No abstract available.
Cell Adhesion* ; Ischemia* ; Microscopy, Video* ; Reperfusion*

No abstract available.
Neoplasm Metastasis* ; Skull* ; Thyroid Gland* ; Thyroid Neoplasms*

Richer's syndrome is a development of a high grade malignant lymphoma in a patient with preexisting chronic 1ymphocytic leukemia, small lymphocytic lymphoma or Waldenstrom's macroglobulinemia. A rare case of Richer's syndrome arising in the spleen of a 35-year-old-man was studied by morphology, immunohistochemistry and gene rearrangement study. He has had weight loss and night sweat for last 6 months. Hepatosplenomegaly and abdominal lymphadenopathy were noted on CT scanning. Especially an ovoid radiolucent mass was found within the image of splenomegaly. Lymph nodes and liver biopsy, bone marrow aspiration and splenectomy were done. In the lymph nodes, liver and bone marrow, well differentiated small lymphocytic infiltrations were found but, in the spleen, pleomorphic, large cells with occasional multinucleated giant cells formed a nodular mass surrounded by diffuse, extensive infiltration of small well differentiated lymphocytes. The two distinctive areas in the spleen had positive staining for B-cell marker (HLA-DR and L26), negative staining for T-cell marker (UCLH1), and positive staining for IgM heavy chain and kappa light chain by immuohistochemical study. so this case was diagnosed as a diffuse large cell 1ymphoma transformed from small lymphocytic lymphoma. We made an another effort to clarify their clonality. Gene rearrangement method usingcomplementarity.determining region 3(CDR3) of immunoglobulin heavy chain (IgH) gene and T-cell receptor gamma (TCRgamma) gene by polymerase chain reaction (PCR) technique was done. The two lymphomas in the spleen demonstrated the same rearrangement pattern in both IgH and TCRgamma gene. We think these findings strongly suggest that the large cell lymphoma has the same clonality with that of the small lymphocytic lymphoma.
Male ; Humans

Hypercalcemia is a common complication in CAPD patients treated with calcium-containing phosphate binders and using the standard dialysate (SCD) calcium concentration of 3.5mEq/L. We performed a retrospective study in 25 CAPD patients to determine whether a low calcium dialysate (LCD) containing 2.5mEq/L calcium would reduce the incidence of hypercalemia with adequate control of serum inorganic phosphate levels and diminish the need to use aluminum-containing phosphate binders. All patients had previously used SCD before converting to LCD. The incidence of hypercalcemia (more than 2 episodes of corrected serum calcium > or = 10.5mg/dL) tended to be lower after converting to LCDl 0.27 (0-2.76) vs. 0 (0-1.97) episodes/patient-yearl. Intact PTH level increased from 38.8 (0.1-1599.3)pg/mL to 70.6 (9.5-1540.0)pg/mL after conversion, but there was no statistical sifnificance. Serum calcium, inorganic phosphate, alkaline phosphatase and bicarbonate levels did not change after converting to LCD. We were able to reduce aluminum hydroxide dosagel 1.09 (0-10.88) vs. 0 (0-3.26)g/day/patientl and increase calcium carbonate dosage (1.95 0.92 vs. 2.98 2.14g/day/ patient) after conversion significantly (P<0.05). The frequency of peritonitis was similar in LCD and SCD period. In conclusion, low calcium dialysate is useful in diminishing aluminum-containing phosphate binder dosage and increasing calcium carbonate dosage to maintain a similar phosphate value. Its effects on renal osteodystrophy remain to be assessed.
Alkaline Phosphatase ; Aluminum Hydroxide ; Calcium Carbonate ; Calcium* ; Humans ; Hypercalcemia ; Incidence ; Kidney Failure, Chronic ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Renal Osteodystrophy ; Retrospective Studies

