Unilateral absence of the pulmonary artery (UAPA) is a rare congenital anomaly that occurs in association with other cardiovascular anomalies, such as tetralogy of Fallot or ventricular septal defects. On the other hand, it is less commonly found as an isolated finding without accompanying diseases. Isolated UAPA is a rare cause of hemoptysis, and massive hemoptysis has been reported to occur in approximately 18~20% of UAPA patients during their clinical course. Even if a lung resection is considered a treatment option to control life-threatening hemoptysis, the procedure is more difficult than an ordinary lung resection because of the excessive collateral vessels from the systemic circulation. We encountered an isolated UAPA occurring in a young male patient suffering from intermittent blood tinged sputum. To our knowledge, only a few cases of isolated UAPA have been reported in Korea. This case is expected to be a good example to help clinicians better understand isolated UAPA as an unusual cause of hemoptysis.
Hand ; Heart Septal Defects, Ventricular ; Hemoptysis ; Humans ; Korea ; Lung ; Male ; Pulmonary Artery ; Sputum ; Stress, Psychological ; Tetralogy of Fallot ; Tolnaftate

Endoscopic resection is currently accepted as a standard therapy for colon polyp because of its safety and efficiency. The indications for endoscopic resection have been expanded to treat mucosal colon cancer and submucosal tumor. The major complications of endoscopic resection are hemorrhage, perforation and post- polypectomy coagulation syndrome. Hemorrhage is the most common complication, and this can occur immediately following colonoscopic polypectomy or it can be delayed after completion of the procedure. Delayed hemorrhage usually occurs within 7 days and this can stop by itself or the hemorrhage can be controlled endoscopically in the majority of patients, with only the unusual and serious cases requiring transfusion, angiography and surgery. We experienced a case of delayed massive hemorrhage with hypotension that required transfusion 12 days after performing endoscopic resection for rectal carcinoid tumor. We report here on this case to provide a good example and to place emphasis on delayed massive hemorrhage after endoscopic resection.
Angiography ; Carcinoid Tumor ; Colon ; Colonic Neoplasms ; Hemorrhage ; Humans ; Hypogonadism ; Hypotension ; Mitochondrial Diseases ; Ophthalmoplegia ; Polyps

BACKGROUND: To determine the molecular structure of type II collagen-specific T-cell receptors associated with rheumatoid arthritis (RA). METHODS: We generated CII-specific T-cell lines of 8 RA patient s by prolonged in vitro culture with bovine CII (bCII) and the immunogenic peptide (256-270) of human CII. The proliferation response towards CII stimulation was measured from the uptake of 3 H-thymidine. Changes in the secretion of Th 1 and Th2 cytokines in the culture supernatent were measured by ELISA. The TCR clonotypes of these T-cells were examined by RT-PCR/ SSCP analyses of all 22 V beta chains. RESULTS: T-cells from patients' tissue exhibited strong proliferation index upon CII stimulation, which was maintained up to 6 months in the culture. The secretion of INF-gamma from these T-cells increased along with the duration of culture time, while the amount of IL-4 production did not show significant changes. The SSCP band patterns of patients' T-cells appear as discrete bands unlike the smeary streak produced from normal samples. Some SSCP bands, each representing selected expansion of a TCR containing certain subtype of V beta peptides, appeared to be identical in more than one patients. Among these, the expansion of SSCP band representing the V beta 14 CDR3 region persisted after switching the antigen to the immunogenic human peptide (256-270). CONCLUSION: CII-reactive T-cells expressing distinct CDR3 motifs are selectively expanded in the peripheral blood and synovial fluid of RA patients, and their persistent proliferation upon CII stimulation, as well as the production Th 1-type cytokines, may play pivotal roles in RA pathogenesis.
Arthritis, Rheumatoid* ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interleukin-4 ; Molecular Structure ; Peptides ; Polymorphism, Single-Stranded Conformational ; Receptors, Antigen, T-Cell ; Synovial Fluid ; T-Lymphocytes*

