Cerebral aspergillosis is a rare condition that affects primarily the immunocompromised host. Most of cerebral aspergillosis is developed by hematogenous dissemination from extracranial foci, but aspergillosis of sino-nasal origin rarely affects the CNS. In case 1, wel symptom of tumor recurrence was unilateral numbness of the chin. A 65-year-old male was admitted because of paresthesia around the left chin and left lower lip. Neurologic examination revealed hypesthesia on the left side of chin, lower lip and buccal mucous mem-brane. Bone scan (Tc-99m MDP) showed focal hot uptakes on the left mandible and left first rib. Brain CT with bone window setting showed a focal osteolytic lesion in the bone marrow of the left mandibular canal without destruction of bone cortex. Both coronal T1 weighted image and axial T2 weighted image showed focal low signal intensities on the left ramus. The pathophysiologic mechanism could be understood by identification of the pathologic focus.
Aged ; Aspergillosis* ; Bone Marrow ; Brain ; Chin ; Humans ; Hypesthesia ; Immunocompromised Host ; Lip ; Male ; Mandible ; Neurologic Examination ; Paresthesia ; Recurrence ; Ribs

Computed tomographic findings of 24 cases of cervical tuberculous lymphadenitis were retrospectively analyzed. We classified the CT findings as 4 types: type 1(homogeneous soft tissue density mass), type 2(central low density with peripheral rim enhancement and with preservation of surrounding fat plane), type 3(central low density with peripheral rim enhancement and with obliteration of surrounding fat plane), type 4(large confluent low density mass, so called "cold abscess") As a result, there were 2 cases(8.3%) of type 1, 7 cases(29.2%) of type 2, 9 cases(37.5%) of type 3, 3 cases(12.5%) of type 4, 1 cases(4.2%) of type 1 combined with type 3, and 2 cases(8.3%) of type 2 combined with type 4. So 22 cases(91.7%) revealed central low density and peripheral rim enhancement, which suggest necrosis. The maximum thickness of enhancing rim was above 2mm in all of 64 definable necrotic lymph nodes and above 4mm in 42(65.5%) lymph nodes, suggesting that the wall of necrotic tuberculous lymphadenitis tends to be thick. We conclude that CT is useful not only for the diagnosis but also for the evaluation of the extent and the status of cervical tuberculous lymphadenitis.
Diagnosis ; Lymph Nodes ; Necrosis ; Retrospective Studies ; Tuberculosis, Lymph Node*

No abstract available.
Anal Canal* ; Rectum*

Peripartum cardiomyopathy (PPCM) is an unusual and uncommon causes of antepartum and postpartum heart failure, which may result in severe cardiac failure and death. PPCM is often unrecognized as symptoms of normal pregnancy commonly mimic those of mild heart failure but can rapidly progress to cardiac failure. We presented a case of elective labor induction in a patient with peripartum cardiomyopathy. A epidural analgesia technique was performed without difficulty for labor analgesia in parturient with peripartum cardiomyopathy. Her post-delivery course was uncomplicated but her baby has died due to respiratory failure. We suggest that vaginal delivery with careful incremental epidural alnalgesia in patient with PPCM is acceptable methods and close peripartum monitoring is essential in the management of PPCM.
Analgesia* ; Analgesia, Epidural ; Cardiomyopathies* ; Heart Failure ; Humans ; Peripartum Period* ; Postpartum Period ; Pregnancy ; Respiratory Insufficiency

Klotho deficiency is an early event in acute kidney injury (AKI) that exacerbates acute kidney damage. The present study explored the expression of Klotho and inflammation related factors in cisplatin-induced AKI. Rats (n = 18) were treated with cisplatin intraperitoneal injection (5 mg/kg) or left untreated as controls (n = 6), then sacrificed at 5 (n = 6) and 10 days (n = 6) treatment. Five days after cisplatin injection, the serum kidney enzymes and kidney cell apoptosis were significantly increased. Moreover, the expression of Klotho was decreased when compared to the control group, especially in the cortex and outer medulla regions. In contrast, inflammation related signals including nuclear factor kappa B, tumor necrosis factor-alpha, and tumor necrosis factor-like weak inducer of apoptosis were enhanced. However, 10 days after cisplatin injection, Klotho expression was enhanced upon both IHC and Western blot analysis, with slightly recovered renal function and decreased apoptosis. Furthermore, inflammation related signals expression was decreased relative to the 5 days group. Overall, this study confirmed the opposite expression patterns between Klotho and inflammation related signals and their localization in cisplatin-induced AKI kidney.
Acute Kidney Injury* ; Animals ; Apoptosis ; Blotting, Western ; Cisplatin* ; Inflammation ; Injections, Intraperitoneal ; Kidney ; Necrosis ; NF-kappa B ; Rats ; Tumor Necrosis Factor-alpha

