Acute pancreatitis is occasionally caused by endoscopic treatments or radiologic interventions of the pancreatobiliary tract. However, no reports indicate that acute pancreatitis resulted from the insertion of a percutaneous transhepatic cholangiography (PTCS) catheter in the common bile duct (CBD). A 65-year-old woman visited our hospital with acute cholangitis due to about 3 cm-sized CBD stones. We planned to perform PTCS because of the large stones and altered anatomy (Billroth II). The patient was discharged after tract dilatation and insertion of a PTCS catheter in the distal CBD without manipulations of Ampulla of Vater (AOV). However, she visited the emergency room due to acute pancreatitis at three days after discharge. Computed tomography revealed upstream dilation of the main pancreatic duct following the compressed area of a large stone and catheter. Thus, we report a case that presented with acute pancreatitis induced by insertion of a PTCS catheter without manipulations of AOV.
Aged ; Ampulla of Vater ; Catheters* ; Cholangiography ; Cholangitis ; Common Bile Duct* ; Dilatation ; Emergency Service, Hospital ; Female ; Humans ; Pancreatic Ducts* ; Pancreatitis*

OBJECTIVES: Although there have been several reports that described characteristics for young age stroke, information regarding very young age (18–30 years old) has been limited. We aimed to analyze demographic factors, stroke subtype, and 3-month outcome in acute ischemic stroke patient who have relatively very young age in multicenter stroke registry. METHODS: We evaluated all 122 (7.1%) consecutive acute ischemic stroke (within 7 days after symptom onset) patients aged 18 to 30 from 17,144 patients who registered in multicenter prospective stroke registry, 1997 to 2012. Etiology was classified by Trial of Org 10172 in Acute Stroke Treatment criteria. Stroke severity was defined as National Institutes of Health Stroke Scale (NIHSS) and stroke outcome was defined by modified Rankin scale (mRS) at 3 months after index stroke. RESULTS: The mean age of all included patients was 25.1±3.7 years and 76 patients (62.2%) were male. The median NIHSS at admission was 4. Considering stroke subtype, 37 patients (30.3%) had stroke of other determined etiology (SOD), 37 (30.3%) had undetermined negative evaluation (UN) and 31 (25.4%) had cardioembolism (CE) were frequently noted. After adjusting age, sex and variables which had P<0.1 in univariable analysis (NIHSS and stroke subtype), CE stroke subtype (odds ratio, 4.68; 95% confidence interval, 1.42–15.48; P=0.011) were significantly associated with poor functional outcome (mRS≥3). CONCLUSION: In very young age ischemic stroke patients, SOD and UN stroke subtype were most common and CE stroke subtype was independently associated with poor discharge outcome.
Carotid Artery, Internal, Dissection ; Cerebral Infarction ; Demography ; Humans ; Male ; National Institutes of Health (U.S.) ; Prognosis ; Prospective Studies ; Stroke* ; United Nations ; Vertebral Artery Dissection

Chikungunya infection is caused by an arbovirus transmitted by the Aedes mosquito. A 19-year-old man who had traveled to the Republic of Surinam to perform volunteer work complained of a fever, arthralgia, articular stiffness, and a skin rash on both the arm and trunk. Chikungunya fever was diagnosed using a Chikungunya virus specific IgM antibody in an enzyme-linked immunosorbent assay (ELISA) using blood samples obtained during follow-up visits. In this report, we describe a case of imported Chikungunya fever that presented with arthralgia and a skin rash, with islands of normal skin, that occurred following travel to Surinam, South America.
Aedes ; Arboviruses ; Arm ; Arthralgia ; Chikungunya virus* ; Culicidae ; Enzyme-Linked Immunosorbent Assay ; Exanthema ; Fever ; Follow-Up Studies ; Humans ; Immunoglobulin M ; Islands ; Skin ; South America* ; Suriname* ; Volunteers ; Young Adult

