Among patients scheduled for elective thoracic surgery at the Medical Center of Kyung Hee University, 15 patients undergoing lobectomy or pneumonectomy were selected. Three different ventilatory modes were employed and compared to the two-lung ventilation with 50% oxygen (control). First, patients were ventilated with 50% oxygen and left the unventilated lung to deflate during one lung ventilation (test 1). Second, continuous positive airway pressure (CPAP) of 10 cmH2O was applied to the ventilated lung while patients were under one lung ventilation with 50% oxygen (test 2). Lastly, patients were ventilated with 100% oxygen and unventilated lung was left to deflate during one lung ventilation (test 3). PaO2, A-aDO2 and Qsp/QT of three different ventilatory modes were observed and compared to that of control, and that of test 2 to test 1. The results were as followed: 1) Mean PaO2 in test 1 and test 2 were 98+/-24.0 mmHg and 126+/-34.8 mmHg, respectively and were significantly decresed as compared to the PaO2 of control, 234+/-21.4 mmHg. Comparing the PaO2 of test 1 and test 2, there was statistically significant increase in test 2 (P<0.01). 2) Comparing with A-aDO2 of control (68+/-22.5 mmHg), A-aDO2 in both test 1 and test 2 were significantly increased to 210+/-24.3 mmHg and 184+/-33.4 mmHg, respectively. there was significantly decreased in test 2 as compared to test 1 (P<0.01). 3) Shunt percentages (Qsp/QT) were measured as 8.3+/-2.3% in control, 25.4+/- 6.7% in test 1, 19.8+/-3.2% in test 2. Shunt percentages of test 1 and test 2 were increased significantly as compared to the control. Comparing the shunt percentages of test 1 and test 2, there was decreased in test 2 (P<0.01). Based on the above results, the application of appropriate CPAP to the unventilated lung during one lung ventilation is thought to be very effective in preventing hypoxemia. But, vigorous and meticulous monitoring, surveilance of patients and one lung ventilation with 100% oxygen are essential depending on the conditions of ventilated lung and long duration of one lung ventilation.
Anoxia ; Continuous Positive Airway Pressure ; Humans ; Lung* ; One-Lung Ventilation* ; Oxygen* ; Pneumonectomy ; Thoracic Surgery ; Ventilation

Nitric oxide synthases (NOSs) that catalyzed the conversion of L-arginine to nitric oxide and L-citrulline play a role in ischemic-reperfusion injury. The purpose of this study was to observe the expression patterns of nNOS, iNOS and eNOS in the rat tibialis anterior and soleus muscles after multiple cyclic episodes of ischemic preconditioning (IP). Nine weeks old male SD rats were divided into control and IP groups. The IP group was further divided into 3 groups based on cycle of IP. For IP, left commom iliac artery was occluded 3, 6 and 10 times for 5 minutes ischemia followed by 5 minutes reperfusion using rodent vascular clamps. The animals were sacrificed at 0, 3, 6, 24 and 72 hours of reperfusion and the left tibialis anterior and soleus muscles were removed. The expression of nNOS, iNOS and eNOS were examined with immunohistochemical methods and Western blot analysis. IP increased the expression of nNOS, compared with the control. In the tibialis anterior muscle, the levels of nNOS in the 3IP and 6IP were higher than that in 10IP. IP increased the expression of iNOS, compared with the control, and the levels of iNOS in tibialis anterior muscle were higher than that in soleus muscle. The level of iNOS in the 10IP was higher than those in the 3IP and 6IP. IP increased the expression of eNOS, compared with the control, and the level of eNOS in soleus muscle were higher than that in tibialis anterior muscle. At 0 and 3 hours after reperfusion, the level of eNOS in 6IP and 10IP were higer than that in 3IP. In summary, these results suggest that the ischemic preconditioning increases the expression of nNOS, iNOS and eNOS, and 10 times of ischemic preconditioning may induce ischemic injury through upregulation of iNOS. And tibialis anterior muscle is more susceptabile to ischemic injury than soleus muscle.
Animals ; Arginine ; Blotting, Western ; Humans ; Iliac Artery ; Ischemia ; Ischemic Preconditioning* ; Male ; Muscle, Skeletal ; Muscles* ; Nitric Oxide Synthase* ; Nitric Oxide* ; Rats* ; Reperfusion ; Rodentia ; Up-Regulation

