We report on a patient with known tuberous sclerosis who has huge bilateral angiomyolipoma in both kidneys as well in the periaortic lymph node. Under preoperative diagnosis of angiomyolipoma, the problem was managed conservatively. Massive persistent hematuria was controlled by superselective angioinfarction with ethanol and functioning renal parenchyma was preserved in the right kidney. Bleeding within the tumor of the left kidney was treated by angioinfarction followed by nephrectomy.
Angiomyolipoma* ; Diagnosis ; Ethanol ; Hematuria ; Hemorrhage ; Humans ; Kidney* ; Lymph Nodes* ; Nephrectomy ; Tuberous Sclerosis

PURPOSE: The biological function of long non-coding RNAs (lncRNAs) is only partially understood; therefore, in this study, we investigated the expression of the novel HOXA11 antisense (HOXA11as) lncRNA and its oncogenic role in serous ovarian cancer (SOC). MATERIALS AND METHODS: HOXA11as expression was examined in 129 SOC tissue samples by real time reverse transcription polymerase chain reaction. Clinicopathological factors and patient survival were compared between the high (n=27) and low HOXA11as expression group (n=102). To investigate the role of HOXA11as in cell proliferation, invasion, and migration, HOXA11as expression in ovarian cancer cells was knocked down using RNA interference. RESULTS: HOXA11as expression in cancer tissue was 77-fold higher than that of noncancerous tissue (p < 0.05). Higher HOXA11as expression was significantly correlated with histological grade (p=0.017) and preoperative cancer antigen 125 (p=0.048). HOXA11as overexpression in SOC cells led to increased cell proliferation, invasion, and migration. Moreover, HOXA11as was associated with the expression of genes involved in cell invasion, migration, and epithelial-mesenchymal transition (EMT), including vascular endothelial growth factor, matrix metalloproteinase 9 (MMP-9), B-catenin, E-cadherin, Snail, Twist, and vimentin. Multivariate analysis revealed that HOXA11as was a prognostic factor of progressive disease and mortality (hazard ratio [HR], 1.730; p=0.043 and HR, 2.170; p=0.033, respectively). Progression-free and overall survival were significantly shorter in patients with high HOXA11as expression. CONCLUSION: These findings highlight the clinical significance of HOXA11as to predicting the prognosis of SOC patients and suggest its potential in promoting tumor aggressiveness via regulation of vascular endothelial growth factor (VEGF), MMP-9, and EMT-related mechanisms.
Cadherins ; Cell Proliferation* ; Epithelial-Mesenchymal Transition ; Humans ; Matrix Metalloproteinase 9 ; Mortality ; Multivariate Analysis ; Ovarian Neoplasms* ; Polymerase Chain Reaction ; Prognosis* ; Reverse Transcription ; RNA Interference ; RNA, Long Noncoding* ; Snails ; Vascular Endothelial Growth Factor A ; Vimentin

PURPOSE: To assess the quantitative accuracy and the clinical utility of 3D volumetric PET imaging with FDG in brain studies, 24 patients with various neurological disorders were studied. MATERIALS AND METHODS: Each patient was injected with 370 MBq of 2-[18F]fluoro-2-deoxy-D-glucose. After a 30 min uptake period, the patients were imaged for 30 min in 2 dimensional acquisition (2D) and subsequently for 10 min in 3 dimensional acquisition imaging (3D) using a GE AdvanceTM PET system. The scatter corrected 3D (3D SC) and non scatter-corrected 3D images were compared with 2D images by applying ROIs on gray and white matter, lesion and contralateral normal areas. Measured and calculated attenuation correction methods for emission images were compared to get the maximum advantage of high sensitivity of 3D acquisition. RESULTS: When normalized to the contrast of 2D images, the contrasts of gray to white matter were 0.75+/-0.13 (3D) and 0.95+/-0.12 (3D SC). The contrasts of normal area to lesion were 0.83+/-0.05 (3D) and 0.96+/-0.05 (3D SC). Three nuclear medicine physicians judged 3D SC images to be superior to the 2D with regards to resolution and noise. Regional counts of calculated attenuation correction was not significantly different to that of measured attenuation correction. CONCLUSION:: 3D PET images with the scatter correction in FDG brain studies provide quantitatively and qualitatively similar images to 2D and can be utilized in a routine clinical setting to reduce scanning time and patient motion artifacts.
Artifacts ; Brain* ; Humans ; Nervous System Diseases ; Noise ; Nuclear Medicine ; Positron-Emission Tomography