BACKGROUND: Central venous cannulation is one of the important parts of anesthetic management. Because general anesthesia causes external-landmarks (e.g. sternocleidomastoid muscle, carotid artery pulse) indistinct, we developed a new external landmark for internal jugular vein cannulation that can be easily detected under general anesthesia. METHODS: We cannulated the right internal jugular vein of 110 patients under general anesthesia. We used the external jugular vein and cricoid cartilage as a landmark. RESULTS: Cannulation of the right internal jugular vein was successful in 108 out of 110 patients (98.2%). Patients required an average 1.48+/-0.63 attempts. There were 2 carotid punctures (1.8%), 3 discomforts (2.7%) and no brachial plexus irritation. CONCLUSIONS: This new landmark technique has a high success rate and few complications.
Anesthesia, General ; Brachial Plexus ; Carotid Arteries ; Catheterization* ; Central Venous Catheters ; Cricoid Cartilage ; Humans ; Jugular Veins* ; Punctures

A 13-year-old girl presented with multiple skin abscesses. She was diagnosed as having juvenile dermatomyositis (DM) at the age of 7 years. She had suffered from recurrent skin infections, atypical pruritic dermatitis and pneumonia since the age of 8 years. Bacteriologic and fungal cultures for skin abscesses and oral mucosa were positive S. aureus and C. albicans, respectively. Chemotactic defect in peripheral blood neutrophils was observed. The level of serum IgE was markedly elevated, and anti-S.aureus specific IgE was found. A diagnosis of hyperimmunoglobulin E-recurrent infection syndrome (HIE) was made and she was successfully treated with surgical drainage and antibiotics. To our knowledge, this is the first case report of HIE in a patient with juvenile dermatomyositis.
Adolescence ; Case Report ; Dermatomyositis/complications* ; Female ; Human ; IgE/blood ; Job's Syndrome/immunology ; Job's Syndrome/diagnosis ; Job's Syndrome/complications* ; Staphylococcal Infections/immunology ; Staphylococcal Infections/complications ; Staphylococcus aureus/immunology

Bronchopulmonary infections caused by trichomonads have been reported principally in patients with pre-existing pulmonary diseases, such as bronchial carcinoma, lung abscess, or bronchiectasis. Pulmonary trichomoniasis is most often caused by Trichomonas tenax, which is usually regarded as a harmless commensal organism of the human mouth. However, pulmonary infection may rarely be caused by other trichomonas species, including Trichomonas vaginalis from the genitourinary tract and Trichomonas hominis from the intestines. Because of the rarity of trichomonas pulmonary infection, and because of its close association with underlying lung and systemic disease, pulmonary trichomoniasis is considered an opportunistic infection. We recently treated a case of pulmonary trichomoniasis occurring in a young, healthy male without obvious underlying pulmonary or systemic illness. To our knowledge, there has been only one reported case of pulmonary trichomoniasis in Korea, and there have been only two reported cases of pulmonary trichomoniasis occurring in normal lung worldwide.
Bronchiectasis ; Carcinoma, Bronchogenic ; Humans ; Intestines ; Korea ; Lung ; Lung Abscess ; Lung Diseases ; Male ; Mouth ; Opportunistic Infections ; Polymers ; Trichomonas ; Trichomonas vaginalis

Purpose: The purpose of this study was to investigate the concordance rate of PIK3CA mutations between primary and matched distant metastatic sites in patients with breast cancer and to verify whether there are differences in the frequency of PIK3CA hotspot mutations depending on the metastatic sites involved. Materials and Methods: Archived formalin-fixed paraffin-embedded (FFPE) specimens of primary breast and matched distant metastatic tumors were retrospectively obtained for 49 patients. Additionally, 40 archived FFPE specimens were independently collected from different breast cancer metastatic sites, which were limited to three common sites: the liver, brain, and lung. PIK3CA mutations were analyzed using droplet digital PCR, including hotspots involving exons 9 and 20. Results: After analysis of 49 breast tumors with matched metastasis sites, 87.8% showed concordance in PIK3CA mutation status. According to PIK3CA hotspot mutation testing in 89 cases of breast cancer metastatic sites, the proportion of PIK3CA mutations at sites of metastasis involving the liver, brain, and lung was 37.5%, 28.6%, and 42.9%, respectively, which did not result in statistical significance. Conclusion The high concordance of PIK3CA mutation status between primary and matched metastasis sites suggests that metastatic sites, regardless of the metastatic organ, could be considered sample sources for PIK3CA mutation testing for improved therapeutic strategies in patients with metastatic breast cancer.

