BACKGROUND AND OBJECTIVES: Mucus hypersecretion is a major problem in inflammatory airway disease. Interleukin-1beta (IL-1beta) has been implicated in the pathogenesis of inflammatory airway diseases. This study was designed to investigate the signal transduction mechanism and the relationship between cyclooxygenase-2 (COX-2) expression and the IL-1beta-mediated MUC5AC secretion. MATERIALS AND METHOD: In cultured human airway NCI-H292 epithelial cells, the IL-1beta-mediated MUC5AC gene expression and mucin secretion were analyzed by reverse transcription-polymerase chain reaction and immunoassay. To identify the signal transduction pathway of the IL-1beta-mediated MUC5AC expression, we used specific inhibitors. RESULTS: IL-1beta induced COX-2 and MUC5AC expression at the mRNA and protein levels. Mucin secretion was blocked by NS398 and resveratrol, selective COX-2 inhibitors. Prostaglandin E2 (PGE2) directly induced MUC5AC expression at both mRNA and protein levels in a dose-dependent manner. Cells activated by IL-1beta showed increased extracellular-regulated protein kinase (ERK) 1/2 and p38 phosphorylation. IL-1beta-induced MUC5AC gene expression and mucin secretion were blocked by PD98059, the MEK/ ERK inhibitor and SB203580, the p38 inhibitor. Furthermore, inhibition of both mitogen-activated protein kinases (MAPKs) reduced the IL-1beta-induced COX-2 expression and PGE2 synthesis. Ro31-8220, the PKC inhibitors prevented the IL-1beta-induced COX-2 expression and mucin secretion. Also Ro31-8220 inhibited the IL-1beta-mediated MAPKs phosphorylation. CONCLUSION: IL-1beta-induced MUC5AC gene expression and mucin secretion are regulated through the sequential activation of PKC-ERK/ p38-COX-2-PGE2 in the human airway NCI-H292 epithelial cells.
Cyclooxygenase 2 ; Cyclooxygenase 2 Inhibitors ; Dinoprostone ; Epithelial Cells* ; Gene Expression* ; Humans* ; Immunoassay ; Interleukin-1 ; Interleukin-1beta ; Mitogen-Activated Protein Kinases ; Mucins* ; Mucus ; Phosphorylation ; Prostaglandin-Endoperoxide Synthases ; Protein Kinase C ; Protein Kinases ; RNA, Messenger ; Signal Transduction

OBJECTIVES: The purpose of this study was to investigate the clinical characteristics of "fake bad" and "fake good" patients with traumatic head injury in neuropsychological tests. METHODS: We measured subjective symptoms by SCL-90-R and objective symptoms by McBride obstacle-valuation measure. The patient was divided into three groups according to differences between subjective and objective symptoms. We also examined their intelligence, memory, clinical characteristics, using K-WAIS, K-MAS, MMPI. RESULTS: The group who overly expressed their subjective symptoms has its psychotic symptom exaggeratingly measured, so it will be helpful to be careful to such over-expressed symptoms in those who present a psychotic symptom in a clinical view-point. An K-WAIS measurement among those who exaggerated their subjective symptoms showed less value than the actual one, which weakens the reliability of this intelligent test. Rather, for that group, the result of K-MAS can be used with a confidence in the estimation of their severity of symptoms. CONCLUSION: MMPI and neuropsychological tests are helpful to understand characteristics between subjective symptoms and objective disabilities of patients with traumatic head injury.
Craniocerebral Trauma* ; Head* ; Humans ; Intelligence ; Memory ; MMPI* ; Neuropsychological Tests*

A case of mucinous cystadenocarcinoma arising from a mature cystic teratoma in the right ovary of a 37-year-old woman is reported. Malignant transformation of a mature teratoma is a rare event and the commonest malignant neoplasm to develop is squamous cell carcinoma.(83%) Adenocarcinoma occurs with less frequency.(6.8%) The patient was treated by staging operation followed by adjuvant chemotherapy. After six courses of combination chemotherapy, oncological investigations, including chest X-ray, abdominopelvic CT scan and tumor markers, all revealed no evidence of recurrence.
Adenocarcinoma ; Adult ; Chemotherapy, Adjuvant ; Cystadenocarcinoma, Mucinous* ; Drug Therapy, Combination ; Female ; Humans ; Mucins* ; Ovary* ; Recurrence ; Teratoma* ; Thorax ; Tomography, X-Ray Computed ; Biomarkers, Tumor