The objective of study was to evaluate the incidence and mortality rates of disasters and mass casualty incidents (MCIs) over the past 10 yr in the administrative system of Korea administrative system and to examine their relationship with population characteristics. This was a population-based cross-sectional study. We calculated the nationwide incidence, as well as the crude mortality and injury incidence rates, of disasters and MCIs. The data were collected from the administrative database of the National Emergency Management Agency (NEMA) and from provincial fire departments from January 2000 to December 2009. A total of 47,169 events were collected from the NEMA administrative database. Of these events, 115 and 3,079 cases were defined as disasters and MCIs that occurred in Korea, respectively. The incidence of technical disasters/MCIs was approximately 12.7 times greater than that of natural disasters/MCIs. Over the past 10 yr, the crude mortality rates for disasters and MCIs were 2.36 deaths per 100,000 persons and 6.78 deaths per 100,000 persons, respectively. The crude injury incidence rates for disasters and MCIs were 25.47 injuries per 100,000 persons and 152 injuries per 100,000 persons, respectively. The incidence and mortality of disasters/MCIs in Korea seem to be low compared to that of trend around the world.
Cross-Sectional Studies ; Databases, Factual ; Disasters/*statistics & numerical data ; Humans ; Incidence ; Mass Casualty Incidents/*mortality ; Republic of Korea/epidemiology

PURPOSE: The goal of this study was to improve the accuracy of three-dimensional conformal radio therapy (3-D CRT) by measuring the treatment setup error and physiological movement of liver based on the analysis of images which were obtained by electronic portal imaging device (EPID). MATERIALS AND METHODS: For 10 patients with hepatocellular carcinoma, 4-7 portal images were obtained by using EPID during the radiotherapy from each patient daily. We analyzed the setup error and physiological movement of liver based on the verification data. We also determined the safety margin of the tumor in 3-D CRT through the analysis of physiological movement. RESULTS: The setup errors were measured as 3 mm with standard deviation 1.70 mm in x direction and 3.7 mm with standard deviation 1.88 mm in y direction respectively. Hence, deviation were smaller than 5 mm from the center of each axis. The measured range of liver movement due to the physiological motion was 8.63 mm on the average. Considering the motion of liver and setup error, the safety margin of tumor was at least 15 mm. CONCLUSION: EPID is a very useful device for the determination of the optimal margin of the tumor, and thus enhance the accuracy and stability of the 3-D CRT in patients with hepatocellular carcinoma.
Axis, Cervical Vertebra ; Carcinoma, Hepatocellular* ; Humans ; Liver* ; Radiotherapy

PURPOSE: The aim of this study was to evaluate the characteristics of Emergency Medical Service (EMS) provider responded chemical, biological, radiological, and nuclear (CBRN) incidents in Korea. METHODS: Nationwide EMS rescue records from Jan 2012 to Dec 2014 were analyzed. All EMS rescue records were integrated according to the unique accident ID. Cases related to animal rescue, hive removal, and suicide-related were excluded. CBRN-associated keywords were extracted by literature review and pilot survey. In-depth review of cases containing CBRN-associated keywords in the activity summary were conducted by trained emergency medical technicians, and predefined information was abstracted. Descriptive analyses were performed to characterize the EMS provider responded CBRN incidents. RESULTS: A total of 1,571,293 cases were included, and 1,335,205 cases had a unique accident ID; 515,417 cases were excluded because of their association with animal rescue, hive removal, and suicide attempts; 19,663 cases contained CBRN-associated keywords in the activity summary, and in-depth review identified 1,862 cases as CBRN incidents. Among them 1,856 cases were chemical incidents, and 6 cases were radiological incidents; 144 cases were resulted to victims. In chemical incidents, ammonia, hydrogen chloride, sulfuric acid, hydrogen fluoride, and nitric acid were the top 5 toxic substances. In chemical incidents with victims, the proportion of explosion/implosion, and suffocation in sealed space was more prevalent than chemical incidents without victims. Median scene time of all CBRN incidents was 41 minutes (interquartile range 18.0-57.0). CONCLUSION: We evaluated the characteristics of CBRN incidents responded by EMS in Korea.
Ammonia ; Animals ; Asphyxia ; Biohazard Release ; Chemical Hazard Release ; Emergencies* ; Emergency Medical Services* ; Emergency Medical Technicians ; Humans ; Hydrochloric Acid ; Hydrofluoric Acid ; Korea ; Nitric Acid ; Radioactive Hazard Release ; Suicide ; Sulfur

