BACKGROUND: c-erbB-1 (epidermal growth factor receptor) and c-erbB-2 oncoprotein have common tyrosine kinase activities, and alteration in their expression has been defined in various visceral tumors. However, relatively little is known about their expression in skin tumors. OBJECTIVE: Our aim was to evaluate the distribution and expression pattern of c-erbB-1 and c-erbB-2 in skin neoplasms. METHODS: We have undertaken an immunohistochemical survey of c-erbB-1 and c-erbB-2 in the tissue specimens of keratoacanthoma (KA), actinic keratosis (AK), squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). RESULTS: Membranous c-erbB-1 expression had a tendency to be down-regulated in some specimens of SCC and dysplastic portions of AK. In invasive lesions of SCC, we observed increased cytoplasmic accumulation of c-erbB-1. Most specimens of BCC showed rather decreased expression of c-erbB-1 compared with other skin tumors. c-erbB-2 oncoprotein showed strong cytoplasmic staining in SCC, especially in the invasive tumor mass, and in some deeply dysplastic or hyperplastic portions of AK, though the difference of intensity was not striking between tumors. BCC revealed relatively weaker expression of c-erbB-2 than other skin tumors, which was similar in pattern to c-erbB-1. CONCLUSION: The expression patterns of c-erbB-1 and c-erbB-2 are altered in various skin neoplasms, and seem to be related to the dysplastic status or differentiation level of tumor cells.
Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Cytoplasm ; Keratoacanthoma ; Keratosis, Actinic ; Protein-Tyrosine Kinases ; Skin Neoplasms ; Skin* ; Strikes, Employee

Necrotizing fasciitis, first described by Wilson in 1952, is one of the most dramatic infectious diseases which develops at the level of superficial fascia and involves the overlying dermis. Clinical diagnosis is often initially confused with cellulitis, and delay in the diagnosis and treatment is associated with high mortality in the range from 30% to 70%. Early diagnosis and prompt excision of all devitalized tissue are critical because any remaining necrotic tissue will continue the rapidly progressive infectious process. We, herein, report a 64-year-old man who was presented with a typical clinical course of necrotizing fasciitis.
Cellulitis ; Communicable Diseases ; Dermis ; Diagnosis ; Early Diagnosis ; Fasciitis, Necrotizing* ; Humans ; Middle Aged ; Mortality ; Subcutaneous Tissue

OBJECTIVES: To evaluate the occurrence of patient adverse events in Korean hospitals as perceived by nurses and examine the correlation between patient adverse events with the nurse practice environment at nurse and hospital level. METHODS: In total, 3096 nurses working in 60 general inpatient hospital units were included. A two-level logistic regression analysis was performed. RESULTS: At the hospital level, patient adverse events included patient falls (60.5%), nosocomial infections (51.7%), pressure sores (42.6%) and medication errors (33.3%). Among the hospital-level explanatory variables associated with the nursing practice environment, 'physician- nurse relationship' correlated with medication errors while 'education for improving quality of care' affected patient falls. CONCLUSIONS: The doctor-nurse relationship and access to education that can improve the quality of care at the hospital level may help decrease the occurrence of patient adverse events.
Accidental Falls ; Accidents, Occupational ; Adult ; Cross Infection/etiology ; Female ; Hospitals ; Humans ; Logistic Models ; Male ; Medication Errors ; Middle Aged ; Nurses/*psychology ; Odds Ratio ; Pressure Ulcer/etiology ; *Quality of Health Care ; Questionnaires

OBJECTIVES: To evaluate the occurrence of patient adverse events in Korean hospitals as perceived by nurses and examine the correlation between patient adverse events with the nurse practice environment at nurse and hospital level. METHODS: In total, 3096 nurses working in 60 general inpatient hospital units were included. A two-level logistic regression analysis was performed. RESULTS: At the hospital level, patient adverse events included patient falls (60.5%), nosocomial infections (51.7%), pressure sores (42.6%) and medication errors (33.3%). Among the hospital-level explanatory variables associated with the nursing practice environment, 'physician- nurse relationship' correlated with medication errors while 'education for improving quality of care' affected patient falls. CONCLUSIONS: The doctor-nurse relationship and access to education that can improve the quality of care at the hospital level may help decrease the occurrence of patient adverse events.
Accidental Falls ; Accidents, Occupational ; Adult ; Cross Infection/etiology ; Female ; Hospitals ; Humans ; Logistic Models ; Male ; Medication Errors ; Middle Aged ; Nurses/*psychology ; Odds Ratio ; Pressure Ulcer/etiology ; *Quality of Health Care ; Questionnaires

No abstract available.
Adenocarcinoma, Papillary* ; Thyroid Gland*

Spontaneous rupture of intrahepatic cholangiocarcinoma is rare due to its abundant fibrous stroma. We report our experience in a case of spontaneous rupture of intrahepatic cholangiocarcinoma in a pregnant patient. In our case, multiple hepatic masses with intratumoral hemorrhage were noted on post-delivery computed tomography and magnetic resonance imaging and they caused hemoperitoneum. A right hemi-hepatectomy was carried out to control the bleeding and the diagnosis of intrahepatic cholangiocarcinoma with metastasis was performed.
Bile Ducts, Intrahepatic ; Cholangiocarcinoma* ; Diagnosis ; Hemoperitoneum ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Pregnancy ; Rupture ; Rupture, Spontaneous*