The prognoses for the gastric cancer patients treated with total gastrectomies are known to be unsatisfactory due to the low survival rates, the high frequency of postoperative mortality or morbidity, and long-term complications such as nutritional deficiency. The authors evaluated the 5-year survival rates and analyzed the prognostic factors in 557 patients with gastric cancer who underwent total gastrectomies during the period between Jan. 1987 and Dec. 1993. The overall 5-year survival rate was 49.7%, and the survival rates according to the stage were stage Ia, 92.0%; Ib, 85.5%; II 64.1%; IIIa 55.0%; IIIb 26.5%; and stage IV, 6.3%. Postoperative mortality rate was 1.1%. By using univariate analysis to evaluate the prognostic factors, factors such as age, depth of invasion, extent of lymph node metastasis (according to the Japanese rule), number of involved nodes, lymph node ratio, distant metastasis (peritoneal and/or hepatic), size of the tumor, gross type, histological type, the surgical curability and the TNM stage were found to be related with the survival of the patients. In a multivariate analysis using 11 variables, the TNM stage was the single most significant prognostic factor. Besides the TNM, depth of invasion (ratio of risk (R.R)=1.50), extent of lymph node metastasis (R.R=1.83), number of involved nodes (R.R=1.64), lymph node ratio (R.R=1.91), and peritoneal metastasis (R.R=3.11) were found to be independent prognostic factors influencing survival. It was thought that the radicality of surgery could be reflected in the number of removed nodes per specimen. In this study, the average number of removed nodes was 42.3 per case. Hence, it may be said that adequate lymphadenectomy was performed for almost all the grossly curable cancers. The 5-year survival rate in stage IV patients with tertiary node (N3) metastasis and no peritoneal or hepatic metastasis was 16.8%; in patients with peritoneal or hepatic metastasis, the survival rate was 0%. There was a significant survival difference between these two groups (p<0.05). This result suggests that the tertiary node metastasis is a potentially curable factor, and that it should be classified differently in the current TNM system. In conclusion, the overall survival rates in the patients treated with total gastrectomies were favorable compared with the results in other reports. Depth of invasion, extent of lymph node metastasis, number of involved nodes, lymph node ratio were important prognostic factors for survival after a total gastrectomy. The current TNM staging system appears to be a reasonable one, except that the probable curability of tertiary node metastasis may need to be taken into consideration.
Asian Continental Ancestry Group ; Gastrectomy* ; Humans ; Lymph Node Excision ; Lymph Nodes ; Malnutrition ; Mortality ; Multivariate Analysis ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Stomach Neoplasms* ; Survival Rate

OBJECTIVE: Premorbid demographic backgrounds of injured individuals are likely to reflect more accurately the status of patients with traumatic brian injury (TBI) than clinical factors. However, the concrete study about the relationship between the demographic factors and neurocognitive function in TBI patients has not been reported. The object of this study was to evaluate the effect of premorbid demographic factors on the recovery of neurocognitive function following TBI. METHODS: From July 1998 to February 2007, 293 patients (male: 228, female: 65) with a history of head injury, who had recovered from the acute phase, were selected from our hospital to include in this study. We analyzed the effect of premorbid demographic factors including age, sex, educational level and occupation on the recovery of neurocognitive function in each TBI subgroup as defined by Glasgow Coma Scale (GCS) score. Intelligence and memory are components of neurocognitive function, and the Korean Wechsler Intelligence Scale (K-WAIS) and the Korean memory assessment scale (K-MAS) were used in this study. The results were considered significant at p<0.05. RESULTS: The higher level of education was a good prognostic factor for intelligence regardless of GCS score and younger age group showed a better result for memory with an exception of severe TBI group. In the severe TBI group, the meaningful effect of demographic factors was not noted by the cause of influence of severe brain injury. CONCLUSION: The demographic factors used in this study may be helpful for predicting the precise prognosis and developing an appropriate rehabilitation program for TBI patients.
Brain Injuries ; Craniocerebral Trauma ; Demography ; Glasgow Coma Scale ; Humans ; Intelligence ; Memory ; Occupations ; Prognosis

