PURPOSE: We undertook this study to investigate discrepancies in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values, and variations following intravenous immunoglobulin (IVIG) therapy in Kawasaki disease (KD). METHODS: A total of 123 KD patients were retrospectively enrolled. Patients were treated with IVIG 2 g/kg at 2 to 9 days after disease onset. We obtained white blood cell (WBC) count, percentage of neutrophils (% neutrophils), CRP, ESR, and N-terminal pro-brain natriuretic peptide (NT-proBNP) values before and 48 to 72 hours after IVIG treatment. Discrepancy was defined as CRP ≥10 mg/dL and ESR <50 mm/hr (Group 1), or CRP <10 mg/dL and ESR ≥50 mm/hr (Group 2). RESULTS: Thirty-six of 123 subjects (29.2%) had a discrepancy: 25 (20.3%) in Group 1 and 11 (8.9%) in Group 2. In Group 1, 15 patients (60%) had fever for <5 days (early presenter) and 10 (40%) had fever for ≥5 days (late presenter). There were six early presenters (55%) and five late presenters (45%) in Group 2. Late presenters had higher ESR than early presenters (34.3±21.0 mm/hr vs. 26.3±19.3 mm/hr, P=0.029). After IVIG treatment, elevated WBC count, % neutrophils, CRP, and NT-proBNP levels normalized. In contrast, ESR increased from 37.4±21.9 mm/hr to 48.0±22.7 mm/hr (n=36, P=0.051). CONCLUSIONS: A discrepancy may be related to the duration of fever. Due to discrepancies in CRP and ESR values in acute KD, both should be measured to assess the degree of inflammatory activity before IVIG treatment. After IVIG treatment, the ESR should not be used as a marker of response to therapy in KD.
Blood Sedimentation* ; C-Reactive Protein* ; Erythrocytes* ; Fever ; Humans ; Immunization, Passive* ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Leukocytes ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils ; Retrospective Studies

The bcl-2 gene is a proto-oncogene which extends cell survival by blocking apoptosis. Bcl-2 expression has been detected in many types of nodal and MALT lymphoma. The p53 gene is a tumor suppressor gene and p53 mutation is the most common genetic alteration in human malignancies. The relationship between the expression of bcl-2 and p53 protein in primary gastric lymphoma has been rarely reported. The authors investigated the expression of bcl-2 and p53 protein in 37 cases of primary gastric lymphoma by immunohistochemical method using bcl-2 and p53 monoclonal antibodies. There were five cases of low grade B-cell MALT lymphomas and thirty two cases of high grade B-cell lymphomas. Fifteen of 37 cases (41%) showed bcl-2 protein expression in the cytoplasm of tumor cells and 26 cases (70%) showed p53 protein expression in the nucleus of tumor cells. Bcl-2 protein was detected in 4 of 5 (80%) low grade MALT lymphomas, and in 11 of 32 (34%) high grade lymphomas. There was no significant correlation between bcl-2 expression and histologic grade of primary gastric lymphomas (p>0.05). p53 protein was positive in 25 of 32 (78%) high grade lymphomas, and in 1 of 5 (20%) low grade MALT lymphomas. The expression of p53 protein is significantly higher in high grade lymphoma than in low grade MALT lymphoma (p<0.05). The p53 expression in the bcl-2 negative cases (86%) was significantly higher than in the bcl-2 positive cases (47%). There was an inverse relationship between bcl-2 and p53 expression in primary gastric lymphoma. These results suggest that bcl-2 and p53 expression in primary gastric lymphoma may be involved in the transition from low grade MALT lymphoma to high grade lymphoma.
Antibodies, Monoclonal ; Apoptosis ; B-Lymphocytes ; Cell Survival ; Cytoplasm ; Genes, bcl-2 ; Genes, p53 ; Genes, Tumor Suppressor ; Humans ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone ; Proto-Oncogenes

