Spinal epidural emphysema is rare and has been described secondary to following medical intervention, such as lumbar puncture and epidural analgesia, pneumothorax or pneumomediastinum, degenerative disk disease, epidural abscess, and trauma. Rarely, it occurs after chest tube placement. We report a case of spinal epidural emphysema incidentally noted on HRCT after chest tube placement.
Analgesia, Epidural ; Chest Tubes ; Emphysema ; Epidural Abscess ; Epidural Space ; Mediastinal Emphysema ; Pneumothorax ; Spinal Puncture ; Subcutaneous Emphysema ; Thorax ; Tomography, X-Ray Computed

OBJECTIVE: Invasive cancer cells penetrate the extracellular matrix(ECM), including basement membrane during the metastatic cascades. Matrix metalloproteinases(MMPs) play a critical role in tumor invasion and metastasis and their activities are regulated by specific tissue inhibitors of metalloproteinase(TIMPs). Aberrant ECM degradation in tumor biology is attributed to an imbalance in local MMP and TIMP activity, resulting in the overexpression or enhanced activation of MMPs or reduced TIMP expression. The aim of this study was to compare the MMP-2 & -9, TIMP-1 & -2 mRNA expression in cervical cancer with those in normal cervix and to investigate that their expression is related to cancer stages and other prognostic factors. METHODS: The normal cervix and cervical cancer tissues were obtained from healthy women(n=14), and the patients with cervical cancer(n=31), respectively. Total RNA was extracted and reverse transcribed into cDNA. The expression of MMP-2 & -9, TIMP-1 & -2 mRNA was examined by quantative competitive PCR(QC PCR) and each results were analyzed by t-test and univariate analysis. RESULTS: The expression of MMP-2, TIMP-1 mRNA in cervical cancer was higher than that in nomal cervix(p<0.05). The TIMP-2 mRNA expression was elevated in cervical cancer while that was not shown in normal cervix. The MMP-9 mRNA expression was not statistically different between normal cervix and cervical cancer(p>0.05). CONCLUSIONS: These results suggested that increased MMP-2, TIMP-1 & -2 mRNA expression is an early event during malignant transformation of cervical cancer.
Basement Membrane ; Biology ; Cervix Uteri ; DNA, Complementary ; Female ; Humans ; Matrix Metalloproteinase 2* ; Matrix Metalloproteinases ; Neoplasm Metastasis ; RNA ; RNA, Messenger* ; Tissue Inhibitor of Metalloproteinase-1* ; Tissue Inhibitor of Metalloproteinase-2 ; Uterine Cervical Neoplasms*

A pregnane steroid, 3α-hydroxy-pregn-7-ene-6,20-dione (1), was isolated from a Hydractinia-associated Cladosporium sphaerospermum SW67 by repetitive column chromatographic separation and highperformance liquid chromatography (HPLC) purification. The planar structure of 1 was elucidated from the analysis of the spectroscopic data (1D and 2D NMR spectra) and LC-MS data. The absolute configuration of 1 was determined by interpretation of ROESY spectrum of 1, together with the comparison of reported spectroscopic values in previous studies. To the best of our knowledge, this is the first report of the identification of the pregnane scaffold from C. sphaerospermum, a natural source. Compound 1 was evaluated for its effects on lipid metabolism and adipogenesis during adipocyte maturation and showed that compound 1 substantially inhibited lipid accumulation compared to the control. Consistently, the expression of the adipocyte marker gene (Adipsin) was reduced upon incubation with 1. Further, we evaluated the effects of 1 on lipid metabolism by measuring the transcription of lipolytic and lipogenic genes. The expression of the lipolytic gene ATGL was significantly elevated upon exposure to 1 during adipogenesis, whereas the expression of lipogenic genes FASN and SREBP1 was significantly reduced upon treatment with 1. Thus, our findings provide experimental evidence that the steroid derived from Hydractinia-associated C. sphaerospermum SW67 is a potential therapeutic agent for obesity.

Clearance of a difficult biliary stone can be obtained using various interventional techniques such as endoscopic sphincterotomy followed by endoscopic papillary large balloon dilation, mechanical lithotripsy, peroral cholangioscopy-assisted intraductal electrohydraulic/laser lithotripsy, temporary plastic stent insertion, percutaneous transhepatic cholangioscopy-guided lithotripsy, and extracorporeal shock wave lithotripsy. We hereby describe the successful endoscopic treatment using various currently available interventional techniques in a case with multiple difficult common bile duct stones. Furthermore, we discuss the countermeasures to overcome the hurdles of each procedure.

