BACKGROUND AND AIMS: When acute gastric anisakiasis is clinically suspected, endoscopic removal of larva is the only definite treatment method. However, there has been little known for endoscopic findings of gastric anisakiasis. METHODS: In 39 patients with gastric anisakiasis, the ingested species of marine products and clinical findings were investigated. The form of larvae, the mucosal changes of the insertion site, close and distant area were also analysed during endoscopic examination. RESULTS: Twelve patients (30.8%) ate raw Astroconger myriaster solely, and the most frequent mucosal insertion site of larvae was around the greater curvature of the body (59.5%). Endoscopic findings of erosion (33.3%), hemorrhagic erosion (33.3%) and redness of the mucosa (11.9%) were observed at the insertion site. The adjacent mucosal changes were edema and fold enlargement. All patients were treated medically. CONCLUSIONS: When acute gastric anisakiasis is suspected, the careful endoscopic examination of larva was necessary for confirmatory diagnosis and definite treatment of the disease.
Anisakiasis* ; Diagnosis ; Edema ; Humans ; Incheon* ; Larva ; Mucous Membrane

Toxoplasma gondii is an obligate intracellular protozoan parasite, which invades a wide range of hosts including humans. The exact mechanisms involved in its invasion are not fully understood. This study focused on the roles of Ca2+ in host cell invasion and in T. gondii replication. We examined the invasion and replication of T. gondii pretreated with several calcium modulators, the conoid extrusion of tachyzoites. Calmodulin localization in T. gondii were observed using the immunogold method, and Ca2+ levels in tachyzoites by confocal microscopy. In light microscopic observation, tachyzoites co-treated with A23187 and EGTA showed that host cell invasion and intracellular replication were decreased. The invasion of tachyzoites was slightly inhibited by the Ca2+ channel blockers, bepridil and verapamil, and by the calmodulin antagonist, calmidazolium. We observed that calcium saline containing A23187 induced the extrusion of tachyzoite conoid. By immunoelectron microscopy, gold particles bound to anti-calmodulin or anti-actin mAb, were found to be localized on the anterior portion of tachyzoites. Remarkably reduced intracellular Ca2+ was observed in tachyzoites treated with BAPTA/AM by confocal microscopy. These results suggest that host cell invasion and the intracellular replication of T. gondii tachyzoites are inhibited by the calcium ionophore, A23187, and by the extracellular calcium chelator, EGTA.
Animals ; Calcium/*physiology ; Calcium Channel Blockers/pharmacology ; Calmodulin/antagonists & inhibitors ; Chelating Agents/pharmacology ; Hela Cells ; Host-Parasite Relations ; Humans ; Ionophores/pharmacology ; Research Support, Non-U.S. Gov't ; Toxoplasma/drug effects/pathogenicity/*physiology

This paper reports a case of a 21-year-old male patient who complained of intermittent pain and snapping at 110° of flexion in his left elbow joint. Magnetic resonance imaging revealed a band-like low signal intensity in front of the radiohumeral joint. An ultrasound was conducted to check its association with the symptoms. Observations of a high echo escaping from the radiohumeral joint at the point when snapping occurred indicated noted that the hypertrophic plica was a cause of the snapping. The hypertrophic plica removed arthroscopically, and the results were good for up to 6 months after surgery. If snapping is observed in the elbow joint, it will be necessary to consider the symptoms from the hypertrophic plica, although rare, and ultrasound might be an effective tool for a differential diagnosis.
Diagnosis* ; Diagnosis, Differential ; Elbow Joint ; Elbow* ; Humans ; Joints ; Magnetic Resonance Imaging ; Male ; Ultrasonography* ; United Nations ; Young Adult

The treatment approach for proximal humeral fractures is determined by various factors, including patient age, sex, dominant arm, fracture pattern, presence of osteoporosis, preexisting arthritis, rotator cuff status, and medical comorbidities. However, there is a lack of consensus in the literature regarding the optimal treatment for displaced proximal humeral fractures. This study aimed to assess and quantify the decision-making process for either conservative or surgical treatment and the choice of surgical method among shoulder surgeons when treating proximal humeral fractures. Methods: Forty sets of true anteroposterior view, scapular Y projection view, and three-dimensional computed tomography of proximal humeral fractures were provided to 12 shoulder surgeons along with clinical information. Surveys regarding Neer classification, decisions between conservative and surgical treatments, and chosen methods were conducted twice with an interval of 2 months. The factors affecting the treatment plans were also assessed. Results: The inter-rater agreement was fair for Neer classification (kappa=0.395), moderate for the decision between conservative and surgical treatments (kappa=0.528), and substantial for the chosen method of surgical treatment (kappa=0.740). The percentage of agreement was 71.1% for Neer classification, 84.6% for the decision between conservative and surgical treatment, and 96.4% for the chosen method of surgical treatment. The fracture pattern was the most crucial factor in deciding between conservative and surgical treatments, followed by age and physical activity. Conclusions: The decision between conservative and surgical treatment for proximal humeral fractures showed good agreement, while the chosen method between osteosynthesis and arthroplasty showed substantial agreement among shoulder surgeons.

