We experienced a case of primary hepatic actinomycosis which was initially diagnosed by means of fine needle aspiration. The patient was a 31-year-old emaciated man with a 2-month history of 10 kg weight loss, right upper quadrant pain and flank pain. The liver was palpable and tender on physical examination. Computerized tomography scan of the liver showed two ill-defined hypodense masses in gallbladder fossa and inferior pole of right lobe. Hepatocellular carcinoma was clinically suspected. A CT-guided fine needle aspiration was performed. Microscopically, smears showed numerous radiating clusters of filamentous bacteria with many neutrophils and monocytes in necrotic background. The symptoms were improved by incision and drainage and massive administration of penicillin.
Actinomycosis ; Adult ; Bacteria ; Biopsy, Fine-Needle ; Breast ; Carcinoma, Hepatocellular ; Diverticulum* ; Drainage ; Fibroadenoma ; Flank Pain ; Gallbladder ; Humans ; Infarction ; Liver ; Monocytes ; Neutrophils ; Penicillins ; Physical Examination ; Vesico-Ureteral Reflux* ; Weight Loss

Paraneoplastic pemphigus is a distinct and rare autoimmune disease characterized by extensive and painful mucosal ulcerations and polymorphic desquamated skin lesions in the setting of an underlying neoplasm, typically of lymphoreticular origin. Thus difficulties in the management of anesthesia can be expected. A 66-years-old man was scheduled for removal of intraabdominal sarcoma associated with paraneoplastic pemphigus. Physical examination showed multiple erythematous bullae, crusts, plaques and target-like lesions on the whole body and desquamated erythematous skin lesions on the back and extremities. In the operating room, his right femoral artery was cannulated with a 20 G, 12.7 cm CVP catheter and left femoral and subclavian veins with 14 G, 20 cm CVP catheters, respectively. After application of 4 % lidocaine spray, his oropharynx and supraglottic area were evaluated under direct laryngoscopy and revealed multiple ulcerations on oral mucosa, but no distinct lesion on supraglottic area. Anesthesia was induced by rapid-sequence method with fentanyl, thiopental sodium and succinylcholine followed by endotracheal intubation. The endotracheal tube was held by a roll gauze around the neck and its cuff was minimally inflated to avoid overpressure against his tracheal wall. After the end of surgery, his oral cavity was suctioned with no remarkable bleeding, and tracheal wall including cuff-contacted area was evaluated under fiberoptic bronchoscopy, revealed intact wall without any bulla or ulceration. The patient was transferred to intensive care unit for proper postoperative management after extubation of endotracheal tube.
Anesthesia ; Autoimmune Diseases ; Bronchoscopy ; Catheters ; Extremities ; Femoral Artery ; Fentanyl ; Hemorrhage ; Humans ; Intensive Care Units ; Intubation, Intratracheal ; Laryngoscopy ; Lidocaine ; Mouth ; Mouth Mucosa ; Neck ; Operating Rooms ; Oropharynx ; Pemphigus* ; Physical Examination ; Sarcoma ; Skin ; Subclavian Vein ; Succinylcholine ; Suction ; Thiopental ; Ulcer

STUDY DESIGN: This is a retrospective study analyzing 73 patients treated by decompression, pedicular screw instrumentation and posterior lumbar interbody fusion (PLIF) for lumbosacral spondylolithesis and symptomatic spinal stenosis. we used laminected laminar and spinous process instead of iliac bone. OBJECTIVES: This is to evaluate fusion rate and clinical results of PLIF with laminected laminar and spinous process. MATERIALS AND METHODS: PLIF in 73 patients with lumbosacral disorders who carried out at Pohang St. Mary's Hospital from March 1994 to January 1996. Fusion rate was evaluated by simple X-ray and dynamic view. Clinical effect was evaluated by Kirkaldy-Willis criteria. RESULTS: The solid fusion was achieved at 67 cases(91.8%) and the average period of fusion was 6.4 months. Complications were 2 cases of superficial skin infection and 3 cases of root irritation. The functional results by Kirkaldy-Willis were as follows ; excellent 40 cases, good 23 cases, fair 9 cases and poor 1 case. CONCLUSIONS: This PLIF procedure combined with transpedicular instrumentation showed sufficient fusion rate and excellent clinical results and improvement in vertebral alignment.
Decompression ; Gyeongsangbuk-do ; Humans ; Retrospective Studies ; Skin ; Spinal Stenosis

No abstract available.