PURPOSE: In T1 tumors, the reported incidence of lymph-node metastases ranges from 21% to 35%. We analyzed the pathological parameters of T1 tumors for their association with the likelihood of axillary lymph-node metastases. Our objectives were to determine if standard pathologic factors can predict lymph-node metastases in T1 tumors and to provide a basis for patient selection for nonradical surgery. METHODS: Sixty-five patients with T1 unilateral invasive breast cancer were studied. All patients underwent axillary dissection from 1990 to 1999 at Masan Samsung Hospital, and the pathologic status of the nodes was reviewed. The associations between the incidence of axillary lymph-node metastases and pathologic factors, including age, size, histologic subtype, nuclear grade, hormone receptor status, and lymphatic/vascular invasion, were analyzed. RESULTS: Of the 65 patients, 21 (32.3%) had nodes that were positive for metastases. The independent predictor of lymph-node metastases in the multivariate logistic regression analyses was a tumor size larger than 1 cm (p<0.05). However, other predictors showed nonspecific findings. CONCLUSION: These results suggest that the characteristics of the primary tumor can help assess the risk for axillary lymph-node metastases. Axillary lymph-node dissection should be performed routinely for all patients with lesions with a tumor more than 1 cm in size. Although a routine axillary dissection or radiation therapy to the axilla might be spared in selected patients who are assessed to be at minimal risk, new prognostic factors for providing reliable assurance of the absences of axillary lymph-node metastases must be investigated.
Axilla ; Breast Neoplasms* ; Breast* ; Humans ; Incidence ; Logistic Models ; Neoplasm Metastasis* ; Patient Selection

PURPOSE: As the life expectancy increases, the population of elderly patients increases. We evaluated the complications and survival rate of patients over 80 years old, who underwent laparoscopic gastrectomy. METHODS: A retrospective analysis was conducted for a total of 1,912 patients, who underwent surgery with stomach cancer from 2008 to 2016. We analyzed postoperative complications and the survival rate between the middle old (70~79, n=255) group and the very old (≥80, n=37) group. RESULTS: Among 1,912 patients, 255 people in the middle old group and 37 people within the very old group underwent laparoscopic gastrectomy. We confirmed that there was no significant difference except for the age (p<0.001) between the two groups. Overall complications were not statistically significantly different between the Middle old (70~79) group and the very old (≥80) group, 11.8% and 16.2%, respectively. There were also no statistically significant differences in severe complications beyond Clavien-Dindo classification Grade III. Risk factors for overall complications were higher in males than in females (p=0.002). Overall survival was statistically significantly lower with very old group (p<0.001). CONCLUSION: Laparoscopic gastrectomy in gastric cancer patients over 80 years of age is feasible and safe in terms of complications. However, considering the life expectancy, it seems necessary to pay attention to the patients who apply surgery.
Aged ; Classification ; Female ; Gastrectomy* ; Humans ; Life Expectancy ; Male ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms* ; Survival Rate*

BACKGROUND: Lidocaine has been used for attenuating cardiovascular responses to endotracheal intubation and thought to have the sedative effect. The sedative effect of lidocaine has not been known well. The BIS (bispectral index) has been used an indicator of the sedative state and has been considered to be related to anesthetic agents and noxious stimulus. The purpose of this study is to evaluate sedative and cardiovascular effects of lidocaine during TCI (target controlled infusion) of propofol by monitoring BIS and hemodynamics. METHODS: Fifty ASA patient status 1 and 2, aged from 20 to 65 years patients (n = 50, 2 groups) undergoing elective surgeries with general anesthesia. These patients were randomly allocated to group C or L. Patients in Group L received 1.5 mg/kg injection and 40microgram/kg/min infusion of lidocaine. Patients in Group C received normal saline. The BIS, blood pressure and heart rate were mesasured before injection of drug, 1, 2 minute after injection of drug, just before intubation, 1, 2, 5 and 10 min after intubation. RESULTS: The BIS of group L more decreased than group C at 1, 2, 5 and 10 min after endotracheal intubation. The blood pressure and heart rate did not show any differences between two groups. CONCLUSIONS: Intravenous injection of lidocaine reduced BIS. Lidocaine had sedative effects under propofol target controlled infusion. But Cardiovascular variables of this study failed to show any differences between two groups (P < 0.05).
Anesthesia, General ; Anesthetics ; Blood Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Hypnotics and Sedatives ; Injections, Intravenous* ; Intubation ; Intubation, Intratracheal ; Lidocaine* ; Propofol*

The pegylated interferon plus ribavirin combination therapy has been used as the primary treatment for chronic hepatitis C (CHC) but fails to produce a sustained viral response (SVR) in many patients. In recent years, the treatment of CHC has been rapidly changing because of the introduction of direct-acting antivirals (DAAs), which have a high cure rate. However, retreatment of patients after failure of the first DAA therapy is difficult. We report two rare cases of CHC that showed acquired SVR with other DAA combinations after failure to daclatasvir and asunaprevir.

Authors requested to change the name of the hospital to proper name.