No abstract available.
Rabbits*

PURPOSE: In 1970, the Berlin-Frankfurt-Munster(BFM) group introduced an intensification therapy after remission induction to reduce relapse of acute lymphoblastic leukemia(ALL) in childhood. Delayed intensification(DI) phase has been included for treatment of ALL in our hospital since the mid-1990s. The purpose of this study is to evaluate the outcome with vs. without DI phase and the outcome with two vs. one DI phase for intermediate risk patients. METHODS: One hundred and thirty nine children with ALL who were treated at the Department of Pediatrics of Wonju Christian Hospital and Yonsei University Medical Center between March, 1990 and July, 2002 were analysed retrospectively. RESULTS: Thirty-eight patients were treated with a DI phase, and 101 patients were treated without a DI phase. Among the DI patients, seven patients were treated with a double DI phase. Five-year overall survival(OS) in the low, intermediate, and high risk groups were 68%, 66% and 58%, respectively. 5-year OS in DDI, DI, and control were 95%, 86% and 40%, espectively. In the low risk group, 5-year event free survival(EFS) in DI, and control were 94% and 58%, respectively. CONCLUSIONS: Delayed intensification improved EFS on childhood ALL in all risk groups.
Academic Medical Centers ; Child ; Gangwon-do ; Humans ; Pediatrics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Recurrence ; Remission Induction ; Retrospective Studies

BACKGROUND/AIMS: Ulcerative colitis (UC) is a chronic inflammatory bowel disease with heterogeneous clinical features. Data on the disease course and prognosis of UC patients who have been regularly treated are lacking. We aimed to investigate relapse rates of UC in remission and factors related to relapse. METHODS: We retrospectively analyzed clinical courses of 84 patients (43 males, median age 43 years, ranged 20-73 years) diagnosed as UC at Ajou University Hospital between January 1997 and December 2005 based on clinical, endoscopic and pathologic findings, and who were regularly followed for at least one year after the remission. RESULTS: Study subjects consisted of 32 proctitis (38%), 21 left-sided colitis (25%), and 31 subtotal or total colitis (37%). Of 84 patients, relapse was observed in 52 patients (62%) during the follow-up period (ranged 1-9 years). The relapse rate was 24%, 41%, 51%, 65%, 71%, and 79% at 1 year, 2 years, 3 years, 4 years, 5 years and 6 years, respectively. Among sex, age, hemoglobin, ESR, and the extent of disease on admission, decrease of hemoglobin level was the only independent factor related to relapse (odds ratio=2.67, 95% CI (1.32-5.42), p<0.01). CONCLUSIONS: In Korea, relapse of UC in remission is not rare. Decrease of hemoglobin level is an independent risk factor related to its relapse, while the extent of disease is not.
Adult ; Aged ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Antimetabolites/therapeutic use ; Azathioprine/therapeutic use ; Chronic Disease ; Colitis, Ulcerative/*diagnosis/*epidemiology/therapy ; Data Interpretation, Statistical ; Female ; Follow-Up Studies ; Hemoglobins/analysis ; Humans ; Male ; Mesalamine/therapeutic use ; Middle Aged ; Odds Ratio ; Recurrence ; Retrospective Studies ; Risk Factors ; Time Factors

No abstract available.
Hematoma* ; Liver* ; Snake Bites* ; Snakes*

In acute stroke, emboli are mostly composed of thrombi from artery, cardiac chamber, valve and vein. Non-thrombotic emboli are sometimes difficult to identify the origin. According to the increased number of cancer patients, now 10% of stroke patients have a cancer. However, the potential mechanisms of stroke in patients with cancer are various. We presented a case of serious acute arterial occlusion with a tumor embolus, which was revealed by histopathologic analysis of retrieved emboli during mechanical thrombectomy.

Pneumoperitoneum, Pneumomediastinum, subcutaneous emphysema and a pneumothorax are some of the mechanical complications of bronchial asthma. The incidence of pneumoperitoneum during an attack of acute asthma is rare. The pathogenesis is free gas track from the overdistended alveoli, through the bronchovascular sheaths to the mediastinum. If the high pressure is maintained, air can escape retroperitoneally into the abdomen and burst into the peritoneal cavity. A 43-year-old woman was admitted due to a severe asthma attack. She was required endotracheal intubation and AMBU(air mask bag unit) ventilation. Immediately after these procedures, pneumoperiotneum, pneumomediastinum, and subcutaneous emphysema daveloped. She was treated with mechanical ventilation and medical therapy. The pneumoperitoneum was resolved after 27 days. Here, we report this case with the review of the relevant literature.
Abdomen ; Adult ; Asthma* ; Female ; Humans ; Incidence ; Intubation, Intratracheal ; Masks ; Mediastinal Emphysema* ; Mediastinum ; Peritoneal Cavity ; Pneumoperitoneum* ; Pneumothorax ; Respiration, Artificial ; Subcutaneous Emphysema ; United Nations ; Ventilation*