Somatostatinoma is a rare form of neuroendocrine tumor that was first described in 1977. Most tumors have involved the pancreas, and gastrointestinal tract involvement is rare. Somatostatinomas of the ampulla of Vater are extremely rare and present distinct clinical and pathologic differences. Pancreatic somatostatinoma has been associated with a clinical syndrome of dyspepsia, mild diabetes, cholelithiasis, steatorrhea, and hypochlorhydria, but duodenal somatostatinoma, in general, has been clinically silent. A further contrast is that duodenal carcinoid tumors, mainly gastrinoma, tended to be benign, whereas ampullary carcinoid tumors, mainly somatostatinoma, exhibited malignant behavior. Therefore, definite diagnosis is important for treatment and prognosis, and is performed by image study, immunohistochemistry and electron microscopic examination. We report a case of somatostatinoma of the ampulla of Vater in a 51-year-old male. He complained of generalized abdominal pain for a few days. Gastrofiberscopically, a 1.2 cm sized bulging mass was observed on the ampulla of Vater. Radiologically, on abdomen CT, a protruding enhancing mass was revealed in the duodenum. In octreoscan, there was an abnormal focus off increased radiouptake in the infrahepatic area. He underwent a pancreatoduodenectomy. Grossly, the mass was an intraluminary protruding polypoid submucosal mass with focal ulceration in the ampulla of Vater. Histologically, it showed well-differentiated nonpleomorphic tubular cell nest and psammoma bodies. Immunohistochemically, the tumor cells showed a neuroendocrine nature with synaptophysin immunostain and intense staining only for somatostatin.
Abdomen ; Abdominal Pain ; Achlorhydria ; Ampulla of Vater* ; Carcinoid Tumor ; Cholelithiasis ; Diagnosis ; Duodenum ; Dyspepsia ; Gastrinoma ; Gastrointestinal Tract ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Neuroendocrine Tumors ; Pancreas ; Pancreaticoduodenectomy ; Prognosis ; Somatostatin ; Somatostatinoma* ; Steatorrhea ; Synaptophysin ; Ulcer

Inflammatory bowel disease, such as ulcerative colitis and Crohn's disease, has a potential risk of developing into colorectal cancer. However, there is little relationship between intestinal tuberculosis and colon cancer because intestinal tuberculosis is a curable disease and has a relatively short disease course. Nevertheless, there have been a few case reports of intestinal tuberculosis associated with colon cancer. There was a case report in which the carcinoma facilitated entry of tubercle bacilli with development of a secondary infection, and ulcerative lesions of tuberculosis may be precursors of carcinomas. We experienced a 77-year-old woman who had intestinal tuberculosis combined with ascending colon cancer. She visited our hospital because of abdominal pain and constipation. Colonoscopy showed a luminal obstruction mass in the ascending colon. Histologic examination revealed an adenocarcinoma. After surgery, the surgical specimen disclosed an adenocarcinoma in the cecum and ascending colon and intestinal tuberculosis around the cancer site of the cecum. Herein, we report a rare case of colon cancer co-existing with colonic tuberculosis with a review of the literature.
Female ; Humans ; Adenocarcinoma

