Acute interstitial pneumonia is a fulminant disease of unknown etiology that usually occurs in a previously healthy person and produces the histologic findings of the organizing phase of diffuse alveolar damage. We experienced an autopsy case of acute interstitial pneumonia of unknown etiology. The patient was a 48 year old man who had been healthy and had not been exposed to organic dusts or other toxic materials. The chief complaints represented were dyspnea and a dry cough for several weeks before hospitalization, and the chest radiographs showed bilateral interstitial infiltrates. Patchy consolidation of air space was also identified and ground-glass attenuation similar to those described in ARDS was detected on high-resolution computed tomography. Steroid pulse therapy, mechanical ventilation, and antibiotics for superimposed bacterial infection were performed, but the symptoms did not improve and the patient died of generalized respiratory insufficiency and severe hypoxemia 2 1/2 months after hospitalization. At autopsy the macroscopic and microscopic findings were confined mainly to the lungs. On the whole, both lungs were firm in consistency and the external surface showed a cobblestone appearance. The cut surface showed almost complete replacement of the normal lung parenchyma with gray to yellow fibrous tissue with a little residual functional area remaining. The pathology of both open lung biopsy and autopsy tissue showed marked hyperplasia of type II pneumocytes, hyaline membrane formation, thickening of the alveolar wall due to extensive fibroblast proliferation, and relatively abundant young collagen deposition in the interstitium. An immunohistochemical stain for cytokeratin revealed epithelial hyperplasia and showed that the alveolar spaces were markedly shrunken by fibrous tissue.
Anoxia ; Anti-Bacterial Agents ; Autopsy* ; Bacterial Infections ; Biopsy ; Collagen ; Cough ; Dust ; Dyspnea ; Fibroblasts ; Hospitalization ; Humans ; Hyalin ; Hyperplasia ; Keratins ; Lung ; Lung Diseases, Interstitial* ; Membranes ; Middle Aged ; Pathology ; Pneumocytes ; Pulmonary Fibrosis ; Radiography, Thoracic ; Respiration, Artificial ; Respiratory Insufficiency

BACKGROUND: Shipbuilding involves intensive welding activities, and welders are exposed to a variety of metal fumes, including manganese, that may be associated with neurological impairments. This study aimed to characterize total and size-fractionated manganese exposure resulting from welding operations in shipbuilding work areas. METHODS: In this study, we characterized manganese-containing particulates with an emphasis on total mass (n = 86, closed-face 37-mm cassette samplers) and particle size-selective mass concentrations (n = 86, 8-stage cascade impactor samplers), particle size distributions, and a comparison of exposure levels determined using personal cassette and impactor samplers. RESULTS: Our results suggest that 67.4% of all samples were above the current American Conference of Governmental Industrial Hygienists manganese threshold limit value of 100 μg/m3 as inhalable mass. Furthermore, most of the particles containing manganese in the welding process were of the size of respirable particulates, and 90.7% of all samples exceeded the American Conference of Governmental Industrial Hygienists threshold limit value of 20 μg/m3 for respirable manganese. CONCLUSION: The concentrations measured with the two sampler types (cassette: total mass; impactor: inhalable mass) were significantly correlated (r = 0.964, p < 0.001), but the total concentration obtained using cassette samplers was lower than the inhalable concentration of impactor samplers.
Humans ; Manganese* ; Particle Size ; Welding

BACKGROUND: Sulfonylurea drugs have been used for many decades as one of the main families of drugs for the treatment of type 2 diabetes mellitus. Even though there are many opportunities to medicate sulfonylurea drugs concomitantly with many other drugs, and furthermore there have been several case reports on drug interactions with sulfonylurea drugs, there has been no clear demonstration revealing the mechanisms that cause these interactions. We therefore evaluated inhibitory potential of sulfonylurea drugs, including glibenclamide, glipizide and gliclazide, on the cytochrome P450 (CYP)-catalyzing enzymes using human liver microsomes. METHODS: The inhibitory effects of glibenclamide, glipizide and gliclazide, on the CYP-catalyzing reaction, were evaluated for CYP1A2, CYP2C9, CYP2C19, CYP2D6 and CYP3A4 using human liver microsomes, and probe drugs for each. RESULTS: Glibenclamide showed relative potent inhibitory effects on the CYP2C9- and CYP3A4-catallyzed reaction (IC50; 11.3 ( microM and 59.0 ( microM). The other CYP isoforms tested showed only weak inhibitory effects by due to glibenclamide (IC50 > 112 ( microM). Glipizide showed potent inhibitory effect on CYP3A4-catalyzed reaction only (IC50; 11.2 ( microM), and weak, or no, inhibitory effects on each on the other CYP isoforms tested (IC50 > 276 ( microM). CONCLUSION: The sulfonylurea drugs showed inhibitory potential on the CYP-catalyzing reaction in human liver microsomes. The results obtained in the present study provide insights into the potential of the drug interaction to ward drugs co-administered with sulfonylureas. It will be necessary to take into consideration the control of blood glucose, as well as therapeutic drug monitoring, to reduced toxicities when sulfonylurea drugs are co-administered with drugs of a narrow therapeutic range, or with severe dose-dependent toxicities.
Blood Glucose ; Cytochrome P-450 CYP1A2 ; Cytochrome P-450 CYP2D6 ; Cytochrome P-450 Enzyme System ; Cytochromes* ; Diabetes Mellitus, Type 2 ; Drug Interactions ; Drug Monitoring ; Gliclazide ; Glipizide ; Glyburide ; Humans* ; Liver* ; Microsomes, Liver* ; Protein Isoforms

