A ventriculo-peritoneal shunt is a standard surgical management for hydrocephalus, but complications may impede the management of this disease. Obstruction of the catheter is one of the most common complications and manifests clinically in various ways. Intraparenchymal cyst development after shunt malfunction has been reported by several authors, but the underlying mechanism and optimal treatment methods are debatable. The authors report a case of intraparenchymal cyst formation around a proximal catheter in a premature infant after a ventriculo-peritoneal shunt and discuss its pathogenesis and management.
Catheters ; Humans ; Hydrocephalus ; Infant, Newborn ; Infant, Premature ; Ventriculoperitoneal Shunt

BACKGROUND/OBJECTIVES: Inflammation is associated with various types of acute and chronic alcohol liver diseases. In this study, we examined whether umbelliferone (7-hydroxycoumarin, UF) ameliorates chronic alcohol-induced liver damage by modulating inflammatory response and the antioxidant system. METHODS: Rats were fed a Liber-Decarli liquid diet containing 5% alcohol with or without UF (0.05 g/L) for 8 weeks, while normal rats received an isocaloric carbohydrate liquid diet. RESULTS: Chronic alcohol intake significantly increased serum tumor necrosis factor-alpha (TNF-alpha) and interleukin 6 levels and decreased interleukin 10 level; however, UF supplementation reversed the cytokines related to liver damage. UF significantly suppressed hepatic lipopolysaccharide binding protein, toll-like receptor 4 (TLR4), nuclear factor kappa B, and TNF-alpha gene expression increases in response to chronic alcohol intake. Masson's trichrome staining revealed that UF improved mild hepatic fibrosis caused by alcohol, and UF also significantly increased the mRNA expressions and activities of superoxide dismutase and catalase in liver, and thus, decreased lipid peroxide and mitochondrial hydrogen peroxide levels. CONCLUSIONS: The findings of this study indicate that UF protects against alcohol-induced liver damage by inhibiting the TLR4 signaling pathway and activating the antioxidant system.
Animals ; Antioxidants* ; Carrier Proteins ; Catalase ; Cytokines ; Diet ; Fibrosis ; Gene Expression ; Hydrogen Peroxide ; Inflammation ; Interleukin-10 ; Interleukin-6 ; Liver ; Liver Diseases ; NF-kappa B ; Rats* ; RNA, Messenger ; Superoxide Dismutase ; Toll-Like Receptor 4 ; Tumor Necrosis Factor-alpha

OBJECTIVE: The Revised Obsessive Intrusion Inventory (ROII) is a 52-item scale that evaluates obsessional intrusive thoughts. The aim of the present study was to validate a short, 20-item Korean version of the ROII (ROII-20). METHODS: Of the 1125 participants who completed the ROII-20, 895 participants completed the scale to examine the factor structure of the scale. A subgroup of these participants (n=53) completed the scale twice to determine test-retest reliability. To establish external validity, 230 participants completed the scale and other questionnaires. RESULTS: Exploratory factor analyses suggested a hierarchical model comprising two higher order factors of autogenous obsessions (resulting from aggressive thoughts and sexual thoughts) and reactive obsessions (resulting from thoughts about contamination, thoughts about accidents, and thoughts about dirt). Confirmatory factor analyses supported this model. The results indicated good internal consistency and test-retest reliability. External validity was supported by relationships with obsessive-compulsive symptoms and general distress. CONCLUSION: The ROII-20 presents good psychometric properties and may be considered as a promising instrument for measuring obsessional intrusions.
Obsessive Behavior ; Psychometrics* ; Surveys and Questionnaires

The proteasome inhibitor, bortezomib, is ineffective against many solid tumors. Nutlin-3 is a potent antagonist of human homolog of murine double minute 2/p53 interaction exhibiting promising therapeutic anti-cancer activity. In this study, we show that treatment of various p53-defective bortezomib-resistant solid tumor cells with bortezomib plus nutlin-3 induces paraptosis, which is a cell death mode accompanied by dilation of the endoplasmic reticulum (ER) and mitochondria. Bortezomib alone did not markedly alter cellular morphology, and nutlin-3 alone induced only a transient mitochondrial dilation. However, bortezomib/nutlin-3 co-treatment triggered the progressive fusion of swollen ER and the formation of megamitochondria, leading to cell death. Mechanistically, proteasomal-impairment-induced ER stress, CHOP upregulation and disruption of Ca²⁺ homeostasis were found to be critically involved in the bortezomib/nutlin-3-induced dilation of the ER. Our results further suggest that mitochondrial unfolded protein stress may play an important role in the mitochondrial dilation observed during bortezomib/nutlin-3-induced cell death. Collectively, these findings suggest that bortezomib/nutlin-3 perturbs proteostasis, triggering ER/mitochondria stress and irrecoverable impairments in their structure and function, ultimately leading to paraptotic cell death.
Bortezomib* ; Cell Death ; Endoplasmic Reticulum ; Homeostasis ; Humans ; Mitochondria ; Proteasome Inhibitors ; Up-Regulation

