Direct immunofluorescent (DIF) starining was performed on biopsy specimens from four patients with pityraasis lichenoides chronica. Deposits of IgM and C3 were foundin the dermal vessel walls of the lesional skin in two patients with pityriasis lichenoides chronic. Deposition of C3 and cytoid bodies were detected along the dermo-epidermal junction in one patient. This supports the view that deposition of immune complexes may play a part in the pathogenesis of pityriasis lichenoides chronica.
Antigen-Antibody Complex ; Biopsy ; Humans ; Immunoglobulin M ; Pityriasis Lichenoides ; Skin ; Vasculitis*

INTRODUCTIONThe revised Human Organ Transplant Act (HOTA) was implemented in Singapore in July 2004. We aim to evaluate expanding the potential donor pool for liver transplant in Singapore with the inclusion of marginal donors.

MATERIALS AND METHODSAll donor referrals between July 2004 and June 2007 were studied. All potential deceased liver donors were heart-beating. After being reviewed by the transplant coordinator, potential donors were assessed by a transplant hepatologist and a transplant surgeon for suitability of organ donation strictly based on the programme's donor assessment protocol. Reasons for rejection as potential donors were documented. The clinical characteristics of all donor referrals were retrospectively reviewed, and an independent decision was made as to whether liver retrieval in each rejected case might have been possible.

RESULTSAmong the 128 potential donor referrals, 20 donors (15.6%) underwent liver retrieval. Of the 20 livers retrieved, 16 were implanted and 4 were not implanted (3 unfit recipients, and 1 donor liver with 40% steatosis). Another 10 donor livers were assessed intraoperatively and were rejected because of varying levels of steatosis. Of these livers assessed, 5 donor livers had steatosis <40% and 5 had steatosis >40%. Of the remaining potential donors, 45 were deemed not possible because of prolonged hypotension (9), on-going or unresolved sepsis (13), high-risk behaviour (4), non-actualisation (8), or pre-existing medical conditions (11). Another 53 donors may potentially have been suitable donors but were rejected because of possible sepsis (13), no suitable recipients (12), transient hypotension (10), transient abnormal liver function test (6), history of alcohol ingestion (5), non-actualisation because of consent (4) and other reasons (3). Overall, it was deemed that 61 donors (47.7%) might potentially have been suitable liver donors.

CONCLUSIONSDespite new legislation (HOTA) in Singapore, the utilisation of cadaveric donor livers showed no increase in the last 3 years. By expanding our donor criteria to include marginal donors, we could potentially increase the availability of deceased donor livers to meet our waiting list demands.

Adult ; Female ; Humans ; Liver Transplantation ; Living Donors ; legislation & jurisprudence ; supply & distribution ; Male ; Middle Aged ; Referral and Consultation ; organization & administration ; Retrospective Studies ; Singapore ; Tissue and Organ Procurement ; legislation & jurisprudence ; Waiting Lists

In the present study, a perfluorochemical emulsion (Fluosol-DA 20%) did not alter Do and and Dq values on cell survival curve, indicating that the lack of a direct effect of Fluosol-DA 20% on cellular radiosensitivity in vitro. The effect of Fluosol-DA 20% injection in combination with carbogen breathing was determined on the hupoxic cell fraction in SCK tumors. The hypoxic cell fraction in control SCK tumors was 0.39. This value decreased to 0.05 when the mice were i.v. injected with 12 ml/kg of Fluosol-DA 20% in a carbogen atomosphere. The measured mean and median PO2 values with a microelectorde in the control tumors was 9 mmHg and 4 mmHg, respectively. The treatment of the SCK tumors in the host mice with injected Fluosol-DA 20% in combination with carbogen breathing increased the mean and median PO2 values to 67 mmHg and 62 mmHg, respectively. Using carbogen breathing alone caused a moderate increase of tumor PO2. But Fluosol-DA 20% injection alone caused little change PO2 in the tumor. It was concluded that the combination of Fluosol-DA injection and carbogen breathing is an effective means to improve oxygenation of tumors.
Animals ; Cell Survival ; Mice ; Oxygen* ; Radiation Tolerance ; Respiration

OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of cervical midline-splitting French-door laminoplasty with a polyether ether ketone (PEEK) plate. The authors retrospectively analyzed the results of patients with cervical laminoplasty miniplate (MAXPACER(R)) without bone grafts in multilevel cervical stenosis. METHODS: Fifteen patients (13 males and 2 females, mean age 50.0 years (range 35-72)) with multilevel cervical stenosis (ossification of the posterior longitudinal ligament and cervical spondylotic myelopathy) underwent a combined surgery of midline-splitting French-door laminoplasty with or without mini plate. All 15 patients were followed for at least 12 months (mean follow-up 13.3 months) after surgery, and a retrospective review of the clinical, radiological and surgical data was conducted. RESULTS: The radiographic results showed a significant increase over the postoperative period in anterior-posterior diameter (9.4+/-2.2 cm to 16.2+/-1.1 cm), open angles in cervical lamina (46.5+/-16.0degrees to 77.2+/-13.1degrees), and sectional volume of cervical central canal (100.5+/-0.7 cm2 to 146.5+/-4.9 cm2) (p<0.001). The sagittal alignment of the cervical spine was well preserved (31.7+/-10.0degrees to 31.2+/-7.6degrees, p=0.877) during the follow-up period. The clinical results were successful, and there were no significant intraoperative complications except for screw displacement in two cases. The mini plate constructs did not fail during the 12 month follow-up period, and the decompression was maintained. CONCLUSION: Despite the small cohort and short follow-up duration, the present study demonstrated that combined cervical expansive laminoplasty using the mini plate is an effective treatment for multilevel cervical stenosis.
Cohort Studies ; Constriction, Pathologic ; Decompression ; Ether* ; Female ; Follow-Up Studies ; Humans ; Intraoperative Complications ; Longitudinal Ligaments ; Male ; Postoperative Period ; Retrospective Studies ; Spine ; Spondylosis* ; Transplants

BACKGROUND AND OBJECTIVES: Long-term right ventricular (RV) apex pacing has been associated with left ventricular (LV) systolic dysfunction. However, pacing in the RV outflow tract (RVOT) is associated with a narrower QRS duration and may have a more normal LV activation in comparison to RV apical (RVA) pacing. We hypothesized that RVOT pacing is associated with less mechanical dyssynchrony compared to RVA pacing and that it also more closely resembles mechanical activation in normal controls with a narrow QRS. SUBJECTS AND METHODS: We studied 9 patients with RV pacing, 9 with left bundle branch block (LBBB), and 15 normal controls with a narrow QRS. In the RV pacing group, we paced from the RVA and RVOT. At the end of each pacing train, we obtained echocardiographic images in the apical 4- and 2-chamber views and obtained the following parameters: the compression/expansion crossover point (CEP) for myocardial strain and the time from QRS onset to the CEP in the strain image. The degree of dyssynchrony was evaluated using the dispersion and standard deviation of CEP times in 12 segments of the LV. RESULTS: Significant dyssynchrony was observed in the RVOT pacing group compared to the group with normal QRS. No significant difference was observed in LV mechanical dyssynchrony among the RVOT pacing, RVA pacing, and LBBB groups. CONCLUSION: RVOT pacing is associated with significant LV dyssynchrony. Although the RVOT has been recommended as an alternative site for pacing, this approach may have adverse effects on long-term LV function.
Bundle-Branch Block ; Heart Ventricles ; Humans ; Sprains and Strains

