BACKGROUNDS: When measuring lung function and response to bronchodilator, MDI(metered-dose inhaler) is commonly used but unfamiliarity of its use and cold sensation by the puffed gas decrease reliability of the result. Spacer can reduce the cold freon effect and undesired oropharyngeal deposition caused by the rapid evaporation of the propellant and there are many studies which showed more effectiveness of spacer on the treatment of children with asthma but no study whether it is effective on the bronchodilator response test in the first medical examination of old age. Therefore, we tested whether the use of spacer can reduce the cold freon effect and improve the bronchodilator response in the first medical examination of old age. METHODS: Two hundred of elderly patients( 65years) who had never used MDI were measured the bronchodilator response. Subjects were randomised to either spacer-user or spacer-nonuser. Twenty minutes after 400 g fenoterol was administered, FEV1 (forced expiratory volume in one second) was measured. Bronchoconstriction was defined as a decrease in FEV1 by 10% or greater after bronchodilator inhalation. We further devided each group into normal or obstructive group, obstructive group was defined as FEV1<80% of predicted and FEV1/FVC<70%. RESULTS: In normal group, spacer-user(n=83) showed greater bronchodilator response than spacer-nonuser(n=66), 6.43% vs 3.81% respectively(p<0.05) and two case of bronchoconstriction occured only in spacer-nonuser. In obstructive group, there is no significant difference in bronchodilator response between spacer-user(n=18) and spacer-nonuser(n=33), 12.32% vs 11.16% respectively(p>0.05) but brochoconstriction(n=1) occured only in spacer-nonuser. CONCLUSION: Spacer improved bronchodilator response and prevented bronchoconstriction, in the first medical examination of old age.
Aged ; Asthma ; Bronchoconstriction ; Child ; Chlorofluorocarbons ; Fenoterol ; Humans ; Inhalation ; Lung ; Sensation

Cardiac tumors are rare. Benign myxoma is the most common among them. Malignant fibrous histiocytoma is a tumor originating from primitive mesenchymal cell and found most commonly in four extremities. Since this disease was first described by Shah in 1978, there have been a lot of case reports of cardiac malignant fibrous histiocytoma. If originating in the heart, it is usually found in left atrium which is unusual for malignant cardiac tumor. Since the advent of the echocardiography as a diagnostic tool in the cardiac disease, a lot more cases of cardiac tumor have been reported. Here, we report a case of cardiac malignant fibrous histiocytoma in a 67 year old man presenting with dyspnea who, at first sight, seemed to have benign myxoma but turned out to have malignant fibrous histiocytoma. However, strictly speaking,the case we found is a cardiac invasion of the retroperitoneal malignant fibrous histiocytoma.
Aged ; Dyspnea ; Echocardiography ; Extremities ; Heart Atria ; Heart Diseases ; Heart Neoplasms ; Heart* ; Histiocytoma, Benign Fibrous ; Histiocytoma, Malignant Fibrous* ; Humans ; Myxoma*

No abstract available.
Perfusion* ; Stomach Neoplasms* ; Stomach*

Typhlitis is a necrotizing enterocolitis of the cecum, ascending colon and terminal ileum. Typhlits has been reported in the severely neutropenic patients and likely results from a combination of neutropenia and defects in the bowel mucosa related to cytotoxic chemotherapy. This disease is most common in patients with leukemia who have undergone intensive myeloablative chemotherapy. Presumptive diagnostic criteria for typhlitis include fever, abdominal pain and tenderness, and radiologic evidence of right-sided colonic inflammation in patients with neutropenia. Recently, this disease is also reported in patients with solid tumor due to increasing challenges of high dose chemotherapy. We report a case of typhlitis developed in the circumstance of neutropenia induced by chemotherapy in a patient with malignant testicular tumor.
Abdominal Pain ; Cecum ; Colon ; Colon, Ascending ; Drug Therapy* ; Enterocolitis, Necrotizing ; Fever ; Humans ; Ileum ; Inflammation ; Leukemia ; Mucous Membrane ; Neutropenia ; Typhlitis*

