A 14-year-old female South American sea lion (Otaria byronia) with persistent vaginal secretion and chronic hemorrhagic diarrhea was encountered. During postmortem examination, the uterus was found to resemble a balloon with mucosal congestion and was filled with grayish milky material. The ovaries also had abnormal features, including necrotic surface lesions and multiple whitish foci in the cut section. Hemorrhages and ulcerated changes due to toxemia were observed in other organs, including the liver, spleen, lung, intestines, and lymph nodes. Microscopically, the left ovary contained interlacing fascicles of fibroblast-like cells with blunt-end nuclei showing cytoplasmic positive immunoreactivity against alpha-smooth muscle actin and desmin. The right ovary contained cells with round to cigar-shaped nuclei showing cytoplasmic positive immunoreactivity against vimentin. In conclusion, based on classification of bilateral ovarian tumors as a leiomyoma in the left region and a fibroma in the right region, this sea lion was diagnosed with chronic closed pyometra.
Actins ; Autopsy ; Cytoplasm ; Desmin ; Diarrhea ; Estrogens, Conjugated (USP) ; Female ; Fibroma ; Hemorrhage ; Humans ; Intestines ; Leiomyoma ; Liver ; Lung ; Lymph Nodes ; Muscles ; Ovary ; Pyometra ; Sea Lions ; Spleen ; Toxemia ; Ulcer ; Uterus ; Vimentin

BACKGROUND AND OBJECTIVES: Supraglottic partial laryngectomy (SPL), which provides the removal of selected tumors involving the upper structure of the glottis, shows equivalent oncologic outcome when compared to total laryngectomy with functional preservation. We report our 18-year experience of applying supraglottic partial laryngectomy in the Yonsei Head and Neck Cancer Clinic. SUBJECTS AND METHOD: We retrospectively reviewed the charts of 78 patients who underwent SPL. We divided the patients into two groups, the early and the recent, and performed Kaplan-Meier survival analysis and chi2-test on the groups. The post-operative functional outcome was assessed. RESULTS: The 3-year-disease-specific survival rate of the early and recent period was 87% and 84.6%, respectively. Decannulation and tolerability of an oral diet was possible in 93% and 95% of the earlier group, and 95% and 98% in the recent group, respectively. There was no statistically significant difference in survival rate, recurrence pattern, decannulation and tolerability of oral diet between the two groups. CONCLUSION: We achieved a satisfactory survival rate through SPL. In addition, almost all patients could be decannulated and eventually tolerated an oral diet. Our results confirm that SPL is an oncologically & functionally sound procedure for selected supraglottic tumors.
Diet ; Glottis ; Head and Neck Neoplasms ; Humans ; Laryngeal Neoplasms ; Laryngectomy ; Recurrence ; Retrospective Studies ; Survival Rate

BACKGROUND: The significance of ER expression and hormone manipulation in gastric cancer is not established. There have been several reports supporting the role of the ER gene as tumor suppressor gene in carcinogenesis. The ER-alpha gene is located on chromosome 6q25.1. Deletions of the long arm of chromosome 6 are common in gastric carcinoma, suggesting the presence of tumor suppressor genes in this region. The proportion of ER-positive gastric cancers ranges between 0% and 67% depending on the method of detection. Epigenetic inactivation might explain the loss of ER-alpha gene expression in gastric cancer. There is no information available regarding the methylation status of the ER-alpha gene promoter region in gastric cancer so far. The aim of this study was to assess the expression of ER-alpha in gastric cancer cell lines and determine whether methylation of the 5' promoter region is associated with loss of ER-alpha expression in gastric cancer. METHODS: We investigated such methylation in 13 gastric cancer cell lines. Western blot analysis, reverse transcription-polymerase chain reaction (PCR), methylation-specific PCR (MS-PCR) and bisulfite sequencing analyses were used. Immunohistochemical staining for the ER-alpha gene was dome for forty-two paraffin embedded tissues from gastric cancer patients. RESULTS: ER-alpha protein was not detected in any cell line, ER-alpha mRNA was expressed in only Kato III cell line. MS-PCR and bisulfite sequencing showed all thirteen gastric cancer cell lines had methylated CpG regions in their ER-alpha gene promoters. Immunohistochemical staining of ER-alpha showed no positivity in any of examined samples. CONCLUSION: Inactivation of ER-alpha gene expression in gastric cancer cell lines appears associated with CpG island methylation near the TGA initiation codon of the ER-alpha gene.
Arm ; Blotting, Western ; Carcinogenesis ; Cell Line ; Chromosomes, Human, Pair 6 ; Codon, Initiator ; CpG Islands ; Epigenomics ; Estrogens* ; Gene Expression ; Genes, Tumor Suppressor ; Humans ; Methylation ; Paraffin ; Polymerase Chain Reaction ; Promoter Regions, Genetic ; RNA, Messenger ; Stomach Neoplasms*

