Liver biopsies are used routinely in the assessment of graft dysfunction following liver transplantation and generally considered to be the most reliable method for the diagnosis of posttransplant complications with overlapping clinical and laboratory findings. To investigate posttransplant complications causing graft dysfunction and usefulness of liver biopsy, we analysed clinicopathologic features of 65 posttransplant liver biopsies, 2 autopsies and an explanted liver, taken from 20 patients. The frequencies of posttransplant complications were acute cellular rejection in 9 patients (45%), postoperative infection in 11 patients (55%), of which cytomegalovirus (CMV) infection and systemic invasive aspergillosis with candidiasis occured in 10 patients (50%) and 1 patient (5%), respectively. Remainders were hepatic arterial thrombosis in two (10%), primary graft dysfunction due to fatty donor liver in one (5%), and posttransplant lymphoproliferative disorder (PTLD) in two (10%). There were no chronic rejection or recurrent disease. Postoperative mortality was 25%. Histologic grade by Banff schema was well correlated with clinical parameters associated with unfavorable short term prognosis. CMV infection was associated with acute cellular rejection in 6 out of 10 patients (60%). Immunohistochemical staining for CMV was more sensitive method than CMV in situ hybridization or histologic detection of viral inclusion on tissue section. It was unique that one case of PTLD developed under the circumstances of the lowest dosage of immunosuppression and took grave outcome. Based on these results, we concluded that clinicopathologic correlation with integration of all the clinical and laboratory findings is necessary in the interpretation of accurate and early diagnosis of posttransplant liver biopsies. The interrelationship between chronic rejection and CMV infection as well as pathogenetic factors of PTLD remains to be clarified through further ongoing observation.
Aspergillosis ; Autopsy ; Biopsy* ; Candidiasis ; Cytomegalovirus ; Diagnosis ; Early Diagnosis ; Humans ; Immunosuppression ; In Situ Hybridization ; Liver Transplantation ; Liver* ; Lymphoproliferative Disorders ; Mortality ; Primary Graft Dysfunction ; Prognosis ; Thrombosis ; Tissue Donors ; Transplants

Although the incidence is not high in the general surgical population, pulmonary aspiration of gastric contents can result in serious long-term morbidity and mortality. We report a case of early use of extracorporeal membrane oxygenation (ECMO) to correct severe hypoxemia refractory to conventional mechanical ventilation in a patient with massive aspiration of gastric contents immediately followed by acute lung injury during general anesthesia induction. A 64-year-old woman diagnosed with stomach cancer was scheduled for elective diagnostic laparoscopy. Although there was no sign of gastrointestinal tract obstruction and midnight Nil per Os (NPO) was performed before the operation, pulmonary aspiration occurred during the induction of anesthesia. Despite the endotracheal intubation with mechanical ventilation, severe hypoxemia with hypercapnea persisted. Medical team agreed with applying veno-venous (VV) ECMO, and her blood gas analysis results became stable. ECMO was weaned successfully 9 days after the first aspiration event had occurred. Based on this case, early application of extracorporeal life support can have survival benefits.
Acute Lung Injury ; Anesthesia* ; Anesthesia, General ; Anoxia ; Blood Gas Analysis ; Extracorporeal Membrane Oxygenation* ; Female ; Gastrointestinal Tract ; Humans ; Incidence ; Intubation, Intratracheal ; Laparoscopy ; Middle Aged ; Mortality ; Pneumonia, Aspiration ; Respiration, Artificial ; Stomach Neoplasms

Postnasal drip syndrome is one of the most common causes of chronic cough, and is caused by a variety of conditions including vasomotor rhinitis, allergic rhinitis, nasal polyps and chronic sinusitis. Postnasal drip syndrome is diagnosed based on clinical symptoms, and patients may complain of tickles or drainage of liquid in the back of the throat. Cobblestoning of the nasal or oropharyngeal mucosa may be observed upon physical examination. However, in many patients cough may be the only symptom of postnasal drip syndrome. Confirmation of the diagnosis may depend on the resolution of symptoms after treatments with antihistamines and intranasal or systemic corticosteroids.
Adrenal Cortex Hormones ; Cough ; Drainage ; Histamine Antagonists ; Humans ; Mucous Membrane ; Nasal Polyps ; Pharynx ; Physical Examination ; Rhinitis ; Rhinitis, Allergic, Perennial ; Rhinitis, Vasomotor ; Sinusitis

