Eighty cases of malignant effusion were cytologically studied to elucidate the incidence of primary tumor site and cytologic characteristics of each tumor types. Eighty fluid specimens were composed of 43 ascitic, 35 pleural, and 2 pericardial effusion and primary tumor site had been confirmed by histology. The frequent primary sites were stomach (22 cases, 28%), lung (21 cases, 26%), ovary (11 cases, 14%), liver (7 cases, 9%), and breast (4 cases, 5%). The principal malignant tumors were adenocarcinoma (56 cases, 70%), squamous cell carcinoma (7 cases, 9%), liver cell carcinoma (7 cases, 9%), small cell carcinoma (4 cases, 5%), and non-Hodgkin's lymphoma (4 cases, 5%). The distinctive cytologic findings according to primary tumor types were as follows; the gastric adenocarcinomas were mainly characterized by isolated cells and irregular clusters sometimes with signet ring cells. Papillary serous cystadenocarcinoma of ovary showed frequently papillary clusters and occasional psammoma bodies. Breast carcinoma of ductal type showed cell balls with smooth margins. Colonic adenocarcinoma showed rather irregular clusters o palisading pattern of cylindrical cells. Metastatic squamous cell carcinoma, liver cell carcinoma, small cell carcinoma, and non-Hodgkin's lymphoma showed also characteristic features. These findings indicate that the cytological features observed in the great majority of malignant effusion are similar to those of primary tumor types, which are very helpful to indentify the primary tumor site.
Adenocarcinoma ; Breast ; Breast Neoplasms ; Carcinoma, Hepatocellular ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Child* ; Colon ; Cystadenocarcinoma, Serous ; Diagnostic Errors ; Female ; Granuloma, Plasma Cell ; Humans ; Iliac Artery* ; Incidence ; Liver ; Lung ; Lymphoma, Non-Hodgkin ; Nephrosis, Lipoid* ; Ovary ; Pericardial Effusion ; Stomach

PURPOSE: We wanted to compare CT urography (CTU) with using multi-detector row CT (MDCT) and intravenous urography (IVU) for diagnosing the causes of hematuria. MATERIALS AND METHODS: From January 2003 to March 2004, IVU and CTU were obtained in 48 patients. We evaluated the causes of hematuria in 34 of 48 patients. The IVU images were obtained by the conventional method. The CTU images were routinely obtained before intravenous contrast injection, and at 2 and 5 minutes after intravenous contrast injection. In case of delayed excretion of contrast by the kidneys, the delayed CT scans were obtained at 120 minutes after contrast injection. All the CT images, including the axial and 3D coronal reformatted CTUs with using software as well as conventional IVU images, were reviewed by two radiologists working in consensus. We decided if urinary stone existed or not and we looked for the indirect signs such as hydronephrosis or delayed excretion, etc. We also observed if it was possible to determine the mass, ureteral stricture and enhancement of the ureteral wall, etc. We calculated sensitivity, specificity, positive predictive value and negative predictive value for each modality to diagnose urinary stone. We compared the detection rate according to the phases of CTU. RESULTS: We confirmed the presence of urinary tract stones in 27 of 34 patients who had undergone both IVU and CTU. We diagnosed ureteritis in 1, transitional cell carcinoma in 5 and acute pyelonephritis in 1 of the remaining 7 patients. The urinary stones were detected in fifteen patients on both IVU and CTU (15/27, 55.6%). We detected the urinary stones on CTU, but not IVU, in twelve patients (12/27, 44.5%). The sensitivity to detect the urinary stones was 100% (27/27) on CTU and 55.6% (12/27) on IVU respectively. The specificity was 100% (7/7) on IVU and CTU, respectively. The positive predictive value was 100% (15/15) on IVU and 100% (27/27) on CTU, respectively. The negative predictive value was 36.8% (7/19) on IVU and 100% (7/7) on CTU. Precontrast CTU demonstrated the urinary stones in all 27 patients (100%, 27/27). On the other hands, urinary stones were detected in 19 patients (19/27, 70.4%) and 8 patients (8/27, 29.6%) at 2 and 5 minutes on CTU, respectively. CONCLUSION: CTU is superior to IVU to diagnose the causes of hematuria such as urinary tract stone or extrarenal lesion. Precontrast CTU is the most useful modality for the detection of the urinary tract stone of the other enhanced CTUs.
Carcinoma, Transitional Cell ; Consensus ; Constriction, Pathologic ; Hand ; Hematuria* ; Humans ; Hydronephrosis ; Kidney ; Pyelonephritis ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Ureter ; Urinary Calculi ; Urography*

