PURPOSE: To evaluate the significance of T2-weighted MR imaging(T2WI) in the diagnosis of pituitarymicroadenoma. MATERIAL AND METHODS: We retrospectively evaluated the MR imaging findings of 30 cases of pituitarymicroadenoma. Diagnosis was made on the basis of surgery, serum hormonal level, and the presence of mass lesion onMR (T1WI and T2WI), and conventional as well as dynamic contrast enhanced T1WI images were obtained. In each MRsequence, signal intensity and detectability of the tumor were evaluated. We also determined whether diagnosis waspossible on both T1WI and T2WI. In eight cases, histopathologic findings (cellularity, fibrosis, and cysticchange) were correlated with T2 signal intensity of the tumor. RESULTS: T2WI, T1WI, and dynamic and conventionalenhanced T1WI detected the tumor in 21 cases (70%), 21 cases (70%), 28 cases (93.3%), and 22 cases (73.3%),respectively. On T2WI, pituitary microadenomas showed a high signal in 18 cases (60%), an iso-signal in nine(30%), and a low signal in three (10%) compared with normal pituitary gland. In 20 cases (66.7%), diagnosis ofpituitary microadenoma was possible on both T1WI and T2WI, but in one case, the tumor was detected only on T2WI.Three cases with fibrosis, as seen on histopathologic examination showed an iso or low signal on T2WI. CONCLUSION: T2WI is useful in the diagnosis of pituitary microadenoma Decreased signal intensity on T2WI may suggestfibrosis.
Diagnosis* ; Fibrosis ; Magnetic Resonance Imaging ; Pituitary Gland ; Retrospective Studies

BACKGROUND: Tight control of blood pressure in patients with coronary artery disease is critical, especially in the setting of long-standing hypertension and left ventricular dysfunction. With off-pump coronary artery bypass graft (CABG), hypertension usually occurs after the sternotomy, along with an increase in heart rate and filling pressure. In order to minimize hypertension during this period, nitroglycerin or nicardipine was prophylactically infused. METHODS: Twenty patients scheduled to undergo an off-pump CABG from April to August, 2001, were selected and divided into two groups. Group I (n = 10) received nicardipine and Group II (n = 10) received nitroglycerin. Before the skin incision, nicardipine (0.5 - 1.0ng/kg/min) or nitroglycerin (0.5 - 1.0ng/kg/min) was continuously infused. Mean arterial pressure (MAP), heart rate (HR), mean pulmonary artery pressure (mPAP), pulmonary artery occlusion pressure (PAOP), cardiac index (CI), and the systemic vascular resistance index (SVRI) were repeatedly measured at the stages of preincision, postincision, poststernotomy, pericardium open, and 10 min after reperfusion. RESULTS: Although MAP after the sternotomy was increased compared with preincision, it remained within a normal range. Similarly, HR, mPAP, and PAOP were all within a normal range despite increases. The CI was within a normal range at all stages in both groups, and there were no significant difference between the two groups. In group I, the SVRI was significantly decreased compared with group II when pericardium was opened. CONCLUSIONS: Both nicardipine and nitroglycerin were effective in preventing or attenuating hypertension after sternotomy with the hemodynamic stability.
Arterial Pressure ; Blood Pressure ; Coronary Artery Bypass, Off-Pump* ; Coronary Artery Disease ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Nicardipine* ; Nitroglycerin* ; Pericardium ; Pulmonary Artery ; Reference Values ; Reperfusion ; Skin ; Sternotomy ; Transplants* ; Vascular Resistance ; Ventricular Dysfunction, Left

