We present the case of a 71-year-old man who was diagnosed with amoebic encephalitis caused by Balamuthia mandrillaris. He had rheumatic arthritis for 30 years and had undergone continuous treatment with immunosuppressants. First, he complained of partial spasm from the left thigh to the left upper limb. Magnetic resonance imaging revealed multifocal enhancing nodules in the cortical and subcortical area of both cerebral hemispheres, which were suggestive of brain metastases. However, the patient developed fever with stuporous mentality and an open biopsy was performed immediately. Microscopically, numerous amoebic trophozoites, measuring 20 to 25 µm in size, with nuclei containing one to four nucleoli and some scattered cysts having a double-layered wall were noted in the background of hemorrhagic necrosis. Based on the microscopic findings, amoebic encephalitis caused by Balamuthia mandrillaris was diagnosed. The patient died on the 10th day after being admitted at the hospital. The diagnosis of amoebic encephalitis in the early stage is difficult for clinicians. Moreover, most cases undergo rapid deterioration, resulting in fatal consequences. In this report, we present the first case of B. mandrillaris amoebic encephalitis with fatal progression in a Korean patient.
Aged ; Balamuthia mandrillaris ; Biopsy ; Brain ; Cerebrum ; Diagnosis ; Encephalitis ; Fever ; Humans ; Immunosuppressive Agents ; Magnetic Resonance Imaging ; Necrosis ; Neoplasm Metastasis ; Rheumatic Fever ; Spasm ; Stupor ; Thigh ; Trophozoites ; Upper Extremity

BACKGROUND: Procalcitonin (PCT) has been suggested as a marker of bacterial infection with systemic manifestation. The purpose of this study was to determine whether PCT level can be used to discriminate between the sepsis or septic shock and localized infection or non-infection. MATERIALS AND METHODS: This was a prospective study involving 71 patients who presented with fever. The final diagnosis was inflammation without infection in 16, localized infection in 25, sepsis in 15, and septic shock in 15. We compared the different parameters of infection- erythrocyte sedimentation rate (ESR), C- reactive protein (CRP), interleukin-6 (IL-6), and PCT - by comparing the area under the receiver operating characteristic curves (AUCs) of sepsis/or septic shock and localized infection/or non-infection. We also determined the predictive power of PCT in detecting sepsis. RESULTS: The median PCT concentrations were 0.85 (range, 0.747-1.57) ng/mL for non-infection, 1.28 (0.73- 2.33) ng/mL for localized infection, 2.59 (1.87-9.0) ng/ mL for sepsis, and 23.9 (23.1-126.1) ng/mL for septic shock. PCT exhibited the highest discriminative value, with an AUC of 0.889 (95% CI, 0.81-0.97), followed by IL-6 (0.779; CI, 0.65-0.90), CRP (0.642; CI, 0.51-0.78), and ESR (0.412; CI, 0.28-0.56). At a cutoff value of 1.73 ng/mL, PCT showed sensitivity of 86.5%, specificity of 75.6%, positive predictive value of 72.2%, and negative predictive value of 88.6%. CONCLUSION: The PCT concentrations could be used to help discriminate sepsis in newly admitted febrile patients.
Area Under Curve ; Bacterial Infections ; Blood Sedimentation ; Diagnosis* ; Fever* ; Humans ; Inflammation ; Interleukin-6 ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Sepsis ; Shock, Septic

