The hepatic hemopoiesis in intrauterine lifeis predominently erythropoiesis,and the erythroblasts undergo the differentiation process finally to form reticulocytes.In this syudy, the development of erythropoiesis in human fetal liver was observed using transmission electron microscope. The immature erythroblasts were more prominent in earlier fetal liver and proliferated rather than went through final differentiation process. The erythroblasts of different differentiation stages exhibited apoptosis in addition to the normal differentiation process. The nuclei of acidophilic erythroblasts were removed by the excessive condensation and dissociation of nuclei from the cytoplasm or by the displacement of nuclei to one side of the cell with deformation of nuclei. The deformed nuclei restored the round shape after the completion of enucleation and engulfed by hepatocytes and Kupffer cells. Two types of erythroblast islands were present in hepatic plate by the differentiation stages of erythroblasts, id est, islands of the same and the different differentiation stages. And several erythroblasts and enucleated nuclei were included in hepatocytes, intrahepatic macrophages and Kupffer cells, and the intrahepatic macrophages resembling Kupffer cell could be suggested to be originated from the Kupffer cell. But there was no morphological evidence of phagocytosis of erythroblasts and nuclei by these cells. In summary, human fetal hepatic erythropoiesis occurred by forming erythroblastic islands and some erythroblasts proceeded to apoptosis during the differentiation. Hepatocytes and macrophages were present in close relation to erythroblast islands and were suggested to influence the development and differentiation of erythroblasts.
Apoptosis ; Cytoplasm ; Erythroblasts* ; Erythropoiesis ; Hepatocytes ; Humans* ; Islands ; Kupffer Cells ; Liver* ; Macrophages ; Phagocytosis

PURPOSE: We evaluated treatment outcomes of thymic carcinomas to determine prognostic factors for survival. MATERIALS AND METHODS: Between May 1988 and May 2009, 41 patients had pathologic diagnosis of thymic carcinoma in Seoul National University Hospital, Seoul, Korea. Of these, 40 patients were followed up to 188 months after treatment. The mean age of all patients was 58.3 years and male to female ratio was 23 to 17. RESULTS: Among 30 patients who underwent surgical resection, 26 achieved R0 resection and postoperative radiotherapy (PORT) was performed in 22 patients (73%). Various chemotherapeutic regimens were given with local treatment modalities, surgery and/or radiotherapy, in 12 patients. The 5-year locoregional control (LRC), distant metastasis-free survival, progression-free survival (PFS), and overall survival were 79.4%, 53.0%, 42.6%, and 63.6%, respectively. Patients with Masaoka stage I or II showed excellent prognosis of 5-year PFS around 90%. In advanced stages, invasion of the great vessels or atrium by thymic carcinomas was negative prognostic factor for PFS in univariate analysis. Lymph node involvement was statistically significant factor for LRC and PFS. Local or regional recurrence was infrequent after surgical resection followed by PORT, while distant metastasis was the major component of treatment failure. CONCLUSION: Complete resection followed by PORT provided remarkable local control without severe acute toxicities in patients with stage II and favorable stage III thymic carcinoma. Invasion of the great vessels or atrium was statistically significant prognostic factor for PFS.
Disease-Free Survival ; Female ; Humans ; Korea ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Thymoma

BACKGROUND AND AIMS: Propofol is a short-acting intravenous sedative-hypnotic agent that can be used as a hypnotics for upper gastrointestinal endoscopy. A study was conducted to evaluate the effectiveness and safety of propofol as a hypnotic agent for upper gastrointestinal endoscopy. METHODS: From June to October 1998, twenty eight patients undergoing upper gastrointestinal endoscopy were to receive propofol. Vital signs and peripheral oxygen saturation (SpO2) were monitored by pulse oximetry during continuous infusion of propofol. Propofol (1% solution) was initially infused by 26.7 mg/kg/hr until loss of eyelash reflex and then titrated to 6-10 mg/kg/hr according to the patient's response and vital sign. Propofol infusion was discontinued while the endoscopic fiber was removed. Recovery time was defined from discontinuation of infusion to positive Romberg test. Evaluation was made from the endoscopists' assessment, patients' satisfaction, patients' recall of the procedure, and consciousness of the patients. RESULTS: It was discovered that systolic, diastolic pressure and heart rate were significantly decreased, compared to control group. But clinically significant changes were not found. Apnea did not exist. And the respiration rate was significantly increased during propofol infusion. Peripheral oxygen saturation (SpO2) was transiently decreased during endoscopy. 14 patients (50%) complained of transient dizziness. Pain and redness over the infusion site was not found. The mean total dose of propofol was 133.6 mg. The mean infusion time of propofol was 6.2 minutes. Mean response and recovery time was 3.7 2.1, 20.9 5.4 minutes. Endoscopists' assessment and patients' comfort for endoscopy were satisfactory. When we asked 28 patients about willingness to undergo the same procedure in the future, 27 patients (96.4%) agreed. Degree of amnesia after examination revealed total amnesia in 27 patients (96.4%), partial amnesia in 1 patients (3.6%), and recall was not. CONCLUSIONS: Propofol has beneficial effects as hypnotic for upper gastrointestinal endoscopy without significant alteration in cardiopulmonary parameters. Patients' and endoscopists' assessment is good. This suggest that propofol may be used more frequently as a kind of premedication, especially in the cases of repeated endoscopy.
Amnesia ; Apnea ; Blood Pressure ; Consciousness ; Dizziness ; Endoscopy ; Endoscopy, Gastrointestinal* ; Heart Rate ; Humans ; Hypnotics and Sedatives ; Oximetry ; Oxygen ; Premedication ; Propofol* ; Reflex ; Respiratory Rate ; Vital Signs

A 71-year-old man who had no prior history of chemotherapy or radiation therapy was diagnosed with nodular sclerosis Hodgkin's disease (HD) and IgA-kappa multiple myeloma (MM) simultaneously. The patient achieved a complete response of HD and a minor response of MM after 6 cycles of COPP/ABV chemotherapy. Thereafter, he had received oral mephalan and prednisolone without disease progression for 12 months. At 27-month follow-up, he succumbed to overwhelming pneumonia and septic shock with progressive disease of MM. We present this case as a first report of simultaneous occurrence of HD and MM in South Korea.
Aged ; Disease Progression ; Drug Therapy ; Follow-Up Studies ; Hodgkin Disease* ; Humans ; Korea ; Multiple Myeloma* ; Pneumonia ; Prednisolone ; Sclerosis ; Shock, Septic

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.