BACKGROUND: The aim of this study was to determine the prognostic significance of the expression of p53 and retinoblastoma (Rb) gene products in cases of curatively resected gastric adenocarcinoma, by immunohistochemical analysis. METHODS: Between January 1996 and December 2001, 736 curatively resected gastric cancer patients underwent immunohistochemical staining for p53 or Rb proteins (pRb), and we retrospectively analyzed the correlation of our results with the clinical outcomes of these cases. RESULTS: High levels of expression of p53 (> 25% p53-positive cells) and Rb (> 50% Rb-positive cells) proteins were detected in 40.1% and 43.7% of cases, respectively. Tubular type was found to frequently exhibit higher levels of p53 expression (high expression in 44.2%) than signet ring cell type (high expression in 26.0%) (p=0.042). The incidence of vascular invasion was lower in the high pRb expressors (43.2%) than in the pRb low expressors (56.8%), but this was not a statistically significant discrepancy (p=0.063). Preoperative CEA levels were found to be low in high pRb expressors: initial CEA level in the high pRb expressors was 2.31 +/- 3.30 ng/mL, and was 5.18 +/- 24.80 ng/mL in the low pRb expressors (p=0.033). Tumor depth and node metastasis were both independent of the levels of expression of p53 and Rb proteins. The seven-year overall survival rate and relapse-free survival rates of patients were 87.2% and 75.7%, respectively. Multivariate Cox regression analysis indicated that tumor stage, tumor size, patient age and pRb expression were the significant prognostic factors with regard to overall survival, and tumor stage and age were both significant factors with regard to relapse-free survival. CONCLUSION: Immunohistochemical staining of retinoblastoma gene products was an independent prognostic factor for the prediction of overall survival in curatively resected gastric cancer patients.
Adenocarcinoma/*genetics/metabolism/mortality ; Adult ; Aged ; Aged, 80 and over ; Female ; Gene Expression ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Prognosis ; Protein p53/*metabolism ; Retinoblastoma Protein/*metabolism ; Retrospective Studies ; Stomach Neoplasms/*genetics/metabolism/mortality

Fracture of odontoid process is relatively common, but fracture of axis body without fracture of odontoid precess is known to be exceptionally. Recently, we have experienced a case of axis body fracture complicating typical Brown-Sequard syndrome below the level of C4, and we present the case with the review of literature.
Axis, Cervical Vertebra* ; Brown-Sequard Syndrome* ; Odontoid Process

BACKGROUND: The pneumoperitoneum created by CO2 insufflation during laparoscopic cholecystectomy has several potential hemodynamic and respiratory consequences. The purpose of this study is to investigate the effects of augmented minute ventilation on cardiovascular and ventilatory changes and to prevent hypercarbia due to CO2 insufflation during laparoscopic cholecystectomy. METHODS: Thirty-six patients were divided into three groups according to the level of minute ventilation. The three groups were: control group C (minute ventilation 100 ml/kg, respiratory rate 12 per minute), group R (MV 150 ml/kg, RR is 18 per minute) and group V (MV 150 ml/kg, tidal volume is 1.5 times as much as group C). We repeatedly measured mean arterial pressure , pulse rate , arterial blood gas analysis and end tidal carbon dioxide and peak inspiratory airway pressure before CO2 insufflation, 15 and 30 minutes after CO2 insufflation and 15 minutes after CO2 deflation. RESULTS: During CO2 insufflation, MAP significantly increased but PR showed little changes in all three groups. PaCO2 and PetCO2 increased in group C, whereas in group R and V, they remained unchanged during CO2 insufflation. But the level of PaCO2 in group V decreased more than in the other two groups after CO2 deflation,. PIP in group V increased 3 times as much as the control value. CONCLUSIONS: These results suggest that augmented minute ventilation in group R and V, prevented hypercarbia during CO2 insufflation and increasing the tidal volume in controlled ventilation was more effective than increasing respiratory rate after CO2 deflation.
Anesthesia, General* ; Arterial Pressure ; Blood Gas Analysis ; Carbon Dioxide ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Heart Rate ; Hemodynamics ; Humans ; Insufflation ; Laparoscopy ; Pneumoperitoneum ; Respiratory Rate ; Tidal Volume ; Ventilation*

