BACKGROUND: Paradoxical puborectalis syndrome (PPS) is a complex and poorly understood entity characterized by contraction rather than relaxation of the pelvic floor muscles during attempted evacuation. Anal electromyography (EMG) and cinedefecography (CD) are the most commonly used tests for the diagnosis of PPS. Therefore, the aim of this study was to prospectively assess the correlation of EMG and CD in the diagnosis of PPS. METHODS: All patients with symptoms of obstructed evacuation who underwent EMG and CD between September 1998 and February 1999, were evaluated. The clinical criteria for PPS included incomplete or difficult evacuation, straining, tenesmus, and the need for an enema or digitation. The EMG criteria included failure to achieve a significant decrease in the electrical activity of the puborectalis during attempted evacuation. The CD criteria included either paradoxical contraction or failure of the puborectalis to relax along with incomplete evacuation. RESULTS: Twenty-nine (29) patients had clinical evidence of PPS, 8 males and 21 females with a mean age of 42.6 years (range, 19-75 years), and underwent CD and EMG. The mean duration of symptoms was 7.2 years (range, 3 months-30 years). Nineteen patients (65.5%) had evidence as having PPS on CD and/or EMG. Of these patients, six patients (20.7%) were diagnosed as having PPS on both tests, five patients (17.2%) were only diagnosed on CD, and eight patients (27.6%) were only diagnosed on EMG. The remaining ten patients had normal puborectalis muscle relaxation on CD and EMG. Therefore, the correlation rate between the two tests was 55.2%. If EMG was considered as the ideal test for the diagnosis of PPS, CD had a sensitivity of 42.9% and a specificity of 66.7%. Conversely, if CD was considered as the ideal test, EMG had a sensitivity of 54.5% and a specificity of 55.6%. CONCLUSIONS: The sensitivity and the specificity values of EMG and CD for the diagnosis of PPS are suboptimal, and a low correlation existed between the two tests. This result suggests that the diagnosis of PPS should not be based upon only one test.
Constipation ; Diagnosis* ; Electromyography* ; Enema ; Female ; Humans ; Male ; Muscle Relaxation ; Muscles ; Pelvic Floor ; Prospective Studies ; Relaxation ; Sensitivity and Specificity

OBJECTIVES: To evaluate the factors that limit post-cochlear implantation (CI) speech perception in prelingually deaf children. METHODS: Patients with CI were divided into two groups according to Category of Auditory Performance (CAP) scores 3 years post-CI: the poor performance group (poor performance group, CAP scores≤4, n=41) and the good performance group (good performance group, CAP scores≥5, n=85). The distribution and contribution of the potential limiting factors related to post-CI speech perception was compared. RESULTS: Perinatal problems, inner ear anomalies, narrow bony cochlear nerve canal (BCNC), and intraoperative problems was significantly higher in the poor performance group than the good performance group (P=0.010, P=0.003, P=0.001, and P=0.045, respectively). The mean number of limiting factors was significantly higher in the poor performance group (1.98±1.04) than the good performance group (1.25±1.11, P=0.001). The odds ratios for perinatal problems and narrow bony cochlear nerve canal in the poor performance group in comparison with the good performance group were 4.878 (95% confidence interval, 0.067 to 0.625; P=0.005) and 4.785 (95% confidence interval, 0.045 to 0.972; P=0.046). CONCLUSION: This study highlights the comprehensive prediction of speech perception after CI and provides otologic surgeons with useful information for individualized preoperative counseling of CI candidates.
Child ; Cochlear Implantation ; Cochlear Implants* ; Cochlear Nerve ; Counseling ; Deafness* ; Ear, Inner ; Hearing Loss, Sensorineural ; Humans ; Language Development ; Odds Ratio ; Prognosis ; Speech Perception ; Surgeons

The aim of this study was to determine if the apoptotic degree could predict the prognosis for breast cancer in mastectomy specimens and to establish if any association existed between the apoptotic degree and clinical variables such as age, size, hormone receptor, lymph node metastasis, stage, result of follow up. The apoptotic degree, defined as the number of morphologically identified apoptotic bodies in the view of a 200X microscope, was calculated for 59 breast cancers. We applied an immunohistochemical procedure for staining the apoptotic cells in parapin sections of 59 breast cancers. The histochemical method used for the analysis of apoptosis was based on the detection of DNA breaks by terminal transferase-mediated in situ end labeling (TUNEL). The results were as follows; 1. An association between apoptotic degree and age was demonstrable (p=0.050). 2. No association between apoptotic degree and tumor size was demonstrable. 3. No association between apoptotic degree and lymph node metastasis was demonstrable. 4. An association between apoptotic degree and stage was demonstrable. 5. No association between apoptotic degree and hormone receptor was demonstrable (p=0.023). 6. No association between apoptotic degree and follow up results was demonstrable, however a low apoptotic degree showed a tendency for a poor clinical outcome, and this result had partiall statistical significance. Thus provisionally its value as an independent prognostic index has yet to be established and demands more study.
Apoptosis* ; Breast Neoplasms* ; Breast* ; DNA Breaks ; Follow-Up Studies ; Lymph Nodes ; Mastectomy ; Neoplasm Metastasis ; Prognosis

