We recently experienced a case of an elderly patient with mediastinal abscess, which is a rare complication of esophageal perforation, in whom dyspnea, chest pain and odynophagia were main clinical symptoms after eating cooked fish. During evaluation, upper mediastinal widening, with air-fluid level, and eaophageal perforation plugged with pus were detected by chest X-ray films and endoscopic examinatien. After draining of pus(about 300 cc) through the perforation site by careful manipulation of endoscope, inner wall of abacess cavity communicating with esophagus could be observed through esophago-mediastinal fistula. For further management, drainage procedure of mediastinal abscess, esophageal diversion and feeding gastrostomy were done.
Abscess* ; Aged ; Chest Pain ; Drainage ; Dyspnea ; Eating ; Endoscopes ; Esophageal Perforation* ; Esophagus ; Fistula ; Gastrostomy ; Humans ; Suppuration ; Thorax ; X-Ray Film

No abstract available.
Hyperhidrosis

Percutaneous transhepatico-biliary duodenal drainage(PTBDD) (n=2) and percutaneous transhepatic duodenaldrainage(PTDD) (n=1) were performed as palliative treatment of obstructed afferent loop in patients in whomobstructive jaundice had occurred after surgery for malignant tumors. All three patients experienced septic shockafter PTBDD or PTDD. We describe these cases and review the literature.
Duodenum ; Humans ; Jaundice ; Jaundice, Obstructive* ; Palliative Care ; Sepsis ; Shock, Septic*

We report the first case of an angiomyomatous hamartoma (AH) of the popliteal lymph nodes (LNs) occurring in association with diffuse pigmented villonodular synovitis (PVNS) of the knee. AH is a rare benign vascular disease with a predisposition for the LNs of the inguinal region. Twenty-five cases of AH have been reported to date; however, the precise pathogenesis is still undetermined. In the present case, an open synovectomy revealed two of three popliteal LNs in close proximity to the extra-articular component of diffuse PVNS. These LNs demonstrated irregularly distributed thick-walled blood vessels in the hilum. These vessels extended into the medulla and cortex and were associated with haphazardly arranged smooth muscle cells in the sclerotic stroma. These findings are compatible with an AH. Our observations raise the possibility that AH of the popliteal LNs may represent an abnormal proliferative reaction against the inflammatory process caused by PVNS of the knee.
Angiomyoma ; Blood Vessels ; Hamartoma ; Knee ; Lymph Nodes ; Myocytes, Smooth Muscle ; Synovitis, Pigmented Villonodular ; Vascular Diseases

No abstract available.
Ascorbic Acid* ; Vitamins*

Wilson's Disease is a rare familial disorder of abnomalities in hepatic copper metabolism usually presenting with neuropsychiatric or hepatic manifestation. Hemolytic anemia is known as one of its initial clinical manifestation, but that with fulminant hepatitis is a rare presentation of Wilson's disease and so fatal leading always to death, to our best knowledge. This 16-year-old woman was transferred to our hospital with problems of acute Coombs' negative hemolytic anemia and unknown fulminant hepatitis features. She was early diagnosed as complications of Wilson's disease by slit-lamp examination of characteristic Kayser-Fleischer ring and later confirmed by raised serum free copper (55.9microgram/dL, control;< 15 microgram/dL) and 24h urine copper (1,546 microgram/dL, control; 38~70 microgram/dL). She was soon treated with D-penicillamine and pyridoxine with the plan of early liver transplantation. She was fortunately recovered with conservative treatment alone but did have active cirrhosis on consequent liver biopsy. She has been followed up for 7months. Wilson's disease should always be thought in childhood or adolescent patient with Coombs' negative hemolytic anemia and unknown fulminant hepatitis.
Adolescent ; Anemia, Hemolytic* ; Biopsy ; Copper ; Female ; Fibrosis ; Hepatitis* ; Hepatolenticular Degeneration* ; Humans ; Liver ; Liver Transplantation ; Metabolism ; Penicillamine ; Pyridoxine

