PURPOSE: With the process of neoangiogenesis being linked to the growth and metastasis of various tumors, anticancer therapeutics with a basis in the suppression of neoangiogenesis has recently been receiving attention. In this study, we tried to clarify the immunoreactivities of vascular endothelial growth factor (VEGF), major angiogenic inducer and thrombospondin-1 (TSP-1), major angiogenic inhibitor in human Wilms' tumor and its clinicopathological significance. MATERAILS AND METHODS: Utilizing immunohistochemical staining, we assessed the immunoreactivities of VEGF and TSP-1 in archival tissues of 29 Wilms' tumors and 25 normal kidneys. Also, we assessed the relationship between expression of each factor and clinicopathological parameters in 29 cases of Wilms' tumors. RESULTS: Immunoreactivities of VEGF and TSP-1 were detected mainly in the cytoplasm of the tubular cells in normal kidneys. In Wilms' tumors, whereas VEGF was detected in the cytoplasm of the tumor cells and peritumoral stromal tissues, but TSP-1 only in the peritumoral stromal tissues. Immunohistochemical expression patterns of each factor were divided into two groups according to the area of immunoreactivity (negative:<10%, positive: > OR =10%). VEGF immunoreactivity was detected in 25 (100%) normal kidneys and in 20 (69%) Wilms' tumors. However, TSP-1 immunoreactivity was detected in 24 (97%) normal kidneys and in 3 (10%) Wilms' tumors. Therefore, although no significant difference was observed between the expressions of VEGF and TSP-1 in normal kidney, the TSP-1 immunoreactivity was significantly lower than VEGF immunoreactivity in Wilms' tumors. A relatively higher rate of positive expression of TSP-1 was observed in the patients with no demonstrable lymph node metastasis. Also, as for the VEGF, maximal diameter of the tumor was larger in the positive expression group. However, it proved otherwise for TSP-1 as the negative expression group demonstrated tumors with larger maximal diameters. CONCLUSIONS: Our study demonstrated that the TSP-1 immunoreactivity was significantly lower than VEGF immunoreactivity in Wilms' tumors, and disease progression has a tendency to be found in the VEGF-positive cases and TSP-1 negative cases. We suggest that the growth and metastasis of Wilms' tumor may be influenced mainly by TSP-1 decrease rather than VEGF increase.
Cytoplasm ; Disease Progression ; Humans ; Kidney ; Lymph Nodes ; Neoplasm Metastasis ; Thrombospondin 1 ; Vascular Endothelial Growth Factor A* ; Wilms Tumor*

This study was conducted to examine the predicting factors for the intention of breastfeeding with The Theory of Planned Behavior. The questionnaires were distributed to 131 primigravidas who were in their third trimester of pregnancy in Seoul, Kyonggido, Kyongsangbukdo, and Kyongsnagnamdo. Descriptive statistics, Pearsons Correlation and Multiple Regression were used to analyse the data. The subjects showed strong intention of breastfeeding. The subjects showed favorable attitudes toward breastfeeding. This fact showed significant correlation with the belief that their breastfeeding intention was due to the advantage of breast milk for the infant with regard to allergy prevention, disease protection, contribution to intellectual development, psychological closeness between mother and infant, convenience, cost, and the reduction of breast cancer risk and weight of the mother. No item of outcome evaluation did showed significant correlation with behavioral intension. The subjects were influenced about breastfeeding by their referents such as siblings and friends with breastfeeding experience, their mothers and husbands, and mothers-in-law. Most items of the control beliefs had a significant influence on the intention of breastfeeding. The subjects felt they could not control the situation ie. "when I have to breastfeed in public". However they felt they could control the situation ie. "when I suffer from mastitis", "when I have to cut down on coffee, alcohol, and smoking", "when I have Caesarean section", "when I need to maintain breast condition", and "when the infant hates to suck my nipple". Regression analysis revealed that control beliefs and attitudes toward breastfeeding could predict the behavioral intention of breastfeeding. Control beliefs were the most important factor in predicting behavioral intention. Therefore, nutrition education is needed to enhance the ability to cope with difficult situations while breastfeeding and increase faborable attitudes toward breastfeeding.
Breast ; Breast Feeding* ; Breast Neoplasms ; Coffee ; Education ; Female ; Friends ; Gyeonggi-do ; Hate ; Humans ; Hypersensitivity ; Infant ; Intention* ; Milk, Human ; Mothers ; Pregnancy ; Pregnancy Trimester, Third ; Seoul ; Siblings ; Spouses ; Surveys and Questionnaires

