Osler-Weber-Rendu disease is a rare autosomal dominant disorder of fibrovascular tissues, characterized by a classic triad of mucocutaneous telangiectasias, recurrent hemorrhages, and a familial occurrence. Portosystemic encephalopathy in a patient with Osler-Weber-Rendu disease is rare, but we experienced a case presenting with recurrent portosystemic encephalopathy in Osler-Weber-Rendu disease. We report on a case of a 75-year-old female presenting with an altered mentality. Initial studies including brain imaging study did not reveal any specific cause for her mental status. She was diagnosed with the rare disease after a series of tests and received conservative treatment. Her neurological status recovered fully without complication after conservative treatment and she was discharged after 18 hospital days. This case demonstrated an extremely rare case of Osler-Weber-Rendu disease presenting as portosystemic encephalopathy treated successfully with conservative treatment. For patients who have shown hepatic encephalopathy without a definite cause, we recommend evaluation for the possibility of Osler-Weber-Rendu disease. Conservative treatment based on treatment of advanced liver cirrhosis could be an alternative solution.
Aged ; Brain/diagnostic imaging ; Electroencephalography ; Female ; Hepatic Encephalopathy/*diagnosis ; Humans ; Magnetic Resonance Imaging ; Pedigree ; Telangiectasia, Hereditary Hemorrhagic/*diagnosis ; Tomography, X-Ray Computed ; Vascular Malformations/etiology

BACKGROUND: It has been reported that early prescription of statin might enhance the vascular protection in acute atherothrombosis by its various mechanisms. However, until now, there has been little information about the serial changes of high sensitive C-reactive protein (hs-CRP), one of the notable inflammatory markers in atherothrombosis, by early prescription of statin in acute ischemic stroke. METHODS: We retrospectively collected one hundred eighteen (118) patients with acute ischemic stroke who had conformed to the Atherosclerotic Stroke Mechanism Algorithm (ASMA), one of the guidelines for statin, and evaluated the effects of Atorvastatin 20 mg on the changes of hs-CRP levels and clinical severity at 7 days and 30 days after ischemic events. RESULTS: Among the 118 patients who should have been prescribed statin on the ASMA guideline, sixty-three patients (53.4%) used the statin (Atorvastatin 20 mg) within 48 hrs after admission. Serum concentration of hs-CRP levels was decreased from admission to 30 days later in both statin and non-statin users. Particularly, its extent was significant (0.39+/-0.74 vs 0.75+/-0.98 mg%, p=0.042) after 30 days of ischemic events in statin users. Statin users had lower mortality and vascular recurrence (p=0.083) and fewer bad prognosis rates (27.7% vs. 34.5%) compared to non-statin users over 30 dyas after ischemic events, although there was no statistical significance. CONCLUSIONS: These results suggest that early prescription of statin (Atorvastatin 20 mg) might regulate the inflammatory activity over 30 days after acute ischemic stroke.
C-Reactive Protein* ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Inflammation ; Mortality ; Prescriptions ; Prognosis ; Recurrence ; Retrospective Studies ; Stroke* ; Atorvastatin Calcium

No abstract available.
Bacteremia* ; Female ; Humans ; Pregnant Women*

The tracheobronchial histopathologic findings in 7 healthy cats used with high frequency oscillation ventilation (HFOV) were compared with those in 6 cats used with conventional mechanical ventilation (CMV). 4-point, 9-variable scoring system was used to evaluate the injury in the trachea, right & left main bronchi and parenchyma. The following results were obtained; 1) The tracheobronchial tree received HFOV had no significant damage compared with CMV (P>0.05). 2) Intraepithelial mucus loss and emphysema were slightly more prominent in CMV groups. As above results; the tracheobronchial histopathologic difference was not prominent between CMV and HFOV groups received with relatively short period, however, the cellular of function and barotrauma may be more prominent in CMV groups. From now on, as causes of tracheobronchial injury in HFV, interaction between humidification and mechanical trauma considers further study.
Animals ; Barotrauma ; Bronchi ; Cats* ; Emphysema ; High-Frequency Ventilation* ; Mucus ; Respiration, Artificial* ; Trachea ; Trees

Infliximab is a chimeric IgG1 monoclonal antibody to tumor necrosis factor (TNF)-alpha used in the treatment of steroid refractory or dependent Crohn's disease (CD). Patients with active CD are more likely to experience stillbirth, preterm labor, or small for gestational aged babies. The safety of administering infliximab in pregnant patients is not well documented. A 25-year-old woman, who was diagnosed with small bowel CD three years ago, was admitted to our hospital due to the aggravation of abdominal pain. She had been treated with mesalazine, azathioprine and intermittent steroid for three years. After admission, she did not respond to steroid therapy, we decided to try infliximab. After the administration of infliximab, epigastric pain was relived and Crohn's disease activity index score decreased significantly. However after the fourth infusion of infliximab, the patient became aware that she was ten gestational weeks old pregnancy state After then, infliximab was stopped and maintained by mesalazine. The patient gave birth to a healthy baby via normal vaginal delivery without the recurrence of CD. This case suggests that infliximab administration is safe during the early period of pregnancy. Thus, we report this case with a review of literature.
Adult ; Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Antibodies, Monoclonal/*therapeutic use ; Capsule Endoscopy ; Colon, Sigmoid/pathology ; Crohn Disease/*drug therapy/pathology ; Female ; Humans ; Infant, Newborn ; Mesalamine/therapeutic use ; Pregnancy ; Severity of Illness Index ; Term Birth ; Tomography, X-Ray Computed

