Toxoplasma gondii tachyzoites were isolated from the blood of an ocular patient, and have been successfully passaged in the laboratory, for over a year, by peritoneal inoculation in mice. The isolated parasite was designated the Korean Isolate-1 (KI-1) and its characteristics were compared with those of the RH strain, a wellknown virulent strain originating from a child who suffered from encephalitis. The morphology, pathogenicity, infectivity and cell culture characteristics of the KI-1 were similar to those of the RH strain. Both RH and KI-1 antigens were detected by an anti-T. gondii monoclonal antibody (mAb), Tg563, against the major surface protein SAG1 (30 kDa), whereas no reaction was observed against an anti-Neospora caninum mAb, 12B4. The KI-1 was confirmed as an isolate of T. gondii. A long-term laboratory maintenance and characterization of a local T. gondii isolate is reported for the first time in the Republic of Korea.
Animals ; Antigens, Protozoan/analysis ; Female ; Humans ; Korea ; Mice ; Mice, Inbred BALB C ; Microscopy, Electron ; Middle Aged ; Parasitemia/parasitology ; Sarcoma 180 ; Serial Passage ; Specific Pathogen-Free Organisms ; *Toxoplasma/classification/growth & development/isolation & purification/pathogenicity ; Toxoplasmosis, Ocular/*diagnosis/parasitology ; Tumor Cells, Cultured ; Virulence

Iatrogenic aortic dissection (IAD) is a life-threatening complication that can occur during open heart surgery, therefore IAD requires early diagnosis and prompt management. We describe here a case of IAD that occurred during mitral valve replacement. The transesophageal echocardiography (TEE) evaluation revealed features indicative of acute aortic dissection and the tear was successfully repaired by interposition of a graft.
Early Diagnosis ; Echocardiography, Transesophageal ; Mitral Valve* ; Thoracic Surgery ; Transplants

Pressure damage to respiratory mucosa from overinflation of bronchial cuffs has been implicated as a cause of bronchial rupture, a rare but devastating complication of double-lumen endobronchial tubes (DLTs). In vivo, we evaluated the pressure/volume characteristics of the bronchial cuffs by left main bronchus diameter and DLT size. Thirty patients were divided into three groups : in group 1, 35 Fr DLT was used and left main broncus diameter (LMBD) was less than 12 mm; in group 2, 37 Fr DLT and LMBD less than 12 mm ; in group 3, 37 Fr DLT and LMBD larger than 12 mm. The bronchial cuff volume needed to seal left main bronchus(cuff sealing volume) and bronchial cuff pressure to 2.5 ml of cuff volume at 0.5 ml increments were measured . The results were as follows. 1) The mean+SE cuff sealing volume were 0.3+/-0.1 ml, 0.4+/-0.1 ml and 1.0+/-0.2 ml in group 1, 2 and 3 respectively. 2) The mean+ SE bronchial cuff pressure at 0.5, 1, 1.5 and 2 ml of cuff volume were 27.5+/-5.0, 64.0+/-10.2, 105.4+/-15.5, 124.1+/-16.7 mmHg in group 1, 31.5+/-3.7, 74.1+/-6.2, 126.0+/-11.8, 175.3+/-14.6 mmHg in group 2 and 10.9+/-2.4, 23.8+/-3.4, 50.5+/-5.4, 89.2+/-7.5 mmHg in group 3 respectively. We concluded that initial cuff inflation volume of 0.5 ml in group 1 and 2, 1ml in group 3 is appropriate.
Bronchi* ; Humans ; Inflation, Economic ; Respiratory Mucosa ; Rupture