No abstract available.
Histiocytosis*

Abductor deficiency in native hip joint may cause severe limping and pain. It is more serious situation in case of arthroplasty due to instability and recurrent dislocation. Well-known causes of abductor deficiency are repeated surgery, chronic trochanteric bursitis, superior gluteal nerve injury, failure of repair of abductor tendon insertion to the greater trochanter. Author had experienced primary abductor deficiency during total hip replacement and treated successfully with the transfer of gluteus maximus. We'd like to introduce the operation technique with the review of literature.
Arthroplasty ; Arthroplasty, Replacement, Hip* ; Bursitis ; Dislocations ; Femur ; Hip ; Hip Joint ; Tendons

The use of levothyroxine is increasingly widespread. There are relatively few reports of acute massive levothyroxine intoxication leading to emergencies in adults, and such intoxication has a wide range of presentations. Although thyroid gland activity is suppressed by thyroid stimulating hormone as a result of overdose exposure to exogenous thyroid hormone, it is unclear what symptoms are to be expected in acute levothyroxine intoxication in the absence of the thyroid gland. We report a case of massive acute levothyroxine intoxication in a patient with total thyroidectomy, along with observed changes over time in thyroid hormone levels and symptoms. To the best of our knowledge, this report presents the first description of acute massive levothyroxine intoxication in the absence of a thyroid gland.
Adult ; Emergencies ; Humans ; Thyroid Gland ; Thyroidectomy* ; Thyrotropin ; Thyroxine*

BACKGROUND: Therapy-related myeloid neoplasms (t-MN) occur as late complications of cytotoxic therapy. This study reviewed clinical and cytogenetic characteristics of patients with t-MN at a single institution in Korea. METHODS: The study subjects included 39 consecutive patients diagnosed with t-MN. Each subject's clinical history of previous diseases, treatments, and laboratory data was reviewed, including cytogenetics. The primary diagnosis was hematologic malignancy in 14 patients and solid tumor in 25 patients. RESULTS: Therapy-related acute myeloid leukemia (t-AML, 66.7%) was found to be more common than therapy-related myelodysplastic syndrome (t-MDS). Primary hematologic malignancies that were commonly implicated included mature B-cell neoplasm and acute leukemia. Breast cancer was the most common primary solid tumor. The mean time interval from cytotoxic therapy initiation to t-MN detection was 49 months. Chromosomal aberrations were observed in 35 patients, and loss of chromosome 5, 7, or both accounted for 41% of all cases. Balanced rearrangements occurred in 13 patients; these patients showed shorter latency intervals (mean, 38 months) than patients with loss of chromosome 5 or 7 (mean, 61 months). CONCLUSIONS: In this study, we determined the clinical and cytogenetic characteristics of Korean patients with t-MN. Although our results were generally consistent with those of previous reports, we found that t-MN resulting from de novo leukemia was common and that t-AML was more common than t-MDS at presentation. Multi-institutional studies involving a larger number of patients and additional parameters are required to investigate the epidemiology, genetic predisposition, and survival rate of t-MN in Korea.
Adolescent ; Adult ; Aged ; Antineoplastic Agents/*adverse effects/therapeutic use ; Asian Continental Ancestry Group ; Bone Marrow/pathology ; Breast Neoplasms/drug therapy/pathology/radiotherapy ; Child ; Child, Preschool ; Chromosome Aberrations ; Chromosomes, Human, Pair 5 ; Chromosomes, Human, Pair 7 ; Female ; Hematologic Neoplasms/drug therapy/pathology/radiotherapy ; Humans ; Karyotyping ; Leukemia, Myeloid, Acute/*diagnosis/etiology/genetics ; Male ; Middle Aged ; Myelodysplastic Syndromes/*diagnosis/etiology/genetics ; Neoplasms, Second Primary/*diagnosis/etiology/genetics ; Republic of Korea ; Young Adult

