Acute appendicitis in children under the age of 12 has remained the surgical emergency condition with the highest percentage of misdiagnosis leading to removal of a normal appendix. From January 1994 to April 1997, 312 children (176 boys, 136 girls) were admitted to Jun-ang Gil Hospital with the impression of acute appendicitis. The average age was 8.6 years (2 to 12 years). We reviewed medical records retrospectively for demographics, presenting signs, symptoms, findings of abdominal ultrasonography (USG) and barium enemas, and surgical results. The patients were divided in 2 groups as follows: group I (n=144) received immediate operations without further evaluation, group II (n=168) was treated after a delay for observation and/or special studies (USG and/or barium enema). Group II was subdivided into Group IIa (n=119) (treatment after study) and Group IIb (n=49)(treatment by clinical observations only). In group I, 124 patients were confirmed intraoperatively as having acute appendicitis, and 20 cases were not. In IIa, 36 patients underwent exploratory surgery and 30 cases revealed acute appendicitis. The remaining 83 patients were discharged because of symptomatic relief. In group IIb, 43 patients underwent exploratory surgery and acute appendicitis was revealed in 35. The diagnostic accuracies of groups were 86%, 95% and 84%. The sensitivity, specificity and diagnostic accuracy of an abdominal ultrasonography (n=105) were 96.1%, 82.1% and 92.4%, respectively. Those of a barium enema (n=63) were 94.7%, 100%, and 95.2% respectively. When both modalities were used (n=49), the results were 95.6%, 100% and 95.9%, respectively. The frequencies of a perforated appendicitis had no difference among the groups. In conclusion, in a child suspected of having acute appendicitis, if there are no apparent toxic signs or panperitonitis, surgical observation, USG, and/or a barium enema can decrease the number of unnecessary appendectomy without increasing the risk of perforation.
Appendectomy ; Appendicitis* ; Appendix ; Barium ; Child* ; Demography ; Diagnostic Errors ; Emergencies ; Enema ; Humans ; Medical Records ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography

Tumor angiogenesis was simulated using a two-dimensional computational model. The equation that governed angiogenesis comprised a tumor angiogenesis factor (TAF) conservation equation in time and space, which was solved numerically using the Galerkin finite element method. The time derivative in the equation was approximated by a forward Euler scheme. A stochastic process model was used to simulate vessel formation and vessel elongation towards a paracrine site, i.e., tumor-secreted basic fibroblast growth factor (bFGF). In this study, we assumed a two-dimensional model that represented a thin (1.0mm) slice of the tumor. The growth of the tumor over time was modeled according to the dynamic value of bFGF secreted within the tumor. The data used for the model were based on a previously reported model of a brain tumor in which four distinct stages (multicellular spherical, first detectable lesion, diagnosis, and death of the virtual patient) were modeled. In our study, computation was not continued beyond the 'diagnosis' time point to avoid the computational complexity of analyzing numerous vascular branches. The numerical solutions revealed that no bFGF remained within the region in which vessels developed, owing to the uptake of bFGF by endothelial cells. Consequently, a sharp declining gradient of bFGF existed near the surface of the tumor. The vascular architecture developed numerous branches close to the tumor surface (the brush-border effect). Asymmetrical tumor growth was associated with a greater degree of branching at the tumor surface.
Computer Simulation ; Fibroblast Growth Factor 2/metabolism ; Humans ; *Models, Biological ; Neoplasms/*blood supply/metabolism ; Neovascularization, Pathologic/*physiopathology ; Research Support, Non-U.S. Gov't

BACKGROUND: The recent advances in flow cytometric technology and the development of monoclonal antibodies have led to the important insights into the cell lineage and maturation stage of leukemia. The increased use of immunophenotyping in acute leukemia revealed the unusual anigen expression and biclonal or biphenotypic acute mixed lineage leukemia (AMLL). However, the data on their frequency and prognostic significance are still conflicting. METHODS: The immunophenotyping of leukemic cells (HLA-DR, CD10, CD19, CD20, CD22, CD3, CD5, CD7, CD13, CD33, CD61, TdT, cytoplasmic Ig, surface Ig) was performed by flow cytometry in 115 cases of acute leukemia between January 1994 and August 1996. Double-color immunofluorescent staining was performed in the cases expressing unusual antigens. RESULTS: 51 cases (44.3%) of 115 acute leukemias showed unusual antigens expression. These included 27 cases (38.6%) of 70 AML, 13 cases (43.3%) of 30 B-lineage ALL, 4 cases (50%) of 8 T-LL and 7 AMLL cases (6.1%) of 115 acute leukemias. CD7 (28.6%) and CD19 (11.4%) are expressed in AML, and CD13 (36.7%) and CD33 (26.7%) are expressed in ALL. Among 7 cases of AMLL, we could obtain the clinical data of 5 cases. The 4 cases of 5 AMLL failed to respond to induction chemotherapy or died before or during induction chemotherapy, and only one case showed partial remission. CONCLUSION: The unusual antigen expressions of acute leukemic cells are frequently observed, and the identification of relatively rare AMLL is very important, because AMLL showed poor response to the chemotherapy.
Antibodies, Monoclonal ; Cell Lineage ; Cytoplasm ; Drug Therapy ; Flow Cytometry ; Immunophenotyping ; Induction Chemotherapy ; Leukemia*

