BACKGROUND/AIMS: The primary pathophysiologic abnormality in achalasia is known to be a loss of inhibitory myenteric ganglion cells, which may result from an immune-mediated response or neuronal degeneration. The aim of this study was to identify proteins suggestive of an immune-mediated response or neuronal degeneration in the serum of achalasia patients using a proteomic analysis. METHODS: Blood samples were collected from five symptomatic achalasia patients and five sex- and age-matched healthy controls. Serum proteomic analysis was conducted, and the protein spots were identified using matrix-assisted laser desorption ionization/time-of-flight and a proteomics analyzer. The serum level of C3 was measured by enzyme-linked immunosorbent assay in nine patients with achalasia and 18 sex- and age-matched healthy controls. RESULTS: Of the 658 matched protein spots, 28 spots were up-regulated over 2-fold in the serum from achalasia patients compared with that from controls. The up-regulated proteins included complement C4B5, complement C3, cyclin-dependent kinase 5, transthyretin, and alpha 2 macroglobulin. The serum levels of C3 in achalasia patients were significantly higher than those of controls. CONCLUSIONS: The serum proteomic analysis of achalasia patients suggests an immune-mediated response or neuronal degeneration. Further validation studies in larger samples and the esophageal tissue of achalasia patients are required.
alpha-Macroglobulins ; Complement C3 ; Complement System Proteins ; Cyclin-Dependent Kinase 5 ; Enzyme-Linked Immunosorbent Assay ; Esophageal Achalasia ; Ganglion Cysts ; Humans ; Neurons ; Prealbumin ; Proteins ; Proteomics

Primary pulmonary Hodgkin's lymphoma is a rare but distinct entity to be distinguished from nodal Hodgkin's lymphoma and from lymphomas involving lung secondarily. This lymphoma affects women more frequently than men, and typically involves superior portions of the lung. This case is reported to illustrate the clinical, radiographic and anatomic characteristics of the primary pulmonary Hodgkin's lymphoma. A 34-year-old woman presented for the evaluation of hemoptysis. A chest CT revealed a large poorly defined mass in the medial aspect of the right upper lobe, extending to the right mediastinum and trachea. The microscopic examination of the biopsied lesion revealed fibroblastic stroma infiltrated by a mixture of lymphocytes, histiocytes, and eosinophils. The clinical impression was inflammatory pseudotumor, presumably due to slightly favorable response to corticosteroid therapy. Two months later the patient's symptoms worsened despite the steroid therapy and a lobectomy was done. The specimen showed a soft to firm, pale yellow, ill defined mass, 10.0 8.0 cm, involving the visceral pleura. A few satellite nodules around the main mass were noted. The histologic findings were consistent with Hodgkin's lymphoma, nodular sclerosis type.
Adult ; Eosinophils ; Female ; Fibroblasts ; Granuloma, Plasma Cell ; Hemoptysis ; Histiocytes ; Hodgkin Disease* ; Humans ; Lung ; Lymphocytes ; Lymphoma ; Male ; Mediastinum ; Pleura ; Sclerosis ; Tomography, X-Ray Computed ; Trachea

BACKGROUND: Antioxidants vitamin C and vitamin E may protect against the toxic effect of oxygen free radicals that are preferentially produced after exposures to hyperbaric oxygen (HBO). This study investigated the effect of vitamin C and vitamin E on serum nitric oxide (NO) concentration and intercellular adhesion molecule-1 (ICAM-1) expression on lung after HBO exposure. METHODS: Male Sprague-Dawley rats weighing 200 to 250 g were exposed to HBO at 3 ATA of 100% O2 for 3 hours. The experimental groups were given vitamin C (125 mg/day per rat) and/or vitamin E (50 mg/day per rat) orally, from 5 days prior to the HBO exposure to the day of sacrifice. Serum NO concentrations were determined by measuring NO end product nitrite by non-enzymatic Griess assay. Expression of ICAM-1 on lung was observed by immunohistochemical analysis. RESULTS: The serum nitrite levels were significantly increased after HBO exposure and were higher at 24 hours after HBO exposure than at 0 h (P<0.05). The expression of ICAM-1 was weak immediately after HBO exposure and enhanced at 24 hours. There were no pronounced suppressive effects of vitamins on serum NO production and ICAM-1 expression induced by the 3 hours HBO exposure. CONCLUSION: The 3 hours HBO exposure induces the serum NO production and ICAM-1 expression on lung. The short-term supplementation of vitamin C or/and E do not suppress the NO production and ICAM-1 expression on lung.
Animals ; Antioxidants ; Ascorbic Acid ; Free Radicals ; Humans ; Hyperbaric Oxygenation ; Intercellular Adhesion Molecule-1 ; Lung ; Male ; Nitric Oxide ; Oxygen* ; Rats* ; Rats, Sprague-Dawley ; Vitamin E ; Vitamins*

