PURPOSE: Endobronchial tuberculosis and bronchogenic cancer are common causes of atelectasis or obstructive pneumonitis in Korea. Differntiation between endobronchial tuberculosis and bronchogenic carcinoma is important for the treatment and prognosis but it is sometimes difficult to differentiate these two lesions with radiologic examinations. The purpose of this study was to find the differential points between endobronchial tuberculosis and bronchogenic carcinoma associated with atelectasis or obstructive pneumonitis. MATERIALS AND METHODS: Forty patients in whom atelectasis or obstructive pneumonitis was detected on chest radiographs comprised the study. A definite mass opacity was not observed on chest radiographs in all patients. In these patients, the causes of obstruction were endobronchial tuberculosis (n=20) and bronchogenic cancer (n=20) which were microbiologically or pathologically confirmed. RESULTS: Double obstructive lesions were more frequently found in endobronchial tuberculosis (8/20) than in bronchogenic cancer (1/20). Multiple calcifications along the bronchial wall and severe distortion of bronchi were observed only in endobronchial tuberculosis (4/20) and associated low density mass at obstruction site was only observed in bronchogenic cancer (6/20). Bronchial dilatation (11/20) and parenchymal calcifications (14/20) distal to obstruction site, air containing bronchogram at post obstructive bronchus (14/20) were more frequently found in endobronchial tuberculosis. Contour bulging at obstruction site (14/20), and only mucus bronchogram at post obstructive bronchus (14/20) were more frequently found in bronchogenic carcinoma. CONCLUSION: In patients with atelectasis or obstructive pneumonitis, endobronchial tuberculosis is characterized by double obstructive lesion, multiple calcifications at the bronchial wall, and severe distortion of the bronchi. Endobronchial carcinoma is characterized by a low density mass at the obstructive site.
Bronchi ; Carcinoma, Bronchogenic* ; Dilatation ; Humans ; Korea ; Mucus ; Pneumonia* ; Prognosis ; Pulmonary Atelectasis* ; Radiography, Thoracic ; Tuberculosis*

PURPOSE: Early gastric cancer (EGC) is defined as gastric cancer confined to the mucosa or submucosa, regardless of lymph node (LN) metastasis. The prognosis of EGC is more favorable than that of advanced gastric cancer. Due to the variety of prognosis of EGC, in relation to LN metastasis, this study was undertaken to determine the impact of LN metastasis on the survival of patients with EGC, and to aid in planning therapeutic approaches for such patients. METHODS: A retrospective study of 517 patients with EGC, who had undergoing a gastrectomy with lymphadenectomy, between 1990 and 1999 was performed. Stages were classified using the UICC TNM classification (1997). RESULTS: LN metastasis was observed in 67 cases (13.0%). 6.7% (17/288) of the EGC within the mucosa, and 19.0% (50/281) within the submucosa, had LN metastasis. The overall Five-year survival rates (5YSR) of 517 EGC patients was 95.5%, and for the EGC patients in N0, N1, N2 and N3 groups were 98.3, 82.2, 27.8 and 0%, respectively (P<0.001). The 5YSRs for patients with mucosal and submucosal cancers were 98.9 and 92.4%, respectively (P= 0.023), and was poorer in those EGC patients with tumor sizes above 5 cm than in those below 5 cm (5YSR 96.3 and 86.7%, respectively. P=0.020). However, the survival rates for EGC patients did not differ significantly based on the gross and histological types. The 5YSR for EGC patients with stage IA, IB, II and IV were 98.3, 82.1, 40.0 and 33.3%, respectively (P<0.001). LN metastasis and depth of invasion were found to be significant risk factor from the multivariate analysis. CONCLUSION: Based on the results of this study, the significant prognostic factors of EGC were LN metastasis and depth of invasion. Although the prognosis of EGC is favorable, it depends upon the prognostic factors.
Classification ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Mucous Membrane ; Multivariate Analysis ; Neoplasm Metastasis* ; Prognosis* ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms* ; Survival Rate

We reports a woman's death caused by massive intraabdominal hemorrhage, who was in chronic alcoholic state with advanced liver cirrhosis and found dead in her room. No macroscopic source for the bleeding was found in her intraabdomen and there was no circumstances of traumatic forces to the individual's body around the death. The presenting unsuspected death could be consistent with the forensic pathological cases described as sudden, unexpected death due to massive nontraumatic intraabdominal hemorrhage in association with liver cirrhosis by DiMaio in 1987.
Alcoholics ; Hemorrhage* ; Humans ; Liver Cirrhosis* ; Liver*

