PURPOSE: To evaluate the lung changes in healthy smokers, as seen on inspiratory and expiratoryhigh-resolution computed tomography (HRCT). MATERIAL AND METHODS: Twenty-seven healthy smokers (light smokers,below 20 pack-years, n=16; heavy smokers, above 20 pack-years, n=11) and 25 nonsmokers underwent inspiratory andexpiratory HRCT. All healthy smokers had normal pulmonary function and chest radiography. Parenchymal andsubpleural micronodules, ground-glass attenuation, centrilobular and paraseptal emphysema, bronchial wallthickening, bronchiectasis and septal line were evalvated on inspiratory scan and by air-trapping on expiratoryscan. RESULTS: On inspiratory scan, parenchymal micronodules were observed in one of 25 nonsmokers(4%), two of 16light smokers(13%) and five of 11 heavy smokers(45%); subpleural micronodules in two(8%), four(25%), two(18%);ground-glass attenuation in 0(0%), one(6%), three(27%); centrilobular emphysema in 0(0%), one(6%), three(27%);paraseptal emphysema in three(12%), 0(0%), five(45%); bronchial wall thickening in 0(0%), two(13%), one(9%),bronchiectasis in 0(0%), one(6%) two(18%) and septal line in one(4%), four(25%), two(18%). On expiratory scan,air-trapping was detected in 0 of 15 nonsmokers(0%), two of 17 light smokers(12%), and five of 11 heavysmokers(45%). Statistically significant differences between these three groups were found in parenchymalmicronodules(P=0.006), ground-glass attenuation(P=0.008), centrilobular emphysema(P=0.018), paraseptal emphysema(P=0.005) and air-trapping(P=0.013) between these three groups. CONCLUSION: According to the findings of HRCT,heavy smokers had higher frequency of parenchymal micronodules, ground-glass attenuation, centrilobular andparaseptal emphysema, and air-trapping than nonsmokers and light smokers.
Bronchiectasis ; Bronchiolitis ; Emphysema ; Lung* ; Pulmonary Emphysema ; Radiography ; Thorax

OBJECTIVES: To evaluate cognitive reserve in Korea using Korean version of Cognitive Reserve Index questionnaire (K-CRIq) and to investigate the effects of gender and age on cognitive reserve. METHODS: Three hundred and fifty-eight healthy subjects aged 25–85 years old in one community participated in the study. K-CRIq was developed and administered to all subjects to assess the effects of gender and age on cognitive reserve. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were administered to subjects over 65 years old to test concurrent validity. RESULTS: Age and gender as well as their interaction significantly affected Cognitive Reserve Index (CRI) score. Men had higher cognitive reserve than women over 45 years old, but at younger ages there was no gender difference in cognitive reserve. CRI score and sub-scores were strongly associated with the MMSE and MoCA. CONCLUSION: The results indicate that the gender effect on cognitive reserve is disappearing in the young generation in Korea. Scores in neuropsychological tests are predicted well by the CRI score.
Aging ; Cognitive Reserve* ; Female ; Healthy Volunteers ; Humans ; Korea* ; Male ; Methylenebis(chloroaniline) ; Neuropsychological Tests

Fournier’s gangrene (FG) is a necrotizing fasciitis of the perianal, perineal, and genital regions, leading to necrosis of the fascia and subcutaneous tissue. It is a rare condition, particularly when induced by rectal cancer. Herein, we present a rare case in which FG was discovered incidentally during the physical examination of a patient who complained of general weakness. The patient was diagnosed with FG induced by rectal cancer with liver metastasis and underwent laparoscopic diverting loop ileostomy instead of abdominoperineal resection (APR). After 13 rounds of chemotherapy over 9 months, the condition of the rectal cancer partially improved.Furthermore, FG lesions showed improvement with this treatment plan compared to the initial treatment with dressings and antibiotics. Therefore prompt surgical intervention is important for treating FG induced by rectal cancer.

