This prospective study was designed to investigate the clinical consequence of neuropsychiatric sequelae generated by acute carbon monoxide poisoning. For this study, 167 subjects who received the hospital emergency care for acute carbon monoxide poisoning during the period of November 1983 to December 1983 were selected from the emergency patients' lists of two general hospitals in Incheon area. Among them only 73 subjects could be followed up completely. Informations on the clinical consequence of neuropsychiatric sequelae were collected by 4-time-home visiting on the 10th, 30th, 70th and 180th day after acute carbon monoxide poisoning. Interviewers interviewed each family with pre-arranged questionnaire and the author performed neuropsychiatric examination for himself. The results were as follows: 1. During the 180 days after acute carbon monoxide poisoning, four types of clinical consequence were revealed. Full recovery rate was 83.6%, partial recovery rate 4.1%, delayed neuropsychiatric sequelae rate 6.8%, and death rate was 5.5%. 2. The prevalence rates of neuropsychiatric sequelae at the 2nd, 10th, 30th, 70th and 180th day were 50.7%, 32.9%, 15.1%, 15.1% and 13.7%, respectively. After the 30th day of acute carbon monoxide poisoning, no significant change of prevalence rates was observed and about half of total prevalence rate was occupied by mild and moderate degree neuropsychiatric sequelae (5.4%~8.2%). 3. After 30th day of acute carbon monoxide poisoning, there was no significant difference of the prevalence rates of neuropsychiatric sequelae among each age groups except below-19-year-old group, and prevalence rate in the female group was about three times higher than the male group. The poorer the consciousness level of the subject at emergency room was, the higher the prevalence rate was. Those of the stuporous, semicomatose and comatose groups were 4 to 20 times higher than the clear and drowsy groups. The prevalence rate of neuropsychiatric sequelae by emergency treatment was 5 to 10 times higher in hyperbaric oxygen therapy group than in 100% oxygen group. 4. At each time observed, as many as 60~90% of subjects with neuropsychiatric sequelae received no treatment at all.
Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Coma ; Consciousness ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Emergency Treatment ; Epidemiologic Studies* ; Female ; Follow-Up Studies* ; Hospitals, General ; Humans ; Hyperbaric Oxygenation ; Incheon ; Male ; Mortality ; Oxygen ; Prevalence ; Prospective Studies ; Surveys and Questionnaires ; Stupor

MAGE (melanoma antigen gene) is a tumor specific shared antigen, presented by HLA class I molecules, which is recognized by cytotoxic T lymphocytes. MAGE proteins are expressed in malignant tumor cells, in contrast to no expression in normal or benign tissues except for testis and placenta. MAGE might be a potential target for immunotherapy of malignant tumors. However, its biological aspects associated with cell cycle are not yet described. The flow cytometry is a useful tool for objective and quantitative analyses of heterogenous tumor cell population. To understand the status of MAGE related to cell cycle and its relationship with p53 as the G1 checkpoint regulator, p21, and PCNA as a proliferative index, we investigated expression of MAGE-3 protein, mutant p53, p21, and PCNA by flow cytometry and immunohistochemical stain. In addition, double stains for MAGE-3/p53, p53/PCNA, and p53/p21 were analysed with bivariate flow cytometry. DNA histograms using MAGE-3/PI (DNA) and p53/PI (DNA) were also analysed. The cell line (PNUH- 12) used for this study originated from a hypopharyngeal squamous cell carcinoma, which has point mutation (exon 7, C-->G) of p53. The expression rate of MAGE-3 was 83%, PCNA 85%, and p53 81%. No expression for p21 was identified. MAGE-3 was expressed in cytoplasm, while both PCNA and p53 were expressed in nuclei of tumor cells. With bivariate analyses, coexpression rates of MAGE-3/p53 and p53/PCNA were 0.96 and 0.97, respectively. Both MAGE-3 and p53 showed constantly high level throughout the cell cycle. These results suggest that expression of MAGE-3 and mutant p53 is not dependent on the cell cycle. p21 seems to be inactivated.
Carcinoma, Squamous Cell* ; Cell Cycle ; Cell Line* ; Coloring Agents ; Cytoplasm ; DNA ; Flow Cytometry* ; Immunotherapy ; Mutant Proteins ; Placenta ; Point Mutation ; Proliferating Cell Nuclear Antigen* ; T-Lymphocytes, Cytotoxic ; Testis

