More than half of the cryptococcal infections occur in acquired immune deficiency (AIDS) patients, and more than half of the non-AIDS patients with cryptococcosis are immunocompromised. Most immunocompromised patients have meningoencephalitis at the time of diagnosis. Without the appropriate therapy, this from of the infection is invariably fatal. Death can occur any time from 2 weeks to several years after the onset of symptoms. Pulmonary crytococcosis in immunocompromised patients is usually asymptomatic, but coughing, chest pain, fever, or hemoptysis may occur in immunocompetent patients. Pulmonary cryptococcosis symptoms in immunocompetent patients tend to improve without treatment. Here, we describe the various pulmonary manifestations of cryptococcal pneumoniae in three immunocmpetent patients.
Chest Pain ; Cough ; Cryptococcosis ; Diagnosis ; Fever ; Hemoptysis ; Humans ; Immunocompromised Host ; Meningoencephalitis ; Pneumonia*

PURPOSE: The purpose of this study was to evaluate the outcomes of total hip arthroplasty (THA) with an ABG I hip prosthesis after a minimum ten-year follow up. MATERIALS AND METHODS: From January 1996 to March 2001, 121 hips in 104 patients, whi were followed up for a minimum of ten-years, were enrolled in this study. The clinical and radiographic outcomes were evaluated and Kaplan-Meier survival analysis was performed. RESULTS: The mean Harris hip score at the last follow-up was 84 points. A radiolucent line around the cup, osteolysis, and cup loosening were observed in 5 hips(4.1%), 53 hips(43.8%), and 5 hips(4.1%), respectively. In the femoral side, osteolysis and stem loosening were observed in 11 hips(9.1%) and 2 hips(1.7%), respectively. The mean linear wear rate of the polyethylene liner was 0.23 mm/yr. Forty four revisions(36.3%) were performed. The outcomes were similar regardless of the cause of primary THA. The survival rate with the end point of revision due to cup loosening was 56.3%, and revision due to stem loosening was 98.1% after a 16 year follow-up. CONCLUSION: High polyethylene wear and the disappointing survival rate of the ABGI cup were observed after a minimum ten year follow-up. Therefore, close observation of patients who have received an ABG I prosthesis is necessary.
Arthroplasty ; Arthroplasty, Replacement, Hip* ; Follow-Up Studies* ; Hip Prosthesis ; Hip ; Humans ; Osteolysis ; Polyethylene ; Prostheses and Implants ; Survival Rate

PURPOSE: The isoflavones in soy are likely to contribute to the historically low incidence of breast cancer among Asian women that consume traditional diets. A possible role of isoflavones in controlling the expression of cyclooxygenase-2 (Cox-2) has not previously been explored. In this study, the ability of the isoflavone, genistein, to regulate the expression of Cox-2 in breast cancer cells was evaluated. METHODS: The effects of genistein and NS-398, a Cox-2 inhibitor, were examined on the expression of Cox-2 at the mRNA level using the MDA-MB 231, and MCF-7 breast cancer cell-lines. RESULTS: In the MCF-7 cells, the Cox-2 mRNA could not be detected using RT-PCR. In the MDA-MB-231 cells, NS-398 and genistein were found to inhibit the Cox-2 mRNA expressions by 50 and 35~40%, respectively. CONCLUSION: These studies suggest that dietary isoflavonoids may contribute to the prevention or inhibition of breast cancer by inhibiting the Cox-2 expression.
Asian Continental Ancestry Group ; Breast Neoplasms* ; Breast* ; Cyclooxygenase 2* ; Diet ; Female ; Genistein* ; Humans ; Incidence ; Isoflavones ; MCF-7 Cells ; RNA, Messenger

Xanthogranulomatous cholecystitis is an unusual inflammatory disease of the gallbladder characterized by severe proliferative fibrosis and the accumulation of lipid-laden macrophages in areas of destructive inflammation. Its macroscopic appearance may occasionally be confused with gallbladder carcinoma. We present a case of perforated xanthogranulomatous cholecystitis presenting as biloma. An 80-year-old woman was referred to our hospital with a 1-week history of abdominal pain and febrile sensation. Abdominal CT showed a biloma in the subhepatic area. The follow-up CT showed that the biloma increased in size. Therefore, ultrasonography-guided aspiration was performed. The aspirated fluid/serum bilirubin ratio was greater than 5, which was strongly suggestive of bile leakage complicated by perforated cholecystitis. She underwent a laparoscopic cholecystectomy with cyst aspiration and adhesiolysis. A histological diagnosis of perforated xanthogranulomatous cholecystitis was made.
Aged, 80 and over ; Bilirubin/blood ; Cholecystectomy ; Cholecystitis/*diagnosis/pathology/ultrasonography ; Drainage ; Female ; Gallbladder Neoplasms/diagnosis ; Granuloma/*diagnosis/pathology/ultrasonography ; Humans ; Tomography, X-Ray Computed ; Xanthomatosis/*diagnosis/pathology/ultrasonography

