No abstract available.
Hypertension, Pulmonary*

Spontaneous intracranial hypotension (SIH) is a condition caused by spontaneous cerebrospinal fluid (CSF) leakage, resulting in orthostatic headache as the main symptom, but other symptoms such as memory loss, nausea, and tinnitus may also be present. Various imaging techniques are used to diagnose SIH, with magnetic resonance imaging myelography being an important tool for detecting the leakage site of CSF. Conservative treatments including hydration, bed rest, and intravenous caffeine have been tried with limited success. Epidural blood patch (EBP) is the most commonly performed treatment for SIH after the failure of conservative management. There are different opinions about the EBP procedure (e.g., blind EBP vs. targeted EBP). This report describes the treatment of SIH with targeted EBP according to imaging diagnosis after the failure of initial blind lumbar EBP.

PURPOSE: The Sitz bath is a commonly used nonsurgical treatment for patients with hemorrhoids. When these patients use public baths, possibilities exposure to infectious diseases due to public-bath utilization by exist for person infected with many kinds of diseases. In particular, because Hepatitis type B and type C viruses are infection sources for chronic liver diseases, we shall examine the risks of infections of HBV and HCV in acute hemorrhoids patients by examining the existences of HBV DNA and HCV RNA in the waters of public baths. RESULTS: From March 2005 to March 2006, 29 hot-water samples and 22 cold-water samples were obtained from public baths within Busan. With each sample, COBAS Amplicor HBV DNA monitor and HCV RNA monitor were used to run a quantitative (PCR) for HBV DNA and HCV RNA. Additionally, HBsAg and HBeAg were examined through chemiluminescent microparticle immuno assay (CMIA). RESULTS: HBV DNA was detected in 4 samples and HCV RNA was detected in an other 4 samples of the 29 samples from the hot baths. In 22 samples from the cold baths, HBV DNA was detected in 3 samples and HCV RNA in an other 2 samples. The mean levels of HBV DNA detected were 162.8 IU/ml and 1,586 IU/ml and the mean levels of HCV RNA were 276 IU/ml and 3,067 IU/ml from specimens in hot and cold baths, respectively. In the tests for HBs Ag and HBeAg, among 51 samples, 2 hot-water samples showed positive for HBs Ag while the others showed negative. CONCLUSIONS: HBV DNA and HCV RNA were detected in both the hot and the cold waters of public baths. However, this result cannot be regarded as demonstrating infectivity, but further studies are thought to be needed to examine the risks of infections to patients with acute hemorrhoids of higher than third degree or patients with open wounds or external orifices. A patient with hemorrhoids or fistulas with external orifices should not use public baths and should undergo curative surgery.
Baths* ; Busan ; Communicable Diseases ; DNA* ; Fistula ; Hemorrhoids* ; Hepacivirus ; Hepatitis ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Humans ; Liver Diseases ; RNA* ; Water ; Wounds and Injuries

Antiandrogens are generally used for the treatment of prostate cancer, with gynecomastia the most common adverse event seen during therapy. However, a breast mass in a man with a carcinoma of the prostate may represent a metastatic disease or, less often, a primary carcinoma of the breast. Clinically diagnosed metastatic prostate cancer to the breast is a rare event. Breast metastasis represents an end-stage manifestation of the cancer, with an extremely poor prognosis. Herein, the case of a 62-year-old man, who presented with bilateral breast masses 7 months after antiandrogen therapy for the treatment of prostate cancer, is reported. An excisional biopsy of the breast mass revealed a metastatic prostatic adenocarcinoma.
Adenocarcinoma ; Androgen Antagonists ; Biopsy ; Breast* ; Gynecomastia ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Prostate* ; Prostatic Neoplasms

