During tumor progression, a subset of cells acquires metastatic properties, presumably through a series of genetic alterations. As the result, cells detach from the primary tumor, penetrate the basement membrane and invade the adjacent structures including lymph and blood vessels. Loss of adhesive functions and gain of new adhesive functions are thought to play a crucial role in this metastatic cascade. Since tumor metastasis is the principle cause of death for cancer patients including colon cancer, there is a consensus that a search for tools that allow effective assessment of the metastatic potential of tumors is a prime goal for cancer research. An immunohistochemical study of cell adhesion molecules, CD44H and its variant CD44v6, was done to evaluate their relationship with known prognostic factors related to the progression and metastasis of colorectal carcinoma in 94 cases of colorectal carcinoma tissues. The results were as follows. The CD44H expression was detected in 90 (95.7%) and CD44v6 in 53 (56.4%) out of 94 cases of colorectal carcinoma, and the CD44H was overexpressed in tumor tissue more than in normal mucosa in 62% of the cases. The expression rates of both protein were not significantly correlated with age and sex of the patients, invasion depth, lymph node metastasis, tumor differentiation, and tumor site. The coexpression of CD44H and CD44v6 in tumor was significant (p<0.05). The above results suggest that overexpression of CD44H and loss of function to control the alternative splicing of CD44 mRNA resulting in CD44v6 expression and alteration of adhesive function are closely associated with tumorigenesis of the colorectum.
Adhesives ; Alternative Splicing ; Basement Membrane ; Blood Vessels ; Carcinogenesis ; Cause of Death ; Cell Adhesion Molecules* ; Cell Adhesion* ; Colonic Neoplasms ; Colorectal Neoplasms* ; Consensus ; Humans ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Prognosis ; RNA, Messenger

Adenomyoepithelioma is a rare benign tumor which occurs mainly in the skin, salivary gland and very rarely in the breast. Histologically this tumor demonstrates biphasic differentiation of luminal epithelial cells and myoepithelial cells. We report a case of adenomyoepithelioma occuring in the outer lower quadrant of the right breast of a 56-year-old female, confirmed histologically with an aid of immunohistochemistry. This is the first documented report in Korean literature.
Adenomyoepithelioma* ; Breast* ; Epithelial Cells ; Female ; Humans ; Immunohistochemistry ; Middle Aged ; Phenobarbital ; Salivary Glands ; Skin

Malignant rhabdoid tumor is a distinct renal tumor in pediatric age group and extremely rare in adults. It was originally described as a rhabdomyosarcomatoid variant of Wilms' tumor. But subsequent studies failed to confirm myogenous differentiation, so the rhabdoid tumor is now considered to be a distinct and unique disease type of highly malignant renal tumor, histogenetically unrelated to Wilms' tumor. However the histogenesis have not been clearly defined until now. We report a case of malignant rhabdoid tumor of the kidney in a 34-year-old man who represented with a left abdominal mass. Grossly, a large mass occupying most of the left kidney except for a part of upper pole was invading beyond renal capsule and the perirenal soft tissue. It measured 18x14 cm in dimension and was soft, lobulated and yellowish gray with large areas of hemorrhage and necroses. Microscopically, the tumor mass was composed of sheets of round or polygonal neoplastic cells growing in a solid pattern. These tumor cells were medium to large in size with ample cytoplasm containing recognizable eosinophilic inclusion and had an eccentrically located, large nucleus with one or a few prominent nucleoli. Mitotic figures were frequently observed. Ultrastructurally, the tumor cells contained whorled filamentous inclusions corresponding to vimentin, epithelial membrane antigen and cytokeratin in immunostaining.
Adult ; Male ; Female ; Humans

Hemorrhagic cystitis is potentially life-threatening sequellae of chemotherapy using oxazaphosphorine alkylating agents (cyclophosphamide and ifosfamide). Mesna contains a sulfhydryl group that is believed to bind acrolein within the urinary collecting system and reduce the hemorrhagic cystitis without affecting the chemotherapeutic potential. To date, about thirty cases of hypersensitivity or allergic reactions of the delayed and urticarial type associated with mesna have been reported. We reported two patients with systemic lupus erythematosus who developed facial rash and flushing associated with mesna which imitate malar rash.
Acrolein ; Alkylating Agents ; Cyclophosphamide ; Cystitis ; Drug Therapy ; Exanthema* ; Flushing ; Humans ; Hypersensitivity* ; Lupus Erythematosus, Systemic ; Mesna*

