Emphysematous gastritis is a rare disorder characterized by emphysematous change of the gastric wall due to infection with a gas-forming organism. Acute necrotizing esophagitis is a rare disorder with an unknown pathogenesis. Above two disorders rarely occur together, only three global cases have been reported to date. Such a case has never been reported in Korea, we report a novel case of severe emphysematous gastritis with concomitant portal venous air and acute necrotizing esophagitis in type 1 diabetes presenting with diabetic ketoacidosis. A 24-year-old man known to have type 1 diabetes and pulmonary tuberculosis was brought to the emergency room for epigastric pain with vomiting. His body mass index was 14.7, and the laboratory findings demonstrated leukocytosis and acidosis, as well as elevated serum glucose, ketone, and C-reactive protein levels. Enhanced computed tomography showed portal vein gas and edematous wall thickening without enhancement in the stomach wall, with air density along the stomach and esophageal wall. The patient required surgical intervention of total gastrectomy and cervical esophagostomy followed by esophagocolostomy and esophageal reconstruction. Early radiologic diagnosis and clinical suspicion of this disease and prompt intervention including antibiotics, decompression, and surgery are important for a good prognosis.
Acidosis ; Anti-Bacterial Agents ; Blood Glucose ; Body Mass Index ; C-Reactive Protein ; Decompression ; Diabetic Ketoacidosis* ; Diagnosis ; Emergency Service, Hospital ; Esophagitis* ; Esophagostomy ; Gastrectomy ; Gastritis* ; Humans ; Korea ; Leukocytosis ; Portal Vein ; Prognosis ; Stomach ; Tuberculosis, Pulmonary ; Vomiting ; Young Adult

An ectopic pancreas in the gastrointestinal tract is mostly found incidentally and its malignant transformation is extremely rare. We report herein a rare case of malignant transformation of ectopic pancreas in the stomach, associated with gastric outlet obstruction. A 69-year-old woman was admitted to our hospital, complaining of vomiting. Esophagogastroduodenoscopy revealed an encircling submucosal tumor-like lesion on the prepyloric antrum showing outlet obstruction. Abdominal CT showed an enhancing mass on the antrum and PET CT showed hypermetabolic wall thickening. So we performed a subtotal gastrectomy. Surgical specimens showed a moderately differentiated ductal adenocarcinoma, and the tumor cells were strongly positive for cytokeratin 7. The tumor was located close to the ectopic pancreas tissue. The tumor showed subserosal and omental invasion. There was one lymph node metastasis and no distant metastasis. The patient is being followed up in the outpatient department.
Adenocarcinoma ; Aged ; Carcinoma, Pancreatic Ductal ; Endoscopy, Digestive System ; Female ; Gastrectomy ; Gastric Outlet Obstruction ; Gastrointestinal Tract ; Humans ; Keratin-7 ; Lymph Nodes ; Neoplasm Metastasis ; Outpatients ; Pancreas ; Stomach ; Stomach Neoplasms ; Vomiting

PURPOSE: To compare immunogenicity and reactogenicity of a combined diphtheria-tetanus-acellular pertussis-inactivated poliovirus vaccine (DTPa-IPV, Infanrix(TM) IPV, GlaxoSmithKline Biologicals) with co-administration of commercially available DTPa and IPV vaccines at separate injection sites (DTPa+IPV). METHODS: A total of 458 infants aged 8-12 weeks were randomized to receive three-dose primary vaccination at 2, 4 and 6 months with DTPa-IPV or DTPa+IPV. Blood samples were collected pre and post vaccination for measurement of immune responses. Reactogenicity was assessed following each dose using diary cards. RESULTS: One month post-dose 3, seroprotection rates for anti-diphtheria, anti-tetanus and anti-poliovirus types 1, 2 and 3 were > or =99.5% and vaccine response rates to pertussis antigens were at least 98.6% in both DTPa-IPV and DTPa + IPV groups. Non-inferiority between the groups was demonstrated based on pre-defined statistical criteria. Incidences of both local and systemic symptoms were within the same range across both groups with grade 3 symptoms reported following no more than 4.3% of DTPa-IPV doses and 4.5% of DTPa + IPV doses. Two serious adverse events (both pyrexia) after DTPa-IPV administration were considered vaccine-related. Both infants recovered fully. CONCLUSION: Combined DTPa-IPV vaccine was immunogenic and well tolerated when used as a three-dose primary vaccination course in Korean infants. DTPa-IPV could be incorporated into the Korean vaccination schedule, reducing the number of injections required to complete primary immunization.
Aged ; Appointments and Schedules ; Humans ; Immunization ; Incidence ; Infant ; Pentetic Acid ; Poliovirus ; Vaccination ; Vaccines ; Whooping Cough