BACKGROUND: Procalcitonin (PCT) has been suggested as a marker of bacterial infection with systemic manifestation. The purpose of this study was to determine whether PCT level can be used to discriminate between the sepsis or septic shock and localized infection or non-infection. MATERIALS AND METHODS: This was a prospective study involving 71 patients who presented with fever. The final diagnosis was inflammation without infection in 16, localized infection in 25, sepsis in 15, and septic shock in 15. We compared the different parameters of infection- erythrocyte sedimentation rate (ESR), C- reactive protein (CRP), interleukin-6 (IL-6), and PCT - by comparing the area under the receiver operating characteristic curves (AUCs) of sepsis/or septic shock and localized infection/or non-infection. We also determined the predictive power of PCT in detecting sepsis. RESULTS: The median PCT concentrations were 0.85 (range, 0.747-1.57) ng/mL for non-infection, 1.28 (0.73- 2.33) ng/mL for localized infection, 2.59 (1.87-9.0) ng/ mL for sepsis, and 23.9 (23.1-126.1) ng/mL for septic shock. PCT exhibited the highest discriminative value, with an AUC of 0.889 (95% CI, 0.81-0.97), followed by IL-6 (0.779; CI, 0.65-0.90), CRP (0.642; CI, 0.51-0.78), and ESR (0.412; CI, 0.28-0.56). At a cutoff value of 1.73 ng/mL, PCT showed sensitivity of 86.5%, specificity of 75.6%, positive predictive value of 72.2%, and negative predictive value of 88.6%. CONCLUSION: The PCT concentrations could be used to help discriminate sepsis in newly admitted febrile patients.
Area Under Curve ; Bacterial Infections ; Blood Sedimentation ; Diagnosis* ; Fever* ; Humans ; Inflammation ; Interleukin-6 ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Sepsis ; Shock, Septic

Background: Pituitary tumor transforming gene 1 (PTTG1), paired-like homeodomain 2 (PITX2), and galectin-3 have been widely studied as predictive biomarkers for various tumors and are involved in tumorigenesis and tumor progression. We evaluated the usefulness of PTTG1, PITX2, and galectin-3 as predictive biomarkers for invasive non-functioning pituitary adenomas (NFPAs) by determining the relationship between the expressions of these three proteins and the invasiveness of the NFPAs. We also investigated whether PTTG1, E-cadherin, and Ki-67, which are known to be related to each other, show a correlation with NFPA features. Methods: A retrospective study was conducted on 87 patients with NPFAs who underwent surgical removal. The NFPAs were classified into three groups based on magnetic resonance imaging findings of suprasellar extension and cavernous sinus invasion. Immunohistochemical staining for PTTG1, PITX2, galectin-3, E-cadherin, and Ki-67 was performed on tissue microarrays. Results: PTTG1 expression showed a statistically significant correlation with the invasiveness of NFPAs, whereas PITX2 and galectin-3 did not have a relationship with the invasiveness of NFPAs. Moreover, there was no association among PTTG1, E-cadherin, and Ki-67 expression. Conclusions PTTG1 has the potential to serve as a predictive biomarker for invasive NFPA. Furthermore, this study may serve as a reference for the development of PTTG1-targeted therapeutic agents.

On October 4, 2018, an outbreak of gastroenteritis associated with sapovirus occurred among elementary school students in Gyeonggi-do, Korea. Epidemiologic studies were conducted in a retrospective cohort approach. Using self-administered questionnaires, we collected information on symptoms and food items consumed. Of the 999 subjects, 17 developed patients that met the case definition. The main symptom was vomiting (100%), and the symptomatic age was 6-12 years. Positive samples were identified by conventional reverse transcription polymerase chain reaction for sequencing. They were classified into genotype GI.3 by phylogenetic analysis. This is the first report of an outbreak associated with sapovirus GI.3 in Korea.

