BACKGROUND: Apoptosis plays a crucial role in carcinogenesis, as well as in development and tissue homeostasis. Terminal deoxyribonucleotidyl transferase mediated neck end labelling (TUNEL) and in situ nick end labelling (ISEL) have been used to investigate the apoptosis in tissues. Since the introduction of the M30 monoclonal antibody to overcome drawbacks of TUNEL and ISEL, the apoptosis in various tumors, with the exception of pulmonary carcinomas, has been studied. In this study, attempts were made to examine the correlation of apoptosis in non-small cell carcinomas, using both M30 and the expression of p53 protein, with the clinicopathological factors. MATERIAL AND METHOD: Forty five patients with surgically resected non-small cell carcinomas were included. Immunohistochemical staining with M30 and p53 monoclonal antibody were performed, and their expressions compared with the clinicopathological features. The overall survival time and recurrence-free survival time were calculated, and the factors influencing the survival time analyzed using a univariate analysis. The effects of the expression stati of M30 and p53 on the risks of cancer related to both death and recurrence were evaluated using a multivariate analysis. RESULT: The p53 positive group had many more M30 positive cells than the p53 negative group (p53 positive group; 61.7+/-26.8 cells vs. p53 negative group; 45.6+/-29.6 cells, p=0.005) and significantly more p53 positive patients showing at least 10 positive cells (apoptotic index, AI > or =1) on M30 staining (p53 positive group; 52.4% [11/21] vs. p53 negative group 16.7% [4/24], p=0.025). In the univariate analysis, the survival times in relation to smoking (pack-year), performance status (PS) and AI showed significant differences. The multivariate analysis demonstrated the relative risk (R.R) of cancer death increased almost 7.5-fold (R.R 7.482; 95% CI 1.886~29.678; p=0.004) and the risk of recurrence almost 3.8-fold (R.R 3.795; 95% CI; 1.184~12.158; p=0.025) in the high AI (> or =1) compared to the low AI (<1) group. There was no prognostic effect of p53 expression on the survival time or risk of cancer death and recurrence. CONCLUSION: In non-small cell lung carcinomas, M30 immunohistochemistry was an excellent method for analyzing apoptosis; the high apoptotic index could be an adverse prognostic predictive factor.
Apoptosis* ; Carcinogenesis ; Cell Death ; DNA Nucleotidylexotransferase ; Homeostasis ; Humans ; Immunohistochemistry ; In Situ Nick-End Labeling ; Lung Neoplasms ; Lung* ; Multivariate Analysis ; Neck ; Recurrence ; Smoke ; Smoking

BACKGROUND: Spontaneous pneumothorax is a common respiratory condition and has been postulated that it develops because of rupture of subpleural blebs. Although the morphology and ultrastructure of causative lesions are well known, the reason for rupture of sbupleural blebs is not absolutely clear. Broad consensus concerning the role of meteorological factors in spontaneous pneumothorax dose not exist. The aim of the study was to examine the influence of change of atmospheric pressure and temperature on the occurrence of spontaneous pneumothorax. MATERIAL AND METHOD: One hundred twenty eight consecutive spontaneous pnemothorax events that occurred between January 2003 and December 2004 were selected. Changes of meteorological factors of particular days from the day before for 5 consecutive days were calculated and compared between the days with pneumothorax occurrence (SP days) and the days without pneumothorax occurrence (Non SP days). The correation between change of pressure and temperature and the occurrence of SP was evaluated. RESULT: SP occurred on 117 days (16.0%) in the 2-year period. Although there was no significant differences in change of pressure factors prior 4 days of SP occurrence compare to the 4 days prior Non SP day, change of mean pressure was higher (+0.934 vs. -0.191hPa, RR 1.042, CI 1.003~1.082, p=0.033), and change of maximum pressure fall was lower (3.280 vs. 4.791 hPa, RR 1.051, CI 1.013~1.090, p=0.009) on the 4 days prior SP day. There were significant differences in change of temperature factors prior 2 days and the day of SP, Changes of mean temperature (-0.576 vs.+0.099 degrees C, RR 0.886, 95% CI 0.817~0.962, p=0.004) and maximum temperature rise (7.231 vs. 8.079 degrees C, RR 0.943 CI 0.896~0.993, p=0.027) were lower on the 2 days prior SP. But changes of mean temperature (0.533 vs. -0.103 degrees C, RR 1.141, CI 1.038~1.255, p=0.006) and maximum temperature rise (9.209 vs. 7.754 degrees C, RR 1.123, CI 1.061~1.190, p=0.000) were higher on the SP days. CONCLUSION: Change of atmospheric pressure and temperature seems to influence the chance of occurrence of SP. Meteorological phenomena that pressure rise 4 day prior to SP and following temperature fall and rise might explain the occurrence of SP. Further studies should be continued in the future.
Atmospheric Pressure* ; Blister ; Consensus ; Meteorological Concepts ; Pneumothorax* ; Rupture