Acute pancreatitis is a serious disease with fatality rate up to 15%. We recently experienced a case of acute pancreatitis induced by multiple drugs in a patient with ulcerative colitis. A 20-year-old female visited with abdominal pain and hematochezia and diagnosed of ulcerative colitis. Sulfasalazine and prednisolone were used. However, acute pancreatitis occurred after 4 weeks of treatment with additional azathioprine treatment. Drug-induced pancreatitis was suspected, and she was recovered with conventional therapy for acute pancreatitis. Therefore, it was proposed that acute pancreatitis was induced by azathioprine. However, after the administration of sulfasalazine, pancreatitis relapsed. Furthermore, even the re-administration of 5-ASA and azathioprine induced relapse of acute pancreatitis. We concluded that acute pancreatitis was induced by multiple drugs in this patient with ulcerative colitis.
Acute Disease ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Antimetabolites/adverse effects ; Azathioprine/adverse effects ; Colitis, Ulcerative/diagnosis/*drug therapy ; Colonoscopy ; Female ; Humans ; Mesalamine/adverse effects ; Pancreatitis/*chemically induced/*diagnosis ; Sulfasalazine/adverse effects ; Tomography, X-Ray Computed ; Young Adult

PURPOSE: The growth, progression, and metastasis of malignant neoplasms are influenced by the environment of the tumor and by proliferation of the tumor itself. Angiogenesis of a malignant neoplasm is a very important environmental factor of tumor growth and metastasis. Also, it is a prognostic factor for malignant neoplasms. The mechanism of angiogenesis, such as the effects of cytokines and angiogenesis-promoting factors, is incompletely understood. METHODS: This study was designed to define the role of tumor necrosis factor-alpha (TNF-alpha) and the vascular endothelial growth factor (VEGF) in angiogenesis induced by lipopolysaccharide (LPS) and thalidomide (anticytokine drug) in CT26 murine colon cancer transplanted to BALB/c mice. RESULTS: The tumor size in the LPS-treated group (n=3, 2.1+/-0.26 cm) was larger than it was in the LPS thalidomide-treated group (n=4, 1.95+/-0.19 cm) and in the control group (n=3, 1.6+/-0.20 cm) (P<0.05). The microvessel density determined by CD31 immunostaining was lowest for the control group and highest for the LPS- treated group, but the differences were not statistically significant. An immunohistochemical study showed that the expressions of TNF-alpha (P<0.01) and VEGF (P<0.05) were higher in the experimental groups than they were in the control group. Also, the LPS thalidomide-treated group had lower expressions of TNF-alpha (P<0.01) and VEGF (P<0.05) than the LPS-treated group. Western blots revealed that the TNF-alpha and the VEGF levels semiquantitatively increased from the control group to the LPS thalidomide-treated group to the LPS-treated group. CONCLUSIONS: Our study revealed that low doses of LPS stimulated angiogenesis through increased expression of TNF-alpha and VEGF. Thalidomide decreased angiogenesis, probably through suppression of TNF-alpha with a decreased expression of VEGF. We conclude that TNF-alpha, suppressed by thalidomide, in the model of transplanted colon cancer may inhibit angiogenesis through coincident decrease in the expression of VEGF.
Animals ; Blotting, Western ; Colon* ; Colonic Neoplasms* ; Colorectal Neoplasms ; Cytokines ; Mice* ; Microvessels ; Neoplasm Metastasis ; Thalidomide* ; Tumor Necrosis Factor-alpha* ; Vascular Endothelial Growth Factor A*

