We experienced a case of submucosal gastric actinomycosis, presenting as bleeding. The 65-year-old woman had a symptom of epigastric pain, without any other intra-abdominal disease entity. A gastrofiberscopic study demonstrated a submucosal mass lesion with bleeding at the fundus. Because of the bleeding, laparotomy was undertaken, and a abscess containing a large mass was found at the gastric fundus, and total gastrectomy undertaken. Histological examination revealed a giant acute ulcer with a submucosal abscess due to actinomycosis. Because of its rarity, submucosal gastric actinomycosis is an entity overlooked by most surgeons. We report upon this case of submucosal gastric actinomycosis and include a review of the literature.
Female ; Humans

PURPOSE: Despite many reports on laparoscopic-assisted colectomies (LAC) over the past decade, the feasibility of their use in both benign and malignant disease of the colon is not clear. The purpose of this study was to evaluate the feasibility and safety of LAC for the treatment of colonic diseases. METHODS: Between April 2000 and August 2002, we attempted a laparoscopic-assisted colectomy in 95 patients (LAC group). We excluded 3 patients who had converted to open surgery. The surgical outcomes were compared with 92 matched patients who underwent conventional open surgery during the same period (open group), focusing on the results of the surgery, postoperative recovery, complications and oncologic clearance. Between the two groups, there were no significant differences in age, Dukes stage, and type of resection. RESULTS: There were 29 benign and 63 malignant diseases. The mean operating time for the LAC group and the open group were 167.9 and 95.1 minutes, respectively (P<0.00). However, the time taken for passing gas (40.4 hours vs 56.7 hours)(P=0.02) and the length of hospital stay (7.9 days vs 8.6 days) (P=0.07) were significantly shorter in the LAC group than in the open group. Nine patients in the LAC group had complications (9.7%): anastomotic site bleeding (4), chyle leakage (3), urinary retention (1), and ileus (1). All were treated conservatively. There were no differences in complication rates between the groups. The average number of harvested lymph nodes was 20.9 (2~64) in the LAC group and 21.5 (4~60) in the open group (P=0.49). The average distal resection margins were 3.7 (2.0~9.0) cm in the LAC group and 3.3 (1.0~5.0) cm in the open group (P=0.21) for an anterior resection and 3.2 (1.0~7.0) cm in the LAC group and 2.3 (0.7~7.0) cm in the open group for a low anterior resection (P=0.48). CONCLUSIONS: This study showed that LAC had an advantage over open surgery in terms of earlier recovery. Oncological clearance (the number of lymph nodes removed and the resection margins) did not differ between the two procedures. Thus, LAC is a feasible technique in the treatment of colon disease with acceptable morbidity. However, long-term data from a randomized trial is needed.
Case-Control Studies* ; Chyle ; Colectomy* ; Colon ; Colonic Diseases ; Hemorrhage ; Humans ; Ileus ; Length of Stay ; Lymph Nodes ; Retrospective Studies* ; Urinary Retention

