Plasma col1 leukemia with motility-related morphological behavior is rarely studied. The plasma cells have variable degrees of cytoplasmic morphologies as dairy Projections, long extensions and pseudopods. These morphological evidences show the papa bility of wide spread and dissemination of disease itself. We present a case of a 38 year old woman who had back pain for 4 months and was diagnosed as a solitary plasmacytoma of the third lumbar vertebra. In spite of resection of the tumor and chemotherapy, the plasmacytoma was disseminated into both breasts and ovaries within less than a year. On her blood examination, we counted 34% of plasma cells in peripheral blood and 91.6% of plasma cells in bone marrow aspiration. Most of them resealed hairy projections and pseudopods of the cytoplasm.
Adult ; Back Pain ; Bone Marrow ; Breast ; Cytoplasm ; Drug Therapy ; Female ; Humans ; Leukemia ; Leukemia, Plasma Cell* ; Ovary ; Plasma Cells* ; Plasma* ; Plasmacytoma ; Spine

BACKGROUND: The importance of extended-spectrum beta-lactamases (ESBL) produced in gramnegative bacilli is now well recognized, but most clinical laboratories have problems in detecting and interpreting ESBL and implicating the findings in nosocomial infections caused by ESBL producing gram-negative bacilli. The present study aims primarily to evaluate the distributions of these enzymes among Escherichia coli and Klebsiella pneumoniae, the most frequent isolates of Enterobacteriaceae producing ESBL, to differentiate the types of enzymes in theses isolates and finally to relate the clonality of specific types within a part of Daegu city. METHODS: The clinical isolates of 1, 242 E. coli and 859 K. pneumoniae were screened for ESBL production by the disk diffusion method of the National Committee of Clinical Laboratory Standard, and it was confirmed by the double-disk synergy test (DDS). Antimicrobial susceptibility test was performed by the agar dilution method. The presence of -lactamase was tested by polymerase chain reaction (PCR) and plasmid analysis. Isoelectric focusing and nucleotide sequence analysis were performed to evaluate ESBL types. Pulsed-field gel electrophoresis (PFGE) of XbaI-digested DNA fragments was carried out to determine the extend of clonality within the hospital. RESULTS: Of 34 isolates of E. coli and 31 isolates of K. pneumoniae ramdomly selected from those isolates screened for ESBL production were further tested by DDS to confirm its production: 30 (88.2%) E. coli and 29 (93.5%) K. pneumoniae were positive. TEM-52 and SHV-12 were present both in E. coli and K. pneumoniae, but SHV-2a was distributed only in K. pneumoniae. The resistance was transferable in 66.7% of E. coli and 68.9% of K. pneumoniae. Six and 5 PFGE patterns were shown by E. coli and K. pneumoniae, respectively. Among the 5 patterns of K. pneumoniae, type B was dominant, suggesting a clonal outbreak in the hospital. CONCLUSIONS: The ESBL specific enzyme types were TEM-52, SHV-2a and SHV-12. Despite many different PFGE patterns of the ESBL producing isolates, a few outbreak and edemic clones appear to be prevalent in Dongsan Medical Center.
Agar ; Base Sequence ; beta-Lactamases* ; Clone Cells ; Cross Infection ; Daegu ; Diffusion ; DNA ; Electrophoresis, Gel, Pulsed-Field ; Enterobacteriaceae ; Escherichia coli* ; Isoelectric Focusing ; Klebsiella pneumoniae* ; Plasmids ; Pneumonia ; Polymerase Chain Reaction

No abstract available.
Constriction, Pathologic* ; Stents*

The case of a 44-year-old female with extraskeletal osteosarcoma is reported. She had been treated by low anterior resection and radiation therapy due to rectal cancer (Modified Duke's classification B2) about 35 months ago. Also, she had a history of hematoma formation in a previous incision scar of the low mid-abdomen due to a fall. The patient developed a hard, nontender, fixed mass in the low abdominal wall after the hematoma. Treatment consisted of a wide surgical excision and local advanced flap. To our knowledge, an osteosarcoma of the abdominal wall is very rare, but the outlook for recovery is grave.
Abdominal Wall* ; Adult ; Cicatrix ; Classification ; Female ; Hematoma ; Humans ; Osteosarcoma* ; Rectal Neoplasms*

