No abstract available.
Respiratory Insufficiency* ; Ventilators, Mechanical* ; Weaning*

Behcet's disease was originally described as a triple symptom complex of oral aphthous ulceration, genital ulceration, and hypopyon iritis. It is now known to have a wide systemic manifestations. Among them, the central nervous system involvement should be diagnosed earlier because of it's lethal potential. Recently the authors experienced a case of Behcet's disease with CNS involvement. A 51-year-old female patient was admitted due to deterioration of mentality and generalized ache since 2 years prior to admission. The findings on physical examination were compatible with Behcet's disease, but without cerebrospinal pleocytosis. The manifestations were improved with medications of prednisolone, chlorambucil, colchicines, but relapsed relapsed 2 months later during subsequent tapering of prednisolone and chlorambucil. The patient is now on medication again. A case of Behcet's disease with CNS manifestations is reported with review of literature.
Behcet Syndrome ; Central Nervous System ; Chlorambucil ; Female ; Humans ; Iritis ; Leukocytosis ; Middle Aged ; Physical Examination ; Prednisolone ; Stomatitis, Aphthous ; Ulcer

BACKGROUND: The purpose is to determine the efficacy of additional intravenous patient-controlled analgesia (IV-PCA) by comparing the analgesic effects between interscalene block (ISB) combined with IV-PCA and single ISB after arthroscopic shoulder surgery. METHODS: A total of 213 patients who underwent arthroscopic shoulder surgery were divided into two groups based on the type of perioperative anesthesia. The single ISB group included 100 patients, while the IV-PCA group included 113 patients. The visual analogue scale for pain (VAS pain) scores were assessed at 12, 24, and 48 hours postoperatively in accordance with shoulder pathology. Postoperative narcotics-related complications and consumption of additional non-steroidal anti-inflammatory drugs between the two groups were compared. RESULTS: VAS pain showed no significant difference between the two groups at most points of the postoperative timeline, regardless of shoulder pathology, except in patients with rotator cuff repair at postoperative 24 hours. Although the IV-PCA group showed a statistically lower VAS pain score than the ISB group at postoperative 24 hours (p=0.04), the difference in the VAS pain score was only 9.0 mm in patients with rotator cuff repair. Narcotics-related complications were observed more frequently in the IV-PCA group than in the ISB group for patients with rotator cuff repair. CONCLUSIONS: Additional IV-PCA demonstrated no booster effect for immediate pain control in patients undergoing arthroscopic shoulder surgery with preoperative single ISB. Furthermore, patients with IV-PCA experienced greater narcotics-related complications.
Analgesia ; Analgesia, Patient-Controlled* ; Anesthesia ; Arthroscopy ; Humans ; Pathology ; Prospective Studies* ; Rotator Cuff ; Shoulder*

The enteric protozoan parasite Entamoeba histolytica is the causative agent of human amebiasis. During infection, adherence of E. histolytica through Gal/GalNAc lectin on the surface of the amoeba can induce caspase-3-dependent or -independent host cell death. Phosphorylinositol 3-kinase (PI3K) and protein kinase C (PKC) in E. histolytica play an important function in the adhesion, killing, or phagocytosis of target cells. In this study, we examined the role of amoebic PI3K and PKC in amoeba-induced apoptotic cell death in Jurkat T cells. When Jurkat T cells were incubated with E. histolytica trophozoites, phosphatidylserine (PS) externalization and DNA fragmentation in Jurkat cells were markedly increased compared to those of cells incubated with medium alone. However, when amoebae were pretreated with a PI3K inhibitor, wortmannin before being incubated with E. histolytica, E. histolytica-induced PS externalization and DNA fragmentation in Jurkat cells were significantly reduced compared to results for amoebae pretreated with DMSO. In addition, pretreatment of amoebae with a PKC inhibitor, staurosporine strongly inhibited Jurkat T cell death. However, E. histolytica-induced cleavage of caspase-3, -6, and -7 were not inhibited by pretreatment of amoebae with wortmannin or staurosporin. In addition, we found that amoebic PI3K and PKC have an important role on amoeba adhesion to host compartment. These results suggest that amebic PI3K and PKC activation may play an important role in caspase-independent cell death in Entamoeba-induced apoptosis.
*Apoptosis ; Caspases/metabolism ; Entamoeba histolytica/*enzymology/*growth & development ; Humans ; Hydrolysis ; Jurkat Cells ; Phosphatidylinositol 3-Kinases/*metabolism ; Protein Kinase C/*metabolism ; T-Lymphocytes/*parasitology/*physiology