Venomous snakes are estimated to inflict 400,000 bites annually, resulting in approximately 40,000 deaths. There are nearly 3,500 known species of snakes worldwide, and three species exist in Korea. Venom contains toxins that effect the cardiovascular system, the kidneys, the respiratory system and the muscles. There are many modalities in treating snake bites, but most of all, neutralization of the venom is the most important. however, many doctors in Korea hesitate in using antivenom. The reason is that there are no specific antivenoms against Korean venous snakes. In this case, a 2-year-old female child with a snake bite vistied our hospital Korea via a local clinic. Severe systemic symptoms and local symptoms, including compartment syndrome, were observed. When we tried antivenom, the result was satisfactory.
Agkistrodon* ; Antivenins ; Cardiovascular System ; Child ; Child, Preschool ; Compartment Syndromes ; Female ; Humans ; Kidney ; Korea ; Muscles ; Respiratory System ; Snake Bites* ; Snakes* ; Venoms

PURPOSE: Overexpression of the protein tyrosine phosphatase (PRL-3) is elevated in liver metastases derived from colorectal cancer. We examined PRL-3 expression in the primary lesion of colorectal cancer patients and investigated its relation to clinicopathological features. METHODS: A total of 63 randomly selected patients who underwent surgical resection for colorectal cancer between May 2001 and June 2005 at our hospital were investigated. Formalin-fixed and paraffin-embedded specimens from colorectal cancer patients who underwent surgical resections for primary tumors were collected. The expression of PRL-3 was detected by immunohistochemistry and the relation with age, sex, primary tumor size, tumor cell differentiation, depth of invasion, microscopic lymph node metastases, vascular invasion, numbers of lymph node metastases, postoperative stage, and postoperative survival time were analyzed. RESULTS: A total of 16 of the 63 colorectal cancer patients were detected with liver metastases during the follow-up periods. Liver resection was performed for those liver metastases patients. Five patients developed lung metastases after liver resection. PRL-3 expression was detected in 46 colorectal cancer patients. Fourteen patients with lymphatic invasion had positive expression of PRL-3 that was significant (P=0.042). The incidence of PRL-3 expression in the T stage was significant (P=0.019). Moreover, PRL-3 expression was closely associated with liver metastases (P=0.048). CONCLUSIONS: These results indicate that an investigation of PRL-3 expression in primary colorectal cancer lesions may contribute to the detection of occult liver metastases and to a differentiation between postoperative management strategies.
Cell Differentiation ; Colonic Neoplasms ; Colorectal Neoplasms* ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Incidence ; Liver ; Lung ; Lymph Nodes ; Neoplasm Metastasis ; Protein Tyrosine Phosphatases ; Rectal Neoplasms

In order to assess the effects of radiofrequency-induced local hyperthermia on the normal liver, histopathologic findings and biochemical changes after localized hyperthemia in canine liver were studied. Hyperthermia was externally administered using the Thermotron RF-8 (Yamamoto Vinyter Co., Japan; Capacitive type heating machine) with parallel opposed electrodes. Thirteen dogs were used and allocated into one control group (N=3) and two treatment groups according to the treatment temperature. GroupI(N=5) was heated with 42.5+/-0.5degree C for 30 minutes, and GroupII(N=5) was heated with 45+/-0.5degree C for 15-30 minutes. Samples of liver tissue were obtained through a needle biopsy immediately afterhyperthermia and 7, 14 and 28 days after treatment and examined for SGOT, SGPT and alkaline phosphatase. Although SGOT and SGPT were elevated after hyperthermia in both groups (three of five in each group), there was no liver cell necrosis or hyperthermia related mortality in GroupI. A hydropic swelling of hepatocytes was prominent histologic finding. Hyperthermia with 45degree C for 30 minutes was fatal and showed extensive liver cell necrosis. In conclusion, liver damage day heat of 42.5+/-0.5degree C for 30 minutes is reversible, and liver damage by heat of 45+/-0.5degree C for 30 minutes can be fatal or irreversible. However, these results cannot be applied directly to human trial. Therefore, in order to apply hyperthermic treatment on human liver tumor safely, close observation of temperature with proper thermometry is mandatory. Hyperthermic treatment should be confined to the tumor area while sparing a normal liver as much as possible.
Alanine Transaminase ; Alkaline Phosphatase ; Animals ; Aspartate Aminotransferases ; Biopsy, Needle ; Dogs ; Electrodes ; Fever ; Heating ; Hepatocytes ; Hot Temperature ; Humans ; Hyperthermia, Induced* ; Japan ; Liver* ; Mortality ; Necrosis ; Thermometry