Combined resection of the spleen during total gastrectomy for gastric cancer is usually performed to remove the lymph nodes adequately and thereby achieving surgical radicality. However there is still controversy whether a total gastrectomy combined with a splenectomy can improve the survival rate. The authors retrospectively analyzed 557 gastric cancer patients, who underwent total gastrectomy at the Department of Surgery of Yonsei University during the 7-year period between 1987 and 1993, in order to investigate the influence of combined resection of the spleen upon the patients' survival. The patients were followed until March 1996, and the rate of follow up was 90.6%. The number of cases in which the spleen was saved was 101(the spleen conservation group, SC) and the number of cases in which the spleen was resected was 431(the spleen resection group, SR). Twenty-five cases were excluded due to incomplete data. Among the 431 cases for whom splenectomy was done, 343 were cases in which spleen was the only organ removed other than the stomach (SOR). For the other 88 cases, at least 1 more organs were resected along with the stomach and the spleen(Sp combined). There were no significant differences in the clinical characteristics such as age, sex ratio, tumor size, depth of invasion, nodal stage, TNM stage and histological type between SC and SOR group. In terms of the nodes removed during operation, there was significant difference between the SC and the SOR groups. Also, the Sp combined group showed significant differences in terms of tumor size, depth, nodal stage, TNM stage, and removed nodes. The overall 5-yr survival rate for the spleen conservation group(SC, N=101) was 61.2% and the survival rates according to TNM stage were 94.0% for stage I, 94.1% for stage II, 30.0% for III, and 0.0% for stage IV. The overall 5-yr survival rate for the 343 patients with splenectomy(SOR) was 51.9%, and the survival rates according to TNM stages were 88.7% for stage I, 57.0% for II, 44.0% for III, and 10.8% for stage IV. The overall 5-yr survival rate for the 431 patients with splenectomies or with splenectomies and multiple organ resection(SR) was 48.2%, and the survival rates according to the stages were 88.2% for stage I, 60.2% for II, 41.5% for III, and 6.8% for stage IV. The overall 5-yr survival rate was higher in SC group than in the SOR or the SR groups, but there was no statistical significance to this difference (p>0.05). In a compared according to the TNM stage, the SC group showed better survival rates in the relatively early stages (I, II) than the SOR or the SR groups did; in advanced stages (III, IV), the SOR and the SR groups showed better survival rates than the SC group. However, there was no statistically significant differences in survival among the three groups. These results suggest that during a total gastrectomy, it may be better to save the spleen in early stages of gastric cancer and that it may be better to resect the spleen for adquate lymphadenectomy in grossly advanced stages. To identify statistical difference in survival, it might be necessary to perform a randomized prospective study.
Follow-Up Studies ; Gastrectomy* ; Humans ; Lymph Node Excision ; Lymph Nodes ; Retrospective Studies ; Sex Ratio ; Spleen* ; Splenectomy ; Stomach ; Stomach Neoplasms* ; Survival Rate

There has been considerable controversy over the prognosis of mucinous gastric enocarcinoma (MGC). In this study we analyzed the clinicopathologic fferences between MGC and non-mucinous gastric carcinoma (NMGC). In addition, e relationship between mucin content and other clinicopathologic variables, cluding prognosis in MGC, was also investigated. We reviewed 2118 patients th pathologically-confirmed gastric cancer who underwent gastrectomy at the partment of Surgery, Yonsei University College of Medicine, during the period tween Jan. 1987 and Dec. 1993. Among them, 130 patients had gastric carcinoma th extracellular mucin (MGC) and 1988 patients had gastric carcinoma without tracellular mucin (NMGC). We placed the MGC patients into two groups according mucin content: mucin content involving over 50% of the tumor (dominant type, = 94) and mucin content involving less than 50% of the tumor area (partial pe, n = 36). The results were as follows: MGC was more common in males than GC. The size of the tumor in MGC (mean 5.3 cm) was larger than that of NMGC ean 4.4 cm). The patients with MGC had a higher incidence of Borrmann type IV GC: 16.1%, NMGC: 9.9%), more frequent serosal invasion (MGC: 75.4%, NMGC: .6%), lymph-node metastasis (MGC: 75.4%, NMGC: 50.7%), and peritoneal tastasis (MGC: 10.0%, NMGC: 3.5%) than patients with NMGC. The patients with C were more advanced in stage at the time of diagnosis and had a worse overall -year survival rate (44.9%) than patients with NMGC (54.7%). However, the -year survival rate according to the stage of MGC was similar to that of NMGC. ere were no significant differences between the mucin content and other thologic variables, including prognosis, i.e. similar biologic behavior tween dominant type MGC and partial type MGC. In conclusion, we suggest that C was more frequently diagnosed in advanced stage than NMGC with a poorer ognosis and that it is reasonable to consider the carcinoma with mucin content volving more than 30% of the tumor area as MGC.
Adenocarcinoma/pathology ; Adenocarcinoma/metabolism ; Adenocarcinoma, Mucinous/pathology* ; Adenocarcinoma, Mucinous/metabolism* ; Adult ; Aged ; Aged, 80 and over ; Female ; Human ; Male ; Middle Age ; Mucins/metabolism ; Neoplasm Staging ; Stomach Neoplasms/pathology* ; Stomach Neoplasms/metabolism*