Peritonitis is one of the major complications of CAPD (continuous ambulatory peritoneal dialysis). Among its causative organisms, vancomycin-resistant enterococcus (VRE) is rare, but serious causative organism, because it is refractory to antibiotics commonly used for CAPD peritonitis. Some drugs such as linezolid and dalfopristin have been introduced for VRE infections nowadays, but reports about usefulness of those drugs in VRE peritonitis are rare. We experienced a case of CAPD peritonitis caused by VRE, which was treated successfully with removal of CAPD catheter and use of linezolid. We report our experience with review of the literature.
Anti-Bacterial Agents ; Catheters ; Enterococcus ; Humans ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Linezolid

BACKGROUND: Recently, many institutions have acquired multi-detector computed tomography (MDCT) systems. This made it easier and more convenient to use MDCT as a initial diagnostic modality for hemoptysis. The purpose of this study was to evaluate the usefulness of MDCT before bronchoscopy and/or bronchial arterial embolization (BAE) for hemoptysis. METHODS: We studied a total of 125 patients with hemoptysis who underwent, between 2006 and 2008, MDCT in a routine protocol before bronchoscopy and/or BAE. One hundred two patients underwent bronchoscopy and 29 patients underwent BAE. We compared the usefulness of MDCT and bronchoscopy for detecting the bleeding site and identifying the cause. We also evaluated our ability, using MDCT, to detect instances where the bronchial artery caused hemoptysis. RESULTS: The rate of detection of a bleeding site was 75.5% on MDCT and 50.9% on bronchoscopy. MDCT and bronchoscopy detected the bleeding site in agreement in 62.7% of patients. MDCT alone found the bleeding site in 27.5% of cases. MDCT identified the cause of hemoptysis in 77.5% and bronchoscopy in 11.8%. In 29 patients who underwent BAE, we detected a total of 37 hypertrophied bronchial arteries that were causing hemoptysis. Of 37 bronchial arteries, 23 (62.2%) were depicted on MDCT. CONCLUSION: MDCT is superior to bronchoscopy for detecting the bleeding site and identifying the cause of hemoptysis. MDCT can also predict the side of affected bronchial artery with depiction of hypertrophied bronchial artery and localizing the bleeding site. Doing MDCT before bronchoscopy and BAE can provide a guideline for the next step.
Bronchial Arteries ; Bronchoscopy ; Hemoptysis ; Hemorrhage ; Humans ; Tomography, X-Ray Computed

Iron supplements such as ferrous sulfate tablets are usually used to treat iron-deficiency anemia in some elderly patients with primary neurologic disorders or decreased gag reflexes due to stroke, senile dementia, or parkinsonism. While the aspiration of ferrous sulfate is rarely reported, it is a potentially life-threatening condition that can lead to airway necrosis and bronchial stenosis. A detailed history and high suspicion of aspiration are required to avoid delays in diagnosis and treatment. The diagnosis can be confirmed by bronchoscopic examination and a tissue biopsy. Early removal of the aspirated tablet prevents acute complications, such as bronchial necrosis, hemoptysis, and lobar consolidation. Tablet removal is also necessary to prevent late bronchial stenosis. We presented the first case in Korea of a ferrous sulfate tablet aspiration that induced severe endobronchial inflammation.
Aged ; Alzheimer Disease ; Anemia, Iron-Deficiency ; Biopsy ; Bronchi ; Bronchoscopy ; Constriction, Pathologic ; Diagnosis ; Foreign Bodies ; Hemoptysis ; Humans ; Inflammation* ; Iron ; Korea ; Necrosis ; Nervous System Diseases ; Parkinsonian Disorders ; Reflex ; Respiratory Aspiration ; Stroke ; Tablets

