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

Waldenstrom's macroglobulinemia is a disorder of malignant proliferation of plasmacytoid lymphocytes and monoclonal immunoglobulin M. However, the patients occasionally present with malabsorption and diarrhea due to deposition of extracellular periodic acid-Schiff positive homogenous eosinophilic, amorphorous, and proteinaceous materials in the villi and/or lamina propria of the duodenum. We report a 62-year-old man who, despite involvement of the duodenal mucosa, presented only with fatigue, dypnea on exertion, and anemia. Characteristic duodenoscopic and pathologic findings of this patient are described.
Anemia ; Diarrhea ; Duodenum ; Eosinophils ; Fatigue ; Humans ; Immunoglobulin M ; Lymphocytes ; Middle Aged ; Mucous Membrane ; Waldenstrom Macroglobulinemia*

Selective cannulation into the intrahepatic duct during ERCP can occasionally be difficult and time-consuming depending on the GI tract anatomy and the presence of biliary tree anomalies or pathology. A variety of techniques or devices have been used to enhance the success rate of selective cannulation in these situations. The balloon occluded method for selective cannulation of the LHD (left hepatic duct) with using an inflated balloon catheter to occlude the RHD (right hepatic duct) has also been reported. We report here a case of successful selective cannulation of the RHD with using an inflated balloon catheter to occlude the LHD in a patient who had a GB cancer with liver metastasis. After this maneuver, a guidewire is advanced; it deflects off the inflated balloon and then proceeds to the RHD.
Biliary Tract ; Catheterization ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Gastrointestinal Tract ; Humans ; Liver ; Neoplasm Metastasis