BACKGROUND: Flecainide is an antiarrhythmic agent that is used primarily in the treatment of cardiac arrhythmias. Some evidences also suggest that flecainide can participate in alveolar fluid clearance and inflammatory responses. This experiment was aimed to evaluate the effects of flecainide on sepsis induced acute lung injury in a rat model. METHODS: Rats were treated with subcutaneous infusion of saline or flecainide (0.1 or 0.2 mg/kg/hr) by a mini-osmotic pump. Subcutaneous infusion was started 3 hours before and continued until 8 hours after intraperitoneal injection of saline or endotoxin. Animals were sacrificed for analyses of severity of acute lung injury with wet to dry (W/D) ratio and lung injury score (LIS) in lung and inflammatory responses with level of leukocyte, polymorphonuclear neutrophils (PMNs) and inteleukin-8 (IL-8) in bronchoalveolar lavages fluid (BALF). RESULTS: Flecainide markedly improved dose dependently sepsis induced acute lung injury as analysed by W/D ratio (from 2.24 ± 0.11 to 1.76 ± 0.09, p < 0.05) and LIS (from 3 to 1, p < 0.05), and inflammatory response as determined by leukocyte (from 443 ± 127 to 229 ± 95, p < 0.05), PMNs (from 41.43 ± 17.63 to 2.43 ± 2.61, p < 0.05) and IL-8 (from 95.00 ± 15.28 to 40.00 ± 10.21, p < 0.05) in BALF. CONCLUSIONS: Flecanide improve sepsis induced acute lung injury in rats by controlling inflammatory responses.
Acute Lung Injury* ; Animals ; Arrhythmias, Cardiac ; Bronchoalveolar Lavage ; Flecainide* ; Infusions, Subcutaneous ; Injections, Intraperitoneal ; Interleukin-8 ; Leukocytes ; Lung ; Lung Injury ; Models, Animal ; Neutrophils ; Rats ; Sepsis*

Prior to 1988, endometrial cancer was clinically staged but there was the considerable discrepancy between clinical and aetual stage. FIGO surgical staging classification of endometrial cancer(I988) provides the advanatage of recognizing the true disease distribution and extension, and more rational treatraent can be accomplished. This retrospective study was based on a clinical review of 73 patients with endometrial carcinoma from l982 through 1991 who underwent primary surgical evaluation. A11 cases were restaged ueing the newly adopted FIGO surgical staging. The distribution of FIGO clinical staging was as follows:85 patients(89.1%) were with stage I, 5(6.9%) with stage II, 2(2.7%) with stage III and 1(l.3%) with stage IV. Surgical restaging according new FlG0 classification reveald 56(76.7%) patients with stage I, 1(1.4%) with stage II, 14(19.2%) with stage III and 2(2.7%) with stage IV. Surgery upstaged 12.3% of clinical stage I patients, In clinical stage II patients, 80.0% was doenstaged. There wes no stage changing in cliaical stage III and IV patients. The acturial survival rates for surgical stages I a, I b, I c, and III were 80.0%, 77.2%, 68.4A%, and 35.0% respectively. By using FIGO surgical staging, the initial extent of endometrial cancer can be more accurately evaluated and we may predict prognosis and survival relatively well.
Classification ; Endometrial Neoplasms* ; Female ; Humans ; Prognosis ; Retrospective Studies ; Survival Rate

No abstract available.
Angiogenesis Inhibitors/administration & dosage ; Bevacizumab/*administration & dosage ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Male ; Middle Aged ; Optic Disk/*pathology ; POEMS Syndrome/*complications/diagnosis ; Papilledema/diagnosis/*drug therapy/etiology ; Tomography, Optical Coherence ; Vascular Endothelial Growth Factor A/*antagonists & inhibitors

