Candida albicans is the most common cause of infectious esophagitis and usually is an opportunistic infection in immunocompromised patients. Dysphagia and odynophagia are the usual presenting complaints and, importantly, oral lesions are absent in 50 percent of patients. The role of gastrointestinal endoscopy in diagnosing fungal infections of the esophagus is primary. It is the most definitive and often the only method of detecting esophageal candidiasis. Accurate endoscopic diagnosis by biopsy or brushing leads to the initiation nf effective therapy. We have experienced a case of esophageal candidiasis in an 11-year-old girl who was immunologically normal and whose main symptoms were epigastric abdominal pain and nausea for 4 months. The endoscopic and pathologic findings of esophageal candidiasis were presented.
Abdominal Pain* ; Biopsy ; Candida albicans ; Candidiasis* ; Child* ; Deglutition Disorders ; Diagnosis ; Endoscopy, Gastrointestinal ; Esophagitis ; Esophagus* ; Female ; Humans ; Immunocompromised Host ; Intestines* ; Nausea ; Opportunistic Infections ; Stomach*

Subcutaneous emphysema is a complication of the pneumoperitoneum necessary to perform laparoscopy and will be seen more often as laparoscopic techniques are applied to a growing number of intraabdominal procedures. We report a case of subcutaneous emphysema and hypercarbia without pneumothorax or pneumomediastinum during laparoscopic cholecystectomy, which was treated by multiple puncture with 18G needle on emphysematous site. The suspected cause is inadvertent subcutaneous insufflation of carbon dioxide through the trocar sites by increased intra-abdominal pressure for the establishment of pneumoperitoneum. Immediate recognition, evaluation, and treatment of subcutaneous emphysema is necessary since this can be life-threatening complication.
Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Insufflation ; Laparoscopy ; Mediastinal Emphysema ; Needles ; Pneumoperitoneum ; Pneumothorax ; Punctures ; Subcutaneous Emphysema* ; Surgical Instruments

No abstract available.
Cell Cycle Proteins/*metabolism ; Colorectal Neoplasms/diagnosis/*metabolism ; Humans ; Prognosis

BACKGROUND: Abnormal over-expression or gene amplification of epidermal growth factor receptor (EGFR) is important in the prognosis of non-small cell lung cancer (NSCLC). We investigated the frequency of EGFR protein expression and gene amplification, and the correlation between EGFR status and survival in NSCLC. METHODS: We examined 360 cases of microarrayed NSCLC tissues for the EGFR protein expression and EGFR gene amplification using immunohistochemistry and fluorescent in situ hybridization. RESULTS: EGFR protein expression and EGFR gene amplification occurred in 110 cases (30.6%) and 24 cases (6.7%), respectively. EGFR protein expression and gene amplification were more frequent in squamous cell carcinoma than in adenocarcinoma. Differences in EGFR protein expression did not dramatically affect survival curves (p=0.740), but differences in gene amplification did (p<0.05): EGFR gene amplification was associated with a lower 5-year survival rate. CONCLUSION: EGFR protein expression and gene amplification showed moderate correlation with each other. EGFR gene amplification predicted a poor prognosis, whereas EGFR protein expression did not.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Epidermal Growth Factor ; Gene Amplification ; Gene Expression ; Genes, erbB-1 ; Immunohistochemistry ; In Situ Hybridization ; In Situ Hybridization, Fluorescence ; Prognosis ; Receptor, Epidermal Growth Factor ; Survival Analysis ; Survival Rate

