Langerhans cell histiocytosis (LCH) is reported less frequently in adults than in children. The most common site of involvement in adults is the bone, accounting for 30-50% of cases. The gastrointestinal tract is very rare, accounting for approximately 2%. We present a case of Langerhans cell histiocytosis that simultaneously invaded multiple organs, including the stomach and colon, in an adult. A 37-year-old woman with no underlying disease complained of chest discomfort and a palpable right submandibular mass. A right Level II neck mass and mediastinal LN enlargement were confirmed on the pharynx and chest CT scan. Multiple subepithelial masses with central ulceration and erosion were observed in the corpus and fundus on the esophagogastroduodenoscopy and in the right colon on the colonoscopy. The histopathology findings were the same in each tissue biopsied from the stomach, colon, and right neck lymph nodes. Langerhans cells with classical reniform nuclei and prominent eosinophils invaded the normal glands, and S100 and CD1a were positive in the immunohistochemical stain. Gastrointestinal involvement of LCH in adults is rare, asymptomatic,and can involve multiple digestive organs simultaneously, so upper endoscopy and colonoscopy should be considered for a diagnosis.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 not yet has established its treatment, but convalescent plasma has been expected to increase survival rates as in the case with other emerging viral infections. We describe two cases of COVID-19 treated with convalescent plasma infusion. Both patients presented severe pneumonia with acute respiratory distress syndrome and showed a favorable outcome after the use of convalescent plasma in addition to systemic corticosteroid. To our knowledge, this is the first report of the use of convalescent plasma therapy for COVID-19 in Korea.

BACKGROUND: Because conventional echocardiographic parameters have several limitations, strain echocardiography has often been introduced in clinical practice. However, there are also obstacles in using it in clinical practice. Therefore, we wanted to find the current status of awareness on using strain echocardiography in Korea. METHODS: We conducted a nationwide survey to evaluate current use and awareness of strain echocardiography from the members of the Korean Society of Echocardiography. RESULTS: We gathered total 321 questionnaires from 25 cardiology centers in Korea. All participants were able to perform or interpret echocardiographic examinations. All participating institutions performed strain echocardiography. Most of our study participants (97%) were aware of speckle tracking echocardiography and 185 (58%) performed it for clinical and research purposes. Two-dimensional strain echocardiography was the most commonly used modality and left ventricle (LV) was the most commonly used cardiac chamber (99%) for clinical purposes. Most of the participants (89%) did not think LV strain can replace LV ejection fraction (LVEF) in their clinical practice. The common reasons for not performing routine use of strain echocardiography was diversity of strain measurements and lack of normal reference value. Many participants had a favorable view of the future of strain echocardiography. CONCLUSION: Most of our study participants were aware of strain echocardiography, and all institutions performed strain echocardiography for clinical and research purposes. However, they did not think the LV strain values could replace LVEF. The diversity of strain measurements and lack of normal reference values were common reasons for not using strain echocardiography in clinical practice.
Cardiology ; Echocardiography* ; Heart Ventricles ; Korea* ; Reference Values

BACKGROUND/AIMS: We investigated the time of onset of antituberculous drug-induced hepatotoxicity (ADIH) and related characteristics. METHODS: Adult patients (n = 1,031) treated with first-line antituberculous drugs between February 2009 and January 2013 were enrolled. RESULTS: Of the 1,031 patients, 108 patients (10.5%) developed ADIH a mean of 39.6 +/- 43.7 days after treatment initiation. Twenty-eight patients (25.9%) developed ADIH within 7 days, 73 (67.6%) within 30 days, and the rest after 30 days. The < or = 30-day group was characterized by higher peak alanine aminotransferase (ALT) level and a high proportion of patients with maintenance of first-line antituberculous drugs compared to the > 30-day group. In subgroup analysis, the < or = 7-day group was characterized by higher baseline aspartate aminotransferase and ALT, high proportion of patients with maintenance of first-line antituberculous drugs, and high proportion of patients with extrapulmonary tuberculosis compared to patients with ADIH that developed beyond 7 days. In multivariate analysis, serum ALT > 40 IU/L (odds ratio [OR], 2.995; 95% confidence interval [CI], 1.580 to 5.680; p = 0.001) and presence of anti-hepatitis C virus (OR, 4.204; 95% CI, 1.822 to 9.700, p = 0.001) were independent risk factors for development of ADIH. CONCLUSIONS: Approximately 70% of the cases of ADIH occurred in the first month of antituberculous treatment, and were associated with continuation of the first-line drug regimen.
Adult ; Aged ; Alanine Transaminase/blood ; Antitubercular Agents/*adverse effects ; Aspartate Aminotransferases/blood ; Biomarkers/blood ; Chemical and Drug Induced Liver Injury/blood/*diagnosis/etiology ; Chi-Square Distribution ; Clinical Enzyme Tests ; Coinfection ; Drug Monitoring/*methods ; Drug Therapy, Combination ; Early Diagnosis ; Female ; Hepatitis/complications/diagnosis ; Humans ; *Liver Function Tests ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; Time Factors