We analyzed the results of 5.0mm and 6.0mm ablation diameter in excimer laser photorefractive keratectomy using the same excimer laser (Aesculap-Meditec, MEL 60, Germany) In 5.0mm ablation diameter group, forty one eyes of thirty five patients were operated from March 1994 to February 1995 and in 6.0mm ablation diameter group, thirty eyes of twenty three patients were operated from July 1995 to December 1995. All were followed for at least 6 months and analyzed by retrospective method. Refractive change, naked visual acuity, corneal haze and night vision difficulties were measured at 1, 3, and 6 months postoperatively. In eyes treated with 6.0mm ablation diameter, the initial hyperopic shift was reduced with significant differences at 1 and 3 months (p<.01). In measurements of naked visual acuity and corneal haze, the results of 6.0mm zone were better than 5.0mm zone but the differences did not reach the statistical significance (p>.05). The subjective symptoms of night vision difficulty were significantly lower in the 6.0mm treatment group at 1 and 3 months (p=0. 0067, p=0.02). In conclusion, treatment with 6.0mm ablation diameter made less initial hyperopic shift and reduction of side effects in comparison with 5.0mm ablation diameter.
Humans ; Lasers, Excimer* ; Myopia ; Night Vision ; Photorefractive Keratectomy* ; Retrospective Studies ; Visual Acuity

OBJECTIVE: This study aimed to determine whether the menstrual characteristics are different in Korean women with or without ovarian endometrioma. METHODS: We selected 95 premenopausal women aged below 39 years who underwent laparoscopic surgery for ovarian endometrioma (n=46) or other benign ovarian tumors (n=49) between April 2016 and February 2017. We excluded those with uterine diseases that could potentially affect the menstrual characteristics and those on anticoagulants or hormonal medication. At admission, menstrual characteristics such as cycle length, cycle regularity, and menstrual duration, were collected. In addition, amount of menstrual bleeding and severity of dysmenorrhea were recorded using a pictorial blood loss assessment chart (PBAC) and visual analogue scale, respectively. RESULTS: Age and parity were similar in both women with ovarian endometrioma and women with other benign ovarian tumors. Body mass index (BMI) was significantly lower (median, 20.9 vs. 22.1 kg/m2; P=0.031) in women with ovarian endometrioma. The amount of menstrual bleeding (median PBAC score, 183 vs. 165), menstrual duration (median, 6 vs. 6 days), and cycle length in women with regular cycle (median, 29.0 vs. 29.2 days) were not different between the 2 groups. Pain score was significantly higher (median, 4 vs. 3; P=0.005) in women with ovarian endometrioma. CONCLUSION: We found that the menstrual characteristics between women with ovarian endometrioma and women with other benign ovarian tumors were similar. We also observed that low BMI may be one of the risk factor for endometriosis.
Anticoagulants ; Body Mass Index ; Dysmenorrhea ; Endometriosis ; Female ; Hemorrhage ; Humans ; Laparoscopy ; Menorrhagia ; Menstruation ; Parity ; Pilot Projects ; Risk Factors ; Uterine Diseases

Background: Neurocritical care by dedicated neurointensivists may improve outcomes of critically ill patients with severe brain injury. In this study, we aimed to validate whether neurointensive care could improve the outcome in patients with critically ill acute ischemic stroke using the linked big dataset on stroke in Korea. Methods: We included 1,405 acute ischemic stroke patients with mechanical ventilator support in the intensive care unit after an index stroke. Patients were retrieved from linking the Clinical Research Center for Stroke Registry and the Health Insurance Review and Assessment Service data from the period between January 2007 and December 2014. The outcomes were mortality at discharge and at 3 months after an index stroke. The main outcomes were compared between the centers with and without dedicated neurointensivists. Results: Among the included patients, 303 (21.6%) were admitted to the centers with dedicated neurointensivists. The patients treated by dedicated neurointensivists had significantly lower in-hospital mortality (18.3% vs. 26.8%, P = 0.002) as well as lower mortality at 3-month (38.0% vs. 49.1%, P < 0.001) than those who were treated without neurointensivists. After adjusting for confounders, a treatment without neurointensivists was independently associated with higher in-hospital mortality (odds ratio [OR], 1.59; 95% confidence intervals [CIs], 1.13–2.25; P = 0.008) and 3-month mortality (OR, 1.48; 95% CIs, 1.12–1.95; P = 0.005). Conclusion Treatment by dedicated neurointensivists is associated with lower in-hospital and 3-month mortality using the linked big datasets for stroke in Korea. This finding stresses the importance of neurointensivists in treating patients with severe ischemic stroke.