Colonic diverticulosis is small outpouching from the lumen of the colon, and this caused by mucosal herniation. Most patients are asymptomatic, but 5~15% of those affected manifest diverticular bleeding. Because most of them stop bleeding spontaneously, the source of the bleeding can not be found by colonoscopy in 15% of these cases. We report here on a case of sigmoid diverticular bleeding that detected by capsule endoscopy in a 68-year old woman who presented with acute obscure gastrointestinal bleeding.
Aged ; Capsule Endoscopy* ; Colon ; Colon, Sigmoid* ; Colonoscopy ; Diverticulosis, Colonic ; Female ; Hemorrhage* ; Humans

OBJECTIVES: The aim of this study was to investigate levels of matrix metalloproteinase-8 (MMP-8) and substance P (SP) in root canal exudates during root canal treatment (RCT) of nonvital, painful teeth. MATERIALS AND METHODS: Patients scheduled for nonsurgical RCT were prospectively selected; the study was performed after obtaining informed consent from the patients and was approved by the Institutional Review Board for Clinical Research of Gangnam Severance Hospital, Yonsei University (3-2008-0118). Canal exudates samples were collected using sterilized paper points from teeth scheduled for RCT across three different time periods. MMP-8 and SP levels were measured using enzyme-linked immunosorbent assay (ELISA). Data were analyzed using a mixed model analysis and the Pearson correlation analysis (p < 0.05). RESULTS: MMP-8 and SP levels in GCF were decreased during RCT (p < 0.0001), and they showed a weak positive correlation to each other (p < 0.05). Patients'subjective pain levels and the response from percussion test were significantly related to SP level. CONCLUSIONS: This study demonstrated that periradicular inflammation endodontic origin can elevate SP and MMP-8 levels in root canal exudates. Interestingly, SP level of canal exudates showed a possibility of being used as an indicator of pain due to periapical pathosis.
Dental Pulp Cavity ; Enzyme-Linked Immunosorbent Assay ; Ethics Committees, Research ; Exudates and Transudates ; Humans ; Inflammation ; Informed Consent ; Matrix Metalloproteinase 8 ; Percussion ; Prospective Studies ; Substance P ; Tooth ; Tooth, Nonvital

BACKGROUND: Bilateral ureteral obstuction (BUO) has been known to decrease the expression of renal aquaporin-2 (AQP2) and Na-K-2Cl cotransporter (NKCC2). The polyuria and urinary concentration defect in postobstructive diuresis (POD) may be explained by these molecular changes. By contrast, chronic infusion of antidiuretic hormone (ADH) has been known to increase the expression of renal AQP2 and NKCC2, but there have been no studies regarding the chronic effect of ADH in molecular level when introducing to POD. We tried to identify the changes of renal expression of AQP2 and NKCC2 in 24 hour BUO rat at POD-7 day and the chronic effect of ADH to the expression of AQP2 and NKCC2 in sham operation rat and in 24 hour BUO rat, at sham operation 7 day and at POD-7 day, respectively. METHODS: Twenty four Spraugue-Dawley rats were divided into four groups. Group I (Control group): sham operation rats(n=6). Group II (BUO group): 24 hour BUO and release of it (n=6). Group III (dDAVP group): dDAVP (1-deamino-8d-arginine vasopressin: V2-receptor-selective agonist) infusion at rate of 20 ng/hour by osmotic minipump subcutaneously for 7 days in sham operation rats (n=6). Group IV (BUO+dDAVP group): dDAVP infusion at rate of 20 ng/hour by osmotic minipump by same method as Group III in 24 hour BUO rats (n=6). All rats were sacrificed at POD-7 day (Group II, Group IV) or sham operation-7 day (Group I, Group III) and renal expression of AQP2 and NKCC2 were analyzed by immunohistochemistry and by Western blot method. Blood and urinary chemistry examinations were done concurrently. RESULTS: BUO group showed increased urine output and decreased urine osmolality (p<0.05) and decreased expressions of AQP2 and NKCC2 compared with Control group {29.1 +/- 4.2% vs. 100 +/- 10.0% (p< 0.05); 40.2 +/- 5.4% vs. 100 +/- 7.9% (p<0.05) respectively}. dDAVP group had decreased urine output from POD-1 day to POD-5 day and increased urine osmolality (p<0.05) POD-1 day to POD-7 day during and increased expressions of AQP2 and NKCC2 compared with Control group {206.5 +/- 19.0% vs. 100 +/- 10.0% (p<0.05); 180.6 +/- 13.3% vs. 100 +/- 7.9% (p<0.05) respectively}. But BUO group showed no difference in urine output and urine osmolality and expressions of AQP2 and NKCC2 compared with BUO+dDAVP group {29.1 +/- 4.2% vs. 42.2 +/- 2.3% (p<0.84); 40.2 +/- 5.4 % vs. 47.9 +/- 4.3% (p<0.91) respectively}. CONCLUSION: BUO and POD show decreased expressions of AQP2 and NKCC2 and the unresponsiveness to chronic ADH infusion may be the pathophysiologic basis of POD such as increased urine output, decreased urine osmolality.
Animals ; Aquaporin 2* ; Blotting, Western ; Chemistry ; Deamino Arginine Vasopressin ; Diuresis ; Immunohistochemistry ; Osmolar Concentration ; Polyuria ; Rats* ; Ureter* ; Ureteral Obstruction* ; Vasopressins

