Pillows are known to contain significant levels of indoor allergens and endotoxin, that are of importance to house dust mite sensitized asthmatics. Buckwheat pillows are commonly used in Korea. We studied the levels of the house dust mite allergen, Der f 1, and endotoxin on new synthetic and buckwheat pillows and their accumulation over three months. Endotoxin levels were significantly higher on new buckwheat pillows compared to synthetic pillows; geometric mean levels (95% CI) were 60,950 EU/g (30,270-122,700) and 4,887 EU/g (2,570-9,311) respectively (p<0.001). No Der f 1 was detected on the new pillows. After three months Der f 1 levels were similar on buckwheat and synthetic pillows, geometric mean levels (95% CI) were 1.16 microgram/g (0.02-8.13) and 1.08 microgram/g (0.19-1.68) respectively. These results indicate that buckwheat pillows are a source of very high endotoxin levels that may be of relevance to asthma severity of atopic asthmatics.
Allergens/*immunology ; Animals ; Antigens, Dermatophagoides/*immunology ; Asthma/immunology ; *Bedding and Linens ; *Buckwheat ; Dermatophagoides farinae/immunology ; Endotoxins/*immunology ; Humans ; Korea ; Research Support, Non-U.S. Gov't

PURPOSE: The purpose of this study was to determine whether obesity increases the risk of performing a laparoscopic resection for colorectal cancer. METHODS: Prospectively collected data were obtained for 103 patients who had undergone laparoscopic resection for colorectal cancer from September 2001 to August 2002. Patients who had had a previous abdominal operation, a total colectomy or an additional surgical procedure at the time of colon resection were excluded from the analysis. The patients were divided into two groups based on body mass index (BMI kg/m2): the normal group (BMI <25) and the obesity group (BMI 25). Intraoperative blood loss, operative time, conversion, length of hospital stay and complications were analyzed. RESULTS: Nineteen patients (25%) were obese. Operation time (183.2 min vs 202.1 min) and the blood loss (98.2 ml vs 168.2 ml) were significantly increased in the obese patients, but hospital discharge after surgery (11.7 days vs 11.9 days) and the morbidity rate (8.5% vs 5.3%) were not different between the groups. Conversion to the an open precedure occurred with one obese patient, but that was not related to obesity. In the analysis of the low anterior resection, blood loss (94.6 ml vs 186.6 ml) was significantly higher in obese patients, but no statistically significant differences existed for other surgical outcomes between the two groups. CONCLUSIONS: A laparoscopic resection for colorectal cancer can be safely performed in obese patients.
Body Mass Index* ; Colectomy ; Colon ; Colorectal Neoplasms* ; Humans ; Length of Stay ; Obesity ; Operative Time ; Prospective Studies

PURPOSE: This study aimed to assess the oncologic outcomes after a laparoscopic resection in rectal cancer patients with minimum 2-year follow-up. METHODS: Among the 312 patients undergoing a laparoscopic rectal cancer resection between Jan. 2000 and Dec. 2004 at Hansol Hospital, 110 patients who had been followed-up for longer than 24 months (mean 33, range 24~56) after the curative resection were included in this study. Two patients (1.8%) received preoperative chemoradiation. Five patients (4.5%) received radiotherapy postoperatively. RESULTS: TNM stage was 0 in 5 patients, I in 25 (22.7%), II in 35 (31.8%), and III in 45 (40.9%). The T stage was as follows; Tis:T1:T2:T3:T4=4.5%:3.6%:25.5%:40.9%:25.5%. A protective ileostomy was performed in nine patients. The mean operative time was 208 minutes, and the mean blood loss was 179 ml. The mean number of removed lymph nodes was 18, and the mean distal margin was 3.0 cm. The radial margin was positive in one case. Conversion was required in three cases (2.7%). The overall morbidity rate was 17.2%. Anastomotic leak age occurred in five patients (5.5%). There was no operative mortality. During 33 months of mean follow-up, distant metastases and local recurrence were seen in 17 (15.5%) and 5 patients (4.5%), respectively. None had port-site recurrence. For the 94 patients with rectal cancer within 12 cm from the anal verge, the rate of local recurrence was 5.3%. The overall survival rate was 88.9% at 3 years (stage 0, I: 100.0%, stage II: 100.0%, stage III: 72.6%). The disease free survival rate was 78.8% at 3 years (stage 0, I: 100.0%, stage II: 88.6%, stage III: 56.9%). CONCLUSIONS: A laparoscopic resection of rectal cancer provides an acceptable safety profile. If the highly selective indications for radiotherapy (6.3%) and the rather high volume of advanced cancers (stage III 40.9%, T3/4 66.4%) of this study are considered, a 4.5% local recurrence rate is promising. Optimal surgery for rectal cancer by using a laparoscopic technique may reduce the need for radiotherapy.
Anastomotic Leak ; Disease-Free Survival ; Follow-Up Studies* ; Humans ; Ileostomy ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Operative Time ; Radiotherapy ; Rectal Neoplasms* ; Recurrence ; Survival Rate

