Almost all colorectal carcinomas have been thought to develop from pre-existing adenomas. However, some colorectal carcinomas can arise directly from normal flat mucosa, and usually form infiltrative mass at the early stage. The carcinogenesis of this infiltrative carcinoma may be different from the well-known adenoma-carcinoma sequence, which usually forms a polypoid mass. The purpose of this study is to investigate the different expression of various oncogenes in polypoid carcinoma and infiltrative carcinoma. We performed immunohistochemical staining on p53, bcl-2, c-erbB-2 and MIB-1 in 29 polypoid carcinomas arised from adenomas, and 21 infiltrative carcinomas. The average tumor size of infiltrative carcinomas (5.5 cm) was larger than that of polypoid carcinomas (3.1 cm), and the polypoid carcinomas were differentiated more than the infiltrative carcinomas. The results of p53, bcl-2, c-erbB-2, and MIB-1 antisera immunoreactivity in the polypoid carcinoma were 79%, 17%, 21%, and 100%, and those in the infiltrative carcinoma were 71%, 29%, 29%, and 100%, respectively. However the diffuse positivities of p53 and MIB-1 antisera were slightly higher in the infiltraive carcinomas (62%, 76%) than in the polypoid carcinomas (55%, 41%) (p=0.63, 0.01). And the results of p53 and c-erbB-2 immunoreactivity in the adenomas were 52% and 17%, respectively, which is significantly lower than that in the polypoid carcinoma(p=0.03, 0.74). The immunoreactivty of bcl-2 in the adenoma was 72%, which was significantly higher than that in the polypoid carcinoma (17%) (p<0.01). In summary, we did not show the significant difference in expression of p53, bcl-2, c-erbB-2, and MIB-1 proteins between polypoid and infiltrative carcinomas. However, the tendency of infiltrative carcinomas having a more aggressive nature suggests another carcinogenetic mechanism is involved in the colorectal carcinogenesis.
Adenoma ; Carcinogenesis ; Colorectal Neoplasms* ; Immune Sera ; Ki-67 Antigen ; Mucous Membrane ; Oncogenes

Trisomy 18 is the second most common chromosomal anomaly that reach to live birth after Down syndrome. Several methods were proposed to screen patients on the risk of Edward syndrome like maternal serum levels using total human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP) and unconjugated estriol (uE3), or free beta hCG with AFP, but the serum screening has only 50-60% detection rate with a 1-2% of false positive rate. So to cover the limitations that serum marker has, detailed ultrasound examination is also necessary and sensitivities of 65-70% were reported. We report a case of trisomy 18 fetus in which second trimester triple markers of maternal serum was normal, but by detailed ultrasound examination, unilateral radius aplasia was diagnosed cytogenetic study confirmed the fetus as trisomy 18.
alpha-Fetoproteins ; Biomarkers ; Chorionic Gonadotropin ; Cytogenetics ; Down Syndrome ; Estriol ; Female ; Fetus ; Humans ; Live Birth ; Mass Screening ; Pregnancy ; Pregnancy Trimester, Second ; Radius* ; Trisomy ; Ultrasonography

OBJECTIVES: Documented risk factors for obstructive sleep apnea include advanced age, male gender, hypertension, large neck circumference, and obesity; but some controversy remains regarding the risk factors, especially in Asians. In this study, we evaluated the risk factors for obstructive sleep apnea in snoring patients, and also analyzed the risk factors that could predict the severity of obstructive sleep apnea. METHODS: The inclusion criteria were patients 1) who visited our hospital with a chief complaint of snoring as witnessed by a sleep partner and 2) who underwent overnight polysomnography. The primary endpoint was the presence of obstructive sleep apnea as a dependent variable. RESULTS: One hundred forty-seven patients met the inclusion criteria. Of the 147 patients, 109 patients were diagnosed with obstructive sleep apnea. Multivariate analysis showed that old age and large neck circumference were significant independent variables for predicting the presence of obstructive sleep apnea, whereas hypertension and large neck circumference were independent variables for predicting the severity of obstructive sleep apnea. CONCLUSIONS: We demonstrated that neck circumference can be used to predict the presence as well as the severity of obstructive sleep apnea in snoring Asian patients.
Asian Continental Ancestry Group ; Humans ; Hypertension ; Male ; Multivariate Analysis ; Neck* ; Obesity ; Polysomnography ; Risk Factors ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Snoring*