PURPOSE: The purpose of this study was to determine the effect-site concentration (Ce) of remifentanil in 50% of patients (EC50) and 95% of patients (EC95) for smooth laryngeal mask airway (LMA) removal in adults under propofol and remifentanil anesthesia. MATERIALS AND METHODS: Twenty-five patients of ASA physical status I-II and ages 18-60 years who were to undergo minor gynecological or orthopedic surgery were assessed in this study. Anesthesia was induced and maintained with propofol and remifentanil target-controlled infusion (TCI). Remifentanil was maintained at a predetermined Ce during the emergence period. The modified Dixon's up-and-down method was used to determine the remifentanil concentration, starting from 1.0 ng/mL (step size of 0.2 ng/mL). Successful removal of the LMA was regarded as absence of coughing/gagging, clenched teeth, gross purposeful movements, breath holding, laryngospasm, or desaturation to SpO2<90%. RESULTS: The mean+/-SD Ce of remifentanil for smooth LMA removal after propofol anesthesia was 0.83+/-0.16 ng/mL. Using isotonic regression with a bootstrapping approach, the estimated EC50 and EC95 of remifentanil Ce were 0.91 ng/mL [95% confidence interval (CI), 0.77-1.07 ng/mL] and 1.35 ng/mL (95% CI, 1.16-1.38 ng/mL), respectively. CONCLUSION: Our results showed that remifentanil TCI at an established Ce is a reliable technique for achieving safe and smooth emergence without coughing, laryngospasm, or other airway reflexes.
Adolescent ; Adult ; Analgesics, Opioid/*administration & dosage ; Anesthetics, Inhalation/*administration & dosage ; Cough/prevention & control ; Device Removal ; Dose-Response Relationship, Drug ; Female ; Gynecologic Surgical Procedures ; Humans ; *Laryngeal Masks ; Male ; Middle Aged ; Orthopedic Procedures ; Piperidines/*administration & dosage ; Propofol/*administration & dosage ; Treatment Outcome ; Young Adult

Bladder cancer is the seventh most common cancer in men that smoke, and the incidence of disease increases with age. The mechanism of occurrence has not yet been established. Potassium channels have been linked with cell proliferation. Some two-pore domain K+ channels (K2P), such as TASK3 and TREK1, have recently been shown to be overexpressed in cancer cells. Here we focused on the relationship between cell growth and the mechanosensitive K2P channel, TREK2, in the human bladder cancer cell line, 253J. We confirmed that TREK2 was expressed in bladder cancer cell lines by Western blot and quantitative real-time PCR. Using the patch-clamp technique, the mechanosensitive TREK2 channel was recorded in the presence of symmetrical 150 mM KCl solutions. In 253J cells, the TREK2 channel was activated by polyunsaturated fatty acids, intracellular acidosis at -60 mV and mechanical stretch at -40 mV or 40 mV. Furthermore, small interfering RNA (siRNA)-mediated TREK2 knockdown resulted in a slight depolarization from -19.9 mV+/-0.8 (n=116) to -8.5 mV+/-1.4 (n=74) and decreased proliferation of 253J cells, compared to negative control siRNA. 253J cells treated with TREK2 siRNA showed a significant increase in the expression of cell cycle boundary proteins p21 and p53 and also a remarkable decrease in protein expression of cyclins D1 and D3. Taken together, the TREK2 channel is present in bladder cancer cell lines and may, at least in part, contribute to cell cycle-dependent growth.
Acidosis ; Blotting, Western ; Cell Cycle ; Cell Line ; Cell Proliferation ; Cyclins ; Fatty Acids, Unsaturated ; Humans* ; Incidence ; Male ; Patch-Clamp Techniques ; Potassium Channels ; Real-Time Polymerase Chain Reaction ; RNA, Small Interfering ; Smoke ; Urinary Bladder Neoplasms ; Urinary Bladder*

