Pseudoachalasia secondary to primary squamous cell carcinoma (SCC) of the liver is extremely rare and has not been reported until now. Here, we report a unique case of primary SCC of the liver initially presenting with progressive dysphagia along with short periods of significant weight loss. A 58-year-old man initially presented with progressive dysphagia along with significant weight loss over brief periods of time. The radiographic and manometric findings were consistent with achalasia. Subsequent esophagogastroduodenoscopy revealed a moderately dilated esophagus without evidence of neoplasm or organic obstruction. However, firm resistance was encountered while traversing the esophagogastric junction (EGJ), although no mucosal lesion was identified. Due to the clinical suspicion of the presence of a malignant tumor, endoscopic ultrasonography (EUS) and computed tomography scans of the chest and abdomen were obtained. A huge hepatic mass with irregular margins extending to the EGJ was found. EUS-guided fine-needle aspiration was performed, and the mass was diagnosed as a primary SCC of the liver by immunohistochemical staining.
Abdomen ; Biopsy, Fine-Needle ; Carcinoma, Squamous Cell ; Deglutition Disorders ; Endoscopy, Digestive System ; Endosonography ; Esophageal Achalasia ; Esophagogastric Junction ; Esophagus ; Humans ; Liver ; Middle Aged ; Thorax ; Weight Loss

Over the last several years, eosinophilic esophagitis in adults is an increasingly recognized disease in various parts of world. A 77-year-old male with a gastric submucosal tumor was referred to our department for endoscopic ultrasonography. During the examination, there was some resistance in inserting the echoendoscope into the esophagus. Detailed endoscopic examination of the esophagus showed narrow lumen and scattered whitish plaques, and biopsy of the esophagus revealed more than 20 eosinophils per high-power field. We diagnosed this case as eosinophilic esophagitis and treated successfully by topical steroid. We report a case of eosinophilic esophagitis found incidentally during endoscopic ultrasonography for a gastric submucosal tumor.
Adult ; Aged ; Biopsy ; Endosonography ; Eosinophilic Esophagitis ; Eosinophils ; Esophagus ; Humans ; Male

PURPOSE: The human epidermal growth factor receptor-2 (HER2) is overexpressed in breast cancer. The subset of patients with breast cancer demonstrating a HER2-positive status has aggressive tumors and a poor prognosis. Knowledge of the HER2 status is prerequisite when considering a patient's eligibility for anti-HER2 targeted therapy (Herceptin(R)). There are several assays available for determining the HER2 status. The aim of this study was to compare and evaluate the HER2 status in breast cancer by means of immunohistochemistry (IHC), FISH and real-time PCR. METHODS: DNA samples from fresh tumor tissues of 20 patients with breast cancer were analyzed with real-time PCR, using the LightCycler-HER2/neu PCR assay. A tissue microarray, containing 20 samples obtained from formalin- fixed, paraffin-embedded tissues, was used for IHC and FISH (PathyVysionTM). RESULTS: The frequencies of HER2 gene amplification for real-time PCR and FISH were 35 and 65% respectively, and the IHC frequency of overexpression was 70%. This study showed 75% concordance between IHC vs. FISH, 65% between IHC vs real-time PCR and 70% between FISH vs. real-time PCR. Considering real-time PCR as the gold standard, this study showed sensitivities and specificities of 100 and 46.2% for IHC, and of 100% and 53.8% for FISH. CONCLUSION: These results demonstrated marked discordance for the HER2 stati according to the various methods used. IHC, a familiar cost-effective test, will undoubtedly remain in routine clinical practice for HER2 screening but confirmatory HER2 testing using either FISH or real-time PCR is recommended for indeterminate cases. Real-time quantitative PCR for HER2 appears to be clinically useful due to its simplicity and ability to produce rapid results.
Breast Neoplasms* ; Breast* ; DNA ; Epidermal Growth Factor ; Genes, erbB-2* ; Humans ; Immunohistochemistry ; Mass Screening ; Polymerase Chain Reaction ; Prognosis ; Real-Time Polymerase Chain Reaction