We experienced a case of arteriovenous hemangioma showing Dariers sign on the forehead of a 43-year-old man. He presented with a single, 1 * 1.5cm sized, violaceous, asymptomatic nodule with a history of an intermittent wheal at the lesional site. This skin lesion showed Dariers sign clinically and proliferation of mast cells histopathologically with the punch biopsy specirnen suggesting urticaria pig- mentosa. Howerer, we could diagnose it as a arteriovenous hemangioma on complete excision, as the specimen showed arteriovenous proliferation with increased mast cells in a perivascular pattern. This case showed confusing clinical signs and showed the importance of complete excision for the diagnosis of a small skin tumor especially when a vascular proliferating tumor is suspected.
Adult ; Biopsy ; Diagnosis ; Forehead ; Hemangioma* ; Humans ; Mast Cells ; Skin ; Urticaria

OBJECTIVE: Although the regulation of implantation is not clearly understood, recent studies have revealed that many cytokines and growth factors play an essential role in preimplantation endometrial development. Among the cytokines, the expression of leukemia inhibitory factor (LIF) is absolutely essential for implantation, although its precise role is not fully understood. Clomiphene citrate is most commonly used drug in the treatment of infertility, but pregnancy rate achieved with clomiphene citrate is significantly lower than the ovulation rate due to the antiestrogenic effect of it on the cervical mucus and endometrium. The our purpose was to evaluate the endometrial expression of LIF in clomiphene citrate treated infertile women with luteal phase defect and association of clomiphene citrate and unsatisfactory endometrial development. METHODS: The endometrial samples from women with luteal phase defect (n=27) were examined. The endometrial tissue was obtained during secretory phase in 5 cases, and during proliferative phase in 6 cases without clomiphene citrate treatment. In 16 cases, the endometrial tissue was obtained by biopsy during secretory phase after clomiphene citrate treatment. Immunohistochemical staining was performed for LIF in the endometrial tissues. And then the expression of LIF was compared between clomiphene citrate treatment group and no treatment group during secretory phase, and secretory and proliferative phase were compared in the no treatment group. RESULTS: The endometrial expression of LIF was not significantly different between clomiphene citrate treated group and no treated group (p. value=0.123) and between proliferative phase and secretory phase without clomiphene citrate (p. value=0.306). The expressions of LIF were detected mostly in glandular epithelial cells and not in the stromal cells. CONCLUSION: We demonstrated that LIF was expressed in glandular epithelial cells rather than stromal cells and there was not menstrual cycle dependent difference of endometrial expression of LIF in infertile women with luteal phase defect. And our finding suggested that clomiphene citrate did not affect the secretory phase endometrial expression of LIF in infertile women with luteal phase defect.
Biopsy ; Cervix Mucus ; Clomiphene* ; Cytokines ; Endometrium ; Epithelial Cells ; Estrogen Receptor Modulators ; Female ; Humans ; Infertility ; Intercellular Signaling Peptides and Proteins ; Leukemia Inhibitory Factor* ; Leukemia* ; Luteal Phase* ; Menstrual Cycle ; Ovulation ; Pregnancy Rate ; Stromal Cells

