Inducible nitric oxide synthase (iNOS) expression of several organs on the lipopolysaccharides (LPS)-injected rats and on excisional wound was observed by immunohistochemical methods to investigate iNOS-positive cells during inflammation. iNOS expression was induced in response to LPS in the brain and these reactions were observed in the choroidal epithelium, ependymal cells and a few of nerve cells and fiber. A more intensive reaction of nerve cell and fiber was mainly observed in the corpus callosum and hypothalamus. Induction of iNOS of the lung was observed in alveolar macrophage, smooth muscle, pneumocytes and inflammatory cells infilterated in the alveolar septum. iNOS expression of the liver was detected in Kupffer cells, hepatocytes, bile duct and inflammatory cells of spotty necrosis. The cardiac muscle and endothelial cell of the heart showed positive iNOS expression. In the excisional wound, inflammatory cells including macrophages, neutrophil and fibrobast showed iNOS expression and mainly detected necrobiotic layer. Collectively, iNOS expression was induced in the several cell types during inflammatory process. So for better understanding the function of iNOS, more research should be done in relation to each cell type of organ.
Animals ; Bile Ducts ; Brain ; Choroid ; Corpus Callosum ; Endothelial Cells ; Epithelium ; Heart ; Hepatocytes ; Hypothalamus ; Inflammation ; Kupffer Cells ; Lipopolysaccharides ; Liver ; Lung ; Macrophages ; Macrophages, Alveolar ; Muscle, Smooth ; Myocardium ; Necrosis ; Neurons ; Neutrophils ; Nitric Oxide Synthase Type II* ; Pneumocytes ; Rats* ; Shock* ; Wound Healing* ; Wounds and Injuries*

PURPOSE: Pneumonia is the most common cause of death among infectious diseases. Community-acquired pneumonia is the sixth leading cause of death in Korea. This study was designed to analyze the relationship of risk factors and mortality, especially the pneumonia severity index (PSI) in patients with community-acquired pneumonia diagnosed in the emergency department of a referral hospital. METHODS: The medical records of patients admitted to the Yeungnam University Hospital between March 2006 and March 2008 for community-acquired pneumonia were reviewed retrospectively. The demographic data, comorbidity, laboratory results, PSI score and class of PSI, all of which might influence the prognosis of pneumonia, were analyzed. RESULTS: Among 123 patients admitted for community-acquired pneumonia, 18 died (mortality rate of 15%). Laboratory data showed that sodium, glucose, blood urea nitrogen, albumin, platelets, hematocrit and arterial pH were related to the prognosis. For the pneumonia severity index, the mortality rate increased in a step-wise manner from class I through class V. Comorbidities such as neoplasms (p=0.000), cerebrovascular accidents (p=0.005) and liver disease (p=0.003), as well as systolic blood pressure (p=0.003), respiratory rate (p=0.024), sodium (p=0.000), glucose (p=0.000), blood urea nitrogen (p=0.000), albumin (p=0.003), hematocrit (p=0.000) and arterial pH (p=0.042) were the important risk factors for mortality in patients with community-acquired pneumonia. CONCLUSION: The pneumonia severity index could be used as a valuable index for predicting mortality of patients and the prognosis of community-acquired pneumonia in the emergency department.
Blood Glucose ; Blood Platelets ; Blood Pressure ; Blood Urea Nitrogen ; Cause of Death ; Communicable Diseases ; Comorbidity ; Emergencies ; Glucose ; Hematocrit ; Humans ; Hydrogen-Ion Concentration ; Korea ; Liver Diseases ; Medical Records ; Nitrogen ; Pneumonia ; Prognosis ; Referral and Consultation ; Respiratory Rate ; Retrospective Studies ; Risk Factors ; Sodium ; Stroke ; Urea