BACKGROUND: Blood glucose testing (BGT) at the forearm minimizes the pain experienced during sampling of capillary blood. We compared the BGT results for forearm sampling with those for standard finger skin puncture and venous serum to evaluate the clinical validity of forearm BGT. METHODS: BGT was performed on the finger (G(F)) and forearm (G(A)) with a portable glucometer in 555 subjects, including 61 diabetic patients, under fasting conditions. BGT with venous serum (G(V)) was followed within an hour in 514 subjects. Simple linear regression, intraclass correlation, and Passing-Bablok regression analyses were performed using the G(A)-G(F) and G(A)-G(V) data. RESULTS: G(A) showed an excellent linear relationship with both G(F) and G(V) with a Pearson correlation coefficient (r) of 0.97 (P<0.0001) in the patient group, which was similar to the findings in the normal group except for the lower r values. The mean bias between G(A) and G(F) and between G(A) and G(V) were within +/- 10 mg/dL in both groups. The intraclass correlation coefficients were slightly smaller than the corresponding r values, but they showed the same tendency in both groups. In the Passing-Bablok analyses, the 95% confidence intervals of the slope and intercept parameters were <+/-20% of unity and <+/-20 mg/dL, respectively, which were within the acceptable ranges. All 3 statistical analyses supported the satisfactory agreement of G(A) with G(F) or G(V). CONCLUSIONS: BGT at the forearm was highly consistent with the standard BGT, thereby confirming its applicability in clinical practice for self-testing under steady fasting conditions.
Adult ; Aged ; Blood Glucose/*analysis ; Blood Specimen Collection ; Female ; Fingers/*blood supply ; Forearm/*blood supply ; Humans ; Male ; Middle Aged ; Regression Analysis

Splenic artery aneurysms are an uncommon form of vascular disease that carry the risk of rupture and fatal hemorrhage. Precise cause of splenic artery aneurysms are not be established, the most common pathologic finding is defect of the media. Splenic artery aneurysms occur in patient with multiple pregnancies, portal hypertension, splenomegaly, after orthotopic liver transplantation and fibrodysplasia. Most patients who are diagnosised with splenic artery aneurysm are asymptomatic. Arteriography is a confirmed diagnostic method for detecting splenic artery aneurysms and searching the location of aneurysms. Operative treatment and therapeutic catheter embolization have been used for treatment of splenic artery aneurysms.
Aneurysm* ; Angiography ; Catheters ; Diagnosis ; Embolization, Therapeutic ; Female ; Hemorrhage ; Humans ; Hypertension, Portal ; Liver Transplantation ; Pregnancy ; Pregnancy, Multiple ; Rupture* ; Splenic Artery* ; Splenomegaly ; Vascular Diseases

PURPOSE: At present, the hemoglobin count is one of the most commonly performed clinical laboratory tests in the emergency department. However, the conventional method is invasive and permits only intermittent assessments. The aim of this study was to determine whether non-invasive hemoglobin measurements (SpHb) produce comparably accurate results to laboratory hemoglobin tests (tHb) in patients presented to the emergency department. METHODS: From May to July 2009, 217 patients who required hemoglobin tests after presenting to the emergency department of a hospital were enrolled. We measured hemoglobin values using the conventional method (tHb), and the non-invasive method (SpHb). The study population was classified into two groups: 'non-bleeding' and 'bleeding'. The concordance between tHb and SpHb was analyzed by the Pearson's correlation coefficient. RESULTS: A total of 217 data pairs were collected from 217 subjects, 193(88.9%) non-bleeding patients, 24(11.1%) bleeding patients. A total of 114 subjects were male (52.5%). The Pearson's correlation coefficient between tHb and SpHb was 0.814(p=0.000). In the 'non-bleeding' and 'bleeding' groups, the Pearson's correlation coefficients between tHb and SpHb were 0.779(p=0.000) and 0.788(p=0.000) respectively. CONCLUSION: Non-invasive SpHb measurement provides clinically acceptable accuracy compared to the conventional laboratory method (tHb) in the setting of the emergency department.
Emergencies ; Emergency Medicine ; Hemoglobinometry ; Hemoglobins ; Hemorrhage ; Humans ; Male