A prominent cause of death in patients with advanced gastric cancer is peritoneal metastasis or recurrence. There is no definite preventive surgery or treatment in such cases. Cancer tissue is more heat labile than normal tissue, and the administration of anticancer drugs interacts synergically with hyperthermia. The ability of anticancer drugs to eradicate the malignant cells is dependent not only on the dose of the antineoplastic drug but also on the number of tumor cells. Therefore, for success, the combination therapy of cytoreductive surgery and IPHC may be necessary in advanced gastric cancer. We performed this study to evaluate the toxicity and the clinical efficacy of IPHC in far-advanced gastric cancer and to assess the concentration of CDDP. Twenty one patients (11 females and 10 males) with gross serosal invasion (with or without peritoneal metastasis) underwent cytoreductive surgery and were treated with IPHC via hyperex-GHT-cpl (Green Cross Med. Corp. Korea) before closure of the abdominal wound. The IPHC was done using CDDP (200~400 mg/m2) and MMC (30~50 mg/m2) with 10 liters of normal saline as the perfusate. The peritoneal temperature during the IPHC was maintained at 42oC for 60 minutes. We used a modified peritoneal cavity expander to achieve free flow of the perfusate. The concentrations of the plasma and the perfusate were measured by atomic absorption spectrometry (Varian 300 A). Sixteen patients were stage IV, 3 were IIIb, and 2 were IIIa. The plasma concentraton of CDDP was 1.8 ug/ml at 10 minutes after perfusion and reached a maximal concentration (MXC) of 3.6 ug/ml. The area under the time-concentration curve (AUC) of the plasma at the 48th hour after perfusion was 3031.1 ug.min/ml. At the 24th hour, the maximum concentration of CDDP in the perfusate was 16.2 ug/ml. The AUC of the perfusate was 1703.3 ug min/ml at the 24th hour and 1817.7 ug min/ml at the 48th hour. The ratio of AUC of perfusate and the AUC of the plasma were 0.92 at the 24th hour and 0.59 at the 48th hour. The postoperative compllications were lymphatic leakage (2), pneumonia (1), and paralytic ileus (1). The most common drug-related complications of IPHC were anemia (WHO grade I), hematuria, leukopenia, jaundice, and thrombocytopenia in such order. These side effects were eliminated by conservative treatment within 4 weeks postoperatively. We could not determine the long term survival rate because of the short follow up period. However, the mean survival of the cases was about 12.0 months. The three deaths among the resected cases were due to extraperitoneal recurrences. The combination therapy of IPHC and cytoreductive is available for clinical use with a high AUC, high intraperitoneal CDDP concentration with a reasonable plasma concentration and has no threatening complications or mortality.
Absorption ; Anemia ; Area Under Curve ; Cause of Death ; Female ; Fever ; Follow-Up Studies ; Hematuria ; Hot Temperature ; Humans ; Intestinal Pseudo-Obstruction ; Jaundice ; Leukopenia ; Mortality ; Neoplasm Metastasis ; Perfusion ; Peritoneal Cavity ; Plasma ; Pneumonia ; Recurrence ; Spectrum Analysis ; Stomach Neoplasms* ; Survival Rate ; Thrombocytopenia ; Wounds and Injuries

PURPOSE: Nitric oxide (NO) exerts the relaxant effect in vascular smooth muscle cells (VSMC) by activating soluble guanylate cyclase (sGC), which produces cyclic guanidine monophosphate (cGMP) in the cell. This study was undertaken to investigate the mechanism of the inhibitory actions of sGC inhibitors, LY 83583 and methylene blue in the VSMC. METHODS: VSMC was primarily cultured from rat aorta and confirmed by immunocytochemistry of anti-smooth muscle myosin antibody. Bacterial lipopolysacchride (LPS), an inducer of inducible nitric oxide synthase (iNOS) and sodium nitroprusside (SNP), an NO donor, were uesd to increase NO within VSMC. The changes in concentrations of nitrite in culture media by an addition of LPS or SNP with a pretreatment of LY 83583 or methylene blue were measured by the spectrophotometry with griess regent and absorbance at 550 nm. Western blot and RT-PCR for iNOS and iNOS mRNA, respectively were performed. RESULTS: LPS and SNP increased nitrite concentration. LY 83583 potentiated the increase in nitrite concentration by LPS and SNP. LY 83583 also increased expressions of iNOS protein and mRNA induced by LPS. Methylene blue has no effect on nitrite concentration increased by LPS or SNP, and it did not affect the expressions of iNOS protein or mRNA induced by LPS. CONCLUSION: These results suggest that the mechanism of inhibitory actions of LY83583 and methylene blue on sGC are different each other: LY83583 interferes the interaction of sGC and NO resulting positive feedback increase in iNOS gene expression, but methylene blue eliminates NO from cytosol inducing no compensatory effect.
Animals ; Aorta ; Blotting, Western ; Culture Media ; Cytosol ; Gene Expression ; Guanidine ; Guanylate Cyclase* ; Humans ; Immunohistochemistry ; Methylene Blue ; Muscle, Smooth, Vascular* ; Myosins ; Nitric Oxide ; Nitric Oxide Synthase Type II ; Nitroprusside ; Rats ; RNA, Messenger ; Spectrophotometry ; Tissue Donors

As an effort to develop a rapid and sensitive diagnostic test, we produced previously a monoclonal antibody (MAb) specific to the lipoarabinomannan (LAM) antigen and used in a sandwich ELISA for detection of mycobacterial antigens in sputum. In this study, we attempted to improve the antigen detection assay by combination of af5nity-purified antibodies against Mycobacterium tuberculosis soluble antigen and anti-LAM MAb. With the new assay, the LAM antigen was detectable as low as 2 ng/ml, and none of 10 gram-negative and gram-positive organisms gave significant absorbance, thus indicating the specific detection of mycobacterial antigens. Sputum samples from 62 patients who were suspected having tuberculosis and from 37 healthy controls were examined. The sensitivity of the antigen detection assay ranged from 0% in the 1+ culture group to 78.8% in the 3+ culture group. When the results were combined, 15 of 24 culture-positive samples were antigen-positive, thus giving an overall sensitivity of 62.5%. The overall specificity was 96.0%, when all the culture-negative samples were combined. The results thus demonstrate that the antigen detection assay can provide a rapid supplemental information for the diagnosis of pulmonary diagnosis.
Antibodies ; Diagnosis* ; Diagnostic Tests, Routine ; Enzyme-Linked Immunosorbent Assay ; Humans ; Mycobacterium tuberculosis* ; Mycobacterium* ; Sensitivity and Specificity ; Sputum* ; Tuberculosis ; Tuberculosis, Pulmonary*