PURPOSE: We tried to find out whether the nadir PSA level after hormone therapy affected the progression into hormone-refractory prostate cancer (HRPC). MATERIALS AND METHODS: We reviewed the progressive status and the survival of the 177 patients with stage C or D prostate cancer who had received hormone therapies. The relative efficacy of the nadir PSA level for predicting the progression into HRPC was evaluated by the receiver operating characteristic (ROC) analysis. RESULTS: 85.4% of patients responded to the treatment and 78% of responders progressed into HRPC. Median time to nadir PSA level after hormone therapy and to HRPC were 8.1 and 24.0 months, respectively. The nadir PSA levels were under 0.2ng/ml in 31%, 0.2-1.0ng/ml in 23%, 1.1-10ng/ml in 42%, and over 10ng/ml in 5% of the responders (n=151). As the nadir PSA levels were lower, pretreatment PSA levels, Gleason score and the number of cases progressing into HRPC were significantly lower (p<0.05). In addition, the nadir PSA level was inversely correlated with the interval to the establishment of HRPC (r= 0.465, p<0.05). By univariate analysis, the bone metastasis, the nadir PSA level, PSA level at six months after treatment and pretreatment PSA level were associated with the progression into HRPC. Only the nadir PSA level was an independent factor by multivariate analysis. ROC analysis disclosed an accuracy of 86.2% for the nadir PSA level to predict the progression into HRPC after two years. By setting the lower limit of the nadir PSA level to 1.1ng/ml, the sensitivity was 80.3% and the specificity was 83.8%, being most adequate. CONCLUSIONS: The nadir PSA level after hormone therapy may be the most important factor that can predict the progression into HRPC. Also, in consideration of sensitivity and specificity, it would be adequate to set the lower limit of the nadir PSA level to 1.1ng/ml.
Humans ; Multivariate Analysis ; Neoplasm Grading ; Neoplasm Metastasis ; Prognosis ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms* ; ROC Curve ; Sensitivity and Specificity

We report a case of methimazole-induced acute hepatic failure, which occurred 4 days after initiation of drug in a 51-year-old man with hyperthyroidism. Liver function was evaluated before taking methimazole, total bilirubin was 14.2 mg/dL. This finding suggested toxic hepatitis d/t herbal medication or unknown liver disease. He was treated with methimazole with increasing doses from 15 to 45 mg/day, he developed liver failure gradually, despite of suspending methimazole. From the time of admission, his liver function test was abnormal and liver cirrhosis was suspected by liver sonography. With aggravated liver function, he died of renal failure, sepsis of unknown origin and respiratory failure. Fulminant hepatitis rarely occurs in methimazole users, and spontaneous recovery is expected. But this case shows that methimazole-induced hepatotoxicity with possible underlying liver disease could increase the risk of poor outcomes. And in case of continued deterioration of liver function, prompt liver transplatation should be considered.
Bilirubin ; Drug-Induced Liver Injury ; Graves Disease ; Hepatitis ; Humans ; Hyperthyroidism ; Liver ; Liver Cirrhosis ; Liver Diseases* ; Liver Failure ; Liver Failure, Acute* ; Liver Function Tests ; Liver Transplantation ; Methimazole* ; Middle Aged ; Renal Insufficiency ; Respiratory Insufficiency ; Sepsis

