We performed immunohistochemical stain of p-glycoprotein using JSB-1 monoclonal antibody to study multidrug resistant(MDR) gene expression in 137 gastric tumor tissues obtained from 87gastric carcinoma patients. The incidence of p-glycoprotein expression was 60 of 87 cases(69%) and it was not correlated with age, sex, depth of tumor invasion, and lymph node metastasis, but was correlated with histologic type of gastric adenocarcinoma. The distribution of p-glycoprotein positive cells in the tumor tissue was diffuse in 34 cases(73.9%) and focal in 12 cases(26.1%), and the dominant staining patterns of p-glycoprotein in the tumor cells were cytoplasmic and golgi staining in 20 cases(43.5%) and 19 cases(41.3%), respectively, and 7 cases(15.2%) showed fine granules in the cytoplasm. The incidence of p-glyco-protein expression in the tumor tissue was higher in A and AB blood type patients who have A antigen than in 0 and B blood type patients. Cytoplasmic staining pattern was dominant in O and B blood types and golgi staining in A and AB blood type patients. Among 27 patients 'who received chemotherapy, partial remission was noted in 9 of 11 p-glyco-protein negative patients(81.8%) and no remission or progression of the tumor was seen in 9 of 16 p-glycoprotein positive patient(56.3%). The p-glycoprotein expression in gastric carcinoma had no direct correlation with known several prognostic factors of the gastric tumor except for histologic type, and it is supposed that p-glycoprotein detection in gastric tumor tissue by immunohisto-chemical stain is a good method for predicting the response of chemotherapy, especially in p-gly-coprotein negative cases.
Incidence

INTRODUCTION: Intimal hyperplasia can be considered as a physiological reaction to the intravascular injury which occurs spontaneously in human body. But the fact that we can not block the intimal hyperplasia completely so far when there is any form of stimuli, can be thought to be as a result of not understanding thoroughly the pathological phenomenon about it. SUBJECT: There are many drugs, radiation therapies, stent, genetic treatment. Pharmacologic treatment with several drugs have been trided and most of them have all failed. Vascular brachytherapy resulted in no inhibition of restenosis. Stent is preferred to balloon angioplasty because of good patency. Genetic treatment is limited due to other E2F analogue. CONCLUSION: Although it is too early to predict the outcome of inhibition of intimal hyperplasia trials, these fundamental studies provide great evidences and hope that these clinical trials for inhibition of restenosis will eventually become effective option.
Angioplasty, Balloon ; Brachytherapy ; Human Body ; Hyperplasia ; Stents

Cardiovascular changes has been reported eating and digestion. Experimental studies showed an early rise in cardiac output during eating which was attributable to an increased heart rate. This changes reverted to baseline valuse at the end of eating. To investigate postprandial cardiac functional change, we studied 20 healthy young men(average age 27 years) nonivasively with BP measurement, electrocardiography and M-mode echocardiohrapy before, 30 minutes and 3 hours after a lunch(600 Kcal). There was no significant changes in mean blood pressure after eating. On echocardiography, diastolic and systolic left ventricular internal dimensions were 4.9+/-0.4 and 3.1+/-0.4cm before meal and 4.9+/-0.4 and 2.9+/-0.3cm 30 minutes after eating. There was an average increase of 9% in cardiac output 30 minutes after meal. Fractional shortening was 36.4+/-6.4% before meal and 40.4+/-6.1(p<0.05) 30 minutes after eating. Ejection fraction changed from 73.5+/-7.9% to 78.2+/-6.3%(p<0.05) at postprandial 30 minutes. Myocardial contractility index assessed by the ratio of systolic BP to end-systolic volume was 4.3+/-1.6mgHg/ml before and 5.3+/-2.2mmHg/ml 30 minutes after eating. Peripheral resistance index as the ratio of mean blood pressure divided by cardiac index changed from 2,536+/-1,120dynesdSdcm-5/m2 to 2,048+/-472dynesdSdcm-5/m2 at postprandial 30 minutes. Electorcardiographic study revealed no changes in ST SE segment, T wave and heart rate after a meal. In conclusion, the increase of cardiac output after a moderate meal in healthy young men was associated with an increase in myocardial contractility and a decrease in peripheral vascular resistance.
Blood Pressure ; Cardiac Output ; Digestion ; Eating ; Echocardiography* ; Electrocardiography ; Heart Rate ; Humans ; Male ; Meals* ; Vascular Resistance

