In order to clarify the preneoplastic nature of large regenerative nodules without dysplastic change, we analysed the clonality of hepatocellular carcinomas (HCCs) and large nodules, diameter > or =0.5 cm, of cirrhotic liver by X-linked human androgen receptor (HUMARA) gene assay, using the principle of random X chromosome methylation and inactivation in female. Ten cases of HCC and 5 cases of large nodules without dysplasia from 9 female patients were selected. All the tumors, large nodules and paired normal control cells were selectively microdissected from deparaffinized hematoxylin and eosin stained slides. Genomic DNA was isolated and digested with HhaI. Polymerase chain reaction(PCR) amplication of the HUMARA locus was performed using 32P-a-dCTP containing PCR mixtures. The PCR amplified products were separated by gel electrophoresis and analysed by autoradiography. Nine HCCs from 8 patients were monoclonal and 1 case was polyclonal and the remaining 1 case was not polymorphic at the HUMARA locus. The HCC case which showed polyclonality contained many inflammatory cells. All the large nodules were polyclonal by HUMARA assay. These results suggest that all or most of the cells composing the large regenerative nodules without dysplasia are polyclonal. This assay may be informative for the differentiation between regenerative and preneoplastic nodules in cirrhotic liver and the size of nodule may be not important in hepatocarcinogenesis.
Autoradiography ; Carcinoma, Hepatocellular* ; DNA ; Electrophoresis ; Eosine Yellowish-(YS) ; Female ; Fibrosis ; Hematoxylin ; Humans ; Liver ; Methylation ; Polymerase Chain Reaction ; Receptors, Androgen ; X Chromosome

OBJECTIVE: The present study was undertaken to evaluate the findings of multimodality evoked potentials, brain MRI and EEG in cerebral palsy children and to identify the correlations between these findings. METHOD: We examined Brain MRI, EEG and evoked potentials including visual evoked potentials(VEPs), brainstem auditory evoked potentials(BAEPs) and somatosensory evoked potentials(SSEPs) in 80 cerebral palsy children. RESULTS: 1) Abnormal findings of brain MRI and EEG were 79.4% and 81% respectively. 2) Abnormal responses of VEPs and BAEPs were 28.1% and 18.8%. 3) In the median and tibial nerve SSEPs, abnormal responses were 14.6% and 28.6%. Abnormal findings of the tibial nerve SSEPs were more frequent than the median nerve SSEPs. 4) In children with spastic hemiplegia, the abnormal SSEPs were much greater in the affected limb than unaffected limbs. 5) There was a significant correlation between the SSEP abnormalities and brain MRI or EEG abnormalities in cerebral palsy children. CONCLUSION: The data obtained in this study would be helpful for identifying and assessing the central nervous system deficits of cerebral palsy children.
Brain Stem ; Brain* ; Central Nervous System ; Cerebral Palsy ; Child* ; Electroencephalography* ; Evoked Potentials* ; Extremities ; Hemiplegia ; Humans ; Magnetic Resonance Imaging* ; Median Nerve ; Tibial Nerve

The diagnostic and treatment modalities of liver abscess have developed rapidly over the past few years but morbidity and mortality has not been markedly reduced. A total of 482 cases of liver abscess admitted to the Yonsei Medical Center over the past 20 years (Jan. 1971-Dec. 1990) were divided into 261 cases from the 1970s and 221 cases from the 1980s and the clinical and laboratory parameters were analyzed comparatively to determine if the clinical features, therapies and prognosis of liver abscess had changed. The proportion of amebic relative to pyogenic liver abscess decreased. Transbiliary infections increased in pyogenic liver abscess of the 1980s. Clinical signs such as jaundice and hepatomegaly and symptom duration before admission decreased. Abnormal laboratory features including hypoalbuminemia and elevation of alkaline phosphatase decreased and increased, respectively, in the 1980s. Ultrasonically guided percutaneous aspiration was the choice of treatment instead of surgical drainage in the 1980s. Despite diagnostic and therapeutic advances in the management of liver abscess, the prognosis has not improved in the 1980s as compared to the 1970s. This may reflect an increase in the incidence of liver abscess in old aged patients and patients with diabetes mellitus or underlying malignancy in the 1980s.
Adult ; Amebiasis/diagnosis ; Demography ; Drainage ; Female ; Human ; Incidence ; Liver Abscess/etiology/*pathology/physiopathology ; Male ; Mortality ; Serologic Tests ; Suppuration/microbiology