PURPOSE: Decreased expressions of E-cadherin and beta-catenin are known to be associated with tumor metastases. but the clinical relationship between the degree of expression and the prognosis in colorectal cancer remains unclear. In this study, the expressions of E-cadherin and beta-catenin in stage II colorectal cancer patients were evaluated and their relation with metachronous distant metastasis analyzed. METHODS: From the patients who underwent a curative resection for stage II colorectal cancer, 25 who had a recurrence after surgery due to distant metastasis (group with recurrence) were selected, and matched with 25 patients who did not have a recurrence (group without recurrence). Paraffin embedded blocks from these patients and samples from normal colon, primary colon cancer were prepared in tissue microarrays and were stained by immunohistochemistry. The expressions were classified as grades 0, 1, 2, or 3 compared to those of normal tissue. RESULTS: The mena age of the patients was 55.7 years, with a median follow up period of 73.7 months. There are no significant differences in the clinicopathological data between the groups with recurrence and without recurrence. There were no significant differences in the degrees of E-cadherin and beta-catenin expression between the two groups (P=0.16, 0.10), or in the 5-year survival and disease free survival rates between the high and low expression groups (degree > or =2.5 and < or =2, respectively) of E-cadherin and beta-catenin. CONCLUSION: The expressions of E-cadherin and beta-catenin may not play a prognostic role in the prediction of metachronous distant metastasis in stage II colorectal cancers patients.
beta Catenin* ; Cadherins* ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Neoplasm Metastasis* ; Paraffin ; Prognosis ; Recurrence

Behcet's disease is a multisystem disorder characterized by oral and genital ulcers, uveitis, and skin lesions. Renal involvement has rarely been observed in Behcet's disease. However, pathological reports have revealed various lesions, especially, amyloidosis, focal and segmental glomerulonephritis with crescents, and IgA nephropathy. A 49-year old female with Behcet's disease was admitted to evaluate proteinuria and microscopic hematuria, and renal biopsy showed IgA nephropathy (subclass V). Immunohistology revealed mesangial deposits of IgA and staining for C3. We report a case of IgA nephropathy which was diagnosed by renal biopsy in a patient with Behcet's disease.
Amyloidosis ; Biopsy ; Female ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Immunoglobulin A* ; Middle Aged ; Proteinuria ; Skin ; Ulcer ; Uveitis

OBJECTIVE: The purpose of this study is to describe the detailed surgical technique and short-term clinical and radiological outcomes of lateral lumbar interbody fusion (LLIF) and in situ lateral screw fixation using a conventional minimally invasive screw fixation system (MISF) for revision surgery to treat rostral lumbar adjacent segment disease. METHODS: The medical and radiological records were retrospectively reviewed. The surgery was indicated in 10 consecutive patients with rostral adjacent segment stenosis and instability. After the insertion of the interbody cage, lateral screws were inserted into the cranial and caudal vertebra using the MISF through the same LLIF trajectory. The radiological and clinical outcomes were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively. RESULTS: The median follow-up period was 13 months (range, 3–48 months). Transient sensory changes in the left anterior thigh occurred in 3 patients, and 1 patient experienced subjective weakness; however, these symptoms normalized within 1 week. Back and leg pain were significantly improved (p<0.05). In the radiological analysis, both the segmental angle at the operated segment and anterior disc height were significantly increased. At 6 months postoperatively, solid bony fusion was confirmed in 7 patients. Subsidence and mechanical failure did not occur in any patients. CONCLUSION: This study demonstrates that LLIF and in situ lateral screw fixation may be an alternative surgical option for rostral lumbar adjacent segment disease.
Constriction, Pathologic* ; Follow-Up Studies ; Humans ; Leg ; Minimally Invasive Surgical Procedures ; Reoperation ; Retrospective Studies ; Spinal Fusion ; Spinal Stenosis ; Spine* ; Thigh

