At various intervals after first trimester therapeutic abortion, in a total of 1604 cases laparoscopic sterilization procedures were performed at Severance Hospital of Yonsei University Medical Center, Seoul, Korea, from May 1973 to October 1975. A total of 214 women were sterilized immediately after abortion, 359 were sterilized between one and 42 days after abortion and the remaining 1031 women were sterilized 43 or more days after abortion. Electrocoagulation and tubal ring were the two tubal-occlusion techniques used. The findings indicate that patients who underwent the combined abortion-sterilization procedures did not encounter higher rates of technical and/or complications than the other two groups. Only a few patients among the total study subjects had potentially serious complications which neceisstated subsequent laparotomy and hospitalization after sterilization.
Abortion, Therapeutic* ; Adult ; Female ; Human ; Korea ; Postoperative Complications ; Pregnancy ; Pregnancy Trimester, First ; Sterilization, Tubal* ; Time Factors

A 44-year-old patient who had been diagnosed with tuberculous lymphadenopathy came to our hospital with a rash. He began to take antituberculous medications, but the next day, a rash appeared and persisted for one week. When he came to the hospital, he had already stopped the medication by his own decision. We stopped all drugs and reintroduced one drug at a time. After re-administration of rifampin, anaphylactic shock and subsequent acute renal failure and rhabdomyolysis occurred. Intensive care was performed, but the patient died 60 h after the first hypersensitive reaction that occurred due to rifampin. Anaphylaxis and subsequent rhabdomyolysis induced by rifampin is an extremely rare event. It is necessary to initially prescribe low dose rifampin in cases of re-administration.
Acute Kidney Injury ; Adult ; Anaphylaxis ; Exanthema ; Humans ; Hypersensitivity ; Critical Care ; Lymphatic Diseases ; Porphyrins ; Rhabdomyolysis ; Rifampin

A 78-year-old man was diagnosed with renal cell carcinoma, and left nephrectomy was performed. He started pazopanib. One month later, he visited our hospital because of general weakness and dyspnea. His oxygen saturation was low. A chest X-ray showed pulmonary edema and bilateral pleural effusion. An echocardiogram showed a larger left ventricle and lower ejection fraction than observed at the previous examination. The patient discontinued pazopanib and started diuretics and digoxin. His symptoms improved and a follow-up X-ray showed improvement in the pulmonary edema with bilateral pleural effusion.
Aged ; Carcinoma, Renal Cell* ; Digoxin ; Diuretics ; Dyspnea ; Follow-Up Studies ; Heart Failure* ; Heart Ventricles ; Heart* ; Humans ; Nephrectomy ; Oxygen ; Pleural Effusion ; Pulmonary Edema ; Thorax

Behcet's disease is a chronie inflammatory symptom complex consisting of recurrent oral ulcer, genital ulcer, ocular lesion or skin lesion. Intestinal involvement in Behcet's disease most commonly affects the ileocecal region in the patient with gestrointestinal symptoms, But esophageal involvement in Behcet's disease is very uncommon, most commonly affects the midesophagus with localized ulcerative lesion. A 38-Year-old woman with refractory and recurrent oral and genital ulcer was admitted because of aggravation of pharyngodynia and dysphagia. Gastrofiberscopic examination showed multiple, small sized ulcers on oral cavity and mid-to-distal esophagus. She was treated with steroid.
Adult ; Deglutition Disorders ; Esophagus ; Female ; Humans ; Mouth ; Oral Ulcer ; Skin ; Ulcer