The case of a 44-year-old female with extraskeletal osteosarcoma is reported. She had been treated by low anterior resection and radiation therapy due to rectal cancer (Modified Duke's classification B2) about 35 months ago. Also, she had a history of hematoma formation in a previous incision scar of the low mid-abdomen due to a fall. The patient developed a hard, nontender, fixed mass in the low abdominal wall after the hematoma. Treatment consisted of a wide surgical excision and local advanced flap. To our knowledge, an osteosarcoma of the abdominal wall is very rare, but the outlook for recovery is grave.
Abdominal Wall* ; Adult ; Cicatrix ; Classification ; Female ; Hematoma ; Humans ; Osteosarcoma* ; Rectal Neoplasms*

BACKGROUND: Cellular fibronectin (cFN) is derived from the cell surface and extracellular matrix. It is fragmented by proteolytic enzymes, which is released from invasive and malignant tumor cells. It is circulated in blood and body fluids, and finally excreted in urine. This study was undertaken to determine the usefulness of plasma and urine cFN as a tumor marker of gastrointestinal tract cancers. METHODS: We measured the concentration of cFN in plasma and urine samples by Fibronectin EIA kit (Takara Shuzo Co., Ltd., Shiga, Japan). Subjects were 20 healthy adults, 20 patients with benign diseases, 51 patients with stomach cancer and 22 patients with colorectal cancer. We evaluated the clinical records to compare the concentrations of cFN with stage and degree of cancer metastasis. RESULTS: At the recommend cut-off values of 21 microgram/mL in plasma and 157 ng/mgCr in urine, the sensitivity of plasma and urine cFN was 41.2% and 43.1% in gastric cancers; 40.9% and 50.0% in colorectal cancers, respectively. The specificity of urine cFN was 92.5% as compared to 67.1% for plasma cFN. The cFNs in plasma and urine were significantly elevated in cancer group and the concentrations were increased further with peritoneal seeding and distant metastasis. The sensitivity of urine cFN was 73.3% in stomach cancers and 100% in colorectal cancers with distant metastasis. CONCLUSION: The urine cFN is specific and the concentrations increase further with metastasis, and may be useful in diagnosis and monitoring of gastrointestinal tract cancers. Further detailed studies must be made in a large number of patients.
Adult ; Body Fluids ; Colorectal Neoplasms ; Diagnosis ; Extracellular Matrix ; Fibronectins* ; Gastrointestinal Neoplasms* ; Gastrointestinal Tract* ; Humans ; Neoplasm Metastasis ; Peptide Hydrolases ; Plasma* ; Sensitivity and Specificity ; Stomach Neoplasms

PURPOSE: Crohn's disease is chronic, nonspecific inflammatory process and the incidence is becoming larger recently. The authors studied the clinical course of the Crohn's disease by reviewing the clinical characteristics, anatomical distribution, operative indications, operative procedures and postoperative results. METHODS: We reviewed medical records of 30 patients who had treatment at the Chonbuk national university hospital from June 1988 to December 1997. We analyzed their age, sex distribution, clinical symptoms, anatomical distribution, operative indication, operative procedure, postoperative recurrence rate and postoperative results. RESULTS: Sex ratio was 1.5:1 (male:female) and average age of onset was 33 year. Thirteen patients (43%) underwent operation but there was no remarkable difference between the groups that received operation and that had medical treatment. Abdominal pain and diarrhea were common but there were no extraintestinal symptoms. The most common site of involvement was ileocecum and the next was small intestine, followed by large intestine. Intestinal obstruction was the most common indication for surgery and fistula, abscess formation and palpable abdominal mass in order. Three cases out of 13 patients who had undergone primary resection needed second operation, and 2 cases of the 3 recurrent cases underwent the third operation. During the follow up period, there were two cases of re-operation due to anastomotic leak or ileus. The patient who received the third operation (right hemicolectomy, retroperitoneal abscess drainage and jejunal resection) died of anastomotic leak, enterocutaneus fistula, sepsis and respiratory failure. CONCLUSIONS: The incidence of Crohn's disease in Korea is gradually increasing and the disease has been challenging problems to most surgeonsfor its frequent surgical indication, high recurrence rate, complication and poor surgical results. The above results suggest that Crohn's disease needs follow-up even after the operation.
Abdominal Pain ; Abscess ; Age of Onset ; Anastomotic Leak ; Crohn Disease* ; Diarrhea ; Drainage ; Fistula ; Follow-Up Studies ; Humans ; Ileus ; Incidence ; Intestinal Obstruction ; Intestine, Large ; Intestine, Small ; Jeollabuk-do ; Korea ; Medical Records ; Recurrence ; Respiratory Insufficiency ; Sepsis ; Sex Distribution ; Sex Ratio ; Surgical Procedures, Operative