PURPOSE: MAGE (melanoma antigen gene) is a tumor associated antigen, presented by HLA class I molecules, which is recognized by cytotoxic T lymphocytes. The expression of MAGE proteins are confined to malignant tumor tissues, except for the normal testis and placental tissues. Therefore, MAGE may be a potential target for immunotherapy of malignant tumors. However, biological aspects associated with the cell cycle are not yet described. MATERIALS AND METHODS: The material used for this study was a novel human squamous cell carcinoma cell line (PNUH-12) from the hypopharynx, which had one point mutation of 78th base, C to G, in exon 7 of p53 gene. To understand the role of MAGE in relation to cell cycle and its relationship with p53 as the Gl checkpoint regulator, the expressions of MAGE-3 protein and mvtant p53 (Mtp53) were accessed by flow cytometry and immunohistochemistry. Double stains for MAGE-3/Mtp53 was analyzed with bivariate flow cytometry. DNA histograms using MAGE-3/PI (DNA) and Mtp53/PI (DNA) were also analyzed. RESULTS: The expression rate of MAGE-3 and Mtp53 were 83% and 85%, respectively. MAGE-3 was expressed in cytoplasm, while M:p53 were expressed in the nuclei of the tumor cells on the immunohistochemical sections. With bivariate analyses, coexpression rate of MAGE-3/Mtp53 was 0.96, and MAGE-3 and Mtp53 constantly showed high levels throughout the cell cycle except Go. CONCLUSIONS: These results mean that (I) MAGE-3 might have yet unknown relationship with mutant p53, (2) expressions of MAGE-3 and Mtp53 are not dependent on the cell cycle in PNUH-12 hypopharyngeal squamous carcinoma cell line, and suggest that MAGE-3 might have a role as important as p53 during the development of malignant tumors.
Carcinoma, Squamous Cell ; Cell Cycle* ; Cell Line ; Coloring Agents ; Cytoplasm ; DNA ; Exons ; Flow Cytometry* ; Genes, p53 ; Humans ; Hypopharynx ; Immunohistochemistry ; Immunotherapy ; Point Mutation ; T-Lymphocytes, Cytotoxic ; Testis

OBJECTIVES: Pneumonia is one of the leading causes of death in the intensive care unit (ICU). Many biomarkers for predicted prognosis have been suggested; among these, procalcitonin (PCT) is known to increase in cases of bacterial infection. However, there have been many debates regarding whether PCT is an appropriate prognostic marker for pneumonia. Therefore, we investigated whether PCT can serve as a biomarker for pneumonia, and compared it with CURB-65, which is a known tool for predicting the prognosis of pneumonia. METHODS: Levels of PCT and CURB-65 scores were compared between 30-day non-survival (n = 30) and survival (n = 101) patients. Relationships between PCT and CURB-65 were determined by using linear regression analysis, as well as by using receiver operating characteristic (ROC) curve analysis and calculation of the area under the curve (AUC). High and low PCT groups were compared. RESULTS: High PCT and high CURB-65 score were positively associated with 30-day mortality. For the prediction of 30-day mortality, initial PCT and CURB-65 exhibited AUCs of 0.63 and 0.66; these were not significantly different (P = 0.132). We found that the high PCT group had a higher rate of initial treatment failure (91%, P = 0.004). CONCLUSIONS: Initial PCT can be a prognostic biomarker for mortality in severe pneumonia, similar to the CURB-65 score. Initial high PCT was positively associated with initial treatment failure.
Area Under Curve ; Bacterial Infections ; Biomarkers ; Cause of Death ; Critical Care ; Humans ; Intensive Care Units ; Linear Models ; Mortality ; Pneumonia ; Prognosis ; ROC Curve ; Treatment Failure