OBJECTIVE: This study was performed to compare the changes in the blood concentrations of tacrolimus when either itraconazole or voriconazole is together with tacrolimus to prevent or treat invasive aspergillus pneumonia (IAP) in patients with lung transplants. Therefore we can compare the degree of drug-drug interactions between tacrolimus and itraconazole against tacrolimus and voriconazole. METHODS: Patients who were admitted and had lung transplants in a territory referral hospital from September 2012 to May 2015 were analyzed retrospectively. The effects of itraconazole and voriconazole on the plasma concentrations of tacrolimus were analyzed. RESULTS: Mean tacrolimus concentrations was 10.49±2.35 ng/mL vs. 10.95±2.98 ng/mL (p=0.722), and mean concentration of tacrolimus over the dose of tacrolimus per day was 8.510±5.890 (ng/mL)/(mg/d) vs. 15.45±28.47 (ng/mL)/(mg/d) (p=0.947) in itraconazole vs. voriconazole group each. The ratio of the number of the results out of target tacrolimus concentrations to the total number of tacrolimus concentration results was 18.0±13.3% vs. 24.4±18.5% (p=0.185). CONCLUSION: There were no significant differences between itraconzaole and voriconazole to have influences on mean concentrations of tacrolimus over tacrolimus dose per weight per day. However voriconazole tended to raise tacrolimus plasma concentrations more than itraconazole. Safer and more effective drug management to prevent and treat fungal infections should be done by therapeutic drug monitoring not only of tacrolimus but of itraconazole and voriconazole in lung transplant patients.
Aspergillus ; Drug Interactions ; Drug Monitoring ; Humans ; Itraconazole* ; Lung* ; Plasma* ; Pneumonia ; Referral and Consultation ; Retrospective Studies ; Tacrolimus* ; Transplant Recipients* ; Voriconazole*

Background/Aims: Although proton pump inhibitors (PPIs) remain a mainstay for the suppression of gastric acid secretion, long-term PPI use is associated with side effects. However, the genotoxicity associated with long-term PPI use is unclear. Materials and Methods: This prospective observational pilot study enrolled patients who had been on PPIs for >1 year and healthy controls from July 2015 to August 2016. The subjects completed self-report questionnaires pertaining to their drug and medical history, and only those with no medical history and a ≥2-year wash-out period (for drugs other than PPIs) were included. We collected peripheral-blood lymphocytes from long-term PPI users and healthy controls and analyzed the genotoxicity by using the cytokinesis-block micronucleus cytome assay; we also determined the fasting serum levels of pyridoxine, folate, cobalamin, and homocysteine. Results: Ten long-term PPI users and 40 healthy control subjects were enrolled. The median serum pyridoxine, folate, cobalamin, and homocysteine levels were not significantly different between the groups. The median frequencies of micronuclei (MNi), nucleoplasmic bridges (NPBs), and nuclear buds (Nbuds) per 1,000 binucleated cells, in long-term PPI users and healthy controls, were 30.3 and 16.3 (P<0.005), 2.5 and 1.8 (P<0.005), and 9.3 and 5.0 (P<0.005), respectively. Even after adjustment for confounding factors, the OR of the MNi, NPBs, and Nbuds for long-term PPI users compared with healthy control subjects were 14.1 (P<0.001), 2.0 (P=0.001), and 1.3 (P=0.3), respectively. Conclusions Long-term PPI use was significantly associated with an increased risk of genotoxicity after adjustment for age, sex, body mass index, medical history, drug history, and the serum levels of vitamins.

A 44-year-old patient who had been diagnosed with tuberculous lymphadenopathy came to our hospital with a rash. He began to take antituberculous medications, but the next day, a rash appeared and persisted for one week. When he came to the hospital, he had already stopped the medication by his own decision. We stopped all drugs and reintroduced one drug at a time. After re-administration of rifampin, anaphylactic shock and subsequent acute renal failure and rhabdomyolysis occurred. Intensive care was performed, but the patient died 60 h after the first hypersensitive reaction that occurred due to rifampin. Anaphylaxis and subsequent rhabdomyolysis induced by rifampin is an extremely rare event. It is necessary to initially prescribe low dose rifampin in cases of re-administration.
Acute Kidney Injury ; Adult ; Anaphylaxis ; Exanthema ; Humans ; Hypersensitivity ; Critical Care ; Lymphatic Diseases ; Porphyrins ; Rhabdomyolysis ; Rifampin