BACKGROUND: To determine the most effective method for detecting mycobacteria in formalin- fixed paraffin-embedded (FFPE) tissue, we compared the results of Ziehl-Neelsen stain (ZNS) and mycobacterial culture with those of polymerase chain reaction (PCR) and real-time quantitative PCR (RQ-PCR). METHODS: We analyzed 54 cases diagnosed as chronic granulomatous inflammation. In all cases, ZNS and nested PCR using three different primers, IS6110, Mpb64 and IS6110/Rpobeta were done. RQ-PCR with the IS6110/Rpobeta primer was done in 51 cases. RESULTS: Mycobacteria were identified by ZNS in 15/54 (27.8%) cases. RQ-PCR had the highest sensitivity (80.0%) compared to PCR with IS6110 (73.3%), Mpb64 (60.0%) and IS6110/Rpobeta (73.3%). Specificity was higher in all PCR experiments (79.5-82.1%) than in RQ-PCR (69.4%) experiments. The false negative rate was lowest for RQ-PCR (20.0%) than for PCR with IS6110 (26.7%), Mpb64 (40.0%) and IS6110/Rpobeta (26.7%). The false positive rate was highest for RQ-PCR (30.6%) compared to PCR with IS6110 (20.5%), Mpb64 (17.9%) and IS6110/Rpobeta (20.5%). CONCLUSIONS: RQ-PCR had the highest sensitivity, and the lowest false negative rate, but it also had a higher false positive rate than PCR for detection of mycobacteria in FFPE tissues.
Granulomatous Disease, Chronic ; Inflammation ; Mycobacterium ; Polymerase Chain Reaction ; Sensitivity and Specificity

Corticotrophin-releasing factor (CRF) plays a major role in coordinating stress responses. We aimed to test whether blocking endogenous CRF activity can prevent the stress-induced dilation of intercellular spaces in esophageal mucosa. Eighteen adult male rats were divided into 3 groups: 1) a non-stressed group (the non-stressed group), 2) a saline-pretreated stressed group (the stressed group), 3) and an astressin-pretreated stressed group (the astressin group). Immediately after completing the experiments according to the protocol, distal esophageal segments were obtained. Intercellular space diameters of esophageal mucosa were measured by transmission electron microscopy. Blood was sampled for the measurement of plasma cortisol levels. Mucosal intercellular spaces were significantly greater in the stressed group than in the non-stressed group. Mucosal intercellular spaces of the astressin group were significantly smaller than those of the stressed group. Plasma cortisol levels in the stressed group were significantly higher than in the non-stressed group. Pretreatment with astressin tended to decrease plasma cortisol levels. Acute stress in rats enlarges esophageal intercellular spaces, and this stress-induced alteration appears to be mediated by CRF. Our results suggest that CRF may play a role in the pathophysiology of reflux-induced symptoms or mucosal damage.
Animals ; Corticotropin-Releasing Hormone/*antagonists & inhibitors/metabolism/pharmacology ; Esophagus/anatomy & histology/*drug effects ; Extracellular Space/*drug effects ; Hydrocortisone/blood ; Male ; Mucous Membrane/anatomy & histology/*drug effects ; Neuroprotective Agents/pharmacology ; Peptide Fragments/*pharmacology ; Rats ; Rats, Wistar ; *Stress, Psychological/blood/physiopathology

Although chronic myelogenous leukemia (CML) may be involved in any part of the body, infiltration of the body fluid has rarely reported in the literature. Here we report on a 35 year-old male patient who was diagnosed chronic myelogenous leukemia ten years previously and he received allogenic hematopoietic stem cell transplantation. He then presented with left knee pain eight years after the initial diagnosis. MRI revealed a soft tissue mass at the distal femur. Cytology of the joint fluid revealed myeloblasts, promyelocytes, eosinophilic myelocytes, band neutrophils, megakaryocytes and orthochromatic erythroblasts, which was all consistent with leukemic infiltration of the knee joint fluid. The immunohistochemistry was positive for CD34, CD117 and myeloperoxidase (MPO). Despite that the patient underwent radiation therapy, MRI revealed growth of the mass, and ten months later, the lymphoid blast phase of CML was confirmed after biopsy. The patient received an above knee amputation. Five months later, multiple masses were revealed on PET-CT at the left iliopsoas muscle, abdominal wall and bones. Bilateral pleural effusion occurred shortly after this. Cytologic evaluation of the pleural fluid also revealed blast-like cells, and histologic evaluation of the abdominal mass confirmed the lymphoid blast phase of CML with positivity for CD3, UCHL-1, CD34 and CD117, but negativity for MPO.
Abdominal Muscles ; Amputation ; Biopsy ; Blast Crisis ; Body Fluids ; Eosinophils ; Erythroblasts ; Femur ; Granulocyte Precursor Cells ; Hematopoietic Stem Cell Transplantation ; Humans ; Immunohistochemistry ; Joints ; Knee ; Knee Joint ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukemic Infiltration ; Male ; Megakaryocytes ; Neutrophils ; Peroxidase ; Pleural Effusion