Intramural duodenal hematoma is a rare finding in the adult, especially when related to iatrogenic complications of ulcer treatment, it can lead to biliary obstruction and pancreatitis, which can be fatal in severe case. We report one case of intramural duodenal hematoma complicated with pancreatitis after endoscopic hemostasis in a chronic renal failure patient with maintenance hemodialysis. He had a duodenal ulcer bleeding treated with endoscopic epinephrine injection and electro-coagulation therapy, but on the second day, he complained of persistent abdominal pain, nausea and vomiting. Abdominal ultrasound showed acute, edematous pancreatitis and a mass with low echodensity in the wall of the 2nd portion of the duodenum. Symptom and laboratory findings were persistent under conservative therapy, 7 days later, gastric resection, hematoma evacuation was carried out, subsequently the patient recovered from the pancreatitis but the patient died of septic shock and multiple organ dysfunction.
Abdominal Pain ; Adult ; Duodenal Ulcer ; Duodenum ; Epinephrine ; Hematoma* ; Hemorrhage ; Hemostasis, Endoscopic* ; Humans ; Kidney Failure, Chronic* ; Nausea ; Pancreatitis* ; Renal Dialysis* ; Shock, Septic ; Ulcer ; Ultrasonography ; Vomiting

OBJECTIVE: The spot sign is related with the risk of hematoma expansion in spontaneous intracerebral hemorrhage (ICH). However, not all spot sign positive patients undergo hematoma expansion. Thus, the present study investigates the specific factors enhancing the spot sign positivity in predicting hematoma expansion. METHODS: We retrospectively studied 316 consecutive patients who presented between March 2009 to March 2011 with primary ICH and whose initial computed tomography brain angiography (CTA) was performed at our Emergency Department. Of these patients, 47 primary ICH patients presented spot signs in their CTA. We classified these 47 patients into two groups based on the presence of hematoma expansion then analyzed them with the following factors : gender, age, initial systolic blood pressure, history of anti-platelet therapy, volume and location of hematoma, time interval from symptom onset to initial CTA, spot sign number, axial dimension, and Hounsfield Unit (HU) of spot signs. RESULTS: Of the 47 spot sign positive patients, hematoma expansion occurred in 26 patients (55.3%) while the remaining 21 (44.7%) showed no expansion. The time intervals from symptom onset to initial CTA were 2.42+/-1.24 hours and 3.69+/-2.57 hours for expansion and no expansion, respectively (p=0.031). The HU of spot signs were 192.12+/-45.97 and 151.10+/-25.14 for expansion and no expansion, respectively (p=0.001). CONCLUSIONS: The conditions of shorter time from symptom onset to initial CTA and higher HU of spot signs are the emphasizing factors for predicting hematoma expansion in spot sign positive patients.
Angiography ; Blood Pressure ; Brain ; Cerebral Hemorrhage* ; Emergency Service, Hospital ; Hematoma* ; Humans ; Retrospective Studies