The surgeries based on the outpstient department have increased recently. One of the indications of outpatient surgery is chemical peeling of the face that usually re- quires only deep sedation of short duration. The purpose of this study was to evaluate the effeets of ketamine and midszolam for out patient facial chemical peeling. Fifty-nine unpremedicated patients undergoing chemical peeling of the face were anesthetized with bolus intravenous injection of 1mg/kg of ketamine and 0.1 mg/kg of midazolam. Additional dose of ketamine(10-20mg) was given as needed. During operation, we observed systolic and diastolic blood pressure with noninvasive blood pressure monitor and peripheral oxygen saturation(SpO2) with pulse oximeter. All patients were allowed to breathe spontane- ously without ventilatory support during the operation. There was no case of airway ob- struction and SpO2 value was over 97% in most cases. The systolic and diastolic blood pressure and pulse rate were increased after the injection of ketamine and midazolam. And we observed the untoward effect of anesthetics such as the purposeless movement(6.8%), involuntary phonation(3.4%), skin rash(3.4%) and headache(1.7%). In postoperative analysis about the recall, bad dream, mood, and the degree of satisfaction of this type of anesthesia, the rate of patient's positive acceptance was high(86.4%) and the reeovery time was 58min. We conclude that combination of intravenous ketamine and midszolam can produce satisfactory anesthesia with few complications for outpatient chemical peeling surgery of the face.
Ambulatory Surgical Procedures ; Anesthesia* ; Anesthetics ; Blood Pressure ; Blood Pressure Monitors ; Deep Sedation ; Dreams ; Heart Rate ; Humans ; Injections, Intravenous ; Ketamine* ; Midazolam* ; Outpatients* ; Oxygen ; Skin

PURPOSE: To evaluate factors that influence morbidity and mortality in colorectal injuries. METHODS: We reviewed the medical records of 59 patients who underwent emergency operation in JNUH from Jan. 1988 through Dec. 1997. Univariate and multivariate analyses were used to calculate the prognostic significance of the following variables: sex, age, time to operation, preoperative shock, penetrating abdominal trauma index (PATI), APACHE II score, site of injury, organ injury scale (OIS), Flint grade, associated intraabdominal injuries, the sum of transfusion during 48hours of preoperative and postoperative period and operative method. RESULTS: Univariate analysis showed that colorectal organ iujury scale, and operative method were related to the complication, and preoperative shock, APACHE II score, PATI, and transfusion in 48hrs of injury were related to the mortality of colorectal injury. Multivariate logistic regression analysis showed that colorectal organ injury scale (2 vs 1) was significant risk factor in the development of complication, and the odds ratios were 5.0 and 1.69 respectively. The sum of transfusion in 48hours of injury was a only significant risk factor in the mortality and the odds ratio was 1.5. CONCLUSIONS: We concluded that preoperative condition was very important and preservation of hemodynamic stability was critical in improvement of prognosis. We also concluded that the shortening of operative time and proper management of associated injury may reduce the development of complication and even death.
APACHE ; Emergencies ; Hemodynamics ; Humans ; Logistic Models ; Medical Records ; Mortality ; Multivariate Analysis ; Odds Ratio ; Operative Time ; Postoperative Period ; Prognosis ; Risk Factors* ; Shock

OBJECTIVE: The surface roughness of orthodontic materials is an essential factor that determines the coefficient of friction and the effectiveness of tooth movement. The aim of this study is to evaluate the surface roughness change of the brackets and wires after experimental sliding quantitatively. METHODS: Before and after experimental sliding tests, the surface roughness of stainless steel brackets, ceramic brackets, stainless steel wires, and beta-titanium (TMA) wires were investigated and compared using atomic force microscopy (AFM). RESULTS: After sliding tests, changes in the surface of the wire were greater than changes in the bracket slot surface. The surface roughness of the stainless steel bracket was not significantly increased after sliding test, whereas the roughness of ceramic brackets was decreased. Both the surface roughness of stainless steel and TMA wires were increased after sliding test. More changes were observed on the ceramic bracket than the stainless steel bracket. CONCLUSIONS: AFM is a valuable research tool when analyzing the surface roughness of the brackets and wires quantitatively.
Ceramics ; Friction ; Microscopy, Atomic Force ; Stainless Steel ; Tooth Movement