To evaluate the coronary vasomotor tone in vasospasic angina, we compared the diameters of non-spastic segments of vasospastic group with those of control group. The internal diameters of each segment of three major coronary arteries were measured on the basal coronary angiogram, and nitroglycerin administration after provocation with ergonovine or acetylcholine. The vasospastic angina group consisted of 26 patients(20 males, 6 females, mean age of 54 years) and control group consisted of 25 patients (7 males, 18 females, mean age of 55 years). The basal coronary arterial diameters in vasospastic angina group were smaller than those in control group(p<0.05) except the distal segment of right coronary artery. The percent dilation ratio in vasospastic angina group was greater than that in control group(p<0.05). In vasospastic angina group there was no significant difference in the degree of constriction after provocation with ergonovine or acetylcholine between proximal and distal segment. These observations suggest that in vasospastic angina, basal coronary arterial tone is increased in the entire coronary arterial tree and the localized spasm may reflect local hyperrespon siveness.
Acetylcholine ; Constriction ; Coronary Vessels ; Ergonovine ; Female ; Humans ; Male ; Nitroglycerin ; Spasm

PURPOSE: The purpose of this study was to investigate the prognostic significance of the expression of EGFR and C-erbB-2 gene products by immunohistochemical analysis for curatively resected gastric adenocarcinoma. MATERIALS AND METHODS: Between January 1996 and December 2001, 739 patients with curatively resected gastric cancer patients underwent Immunohistochemical staining for EGFR and C-erbB-2 proteins, and we retro spectively analyzed their correlation with the clinical outcome. RESULTS: The overexpressions of EGFR and C-erbB-2 were 25.4% and 26.2%, respectively. The overexpressions of EGFR was associated with the more poorly differentiated tumor (p=0.000) and with neuronal invasion (p=0.03). Overexpression of C-erbB-2 was associated with less vascular invasion (p=0.001). Tumor depth or node metastasis was not related to the overexpression of EGFR or C-erbB-2. The seven-year overall survival and relapse-free survival rates were 87.2% and 75.8%, respectively. Upon multivariate Cox regression analysis, the tumor stage, tumor size and patient age were important prognostic factors for overall survival, and tumor stage was the important factor for relapse-free survival. Overexpressions of EGFR or c-erbB-2 were not significant prognostic factors. CONCLUSION: Immunohistochemical staining of EGFR and C-erbB-2 gene products were not independent prognostic factors for predicting the overall survival and the relapse-free survival in curatively resected gastric cancer.
Adenocarcinoma ; Genes, erbB-2 ; Humans ; Immunohistochemistry ; Neoplasm Metastasis ; Neurons ; Prognosis ; Receptor, erbB-2 ; Regression Analysis ; Stomach Neoplasms*

OBJECTIVES: This research was performed in order to develop the social perception scale which could detect the deficits of the social perception, composed of visual perception and contextual perception, in the patients with schizophrenia and might have the desirable reliability and discriminating power between the patients with schizophrenia and the normal controls, and so as to be appropriate to the schizophrenics' cognitive rehabilitation strategy of Brenner, et al. METHODS: We selected 10 photographs among 30 photographs which could show the variable social situations according to the consensus of the staff members of the Integrated Psychological Therapy. Then we developed the questions, composed of visual perception subscale and contextual perception subscale, which we called preliminary social perception scale. We tested the above scale to the 20 patients with schizophrenia in the chronic mental hospital. Then we tested the above scale to both the 20 patients meeting DSM-IV criteria for schizophrenia in the closed ward of the university psychiatric hospital and the 20 normal controls. We developed the final social perception scale to exclude the items of inadequate reliability. We compared the item difficulties of social perception scale between the patients in the chronic mental hospital and those in the university psychiatric hospital. finally, we compared the scores of social perception scale between the patients with schizophrenia and the normal controls. RESULTS: The final 6 items were selected to become the social perception scale according to the values of the item-total correlation, test-retest reliability, and interrater reliability. The final social perception scale showed similar rank of item difficulties between two groups with schizophrenia. The patient group differed significantly fiom the normal control group on the scores of contextual perception subscale(t=-3.09, p<.01) and the total scores of social perception scale(t= -3.33, p<.01). CONCLUSION: This study suggests that the above social perception scale which has excellent internal consistency, test-retest reliability, interrater reliability and the discriminating power. This scale can be applied to both the cognitive rehabilitation strategy in the patients with schizophrenia and the evaluation of the effectiveness of the cognitive rehabilitation.
Consensus ; Diagnostic and Statistical Manual of Mental Disorders ; Hospitals, Psychiatric ; Humans ; Rehabilitation* ; Schizophrenia* ; Social Perception* ; Visual Perception

