The distinction between cholangiocarcinoma (CC) and metastatic colonic adenocarcinoma of the liver (MCA) is often difficult, particularly in needle biopsy and fine-needle aspiration specimens, if histologic features alone are used. To examine the differences in the expressions of the cytokeratin (CK) 7 and 20 in the CCs and MCAs, we performed immunohistochemical studies on surgically resected 19 CCs and 23 MCAs. We used monoclonal antibodies against CK 7 and CK 20, and applied microwave antigen retrieval technique on formalin-fixed, paraffin-embedded tissue. We interpreted diffuse cytoplasmic reactivity found in > or =5% of tumor cells as positive. CCs showed CK 7+/CK 20- immunophenotype in 63%, CK 7+/CK 20+ in 32%, CK 7-/CK 20+ in 5%, and CK 7-/CK 20- in 0%. MCAs exhibited CK 7-/CK 20+ immunophenotype in 87%, CK 7+/CK 20+ in 9%, CK 7-/CK 20- in 4%, and CK 7+/CK 20- in 0%. CK 20-reactive cells in CCs were frequently columnar in shape (p<0.05). In conclusion, the CK 7/CK 20 immunophenotype was useful in the differentiation of CCs from MCAs: the CK 7+/CK 20- immunophenotype strongly suggested CCs, whereas the CK 7-/CK 20+ immunophenotype strongly suggested MCAs.
Adenocarcinoma* ; Antibodies, Monoclonal ; Biopsy, Fine-Needle ; Biopsy, Needle ; Cholangiocarcinoma* ; Colon* ; Cytoplasm ; Keratin-20 ; Keratin-7 ; Keratins* ; Liver* ; Microwaves

BACKGROUND: Assessing and securing airway is the beginning of the treatment for emergency patients. Rapid Sequence Intubation is a technique that uses sedatives and neuromuscular blockers to perform endotracheal intubation. This is a basic technique that all emergency physicians must master. Therefore, we investigated the recent circumstance of Rapid Sequence Intubation in patients at the emergency department. METHODS: Ten-item surveys were mailed to the board certified emergency physicians in the emergency department of 45 hospitals. Among the 45 surveys, 37 surveys were returned. The rate of reply was 82.2%. RESULTS: Throughout the hospital, 35/37 of the endotracheal intubation was performed in the emergency department. Anesthesiologists were not called for endotracheal intubation in 34/37 emergency department, and anesthesiologists were not called for the use of neuromuscular blockers in 36/37 emergency departments. 35 emergency departments used sedatives. The sedatives used were as follows : midazolam(48.6%), diazepam(25.7%), thiopental sodium(22.9%), and ketamine(2.9%). 30 emergency departments used neuromuscular blockers. The neuromuscular blockers used were as fallows : succinylcholine(46.7%), vecuronium(43.3%), and pancuronium(10.0%). The rate of Rapid Sequence Intubation was 33.8%. Various monitoring devices were used during Rapid Sequence Intubation ; cardiac monitors 90.5%, pulse oximeters 80.4%, noninvasive blood pressure monitors 64.9% and ETCO2/ 12.8%. Only 6 of 37 hospitals had the assessment program far endotracheal intubations and 60% was the assessment rate in these hospitals, however, there was no proctocol for the quality assurance assessment. CONCLUSION: Emergency endotracheal intubation was performed independently by the physician of the emergency department. The Rapid Sequence Intubation was effective and had low adverse effect. We recommended that Rapid Sequence Intubation should be used more aggressively in patients. Also, applying these assessment proctocol in patients, we could improve the quality of assurance assessment.
Blood Pressure Monitors ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Hypnotics and Sedatives ; Intubation* ; Intubation, Intratracheal ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Postal Service ; Thiopental

The authors presented a case of gastroschisis with a pedunculated gallbladder embedded in hepatic tissue. The patient was born after fullterm gestation. Due to extensive abdominal wall defect, she succumbed 3 days after birth. There was a pedunculated mass measuring 2.5x1.5x1.5 cm between the liver and distended stomach without any attachment to the liver. The pedicle of the mass was connected to the common bile duct. Cut surface revealed that the mass was an accessory hepatic lobe encircling the gallbladder. The histologic feature of both accessory liver and gallbladder was markedly altered probably due to vascular obstruction. We could find only a single similar case in literlature. That case was associated with Beckwith syndrome and ours was associated with large atrial spetal defect, large patent ductus arteriosus, accessory spleen as well as gastroschisis. The common feature of abdominal wall defect might be a predisposing factor.