BACKGROUND: Obesity is well-known as a risk factor for heart failure, including diastolic dysfunction. However, this mechanism in high-fat diet (HFD)-induced obese rats remain controversial. The purpose of this study was to investigate whether cardiac dysfunction develops when rats are fed with a HFD for 10 weeks; additionally, we sought to investigate the association between mitochondrial abnormalities, adenosine triphosphate (ATP) levels and cardiac dysfunction. METHODS: We examined myocardia in Wistar rats after 10 weeks of HFD (45 kcal% fat, n=6) or standard diet (SD, n=6). Echocardiography, histomorphologic analysis, and electron microscopy were performed. The expression levels of mitochondrial oxidative phosphorylation (OXPHOS) subunit genes, peroxisome-proliferator-activated receptor gamma co-activator-1alpha (PGC1alpha) and anti-oxidant enzymes were assessed. Markers of oxidative stress damage, mitochondrial DNA copy number and myocardial ATP level were also examined. RESULTS: After 10 weeks, the body weight of the HFD group (349.6+/-22.7 g) was significantly higher than that of the SD group (286.8+/-14.9 g), and the perigonadal and epicardial fat weights of the HFD group were significantly higher than that of the SD group. Histomorphologic and electron microscopic images were similar between the two groups. However, in the myocardium of the HFD group, the expression levels of OXPHOS subunit NDUFB5 in complex I and PGC1alpha, and the mitochondrial DNA copy number were decreased and the oxidative stress damage marker 8-hydroxydeoxyguanosine was increased, accompanied by reduced ATP levels. CONCLUSION: Diastolic dysfunction was accompanied by the mitochondrial abnormality and reduced ATP levels in the myocardium of 10 weeks-HFD-induced rats.
Adenosine Triphosphate* ; Adenosine* ; Animals ; Body Weight ; Diet ; Diet, High-Fat* ; DNA, Mitochondrial ; Echocardiography ; Heart Failure ; Microscopy, Electron ; Mitochondria ; Myocardium ; Obesity ; Oxidative Phosphorylation ; Oxidative Stress ; Rats* ; Rats, Wistar ; Risk Factors ; Weights and Measures

Sirtuin 1 (SIRT1) is a mammalian NAD+-dependent protein deacetylase that regulates cellular metabolism and inflammatory response. The organ-specific deletion of SIRT1 induces local inflammation and insulin resistance in dietary and genetic obesity. Macrophage-mediated inflammation contributes to insulin resistance and metabolic syndrome, however, the macrophage-specific SIRT1 function in the context of obesity is largely unknown. C57/BL6 wild type (WT) or myeloid-specific SIRT1 knockout (KO) mice were fed a high-fat diet (HFD) or normal diet (ND) for 12 weeks. Metabolic parameters and markers of hepatic steatosis and inflammation in liver were compared in WT and KO mice. SIRT1 deletion enhanced HFD-induced changes on body and liver weight gain, and increased glucose and insulin resistance. In liver, SIRT1 deletion increased the acetylation, and enhanced HFD-induced nuclear translocation of nuclear factor kappa B (NF-kappaB), hepatic inflammation and macrophage infiltration. HFD-fed KO mice showed severe hepatic steatosis by activating lipogenic pathway through sterol regulatory element-binding protein 1 (SREBP-1), and hepatic fibrogenesis, as indicated by induction of connective tissue growth factor (CTGF), alpha-smooth muscle actin (alpha-SMA), and collagen secretion. Myeloid-specific deletion of SIRT1 stimulates obesity-induced inflammation and increases the risk of hepatic fibrosis. Targeted induction of macrophage SIRT1 may be a good therapy for alleviating inflammation-associated metabolic syndrome.
Acetylation ; Actins ; Animals ; Collagen ; Connective Tissue Growth Factor ; Diet ; Diet, High-Fat ; Fibrosis ; Glucose ; Inflammation* ; Insulin Resistance ; Liver ; Macrophages ; Metabolism ; Mice* ; NF-kappa B ; Obesity ; Sirtuin 1 ; Sterol Regulatory Element Binding Protein 1 ; Weight Gain

