We introduce a rare case of gastric emphysema. A 68-year-old man presented with vomiting and dyspnea. Simple abdominal X-ray and CT showed marked dilatation of the stomach and abnormal intramural gas consistent with gastric emphysema. We performed gastric decompression via nasogastric tube drainage and parenteral nutritional support. Nine days after admission, the abnormal intramural gas had disappeared on follow-up CT. The acute gastric dilatation in this patient may have resulted from gastric hypomotility as a result of diabetic gastroparesis in addition to superior mesenteric artery syndrome resulting from malnutrition.
Aged ; Decompression ; Dilatation ; Drainage ; Dyspnea ; Emphysema ; Follow-Up Studies ; Gastric Dilatation ; Gastric Outlet Obstruction ; Gastroparesis ; Humans ; Malnutrition ; Mesenteric Artery, Superior ; Nutritional Support ; Stomach ; Superior Mesenteric Artery Syndrome ; Vomiting

Issues related to the control of seizures and bleeding, as well as behavioral management due to mental retardation, render dental treatment less accessible or impossible for patients with Sturge-Weber syndrome (SWS). A 41-year-old man with SWS visited a dental clinic for rehabilitation of missing dentition. A bilateral port-wine facial nevus and intraoral hemangiomatous swollen lesion of the left maxillary and mandibular gingivae, mucosa, and lips were noted. The patient exhibited extreme anxiety immediately after injection of a local anesthetic and required various dental treatments to be performed over multiple visits. Therefore, full-mouth rehabilitation over two visits with general anesthesia and two visits with target-controlled intravenous infusion of a sedative anesthesia were planned. Despite concerns regarding seizure control, bleeding control, and airway management, no specific complications occurred during the treatments, and the patient was satisfied with the results.
Adult ; Airway Management ; Anesthesia* ; Anesthesia, General ; Anxiety ; Dental Clinics ; Dentition ; Gingiva ; Hemorrhage ; Humans ; Infusions, Intravenous ; Intellectual Disability ; Lip ; Mouth Rehabilitation* ; Mouth* ; Mucous Membrane ; Nevus ; Rehabilitation ; Seizures ; Sturge-Weber Syndrome*

Issues related to the control of seizures and bleeding, as well as behavioral management due to mental retardation, render dental treatment less accessible or impossible for patients with Sturge-Weber syndrome (SWS). A 41-year-old man with SWS visited a dental clinic for rehabilitation of missing dentition. A bilateral port-wine facial nevus and intraoral hemangiomatous swollen lesion of the left maxillary and mandibular gingivae, mucosa, and lips were noted. The patient exhibited extreme anxiety immediately after injection of a local anesthetic and required various dental treatments to be performed over multiple visits. Therefore, full-mouth rehabilitation over two visits with general anesthesia and two visits with target-controlled intravenous infusion of a sedative anesthesia were planned. Despite concerns regarding seizure control, bleeding control, and airway management, no specific complications occurred during the treatments, and the patient was satisfied with the results.
Adult ; Airway Management ; Anesthesia* ; Anesthesia, General ; Anxiety ; Dental Clinics ; Dentition ; Gingiva ; Hemorrhage ; Humans ; Infusions, Intravenous ; Intellectual Disability ; Lip ; Mouth Rehabilitation* ; Mouth* ; Mucous Membrane ; Nevus ; Rehabilitation ; Seizures ; Sturge-Weber Syndrome*

Although, erythema nodosum is a common skin manifestation associated with syphilis, nodular vasculitis is a rare feature. Here, we describe a case of a 22-year-old, human immunedeficiency virus negative, non-immunocompromised man who developed recurrent oral and scrotal ulcers with nodular lesions of the lower extremitie. Behcet's disease was initially suspected, however, his serologic test for syphilis was positive, and he was thus diagnosed with secondary syphilis, with a skin biopsy showing nodular vasculitis. The patient was treated with benzathine penicillin, and the skin lesions disappeared after treatment.
Biopsy ; Erythema Nodosum ; Humans ; Penicillin G Benzathine ; Serologic Tests ; Skin ; Skin Manifestations ; Syphilis* ; Ulcer ; Vasculitis* ; Viruses ; Young Adult