A seventyone-year-old male presented with sudden epigastric pain followed by jaundice and intermittent right upper abdominal pain. He was diagnosed as hepatocellular carcinoma 7 years ago, and has been treated with transarterial chemoembolization, percuaneous ethanol injection and segmentectomy. On admission, the level of serum bilirubin, amylase and lipase were 8.7 mg/dL, 560 IU/L, and 13,297 IU/L, respectively. Stool occult blood test was positive. Abdominal computed tomography revealed newly-appeared intraductal soft tissue mass with ductal dilatation. Endoscopic retrograde cholangiography demonstrated filling defects in the common hepatic and distal common bile duct (CBD). Endoscopic sphincterotomy was performed and the clots in the distal CBD were removed. An intraductal stent was inserted at the common hepatic duct. The obstructive jaundice and pancreatitis were resolved. Our case suggests that intraductal hepatocellular carcinoma may induce hemobilia as a possible cause of acute pancreatitis.
Abdominal Pain ; Amylases ; Bilirubin ; Carcinoma, Hepatocellular* ; Cholangiography ; Common Bile Duct ; Dilatation ; Ethanol ; Hemobilia* ; Hepatic Duct, Common ; Humans ; Jaundice ; Jaundice, Obstructive ; Lipase ; Male ; Mastectomy, Segmental ; Occult Blood ; Pancreatitis ; Sphincterotomy, Endoscopic ; Stents

BACKGROUND: In organ transplantation, the cellular immune reaction, namely T-cell immunity, plays a major role in rejecting the graft. While T & B cell activities in organ transplantation have been studied extensively, monocytes/macrophages have not because of their a minor role in innate immunity. Monocytes act as immunologically active cells in several aspects in organ transplantation, such as antigen-presenting cells, cells releasing many substance, such as IL-1, IL-2, TNF-alpha, and many growth factors, and cells phagocytosing foreign antigens and tissues in the effector phase of immune reaction. METHODS: We attempted to study the role of monocytes/ macrophages in graft rejection following allogenic organ transplantation in rodents. RESULTS: While graft survivals following a cardiac allograft were more then 100 days in all the singenic Wistar to Wistar transplants, the graft survival for Lewis to Wistar allografts were 7 to 12 days with a mean of 9.2 days. In the histology of the transplanted hearts, cellular infiltration developed from posttransplantation day 1, and all the histologic findings, such as myocardial ischemia, interstitial bleeding, and endocardial changes, were more progressive around the days of graft rejection. Macrophage infiltration analyzed by immunohistochemstry using the spectific antibody ED1, was noticed from postoperative day 1, and the macrophages were distributed all through the layer of the heart. In the study on the intragraft monokine gene by using RT-PCR, mRNA of IL-1 expressed on day 1 and reappearedon day 7. mRNA of TNF-alphaexpressed on day 3 and MCP-1 on day 1. All the monokine gene expressions progressed up to the days of rejection. CONCLUSION: From these results showing the concurrent pattern of cell infiltration and intragraft cytokine gene expression of monocytes/macrophages with the lymphocyte, we suggest that intervention of monocytes in organ transplantation may prolong graft survival with or without the anti T cell strategy.
Allografts ; Animals ; Antigen-Presenting Cells ; Gene Expression ; Graft Rejection ; Graft Survival ; Heart Transplantation* ; Heart* ; Hemorrhage ; Immunity, Innate ; Intercellular Signaling Peptides and Proteins ; Interleukin-1 ; Interleukin-2 ; Lymphocytes ; Macrophages ; Monocytes ; Myocardial Ischemia ; Organ Transplantation ; Rats* ; RNA, Messenger ; Rodentia ; T-Lymphocytes ; Transplantation ; Transplants* ; Tumor Necrosis Factor-alpha

BACKGROUND/AIMS: To identify the risk factors for metachronous gastric neoplasms in patients who underwent an endoscopic resection of a gastric neoplasm. METHODS: We prospectively collected clinicopathologic data and measured the methylation levels of HAND1, THBD, APC, and MOS in the gastric mucosa by methylation-specific real-time polymerase chain reaction in patients who underwent endoscopic resection of gastric neoplasms. RESULTS: A total of 257 patients with gastric neoplasms (113 low-grade dysplasias, 25 high-grade dysplasias, and 119 early gastric cancers) were enrolled. Metachronous gastric neoplasm developed in 7.4% of patients during a mean follow-up of 52 months. The 5-year cumulative incidence of metachronous gastric neoplasm was 4.8%. Multivariate analysis showed that moderate/severe corpus intestinal metaplasia and family history of gastric cancer were independent risk factors for metachronous gastric neoplasm development; the hazard ratios were 4.12 (95% confidence interval [CI], 1.23 to 13.87; p=0.022) and 3.52 (95% CI, 1.09 to 11.40; p=0.036), respectively. The methylation level of MOS was significantly elevated in patients with metachronous gastric neoplasms compared age- and sex-matched patients without metachronous gastric neoplasms (p=0.020). CONCLUSIONS: In patients who underwent endoscopic resection of gastric neoplasms, moderate/severe corpus intestinal metaplasia and a family history of gastric cancer were independent risk factors for metachronous gastric neoplasm, and MOS was significantly hypermethylated in patients with metachronous gastric neoplasms.
Aged ; Basic Helix-Loop-Helix Transcription Factors/genetics ; DNA Methylation ; Female ; Gastrectomy/methods ; Genes, APC/physiology ; Genes, mos/genetics ; Humans ; Incidence ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasms, Second Primary/epidemiology/*genetics/pathology ; Proportional Hazards Models ; Risk Factors ; Stomach Neoplasms/genetics/*pathology/surgery ; Thrombomodulin/genetics