BACKGROUND: Auditory evoked potentials (AEPs) have assumed an essential role in the clinical practice of auditory and several other professions. AEP classification and nomenclature systems are generally based on such aspects as the time domain (short, middle, long), anatomic origin, stimulus-response relationship. The P300 component of the human event related potential is an endogenous positive wave with a latency of 300msec or greater. OBJECTIVES: Our purpose of this study was to estimate normal values of auditory late response (ALR) and P300 in adults and use them in mapping of the brain. MATERIALS AND MEHTODS: An auditory evoked potential was performed on 40 normal adults, and a scalp surface electrode with 30 electrodes was attempted. Forty adults with normal hearing were divided into 2 groups, one consisting of thirty persons under 30 years of age and the other consisting of ten persons over 30 years of age. RESULTS: The latencies of P1, N1, P2, N1-P2 were 53.17 +/- 19.57 msec, 98.25 +/- 32.68 msec, 166.12 +/- 44.0 msec, 65.12 +/- 23.68 msec, respectively, in the whole group and 54.23 +/- 20.86 msec, 98.7 +/- 34.35 msec, 160.93 +/- 44.02 msec 62.23 +/- 25.36 msec, respectively, in the group under 30 years old, and 50.0 +/- 15.57 msec, 96.9 +/- 28.69 msec, 181.7 +/- 42.28 msec 73.8 +/- 15.69 msec, respectively, in the group over 30 years old. The P300 latencies for the whole group and the two groups were 299.37 +/- 34.01 msec, 295.16 +/- 33.36 msec, 312.0 +/- 34.49 msec, respectively. There was no significant difference in the latency and amplitude of the ALR and P300 between the two groups (p>0.05). CONCLUSION: ALR and P300 were measured in 40 normal adults. Description of the normal topography of P300 may facilitate the examination of the P300 topography in cognitive disorders. Such an examination might help ALR and P300 to serve as better diagnostic tools of cognitive disorder in adults.
Adult* ; Brain ; Brain Mapping ; Classification ; Electrodes ; Event-Related Potentials, P300 ; Evoked Potentials ; Evoked Potentials, Auditory ; Hearing ; Humans ; Reference Values ; Scalp

BACKGROUND: There is considerable experimental evidence to indicate that tumor growth is dependent on angiogenesis. To investigate how tumor angiogenesis correlates with clinical factors and prognosis in breast carcinoma, we counted microvessels (capillaries and venules) and graded the density of micro vessels within the invasive ductal carcinomas of 59 patients. METHODS: Using light microscopy, we highlighted the vessels by staining their endothelial cells immu nohistochemically for rabbit antihuman factor-VIII related antigen (Dako L1809, USA). The microvessels were carefully counted (per 200 field) in the most active areas of neovascularization without knowledge of either the outcome in the patient or the clinical variables. RESULTS: The mean age was 47.8 years. There was no statistical correlation between angiogenesis and either estrogen receptor status or age. However, there was a statistical correlation with tumor size (p< or =0.05). There was a statistical difference between lymph-node-metastasis positive group and negative group (p= 0.006). Angiogenesis correlated statistically with TMN stage (microvessels count:stage I= 31.27, stage II= 40.74, and stage III= 78.9)(p= 0.001). There was a statistical correction between angiogenesis and follow-up results (microvessels counts:disease free group= 42.11, living metastatic group= 63.64, and expired group= 73.60)(p= 0.031). CONCLUSIONS: In this study, the degree of angiogenesis (the number of microvessels per 200 field in the area of most intensive neovascularization) may have a predictive value in invasive breast carci nomas. Therefore, assessment of tumor angiogenesis may give us useful information for selecting thera peutic and follow-up plan for patients with breast carcinomas.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Endothelial Cells ; Estrogens ; Follow-Up Studies ; Humans ; Microscopy ; Microvessels ; Noma ; Prognosis