The factors affecting the survival rate of breast-cancer patients were studied in 185 cases treated at the Department of Surgery, College of Medicine, Chonbuk National University from January 1987 to December 1996. The results are as follows: 1) The most prevalent age group was the 5th decade (57 cases, 30.8%). 2) The most common initial symptom was a palpable mass (167 cases, 90.3%). 3) In 134 cases (72.4%), the patients visited the hospital within 6 months of the onset of the first symptom. 4) The primary tumor was located on the left side in 101 cases (54.6%) and on the right side in 84 cases (45.4%), and the most frequent tumor location was the upper outer quadrant (113 cases, 61.1%). 5) The pathological types, according to the WHO classification, were an invasive ductal carcinoma (179 cases, 96.7%) and a medullary carcimona (22 cases, 11.9%) in that order. 6) According to the TNM system, the most common stage was stage II (100 cases, 54.1%). The overall 5-year survival rates according to pathologic stage were 96.0% for Stage I, 83.1% for Stage II, 67.8% for Stage III, and 12.5% for Stage IV. 7) The estrogen and the progesterone receptor status had no significance for the survival rate. 8) The most common type of operation was a modified radical mastectomy (Patey) (150 cases, 81.0%). 9) Axillary lymph node metastases were present in 77 cases (41.6%). 10) The most common distant metastasis was the bone (12 cases, 6.5%). 11) The overall 5-year actuarial survival rate after surgery was 76.6%. The 5-year survival rates according to the number of invaded lymph-node were 83.5% for 0 nodes, 77.6% for 1~3 nodes, 57.5% for 4~9 nodes, and 49.4% in cases of more than 10 nodes.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Classification ; Estrogens ; Humans ; Jeollabuk-do ; Lymph Nodes ; Mastectomy, Modified Radical ; Neoplasm Metastasis ; Receptors, Progesterone ; Survival Rate

Background: To compare the sensory change and recovery of infraorbital area associated with zygomaticomaxillary and orbital floor fractures and their recoveries and investigate the factors that affect them. Methods: We retrospectively reviewed 652 patients diagnosed with zygomaticomaxillary (n= 430) or orbital floor (n= 222) fractures in a single center between January 2016 and January 2021. Patient data, including age, sex, medical history, injury mechanism, Knight and North classification (in zygomaticomaxillary fracture cases), injury indication for surgery (in orbital floor cases), combined injury, sensory change, and recovery period, were reviewed. The chi-square test was used for statistical analysis. Results: Orbital floor fractures occurred more frequently in younger patients than zygomaticomaxillary fractures (p< 0.001). High-energy injuries were more likely to be associated with zygomaticomaxillary fractures (p< 0.001), whereas low-energy injuries were more likely to be associated with orbital floor fractures (p< 0.001). The sensory changes associated with orbital floor and zygomaticomaxillary fractures were not significantly different (p= 0.773). Sensory recovery was more rapid and better after orbital floor than after zygomaticomaxillary fractures; however, the difference was not significantly different. Additionally, the low-energy group showed a higher incidence of sensory changes than the high-energy group, but the difference was not statistically significant (p= 0.512). Permanent sensory changes were more frequent in the high-energy group, the difference was statistically significant (p= 0.043). Conclusion The study found no significant difference in the incidence of sensory changes associated with orbital floor and zygomaticomaxillary fractures. In case of orbital floor fractures and high-energy injuries, the risk of permanent sensory impairment should be considered.

