BACKGROUND: Preservation of antigen determinants while retaining morphological detail is prerequisite for high quality immunohistochemistry. Conventional formalin fixation and paraffin embedding procedures are useful in preserving tissue architecture and cytologic detail. However, they destroy the antigenicity of many proteins is tissue samples. On the other hand, fresh frozen section preserve the antigenicity of most proteins, but vield poor morphological preservation. OBJECTIVE: The purpose of this study is to evaluate the AMeX method as to the ability to preserve both antigenicity and morphologic details of the skin basement membrane zone so that precise localization of antigens can be attained in immunohistochemistry. METHODS: Tissues were fixed in acetone at -20degrees C over night, then cleared in methyl benzoate and xylene, consecutively, and embedded in ordinary paraffin at 58-60degrees C. Sections made from this paraffinembedded tissue were stained with hematoxylin and eosin for a morphologic study and immunolabelled with antibodies against major basement membrane antigens to evaluate antigenic preservation. The staining intensity and preservation of the morphology by the AMeX method were compared with conventional formalin processed tissues and frozen tissues. RESULTS: Morphological preservation of the AMeX method-processed sections was good throughout the epidermis, basement membrane, and dermis, and as good as that of routinely formalin-fixed paraffin-embedded sections. Frozen sections usually revealed revealed various degrees of damage by ice crystal formation throughout the epidermis to the dermis. The AMeX method-processed sections showed better or same antigenic preservation comparing the frozen sections when the sections were immunolabelled with specific monoclonal antibodies. But, when the sections were immunolabelled with patient's sera, the AMex method showed less antigenic preservation than the frozed sections. The anti-type IV collagen monoclonal antibody exhibited immunoreactivity only conventional formalin-fixed paraffin-embedded skin sections, but the intensity of the staining was weaker than the AMeX processed sections and the frozen sections. CONCLUSION: The AMeX method can be utilized for the demonstration of skin basement membrane antigens and is superior to the fresh-frozen method in that the histologic figures are more distinct and antigencity can be preserved for a long time.
Acetone* ; Antibodies ; Antibodies, Monoclonal ; Basement Membrane* ; Benzoates* ; Collagen ; Dermis ; Eosine Yellowish-(YS) ; Epidermis ; Formaldehyde ; Frozen Sections ; Hand ; Hematoxylin ; Ice ; Immunohistochemistry ; Paraffin ; Paraffin Embedding ; Skin* ; Xylenes*

Caudal anesthesia for total hip replacement in geriatric patients has been evaluated clinically. The caudal epidural puncture was performed by a 22 G short needle through sacral hiatus with a lateral decubitus position. 1.5% lidocaine 20 mL and 0.5% bupivacaine 15 mL mixed with 1:200,000 epinephrine and 2 mg morphine was used as an anesthetics. The results were follows ; 1) The onset of caudal anesthesia was 7.9+/-4.5 min (2-20 min) and the duration was 4.8+/-3.0 hrs (1-12 hrs). 2) Anesthetic sensory level was not related with the patient's weight or height. 3) The failure rate including systemic toxicity was 13%. 4) The most common complication was hypotension and its incidence was 26.6%. 5) Time to first analgesics was 8.3+/-3.6 hrs. These results indicate that caudal anesthesia in lateral decubitus position is a recommendable anesthetic technique for total hip replacement in geriatric patients. However, the further studies for the determinations of the optimum dose of local anesthetics are needed.
Analgesics ; Anesthesia, Caudal* ; Anesthetics ; Anesthetics, Local ; Arthroplasty, Replacement, Hip* ; Bupivacaine ; Epinephrine ; Geriatrics ; Humans ; Hypotension ; Incidence ; Lidocaine ; Morphine ; Needles ; Punctures

To objectively compare the response of the palliative radiotherapy in bone metastatic patients which decreases pain and prevents pathologic fractures, we introduced and applied the RTOG pain and narcotic measure system. From Oct in 1991 to July in 1993, thirty-two patients with painful bone metastases, 17 of them were solitary lesions and others were multiple lesions, were treated with mainly 6 MV photon otherwise 15 MV photon. Radiation doses to bone metastatic sites ranged about from 2000 to 4600cGy. Responses of radiation therapy were compared with days of pre-RT, RT finish, 3, 6, 9 months after the start of RT and solitary versus multiple lesions and follow up scores according to the RTOG measure system. Survival analysis was done. Pain and narcotic score of the entire patients were 7.3, 7.8 at the pre-RT period and 2.6, 3.9 at the immediate or 2 weeks after RT, which was 64%, 50% decrement compared with the pre-RT score. Pain scores of 3, 6 and 9 months after the beginning of irradiation were 3.6, 3.7 and 3.3. The best response found in the breast and prostate primaries was 84%, 78% decrement of pain score as compared with pre-RT score (statistically insignificant). Median survival was 5.5 months and mean survival was 5 months. We conclude that the RTOG pain and narcotic measure system in relatively effective scale in the comparison of before and after palliative irradiation to the painful bone metastatic sites but more detailed parameters will be required in the narcotic scoring system. More aggressive but less or similar toxic radiotherapy is needed in the patients having relatively long life expected time.
Breast ; Follow-Up Studies ; Fractures, Spontaneous ; Humans ; Neoplasm Metastasis ; Prostate ; Radiotherapy*