BACKGROUND: The purpose of this study was to evaluate the etiologic organisms, risk factors, and other infectious features of febrile neutropenic patients developing septic shock. METHODS: We reviewed medical record of 457 patients developing neutropenic fever after chemotherapy or hematopoietic stem cell transplantation (HSCT) at Catholic HSCT Center from Jan 1998 to Dec 1999. Out of them, age/sex matched patients without septic shock were enrolled into the control group, and retrospective case-control study was conducted. RESULTS: Overall incidence of septic shock was 8.5%. Most common underlying disease of the two groups was acute leukemia. Microbiologically defined infection (MDI), especially Gram-negative bacterial infection, was significantly more common in the septic shock group than in the control group. Escherichia coli was the most common organism in the two groups (51.3% vs 27.7%, P<0.001). However, empirical use of glycopeptide was more frequent in the shock group (P<0.05). Differing from other report, fatal infection due to viridans streptococci was not observed in spite of quinolone prophylaxis. Mean leukocyte count at the onset of fever was 207/mm3 and 355/mm3 (P=0.027) and mean duration of total febrile day was 12.3 days and 7.8 days, respectively (P=0.001). On multivariate analysis, MDI and leukocyte count at the onset of fever were the significant risk factors for the septic shock. Overall mortality showed higher tendency in the shock group than in the control group (23.1% vs. 12.0%, P=0.057). Especially, in patients with Gram-positive bacterial infection, infection related mortality was significantly higher in the shock group than in the control group (50% vs. 8.9%, P=0.013). CONCLUSION: Although Gram-positive bacterial infection has been increasing, Gram-negative bacteria, including E. coli, were the most common causative organisms for sepctic shock in febrile neutropenic patients. However, considering high mortality in the septic shock caused by Gram-positive bacteria, glycopeptide must immediately be administered to the febrile neutropenic patients developing septic shock.
Case-Control Studies ; Drug Therapy ; Escherichia coli ; Fever* ; Gram-Negative Bacteria ; Gram-Negative Bacterial Infections ; Gram-Positive Bacteria ; Gram-Positive Bacterial Infections ; Hematopoietic Stem Cell Transplantation ; Humans ; Incidence ; Leukemia ; Leukocyte Count ; Medical Records ; Mortality ; Multivariate Analysis ; Neutropenia ; Retrospective Studies ; Risk Factors* ; Shock ; Shock, Septic* ; Viridans Streptococci

BACKGROUND: The purpose of this study was to evaluate the etiologic organisms, risk factors, and other infectious features of febrile neutropenic patients developing septic shock. METHODS: We reviewed medical record of 457 patients developing neutropenic fever after chemotherapy or hematopoietic stem cell transplantation (HSCT) at Catholic HSCT Center from Jan 1998 to Dec 1999. Out of them, age/sex matched patients without septic shock were enrolled into the control group, and retrospective case-control study was conducted. RESULTS: Overall incidence of septic shock was 8.5%. Most common underlying disease of the two groups was acute leukemia. Microbiologically defined infection (MDI), especially Gram-negative bacterial infection, was significantly more common in the septic shock group than in the control group. Escherichia coli was the most common organism in the two groups (51.3% vs 27.7%, P<0.001). However, empirical use of glycopeptide was more frequent in the shock group (P<0.05). Differing from other report, fatal infection due to viridans streptococci was not observed in spite of quinolone prophylaxis. Mean leukocyte count at the onset of fever was 207/mm3 and 355/mm3 (P=0.027) and mean duration of total febrile day was 12.3 days and 7.8 days, respectively (P=0.001). On multivariate analysis, MDI and leukocyte count at the onset of fever were the significant risk factors for the septic shock. Overall mortality showed higher tendency in the shock group than in the control group (23.1% vs. 12.0%, P=0.057). Especially, in patients with Gram-positive bacterial infection, infection related mortality was significantly higher in the shock group than in the control group (50% vs. 8.9%, P=0.013). CONCLUSION: Although Gram-positive bacterial infection has been increasing, Gram-negative bacteria, including E. coli, were the most common causative organisms for sepctic shock in febrile neutropenic patients. However, considering high mortality in the septic shock caused by Gram-positive bacteria, glycopeptide must immediately be administered to the febrile neutropenic patients developing septic shock.
Case-Control Studies ; Drug Therapy ; Escherichia coli ; Fever* ; Gram-Negative Bacteria ; Gram-Negative Bacterial Infections ; Gram-Positive Bacteria ; Gram-Positive Bacterial Infections ; Hematopoietic Stem Cell Transplantation ; Humans ; Incidence ; Leukemia ; Leukocyte Count ; Medical Records ; Mortality ; Multivariate Analysis ; Neutropenia ; Retrospective Studies ; Risk Factors* ; Shock ; Shock, Septic* ; Viridans Streptococci

