BACKGROUND: Infiltration of eosinophils and activated T cells into the airway is a characteristic feature of allergic inflammation such as asthma. IL-4 has been shown to mediate adhesion of eosinophils and T cells to endothelial cells by inducing VCAM-1 expression on endothelial surface. IL-13 shares a number of biologic properties with IL-4. OBJECTIVE: We aimed to investigate the effects of IL-13 on the adhesion of eosinophils to human umbilical vein endothelial cells (HUVEC) and on the expression of VCAM-1 in HUVEC. METHOD: HUVEC was incubated for 24h with IL-13 (10ng/ml), IL-4 (10ng/ml) and TNF-a (10ng/ml). Surface expression of VCAM-1 in HUVEC was detected using irnmuno-cytochemical stain and reverse transcription-polymearse chain reaction (RT-PCR), and the adhesion of eosinophils to HUVEC was quantitated using eosinophil peroxidase (EPO) assay. RESULTS: The VCAM-1 expression on IL-13-treated HUVEC increased more than in the expression on medium-treated HUVEC (p<0.05). The adhesion of eosinophil to IL-13- treated HUVEC also increased more than in the adhesion to medium-treated HUVEC (p<0.05). The VCAM-1 expression was synergistically induced by TNF-a and IL-13 (p<0.05). IL-13 induced VCAM-1 expression and adhesion of eosinophils to HUVEC, similar to IL-4. IL-13 also induced VCAM-1 mRNA expression, with greater expression than with medium and TNF-a(p<0.05). IL-13-induced surface VCAM-1 was associated with expression of mRNA transcripts and adhesion of eosinophils to HUVEC(r=0.89, r=0.93, p<0.05). CONCLUSION: These findings demonstrate that IL-13 stimulates HUVEC to express surface VCAM-1 and has a possible role in promoting VCAM-1/VLA-4 dependent accumulation of eosinophils during allergic and other inflammatory responses.
Asthma ; Endothelial Cells* ; Eosinophil Peroxidase ; Eosinophils* ; Human Umbilical Vein Endothelial Cells ; Inflammation ; Interleukin-13* ; Interleukin-4 ; RNA, Messenger ; T-Lymphocytes ; Vascular Cell Adhesion Molecule-1

PURPOSE: Oral UFT is known to be a safe and effective antineoplastic regimen for adjuvant chemotherapy of colorectal cancer. As it sometimes produces upper gastrointestinal symptoms such as anorexia, nausea, vomiting and abdominal pain, medication should be stopped transiently or dosage reduced. UFT-E, an enteric coated granule of UFT was introduced to reduce UGI toxicity. We analyzed the toxicity of UFT and UFT-E prospectively for the purpose of comparison between the two types. METHODS: The toxicity of UFT and UFT-E were evaluated in 83 patients (UFT; 45, UFT-E; 38) with colorectal cancer who underwent curative surgery according to the WHO toxicity criteria. All patients were selected consecutively with patients' approval and by the "Institutional Review Board, Asan Medical Center". RESULTS: The toxicity incidence in UFT-E group was slightly less than that in UFT group without statistical significance. The severity of toxicity seemed to be mild within grade 1 or 2 and most of them toxicity self-limiting. The regimen was completely interrupted in 9 patients (20%) in the UFT group, 3 patients (7.9%) in the UFT-E group due to severe UGI symptoms, prolonged leukopenia, derrangement of liver function and skin rash. CONCLUSIONS: Toxicity rate of UFT-E was not higher than that of UFT. But we cannot prove superiority of UFT-E on UGI toxicity. Oral UFT-E can be administered safely on an outpatient basis without lethal toxicity requiring hospitalization.
Abdominal Pain ; Anorexia ; Chemotherapy, Adjuvant ; Chungcheongnam-do ; Colorectal Neoplasms* ; Exanthema ; Hospitalization ; Humans ; Incidence ; Leukopenia ; Liver ; Nausea ; Outpatients ; Prospective Studies ; Vomiting

Hashimotos thyroiditis and Graves disease have been thought to be the autoirnmune diseases having their distinct and separate clinical and pathologic features. Because of the partial and complete simi1arity in histologic feature, it has been hypothesized that Hashimoto's thyroiditis and Oraves disease may be interrelated. Several patients who had been diagnosed as Graves disease showed features of hypothyroidism, and were proven to have histologie features of Hashimotos thyroiditis in their thyroid tissue. Two meehanisms had been suggested to explain tbis phenomenon. One is that the combined Hashimotos thyroiditis in Graves' disease may become predominant with time, The other is that the amount of TSH receptor blocking antibody may increase in the course of Graves disease. Early recognition of these patients would be impartant to estabilish therapeutic plan. Futhermcee, extensive study of these patients would give more understanding of the mechanism of these diseases. Here we report 5 cases of clinically diagnosed Graves disease with pathologic features of Hashimotos thyroiditis or focal lymphocytic thyroiditis.
Graves Disease ; Humans ; Hypothyroidism ; Receptors, Thyrotropin ; Thyroid Gland ; Thyroiditis ; Thyroiditis, Autoimmune

No abstract available.