PURPOSE: The favorable types of the breast cancer - medullary, mucinous, papillary and tubular carcinoma are uncommon subtypes and their incidences in different series ranges between 2.0% and 8.0%, 1% and 2%, 0.3% and 3%, less than 2% of all breast cancers, respectively. In westem countries these subtypes have been reported to have good prognosis and slow growth rate. Clinically, these tumors have lower frequency of axillary nodal involvement and better 5-year or 10-year surviral rate than the other common types of breast cancer. MATERIALS AND METHODS: To determine the clinical characteristics and to evaluate the correlation between the progrostic factors and survival rate of these tumors, the medical records of 83 women with medullary, mucinous, papillary and tubular carcinoma treated at Korea Cancer Center Hospital between Jan. 1987 and Dec. 1997 were reviewed retrospectively. RESULTS: The incidences of medullary, mucinous, papillary and tubular carcinoma were 0.51%, 1.45%, 0.71% and 0.14% of all breast cancer, respectively. There were 1 case of local recurrence and 5 cases of systemic relapse during the follow-up (median follow-up peroid of 56 months). Overall 5-year survival and 10-year survival rate were 98.5% and 94.2%, respectively. No significant difference in overall survival rate was detected according to histologic types of these tumors but disease-free survival was significantly lower in papillary carcinoma than the other types of these tumors (p=0.042). Standard prognostic factors of breast cancer such as tumor size, lymph node status, age of the patient and ER status did not affect the prognosis of these tumors. CONCLUSION: Medullary, mucinous, papillary and tubular carcinoma revealed very excellent prognosis in this study regardless of tumor size, lymph node status, age of the patients and ER status.
Adenocarcinoma* ; Breast Neoplasms* ; Breast* ; Carcinoma, Papillary ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Lymph Nodes ; Medical Records ; Mucins* ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

One of the indications of outpatient surgery is chemical peeling of the face. It usually requires deep sedation with analgesia of short duration. For this purpose we tried to use ketamine(1 mg/kg) and midazolam(0.1 mg/kg) but experienced frequent hypertension and tachycardia. We tried to use beta blocker, esmolol for the of control blood pressure and heart rate. The patients were divided into two groups. In control group, eighty-five patients were anesthetized with bolus intravenous injection of I mg/kg of ketamine and 0.1 mg/kg of midazolam. In esmolol group, eighty-three patients reed a continuous infusion of esmolol(500 mcg/kg/min for initial dose, followed by 200 mcg/kg/min for maintenance) in addition to midazolam(0.1 mg/kg) and ketamine(1 mg/kg). During operation, we observed systolic, diastolic blood pressure and peripheral oxygen saturation(SaO2). All patients were allowed to breathe spontaneously. There was no case of airway obstruction and SaO2 value was over 98% in most cases. So we investigated the effects of esmolol on blood pressure,heart rate,emergence sequelae and patients acceptance in the anesthesia with ketamine and midazolam in the patient of facial chemical peeling. The results were as follows: 1) No one could recall. 2) There were no differences on the status of mood, emotion and patient's positive acceptance between two groups 3) Blood pressure and heart rate were increased during anesthesia with midazolam and ketamine. But esmolol attenuated this response, significantly(P<0.05). We concluded that esmolol added benefits of control of blood pressure and heart rate in the anesthesia of facial chemical peeling. But the control of the high blood pressure is not so easy, so it is needed to find out the optimal dosage of esmolol for complete blocking of the sympathetic response without complications.
Airway Obstruction ; Ambulatory Surgical Procedures ; Analgesia ; Anesthesia* ; Blood Pressure ; Deep Sedation ; Heart Rate ; Humans ; Hypertension ; Injections, Intravenous ; Ketamine* ; Midazolam* ; Oxygen ; Tachycardia