No abstract available.
Cartilage*

Thyroid acropachy is a rare complication of Graves' disease, manifested by clubbing of the terminal phalanges, periosteal new bone formation and overlying soft tissue swelling, It may occur when the patient is hypothyroid, euthyroid or hyperthyroid. In most cases, it is a part of the syndrome, including exophthalmos and/or pretibial myxedema. The authors have experienced one case of thyroid acropachy and report with a review of the literature review. The patient a 56-year-old female with a characteristic feathery new bone formation on the medial side of the shaft of the left first metatarsal bone and overlying soft tissue swelling. However, there was no pretibial myxedema and clubbing of fingers. She was hypothyroid and treated with systemic corticosteroid for mild pain and persistent swelling. The treatment had temporarily improved the patient's condition.
Exophthalmos ; Female ; Fingers ; Graves Disease ; Humans ; Metatarsal Bones ; Middle Aged ; Myxedema ; Osteogenesis ; Thyroid Gland*

OBJECTIVE: Large loop excision of transformation zone(LLETZ) is gaining popularity as an alternative to other ablative or cone methods for the treatment of cervical intraepithelial neoplasia(CIN). The optimal management of CIN after LLETZ, however, remains controversial and the reliable predictors of residual disease after LLETZ have not been consistently identified. This study was performed to identify factors to predict residual disease after LLETZ. METHODS: From August 1993 to July 1995, 133 patients who received subsequent hysterectomy after LLETZ in Department of Obstetrics and Gynecology at Seoul National University Hospital were retrospectively reviewed. Residual disease was defined as positive findings of CIN or further advanced findings in hysterectomy specimen. The age of patients, the severity of disease and the status of resection margin(RM) were analyzed for predictive values of residual disease. The Chi-square test, Fisher's exact test and Student t-test were used for statistical analysis. RESULTS: The residual disease after hysterectomy was negative in 85.7%(114/133) and positive in 14.3%(19/133). Among 19 cases with positive residual disease, 3 cases were revealed to be microinvasive cervical cancer. The mean age of patients with no residual disease was 42.5 years(range; 27-71) and that of patients with residual disease was 49.1 years(range; 33-72). Nine out of 94 cases(9.6%) with negative RM and 10 out of 39 cases(25.6%) with positive RM in LLETZ had residual disease. Two out of 14 cases(14.3%) with CIN II and 17 out of 119 cases(14.3%) with CIN III in LLETZ had residual disease. The success of LLETZ which means no residual disease was influenced by the age of patients(p=0.005) and the status of resection margin of LLETZ(p=0.032). CONCLUSION: The negative resection margin in LLETZ does not always guarantee that there is no residual disease. Close preoperative workup and more aggressive treatment plan(wide conization or hysterectomy) should be considered in patients who has higher possibility of positive residual disease such as old age and positive resection margin in LLETZ.
Cervical Intraepithelial Neoplasia* ; Conization ; Gynecology ; Humans ; Hysterectomy ; Obstetrics ; Retrospective Studies ; Seoul ; Uterine Cervical Neoplasms

Interferon(IFN) has been noted to augment the cytotoxicity of cisplatin analogues and S-FU, and varying degrees of success were reported when combined with chemotherapy in a number of squamous cell carcinomas. The aims of this study were to assess its therapeutic efficacy and to establish the feasibility and toxicity of biochemical modulation of the interferon-a-2a when combined with 5-FU and carboplatin(CBDCA) in locally advanced(> or =FIGO clinical stage IJb) and/or bulky(largest diameter > or = 3cm) cervical cancer. From January 1995 to December 1996, 20 patients with bulky and/or locally advanced cervical cancer were enrolled in this study and received FAC(5-FU/Interferon-a/CBDCA) combination chemotherapy as a neoadjuvant setting. The FAC regimen was composed of IFN- a -2a 3x10(6) IU/day from day l to day 6, 5-FU 750mg/m2/day from day 2 to day 6, and carboplatin at a dose calculated by Calvert formula with AUC(area under the curve) 6.0 on day 2. Three cycles of neoadjuvant chemotherapy was performed with 3 weeks interval if toxicity permitted it. Patients were examined after every treatment cycle and evaluated for toxicities and responses using standard GOG criteria. Two patients(10.0%) showed complete clinical response and 15 patients(75,0%) had partial response. The other patients had stable(10.0%) or progressive disease(5.0%). Among fifteen patients who have undergone radical hysterectomy, pathological complete response was not noted. Surgery was possible in 15 patients(75.0%) and 10 patients received adjuvant radiotherapy. Lymph node metastases were found in 5 patients(33.3%) and the number of positive nodes was ranged from 1 to 5. The most frequent grade 3 or 4 toxicity was neutropenia(60.0%) followed by alopecia(40.0%), nausea/vomiting(35.0%), thrombocytopenia(15.0%), diarrhea(5.0%), and anemia(5.0%). (continue)
Carboplatin ; Carcinoma, Squamous Cell ; Cisplatin ; Drug Therapy* ; Drug Therapy, Combination ; Fluorouracil ; Humans ; Hysterectomy ; Lymph Nodes ; Neoplasm Metastasis ; Radiotherapy, Adjuvant ; Uterine Cervical Neoplasms