BACKGROUND: In non-small cell lung cancer (NSCLC), malignant pleural effusion is a frequently observed complication, and is an important negative prognostic factor. Although many studies concerned to diagnosis and treatment of malignant pleural effusion have been performed, prognostic factors of malignant pleural effusion have rarely been investigated. This study was performed to determine the prognostic factors of malignant pleural effusion in non-small cell lung cancer. MATERIAL AND METHOD: We evaluated 33 NSCLC patients with malignant effusion treated between January 2002 and December 2003. We analyzed possible factors: gender, age, TNM Stage, fluid analysis (pH, CEA, LDH, glucose, albumin) and treatment modality. Median survival time of each factor was calculated by Kaplan-Meier method and difference of median survival time between groups of factor compared by log-rank test. The Cox proportional hazards regression model was used to confirm the significance of prognostic factor. RESULTS: Of the 33 patients, 23 (69.7%) patients were adenocarcinoma. The median interval of the diagnosis of lung cancer and malignant effusion was 7.3 months (25th~75th: 3.9~11.8), and the median survival time was 3.6 months (95% Confidence Interval: 1.14~5.99). In the univariate analysis, using the log-rank test, those with an adenocarcinoma showed a relatively longer median survival time than those of a non-adenocarcinoma (4.067 vs. 1.867 months, p=0.067) without statistical significance. In the multivariate analysis, using the Cox regression, those with a non- adenocarcinoma showed a trend of high risk of cancer death than those with an adenocarcinoma without statistical significance (Relative risk; 2.754, 95% CI; 0.988~7.672, p=0.053). CONCLUSION: We could not find an independent prognostic factor of malignant pleural effusion in NSCLC. As there was a trend of high risk of cancer death according to histology, further study will be needed.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung* ; Diagnosis ; Glucose ; Humans ; Lung Neoplasms ; Multivariate Analysis ; Pleural Effusion, Malignant* ; Prognosis

Drugs containing ergotamine are widely used in the treatment of migraine. Spastic vasoconstriction is one of the most serious side effects even with recommended dosage. We report a case of 63-year-old male with severe arterial occlusion of the upper limbs which might be related with vasospasm caused by ergotamine-containing medication because of migraine for 15 years. He was treated with bypass graft, sympathicotomy and heparin and prostaglandin E1 infusion. But dramatic clinical reversal of the vasospasm was obtained after withdrawal of ergotamine.
Alprostadil ; Ergotamine ; Heparin ; Humans ; Male ; Middle Aged ; Migraine Disorders ; Muscle Spasticity ; Peripheral Vascular Diseases ; Transplants ; Upper Extremity ; Vasoconstriction

A stellate ganglion block is frequently used in the pain clinic. It has been known that a stellate ganglion block maintains the homeostasis of hormones by improvement of blood supply to the brain. Therefore it has a systemic effect as well as a regional effect. Androgen, the sebaceous gland, hair follicle and bacteria are involved in pathogenesis of acne. The background for the treatment of acne with a stellate ganglion block can be related to the increase of blood supply to the face and the effect on the pineal gland. We administered a stellate ganglion block for the treatment of acne and had good results. From our experience, we consider a stellate ganglion block as the one of the effective treatment of acne.
Acne Vulgaris* ; Bacteria ; Brain ; Hair Follicle ; Homeostasis ; Pain Clinics ; Pineal Gland ; Sebaceous Glands ; Stellate Ganglion*