BACKGROUND AND OBJECTIVES: Left atrial (LA) fibrosis is a main determinant of LA remodeling and development of atrial fibrillation. However, non-invasive prediction of LA fibrosis is challenging. We investigated whether preoperative LA strain as measured by speckle tracking echocardiography could predict the degree of LA fibrosis and LA reverse remodeling after mitral valve (MV) surgery. SUBJECTS AND METHODS: Speckle tracking echocardiography and LA volume measurements were performed in 50 patients one day before MV surgery. LA tissues were obtained during the surgery, and the degrees of their interstitial fibroses were measured. LA volume measurements were repeated within 30 days after surgery (n=50) and 1-year later (n=39). RESULTS: Left atrial global strain was significantly correlated with the degree of LA fibrosis (r=-0.55, p<0.001), and its correlation was independent of age, underlying rhythm, presence of rheumatic heart disease and type of predominant MV disease (B=-1.37, 95% confidence interval -2.32 - -0.41, p=0.006). The degree of LA fibrosis was significantly correlated with early (r=-0.337, p=0.017) and 1-year (r=-0.477, p=0.002) percent LA volume reduction after MV surgery, but LA global strain was not significant. CONCLUSION: Left atrial strain as measured by speckle tracking echocardiography might be helpful for predicting the degree of LA fibrosis in patients with MV disease.
Atrial Fibrillation ; Echocardiography ; Fibrosis ; Heart Atria ; Humans ; Mitral Valve ; Rheumatic Heart Disease ; Sprains and Strains ; Track and Field

Erdheim-Chester disease is a rare non-langerhans cell histiocytic disorder of an unknown cause that may associate with multisystem, rapidly fatal, infiltrative disease. We report here on a case of Erdheim-Chester disease in a 45-year-old man who presented with chronic renal failure. The patient visited a local clinic due to renal failure that was accidentally diagnosed on a routine health examination. At that time, abdominal computed tomography revealed retroperitoneal fibrosis and bilateral hydronephrosis. However, he did not visit hospital for further evaluation. After 1 year, he visited our clinic due to exertional dyspnea that had developed several months previously. The chest and abdominal CT showed interstitial pneumonitis and pleural effusion and there was progressed hydronephrosis and perirenal fibrosis. He was diagnosed with Erdheim-Chester disease based on the characteristic findings of pleural biopsy (interstitial fibrosis, infiltration of macrophge, CD68-positive but S-100 negative). The patient was treated with insertion of a double J catheter and immunesuppression with prednisolone and azathioprine. Erdheim-Chester disease is a rare disease, but it should be considered in those patients displaying chronic renal failure with retroperitoneal fibrosis.
Azathioprine ; Biopsy ; Catheters ; Dyspnea ; Erdheim-Chester Disease* ; Fibrosis ; Humans ; Hydronephrosis ; Kidney Failure, Chronic* ; Lung Diseases, Interstitial ; Middle Aged ; Pleural Effusion ; Prednisolone ; Rare Diseases ; Renal Insufficiency ; Retroperitoneal Fibrosis ; Thorax ; Tomography, X-Ray Computed

It is well known that tumor necrosis factor (TNF-a), interleukin-1, platelet-activating factor (PAF) and arachidonic acid metabolites, such as thromboxane and leukotriens, are major mediators involved in the pathogenesis of endotoxic shock. In this study, we have investigated the effect of pentoxifylline (inhibitor of TNF-a release), BN50739 (PAF antagonist), indomethacin (cyclooxygenase inhibitor) and diethylcarbamazine (lipoxygenase inhibitor) on LPS- induced lethality as well as the relationship between major mediators in endotoxic shock. All inhibitors described above except diethylcarbamazine significantly protected mice against LPS- induced lethality. BN50739 and indomethacin were also effective in protection of TNF-a-induced lethality. The elevation of circulating TNF-a by LPS was significantly blocked by BN50739, but not affected by indomethacin. Convulsion appeared shortly after LPS injection was prevented by BN50739 but not by indomethacin, whereas diarrhea and limited movement was prevented by indomethacin but not by BN50739. These results indicate that i) TNF-a, PAF and cyclooxygenase products are important mediators involved in the pathogenesis of septic shock and ii) TNF-a directly influenced the release or production of PAF as well as cyclooxygenase products, and strongly suggest that i) TNF-a and PAF stimulate the release of each other via positive feedback network but TNF-a and cyclooxygenase products do not form the network and ii) PAF and cyclooxygenase product appear not to affect the release of each other.
Animals ; Arachidonic Acid ; Diarrhea ; Diethylcarbamazine ; Gene Expression* ; Indomethacin ; Interleukin-1 ; Mice ; Pentoxifylline ; Prostaglandin-Endoperoxide Synthases ; Seizures ; Shock, Septic ; Tumor Necrosis Factor-alpha*

In a case of autoimmune chronic pancreatitis that relapsed despite maintenance therapy with low-dose steroid, high- dose steroid can induce remission of the disease, and maintenance therapy of steroid is usually recommended in that case. A 57-year-old man developed epigastric pain and jaundice. The patient was diagnosed with autoimmune chronic pancreatitis. The abnormalities in the clinical, laboratory and radiologic findings improved after oral steroid therapy. After two relapsed episodes, maintenance therapy of steroid with 5 mg prednisolone/day was administrated. In the studies for follow up, the level of serum IgG was increased and abdominal computed tomography showed calcification and pseudocyst in the pancreatic tail. To our knowledge, this is a rare case of autoimmune chronic pancreatitis aggravated rapidly despite oral steroid maintenance therapy.
Follow-Up Studies ; Humans ; Immunoglobulin G ; Jaundice ; Middle Aged ; Pancreatitis, Chronic