Isolated ACTH deficiency is a uncommon disorder causing secondary adrenocortical insufficiency. Less than 200 cases have been reported in the world. The major clinical manifestations are hypoglycemia, weight loss, hypotension, anemia, weakness, nausea, inability to excrete water load, and hyponatremia. A 56-year-old male was admitted because of weakness, fatigue, nausea and vomiting. He was pallor and not associated with hyperpigmentation. The basal plasma ACTH and cortisol levels were 8.30 pg/ml and 0.6 ug/dl. The serum cortisol did not response to rapid ACTH stimulation test. On combined pituitary stimulation test, the cortisol did not response to insulin-induced hypoglycemia. Other anterior pituitary hormones showed normal responses except elevated prolactin level. Six months after glucocorticoid replacement therapy, the elevated basal prolactin level returned to normal. Brain MRI did not show any anatomic abnormalities of the sellar and suprasella area. We report a case of isolated ACTH deficiency accompanied by hyperprolactineia, which respond to glucocorticoid replacement therapy.
Adrenal Insufficiency ; Adrenocorticotropic Hormone* ; Anemia ; Brain ; Fatigue ; Humans ; Hydrocortisone ; Hyperpigmentation ; Hyperprolactinemia* ; Hypoglycemia ; Hyponatremia ; Hypotension ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nausea ; Pallor ; Pituitary Hormones, Anterior ; Plasma ; Prolactin ; Vomiting ; Water ; Weight Loss

Cerebral arterial embolism which resulted in total occlusion of right proximal middle cerebral artery was occured in 33 years old female patients with severe mitral stenosis and atrial fibrillation during percutaneous mitral balloon valvuloplasty(PMV). The occluded artery could be detected by transfemoral carotid angiography and recanalized immediately by intra-arterial infusion of urokinase. There were no cerebral hemorrhage by CT scan after intra-arterial urokinase infusion and the patients discharged without any neurologic sequale 7 days after thrombolysis. We report a case of successful recanalization with intraarterial infusion of urokinase in patient with cerebral arterial embolism occurred during PMV.
Adult ; Angiography ; Arteries ; Atrial Fibrillation ; Cerebral Hemorrhage ; Embolism* ; Female ; Humans ; Infusions, Intra-Arterial* ; Intracranial Embolism ; Middle Cerebral Artery ; Mitral Valve Stenosis ; Tomography, X-Ray Computed ; Urokinase-Type Plasminogen Activator*

In order to evaluate the effect of cardiac rhythm on hemodynamic changes and pulmonary arterial atrial natriuretic peptide(ANP) levels after percutaneous mitral valvuloplasty(PMV), we measured and analyzed the correlations between hemodynamic parameters and pulmonary arterial ANP levels in 65 patients with mitral stenosis before, 20 minutes, and 24 hours after PMV. The results are as follows: 1) Normal sinus rhythm was present in 49 patients(group1), whereas the other sixteen (group 2) had chronic atrial fibrillation. 2)PMV decreased mean left atrial pressure(LAP) in both groups(p<0.001). Left atrial volume was also reduced after PMV in group 1(p<0.0001), whereas it was not decreased significantly in group 2. 3) Pulmonary arterial ANP levels at 24 hours after PMV decreased significantly in group 1(p<0.001), compared to those prior to PMV. However there was no significantl changes in group 2. 4) In group 1, there was a significant linear relationship between extents of drop in pulmonary arterial ANP levels and LAP, measured 24hours after PMV. These results suggest that ANP secretion might be influenced not only by hemodynamic changes of the left atrium, but also by possible structural changes of left atrial wall induced by chronic atrial fibrillation.
Atrial Fibrillation ; Atrial Natriuretic Factor ; Heart Atria ; Hemodynamics* ; Humans ; Mitral Valve Stenosis

