PURPOSE: The clinical implication of p53 mutation in gastric cancer is still unclear, as shown by the discordant results that continue to be reported in the literature. MATENRIALS AND METHODS: To assess p53 gene mutation, tumor p53 overexpression, and serum anti-p53 antibody, we employed a polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analysis, an immunohistochemistry using monoclonal antibody DO-7, and an enzyme-linked immunosorbent assay (ELISA), respectively. RESULTS: Of 169 surgical specimens of gastric cancer, mutation at exon 5~8 of the p53 was identified in 33 (19.5%) and was significantly correlated with lymph node metastasis. Overexpression of p53 was found in 62 specimens (36.7%) and had a significant correlation with tumor differentiation. Serum anti-p53 antibody was positive in 18 patients (10.7%). Twenty-three of the mutated tumors (69.7%) and 39 of the non-mutated tumors (28.7%) displayed immunoreactivity. Twelve of the immunopositive tumors (19.4%) and 6 of the immunonegative tumors produced anti-p53 antibody. These differences were statistically significant (P<0.001 and P=0.005, respectively). There was no significant difference in survival according to the mutation of p53. CONCLUSION: Mutation and overexpression of p53 can be easily detected by immunohistochemistry. However, standardization of the immunohistochemical staining method, as well as guidelines for interpreting the stained result, will produce concordant results and thereby improve clinical application.
Enzyme-Linked Immunosorbent Assay ; Exons ; Genes, p53* ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Stomach Neoplasms*

Congenital diverticula of the cardiac ventricle have been reported as arising either from the left ventricule or, rarely from both ventricules. A diverticulum arising from the right ventricle alone is very rare. Double chambered right ventricle(DCRV) was first described in 1962 by Lucas et al, and account for 1.5% of congenital heart disease. Right ventricular diverticulum are associated with right ventricle outlet obstructive disease, tetralogy of fallot, double outlet right ventricle, pulmonic stenosis, ventricular septal defect, left ventricule-right atrium communication, persistant truncus arteriosus. DCRV are freqently associated with ventricular septal defect(80%), pulmonic stenosis(33%), renal anormaly(43%). Treatment consist of suture of diverticulum and resection of septum. We report a case of double chambered right ventricle with congenital right ventricular true diverticulum in 62 years of female patients admitted due to anterior chest pain and mild exertional dyspnea.
Chest Pain ; Diverticulum* ; Double Outlet Right Ventricle ; Dyspnea ; Female ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Heart Ventricles* ; Humans ; Pulmonary Valve Stenosis ; Sutures ; Tetralogy of Fallot ; Truncus Arteriosus

PURPOSE: Isosulfan blue has been traditionally used as a tracer to map the lymphatic system during identification of the sentinel lymph node (SLN). However, this vital dye is difficult to obtain in Korea. Radioisotopes such as technetiumlabeled sulfur colloid or albumin colloid are also expensive and complex to use. The purpose of this study is to evaluate usefulness of a sentinel lymph node biopsy (SLNB) using methylene blue dye in breast cancer patients. METHODS: We evaluated the sentinel node mapping experience using methylene blue dye from July 2003 to January 2007. Fifty-eight patients with clinical T1-T2 breast cancer without palpable axillary lymph nodes were enrolled. All SLNs were submitted for intraoperative frozen section and hematoxyline and eosin (H & E) stain analysis. For the negative SLNs, serial sections of each SLN specimen were examined by permanent H & E staining and by immunohistochemical techniques (IHC) using cytokeratin. Regardless of the results of a frozen section for the SLNs, a backup level II or III axillary lymph node dissections (ALND) was performed. RESULTS: Of the 58 patients that underwent a SLNB using methylene blue dye, an SLN was identified in 56 patients (96.6%), and metastatic SLNs were detected in 14 cases. Axillary lymph node metastasis found in 18 out of 58 patients. Thus, the false negative rate for a SLNB was 22.2% (4/18). Two patients had a micrometastasis (pN1mi) and two patients had clusters of isolated tumor cells (pN0[i+]) that were identified in the SLNs by IHC with the additional use of cytoketatin. The sensitivity, specificity, and accuracy of the SLNBs were 77.8%, 100%, and 92.9%, respectively. The false negative rate improved with the accumulation of experience for performing a SLNB (12.5% vs 30.0%). The sensitivity, specificity, positive predictive value, and accuracy of preoperative ultrasonography (USG) for an axillary lymph node metastsis were 50.0%, 95.5%, 81.8% and 81.0% respectively. CONCLUSION: Based on our initial experience, methylene blue dye is safe, inexpensive, and a readily available tracer for the SLN mapping, and it could be an effective alternative to the use of isosulfan blue dye for accurately identifying SLNs in early breast caner patients. We expected that the findings of preoperative USG could serve as useful adjuncts to a SLNB.
Biopsy* ; Breast Neoplasms* ; Breast* ; Colloids ; Eosine Yellowish-(YS) ; Frozen Sections ; Hematoxylin ; Humans ; Keratins ; Korea ; Lymph Node Excision ; Lymph Nodes* ; Lymphatic System ; Methylene Blue* ; Neoplasm Metastasis ; Neoplasm Micrometastasis ; Radioisotopes ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy ; Sulfur ; Ultrasonography