Purpose: To report a case of late-onset bleb-associated endophthalmitis caused by streptococcus cristatus (S. cristatus) after trabeculectomy.Case summary: A 59-year-old woman presented with left ocular pain and visual disturbance. She had undergone trabeculectomy of the left eye 2 years ago. At the initial visit, she was only able to count fingers from the left eye. Whitish thin bleb, conjunctival injection, and inflammation were observed in the left anterior chamber, and the fundus could not be visualized. Despite administering topical and systemic antibiotics, the chamber reaction worsened, and hypopyon and inflammatory membrane were noticed the next day. Vitrectomy with phacoemulsification and intravitreal antibiotic injection was performed, and the intravitreal antibiotic injections were repeated over the next two days. Bacterial culture of vitreous fluid showed a growth of S. cristatus 5 days after the surgery, and inflammation improved after 7 days. One month later, she was still only able to count fingers from the left eye, but there were no signs of endophthalmitis. Conclusions Postoperative endophthalmitis after glaucoma filtering surgeries caused by S. cristatus has not been reported previously from Korea. To the best of our knowledge, this is the first Korean case of late-onset bleb-associated endophthalmitis caused by S. cristatus. If gram-positive cocci are grown in samples from the patients with endophthalmitis after trabeculectomy, resident oral microflora such as S. cristatus should be considered as the causative pathogen.

Carcinoma of the parathyroid gland is rare, comprising only 0.1% to 5% of all patients with primary hyperparathyroidism. It presents with severe hypercalcemia, bone disease, palpable neck mass, renal involvement and etc. Since the initial operation offers the best chance for cure, preoperative localization and intraoperative recognition of parathyroid cancer are essential. Recently parathyroid imaging has been described with 99mTc-sestamibi as an alternative to 201Tl. This newer agent has many physical and dosirnetric advantages and represents higher detection sensitivity than 201Tl-99mTc subtraction scan. We experienced a 41-year-old man presenting with recurrent hyperparathyroidism in spite of 2 previous operations. In preoperative localization, there was no abnormal uptake in 201Tl-99mTc subtraction scan but 99mTc-sestamibi scan revealed metastatic foci on right cervical area. He was successfully treated with modified radical neck dissection.
Adult ; Bone Diseases ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Neck ; Neck Dissection ; Parathyroid Glands ; Parathyroid Neoplasms* ; Technetium Tc 99m Sestamibi*

A ganglioneuroma is a rare benign tumor that originates in the neural crest, and is found along the path of the sympathetic chain, from the base of the skull to the pelvic cavity. It is characterized histologically by the composition of mature ganglion cells and nerve fibers. Due to the slow growth of the tumor, it may be incidentally found or detected by the pressure effects on adjacent structures. Herein, a case of a ganglioneuroma arising from the retroperitoneal sympathetic chain is reported in a 45-year-old female patient with a review of the literature.
Female ; Ganglion Cysts ; Ganglioneuroma* ; Humans ; Middle Aged ; Nerve Fibers ; Neural Crest ; Retroperitoneal Space ; Skull