OBJECTIVE: To evaluate the usefulness of serum concentrations of macrophage migration inhibitory factor (MIF) of patients with ovarian cysts for differential diagnosis of endometrioama. METHOD: From Jan. 2003 to Dec. 2004, preoperative serum MIF levels were assessed in 28 women with endometrioma, 32 with benign epithelial tumor, 23 with functional and simple cysts, 22 with benign mature cystic teratoma, and 25 women without ovarian tumor as control. MIF levels were determined using an ELISA (Quantikine Human MIF immunoassay, R&D Systems, Inc., USA). RESULTS: Mean MIF levels were higher in all groups with benign tumors than control (all p<0.01), but there was no significant difference between benign tumor groups (p=0.95). There was no significant correlation between MIF levels and tumor volume, body mass index (BMI) (p=0.635, 0.674 respectively) Serum MIF level had significant correlation with count of WBC and neutrophils (p=0.008, 0.024 respectively), but had no correlation with count of lymhocytes and monocytes (p=0.688, 0.294 respectively). CONCLUSIONS: This study showed a marked increase in MIF concentrations in the peripheral blood of patients with endometrioma, but there was no significant difference with other benign tumors. Serum MIF level had significant correlation with count of WBC and neutrophils. These suggest serum MIF level has no usefulness for differential diagnosis of endometrioma from other benign ovarian cysts.
Body Mass Index ; Diagnosis, Differential* ; Endometriosis* ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunoassay ; Macrophages* ; Monocytes ; Neutrophils ; Ovarian Cysts* ; Teratoma ; Tumor Burden

OBJECTIVE: The purpose of this study was to compare the efficacy of intravaginal misoprostol and that of intravenous sulprostone for termination of second-trimester pregnancy. METHODS: Fouty-six patients were randomly assigned to misoprostol and sulprostone group, and the misoprostol group was further divided into two groups according to gestational age. In the misoprostol group, the patients at or before 20 weeks of gestation received 400 microgram of intravaginal misoprostol every 4 hours until labor pain was established, 200 microgram every 6 hours after 20 weeks of gestation. In the sulprostone group, intravenous sulprostone was infused at the speed of 100 microgram/hr regardless of gestational age. RESULTS: At or before 20 weeks of gestation, the mean time from induction to completion of termination was shorter, and the success rate within 24 hours was higher in the misoprostol group than in the sulprostone group (9.0 vs. 20.2 hours; 86% vs 50%). After 20 weeks, the mean induction time was longer at misoprostol group than sulprostol group but, there was no significant difference in success rate within 24 hours (14.7 vs. 7.1 hours; 83% vs. 86%). There was no significant difference in the prevalence of complication between two groups. CONCLUSION: Misoprostol is superior to sulprostone for termination of pregnancy at or before 20 weeks of gestation, but both have almost equal effectiveness after 20 weeks of gestation. Considering less cost and complication, the efficacy of misoprostol should be further investigated for termination of second-trimester pregnancy.
Female ; Gestational Age ; Humans ; Labor Pain ; Misoprostol* ; Pregnancy* ; Prevalence

BACKGROUND: Nontuberculous mycobacteria (NTM) are ubiquitous in soil and water. Most NTM cause disease in humans only rarely unless some aspect of host defense is impaired. Recently, rapidly growing mycobacteria (RGM) is not uncommon, and the prevalence of RGM infection has been increasing. RGM causes a wide spectrum of pulmonary and extrapulmonary diseases and has been shown as an important source for opportunistic infection. MATERIALS AND METHODS: We report 5 patients of skin and soft tissue infection due to RGM in tertiary medical center in Jeju Island and analyzed 21 patients of skin and soft tissue infection due to RGM in Republic of Korea. Clinical, microbiological and epidemiological data were collected from each patient. NTM isolates were identified using conventional and molecular methods including 16S rDNA gene sequencing. RESULTS: The mean age of the RGM patients (n=26) was 54.9 +/- 15.9 years and 73% were women. Mycobacterium fortuitum complex was the most common (12/26). Antimicrobial resistance for clarithromycin and quinolone were 12% and 60%, respectively. Clarithromycin based therapy was done in 46%. The mean duration of treatment was 21.2 +/- 8.7 weeks. CONCLUSIONS: Many cases can be cured after therapy for 4-7 month with at least 2 or 3 antibiotics according to in vitro susceptibility. Recent increasing of NTM cases suggests that species and subspecies identification is epidemiologically important, especially related to medical procedure, and surgery.
Anti-Bacterial Agents ; Clarithromycin ; DNA, Ribosomal ; Female ; Humans ; Mycobacterium fortuitum ; Nontuberculous Mycobacteria ; Prevalence ; Republic of Korea ; Skin ; Soft Tissue Infections ; Soil

