We aimed to examine the effects of angiotensin II AT1 receptor blocker on the expression of major renal sodium transporters and aquaporin-2 (AQP2) in rats with chronic renal failure (CRF). During 2 wks after 5/6 nephrectomy or sham operation, both CRF rats (n=10) and sham-operated control rats (n=7) received a fixed amount of low sodium diet and had free access to water. CRF rats (n=10) were divided into two groups which were either candesartan-treated (CRF-C, n=4) or vehicletreated (CRF-V, n=6). Both CRF-C and CRF-V demonstrated azotemia, decreased GFR, polyuria, and decreased urine osmolality compared with sham-operated rats. When compared with CRF-V, CRF-C was associated with significantly higher BUN levels and lower remnant kidney weight. Semiquantitative immunoblotting demonstrated decreased AQP2 expression in both CRF-C (54% of control levels) and CRF-V (57%), whereas BSC-1 expression was increased in both CRF groups. Particularly, CRF-C was associated with higher BSC-1 expression (611%) compared with CRF-V (289%). In contrast, the expression of NHE3 (25%) and TSC (27%) was decreased in CRF-C, whereas no changes were observed in CRF-V. In conclusion, 1) candesartan treatment in an early phase of CRF is associated with decreased renal hypertrophy and increased BUN level; 2) decreased AQP2 level in CRF is likely to play a role in the decreased urine concentration, and the downregulation is not altered in response to candesartan treatment; 3) candesartan treatment decreases NHE3 and TSC expression; and 4) an increase of BSC-1 is prominent in candesartan-treated CRF rats, which could be associated with the increased delivery of sodium and water to the thick ascending limb.
Angiotensin II Type 1 Receptor Blockers ; Animals ; Aquaporins/genetics ; Benzimidazoles/*pharmacology ; Blood Urea Nitrogen ; Kidney Failure, Chronic/drug therapy/*metabolism ; Male ; Organ Size/drug effects ; Rats ; Rats, Sprague-Dawley ; Receptors, Drug/*genetics ; Research Support, Non-U.S. Gov't ; Sodium-Hydrogen Antiporter/*genetics ; Sodium-Potassium-Chloride Symporters/*genetics ; Symporters/*genetics ; Tetrazoles/*pharmacology

A 70-year-old man with aphasia due to ischemic cerebral events by thromboemboli was admitted. The cause of thromboemboli was investigated, and transesophageal echocardiography and chest MRI revealed an encapsulated cystic mass in the right atrium, not circulating. It was a homogeneous cystic mass suggesting a tumor (Myxoma) rather than thrombus. Right atrial mass was resected together with partial atrial septum under the normothermic cardiopulmonary bypass. Histologically it was an atrial septal aneurysm, closed on itself, filled with blood. We report this rarely seen case with a review of the literatures.
Aged ; Aneurysm* ; Aphasia ; Atrial Septum ; Cardiopulmonary Bypass ; Echocardiography, Transesophageal ; Heart Atria ; Heart Neoplasms ; Heart Septum ; Humans ; Magnetic Resonance Imaging ; Thorax ; Thrombosis

No abstract available.
Cardioplegic Solutions* ; Ischemia*

The reversibility of arterial stenosis in arteritis of tuberculous meningitis (TBM) has been rarely reported. However, we report a 25-year-old man with TBM who developed arteritis. Initial TCD and MRA showed stenosis in the left middle cerebral and intracranial internal carotid arteries, which improved on follow-up TCD and MRA after antituberculous and steroid treatment. This case showed that the arterial stenosis in TBM could be reversed with proper management and that TCD with MRA can be useful diagnostic tools.
Adult ; Arteritis ; Carotid Artery, Internal ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Magnetic Resonance Angiography* ; Tuberculosis, Meningeal*

Hypertensive encephalopathy and basal ganglia intracerebral hemorrhage (ICH) are a medical emergency caused by a sudden elevation of systemic blood pressure. Although the relationship between hypertensive encephalopathy and large ICH has not been clarified yet, Cushing reflex in acute elevations of ICP due to large ICH may induce or aggravate hypertensive encephalopathy. We report a rare case of isolated hypertensive brainstem encephalopathy combined with hypertensive ICH.
Basal Ganglia ; Blood Pressure ; Brain Stem* ; Cerebral Hemorrhage* ; Emergencies ; Hypertension ; Hypertensive Encephalopathy ; Magnetic Resonance Imaging ; Reflex

Bilateral diaphragmatic paralysis is a rare disease. It is caused by trauma, cardiothoracic surgery, neuromuscular disorders, cervical spondylosis, and infection. A 60 year-old male patient developed bilateral diaphragmatic paralysis after an en-bloc resection of thymic carcinoma which invaded the right upper lobe, pericardium, superior vena cava and innominate vein. Severe respiratory difficulty developed and ventilator weaning was impossible. We performed bilateral diaphragmatic plication. After the operation, satisfactorily ventilator weaning and sleeping in supine position were possible; therefore, we report this case.
Brachiocephalic Veins ; Diaphragm ; Humans ; Male ; Middle Aged ; Pericardium ; Rare Diseases ; Respiratory Paralysis* ; Spondylosis ; Supine Position ; Thymoma* ; Thymus Neoplasms ; Vena Cava, Superior ; Ventilator Weaning