PURPOSE: To evaluate the low attenuation of mosaic pattern in pulmonary embolism, as observed on HRCT, and to correlate the findings with the pathologic features of resected lung. MATERIALS AND METHODS: Using permanent embolic materials, pulmonary embolism was induced in eight Yorkshire pigs. Pre-and post-embolic pulmonary angiography was performed and after 6 weeks, the incidence and pattern of parenchymal change in low attenuation (mosaic pattern), as seen on HRCT, was evaluated. The animals were then sacrified and contact radiography of the lung was performed. Thirty-eight segments of pathology were taken from the area in which the presence of embolism had been suggested. Pathologic and HRCT findings were then correlated. RESULTS: On HRCT, low attenuation was seen in 23 of 36 segments (64%) and showed variable patterns : crescent peripheral hyperlucency (61%, n=14), heterogeneous mottled hyperlucency (17%, n=4), lobular hyperlucency (13%, n=3), and homogeneous segmental hyperlucency (9%, n=2). Parenchymal low attenuation was seen on HRCT in 10 of 11 segments (91%) in which large segmental arterial occlusion occurred, and in 3 of 16 segments (19%) in which there was small segmental arterial occlusion. Abnormal pathologic findings were pulmonary congestion, dilatation of pulmonary arteries, interlobular septal thickening, and thrombus formation. Among the 38 pathologic segmental specimens, 29 were from the area in which HRCT findings were positive, and in which pulmonary embolism subsequently occurred. In only four of nine segments (44%) in the area in which HRCT fingings were negative was pulmonary embolism subsequently. CONCLUSION: HRCT findings of pulmonary embolism at six weeks after embolization showed variable patterns of low attenuation, diminished diameter of pulmonary arteries, and normal diameter of bronchi. In cases with large segmental arterial occlusion, the finding of low attenuation was more common ; this may be due to reduced blood flow to the embolic area, in combination with bronchiolar spasm. For the early diagnosis of pulmonary embolism, these findings may be useful.
Angiography ; Animals ; Bronchi ; Dilatation ; Early Diagnosis ; Embolism ; Estrogens, Conjugated (USP) ; Incidence ; Lung ; Pathology ; Pulmonary Artery ; Pulmonary Embolism* ; Radiography ; Spasm ; Swine ; Thrombosis

Recent studies have demonstrated that tumor necrosis factor-alpa(TNF-alpa) decreased production of type I and III procollagens and increased production of collagenase in cultured human dermal fibroblasts. The purpose of this study was to examine the effect of TNF-alpa on the level of expression of type I procollagen, collagenase mRNA in hypertrophic scar and keloid fibroblasts in culture. The cultured fibroblasts from normal skin, hypertrophic scar and keloid were exposed to 0, 1, 10, and 100 ng/ml of TNF-alpa for 24 hours. Then, type I procollagen mRNA and collagenase mRNA were measured by quantitative RT-PCR and quantified by computerized densitometry(TINA). In normal skin fibroblasts, TNF-alpa significantly decreased the level of type I procollagen mRNA and increased collagenase mRNA. The maximal inhibition for type I procollagen mRNA was noted at 100 ng/ml of TNF-alpa and maximal enhancement for collagenase mRNA was noted at 100ng/ml of TNF-alpa. In hypertrophic scar fibroblasts, TNF-alpa significantly decreased the level of type I procollagen mRNA and increased collagenase mRNA. The maximal inhibition for type I procollagen mRNA was noted at 100 ng/ml of TNF-alpa which was the same as normal skin fibroblasts but there were no significant differences among TNF-alpa treated groups for collagenase mRNA. In keloid fibroblasts, TNF-alpa also significantly decreased the level of type I procollagen mRNA and increased collagenase mRNA. The maximal inhibition for type I procollagen mRNA was noted at 100 ng/ml of TNF-alpa which was the same as normal skin and hypertrophic scar fibroblasts but there were no significant differences among TNF-alpa treated groups for collagenase mRNA. These results strongly suggested that TNF-alpa might have a role in preventing progression of fibroproliferative disease, such as hypertrophic scar or keloid, and that the most effective concentration of TNF-alpa was found in 100 ng/ml.
Cicatrix, Hypertrophic* ; Collagen Type I* ; Collagenases* ; Fibroblasts* ; Gene Expression* ; Humans ; Keloid* ; Necrosis* ; Procollagen ; RNA, Messenger ; Skin

PURPOSE: Although the possibility of distal radius fractures is strong in hemodialysis patients, there are many difficult problems such as the bleeding tendency, hypervascularity and injury to arteriovenous fistula. We studied the outcomes of open reduction and volar locking plate fixation of the distal radius fractures in hemodyalisis patients with ipsilateral arteriovenous fistula. METHODS: From 2007 to 2009, a retrospective chart review was performed of eleven hemodialysis patients who underwent volar locking plate fixation for treatment of distal radius fractures. Eight of them were female and three were male and mean age was 68 years (range, 57-81 years). Mean follow-up period was 19 months (range, 12-28 months). All patients had osteoporosis with mean T-score of -2.7. All operations were performed on the next day of hemodialysis. Scheduled hemodialysis was possible on the next day of surgery without splint. We analyzed radiographic results, the wrist range of motion, Mayo wrist score and disabilities of the arm, shoulder and hand (DASH) score at the last follow-up. RESULTS: All fractures achieved anatomical reduction and united at final follow-up. Complications such as hematoma or occlusion of arteriovenous fistula were not observed. Mean Mayo wrist score was 78 and mean DASH score was 22. CONCLUSION: Volar locking plate fixation for distal radius fractures provides immediate support for continuing hemodialysis and exercise. Open reduction of the fractures and the use of tourniquet don't seem to increase the vascular complications like hematoma and fistula occlusion.
Arm ; Arteriovenous Fistula ; Female ; Fistula ; Follow-Up Studies ; Hand ; Hematoma ; Hemorrhage ; Humans ; Male ; Osteoporosis ; Radius Fractures* ; Radius* ; Range of Motion, Articular ; Renal Dialysis* ; Retrospective Studies ; Shoulder ; Splints ; Tourniquets ; Wrist