PURPOSE: A retrospective study was undertaken to test the hypothesis that febrile neonates, who have bacterial infections, can be accurately predicted early by diagnostic criteria. METHODS: We conducted a retrospective study of 152 infants, 28 days or less of age, whose rectal temperature was at least 38degrees C. Past history, family history, finding on physical examinations and results of CBC, urinalysis, lumbar puncture, CRP, and cultures of blood, urine and CSF were recorded. The diagnostic criteria for bacterial infection were : presence of identifiable fever focus(skin, soft tissue, bone, joint, eyes, ears), presence of maternal risk factors(malnutrition, fever, infection, premature rupture of membrane) & neonatal risk factors(prematurity, SGA), unhealthy condition at physical examinations, neutrophil index(immature neutrophil count/total neutrophil count ratio)> OR =0.15 and CRP> OR =2.0mg/dL, urinalysis-> OR =5 WBC/high-power field, absence of upper respiratory tract illness in parent and contact people. Febrile neonates who meet any of the diagnostic criteria were considered as high risk for bacterial infection. RESULTS: The overall incidence of bacterial infections in the 152 febrile neonates was 13.8%(21 neonates) with urinary tract infections in 8 neonates, bacteremia in 8 neonates and meningitis in 5 neonates. Only 1 neonate, who was classified as low risk for bacterial infection, was identified with a bacterial urinary tract infection. The sensitivity, specificity, positive predictive value and negative predictive value of the diagnostic criteria were 95.2, 92.4, 66.7 and 99.2%, respectively. CONCLUSION: These data show the ability of diagnostic criteria to identify neonates with bacterial infection. Febrile neonates who meet the diagnostic criteria must be treated intensively and those who do not meet the diagnostic criteria can be carefully managed as inpatients or outpatients without administering antimicrobial agents, avoiding iatrogenic complications.
Anti-Infective Agents ; Bacteremia ; Bacterial Infections* ; Bone and Bones ; Fever ; Humans ; Incidence ; Infant ; Infant, Newborn* ; Inpatients ; Joints ; Meningitis ; Neutrophils ; Outpatients ; Parents ; Physical Examination ; Respiratory System ; Retrospective Studies ; Rupture ; Sensitivity and Specificity ; Spinal Puncture ; Urinalysis ; Urinary Tract Infections

PURPOSE: A retrospective study was undertaken to test the hypothesis that febrile neonates, who have bacterial infections, can be accurately predicted early by diagnostic criteria. METHODS: We conducted a retrospective study of 152 infants, 28 days or less of age, whose rectal temperature was at least 38degrees C. Past history, family history, finding on physical examinations and results of CBC, urinalysis, lumbar puncture, CRP, and cultures of blood, urine and CSF were recorded. The diagnostic criteria for bacterial infection were : presence of identifiable fever focus(skin, soft tissue, bone, joint, eyes, ears), presence of maternal risk factors(malnutrition, fever, infection, premature rupture of membrane) & neonatal risk factors(prematurity, SGA), unhealthy condition at physical examinations, neutrophil index(immature neutrophil count/total neutrophil count ratio)> OR =0.15 and CRP> OR =2.0mg/dL, urinalysis-> OR =5 WBC/high-power field, absence of upper respiratory tract illness in parent and contact people. Febrile neonates who meet any of the diagnostic criteria were considered as high risk for bacterial infection. RESULTS: The overall incidence of bacterial infections in the 152 febrile neonates was 13.8%(21 neonates) with urinary tract infections in 8 neonates, bacteremia in 8 neonates and meningitis in 5 neonates. Only 1 neonate, who was classified as low risk for bacterial infection, was identified with a bacterial urinary tract infection. The sensitivity, specificity, positive predictive value and negative predictive value of the diagnostic criteria were 95.2, 92.4, 66.7 and 99.2%, respectively. CONCLUSION: These data show the ability of diagnostic criteria to identify neonates with bacterial infection. Febrile neonates who meet the diagnostic criteria must be treated intensively and those who do not meet the diagnostic criteria can be carefully managed as inpatients or outpatients without administering antimicrobial agents, avoiding iatrogenic complications.
Anti-Infective Agents ; Bacteremia ; Bacterial Infections* ; Bone and Bones ; Fever ; Humans ; Incidence ; Infant ; Infant, Newborn* ; Inpatients ; Joints ; Meningitis ; Neutrophils ; Outpatients ; Parents ; Physical Examination ; Respiratory System ; Retrospective Studies ; Rupture ; Sensitivity and Specificity ; Spinal Puncture ; Urinalysis ; Urinary Tract Infections

OBJECTIVE: To evaluate the epidemiologic change of patients with spinal cord injury who were admitted to a Rehabilitation Hospital, Yonsei University College of Medicine, during 1987-1996 and 2004-2008. METHODS: Medical records of 629 patients with spinal cord injury admitted to the Rehabilitation Hospital, Yonsei University College of Medicine, from 2004 to 2008 were collected and reviewed retrospectively. RESULTS: The male-to-female ratio decreased to 2.86:1, the mean age at injury increased, nontraumatic etiology increased, traffic accident remained to be the most common in traumatic spinal cord injury, and falling increased significantly. Tumor was the most common etiology in nontraumatic spinal cord injury, tetraplegia and incomplete injuries occurred more than paraplegia and complete injuries, indwelling catheter was the most common voiding method, and the duration of hospitalization decreased. CONCLUSION: Many trends changed in epidemiology of spinal cord injury.
Accidents, Traffic ; Catheters, Indwelling ; Hospitalization ; Humans ; Medical Records ; Paraplegia ; Quadriplegia ; Spinal Cord ; Spinal Cord Injuries