This is a 20 year analysis of the problems associated with enterostomy formation, and closure. Forty-three stomas were established in 43 patients: 23 for anorectal malformations, 11 for Hirschsprung's diseases, 4 for necrotizing enterocolitis, 3 for multiple ileal atresias, 1 for volvulus neonatorum with perforation, and 1 for diaphragmatic hernia with colon perforation. Thirty boys and 13 girls were included (mean age 4.8 months). Stoma complications were encountered in 13 patients (30.2 %): stomal prolapse, stenosis, obstruction, paracolic hernia, retraction, dysfunction, and skin excoriation. Four patients (9.3 %) required stomal revision. Occurrence of complications was not related to age and primary disease, but sigmoid colostomy showed lower complication rate than transverse colostomy (20.0 % vs 42.9 %, p<0.05). There were five deaths but, only one (2.3 %) was directly related to the enterostomy complication. Twenty-one stomas were closed in our hospital and complications occurred in seven patients (33.3 %). The most common complication was wound sepsis in 5 children. In conclusion, because the significant morbidity of stomal formation still exists, refinements of the surgical technique seem to be required. Sigmoid loop colostomy is preferred whenever possible.
Child* ; Colon ; Colon, Sigmoid ; Colostomy ; Constriction, Pathologic ; Enterocolitis, Necrotizing ; Enterostomy ; Female ; Hernia ; Hernia, Diaphragmatic ; Humans ; Intestinal Volvulus ; Prolapse ; Sepsis ; Skin ; Wounds and Injuries

PURPOSE: While apoptosis of the rat prostate cells has been the focus of many studies on androgen action and prostatic carcinogenesis, little is known for morphometric measurement about rat prostatic glands. Apoptosis was described as a morphologically distinct form of cell death. However, the approach of morphological assessment in one cell to define apoptosis has some disadvantages. We studied androgen ablation induced reduction of glandular epithelial cells with counting apoptotic cells and measuring glandular cell mass with image analyzer. MATERIALS AND METHODS: Male Sprague-Dawley rats were used. The morphologic changes were evaluated at 4, 7, 14 days after castration. The ventral lobe was microdissected. The distal part of it was harvested under guide of dissecting microscope. The number of apoptotic cells were quantified in Masson & trichrome stained specimens. Using image analyzer, area densities in glandular lesion of prostatic epithelium were calculated. RESULTS: After castration. the distal duct may seem to be melted down into the proximal ducts and tall columnar epithelial cells of distal duct seem to be changed into cubodial cells. The apoptotic counts were 1.00+/-0.28, 5.06+/-0.98, 6.01+/-0.97, and 2.04+/-0.70 in control, 4th, 7th and 14th day group, respectively (p<0.05), The areas of epithelial cell mass were 13874+/-3106 micrometer2. 5530+/-3244 micrometer2, 2345+/-1226micrometer2, and 1339+/-652 micrometer2. in control, 4th. 7th and 14th day group, respectively(p<0.05). CONCLUSIONS: We conclude that castration induces a more profound involution of the rat ventral prostate. After castration, the apoptotic count and reduction of the area of epithelial cell mass rapidly processed by 7th day and after that time, this process is continuously but slowly decreased until 14th day after castration. The apoptotic counts among the epithelial cells are well matched with the morphometric measurements about epithelial glands.
Animals ; Apoptosis* ; Carcinogenesis ; Castration* ; Cell Death ; Epithelial Cells* ; Epithelium ; Humans ; Male ; Prostate* ; Rats* ; Rats, Sprague-Dawley

