Laparascapic Cholecystectomy is a recentely rapidly emerged, minimally invasive procedure whereby the gallbladder is removed using laparoscopic techniques. The procedure offers the patient reduced hospital stay, faster to work, less pain, less complication, less expensiveness, and improved cosmetic results over the traditional open cholecystectomy. (continue...)
Cholecystectomy* ; Cholelithiasis* ; Gallbladder ; Humans ; Laparoscopy* ; Length of Stay

No abstract available.
Mass Screening* ; Rural Health*

BACKGROUNDS: The p21 protein inhibits cyclin-dependent kinases and mediates cell-cycle arrest and cell differentiation. METHODS: This study was performed in 61 patients with gastric adenocarcinoma to investigate the realtionship between p21 expression and clinicopathological findings, and the usefulness of p21 as a prognostic factor. Correlation was determined between p21 immunoreactivity by immunohistochemistry and clinicopathological features, including the clinical outcome. RESULTS: Immunoreactivity for p21 was detected in 31 (50.8%) patients. There were no significant correlations between the presence or absence of p21 immunoreactivity and age, sex, site, tumor invasion, tumor size, lymph node metastasis, distant metastasis, or stage except histologic subtype (P=0.002). Survival curves revealed that there was no significant difference of the prognosis between patients with p21 expression and those without p21 expression (P=0.836). CONCLUSIONS: Immunohistochemical analysis of p21 was not useful for evaluating the prognosis and biological status of patients with gastric adenocarcinoma.
Adenocarcinoma* ; Cell Differentiation ; Cyclin-Dependent Kinases ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis

BACKGROUND: Studies of immune response for cancer have demonstrated that the antitumor immune response plays a role in competing against the growth of cancer cells and is frequently altered in advanced cancer. METHODS: We evaluated the changes of peripheral blood lymphocytes and their subsets during preoperative and postoperative periods according to the time sequence of the postoperative condition in gastrointestinal carcinoma patients. Lymphocyte surface markers were determined in 39 stomach cancer patients and 33 colon cancer patients by using the indirect immunofluorescence technique with monoclonal antibodies. The patient's body weights, hemoglobin, hematocrits, total protein, and albumin were also measured preoperatively at and 1, 3, 6, 12, 18, and 24 months postoperatively. RESULTS: There were significant differences of clinico-laboratory findings between the preoperative and the postoperative periods except for hemoglobin, total protein, and albumin in postoperative course. The total leukocyte count significantly decreased from the postoperative 6th month. The lymphocyte count significantly increased from the postoperative 3rd month. The granulocytes decreased significantly in the postoperative 6th month. The T cells and B cells decreased in the postoperative 3rd month and 1st month, respectively. CD8 increased in the postoperative 3rd month and NK cells also increased in the postoperative 3rd, 6th and 24th months. Other peripheral lymphocytes and their subsets showed no significant differences. The changes in the lymphocyte subsets according to stage were not statistically significant (p<0.005). CONCLUSIONS: The postoperative changes in lymphocytes, granulocytes, and NK cells were significantly different compared with preoperative levels, but these results did not correlate with postoperative survival and recurrence rate because of the short postoperative follow-up periods.
Antibodies, Monoclonal ; B-Lymphocytes ; Body Weight ; Colonic Neoplasms ; Fluorescent Antibody Technique, Indirect ; Follow-Up Studies ; Granulocytes ; Hematocrit ; Humans ; Killer Cells, Natural ; Leukocyte Count ; Lymphocyte Count ; Lymphocyte Subsets ; Lymphocytes* ; Postoperative Period ; Recurrence ; Stomach Neoplasms ; T-Lymphocytes