No abstract available.
Leukemia, Myeloid, Acute*

Delftia acidovarans is aerobic, nonfermentative Gram-negative rod commonly found in soil and water. Generally it is nonpathogenic but it unusually can cause bacteremia in immunocompromised patients. We present a case of peritonitis due to D. acidovorans in a patient on continuous ambulatory peritoneal dialysis. A 75-year-old woman was admitted with abdominal pain and cloudy peritoneal effluent. She was empirically treated with intraperitoneal (IP) cefazolin and ceftazidime, and then IP ceftazidime and oral ciprofloxacin, but peritonitis did not improve. Seven days after admission, D. acidovorans was identified from the peritoneal effluent, which was sensitive to amikacin, ceftazidime, ciprofloxacin and imipenem. Catheter removal was considered with regard to poor response to adequate antibiotics; however, 4 days after changing to IP imipenem/cilastatin, abdominal pain, the leukocyte count of peritoneal effluent and C-reactive protein decreased. She was treated with imipenem/cilastatin for two weeks and discharged with the dialysis catheter intact.
Abdominal Pain ; Aged ; Amikacin ; Bacteremia ; C-Reactive Protein ; Catheters ; Cefazolin ; Ceftazidime ; Ciprofloxacin ; Delftia ; Delftia acidovorans ; Dialysis ; Female ; Humans ; Imipenem ; Immunocompromised Host ; Leukocyte Count ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Soil

BACKGROUND AND OBJECTIVE: Epidermal growth factor receptor(EGFR) and TGF beta1 have been known as a central regulator in airway remodeling. There have been some reports demonstrating expression of EGFR and TGF beta1 in airway mucosa of asthmatic patients. However, the expression of EGFR and TGF beta1 in bronchial epithelium of TDI-induced asthmatics has not been observed. The aim of this study was to observe expression of EGFR and TGF beta1 and evaluate their roles in pathogenic mechanism of TDI-induced asthma. METHODS: EGFR and TGF beta1 expression were compared using immunohistochemistry technique in bronchial mucosa from 22 subjects with TDI-induced asthma(group I: 10 newly diagnosed, group II: 12 TDI-induced asthma patients with persistent asthma symptoms for more than 5 years after diagnosis), 7 non-asthmatics undergoing pneumonectomy from lung tumor, and 3 healthy subjects. The intensity of expression was analyzed by two observers. The grade of intensity was presented from 0 to 3. Subepithelial basement membrane (SBM) thickness was measured using an image analyzer. RESULTS: EGFR expression was significantly higher in asthmatic patients than in wntrois (p>0.05), while no significant difference were nosed in TGF beta1 expression (p>0.05). There was no significant difference in EGFR expression between group I and II (p>0.05). However, grade of TGF beta1 expression was significantly higher in group II than those of group I (p<0.05). There was a significant difference in EGFR/TGF beta1 ratio between between group I and II (2.31+/-0.27 vs 1.28+/-0.11, p<0.05). SBM thickness of TDI-induced asthma was significantly higher than those of non-asthmatics (p<0.05), while there was no significant difference between group I and II (p>0.05). CONCLUSION: These findings suggest that EGFR and TGF beta1 may contribute to pathogenesis of TDI-induced asthma. However, further studies are required to evaluate the role of EGFR and TGF beta1 in the pathogenesis of TDI-induced asthma.
Airway Remodeling ; Asthma* ; Basement Membrane ; Epidermal Growth Factor* ; Epithelium ; Humans ; Immunohistochemistry ; Lung ; Mucous Membrane* ; Nose ; Pneumonectomy ; Receptor, Epidermal Growth Factor* ; Toluene 2,4-Diisocyanate* ; Toluene* ; Transforming Growth Factor beta1* ; Transforming Growth Factors*