PURPOSE: Patients with triple-negative breast cancer (TNBC) are known to carry an increased risk of distant metastasis and poor survival. The principal objective of this study was to investigate survival after brain metastases in patients with TNBC. METHODS: The authors retrospectively evaluated clinical data obtained from 66 patients who had been diagnosed with breast cancer and brain metastasis from 2003 to 2009. Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth receptor-2 (HER2) statuses were determined via immunohistochemical staining. TNBCs were defined as those that were ER-negative, PR-negative, and HER2-negative. The time interval from initial diagnosis to brain metastasis and overall survival after brain metastasis was evaluated via the Kaplan-Meier method. RESULTS: Twenty four (40.0%) of 60 patients were diagnosed with TNBC. The clinicopathologic characteristics did not differ between the TNBC and non-TNBC patients. The disease-free survival durations of the TNBC and non-TNBC subjects were 17.9 and 25.6 months, respectively (p=0.135). The time intervals from initial diagnosis to brain metastasis were 25.5 and 43.7 months, respectively (p=0.027). The time intervals from distant metastasis to brain metastasis were 8.4 and 19.5 months, respectively (p=0.006). Overall survival durations from brain metastasis to death were 4.3 and 7.6 months, respectively (p=0.046). CONCLUSION: Patients with TNBC were more likely to develop brain metastasis earlier, and exhibit poor overall survival. Triple receptor status may be utilized as a prognostic marker for breast cancer patients with brain metastasis.
Brain ; Breast ; Breast Neoplasms ; Disease-Free Survival ; Estrogens ; Humans ; Neoplasm Metastasis ; Receptors, Progesterone ; Retrospective Studies

PURPOSE: To determine whether there is a discrepancy between the medical professions perception of what patients should know and that of the patients themselves, we studied patients need to be informed about different aspects of epilepsy and compared findings with medical personnels perceptions of the issue. METHODS: Our study population consisted of 39 patients with epilepsy from the inpatient epilepsy unit, and 51patients from the outpatients clinic of the S. University Hospital between July and November 1997. However, the patients who declined to participate or who were not able to understand the directions and content of the questionnaire were excluded. The medical personnel participated in this study were 56 residents or nurses who were working in either Neurology or Neuro surgery Units. The questionnaire consisted of 6 categories with a total of 79 questions. The responses were indicated on a 5point Likert scale with 5 indicating the highest need . The data were analyzed with descriptive statistics, students t-tests, and chi-square. RESULTS: Of the 90 patients and 56 medical personnel studied, the need for lifestyle information such as smoking, drinking, sleep, driving, employment, and marriage was significantly higher from medical personnel than that of the patients(p=0.00). Regarding medical knowledge about epilepsy, the patients group had higher scores in the need for information on the structure of the brain (p=0.00), whereas medical personnel had higher scores on the symptoms of epilepsy. There was no correlation between the length of epilepsy and the need for information on every item on the questionnaire. The patients had higher rank regarding diet, although it was not significantly different from the medical personnel. Regarding antiepileptic drugs and what to do when there is an attack, medical personnel scored higher. The items on which the patients group scored higher than 4.5 were the possibility of inheritance, the factors that might reduce the number of attacks, the period of usage of AED, and the food they have to avoid or the food they have to take to reduce seizure attacks. CONCLUSIONS: Our study indicates that the patients group requires higher educational need in the structure of the brain, diet, and surgical treatment, but less in lifestyles and what to do when there is an attack. The educational program for the patients with epilepsy should emphasize medical knowledge with regard to brain anatomy, what to eat and what to avoid, and details of surgical treatment.
Anticonvulsants ; Brain ; Diet ; Drinking ; Employment ; Epilepsy* ; Humans ; Inpatients ; Life Style ; Marriage ; Neurology ; Outpatients ; Surveys and Questionnaires ; Seizures ; Smoke ; Smoking ; Wills

Pulmonary vein (PV) stenosis is a complication of ablation therapy for arrhythmias. We report two cases with chronic lung parenchymal abnormalities showing no improvement and waxing and waning features, which were initially diagnosed as nonspecific pneumonias, and finally confirmed as PV stenosis. When a patient presents for nonspecific respiratory symptoms without evidence of infection after ablation therapy and image findings show chronic and repetitive parenchymal abnormalities confined in localized portion, the possibility of PV stenosis should be considered.
Atrial Fibrillation/surgery ; Catheter Ablation/*adverse effects/methods ; Constriction, Pathologic/diagnosis/*radiography ; *Diagnostic Errors ; Female ; Humans ; Lung/surgery ; Male ; Middle Aged ; Pneumonia/diagnosis ; Pulmonary Infarction/pathology/*radiography ; Pulmonary Veins/physiopathology/radiography ; Tomography, X-Ray Computed/adverse effects ; Vascular Diseases/physiopathology

