BACKGROUND AND OBJECTIVES: Cisplatin is an ototoxic agent commonly used for the treatment of solid tumors. Recently, it has been recognized to cause apoptosis in tumor cells, kidney and cochlea. The Bcl-2 family are specific proteins which are a well-known group of death modulating factors. The aims of this study was to analyze the expression of Bcl-2 family for the time course after cisplatin injection. MATERIALS AND METHODS: Sprague-Dawley (SD) rats were injected intraperitoneally wtih either 20 mg/kg of cisplatin, or the same amount of saline water to be used as control. Cochleae were harvested 6, 12 and 24 hours after injection and compared to those of the control ones. TUNEL staining was performed to observe apoptotic cells. Immunohistochemistry and Western blotting were performed to investigate the expression of Bax and Bcl-2. RESULTS: Positively TUNEL-labeled nuclei were observed mainly in the outer hair cells (OHCs), inner hair cells (IHCs), supporting cells and marginal cells. Bax and Bcl-2 immunoreactivity was observed in stria vascularis, OHCs, IHCs and Deiter's cells in the groups harvested at 6 h and 12 h. Bax was expressed most highly at 6 h and Bcl-2 at 12 h. The western blotting method showed that in the group harvested at 24 h, the intensity of Bax and Bcl-2 expression showed no difference compared with those of the control group. CONCLUSION: The present results suggest that apoptotic mechanism in which Bax and Bcl-2 play an important role begins before 6 h and terminates within 24 h after a single injection of high dose cisplatin.
Animals ; Apoptosis* ; Blotting, Western ; Cisplatin* ; Cochlea* ; Hair ; Humans ; Immunohistochemistry ; In Situ Nick-End Labeling ; Kidney ; Rats* ; Rats, Sprague-Dawley ; Stria Vascularis ; Water

Endomyocardial biopsy often fails to show myocardial inflammation for patients with clinically suspected myocarditis. The serum isoforms of troponin T (cTnT) level is a very sensitive marker of myocardial injury and it is elevated even in the absence of myocardial inflammation. We investigated the correlations for myocardial injury, virus titers and inflammation in acute viral infection. Using the murine coxsackievirus group B3 (CVB3) myocarditis model, the histopathologic findings and virus titers in mouse hearts were compared with the serum cTnT levels measured by ELISA at various time points. Viable virus titers in the hearts peaked at 3 days after infection (8.22+/-0.13 log10 PFU/100 mg of heart); they decreased at day 7 and no viable virus was detected from day 14. Myocardial inflammation was minimal at day 3, peaked at day 7 and markedly decreased at day 14. The individual serum TnT levels were significantly increased at day 3 (7.37+/-1.46 ng/ml), persisted to day 7 (0.73+/-0.08 ng/ml), and normalized at day 14. Serum cTnT levels were correlatable with virus titers in the heart (r=0.744, P <0.01), but the serum cTnT levels were not correlated with the degrees of inflammation. Using the less myocarditic strain of CVB3, similar relationships were observed between the changes for the serum cTnT levels and the heart virus titers. During the course of viral infection, myocardial injury precedes the pathologic evidence of inflammation, and the elevated cTnT levels provide evidence of myocardial injury even in the absence of any histologic findings of myocarditis.
Acute Disease ; Animals ; Coxsackievirus Infections/*pathology ; Enterovirus B, Human/isolation & purification/pathogenicity/*physiology ; Female ; Heart/*virology ; Hela Cells ; Humans ; Inflammation/*immunology ; Mice ; Mice, Inbred BALB C ; Myocardial Infarction/immunology/*pathology ; Myocarditis/immunology/pathology/*virology ; *Myocardium/immunology/pathology ; Research Support, Non-U.S. Gov't ; Troponin T/blood ; Virus Replication

Renal failure frequently accompanies advanced hepatic failure. Even if adequate renal function is not considered as a prerequisite for transplant candidacy, impaired renal function prior to liver transplantation has been regarded as an independent risk factor of graft dysfunction and mortality. Liver transplantation in such a patient also presents a number of challenges to the anesthesiologists. Optimal fluid therapy, prompt and aggressive correction of electrolytes and metabolic disturbances, careful selection of anesthetic techniques and agents, and close monitoring of cardio-respiratory function help reduce the graft failure and perioperative mortality. In such cases, continuous renal replacement therapy (CRRT) is used with increasing frequency during or after the surgery. So, anesthesiologists need to understand the basic principles, potential applications, and anesthetic implications of several CRRT options. We therefore present the anesthetic experience in a patient with hepatic failure combined with primary renal failure, successfully managed during or after liver transplantation.
Anesthesia* ; Electrolytes ; Fluid Therapy ; Humans ; Liver Failure* ; Liver Transplantation* ; Liver* ; Mortality ; Renal Insufficiency* ; Renal Replacement Therapy ; Risk Factors ; Transplants