OBJECTIVE: To evaluate how patients in the four diagnosis groups differ in their symptoms and other characteristic levels in female stress urinary incontinence METHOD: A retrospective chart review of 240 patients with stress urinary incontinence was performed. Patients were categorized as intrinsic sphincter deficiency (ISD) or stress urinary incontinence (SUI). Within these groups, patients with hypermobility were separated from those without hypermobility. And then just patients with hypermobility were compared. Information on several types of symptoms and characteristics were captured for all patients. RESULTS: There are nothing to do with among 4 each groups and 6 symptoms (frequency, urgency, postvoid dribbling, voiding difficulty, hematuria, recurrent infection) in stress urinary incontinence. Only in diabetic status and antiincontinence surgery did the diagnosis groups differ statistically. In diabetes, patient in the ISD without hypermobility tended to have a higher prevalence of diabetes than the other 3 groups (p=0.007). Patients in the ISD with hypermobility group were more likely to have antiincontinence surgery than thosein the SUI with hypermobility group (p=0.046). No other statistical comparisons were significant at the 0.05 level, although there is some evidence that patients in the ISD with hypermobility group were more likely to have a previous hysterectomy than those in the SUI with hypermobility group (p=0.072). Patients in the ISD without hypermobility group had the largest mean and median age among the four groups, and a statistically significant difference in age was detected across all groups (p<0.001). More specifically, the ISD without hypermobility group was significantly older than the SUI with hypermobility group. CONCLUSION: There was no statistically significant among 4 each group according to each 6 symptom in stress urinary incontinence. Of the variables, diabetes, antiincontinence surgery history, hormonal use, parity and age tended to have a statistically significant difference.
Diagnosis ; Female* ; Hematuria ; Humans ; Hysterectomy ; Parity ; Prevalence ; Retrospective Studies ; Urinary Incontinence*

PURPOSE: Bile acids (especially deoxycholate) was known to be toxic and mutagenic on colon epithelium. They proposed at least four mechanisms for the bile acid toxicity. It is the one of these mechanisms that bile acid inhibits the xenobiotic metabolizing enzyme activity (esp glutathione S-transferase, GST). So we measured the cytosolic GST level of colon carcinoma cell lines after deoxycholate exposure whether or not the deoxycholate lowered the cytosolic GST activity. METHODS: Three colon cancer cell lines (LoVo, SW480, HT29) were used for this study. We calculated the cellular toxicity by MTS method. And cytosolic GST activity was measured according to the method as Habig described. For total GST activity, 2.5 mM 1-chloro-2,4-dinitrobenzene was used for substrate, and measured as absorbance in 340 nm. RESULTS: Basal cytosolic GST level for LoVo, SW480, HT29 cell line was 514.59+/-27.01, 291.63+/-38.44 and 344.58+/-47.92 nmol/min/mg cytosol protein. GST level did not changed significantly after 5 days culture without DCA. But GST level was decreased significantly to 128.63+/-21.35, 134.33+/-41.76 and 163.10+/-22.73 nmol/min/mg cytosol protein each cell line after 5 days deoxycholate exposure (p<0.005). CONCLUSION: Cytosolic GST level was lowered significantly after deoxycholate exposure for 5 days. One of the mechanisms of bile acid toxicity for colon cancer cell is proposed to inhibit cytosolic GST activity.
Bile ; Bile Acids and Salts ; Cell Line* ; Colon* ; Colonic Neoplasms* ; Cytosol* ; Deoxycholic Acid* ; Dinitrochlorobenzene ; Epithelium ; Glutathione Transferase* ; Glutathione* ; HT29 Cells ; Humans