Traumatic rupture of the thoracic aorta is the second most common cause of death from motor vehicle accidents after head injury. About 85% of these patients do not survive to reach the hospital. The most common mechanism for this is deceleration injury, as occurs in a high speed motor vehicle accident. The aortic isthmus is the site of disruption for about 95% of all blunt thoracic aortic injuries. Another mechanism is crush injury which causes compression of the aorta between the displaced sternal body or manubrium and the thoracic vertebral column. These forces tear the inner layer of the aortic wall at an unusual location. We report here on a case of aortic arch dissection where the injury clearly occurred due to a crush injury and not because of deceleration. The surgical repair was delayed for 10 days after administering intensive medical therapy. The ascending aorta and aortic arch were replaced with an artificial graft with the patient under circulatory arrest and cerebral protection.
Aorta ; Aorta, Thoracic ; Aortic Rupture ; Cause of Death ; Craniocerebral Trauma ; Deceleration ; Humans ; Manubrium ; Motor Vehicles ; Rupture ; Spine ; Transplants

BACKGROUND: BACKGROUND: Computed tomography (CT) is the main tool for detecting abnormalities of the thoracic aorta, but conventional CT only shows the cross-sectional images. These CT images have some limitations fo accuratly measuring the thoracic aortic diameters at various levels. Multidetector computed tomography (MDCT) overcomes these limitations. We measured the thoracic aortic diameter perpendicular to the loop-shaped thoracic aortic course and this was studied in relation to age, gender, height, weight, the body surface area, the body mass index and the presence of hypertension. MATERIAL AND METHOD: Thirty hundred thirty one patients (males: 141 patients and females: 190 patients) who had no abnormalities of the thoracic aorta were investigated using MDCT aortography. They were divided into three age categories: 20~39 years old, 40~59 years old and over age 60. The image was reformed with multiplanar reconstruction and the diameter of the aorta was measured perpendicular to the aortic course at 5 anatomic segments. Level A was the mid-ascending aorta, level B was the distal ascending aorta, level C was the aortic arch, level D was the aortic isthmus and level E was the mid-descending aorta. RESULT: The mean age was 49.5 years old for males and 54.9 years old for females (p<0.05). The mean diameter of the thoracic aorta at level A was 31.1 mm, that at level B was 30.2 mm, that at level C was 26.5 mm, that at level D was 24.0 mm and that at level E was 22.6 mm. The diameters at all the levels were gradually increased with age. Hypertensive patients had larger diameters than did the non-hypertensive population. There was a positive correlation between the ascending aortic diameter (levels A&B) and height and the body surface area, but there were no statistical differences at the aortic arch (level C) and the descending aorta (levels D&E). There were no statistical differences of the weight and body mass index at all levels. CONCLUSION: The diameters of the thoracic aortas were directly correlated with gender, age and hypertension. Height and the body surface area were only correlated with the ascending aorta. Weight and the body mass index have no statistical difference at all levels. We measured the age related thoracic aortic diameters and the upper normal limits and we provide this data as reference values for the thoracic aortic diameter in the Korean population.
Angiography ; Aorta ; Aorta, Thoracic ; Aortography ; Body Mass Index ; Body Surface Area ; Female ; Humans ; Hypertension ; Male ; Multidetector Computed Tomography ; Reference Values