BACKGROUND/AIMS: Noncardiac chest pain (NCCP) is defined as recurring angina-like retrosternal chest pain of noncardiac origin. Gastroesophageal reflux disease (GERD) is by far the most common cause of NCCP. We evaluated the incidence of some esophageal abnormalities as a cause of NCCP and the treatment response to a proton pump inhibitor (PPI). METHODS: Forty seven NCCP cases were selected from 184 cases who underwent 24-hour ambulatory pH monitoring or esophageal manometry. Patients were excluded if they had a history of gastrointestinal surgery, pancreatobiliary disorder, coronary artery disease, valvular heart disease, depression or tuberculosis. In this study, all GERD patients had non-erosive reflux disease (NERD). RESULTS: Of the 47 NCCP cases, 30 (63.8%) were female and 17 (36.2%) were male. Only 7 (14.9%) cases had typical GERD symptoms such as acid regurgitation and heartburn. Of the 47 NCCP cases, 12 (25.5%) had GERD-related NCCP, and six (12.8%) had esophageal motility disorder. Of the 12 cases diagnosed as GERD-related NCCP, nine (75.0%) showed a satisfactory PPI response. The PPI was effective for GERD-related NCCP compared with non-GERD related NCCP (p=0.015). CONCLUSIONS: About 40% of NERD patients with NCCP had an esophageal disorder including GERD and esophageal motility disorder. A PPI was effective for GERD-related NCCP.
Chest Pain ; Coronary Artery Disease ; Depression ; Esophageal Motility Disorders ; Female ; Gastroesophageal Reflux ; Heart Valve Diseases ; Heartburn ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Male ; Manometry ; Proton Pump Inhibitors ; Proton Pumps ; Thorax ; Tuberculosis

Schwannoma of the stomach is a rare controversial neoplasm which requires extensive studies to clarify its nature as a stromal tumor or leiomyoma. We describe the pathologic, immunohistochemical, and ultrastructural characteristics of schwannoma of the stomach in a 33-year-old woman. The tumor was a well-circumscribed submucosal mass located in the posterior wall of the midbody of the stomach. Microscopically, the cells were made up of fasciculating bundles of spindle cells featured with peripheral lymphoid cell cuffing. The tumor cells revealed a diffuse, strong immunoreactivity to S-100 protein and vimentin, but were negative to desmin and smooth muscle actin. They also had a focal positive reaction to glial fibrillary acidic protein. Ultrastructurally, many tumor cells showed a number of thin, elongated and interdigitating dendritic-cell-like processes, distinctly uniformed basal laminae, frequent cellular attachments, and microfilaments. These findings support the schwannian nature of the tumor.
Actin Cytoskeleton ; Actins ; Adult ; Basement Membrane ; Desmin ; Female ; Glial Fibrillary Acidic Protein ; Humans ; Leiomyoma ; Lymphocytes ; Muscle, Smooth ; Neurilemmoma* ; S100 Proteins ; Stomach ; Vimentin

PURPOSE: To determine usefulness of spiral CT in the preoperative evaluation of peritoneal seeding from a gastric carcinoma. MATERIALS AND METHODS: From a database of 411 consecutive patients with surgically proven advanced gastric cancinoma obtained over a six-month period, 17 with peritoneal seeding and a control group of 24 without peritoneal seeding underwent spiral CT scanning with 7 -8 mm scan thickness and interval during the portal phase. Preoperative CT images were analyzed by two readers who reached a consensus with regard to the presence and location of the ascites, thickening of the parietal peritoneum, and changes in the omentum and mesentery. RESULTS: Ascites was present in 47% (8/17) of patients with peritoneal seeding The right subhepatic space (n=6, 35%) and right paracolic gutter (n=5, 29%) but not the cul-de-sac (n=2, 12%)-were common sites of fluid collection. Permeative changes in the omentum and mesentery were seen in 18% (3/17) and 12% (2/17) of patients, respectively. Among five controls with false positive results, ascites in the cul-de-sac was present in three (two males and one female, 12%) while omental nodules and a thickened peritoneum were found in two (8%) and one (4%), respectively. In nine controls with false negative results, small disseminated nodules were seen in the mesentery and omentum at surgical field. The sensitivity and specificity of spiral CT were 47% (8/17) and 79% (19/24), respectively. CONCLUSION: In terms of sensitivity and specificity, spiral CT is not especially accurate in distinguishing peritoneal seeding from gastric carcinoma.
Ascites ; Consensus ; Female ; Humans ; Male ; Mesentery ; Omentum ; Peritoneum ; Sensitivity and Specificity ; Stomach Neoplasms* ; Tomography, Spiral Computed*