BACKGROUND/AIMS: Our previous studies of ionization and solubility of unconjugated bilirubin (UCB) yielded inappropriately large differences between the two carboxylic pK'a values of UCB. These data, however, were not ideal due to crystal effects, matastability, impurities of the bilirubin, and imprecision of analyses at low UCB. METHODS: The sodium salt of taurocholate (TC) was purified and dissolved in water to 100 mM. Chloroform (CHCl3) was purified by vacuum distillation. Buffers used were: citrate from pH 4 to 6, phosphate from pH 6 to 8, and borate above pH 8. All had an ionic strength of 0.10. The problems were minimized by rapid solvent partition of UCB from CHCl3 into buffered aqueous NaCl, and a new, accurate assay of low UCB in the aqueous phase which was achieved by concentrating the UCB through back extraction into small volumes of CHCl3. RESULTS: In contrast with the crystal dissolution studies, the two pK'a value were similar. H2B0, not HB-, was the dominant UCB species in the pH range of bile (6.0 to 8.0). The aqueous solubilities of UCB were 90 to 98% less. Less than 0.01% of the bile salt partitioned into the CHCl3 phase and self-association of B= was negligible. UCB solubilities in 50 mM TC were 2 to 10% of those obtained by crystal dissolution, and, up to pH 7.9, were below the maximum UCB concentration in normal human bile. CONCLUSIONS: We suggest that the markedly increased binding of UCB with each ionization step is due to the disruption of the internal hydrogen bonds of the ionized carboxyl groups on interaction with the bile salt. We propose to extend the study of partition to determine the activity and the degradation products of calcium salts of unbound bilirubin fractions.
Bilirubin/*chemistry ; Chloroform ; English Abstract ; Hydrogen-Ion Concentration ; In Vitro ; Solubility ; Solvents ; Taurocholic Acid/*chemistry

PURPOSE: To determine the CT findings which distinguish consolidation-type bronchioloalveolar carcinoma fromnecrotizing pneumonia. MATERIALS AND METHOD: This study involved ten patients with pathologically-provenconsolidation-type bronchioloalveolar carcinoma and 34 with necrotizing pneumonia proven pathologically either inthe laboratory or clinically. We retrospectively analyzed CT features including the enhancement pattern ofconsolidated lung, the presence and internal density of cavity within consolidated lung, CT angiogram sign,air-bronchogram, pleural enhancement, pleural effusion, and change in extrapleural tissue and its density. RESULT: CT findings in patients with necrotizing pneumonia showed higher attenuation in marginal (94.1%) and inner(85.3%) portions in consolidated lung than in muscles (p<0.005); the presence of cavity (91.2%, p<0.05) ; cavitywith fluid or air-fluid level (77.4%, p<0.005); pleural enhancement (88.2%, p<0.00003) ; pleural effusion (33.3%,p<0.05); and change in extrapleural tissue (64.7%, p<0.05). CT findings in patients with consolidation-typebronchioloalveolar carcinoma showed lower attenuation in marginal (90.0%) and inner (60.0%) portions ofconsolidated lung than muscles (p<0.005) and of cavity containing air (100%; p<0.005). However, air-bronchogramand CT angiogram signs were not helpful in differentiating the two groups. CONCLUSION: CT can help differentiateconsolidation-type bronchioloalveolar carcinoma and necrotizing pneumonia.
Adenocarcinoma, Bronchiolo-Alveolar* ; Diagnosis, Differential* ; Humans ; Lung ; Muscles ; Pleural Effusion ; Pneumonia* ; Retrospective Studies

