It has been reported that beta-HCG is produced in the transitional cell carcinoma of the bladder and measuring of its level can be used as a tumor marker. We measured the serum and urinary levels of beta-HCG in the patients with the transitional cell carcinoma of the bladder and analysed the relationship to the clinical stage and histological grade and its significance as a tumor marker. The levels of the beta-HCG in the serum and early morning urine were measured in 40 cases of transitional cell carcinoma of the bladder and 37 cases of control group. Double-antibody immunometric assay (Coat-A-Count HCG IRMA) using I-labeled anti HCG antibody and monoclonal anti HCG antibody were used. The mean levels of the serum and urinary f-HCG in control group were 1.2mIU/ml, 1.4mIU/ ml and 3.6mIU/ml, 6.0mIU/ml in patient group, which showed a statistically significant difference between the two groups(p<0.05). In patient group, the levels of the serum and urinary beta- HCG were 2.9mIU/ml and 3.5mIU/ml in the superficial tumor, 2.6mIU/ml and 7.0mIU/ml in the invasive tumor and 7.5mIU/ml and 9.9mIU/ml in the metastatic tumor, showing a statistically significant increase as the clinical stage was advanced(p <0.05). The levels of the serum and urinary beta-HCG were 3.3mIU/ml and 1.3mIU/ml in grade I, 2.9mIU/ml and 5.9mIU/ml in grade II and 4.7mIU/ml and 7.6mIU/ml in grade III, which did not demonstrate a significant relationship to the histological grade(p>0.05). We think that the serum and urinary levels of beta-HCG in the transitional cell carcinoma of the bladder are related to the tumor stage but not to the histological grade and in the metastatic tumor urinary beta-HCG level can be used as a reliable tumor marker.
Carcinoma, Transitional Cell* ; Humans ; Urinary Bladder*

There have been some case reports of the coexitence of extraadrenal pheochromocytoma and renal artery stenosis. Some reporters proposed that their coexistence may be associated through a common pathophysiological mechanism mediated by catecholamine secretion. Also some noted that trasient renal artery stenosis due to a spasm was induced by the catecholamines released from pheochromacytoma. We report a case of left paraaortic extraadrenal pheochromacytoma that had a transient oral captopril test positive result. After 5 days alpha-antagonist reduced the vasospastic response of catecholamines. After surgical removal of the tumor, plasma catecholamines and urinary vanillymandelic acid concentrations as well as the blood pressure level, were restored to normal.
Blood Pressure ; Captopril* ; Catecholamines ; Pheochromocytoma* ; Plasma ; Renal Artery Obstruction ; Spasm

No abstract available.
Hypopituitarism*

Lymphocytic ascites with low serum-ascites albumin gradient (SAAG) are observed mainly in tuberculous peritonitis, peritoneal carcinomatosis, and pancreatic disease. However, pelvic inflammatory disease (PID) induced generalized peritonitis causing diffuse ascites has been rarely described. We report a 26-year old female patient, who was diagnosed as generalized peritonitis with diffuse ascites due to Chlamydia trachomatis infection. Gynecologic examination did not show the clue of PID and in the analysis of ascites, low SAAG, predominant lymphocyte count and high level of adenosine deaminase were noted. Although the best impression was tuberculous peritonitis on the base of these findings, the laparoscopic finding was consistent with PID and the PCR for C. trachomatis infection in cervical swab was positive. This case suggests that C. trachomatis peritonitis should be considered as a rare cause of low SAAG and lymphocytic ascites in sexually active women and should be intensively evaluated including laparoscopic examination.
Adult ; Anti-Bacterial Agents/therapeutic use ; Ascites/diagnosis/metabolism/therapy ; Ascitic Fluid/chemistry ; Cephalosporins/therapeutic use ; Chlamydia Infections/complications/*diagnosis/drug therapy ; Chlamydia trachomatis/genetics/*isolation & purification ; Diagnosis, Differential ; Female ; Humans ; Laparoscopy ; Peritonitis/*diagnosis/etiology/radiography ; Peritonitis, Tuberculous/diagnosis ; Serum Albumin/metabolism ; Tomography, X-Ray Computed

We present a case of ileal stenosis with delayed presentation 3 months after car accident. Ileal stenosis after blunt abdominal trauma is a rare clinical entity. We present CT and small bowel series 3 months after trauma. Image showed segmental thickening of intestinal wall and proximal bowel dilation. At surgery, a stenotic bowel loop was adjacent to a fibrotic mesentery. Histological examination showed ulcers, inflammatory cells and fibroblasts infiltrated to the muscularis mucosae, submucosa, and mesentery. The most likely cause, supported by most authors, implicates an injury to the mesentery. Post-traumatic ischemic bowel stenosis may result from even small tears and contusions of mesentery. Posttraumatic intestinal stenosis should be included in the differential diagnosis in a patient with a history of blunt abdominal trauma and signs of intestinal obstruction.