A case of antiphospholipid antibody syndrome, accompanied by valvular heart disease and Moya moya syndrome, has never been reported. Here, we report on a case that had mitral regurgitation and Moya moya syndrome, associated with antiphospholipid antibody syndrome secondary to systemic lupus erythematosus. This patient underwent a mitral valve replacement for mitral valve regurgitation. The postoperative course was uneventful, and the pathological findings of the mitral valve showed a degenerative change, due to chronic inflammation, a proliferative fibrous change and calcification, but without thrombus formation. However, the patient returned to the hospital with a cerebral hemorrhage, which was caused by Moya moya syndrome. Surgical drainage was performed, and the patient was discharged without any complications. The patient is on anticoagulation and immunosuppression drugs, with no problems to date.
Antibodies, Antiphospholipid* ; Antiphospholipid Syndrome* ; Cerebral Hemorrhage ; Drainage ; Heart Valve Diseases* ; Humans ; Immunosuppression ; Inflammation ; Lupus Erythematosus, Systemic ; Mitral Valve ; Mitral Valve Insufficiency ; Thrombosis

BACKGROUND/AIMS: After a study comparing drug-eluting stents (DESs) to sequential treatment with drug-eluting balloons (DEBs) and bare metal stents (BMSs), we retrospectively analysed strut malapposition and neointimal hyperplasia in de novo coronary lesions using optical coherence tomography (OCT) or intravascular ultrasonography (IVUS). METHODS: We obtained OCT data from 16 patients (eight per group) and IVUS data from 40 patients (20 per group). OCT or IVUS was performed after the index procedure and after 9 months. Parameters including obstruction volume due to neointimal hyperplasia (neointimal hyperplasia volume/stent volume, %), strut malapposition (% of malapposed struts), and intra-individual inhomogeneity of in-stent restenosis were compared. RESULTS: Although obstruction volume due to neointimal hyperplasia was significantly higher in the DEB-BMS group (14.90 ± 15.36 vs. DES 7.03 ± 11.39, p = 0.025), there was no difference in strut malapposition between the two groups (DEB-BMS 1.99 ± 5.37 vs. DES 0.88 ± 2.22, p = 0.856). The DEB-BMS group showed greater intra-individual inhomogeneity of in-stent restenosis pattern than the DES group. CONCLUSIONS Treatment with DEB followed by BMS failed to improve strut malapposition despite higher in-stent neointimal growth, probably because of the inhomogeneous inhibition of in-stent neointimal hyperplasia by DEB. DEB technology should be improved to obtain even drug delivery to the vessel wall and homogeneous prevention of neointimal growth comparable to contemporary DES.

Pulmonary artery intimal sarcoma is a rare highly lethal disease, with additional retrograde extension to pulmonic valve and right ventricle being an extremely rare condition. It is frequently mistaken for pulmonary thromboembolism. We report a case of 64-year-old woman with progressive dyspnea initially suspected and treated for pulmonary thromboembolism. Her helical chest CT scan with 3 dimensional (3D) reconstruction combined with echocardiography revealed a compacting main pulmonary artery mass extending to the right ventricular outflow tract and the right pulmonary artery. After excision of the mass, the patient's condition improved dramatically, and the pathologic findings revealed pulmonary intimal sarcoma. This report emphasizes that helical chest CT with 3D reconstruction can be an important tool to differentiate the characteristics of pulmonary artery lesions, such as intimal sarcoma and thromboembolism.
Diagnosis, Differential ; Echocardiography ; Female ; Human ; Imaging, Three-Dimensional ; Middle Aged ; Pulmonary Artery/pathology/*radiography ; Sarcoma/pathology/*radiography/ultrasonography ; Tomography, X-Ray Computed/*methods ; Tunica Intima/pathology/radiography ; Vascular Neoplasms/pathology/*radiography/ultrasonography