This study was performed to evlauate the usefulness of red ginseng extract as an adjuvant therapeutic agent to improve immune function in immune compromizing gastrointestinal carcinoma patients. We treated 48 patients with two regimens after we undertook the curative resection for gastrointestinal carcinoma: 1) only chemotherapy and immunotherapy (control group), 2) chemotherapy and immunotherapy with 4500-5400mg red ginseng for 6 months (study group). For investigating the immunologic alternations alongside the numerical changes in peripheral blood lymphocyte and their subsets in the gastrointestinal carcinoma patients, lymphocyte surface markers were determined by monoclonal antibodies on the preoperative 1st day, and postoperative 5th day, 1 month, 3 month and 6 month in 28 controls and 20 red ginseng groups in gastrointestinal carcinoma patients which were recruited at Korea University Hospital from March, 1995 to December, 1995. The mean value for body weight was increased in the ginseng group than in the control group. There were no significant differences of serum hematocrit, hemoglobin, total protein and albumin in both groups. The total lymphocyte count was much more increased in the ginseng group than in the control group. The number of T cell, B cell, CD8, CD4, NK cell and activated T cell were increased in ginseng group more than in control group. The T cell was significantly increased on postoperative 5th day, 3 month and 6 month, and B cell on postoperative 6 month in ginseng group than in control group. The CD8 was significantly increased on postoperative 3 month and 6 month, CD4 on postoperative 5th day, and NK cell and activated T cell also on postoperative 6 month in ginseng group than in control group. In conclusion, red ginseng may be useful as a longterm adjuvant therapeutic agent for improving the immune function and anticarcinogenic effect after curative operation for immune compromizing gastrointestinal carcinoma patients.
Antibodies, Monoclonal ; Anticarcinogenic Agents ; Body Weight ; Drug Therapy ; Hematocrit ; Humans ; Immunotherapy ; Killer Cells, Natural ; Korea ; Lymphocyte Count ; Lymphocytes ; Panax*

No abstract available.
Posterior Cruciate Ligament*

Aneurogenic pulmonary edema(NPE) following an aneurysmal subarachnoid hemorrhage(SAH) is a rare but devastating complication. The authors analyzed the clinical characteristics, therapeutic problems and management results from our cases in order to throughly evaluate for future therapeutic guide for such patients. There were seven patients diagnosed as NPE out of 546 patients who were admitted within one day following a SAH(1.3%) during the past 13 years. They were relatively young(average 51.3 years), had poor clinical grades on admission and had large amount of SAH. Hypotension and hypoxia on admission were also characteristics. Good results were obtained in 4 of the 7 patients by rapid correction of hypoxia and hypotension with intubation, mechanical ventilation and with positive end-expiratory pressure, diuretics and hypertensive drugs. We conclude that NPE following SAH may be triggered by an acute rise in intracranial pressure followed by a simultaneous decrease of the function of the heart and lungs. Although the patients had shown fulminant clinical state on admission, we recommend aggressive management of these patients because some of these patients can recover without neurological deficits by an aggressive treatment.
Aneurysm* ; Anoxia ; Diuretics ; Heart ; Humans ; Hypotension ; Intracranial Aneurysm ; Intracranial Pressure ; Intubation ; Lung ; Positive-Pressure Respiration ; Pulmonary Edema* ; Respiration, Artificial ; Subarachnoid Hemorrhage*

Recent studies of immune responses to pathogens have identified pathogen-associated molecular patterns recognized by the innate immune system through specialized receptors called toll-like receptors (TLRs). Signaling through these receptors initiates robust immune responses. By exploiting TLR signaling pathways, immunity to tumor-associated antigens may be generated. Many tumor-associated antigens are involved in the regulation of tumor phenotype or carcinogenesis. Immune targeting of these antigens may either alter the tumor phenotype, yielding a more treatable tumor, or eradicate early tumor stem cells preventing tumor formation. The oncoprotein HER2/neu, which is often overexpressed in ductal carcinoma in situ (DCIS), may provide such a target. Immune responses directed against HER2/neu may eliminate the disease, make tumors more amenable to anti-estrogen therapy, or prevent escape of hormone-resistant tumor phenotypes. Effective breast cancer prevention in preclinical studies utilizing murine HER2/neu transgenic models has stimulated interest in, and optimism regarding, protective breast cancer vaccines in humans. Induction of anti-HER2 neu T cell (CD4+ and CD8+) and B cell responses has been demonstrated in an ongoing clinical study targeting HER2/neu using a TLR agonist-primed dendritic cell vaccine. Moreover, these vaccinations lead to reductions in both HER2/neu expression and extent of DCIS. HER2/neu expression and aromatase activity have recently been linked through the intermediary cyclooxygenase 2 (COX-2). This convergence between growth factor and hormone mediated pathways provides additional support for the notion that a significant number of breast cancers may be prevented through effective immune targeting of HER2/neu. As progress is made towards the development of vaccines for breast cancer prevention, the contributions of immune-mediated effecter and inhibitory mechanisms to the pathogenesis of HER2/neu overexpressing breast cancer will need to be better understood.
Aromatase ; Breast ; Breast Neoplasms ; Cancer Vaccines ; Carcinoma, Intraductal, Noninfiltrating ; Cyclooxygenase 2 ; Dendritic Cells ; Humans ; Immune System ; Neoplastic Stem Cells ; Phenotype ; Toll-Like Receptors ; United Nations ; Vaccination ; Vaccines