PURPOSE: Tamoxifen has been well known as an effective anti-tumor agent against breast cancer. The important role of bcl-2 and p53 proteins in tamoxifen-induced apoptosis of breast cancer cells has been suggested. However, the paradoxical fact that bcl-2 over-expression is assdegrees Ciated with better prognosis in clinic has not yet been clearly explained. To investigate this paradox, we analyzed the effect and dynamics of bcl-2 and p53 on the apoptosis after treatment of breast cancer cells with tamoxifen. MATERIALS AND METHODS: The human breast cancer cell lines MCF-7 and MB MDA-468 were treated with 17-betaestradiol (E2) and tamoxifen. RESULTS: Following tamoxifen treatment, MCF-7 cells underwent apoptosis accompanied by reduced bcl-2 expression. E2 pre-treatment led to the inhibition of tamoxifen-mediated apoptosis and bcl-2 down-regulation. When MB MDA-468 cells were treated with E2 or tamoxifen, bcl-2 and p53 protein expression did not change and apoptosis did not develop. CONCLUSION: We observed that the down-regulation of bcl-2 by tamoxifen treatment can facilitate the apoptosis of breast cancer cells without p53 mutations. This finding was consistent with clinical experiences in which bcl-2 positive tumors were assdegrees Ciated with more indolent phenotypes in breast cancer.
Apoptosis* ; Breast Neoplasms* ; Breast* ; Cell Line* ; Down-Regulation ; Humans* ; MCF-7 Cells ; Phenotype ; Prognosis ; Tamoxifen

PURPOSE: This study was designed to evaluate the safety including the morbidity and mortality of total gastrectomy and combined organ resection, to examine the survival rate and the prognostic factors of gastric cancer following the total gastrectomy and to assess the prognostic predictability of new UICC staging system after surgery in gastric cancer patients. MATERIAL AND METHOD: To evaluate demographic features, clinical presentations, preoperative diagnostic accuracy, postoperative complications and prognostic factors, we analyzed 329 patients who underwent the total gastrectomy or the total gastrectomy with combined resection for gastric malignancy at KCCH from Jan. 1990 to Dec. 1993 retrospectively. RESULTS: The early postoperative complication rates of overall patients and combined resection group were 9.1% and 8.9%. Mortality of these were 0.9% and 1.1%(p>0.05). The overall 5YSR was 52.8% and there was no significant differrence in the survival rate between the total gastrectomy only group and the combined resection group. The accuracy of preoperative UGIS and abdominal CT for determiantion of resectability were over 80%. The depth of invasion and lymph node metastasis were independent prognostic factors. CONCLUSION: The total gastrectomy with combined resection should be considered when indicated, because the postoperative morbidity and mortality is low and long term survival is expected. The new UICC staging system seems to be good to predict prognosis in gastric cancer patients.
Gastrectomy* ; Humans ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate ; Tomography, X-Ray Computed

PURPOSE: Authors analyzed the clinico-pathologic parameters of 34 remnant gastric cancers to know the general behavior and prognosis of remnant gastric cancer. MATERIALS AND METHODS: Medical records of 34 patients were reviewed retrospectively, who were diagnosed as remnant gastric adenocarcinoma and underwent operation in Korea Cancer Center Hospital from February of 1988 to March of 1998. RESULTS: The incidence of remnant gastric cancer was 0.7% (34/4,904 cases). Sex ratio, male to female, was 2.8: 1. Mean age was 55 years of age. Diagnoses of primary lesion were 10 cases of benign lesion, 24 cases of malignant lesion. The operation for the remnant gastric cancer is total gastrectomy or extended total gastrectomy. The most common extended-resected organ was spleen (21 cases). The morbidity following operation of remnant gastric cancer were quite rare and treated conservatively. The overall five year survival rate was 11.3%. CONCLUSION: Authors concluded that aggressive operation of remnant gastric cancer is warranted, as it is proved relatively safe and is the only option to lengthen patients survival and to alleviate their QOL (quality of life).
Adenocarcinoma ; Diagnosis ; Female ; Gastrectomy ; Humans ; Incidence ; Korea ; Male ; Medical Records ; Prognosis ; Retrospective Studies ; Sex Ratio ; Spleen ; Stomach Neoplasms* ; Survival Rate