Objective: To investigate the effect of tumor necrosis factor (TNF)-alpha on the production of macrophage migration inhibitory factor (MIF), which might have important roles in the immune mediated inflammatory response of Behcet's syndrome. Methods: Sixty two patients with Behcet's syndrome and thirty healthy controls were included in this study. The concentrations of TNF-alpha in sera were determined by enzyme-linked immunosorbent assay (ELISA). Peripheral blood mononuclear cells (PBMCs) from eleven patients with Behcet's syndrome were cultured for 48 hours with various concentration of TNF-alpha. The concentrations of MIF in sera and culture supernatants were determined by ELISA. Results: Serum levels of TNF-alpha were significantly higher in patients with Behcet's syndrome than in healthy controls. TNF-alpha dose-dependently increased MIF production from PBMCs in patients with Behcet's syndrome. Serum levels of TNF-alpha tended to correlate with serum levels of MIF, although did not reach statistical significance. Conclusion: Upregulation of MIF production by increased levels of TNF-alpha in patients with Behcet's syndrome might be related to the pathogenesis of Behcet's syndrome.
Behcet Syndrome* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Macrophages* ; Tumor Necrosis Factor-alpha* ; Up-Regulation*

This study aimed to evaluate the reproducibility of apparent diffusion coefficient (ADC) measurements in malignant breast masses, and to determine the influence of mammographic parenchymal density on this reproducibility. Sixty-six patients with magnetic resonance findings of the mass were included. Two breast radiologists measured the ADC of the malignant breast mass and the same area on the contralateral normal breast in each patient twice. The effects of mammographic parenchymal density, histology, and lesion size on reproducibility were also assessed. There was no significant difference in the mean ADC between repeated measurements in malignant breast masses and normal breast tissue. The overall reproducibility of ADC measurements was good in both. The 95% limits of agreement for repeated ADCs were approximately 30.2%-33.4% of the mean. ADC measurements in malignant breast masses were highly reproducible irrespective of mass size, histologic subtype, or coexistence of microcalcifications; however, the measurements tended to be less reproducible in malignant breast masses with extremely dense parenchymal backgrounds. ADC measurements in malignant breast masses are highly reproducible; however, mammographic parenchymal density can potentially influence this reproducibility.
Adult ; Aged ; Aged, 80 and over ; *Algorithms ; Breast Neoplasms/*pathology ; Diffusion Magnetic Resonance Imaging/*methods ; Female ; Humans ; Image Enhancement/*methods ; Image Interpretation, Computer-Assisted/*methods ; Middle Aged ; Reproducibility of Results ; Sensitivity and Specificity

OBJECTIVE: Vascular endothelial growth factor (VEGF),a potent angiogenic, permeability-enhancing cytokine plays an important role in chronic inflammatory process of rheumatoid arthritis (RA).Nonsteroidal anti-inflammatory drugs (NSAIDs)are the most widely used drugs for the treatment of RA.However, the effect of NSAIDs on angiogenesis in rheumatoid synovium is unclear.In this study,we investigated the effects of NSAIDs such as indomethacin (IDC) on TGF-beta-induced VEGF production in rheumatoid synoviocytes. METHODS: Fibroblast-like synoviocytes (FLS)from RA were stimulated with T G F -beta(10 ng/ml)for 24hr in the presence of the various concentrations of IDC. The levels of VEGF were measured in culture supernatant by ELISA.In addition, COX-2 and VEGF mRNA expression of cultured FLS were evaluated by RT-PCR. RESULTS:VEGF production from FLS was significantly increased in the presence of TGF-beta.IDC exerted a dose-dependent inhibitory effect on the production of VEGF induced by TGF-beta.RT-PCR analysis showed that IDC also inhibited TGF-beta-induced COX-2 and VEGF mRNA expression in cultured FLS by a dose-dependent manner. CONCLUSION:Our results demonstrate that NSAIDs inhibit VEGF production and the expression of its mRNA and COX-2 mRNA in synovial cells of RA patients.These findings suggest that NSAIDs may suppress progression and perpetuation of rheumatoid synovitis by anti-angiogenic activity.
Anti-Inflammatory Agents, Non-Steroidal ; Arthritis, Rheumatoid ; Indomethacin ; RNA, Messenger ; Synovial Membrane ; Synovitis ; Vascular Endothelial Growth Factor A*