BACKGROUND: IL-18 was originally cloned as a IFN-gamma inducing factor in primed T cells. In synergy with IL-12, IL-18 has been shown to induce strikingly high levels of IFN-gamma production by T cells and to enhance Th1 development. Also this cytokine exerts induction of Th2 development through IL-4 induction. METHODS: Resting CD4+ T cells were sorted by negative selection and activated by anti-CD3 plus anti-CD28 Ab. Expression of IL-12 binding sites, IL-18 binding sites, IL-18Ralpha, and GATA-3 mRNA were analysed by FACS and RT-PCR, respectively. RESULTS: Resting CD4+ T cells expressed IL-18Ralpha chain but not IL-18 binding sites, suggesting a lack of IL-18Rbeta expression. IL-18Ralpha was maintained on the Th1 and Th2 committed cells. IL-18 binding sites were induced on the Th1 but not Th2 cells. Exposure of these cells to IL-18 led to up-regulation of GATA-3 mRNA expression only in Th2 committed cells. To elucidate the relationship between IL-18Ralpha expression and GATA-3 induction by IL-18, Th1 and Th2 committed cells were further cultured in medium with or without IL-12 for 2 days. IL-12 binding sites were maintained on the Th1 and Th2 cells regardless of IL-12 treatment, but IL-18Ralpha expression was rapidly down-regulated on the IL- 12-untreated Th2 cells which did not induce GATA-3 mRNA expression followed by IL-18 stimulation. CONCLUSION: IL-12 supports expression of IL-18Ralpha and GATA-3 mRNA expression was induced by IL-18 through IL-18Ralpha without expression of IL-18 binding site in Th2 cells.
Binding Sites ; Clone Cells ; Interleukin-12* ; Interleukin-18 ; Interleukin-4 ; RNA, Messenger ; T-Lymphocytes ; Th2 Cells* ; Up-Regulation

Uterus didelphys with unilateral obstructed hemivagina is indeed a very rare congenital anomaly due to M llerian duct malformation. The most common clinical presentation is pelvic pain and dysmenorrhea shortly after menarche, in associated with the finding of a vaginal or pelvic mass. An accurate and prompt diagnosis is of importance to permit treatment and to assure the future fertility of the patient. The simple and adequate treatment of the condition is incision of the obstructed vaginal septum providing adequate drainage of the retained blood. We report a case of uterus didelphys with obstructed hemivagina with brief review of the literature.
Diagnosis ; Drainage ; Dysmenorrhea ; Female ; Fertility ; Humans ; Menarche ; Pelvic Pain ; Uterus*

PURPOSE: Hydronephrosis constitutes a great portion of fetal anomalies screened by prenatal sonogram. The present authors made an attempt to access its natural courses through follow up neonatal hydronephrosis diagnosed by prenatal sonogram. METHODS: The study was composed of 23 neonates(36 renal units) who were diagnosed with hydronephrosis through prenatal sonogram screening and confirmed 3-7 days after birth with sonographic evaluation at Kyung Hee University Hospital. The neonates were closely monitored for 12-24 months with renal sonogram, diuretic renogram, intravenous pyelography(IVP) and voiding cystoureterography(VCUG). RESULTS: The underlying diseases were composed of 16 cases(44%) of functional abnormalities, 14 cases(39%) of ureteropelvic junction(UPJ) obstruction, three cases(8%) of vesicoureteral reflux (VUR) and on case each of multicystic dysplastic kidney, UPJ obstruction with ureteral stenosis and ureterovesical junction(UVJ) obstruction with VUR. The degree of hydronephrosis was divided into three classes according to its severity. In 30 renal units with UPJ obstruction and functional abnormalities, 26(87%) showed mild hydronephrosis, while four(13%) were moderate. During the follow up period, six cases(20%) showed natural resolution of hydronephrosis, 15 cases(50%) showed improvement while two cases(7%) were aggravated with improvement only after surgery of the underlying disease. The cases which showed natural resolution were all mild hydronephrosis at diagnosis and the cases which underwent surgery due to continuous aggravation were mild one case and moderate one case. CONCLUSION: Those with cases of mild hydronephrosis show rapid natural improvement. On the other hand, in some cases, follow up monitoring reveal aggravation of the situation, emphasizing the necessity for thorough follow up for a long period of time.
Constriction, Pathologic ; Diagnosis ; Follow-Up Studies ; Hand ; Humans ; Hydronephrosis* ; Infant, Newborn ; Mass Screening ; Multicystic Dysplastic Kidney ; Parturition ; Ultrasonography ; Ultrasonography, Prenatal* ; Ureter ; Vesico-Ureteral Reflux

BACKGROUND: Disseminated intravascular coagulation (DIC) is a clinicopathologic syndrome for widespread intravascular coagulation. DIC occurs when the processes that regulate coagulation break down. Staphylococcal infection is one of the causes of DIC. Staphylococcus aureus produces coagulase that can clot plasma. There are two different tests to detect the coagulase; a tube test for free coagulase and a slide test for bound coagulase or clumping factor. The goal of the present study is to evaluate the characteristics of coagulase in Staphylococcus aureus for establishment of an in-vitro model for DIC. METHODS: Coagulase tests were performed by mixing plasma with two-fold diluted culture broths, culture supernatant and culture filtrates. Coagulase activity was expressed as the reciprocal of the highest dilution titer. Cell pellets treated with normal saline, ethyl alcohol, and aceton were used for the clumping tests. Platelet aggregation tests were conducted using a culture broth and a concentrated culture supernatant. A fibrinogen binding protein was isolated from sonificated bacteria and thus, determined the molecular weight. RESULTS: Coagulase activity was higher in the broth culture than in the culture supernatant and culture filtrate. Coagulase activity decreased after incubation at 37degrees C for 24 hours but culture filtrates were clumped after boiling at 100degrees C for 10 minutes. Alcohol and aceton did not inhibit the clumping test. S. aureus induced platelet aggregation but a concentrated culture filtrate did not induce platelet aggregation. Molecular weight of fibrinogen binding protein was 57 kDa. CONCLUSIONS: It is suggested that the plasma clot was due to free coagulase or a clumping factor. Free coagulase is different from a clumping factor. We concluded that the pathogenesis of DIC in the staphylococcal infection was due to platelet aggregation triggered by a clumping factor or coagulase with other substances.
Bacteria ; Carrier Proteins ; Coagulase* ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Ethanol ; Fibrinogen ; Molecular Weight ; Plasma ; Platelet Aggregation ; Staphylococcal Infections ; Staphylococcus aureus* ; Staphylococcus*