Few studies have compared outcomes in patients undergoing liver transplantation (LT) for hepatitis B virus (HBV) and alcoholic liver disease (ALD) in Asian countries in which living donor LT (LDLT) is dominant, where HBV is endemic and where there are no strict regulations on pre-transplant abstinence for ALD. This study compared post-LT outcomes of deceased donor LT (DDLT) in patients with ALD and HBV. Data from 220 patients who underwent primary DDLT at Seoul National University Hospital from January 2010 to December 2014, including 107 with HBV and 38 with ALD, were retrospectively analyzed. Seventy-four patients (69.2%) in the HBV group and 30 (78.9%) in the ALD group had United Network for Organ Sharing (UNOS) status 2A (P = 0.250). There were no significant differences in their 1-year (90.7% vs. 92.1%) and 3-year (82.1% vs. 82.3%) overall survival rates (P = 1.000). Multivariate analysis showed that high serum gamma glutamyltransferase concentration (≥ 70 IU/L) was independently prognostic of 1-year post-LT overall survival. Survival outcomes following DDLT were similar in Korean patients with ALD and HBV, even in the absence of strict pre-transplant abstinence from alcohol as a selection criterion.
Alcoholics* ; Asian Continental Ancestry Group ; gamma-Glutamyltransferase ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Liver Cirrhosis ; Liver Diseases, Alcoholic* ; Liver Transplantation* ; Liver* ; Living Donors ; Multivariate Analysis ; Retrospective Studies ; Seoul ; Social Control, Formal ; Survival Rate ; Tissue Donors*

Left atrial wall calcification is frequently observed in patients with rheumatic valvular heart disease. However, massive left atrial wall calcification, so called porcelain or coconut atrium, with left atrium thrombi is very rare. Here, we describe the case of a 67-year-old male patient with porcelain atrium, recurrent left atrial thrombi, and a spontaneous axillary hematoma after mitral valve replacement and surgical thrombectomy due to rheumatic valvular heart disease. The patient underwent two valvular surgeries 20 years prior; therefore, we determined not to perform additional surgeries because of a high risk of morbidity, mortality, and the recurrence of atrial thrombi. The patient has been maintained on daily warfarin as an anti-thrombic therapy for more than 5 years without major embolic complications.
Aged ; Cocos ; Dental Porcelain ; Heart Atria ; Heart Valve Diseases ; Hematoma ; Humans ; Male ; Mitral Valve ; Recurrence ; Thrombectomy ; Thrombosis ; Warfarin

The incidence of a pulmonary leiomyosarcoma as a primary lung tumor is quite rare. We report a case of primary leiomyosarcoma with a cardiac invasion in a 76 year old man. He was admitted due to left anterior chest wall pain for one month. Chest computed tomography showed a 9x8x10cm sized , large round mass in the left upper and lower lobes, and an amorphous low density lesion within the left atrium. Chest magnetic resonance imaging showed a large round mass in the left upper and lower lobes with growth into the left atrium. A diagnosis of leiomyosarcoma with prominent osteoclast-like giant cells was made based on the microscopic and immunohistochemical findings of a permanent specimen by explothoracotomy. The pathologic features of the tumor showed round mononuclear hyperchromatic cells and multinucleated giant cells that resembled osteoclasts. The immunohistochemical staining showed that the giant cells are positive for CD68 but negative for the muscle markers while the round cells were positive for the muscle marker. The patient refused further treatment and died after two months.
Aged ; Diagnosis ; Giant Cells* ; Heart Atria ; Humans ; Incidence ; Leiomyosarcoma* ; Lung* ; Magnetic Resonance Imaging ; Osteoclasts ; Thoracic Wall ; Thorax

Left atrial wall calcification is frequently observed in patients with rheumatic valvular heart disease. However, massive left atrial wall calcification, so called porcelain or coconut atrium, with left atrium thrombi is very rare. Here, we describe the case of a 67-year-old male patient with porcelain atrium, recurrent left atrial thrombi, and a spontaneous axillary hematoma after mitral valve replacement and surgical thrombectomy due to rheumatic valvular heart disease. The patient underwent two valvular surgeries 20 years prior; therefore, we determined not to perform additional surgeries because of a high risk of morbidity, mortality, and the recurrence of atrial thrombi. The patient has been maintained on daily warfarin as an anti-thrombic therapy for more than 5 years without major embolic complications.
Aged ; Cocos ; Dental Porcelain ; Heart Atria ; Heart Valve Diseases ; Hematoma ; Humans ; Male ; Mitral Valve ; Recurrence ; Thrombectomy ; Thrombosis ; Warfarin

