We experienced a case of primary hepatic actinomycosis which was initially diagnosed by means of fine needle aspiration. The patient was a 31-year-old emaciated man with a 2-month history of 10 kg weight loss, right upper quadrant pain and flank pain. The liver was palpable and tender on physical examination. Computerized tomography scan of the liver showed two ill-defined hypodense masses in gallbladder fossa and inferior pole of right lobe. Hepatocellular carcinoma was clinically suspected. A CT-guided fine needle aspiration was performed. Microscopically, smears showed numerous radiating clusters of filamentous bacteria with many neutrophils and monocytes in necrotic background. The symptoms were improved by incision and drainage and massive administration of penicillin.
Actinomycosis ; Adult ; Bacteria ; Biopsy, Fine-Needle ; Breast ; Carcinoma, Hepatocellular ; Diverticulum* ; Drainage ; Fibroadenoma ; Flank Pain ; Gallbladder ; Humans ; Infarction ; Liver ; Monocytes ; Neutrophils ; Penicillins ; Physical Examination ; Vesico-Ureteral Reflux* ; Weight Loss

No abstract available.
Blood Transfusion* ; Humans ; Infant, Newborn ; Infant, Premature*

PURPOSE: To report a rare case of orbital malignant lymphoma that occurred in a patient with acquired immunodeficiency syndrome. CASE SUMMARY: A 39-year-old male with acquired immunodeficiency syndrome complained of proptosis and loss of visual acuity. The best corrected visual acuity of his right eye was no light perception, and the BCVA of his left eye was 1.0. Ocular movement was limited, and esotropia of 15 prism diopters was detected. Exophthalmometry measurements showed a significant difference between both eyes (right eye was 18 mm, left eye was 15 mm). Computed tomography scans of the patient's orbit with contrast showed an enhancing mass in the right orbit, so a biopsy was performed. A biopsy specimen of the mass revealed non-Hodgkin's lymphoma (anaplastic variant, diffuse large B cell type). Distant metastasis was not found using abdominal and thoracic computed tomography and positron emission tomography. He underwent radiotherapy (30 Gy, 15 times). CONCLUSIONS: Orbital non-Hodgkin's lymphoma (B cell type) in a patient with AIDS is rare, but our case showed a good response to radiation therapy.
Acquired Immunodeficiency Syndrome ; Adult ; Biopsy ; Esotropia ; Exophthalmos ; Eye ; Humans ; Light ; Lymphoma ; Lymphoma, Non-Hodgkin ; Male ; Neoplasm Metastasis ; Orbit ; Positron-Emission Tomography and Computed Tomography ; Visual Acuity

We report a case of trichoblastic fibroma involving the scrotum in a 60-year-old man. Trichoblastic fibroma is very rare and benign trichogenic tumor that has both epithelial and mesenchymal components and histologically recount the embryologic development of the hair follicle. The diagnosis was confirmed by histopathologic examination.
Diagnosis ; Fibroma* ; Hair Follicle ; Humans ; Middle Aged ; Scrotum*

Genipin, an aglycone derived from geniposide found in Gardenia jasminoides, is known to be an excellent natural cross-linker, strong apoptosis inducer, and antiviral agent. Although evidence suggests antiviral activity of genipin in several in vitro viral infection systems, there have been few literatures which review antitumor effects of genipin in a variety of in vitro/in vivo models of cancers yet. In this review, we present some of the latest findings in the studies of genipin focusing on antitumor effects and its mechanisms. In brief, genipin inhibits mitochondrial uncoupling protein 2 to increase accumulation of reactive oxygen species, leading to ROS/c-Jun N-terminal kinase-dependent apoptosis of cancer cells. Genipin also increase tissue inhibitors of metalloproteases (MMP), resulting to decrease activities of MMP-2 which plays a key role in metastasis of cancers. Genipin has shown a biphasic effects on cell death and survival in cancer cells as many other plant-derived phytochemicals do. Finally we discuss the potential of genipin as a promosing novel antitumor agent which could be applicable to chemotherapy and/or chemoprevention for cancers.
Apoptosis ; Cell Death ; Chemoprevention ; Drug Therapy ; Gardenia ; In Vitro Techniques ; Metalloproteases ; Neoplasm Metastasis ; Phytochemicals ; Reactive Oxygen Species

Carotid sinus nerve blockade (CSNB) has been shown to be effective for management of post-carotid endarterectomy (CEA) hypotension. The underlying hemodynamic changes are unknown. We retrospectively analyzed a recorded arterial blood pressure (ABP) waveform using a Modelflow technique. After declamping, total peripheral resistance (TPR) decreased (-65% of predeclamping value), but cardiac output (CO) and stroke volume (SV) increased (+60 and +57% of predeclamping value, respectively). CSNB abruptly increased blood pressure (BP) and TPR (75 and 95% of nadir, respectively), while CO and SV gradually decreased to -21 and -16% of maximum value, respectively). In conclusion, we found that severe decline of TPR was a cause of severe hypotension after declamping and CSNB increased BP mainly through increase in TPR, with little change in CO and SV.
Arterial Pressure ; Blood Pressure ; Cardiac Output ; Carotid Sinus* ; Endarterectomy ; Endarterectomy, Carotid* ; Hemodynamics* ; Hypotension* ; Nerve Block* ; Retrospective Studies ; Stroke Volume ; Vascular Resistance