PURPOSE: The purpose of this study was to compare the grade of fatty degeneration and atrophy of rotator cuffs on immediate postoperative MRI to those on preoperative MRI in patients with rotator cuff tears. MATERIALS AND METHODS: Seventy patients were included in this study, who received arthroscopic rotator-cuff repair and underwent both preoperative magnetic resonance imaging (MRI) and immediate postoperative MRI in our institution. Fatty degeneration of rotator cuffs and the atrophy of supraspinatus muscles were evaluated with T1 oblique sagittal images in the Y-shaped view. Fatty degeneration was evaluated using a Goutallier classification system, and the atrophy of supraspinatus muscles was evaluated using a modified tangent sign and a visual occupation ratio. RESULTS: From 70 patients, a total of 100 tendons were repaired: 18, 69, and 13 tendons were treated for subscapularis, supraspinatus, and infraspinatus, respectively. The Goutallier grades (P = 0.012), modified tangent signs (P = 0.000), and visual occupation ratios (P = 0.000) of supraspinatus muscles were significantly decreased in immediate postoperative MRIs when compared to preoperative MRIs. In immediate postoperative MRIs, the Goutallier grades of supraspinatus muscles were decreased by one grade in 18.8% (n = 13) of the patients, and the atrophy of supraspinatus muscles was improved by one grade in 26.1% (n = 18) for modified tangent signs and 21.7% (n = 15) for visual occupation ratios. However, fatty infiltration by the Goutallier grades of subscapularis (P = 1.000) and infraspinatus (P = 0.157) muscles were not significantly changed after arthroscopic surgery. CONCLUSION: Immediate postoperative MRIs showed a significant improvement of fatty degeneration and muscle atrophy in supraspinatus muscles when compared to preoperative MRIs.
Arthroscopy ; Atrophy* ; Classification ; Humans ; Magnetic Resonance Imaging* ; Muscles ; Muscular Atrophy ; Occupations ; Rotator Cuff* ; Tears ; Tendons

BACKGROUND: Although many single nucleotide polymorphisms (SNPs) of mtDNA have been found to be associated with type 2 diabetes mellitus, the results of studies using different population samples and different methods are mixed. Therefore, we conducted a genetic association study of mtDNA SNPs and type 2 diabetes mellitus in a Korean sample and compared our results with those of studies conducted in other human populations. METHODS: A total of 298 blood samples from 147 type 2 diabetic patients and 151 normal controls were surveyed for SNPs via PCR directed sequencing. Sequencing analyses were performed using the SeqMan module of the DNASTAR program. The identified SNPs were compared to previously reported SNP lists on NCBI and V-mitoSNP. RESULTS: A total of 24 SNPs were identified in the MT-RNR2, MR-TL1 and MT-ND1 mtDNA genes in Korean type 2 diabetes mellitus patients and normal controls. The SNPs identified in the Korean sample were not closely associated with the type 2 diabetes mellitus phenotype, a significantly different result from those previously observed in European, Chinese and Japanese samples. Additionally, a haplotype and prevalence analysis could not detect any differences between the type 2 diabetes mellitus patients and normal controls. CONCLUSION: The 24 mtDNA SNPs were not associated with type 2 diabetes mellitus risk in our Korean sample. The results of the present study support the possibility that mtDNA SNPs have a differential effect on the risk of type 2 diabetes mellitus according to geographical origin.
Asian Continental Ancestry Group ; Diabetes Mellitus, Type 2 ; DNA, Mitochondrial ; Genetic Association Studies ; Haplotypes ; Humans ; Phenotype ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Prevalence