9,10-Dimethyl-1,2-benzanthracene ; Animals ; Carcinogenesis ; Carcinoma in Situ ; Carcinoma, Squamous Cell ; Cricetinae ; Cytoplasm ; Epigenomics ; Epithelium ; Islands ; Mineral Oil ; Mouth Neoplasms ; Mucous Membrane ; Prognosis ; Transforming Growth Factor alpha ; Transforming Growth Factor beta ; Transforming Growth Factors

Chronic subdural hematoma usually occurs as a consequence of minor trauma. But, chronic subdural hematoma of occupational origin has not been reported yet in Korea. We experienced a case of chronic subdural hematoma induced by repeated trauma to the head. The patient was a 45-year-old male. He complained of repeated headache and nausea. By the computed tomogram, he diagnosed as chronic subdural hematoma and took the operation. He was not an alcoholism and had no intracranial disease nor coagulopathy. We studied all possibilities through working environment and personal environment survey. As a result, we decided the case as an example of cumulative trauma disorder to the head by occupational origin. We report a case of chronic subdural hematoma in the worker exposed repeated head trauma of occupational origin.
Alcoholism ; Craniocerebral Trauma ; Cumulative Trauma Disorders ; Head* ; Headache ; Hematoma, Subdural, Chronic* ; Humans ; Korea ; Male ; Middle Aged ; Nausea

BACKGROUND: Endocrine pancreas tumor is a rare disease which incidence is less than 2% of all pancreatic tumors. But it comprises various types of tumor and usually secretes several hormones from one type of tumor although the patient with this tumor complains of sole symptom associated with only one hormone. The mechanism and clinical significance of multiple hormone secretion in the endocrine pancreas tumom are not yet clearly defined. METHODS: We analyzed retrospectively the clinicopathologic features of 20 cases which were operated at Seoul National University Hospital during the period between February 1989 and May 1998. RESULTS: The most common tumor was insulinoma (13 cases) and the second most common tumor was nonfunctioning tumor (6 cases). There was one case of somatostatinoma. Most of the patients with insulinoma complained of neuroglycopenic symptoms. There were 9 cases (45.0%) in which the tumors secreted more than two kinds of hormones, 7 cases in insulinoma, 2 cases in nonfunctioning tumors. Whether the tumor secreted multiple hormones was detected by the method of immunohistochemical staining. Though the tumors secreted more than two kinds of hormones, the patients with the tumors complained of symptoms which were associated with the cell type most strongly stained by immunohistochemical method. Whether or not the tumors secreted multiple hormones was not associated with the pathologic features such as tumor size, histologic patterns of the tumor, status of tumor cell differentiation and malignancy. CONCLUSION: From this results, we suggest that endocrine tumors of the pancreas secreted multiple hormones not by the mechanism of dedifferentiation from already differentiated endocrine cells but by the mechanism of neogenesis of multipotent islet stem cells. Since the relationship between the function of multiple hormone secretion in the endocrine pancreas tumors and islet stem cell would be significant, further study should be needed to find out the function of stem cells and application of stem cells to clinical use.
Cell Differentiation ; Endocrine Cells ; Humans ; Incidence ; Insulinoma ; Islets of Langerhans ; Pancreas* ; Rare Diseases ; Retrospective Studies ; Seoul ; Somatostatinoma ; Stem Cells

