Colchicine poisoning is relatively uncommon, but potentially life-threatening, situation confronting the emergency physician. Although the toxic dose of colchicine is reported to be more than 0.5 mg/kg, it is extremely variable. Therefore, the emergency physician should always consider colchicine poisoning to be serious, even when the dose is small. We present a case of death after intentional ingestion of 12 mg (0.17 mg/kg) of colchicine by a 30-year-old male.
Adult ; Colchicine* ; Eating ; Emergencies ; Humans ; Male ; Poisoning*

A gastric intramural hematoma is very rare and commonly associated with trauma, anticoagulation therapy, coagulopathy, pancreatic disease, aneurysm and peptic ulcer disease. This is a case of gastric intramural hematoma which occurred in a patient taking aspirin after hypertonic saline-epinephrine injection for bleeding from a biopsy site. We describe a case of gastric intramural hematoma that was successfully managed with conservative therapy.
Aneurysm ; Aspirin ; Biopsy ; Epinephrine ; Hematoma* ; Hemorrhage ; Hemostasis* ; Humans ; Pancreatic Diseases ; Peptic Ulcer ; Saline Solution, Hypertonic

BACKGROUND/AIMS: Lamivudine is highly effective in suppressing hepatitis B virus replication and hepatitis B induced necroinflammatory activity. The objective of this study was to evaluate the virological and biochemical responses to lamivudine by patients with HBV associated chronic liver disease. In particular we stressed the importance of lamivudine therapy by patients with decompensated liver cirrhosis. METHODS: We conducted a one-year trial of lamivudine in 80 patients with HBV associated chronic liver disease (chronic hepatitis 44, cirrhosis 36). We classified these patients according to the severity of hepatic dysfunction as chronic B hepatitis (Group A) or liver cirrhosis (Group B). These patients were treated for 12 months with 100 mg daily doses of lamivudine. RESULTS: The seroconversion rate of HBeAg was 23.5% in group A patients and 26.7% in group B patients. The negative conversion of HBV-DNA was sustained for one year in 79.5% of patients in group A and 86.1% in group B. The normalization rates of serum ALT were 90.9% in group A and 88.9% in group B patients. No serious side effect after discontinuance of the treatment was found. There were 12 ALT breakthrough cases and all of them showed mutation of YMDD motif. However, they did not deteriorate clinically in spite of ALT elevation and HBV-DNA reappearance. The Child-Pugh scores improved even in patients with decompensated liver cirrhosis. CONCLUSION: One-year lamivudine treatment resulted in excellent virological and biochemical improvements and was well tolerated in the patients with HBV associated chronic liver disease, even in decompensated cirrhosis. We conclude that lamivudine is relatively safe in chronic hepatitis B and liver cirrhosis treatment.
Fibrosis ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis* ; Humans ; Lamivudine* ; Liver Cirrhosis* ; Liver Diseases ; Liver*

PURPOSE: Glomus tumors are uncommon benign neoplasms arising from the neuromyoarterial apparatus, usually seen in the nail bed of fingers. Most of this mass presents typical symptoms such as severe pain, point tenderness and hypersensitivity to cold like neuroma, gout or causalgia. Concerning about the origin, there were few written reports about extra-digit glomus tumor, especially that occurred in the skeletal muscule. METHODS: A 48-year-old female complained of painful tender mass in her right calf aggravated several months ago. Her MRI and femoral angiogram showed a well defined hypervascular tumor such as hemagioma or hemagioendothelioma in the right calf. Surgical treatment was performed, and it proved glomus tumor in soleus muscle histologically. RESULTS: After the operation, patient didn't complain of her symptoms any more and there was no evidence of recurrence during 1 year follow-up period. CONCLUSION: Authors have found only eight cases of intramuscular glomus tumor reported in the literature and present here the ninth case of an intramuscular glomus tumor and first case of soleus muscle.
Causalgia ; Female ; Fingers ; Follow-Up Studies ; Glomus Tumor* ; Gout ; Humans ; Hypersensitivity ; Magnetic Resonance Imaging ; Middle Aged ; Muscle, Skeletal* ; Neuroma ; Recurrence

The intrauterine device (IUD) is a widely used contraceptive method. One of the most serious and rare complications of using an IUD is colon perforation. We report a case of colonoscopic removal of an IUD that had perforated into the rectosigmoid colon in a 42-year-old woman who presented with no symptoms. Colonoscopy showed that the IUD had penetrated into rectosigmoid colon wall and that an arm of the IUD was embedded in the colon wall. We were able to remove the IUD easily by using colonoscopy. The endoscopic approach may be considered the first choice therapy for selected patients.
Adult ; Arm ; Colon* ; Colonoscopy ; Contraception ; Female ; Humans ; Intrauterine Devices*