PURPOSE: Recently, single-incision laparoscopic surgery (SILS) has been popular for minimally invasive surgery and cosmetic improvement. However, some papers have reported that SILS for an appendectomy (SILS-A) has had the more postoperative complaints of pain. We investigated postoperative pain relief using wound infiltration with 0.5% bupivacaine in SILS-A and compared the result with that for conventional SILS-A. METHODS: Between July 2010 and September 2012, 75 patients who underwent SILS-A were enrolled in this study. The patients were randomly assigned to two groups: conventional SILS-A group (C-SILS-A) or wound infiltrated with 0.5% bupivacaine in SILS-A group (W-SILS-A). Forty-five patients were in the C-SILS-A, and 30 patients were in the W-SILS-A. Patients with perforated appendicitis were excluded. The clinical outcomes were compared between the groups by using the verbal numerical rating scale (VNRS). RESULTS: Clinical outcomes were similar in both study groups except for the pain score. The W-SILS-A group showed significantly lower numbers of additional pain killers and lower VNRS scores 1, 6, and 12 hours after surgery than the C-SILS-A group. CONCLUSION: W-SILS-A is a technically simple and effective method of reducing early postoperative pain. It may be applicable in SILS-A for pain control system.
Appendectomy* ; Appendicitis ; Bupivacaine* ; Humans ; Laparoscopy* ; Methods ; Pain, Postoperative* ; Wounds and Injuries*

Strongyloides stercoralis is endemic to tropical and subtropical regions, and infections are usually asymptomatic. However, immunocompromised patients, such as those receiving immunosuppressive therapy, high-dose steroids, or chemotherapy, can develop fatal hyperinfections. An 84-year-old man without any symptoms was diagnosed with strongyloidiasis during a regular screening colonoscopy. His medical history only involved a gastric endoscopic submucosal dissection for early gastric cancer 6 months previously. Few cases have been published about asymptomatic strongyloidiasis diagnosed in an immunocompetent host via endoscopic mucosal resection with characteristic colonoscopic findings. We report a case of colon-involved asymptomatic strongyloidiasis with specific colonic findings of yellowish-white nodules. This finding may be an important marker of S. stercoralis infection, which could prevent hyperinfections.
Aged, 80 and over ; Colon ; Colonoscopy ; Drug Therapy ; Humans ; Immunocompromised Host ; Mass Screening ; Steroids ; Stomach Neoplasms ; Strongyloides stercoralis ; Strongyloidiasis

Background: Psoriasis is a common chronic inflammatory skin disease. The development of psoriasis is dependent on many intercellular events such as innate immunity and T cell-mediated inflammation. Furthermore, genetic factors are strongly implicated in the pathophysiology of psoriasis. Although a variety of susceptible genes are identified, it is likely that many important genes remain undisclosed. Objective: The aim of this study is to investigate the possible role of lysine demethylase 2A (KDM2A) in the pathophysiology of psoriasis. Methods: We examined the expression of KDM2A using a well established imiquimod-induced psoriasiform dermatitis model. Results: Immunohistochemistry analysis showed that expression of KDM2A was increased in imiquimod-induced psoriasiform dermatitis. Consistent with this result, KDM2A level was markedly increased in the epidermis of psoriatic patient. When keratinocytes were stimulated with TLR3 agonist poly(I:C), KDM2A was increased at both the mRNA and protein levels. Poly(I:C) increased the expression of psoriasis-related cytokines including tumor necrosis factor-α, interleukin-8, and CCL20, and KDM2A inhibitor daminozide enhanced the poly(I:C)-induced cytokine expression. Finally, topical co-application of imiquimod and daminozide exacerbated the imiquimod-induced psoriasiform dermatitis. Conclusion Together, these results suggest that KDM2A is increased to negatively regulate the inflammatory reaction of epidermal keratinocytes in psoriasis.