Regionalization of high-risk perinatal care has been advocated because intensive care for small and ill newborn infants lowers mortality and morbidity. This report is based on analysis of admissions to the Neonatal Intensive Care unit (NICU) at the Wonju christian Hospital during the 4-year period from January, 1988 to December, 1991. There were 786 inborn infants and 1155 outborn infants admitted to the NICU. The results of our study follow; 1) Mean gestational ages were 36.8 weeks in inborn infants and 39.0 weeks in outborn infants. Mean birth weight was 2.5kg in inborn and 3.0kg in outborn infants. 2) The high-risk maternal factors, such as cesarian section delivery, eclampsia, preeclampsia, multiple pregnancy and placental anomaly were significantly more frequent in inborn infants than in outborn infants. 3) Perinatal sphyxia, HMD and transient tachypnea of newborn (TTN) were more common in inborn than in outborn infants, but pneumonia, meconium aspiration syndrome, and seizure were more common in outborn infants. 4) The positivity of bacterial cultures in blood and urine was higher in outborn infants than in inborn infants. The most frequently isolated microorganism was staphylococcus species in both inborn and outborn infants. 5) Hospital days, duration of TPN, duration of mechanical ventilation, frequency of seizure, and frequency of transfusion were longer or more frequent in inborn than in outborn infants. 6) Mortality rate was higher in inborn infants than in outborn infants. 7) In outborn infants, mortality rate was higher in infants whose transporting time was longer than 2 hours than for infants within 2 hour distances. However, this difference was not statistically significant. 8) These findings suggest that many lower birth weight and severly ill infants were not transported to the NICU of Wonju Christian Hospital perhaps due to poor transport systems, distance or socio-economic status. In conclusion, the improvement of transporting systems and socio-economic conditions will be required within this region.
Birth Weight ; Eclampsia ; Female ; Gangwon-do ; Gestational Age ; Humans ; Infant* ; Infant, Newborn ; Critical Care ; Intensive Care, Neonatal ; Meconium Aspiration Syndrome ; Mortality ; Perinatal Care ; Pneumonia ; Pre-Eclampsia ; Pregnancy ; Pregnancy, Multiple ; Respiration, Artificial ; Seizures ; Staphylococcus ; Transient Tachypnea of the Newborn

Autogenous bone graft used for the contouring and reconstruction of craniofacial bone defect has many advantages over the alloplastic material implantations. However, there are several problems associated to the autogenous bone grafting: obtaining the donor site is the most problematic; transplanted bone may be absorbed at the recipient site; and the molding to fit to the recipient site is difficult. Therefore, research in alloplastic materials is inevitable. The current research is focused on two types of hydroxyapatite, calcium phosphate and calcium carbonate. The calcium phosphate is known to show a limited osteogenesis. However, Coral(Biocoral, Inoteb B.P., Saint Gonnery, France) composed of calcium carbonate is known to be more effective in osteogenesis. Fibrin sealant(Duplojet system, Immuno AG. Vienna, Austria), a tissue glue, is known to increase tissue affinity, proliferation of fibroblast and vessel ingrowth. It is also known to have osteoinductive effect. We believe that fibrin sealant improves the effect of coral by increasing bone graft substitution, enhancement of plasticity and stability of the granular material. Therefore, we have undertaken an experimental investigation as following; Using high speed burr, three 10 mm in diameter skull defects were made on 24 New Zealand white rabbits. The defects were treated with implantations, which are divided into three samples: A) Control in which on coral or fibrin sealant, B) Coral 50 mg with fibrin sealant 0.3 cc, C) Coral 50 mg with saline 0.3 cc. The specimens of its skull were collected at 3, 7, 14, 28, 42 and 56 days postoperatively. The operative sites were carefully examined grossly, microscopially and radiologically. The experimental results are as followings: At 56 days post operation date, control group showed a thin layer of only fibrous connective tissue and minimal immature bone filling the defect. Coral with saline given group showed a thick layer of connective tissue and granule of coral, accompanied by partial new bone formation, mostly composed of woven bone, in the middle of the defect. In the group that were given coral with fibrin sealant, a thick layer of fibrous connective tissue and granules of coral, accompanied by more increased new bone formation in the middle of the defect were observed. Another difference from the Group B is a formed new bone replaced by lamellar bone.We concluded that by using coral and fibrin sealant together, contouring and reconstruction of bone defected areas were enhanced. It was difficult to prove directly that fibrin has osteoinductive effect. However, the plasticity and stability, the fibrin sealant gives to coral enhances the osteogenesis. Our study provides evidence that coral used with fibrin sealant will significantly improve the result of the craniofacial bone surgery.
Adhesives ; Anthozoa* ; Bone Transplantation ; Calcium ; Calcium Carbonate ; Connective Tissue ; Durapatite ; Fibrin Tissue Adhesive* ; Fibrin* ; Fibroblasts ; Fungi ; Humans ; Osteogenesis* ; Plastics ; Rabbits ; Saints ; Skull ; Tissue Donors ; Transplants