PURPOSE: To investigate whether changes in plasma concentrations of transforming growth factor-beta1 (TGF-beta1), tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) could be used to identify the development of radiation-induced pneumonitis in the lung cancer patients. METHODS AND MATERIALS: Seventeen patients with lung cancer (11 NSCLC, 6 SCLC) were enrolled in a prospective study designed to evaluate clinical and molecular biologic correlation of radiation-induced pneumonitis. The study began in May 1998 and completed in July 1999. All patients were treated with radiotherapy with curative intent : 1.8 Gy per day, 5 fractions per week. Serial measurements of plasma TGF-beta1, TNF-alpha and IL-6 were obtained in all patients before, weekly during radiotherapy and at each follow-up visits after completion of treatment. These measurements were quantified using enzyme linked immunosorbent assay (ELISA). All patients were evaluated for signs and symptoms of pneumonitis at each follow-up visit after completion of radiotherapy. High resolution CT (HRCT) scans were obtained when signs and symptoms of pneumonitis were developed after completion of radiotherapy. RESULTS: Thirteen patients eventually developed signs and symptoms of clinical pneumonitis while four patients did not. TGF-beta1 levels were elevated in all 13 patients with pneumonitis, which showed characteristic pattern of elevation (38.45 ng/ml at pretreatment, 13.66 ng/ml during radiotherapy, then 60.63 ng/ml at 2-4 weeks after completion of radiotherapy). The levels of TNF-alpha and IL-6 were also elevated in the group of patients who developed pneumonitis but the pattern was not characteristic. CONCLUSIONS: Changes in plasma TGFbeta-1 levels before, during and after radiotherapy appears to be a useful means by which to identify patients at risk for the development of symptomatic pneumonitis. Other cytokines like TNF-alpha and IL-6 shows no meaningful changes in association with radiation pneumonitis.
Cytokines* ; Enzyme-Linked Immunosorbent Assay ; Follow-Up Studies ; Humans ; Interleukin-6 ; Lung Neoplasms* ; Lung* ; Plasma* ; Pneumonia* ; Prospective Studies ; Radiation Pneumonitis ; Radiotherapy ; Transforming Growth Factor beta1 ; Tumor Necrosis Factor-alpha