BACKGROUND: Henoch-Shnlein purpura is a systemic disease and has characteristic features of purpuric skin rash, abdominal pain, arthralgia and abnormal urinary findings and characterized by immunoglobulin A deposits in the involved organ. Renal involvement is the most important prognostic factor in Henoch-Shnlein purpura. METHODS: I retrospectively analyzed the clinical data of 48 patients with Henoch-Shoenlein purpura and 10 biopsy-proven Henoch-Schoenlein nephritis examined at Pusan National University Hospital. RESULTS: 23 cases were males and 25 cases females. Male to female ratio was 1:1.08. The peak of seasonal incidence was seen in spring (41.7%) and winter (27.1%) At presentation, skin purpura was present in 100% of patients, arthralgia was reported in 52.1% and gastrointestinal involvement in 70.8%. 75% of the patients showed renal involvement and pulmonary hemorrhage observed in 2 cases. Common types of skin rash were petechiae, purpura and erythematous maculopapular lesion on the lower extremities. The most common gastrointestinal symptom was abdominal pain (82.3%). Frequently involved joints were knee and ankle (48.0%). Renal involvement were microscopic hematuria (50.0%), proteinuria (50.0%), gross hematuria (29.2%). 25% of patients reached renal insufficiency (GFR<70 mL/min) and 4 cases (8.3%) reached acute renal failure (GFR<30 mL/min and anuria) and 3 patients of them experienced hemodialysis. All renal biopsies showed predominant IgA mesangial deposition. There were 2 cases of grade II, 6 cases of grade III and 2 cases of grade IV by classification of Meadow. Steroids were given in 16 patients (33.3%). Methylprednisolone pulse treatements were given in 4 patients for severe nephritis. 10 patients received angiotensin converting enzyme inhibitor. Clinical remission of extrarenal symptoms was achieved in 83.3% but relapses of purpura were observed in 27.1%. Clinical remissions of nephritis defined as the absence of proteinuria, hematuria and normal renal function was achieved in only 8.3%, Abnormal urinary finding continued in 37.8%. 8.3% of patients expired. CONCLUSION: Although it has been well known that Henoch-Shnlein purpura has benign courses, we experienced 4 case of deaths and The cause of death was acute renal faliure, pulmonary hemorrhage, adult respiratory distress syndrome, massive gastrointestinal bleeding, peritonitis due to bowel perforation.
Abdominal Pain ; Acute Kidney Injury ; Adult* ; Ankle ; Arthralgia ; Biopsy ; Busan ; Cause of Death ; Classification ; Exanthema ; Female ; Hematuria ; Hemorrhage ; Humans ; Immunoglobulin A ; Incidence ; Joints ; Knee ; Lower Extremity ; Male ; Methylprednisolone ; Nephritis ; Peptidyl-Dipeptidase A ; Peritonitis ; Proteinuria ; Purpura ; Purpura, Schoenlein-Henoch* ; Recurrence ; Renal Dialysis ; Renal Insufficiency ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Seasons ; Skin ; Steroids

OBJECTS: 99mTc-lactosylated human serum albumin (LSA) is a newly synthesized radiopharmaceutical that binds to asialoglycoprotein receptors, which are specifically presented on the hepatocyte membrane. Hepatic uptake and blood clearance of LSA were evaluated in rat with acute hepatic injury induced by dimethylnitrosamine (DMN) and results were compared with corresponding findings of liver enzyme profile and these of histologic changes. MATERIALS AND METHODS: DMN (27 mg/kg) was injected intraperitoneally in Sprague-Dawley rat to induce acute hepatic injury. At 3 (DMN-3), 8 (DMN-8), and 21 (DMN-21) days after injection of DMN, LSA injected intravenously, and dynamic images of the liver and heart were recorded for 30 minutes. Time-activity curves of the heart and liver were generated from regions of interest drawn over liver and heart area. Degree of hepatic uptake and blood clearance of LSA were evaluated with visual interpretation and semiquantitative analysis using parameters (receptor index : LHL3 and index of blood clearance : HH3), analysis of time-activity curve was also performed with curve fitting using Prism program. RESULTS: Visual assessment of LSA images revealed decreased hepatic uptake in DMN treated rat, compared to control group. In semiquantitative analysis, LHL3 was significantly lower in DMN treated rat group than control rat group (DMN-3: 0.842, DMN-8: 0.898, DMN-21: 0.91, Control: 0.96, p< 0.05), whereas HH3 was significantly higher than control rat group (DMN-3: 0.731, DMN-8: 0.654, DMN-21: 0.604, Control: 0.473, p< 0.05). AST and ALT were significantly higher in DMN-3 group than those of control group. Centrilobular necrosis and infiltration of inflammatory cells were most prominent in DMN-3 group, and were decreased over time. CONCLUSION: The degree of hepatic uptake of LSA was inversely correlated with liver transaminase and degree of histologic liver injury in rat with acute hepatic injury.
Animals ; Asialoglycoprotein Receptor ; Dimethylnitrosamine* ; Heart ; Hepatocytes ; Humans ; Liver* ; Membranes ; Necrosis ; Radionuclide Imaging* ; Rats* ; Rats, Sprague-Dawley ; Serum Albumin*