PURPOSE: Local excision, including transanal endoscopic microsurgery (TEM), has become an alternative to the classic radical operation for early rectal cancer. However, radical resection for rectal cancer is necessary for advanced tumor, poor differentiation, a narrow resection margin, and positive lymphovascular invasion. This study presents the factors related to recurrence in patients who required secondary radical surgery after TEM, but did not undergo the operation. METHODS: From November 1994 to December 2004, 167 patients underwent TEM for rectal cancer. Thirty-six of those patients were included in this study. Inclusion criteria were poor differentiation, a mucinous carcinoma, invasion to a proper muscle layer, lymphovascular invasion, and a positive resection margin. RESULTS: Twelve of the 36 patients underwent a secondary radical operation, but 24 of them did not due to poor general condition or refusal. One of 12 patients (8.3%) who underwent a secondary radical operation had a systemic recurrence. Five of 24 patients (20.8%) who did not receive surgery had recurrences; 3 of 5 were local recurrence, and the others were distant metastases. Among the 24 patients who did not undergo a secondary radical operation, there were no recurrences in 2 cases of poor differentiation or mucinous carcinoma and in 2 cases of positive resection margin. There were 2 cases of recurrences in the 7 patients (25.0%) who had lymphovascular invasion, 1 case in the 1 patient (100%) who had a T3 lesion, 3 cases in the 17 patients (12.5%) who had T2 lesions. CONCLUSIONS: In high-risk patients, TEM followed by radical surgery is most beneficial in preventing local recurrence. A radical operation is strongly recommended especially if pathologic results after TEM shows T3 lesions or lymphovascular invasion.
Adenocarcinoma, Mucinous ; Disulfiram ; Humans ; Microsurgery* ; Neoplasm Metastasis ; Rectal Neoplasms* ; Recurrence

BACKGROUND: Admission blood glucose (BG) level is a predictor of mortality in critically ill patients with various conditions. However, limited data are available regarding this relationship in critically ill patients with cardiovascular diseases according to diabetic status. METHODS: A total of 1,780 patients (595 with diabetes) who were admitted to cardiac intensive care unit (CICU) were enrolled from a single center registry. Admission BG level was defined as maximal serum glucose level within 24 hours of admission. Patients were divided by admission BG level: group 1 (< 7.8 mmol/L), group 2 (7.8–10.9 mmol/L), group 3 (11.0–16.5 mmol/L), and group 4 (≥ 16.6 mmol/L). RESULTS: A total of 105 patients died in CICU (62 non-diabetic patients [5.2%] and 43 diabetic patients [7.9%]; P = 0.105). The CICU mortality rate increased with admission BG level (1.7%, 4.8%, 10.3%, and 18.8% from group 1 to group 4, respectively; P < 0.001). On multivariable analysis, hypertension, mechanical ventilator, continuous renal replacement therapy, acute physiology and chronic health evaluation II (APACHE II) score, and admission BG level significantly influenced CICU mortality in non-diabetic patients (group 1 vs. group 3: hazard ratio [HR], 3.31; 95% confidence interval [CI], 1.47–7.44; P = 0.004; group 1 vs. group 4: HR, 6.56; 95% CI, 2.76–15.58; P < 0.001). However, in diabetic patients, continuous renal replacement therapy and APACHE II score influenced CICU mortality but not admission BG level. CONCLUSION: Admission BG level was associated with increased CICU mortality in critically ill, non-diabetic patients admitted to CICU but not in diabetic patients.
APACHE ; Blood Glucose ; Cardiovascular Diseases ; Critical Care ; Critical Illness ; Diabetes Mellitus ; Humans ; Hypertension ; Intensive Care Units ; Mortality ; Prognosis ; Renal Replacement Therapy ; Ventilators, Mechanical

