A 37 year old female presented with epigastric pain and weight loss over a period of 3 months. Her abdominal CT finding showed a 4.5 cm size hepatic mass and 4.3 cm size pancreatic head mass with multiple macronodules in the liver. At the same time, her chest CT revealed a 5 cm size necrotic mass in the left lower lobe of the lung with multiple bilateral pulmonary nodules. We diagnosed these lesions as tuberculosis through multiple biopsies. She was treated with anti-tuberculous medication. After taking the medications, her symptoms were improved. Twelve months later, imaging studies indicated an improvement in the patient's health. Here we report a case report of multi-organ macronodular tuberculosis in lung, liver and pancreas.
Biopsy ; Female ; Head ; Humans ; Liver ; Lung ; Multiple Pulmonary Nodules ; Pancreas ; Thorax ; Tuberculoma ; Tuberculosis ; Tuberculosis, Hepatic ; Weight Loss

OBJECTIVES: This study investigated the relationship of occupational class and educational background with proportional mortality ratios in Korea. METHODS: Mortality was investigated using the entire registered death data from 1993 to 2004, obtained from the Korean National Statistics Office. Proportional mortality ratios (PMRs) for specific diseases were calculated according to the occupational class and educational background of men aged 20-64. RESULTS: Manual workers were found to have higher PMRs for liver disease and traffic accidents, as did the lower educated group. Especially, this study showed trends of an increasing of the wide gap between lower and higher socioeconomic stati for liver disease, traffic accidents, diabetes mellitus and cerebral vascular disease. The mortality for cerebrovascular disease, diabetes mellitus, heart disease, traffic accident and liver disease showed increasing trends according to the calendar year for the lower than the higher social class. CONCLUSIONS: The specific conditions that had higher PMRs in the Korean lower social class were liver disease and traffic accidents. Especially, there was an increasing trend for a widening of the gap between manual and nonmanual groups in relation to mortality from liver disease, diabetes mellitus and traffic accidents.
Socioeconomic Factors ; Odds Ratio ; Occupations/*classification/statistics & numerical data ; Middle Aged ; Male ; Liver Diseases/mortality ; Korea/epidemiology ; Humans ; *Educational Status ; Diabetes Mellitus/mortality ; Cerebrovascular Disorders/mortality ; Cause of Death/*trends ; Adult ; Accidents, Traffic/mortality

Hyperhidrosis is a disorder characterized by perspiration in excess of the physiologic amount necessary to maintain thermal homeostasis. It is categorized as either a primary condition or a condition occurring secondary to a number of diseases and the use of prescribed drugs and is further classified according to anatomical distribution as being focal, regional, or generalized. Severe generalized hyperhidrosis is extremely rare but significantly inhibits social activities in those affected. A 48-year-old female with oliguria was admitted to our hospital. Both a physical examination and a starch-iodine test showed generalized hyperhidrosis, suggesting that excessive loss of body fluid via sweating had led to prerenal acute renal failure (ARF). To our knowledge, severe cases of generalized hyperhidrosis causing ARF have not previously been reported. The present case is reported with a review of the literature on the etiology and management of generalized hyperhidrosis.
Acute Kidney Injury ; Body Fluids ; Cholinergic Antagonists ; Female ; Homeostasis ; Humans ; Hyperhidrosis ; Middle Aged ; Oliguria ; Physical Examination ; Sweat ; Sweating

Haemophilus parainfluenzae, one of the member of the HACEK group of gram-negative oropharyngeal species, is a rare cause of subacute native valve endocarditis. Infective endocarditis caused by H. parainfluenzae appears to carry a high incidence rate of cerebral embolism, often making the timing of surgical intervention difficult. A 52-year-old male was diagnosed with acute endocarditis caused by H. parainfluenzae complicated with acute cerebral infarctions. After institution of antibiotic therapy, this patient was mechanically ventilated because of the sudden onset of dyspnea. Repeated two-dimensional echocardiography demonstrated rate-dependent mitral stenosis without interval change of vegetations on the mitral valve. Making a decision regarding the timing of surgical intervention was difficult because of a fear of clinical deterioration after early valve replacement.
Cerebral Infarction ; Dyspnea ; Echocardiography ; Endocarditis ; Endocarditis, Bacterial ; Haemophilus ; Haemophilus parainfluenzae ; Heart Valve Prosthesis Implantation ; Humans ; Incidence ; Intracranial Embolism ; Male ; Middle Aged ; Mitral Valve ; Mitral Valve Stenosis ; Paramyxoviridae Infections