This study assessed the dynamics of morphological and immunophenotypic properties of activated microglia in a 6-hydroxydopamine (6-OHDA) induced Parkinsonian animal model. Neurodegeneration in the substantia nigra pars compacta (SNc) was induced by unilateral injection of 6-OHDA into the medial forebrain bundle. Parkinsonian animal model were sacrificed at 1, 2, 4 and 8 weeks after 6-OHDA injection. Changes in the functional activity of activated microglia were identified using different monoclonal antibodies: OX6 for major histocompatibility complex (MHC) class II, ED1 for phagocytic activity. Phagocytic microglia, characterized by ED1- or OX6-immunoreactivity, appeared in the SNc at 1 week after 6-OHDA injection, activated microglia selectively adhered to degenerating axons, dendrites and dopaminergic neuron somas in the SNc. This was followed by significant loss of these fibers and nigral dopaminergic neurons. Activation of microglia into phagocytic stage was most pronounced at 2 week after 6-OHDA injection and gradually subsided, but phagocytic microglia persisted until 8 weeks after 6-OHDA injection. Taken together, our results indicate that activated microglia is lead to persistently neuron cell death and promotes loss of dopaminergic neuron by degeneration of the dopaminergic neurons.
Animals ; Axons ; Carisoprodol ; Cell Death ; Dendrites ; Dopaminergic Neurons ; Major Histocompatibility Complex ; Medial Forebrain Bundle ; Microglia ; Models, Animal ; Neurons ; Oxidopamine ; Substantia Nigra

BACKGROUND: To determine the prevalence of chronic fatigue syndrome and idiopathic chronic fatigue in Korea and to describe demographic, clinical, and psychological differences among those with chronic fatigue syndrome (CFS), those with idiopathic chronic fatigue, and healthy controls. METHODS: 1,526 persons aged 18-76 years who visited Korea university hospital health management center for general check-up between December 1998 and August 1999 were participated in the study. The questionnaire made according to the Centers for Disease Control and Prevention criteria was administered to the recruited persons and patients with chronic fatigue syndrome were diagnosed by questionnaire, physical examination and laboratory tests. The Korean version of the Center for Epidemiological Studies-Depression Scale (CES-D) was used to assess depression. RESULTS: Of the 1,526 persons studied, 433 (29.4 %) reported severe fatigue lasting at least 6 months. Of the 202 persons with unexplained chronic fatigue, 31 persons (2.0% of the study population) were classified as CFS cases. The prevalence of CFS was 2.81% in women, 1.49% in men respectively (p<0.05). When CES-D cut-off score of 25 was used, 30.43% of persons with CFS and 5.93% of persons without chronic fatigue had scores suggestive of depression. CFS patients had higher mean scores on CES-D than persons without chronic fatigue (p<0.05). CONCLUSION: Persons who met the criteria for chronic fatigue syndrome were found in 2.0%. The prevalence of chronic fatigue syndrome in our study were high, compared with previous studies in other countries. CFS patients had higher mean scores on CES-D than persons without chronic fatigue.
Centers for Disease Control and Prevention (U.S.) ; Depression ; Fatigue ; Fatigue Syndrome, Chronic* ; Female ; Humans ; Korea ; Male ; Physical Examination ; Prevalence* ; Surveys and Questionnaires

PURPOSE: This study was performed to evaluate the clinical outcomes of operative treatment using mini-open sinus tarsi approach for displaced intraarticular calcaneal fractures. MATERIALS AND METHODS: We studied 18 cases (16 patients) of intraarticular calcaneal fractures who were treated with sinus tarsi approach by same surgeon. The mean age of patients was 44.8 years, and mean follow-up period was 17.2 months. The measurement of Bohler angle, Gissane angle, the degree of articular surface depression, and the period to union were performed through preoperative and postoperative radiographs. The clinical evaluation was performed according to hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and scale of the Creighton-Nebraska health foundation (CNHF). RESULTS: Bohler angle and Gissane angle had improved significantly from preoperative average 9.8degrees, 117.6degrees to average 22.4degrees, 113.4degrees immediate postoperatively, and had maintained to average 21.8degrees and 114.2degrees at the last follow-up. The degree of articular surface depression had improved significantly from preoperative average 5.2 mm to 1.2 mm at the last follow-up. All cases achieved bone union, and the period to union was average 10.5 weeks. AOFAS score was average 86.2 points at the last follow-up. There were 7 excellent, 9 good, and 2 fair results according to the CNHF scale. Therefore, 16 cases (88.8%) achieved satisfactory results. CONCLUSION: The minimally invasive sinus tarsi approach using headless compression screw seems to be an effective surgical method for displaced intraarticular calcaneal fractures, because of the possibility of accurate restoration of articular surface and the low risk of postoperative soft tissue complications.
Animals ; Ankle ; Calcaneus ; Depression ; Follow-Up Studies ; Foot ; Humans ; Intra-Articular Fractures