BACKGROUND: We investigated the effect of donor marrow T cell depletion, administration of FK506, cyclosporin A (CSA), and 3-deazaadenosine (DZA) on graft versus host disease (GVHD) after allogeneic murine hematopoietic stem cell transplantation (HSCT). METHODS: We used 4 to 6 week old Balb/c (H-2(d), recipient), and C3H/He (H-2(k), donor) mice. Total body irradiated recipients received 1x10(7) bone marrow cells (BM) and 0.5x10(7) splenocytes of donor under FK506 (36 mg/kg/day), CSA (5 mg/kg/day, 20 mg/kg/day), and DZA (45 mg/kg/day), which were injected intraperitoneally from day 1 to day 14 daily and then three times a week for another 2 weeks. To prevent the GVHD, irradiated Balb/c mice were transplanted with 1x10(7) rotor-off (R/O) cells of donor BM. The severity of GVHD was assessed daily by clinical scoring method. RESULTS: All experimental groups were well grafted after HSCT. Mice in experimental group showed higher GVHD score and more rapid progression of GVHD than the mice with R/O cells (R/O group) (p<0.01). There were relatively low GVHD scores and slow progressions in FK506 and low dose CSAgroups than high dose CSA group (p<0.01). The survival was better in FK506 group than low dose CSA group. All mice treated with CSA died within 12 days after HSCT. The GVHD score in DZA group was low and slow in comparison with control group (p<0.05), but severity and progression were similar with low dose CSA group (p=0.11). All mice without immunosuppressive treatment died within 8 days, but all survived in R/O group (p<0.01). Survival in low dose CSA group was longer than in control group (p<0.05), but in high dose CSA group, survival was similar to control group. The survival benefit in DZA group was similar with low dose CSA group. FK506 group has the best survival benefit than other groups (p<0.01), comparable with R/O group (p=0.18), although probability of survival was 60%. CONCLUSION: We developed lethal GVHD model after allogeneic murine HSCT. In this model, immunosuppressive agents showed survival benefits in prevention of GVHD. DZA showed similar survival benefits to low dose CSA. We propose that DZA can be used as a new immunosuppressive agent to prevent GVHD after allogeneic HSCT.
Animals ; Bone Marrow ; Bone Marrow Cells ; Cyclosporine* ; Graft vs Host Disease* ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Immunosuppressive Agents ; Mice ; Research Design ; Tacrolimus* ; Tissue Donors ; Transplants

BACKGROUND: Pneumocytitis cainii pneumonia (PCP) can occur in immunocompromised hosts especially such as AIDS or cancer patients. Although recent research had focused on PCP in AIDS patients, few studies have described the clinical presentations of PCP in recipients of stem cell transplantation (SCT). We evaluated the clinical manifestations of PCP in SCT patients admitted at St. Mary's hospital, Seoul, Korea. METHODS: The medical records of 17 PCP patients undergoing SCT between Feb. 1998 and Feb. 2000 were reviewed. The diagnosis of PCP was confirmed through the demonstration of Pneumocystis carinii via either cytology of brochoalveolar lavage (BAL) or histological technique of lung biopsy. CMV disease and CMV infection were confirmed by BAL culture and antigenemia respectively. RESULTS: Seventeen patients were all recipients of allogeneic SCT and 7 of 17 patients were performed non-sibling SCT. Patients presented with symptoms including brief period (4~23 days) of fever (76%), dyspnea (70%), cough (64%), and signs such as rale (58.8%). Sixteen patients (94%) had been receiving immunosuppressive agent such as cyclosporine A (64%) or FK506 (35%) without PCP prophylaxis. Eleven patients (64%) were treated with corticosteroid with mean dose of 16 mg/day prednisolone and mean duration of 4.6 months after post-SCT period. Twelve patients were co-infected with CMV. Another co-infected microorganisms were Pseudomonas aeruginosa, Mycobacterium tuberculosis, herpes simplex virus, parainfluenza virus. Average duration of treatment with trimethoprim-sulfamethoxazole (TMP/SMX) was 21+/-9 days. Four patients died, and three of them were related with PCP. CONCLUSION: PCP developed frequently in patients who were taking immunosuppressive drug due to graft versus host disease or were not taking TMP/SMX prophylaxis. High risk patients showing fever, cough, or dyspnea should be considered to take early bronchoscopic intervention for detection of PCP. When treat for PCP, it also be considered to the possibility of co- infection such as CMV.
Biopsy ; Cough ; Cyclosporine ; Cytomegalovirus ; Diagnosis ; Dyspnea ; Fever ; Graft vs Host Disease ; Histological Techniques ; Humans ; Immunocompromised Host ; Korea ; Lung ; Medical Records ; Mycobacterium tuberculosis ; Paramyxoviridae Infections ; Pneumocystis carinii* ; Pneumocystis* ; Pneumonia ; Pneumonia, Pneumocystis* ; Prednisolone ; Pseudomonas aeruginosa ; Respiratory Sounds ; Seoul ; Simplexvirus ; Stem Cell Transplantation* ; Stem Cells* ; Tacrolimus ; Therapeutic Irrigation ; Trimethoprim, Sulfamethoxazole Drug Combination