Metformin, commonly prescribed for type 2 diabetes, is considered safe with minimal side-effect. Acute pancreatitis is rare but potentially fatal adverse side-effect of metformin. We report a patient on hemodialysis with metformin-related acute pancreatitis and lactic acidosis. A 62-year-old woman with diabetic nephropathy and hypertension presented with nausea and vomiting for a few weeks, followed by epigastric pain. At home, the therapy of 500 mg/day metformin and 50 mg/day sitagliptin was continued, despite symptoms. Laboratory investigations showed metabolic acidosis with high levels of lactate, amylase at 520 U/L (range, 30-110 U/L), and lipase at 1,250 U/L (range, 23-300 U/L). Acute pancreatitis was confirmed by computed tomography. No recognized cause of acute pancreatitis was identified. Metformin was discontinued. Treatment with insulin and intravenous fluids resulted in normalized amylase, lipase, and lactate. When she was re-exposed to sitagliptin, no symptoms were reported.
Acidosis ; Acidosis, Lactic* ; Amylases ; Diabetes Mellitus ; Diabetic Nephropathies ; Female ; Humans ; Hypertension ; Insulin ; Lactic Acid ; Lipase ; Metformin* ; Middle Aged ; Nausea ; Pancreatitis* ; Renal Dialysis* ; Sitagliptin Phosphate ; Vomiting

Choriocarcinoma associated with a normal pregnancy is rare. Especially, choriocarcinoma coexistent with a viable pregnancy is even rarer and commonly presents with widespread metastatic disease. We experienced a patient at 34th week of pregnancy with dyspnea and sputum production due to pulmonary metastasis of choriocarcinoma. The serum B-hCG level was extremely elevated and the placenta had multifocal choriocarcinoma. After vaginal delivery, the patient was successfully treated with combination chemotherapy (EMA-CO). The patient is receiving follow up with monthly measurement of hCG values. We report one case of metastatic choriocarcinoma with viable pregnancy with review of literature.
Choriocarcinoma* ; Drug Therapy, Combination ; Dyspnea ; Female ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Placenta ; Pregnancy ; Pregnancy* ; Sputum

PURPOSE: The purpose of this study was to assess the clinician satisfaction of a newly introduced around-the-clock radiology coverage system for the emergency department. MATERIALS AND METHODS: Seventeen emergency physicians (8 board certified physicians, 9 residents) were invited to fill out a survey pertaining to the newly introduced radiology coverage system for the emergency department. The questionnaire included 10 questions covering three major topics. The first topic related to the around-the-clock radiology coverage by two full-time radiology residents. The second topic focused on the preliminary interpretations of radiology residents. The last topic included the interpretation assistance system by board-certified radiologists. The answers to each question were assessed using a scoring system of 1 to 5. RESULTS: The mean satisfaction score of the around-the-clock radiology coverage system by the two full-time radiology residents was 4.6 (range 3-5). The mean score for the preliminary interpretation system by the radiology residents was 4.8 (range 4-5). The score for the reliability of the preliminary versus the final interpretations was 4.1 (range 4-5). Lastly, the mean score for the interpretation assistance system by board-certified radiologists was 4.9 (range 4-5). CONCLUSION: The results of this study indicate a high satisfaction rating among clinicians' of the new around-the-clock radiology coverage system for the emergency department.
Emergencies ; Emergency Service, Hospital ; Surveys and Questionnaires

BACKGROUND: Recent advances in laboratory information systems have largely been focused on automation. However, the phlebotomy services have not been completely automated. To address this issue, we introduced an automated reception and turnaround time (TAT) management system, for the first time in Korea, whereby the patient's information is transmitted directly to the actual phlebotomy site and the TAT for each phlebotomy step can be monitored at a glance. METHODS: The GNT5 system (Energium Co., Ltd., Korea) was installed in June 2013. The automated reception and TAT management system has been in operation since February 2014. Integration of the automated reception machine with the GNT5 allowed for direct transmission of laboratory order information to the GNT5 without involving any manual reception step. We used the mean TAT from reception to actual phlebotomy as the parameter for evaluating the efficiency of our system. RESULTS: Mean TAT decreased from 5:45 min to 2:42 min after operationalization of the system. The mean number of patients in queue decreased from 2.9 to 1.0. Further, the number of cases taking more than five minutes from reception to phlebotomy, defined as the defect rate, decreased from 20.1% to 9.7%. CONCLUSIONS: The use of automated reception and TAT management system was associated with a decrease of overall TAT and an improved workflow at the phlebotomy room.
Automation, Laboratory ; Efficiency, Organizational/*standards ; Phlebotomy/*statistics & numerical data ; Republic of Korea ; Time Factors ; Workflow