PURPOSE: Prostate is a well known androgen dependent accessary sex organ and androgen plays major roles in growth and development of prostate. While rat prostate has been the focus of many studies on androgen action and prostatic carcinogenesis, little is known of the pattern of regional variation and lobe-specific morphologic difference. Therefore, the study was designed to determine the morphologic differences in the proximal and distal duct, and in the ventral lobe and coagulating gland after castration through use of a microdissection method. MATERIALS AND METHODS: Male Sprague-Dawley rats were used in all studies. The morphologic changes evaluated at 4, 7, 14 days after castration. RESULTS: Wet weights of the ventral prostatic lobes in 7-, 14-day-post castration group were significantly different from control group(p=0.0001, ANOVA test), respectively. After castration the distal ducts may seemed to be melted down into the proximal ducts and tall simple columnar epithelial cells of distal duct changed into cuboidal cells. The distal duct of the castration groups showed decrease in ductal diameter, the numbers of cell and reduction of epithelial cell height. But these changes were not predominant in the proximal ducts of both lobes. There was no morphological difference between the ventral lobe and the coagulating gland after the orchiectomy. CONCLUSIONS: This study demonstrated that the androgen was a very important hormone to maintain the prostate gland. There was a morphological heterogeneity between the proximal and the distal ducts. We suggested that the regional variation in androgen responsiveness may provide an appropriate model for the study of androgen independent prostatic cell survival.
Animals ; Carcinogenesis ; Castration* ; Cell Survival ; Epithelial Cells ; Growth and Development ; Humans ; Male ; Microdissection ; Orchiectomy ; Population Characteristics* ; Prostate ; Rats* ; Rats, Sprague-Dawley ; Weights and Measures

PURPOSE: The main objective in management of neuropathic bladder is the preservation of renal function because the renal deterioration is the most serious problem of neuropathic bladder. We investigated risk factors for renal dysfunction in neuropathic bladder. MATERIALS AND METHOD: A total 75 patients of neuropathic bladder with voiding dysfunction was evaluated by urodynamic study and we analyzed the risk factors associated with upper urinary tract deterioration. RESULTS: High risk factor In developing renal dysfunction in cerebrovascular accident was high detrusor pressure, however in cases of spinal cord injury, detrusor external sphincter dyssynergia, high detrusor pressure and low compliance were risk factors of upper tract deterioration. CONCLUSIONS: In management of neuropathic bladder, the abnormalities of individual lesion-specific urodynamic parameters(detrusor sphincter dyssynergia, low compliance, high detrusor pressure) should be factored into the assessment of upper urinary tract deterioration.
Ataxia ; Compliance ; Humans ; Risk Factors ; Spinal Cord Injuries ; Stroke ; Urinary Bladder, Neurogenic* ; Urinary Tract ; Urodynamics*

Typical urodynamic findings in patients with intracranial lesion are uninhibited bladder contraction (detrusor hyperreflexia) with coordinated sphincter activity. However, the findings of urodynamic study are variable and dependent on the degree and site of intracranial lesion, the presence of underlying disease and the adequacy of initial management of voiding problems from onset of the neurologic symptoms. . In this study, we tried to investigate the urodynamic findings in 40 patients who had intracranial lesions (traumatic or organic brain disease) with voiding dysfunction. The following results were obtained. 1. Out of all 40 patients, 35 had organic brain disease such as infarct, intracranial hemorrhage, or Parkinsonism etc. and 5 had traumatic brain disease. 2. Among 40 patients, detrusor hyperreflexia was presented in 29 (72.5%), detrusor areflexia in 9 (22.5%) and normal detrusor pressure in 2 (5%). 3. In 29 cases of detrusor hyperreflexia, there was no history of urinary retention, but in 12 cases with history of urinary retention, 9 cases (75%) revealed as detrusor areflexia. 4. No specific cause except the history of urinary retention was considerable in 8 of 9 patients with detrusor areflexia. In our study, urodynamic findings in the patients with intracranial lesion who had voiding dysfunction revealed nine cases (22.5%) of detrusor areflexia and the presumptive cause of detrusor areflexia is considered to previous urinary retention. Therefore, highly individualized and programmed early urologic involvement on the basis of urodynamic study is recommended for the prevention of urinary retention in initial ""cerebral shock"" stage of cerebrovascular accident and when detrusor areflexia had been developed, intensive management for the removal of the residual urine is necessary.
Brain ; Brain Diseases ; Humans ; Intracranial Hemorrhages ; Neurologic Manifestations ; Parkinsonian Disorders ; Reflex, Abnormal ; Stroke ; Urinary Bladder ; Urinary Retention ; Urodynamics*