BACKGROUND AND PURPOSE: We investigated the potential role of serum procalcitonin in differentiating tuberculosis meningitis from bacterial and viral meningitis, and in predicting the prognosis of tuberculosis meningitis. METHODS: This was a retrospective study of 26 patients with tuberculosis meningitis. In addition, 70 patients with bacterial meningitis and 49 patients with viral meningitis were included as the disease control groups for comparison. The serum procalcitonin level was measured in all patients at admission. Differences in demographic and laboratory data, including the procalcitonin level, were analyzed among the three groups. In addition, we analyzed the predictive factors for a prognosis of tuberculosis meningitis using the Glasgow Coma Scale (GCS) at discharge, and the correlation between the level of procalcitonin and the GCS score at discharge. RESULTS: Multiple logistic regression analysis showed that a low level of procalcitonin (≤1.27 ng/mL) independently distinguished tuberculosis meningitis from bacterial meningitis. The sensitivity and specificity for distinguishing tuberculosis meningitis from bacterial meningitis were 96.2% and 62.9%, respectively. However, the level of procalcitonin in patients with tuberculosis meningitis did not differ significantly from that in patients with viral meningitis. In patients with tuberculosis meningitis, a high level of procalcitonin (>0.4 ng/mL) was a predictor of a poor prognosis, and the level of procalcitonin was negatively correlated with the GCS score at discharge (r=-0.437, p=0.026). CONCLUSIONS: We found that serum procalcitonin is a useful marker for differentiating tuberculosis meningitis from bacterial meningitis and is also valuable for predicting the prognosis of tuberculosis meningitis.
Bacteria ; Glasgow Coma Scale ; Humans ; Logistic Models ; Meningitis, Bacterial ; Meningitis, Viral ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity ; Tuberculosis* ; Tuberculosis, Meningeal*

BACKGROUND: The aim of this study was to investigate the predictive value of snoring frequency in the diagnosis and severity of obstructive sleep apnea. METHODS: Patients who underwent polysomnography with one or more of the following characteristics were included: 1) sleepiness, non-restorative sleep, fatigue, or insomnia symptoms; 2) arousal due to cessation of breathing or the occurrence of gasping or choking when waking up; and 3) habitual snoring, breathing interruptions, or both, noted by a bed partner or other observer. We analyzed the differences in clinical and polysomnographic variables between patients with and without obstructive sleep apnea and investigated the associations of those variables with obstructive sleep apnea severity. RESULTS: One hundred ninety-three patients met the inclusion criteria, and 145 of the 193 patients were diagnosed with obstructive sleep apnea. Multiple logistic regression analysis showed that large neck circumference (p = 0.0054) and high snoring index (p = 0.0119) were independent predictors for obstructive sleep apnea. Moreover, between the obstructive sleep apnea severity groups, there was a strong tendency of difference in body mass index (p = 0.0441) and neck circumference (p = 0.0846). However, there was no significant difference in snoring frequency according to obstructive sleep apnea severity (p = 0.4914). CONCLUSIONS: We confirmed that snoring frequency is a predictor of obstructive sleep apnea. In addition, we showed for the first time that snoring frequency is not associated with obstructive sleep apnea severity, thus it is not a valuable marker for predicting obstructive sleep apnea severity.
Airway Obstruction ; Arousal ; Body Mass Index ; Diagnosis ; Fatigue ; Humans ; Logistic Models ; Neck ; Polysomnography ; Respiration ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Sleep Initiation and Maintenance Disorders ; Snoring*