Generally alloplastic matrials such as collagen compound and liquid silicone injection, or autologous fat injection have been used for correction of surface irregularity. But, except for autologous fat injection, the other methods have been proved to be not effective or even dangerous. Then with the explosion in the popularity of liposuction, the autologous fat injection has been applied to variable clinical uses for contouring of the soft tissue irregularities. The author performed main operations with fat injections as ancillary procedure in 16 patients from 1993 to 1996, and long term follow-ups were reported. The lesions treated most frequently were cheeks, and others were thighs, legs, nasolabial folds and upper eyelids in order of frequency. The donor sites were lower abdomen, thigh, buttock and cheek. Our method of fat injection was used as an ancillary procedure for improving post-operative results in variable cases (craniofacial microsomia, fibrous dysplasia, asymmetry of leg, etc). And the important technical points in our method for reducing the absorption of fat after injection were atraumatic liposuction, multilayered dispersed injection, and 20% overcorrection. We obtained satisfactory aethetic results without major complications.
Abdomen ; Absorption ; Buttocks ; Cheek ; Collagen ; Explosions ; Eyelids ; Follow-Up Studies ; Humans ; Leg ; Lipectomy ; Nasolabial Fold ; Silicones ; Thigh ; Tissue Donors ; Transplants*

A total 73 cases of primary malignant bone tumors was reviewed and analysed clinically at the department of orthopaedic surgery, Kosin medicsl center, Pusan, Kores for 11 years from January, 1975 to December, 1985. The results were obtained as follows ; l. In the 73 cases of primsry malignant bone tumors, osteogenic sarcoma was the most common primary malignant bone tumor (57%) and followed by chondrossrcoma (10%), multiple myeloma (8%). 2. Average survival times according to each primary malignant bone tumors was more than 3 years in chondrosarcoma, reticulum cell sarcoma, and synovial sarcoma, 28 months in osteogenic sarcoma, and 7 months in Ewings sarcoma. Ewings sarcoma had the worse prognosis and the slowly progressing tumors-chondrosarcoma, reticulum cell sarcoma and synovial sarcoma are needed long term follow up. 3. In osteogenic sarcoma, the prognosis was better when developed in their 3rd decsde than when developed in their 2nd decade. 4. There is a slight difference in average survival time on the location of the site, for example when tumor is located in the distal femur, the prognosis was worst. 5. There is no difference in the prognosis. The mode of treatment did not effect to their prognosis. 6. It was clear that the tumors which had not been responded to chemotherapy or radiation therapy had poorer prognosis. Chondrosarcoma, fibrosarcoma and synovisl sarcoma were considered as slowly progressed tumors, and so it may be benefit to the patients that chemotherapy and/or radiotherapy were prescribed.
Busan ; Chondrosarcoma ; Drug Therapy ; Femur ; Fibrosarcoma ; Follow-Up Studies ; Humans ; Lymphoma, Non-Hodgkin ; Multiple Myeloma ; Osteosarcoma ; Prognosis ; Radiotherapy ; Sarcoma ; Sarcoma, Ewing ; Sarcoma, Synovial