PURPOSE: The probiotic effects of lactic acid bacteria have widely been researched in diverse human pathogens, but only a few effects are reported against oral pathogens. The antimicrobial effects of the Enterococcus faecium 7413 isolated from Korean infants on the 9 pathogen including 6 oral streptococci were investigated the clinical use of the antimicrobial peptide for oral microflora control. MATERIALS AND METHODS: E. faecium 7413 was identified by morphological, biochemical tests and 16S rDNA sequence analysis. Inhibitory effects of culture supernatants were determined for their ability to grow on agar plate containing pathogenic bacteria. RESULT: The culture supernatant of Enterococcus faecium 7413 showed inhibitory effects on oral pathogens, namely Streptococcus pyogenes KCTC 3556, S. pneumoniae KCTC 5080, S. mutans ATCC 25175, S. anginosus ATCC 33397, S. constellatus KCTC 3268, S. intermedius ATCC 27823 and Shigella flexneri KCTC 2008. Whereas it did not affect the multiplication of E. coli strains, KCTC 1041 and ATCC 43894. CONCLUSION: The data obtained in this study could be useful for future development of effective probiotics allowing prevention for oral pathogens.
Agar ; Bacteria ; DNA, Ribosomal ; Enterococcus ; Enterococcus faecium ; Humans ; Infant ; Lactic Acid ; Pneumonia ; Probiotics ; Sequence Analysis ; Shigella flexneri ; Streptococcus pyogenes

BACKGROUND: The combination chemotherapy of gemcitabine and cisplatin has been proven effective in the treatment of advanced non-small cell lung cancer (NSCLC). However, the optimal schedule for administration of the two drugs has not yet been determined. We therefore started a phase II trial to evaluate efficacy, toxicity and dose intensity (DI) as three-week scheduled chemotherapy of gemcitabine and cisplatin. METHODS: Between October 2000 and March 2003, a total of 56 patients with stage IIIB and IV NSCLC were enrolled in this study. Treatment schedule consisted of gemcitabine 1200 mg/m2 i.v. on days 1 and 8, and cisplatin 80 mg/m2 i.v. on day 1 of each chemotherapy cycle followed by two weeks of rest. RESULTS: Forty-eight patients were evaluable in response and adverse effects in this study. The median DI was 529 mg/m2/week for gemcitabine (66%) and 22 mg/m2/week for cisplatin (83%). Partial response was observed in 23 patients. The overall response rate was 47.8% (95% confidence interval [CI], range from 33.6% to 61.9%). Anemia and thrombocytopenia were the main hematologic adverse effects, with 8.3% and 8.3% of patients experiencing grade III to IV toxicity, respectively. The median survival time was 11.78 months (95% CI, range from 8.59 to 14.97months). No significant differences in response rate were observed according to sex, age, histology and DI of gemcitabine and cisplatin. CONCLUSION: The 3-week-scheduled combination chemotherapy of gemcitabine and cisplatin has feasibility to treat advanced stage IIIB and IV NSCLC with modest adverse effects. The regimen deserves further evaluaton in a phase III prospective randomized trial.
Anemia ; Appointments and Schedules ; Carcinoma, Non-Small-Cell Lung ; Cisplatin* ; Drug Therapy ; Drug Therapy, Combination* ; Humans ; Thrombocytopenia