Most of the breast cancer revealed mass and/or microcalcifications on mammography. We analyzed morphologic characteristics of the masses and microcalcifications on mammography which confirmed as breast cancer pathologically. Of all 54 cases, 4 patients (7%) showed microcalcification only, 27 patients (50%), mass only, and the other 23 patients (43%), both microcalcification and mass on the mammography. The margin of the breast mass were ill-defined in 37 cases, well-defined in 8 cases, and well-defined with surrounding infiltration in 5 cases. The morphologic characteristics of the microcalcification were punctate-linear-V shape in 11 patients, punctate-linear shape in 9 patients, and punctate shape in 7 patients.
Breast Neoplasms* ; Breast* ; Humans ; Mammography

No abstract available.
Arthritis, Juvenile*

Helicobacter pylori(H. pylori) has been associated with the cause of chronic gastritis, peptic ulcers and gastric cancer. Although it may be transmitted through the oral cavity, it is unknown whether the oral cavity acts as a reservoir of H. pylori. The purpose of this study was to investigate the mode of detection of H. pylori in oral cavity of adult periodontitis patients with plaque and periodontal pocket which atmosphere is grown well H. pylori. We analysed detection rate of H. pylori in saliva and subgingival plaques of 17 adult periodontitis patients without symptoms of gastroduodenal disease by nested PCR. Samples tested comprised saliva and subgingival plaques from central incisor, 1st premolar and 1st molar. H. pylori DNA was not identified in saliva from all patients. The detection rate in subgingival plaque from incisors, premolars and molars was 5.9%, 5.9% and 17.7%, respectively. In conclusion, the dental plaque and periodontal pocket (especially, of molars) in adult periodontitis can be favorable reservoir of H. pylori and may be the source of infection and transmission of H. pylori.
Adult* ; Atmosphere ; Bicuspid ; Chronic Periodontitis* ; Dental Plaque ; DNA ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Incisor ; Molar ; Mouth ; Peptic Ulcer ; Periodontal Pocket ; Polymerase Chain Reaction ; Saliva* ; Stomach Neoplasms

A 65-year-old man with diabetes mellitus was presented with left visual aura, followed by a versive seizure, each lasting approximately 3 minutes. Neurological examination showed an intermittent left homonymous hemianopsia. Brain magnetic resonance imaging (MRI) showed right occipital lobe lesion, with cytotoxic edema. Blood glucose was 593 mg/dL and serum osmolarity was 309 mOsm/kg. The seizures were controlled by normalization of blood sugar and short-term anticonvulsant, and the lesions were resolved in a follow-up MRI. We report a case of visual seizures associated with non-ketotic hyperglycemia.
Aged ; Blood Glucose ; Brain ; Diabetes Mellitus ; Edema ; Epilepsy ; Epilepsy, Partial, Motor ; Follow-Up Studies ; Hemianopsia ; Humans ; Hyperglycemia ; Magnetic Resonance Imaging ; Neurologic Examination ; Occipital Lobe ; Osmolar Concentration ; Seizures

In recent years, advancements in information and communication technologies, including artificial intelligence, big data, virtual reality, and augmented reality, have driven substantial growth in the field of digital medical diagnosis and treatment, thereby enhancing quality of life. Beginning in the mid-2010s with the advent of digital healthcare applications, and further accelerated by the impact of coronavirus disease 2019, digital therapeutic products have profoundly influenced society. Nevertheless, the expansion of digital therapeutics has encountered challenges associated with regulatory hurdles, differentiation from general digital healthcare, and the necessity for trustworthiness, which have contributed to a slower rate of progress. This study proposes a 3P content model–encompassing pre-education, prediction/diagnosis/treatment, and postmanagement–to increase the trustworthiness of digital therapeutics. The design of the 3P content model includes a fundamental structure that establishes networks with healthcare institutions, aiming to increase the reliability of data utilization and to facilitate integration with medical decision support systems. For case development, the study introduces a prototype of a mobile application that utilizes chronic disease urinary dysfunction data, demonstrating the cyclical structure inherent in the 3P content model.

Underactive bladder and impaired bladder compliance are irreversible problems associated with bladder fibrosis. Remodeling of the extracellular matrix is regarded as an important mechanism associated with bladder fibrosis. However, various risk factors and conditions contribute to the functional impairment of the bladder associated with fibrosis, and there is limited knowledge about bladder fibrosis-associated problems in the field of neurourology. Further studies are thus necessary to elucidate the underlying mechanism of bladder fibrosis and to identify effective treatment.

Underactive bladder and impaired bladder compliance are irreversible problems associated with bladder fibrosis. Remodeling of the extracellular matrix is regarded as an important mechanism associated with bladder fibrosis. However, various risk factors and conditions contribute to the functional impairment of the bladder associated with fibrosis, and there is limited knowledge about bladder fibrosis-associated problems in the field of neurourology. Further studies are thus necessary to elucidate the underlying mechanism of bladder fibrosis and to identify effective treatment.