Mesenteric fibromatosis is a rare benign fibrous tumor that can occur from bowel mesentery of the retroperitoneum. It can infiltrate the surrounding structures and tends to recur locally even after resection but does not have metastatic capability. Mesenteric fibromatosis represents 8% of all intra-abdominal desmoid neoplasm. We experienced a case of mesenteric fibromatosis in a 50-year-old woman with a painless abdominal mass. An exploratory laparotomy was performed, and two large, small bowel mesenteric masses were found which were invading the transverse colon. The segment of the jejunum and transverse colon including the masses were resected widely and the pathologic report confirmed the diagnosis of fibromatosis. We reviewed the features of the mesenteric fibromatosis, that is, clinical, imaging, pathological, immunohistological features, and differential diagnosis and treatment of mesenteric fibromatosis.
Colon, Transverse ; Diagnosis, Differential ; Female ; Fibroma ; Fibromatosis, Aggressive ; Humans ; Jejunum ; Laparotomy ; Mesentery ; Middle Aged

Thrombotic thrombocytopenic purpura (TTP) is a clinical syndrome characterized by micro-angiopathic hemolytic anemia, thrombocytopenia, fever, renal disorders, and neurological manifestations. Its clinical course is rapid and the mortality rate is high if untreated or relapse occurs. Previous studies reported that rituximab, a monoclonal antibody for CD20 surface antigen on B lymphocytes, may be effective in treating idiopathic TTP that is refractory to plasma exchange or relapses after remission. A 27-year-old Vietnamese man presented with fever and fatigue starting 3 days earlier, which was diagnosed as idiopathic TTP. To overcome his poor responsiveness to combined therapy using steroids and plasma exchange, rituximab was considered. In the current case, the patient was treated with a lower dose of rituximab, instead of the conventional 375 mg/m2/week, and achieved successful remission.
Adult ; Anemia, Hemolytic ; Antigens, Surface ; Asian Continental Ancestry Group ; B-Lymphocytes ; Fatigue ; Fever ; Glucocorticoids ; Humans ; Mortality ; Neurologic Manifestations ; Plasma Exchange ; Plasma* ; Purpura, Thrombotic Thrombocytopenic* ; Recurrence ; Steroids ; Thrombocytopenia ; Thrombotic Microangiopathies ; Rituximab

BACKGROUND: This study aimed to present our 5-year experience of extracorporeal cardiopulmonary resuscitation (ECPR) performed by emergency physicians. METHODS: We retrospectively analyzed 58 patients who underwent ECPR between January 2010 and December 2014. The primary parameter analyzed was survival to hospital discharge. The secondary parameters analyzed were neurologic outcome at hospital discharge, cannulation time, and ECPR-related complications. RESULTS: Thirty-one patients (53.4%) were successfully weaned from extracorporeal membrane oxygenation, and 18 (31.0%) survived to hospital discharge. Twelve patients (20.7%) were discharged with good neurologic outcomes. The median cannulation time was 25.0 min (interquartile range 20.0-31.0 min). Nineteen patients (32.8%) had ECPR-related complications, the most frequent being distal limb ischemia. Regarding the initial presentation, 52 patients (83.9%) collapsed due to a cardiac etiology, and acute myocardial infarction (33/62, 53.2%) was the most common cause of cardiac arrest. CONCLUSIONS: The survival to hospital discharge rate for cardiac arrest patients who underwent ECPR conducted by an emergency physician was within the acceptable limits. The cannulation time and complications following ECPR were comparable to those found in previous studies.
Cardiopulmonary Resuscitation ; Catheterization ; Emergencies* ; Extracorporeal Membrane Oxygenation ; Extremities ; Heart Arrest ; Humans ; Ischemia ; Myocardial Infarction ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: The purpose of this study was to evaluate the different patterns of bone loss between the lumbar spine and the femur after ovariectomy in rats. METHODS: Twenty-four female Sprague-Dawley rats underwent a sham operation (the sham group) or bilateral ovariectomy (the ovariectomized group). Four and eight weeks after operation, six rats from each of the two groups were euthanized. Serum biochemical markers of bone turnover including osteocalcin and alkaline phosphatase (ALP), which are sensitive biochemical markers of bone formation, and the telopeptide fragment of type I collagen C-terminus (CTX), which is a sensitive biochemical marker of bone resorption, were analyzed. Bone histomorphometric parameters of the 4th lumbar vertebrae and femur were determined by micro-computed tomography. RESULTS: Ovariectomized rats were found to have higher osteocalcin, ALP and CTX levels than sham controls. Additionally, 8 weeks after ovariectomy in the OVX group, serum levels of osteocalcin, ALP and CTX were significantly higher than those of 4 weeks after ovariectomy. Bone loss after ovariectomy was more extensive in the 4th lumbar spine compared to the femur. Bone loss in the 4th lumbar spine was mainly caused by trabecular thinning, but in the femur, it was mainly caused by trabecular elimination. CONCLUSION: The present study demonstrates different patterns of bone loss between the 4th lumbar spine and the femur in ovariectomized rats. Therefore, when considering animal models of osteoporosis, it is important that bone sites should be taken into account.
Alkaline Phosphatase ; Animals ; Biomarkers ; Bone Resorption ; Collagen Type I ; Female ; Femur ; Humans ; Lumbar Vertebrae ; Models, Animal ; Osteocalcin ; Osteogenesis ; Osteoporosis ; Ovariectomy ; Rats ; Rats, Sprague-Dawley ; Salicylamides ; Spine