BACKGROUND: Acute renal failure(ARF) is characterized by rapid decline in glomerular filtration rate and retension of nitrogenous waste products. This syndrome occurs in approximately 5 percent all hospital admissions and up to 30 percent of admissions to intensive care units. ARF is diagnosed when screening of hospital patients reveals a recent increase in serum BUN(blood urea nitrogen) and creatinine. The mortality rate for ARF is approximate 40-60% and has changed little in past three decades. This lack of improvement in outcome, despite significant advances in medicine. The reasons of high mortality rate is not certain. This study intend to identify prognostic risk factors influencing survivals. METHODS: We retrospectively analyzed 60 patients with ARF during 2 years period from Oct. 1996 to Oct. 1998 at chosun university hospital. Multiple factors which may influence mortality were evaluated. RESULTS: 1)Of the 60 patients, 34 were male and 26 were female. The mean age was 55.8+/-15.9 years. 2)The cause of ARF is Drug, toxin, dehydration, infection, trauma, surgery, urinary tract obstruction, HFRS, rhabdomyolysis and bleeding. 3)Underline disease is observed in 52 case. DM, Hypertension, Malignancy, Pulmonary disease, Liver disease, Renal disease 4)The mortality rate is 31.7%. The major cause of deaths is DIC, infection and hepatic failure. 5)Based on the unpaired t-test, chi-squre analysis, albumin, total bilirubin, hemoglobin, thrombocytopenia, APACHE II score, serum sodium, urine creatinine, number of multiple organ failure, cause of acute renal failure, pH, vital sign on admission, sepsis, DIC, oilguria, and hemodialysis were significant factors between survivors and nonsurvivors(p< 0.05). 6)APACHE II score on admission is good prognostic factor for patients with acute renal failure (p<0.001). CONCLUSION: This results suggest that the evaluation of patients symptom, sign, laboratory data, APACHE II score is important for patients with acute renal failure. the discriminant score by multiple analysis and APACHE II score could relatively predict the mortality of ARF patients. however further evaluation and clinical apply of prognostic factors is required to confirm these results.
Acute Kidney Injury* ; APACHE ; Bilirubin ; Cause of Death ; Creatinine ; Dacarbazine ; Dehydration ; Female ; Glomerular Filtration Rate ; Hemorrhage ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Hydrogen-Ion Concentration ; Hypertension ; Intensive Care Units ; Liver Diseases ; Liver Failure ; Lung Diseases ; Male ; Mass Screening ; Mortality ; Multiple Organ Failure ; Nitrogen ; Renal Dialysis ; Retrospective Studies ; Rhabdomyolysis ; Risk Factors* ; Sepsis ; Sodium ; Survivors ; Thrombocytopenia ; Urea ; Urinary Tract ; Vital Signs ; Waste Products

PURPOSE: A family history of gastric cancer is considered to be a possible etiologic factor. This study was designed to analyze the clinicopathological characteristics of gastric cancer patients with a family history of gastric cancer and to aid in planning diagnostic and therapeutic approaches in such patients. METHODS: Consecutive 859 gastric cancer patients who underwent surgery at Kyungpook National University Hospital were reviewed. RESULTS: Fifty one patients (5.9%) had a family history of gastric cancer. There were 56 family members with gastric cancer in 51 families. Based on the current Euro-American kinship classification, 50 (89.3%) family members were first-degree in distance and 6 (10.3%) were second-degree. There were no statistically significant differences in sex ratio and age distribution between the groups with and without a family history of gastric cancer. Among the 754 patients who underwent a gastric resection, there was a statistically significant difference in the depth of tumor invasion (p= 0.041). There were no statistically significant differences in lymph node metastasis, tumor stage, tumor location, macroscopic and microscopic types, or curability of the surgery between the groups. The overall 5-year survival rate was 59.1% in patients with a family history of gastric cancer, and 51.9% in patients without a family history, but this difference was not statistically significant. Also, there was no statistically significant difference in survival rate after a curative resection. CONCLUSION: Patients with a family history of gastric cancer tended to be diagnosed earlier than patients without a family history. The majority of affected family members were 1stdegree in distance, so genetic approaches and intensive screening examinations are recommended to those relatives for earlier detection of gastric cancer.
Stomach Neoplasms

Neonatal cholestasis is caused by various forms of liver injury and has a complex etiological background. Among these, cases of severe cholestasis due to primary hemolytic disease are rare. Herein, we report a case in which thalassemia-induced severe hemolysis caused bile duct injury by hemosiderosis, with cholestasis occurring shortly after birth and lasting for >4 months. In addition, complete recovery of liver pathology was observed both biochemically and histologically. Hence, clinicians should consider hemolytic disease as a rare cause of neonatal cholestasis in the differential diagnosis of neonates as well as the advisability of conservative treatment based on case progression.