OBJECTIVE: This study was performed to identify the prognostic factor for survival of patients with recurrent cervical cancer. METHODS: Sixty-eight patients were diagnosed as recurrent cervical cancer at the Seoul National University Hospital from January, 1988 to December, 1998. Recurrence was defined as new evidence of tumor after 6 months of disease free survival. Retrospective analysis was done in terms of clinical features and the Cox proportional hazard model was used to identify independent variables associated with an improved survival rate. Histopathologic types were distributed as follows; squamous cell carcinoma in 70.6%, adenocarcinoma in 11.8%, adenosquamous cell carcinoma in 11.8%, and small cell carcinoma in 1.5%. Distribution of FIGO stage was as follows; stage I in 25.0%, stage II in 66.2%, and stage III in 4.4%. Sites of recurrence were as follows; central pelvic recurrence in 44.1%, pelvic side wall recurrence in 11.8%, and distant metastasis in 44.1% and the most common site of distant recurrence was extrapelvic lymph nodes (29.4%). 29.4% of recurrences were observed within the first 12 months after initial therapy, 50.0% within 2 years and 64.7% within 3 years. RESULTS: Positive rate of SCC-Ag at initial diagnosis was 45.2% with cutoff value of 2.0 ng/ml. Positive rate of SCC-Ag at the diagnosis of recurrence was 60.0%. Overall response rate to the treatment was 29.1%. Complete response rate was higher in central pelvic recurrrence than pelvic side wall recurrence and distant metastasis (P = 0.002) and also higher in normal SCC-Ag level (< or = 2.0 ng/ml) at the diagnosis of recurrence than elevated level (P = 0.032). Cumulative survival rates of 1 year after recurrence was 66.8%, 2 year 36.7%, and 5 year 18.7%. Central recurrence showed higher cumulative survival rate than pelvic side wall or distant recurrence (P = 0.029). The patients with elevated SCC-Ag level at the time of diagnosis of recurrence showed lower cumulative survival rate than those with normal SCC-Ag level (P < 0.001). Cox proportional hazard model showed that SCC-Ag elevation at the time of diagnosis of recurrence retained significant values in predicting survival(OR = 2.56; 95% CI = [1.22-5.39]; P = 0.01). CONCLUSION: SCC-Ag elevation at the diagnosis of the recurrence is a strong independent prognostic indicator for survival of patients with recurrent cervical cancer.
Adenocarcinoma ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Disease-Free Survival ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Proportional Hazards Models ; Recurrence ; Retrospective Studies ; Seoul ; Survival Rate ; Uterine Cervical Neoplasms*