OBJECTIVE: The object of this study was to assess the accuracy of dipyridamole stress intravenous (IV) myocardial contrast echocardiography (MCE) using pulse inversion harmonic imaging and PESDA in the detection of perfusion defect in the patients with coronary artery disease in comparison with dipyridamole stress Tc-99m sestamibi SPECT. METHODS: Total 46 patients (29 males, mean age 64 years old) were consecutively enrolled. Patients with prior myocardial infarction were excluded. MCE and Tc-99m sestamibi SPECT were performed at the same day during rest and after 0.56 or 0.84mg/Kg dipyridamole infusion. Continuous IV infusion of PESDA (2-5 mL/min) was administered while obtaining triggered (1:1) end-systolic apical 2, 4 chamber and long axis views. Tc-99m sestamibi was injected 3 minutes after dipyridamole. Tc-99m sestamibi SPECT images were obtained one hour later. Coronary angiography was followed within two days in all patients. Tc-99m sestamibi SPECT images were matched to the sixteen segments of left ventricle according to American Society of Echocardiography for segmental comparison. Both images were analyzed visually. Results Using coronary angiography as the standard, MCE showed overall sensitivity of 70.7%, specificity of 95.8%, positive predictive value (PPV) of 87.8% and negative predictive value (NPV) of 88.5% in the detection of coronary atherosclerosis (70% stenosis). Tc-99m sestamibi SPECT showed sensitivity of 75.6%, specificity of 98.9%, PPV of 96.8% and NPV of 90.6%. The overall concordance rate between MCE and Tc-99m sestamibi SPECT for the detection of perfusion defects was 86.9% (Cohen's kappa value 0.63) according to the coronary territory and 86.8% (Cohen's kappa value 0.55) according to segmental analysis. CONCLUSION: Dipyridamole stress IV MCE using pulse inversion harmonic imaging and PESDA is feasible and comparable to Tc-99m sestamibi SPECT in identifying significant coronary stenosis and inducible myocardial perfusion defects in the patients with coronary artery disease. MCE using pulse inversion harmonic imaging seems to be a promising modality for assessing myocardial perfusion in the patients with suspected coronary artery disease.
Axis, Cervical Vertebra ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Dipyridamole ; Echocardiography* ; Heart Ventricles ; Humans* ; Male ; Myocardial Infarction ; Perfusion* ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

OBJECTIVE: Team approach for patient-specific rehabilitation for acute stroke patient is important to minimize loss of function and facilitate recovery as well as cost effectiveness. We tried to establish acute stroke rehabilitation algorithm to maximize efficiency of delivering patient-specific and comprehensive rehabilitation in acute stroke patients. METHOD: We developed the clinical algorithms through the informal consensus development process by thorough discussions within the rehabilitation team members. Before and after adoption of the rehabilitation algorithms in clinical activity, we investigated satisfaction of patients and staffs by questionnaire. In addition, length of hospitalization was assessed. RESULTS: Ten algorithms were developed on the general rehabilitation, physical, occupational, and speech therapy, dysphagia, cognitive rehabilitation, nursing care and complication, and psychosocial rehabilitation. Every algorithm was comprised to take care of patients from the acute stage of rehabilitation to long term management. After algorithms to the clinical practice, total mean score of satisfaction was significantly improved in patients and staffs (p<0.05). Mean length of stay for rehabilitation tended to decline without statistical significance. CONCLUSION: Algorithm for patient specific acute stroke rehabilitation could contribute to increase the level of satisfaction among patients and staffs.