PURPOSE: Variable changes occur in the progression from normal gastric epithelium to cancer, including many tumor, tumor suppressor and DNA repair genes, as well as growth factor and its receptors. The mutation and protein expression of the p53 gene may be useful prognostic factors, but their significance is still uncertain. METHODS: Specimens from 296 gastric cancer patients, treated by a curative gastrectomy, between March 1999 and April 2001, at Kyungpook National University Hospital, were used. The p53 gene mutation was assessed using a polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analysis, and the overexpression of tumor p53 protein using immunohistochemistry. The correlation between the results and clinicopathological parameters were then analyzed. RESULTS: The mutation and protein overexpression of the p53 gene were shown in 61 (20.6%) and 124 (41.9%) tumors, respectively. Of the 61 cases with a p53 mutation, 43 (70.5%) showed overexpression of the p53 protein, and of the 235 without mutation of the p53 gene, 81 (34.5%) had no overexpression of the p53 protein, and also showed statistical significance (P< 0.001). The mutation and protein overexpression of the p53 gene showed no significant differences according to age, gender, stage, location and gross type, but of the 138 intestinal and 128 of the diffuse types, 33 (23.9%) and 18 (14.1%) cases, respectively, showed p53 mutation (P=0.027); whereas, of the 150 well differentiated and 142 poorly differentiated tumors, 75 (50%) and 18 (33.8%), respectively, showed overexpression of the p53 protein. Also, of the 138 intestinal and 128 diffuse types, 71 (51.4%) and 43 (33.6%) showed overexpression of the p53 protein. There were no significant differences in the 5 year survival according to the mutation and protein overexpression of the p53 gene. CONCLUSION: The mutation and protein overexpression of the p53 gene, as assessed by PCR-SSCP and immunohistochemistry, respectively, showed a statistically significant correlation, but had little value as prognostic factors following a curative gastrectomy.
DNA Repair ; Epithelium ; Gastrectomy ; Genes, p53 ; Genes, vif ; Gyeongsangbuk-do ; Humans ; Immunohistochemistry ; Stomach Neoplasms*

Ketamine is used widely in emergency departments for a variety of purposes, including procedural sedation for facial laceration in pediatric patients. The major benefits are its rapid onset of effects, relatively short half-life, and lack of respiratory depression. The known side effects of ketamine are hallucinations, dizziness, nausea, and vomiting. Seizure is not a known side effect of ketamine in patients without a seizure history. Here, we present the case of a patient in whom ketamine likely induced a generalized tonic-clonic seizure when used as a single agent in procedural sedation for facial laceration repair. The aim of this article is to report a rare and unexpected side effect of ketamine used at the regular dose for procedural sedation. This novel case should be of interest to not only emergency physicians but also plastic surgeons.

Ketamine is used widely in emergency departments for a variety of purposes, including procedural sedation for facial laceration in pediatric patients. The major benefits are its rapid onset of effects, relatively short half-life, and lack of respiratory depression. The known side effects of ketamine are hallucinations, dizziness, nausea, and vomiting. Seizure is not a known side effect of ketamine in patients without a seizure history. Here, we present the case of a patient in whom ketamine likely induced a generalized tonic-clonic seizure when used as a single agent in procedural sedation for facial laceration repair. The aim of this article is to report a rare and unexpected side effect of ketamine used at the regular dose for procedural sedation. This novel case should be of interest to not only emergency physicians but also plastic surgeons.

PURPOSE: Fas ligand is known to play a key role in intraocular inflammation. We investigated the change of the expression of Fas ligand in the eye with experimental melanin-induced uveitis (EMIU). METHODS: EMIU was induced in 16 Lewis rats after immunization with melanin-associated antigen. Immunohistochemistry, in situ hybridization, and Western blot for Fas ligand were performed serially after immunization. RESULTS: The expression of Fas ligand was higher in the inflammatory eyes at cornea, iris, ciliary body, choroids and retina compared with control eyes. The expression of FasL remained elevated ever at 30 days after immunization in comparison with control eyes even though the inflammation of the eyes had subsided. CONCLUSIONS: These results suggest that the spontaneous regression of intraocular inflammation may be mediated by Fas ligand in EMIU.
Animals ; Apoptosis* ; Blotting, Western ; Choroid ; Ciliary Body ; Cornea ; Fas Ligand Protein ; Immunization ; Immunohistochemistry ; In Situ Hybridization ; Inflammation ; Iris ; Rats ; Retina ; Uveitis*