Gastric adenocarcinoma may coexist with tumors of other histological types. The synchronous occurrence of gastric adenocarcinoma and gastrointestinal stromal tumor (GIST) has rarely been reported in the literature. It is still not known whether such an association represents an incidental coexistence or indicates a similar pathogenesis in the simultaneous development of tumors of different histological types. Here we report a case of an exoluminal GIST that was confused with a metastatic lymph node in early gastric cancer.
Adenocarcinoma ; Gastrointestinal Stromal Tumors ; Lymph Nodes ; Stomach Neoplasms

We report two cases of endoscopic submucosal dissection (ESD) for recurrent or residual esophageal squamous cell carcinoma (ESCC) lesions after chemoradiotherapy for advanced esophageal cancer. Case 1 involved a 64-year-old man who had previously undergone chemoradiotherapy for advanced ESCC and achieved a complete response (CR) for 22 months, until metachronous recurrent superficial ESCC was detected on follow-up esophagogastroduodenoscopy (EGD). We performed ESD and found no evidence of recurrence for 24 months. Case 2 involved a 59-year-old man who had previously undergone chemoradiotherapy for advanced ESCC. He responded favorably to treatment, and most of the tumor had disappeared on follow-up EGD 4 months later. However, there were two residual superficial esophageal lugol-voiding lesions. We performed ESD, and he had a CR for 32 months thereafter. ESD can be considered a viable treatment option for recurrent or residual superficial ESCC after chemoradiotherapy for advanced esophageal cancer.
Carcinoma, Squamous Cell ; Chemoradiotherapy* ; Endoscopy, Digestive System ; Esophageal Neoplasms* ; Follow-Up Studies ; Humans ; Middle Aged ; Recurrence

BACKGROUND/AIMS: Bicarbonate-containing alginate formulations are reported to be effective for controlling reflux symptoms. However, the efficacy of Lamina G alginate without gas production has not been reported. The aim is to evaluate the efficacy of a non-bicarbonate alginate in individuals with reflux symptoms without reflux esophagitis. METHODS: Participants who had experienced heartburn or regurgitation for 7 consecutive days were randomized to one of the following treatment groups: proton pump inhibitors (PPI) plus alginate (combination) or PPI plus placebo (PPI only). In addition, as a reference group, patients received placebo plus alginate (alginate only). The primary endpoint compared the percentage of patients with complete resolution of symptoms for the final 7 days of the treatment. Secondary endpoints compared changes in symptom score, symptom-free days during the treatment period, the Reflux Disease Questionnaire, Patient Assessment of Upper Gastrointestinal Disorders (PAGI)-Quality of Life and PAGI-Symptoms Severity Index scores, the investigator's assessment of symptoms, and incidence of adverse events. RESULTS: Complete resolution of heartburn or regurgitation was not significantly different between the combination and PPI only groups (58.7% vs 57.5%, p=0.903). The secondary endpoints were not significantly different between the two groups. Complete resolution of heartburn or regurgitation, did not differ between the alginate only reference group and the PPI only group (75.0% vs 57.5%, p=0.146). CONCLUSIONS: The addition of non-bicarbonate alginate to PPI was no more effective than PPI alone in controlling reflux symptoms.
Alginates ; Clinical Study ; Esophagitis, Peptic ; Gastroesophageal Reflux ; Heartburn ; Humans ; Incidence ; Proton Pump Inhibitors ; Treatment Outcome