PURPOSE: For the first time, a nationwide survey of the Patterns of Care Study (PCS) for the various radiotherapy treatments of esophageal cancer was carried out in South Korea. In order to observe the different parameters, as well as offer a solid cooperative system, we compared the Korean results with those observed in the United States (US) and Japan. MATERIALS AND METHODS: Two hundreds forty-six esophageal cancer patients from 21 institutions were enrolled in the South Korean study. The patients received radiation theraphy (RT) from 1998 to 1999. In order to compare these results with those from the United States, a published study by Suntharalingam, which included 414 patients [treated by Radiotherapy (RT)] from 59 institutions between 1996 and 1999 was chosen. In order to compare the South Korean with the Japanese data, we choose two different studies. The results published by Gomi were selected as the surgery group, in which 220 esophageal cancer patients were analyzed from 76 facilities. The patients underwent surgery and received RT with or without chemotherapy between 1998 and 2001. The non-surgery group originated from a study by Murakami, in which 385 patients were treated either by RT alone or RT with chemotherapy, but no surgery, between 1999 and 2001. RESULTS: The median age of enrolled patients was highest in the Japanese non-surgery group (71 years old). The gender ratio was approximately 9:1 (male:female) in both the Korean and Japanese studies, whereas females made up 23.1% of the study population in the US study. Adenocarcinoma outnumbered squamous cell carcinoma in the US study, whereas squamous cell carcinoma was more prevalent both the Korean and Japanese studies (Korea 96.3%, Japan 98%). An esophagogram, endoscopy, and chest CT scan were the main modalities of diagnostic evaluation used in all three countries. The US and Japan used the abdominal CT scan more frequently than the abdominal ultrasonography. Radiotherapy alone treatment was most rarely used in the US study (9.5%), compared to the Korean (23.2%) and Japanese (39%) studies. The combination of the three modalities (Surgery+RT+Chemotherapy) was performed least often in Korea (11.8%) compared to the Japanese (49.5%) and US (32.8%) studies. Chemotherapy (89%) and chemotherapy with concurrent chemoradiotherapy (97%) was most frequently used in the US study. Fluorouracil (5-FU) and Cisplatin were the most preferred drug treatments used in all three countries. The median radiation dose was 50.4 Gy in the US study, as compared to 55.8 Gy in the Korean study regardless of whether an operation was performed. However, in Japan, different median doses were delivered for the surgery (48 Gy) and non-surgery groups (60 Gy). CONCLUSION: Although some aspects of the evaluation of esophageal cancer and its various treatment modalities were heterogeneous among the three countries surveyed, we found no remarkable differences in the RT dose or technique, which includes the number of portals and energy beams.
Adenocarcinoma ; Asian Continental Ancestry Group ; Carcinoma, Squamous Cell ; Chemoradiotherapy ; Cisplatin ; Endoscopy ; Esophageal Neoplasms ; Female ; Fluorouracil ; Humans ; Japan ; Korea ; Republic of Korea ; Thorax ; United States