AMP-activated protein kinase (AMPK), an enzyme involved in energy homeostasis, regulates inflammatory responses, but its precise mechanisms are not fully understood. Recent evidence has shown that resveratrol (RES), an AMPK activator, reduces prostaglandin E2 production in lipopolysaccharide (LPS)-treated microglia. Here, we examined the effect of RES on nuclear factor kappa B (NF-kappaB) dependent cyclooxygenase (COX)-2 activation in LPS-treated RWA 264.7 macrophages. We found that treatment with RES increased AMPK activation. AMPK and acetyl CoA carboxylase phosphorylation were attenuated in cells treated with LPS+RES, compared to cells treated with LPS alone. RES inhibited tumor necrosis factor (TNF)-alpha and TNF receptor 1 in LPS-treated cells. Finally, RES inhibited LPS-induced NF-kappaB translocation into the nucleus and COX-2 expression. Moreover, the effects of 5-aminoimidazole-4-carboxamide ribose and compound C were consistent with the effects of RES in LPS-treated cells. Taken together, these results suggest that the anti-inflammatory action of RES in RAW 264.7 macrophages is dependent on AMPK activation and is associated with inhibition of the LPS-stimulated NF-kappaB-dependent COX-2 signaling pathway.
Acetyl-CoA Carboxylase ; AMP-Activated Protein Kinases ; Dinoprostone ; Homeostasis ; Macrophages ; Microglia ; NF-kappa B ; Phosphorylation ; Prostaglandin-Endoperoxide Synthases ; Receptors, Tumor Necrosis Factor ; Ribose ; Stilbenes ; Tumor Necrosis Factor-alpha

BACKGROUND: It has been reported that the abdominal obesity can cause various metabolic abnormalities not only in adults but also in adolescents. This study was conducted to investigate lifestyle habits related to abdominal obesity in Korean adolescents. METHODS: This study is a cross-sectional study on 561 adolescents (305 boys and 256 girls) aged 12-18 years from the Korean National Health and Nutrition Examination Survey 2005. The abdominal obesity was defined as waist circumference at or above the 90th percentile for each age and gender based on the 2007 growth chart for Korean children. The frequency of physical activity, screen time, and the intake amount of energy and macronutrients were investigated as lifestyle habits. RESULTS: The prevalence of abdominal obesity in Korean adolescents aged 12-18 years was 9.1% (Boys, 9.4%; Girls, 8.7%). The mean of daily screen time was 4.3 +/- 0.1 hours (Boys, 4.4 +/- 0.2 hours; Girls, 4.2 +/- 0.2 hours). The subjects with daily screen time > or = 5 hours had a 3.0 times increased risk of abdominal obesity compared to subjects with daily screen time < 3 hours (P-value = 0.004). The adjusted odds ratio of fat intake > or = 35% of energy was 2.57 (95% confidence interval, 1.16 to 5.68; P-value = 0.020) with fat intake < 25% of energy as reference. The relationship between long screen time and abdominal obesity was observed in girls and high fat intake was related to abdominal obesity in boys. CONCLUSION: This study shows that abdominal obesity in Korean adolescents is associated to long screen time and high fat intake.
Adolescent ; Adult ; Aged ; Child ; Cross-Sectional Studies ; Growth Charts ; Humans ; Life Style ; Motor Activity ; Nutrition Surveys ; Obesity, Abdominal ; Odds Ratio ; Prevalence ; Waist Circumference

Klebsiella are opportunistic pathogens that cause a wide spectrum of severe diseases, such as septicemia, pneumonia, urinary tract infection, and soft tissue infection. Klebsiella oxytoca is rarely isolated from human clinical specimens, and bacteremia due to Klebsiella oxytoca remains relatively uncommon. We experienced a case of liver abscess due to Klebsiella oxytoca in a 71-year-old male with a history of pylorus-preserving pancreaticoduodenectomy (PPPD) 4 years earlier. The patient was diagnosed with hemobilia secondary to a pseudo-aneurysm at the lower pole of the abscess cavity during antibiotic treatment and was treated successfully with selective percutaneous transcatheter embolization
Abscess ; Aged ; Bacteremia ; Hemobilia ; Humans ; Klebsiella ; Klebsiella oxytoca ; Liver ; Liver Abscess ; Male ; Pancreaticoduodenectomy ; Pneumonia ; Sepsis ; Soft Tissue Infections ; Urinary Tract Infections

Schwannomas or neurilemmomas of the gastrointestinal tract are very rare and constitute less than 1% of all gut neoplasms. We experienced a case of schwannoma in the stomach, which is an extremely rare site. The patient was a 55-year-old woman who complained of an abdominal mass. At endoscopy, a 10-cm ulcerated submucosal mass was seen in the posterior wall of the body of the stomach. Computed tomography showed a heterogenous mass in the stomach without metastasis. The tumor was resected with the stomach. Both histological and immunohistochemical staining with S-100 protein revealed that it was a schwannoma.
Endoscopy ; Female ; Gastrointestinal Tract ; Humans ; Middle Aged ; Neoplasm Metastasis ; Neurilemmoma ; S100 Proteins ; Stomach ; Ulcer