The treatment of choice for post-intubation tracheal stenosis is partial tracheal resection and end-to-end anastomosis. The surgical treatment of tracheal restenosis that results from unsuccessful repair of post-intubation tracheal stenosis is not easy. Failed reoperation results in permanent tracheostomy and loss of voice. If the first operation fails, about 4~6 months of period for resolution of inflammatory reaction, edema, and fibrosis is needed. The exact evaluation of the patient's status is necessary and success rate of reoperation for the appropriate candidates is over 90%. We report the results of treatment in two cases of tracheal restenosis that resulted from unsuccessful repair of post-intubation tracheal stenosis with review of literatures.
Edema ; Fibrosis ; Reoperation ; Tracheal Stenosis* ; Tracheostomy ; Voice

This study was developed and validated for the determination of oxyclozanide residue concentrations in beef and commercial milk, using high-performance liquid chromatography system. Oxyclozanide was successfully separated on a reverse phase column (Xbridge-C18, 4.6x250 mm, 5 microm) with a mobile phase composed of acetonitrile and 0.1% phosphoric acid (60:40, v/v%). This analytical procedure involved a deproteinization process using acetonitrile for beef and 2% formic acid in acetonitrile for commercial milk, dehydration by adding sodium sulfate to the liquid analytical sample, and a defatting process using n-hexane; after these steps, the extract was exposed to a stream of nitrogen dryness. The final extracted sample was dissolved in the mobile phase and filtered using a 0.45 microm syringe filter. This method had good selectivity and recovery (70.70+/-7.90-110.79+/-14.95%) from the matrices. The LOQs ranged from 9.7 to 9.8 microg/kg for beef and commercial milk. The recoveries met the standards set by the CODEX guideline.
Acetonitriles ; Chromatography, High Pressure Liquid ; Chromatography, Liquid ; Dehydration ; Formates ; Milk ; Nitrogen ; Oxyclozanide ; Phosphoric Acids ; Rivers ; Sodium ; Sulfates ; Syringes

Multiple myeloma can usually be identified by non-traumatic vertebral fracture or signs of recurrent infection. Without these clinical signs, detection is unlikely. We briefly report a case of extraosseous multiple myeloma presenting as repeated intracranial bleeding and relapsing high fever. In doing so, we highlight the importance of subtle changes in laboratory findings. A 67-year-old man presented with spontaneous acute epidural hematoma, and hematoma evacuation was performed at the same site 3 times. A radiologic work-up failed to reveal any osseous lesions and he made a gradual recovery. In the meantime, he suffered unexplained fever up to 39oC despite normal chest and abdominal radiograms. Blood chemistry showed mild leukocytosis, high ESR and CRP, and a slightly elevated globulin. On his 15th hospital day, immunoglobulin studies confirmed the diagnosis of multiple myeloma. He was treated in the ICU for difficult breathing and uncontrolled fever. In spite of intensive critical care, his leukocyte count fell to below 2,000 and he died on postoperative day 28. Apparently normal laboratory and radiologic findings can hamper swift discovery and ultimate management of multiple myeloma. When there is unexplained repeated intracranial bleeding and accompanying fever, the possibility of hidden malignancy should be assessed to avoid delaying or missing treatment.
Aged ; Critical Care ; Fever ; Hematoma ; Hemorrhage ; Humans ; Immunoglobulins ; Leukocyte Count ; Leukocytosis ; Multiple Myeloma ; Respiration ; Respiratory Insufficiency ; Thorax

BACKGROUND AND OBJECTIVES: The change in QT dispersion (QTd) immediately after balloon angioplasty reflects the immediate impact of ischemia. We intended to analyze the immediate impact of ischemia on myocardial repolarization. MATERIALS AND METHODS: Forty-six patients who underwent percutaneous coronary intervention were enrolled. The standard 12-lead electrocardiogram (ECG) was recorded just before, during, and 1 minute, 5 minutes and 10 minutes after ballooning. QTd was determined by the difference between the maximum and minimum QT interval (QTi). We then calculated the corrected QTi (QTc) using Bazett's formula. QTd and QTi were compared according to the site of the ballooned vessel, number of ballooned vessels and history of acute myocardial infarction. RESULTS: QTd just before, during, and 1 minute, 5 minutes and 10 minutes after ballooning were 35.21+/-10.36 msec, 54.56+/-16.89 msec, 50.91+/-14.20 msec, 45.52+/-9.6 msec and 38.56+/-10.89 msec, respectively. QTd increased markedly during ballooning, but after myocardial ischemia was relieved, decreased rapidly. Ten minutes after ballooning, QTd was reduced to a similar level as that of baseline. There were no significant differences between the AMI and non-myocardial infarction groups, single-vessel and multi-vessel groups, and the location of the stenosed artery. There was no significant difference in QTi according to different stenosed vessel. CONCLUSION: QT (QTc) dispersion increased rapidly with myocardial ischemia and reduced rapidly after the myocardial ischemia was resolved. Therefore, increased QTd can be used as an early clue of myocardial ischemia.
Angioplasty* ; Angioplasty, Balloon ; Arteries ; Electrocardiography ; Humans ; Infarction ; Ischemia ; Myocardial Infarction ; Myocardial Ischemia ; Percutaneous Coronary Intervention