PTC is the single most valuable diagnostic method available to evaluate the size, shape and site of the causesof obstuctive jaundice among various radiological procedures. The authors reviewed and radiologically classifiedthe PTC films of 203 cases of obstructive jaundice from July 1977 to June 1983 at Presbyterian Medical Center,Jeon-ju confirmed clinically, operatively and pathologically. The resuls are as follows; 1. The most common causeof obstructive jaundice was bile duct stoen (64/203:31.53%) and the other causes were bile duct cancer(43/203:21.18%), pancreas cancer(41/203:20.19%), biliary ascariasis &/or clonorchiasis(20/203:9.85%), ampulla andduodenal cancer (7/203:3.45%), fibrotic stenosis of sphincter of Oddi(6/203: 2.96%) etc. in that order. Of theseprimary involvement with cancer was more frequent (91/203:44.33%) than stone. 2. 88.33%(179/203) of patients wasover 40-year-of- age and the sex ratio between male and female was about 2:1. 3. The average maximal diameter ofextrahepatic bile duct just proximal to the site of obstruction or stenosis by stones or by cancers was nearlyequal(2.36cm:2.38cm). 4. Cancers caused complete bile duct obstruction in about 75%(68/91) of cases and also wereassociated with intrahepatic duct dilatation about 92%(84/91) of cases. But in contrast biliary calculi showedgood drainage of contrast medium in 75%(48/64) of cases and 92%(59/64) showed normal diameter of intrahepaticduct. 5. The differential PTC findings between bile duct cancer and pancreas cancer were not so distinct but inbiel duct cancer the obstruction site of the bile duct was more irregular and serrated than pancreas cancer, whilethe latter showed a more downward convexity and a smoother end. Moreover annular filling defect with overhangingedges was seen only in bile duct cancer.
Ascariasis ; Bile Duct Neoplasms ; Bile Ducts ; Cholestasis ; Constriction, Pathologic ; Dilatation ; Drainage ; Female ; Gallstones ; Humans ; Jaundice ; Jaundice, Obstructive ; Male ; Methods ; Pancreas ; Pancreatic Neoplasms ; Protestantism ; Sex Ratio

The incidence of colorectal cancer of Korea is much lower than that of Western countries, but has shown a tendency to a slight increase recently Barium enema is the most valuable, noninvasive and inexpensive method available to evaluate the size, shape and site of colorectal cancer. The authors reviewed and radiologically classified barium enema studies of 232 cases of colorectal cancer from Aug. 1967 to July 1982 at Presbyterian Medical Center, Jeon-ju , Confirmed clinically, operatively and pat hologically. The results were as follows; 1. The ratio of male and female was 1.3:1, and youngest was 13 year-old and the oldest 86 year-old. 2. The peak incidence occurred from 5th to 7th decades, accounting for 78% of all cases (181/232), and there was a relatively high incidence of the disease in patients below 30 years of age at 7.8% (18/232). 3. Rectum and rectosigmoid region are the most frequently involved regions (127/23 2:54.8%). 4. The positivity of barium enema examination was 4.0% (232/5807), and its accuracy was 96.5% (224/232) . 5. The radiologic findings were classified into 4 groups, and they were annular encircling 62.9% (146/232), polypoid fungating 26.8% (62/232), infiltrating 8.6% (20/232), and primary ulcerating 1.7% (4/232) in order of frequency. 6. The linear length of the cancer ranged from 1.5 Cm to 15 Cm , and the average length was 5.5 Cm. 7. There was no statistical correlation between the length of lesion, the site, and the radiologic findings, and stages of the lesion (P:0.750-0.250). 8. The majority of colorectal cancers was adenocarcinoma (217/232:93.6%).
Adenocarcinoma ; Barium ; Colorectal Neoplasms ; Enema ; Female ; Humans ; Incidence ; Jeollabuk-do ; Korea ; Male ; Methods ; Protestantism ; Rectum ; Ulcer

