Seven patients with aortic valve vegetation were examined by M-mode and two dimensional echocardiography. Underlying cardiac abnormalities were found in 6 patients, four had rheumatic heart disease, one had congenital bicuspid aortic valve, one had coexistence of asymmetrical septal hypertrophy and aortic regurgitation. Aortic regurgitation were found in all patients. One of seven patients had cerebral embolization and all patients had overt congestive heart failure. Of 5 patients medically treated, three became moribund, one died and one improved clinically. One patient underwent cardiac surgery, the aortic cusps were congenital bicuspid with vegetation, aortic valve replacement was successful. Echocardiogram of 7 patients with aortic valve vegetation showed characteristic shaggy, irregular mass of echoes produced by vegetation in the aortic valve during systole and diastole. Two of seven patients had abnormal mass of echoes in the left ventricular outflow tract. During systole, two had vegetation on the right coronary cusp and one had vegetation on the noncoronary cusp by M-mode echocardiography. In other patients we could not localize invoving aortic cusps by M-mode echocardiogram. All patients had left ventricular volume overload. For of seven patients had fluttering of anterior mitral valve. Two had fluttering of interventricular seputm. Five had premature mitral valve closure before QRS complex.
Aortic Valve Insufficiency ; Aortic Valve* ; Bicuspid ; Diastole ; Echocardiography* ; Heart Failure ; Humans ; Hypertrophy ; Mitral Valve ; Rheumatic Heart Disease ; Systole ; Thoracic Surgery

No abstract available.
Leukemia, Plasma Cell* ; Plasma Cells* ; Plasma*

PURPOSE: The aim of this study was to evaluate local control and long-term survival of concurrent hyperfractionated radiotherapy with CDDP/VP-16 chemotherapy in limited stage small cell lung cancer. MATERIALS AND METHODS: From April 1992 to April 1997, twenty-nine patients with limited stage small cell lung cancer received cisplatin 25 mg/m plus etoposide 120 mg/m(2) on day 1, 2 and 3. Chemotherapy was repeated every 4 weeks for a total of 4 courses. Radiation was given to 60 Gy in 50 twice-daily fractionation separated by at least 6 hours, 5 days per week Thoracic radiotherapy was started with first coese of chemotherapy for 28.8 Gy. After 12 days break, radiotherapy was resumed with second course of chemotherapy for another 31,2 Gy. RESULTS: Twenty-eight patients (96.6%) were evaluable. Patient characteristics include: median age 58.4 years (range 45-67); clinical stage 1IIa 13 pts, stage IIIb 15 pts; ECOG performance status 0 (8 pts), 1 (16 pts) and 2 (4 pts). Objective responses were 21 complete response, 6 partial response, 1 stable disease with overall response rate of 96.4%. Grade III and IV toxicities were leukopenia in 23/28 pts, thrombocytopenia in 8/28 pts, stomatitis in 10/28 pts, and alopecia in 8/28 pts. The median survival time was 19.2 months with 1 year, 2 year, 3 year, and 4 year actuarial survival rates and RFS are 65.6%, 30.6%, 30.6%, 24.5%, and 65.3%, 52.8%, 52.8%, 42.2%, respectively. Overall survival rate according to TNM stage, weight loss, age and sex were not statistically significant. Pattems of relapse were local only in 2 pts, systemic only in 7 pts, and local plus systemic in 1 pt, and brain was the most frequent systemic recurrent site (4 pts). CONCLUSION: Concurrent hyperfractionated radiotherapy with CDDP/VP-16 chemotherapy seems to produce better local contml and survival rates in limited stage small cell lung cancer.
Alopecia ; Brain ; Cisplatin ; Drug Therapy* ; Etoposide* ; Humans ; Leukopenia ; Radiotherapy* ; Recurrence ; Small Cell Lung Carcinoma* ; Stomatitis ; Survival Rate ; Thrombocytopenia ; Weight Loss

BACKGROUND: Anaplastic thyroid carcinoma is one of the most aggressive human cancers with a median survival of only 6 months. Local surgical tumor debulking combined with radio-chemotherapy is generally used to treat this malady, but the low success rate has prompted the search for new therapeutic targets. We used 5-aminoimidazole-4-carboxamide-1-beta-D-ribofuranoside (AICAR) as an AMP-activated protein kinase (AMPK) activator to induce growth suppression and apoptosis in the anaplastic thyroid carcinoma cells. METHODS: We investigated the effect of AICAR on the proliferation of thyroid cancer cell lines (ARO, WRO and FRO) by performing methyl-thiazoletetrazolium bromide assay. We wanted to see the effect of AICAR on the apoptosis and cell cycle of the thyroid cancer cells, and we wanted to determine the mechanism of these changes. RESULTS: The proliferation of all thyroid cancer cell lines was significantly inhibited by administration of AICAR. FRO was the most susceptible cell line to AICAR treatment and so further studies were then performed with this cell line. The suppressive effect of AICAR on cell proliferation was related with phosphorylation of AMPK and the increased apoptosis. Also, cell cycle analysis revealed that progression to the G2-M phase was arrested (S-phase arrest) by AICAR treatment. S-phase arrest was associated with the increased protein expression of p21. CONCLUSION: In the anaplastic thyroid cancer cell lines, AICAR inhibited proliferation due to the arrest in the S-phase; this was accompanied with the increased expression of p21. Overall, AMPK activation by AICAR or any other pharmacological agent could be a tempting potential target for thyroid cancer therapy.
Aminoimidazole Carboxamide ; AMP-Activated Protein Kinases ; Apoptosis ; Cell Cycle ; Cell Line ; Cell Proliferation ; Humans ; Phosphorylation ; Thyroid Gland* ; Thyroid Neoplasms*