BACKGROUND: Because of the heterogeneity of human mesenchymal stem cells (MSCs), methods for cell expansion in culture and the effects on gene expression are critical factors that need to be standardized for preparing MSCs. We investigated gene expression patterns of MSCs with different seeding densities and culture times. METHODS: Bone marrow-derived MSCs were plated at densities from 200 cells/cm2 to 5,000 cells/cm2, and the gene expression patterns were evaluated over time using a reverse-transcription polymerase chain reaction assay. RESULTS: The mRNA levels of factors that play a critical role in cell migration and tissue regeneration, such as podocalyxin-like protein (PODXL), alpha4-integrin, alpha6-integrin, and leukemia inhibitory factor (LIF), were higher in MSCs plated at 200 cells/cm2 than in MSCs plated at 5,000 cells/cm2. The mRNA levels of these factors gradually increased for 10 days and then decreased by day 15 in culture. MSCs seeded at 200 cells/cm2 that were cultured for 10 days expressed high levels of Oct-4 and Nanog. Indoleamine 2,3-dioxygenase, cyclooxygenase-1, and hepatocyte growth factor expression were upregulated in the presence of the proinflammatory cytokine interferon-gamma in these cells. CONCLUSION: We found differences in the gene expression patterns of MSCs under different culture conditions. MSCs from 10-day cultures seeded at a low density were efficiently expanded, expressed PODXL, alpha6-integrin, alpha4-integrin, and LIF, and maintained properties like stemness and immunomodulation. Therefore, ex vivo expansion of MSCs maintained for an adequate culture time after plating at low cell density can provide an effective regenerative medicinal strategy for cell therapies using MSCs.
Cell Count ; Cell Movement ; Cyclooxygenase 1 ; Gene Expression ; Hepatocyte Growth Factor ; Humans ; Immunomodulation ; Indoleamine-Pyrrole 2,3,-Dioxygenase ; Interferon-gamma ; Leukemia Inhibitory Factor ; Mesenchymal Stromal Cells ; Polymerase Chain Reaction ; Population Characteristics ; Regeneration ; RNA, Messenger ; Seeds ; Tissue Therapy

BACKGROUND: Since various hematology analyzers apply common or different principles in complete blood counting, difference between measured values could developed according to the control material used in external quality assessment. Diagnostic Hematology Subcommittee has been using formalin fixed blood and Liquichek(TM) Hematology-16 (Bio-Rad, USA) as control material of external quality assessment alternately but recently significant difference of test results was found in some analyzers. We intended to select adequate control material showing similar test results in most analyzers. METHODS: Using fresh whole blood, formalin fixed blood, Liquichek(TM) Hematology-16 and CBC-4K (R&D, USA), 5 parameters (WBC, RBC, Hb, Hct, platelet) were measured in 4 hematology analyzers; CELL-DYN sapphire (Abbott Diagnostics, USA), Coulter LH750 (Beckman Coulter, USA), ADVIA 2120 (Siemens Diagnostics, USA) and Sysmex XE-2100 (Sysmex Co., Japan). Linearity, within-run precision and between-day precision of 4 materials for each parameter were evaluated at different analyzers. RESULTS: The between-day precisions for WBC of formalin fixed blood showed very high CVs of 6.5~13.5% in all 4 hematology analyzers. The within-run and between-day precisions for WBC and platelet of Liquichek(TM) Hematology-16 showed high CVs of 9.3%, 16% and 19.8%, 18%, respectively in CELL-DYN analyzer. But, CBC-4K showed a good linearity (r2=0.9953~0.9993) and precision (within-run CVs, 0~1.5% and between-day CVs, 0~2.0%) in all analyzers. CONCLUSIONS: Fresh whole blood, formalin fixed blood and Liquichek(TM) Hematology-16 are not appropriate for standardization of external quality control materials because of some different test results among analyzers. We conclude that CBC-4K with good performance in all hematology analyzer is adequate as external quality control material.
Aluminum Oxide ; Blood Cell Count ; Blood Platelets ; Formaldehyde ; Hematology ; Quality Control

We experienced a case of diastasis of the symphysis pubis accompanying severe pubic pain and serious gait disturbance, which was developed at 34 weeks gestation before labor pain in 36-year-old primiparous woman, who has experienced previous cesarean section at her first pregnancy due to pelvic pain before onset of labor, so we report a case with a review of the literature.
Adult ; Cesarean Section ; Female ; Gait* ; Humans ; Labor Pain* ; Pelvic Pain ; Pregnancy