OBJECTIVE: To investigate the neuroanatomical correlation of conduction aphasia by analyzing neuroimage data of patients who were diagnosed as conduction aphasia after stroke. METHOD: Nine patients with conduction aphasia after stroke were retrospectively reviewed with their medical records. Language functions of patients were assessed by Korean-version Western Aphasia Battery (K-WAB). Stroke lesions were assessed by brain computed tomography or magnetic resonance images taken within 1 month after onset of stroke. RESULTS: The stroke subtypes were cerebral infarction in 5 patients and intracranial hemorrhage in 4 patients. The lesions were located in left hemisphere in 8 subjects and right hemisphere in 1 subject. The left hemispheric lesion were located in the insula and superior temporal lobe in 3, the inferior parietal lobe in 2, the corona radiate in 1, the basal ganglia in 1 patient and both corona radiata and basal ganglia in 1. The right hemispheric lesion was located in the inferior parietal and superior temporal lobe. CONCLUSION: 6 of 9 patients with conduction aphasia had brain lesions in the path of arcuate fasciculus in the left hemisphere, however, 3 of 9 patients showed other brain lesions. These findings suggested that conduction aphasia could be caused by heterogeneous brain lesions. The characteristic features of conduction aphasia according to diverse brain lesions may need further investigation.

Despite the increasing use of stereotactic body radiation therapy (SBRT) and stereotactic radiation surgery (SRS) in recent years, the biological base of these high-dose hypo-fractionated radiotherapy modalities has been elusive. Given that most human tumors contain radioresistant hypoxic tumor cells, the radiobiological principles for the conventional multiple-fractionated radiotherapy cannot account for the high efficacy of SBRT and SRS. Recent emerging evidence strongly indicates that SBRT and SRS not only directly kill tumor cells, but also destroy the tumor vascular beds, thereby deteriorating intratumor microenvironment leading to indirect tumor cell death. Furthermore, indications are that the massive release of tumor antigens from the tumor cells directly and indirectly killed by SBRT and SRS stimulate anti-tumor immunity, thereby suppressing recurrence and metastatic tumor growth. The reoxygenation, repair, repopulation, and redistribution, which are important components in the response of tumors to conventional fractionated radiotherapy, play relatively little role in SBRT and SRS. The linear-quadratic model, which accounts for only direct cell death has been suggested to overestimate the cell death by high dose per fraction irradiation. However, the model may in some clinical cases incidentally do not overestimate total cell death because high-dose irradiation causes additional cell death through indirect mechanisms. For the improvement of the efficacy of SBRT and SRS, further investigation is warranted to gain detailed insights into the mechanisms underlying the SBRT and SRS.
Antigens, Neoplasm ; Cell Death ; Humans ; Radiobiology ; Radiotherapy ; Recurrence

BACKGROUND: Microsatellite instability (MSI) analysis is becoming increasingly important in many types of tumor including colorectal cancer (CRC). The commonly used MSI tests are either time-consuming or labor-intensive. A fully automated MSI test, the Idylla MSI assay, has recently been introduced. However, its diagnostic performance has not been extensively validated in clinical CRC samples.METHODS: We evaluated 133 samples whose MSI status had been rigorously validated by standard polymerase chain reaction (PCR), clinical next-generation sequencing (NGS) cancer panel test, or both. We evaluated the diagnostic performance of the Idylla MSI assay in terms of sensitivity, specificity, and positive and negative predictive values, as well as various sample requirements, such as minimum tumor purity and the quality of paraffin blocks.RESULTS: Compared with the gold standard results confirmed through both PCR MSI test and NGS, the Idylla MSI assay showed 99.05% accuracy (104/105), 100% sensitivity (11/11), 98.94% specificity (93/94), 91.67% positive predictive value (11/12), and 100% negative predictive value (93/93). In addition, the Idylla MSI assay did not require macro-dissection in most samples and reliably detected MSI-high in samples with approximately 10% tumor purity. The total turnaround time was about 150 minutes and the hands-on time was less than 2 minutes.CONCLUSIONS: The Idylla MSI assay shows good diagnostic performance that is sufficient for its implementation in the clinic to determine the MSI status of at least the CRC samples. In addition, the fully automated procedure requires only a few slices of formalin-fixed paraffin-embedded tissue and might greatly save time and labor.
Colorectal Neoplasms ; Microsatellite Instability ; Microsatellite Repeats ; Paraffin ; Polymerase Chain Reaction ; Sensitivity and Specificity