PURPOSE: The use of pre- and intraoperative vitreous bevacizumab injection and combined lens extraction with vitrectomy in patients with proliferative diabetic retinopathy (PDR) is increasing. In this study we analyzed the incidence and risk factors of neovascular glaucoma (NVG) after vitrectomy for PDR. METHODS: Patients who underwent vitrectomy for PDR from January 2004 to June 2011 were retrospectively reviewed. The minimum follow-up was 12 months. The cumulative incidence of NVG was calculated using the Kaplan-Meier survival analysis. The patients were divided into 4 groups according to lens status (preoperative pseudophakic group, simultaneous cataract surgery group, sequential cataract surgery group, non-cataract surgery group). The differences in incidence between the groups were determined by the Chi-square test. Finally, to analyze the risk factors associated with the occurrence of NVG, the Cox's regression model was used. RESULTS: Of the 614 eyes (402 patients), 284 were males and 330 were females. The mean age was 55.8 +/- 10.46 years (range 30-81 years) and the mean follow-up period was 36.6 months (range 1-93 months). Thirty-four of 614 patients (5.5%) developed postoperative NVG after vitrectomy. The probability of NVG occurrence at 6 and 12 months after vitrectomy was 0.7% and 2.5%, respectively. The incidence between the 4 groups did not show a statistically significant difference. The risk factors for postoperative NVG were male gender (RR = 3.01 p = 0.004), preoperative intravitreal bevacizumab injection (RR = 7.20, p < 0.001), and reoperation (RR = 3.18, p = 0.0037). CONCLUSIONS: The frequency of NVG after vitrectomy in patients with PDR was 5.5%. Lens status was not associated with NVG occurrence. The risk factors related to NVG were male gender, preoperative intravitreal bevacizumab injection, and reoperation.
Cataract ; Diabetic Retinopathy* ; Female ; Follow-Up Studies ; Glaucoma, Neovascular* ; Humans ; Incidence ; Male ; Phacoemulsification ; Reoperation ; Retrospective Studies ; Risk Factors* ; Vitrectomy* ; Bevacizumab

Signet ring cell carcinoma has been previously described in many organs, most frequently in the stomach, and rarely in the colon, rectum, gallbladder, pancreas, breast, nadsal cavity, prostate, urinary bladder and ureter. Signet ring cell carcinomas in the lung, especially, when examined by small biopsies, are generally believed to be metastatic. This case was diagnosed by bronchoscopic biopsy. We also examined various organs by noninvasive method, including UGI series, barium enema and abdomen CT scarf, but all studies were nomal. Patient received cisplatin and etoposide combination chemotherapy followed by local radiotherapy ai a primary non-small cell lung cancer. Patient died of his disease 6 months after diagnosis. Now we report a case of primary signet ring cell carcinoma of the lung.
Abdomen ; Barium ; Biopsy ; Breast ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Signet Ring Cell* ; Cisplatin ; Colon ; Diagnosis ; Drug Therapy, Combination ; Enema ; Etoposide ; Gallbladder ; Humans ; Lung Neoplasms ; Lung* ; Pancreas ; Prostate ; Radiotherapy ; Rectum ; Stomach ; Ureter ; Urinary Bladder