PURPOSE: To assess the effect of a rectal enema on interfraction prostate movement in bone alignment (BA) for prostate radiotherapy (RT), we analyzed the spatial difference in prostates in a bone-matched setup. MATERIALS AND METHODS: We performed BA retrospectively with data from prostate cancer patients who underwent image-guided RT (IGRT). The prostate was identified with implanted fiducial markers. The setup for the IGRT was conducted with the matching of three fiducial markers on RT planning computed tomography images and those on two oblique kV x-ray images. Offline BA was performed at the same position. The coordinates of a virtual prostate in BA and a real prostate were obtained by use of the ExaxTrac/NovalisBody system, and the distance between them was calculated as the spatial difference. Interfraction prostate displacement was drawn from the comparison of the spatial differences. RESULTS: A total of 15 patients with localized prostate cancer treated with curative hypofractionated IGRT were enrolled. A total of 420 fractions were analyzed. The mean of the interfraction prostate displacements after BA was 3.12+/-2.00 mm (range, 0.20-10.53 mm). The directional difference was profound in the anterior-posterior and supero-inferior directions (2.14+/-1.73 mm and 1.97+/-1.44 mm, respectively) compared with the right-left direction (0.26+/-0.22 mm, p<0.05). The required margin around the clinical target volume was 4.97 mm with the formula of van Herk et al. CONCLUSIONS: The interfraction prostate displacement was less frequent when a rectal enema was performed before the procedure. A rectal enema can be used to reduce interfraction prostate displacement and resulting clinical target volume-to-planning target volume margin.
Enema* ; Fiducial Markers ; Humans ; Prostate* ; Prostatic Neoplasms ; Radiotherapy* ; Retrospective Studies

PURPOSE: To investigate the growth inhibitory effects, and the underlying mechanism of human colon cancer cell (HT-29) death, induced by a new synthetic bile acid derivative (HS-1200). MATERIALS AND METHODS: Human colon cancer cells (HT-29), in exponential growth phase, were treated with various concentrations of a new synthetic bile acid derivative (HS-1200). The growth inhibitory effects on HT-29 cells were examined using a trypan blue exclusion assay. The extent of apoptosis was determined using agarose gel electrophoresis, TUNEL assays and Hoechst staining. The apoptotic cell death was also confirmed by Western blotting of PARP, caspase-3 and DNA fragmentation factor (DFF) analysis. To investigate the involvement of mitochondria, we employed immunofluorescent staining of cytochrome c and mitochondrial membrane potential analyses. RESULTS: The dose required for the half maximal inhibition (IC50) of the HT-29 cell growth was 100~150 micro M of HS-1200. Several changes, associated with the apoptosis of the HT-29 cells, were reveal by the agarose gel eletrophoresis, TUNEL assays and Hoechst staining, following their treatment with 100 micro M of HS-1200. HS-1200 treatment also induced caspase-3, PARP and DFF degradations, and the western blotting showed the processed caspase-3 p20, PARP p85 and DFF p30 and p11 cleaved products. Mitochondrial events were also demonstrated. The cytochrome c staining indicated that cytochrome c had been released from the mitochondria in the HS-1200 treated cells. The mitochondrial membrane potential (deltaxm) was also prominently decreased in the HS-1200 treated cells. CONCLUSION: These findings suggest that the HS-1200 - induced apoptosis of human colon cancer cells (HT-29) is mediated via caspase and mitochondrial pathways.
Apoptosis* ; Bile ; Bile Acids and Salts ; Blotting, Western ; Caspase 3 ; Cell Death ; Colon* ; Colonic Neoplasms* ; Cytochromes c ; DNA Fragmentation ; Electrophoresis, Agar Gel ; HT29 Cells ; Humans* ; In Situ Nick-End Labeling ; Membrane Potential, Mitochondrial ; Mitochondria ; Sepharose ; Trypan Blue

PURPOSE: We investigated incidence of feeding intolerance and time when normal enteral feeding can be established in full term neonates with hypoxic-ischemic encephalopathy (HIE). METHODS: We reviewed medical records of 61 full term infants with HIE who were admitted to St. Paul's Hospital from Jan. 1996 to Dec. 2001. The incidence of feeding intolerance, day of first feeding, and day of full enteral feeding were studied in respective to Sarnat stages. RESULTS: Among the full term with HIE, 32 were classified into stage I, 20 into stage II, and 9 into stage III. The incidence of feeding intolerance was 6%, 30%, and 89% for stages I, II and III, respectively. There was only one case of necrotizing enterocolitis among infants of stage III HIE. Feeding first began on 0.13+/-0.01 postnatal day (PND) in normal infants compared to 0.15+/-0.03 PND in infants of stage I, 3.24+/-1.82 PND in stage II and 5.58+/-2.50 PND in stage III. The incidence of feeding intolerance, day of first feeding, and day of normal enteral feeding achieved in infants with stage I were not different from those of normal infants but significantly higher and delayed in infants with more severe degrees of encephalopathy. CONCLUSION: The first feeding should vary according to severity of encephalopathy so as to lower the incidence of feeding intolerance and the risk of necrotizing enterocolitis. We suggest that infants of stageIencephalopathy be first fed as same as normal infants, but precaution is in order when deciding an appropriate time to start feeding in infants of stage II, III encephalopathy.
Enteral Nutrition ; Enterocolitis, Necrotizing ; Humans ; Hypoxia-Ischemia, Brain* ; Incidence* ; Infant ; Infant, Newborn* ; Medical Records