BACKGROUND: There are therapies to lower intracranial pressure (ICP) including head elevation, hyperventilation, diuretics injection, intravenous mannitol, hypothermia, cerebrospinal fluid drainage, and cerebral resection in neurosurgical patients. However in recent reports, hyperventilation followed by mannitol administration may lead to cerebral ischemia. Therefore, we investigated the effect of 0.5-1.0 g/kg mannitol administration on jugular venous oxygen saturation (SjVO2) and cerebral arterial- jugular venous oxygen content difference (AVDO2) at PaCO2 25-30 mmHg and 35-40 mmHg in patients undergoing neurosurgery. METHODS: We studied 17 patients undergoing neurosurgery in the Ajou University Hospital. Anesthesia was induced with fentanyl, midazolam, thiopental, and vecuronium, and maintained with O2-Air-Isoflorane, a continuous infusion of fentanyl, and vecuronium. Patients were divided into two groups. Group 1 (n = 10) which is PaCO2 25-30 mmHg and Group 2 (n = 7) which is PaCO2 35-40 mmHg by controlling ventilator. Measurements of SjVO2 and AVDO2 in following time intervals: I = preinjection of mannitol, II = postinjection 20 minutes of mannitol, III = postinjection 40 minutes of mannitol were obtained for each group. 0.5-1.0 g/kg mannitol was administered intravenously just at duramater opening. RESULTS: Hemodynamics and hematologics were not significantly different among the two groups. SjVO2 of each group are as follows; Group 1; I (70.3+/-8.1%), II (66.3+/-6.9%), III (69.1+/-7.9%) and Group 2; I (78.6+/-7.4%), II (75.1+/-8.1%), III (76.0+/-11.2%). Hyperventilation significantly decreased SjVO2. AVDO2 was not significantly different but SjVO2 in II was significantly decreased compared with I and III in Group 1 (20% patients). CONCLUSIONS: Mannitol produced a change of SjVO2 and AVDO2 during hyperventilation. Therefore, intravenous mannitol during hyperventilation should be given cautiously according to the patients status because it may cause cerebral ischemia in critical patients.
Anesthesia ; Brain Ischemia ; Cerebrospinal Fluid ; Diuretics ; Drainage ; Fentanyl ; Head ; Hemodynamics ; Humans ; Hyperventilation* ; Hypothermia ; Injections, Intravenous ; Intracranial Pressure ; Mannitol* ; Metabolism* ; Midazolam ; Neurosurgery ; Oxygen ; Thiopental ; Vecuronium Bromide ; Ventilators, Mechanical

BACKGROUND: Viruses can cause either meningitis or encephalitis. It is unclear why some people suffer from aseptic meningitis, and others acquire aseptic encephalitis when infected with the same viral pathogens. The aim of this study was to compare demographic and laboratory factors between patients with aseptic meningitis and encephalitis. METHODS: The demographic and laboratory differences were analyzed according to age, sex, diabetes, hypertension, C-reactive protein in the blood, white blood cell and protein in the cerebrospinal fluid, and glucose ratio (cerebrospinal fluid/blood). Additionally, we analyzed the nation-wide differencesin age between the patients with aseptic meningitis and those with encephalitis in Korea. RESULTS: The patients with aseptic encephalitis were older, more likely to have hypertension, and had higher levels of C-reactive protein than did the patients with aseptic meningitis. However, the numbers of white blood cells in the cerebrospinal fluid were significantly higher in the patients with meningitis than in the patients with encephalitis. Multivariable analysis revealed that age >49 years, hypertension and a C-reactive protein level >5.81 mg/dL were independent and significant variables in the prediction of aseptic encephalitis. Additionally, the patients with aseptic encephalitis were older than those with aseptic meningitis in the nation-wide Korean database. CONCLUSIONS: Older age, hypertension, and higher levels of C-reactive protein are useful factors for the prediction of aseptic encephalitis.
Blood-Brain Barrier ; C-Reactive Protein* ; Cerebrospinal Fluid ; Encephalitis* ; Glucose ; Humans ; Hypertension ; Korea ; Leukocytes ; Meningitis ; Meningitis, Aseptic*