To determine the optimal administration route of calcitriol in CAPD patients with secondary hyperparathyroidism, we conducted a prospective study on 33 patients who performed CAPD for more than 6 months an d whose intact parathyroid hormone(iPTH) level was higher than 250pg/mL. The patients were randomized into 3 groups:IP(n=11); 1.0 microgram of calcitriol once daily via intraperitoneal route by overnight retention with dialysate, SC(n=11); 1.0 microgram of calcitriol three times a week via subcutaneous route, and PO (n=11); 1.0 microgram of calcitriol three times a week by ingestion. 11 out of 33 patients(6 in IP, 4 in SC, and 1 in PO) dropped out during the 6-months study period, and 5 among the 6 patients in IP were due to recurrent peritonitis. Biochemical data including calcium, phosphorus, iPTH, alkaline phosphatase, bone-specific alkaline phosphatase, osteocalcin and 1,25(OH)2D3 were measured regularly, and the data of 22 patients who had completed the 6-months study were analyzed. There was a statistically significant decrease in iPTH level(pg/mL) in the three groups after 6-months calcitriol therapy(IP; 812.0+/-276.7 vs. 354.7+/-129.4, PO; 571.8+/-330.7 vs. 159.6+/-192.3, SC; 786.1+/-535.0 vs. 551.8+/-729.9, respectively, P<0.05), but there were no differences in the percentage of decrease in iPTH from baseline values among the three groups. Alkaline phosphatase, bone- specific alkaline phosphatase and osteocalcin also decreased significantly in all three groups(IP; 50.1+/-14.6, 33.5+/-11.6, 52.3+/-10.9% of baseline value; SC; 80.9+/-14.8, 67.4+/-20.80, 54.4+/-11.1% of baseline value; PO; 48.8+/-24.4, 36.6+/-23.5, 54.2+/-11.6% of baseline value, respectively, P<0.05), but they were not different with each other. Among 22 patients who completed the 6-months study, hypercalcemia(Ca>=10.5 mg/dL) occurred in 7 patients(31.8%). IP(2/5, 40%) and SC groups(5/7, 71.4%) had significantly higher incidence of hypercalcemia than PO group(0/10, 0%) (P<0.05). IP group(2/5, 40%) also experienced significantly higher incidence of hyperphosphatemia than SC(1/7, 14.3%) and PO groups(1/10, 10%). Peritonitis occurred significantly more in IP than in SC and PO groups(P<0.05). In conclusion, calcitriol treatment resulted in a significant decrement in iPTH levels in CAPD patients and no significant differences were noted in the iPTH-suppressive effect of calcitriol according to the administration route. Because of higher incidence of peritonitis and hypercalcemia in IP and SQ groups, oral ingestion may be the most optimal route for calcitriol treatment in CAPD patients with secondary hyperparathyroidism.
Alkaline Phosphatase ; Calcitriol* ; Calcium ; Eating ; Humans ; Hypercalcemia ; Hyperparathyroidism, Secondary ; Hyperphosphatemia ; Incidence ; Osteocalcin ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Phosphorus ; Prospective Studies*

Relapsing peritonitis are major limitation of CAPD, a common reason for discontinuation of this form of therapy. Inappropriate treatment of previous peritonitis often leads to relapsing peritonitis, especially in patients with catheter-related infections. Although a multitude of therapeutic approaches have been tried, there is a controversy over the optimal antimicrobial treatment. The purposes of this study were: 1) to analyze the causative pathogen; 2) to determine the appropriate treatment regimen and duration; and 3) to evaluate the role of catheter replacement in recurrent peritonitis. Follow-up data were obtained in 43 CAPD patients who experienced 104 episodes of reucrrent peritonitis. 1) Among 104 episodes of recurrent peritonitis, 70 (67%) were culture-positive. The distribution of isolates was as follows : coagulase negative Staphylococci, 39 (38%); Enterococcus, 9 (9%); Staphylococcus aureus, 8 (8%); Pseudomonas, 4 (4%); Serratia, 4 (4%); Xanthomonas, 3 (3%); Klebsiella, 2 (2%); and fungus, 1 (1%). 2) Peritonitis recurred in 46 (50%) and did not recur in the other 46 (50%) of the 92 catheter- maintained peritonitis. After catheters were removed in 12 patients, new catheters were inserted in 3 patients without any more peritonitis. 3) There was no significant difference of recurrence between Gram-positive and Gram-negative peritonitis (56 vs. 50%). 4) Five (29%) of 17 peritonitis treated with vancomycin and amikacin, and 22 (73%) of 30 peritonitis treated with cefazolin and tobramycin experienced recurrence. Compared with cefazolin, initial therapy with vancomycin decreased the recurrence rate (P<0.05). 5) In Gram-positive and Gram-negative peritonitis, there was no reduction of recurrence in peritonitis treated for more than 2 weeks (63 vs. 51%, 40 vs. 60%). In coagulase negative Staphylococcal peritonitis, treatment for more than 2 weeks reduced the recurrence without statistical significance (59 vs. 30%, P=0.10). 6) In Gram-positive and Gram-negative peritonitis, there was no reduction of recurrence in peritonitis treated for more than 10 days after resolution (59 vs. 53%, 40 vs. 69%). In coagulase negative Staphylococcal peritonitis, treatment more than 10 days after resolution reduced the recurrence without statistical significance (50 vs. 26%, P=0.08). In conclusion, treatment with vancomycin and a longer treatment duration seem to be beneficial in relapsing CAPD peritonitis. Moreover, removal and replacement of catheter should be considered in cases unresponsive to antibiotic treatment.
Amikacin ; Catheter-Related Infections ; Catheters ; Cefazolin ; Coagulase ; Enterococcus ; Follow-Up Studies ; Fungi ; Humans ; Klebsiella ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Pseudomonas ; Recurrence ; Serratia ; Staphylococcus aureus ; Tobramycin ; Vancomycin ; Xanthomonas