Intrathecal chemotherapy with methotrexate and cytarabine arabinoside is used for the treatment and prophylaxis of malignancies, but can induce myelopathy. We report the case of a 50-year-old woman with stomach cancer who developed myelopathy after administration of intrathecal cytarabine arabinoside and methotrexate. The patient's neurologic status improved rapidly after the administration of folinate (15 mg) four times daily and cyanocobalamin (100 mug) once daily. The folate metabolites may be effective in the management of intrathecal-chemotherapy-induced myelopathy.
Cytarabine ; Female ; Folic Acid ; Humans ; Methotrexate ; Middle Aged ; Spinal Cord Diseases ; Stomach Neoplasms ; Vitamin B 12

Objective: The Patient Health Questionnaire–9 (PHQ-9) and PHQ-2 have not been validated in the general Korean population. This study aimed to validate and identify the optimal cutoff scores of the PHQ-9 and PHQ-2 in screening for major depression in the general Korean population. Methods: We used data from 6,022 participants of the Korean Epidemiological Catchment Area Study for Psychiatric Disorders in 2011. Major depression was diagnosed according to the Korean Composite International Diagnostic Interview. Validity, reliability, and receiver operating characteristic curve analyses were performed using the results of the PHQ-9 and Euro Quality of life-5 dimension (EQ-5d). Results: Of the 6,022 participants, 150 were diagnosed with major depression (2.5%). Both PHQ-9 and PHQ-2 demonstrated relatively high reliability and their scores were highly correlated with the “anxiety/depression” score of the EQ-5d. The optimal cutoff score of the PHQ-9 was 5, with a sensitivity of 89.9%, specificity of 84.1%, positive predictive value (PPV) of 12.6%, negative predictive value (NPV) of 99.7%, positive likelihood ratio (LR+) of 5.6, and negative likelihood ratio (LR-) of 0.12. The optimal cutoff score of the PHQ-2 was 2, with a sensitivity of 85.3%, specificity of 83.2%, PPV of 11.6%, NPV of 99.5%, LR+ of 5.1, and LR- of 0.18. Conclusion The PHQ-9 and PHQ-2 are valid tools for screening major depression in the general Korean population, with suggested cutoff values of 5 and 2 points, respectively.

No abstract available.
Female ; Humans ; Infarction* ; Meningitis*

The adverse effects of BCG vaccination span diversely from systemic to local reactions. However, the adverse effects of BCG vaccination on the skin are rare and these can appear as non-specific or specific skin reactions. We experienced two cases of non-specific skin reaction, which occurred on a vaccine-injected site. Eczematous lesions with the clinical and pathological findings have not previously been report in the English dermatologic literature. Herein, we present two interesting cases of non-specific skin reactions from dermatological complications of BCG vaccination.
Mycobacterium bovis* ; Skin ; Vaccination*

PURPOSE: The adipocyte has traditionally been known as a reservoir for energy, but currently there is growing evidence that the adipocyte plays an important role in the pathogenesis of energy metabolism and homeostasis. Adipocytokine released from the adipocyte has been known to play a role in diabetes mellitus, coronary artery disease and other diseases related with obesity. The purpose of this study was to investigate the relationship between adipocytokines and hypertension and to find out whether it is useful to evaluate adipocytokines as a risk factor for the development of hypertension in obese adolescents. METHODS: Forty five obese adolescents(16-17-years-old, obesity index >130) with hypertension and 27 normal controls with normotensive blood pressure were included in this sudy. Obesity index and body mass index were calculated and blood pressure was measured at the resting state. Lipid profile, insulin, adiponectin, leptin, TNF-alpha and IL-6 levels were tested after 10 hours of fasting. RESULTS: Adiponectin was significantly lower in the obese group, compared to the control group (3,241.3+/-2,055.9 mug/mL vs 5,088.4+/-1,347.1 mug/mL). Leptin(10.6+/-5.4 ng/mL), TNF-alpha(7.2+/-0.8 pg/mL) and IL-6(7.2+/-0.8 pg/mL) were significantly higher in the obese group. Insulin was significantly higher in the obese group than the control group(14.7+/-7.5 IU/mL vs 7.9+/-2.9 IU/mL). Adiponectin had negative correlations with TNF-alpha, body mass index, LDL cholesterol, obesity index, diastolic, and systolic blood pressure. CONCLUSION: Adiponectin might be a predictor of hypertension and a guideline for clinical intervention. Further clinical research will be necessary to ascertain the relation of adiponectin in hypertensive patients without obesity.
Adipocytes ; Adipokines ; Adiponectin* ; Adolescent* ; Blood Pressure ; Body Mass Index ; Cholesterol, LDL ; Coronary Artery Disease ; Diabetes Mellitus ; Energy Metabolism ; Fasting ; Homeostasis ; Humans ; Hypertension* ; Insulin ; Interleukin-6 ; Leptin ; Obesity ; Risk Factors ; Tumor Necrosis Factor-alpha