3 %), hemoglobin 10.5 g/dl, platelet 119,000/mm(3), AST/ALT 85/84 U/L, total bil-irubin 10.8 mg/dl, BUN/Creatinine 25/1.3 mg/dl. Streptococcus viridians grew in blood culture. Computerized tomography showed a splenomegaly with multifocal round or tubular shaped cystic lesions in spleen as well as infiltrative low density lesions in pancreatitic taie like intrasplenic pseudocysts, which was failed by ultrasound-guided aspiration due to multiple, small and scattered location. Echocardiography showed no evidence of intracardiac source of infective thromboembolism. Endoscopic retrograde cholangiography shows mild intrahepatic duct and common bile duct dilataton with no evidence of stone. Exploratory laparotomy was performed. The spleen being found enlarged and distal pan creas with probably pseudocystic involvement were removed. It was also noticed that there were cystic-like structure filled with pus on crosssectional surface. The result of pus cultures was no organism.
Abscess* ; Aged ; Blood Platelets ; Cholangiography ; Common Bile Duct ; Drug Therapy ; Echocardiography ; Embolism ; Emergency Service, Hospital ; Endocarditis, Bacterial ; Fever ; Humans ; Immunosuppression ; Laparotomy ; Leukocytes ; Male ; Mortality ; Neutrophils ; Sepsis ; Spleen ; Splenectomy ; Splenomegaly ; Streptococcus ; Suppuration ; Thromboembolism ; Toothache ; Vital Signs

Adventitial cystic disease (ACD) is an uncommon vascular disease of an unknown origin, and this malady can be suspected in a young, healthy patient who has sudden onset of claudication. We describe here a case of ACD of the right popliteal artery. A 43-year-old male presented with 4 month history of severe right leg claudication. He had no other atherosclerotic predisposing history except for 10 pack years of smoking. On examination, the right femoral pulses were normal, the popliteal artery absent and the dorsalis pedis and posterior tibial artey pulses were decreased. The ankle-brachial pressure index (ABI) was 0.4. Ultrasonography showed a hypoechoic cystic lesion with a well-defined marin along the arterial wall. Computed tomography showed a round hypodense cystic mass with thin enhancing rim and a non-enhancing center in the popliteal fossa. Operatively, the 2.5 cm-sized expanding cyst indented the popliteal artery, which involved half of its diameter with adhesion to the adhesion to the adjacent structures. The artery had no thrombosis and it was a short-segment lesion with luminal patency, but half of the arterial wall was thickened with inflammation. Partial excision of the cyst wall and evacuation of the gelatineous materials was performed. Postoperatively, his symptoms improved somewhat, but ABI was 0.6. On the angiography, there was residual stenosis and contrast pooling. These findings disappeared after balloon angioplasty. he was asymptomatic 6 months later with an ABI >1 in the right side.
Adult ; Angiography ; Angioplasty* ; Angioplasty, Balloon ; Arteries ; Constriction, Pathologic* ; Cystotomy* ; Gelatin ; Humans ; Inflammation ; Leg ; Male ; Phenobarbital ; Popliteal Artery ; Smoke ; Smoking ; Thrombosis ; Ultrasonography ; Vascular Diseases