Antineutrophil cytoplasmic antibodies (ANCAs) are now regarded as a serologic marker for pauci-immune crescentic necrotizing glomerulonephritis either in renal-limited form or in association with systemic vasculitis, such as Wegener? granulomatosis, microscopic polyarteritis, and Churg-Strauss syndrome. Two major ANCA antigens have been indentified: proteinase3, which produces a cytoplasmic staining pattern termed C-ANCA, and myeloperoxidase, which produces a perinuclear pattern termed P-ANCA on ethanol-fixed neutrophils by indirect immunofluorescence. In ANCA- associated diseases, eosinphilia in excess of 1.5X109/L has been proposed to be characteristic of Churg-Strauss syndrome and is rare in other forms of ANCA-associated systemic vasculitis and crescentic necrotizing glomerulonephritis. Recently, there were two cases of P-ANCA positive crescentic necrotizing glomerulonephritis with peripheral blood eosinophilia and extrarenal microscopic vasculitis without asthma or granulomas. We experienced a patient with P-ANCA positive pauci-immune necrotizing glomerulonephritis with few eosinophilic infiltration and eosinophilia. He improved with oral prednisolone along with combination of intravenous cyclophosphamide. So we report this case with the review of literature.
Antibodies, Antineutrophil Cytoplasmic* ; Asthma ; Churg-Strauss Syndrome ; Cyclophosphamide ; Cytoplasm ; Eosinophilia* ; Eosinophils ; Fluorescent Antibody Technique, Indirect ; Glomerulonephritis* ; Granuloma ; Humans ; Neutrophils ; Peroxidase ; Prednisolone ; Systemic Vasculitis ; Vasculitis

Cervical cancer is characterized by a long period of preclinical dysplasia or carcinoma in situ progressing into invasive cancer. Although Papanicolaou (Pap) smear test has contributed significantly to the early detection of precursor lesions, the cytological screening has inherent problems that produce considerable false negative/positive results. Since the infection of high-risk type of human papillomavirus (HPV) is strongly associated with cervical cancer, we investigated the feasibility of an immunostaining test to detect cells infected by HPV in cervical smear. We produced monoclonal antibodies against HPV16 E7 in mice by repeated injections with the recombinant HPV16 E7. Western blot analysis and immunocytochemical assay demonstrated that the selected monoclonal antibody, mAb (130-9-7), reacts specifically with cultured cervical cancer cell lines infected by HPV16. Specific staining was observable with the HPV16-positive smear specimens obtained from the cervical cancer patients, whereas no staining was detected with the HPV-negative smear specimens. To achieve the desired sensitivity, specificity and reproducibility, we modified and optimized the conventional immunocytochemical procedure for cervical smear specimens. Our results suggest that this immunostaining method for detecting high-risk HPV in cervical smear may be used as a strategy to distinguish a high-risk group, especially those patients with low grade cytological abnormality.
Animals ; Antibodies, Monoclonal ; Antibodies, Viral ; Cell Line ; Cervix Uteri/*virology ; Female ; Human papillomavirus 16/genetics/*isolation & purification ; Humans ; Hybridomas ; Immunohistochemistry/methods ; Mice ; Oncogene Proteins, Viral/genetics/*metabolism ; Transfection ; Uterine Cervical Neoplasms/virology ; Vaginal Smears

BACKGROUND AND OBJECTIVES: Coronary flow reserve (CFR) is the capability of coronary arteriolar bed to dilate in response to increased cardiac metabolic demand. Nocorandil, a hybrid of ATP-sensitive K+ channel opener and nitrates, causes coronary vasodilation of both epicardial and resistance vessels. We investigated the feasibility and safety of nicorandil as compared to adenosine in the measurement of CFR using a Doppler guide wire. SUBJECTS AND METHODS: We measured CFR in 26 consecutive patients (mean age 52+/-19 years, M:F=16:10) during coronary intervention with a 0.014-inch Doppler guide wire. We recorded the baseline average peak velocity (APV) and the hyperemic APV induced by intracoronary adenosine or nicorandil. The heart rate, mean aortic pressure and the time interval from maximal APV to baseline APV were also recorded. RESULTS: There were no significant differences between APV, diastole/systole velocity ratio and CFR induced by adenosine and those induced by nicorandil (44.4 +/- 17.3 vs 45.5 +/- 17.6, p=0.78, 1.59 +/- 0.51 vs 1.57 +/- 0.52 p=0.78, 2.22 +/- 0.89 vs 2.27 +/- 0.94, p=0.36). The CFR and diastole/systole velocity ratio induced by nicorandil showed a strong positive linear correlation with those by adenosine (r2=0.77, p=0.0001, r2=0.83, p=0.0001). Adenosine significantly decreased the heart rate as compared to nicorandil =-25.5 +/- 9.7 vs -8.7 +/- 4.9 bpm, p=0.001). There were no differences in the changes of mean aortic pressure between adenosine and nicorandil (-7 +/- 9 vs -2 +/- 3 mmHg, p=0.17). Nicorandil prolonged the time interval from maximal APV to baseline APV compared to adenosine (194 +/- 62 vs 37 +/- 12 sec, p=0.001). CONCLUSION: Nicorandil is feasible and safe for use in measuring CFR using a Doppler guide wire and may replace adenosine.
Adenosine* ; Arterial Pressure ; Blood Flow Velocity ; Heart Rate ; Humans ; Nicorandil* ; Nitrates ; Ultrasonography ; Vasodilation