BACKGROUND: The HER-2/neu proto-oncogene (also known as c-ErbB-2) encodes a 185 kD transmembrane glycoprotein with intrinsic tyrosine kinase activity. Many studies revealed the correlation between the aberrant overexpression of HER-2/neu oncogene and poor prognosis of the malignant tumors such as breast, stomach, colon, lung cancers. But the significance of HER-2/neu oncogene overexpression as a prognostic factor in ovarian cancer remains controversial. OBJECTIVE: The aims of this study were to assess the prevalence of HER-2/neu oncogene amplification by polymerase chain reaction(PCR) and to evaluate the prognostic significance of HER-2/neu oncogene overexpression in terms of chemo-responsiveness and survival rate. MATERIALS AND METHODS: This study included 32 patients with advanced ovarian cancers(24 epithelial ovarian cancers, 2 Brenner tumors, 2 malignant mixed miillerian tumors, 2 granulosa cell tumors, 1 struma ovarii, 1 Krukenberg tumor). All patients had underwent staging laparotomy, and postoperative adjuvant chemotherapy with platinum-based combination chemotherapy. PCR was performed using tissues preserved in liquid nitrogen at the time of debulking operation. Overexpression of HER-2/neu oncogene was defined as being equal to or greater than 1.5 a.u. We analyzed whether the HER-2/neu overexpression correlated with chemoresponsiveness and 5-year survival rate(5-YSR). RESULT: HER-2/neu oncogene amplification was present in all of the ovarian cancers(32/32). Significant overexpression[gene copy number(GCN) > or =1.5 a.u.] was present in 13 of 32 ovarian cancers(41%) and 12 of 24 epithelial ovarian cancers (50%). The clinical response rate to chemotherapy in high copy group(GCN > or = 1.5 a.u.) was 67%(8/12) and that of low copy group(GCN<1.5 a.u.) was 92%(11/12)(p>0.05). Pathologic response rate to chemotherapy was 0%(0/5) and 50%(3/6), respectively(p>0.05). 5-YSR was 8% in high copy group and 25% in low copy group, but this difference was not statistically significant(p=0.17). CONCLUSION: HER-2/neu overexpression might be a poor prognostic factor, but this difference was not definitely elucidated by satistical analytsis in this study. Larger scaled prospective randomized study is needed to define the prognostidc significance of the HER-2/neu overezpression in ovarian cancer.
Breast ; Brenner Tumor ; Chemotherapy, Adjuvant ; Colon ; Drug Therapy ; Drug Therapy, Combination* ; Glycoproteins ; Granulosa Cell Tumor ; Humans ; Laparotomy ; Lung Neoplasms ; Nitrogen ; Oncogenes* ; Ovarian Neoplasms* ; Polymerase Chain Reaction ; Prevalence ; Prognosis ; Protein-Tyrosine Kinases ; Proto-Oncogenes ; Stomach ; Struma Ovarii ; Survival Rate

OBJECTIVE: Cervical carcinoma can be adequately treated when diagnosed in early stage. However, the progsnosis of recurrent cervical carcinoma remains poor. The objective of this study is to analyze the prognostic factors affecting survial of recurrent cervical carcinoma patients. METHODS: The clinical characteristics of eighty-three patients who were diagnosed as recurrent cervical carcinoma from Jan 1988 to Apr 1999 were retrospecively analyzed, The initial FIGO stage of II (67.5%) was the most predominant. There were 9.6% of adenocarcinoma, 9.6% of adenosquamous carcinoma, and 1.2% of small cell carcinoma other than squamous cell carcinoma (77.1%). Diagnosis of recurrence was made by histopathologic examination, CT/MRI, Chest X-ray, intravenous pyelography. The recurrence was detected on routine follow-up in 41.0%. Comparison of Kaplan-Meyer survival curve was made with log-rank test, P-value less than 0.05 was regarded as statistically significant. RESULTS: Overall 2-year survival rate was 37.3% and median survival was 17 [13-21, 95%CI] months. Four patients survived more than 5 years. There was no significant difference among survival rates of histopathologic types, Survival rates of patients with central recurrence were significantly higher than those of lateral and distant recurrence (P= 0.009). 13 patients who did not receive any treatment after recurrence survived only for 9 [7-11] months and the survival of those were significantly lower than the survival of patients who received treatment of any kind (P<0.001). The treatment modalities after recurrence did not affect survival. CONCLUSION: We conclude that regular follow-up of cervical carcinoma patients is very important in detecting recurrence and that treatment after recurrence does affect survival of patients.
Adenocarcinoma ; Carcinoma, Adenosquamous ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Follow-Up Studies ; Humans ; Recurrence ; Survival Rate ; Thorax ; Urography