BACKGROUND: Recent clinical observation reported that there was a significant correlation between change in circulating vascular endothelial growth factor (VEGF) levels and the occurrence of severe acute graft-versus-host disease (GVHD) following allogeneic hematopoietic stem cell transplantation (allo-HSCT), but the action mechanisms of VEGF in GVHD have not been demonstrated. METHODS: This study investigated whether or not blockade of VEGF has an effect on acute GVHD in a lethally irradiated murine allo-HSCT model of B6 (H-2b)-->B6D2F1 (H-2b/d). Syngeneic or allogeneic recipient mice were injected subcutaneously with anti-VEGF peptides, dRK6 (50 microg/dose) or control diluent every other day for 2 weeks (total 7 doses). RESULTS: Administration of the dRK6 peptide after allo-HSCT significantly reduced survival with greaterclinical GVHD scores and body weight loss. Allogeneic recipients injected with the dRK6 peptide exhibited significantly increased circulating levels of VEGF and expansion of donor CD3+ T cells on day +7 compared to control treated animals. The donor CD4+ and CD8+ T-cell subsets have differential expansion caused by the dRK6 injection. The circulating VEGF levels were reduced on day +14 regardless of blockade of VEGF. CONCLUSION: Together these findings demonstrate that the allo-reactive responses after allo-HSCT are exaggerated by the blockade of VEGF. VEGF seems to be consumed during the progression of acute GVHD in this murine allo-HSCT model.
Animals ; Body Weight ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Mice ; Oligopeptides ; Peptides ; T-Lymphocyte Subsets ; T-Lymphocytes ; Tissue Donors ; Vascular Endothelial Growth Factor A

BACKGROUND: Bronchoconstriction is known to be induced by hypocarbia or hypercarbia. But the above effect has not been studied during general anesthesia. This study was proposed to investigate the effects of hypocarbia and hypercarbia on the respiratory system mechanics in 0.5 MAC enflurane anesthetized cats. METHODS: Six cats, weighing 3.0~3.6 kg were used. Pentobarbital sodium was intraperitonially injected to induce anesthesia and endotracheal intubation was followed. The anesthesia was maintained by 0.5 MAC enflurane, oxygen, and air (FiO2; 0.5). Intermittent mandatory ventilation was applied with Siemens Servo 900C ventilator. The inspiratory flow rate and tidal volume were fixed througout the experiment. Only the respiratory rate was adjusted to achieve normocarbia(PaCO2; 31~38 mmHg), hypercarbia(PaCO2; 38~45 mmHg) and hypocarbia(PaCO2; 24~31 mmHg), which were done not in the order. We used the flow-interruption technique to measure respiratory mechanics. The course of changes in the pressure along with the prefixed flow rate and volume were monitored and recorded with Bicore CP100 pulmonary monitor. The data were transfered to a PC and analyzed by Anadat processing software. Total respiratory system, airway and tissue viscoelastic resistances, and dynamic and static compliances were calculated for normocarbia, hypercarbia and hypocarbia. RESULTS: There are no significant differences of resistances and compliances of respiratory system among hypocarbia, normocarbia and hypercarbia. CONCLUSIONS: The changes in PaCO2 do not influence significantly the resistances and compliances measured by the flow interruption technique used in the study.
Airway Resistance ; Anesthesia ; Anesthesia, General ; Anesthetics ; Animals ; Bronchoconstriction ; Carbon Dioxide* ; Carbon* ; Cats* ; Compliance ; Enflurane* ; Intubation, Intratracheal ; Lung ; Mechanics* ; Oxygen ; Pentobarbital ; Respiratory Mechanics ; Respiratory Rate ; Respiratory System* ; Tidal Volume ; Ventilation ; Ventilators, Mechanical