No abstract available.
Animals ; Clone Cells* ; Cloning, Organism* ; Mast Cells* ; Mice*

In order to explore the potential of ascorbic acid supplementation for the prevention and treatment of herpes simplex viral diseases, plaque reduction assays were performed. Ascorbic acid as well as copper chloride/ferric chloride were added to wells containing Vero cells infected with herpes simplex virus type 1 (HSV-1), and the infectivity of HSV-1 was determined. Since copper and iron are major transition metals in human plasma, near the normal human plasma concentrations of them were used for experiments. When Cu(II) and Fe(III) were applied, there were no significant differences between virus control and Cu(II)/Fe(III)-treated groups. But, when appropriate concentrations of ascorbic acid were added to wells, meaningful differences between control and ascorbate-treated groups were found. In the presence of Cu(II)/Fe(III) at 5.8/3.7 muM, 72-h treatment with ascorbate at 50 muM reduced HSV-1 infections to 10.77%+/-4.25% (P<0.001) and 500 muM did to 3.06%+/-1.62% (P<0.001). Moreover, the cytotoxicities for Vero cells at those concentrations were insignificant (P > 0.05). Current recommended dietary allowance (RDA) of ascorbic acid is 60 mg/day, and the oral intake of 60 mg/day of ascorbic acid yields plasma ascorbic acid at 45 to 58 muM in a healthy adult man. Therefore, the results of this study suggest that the maintenance of appropriate level (more than 50 muM) of ascorbic acid in human plasma by appropriate amount (more than the RDA) of ascorbic acid supplementation may be helpful for the prevention and treatment of diseases caused by HSV-1 in an adult man. In addition, this study also suggests that ascorbic acid may be useful for the prophylaxis of fatal HSV-1 infections in neonates and the prevention of HSV-1 reactivation in immunocompromised hosts.
Adult ; Ascorbic Acid* ; Copper ; Herpes Simplex* ; Herpesvirus 1, Human ; Humans ; Immunocompromised Host ; Infant, Newborn ; Iron ; Metals ; Plasma ; Recommended Dietary Allowances ; Simplexvirus* ; Vero Cells ; Virus Diseases

BACKGROUND: Minimally invasive direct coronary artery bypass surgery(MIDCAB) has been increasing in interest along with the new techniques in myocardial immobilization for easier and safer procedures. Until the opening of the era of new techniques, adequate accuracy and good patency of grafts were debatable. Our experiences of MIDCAB were studied according to the stages of technical developments. Material and Methods: Since March 1996, 55 patients have undergone MIDCAB procedures. The patients of off-pump CABG(no cardiopulmonary bypass under full sternotomy) were excluded from the study. In the early experience(Stage I), a left anterior small thoracotomy through the left parasternal incision was performed(n=6); then an approach through the lower partial sternotomy was used(Stage II, n=33); and recently, a chest wall elevator for harvesting the internal thoracic artery and the foot plate for myocardial immobilization have been used(USSC, Norwalk, CT)(Stage III, n=16). RESULT: The surgical procedures of four patients in the Stage II group have been converted to conventional bypass because of the deeply seated left anterior descending coronary artery in two patients, fracture of the calcific lesion in the right coronary artery in one patient, and a cardiogenic shock during hypothermia in the other patient with ventricular dysfunction. Two patients in stage II experienced symptomatic recurrences after surgery and restenosis was verified on angiocardiography. They were managed by interventional procedures. All the other patients were doing well without symptoms, except one patients in Stage II who underwent PTCA procedure for a lesion in the circumflex artery during the follow up period. CONCLUSION: The new and specialized devices are essential to the development of MIDCAB surgery. MIDCAB and the hybrid procedures in multi-vessel disease are on the way to further development. So far, our experience is limited only to a single device among the many new devices for the purpose.
Angiocardiography ; Arteries ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Vessels ; Elevators and Escalators ; Follow-Up Studies ; Foot ; Humans ; Hypothermia ; Immobilization ; Mammary Arteries ; Recurrence ; Shock, Cardiogenic ; Sternotomy ; Surgical Procedures, Minimally Invasive ; Thoracic Wall ; Thoracotomy ; Transplants ; Ventricular Dysfunction