BACKGROUND: Broad-spectrum antibiotic therapy has been recommended as an empirical regimen in cancer patients with febrile neutropenia. Cefepime is a fourth generation cephalosporin with good activity against both gram-positive cocci and gram-negative bacilli. MATERIALS AND METHODS: To compare the efficacy and safety of cefepime alone with ceftazidime plus tobramycin as empirical regimen for adult cancer patients with febrile neutropenia, a randomized, open label, comparative trial was performed. If the patient showed clinical improvent 72 hours, antibiotic could be changed to oral ciprofloxacin. Clinical and microbiological responses were determined at 72 hours and at the end of therapy. To investigate the antimicrobial resistance of viridans streptococci, swab cultures were obtained from throat in all enrolled patients and antimicrobial susceptibility tests were performed by using microdilution method according to the NCCLS. RESULTS: A total of 89 patients were enrolled. Forty-eight patients received cefepime alone (CA), and 41 patients received ceftazidime plus tobramycin (CT). Demographic and baseline clinical characteristics were similar in both groups (P>0.05). The initial clinical success rate at day 2-4 in group CA (91.7%) was similar with that in CT group (85.4%) (P=0.31). At the end of therapy, the final clinical success rate in CA group (91.7%) was similar to that in CT group (100%) (P=0.15). In 18 patients, with microbiologically defined infections, the eradication rate was 100% in both groups. Adverse events including liver dysfunction (21.3%) and renal dysfunction (2.2%), were similar in both groups (P=0.87). Viridans streptococci were isolated from the throat cultures in 25 cases, and all of these strains were susceptible to penicillin (MIC(90)0.12 microgram/mL), cefepime (1 microgram/mL), and vancomycin (0.12 microgram/mL). CONCLUSION: Efficacy and safety of cefepime monotherapy was comparable to the combination of ceftazidime and tobramycin. It could be used as an alternative empirical regimen for treating cancer patients with febrile neutropenia.
Adult ; Ceftazidime* ; Ciprofloxacin ; Febrile Neutropenia* ; Fever ; Gram-Positive Cocci ; Humans ; Liver Diseases ; Neutropenia ; Penicillins ; Pharynx ; Tobramycin* ; Vancomycin ; Viridans Streptococci

BACKGROUND: Broad-spectrum antibiotic therapy has been recommended as an empirical regimen in cancer patients with febrile neutropenia. Cefepime is a fourth generation cephalosporin with good activity against both gram-positive cocci and gram-negative bacilli. MATERIALS AND METHODS: To compare the efficacy and safety of cefepime alone with ceftazidime plus tobramycin as empirical regimen for adult cancer patients with febrile neutropenia, a randomized, open label, comparative trial was performed. If the patient showed clinical improvent 72 hours, antibiotic could be changed to oral ciprofloxacin. Clinical and microbiological responses were determined at 72 hours and at the end of therapy. To investigate the antimicrobial resistance of viridans streptococci, swab cultures were obtained from throat in all enrolled patients and antimicrobial susceptibility tests were performed by using microdilution method according to the NCCLS. RESULTS: A total of 89 patients were enrolled. Forty-eight patients received cefepime alone (CA), and 41 patients received ceftazidime plus tobramycin (CT). Demographic and baseline clinical characteristics were similar in both groups (P>0.05). The initial clinical success rate at day 2-4 in group CA (91.7%) was similar with that in CT group (85.4%) (P=0.31). At the end of therapy, the final clinical success rate in CA group (91.7%) was similar to that in CT group (100%) (P=0.15). In 18 patients, with microbiologically defined infections, the eradication rate was 100% in both groups. Adverse events including liver dysfunction (21.3%) and renal dysfunction (2.2%), were similar in both groups (P=0.87). Viridans streptococci were isolated from the throat cultures in 25 cases, and all of these strains were susceptible to penicillin (MIC(90)0.12 microgram/mL), cefepime (1 microgram/mL), and vancomycin (0.12 microgram/mL). CONCLUSION: Efficacy and safety of cefepime monotherapy was comparable to the combination of ceftazidime and tobramycin. It could be used as an alternative empirical regimen for treating cancer patients with febrile neutropenia.
Adult ; Ceftazidime* ; Ciprofloxacin ; Febrile Neutropenia* ; Fever ; Gram-Positive Cocci ; Humans ; Liver Diseases ; Neutropenia ; Penicillins ; Pharynx ; Tobramycin* ; Vancomycin ; Viridans Streptococci