PURPOSE: To evaluate the usefulness and diagnostic accuracy of turbo spin-echo(TSE) proton-density andT2-weighted images of meniscal tears of the knee. MATERIALS AND METHODS: We retrospectively evaluated thesensitivity, specificity, and accuracy of TSE proton density and T2-weighted images of meniscal tears confirmedarthroscopically or surgically in 47 patients(98 menisci). The routine TSE parameters used in all patients werethe dual echo sequence with sagittal proton density and T2-weighed images(4000/16, 90/5/2 [TR/effectiveTE/ETL/NEX]), and fat-suppressed coronal proton density and T2-weighted images. The chi-square test was used forstatistical analysis. RESULTS: The sensitivity, specificity, and accuracy of TSE proton density images for thedetection of meniscal tears were 93.9%, 93.8%, and 93.9%, respectively, in the medial meniscus, and 92.9%, 91.4%,and 91.8% in the lateral. On T2-weighted images the corresponding figures were 87.9%, 93.8%, and 89.8%,respectively, in the medial meniscus, and 64.3%, 91.4%, and 83.7 % in the lateral. CONCLUSION: With regard tosensitivity and accuracy, TSE proton density images of meniscal tears were superior to TSE T2-weighted images.
Humans ; Knee* ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Protons ; Retrospective Studies ; Sensitivity and Specificity

Anal cancer is a relatively rare disease to supply consistent therapeutic modality. We analysed 18 anal cancer patients treated from 1989 to 1996 at the Department of Surgery, Asan Medical Center, to evaluate two categories of the treatment e.g. initial surgery followed by radiochemotherapy and radiochemotherapy Preceding surgery. The aim of this study is to evaluate the advantage and pitfall of both therapeutic options. Among 18 patients presenting with carcinoma of the anus, the dominant histologic type was squamous followed by cloacogenic and verrucous carcinoma, 72%, 17%, 11% respectively According to the staging system of AJCC/UICC, T1 and T2 were 12 patients, NO were 7 patients. According to the treatment options, abdominoperineal resection preceding radiochemotherapy were performed in 8 patients, Whereas surgery after radiochemo-therapy were in 10 patients. Among the 8 patient with prior surgery, two patients developed recurrent disease and one patient was dead. Among the 10 patient with prior radiochemotherapy, two patients developed recurrent disease and two patients were dead. Histological differentiation of squamous cell carcinoma was significantly related with survival. The metachronous lymph nodes metastasis showed poorer prognosis than the synchronous metastasis. Radiochemotherapy shoud be considered as primary therapy of anal cancer that obviated wide excision sacrificing anorectal function.
Anal Canal ; Anus Neoplasms* ; Carcinoma, Squamous Cell ; Carcinoma, Verrucous ; Chemoradiotherapy ; Chungcheongnam-do ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Rare Diseases

PURPOSE: To evaluate the patterns of injuries and frequency of associated findings on MR imaging in patients with both anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears; to compare the associated findings, as seen on MR imaging, in cases with both ACL and PCL tears with those with ACL or PCL tears. MATERIALS AND METHODS: Ten patients with combined ACL and PCL tears, 16 with ACL tears and 18 with PCL tears, all confirmed by arthroscopy or open surgery, were involved in this study. To identify the associated knee injuries, MR images were retrospectively evaluated. RESULTS: In ten patients with combined ACL and PCL tears, open surgery led to the identification of six complete ACL tears (60%), four partial ACL tears (40%), eight complete PCL tears (80%) and two partial PCL tears (20%). Injuries associated with these combined tears, and revealed by MR imaging, comprised six medial collateral ligament injuries (60%), six lateral collateral ligament injuries (60%), five medial meniscal injuries (50%), three lateral meniscal injuries (30%), nine bony injuries (90%), two posterior capsular injuries (20%), and three popliteus muscle injuries (30%). The frequency of popliteus muscle injury was significantly different (p<0.05, Fisher's exact test) between the group with both ACL and PCL tears and that with ACL or PCL tears. CONCLUSION: Associated findings in patients with combined ACL and PCL tears are more frequentthan in those with ACL or PCL tears. In cases involving combined ACL and PCL tears, associated findings-as seen on MR images-should thus be carefully examined.
Anterior Cruciate Ligament ; Arthroscopy ; Collateral Ligaments ; Humans ; Knee Injuries ; Lateral Ligament, Ankle ; Magnetic Resonance Imaging* ; Posterior Cruciate Ligament* ; Retrospective Studies