In order to investigate cytokine productions in patients undergoing continuous ambulatory peritoneal dialysis (CAPD), we studied the production of interleukin (IL)-1 beta, -6 and interferon (IFN)-gamma by cultured peripheral blood mononuclear cells (PBMC) in peritonitis-free CAPD patients. The correlation of cytokine production with plasma parathyroid hormone (PTH) and albumin levels was also evaluated. While the release of IL-1 beta was not markedly different from controls release of IL-6 from 24-hour cultured PBMCs was significantly greater than that of controls, (Mean +/- S.D., IL-6: 2186.8 +/- 1217.9 pg/ml, vs 1516.3 +/- 767.9, P <0.05). The addition of lipopolysaccharide (LPS, 10 micrograms/ml, significantly stimulated IL-1 beta and -6 production of PBMCs in CAPD patients and controls, compared to an unstimulated condition. The LPS-induced IL-1 beta production was also not markedly different from controls, whereas LPS-induced IL-6 production was significantly higher than controls (IL-6: 13,220.7 +/- 7177.4 vs 7411.4 +/- 1236.9, P <0.05). However, the percentage increases of IL-6 production stimulated with LPS in CAPD patients were not significantly different from controls (p > 0.05). No difference of baseline IFN-gamma was detected between CAPD patients controls, but phytohemagglutinin (PHA, 10 micrograms/ml)-stimulated IFN-gamma release was significantly higher in CAPD patients than controls (2425.9 +/- 1565.0 pg/ml vs 1364.0 +/- 755.1, P <0.05). There was no significant correlation between PTH and, IL-1 beta, serum albumin level and LPS-stimulated IL-6 production (r = 0.54, P <0.05). In conclusion, CAPD seems to partly induce activation of PBMCs with an enhanced release of IL-6 and IFN-gamma, and CAPD patients with higher serum albumin levels tend to show higher IL-6 production in immune response.
Adult ; Cells, Cultured ; Female ; Human ; Interferon Type II/biosynthesis* ; Interleukin-1/biosynthesis* ; Interleukin-6/biosynthesis* ; Male ; Middle Age ; Monocytes/metabolism ; Parathyroid Hormones/blood ; Peritoneal Dialysis, Continuous Ambulatory* ; Serum Albumin/analysis

Systemic lupus erythematosus (SLE) is a disease of unknown etiology in which tissues and cells are damaged by pathogenic autoantibodies and immune complexes. Optic neuritis in SLE is very rare and the prevalence can be estimated to be approximately 1% of the patients of SLE. The main pathogenesis of optic neuritis with SLE is that of a vaso-occlusive disease in small vessels and the histopathologic appearance has varied from demyelination to definite vascular disease with axonal necrosis. The visual outcome of optic neuritis in SLE has often been poor. The treatments of optic neuritis in SLE are intravenous methylprednisolone, immunosuppressive agents and plasmapheresis. The authors experienced a case of lupus nephritis and CNS lupus which was complicated by optic neuritis in 18-year-old female patient who complained of sudden visual disturbance of the both eyes After treatment with plasmapheresis and systemic corticosteroid, her visual deficit was gradually recovered.
Adolescent ; Antigen-Antibody Complex ; Autoantibodies ; Axons ; Demyelinating Diseases ; Female ; Humans ; Immunosuppressive Agents ; Lupus Erythematosus, Systemic* ; Lupus Nephritis ; Methylprednisolone ; Necrosis ; Optic Neuritis* ; Plasmapheresis ; Prevalence ; Vascular Diseases