Duodenal diverticulitis is a rare complication of the duodenal diverticulum. Its rarity is due to the relatively large diameter of the duodenum, which makes the intraluminal flow of sterile liquid duodenal contents fluent. Additionally, nonspecific signs and symptoms of duodenal diverticulitis make it very difficult to diagnose properly. We describe a patient presenting with abdominal pain, nausea, and leukocytosis, with diverticulitis of the third portion of the duodenum caused by the impaction of a foreign body, who was diagnosed and treated with enteroscopy.
Abdominal Pain ; Diverticulitis ; Diverticulum ; Double-Balloon Enteroscopy ; Duodenum ; Foreign Bodies ; Humans ; Leukocytosis ; Nausea

No abstract available.

BACKGROUND: Fungus is the common pathogen of nosocomial infection, and the 4th common pathogen of nosocomial bloodstream infection. We evaluated the annual occurrence, the relation between fungemia and central venous catheter-related infection, the risk factors and survival rate of fungemia. METHODS: We reviewed medical record of 209 cases with fungemia occurred in the period of from 1992 to 1997 in Severance hospital retrospectively. RESULTS: The annual occurrence of nosocomial fungemia was 3.9, 6.7, 6.7, 7.8, 13.6, 8.0, per 10,000 patient discharges in 1992, 1993, 1994, 1995, 1996, 1997. The species of fungemia wete Candida albicans (47.79o), C. glabrata (12.1%), C. parapsilosis (11.7%), C. tropicalis (11.2/o), C. guilliermondii (1.9fo), C. krusei (1.9%), Rhodotorula species (2.3%), Trichosporon species (1.9%), molds (4.7%). The proportion of definite catheter-related bloodstream infection was 41.6%, probable catheter-related bloodstream infection 28.2%, and the fungemia that was not related with central venous catheter infection was 30.1%. Mortality rate of fungemia was 53.6%, and median survival days were 29 days. Catheter removal and antifungal therapy increased survival rate, but persistent fungemia and thrombocytopenia were poor prognostic factors. CONCLUSION: The fungal bloodstream infection is increased and high proportion of fungemia is related to central venous catheter-related infection. Since catheter removal and antifungal therapy have benefit on survival rate, early evaluation of catheter-related infection and antifungal therapy in fungemia patient is recommended.
Candida albicans ; Catheter-Related Infections ; Catheters ; Central Venous Catheters ; Cross Infection ; Fungemia* ; Fungi ; Humans ; Incidence* ; Medical Records ; Mortality ; Patient Discharge ; Retrospective Studies ; Rhodotorula ; Risk Factors ; Survival Rate ; Thrombocytopenia ; Trichosporon

Tuberculosis remains a serious infectious disease with primary features of pulmonary manifestation in Korea. However, duodenal tuberculosis is rare in gastrointestinal cases of extrapulmonary tuberculosis. Here, we report a case of primary duodenal tuberculosis mistaken as a malignant tumor and diagnosed with QuantiFERON-TB GOLD (Cellestis Ltd.) in an immunocompetent male patient.
Communicable Diseases ; Humans ; Korea ; Male ; Tuberculosis*

BACKGROUND/AIMS: Proton pump inhibitors (PPIs) act by irreversibly binding to the H+-K+-ATPase of the proton pump in parietal cells and may possibly affect the vacuolar H+-ATPase in osteoclasts. METHODS: We investigated the effect of 8 weeks of PPI treatment on the parameters of bone turnover and compared PPI with revaprazan, which acts by reversibly binding to H+-K+-ATPase in proton pumps. This study was a parallel randomized controlled trial. For 8 weeks, either a PPI or revaprazan was randomly assigned to patients with gastric ulcers. The parameters of bone turnover were measured at the beginning of and after the 8-week treatment period. RESULTS: Twenty-six patients (PPI, n=13; revaprazan, n=13) completed the intention-to-treat analysis. After the 8-week treatment period, serum calcium and urine deoxypyridinoline (DPD) were increased in the PPI group (serum calcium, p=0.046; urine DPD, p=0.046) but not in the revaprazan group. According to multivariate linear regression analysis, age > or =60 years was an independent predictor for the changes in serum calcium and urine DPD. CONCLUSIONS: In elderly patients, administering a PPI for 8 weeks altered bone parameters. Our study suggested that PPIs might directly alter bone metabolism via the vacuolar H+-ATPase in osteoclasts.
Aged ; Amino Acids/drug effects/urine ; Bone Remodeling/*drug effects ; Bone and Bones/*metabolism ; Calcium/blood ; Female ; Humans ; Intention to Treat Analysis ; Linear Models ; Male ; Middle Aged ; Multivariate Analysis ; Osteoclasts/*metabolism ; Prospective Studies ; Proton Pump Inhibitors/*pharmacology ; Pyrimidinones/*pharmacology ; Tetrahydroisoquinolines/*pharmacology