In Korea, all domestic made test systems for detecting antibodies in HIV-1 contain the antigens from human immunodeficiency type 1 (HIV-1) subtype B. However, because HIV-1 subtype O is significantly different in amino acid sequences from all other subtypes of HIV-1, there has been a need for developing a test for detecting antibodies in subtype O. For this purpose, the entire nucleotide sequence corresponding to the extracellular domain of the transmembrane glycoprotein of HIV-1 subtype O was synthesized with consideration of Escherichia coli cordon usage. Various regions of the extracellular domain were cloned into E. coli expression vectors and tested for levels of protein production. The nucleotide sequence, named ECTM, that can encode a 129 amino acid-long peptide, was found to be expressed at a high level in E. coli. The protein of approximately 17 kDa specifically reacted with sera from individuals infected with HIV-1 subtype O. The ECTM protein was purified to near homogeneity by the CM-T gel chromatography, using concentrated, denatured inclusion bodies. In Western blot analysis, the purified viral antigen reacted with sera from individuals infected with subtype O more efficiently than subtype B. The enzyme linked immunoabsorbent assay (ELISA) system was developed using the subtype O viral protein and compared with the commercially available kit lacking the antigens from subtype O. The ELISA kit containing the subtype O antigen ECTM alone efficiently reacted with sera from individuals infected with subtype O. The subtype O antigen-containing kit produced a positive absorbence even when sera were diluted 512-fold, suggesting a high sensitivity. The commercially available kit also reacted with subtype O sera, but produced a negative result at a dilution of 8-fold. Our results suggest that the currently available kit may not be able to efficiently detect subtype O sera and that the viral protein developed in this study may be added to the current system to maximize the detection of sera from individuals infected with subtype O.
Amino Acid Sequence ; Antibodies ; Base Sequence ; Blotting, Western ; Chromatography, Gel ; Clone Cells ; Enzyme-Linked Immunosorbent Assay ; Escherichia coli ; Glycoproteins ; HIV* ; HIV-1* ; Humans* ; Inclusion Bodies ; Korea ; O Antigens

The antihypertensive effect and side reaction of pindolol were studied in 48 cases of essential hypertension 5mg to 15mg once regiment for average period of 6 weeks. 1) Average reduction of 25.11mmHg in systolic and 16.36mmHg in diastolic pressure were observed and their percentile reduction was 15.20% and 14.79%, respectively. The overall effect rate was 83.21%. The blood pressure was lowered significantly since 1 week of both in systolic and diastolic pressure with the daily of 10-15mg. 2) There was no significant change in heart rate before and after treatment. 3) No specific side reaction was observed except 1 cases in which discontinued the medication because of severe headache and fatigability on 2nd day of medication.
Blood Pressure ; Headache ; Heart Rate ; Hypertension ; Pindolol

OBJECTIVE: To evaluate the design characteristics of studies that evaluated the performance of artificial intelligence (AI) algorithms for the diagnostic analysis of medical images. MATERIALS AND METHODS: PubMed MEDLINE and Embase databases were searched to identify original research articles published between January 1, 2018 and August 17, 2018 that investigated the performance of AI algorithms that analyze medical images to provide diagnostic decisions. Eligible articles were evaluated to determine 1) whether the study used external validation rather than internal validation, and in case of external validation, whether the data for validation were collected, 2) with diagnostic cohort design instead of diagnostic case-control design, 3) from multiple institutions, and 4) in a prospective manner. These are fundamental methodologic features recommended for clinical validation of AI performance in real-world practice. The studies that fulfilled the above criteria were identified. We classified the publishing journals into medical vs. non-medical journal groups. Then, the results were compared between medical and non-medical journals. RESULTS: Of 516 eligible published studies, only 6% (31 studies) performed external validation. None of the 31 studies adopted all three design features: diagnostic cohort design, the inclusion of multiple institutions, and prospective data collection for external validation. No significant difference was found between medical and non-medical journals. CONCLUSION: Nearly all of the studies published in the study period that evaluated the performance of AI algorithms for diagnostic analysis of medical images were designed as proof-of-concept technical feasibility studies and did not have the design features that are recommended for robust validation of the real-world clinical performance of AI algorithms.
Artificial Intelligence ; Case-Control Studies ; Cohort Studies ; Data Collection ; Feasibility Studies ; Machine Learning ; Prospective Studies

PURPOSE: We experienced six cases of late infection of the hydroxyapatite (HA) orbital implant treated with surgical procedures. METHODS: Exposures of the HA and pyogenic granulomas around conjunctival dehiscence helped us to confirm infections of the HA orbital implants. Infections were not controlled by medical therapies so the HA implants were exchanged by silicone implants in all cases. Finally, the silicone implants were replaced by Medpor(R) after the inflammation had been controlled. Dermis fat graft was also performed in two cases due to insufficient conjunctival sac. RESULTS: Infections of HA orbital implants occurred at 62 to 106 months postoperatively. Staphylococcus aureus and Pseudomonas aeruginosa were cultured from removed implants. All cases show successful outcomes during 12 to 42 months after Medpor(R) implantations. CONCLUSIONS: Infections of peg-inserted HA orbital implants occurred after five years due to exposure of HA orbital implants. To replace infected HA implants with Medpor(R) implants is considered a functionally and aesthetically effective therapeutic method.
Dermis ; Durapatite* ; Granuloma, Pyogenic ; Inflammation ; Orbit* ; Orbital Implants* ; Pseudomonas aeruginosa ; Silicones ; Staphylococcus aureus ; Transplants