BACKGROUND: The goal of this study was to compare the patency and complications of femoropopliteal bypass with superficial femoral artery stenting for patients with atherosclerotic superficial femoral artery occlusive disease. MATERIAL AND METHOD: Between July 2005 and July 2008, we reviewed 29 femoropopliteal bypass procedures (24 patients) with prosthetic grafts (the bypass group) and 19 superficial femoral artery stentings (15 patients) with nitinol stent (the stent group). There were 35 male patients (89.7%) and the mean age of the patients was 69.2 years (range: 48~84). The number of patients who had DM, hypertension and a smoking history was 25 patients (64.1%), 17 patients (43.6%) and 30 patients (76.9%), respectively. 23 (59.0%) patients had skin ulceration or tissue gangrene at admission. RESULT: There were 27 cases (93.0%) of TASC C&D lesion in the bypass group and 16 cases (84.2%) of TASC A&B lesion in the stent group. There were significant differences for the indications for a procedure between the two groups (p<0.01). The primary patency rates at 6 months, 12 months and 24 months were 91.9%, 79.7% and 79.7% for the bypass group and 93.3%, 86.2% and 86.2% for the stent group, respectively. There were no statistical difference between the two groups (p=0.48). CONCLUSION: There were no significant differences in the outcome between two groups. TASC C&D lesion and failed intervention therapy should be treated with femoropopliteal bypass surgery, and TASC A&B lesion and the high-risk patients should be treated with femoral artery stent insertion.
Alloys ; Atherosclerosis ; Femoral Artery ; Gangrene ; Humans ; Hypertension ; Male ; Peripheral Vascular Diseases ; Skin Ulcer ; Smoke ; Smoking ; Stents ; Transplants

BACKGROUND: Arteriovenous fistula formation is not always easy to perform in hemodialysis patients because of poor preservation of veins due to repeated venipuncture and cannulation. We analyzed the patency rate and complications of prosthetic arteriovenous fistulas using the vena comitantes as a venous outflow in the antecubital fossa, which are protected from venipuncture. MATERIAL AND METHOD: Between January 2006 and June 2008, 12 patients underwent prosthetic arteriovenous fistula formation using the vena comitantes as a venous outflow. Arterial inflow was via the brachial artery and the graft was placed in a loop fashion. The male-to-female ratio was 7:5 and the mean age was 59+/-14 years. Six patients had diabetes mellitus and 10 patients had hypertension. RESULT: There were no complications, such as a graft infection or bleeding. Five patients showed postoperative stenosis at an average of 3 months. The primary patency rate was 75.0, 65.6, and 52.2% at 3, 6, and 12 months, respectively. All the patients with stenosis were able to continue hemodialysis after intervention therapy. The secondary patency rate was 100% at 12 months. CONCLUSION: Creation of a prosthetic arteriovenous fistula using uninjured vena comitantes resulted in a good patency rate and this vein may become a substitute for inappropriate superficial veins.
Arteriovenous Fistula ; Brachial Artery ; Catheterization ; Constriction, Pathologic ; Diabetes Mellitus ; Hemorrhage ; Humans ; Hypertension ; Phlebotomy ; Renal Dialysis ; Transplants ; Veins

Alveolar soft-part sarcoma(ASPS) is a rare, aggressive malignancy of uncertain histologic origin with a propensity for vascular invasion and distant metastasis. ASPS may mimic benign vascular neoplams of malformation but careful evaluation of the unique imaging features on CT scans, MR images, and angiograms lead to the correct diagnosis. ASPS of the tongue is slow-growing, painless mass, especially ASPS of the base the tongue is difficult to be noticed by patient, dentists or oral and maxillofacial surgeons on oral examintion because of its location and clinical resemblance to a benign lesion. And it leads to delayed or inadequate diagnosis. We report radiologic and clinical features of an ASPS of the basal portion of the tongue in a 17-year-old boy, showing normal appearance, but palpation of the tongue and floor of the mouth reveals the tumor. Among the 23 cases of a primary ASPS of tongue reported, 7 cases occured on the basal region of the tongue, inculding the present one. There has been no recurrence or metastasis as of 3 years postoperatively.
Adolescent ; Dentists ; Diagnosis ; Humans ; Male ; Mouth ; Neoplasm Metastasis ; Palpation ; Recurrence ; Sarcoma, Alveolar Soft Part* ; Tomography, X-Ray Computed ; Tongue* ; Viperidae