Sigmoid colon cancer occasionally attaches to the adjacent viscera. It is estimated that such attachment occurs in 6% to 12% of all patients with colon carcinoma without distant metastases. This study was performed to identify the parameters to distinguish direct tumor invasion to adjacent organs from simple inflammatory adhesion in sigmoid colon cancer and to clarify the difference of survival and recurrence pattern between two groups. METHODS: Between 1989 and 1998, 415 patients underwent resection of sigmoid colon cancer in our clinic. Of these, 46 had tumors adherent to adjacent organs and confirmed as tumor direct invasion or simple inflammatory adhesion by pathologic examination. The mean age of 46 cases was 54.2+/-12.8 (mean+/-SD) years and median follow up was 21 (3~53) months. RESULTS: Among the clinical and pathologic parameters such as symptoms and laboratory findings presenting bowel obstruction, serum CEA levels, preoperative radiological findings, tumor size, differentiation, and stage, there was no specific one that was correlated with direct tumor invasion or inflammatory adhesion. Almost all cases with adhesion to adjacent organ were treated by an en bloc resection including mutivisceral resection. The group with direct invasion had inferior disease free survival rate and overall survival rate comparing with simple inflammatory adhesion group. CONCLUSIONS: In the situation that there was no valuable parameter suggesting direct tumor invasion, en bloc resection or multivisceral resection involving one tumor-free plane may be beneficial to the patients with sigmoid colon cancer adherent to adjacent organ.
Colon ; Colon, Sigmoid* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Recurrence ; Sigmoid Neoplasms* ; Survival Rate ; Viscera

PURPOSE: Intussusceptions occurring in adults are relatively rare, however, surgery is usually recommended since they frequently accompany organic lesions as predisposing factor. The purpose of this study is to analyze clinical manifestations and investigate optimal treatment principles for adult intussusception. METHODS: Clinicopathogic manifestations of 28 adult intussusception patient were analyzied, retrospectively. The types of adult intussusception were classified as enteric and colonic types. Sex ratio was 15:13 and mean age was 52 (17-80) years. RESULTS: CT scan was the most accurate tool for diagnosis of adult intussusception and detection of underlying causes. The types of adult intussusception were 4 jejuno-jejunal, 7 ileo-ileal, 15 ileo-cecal, and 2 colo-colic types. The pathologic lesions were identified in 23 out of 28 cases (82%). Malignancy was the cause of adult intussusception in 5 cases (45%) of enteric type and in 6 cases (35%) of colonic type intussusception. Operations were performed in 26 cases (93%) and resection without reduction was performed in 23 cases. CONCLUSIONS: Surgical exploration without reduction may be the treatment of choice since the majority of cases have organic lesions as the etiology, with relatively frequent association of malignancies.
Adult* ; Causality ; Colon ; Diagnosis ; Humans ; Intussusception* ; Retrospective Studies ; Sex Ratio ; Tomography, X-Ray Computed

Vinegar is a very popular ingredient used in many cuisines. It is also known for its beneficial health, beauty and possible weight-loss properties. The authors report on a patient who presented to the emergency department with unstable vital signs complaining of generalized abdominal pain after ingestion of 450 ml of apple cider vinegar. We documented a case of corrosive gastrointestinal injury with persistent metabolic acidosis occurring after ingesting apple cider vinegar with an acetic acid concentration of 12~14%. Toxic damage to the liver and kidney were also observed, peaking on post-ingestion day 3. The patient received supportive care and hemoperfusion for three days without much clinical improvement and died in the seventh day of intensive care due to disseminated intravascular coagulation and multi organ failure. Edible vinegar, when taken in large amounts, is capable of inducing corrosive injuries of the GI tract as well as severe systemic toxicities, such as metabolic acidosis. Safety precautions regarding vinegar deserve more public attention and clinicians also should be astute enough to recognize the potential damage accompanying vinegar ingestion.
Abdominal Pain ; Acetic Acid ; Acidosis ; Beauty ; Disseminated Intravascular Coagulation ; Eating ; Emergencies ; Gastrointestinal Tract ; Hemoperfusion ; Humans ; Critical Care ; Kidney ; Liver ; Vital Signs