Fifteen cases of diffuse axonal injury(DAI) brought about by nonmissile head injury in humans are analyzed. All cases were subjected to comprehensive clinical studies such as measurement of cerebral blood flow by SPECT, continuous intracranial pressure monitoring and multimodality evoked potentials(MEPs). In the patients with DAI, a high incidence of low cerebral perfusion and abnormal MEPs. especially auditory evoked potentials, were found, with high incidence of high velocity traffic accident injury mechanism. On the other hand, a low incidence of increased intracranial pressure was found and dehydrating agents such as glycerol and mannitol did not exert a beneficial influence upon the clinical courses or the outcomes. The outcome of the patients with DAI depended upon the duration of coma and whether or not brain stem signs were noted.
Accidents, Traffic ; Axons ; Brain Stem ; Coma ; Craniocerebral Trauma ; Diffuse Axonal Injury* ; Evoked Potentials* ; Evoked Potentials, Auditory ; Glycerol ; Hand ; Humans ; Incidence ; Intracranial Pressure* ; Mannitol ; Perfusion ; Tomography, Emission-Computed, Single-Photon

Protein Kinase C (PKC) relays information in the form of a various extracellar signals across the membrane and is known to play an important role in the production of B lymphocytes and T lymphocytes, in the antigen-presentation of Langerhans cell, and in inflammatory reactions. The presentation of allergens to T lymphocytes is likely an important aspect in the pathophysiological mechanism of allergic rhinitis. Although several theories have been formulated in allergic rhinitis, signal transduction of this disease remains unknown. In this study, we focused on the role of the enzyme PKC in the allergic mucosa of the nose. Specifically, we investigated the role and the distribution of PKC isozymes in the mucous membrane of the nose. We obtained nasal mucous membrane specimens from 10 patients with house dust mite allergy and 10 patients with normal nasal mucous membrane. We performed an immunohistochemical study, an RT-PCR, and a densitometric measurement. PKCalpha, PKCbeta, and PKCzeta proteins were detected in the subepithelial layer of the allergic mucosa. However there were no detectable reactions in the nonallergic mucosa. In the RT-PCR for PKCalpha, PKCbeta and PKCzeta, there was no difference between the allergic and nonallergic nasal mucous membrane in terms of m-RNA expression. It is possible that the signal transduction pathway of PKC and over-expression of PKC protein at the post-transcription level contribute to the development of allergic inflammation in allergic nasal mucosa.
Allergens ; B-Lymphocytes ; Humans ; Hypersensitivity ; Inflammation ; Isoenzymes ; Membranes ; Mucous Membrane ; Nasal Mucosa* ; Nose ; Protein Kinase C* ; Protein Kinases* ; Pyroglyphidae ; Rhinitis ; Signal Transduction ; T-Lymphocytes

PURPOSE: The laparoscopic adrenalectomy has become the golden standard procedure for adrenal tumors because of its many advantages. The purpose of our study was to compare the outcomes for patients who underwent a transperitoneal laparoscopic adrenalectomy with those of patients who had a conventional open adrenalectomy. Similar to the open adrenalectomy, the laparoscopic adrenalectomy was divided into anterior (LA: Laparoscopic anterior) and posterior (LP: Laparoscopic posterior) approaches. METHODS: Between January 1991 and September 1998, a retrospective review of consecutive ad renalectomies performed at Kyung Hee University Hospital was done. Outcome measurements of operative indications, tumor size, operation time, first oral intake, postoperative stay, and postoperative complications were reviewed. RESULTS: Eleven(11) laparoscopic adrenalectomies (4 LAs and 7 LPs) were performed in 11 patients and 47 open adrenalectomies [24 with an anterior, OA (Open anterior), approach and 23 with a posterior, OP (Open posterior), approach] in 43 patients. The LA approach showed a significantly shorter time to first oral intake (1.8 vs 3.4 days p=0.001) and postoperative hospital stay (5.5 vs 12.8 days p=0.001) compared to the OA approach. The LP approach also showed a significantly shorter time to first oral intake (0.9 vs 1.6 days p=0.046) and postoperative hospital stay (5.9 vs 9.9 days p=0.004) compared to the OP approach. There were no differences in tumor size, operation time, and postoperative complications between laparoscopic adrenalectomies and open adrenalectomies. CONCLUSION: The laparoscopic adrenalectomy is superior to the open adrenalectomy when performed by appropriately trained and skilled surgeons.
Adrenalectomy* ; Humans ; Length of Stay ; Postoperative Complications ; Retrospective Studies

