The overt effects of the anticancer drugs such as cisplatin and taxol appear to be DNA modification and microtubule stabilization respectively. But the mechanism by which these drugs affect tumor cell cycle perturbation and their correlation to apoptosis and cytotoxicity are not well understood, especially in combined sequential treatment of cisplatin and paclitaxel (taxol). In this study, to elucidate the action mechanisms as a function of cell cycle changes and cytotoxicities and to determine the adequate treatment sequence of cisplatin and taxol to acquire more enhanced cytotoxic effects when they are combined, we evaluated the cell cycle perturbations and its correlation to cytotoxic effects, which is measured by the extents of apoptosis and the fractions of cellular debris and live cells after combination treatment of cisplatin and taxol changing their treatment sequences in NIHOVCAR-3 ovarian cancer cell line. Our results were as follows; (1) The accumulation in S phase inhibited the entrance of tumor cells to G2M phase when the cisplatin treatment was preceded to taxol in their combination. (2) The tumor cells were not accumulated in S phase but most of them entered to and accumulated in G2M phase and they were leading to cell death when the taxol treatment was preceded to cisplatin in their combination. (3) Apoptotic peaks in taxol pretreatment group were detected earlier and persisted longer than that of cisplatin pretreatment group. (4) The cytotoxicities represented by the decreased fractions of live cells and the increased fractions of cellular debris were higher in taxol pretreatment group than those of cisplatin pretreatment group. These results suggested that the taxol pretreatment is more effective in combination of cisplatin and taxol and the relative decrease in the cytotoxicity in cisplatin pretreatment group was considered to be derived from the inhibition of entrance of tumor cells to G2M and protected them from the action by taxol. From these results, we concluded that the taxol pretreatment will enhance the cytotoxic effects to tumor cells when cisplatin and taxol will be administered and it indicates that correlations between cell cycle perturbation, apoptosis and cell death have to be considered in the future combination treatment of other drugs and in the development of new treatment regimens.
Apoptosis ; Cell Cycle* ; Cell Death* ; Cell Line* ; Cisplatin* ; DNA ; Microtubules ; Ovarian Neoplasms ; Paclitaxel* ; S Phase

To help clarify the comparative effects of percutaneous endoscopic discectomy and microsurgical discectomy in the treatment of lumbar disc herniation, the authors studied 37 consecutive patients with discogenic symptoms who had not responded to conservative treatment. Their indications are restricted to discogenic root compression with"contained"or small"noncontained"lumbar disc. Patients with sequestrated disc, spinal stenosis, or spondylolisthesis were excluded. All patients underwent magnetic resonance imaging and if the radiological interpretation was confused with extruded migrated disc, a discogram was also obtained. Of the 37 patients, 18 underwent percutaneous endoscopic discectomy and 19, microsurgical discectomy. In order to compare the efficacy of the two methods, both groups were investigated. Disc herniations were located at L4-5(24 patients), L5-S1(11 patients), or L4-5 and L5-S1(2 patients). With regard to age and sex distribution, preoperative complaints, and clinical symptoms, there were no differences between the two groups. At the last follow-up evaluation after percutaneous endoscopic discectomy, low back pain had disappeared in three patients(17.6%), sciatica in nine(50.0%), sensory deficits in two(16.7%), motor deficits in three(42.5%), and reflex differences in one (50%). After microsurgical discectomy, low back pain had disappeared in one patient(5.6%), sciatica in nine(47.4%), sensory deficits in five(33.3%), motor deficits in six(66.7%), and reflex differences in three(75.0%). In 83.3% of patients in the percutaneous endoscopic discectomy group, the outcome was successful(excellent or good result), compared with 78.9% of those who had undergone microsurgical discectomy. One patient in the percutaneous endoscopic discectomy group suffered from discitis. For patients with"contained"or slight subligamentous lumbar disc herniations, percutaneous endoscopic discectomy offers a surgical alternative.
Discitis ; Diskectomy* ; Follow-Up Studies ; Humans ; Low Back Pain ; Magnetic Resonance Imaging ; Reflex ; Sciatica ; Sex Distribution ; Spinal Stenosis ; Spondylolisthesis

Supratentorial hemangioblastomas are rare tumors. The first documented case of congenital cystic supratentorial hemangiblastoma associated with intracystic hemorrhage is presented; it occurred in a 38-day-old male infant.
Hemangioblastoma* ; Hemorrhage* ; Humans ; Infant ; Male