BACKGROUND AND OBJECTIVES: We sought to characterize the lesion characteristics of mitral valve prolapse (MVP), which is being increasingly recognized as a cause of mitral regurgitation (MR) in Koreans SUBJECTS AND METHODS: 497 Patients with MVP that was diagnosed by echocardiography in 13 university-affiliated hospitals from Jan to Dec 2003 were prospectively enrolled in our study. RESULTS: A total of 497 patients (270 males, 54%) were enrolled and their mean age was 52+/-17 years. Grade 4 MR was present in 272 patients (54.7%); grade 3, 2 and 1 MR as present in 30.2%, 10.7% and 4.2%, respectively. MVP of the anterior and posterior mitral leaflet was present in 170 patients (34.2%) and 223 patients (44.9%), respectively; MVP developed in both leaflets in 104 patients (20.9%). In 37 patients (7.4%), MVP developed in all 6 segments of the mitral leaflet and these patients were younger (37+/-14 versus 54+/-16 years, respectively, p<0.05) and had a lower prevalence of chordae rupture and severe MR compared to the other patients. Among the 266 mitral segments showing prolapse in the 132 patients (26.6%) who underwent transesophageal echocardiography, the posterior medial scallop was the most frequently diseased one (26%), and this was followed by the posterior middle scallop (18%), the medial (17%), lateral (14%) and middle (13%) part of the anterior leaflet, and the posterior lateral scallop (12%). Younger patients with a mean age <45 years showed a lower prevalence of single segment prolapse, hypertension, severe MR and chordae rupture compared to the older patients (p<0.001, each). CONCLUSION: The medial part of both mitral leaflets was the predilection site for the development of MVP in Koreans and the lesion characteristics were different according to the patients' age.
Echocardiography* ; Echocardiography, Transesophageal ; Humans ; Hypertension ; Korea* ; Male ; Mitral Valve Insufficiency ; Mitral Valve Prolapse* ; Mitral Valve* ; Pectinidae ; Prevalence ; Prolapse ; Prospective Studies* ; Rupture

BACKGROUND AND OBJECTIVES: The purpose of this study was to assess the results of a newly developed aortic valve repair technique. SUBJECTS AND METHODS: Between December 1997 and April 2005, 75 aortic valvuloplasties were performed using a new technique that addressed the 3 main components of the aortic root; annulus, sinotubular junction and leaflet. An internal synthetic strip and ring were implanted along the fibrous annulus to reduce the annulus and sinotubular junction, and additional leaflets were implanted for leaflet correction. Based on the primary pathology, there were 35, 22 and 18 cases of isolated aortic regurgitation, aortic regurgitation due to ascending aortic aneurysm and aortic regurgitation due to annuloaortic ectasia, respectively. RESULTS: The average age of the subjects was 46.4+/-16 years; there were 51 and 24 males and females, respectively. There was no operative mortality, with a 2-year freedom from reoperation rate of 97%. Follow up echocardiograms showed significant improvements in the grade of aortic regurgitation, from a preoperative mean of 3.1+/-1.2 to 1.08+/-0.7 immediate postoperatively, to 1.15+/-0.6 at the final follow up. CONCLUSION: The results of the current study showed this technique to be effective in the treatment of aortic regurgitation of various causes. Although long-term results are pending, it is our contention that this aortic valve repair technique will be a reliable method in the future.
Aortic Aneurysm ; Aortic Valve Insufficiency ; Aortic Valve* ; Dilatation, Pathologic ; Female ; Follow-Up Studies ; Freedom ; Humans ; Male ; Marfan Syndrome ; Mortality ; Pathology ; Reoperation