PURPOSE: The purpose of this study was to evaluate the B-mode sonographic and sonoelastographic features of high risk lesions of the breast. MATERIALS AND METHODS: From April 2009 to February 2010, 1390 patients with breast lesions underwent US-guided core-biopsy. Among them, 13 lesions were confirmed to be pure sclerosing adenosis by subsequent surgical excision or on imaging follow-up of more than 1 year. Two radiologists retrospectively analyzed the B-mode sonography according to the Breast Imaging Reporting and Data System classification. The sonoelastographic images were classified into 5 elasticity scores according to the Itoh classification and the strain ratio between the mass and the surrounding fat tissue was reviewed. We considered the sonoelastographic patterns to be suspicious for the case with a score of 4 and 5 and a strain ratio of more than a 2.24. RESULTS: The common B-mode sonographic features of sclerosing adenosis were an irregular shape (69.2%, 9 of 13), an indistinct margin (92.3%, 12 of 13), hypoechogenicity (76.9%, 10 of 13) and category 4A, a low suspicion of malignancy (61.5%, 8 of 13). The common sonoelastographic features were a score of 2 (42%, 6 of 13) and a strain ratio < 2.24 (69.2%, 9 of 13). CONCLUSION: Sclerosing adenosis showed suspicious B-mode sonographic findings, but it had benign sonolastographic features.
Breast ; Elasticity ; Elasticity Imaging Techniques ; Follow-Up Studies ; Humans ; Information Systems ; Retrospective Studies ; Sprains and Strains

Background/Aims: Crohn’s disease (CD) with recurrent inflammation can cause intestinal fibrostenosis due to dysregulated deposition of extracellular matrix. However, little is known about the pathogenesis of fibrostenosis. Here, we performed a differential proteomic analysis between normal, inflamed, and fibrostenotic specimens of patients with CD and investigated the roles of the candidate proteins in myofibroblast activation and fibrosis. Methods: We performed two-dimensional difference gel electrophoresis and identified candidate proteins using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and orbitrap liquid chromatography-mass spectrometry. We also verified the levels of candidate proteins in clinical specimens and examined their effects on 18Co myofibroblasts and Caco-2 intestinal epithelial cells. Results: We identified five of 30 proteins (HSP72, HSPA5, KRT8, PEPCK-M, and FABP6) differentially expressed in fibrostenotic CD. Among these proteins, the knockdown of heat shock protein 72 (HSP72) promoted the activation and wound healing of myofibroblasts. Moreover, knockdown of HSP72 induced the epithelial-mesenchymal transition of intestinal epithelial cells by reducing E-cadherin and inducing fibronectin and α-smooth muscle actin, which contribute tofibrosis. Conclusions HSP72 is an important mediator that regulates myofibroblasts and epithelial-mesenchymal transition in fibrosis of CD, suggesting that HSP72 can serve as a target for antifibrotic therapy.

PURPOSE: This study was performed to review the clinical presentation, diagnostic methods, treatments and prognosis of children with vascular rings. METHOD: We reviewed the medical records of 7 patients with vascular ring who were admitted in Samsung medical center between 1996 and 2000 retrospectively. RESULT: Pulmonary artery sling was noted in 4 cases. Two cases had double aortic arch, and 1 case had right aortic arch with left ligamentum arteriosus and aberrant left subclavian artery. The mean age at onset of symptoms was 3.2 months(from birth to 11 months). The mean age at diagnosis was 7.0 months(from 6 weeks to 15 months). Presenting symptoms and signs were respiratory difficulty, stridor, chest retraction, coughing, grunting, wheezing, sputum, cyanosis, choking, dysphagia, and poor feeding. All patients with pulmonary artery sling had tacheobronchial and/or pulmonary anomalies and cardiac defects were associated in two of them. Surgical repair was done successfully for the patients with double aortic arch or right aortic arch, but three deaths occurred to the patients with pulmonary artery sling combined with bronchial anomaly. CONCLUSION: Vascular ring should be considered especially for infants with respiratory distress or chronic respiratory symptoms. Associated anomalies are likely to affect the prognosis in these patients.
Airway Obstruction* ; Aorta, Thoracic ; Child ; Cough ; Cyanosis ; Deglutition Disorders ; Diagnosis ; Humans ; Infant ; Medical Records ; Parturition ; Prognosis ; Pulmonary Artery ; Respiratory Sounds ; Retrospective Studies ; Sputum ; Subclavian Artery ; Thorax