There has been a considerable controversy on the prognosis of the mucinous gastric adenocarcinoma(MGC). In this study we analyzed the clinicopathologic differences between MGC and non-mucinous gastric carcinoma(NMGC). In addition, the relationship between mucin content and other clinicopathologic variables, including prognosis in MGC was examined. We reviewed 2118 patients with pathologically confirmed gastric cancer who had underwent gastrectomy at the department of surgery of Yonsei University College of Medicine, during the period between Jan. 1987 and Dec. 1993. Among them, 130 patients had gastric cancer with extracellular mucin(MGC) and 1988 patients had gastric carcinoma without extracellular mucin(NMGC). We studied the MGC patients into two groups according to mucin content: mucin content involving over 50% of the tumor(dominant type, n=94) and mucin content involving less than 50% of the tumor area(partial type, n=36). The results are as follows: The MGC was more common in male then NMGC. The size of tumor in MGC was larger than that of NMGC. The patients with MGC had higher incidence of Borrmann type IV, more frequent serosal invasion, lymph nodes metastasis and peritoneal metastasis than the patients with NMGC. The patients with MGC had more advanced stage at the time of diagnosis and worse overall 5-year survival rate than the patients with NMGC. But the 5-year survival rate according to the stage of MGC was similar to that of NMGC. There were no significant differences between the mucin content and other pathologic variables including prognosis. So we suggested that MGC has worse prognosis than NMGC and it is reasonable to consider the carcinoma with mucin content involving less than 50% of the tumor area as MGC.
Adenocarcinoma* ; Diagnosis ; Gastrectomy ; Humans ; Incidence ; Lymph Nodes ; Male ; Mucins* ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms ; Survival Rate

BACKGROUND: Cyclin-dependent kinase (CDK) inhibitors are family of molecules that regulate the cell cycle. The CDKN2, a CDK4 inhibitor, also called p16, has been implicated in human tumorigenesis. The CDKN2 inhibits the cyclin/CDK complexes which regulate the transition from G1 to S phase of cell cycle. There is a previous report that homozygous deletion of CDKN2 region on chromosome 9p21 was detected frequently in astrocytoma, glioma and osteosarcoma, less frequently in lung cancer, leukemia and ovarian cancer, but not detected in colon cancer and neuroblastoma. However, little is known about the relationship between CDKN2 and laryngeal cancer. Therefore this study was initiated to investigate the role of CDKN2 in human laryngeal squamous cell carcinoma development. MATERIALS AND METHODS: We used 5 human laryngeal carcinoma cell lines whether they have deletions or losses of CDKN2 gene expression by DNA-PCR or RT-PCR, respectively. We examined 8 fresh frozen human laryngeal cancer tissues to detect the loss of heterozygosity (LOH) of CDKN2. PCR was performed by using microsatellite markers of short arm of human chromosome 9 (D9S126, D9S144, D9S156, D9S161, D9S162, D9S166, D9S171, D9S200 and D9SIFNA). For informative cases, allelic loss was scored if the signal of one allele was significantly decreased in tumor DNA when compared to the same allele in normal DNA. RESULTS: The CDKN2 DNA deletion was observed in 3 cell lines. The CDKN2 mRNA expression was observed in only one cell line, which was very weak. LOH was detected in 7 cases (87.5%). CONCLUSION: These results suggest that CDKN2 plays a role in the carcinogenesis of human laryngeal squamous cell carcinoma.
Alleles ; Arm ; Astrocytoma ; Carcinogenesis ; Carcinoma, Squamous Cell* ; Cell Cycle* ; Cell Line* ; Chromosomes, Human ; Colonic Neoplasms ; DNA ; Genes, p16* ; Glioma ; Head* ; Humans ; Laryngeal Neoplasms ; Leukemia ; Loss of Heterozygosity ; Lung Neoplasms ; Microsatellite Repeats ; Neck* ; Neuroblastoma ; Osteosarcoma ; Ovarian Neoplasms ; Phosphotransferases ; Polymerase Chain Reaction ; RNA, Messenger ; S Phase

A microdebrider is increasingly used in endoscopic sinus surgery. Although it has many advantages over conventional instruments, it has been associated with severe complications. We treated a case of rupture of the left medial rectus muscle after use of a microdebrider during endoscopic sinus surgery in a 50 year-old female patient who complained of binocular diplopia and exotropia. The patient showed marked limitation on adduction and about 40 prism diopters of left exodeviation. The orbital computed tomography showed a bony defect at the left medial orbital wall, and injury of the medial rectus muscle. The exodeviation was corrected after ophthalmologic surgery. We report a case of the rupture of the medial rectus muscle after use of a microdebrider during endoscopic sinus surgery and review the medical literature.
Diplopia ; Exotropia ; Female ; Humans ; Middle Aged ; Orbit ; Rupture ; Telescopes