PURPOSE: To determine the metal plate that has almost the same volume and weight as the conventional plate, but has improved properties by changing the shape using finite element analysis. MATERIALS AND METHODS: The bone is assumed to be of 100 mm length, 20 mm outer diameter and 12 mm inner diameter, respectively. There is a fracture line that is perpendicular to the major axis of the bone at the center. The two pieces of bone are joined together using a metallic plate that is made of titanium. Six holes are located, with an interval of 12 mm. We suppose that screws of 2 mm diameter and 25 mm length are inserted in six holes. The metallic plates are of 5 shapes (A, B, C, D and E) in total. Shape A is the standard or nominal type. Shape B and C are thicker at the center of the plate, respectively. Shape D and E are wider at the center. Six types of load are applied to each of those plates: tension, compression, anterior flexion, posterior flexion, lateral flexion and torsion. We compared stress, deformation, maximal stress and maximal deformation, according to the six types of load. RESULTS: Our deliberate investigation using finite element analysis showed that increasing the thickness or width at the center of metallic plates lowered the maximum stress and deformation. In particular, maximal stress and deformation could be reduced by 33.5% and 38.6%, respectively, in the anterior bending situation. Compression showed lower stress and deformation in type C or D, but the absolute quantity was much smaller than others, for example 0.01-0.001 times. CONCLUSION: As for the internal bone fixation plates with the same volume, the wider or thicker in the middle the plate become, the less deformation and yielding it bears.
Axis, Cervical Vertebra ; Bone Plates ; Finite Element Analysis ; Fracture Fixation ; Stress, Mechanical ; Titanium ; Ursidae

We report a young man with congenital bilateral perisylvian syndrome (CBPS), who showed eating reflex seizures (ERS). His ERS were related to the taste of foods. The subtracted ictal SPECT co-registered to MRI (SISCOM) revealed the hyperperfusion in the insula as well as the subcortical nuclei and brainstem. The ERS in CBPS may be partially related with the taste function of the insula and SISCOM may be helpful for the localization of the epileptogenic foci in ERS.
Brain Stem ; Eating* ; Humans ; Magnetic Resonance Imaging ; Reflex* ; Seizures* ; Tomography, Emission-Computed, Single-Photon

Nitric oxide (NO) modulates the activities of various channels and receptors to participate in the regulation of neuronal intracellular Ca2+ levels. Ca2+ binding protein (CaBP) expression may also be altered by NO. Accordingly, we examined expression changes in calbindin-D28k, calretinin, and parvalbumin in the cerebral cortex and hippocampal region of neuronal NO synthase knockout(-/-) (nNOS-/-) mice using immunohistochemistry. For the first time, we demonstrate that the expression of CaBPs is specifically altered in the cerebral cortex and hippocampal region of nNOS-/- mice and that their expression changed according to neuronal type. As changes in CaBP expression can influence temporal and spatial intracellular Ca2+ levels, it appears that NO may be involved in various functions, such as modulating neuronal Ca2+ homeostasis, regulating synaptic transmission, and neuroprotection, by influencing the expression of CaBPs. Therefore, these results suggest another mechanism by which NO participates in the regulation of neuronal Ca2+ homeostasis. However, the exact mechanisms of this regulation and its functional significance require further investigation.
Animals ; Calcium ; Calcium-Binding Protein, Vitamin D-Dependent ; Calcium-Binding Proteins ; Carrier Proteins ; Cerebral Cortex ; Homeostasis ; Immunohistochemistry ; Mice ; Neurons ; Nitric Oxide ; Nitric Oxide Synthase ; Synaptic Transmission