Leiomyomas are the most common benign tumors found in the esophagus. They are mostly solitary and multiple diffuse lesions are rare, occurring in only 2.4% of cases (1). We describe the case of a 13-year-old boy with a history of Alport syndrome who complained of progressive dysphagia and postprandial vomiting, and in whom diffuse leiomyomatosis of the esophagus was diagnosed. Chest PA showed mediastinal widening, and a barium study revealed diffuse esophageal wall thickening with dilatation, and obstruction at the level of the distal esophagus. Manometry showed increased pressure in the lower esophagus, and CT demonstrated diffuse thickening of the entire esophageal wall and an intraluminal mass in the distal esophagus. Follow-up CT three years later showed further esophageal wall thickening, as well as luminal narrowing. By means of distal esophagectomy, diffuse leiomyomatosis involving the entire esophageal wall and intraluminal mass was diagnosed.
Adolescent ; Barium ; Deglutition Disorders ; Dilatation ; Esophagectomy ; Esophagus ; Follow-Up Studies ; Humans ; Leiomyoma ; Leiomyomatosis* ; Male ; Manometry ; Nephritis, Hereditary ; Phenobarbital ; Thorax ; Vomiting

Purpose: The present study aimed to develop guidelines regarding initial choice of antibiotics for diabetic foot ulcers (DFU) by investigating bacterial isolates. Materials and Methods: This study included 223 DFU patients that visited a single tertiary hospital and underwent bacterial culture between January 2016 and February 2020. The study was conducted in two parts: 1) to compare bacterial isolates and wound healing according to comorbidities such as chronic kidney disease (CKD) and peripheral artery disease (PAD), and 2) to compare bacterial isolates according to wound depth using the Wagner classification. Results: Of the 223 patients, 43 had CKD (group A), 56 had PAD (group B), 30 had CKD and PAD (group C), and 94 had none of these comorbidities (group D). The isolation rate for multidrug-resistant gram-negative bacteria (MRGNB) and gram-negative to grampositive bacteria ratio were highest in group C (p=0.018, p=0.038), and the proportion that achieved wound healing was lowest in group C (p<0.001). In the second part of the study, subjects were classified into 5 grades by wound depth using the Wagner classification; 13 grade I, 62 grade II, 60 grade III, 70 grade IV, and 17 grade V. No significant difference was observed between these grades in terms of isolation rates or gram-negative to gram-positive bacteria ratios. Conclusion This study suggests antibiotics that cover gram-negative bacteria including MRGNB produces better results in the presence of CKD and PAD and that initial antibiotic choice should be based on the presence of CKD and PAD rather than wound depth.

Purpose: The present study aimed to develop guidelines regarding initial choice of antibiotics for diabetic foot ulcers (DFU) by investigating bacterial isolates. Materials and Methods: This study included 223 DFU patients that visited a single tertiary hospital and underwent bacterial culture between January 2016 and February 2020. The study was conducted in two parts: 1) to compare bacterial isolates and wound healing according to comorbidities such as chronic kidney disease (CKD) and peripheral artery disease (PAD), and 2) to compare bacterial isolates according to wound depth using the Wagner classification. Results: Of the 223 patients, 43 had CKD (group A), 56 had PAD (group B), 30 had CKD and PAD (group C), and 94 had none of these comorbidities (group D). The isolation rate for multidrug-resistant gram-negative bacteria (MRGNB) and gram-negative to grampositive bacteria ratio were highest in group C (p=0.018, p=0.038), and the proportion that achieved wound healing was lowest in group C (p<0.001). In the second part of the study, subjects were classified into 5 grades by wound depth using the Wagner classification; 13 grade I, 62 grade II, 60 grade III, 70 grade IV, and 17 grade V. No significant difference was observed between these grades in terms of isolation rates or gram-negative to gram-positive bacteria ratios. Conclusion This study suggests antibiotics that cover gram-negative bacteria including MRGNB produces better results in the presence of CKD and PAD and that initial antibiotic choice should be based on the presence of CKD and PAD rather than wound depth.