For the patients presenting with obscure gastrointestinal bleeding, various diagnostic approaches have been tried such as push enteroscopy, technetium labeled RBC scan and enteroclysis. Capsule endoscopy is an emerging and powerful diagnostic method that enables physicians to investigate the entire small bowel. Therefore, it is useful to make a correct diagnosis of obscure gastrointestinal bleeding in cases with negative findings by endoscopy or colonoscopic examination. We experienced a case of a 30 year-old male patient who presented with obscure intestinal bleeding, and this was diagnosed with capsule endoscopy and he was treated with laparoscopic assisted small bowel resection.
Adult ; Capsule Endoscopy* ; Diagnosis ; Endoscopy ; Hemorrhage ; Humans ; Laparoscopy* ; Male ; Technetium

The purpose of this report is to describe the high-resolution computed tomography (H RCT) findings of the lung in survivors of acute respiratory distress syndrome (ARDS). Among eleven patients who survived ARDS for one ye a r, chest radiography and HRCT revealed pulmonary fibrosis in four. Causes of ARDS included pneumonia during pregnancy, near drowning, pneumonia during liver cirrhosis, and postoperative sepsis. Thoracoscopic biopsy and histopathologic correlation were available in one patient. HRCT showed diffuse interlobular septal thickening, ground glass opacity, parenchymal distortion, and traction bronchiectasis. Fuzzy centrilobular nodules were seen in two patients and one patient had multiple, large bullae in the left hemithorax. In all patients, lesions affected the upper and anterior zones of the lung more prominently. The distribution of pulmonary fibrosis was characteristic and reflected the pathogenesis of lung injury; fibrosis was largely due to hy p e r oxia caused by ventilator care. In one patient, histopathologic correlation showed that imaging findings were accounted for by thickening of the alveolar septum along with infiltration of chronic inflammatory cells and fibrosis. Fuzzy centrilobular nodules corresponded with bronchiolitis.
Biopsy ; Bronchiectasis ; Bronchiolitis ; Fibrosis ; Glass ; Humans ; Liver Cirrhosis ; Lung ; Lung Injury ; Near Drowning ; Pneumonia ; Pregnancy ; Pulmonary Fibrosis ; Radiography ; Respiratory Distress Syndrome, Adult ; Sepsis ; Survivors* ; Thorax ; Traction ; Ventilators, Mechanical

Cervical thymic cyst is uncommon and usually occurs in the first and second decades. Cervical thymic cyst after the third decade is so rare that it is very difficult to diagnose in spite of its typical location. We present a rare case of cervical thymic cyst in the lower left - anterior of the neck in a 50-year-old woman. It showed well-defined, anechoic cyst on ultrasonography and non-enhancing low attenuation mass on CT. A typical anatomic relationship was noted between the mass and carotid sheath.
Case Report ; Female ; Human ; Mediastinal Cyst/ultrasonography* ; Mediastinal Cyst/radiography* ; Middle Age ; Tomography, Emission-Computed

Pulmonary epithelioid hemangioendothelioma (PEH), originally termed an intravacular bronchioloalveolar tumor, is a rare pulmonary neoplasm with a vascular origin and slow rate of malignancy. It affects various organs such as the liver, the central nervous system, lung, etc. Clinically, pulmonary epithelioid hemangioendothelioma has been considered to be a borderline malignancy, a generally indolent and nonaggressive tumor that displaes the pulomonary parenchyma over a number of years by slowly enlarging the tumor nodule. The clinical course of PEH is known to be usually benign. Here we report an unusual case of PEH that was highly malignant and was eventually fatal. The PEH was confirmed by microscopic analysis and hmmunohistochemical staining of CD31+(a membrane receptor and a sensitive and specific marker for vascular lesions) from an open lung biopsy specimen.
Biopsy ; Central Nervous System ; Hemangioendothelioma, Epithelioid* ; Liver ; Lung ; Lung Neoplasms ; Membranes