Despite recent successful efforts to shorten the door-to-balloon time in patients with acute ST-segment elevation myocardial infarction (STEMI), prehospital delay remains unaffected. Nonetheless, the factors associated with prehospital delay have not been clearly identified in Korea. We retrospectively evaluated 423 patients with STEMI. The mean symptom onset-to-door time was 255 +/- 285 (median: 150) min. The patients were analyzed in two groups according to symptom onset-to-door time (short delay group: < or = 180 min vs long delay group: > 180 min). Inhospital mortality was significantly higher in long delay group (6.9% vs 2.8%; P = 0.048). Among sociodemographic and clinical variables, diabetes, low educational level, triage via other hospital, use of private transport and night time onset were more prevalent in long delay group (21% vs 30%; P = 0.038, 47% vs 59%; P = 0.013, 72% vs 82%; P = 0.027, 25% vs 41%; P < 0.001 and 33% vs 48%; P = 0.002, respectively). In multivariate analysis, low educational level (1.66 [1.08-2.56]; P = 0.021), symptom onset during night time (1.97 [1.27-3.04]; P = 0.002), triage via other hospital (1.83 [1.58-5.10]; P = 0.001) and private transport were significantly associated with prehospital delay (3.02 [1.81-5.06]; P < 0.001). In conclusion, prehospital delay is more frequent in patients with low educational level, symptom onset during night time, triage via other hospitals, and private transport, and is associated with higher inhospital mortality.
Acute Disease ; Aged ; Demography ; Electrocardiography ; Emergency Service, Hospital ; Female ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Middle Aged ; Myocardial Infarction/*mortality/physiopathology ; Retrospective Studies ; Socioeconomic Factors ; Time Factors ; Triage

No abstract available.
Angiography ; Coronary Sinus ; Coronary Vessels

BACKGROUND: Cholestatic hepatitis is failure of bile to reach the duodenum with hepatocellular damage and no demonstable obstruction of the major bile ducts. The prognosis of usually good with recovery in less than 4 weeks after withdrawal of the offending drug. However, a prolonged causes of Chronic liver disease is needed. MATERIALS AND METHODS: From January 1991 through January 2000, 14 patients diagnosed as cholestatic hepatitis by liver biopsy were included. The possible causative drug, clinical features, laboatory findings, and progression of cholestatic hepatitis were evaluated. The semiquantitative study of liver lesions was performed by two independent observers. RESULTS: Causes of cholestatic hepatitis are 5 cases of oriental medicine, 3 cases of anti-tuberculosis medication, 1 case of ticlopidine and antibiotics and 4 cases of unknown causes. The clinical features of cholestatic hepatitis were jaundice, itching, urine color change, and general weakness. During 6 to 50 months, LFT of 5 patients showed prolonged elevation. Elevated total cholesterol > or =250 mg/dL in 6 patients, pheripheral blood eosinophilia in 5 patients, auto-antibody positive in 6 patients were observed respectively. The biopsies showed intralobular bilirubinostasis with a mixed portal inflammatory infiltration. CONCLUSION: In chlestatic hepatitis, durations of abnormal LET are variable regardless of causative drugs. If chlestatic hepatitis progresses toward chronic course, viral hepatitis, primary biliary cirrhosis, and autoimmune hepatitis should be differentially diagnosed and sequential liver biopsies are needed.
Anti-Bacterial Agents ; Bile ; Bile Ducts ; Biopsy ; Cholesterol ; Duodenum ; Eosinophilia ; Hepatitis* ; Hepatitis, Autoimmune ; Humans ; Jaundice ; Linear Energy Transfer ; Liver ; Liver Cirrhosis, Biliary ; Liver Diseases ; Medicine, East Asian Traditional ; Prognosis ; Pruritus ; Ticlopidine

PURPOSE: The mechanisms underlying syncope remain unknown in about 20% of patients with recurrent syncope. The implantable loop recorder (ILR) has been shown to be a useful diagnostic tool in patients with unexplained syncope even after negative initial evaluations. Nevertheless, ILR has rarely been used in clinical practice. MATERIALS AND METHODS: This study included 18 consecutive patients who had an ILR implanted at our center because of recurrent unexplained syncope after extensive diagnostic tests between February 2006 and June 2011. RESULTS: Diagnosis was confirmed in 10 (55.6%) of the 18 enrolled patients (13 males, 61+/-15 years). The confirmed diagnoses included sick sinus syndrome (n=6, 60%), advanced atrioventricular block (n=2, 20%) and ventricular tachyarrhythmia (n=2, 20%). The mean follow-up durations of the total study subjects and the diagnosed patients were 11.3+/-10.6 months and 5.6+/-9.2 months, respectively. Of the 10 diagnosed patients, 8 (80%) were diagnosed within 6 months of loop recorder implantation. CONCLUSION: ILR may be a valuable and effective diagnostic tool for patients with unexplained syncope.
Adult ; Aged ; Electrocardiography/instrumentation/methods ; Female ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic/instrumentation/methods ; Syncope/*diagnosis/etiology