BACKGROUND: Immune hemolysis secondary to ABO minor incompatibility is a rare graft versus host disease in renal recipients, secondary to anti-ABO antibody produced by lymphocytes of donor origin that reacts against recipient RBCs. METHODS: To investigate the incidence and clinical features of immune hemolysis secondary to ABO minor incompatibility in renal allograft recipients, clinical records of 358 renal transplantation performed in Maryknoll Hospital since 1991 were analyzed retrospectively. RESULTS: Fifty four (15%) of 358 renal transplants were ABO minor incompatible. Immune hemolysis secondary to anti-ABO antibody developed in 5 (9.2%) of 54 ABO minor incompatible renal transplant recipients. Immune hemolysis occurred in 3 (13.6%) patients among 22 allografts from blood type O donor to A recipients and 2 (10%) patients among 20 from blood type O donor to B recipients. All 5 patients received cyclosporin with prednisolone, and MMF was administered to one patient additionally. Immune hemolysis developed on 14+/-3 days after renal transplantation and lasted for about 10+/-3 days. The maximum reduction of hemoglobin was 3.3+/-1.0 g/dL. All patients required donor type (blood type O) washed RBCs transfusion (5.0+/-2.6 units per patient) and plasmapheresis were performed in 3 patients (4.0+/-1.0 per patient). All patients recovered without deterioration of graft function. Age, number of HLA mismatch, creatinine at 1 year after transplantation, frequency of acute rejection and serum cyclosporin level during first 2 weeks were not significantly different between hemolysis group (N=5) and non-hemolysis group (N=49). Living unrelated transplantation is associated with increased incidence of immune hemolysis compared with living related transplantation (p<0.01). CONCLUSION: Although immune hemolysis secondary to ABO minor incompatibility is uncommon, we experienced cases with marked reduction of hemoglobin that required a large amount of transfusion. Therefore, this type of immune hemolysis needs to be considered as a differential diagnosis of posttransplant hemolysis. As our center routinely performs donor specific transfusion (DST), the incidence may be higher than that of other centers where DST is not usually given.
Allografts ; Anemia, Hemolytic* ; Blood Group Incompatibility ; Creatinine ; Cyclosporine ; Diagnosis, Differential ; Graft vs Host Disease ; Hemolysis ; Humans ; Incidence ; Kidney Transplantation ; Lymphocytes ; Plasmapheresis ; Prednisolone ; Retrospective Studies ; Tissue Donors ; Transplantation ; Transplants

PURPOSE: The method of locally administered ketorolac and bupivacaine with epinephrine in LAG patients was examined for the control of postoperative pain. METHODS: Fifty-one patients who had undergone LAG for gastric cancer from Jan. 2005 and Aug. 2005 were enrolled in this study. All the patients were administered a fentanyl patch (25 microgram/hr) on the upper back 2 hours before the entry into the OR. Upon the completion of LAG, the patients were randomly selected for a local injection of Ketolorac and bupivacaine. Ketolorac (30 mg, 1 cc) plus 0.5% bupivacaine with 1 : 100,000 epinephrine (9 cc) was injected in the peritoneum and subcutaneous tissue of the mini-laparotomy wound in the study group, and normal saline (10 cc) was injected into the control group. The postoperative pain scores were assessed at 6 hr, day 1, day 2 and day 5 using a Verbal Numerical Rating Scale by a Wound Ostomy Continence Nurse. Meperidine (25 mg iv.) was used for additional analgesia. RESULTS: The frequency of additional analgesic requirement was significantly lower in the study group and the pain score was significantly lower at 6 hr postoperatively than in the control group. CONCLUSION: Locally administered ketorolac and bupivacaine with epinephrine is a simple and cost-effective technique for alleviating postoperative pain in LAG patients with gastric cancer.
Analgesia ; Anesthesia, Local ; Bupivacaine* ; Double-Blind Method* ; Epinephrine ; Fentanyl ; Humans ; Ketorolac* ; Meperidine ; Ostomy ; Pain, Postoperative* ; Peritoneum ; Prospective Studies* ; Stomach Neoplasms* ; Subcutaneous Tissue ; Wounds and Injuries