PURPOSE: We examined an occurrence of the lower urinary tract symptoms (LUTS) within the chronic kidney disease (CKD) comparatively analyzed implications with components of the CKD. MATERIALS AND METHODS: We surveyed eighty-two CKD patients who were over than 50-year-old, micturated upward of 1,000cc a day. The check list concerned with the LUTS consists of International Prostate Symptom Score (IPSS), quality of life, volume of prostate, maximal flow rate and residual urine volume and we evaluated GFR, serum creatinine, prevalence period, causative disease and diabetes. We analyzed correlations between the CKD and components of the LUTS and examined an aspect of LUTS concerned with the degree of CKD, prevalence period and diabetes. A control group composed of twenty-eight male adults who visited to the general medical examination center and they were examined by the same checklist. RESULTS: The group of CKD is significantly worse than the control group over the whole items of LUTS beside the volume of prostate; they were on the average 57.3+/-3.8 years old, 17.1+/-2.3 of IPSS, 3.8+/-1.2 of quality of life, 12.6+/-3.2ml/sec of maximal flow rate and 38.9+/-4.3ml of residual urine, 25.9+/-3.4g of prostate in the group of CKD. Furthermore, a group of patients who had suffered from the CKD for over than 3 years and combined with diabetes is significantly worse than control group. CONCLUSIONS: The study revealed that a number of CKD have LUTS and they seem to be influenced by prevalence period, stage and causative disease of CKD rather than the volume of prostate.
Adult ; Checklist ; Chronic Disease ; Creatinine ; Humans ; Kidney ; Lower Urinary Tract Symptoms ; Male* ; Middle Aged ; Prevalence ; Prostate ; Quality of Life ; Renal Insufficiency, Chronic* ; Urination Disorders

To evaluate effects of IPV (Intrapulmonary Percussive Ventilation) on cardiopulmonary hemodynamics and oxygenation, we compared IPV with conventional IPPV (Intermittent Positive Pressure Ventilation} in eight mongrel dogs. After Swan-Ganz catheterization and femoral arterial cannulation, we applied IPPU and IPV for 30 minutes respectively at random order. There were no significant differences in cardiac output (CO), heart rate (HR), mean arterial pressure (MAP), vascular resistance (VR), pulmonary capillary wedge pressure (PCWP), rate pressure product (RPP), coronary perfusion pressure (CPP) and oxygenation-reflecting parameters such as AaDO2, oxygen flux and oxygen consumption (VO2) between IPPV and IPV. A slight increase of diastolic pulmonary arterial pressure (PAP) resulted in increase of pulmonary perfusion pressure (PPP). IPV increases left and right ventricular stroke work index which might be related to slight metabolic acidosis and a little deficient ventilation during IPV. We can conclude that IPV is safe and good in cardiopulmonary hemodynamics and tissue oxygena-tion in dogs, but its better to be cautious in ventilation during IPV.
Acidosis ; Animals ; Arterial Pressure ; Cardiac Output ; Catheterization ; Catheterization, Swan-Ganz ; Dogs* ; Heart Rate ; Hemodynamics* ; Intermittent Positive-Pressure Ventilation ; Oxygen Consumption ; Oxygen* ; Perfusion ; Pulmonary Wedge Pressure ; Stroke ; Vascular Resistance ; Ventilation*