PURPOSE: In addition to chemical burn of the alimentary tract, caustic ingestion can cause severe complications including esophageal perforation, airway edema, esophageal stricture, and death. Hematological parameters have been reported to be useful inflammatory markers predicting prognoses in various clinical situations where oxidative stress is increased. We hypothesized that hematological parameters might be useful for prediction of complications after caustic ingestion. METHODS: We performed a retrospective analysis of patients admitted to our Emergency Department after caustic ingestion. The numbers of leukocytes, neutrophils, lymphocytes, and monocytes, and the neutrophil-lymphocyte ratio were compared between uncomplicated and complicated patient groups. Receiver operating characteristic curve analysis was performed for parameters that differed between the two groups. Subgroup analysis was performed according to the substance ingested, thus acid or alkali. RESULTS: Thirty-seven patients were included in our study and eight had complications. Leukocyte, neutrophil counts, and the neutrophil-lymphocyte ratio of the complicated group were higher than those of the uncomplicated group. The areas under the receiver operating characteristic curves of leukocyte counts, neutrophil counts, and the neutrophil- lymphocyte ratio, were 0.819, 0.832, and 0.750, respectively. The cut-off values of these parameters for prediction of complications were 12 060/uL, 9607/uL, and 2.72, respectively. In subgroup analysis, the leukocyte and neutrophil counts, and the neutrophil-lymphocyte ratio of complicated patients who had ingested alkali were higher than those of the uncomplicated group. CONCLUSION: Leukocyte counts, neutrophil counts, and the neutrophil-lymphocyte ratio might serve as useful predictors of complications after ingestion of caustic substances.
Alkalies ; Blood Cell Count ; Burns, Chemical ; Caustics ; Eating* ; Edema ; Emergency Service, Hospital ; Esophageal Perforation ; Esophageal Stenosis ; Esophagus ; Humans ; Leukocyte Count ; Leukocytes ; Lymphocytes ; Monocytes ; Neutrophils ; Oxidative Stress ; Prognosis ; Retrospective Studies* ; ROC Curve ; Wounds and Injuries

OBJECTIVE: Smart glasses can provide sonographers with real-time ultrasound images. In the present study, we aimed to evaluate the utility of smart-glasses for ultrasound-guided peripheral venous access.METHODS: In this randomized, crossover-design, simulation study, 12 participants were recruited from the emergency department residents at a university hospital. Each participant attempted ultrasound-guided peripheral venous access on a pediatric phantom at intervals of 5 days with (glasses group) or without (non-glasses group) the use of smart glasses. In the glasses group, participants confirmed the ultrasound image through the lens of the smart glasses. In the non-glasses group, participants confirmed the ultrasound image through the display viewer located next to the phantom. Procedure time was regarded as the primary outcome, while secondary outcomes included the number of head movements for the participant, number of skin punctures, number of needle redirections, and subjective difficulty.RESULTS: No significant differences in procedural time were observed between the groups (non-glasses group: median time, 15.5 seconds; interquartile range [IQR], 10.3 to 27.3 seconds; glasses group: median time, 19.0 seconds; IQR, 14.3 to 39.3 seconds; P=0.58). The number of head movements was lower in the glasses group than in the non-glasses group (glasses group: median, 0; IQR, 0 to 0; non-glasses group: median, 4; IQR, 3 to 5; P<0.01). No significant differences in the number of skin punctures or needle restrictions were observed between the groups.CONCLUSION: Our results indicate that smart-glasses may aid in ensuring ultrasound-guided peripheral venous access by reducing head movements.
Emergency Service, Hospital ; Eyeglasses ; Glass ; Head Movements ; Needles ; Pilot Projects ; Punctures ; Skin ; Ultrasonography ; Wireless Technology