PURPOSE: A nasolabial cyst is a rare non-odontogenic, soft-tissue, developmental cyst arising anywhere on the face inferior to the nasoalar region. It is thought to arise from either epithelial remnants trapped along the lines of fusion during the development of face or the remnants of the developing nasolacrimal duct. This study examines various features of nasolabial cysts with bony involvement to provide a basis for correct diagnosis and treatment. METHODS: Eight cases of nasolabial cyst treated in Soonchunhyang Hospital between March 2002 and July 2010 were examined in terms of their clinical features and radiological and histological findings. Seven patients underwent surgical excision of the cyst via an intraoral, sublabial approach. One underwent incision and drainage. RESULTS: Our eight patients were seven women and one man. The most frequent symptoms and signs were facial deformity and swelling of the nasolabial fold. Computed tomography(CT) showed a well-circumscribed cystic mass lateral to the pyriform aperture. Seven cases had erosive lesions on CT, and the intraoperative findings were consistent with a nasolabial cyst with a bony defect. Typical histopathological findings showed that these cysts were most frequently lined with respiratory epithelium with ciliated columnar cells and cuboid cells. No patient developed complications or recurrences. CONCLUSION: A nasolabial cyst is often unrecognized or confused with other intranasal masses, including fissural and odontogenic cysts, midface infections, or swelling in the nasolabial area. Therefore, a careful clinical and radiological evaluation should be preformed when considering the differential diagnosis. We present eight patients with nasolabial cysts treated via a gingivobuccal approach with excellent functional and cosmetic results.
Congenital Abnormalities ; Cosmetics ; Diagnosis, Differential ; Female ; Humans ; Nasolabial Fold ; Nasolacrimal Duct ; Odontogenic Cysts ; Respiratory Mucosa

The transforming growth factor-beta 1 was known as having the most important influence on chondrocytes among various growth factors, being abundant in articular chondrocytes and osteocytes. We performed in vitro monolayer cultures of human articular chondrocytes from normal and osteoarthritic patients and studied the transforming growth factor-beta 1 responsiveness of those chondrocytes. The cell-growth curve indicated that the primary osteoarthritic chondrocyte culture with transforming growth factor-beta 1 showed a more rapid growth pattern than normal chondrocytes with or without TGF-beta 1 and osteoarthritic chondrocytes without TGF-beta 1. The osteoarthritic group showed a sharp decline in growth pattern with subsequent culture. The shape of osteoarthritic chondrocytes was bigger and more bizarre compared to those of normal chondrocytes. With subsequent culture, this change became prominent. The transforming growth factor-beta 1 increased the [3H]-TdR uptake in each group. The phenotypes of chondrocytes were more clearly expressed in the normal group. The chondrocytes lost their phenotype (production of collagen type II) following subculture in each group. The transforming growth factor-beta 1 could not inhibit or delay the dedifferentiation process (loss of phenotype).
Cartilage, Articular/drug effects* ; Cartilage, Articular/cytology ; Cell Division/drug effects ; Cells, Cultured ; Human ; Osteoarthritis/pathology ; Reference Values ; Transforming Growth Factor beta/pharmacology*

As the number of people vaccinated increases, people who complain of adverse reactions continue to occur. We experienced a case characterized by low blood pressure, persistent fever, edema due to increased systemic vascular permeability, and systemic inflammation confirmed by image and laboratory examinations after ChAdOx1 coronavirus disease 2019 (COVID-19) vaccination. The diagnostic criteria for multisystem inflammatory syndrome (MIS) in adults are known as fever of 3 days or more in adults, 2 or more mucocutaneous/ gastrointestinaleurologic symptoms, elevation of inflammatory markers, and clinical/ imaging diagnosis of heart failure. A 67-year-old man who was medicated for hypertension and diabetes was admitted complaining of fever, maculopapular rash, diarrhea, headache, chills, and dizziness 6 days after the first vaccination of ChAdOx1 nCoV-19 in Korea.The COVID-19 test was negative but with low blood pressure, leukocytosis, skin rash, pulmonary edema, and increased inflammation markers. His lab findings and clinical course were consistent with those of MIS after COVID-19 vaccination. He was medicated with methylprednisolone 1 mg/kg and diuretics and recovered rapidly. He was discharged after 2 weeks and confirmed cure at outpatient clinic. We report an MIS case after COVID-19 vaccination in Korea.