PURPOSE: Estrogens control the development and cell proliferation of various tissues including the normal mammary epithelial cells, where they induce the expression of the immediate and delayed hormone-responsive genes. The proliferative effects of estrogen have been attributed to its ability to increase the expression of the key cell cycle regulatory genes responsible for cell cycle progression. However, the regulation of cell proliferation is only one aspect of estrogen function. It has also been well documented that estrogen plays a critical role in the etiology and progression of human breast and gynecological cancers. This tumorigenic effect of estrogen might be associated with its anti- apoptotic activities such as of Bcl-2 induction. The aim of this study was to clarify the role of E2IG5, which is an estrogen-induced downstream effector molecule, in breast cancer cell lines. RESULTS: This study shows that E2IG5 is a pro-apoptotic protein that is localized to the mitochondrial membrane via two distinct transmembrane domains. When over-expressed, it induces a mitochondrial permeability transition with the resultant of release cytochrome c and caspase activation. However, three out of four breast cancer cell lines lost their estrogen dependence of E2IG5 expression, which suggests the possible involvement of E2IG5 in the development of breast cancer. CONCLUSION: These results suggest that breast cancer cells may loose their pro-apoptotic signals and selectively use the proliferative mechanism of estrogen, which drives the normal mammary epithelial cells to transform into cancer cells. Further studies using breast cancer tissues will be needed.
Breast Neoplasms* ; Breast* ; Cell Cycle ; Cell Line* ; Cell Proliferation ; Cytochromes c ; Epithelial Cells ; Estradiol ; Estrogens ; Genes, Regulator ; Humans ; Mitochondrial Membranes ; Permeability

Statement of Problem: The accuracy and dimensional stability of elastomeric impression materials have been the subject of numerous investigation. Few studies have addressed the effect of changes in time on the dimensional stability of impression materials. Purpose: The purpose of this investigation was to evaluate the effects of elastomeric impression materials and storage time on dimensional stability. Materials and methods: A total of 75 impressions were made of epoxy resin dies mimicked prepared 3-unit fixed partial denture. The dies had 1 buccolingual, 1 mesiodistal and 1 occlusogingival lines and interpreped dot. Impression materials investigated included two polyether impression materials and three polyvinylsiloxane impression material. 15 specimens were made of each impression material and poured by type IV stone over times(30 minutes, 24 hours, 72 hours) after mixing; the same examiner measured each specimen 3 times at a magnification of 3.5*. All statistical tests were performed with the level of significance set at .05. Results: The results indicated that significant difference at any measuring point of stone dies of the polyvinylsiloxane and polyether impression materials when measurements at 30 minutes, 24hours, and 72 hours were compared; the length of measuring point increased significantly as time passed by. However, this result is not significant clinically. Analysis also showed significant differences at any measuring point when polyvinylsiloxane and polyether impression materials were compared and significant differences clinically. Conclusion: Under the conditions of this study, the shrinkage rate of the polyvinylsiloxane and polyether impression materials significantly increased as time passed by. The polyether impression materials showed higher shrinkage significantly, while the shrinkage rate of all five materials showed a significant time-dependent increase.
Denture, Partial, Fixed ; Elastomers*

A case of large aneurysm of azygos anterior cerebral artery(Azygos ACA) is reported. This 52-year-old male patient became unconscious suddenly on working. The CT scan demonstrated small amount of hemorrhage in the interhemispheric fissure and basal cistern and huge intraventricular hematoma with marked dilatation of all ventricles. Emergency external ventricular drainage was done and his consciousness recovered to the level of possible spontaneous eye opening. 4-vessels angiography done a month later revealed a large revealed a large fusiform aneurysm at the bifurcation of distal end of azygos ACA. Authors preferred interhemispheric approach and clipped the aneurysmal neck uneventfully. Despite the successful clipping of the aneurysm confirmed by postoperative angiography, preoperative mutism, spastic weakness of lower extremities and urinary incontinence didn't recovered. This case suggests that preoperative neurological status is no less critical to the postoperative outcome than surgical technique. This is the first case of large aneurysm at this site so far as we know.
Aneurysm* ; Angiography ; Anterior Cerebral Artery* ; Consciousness ; Dilatation ; Drainage ; Emergencies ; Hematoma ; Hemorrhage ; Humans ; Lower Extremity ; Male ; Middle Aged ; Muscle Spasticity ; Mutism ; Neck ; Tomography, X-Ray Computed ; Urinary Incontinence