No abstract available.
Death Certificates* ; Korea*

Poststernotomy mediastinitis is a rare but potentially life-threatening complication of cardiac surgery. Up to present, poststernotomy wound infection has been treated by closure of wound directly or by use of myocutaneous flaps after irrigation and debridement of wound. We describe a new treatment of poststernotomy wound infection by using the vacuum- assisted closure technique. This technique was successfully applied in 3 patients with poststernotomy wound infection and mediastinitis, and a healed sternotomy wound could be achieved using this new technique.
Debridement ; Humans ; Mediastinitis* ; Myocutaneous Flap ; Negative-Pressure Wound Therapy* ; Sternotomy ; Thoracic Surgery ; Wound Infection* ; Wounds and Injuries*

PURPOSE: T1-201 SPECT has been used in differentiating benign and malignant pulmonary lesions. While its sensitivity may be high, the specificity and predictive values are reported to be variable depending on the type of benign lung lesion. The purpose of this study was to prospectively assess the efficacy of T1-201 SPECT for differentiating benign and malignant single pulmonary lesions in a population with a high prevalence of begin pulmonary lesions, especially, tuberculosis. MATERIALS AND METHODS: One-hundred thirty-three patients, having 89 malignant and 44 benign lesions(23 active tuberculosis, 5 inactive tuberculosis, 3 aspergilloma, 3 focal pneumonia, 2 thymoma, and 8 others), were imaged using a dual-headed system at 15 minute(early) and 3 hour (delayed) following administration of 111MBq T1-201. The images were read visually and lesion-to-background ratios(L/B) were obtained from transverse tomographic slices. Retention index was expressed as [(delayed L/B-early L/B) / early L/B]. RESULTS: 82/89(92%) and 83/89(93%) of the malignant lesions were visually positive on the early and delayed images, and 27/44(61%) and 26/44(59%) of the benign lesions wefe also between the mean L/B's of the malignant and benign lesions, L/B was not useful for differentiating the two due to a large overlap. There was no difference in retention indices. CONCLUSION: Despite of its high sensitivity, the specificity of T1-201 SPECT was unacceptably low in patients with active benign lesions. The positive and negative predictive values for lung cancer in a population with a high prevalence of the benign single pulmonary lesion was only marginal.
Diagnosis, Differential* ; Humans ; Lung ; Lung Neoplasms ; Pathology* ; Pneumonia ; Prevalence ; Prospective Studies ; Sensitivity and Specificity ; Thymoma ; Tomography, Emission-Computed, Single-Photon* ; Tuberculosis

BACKGROUND: Erectile dysfunction (ED) is prevalent among patients with diabetes mellitus and impaired renal function. To estimate the prevalence of ED in diabetic nephropathy and to identify its risk factors, we carried out a survey of patients with diabetic nephropathy attending Chonnam University Hospital. METHODS: The presence of ED was assessed among 106 type 2 diabetic patients with microalbuminuria or overt diabetic nephropathy or renal replacement therapy using its self- administered International Index of Erectile Function (IIEF). ED was also classified into five validated severity levels, ranging from none (22-25), mild (17-21), mild/moderate (12-16), moderate (8-11), through severe (5-7). Logistic regression was used to examine associations between ED and other medical conditions. RESULTS: The mean age was 45.30+/-8.57 years in patients without ED and 58.53+/-8.46 years in patients with ED. The prevalence of any level of ED was 72% using IIEF. An independent t-test and chi-square demonstrated age, smoking, smoking duration, degree of nephropathy, coronary heart disease, neuropathy, diabetic foot, and retinopathy to be associated with the presence of any level of ED. Patients with ED had lower serum levels of hemoglobin, albumin, triglyceride, HDL-cholesterol and higher serum levels of BUN in unadjusted analyses compared with patients without ED. A multivariable logistic regression demonstrated age, serum creatinine concentration, and renal replacement therapy to be independently associated with the presence of any level of ED. CONCLUSION: ED is extremely prevalent among type 2 diabetic patients with microalbuminuria or overt diabetic nephropathy or renal replacement therapy. Increased age and serum creatinine concentration, and renal replacement therapy were associated with higher prevalence of ED.
Coronary Disease ; Creatinine ; Diabetes Mellitus ; Diabetic Nephropathies* ; Diabetic Neuropathies ; Erectile Dysfunction* ; Foot ; Humans ; Jeollanam-do ; Logistic Models ; Male ; Prevalence ; Renal Replacement Therapy ; Risk Factors ; Smoke ; Smoking ; Triglycerides