BACKGROUND: In elderly asthmatics, underdiagnosis is one of the most important feature. The main reason of underdiagnosis is thought to be decreases in complaining of symptoms by reduction of intellectual faculties or physical activity. Among various symptoms, wheezing is the principal clue in diagnosing bronchial asthma, and decreases in wheezing complaints are also noted in elderly asthmatics. The objective of this study is to determine whether decreases in wheezing complaints in elderly asthmatic is due to decrease in the development of wheezing or decrease in the perception of wheezing. METHODS: Sixty one young(20-39 years old), 68 middle aged(40-59 years old), and 65 elderly(older than 60 years) stable asthmatic subjects were studied. During methacholine challenge test, lung auscultation and questionnaire survey about presence and perception of wheezing were conducted. RESULTS: One hundred sixty nine patients (87%) developed wheezing during the methacholine challenge test. Development of wheezing during methacholine challenge test was not different between groups. The methacholine concentration, % fall in FEV1, and FEV1% at first detection of wheezing were not different between groups. Among the patients who developed wheezing, 47 patients (90%), 42 patients (74%), and 26 patients (46%) felt wheezing in young, middle, and old age groups, respectively. CONCLUSION: In conclusion, the perception of wheezing are more decreased in elderly asthmatics compared to those in younger patients.
Aged* ; Asthma ; Auscultation ; Humans ; Lung ; Methacholine Chloride ; Motor Activity ; Respiratory Sounds* ; Surveys and Questionnaires

Spontaneous arterial bleeding has been reported rarely. In a patient consuming heavy amounts of alcohol with alcoholic liver cirrhosis, spontaneous bleeding can be evoked by thrombocytopenia, altered platelet function, and shear stress on fully dilated arteries by portal hypertension. Alcohol consumption itself can also predispose a patient to bleeding by influencing the aggregation and activation of platelets, and altering the coagulation and fibrinolysis pathway. All of these mechanisms could cause patients with alcoholic liver cirrhosis to bleed spontaneously; however, conditions inducing peripheral arterial bleeding are very rare. Here, we report three cases of spontaneous arterial bleeding in patients with liver cirrhosis consuming heavy amounts of alcohol. All of the patients bled without any physical trauma, and the involved arteries were the intercostal arteries in two cases and a gastroduodenal artery in the other case. The patients were treated by angiographic embolization. One expired due to recurrence of arterial bleeding despite repeated angiographic embolization and massive transfusion.
Alcohol Drinking ; Arteries ; Blood Platelets ; Embolization, Therapeutic ; Fibrinolysis ; Hemorrhage* ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Liver Cirrhosis, Alcoholic* ; Recurrence ; Thrombocytopenia

BACKGROUND: When patients with chronic respiratory symptoms have a normal spirometry result, it is not always easy to consider bronchial asthma as the preferential diagnosis. Forced expiratory flow between 25% and 75% of vital capacity (FEF(25~75%)) is known as a useful diagnostic value of small airway diseases. However, it is not commonly used, because of its high individual variability. We evaluated the pattern of bronchodilator responsiveness (BDR) and the correlation between FEF25~75% and BDR in patients with suspicious asthma and normal spirometry. METHODS: Among patients with suspicious bronchial asthma, 440 adult patients with a normal spirometry result (forced expiratory volume in one second [FEV1]/forced vital capacity [FVC] > or =70% & FEV1% predicted > or =80%) were enrolled. We divided this group into a positive BDR group (n=43) and negative BDR group (n=397), based on the result of BDR. A comparison was carried out of spirometric parameters with % change of FEV1 after bronchodilator (DeltaFEV1%). RESULTS: Among the 440 patients with normal spirometry, FEF(25~75%)% predicted were negatively correlated with DeltaFEV1% (r=-0.22, p<0.01), and BDR was positive in 43 patients (9.78%). The means of FEF(25~75%)% predicted were 64.0+/-14.5% in the BDR (+) group and 72.9+/-20.8% in the BDR (-) group (p<0.01). The negative correlation between FEF(25~75%)% predicted and DeltaFEV1% was stronger in the BDR (+) group (r=-0.38, p=0.01) than in the BDR (-) group (r=-0.17, p<0.01). In the ROC curve analysis, FEF(25~75%) at 75% of predicted value had 88.3% sensitivity and 40.3% specificity for detecting a positive BDR. CONCLUSION: BDR (+) was not rare in patients with suspicious asthma and normal spirometry. In these patients, FEF(25~75%)% predicted was well correlated with BDR.
Adult ; Asthma ; Bronchodilator Agents ; Humans ; ROC Curve ; Spirometry ; Vital Capacity