BACKGROUND: Excessive daytime sleepiness is one of the most common symptoms in snoring patients. However, the reason why some individuals complain of daytime sleepiness and others do not is unclear. In this study, we evaluated snoring individuals and examined several demographic and polysomnographic profiles in an attempt to identify predictors of excessive daytime sleepiness. METHODS: The inclusion criteria for patients were the following: 1) patients who underwent an overnight polysomnograph, 2) patients with the chief complaint of snoring, and 3) patients who completed the Korean version of the Epworth sleepiness scale. We used the Epworth sleepiness scale to estimate excessive daytime sleepiness. We quantified correlations between the Epworth sleepiness scale and the demographic/polysomnographic parameters. We also analyzed the parameters affecting excessive daytime sleepiness using multiple linear regression analysis. RESULTS: One hundred nineteen patients met the inclusion criteria for this study. Multiple regression analysis showed that young age was the only independent variable showing statistical significance for predicting excessive daytime sleepiness, and was well-correlated with the Epworth sleepiness scale. However, there were no polysomnographic parameters that were predictive. CONCLUSIONS: Clinicians need to be cautious when using the Epworth sleepiness scale for the diagnosis of obstructive sleep apnea and determining the response to treatment.
Diagnosis ; Humans ; Linear Models ; Sleep Apnea, Obstructive ; Snoring*

OBJECTIVE: Our purpose was to determine the effectiveness of transabdominal amnioinfusion in the pregnant women with preterm premature rupture of the membranes (PPROM). METHODS: Between March 1997 and June 1999, 54 pregnancies of 26 weeks to 36 weeks of gestation complicated with preterm premature rupture of the membranes were admitted at our institution, 23 patients were excluded from study due to incomplete data, loss follow up or medical diseases was combined. Among included 31 cases were randomly selected either for amnioinfusion (n=16) or expectant management (n=15). After hospitalization, all patients were assessed for fetal heart rate abnormalities, fetal lung maturity and chorioamnionitis. Labor induction was not performed until progressive labor and chorioamnionitis occurred. Amnioinfusion was done through transabdominal catheter and infused group was managed with prophylactic antibiotics and conservative group were treated by hydration and antibiotics. RESULTS: The median interval from PPROM and delivery was significantly increased in amnioinfused group compared to expectant group (11.19+/-11.52 days vs 3.67+/-5.59 days, p=0.02). There were no differences in 1 minute and 5 minutes Apgar score. However, the duration of incubator treatment and oxygen supplementation were more necessary in expectant group compared to amnioinfused group (p=0.01, respectively). Respiratory distress syndrome was more frequent in expectant group although it did not show statistical significance (20% vs 6%, p<0.25). There was no differences in mode of delivery, birth weight and maternal clinical characteristics between two groups. CONCLUSION: Our results suggest that active management using transabdominal amnioinfusion in pregnancies complicated with PPROM may give a chance to gain minimal time to accelerate lung maturation and thus improve neonatal outcome without increasing complications.
Anti-Bacterial Agents ; Apgar Score ; Birth Weight ; Catheters ; Chorioamnionitis ; Female ; Follow-Up Studies ; Heart Rate, Fetal ; Hospitalization ; Humans ; Incubators ; Lung ; Membranes* ; Oligohydramnios ; Oxygen ; Pregnancy ; Pregnant Women ; Rupture*

OBJECTIVE: To evaluate the availability and efficacy of the Lamellar body count as a predictor of fetal lung maturity METHODS: Amniocentesis was performed for evaluation of fetal lung maturity status within 72 hours of delivery in 32 patients. A Lamellar body count in clean amniotic fluid (AF) was analyzed right after amniocentesis. In case of contaminated AF with meconium or blood, samples was centrifuged for 3 minutes and divided into three. The average of three samples was analyzed successively from Coulter counter. RESULTS: The incidence of RDS showed significant relation with gestational age, 1-minute and 5-minute Apgar Score. Using a value greater than 30,000/ l to indicate pulmonary maturity, the Lamellar body count predicted all lung-maturated cases with no false-negative results (100% negative predictive value). All 4 cases of RDS demonstrated Lamellar body count less than 30,000/microl. By using a lower cutoff of 10,000/microl to predict pulmonary immaturity. Positive predictive value was 100% in RDS patients. CONCLUSION: In high risk pregnancy, fetal lung maturity test from amniotic fluid lamellar body count is a rapid, simple and reliable method in making a decision of delivery-time. And also it has universal availability with cost-effectiveness when we consider the reality of korean medical situation
Amniocentesis ; Amniotic Fluid ; Apgar Score ; Female ; Gestational Age ; Humans ; Incidence ; Lung* ; Meconium ; Pregnancy, High-Risk