PURPOSE: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and are immunohistochemically defined as c-KIT (CD117) positive tumors. This study investigated the behaviors of GISTs of the gastrointestinal tract and determined the prognostic factors associated with GISTs. METHOD: The clinical records of 22 patients, who were diagnosed and underwent surgery for a GIST of the GI tract at Inje university Sanggye Paik hospital from 1998 to 2004, were retrospectively analyzed. The relationship between the disease-free survival rate of the GISTs and several factors including age, gender, mitotic count, tumor site, tumor size, tumor necrosis & hemorrhage, and Ki-67 index was examined. RESULTS: The study group comprised of 13 men and 9 women. The mean age was 57.1 years (31~77 years) at the time of diagnosis. The median follow-up period was 24 months (3~45 months). A complete resection of the tumor was performed in 19 patients. There were lymph node metastases in 1 case. Five out of the 19 patients who had undergone a complete tumor resection showed recurrence (27%). The sites of recurrence were the back (1), liver (1), and abdominal cavity (3). Univariate analysis revealed, the following to be prognostic factors for the disease-free survival of patients with GISTs: high power field mitotic counts of the tumor (<5/50 vs. > or =5/50; P=0.013), the tumor size (<5 cm vs. > or =5 cm; P=0.047) and the Ki-67 index (<5% vs. > or =5%; P=0.001). CONCLUSION: The prognostic factors for disease-free survival rate of GISTs were high power field mitotic counts of the tumor, the tumor size and the Ki-67 index. It is recommended that more careful and frequent postoperative follow-up examinations be performed for patients showing the poor prognostic factors.
Abdominal Cavity ; Diagnosis ; Disease-Free Survival ; Female ; Follow-Up Studies ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Liver ; Lymph Nodes ; Male ; Necrosis ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies

PURPOSE: Axillary lymph node metastasis (ALNM) can occur even in breast cancer smaller than 2 cm in size. This study was performed to investigate the clinicopathologic factors that affect node metastasis in T1 breast cancer. METHODS: We reviewed the medical record of 206 T1 breast cancer patients and we divided them into two groups according to the presence or absence of lymph node metastasis. We analyzed the association between ALNM and various clinicopathological predictive factors such as age, tumor size (T1a, T1b, T1c), multiplicity, the histologic grade, the nuclear grade, the presence of lymphovascular invasion (LVI), the estrogen and progesterone receptor status, an HER2/neu expression, the Ki-67 labeling index and the bcl-2 expression. RESULTS: One hundred and thirty-nine were the node negative group (T1N0) and the remaining 67 cases were allotted to the node positive group (T1N1-3). On the univariate analysis, age (p=0.011), LVI (p<0.001), histologic grade (p=0.019), HER2/neu (p<0.005), Ki-67 (p=0.012) and bcl-2 (p=0.026) were the statistically significant predictive factors related to node metastasis. But on the multivariate analysis, LVI (p<0.001) and HER2/neu (p=0.009) were the statistically significant factors related to node metastasis. CONCLUSION: LVI and HER2/neu overexpression were related to the increased incidence of ALNM in T1 breast cancer patients. LVI was the most predictive factor of ALNM.
Breast ; Breast Neoplasms ; Estrogens ; Humans ; Incidence ; Lymph Nodes ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis ; Receptors, Progesterone

PURPOSE: Wilms tumor is the most common malignant renal tumor in children. We investigated the epidemiology, clinical features and treatment outcome of the children with Wilms tumor in Korea during the recent 10 years. METHODS: Two hundred forty six patients were enrolled between January 1991 and December 2000 from 26 major hospitals in Korea. The data regarding the clinical features including sex, age, pathologic type, prognostic factor and treatment outcome of patients were analyzed retrospectively by review of patient's medical records. Kaplan-Meier survival curves were constructed, The differences between groups were analyzed by log-rank test. RESULTS: There were 130 males and 116 females. The incidence between the age of 1~4 years was the highest with 66.2%. The annual incidence rate per 1, 000, 000 population varied from 1.9 to 2.1. The 10 years overall survival rate according to sex, clinical stage, pathologic type and relapse were as follows: 88.6% in male, 90.9% in female, 100% in stage I, 94.7% in stage II, 92.1% in stage III, 63.4% in stage IV, 85.7% in stage V, 95.3% in favorable histology, 64.1% in unfavorable histology, 94.8% in non-relapse, and 40.9% in relapse. The relapse rate was 12%. The 10 years overall survival rate of 246 patients were 89.1%. CONCLUSION: Our results could provide the most recent and important clinical information on Wilms tumor of children in Korea.
Child ; Epidemiology* ; Female ; Humans ; Incidence ; Kaplan-Meier Estimate ; Korea* ; Male ; Medical Records ; Recurrence ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Wilms Tumor*