INTRODUCTION: This study was conducted to evaluate ssrA expression resulting from adaptation of Escherichia coli (E. coli) to oral pathogens through signal exchange. MATERIALS AND METHODS: Human cell lines Hep2 and HT29, wild-type E. coli (WT K-12), ssrA knock-out E. coli (Delta K-12), and Scleropages aureus (S. aureus) were used. A single culture consisting of Hep2, HT29, WT K-12, and Delta K-12, and mixed cultures consisting of Hep2 and WT K-12, Hep2 and Delta K-12, WT K-12 and S. aureus , Delta K-12 and S. aureus , and Hep2, WT K-12, and S. aureus were prepared. For HT29, a mixed culture was prepared with WT K-12 and with WT K-12 and S. aureus. Total RNA was extracted from each culture with the resulting expression of ssrA, nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kappaB), and p53 was evaluated by Reverse transcription polymerase chain reaction (RT-PCR). RESULTS: The expression of ssrA in a single culture of WT K-12 was lower than that observed in the mixed culture of WT K-12 with S. aureus. Greater ssrA expression was observed in the mixed culture of WT K-12 with Hep2 than in the single culture of WT K-12. The expression of NF-kappaB was higher in the mixed culture of Hep2 with Delta K-12 than that in the mixed culture of Hep2 with WT K-12, and was lowest in the single culture of Hep2. The expression of ssrA was higher in the mixed culture of WT K-12 with Hep2 and S. aureus than in the mixed culture of WT K-12 with Hep2. CONCLUSION: These results suggest that ssrA plays an important role in the mechanism of E. coli adaptation to a new environment.
B-Lymphocytes ; Cell Line ; Escherichia coli ; Humans ; Mouth ; NF-kappa B ; Polymerase Chain Reaction ; Reverse Transcription ; RNA

The diagnosis of hepatocellular carcinoma (HCC) is based on imaging studies particularly in high-risk patients without histologic confirmation. This study evaluated the prevalence and characteristics of false-positively diagnosed HCC in a liver resection cohort for HCC. A retrospective review was performed of 837 liver resection cases for clinically diagnosed HCC between 2005 and 2010 at our institute. High-risk patients with tumors > 1 cm with one or two image findings consistent with HCC and tumors < 1 cm with two or more image findings consistent with HCC with persistently increased serum alpha-fetoprotein (AFP) levels above the normal range with underlying inhibited hepatitis activity underwent liver resection. The false-positive rate was 2.2% (n = 18). Of the 18 patients, 7 patients (0.8%) were diagnosed with benign conditions (one each of hemangioma, inflammation, cortical adenoma, dysplastic nodule, angiomyolipoma, bile duct adenoma, and non-neoplastic liver parenchyme) and 11 patients (1.3%) were diagnosed with malignancies (cholangiocarcinoma [n = 6], hepatoblastoma [n = 2], and one each of lymphoepithelioma-like carcinoma, ovarian cystadenocarcinoma, and nasopharynx carcinoma metastasis). The clinical characteristics of pathologically diagnosed HCC patients were similar (P > 0.05) compared to non-HCC patients except for higher rate of history of alcoholism (P < 0.05) observed in non-HCC patients. Four of 18 non-HCC patients (22.2%) showed diagnostic discordance on the dynamic imaging study. Despite the recent progression in diagnostic imaging techniques, 2.2% of cases were false-positively diagnosed as HCC in a liver resection patient cohort; and the final diagnosis was benign disease in 0.8% of liver resection patients clinically diagnosed with HCC.
Adenoma ; Adenoma, Bile Duct ; Alcoholism ; alpha-Fetoproteins ; Angiomyolipoma ; Carcinoma, Hepatocellular* ; Cohort Studies ; Cystadenocarcinoma ; Diagnosis* ; Diagnostic Imaging ; Hemangioma ; Hepatitis ; Hepatoblastoma ; Humans ; Inflammation ; Liver* ; Nasopharynx ; Prevalence ; Reference Values ; Retrospective Studies