OBJECTIVE: It was to analyze two failed arterial embolization cases in the treatment for pseudoaneurysm followed by D&C. METHODS: Two failure cases out of eight cases were gained in the transarterial embolization treatment for eight years.(1. 1. 1992 - 12. 31. 1999) To search for the factors of failure, we went through obstetrical history and biopsy. RESULTS: Eight cases of transarterial embolization were performed to the treatment for pseudoaneurysm appeared after undergoing D&C. Six cases were successfully treated without complications. However, laparotomy was done due to the continuous bleeding in the other two cases. According to tissue biopsy, they showed the cervical pregnancy in one case and placenta accreta in the other. CONCLUSION: Transarterial embolization is proved to be more preferable to operate in the treatment of pseudoaneurysm than laparotomy, and transarterial embolization therapy failure rate is higher in case of existing remnant villi than not.
Aneurysm, False* ; Biopsy ; Dilatation and Curettage* ; Female ; Hemorrhage ; Hysterectomy ; Laparotomy ; Placenta Accreta ; Pregnancy

BACKGROUD: Ephedrine has been most commonly used for the prevention and treatment of hypotension occurring frequently during spinal anesthesia for cesarean section. But recent studies reported that phenylephrine was more effective for treatment of maternal hypotension and for prevention of fetal acidosis than ephedrine. We compared effect of phenylephrine, ephedrine, and ephedrine combined with phenylephrine to maternal hypotension and fetal acidosis. METHODS: This study compared ephedrine 2 mg/min infusion with 6 mg bolus (n = 30), phenylephrine 33.3microgram/min infusion with 50microgram bolus (n = 30), and ephedrine combined phenylephrine with half the dose infusion rate & bolus (n = 30). Hypotension, defined as systolic blood pressure less than 100 mmHg and less than 80% of baseline, was treated with additional bolus injection. RESULTS: In ephedrine group, the number of bolus given for hypotension was larger than other groups (P < 0.001), the incidence of hypotension was also higher than other groups (P = 0.02). The heart rate was lower in phenylephrine group than other groups, but bradycardia which needs to be treated didn't occur. Umbilical blood gas analysis and Apgar score were similar for three groups, but only one patient in ephedrine group had fetal acidosis (pH = 7.130). Nausea and vomiting were more frequent in ephedrine group than other groups. CONCLUSIONS: In our study, giving phenylephrine alone was more effective in the prevention and treatment of maternal hypotension and nausea & vomiting than giving ephedrine alone or combined phenylephrine.
Acidosis ; Anesthesia, Spinal* ; Apgar Score ; Blood Gas Analysis ; Blood Pressure ; Bradycardia ; Cesarean Section* ; Ephedrine* ; Female ; Heart Rate ; Humans ; Hypotension ; Incidence ; Nausea ; Phenylephrine* ; Pregnancy ; Vomiting

BACKGROUND: We have studied the 67Ga SPECT to determine the activity of pulmonary tuberculosis, especially in patients with minimal extent of the disease on chest radiographs. Because active minimal pulmonary tuberculosis is sometimes difficult to diagnose by means of initial chest X-ray, sputum examination and 67Ga planar imaging, we compared 67Ga planar imaging with SPECT to evaluate minimal pulmonary tuberculosis activity. METHODS: 67Ga planar imagings and SPECTs of 69 patients suspected of minimal pulmonary tuberculosis by the initial chest X-ray were performed and compared to each other. Active pulmonary tuberculosis was defined by a positive AFB smear and/or culture in the sputum and changes shown on the serial chest X-ray findings. RESULTS: 1)67Ga planar imaging imagings showed positive uptakes in 24 patients and no uptakes in 13 patients, which confirms active pulmonary tuberculosis. But SPECT imagings showed positive uptakes in 25 patients and no uptakes in 12 patients. 2) Patients confirmed with inactive pulmonary tuberculosis showed no up-take on 67Ga planar imaging. Only one of the 32 patients confirmed as having inactive pulmonary tuberculosis showed positive uptake on 67Ga SPECT imaging. CONCLUSIONS: According to the results of our study, 67Ga planar imaging and SPECT are both sensitive in detecting the activity of minimal pulmonary tuberculosis. The difference between the two methods is not statistically significant, and the negative predictive value of the 67Ga SPECT is not higher than that of 67Ga planar imaging.
Humans ; Radiography, Thoracic ; Sputum ; Thorax ; Tomography, Emission-Computed, Single-Photon* ; Tuberculosis, Pulmonary*