BACKGROUND: The hypereosinophilic syndrome(HES) represents a leukoproliferative process likely caused by a number of disorders, all of which are marked by sustained over-production of eosinophils. OBJECTIVES: The purposes of this study were aimed at evaluating the clinical and histopathological characteristics of HES. METHODS: The medical records and hist opathological slides of patients with HES who had skin biopsies performed in our department were reviewed. Criteria for the diagnosis of HES include (1) peripheral blood eosinophilia with eosinophil counts greater than 1,500/L for at least 6 months; (2) no evidence of parasitic, allergic, or other known causes of eosinophilia; and (3) presumptive signs and symptoms of multiple organ involvement. RESULTS: Four male and three female patients were included. HES developed in adulthood or old age (mean, 43.4 years). Because only the patients with cutaneous involvement were included, all the patients showed skin lesions. Heart, liver, stomach, nervous system, lymph nodes, and lung were involved organs in decreasing order of frequency. At the onset of HES, 40 to 80% of white blood cells were eosinophils in peripheral blood. White blood cell count and serum IgE level were elevated in all the tested patients. In six patients (85.7%), the level of serum erythrocyte sedimentation rate was elevated. Persistent hypereosinophilia (>1,500/L) was present for longer than 6 months in all patients. Stool examination and skin test for parasitic infestation all gave negative results. All the patients were not taking any medication. Histopathological examinations revealed perivascular mixed inflammatory cell infiltration; predominantly eosinophils in the stomach, liver, and nerve as well as in the skin. Interestingly, two patients who were presented with skin lesions showed the findings of eosinophilic vasculitis. In these patients, the skin lesions were consisted of Raynaud's phenomenon, digital gangrene, and several erythematous plaques. The most common cutaneous manifestations were papules and nodules on the extremities. The main treatment modality was systemic steroid. Except for one patient presented with central nervous system involvement of HES, all the patients were in a well-controlled state. In one patient with the typical clinical and hematologic features of HES, Hodgkin's disease followed. After the complete remission of Hodgkin's disease with chemotherapy, HES subsided. CONCLUSIONS: HES is a heterogenous collection of disorders marked by hypereosinophilia and organ damage. Most common cutaneous manifestations were papules and nodules on the extremities. Raynaud's phenomenon and digital gangrene can be the primary manifestation of HES in which cases cutaneous lesions showed eosinophilic vasculitis. Five patients (71%) responded well to systemic steroids. HES may be a herald of malignancy such as Hodgkin's disease. Further investigation will be mandatory ro elucidate the etiology and pathogenesis of HES.
Biopsy ; Blood Sedimentation ; Central Nervous System ; Diagnosis ; Drug Therapy ; Eosinophilia ; Eosinophils ; Extremities ; Female ; Gangrene ; Heart ; Hodgkin Disease ; Humans ; Hypereosinophilic Syndrome* ; Immunoglobulin E ; Leukocyte Count ; Leukocytes ; Liver ; Lung ; Lymph Nodes ; Male ; Medical Records ; Nervous System ; Skin ; Skin Tests ; Steroids ; Stomach ; Vasculitis

No abstract available.
Female ; Humans ; Hysterosalpingography* ; Laparoscopy*

No abstract available.
Endometrium* ; Female ; Humans

OBJECTIVE: Placement of a ventriculoperitoneal (VP) shunt is a common neurosurgical procedure for cerebrospinal fluid diversion. A rare complication is delayed intracranial hemorrhage (ICH) secondary to VP shunting, and only a few patients with this complication have been reported. We investigate the incidence and risk factors of delayed ICH development following VP shunt placement. METHODS: Over an 11-year period, 167 patients received a VP shunt for hydrocephalus, and of these, 138 patients were eligible for this study. All medical records and computed tomography scans obtained within 48 h after the operation and at postoperative day 7 were reviewed. The risk factors of developing delayed ICH (≥48 hr after VP shunt placement) were analyzed according to the demographic data, including sex and age, original intracranial lesions, co-morbid diseases, and laboratory findings. RESULTS: Delayed ICH following VP shunt placement developed in 34 (24.6%) of the 138 patients. Risk factors for developing delayed ICH were age (p=0.037) and the partial thromboplastin time (PTT) (p=0.032). Intraventricular hemorrhage after VP shunting was the most common complication, occurring in 16 cases. Hemorrhagic volume was < 1 mL in 28 cases and >1 mL in 6 cases. CONCLUSION: This study suggests that old age and delayed PTT are major risk factors for developing delayed ICH following VP shunting. Additionally, delayed ICH after VP shunting commonly occurs even when most patients are asymptomatic. Therefore, extra care should be taken to observe and follow-up with patients who have undergone VP shunt placement.
Cerebrospinal Fluid ; Follow-Up Studies ; Hemorrhage ; Humans ; Hydrocephalus ; Incidence ; Intracranial Hemorrhages* ; Medical Records ; Neurosurgical Procedures ; Partial Thromboplastin Time ; Risk Factors* ; Ventriculoperitoneal Shunt*