OBJECTIVE: Appropriate gestational weight gain (GWG) is important in diabetic women. Current GWG guideline is for US general population, but not specific for diabetic women. We compared the effect of GWG on perinatal outcomes between diabetic and non-diabetic women. METHODS: Fifty two hundred and twelve women who delivered live singleton infants at Korea University Medical Center from January 2009 to December 2013 were included. One hundred twenty-nine overt diabetes women and 322 gestational diabetes women were categorized as diabetic women, and the others were categorized as none-diabetic women. 5,212 women were categorized by GWG (low 1,081; adequate 2,102; or high 2,029; according to the 2009 Institute of Medicine guidelines), and each of the 3 GWG groups was categorized into 2 groups; diabetic or non-diabetic women. And then, we compared perinatal outcomes between diabetic and non-diabetic groups. RESULTS: In each 3 GWG groups, primary cesarean section delivery, high birth weight, and large for gestational age rates were significantly higher in diabetic women than non-diabetic women. Only in adequate GWG group, preterm birth rate was significantly higher in diabetic women than non-diabetic women. CONCLUSION: Our study shows that diabetic women had higher rates of adverse perinatal outcomes than non-diabetic women, although they achieved same GWG. It suggests that current GWG guideline may not be adequate for diabetic women, and that diabetic women may need more strict GWG control than normal population.
Academic Medical Centers ; Birth Weight ; Cesarean Section ; Diabetes, Gestational ; Female ; Gestational Age ; Humans ; Infant ; Institute of Medicine (U.S.) ; Korea ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Premature Birth ; Weight Gain*

Respiratory syncytial virus (RSV) is the leading cause of respiratory viral infection in infants and children. However, little is known about the contribution of monocytes to antiviral responses against RSV infection. We identified the IFN-β production of monocytes using IFN-β/YFP reporter mice. The kinetic analysis of IFN-β-producing cells in in vivo RSV-infected lung cells indicated that monocytes are recruited to the inflamed lung during the early phase of infection. These cells produced IFN-β via the myeloid differentiation factor 88-mediated pathway, rather than the TLR7- or mitochondrial antiviral signaling protein-mediated pathway. In addition, monocyte-ablated mice exhibited decreased numbers of IFN-γ-producing and RSV Ag-specific CD8 + T cells. Collectively, these data indicate that monocytes play pivotal roles in cytotoxic T-cell responses and act as type I IFN producers during RSV infection.

Brunner's gland hamartomas are rare duodenal tumors with characteristic pathologic featmes. The usual clinical presentation is nonspecific symptoms, obstructive symptoms, or intestinal bleeding. The majority of these tumors are less than 3 cm in diameter. In cases of larger size, the manifestations are usually intestinal obstruction or intestinal bleeding. The cases with massive gastrointestinal bleeding and severe anemia, requiring transfusion are rare. The diagnosis is made by radiologic studies and gastroduodenoscopy. The treatment of Brunner's gland hamartomas should be conservative, since they are not premalignant, However, the lesions originate in the submucosa, so the confimative diagnosis usually cannot be made by endoscopie biopey. For definitive diagnosis and relief of symptoms, the lesions must be removed surgically or endoscopically. Endoscopic excision is indicated if the tumar is pedunculated. We recently experienced a case of Brunner's gland hamartoma of about 5.5 cm in diameter with intestinal bleeding, requiring transfusion and intussusception. Preoperative diagnosis was submucosal tumor, such as lymphoma, with duodeno-duodenal intussusception. After surgical removal, the resected specimen showed the histologic features of Bruaner's gland hamartoma.
Anemia* ; Diagnosis ; Duodenum ; Hamartoma* ; Hemorrhage ; Intestinal Obstruction ; Intussusception* ; Lymphoma

Collagenous colitis is characterized clinically by chronic watery diarrhea and pathologically by increased subepithelial collagen deposition associated with an inflammatory infiltrate in the lamina propria. Its etiology is still unclear, although a variety of associated diseases such as rheumatic syndromes, scleroderma, and thyroid diseases have been reported. We report a case of collagenous colitis following the prolonged use of NSAIDs. A 72-year-old woman who has taken NSAIDs for many years due to some dermatologic problems was admitted to the hospital because of chronic watery diarrhea and colicky abdominal pain of 3 months duration. There was no abnormal physical finding except cachectic appearance due to weight loss of 10kg during 3 months. Stool examination for ova and parasites and fat was negative, and stool culture for bacterial pathogens was negative. In complete blood count, there were relative eosinophila and mild anemia. Total serum protein and albumin was low, and thyroid function, RA factor, FANA were all normal. Results of upper and lower gastrointestinal contrast radiographs were normal. Sigmoidoscopy revealed normal colonic mucosa but she had a thick subepithelial collagenous deposit and chronic inflammation in lamina propria on colonic biopsy. Based on the above findings, she was diagnosed as collagenous colitis. Diarrhea improved after withdrawing NSAIDs and the treatment with oral prednisolone. In the post-treatment biopsy, the thickness of the collagen hand was diminished. Collagenous colitis is now recognized as one of the common causes of chronic diarrhea of obscure origin and NSAIDs may play an etiological role in some patient with collagenous colitis.
Abdominal Pain ; Aged ; Anemia ; Anti-Inflammatory Agents, Non-Steroidal ; Biopsy ; Blood Cell Count ; Colitis, Collagenous* ; Collagen* ; Colon ; Diarrhea ; Female ; Hand ; Humans ; Inflammation ; Mucous Membrane ; Ovum ; Parasites ; Prednisolone ; Sigmoidoscopy ; Thyroid Diseases ; Thyroid Gland ; Weight Loss