The effects of cigarette smoking on the psychosocial distress, the absenteeism, the occupational injuries, and on the prevalence for the accidents were assessed in 795 male workers who had been employed since March 1994. The results show that the prevalence of current smokers were higher in young men, lower educational level, lower income, single men(unmarried or divorced), alcohol drinkers, and blue collar workers. In the bivariate analyses, the workers with the high job demand and low work control were more likely to smoke, although the relationship was not strong. Those who reported lower satisfaction on his job tended to smoke more. Mean scores of psychosocial well-being Index(PWI) were higher in current smokers than nonsmokers. For the hierarchical multiple regression analyses, interaction terms between cigarette smoking and job stressors(job demand and work control) were not significant. For smokers, the odds ratios for the occupational injuries, and the accidents were 1.40(95% confidence interval 0.77-2.57) and 1.96 (95% confidence interval 0.75-5.09), respectively. The mean absent day were 4.13 for smokers, 3.65 for nonsmokers, although the differences were not statistically significant. It seems that cigarette smoking had not caused any crucial effects on the psychosocial well-being status and the occupational risks. Some considerations for the further research on the relationship of cigarette smoking on the mental health status and the occupational risks were also discussed.
Absenteeism ; Humans ; Male ; Mental Health ; Occupational Injuries ; Odds Ratio ; Prevalence ; Smoke ; Smoking* ; Tobacco Products*

PURPOSE: Vascular smooth muscle cell (VSMC) proliferation induced by native low-density lipoprotein (nLDL) stimulation is dependent on superoxide production from activated NADPH oxidase. The present study aimed to investigate whether the novel arginase inhibitor limonin could suppress nLDL-induced VSMC proliferation and to examine related mechanisms. MATERIALS AND METHODS: Isolated VSMCs from rat aortas were treated with nLDL, and cell proliferation was measured by WST-1 and BrdU assays. NADPH oxidase activation was evaluated by lucigenin-induced chemiluminescence, and phosphorylation of protein kinase C (PKC) βII and extracellular signal-regulated kinase (ERK) 1/2 was determined by western blot analysis. Mitochondrial reactive oxygen species (ROS) generation was assessed using MitoSOX-red, and intracellular L-arginine concentrations were determined by high-performance liquid chromatography (HPLC) in the presence or absence of limonin. RESULTS: Limonin inhibited arginase I and II activity in the uncompetitive mode, and prevented nLDL-induced VSMC proliferation in a p21Waf1/Cip1-dependent manner without affecting arginase protein levels. Limonin blocked PKCβII phosphorylation, but not ERK1/2 phosphorylation, and translocation of p47phox to the membrane was decreased, as was superoxide production in nLDL-stimulated VSMCs. Moreover, mitochondrial ROS generation was increased by nLDL stimulation and blocked by preincubation with limonin. Mitochondrial ROS production was responsible for the phosphorylation of PKCβII. HPLC analysis showed that arginase inhibition with limonin increases intracellular L-arginine concentrations, but decreases polyamine concentrations. L-Arginine treatment prevented PKCβII phosphorylation without affecting ERK1/2 phosphorylation. CONCLUSION: Increased L-arginine levels following limonin-dependent arginase inhibition prohibited NADPH oxidase activation in a PKCβII-dependent manner, and blocked nLDL-stimulated VSMC proliferation.
Animals ; Aorta ; Arginase* ; Arginine ; Blotting, Western ; Bromodeoxyuridine ; Cell Proliferation* ; Chromatography, High Pressure Liquid ; Chromatography, Liquid ; Lipoproteins ; Luminescence ; Membranes ; Muscle, Smooth, Vascular* ; NADP* ; NADPH Oxidase* ; Phosphorylation ; Phosphotransferases ; Protein Kinase C ; Rats ; Reactive Oxygen Species ; Superoxides

Objective: We compared appendiceal visualization on 2-mSv CT vs. conventional-dose CT (median 7 mSv) in adolescents and young adults and analyzed the undesirable clinical and diagnostic outcomes that followed appendiceal nonvisualization. Materials and Methods: A total of 3074 patients aged 15–44 years (mean ± standard deviation, 28 ± 9 years; 1672 female) from 20 hospitals were randomized to the 2-mSv CT or conventional-dose CT group (1535 vs. 1539) from December 2013 through August 2016. A total of 161 radiologists from 20 institutions prospectively rated appendiceal visualization (grade 0, not identified; grade 1, unsure or partly visualized; and grade 2, clearly and entirely visualized) and the presence of appendicitis in these patients. The final diagnosis was based on CT imaging and surgical, pathologic, and clinical findings. We analyzed undesirable clinical or diagnostic outcomes, such as negative appendectomy, perforated appendicitis, more extensive than simple appendectomy, delay in patient management, or incorrect CT diagnosis, which followed appendiceal nonvisualization (defined as grade 0 or 1) and compared the outcomes between the two groups. Results: In the 2-mSv CT and conventional-dose CT groups, appendiceal visualization was rated as grade 0 in 41 (2.7%) and 18 (1.2%) patients, respectively; grade 1 in 181 (11.8%) and 81 (5.3%) patients, respectively; and grade 2 in 1304 (85.0%) and 1421 (92.3%) patients, respectively (p < 0.001). Overall, undesirable outcomes were rare in both groups. Compared to the conventional-dose CT group, the 2-mSv CT group had slightly higher rates of perforated appendicitis (1.1% [17] vs. 0.5% [7], p = 0.06) and false-negative diagnoses (0.4% [6] vs. 0.0% [0], p = 0.01) following appendiceal nonvisualization. Otherwise, these two groups were comparable. Conclusion The use of 2-mSv CT instead of conventional-dose CT impairs appendiceal visualization in more patients. However, appendiceal nonvisualization on 2-mSv CT rarely leads to undesirable clinical or diagnostic outcomes.