In an attempt to obtain the basic data for mental disability evaluation in psychiatric casualties by traffic accidents, 88 cases referred fiom the court for the purpose of mental disability evaluation for 3 years from 1994 to 1996 were surveyed. The results are summarized as follows: 1) Among the 88 cases, 58 cases(65.9%) were male and 30(34.1%) were female. Cases with low educational and socioeconomic levels outnumbered those with high educational and socioeconomic levels. More than half of the cases were in socially active group with ages of 21 to 50 years. 2) At the time of accidents, 71.6% of the whole cases were diagnosed as cerebral contusion, which was the most common diagnosis. The next common diagnoses were skull fracture(36.4%), brain hemorrhage(33.0%), brain hematoma(26.1%), cerebral concussion(12.6%), and axonal injury(10.2%) in order of frequency. In 9.1% of the cases there was no definite evidence of head injury was found. 3) During the period of mental disability evaluation, the most common symptom was cognitive symptom(85.2%), and the next common symptoms were somatic(83.0%), behavioral(69.3%), and affective(58.0%) ones in order of frequency. On the other side, the most common psychopathology recognized by the psychiatrists was affective symptom, which was present in 80.9% of the cases manifested during the period of evaluation, and the next common psychopathologies were behavioral(77.3%), cognitive(63.6%), and somatic(40.9%) symptoms in order of frequency. 4) Nearly half(48.8%) of the whole patients manifested psychiatric symptoms such as cognitive, affective, behavioral, and somatic symptoms between the first and sixth months after traffic accidents. Only 9.1% of the cases developed psychiatric symptoms after six months of traffic accidents. Meanwhile, 61.4% of the cases were never given psychiatric treatments despite the presence of psychiatric symptoms, and 23.5% of the cases given psychiatric treatments visited psychiatrists after six months of symptom development. 5) All of the cases took neuroimaging studies such as brain CT or MRI and EEG during the feriod of mental disability evaluation. In 47.7% of the cases there were abnormal findings in neuroimaging studies among which encephalomalacia was the most frequent. The next abnormal findings were brain atrophy, axonal injury, cyst, and so on in order of frequency. On the other hand, in 86.4% of the cases EEG findings were within normal limit. 6) In 95.5% of the cases, mental disorders were confirmed, among which personality change due to head trauma was the most common, and the next common mental disorders were dementia due to head trauma, adjustment disorder, depressive disorder due to head trauma, postconcussional disorder, posttraumatic stress disorder, and so on in order of frequency. More than one third of the cases(38.1%) given psychiatric diagnoses were considered to need continuous psychiatric treatments at the time of mental disability evaluation. 7) Posttraumatic decline in intelligence tended to be affected by loss of consciousness and delirium, but not by skull fracture and brain surgery. In brain imaging and EEG studies performed during the period of mental disability evaluation, posttraumatic decrease in intelligence tended to be influenced by abnormal findings on brain imaging, but not EEG findings.
Accidents, Traffic* ; Adjustment Disorders ; Affective Symptoms ; Atrophy ; Axons ; Brain ; Contusions ; Craniocerebral Trauma ; Delirium ; Dementia ; Depressive Disorder ; Diagnosis ; Disability Evaluation* ; Electroencephalography ; Encephalomalacia ; Female ; Hand ; Humans ; Intelligence ; Magnetic Resonance Imaging ; Male ; Mental Disorders ; Neuroimaging ; Psychiatry ; Psychopathology ; Skull ; Skull Fractures ; Stress Disorders, Post-Traumatic ; Unconsciousness