BACKGROUND: Extracorporeal membrane oxygenation (ECMO) during severe acute respiratory failure helps to recover the pulmonary function. This study evaluated our experience with veno-venous ECMO in adult patients with acute respiratory failure. METHODS: From January 2007 to July 2009, ECMO was used on 54 patients. Of these 54 patients, 7 were placed on veno-venous ECMO for acute respiratory failure. The indications of ECMO were based on the lung dysfunction measured as a PaO2/FiO2 ratio <100 mm Hg on FiO2 of 1.0, or an arterial blood gas pH <7.25 due to hypercapnia despite the optimal treatment. EBS(R), Bio-pump(R), and Centrifugal Rotaflow pump(R) were used and all cannulations were performed percutaneously via both femoral veins. When the lung function was improved, an attempt was made to wean on ECMO at moderate ventilator settings followed by decannulation. RESULTS: Five of the 7 patients were male and the mean age was 46.3+/-18.3. The causes of acute respiratory failure were 3 cases of pneumonia, 2 near-drownings, 1 pulmonary hemorrhage due to acute hepatic failure and 1 mercury vapor poisoning. The mean support time of ECMO was 17.3+/-13.7 days. Of the 7 patients implanted with ECMO, 5 patients (71%) were weaned off ECMO and 3 patients (43%) survived to hospital discharge after a mean 89.6 hospital days. CONCLUSION: The early use of ECMO for acute respiratory failure in adults due to any cause is a good therapeutic option for those unresponsive to the optimal conventional treatments.
Adult ; Catheterization ; Extracorporeal Membrane Oxygenation ; Femoral Vein ; Hemorrhage ; Humans ; Hydrogen-Ion Concentration ; Hypercapnia ; Liver Failure, Acute ; Lung ; Male ; Near Drowning ; Pneumonia ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Ventilators, Mechanical

In prostate cancer patients without local invasion and metastasis, radical prostatectomy is performed as a rule for the resection of residual cancer. In a few cases, little amount of cancer volume is identified in radical prostatectomy specimens. This finding has been described as 'minimal residual cancer' or 'vanishing cancer phenomenon' and some reports have demonstrated an increase in the incidence of minimal residual prostate cancer. However, only few cases with 'minimal residual cancer' or 'no residual cancer' despite efforts searching for other possibilites have been reported. We report a case of no residual cancer in radical prostatectomy specimens of biopsy-proven prostate cancer.
Humans ; Incidence ; Neoplasm Metastasis ; Neoplasm, Residual* ; Prostate* ; Prostatectomy* ; Prostatic Neoplasms*

To identify risk factors and causative organisms, and to evaluate clinical manifestations, methods and results of treatment in infectious keratitis, an epidemiological study was performed prospectively under the identical protocol from April 1995 to March 2000.Logistic regression analysis was used to evaluate possible risk factors. The 1474 cases of infectious keratitis reported from 22 hospitals were studied. Five hundred forty-four organisms(442 bacteria, 82 fungi, 20 A c a n t h a m o e b a)were detected in 1320 eyes with infectious keratitis excluding 154 herpetic keratitis. The Pseudomonas aeruginosa was the most common organism in bacterial keratitis, and Fusariumspp. was the major isolate in fungal keratitis. Contact lens wear and occupation(industry, forester, miner, fisherman)were the risk factors for bacterial keratitis. Risk factors in fungal keratitis were fifth decade of age, farmer, and systemic diseases(diabetes mellitus etc.). Risk factors in herpetic keratitis were male and occupation(office worker, service, student, housewife). Risk factors in Acanthamoeba keratitis was contact lens wear.
Acanthamoeba Keratitis ; Bacteria ; Epidemiologic Studies ; Epidemiology* ; Fungi ; Humans ; Keratitis ; Keratitis, Herpetic ; Male ; Prospective Studies ; Pseudomonas aeruginosa ; Risk Factors

Congenital bladder diverticulum usually occurs in areas where the muscle is inadequately formed, typically at the ureterovesical junction, or between bundles of hypertrophied muscle. Congenital bladder diverticulum might be missed in excretory urography, especially in case that primary symptom is not so severe to justify further invasive studies. Physicians should not neglect voiding symptoms in pediatric patients and should have high suspicion of congenital diseases. We report a case of rare congenital bladder diverticulum, misdiagosed as non-neurogenic neurogenic bladder, presenting as nocturnal enuresis, daytime frequency and post-voiding residual urine sensation without vesicoureteral reflux or outlet obstruction.
Diverticulum* ; Enuresis ; Humans ; Nocturnal Enuresis ; Sensation ; Urinary Bladder* ; Urinary Bladder, Neurogenic* ; Urography ; Vesico-Ureteral Reflux