Entamoeba histolytica is a tissue-invasive protozoan parasite causing dysentery in humans. During infection of colonic tissues, amoebic trophozoites are able to kill host cells via apoptosis or necrosis, both of which trigger IL-8-mediated acute inflammatory responses. However, the signaling pathways involved in host cell death induced by E. histolytica have not yet been fully defined. In this study, we examined whether calpain plays a role in the cleavage of pro-survival transcription factors during cell death of colonic epithelial cells, induced by live E. histolytica trophozoites. Incubation with amoebic trophozoites induced activation of m-calpain in a time- and dose-dependent manner. Moreover, incubation with amoebae resulted in marked degradation of STAT proteins (STAT3 and STAT5) and NF-kappaB (p65) in Caco-2 cells. However, IkappaB, an inhibitor of NF-kappaB, was not cleaved in Caco-2 cells following adherence of E. histolytica. Entamoeba-induced cleavage of STAT proteins and NF-kappaB was partially inhibited by pretreatment of cells with a cell-permeable calpain inhibitor, calpeptin. In contrast, E. histolytica did not induce cleavage of caspase-3 in Caco-2 cells. Furthermore, pretreatment of Caco-2 cells with a calpain inhibitor, calpeptin (but not the pan-caspase inhibitor, z-VAD-fmk) or m-calpain siRNA partially reduced Entamoeba-induced DNA fragmentation in Caco-2 cells. These results suggest that calpain plays an important role in E. histolytica-induced degradation of NF-kappaB and STATs in colonic epithelial cells, which ultimately accelerates cell death.
Caco-2 Cells ; Calcium-Binding Proteins ; Calpain/genetics/metabolism ; Caspase 3/genetics/metabolism ; Caspases ; *Cell Death ; Colon/cytology ; Entamoeba histolytica/*physiology ; Epithelial Cells/cytology/parasitology ; Humans ; I-kappa B Proteins/metabolism ; Intestinal Mucosa/cytology ; NF-kappa B/genetics/*metabolism ; RNA Interference ; RNA, Small Interfering ; STAT3 Transcription Factor/genetics/*metabolism ; STAT5 Transcription Factor/genetics/*metabolism ; Signal Transduction

Public attitudes and awareness toward epilepsy were surveyed in Kwang-ju area. A representative population of 587 persons aged over 18 years was selected in a systematic sampling procedure from the Kwang-ju telephone directory published in 1991. The social background of the respondents did not deviated significantly from that of the general population in this age range. The questionnaire consisted of 34 guestions designed to determine the respondent's social background, acquaintance with epileptic patients, awareness of epilepsy, and opinions and attitudes about the disorder. The result from this survey was as follows; 1) The prejudice and misunderstanding toward epilepsy in our society were much more serious than those in other societies reviewed in this study, which may be due to our own peculiar cultural background. 2) Although social discrimination against persons with epilepsy was due mainly to social stigma on epilepsy based on extra-ordinary misunderstanding of people, a very passive and pessimistic attitude of the patient himself may be contributed to it considerably. 3) Even if the epileptic seizure was well controlled with appropriate antiepileptic drugs, the social attitude toward occupational activity of persons with epilepsy was very negative. 4) The negative attitude toward epilepsy in our society was closely correlated to the level of education and age of respondents; the older or less educated they were, the more objections they had.
Anticonvulsants ; Surveys and Questionnaires ; Education ; Epilepsy* ; Gwangju* ; Humans ; Prejudice ; Social Discrimination ; Social Stigma ; Telephone