Although high-dose therapy (HDT) with autologous hematopoietic stem cell transplantation (ASCT) is widely accepted as an effective and safe consolidation therapy for multiple myeloma (MM), few reports on its efficacy are available in Korea. We present the results of a prospective phase II study, involving 33 patients with MM treated with HDT with ASCT. The treatment consisted of 4 courses of VAD (vincristine, adriamycin, dexamethasone) induction, peripheral blood stem cell collection, and high-dose melphalan with stem cell infusion. The overall response rate was 93%, with 45% of patients having complete responses. The toxicity was predictable and tolerable. With a median follow-up of 27.6 months, the 2-year event free survival rate was 43%. At the time of writing, the median overall survival duration had not been reached with 2-year survival and projected 3-year survival rates of 81% and 74%, respectively. The overall survival was significantly better than that of the historical control patients (N=82) treated with conventional chemotherapy at our institution. The results suggest that HDT with ASCT is a valuable first or second-line treatment for patients with MM.
Adult ; Aged ; Female ; Human ; Male ; Melphalan/*therapeutic use ; Middle Aged ; Multiple Myeloma/mortality/pathology/*therapy ; Neoplasm Staging ; *Peripheral Blood Stem Cell Transplantation ; Prognosis ; Prospective Studies ; Survival Rate ; Transplantation, Autologous

BACKGROUND: The paradoxical response refers to an enlargement of old lesions or unexpected new ones during apparently adequate antituberculous therapy. This response has been reported in cases of intracranial tuberculoma, tuberculous lymphadenopathy, tuberculous pleurisy and pulmonary tuberculosis. However, there are few reports on its frequency and clinical characteristics. METHOD: This study enrolled 205 patients who were treated with first line antituberculous agents for more than 6 months. We retrospectively studied 155 patients with pulmonary tuberculosis and 57 patients with pleural tuberculosis (7 patients had both) from July 1998 to March 2000. The patients were divided into the paradoxical response group and the non-paradoxical group. The clinical characteristics of the paradoxical group were investigated. Statistical analysis was done with an independent sample T-test and Chi-squared test. RESULT: 29 of the 205 patients(14.1%) had paradoxical response. Among the 29 patients, there were 19 pulmonary tuberculosis, 8 tuberculous pleurisy(2 patients had both). Paradoxical response appeared 32 days (mean 35 days in pulmonary tuberculosis, mean 25 days in tuberculous pleurisy) after the beginning of chemotherapy. The duration to regress less than half of initial chest lesion was 114 days in pulmonary tuberculosis and 124 days in tuberculous pleurisy, respectively. Most common clinical manifestation of paradoxical response patients was coughing in both pulmonary tuberculosis and tuberculous pleurisy. Male sex, high blood WBC count and high level of pleural fluid LDH were related with paradoxical response. CONCLUSION: These findings suggest that presponse usually appears 1 month and disappears within 4 months after the beginning of anti-tuberculous chemotherapy. Paradoxical response was relatively correlated with male sex, high blood WBC count and high level of pleural fluid LDH.
Male ; Humans

PURPOSE: To determine the frequency of p53 overexpression and to analyse the relationship between p53 overexpression and complete response rate, survival in locoregionl squamous cell esophageal cancers treated with preoperative chemoradiation multimodality approaches. MATERIALS AND METHODS: Using a microwave oven heating method, we have detected p53 overexpression by immunohistochemically with a monoclonal antibody(DO-7) in formalin- fixed paraffin-embedded samples of 42 patients with locoregional squamous cell esophageal cancer, who treated with concurrent chemotherapy and radiatian followed by surgery. RESULTS: In 27 of 42 tumors(64.2%), nuclear immunoreactivity for the p53 protein was detected. Complete response rate, evaluated in surgical specimen 3-4 weeks after chemoradiation seemed to be high in p53 positive group compared to p53 negative group, however, there was no statistically significant difference in acquiring better complete response rate, overall survival and progression free survival between p53 positive and p53 negative group(p=0.0546, p=0.0599, p= 0.6832). Complete response group(n=17) survived longer than non-complete response group(n=25)(p=0.0010). CONCLUSION: The results indicate that p53 is not a statistically significant prognostic factor in obtaining better complete response rate, overall survival and progression free survival of the patients with esophageal carcinoma treated with preoperative chemoradiotherapy. Additional studies are warranted for further evaluation.
Chemoradiotherapy* ; Disease-Free Survival ; Drug Therapy ; Esophageal Neoplasms ; Heating ; Hot Temperature ; Humans ; Immunohistochemistry ; Microwaves ; Survival Rate