PURPOSE: We investigated incidence of feeding intolerance and time when normal enteral feeding can be established in full term neonates with hypoxic-ischemic encephalopathy (HIE). METHODS: We reviewed medical records of 61 full term infants with HIE who were admitted to St. Paul's Hospital from Jan. 1996 to Dec. 2001. The incidence of feeding intolerance, day of first feeding, and day of full enteral feeding were studied in respective to Sarnat stages. RESULTS: Among the full term with HIE, 32 were classified into stage I, 20 into stage II, and 9 into stage III. The incidence of feeding intolerance was 6%, 30%, and 89% for stages I, II and III, respectively. There was only one case of necrotizing enterocolitis among infants of stage III HIE. Feeding first began on 0.13+/-0.01 postnatal day (PND) in normal infants compared to 0.15+/-0.03 PND in infants of stage I, 3.24+/-1.82 PND in stage II and 5.58+/-2.50 PND in stage III. The incidence of feeding intolerance, day of first feeding, and day of normal enteral feeding achieved in infants with stage I were not different from those of normal infants but significantly higher and delayed in infants with more severe degrees of encephalopathy. CONCLUSION: The first feeding should vary according to severity of encephalopathy so as to lower the incidence of feeding intolerance and the risk of necrotizing enterocolitis. We suggest that infants of stageIencephalopathy be first fed as same as normal infants, but precaution is in order when deciding an appropriate time to start feeding in infants of stage II, III encephalopathy.
Enteral Nutrition ; Enterocolitis, Necrotizing ; Humans ; Hypoxia-Ischemia, Brain* ; Incidence* ; Infant ; Infant, Newborn* ; Medical Records

PURPOSE: To evaluate the changes of differential counts and lymphocyte subsets in cancer patients' leukocyte before and after radiotherapy. METHODS AND MATERIALS: From Dec. 1994 to May 1995, the changes of leukocyte and its subsets in 16 patients who received radiotherapy in the Dept. of Radiation Oncology of Dong-A University Hospiatal were investigated. Radiation was delivered from 2700 cGy to 6660 cGy with median dose of 5400 cGy. The results of pre- and post-radiotherapy were analyzed by paired T-test. The results of patients who received < 50 Gy and > or = 50 Gy were analyzed by wilcoxon test. RESULTS: Before and after radiotherapy, there was not any significant differences in the counts of leukocyte, granulocyte and monocyte. A remarkable decrease was noted in lymphocyte counts after radiotherapy(p=0.015). T cells, B cells and natural killer cells were also decreased in number after radiotherapy but it was not significant statistically. T helper cells and T suppressor cells were also decreased in number(p>0.05). The ratio of T helper/suppressor cell was decreased from 1.52 to 1.11 and it was significant statistically(p=0.016). The portion of T suppressor cell among all T cells was increased after radiotherapy (p=0.0195). No significant difference was observed in the analysis of leukocyte and its subsets between patients who reveived < 50 Gy and > or = 50 Gy. CONCLUSION: Radiotherapy caused remarkable decrease in lymphocyte count and its subsets. Among all lymphocyte subsets, T helper cell might be the most vulnerable to radiation, considering decreased ratio of T helper/surppressor cell count after radiotherapy.
B-Lymphocytes ; Cell Count ; Granulocytes ; Humans ; Killer Cells, Natural ; Leukocytes ; Lymphocyte Count ; Lymphocyte Subsets* ; Lymphocytes* ; Monocytes ; Radiation Oncology ; Radiotherapy* ; T-Lymphocytes ; T-Lymphocytes, Helper-Inducer

Hepatoblastoma is a primary embryonic liver tumor usually found in children. It extremely rarely occurs in adults. We report a case of hepatoblastoma in a 56 year old man with chronic hepatitis B of 10years duration. Laboratory investigation of the patient on admission showed a marked elevation of alpha-fetoprotein in serum. Ultrasonography and Computerized tomography scan revealed a primary tumor, 6x7cm in size, in the right lobe. The tumor removed by a right lobectomy. Complete removal of the tumor is the treatment which is potentially curative provided that lesion is confined within the liver capsule. The literature revealed and a case of this tumor reviewed.
Adult* ; alpha-Fetoproteins ; Child ; Hepatitis B, Chronic ; Hepatoblastoma* ; Humans ; Liver ; Middle Aged ; Ultrasonography