BACKGROUND AND OBJECTIVES: Aural cholesteatoma is characterized by hyperproliferation of keratinizing squamous epithelium in the middle ear cleft. Although the exact mechanism of bone destruction in aural cholesteatoma is still not clear, it was recently reported that a variety of cytokines, including epidermal growth factor (EGF), epidermal growth factor receptor (EGFR) and transforming growth factor-alpha (TGF-alpha) were over-expressed in aural cholesteatoma. The aim of this study is to demonstrate that there is over-expression of EGF, EGFR, and TGF-alpha in cholesteatoma and to evaluate the relationships between their expressions and clinical severity of the disease. MATERIALS AND METHODS: Expressions of EGF, EGFR, TGF-alpha were evaluated by immunohistochemical staining of cholesteatoma tissue and normal external auditory canal skin. The degree of expression were measured either by subjective observation and semi-quantitative image analysis. Both subjective scores and density scores were compared with clinical variables, such as the presence of preoperative otorrhea, complication, ossicular destruction, and the stage of cholesteatoma. RESULTS: The expression of EGF and TGF-alpha were more increased, particularly in the suprabasal layer of cholesteatoma epithelium than the normal skin. When the ossicular destruction and more extended cholesteatomas were present, the expressions if EGF and TGF-alpha were increased in the cholesteatoma tissues. CONCLUSION: The degree of expression of EGF and TGF-alpha in cholesteatoma may represent the clinical severity of the disease.
Cholesteatoma ; Cholesteatoma, Middle Ear* ; Cytokines ; Ear Canal ; Ear, Middle ; Epidermal Growth Factor* ; Epithelium ; Immunohistochemistry ; Receptor, Epidermal Growth Factor* ; Skin ; Transforming Growth Factor alpha

INTRODUCTION: Stapled anastomosis in the rectal cancer surgery has been already proven as a safe technique, maintaing secure suture and saving times compared to handsewn anastomosis. With the advancement of stapling device, the incidence of anastomotic leakage has decreased significantly. However, developement of anastomotic stricture has become a major postoperative complication. PURPOSE: An analysis of the clinical features and the predisposing factors of anastomotic stricture was made to identify its pathogenesis and to determine adequate procedure. METHODS: We analyzed 49 patients (8.1%) with the rectal stricture among 608 patients, undergone stapled anastomosis for the rectal cancer surgery at Asan Medical Center from Jan 1993 to Dec 1998. Rectal stricture was defined when index finger or colonoscope could not pass the anastomotic site (high grade), or could pass with difficulty(low grade). RESULTS: Underlying general diseases, e.g., DM, hypertension and cardiovascular disease was associated more frequently in patients with anastomotic stricture (20.4%) than patients without (10.8%) (P<0.05). The rate of postoperative major complications in patients with stricture was 22.4%, while that of anastomotic leakage was 6.1%. Development of anastomotic stricture was not associated with operative methods, age, anastomosis level, and postoperative radiotherapy. In patients with stricture, 34 patients (69.4%) were asymptomatic, and 15 patients were symptomatic. In treating symptomatic rectal stricture, only five patients performed dilation manually or by the Hegar dilator. CONCLUSIONS: Rectal stricture after stapled anastomosis might be associated with underlying diseases, and correlated with prolonged sanguinous drainage and ileus. Meticulous management of underlying disease and complete hemostasis during operation appear to be important to reduce the rate of rectal stricture.
Anastomotic Leak ; Cardiovascular Diseases ; Causality ; Chungcheongnam-do ; Colonoscopes ; Constriction, Pathologic* ; Drainage ; Fingers ; Hemostasis ; Humans ; Hypertension ; Ileus ; Incidence ; Postoperative Complications ; Radiotherapy ; Rectal Neoplasms ; Sutures

Metastases to the liver from carcinoma of the colon and rectum occur as many as 80% of cases. As resection of metastases is proven to enhance survival and to reduce hepatic recurrence, the criteria for selection of patients and surgery type appear to be indispensable. Purpose: The aim of this study was to assess the prognostic factors after hepatic resection for metastatic colorectal cancer and propose the optimal surgical principles for resection of metastatic colorectal cancer. Methods: Sixty-three patients who underwent initial hepatic resection for liver metastases from colorectal cancer between 1989 and 1998 were analyzed regarding clinical and pathologic parameters. Results: Overall 5-year survival rate was 32%. Preoperative serum CEA level and resection margin of metastatic tumors were found to be significant predictors for poor long-term outcome. Resection margin of greater than 5 mm was closely associated with better survival. In multivariate analysis, resection margin alone was an independent prognostic factor. Conclusions: Preoperative serum CEA level and surgical resection margin may affect the outcome for the patients who underwent hepatic resection for metastatic colorectal cancer. Surgical resection margin must be kept enough to avoid re-recurrence or metastasis during hepatic resection for metastatic colorectal cancer.
Colon ; Colorectal Neoplasms* ; Humans ; Liver ; Multivariate Analysis ; Neoplasm Metastasis ; Rectum ; Recurrence ; Survival Rate