BACKGROUND: It is difficult to manage intractable pain from advanced carcinoma of the upper abdomen. One method used to control pain associated with these malignancies is to block the splanchnic nerve. We investigated that VAS (visual analogue scale) difference before and after splanchnic nerve block (SNB) and pain relief day. Also we studied relationship between VAS before SNB and pain relief day. METHODS: A rewiew of 70 patients who took splanchnic nerve block (SNB) from September 1994 to February 1998 was carried out to assess age, sex, primary diseases, pain sites, VAS before and after SNB, date of diagnosis, date of SNB, date of death and pain relief day, etc. RESULTS: Of 70 patients, 44 were males and the remaining 26 were females. The causes of pain were stomach cancer 28 (40%), pancreatic cancer 18 (25%), gall bladder cancer 7 (10%), hepatoma 6 (8.6%) respcectively. Average day from diagnosis to SNB was 272 and average day from diagnosis to death was 341. So, patients died on the average 69 days after they took the splanchnic nerve block in pain clinic. VAS average before SNB was 8.01 and VAS average after SNB was 3.64. Patients felt pain relief during 35 days after SNB. Pain relief day of patients who had lower VAS before SNB was longer than that of patients who had higher VAS before SNB. CONCLUSION: Early application of splanchnic nerve block will make the patients endure the cancer pain more easily.
Abdomen ; Carcinoma, Hepatocellular ; Diagnosis ; Female ; Gallbladder Neoplasms ; Humans ; Male ; Pain Clinics ; Pain, Intractable ; Pancreatic Neoplasms ; Splanchnic Nerves* ; Stomach Neoplasms

PURPOSE: Combined androgen blockade(CAB) is often used in the management of advanced adenocarcinoma of the prostate. Recent case reports indicated that hypogonadism from CAB therapy is associated with osteoporosis and related fracture. The effect of CAB on bone mineral density(BMD) has not been adequately studied in men with prostate cancer. In this study, the possibility, frequency and severity of osteoporosis following CAB in prostate cancer patient was investigated. MATERIALS AND METHODS: A total of 19 men with advanced prostate cancer receiving CAB were evaluated for the presence of osteoporosis defined as bone mass 2.5 standard deviation below peak bone mass of young normal men(T-score). The BMB of the femoral neck and lumbar spine were measured. The BMD was then compared to the age-matched control value and reported as the Z-score. BMD measurements were compared to duration of CAB and Gleason score. RESULTS: Osteoporosis occurred in 10 of 15 patients in lumbar spine, and 4 of 18 patients in femoral neck. Osteoporosis was unrelated to the type of the CAB(orchiectomy, or LHRH-agonist). CAB caused a decrease in mean BMD of lumbar spine and femoral neck. There is a negative linear relation between mean BMD and duration of CAB(lumber spine; R2=0.059, Y=-2.368-0.016X, p>0.05, femoral neck; R2=0.089, Y=-1.923-0.020x, p>0.05). There is a statistically significant negative linear relationship between Gleason score and mean T-score of femoral neck(lumbar spine; R2=0.391, Y=-0.08-0.371X, p<0.05, femoral neck; R2=0.517, Y=0.855-0.450x, p<0.005). CONCLUSIONS: Our study provide evidence for acceleration of osteoporosis among men whose prostate cancers were treated with CAB. This study indicates a need for bone mineral density determination at the onset of CAB and at periodic intervals there after to begin appropriate therapy, undefined at this point, for prevention of osteoporosis and its complications aggravated by this therapy.
Acceleration ; Adenocarcinoma ; Bone Density ; Femur Neck ; Humans ; Hypogonadism ; Male ; Neoplasm Grading ; Osteoporosis* ; Prostate* ; Prostatic Neoplasms* ; Spine

Infectious keratitis is the most common serious ocular infection, and may be caused by various bacteria, fungi, viruses and parasites. The authors performed prospectively an epidemiological study to identify risk factors and causative organisms, and to evaluate clinical manifestations, methods and results of treatment in infectious keratitis under the identical protocol from April 1995 to September 1997. Logistic regression analysis [univariate analysis and multivariate analysis] was used to evaluate possible risk factors. Six hundred sixty cases of infectious keratitis reported from 19 hospitals were studied. Two hundred eighty-three organisms[247 bacteria, 32 fungi, 4 acanthamoeba] were detected in 626 eyes with infectious keratitis excluding 34 pherpetic keratitis. The Pseudomonas aeruginosa, coagulase negative staphylococcus, Staphylococcus aureus and Serratia marcescens were the major orgnisms in bacterial keratitis. Aspergillus, Fusarium and Candida were the major isolates in fungal keratitis. Contact lens wear was a risk factor for bacterial keratitis. Female, age[less than 40 years] and occupation[student, house-wife, office worker, servise] were associated with bacterial keratitis. Risk factors in herpetic keratitis were age[between 40 and 59 years] and ocular adnexal diseases. Male was associated factor with herpetic keratitis.
Adnexal Diseases ; Aspergillus ; Bacteria ; Candida ; Coagulase ; Epidemiologic Studies ; Epidemiology* ; Eye Infections ; Female ; Fungi ; Fusarium ; Humans ; Keratitis ; Keratitis, Herpetic ; Logistic Models ; Male ; Parasites ; Prospective Studies ; Pseudomonas aeruginosa ; Risk Factors ; Serratia marcescens ; Staphylococcus ; Staphylococcus aureus