PURPOSE: We evaluated important factors for pelvic inflammatory disease (PID) and acute appendicitis, respectively, and we developed scoring systems for use in screening for PID or acute appendicitis in childbearing-aged women who visit the emergency department (ED) with abdominal pain. METHODS: By performance of multivariable logistic regression analysis, we found statistically significant factors for PID and acute appendicitis in prospectively collected registries, and we developed scoring systems for screening of each disease. The performances of these scoring systems were compared using the area under the receiver operating characteristics (ROC) curve. RESULTS: A total of 1048 patients were registered. Among them, 279 patients diagnosed as PID (155 patients) or acute appendicitis (124 patients) were finally analyzed in this study. The significant factors that favored PID were a length of pain onset more than two days, a history of coitus within four weeks, fever, a history of abortion, vaginal secretions, taking a painkiller for dysmenorrhea, diffuse low abdominal tenderness, no migration of pain, absence of gastrointestinal symptoms, and no leukocytosis. The significant factors that favored acute appendicitis were directly contrary to the significant factors for PID. Each of these variables was assigned a score of 1 or 2. The ROC areas of PID and acute appendicitis were 0.896 and 0.910, respectively. CONCLUSION: In order to screen for PID and acute appendicitis, among other diseases, using eleven important factors, we developed scoring systems for childbearing-aged women who present with abdominal pain. Conduct of further prospective study that will utilize these scoring systems is needed.
Abdominal Pain ; Appendicitis ; Coitus ; Dysmenorrhea ; Emergencies ; Female ; Fever ; Humans ; Leukocytosis ; Logistic Models ; Mass Screening ; Pelvic Inflammatory Disease ; Registries ; ROC Curve

The present study was undertaken to evaluate the prevalence rate of Taenia spp. infection and distribution of taeniasis caused by T. solium among Koreans in several localities in Korea during the period from 1977 to 1980. A total of 1,946 stool specimens collected from students and inhabitants of Chungcheong Bug Do and Gyeongsang Nam Do were examined by cellophane thick smear method. Among them, 40 persons were detected as Taenia egg positive cases. The overall positive rate of Taenia spp. shows 2.1 percent. The prevalence rate of male (2.3 percent) is relatively higher than that of female (1.4 percent). In order to observe the distribution of Taenia solium infection, the whole worms or a part of proglottids of Taenia spp. were collected from the stools of egg positive cases by normal defecation or anthelmintic treatment. For the species identification, expelled proglottids were examined microscopically by the number of branches of the uterus, presence of a vaginal sphincter or the accessory ovarian lobe etc. Among 199 egg detected cases in this study 59 (39.1 percent) out of 151 cases in Seoul, 12(40.0 percent) of 30 cases in Gyeongsang Nam Do and 2 (25.0 percent) from 8 taeniasis cases in Cheju Do were infected with T. solium. But none of T. solium infection was found from 10 egg positive cases in Chungcheong Bug Do. As a whole, the composition of species shows 36.7 per cent of T. solium infection and 55.8 percent of T. saginata infection, and in 7.5 per cent the species were not identified.
parasitology-helminth-trematoda ; Taenia spp. ; Taenia solium ; Taenia saginata