BACKGROUND/AIMS: Abdominal ultrasonography is useful for the detection and diagnosis of nonalcoholic fatty liver disease (NAFLD). The aims of this study were to establish a predictive model for the selection of subjects for abdominal ultrasonography for the diagnosis of NAFLD and to assess validity of the model. METHODS: The subjects included 901 people who visited the health examination center of the Busan Medical Center. We conducted multiple logistic regression analyses of potential risk factors to identify independent risk factors for NAFLD, and developed an index system. RESULTS: Four independent risk factors were identified. The index system was developed by assigning 1 clinical scoring point to approximately 0.7 logistic regression coefficients to each factor as follows: alanine aminotransferase/aspartate aminotransferase ratio >1.5 (odds ratio [OR], 2.22; 95% confidence interval [CI], 1.21-4.07; P=0.010), 1 point; gamma-glutamyl transpeptidase >50 (OR, 2.15; 95% CI, 1.13-4.07; P=0.019), 1 point; triglyceride >150 mg/dL (OR, 1.92; 95% CI, 1.14-3.24; P=0.015), 1 point; 23 kg/m2< or =BMI<25 kg/m2 (OR, 3.68; 95% CI, 2.05-6.63; P<0.001), 2 points; and BMI 25 kg/m2 (OR, 7.65; 95% CI, 4.29-13.62; P<0.001), 3 points. The area under the receiver operating characteristics curve was 0.797 (95% CI, 0.751-0.842), and when 3 points was used as a cut-off value, the sensitivity and specificity were 71.7% and 75.9%, respectively. CONCLUSIONS: NAFLD can be predicted through the clinical application of the index system established herein. If abdominal ultrasonography is used for high-risk patients, NAFLD will be diagnosed and managed in its early stage.
Adult ; Aged ; Alanine Transaminase/blood ; Area Under Curve ; Aspartate Aminotransferases/blood ; Body Mass Index ; Fatty Liver/*diagnosis/ultrasonography ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Predictive Value of Tests ; Risk Factors ; Sensitivity and Specificity ; Severity of Illness Index ; gamma-Glutamyltransferase/blood

OBJECTIVE: Human infertility clinics have been faced the demand for improving clinical results. The purpose of this study was to evaluate the effect of microsurgical removal of damaged blastomeres (DB) in frozen-thawed embryos on the clinical outcomes. METHODS: From January 2003 to May 2004, out of 258 thawing ET cycles were divided into three groups: Group-1 (n=46): Intact cleavaged embryos after thawing. Remained cycles with embryos containing DB were randomly divided into two groups. Group-2 (n=102): Drilling zona pellucida (ZP) of frozen-thawed embryos by acidified Tyrode's solution. Group-3 (n=110): Drilling ZP and removal of DB. Embryos after microsurgical manipulation were transferred into the uterus of patients. RESULTS: Clinical profiles and the mean number of transferred embryos among three groups were not different. Pregnancy and implantation rates were similar in three groups. It were 30.4% and 9.3% in Group-1, 29.4% and 7.8% in Group-2, and 26.4% and 7.6% in group-3, respectively. Miscarriage rate in Group-3 (37.9%) was slightly higher than those in Group-1 and Group-2 (14.3% and 23.3%), but it was not statistically significant. CONCLUSION: Intact cleaving embryos after DB removal showed higher potent of pregnancy and implantation. We could not find any improvement of clinical outcome by removal of DB in frozen-thawed embryos.
Abortion, Spontaneous ; Blastomeres* ; Embryo Transfer* ; Embryonic Structures* ; Female ; Humans ; Infertility ; Pregnancy ; Pregnancy Rate ; Uterus ; Zona Pellucida

Clear cell acanthoma is a rare, benign tumor of epidermal origin, with distinct histolopathological features which usually includes solitary or rarely multiple tumors, often localized on the lower legs of middle-aged or elderly people. It presents as a flat or dome-shaped, sharply-demarcated papule or nodule, sometimes with a keratotic scale of bright red or pink color. Histopathological findings include clear cells within sharply-demarcated area of the epidermis. We report a case of clear cell acanthoma which developed on the lateral side of the right foot of an 82-year-old man.
Acanthoma* ; Aged ; Aged, 80 and over ; Epidermis ; Foot* ; Humans ; Leg