We introduce a rare case of gastric emphysema. A 68-year-old man presented with vomiting and dyspnea. Simple abdominal X-ray and CT showed marked dilatation of the stomach and abnormal intramural gas consistent with gastric emphysema. We performed gastric decompression via nasogastric tube drainage and parenteral nutritional support. Nine days after admission, the abnormal intramural gas had disappeared on follow-up CT. The acute gastric dilatation in this patient may have resulted from gastric hypomotility as a result of diabetic gastroparesis in addition to superior mesenteric artery syndrome resulting from malnutrition.
Aged ; Decompression ; Dilatation ; Drainage ; Dyspnea ; Emphysema ; Follow-Up Studies ; Gastric Dilatation ; Gastric Outlet Obstruction ; Gastroparesis ; Humans ; Malnutrition ; Mesenteric Artery, Superior ; Nutritional Support ; Stomach ; Superior Mesenteric Artery Syndrome ; Vomiting

Genipin, an aglycone derived from geniposide found in Gardenia jasminoides, is known to be an excellent natural cross-linker, strong apoptosis inducer, and antiviral agent. Although evidence suggests antiviral activity of genipin in several in vitro viral infection systems, there have been few literatures which review antitumor effects of genipin in a variety of in vitro/in vivo models of cancers yet. In this review, we present some of the latest findings in the studies of genipin focusing on antitumor effects and its mechanisms. In brief, genipin inhibits mitochondrial uncoupling protein 2 to increase accumulation of reactive oxygen species, leading to ROS/c-Jun N-terminal kinase-dependent apoptosis of cancer cells. Genipin also increase tissue inhibitors of metalloproteases (MMP), resulting to decrease activities of MMP-2 which plays a key role in metastasis of cancers. Genipin has shown a biphasic effects on cell death and survival in cancer cells as many other plant-derived phytochemicals do. Finally we discuss the potential of genipin as a promosing novel antitumor agent which could be applicable to chemotherapy and/or chemoprevention for cancers.
Apoptosis ; Cell Death ; Chemoprevention ; Drug Therapy ; Gardenia ; In Vitro Techniques ; Metalloproteases ; Neoplasm Metastasis ; Phytochemicals ; Reactive Oxygen Species

Human infection by Rhodococcus species is rare and mostly limited to immunocompromised hosts such as patients infected with the human immunodeficiency virus (HIV) or organ transplant recipients. The most common strain is R. equi, and the most common clinical presentation is pulmonary infection, reported in 80% of Rhodococcus spp. infections. The central nervous system is an uncommon infection site. We report a case of a patient with pneumonia, brain abscess, and recurrent meningitis caused by Rhodococcus spp. He initially presented with pneumonia with necrosis, which progressed to brain abscess and recurrent meningitis. Rhodococcus spp. was identified from the cerobrospinal fluid (CSF) collected during his fourth hospital admission. Despite prolonged treatment with appropriate antibiotics, meningitis recurred three times. Finally, in order to administer antibiotics directly into the CSF and bypass the blood-brain barrier, an Ommaya reservoir was inserted for administration of 90 days of intrathecal vancomycin and amikacin in conjunction with intravenous and oral antibiotics; the patient was finally cured with this treatment regimen.
Amikacin ; Anti-Bacterial Agents ; Blood-Brain Barrier ; Brain Abscess ; Central Nervous System ; HIV ; Humans ; Immunocompromised Host ; Injections, Spinal* ; Meningitis* ; Necrosis ; Pneumonia ; Rhodococcus* ; Transplants ; Vancomycin*

Human herpes virus-8 (HHV-8)-negative primary effusion lymphoma (PEL) is frequently observed in patients with chronic liver disease. We describe herein a case of PEL in a patient with chronic kidney disease. A 59-year-old woman presented with dyspnea. The patient had a history of uncontrolled pleural effusion. The pleural effusion revealed a malignant cell-dominant exudate. Serological tests were negative for human immunodeficiency virus (HIV). Initial chest and abdomen computed tomography showed bilateral pleural effusion; however, no evidence of a tumor mass or lymph node enlargement was found. A malignant lymphoma of diffuse large B-cell type was confirmed by pleural fluid cytology. Immunohistochemical staining of malignant cells was negative for HHV-8. She was treated with rituximab and CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone) chemotherapy. We report a case of PEL in a patient with chronic kidney disease that may be a plausible predisposing factor for HHV-8-negative PEL.
Abdomen ; Antibodies, Monoclonal, Murine-Derived ; B-Lymphocytes ; Doxorubicin ; Dyspnea ; Exudates and Transudates ; Female ; Herpesvirus 8, Human ; HIV ; Humans ; Liver Diseases ; Lymph Nodes ; Lymphoma ; Lymphoma, Primary Effusion ; Middle Aged ; Pleural Effusion ; Renal Insufficiency, Chronic ; Serologic Tests ; Thorax ; Vincristine ; Rituximab

A 53-year-old woman had a 1.7 cm left adrenal mass on an abdominal computed tomography (CT) scan. She presented with paroxysmal headache, palpitation, sweating, and hypertension. The patient was highly suspected of having a pheochromocytoma, but measurements of 24-hour urinary metanephrine, catecholamines, and vanillylmandelic acid were normal. Plasma and urine catecholamine levels were within the normal range even during paroxysmal episodes. A scintigraphic study with 131I-metaiodobenzylguanidine (MIBG) revealed selective concentration of the radiotracer, corresponding to the CT mass. The patient underwent a left adrenalectomy and the pathological examination confirmed the diagnosis of pheochromocytoma. In this report, we describe a rare case of a symptomatic pheochromocytoma with normal catecholamine levels. Our case illustrates that routine nuclear scintigraphy, such as 131I-MIBG, should be performed even in cases with normal hormonal testing for all patients with high clinical suspicion of pheochromocytoma.
3-Iodobenzylguanidine ; Adrenalectomy ; Catecholamines ; Female ; Headache ; Humans ; Hypertension ; Metanephrine ; Middle Aged ; Pheochromocytoma ; Plasma ; Reference Values ; Sweat ; Sweating ; Vanilmandelic Acid