Strongyloides stercoralis, which has two different generations: the free living and parasitic generation, is primarily adapted to warm climates, but strongyloidiasis has been reported sporadically in temperate and cold regions. Strongyloidiasis may be asymptomatic in almost 50 percent of the cases, rarely, infestation presents with severe clinical pictures. The reason for this exacerbation of illness is probably a rapid increase in the number of infecting larvas through the development or acceleration of a cycle of autoinfection. A breakdown of the host-parasite equilibrium due to decreased host resistance may occur in malnutrition, debilitating diseases or therapy with immunosuppressive drugs. Corticosteroid treatment may have an important role in the sudden occurrence of severe stongyloidiasis. We experienced a case of strongyloidiasis with severe malnutrition, accompanied with bronchial asthma and diabetes mellitus. This patient has been treated with corticosteroid for several years. So, we report this rare case with the literature review.
Acceleration ; Asthma ; Climate ; Diabetes Mellitus ; Family Characteristics ; Humans ; Larva ; Malnutrition* ; Strongyloides stercoralis ; Strongyloidiasis*

BACKGROUND/AIMS: It can be difficult to differentiate an extraluminal compression from a true submucosal tumor (SMT) in the stomach. The best method for differentiating an extraluminal compression from a true SMT is endoscopic ultrasonography (EUS). Extragastric compression is frequently observed, but its clinical significance has rarely been reported on. We evaluated the clinical findings of extraluminal compression according to the site of the stomach. METHODS: Ninety-one patients were diagnosed by EUS as having extragastric compressions from January 2006 to July 2008. Abdominal sonography or computed tomography was performed in some cases. RESULTS: The causes of normal structures (64 cases) were the vessels, spleen, intestine, gallbladder, liver, mesentery, pancreas and kidney. The causes of pathologic lesions (27 cases) were hepatic cyst, distended gallbladder with sludge, splenic cyst, hepatic hemangioma, polycystic hepatic and renal disease, pancreatic cyst, renal cyst, calcified lymph node and hepatocelluar carcinoma. The great curvature of the fundus was the most frequent site of extraluminal compressions. The lesions in the anterior wall of the body showed a higher frequency of pathologic lesions than did those lesions in other sites. CONCLUSIONS: EUS is useful for finding the causes of extragastric compression. Careful evaluation is needed because many lesions in the anterior wall of the body of the stomach were due to pathologic causes.
Endosonography ; Gallbladder ; Hemangioma ; Humans ; Intestines ; Kidney ; Liver ; Lymph Nodes ; Mesentery ; Pancreas ; Pancreatic Diseases ; Sewage ; Spleen ; Stomach

Trichuris trichiura (whipworm) is a ubiquitous parasite that resides in the human intestinal tract, and it is known as whipworm because of its whip-like appearance. Trichuriasis is rare in developed countries, but it is more prevalent in tropical countries and areas with suboptimal sanitation. In most patient, whipworm infection is asymtomatic but patient with heavy infection present with anemia, diarrhea, trichuris dysentery syndrome, abdominal pain, weight loss, appendicitis and rectal prolapse. It is characterized by the invasion of the colonic mucosa by the adult Trichuris and produces minor inflammatory changes at the sites of localization. Its diagnosis is usually made by identification of football-shaped eggs in the stool or by confirming adult whipworm during colonoscopy. We report four cases of whipworm infection that were incidentally diagnosed on colonoscopy.
Abdominal Pain ; Adult ; Anemia ; Appendicitis ; Colon* ; Colonoscopy ; Developed Countries ; Diagnosis ; Diarrhea ; Dysentery ; Eggs ; Humans ; Mucous Membrane ; Ovum ; Parasites ; Rectal Prolapse ; Sanitation ; Trichuriasis ; Trichuris* ; Weight Loss

OBJECTIVE: To evaluate the efficacy of intravenous cyclophosphamide pulse therapy (IVC) in proliferative lupus nephritis (PLN) with normal serum creatinine. METHODS: We retrospectively reviewed 53 PLN patients treated with IVC more than 6 times from 1992 to 1997. The patients were classified into the alternative and the initial. In the former, IVC was started after failed remission with steroid or steroid and oral immunosuppressive drug; in the latter, IVC was started as initial treatment. Remmission was endpoint of study and defined as all of the followings should be maintained for more than 6 months, 1) 24-hour urine protein less than 1g, 2) normal serum creatinine, 3) less than 5 RBC in high power field microscopy and no granular and RBC cast in urine. We compared remission rate and frequency of complications associated with IVC between the initial and alternative by chi-square test and analyzed the variables of remission including methodological; initial or alternative, clinical; age, onset age of systemic lupus erythematous (SLE) and lupus nephritis (LN), duration of SLE and LN, laboratory; serum concentration of creatinine, C3, C4, albumin, anti ds-DNA Ab. titers and 24 hour urine proteins and pathological; activity and chronicity index, multivariatly. RESULTS: All 53 patients (22 initial, 31 alternative) had normal serum creatinine at start of IVC, treated with 9.7 +/-2.3 times of IVC and followed up during 37.2 +/-15.4 months. Thirty-four patients (64%) had remission (18 of the initial and 16 of the alternative). The remission rate of the initial was higher (82% vs 52%, p=0.04 by chi-square test) than the alternative, but frequency of complications was not different. In multivariate analysis, any other variables; including methodological, clinical, laboratory and pathological, did not influenced on remmission significantly. CONCLUSIONS: IVC is effective in PLN with normal serum creatinine as initial treatments and our results suggest that IVC may be chosen as an alternative therapy in PLN patients who failed remission with steroid or steroid and oral immunosuppressive drug.
Age of Onset ; Creatinine* ; Cyclophosphamide ; DNA ; Humans ; Lupus Nephritis* ; Microscopy ; Multivariate Analysis ; Retrospective Studies