BACKGROUND: Pulmonary complications including pneumonia and pulmonary edema frequently develop in critically ill surgical patients. Lung ultrasound (LUS) is increasingly used as a powerful diagnostic tool for pulmonary complications. The purpose of this study was to report how LUS is used in a surgical intensive care unit (ICU). METHODS: This study retrospectively reviewed the medical records of 67 patients who underwent LUS in surgical ICU between May 2016 and December 2016. RESULTS: The indication for LUS included hypoxemia (n = 44, 65.7%), abnormal chest radiographs without hypoxemia (n = 17, 25.4%), fever without both hypoxemia and abnormal chest radiographs (n = 4, 6.0%), and difficult weaning (n = 2, 3.0%). Among 67 patients, 55 patients were diagnosed with pulmonary edema (n = 27, 41.8%), pneumonia (n = 20, 29.9%), diffuse interstitial pattern with anterior consolidation (n = 6, 10.9%), pneumothorax with effusion (n = 1, 1.5%), and diaphragm dysfunction (n = 1, 1.5%), respectively, via LUS. LUS results did not indicate lung complications for 12 patients. Based on the location of space opacification on the chest radiographs, among 45 patients with bilateral abnormality and normal findings, three (6.7%) and two (4.4%) patients were finally diagnosed with pneumonia and atelectasis, respectively. Furthermore, among 34 patients with unilateral abnormality and normal findings, two patients (5.9%) were finally diagnosed with pulmonary edema. There were 27 patients who were initially diagnosed with pulmonary edema via LUS. This diagnosis was later confirmed by other tests. There were 20 patients who were initially diagnosed with pneumonia via LUS. Among them, 16 and 4 patients were finally diagnosed with pneumonia and atelectasis, respectively. CONCLUSIONS: LUS is useful to detect pulmonary complications including pulmonary edema and pneumonia in surgically ill patients.
Anoxia ; Critical Care* ; Critical Illness ; Diagnosis ; Diaphragm ; Fever ; Humans ; Lung* ; Medical Records ; Pneumonia ; Pneumothorax ; Pulmonary Atelectasis ; Pulmonary Edema ; Radiography, Thoracic ; Retrospective Studies ; Ultrasonography* ; Weaning

BACKGROUND: The p38 mitogen-activated protein kinases (p38Map kinases) are a family of prolinedirected serine/threonine kinases. At least four isoforms of p38Map kinases have been identified; however, their physiological significances remain to be understood. Recently, the role of p38Map kinase in insulin-stimulated glucose uptake has been suggested. The present study aimed to investigate which isoform(s) were responsive to insulin stimulation. In addition, the activities of p38 Map kinase isoforms that may participate in the insulin's antiapoptotic function in CHO-IR cells were also determined. METHODS: Chinese hamster ovary cells, expressing wild- or mutated human insulin receptors (CHO-IR cells), were used to investigate whether insulin can stimulate any of the isoform(s) of the p38Map kinases. The p38Map kinase activity was determined by measuring the degree of 32P-labelling of ATF-2 protein, a specific substrate of p38Map kinase. A DNA laddering assay was performed to examine the degree of apoptosis and a RT-PCR analysis to determine which isoform(s) of the p38Map kinases were expressed in response to insulin. RESULTS: p38Map kinase activation by insulin was sharply suppressed in only the CHO-IR/A1018K cells, which lack the intrinsic tyrosine kinase activity of insulin receptors. Insulin stimulation of p38Map kinase was insensitive to SB203580, an inhibitor of the alpha(alpha)-and beta(beta)-isoforms of p38Map kinases. Moreover, orthovanadate, known as a specific stimulator of the gamma(gamma)-and delta(delta-) isoforms, stimulated the p38Map kinase activity in CHO-IR cells. Insulin increased the degree of mRNA expression of the delta-isoform, but not that of the alpha-isoform p38Map kinase. Interestingly, PD98059, an inhibitor of ERK, suppressed p38Map kinase stimulation, as well as the antiapoptotic protection of cells by insulin. As insulin was found to still protect ERK-lacking cells (CHO-IR/ SOS) from apoptosis, any substantial role(s) of ERK might be excluded. CONCLUSION: Our data suggest that insulin may stimulate the activity and expression of the-isoform of p38Map kinase in a MEK1/2-dependent manner. The involvement of the delta-isoform of p38Map kinase in insulin's antiapoptotic protection was also suggested, but remains to be investigated further to clarify the nature of its mechanism of action
Animals ; Apoptosis ; Cricetinae ; Cricetulus ; DNA ; Female ; Glucose ; Humans ; Insulin ; Ovary ; p38 Mitogen-Activated Protein Kinases ; Phosphotransferases* ; Protein Isoforms ; Protein-Tyrosine Kinases ; Receptor, Insulin ; RNA, Messenger ; Vanadates