PURPOSE: To detect differentially expressed genes in the patients with uterine cervical cancer during the radiation therapy. MATERIALS AND METHODS: In patients with biopsy proven uterine cervical cancer, we took a tumor tissue just before radiation therapy and at 40 minutes after external irradiation of 1.8 Gy. Total RNAs isolated from non-irradiated and irradiated tumor tissue samples were analyzed using the differential-display reverse transcription-polymerase chain reaction (DDRT-PCR). Complementary DNA (cDNA) fragments corresponding to differentially expressed messenger RNAs(mRNAs) were eluted, and cloned. The differential expression of the corresponding mRNAs was confirmed by reverse northern blot. Differentially expressed cDNA bands were sequenced. Nucleotide sequence data were analyzed in the Gene Bank and EMBL databases via the BLAST network server to identify homologies to known genes or cDNA fragments. Expression pattern of down-regulated clone was examined using RT-PCR in 5 patients undergoing radiotherapy. RESULTS: We identified 18 differentially expressed bands by DDRT-PCR, which were eluted and cloned. There were 10 up-regulated clones and 1 down-regulated clone in reverse northern blot. One cDNA fragment had homology to chemokine receptor CXCR4, four were identified as Human ESTs in the EMBL database in EST clones. Down-regulated CxCa-11 was also down regulated in all patients. CONCLUSION: Using the DDRT-PCR, we have identified 10 up-regulated and 1 down-regulated clone(s) in the patients with uterine cervix cancer during the radiation therapy. The clinical relevance and the functions of these genes will be further investigated.
Base Sequence ; Biopsy ; Blotting, Northern ; Cervix Uteri* ; Clone Cells ; DNA, Complementary ; Expressed Sequence Tags ; Female ; Humans ; Radiotherapy* ; RNA ; RNA, Messenger ; Uterine Cervical Neoplasms

The supranuclear control of eye movement invo l ves the pathway extending from the cerebral cortex to theocular motor nuclei located in the brain stem. This paper de-scribes the normal supranuclear pathway, whichcontrols eye movement. We also include magnetic resonance imaging findings of the typical ocular manifestationscaused by disorders involving the supranuclear pathway, providing the anatomic ex-planations for certain clinicalsigns.
Brain Stem ; Cerebral Cortex ; Eye Movements ; Magnetic Resonance Imaging ; Ocular Motility Disorders*

BACKGROUND: Serum eosinophil cationic protein(ECP) level has been proposed as a indirect marker of eosinophilic inflammation of the airway in bronchial asthma. OBJECTIVE: To evaluate serum ECP against indirect clinical markers of disease, we compared bronchial obstruction, bronchial hyperresponsiveness and peripheral blood eosinophil counts, total IgE with serum ECP levels in patients with bronchial asthma and normal controls. METHOD: Fourty-two patients with bronchial asthma and twenty-six normal controls were enrolled. Measurement were made by spirometry, inhalation challenge with methacholine, peripheral blood eosinophil counts, total IgE and FEIA(fluoroenzymatic immunoassay) of serum ECP RESULT: Serum ECP levels were significantly higher in asthmatic patients than normal controls(p<0.0,5). Serum ECP levels were correlated with peripheral blood eosinophil counts(p<0.01, r=0.544) and bronchial hyperresponsiveness(PC,)(p<0.01, r=-0.456) in patients with bronchial asthma. Serum ECP levels were correlated with degree of bronchial obstruction(FEV, % to predicted value, FEV1/FVC%) in total subjects, but not in asthmatic patients. CONCLUSION: Serum ECP level may be used as indicator of disease activity in bronchial asthma and be helpful in differentiation between normal person and asthmatic patients on simple serological method. Further studies on the changes of serum ECP levels according to disease course and therapeutic responses are needed.
Asthma* ; Biomarkers ; Eosinophil Cationic Protein* ; Eosinophils ; Humans ; Immunoglobulin E ; Inflammation ; Inhalation ; Methacholine Chloride ; Spirometry