BACKGROUND: Dipeptidyl peptidase 4 (DPP-4, also known as CD26) binds with adenosine deaminase (ADA) to activate T lymphocytes. Here, we investigated whether ADA activity is specifically affected by treatment with DPP-4 inhibitor (DPP4I) compared with other anti-diabetic agents. METHODS: Fasting ADA activity, in addition to various metabolic and biochemical parameters, were measured in 262 type 2 diabetes mellitus (T2DM) patients taking various anti-diabetic agents and in 46 non-diabetic control subjects. RESULTS: ADA activity was increased in T2DM patients compared with that in non-diabetic control subjects (mean+/-standard error, 23.1+/-0.6 U/L vs. 18.6+/-0.8 U/L; P<0.05). ADA activity was correlated with fasting plasma glucose (r=0.258, P<0.05), HbA1c (r=0.208, P<0.05), aspartate aminotransferase (r=0.325, P<0.05), and alanine aminotransferase (r=0.248, P<0.05). Compared with the well-controlled T2DM patients (HbA1c<7%), the poorly controlled group (HbA1c>9%) showed significantly increased ADA activity (21.1+/-0.8 U/L vs. 25.4+/-1.6 U/L; P<0.05). The effect of DPP4I on ADA activity in T2DM patients did not differ from those of other oral anti-diabetic agents or insulin. T2DM patients on metformin monotherapy showed a lower ADA activity (20.9+/-1.0 U/L vs. 28.1+/-2.8 U/L; P<0.05) compared with that of those on sulfonylurea monotherapy. CONCLUSION: Our results show that ADA activity is increased in T2DM patients compared to that in non-diabetic patients, is positively correlated with blood glucose level, and that DPP4I has no additional specific effect on ADA activity, except for a glycemic control- or HbA1c-dependent effect.
Adenosine ; Adenosine Deaminase ; Alanine Transaminase ; Aspartate Aminotransferases ; Blood Glucose ; Diabetes Mellitus, Type 2 ; Dipeptidyl Peptidase 4 ; Fasting ; Glucose ; Humans ; Insulin ; Metformin ; Plasma ; T-Lymphocytes

Human herpes virus-8 (HHV-8)-negative primary effusion lymphoma (PEL) is frequently observed in patients with chronic liver disease. We describe herein a case of PEL in a patient with chronic kidney disease. A 59-year-old woman presented with dyspnea. The patient had a history of uncontrolled pleural effusion. The pleural effusion revealed a malignant cell-dominant exudate. Serological tests were negative for human immunodeficiency virus (HIV). Initial chest and abdomen computed tomography showed bilateral pleural effusion; however, no evidence of a tumor mass or lymph node enlargement was found. A malignant lymphoma of diffuse large B-cell type was confirmed by pleural fluid cytology. Immunohistochemical staining of malignant cells was negative for HHV-8. She was treated with rituximab and CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone) chemotherapy. We report a case of PEL in a patient with chronic kidney disease that may be a plausible predisposing factor for HHV-8-negative PEL.
Abdomen ; Antibodies, Monoclonal, Murine-Derived ; B-Lymphocytes ; Doxorubicin ; Dyspnea ; Exudates and Transudates ; Female ; Herpesvirus 8, Human ; HIV ; Humans ; Liver Diseases ; Lymph Nodes ; Lymphoma ; Lymphoma, Primary Effusion ; Middle Aged ; Pleural Effusion ; Renal Insufficiency, Chronic ; Serologic Tests ; Thorax ; Vincristine ; Rituximab

Crohn 's disease is characterized by a chronic relapsing inflammation of the bowel in which pro-inflammatory cytokines play an important role. Rebamipide is an anti-gastric ulcer drug with anti-inflammatory properties in vivo and in vitro. The effects of rebamipide on Crohn 's disease have not been carefully evaluated. This study investigated the potential of rebamipide to protect Crohn 's disease using a murine model of colitis induced by trinitrobenzene sulfonic acid (TNBS). Rebamipide dramatically improved histopathological symptom involving myeloperoxidase (MPO)activation and increase of microscopic damage score in TNBS induced colitis. Rebamipide suppressed IL-8 secretion, ICAM-1 induction and nuclear factor-kappaB (NF-kappaB) activation by TNF-alpha and induced heme oxygenase-1(HO-1)in HT-29 cells. HO-1 inducer cobalt protoporphyrin IX (CoPPIX)suppressed NF-kappaB activation by TNF-alpha in HT-29 cells like rebamipide, and mimicked the protective effects of rebamipide on TNBS induced colitis. This suggests that rebamipide exerts anti-inflammatory effects by down-regulating NF-kappaB activity via inducting HO-1 expression. In conclusion, this study suggests that rebamipide represents a potential therapeutic agent and HO-1 is an important therapeutic target for the treatment of Crohn's disease.
Cobalt ; Colitis ; Colon* ; Crohn Disease ; Cytokines ; Down-Regulation* ; Heme Oxygenase (Decyclizing)* ; Heme* ; HT29 Cells ; Humans ; Inflammation ; Intercellular Adhesion Molecule-1 ; Interleukin-8 ; NF-kappa B* ; Peroxidase ; Tumor Necrosis Factor-alpha ; Ulcer