PURPOSE: The study was to assess I-123-N-(3-iodopropen-2-yl)-2[beta]-carbomethoxy-3[beta]-(4-cholorophenyl) tropane (IPT) SPECT in differential diagnosis among early stage of Parkinson's disease(PD) and essential tremor(ET) and normal control(NL) groups quantitatively. MATERIALS AND METHODS: I-123 IPT brain SPECT of 50 NL, 20 early PD, 30 advanced PD, and 20 ET were performed at 20 minutes and 2 hours. Specific/nonspecific binding of striatum was calculated by using right and left striatal specific to occipital non-specific uptake ratio (striatum-OCC/OCC). RESULTS: Mean value of specific/nonspecific binding ratio was significantly different between advanced PD group and NL group. However, significant overlap of striatal specific/nonspecific binding ratio was observed between PD group and ET group. Bilateral striatal specific/nonspecific binding ratios were decreased in advanced PD. Lateralized differences in the striatal uptake of I-123 IPT correlated with asymmetry in clinical findings in PD group. CONCLUSION: I-123 IPT SPECT may be a useful method for the diagnosis of PD and objective evaluation of progress of clinical stages. Care should be made in the differential diagnosis of early stage of PD and other motor disturbances mimicking PD such as ET in view of significant overlap in striatal I-123 specific/nonspecific binding ratio.
Brain ; Diagnosis, Differential ; Dopamine Plasma Membrane Transport Proteins ; Essential Tremor ; Parkinson Disease ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: Percutaneous dilatational tracheostomy (PDT) performed by an intensivist in critically ill patients is currently popular. Many studies support the safety and feasibility of PDT. However, there is limited data on the safety and feasibility of PDT performed by intensive care trainees. METHODS: To evaluate the safety and feasibility of PDT performed by intensive care trainees and to compare these with those performed by intensivists, we retrospectively analyzed the clinical characteristics and adverse events of all prospectively registered patients who underwent PDT by ICT or intensivists in intensive care units (ICUs) from August 2010 to August 2013. RESULTS: In the study period, 203 patients underwent PDT in ICUs; 139 (68%) by trainees and 64 (32%) by intensivists. There were no statistically significant differences in clinical characteristics including demographics, laboratory findings, and parameters of mechanical ventilation between the two groups. Procedure times and outcomes of the patients were not different between the two groups. The majority of complications observed in 24 hours after PDT were bleeding; however, there was no significant difference between the two groups (trainee 10.8% vs. intensivist 9.4%, p = 0.758). There was no procedure-related death in the two groups. CONCLUSIONS: PDT performed by intensive care trainees was safe and feasible. However, further well-designed studies should be conducted to confirm our results.
Critical Illness ; Demography ; Education ; Fellowships and Scholarships ; Hemorrhage ; Humans ; Intensive Care Units ; Critical Care* ; Prospective Studies ; Respiration, Artificial ; Retrospective Studies ; Surgical Procedures, Minimally Invasive ; Tracheostomy*

Small-bore flexible feeding tubes decrease the risk of ulceration of the nose, pharynx, and stomach compared with large-bore and more rigid tubes. However, small-bore feeding tubes have more respiratory system complications, such as pneumothorax, hydropneumothorax, bronchopleural fistula, and pneumonia, which are associated with significant morbidity and mortality. Thus, it is important to confirm the correct position of feeding tubes. Chest X-ray is the gold standard to detect tracheal malpositioning of the feeding tube. We present three cases in which intubated patients exhibited an altered mental state. An assistant guide wire was used at the insertion of small-bore feeding tubes. These conditions are thought to be potential risk factors for tracheobronchial malpositioning of feeding tubes.
Critical Care ; Critical Illness* ; Enteral Nutrition ; Fistula ; Humans ; Hydropneumothorax ; Mortality ; Nose ; Pharynx ; Pneumonia ; Pneumothorax ; Respiratory System ; Risk Factors ; Stomach ; Thorax ; Ulcer

BACKGROUND: Thoracic actinomycosis is a relatively uncommon anaerobic infection caused by Actinomyces israelii. There have been only a few case reports of endobronchial actinomycosis. The aim of this study was to evaluate the clinical manifestation and treatment of endobronchial actinomycosis. MATERIAL AND METHODS: Seven patients with endobronchial actinomycosis, who were diagnosed in the past 10 years, were retrospectively reviewed. RESULTS: Cough and sputum were the most common symptoms. The chest radiograph and computed tomography showed necrotic consolidation (n=3), atelectasis (n=2), mass (n=1) and an endobronchial nodule (n=1). Proximal broncholithiasis was observed in five patients. All cases were initially suspected to have either lung cancer or tuberculosis. In these patients, the median duration of intravenous antibiotics was 3 days (range 0-12 days) and the median duration of oral antibiotics was 147 days (range 20-412 days). Two patients received oral antibiotic therapy only. There was no clinical evidence of a recurrence. CONCLUSION: Endobronchial actinomycosis frequently manifests as a proximal obstructive calcified endobronchial nodule that is associated with distal post-obstructive pneumonia. The possibility of endobronchial actinomycosis is suggested when findings of broncholithiasis are present at chest CT. The traditional recommendation of 2-6 weeks of intravenous antibiotics and 6-12 months of oral antibiotic therapy are not necessarily essential in all cases of endobronchial actinomycosis.
Actinomyces ; Actinomycosis* ; Anti-Bacterial Agents ; Bronchoscopy ; Cough ; Diagnosis* ; Humans ; Lung Neoplasms ; Pneumonia ; Pulmonary Atelectasis ; Radiography, Thoracic ; Recurrence ; Retrospective Studies ; Sputum ; Tomography, X-Ray Computed ; Tuberculosis