To evaluate the process of tumor progression in chemical carcinogenesis of the bladder cancer. 0.05% BBN was administered to female Wistar rats for 12 weeks. The rats were divided into six groups and sacrificed every or every two weeks from the 12th to the 20th weeks. Cellular touch imprints of urinary bladder for DNA content analysis by image analyzer and mean AgNORs count per nucleus were performed immediately after sacrifice. Thereafter, the urinary bladder was embedded in paraffin for histopathological examination.On histopathological findings, simple hyperplasia was found in all cases after 12 weeks therapy of BBN. Atypical hyperplasia of the bladder, indicative of a precancerous state, was found in 88.9% of the 12 weeks group, 83.3% of the 13 weeks and in all cases after 14 weeks therapy of the BBN. Bladder cancer was found in 33.3% of the 13 weeks, 55.6% of the 14 weeks, and 100% of the above 16 weeks therapy group. The nuclear DNA content of 21 cases of atypical hyperplasia was diploid in 19 cases(91.5%) and aneuploid in 2 cases(9.5%). DNA aneuploidy was found in 18 cases(66.7%) among the 27 cases of the cancer group. Mean AgNORs count per nucleus and proliferation index by flowcytometry were higher in atypical hyperplasia and cancer group than these of simple hyperplasia and control group, but those differences according to histologic type were not statistically significant. And there was statistically significant correlation between proliferation index and mean AgNORs count per nucleus(r=0.57, p<0.05). These data suggest that the change of nuclear DNA content might occur during the early phase of the carcinogenesis in BBN-induced bladder cancer of rats.
Aneuploidy ; Animals ; Carcinogenesis ; Diploidy ; DNA* ; Female ; Humans ; Hyperplasia ; Paraffin ; Rats* ; Rats, Wistar ; Urinary Bladder Neoplasms* ; Urinary Bladder*

To investigate the histopathological characteristics of inverted papillomas of the urinary bladder, including the possibility of malignant transformation, we studied the indicators of cellular proliferation activity in 7 inverted papillomas of the bladder including two cases of malignant inverted papilloma of the bladder. PCNA expression rates in two cases of malignant inverted papilloma were higher than in benign inverted papillomas. Mean numbers of AgNORs per nucleus in malignant inverted papillomas were much more than in benign inverted papillomas. The c-erbB-2 oncoprotein was expressed only in malignant inverted papillomas. These results suggest that PCNA expression rate, mean number of AgNORs per nucleus and c-erB-2 oncoprotein expression may be merited as good indicators to detect the inverted papilloma with more proliferative and aggressive lesions, and with the potential of malignant transformation.
Adult ; Bladder Diseases/pathology ; Bladder Neoplasms/chemistry/*pathology ; Cell Division/physiology ; Cell Transformation, Neoplastic/pathology ; Female ; Human ; Male ; Middle Age ; Nitrosourea Compounds/analysis ; Nucleolus Organizer Region/chemistry ; Papilloma, Inverted/chemistry/*pathology ; Receptor, erbB-2/analysis ; Silver Staining

The expression of proliferating cell nuclear antigen (PCNA) was assessed immunohistochemically in 47 cases of transitional cell carcinoma of the bladder and 3 cases of normal bladder with anti- PCNA/cyclin monoclonal antibody, using routinely processed tissue sections without interferring with histopathological diagnosis. The PCNA expression rates were compared with Ash histologic grade and clinical stage. In bladder cancer, the PCNA expression rate ranged from 3.8% to 32.7 % (mean value 11.2 %). Bladder cancer with Ash grade IV showed the highest PCNA expression rate (mean value 15.8 % ) and cancer with Ash grade I showed the lowest PCNA expression rate (mean value 8.3%). There were statistically significant differences of PCNA expression rates according to Ash grades (P=0.02. Kruskal-Wellis test). When clinical stage was analyzed to assess the relationship to PCNA expression rate invasive bladder cancers were associated ith higher PCNA expression rate then superficial bladder cancer (mean value of stage A; 8.7 %, stage B and C; 16.5 %). and the difference was statistically significant (P=0.003. Kruskal-Wallis test). Also, there was positive linear relationship between PCNA expression rate and Ash grade with regression analysis (r=0.573, P<0.0001, Y=4.41X +0.79). These results suggest that PCNA is useful as a unclear antigenic marker of cellular proliferation and offers an opportunity for analyzing cell kinetics successfully in formalin-fixed, paraffin-embeded tissue sections of transitional cell carcinoma of the bladder. It will be merited as a simple and powerful method to detect transitional cell carcinoma of the bladder with high potential of invasion, metastasis and clinical progression.
Carcinoma, Transitional Cell* ; Cell Proliferation ; Diagnosis ; Kinetics ; Neoplasm Metastasis ; Proliferating Cell Nuclear Antigen* ; Urinary Bladder Neoplasms ; Urinary Bladder*