BACKGROUND: The purpose of this study was to examine the causes and pathologic process of chronic non-productive cough as an isolated symptom with a normal spirometry and chest radiograph by investigating clinicopathologic findings. METHOD: We studied 25 adults with chronic non-productive cough over a 3-week period with a normal chest radiograph and pulmonary function tests without any other symptoms. Clinical assessment, cough score, chest and sinus radiograph, pulmonary function tests, methacholine challenge, allergic skin prick test, and bronchoscopy for bronchial biopsies were performed. Subjects were then treated with prednesolone 20 to 30 mg/day for 1 to 2 weeks. RESULTS: The experimental group was divided into two subgroups - those infiltrated with eosinophils, and those infiltrated with lymphocytes depending on eosinophil and lymphocyte counts, both of which were respectively higher than those of the control group. Eosinophils infiltrated group had mean numbers of eosinophil of 89.8 cells/mm(2) while control group's mean was 0.4 cells/mm(2)(P=0.005). Lymphocyte infiltrated group was 4 patients whose mean was 84.3 cells/mm(2) with 28.4 cells/mm(2) of control group(P=0.026). In addition, the mean thickeness of the basement membrane of experimental group was 14.20+/-5.20microM in contrast of control group whose mean was 3.50+/-1.37microM(P=0.001). With the methacholine challenge test, 7 of the 21 eosinophil infiltrated subjects were diagnosed with cough asthma; the other 14 with eosinophilic bronchitis. Three subjects with eosinophilic bronchitis were atopic positive(21.4%) with the skin prick test. In the lymphocyte dominant group, all four subjects were diagnosed with lymphocytic bronchitis. Cough score was improved after steroid treatment in 22 of 25 subjects in the experimental group (88.0%). CONCLUSION: These results suggest chronic non-productive cough as an isolated symptom with a normal spirometry and chest radiograph was associated with airway inflammation by eosinophil and lymphocyte infiltration. The causes for chronic non-productive cough were eosinophilic bronchitis, cough variant asthma, and lymphocytic bronchitis(written in frequency). They further suggest that therapeutic treatment with steroids can provide effective symptomatic relief.
Adult ; Asthma ; Basement Membrane ; Biopsy* ; Bronchitis ; Bronchoscopy ; Cough* ; Eosinophils ; Humans ; Inflammation ; Lymphocyte Count ; Lymphocytes ; Methacholine Chloride ; Radiography, Thoracic ; Respiratory Function Tests ; Skin ; Spirometry ; Steroids ; Thorax

BACKGROUND: Helicobacter pylori colonizes the gastric surface epithelium and the mucus gel layer. It has been known that H. pylori infection decreased the gastric mucin expression. The aim of this study was to determine the effect of H. pylori eradication on mucin expression (MUC5AC, MUC6 and MUC1) in the gastric epithelium. METHODS: This study included 20 patients positive for H. pylori whom successful eradication was performed between March 1998 and December 1999. H. pylori status was determined by histology, rapid urase test and urea breath test. Gastric antral biopsy specimens were examined by immunohistochemistry for mucin (MUC5AC, MUC6 and MUC1) expression. The distribution of epithelial cells expressing MUC5AC was calculated at two sites (surface mucous cells, pyloric glands). Two scores system (weak-strong) was used to assess staining intensity. RESULTS: There was a gradient of MUC5AC expression, higher to lower from the surface to the glands. Increased MUC5AC expression in the surface mucous cell (p=0.013) and in the glands (p=0.008) was found after H. pylori eradication. MUC6 and MUC1 distribution was not changed after H. pylori eradication. CONCLUSION: MUC5AC expression was increased after H. pylori eradication. These results suggest that MUC5AC may relate in the pathogenesis of H. pylori.
Biopsy ; Breath Tests ; Colon ; Epithelial Cells ; Epithelium ; Gastric Mucins ; Helicobacter pylori* ; Helicobacter* ; Humans ; Immunohistochemistry ; Mucins* ; Mucus ; Urea

BACKGROUND/AIMS: There are few data supporting the diagnostic yield of brush cytology depending on the order of cytologic preparation method or the location or shape of tumors in biliary strictures. We investigated diagnostic yields and variations in brush cytology with direct smear and cell-block preparations according to sampling preparation sequence and tumor location and shape in biliary strictures. METHODS: Patients who had undergone ERCP with tissue sampling between August 2009 and April 2013 were analyzed retrospectively. Group A was examined using brush cytology with direct smear followed by cell-block with or without biopsy, while the reverse order was performed for group B. RESULTS: Among 138 enrolled patients, 92 patients (A: 36, B: 56) underwent both brush cytology with direct smear and cell-block preparations. No differences in sensitivity, specificity, or accuracy were observed according to the sampling preparation method and the location or shape of tumors in biliary strictures. The cellularity observed from brush cytology with direct smear was better than that from cell-block according to the location of the tumor (p<0.01). The diagnostic yield was increased in both groups with addition of an endobiliary biopsy. CONCLUSIONS: No difference in diagnostic accuracy was observed between the sequences of preparation for brush cytology with direct smear and cell-block techniques. Brush cytology showed better cellularity for diagnosis.
Aged ; Aged, 80 and over ; Bile Duct Neoplasms/*pathology ; Cholangiocarcinoma/pathology ; Cholangiopancreatography, Endoscopic Retrograde ; *Cytodiagnosis ; Female ; Gallbladder Neoplasms/pathology ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Pancreatic Neoplasms/pathology ; Retrospective Studies ; Sensitivity and Specificity