A Case of Aortoesophageal Fistula due to Esophageal Cancer Treated with Endovascular Stent Grafting / 대한내과학회지

Hemorrhage into the esophagus due to aortoesophageal communication is very rare but life-threatening with high morbidity and mortality. Because of this, most cases of aortoesophageal fistula are confirmed by autopsy. However, we report herein a case of a 62-year-old male with an aortoesophageal fistula who was successfully treated with endovascular stent-grafting. The patient had undergone esophageal stent insertion due to esophageal cancer and experienced hematemesis and hemodynamic shock due to an aortoesophageal fistula. Emergency endoscopy was unable to identify the source of the hemorrhage due to massive bleeding. Computed tomography of the chest revealed a focal pseudoaneurysm at the descending aorta and diffuse thinning of the esophageal wall, which were treated with endovascular stent-grafting. Although aortoesophageal fistulas are usually fatal, implantation of a covered stent into the esophagus may help prevent massive bleeding, providing valuable time to treat the patient.

Expression of iC3b Receptor on Candida albicans and Its Role on Adhesion of the Yeast to Human Dermal Microvascular Endothelium / 대한의진균학회지

BACKGROUND: The adherence of microorganisms to host tissue is an important process in the pathogenesis of fungal infection. A protein that shares antigenic and structural homology with the alpha-subunit of leukocyte adhesion glycoprotein CD11b/CD18, also known as iC3b receptor, Mo-1 or Mac-1, has been isolated from the surface of C. albicans. OBJECTIVE: This study was done to observe the changes in the expression of iC3b receptor on C. albicans by glucose or immunosuppressive agents and to elucidate the effect of glucose and anti-iC3b receptor antibodies on adhesion between human dermal microvascular endothelial cells(HDMEC) and C. albicans. METHODS: We utilized immunofluorescence study and immunofluorescent flow cytometry and the binding assay of C. albicans to cultured HDMEC in vitro and blocking assay using monoclonal antibody were performed. RESULTS: Immunofluorescence study and immunofluorescent flow cytometric analysis demonstrated surface expression of iC3b receptor on C. albicans. The expression of surface iC3b receptor on C. albicans in creased in a dose dependent manner with increasing concentrations of glucose, cyclophosphamide and prednisolone. The adherence of C. albicans to HDMEC correlated positively with glucose levels. The adherence of C. albicans to HDMEC decreased significantly by the treatment with anti-iC3b receptor antibodies. CONCLUSION: The results suggest that iC3b receptors should be involved in the adherence of C. albicans to vascular endothelial cells and may be involved in the pathogenesis of hematogenous candidiasis