Crohn's disease is a chronic inflammatory bowel disease that can involve the whole gastrointestinal tract. The orofacial manifestation of Crohn's disease, which is rare, can develop irrespective of intestinal involvement. These orofacial lesions are often misdiagnosed as simple oral ulcers. Corticosteroids are the mainstay of therapy for orofacial Crohn's disease. However, infliximab, the chimeric monoclonal antibody to tumor necrosis factor-alpha, is now considered as a primary treatment because of the disease's relatively high rate of steroid resistance. We present a case of deep oral ulcer and periorbital swelling in a 65-year-old woman. She was diagnosed with intestinal Crohn's disease 7 years ago, which was in remission after treatment with an immunosuppressive agent (azathioprine). The patient was given the diagnosed with orofacial Crohn's disease and successfully treated with infliximab.
6-Mercaptopurine/analogs & derivatives/therapeutic use ; Aged ; Anti-Inflammatory Agents/*therapeutic use ; Antibodies, Monoclonal/*therapeutic use ; Crohn Disease/diagnosis/*drug therapy ; Female ; Gastrointestinal Diseases/pathology ; Humans ; Immunosuppressive Agents/therapeutic use ; Oral Ulcer/diagnosis

BACKGROUND: We used warming fluid for maintenance of body temperature in operating room or intensive care unit. This study was aimed to investigate the effect of infusion rate and catheter length on the temperature of warming fluid. METHODS: Normal saline was used for testing infusion and temperature of infusion was maintained by a warmer as 40degrees C. The temperatures of solution in infusion line were measured at 0, 25, 50, 75, and 100 cm apart from warmer at six different flow rates (100, 200, 300, 700, 1,400, and 2,100 ml/h). We also measured the temperature changes at room temperature (RT) and 5degrees C, 10degrees C, and 15degrees C above RT. RESULTS: The time to maintain solution temperature as 40degrees C was 165, 122, 37, 37, 21, and 19 s at flow rate 100, 200, 300, 700, 1,400, and 2,100 ml/h. The peak temperature was 43.58 +/- 0.58, 44.43 +/- 1.18, 44.37 +/- 0.70, 43.79 +/- 0.61, 42.82 +/- 0.97, and 42.11 +/- 0.92degrees C according to increasing flow rate. The temperature at 100 cm apart from warmer was 23.96 +/- 1.53, 25.46 +/- 2.76, 29.32 +/- 3.47, 31.40 +/- 5.38, 31.39 +/- 6.75, and 38.14 +/- 0.96degrees C according to increasing flow rate. CONCLUSIONS: These results suggested that the decreasing rate of temperature was related inversely to the flow rate and directly to the catheter length. There may be needed a rapid infusion pump with adequate heating system at a high flow rate and to locate the warmer close to patient for reserving a heating effect.
Body Temperature ; Catheters ; Heating ; Hot Temperature ; Humans ; Infusion Pumps ; Intensive Care Units ; Operating Rooms

To evaluate the relationship between surgical procedures and clinical outcomes in degenerative lumbar spinal stenosis, we retrospectively analyzed the results of the patients who had been performed decompressive lumbar spinal surgery. Eighty-five patients with degenerative lumbar spinal stenosis underwent decompressive lumbar spinal surgery between Jan. 1994 and Dec. 1996. The patients were randomly assigned to one of two groups; decompression alone(47 patients) and decompression with arthrodesis(38 patients). Among the patients with arthrodesis, the instruments were placed in 34 patients. The follow-up duration was 16-51 months(mean; 32.8 months). Functional outcome was excellent or good in 96% of the patients with decompression alone and in 97% of those with decompression with arthrodesis(p=0.667), and the overall patient's satisfaction was 87.5% and 89.5%, respectively. Although the various factors, which could be possible influent to the clinical outcome, were considered, there were no statistically significant differences in results between the two groups. The findings of this study demonstrate that the spinal fusion procedure has no benefit in clinical outcomes of the patients with degenerative lumbar spinal stenosis. Thus the fusion procedures with instrumentation should be used only in carefully selected patients because of its potential risks of serious complications, such as nerve root injury, massive bleeding, and infection.
Arthrodesis* ; Decompression ; Follow-Up Studies ; Hemorrhage ; Humans ; Laminectomy* ; Retrospective Studies ; Spinal Fusion ; Spinal Stenosis*