OBJECTIVE: To determine the incidence of peripheral neuropathy occurring in post-acute spinal cord injury patients. METHOD: We retrospectively reviewed the distribution of involved nerves in 94 spinal cord injury patients (men: 77, mean age: 45.2 years) who underwent electrodiagnostic studies at an early stage of rehabilitative therapy between March 1999 and June 2007 and looked for the existence of peripheral neuropathy according to the injured area (cervical/ thoracolumbar cord). RESULTS: The incidence of peripheral neuropathy observed on electrodiagnostic studies was 38.3% (36/94). Twenty-one (46.7%) of 45 patients with injured cervical cords exhibited peripheral neuropathy, and 15 (30.6%) of 49 thoracolumbar cord injury patients exhibited peripheral neuropathy; hence, tetraplegia had a higher incidence. The most commonly involved nerve was the peroneal nerve (24 cases), followed by the median nerve (9 cases) and the ulnar nerve (9 cases). CONCLUSION: The incidence of peripheral neuropathy observed in electrodiagnostic studies was high in spinal cord injury patients at the initiation of intensive rehabilitative therapy. The incidence of peripheral neuropathy in cervical cord injury patients was higher than that seen in thoracolumbar injury patients. Active education and training concerning appropriate bed positioning are necessary for spinal cord injury patients at an early stage after injury to prevent peripheral neuropathy.
Electrodiagnosis ; Humans ; Incidence ; Median Nerve ; Peripheral Nervous System Diseases ; Peroneal Nerve ; Quadriplegia ; Retrospective Studies ; Spinal Cord Injuries ; Ulnar Nerve

Mechanical obstruction of the common hepatic duct includes the following causes; choledocholithiasis, sclerosis, cholangitis, pancreatic carcinoma, cholangiocarcinoma, postoperative stricture, primary hepatic duct carcinoma, enlarged cystic duct lymph nodes, and metastatic nodal involvement of the porta hepatis. Partial mechanical obstruction of the common hepatic duct caused by impaction of stones and inflammation surrounding the vicinity of the neck of the gallbladder had been reported on the “syndrome del conducto hepatico” in 1948 by Mirizzi. Nowadays, this disease was named by Mirizzi syndrome. Mrizzi syndrome is a rare entity of common hepatic duct obstruction that results from an inflammatory response secondary to a gallstone impacted in the cystic duct or neck of the gallbladder. It results from an almost parallel course and low insertion of the cystic duct into the common hepatic duct. In a variant of Mirizzi's syndrome, the cause of the common hepatic duct obstruction was a primary cystic duct carcinoma rather than gallstone disease. A 71-year-old man was admitted with a four-day history of right upper quadrant abdominal pain. Past medical history was unremarkable. On physical examination, the patient had a temperature of 38℃, icteric sclera and right upper quadrant tenderness. Pertinent laboratory findings included WBC 18,000/cm3; albumin 2.6 g/dl (normal 0-1) with the direct bilirubin, 4.4 mg/dl (normal 0-0.4). Ultrasonography revealed a dilated extrahepatic biliary tree. ERCP showed that the superior margin was angular and more consistent with a calculus causing partial CHD obstruction (Mirizzi syndrome). At surgery a diseased gallbladder containing calculi was found. In addition, there was two calculi partially eroding through the proximal portion of the cystic duct and compressing the common hepatic duct. A cholecystectomy and excision of common bile duct was performed, with Roux-en-Y hepaticojejunostomy. The postoperative course was uneventful.
Abdominal Pain ; Aged ; Biliary Tract ; Bilirubin ; Calculi ; Cholangiocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystectomy ; Choledocholithiasis ; Common Bile Duct ; Constriction, Pathologic ; Cystic Duct ; Cytochrome P-450 CYP1A1 ; Gallbladder ; Gallstones ; Hepatic Duct, Common ; Humans ; Inflammation ; Jaundice, Obstructive ; Lymph Nodes ; Mirizzi Syndrome* ; Neck ; Physical Examination ; Sclera ; Sclerosis ; Ultrasonography

No abstract available.
Animals ; Rats* ; Reperfusion*

Acute coronary syndrome (ACS) represents a broad spectrum of ischemic myocardial events, including unstable angina, non-ST elevation myocardial infarction, and acute ST elevation myocardial infarction, which are associated with high morbidity and mortality. Early diagnosis and risk stratification are essential for initiation of optimal medical and invasive management. Randomized clinical trials over the past decade have revolutionized the care of patients with ACS. Therapeutic measures consist of administration of aggressive antiplatelet, antithrombotic, and antiischemic agents. In addition, patients with high-risk features, notably positive troponin, ST segment changes, and diabetes, benefit from early invasive intervention as compared to conservative strategies. Lifestyle interventions, modification of risk factor profile, and long-term medical treatment are of pivotal importance in reducing the long-term risk of recurrence.
Acute Coronary Syndrome ; Angina, Unstable ; Anticoagulants ; Early Diagnosis ; Humans ; Life Style ; Myocardial Infarction ; Platelet Aggregation Inhibitors ; Recurrence ; Risk Factors ; Secondary Prevention ; Troponin