OBJECTIVE: To observe the difference in telomerase activity (TA) expression in the placenta between fetal growth restriction (FGR) with preeclampsia and those without and to evaluate the effect of oxygen concentration on the TA expression in the trophoblastic cells. METHODS: Telomerase activity was measured in 48 (normal pregnancies, 16; preeclampsia with FGR, 15; normotensive FGR, 17) placentas which were obtained between 32 and 41 weeks' gestations. Trophoblastic cells were extracted from 8 chorionic villi samples obtained from 8-10 weeks' placenta and were cultured in either 2%, 8%, and 20% oxygen atmosphere. Then TA was examined by using telomeric repeat amplification protocol (TRAP) assay. RESULTS: During 3rd trimester of pregnancy, exhibited TA expression in normal pregnancy, FGR complicated by preeclampsia, and normotensive FGR groups were 11 of 16 (68.8%), 4 of 15 (26.7%), and 4 of 17 (23.5%), respectively. Significantly lower level of TA was detected in the FGR group compared to the normal pregnancies (p=0.009), whereas within FGR pregnancies, presence of preeclampsia did not seem to have statistically significant effect on TA expression. TA expression levels were measured by optical density in trophoblasts cultured under various oxygen concentration which revealed that significantly higher TA was exhibited in the cells cultured in 2% oxygen compared to 8% and 20% (p<0.001). However no significant difference was noted in TA between cells cultured in 8% and 20% oxygen. CONCLUSION: Decreased TA in the placenta from pregnancies with FGR was noted regardless of presence of preeclampsia indicating a probable correlation between FGR and placental senescence. Since increased TA was noted in trophoblastic cells that were cultured in hypoxic condition, we could speculate that the intervillous oxygen tension during early-stage placental development plays a certain role in the placental degeneration in pregnancies complicated by FGR and preeclampsia.
Aging ; Anoxia* ; Atmosphere ; Chorionic Villi ; Fetal Development* ; Oxygen ; Placenta ; Placentation ; Pre-Eclampsia ; Pregnancy* ; Telomerase* ; Trophoblasts

BACKGROUND: The pathophysiologic mechanism of the neuropathic pain is still unclear. We designed this study to evaluate the effect of bilateral cervical sympathectomy on allodynia and the relationship of neuropathic pain with sympathetic nerve system of supraspinal level in rats experiencing neuropathic pain. METHODS: Neuropathic pain was produced by tight ligating the left 5th and 6th lumbar spinal nerves of male Sprague-Dawley rats. Mechanical allodynia was quantified by measuring the foot withdrawal frequency to stimuli with two von Frey filaments of 14.5 mN and 53.9 mN applied to the affected left hind paw, and cold allodynia was quantified with the same manner using 100% acetone. We divided the neuropathic pain models into experimental group (bilateral cervical sympathectomy) and control group (sham operation), and then measured the foot withdrawal frequency 1, 3, 5, 7, 14, 21 and 28 days postoperatively. RESULTS: In experimental group, the foot withdrawal frequency to mechanical stimuli with 14.5 and 53.9 mN of von Frey filament and cold stimuli with 100% acetone was significantly lower than that of control group for all postoperative observation points. Also, the experimental group showed decrease in foot withdrawal frequency compared with preoprative value over the course of the study. CONCLUSIONS: Bilateral cervical sympathectomy reduced mechanical allodynia and cold allodynia in the rat model of neuropathic pain suggesting that neuropathic pain, although the lesions are localized in low extremities, may be correlated with functional disturbance of sympathetic nerve fibers of supraspinal or brain level and help explain the mechanism of neuropathic pain.
Acetone ; Animals ; Brain ; Extremities ; Foot ; Humans ; Hyperalgesia* ; Male ; Models, Animal* ; Nerve Fibers ; Neuralgia* ; Rats* ; Rats, Sprague-Dawley ; Spinal Nerves ; Sympathectomy*