Hyperhidrosis is a disorder characterized by perspiration in excess of the physiologic amount necessary to maintain thermal homeostasis. It is categorized as either a primary condition or a condition occurring secondary to a number of diseases and the use of prescribed drugs and is further classified according to anatomical distribution as being focal, regional, or generalized. Severe generalized hyperhidrosis is extremely rare but significantly inhibits social activities in those affected. A 48-year-old female with oliguria was admitted to our hospital. Both a physical examination and a starch-iodine test showed generalized hyperhidrosis, suggesting that excessive loss of body fluid via sweating had led to prerenal acute renal failure (ARF). To our knowledge, severe cases of generalized hyperhidrosis causing ARF have not previously been reported. The present case is reported with a review of the literature on the etiology and management of generalized hyperhidrosis.
Acute Kidney Injury ; Body Fluids ; Cholinergic Antagonists ; Female ; Homeostasis ; Humans ; Hyperhidrosis ; Middle Aged ; Oliguria ; Physical Examination ; Sweat ; Sweating

Stroke causes systemic immunosuppression. T lymphocytes are involved in infarct size in the early stages of stroke. However, the phenotypes of T lymphocytes and their functions in peripheral immune organs and the brain have not been well analyzed in the acute and chronic phases of stroke. Here, we investigated pathological phenotypic alterations in the systemic immune response, especially changes in T lymphocytes, from one day to six months after ischemic stroke in mice. Impairment in thymocyte numbers, development, proliferation, and apoptosis were observed for up to two weeks. The number of mature T cells in the spleen and blood decreased and showed reduced interferon-γ production. Increased numbers of CD4-CD8-CD3+ double-negative T cells were observed in the mouse brain during the early stages of stroke, whereas interleukin (IL)-10+Foxp3+ regulatory T lymphocytes increased from two weeks during the chronic phase. These phenotypes correlated with body weight and neurological severity scores. The recovery of T lymphocyte numbers and increases in IL-10+Foxp3+ regulatory T lymphocytes may be important for long-term neurological outcomes. Dynamic changes in T lymphocytes between the acute and chronic phases may play different roles in pathogenesis and recovery. This study provides fundamental information regarding the T lymphocyte alterations from the brain to the peripheral immune organs following stroke.

Stroke causes systemic immunosuppression. T lymphocytes are involved in infarct size in the early stages of stroke. However, the phenotypes of T lymphocytes and their functions in peripheral immune organs and the brain have not been well analyzed in the acute and chronic phases of stroke. Here, we investigated pathological phenotypic alterations in the systemic immune response, especially changes in T lymphocytes, from one day to six months after ischemic stroke in mice. Impairment in thymocyte numbers, development, proliferation, and apoptosis were observed for up to two weeks. The number of mature T cells in the spleen and blood decreased and showed reduced interferon-γ production. Increased numbers of CD4-CD8-CD3+ double-negative T cells were observed in the mouse brain during the early stages of stroke, whereas interleukin (IL)-10+Foxp3+ regulatory T lymphocytes increased from two weeks during the chronic phase. These phenotypes correlated with body weight and neurological severity scores. The recovery of T lymphocyte numbers and increases in IL-10+Foxp3+ regulatory T lymphocytes may be important for long-term neurological outcomes. Dynamic changes in T lymphocytes between the acute and chronic phases may play different roles in pathogenesis and recovery. This study provides fundamental information regarding the T lymphocyte alterations from the brain to the peripheral immune organs following stroke.

Background: Papillary breast lesions (PBLs) comprise diverse entities from benign and atypical lesions to malignant tumors. Although PBLs are characterized by a papillary growth pattern, it is challenging to achieve high diagnostic accuracy and reproducibility. Thus, we investigated the diagnostic reproducibility of PBLs in core needle biopsy (CNB) specimens with World Health Organization (WHO) classification. Methods: Diagnostic reproducibility was assessed using interobserver variability (kappa value, κ) and agreement rate in the pathologic diagnosis of 60 PBL cases on CNB among 20 breast pathologists affiliated with 20 medical institutions in Korea. This analysis was performed using hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) staining for cytokeratin 5 (CK5) and p63. The pathologic diagnosis of PBLs was based on WHO classification, which was used to establish simple classifications (4-tier, 3-tier, and 2-tier). Results: On WHO classification, H&E staining exhibited ‘fair agreement’ (κ = 0.21) with a 47.0% agreement rate. Simple classifications presented improvement in interobserver variability and agreement rate. IHC staining increased the kappa value and agreement rate in all the classifications. Despite IHC staining, the encapsulated/solid papillary carcinoma (EPC/SPC) subgroup (κ = 0.16) exhibited lower agreement compared to the non-EPC/SPC subgroup (κ = 0.35) with WHO classification, which was similar to the results of any other classification systems. Conclusions Although the use of IHC staining for CK5 and p63 increased the diagnostic agreement of PBLs in CNB specimens, WHO classification exhibited a higher discordance rate compared to any other classifications. Therefore, this result warrants further intensive consensus studies to improve the diagnostic reproducibility of PBLs with WHO classification.