In order to find out the effect of blood glucose on the ischemic brain injury, the authors studied the relationship between the blood glucose level and the infarct volume in a focal cerebral ischemia-reperfusion model in a series of 60 adult rats. The experimental animals were divided into 4 groups of 15 rats: rats in group I were allowed free access to food until ischemic insults: rats in group II were fasted for 24 hours prior to ischemic insult: rats in group III were fed but received intraperitoneal injection of 1.7unit/kg of insulin 50 minutes before the onset of ischemia: and rats in group IV were fed and received intraperitoneal injection of 2g/kg of 50% glucose during ischemia. The ischemia was made through unilateral occlusion of the middle cerebral artery(MCA) by inserting a 16mm length of 4-0 nylon surgical thread through the internal carotid artery as well as occlusion of both common carotid arteries(CCA) using nontraumatic aneurysm clips. Reperfusion was induced by pulling the thread that occluded the MCA as well as removing the aneurysm clips from both of the CCAs. Each group was further divided into a(2 hour), b(4 hour), and c(6 hour) subgroups of 5 rats according to the duration of ischemia. All animal were killed 3 hours after reperfusion, and infarct volume determined by triphenyltetrazolium chloride was calculated by a computer image software. The results showed that rats of glucose loaded during ischemia(group IV) developed the highest blood glucose levels during ischemia and post-ischemia and the largest infarct volume among groups. The rats which were fed until ischemic insult(group I) developed higher blood glucose levels and larger infarct volume than those developed in group II and III. The rats of group III developed higher blood glucose levels and larger infarct volume than group II. According to our data, lowering the blood glucose level by fasting or intraperitoneal injection of insulin reduced the infarct volme in model of transient focal cerebral ischemia. These results suggest that maintenance of low level of blood glucose during early phase of cerebral infarction may reduce volume of infarction and neurological sequelae.
Adult ; Aneurysm ; Animals ; Blood Glucose* ; Brain Injuries ; Brain Ischemia ; Carotid Artery, Internal ; Cerebral Infarction ; Fasting ; Glucose ; Humans ; Infarction ; Injections, Intraperitoneal ; Insulin ; Ischemia ; Ischemic Attack, Transient* ; Nylons ; Rats* ; Reperfusion

A 69-year-old woman developed right upper quadrant pain and jaundice 4 years after laparoscopic cholecystectomy for cystic duct obstruction by stone. Two stones with a metallic clip nidus in common bile duct were diagnosed with abdominal sonography and endoscopic retrograde cholangiography. Endoscopic retrieval of the stones and a metallic clip was successfully performed. Nowadays, laparoscopic surgery has become a very common procedure, and metallic clips are used more frequently. Therefore, in order to avoid CBD stone and other complications caused by metallic clips, careful application and strict follow-up shoued be stressed during laparoscopic biliary surgery.
Aged ; Cholangiography ; Cholecystectomy, Laparoscopic* ; Choledocholithiasis* ; Common Bile Duct ; Cystic Duct ; Female ; Follow-Up Studies ; Humans ; Jaundice ; Laparoscopy