Tamoxifen, a selective estrogen modulator has been used for more than three decades to treat all stages of estrogen receptor (ER)-positive breast cancer and to prevent the disease. Tamoxifen is a pro-drug that requires metabolic activation to 4-hydroxytamoxifen and 4-hydroxy-N-desmethyltamoxifen (endoxifen) to elicit its pharmacological activity. Endoxifen has identical properties and potency with 4-hydroxytamoxifen, but is present in concentrations up to 10-fold higher than 4-hydroxytamoxifen. The cytochrome P450 2D6 (CYP2D6) enzyme plays a key role in converting tamoxifen into its active metabolites with significantly greater affinity for the ER and greater ability to inhibit cell proliferation. Genetic variants in the CYP2D6 gene may result in CYP2D6 enzymes with reduced or null activity, thereby decreasing the anti-cancer effect. In addition to genetic inactivation of CYP2D6, inhibitors of CYP2D6, including some antidepressants to treat hot flashes or depression in patients with breast cancer, may also alter enzyme activity and negatively affect the outcomes of patients receiving adjuvant tamoxifen. This article reviews and discusses the following issues: tamoxifen metabolism, antiproliferative effects of tamoxifen and its metabolites, CYP2D6 genetic polymorphisms, treatment for hot flashes and depression in breast cancer, and the pharmacological interactions between tamoxifen and antidepressants via CYP2D6. Although routine CYP2D6 testing is not recommended yet, coadministration of potent or intermediate CYP2D6 inhibitors in women taking tamoxifen should be avoided.
Antidepressive Agents ; Biotransformation ; Breast ; Breast Neoplasms ; Cell Proliferation ; Cytochrome P-450 CYP2D6 ; Depression ; Estrogens ; Female ; Hot Flashes ; Humans ; Polymorphism, Genetic ; Tamoxifen

PURPOSE: This study was designed to evaluate the role of oral nutritional support and nutritional counseling by dietician during radiation therapy. MATERIALS AND METHODS: This study included total 58 patients with head/neck, lung, or esophageal cancers who received radiation therapy with radical purpose between February and December, 1996. They were randomized either into nutrient supplement group (Group I) or control group (Group II). In Group I, the dietician advised patients to take high density nutrient supplement (NuCare, 250 kcal/can, Miwon co., LTD) based on dieticians initial evaluation for oral intake from initiation to completion of radiation therapy. In Group II, patients received nutritional support other than high density nutrient supplement only when patients lose weight more than 2 Kg during radiation treatment. All patients were evaluated for nutritional status and diet pattern and received nutritional counseling before radiation therapy and then weekly during treatment. RESULTS: Total 45 patients (22 patients in group I, 23 patients in group II) were available. In group I, all patients received average 3 cans (2~4 cans) a day. The calory from nutrient supplement was 43.9% of their daily energy intake (25.9~68.7%). About 72.7% of patients in Group I could keep up with their oral intake over 80% of daily requirement energy comparing to only 12.3% for patients in Group II(p<0.05). The patients in Group I started to lose weight 2 weeks later and lost weight more than 3 Kg less often than patients in Group II (5/22 vs 8/23, p>0.05). CONCLUSION: There was less significant weight loss in patients who started oral nutritional supplement based on the daily requirement energy early in radiation therapy. We think it is better to recommend nutritional supplement before weight loss started because radiation induced side effects such as esophagitis and oral mucositis prohibited patients to continue to take nutrient supplement.
Counseling ; Diet ; Energy Intake ; Esophageal Neoplasms ; Esophagitis ; Humans ; Lung ; Nutritional Status ; Nutritional Support* ; Nutritionists ; Stomatitis ; Weight Loss

PURPOSE: Perinatal asphyxia is an important cause of neonatal mortality and subsequent lifelong neurodevelopmental handicaps. Although many treatment strategies have been tested, there is currently no clinically effective treatment to prevent or reduce the harmful effects of hypoxia and ischemia in humans. In the clinical setting, maternal hyperthermia induces adverse effects on the neonatal brain, but recent studies have shown that hyperthermic pretreatment (PT) plays some role in hypoxic-ischemic (HI) injuries of the developing brain. The present study investigated the effect of hyperthermic PT on HI brain injuries in newborn rats. METHODS: HI was produced in 7-day-old neonatal rats by unilateral common carotid artery ligation, followed by hypoxia with 8% oxygen at 38degrees C for 2 hours. Twenty-four hours before HI, one-half of the pups were exposed to a 40degrees C environment for 2 hours. The severity of the brain injury was assessed 7 days after the HI. RESULTS: Hyperthermic PT reduced the gross and histopathologic findings of brain injury from 64.7 to 31.2% (P<0.05). There were no differences in location and severity of injury between the pretreated and control brains. CONCLUSION: These findings indicate that hyperthermic PT provides neuroprotective benefits on HI in the developing brain. Also, these findings suggest maternal hyperthermia may have protective effect on perinatal HI brain injuries.
Animals ; Anoxia ; Asphyxia ; Brain ; Brain Injuries ; Carotid Artery, Common ; Fever ; Humans ; Infant ; Infant Mortality ; Infant, Newborn ; Ischemia ; Ligation ; Oxygen ; Rats