BACKGROUND: BCT (breast conserving therapy) is now accepted as one of the standard therapeutic options for stage I, II breast cancers. However, especially in Korean breast cancer patients, many questions still remain to be answered in terms of the optimal indication, the extent of resection and the frequency and proper management of recurrence due to the lack of studies involving large numbers of patients. The aims of this study were to examine the pattern and the frequency of recurrence following BCT and to identify the risk factors of local recurrence and systemic relapse. In addition, the outcomes for the patients treated with a quadrantectomy and with a lumpectomy were compared with particular emphasis on the rate of local recurrence. METHODS: The medical records of 386 patients who underwent a BCT at Korea Cancer Center Hospital during the period from January 1986 to December 1996 were reviewed. RESULTS: Among the 386 patients, 269 (69.7%) patients underwent a quadrantectomy and 117 (30.3%) patients underwent a lumpectomy with microscopic confirmation of margin status. Level I, II axillary dissection and whole breast irradiation, including electron beam boost to tumor site, were performed routinely. The axillar and supraclavicular areas were included in the irradiation field when 4 or more positive nodes were found. Systemic treatment (CMF or CAF tamoxifen) was done depending on the pathological stage and the hormone receptor status of the disease. During the period of follow up (median 66 months), 9 cases (2.3%) of local recurrence and 18 cases (4.7%) of systemic relapse were identified in 24 (6.2%) patients. Between the quadrantectomy and the lumpectomy groups, there were no significant differences in the frequencies of local recurrence (p=0.179) and systemic relapse (p=0.266). Young age (< or =40) (p=0.01) and lymph node metastasis (p=0.0001) were proven to be risk factors of local recurrence. Large tumor size (>2 cm) (p=0.03) and lymph node metastasis (p=0.003) were risk factors of systemic relapse. CONCLUSION: The rates of local recurrence were very low in both the quadrantectomy and the lumpectomy group compared with those in a Western series. These results show that a quadrantectomy or a lumpectomy with confirmation of margin status followed by radiation therapy can provide excellent results in terms of local control and survival in Korean breast cancer patients.
Breast Neoplasms ; Breast* ; Follow-Up Studies ; Humans ; Korea ; Lymph Nodes ; Mastectomy, Segmental ; Medical Records ; Neoplasm Metastasis ; Recurrence* ; Risk Factors

PURPOSE: The prognosis for early gastric cancer (EGC) is favorable, and the 10-year disease-specific survival rate is reported to be around 90%. The absolute number of recurred EGC is too small to assess the risk factors, so recruitment of a large number of cases for statistical analysis is very difficult. We carried out this study to analyze the incidence and the patterns of recurrence of EGC and to identify the clinicopathological risk factors for recurrence of EGC. METHODS: The authors retrospectively investigated the follow- up records of 1,418 patients who underwent a curative resection for EGC from Jan. 1984 to Dec. 1999 at the Korea Cancer Center Hospital and analyzed them with special reference to cancer recurrence. RESULTS: In this retrospective study of 1418 cases, 43 patients died of a recurrence of gastric cancer, and 105 patients died of unrelated causes. The five-year and the ten-year overall survival rates were 89.6% and 81.7%, respectively, while the five-year and the ten-year disease-specific survival rates were 96.5% and 94.3%, respectively. The recurrence patterns of the 45 recurred EGC were hematogenous metastasis (19 cases), lymph node (L/N) metastasis (8 cases), locoregional recurrence (2 cases), peritoneal seeding (3 cases), and combined form (13 cases). The mean time interval to recurrence was 38.6 months, and the number of delayed recurred cases after 5 years was 10 (22.2%). Of the clinicopathologic factors, depth of invasion, L/N metastasis, macroscopic type, lymphatic invasion, and vessel invasion, were significant risk factors in the univariate analysis. However, in the multivariate analysis, only L/N metastasis was an independent prognostic factor. CONCLUSION: Based on the results of this study, L/N metastasis is an independent prognostic factor. Thus, in patients with node-positive disease, adjuvant therapy might be considered, and long-term close follow-up might facilitate early detection and treatment of recurrent disease due to delayed recurrence.
Follow-Up Studies ; Humans ; Incidence ; Korea ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Recurrence* ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms* ; Survival Rate