Thi is a retrospective analysis of 135 patients with invasive carcinoma of the uterine cervix treated with curative radiotherapy from March 1983 through October 1989 at the Department of Therapeutic Radiology, Kang-Nam St. Mary's Hospital. Among them, 78 patients received radiotherapy alone and 42 patients treated with neoadjuvant chemotherapy followed by radiotherapy and 15 patients were lost to follow up. All patients had follow up from 2 to 106 months (median; 62 months). Age of the patients ranged from 32 to 79 years at presentation (median; 59 years). According to FIGO classification, there were 20(16.7%) in stage IB, 19(15.8%) in stage IIA, 49 (40.8) in stage IIB, 5(4.2%) in stage IIIA, 13(10.8%) in stage in stage IIIB, 14(11.7%) in stage IVA. The pathological classification showed 96(80.0%) squamous cell carcinomas, 5 (4.2%) adenocarcinomas and 19(15.8%) proven by cytology. The overall 5-year survival rates was 50.8%, and the 3%, respectively. The 5-year survival rates was noted 51.2% of radiotherapy alone and 50.4% of neoadjuvant chemotherapy followed by radiotherapy. The overall failure rate was 18.3%(22/120) including 11.7% (14/120) locoregional failure, 5.8% (7/120) distant metastasis and 0.8% (1/120) locoreginal failure with distant metastasis. Treatment failure rates by the stages were 15% (3/20) in stage IB, 10.5% (2/19) in stage IIA, 10.2%(5/49) in stage IIB, 20%(1/5) in stage IIA, 61.5%(8/13) in stage IIB, and 28.6%(4/14) in stage IVA. The overall complication rate was 34.2%(41/120), including wet desquamation 7.5%(9/120), diarrhea 6.7%(8/120), radiation proctitis 5.8%(7/120) in decreasing order. A multivariate analysis of factors influencing the survival showed patient age (p<0.0291), FIGO stage(p<0.0001), Karnofsky perfomance status(p<0.0043), initial hemoglobin level(p<0.0001), and intracvitary radiation(p<0.0004), but no significancy in histology(p<0.29) and treatment method(p<0.87).
Adenocarcinoma ; Carcinoma, Squamous Cell ; Cervix Uteri* ; Classification ; Diarrhea ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Lost to Follow-Up ; Multivariate Analysis ; Neoplasm Metastasis ; Proctitis ; Radiation Oncology ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Treatment Failure

Traumatic pulmonary pseudocyst is a rare complication of blunt chest trauma that usually appears immediately in children or young adults and is characterized by a single or multiple pulmonary cystic lesions on chest radiography and has spontaneous resolution of the radiologic manifestations. However, we experienced a case of a delayed complicated pulmonary pseudocyst in a 17-year-old boy following severe traumatic acute respiratory distress syndrome rescued by Veno-venous extracorporeal membrane oxygenation (ECMO). In this case, the pseudocyst appeared on the 12th day after trauma and transformed into an infected cyst. Veno-venous ECMO was successfully maintained for 20 days without anticoagulation.
Adolescent ; Child ; Extracorporeal Membrane Oxygenation* ; Humans ; Lung Injury* ; Male ; Radiography ; Respiratory Distress Syndrome, Adult ; Thorax ; Young Adult

Background: Current international guidelines recommend against deep sedation as it is associated with worse outcomes in the intensive care unit (ICU). However, in Korea the prevalence of deep sedation and its impact on patients in the ICU are not well known. Methods: From April 2020 to July 2021, a multicenter, prospective, longitudinal, noninterventional cohort study was performed in 20 Korean ICUs. Sedation depth extent was divided into light and deep using a mean Richmond Agitation–Sedation Scale value within the first 48 hours. Propensity score matching was used to balance covariables; the outcomes were compared between the two groups. Results: Overall, 631 patients (418 [66.2%] and 213 [33.8%] in the deep and light sedation groups, respectively) were included. Mortality rates were 14.1% and 8.4% in the deep and light sedation groups (P = 0.039), respectively. Kaplan-Meier estimates showed that time to extubation (P < 0.001), ICU length of stay (P = 0.005), and death P = 0.041) differed between the groups. After adjusting for confounders, early deep sedation was only associated with delayed time to extubation (hazard ratio [HR], 0.66; 95% confidence inter val [CI], 0.55– 0.80; P < 0.001). In the matched cohort, deep sedation remained significantly associated with delayed time to extubation (HR, 0.68; 95% 0.56–0.83; P < 0.001) but was not associated with ICU length of stay (HR, 0.94; 95% CI, 0.79–1.13; P = 0.500) and in-hospital mortality (HR, 1.19; 95% CI, 0.65–2.17; P = 0.582). Conclusion In many Korean ICUs, early deep sedation was highly prevalent in mechanically ventilated patients and was associated with delayed extubation, but not prolonged ICU stay or in-hospital death.