PURPOSE: To evaluate the results of postoperative radiotherapy in patients with extra-hepatic bile duct cancer (EHBDC) and identify the prognostic factors for local control and survival. MATERIALS AND METHODS: Between January 2001 and December 2010, we retrospectively reviewed the cases of 70 patients with EHBDC who had undergone curative resection and received postoperative radiotherapy. The median radiation dose was 50.4 Gy (range, 41.4 to 54 Gy). The resection margin status was R0 in 30 patients (42.9%), R1 in 25 patients (35.7%), and R2 in 15 patients (21.4%). RESULTS: The 5-year rates of overall survival (OS), event-free survival (EFS), and locoregional control (LRC) for all patients were 42.9%, 38.3%, and 61.2%, respectively. The major pattern of failure was distant relapses (33 patients, 47.1%). A multivariate analysis showed that the postradiotherapy CA19-9 level, radiation dose (> or =50 Gy), R2 resection margins, perineural invasion, and T stage were the significant prognostic factors for OS, EFS, and LRC. OS was not significantly different between the patients receiving R0 and R1 resections, but was significantly lower among those receiving R2 resection (54.6%, 56.1%, and 7.1% for R0, R1, and R2 resections, respectively). CONCLUSION: In patients with EHBDC who had undergone curative resection, a postoperative radiotherapy dose less than 50 Gy was suboptimal for OS and LRC. Higher radiation doses may be needed to obtain better LRC. Further investigation of novel therapy or palliative treatment should be considered for patients receiving R2 resection.
Bile Duct Neoplasms* ; Bile Ducts* ; Bile* ; Disease-Free Survival ; Humans ; Multivariate Analysis ; Palliative Care ; Radiotherapy Dosage ; Radiotherapy* ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies

PURPOSE: The present study evaluated whether oral supplementation with a branched-chain amino acid (BCAA) improves the biochemical and amino acid profiles of liver tumor patients undergoing radiotherapy. MATERIALS AND METHODS: Patients were randomly assigned to one of 2 groups: a group given oral supplementation with BCAA granules (LIVACT granules; Samil Pharm Co., Korea, each granule containing L-isoleucine 952 mg, L-leucine 1,904 mg, and L-valine 1,144 mg) during radiotherapy, or a placebo group. Physical and biochemical examinations and measurements, including subjective symptoms, Child-Pugh class, body mass index, plasma albumin concentration, and plasma amino acid profiles were monitored. RESULTS: Fifty were enrolled between November 2005 and November 2006. We also analyzed data from 37 hepatocellular carcinoma (HCC) patients in order to evaluate a more homogenous group. The two groups of patients were comparable in terms of age, gender, Child-Pugh score, and underlying hepatitis virus type. Serum albumin, total protein, liver enzymes, and cholesterol showed a tendency to increase in the BCAA group. In this group, the percentage of cases that reverted to normal serum albumin levels between 3 and 10 weeks after administration of BCAA was significantly higher (41.18%) than in the placebo group (p=0.043). CONCLUSION: Oral supplementation with a BCAA preparation seems to help HCC patients undergoing radiotherapy by increasing the BCAA concentration.
Amino Acids, Branched-Chain ; Body Mass Index ; Carcinoma, Hepatocellular ; Cholesterol ; Hepatitis Viruses ; Humans ; Isoleucine ; Korea ; Leucine ; Liver ; Oxytetracycline ; Plasma ; Serum Albumin ; Valine

PURPOSE: The present study evaluated whether oral supplementation with a branched-chain amino acid (BCAA) improves the biochemical and amino acid profiles of liver tumor patients undergoing radiotherapy. MATERIALS AND METHODS: Patients were randomly assigned to one of 2 groups: a group given oral supplementation with BCAA granules (LIVACT granules; Samil Pharm Co., Korea, each granule containing L-isoleucine 952 mg, L-leucine 1,904 mg, and L-valine 1,144 mg) during radiotherapy, or a placebo group. Physical and biochemical examinations and measurements, including subjective symptoms, Child-Pugh class, body mass index, plasma albumin concentration, and plasma amino acid profiles were monitored. RESULTS: Fifty were enrolled between November 2005 and November 2006. We also analyzed data from 37 hepatocellular carcinoma (HCC) patients in order to evaluate a more homogenous group. The two groups of patients were comparable in terms of age, gender, Child-Pugh score, and underlying hepatitis virus type. Serum albumin, total protein, liver enzymes, and cholesterol showed a tendency to increase in the BCAA group. In this group, the percentage of cases that reverted to normal serum albumin levels between 3 and 10 weeks after administration of BCAA was significantly higher (41.18%) than in the placebo group (p=0.043). CONCLUSION: Oral supplementation with a BCAA preparation seems to help HCC patients undergoing radiotherapy by increasing the BCAA concentration.
Amino Acids, Branched-Chain ; Body Mass Index ; Carcinoma, Hepatocellular ; Cholesterol ; Hepatitis Viruses ; Humans ; Isoleucine ; Korea ; Leucine ; Liver ; Oxytetracycline ; Plasma ; Serum Albumin ; Valine

BACKGROUND: Long-chain triglyceride/medium-chain triglyceride (LCT/MCT) propofol is less painful than standard long chain triglyceride (LCT) propofol; however, there is still a need to reduce severe pain. 5-Hydroxytryptamine type 3 (5-HT3) receptor antagonists have an analgesic effect during the injection of standard LCT propofol. This study compared the incidence of moderate-to-severe injection pain with LCT/MCT propofol using pretreatment with palonosetron versus pretreatment with saline or lidocaine. METHODS: This prospective, randomized double-blind study divided 98 patients scheduled for general anesthesia into three groups: control (n = 33), palonosetron (n = 32), and lidocaine (n = 33) groups. An 18-gauge intravenous catheter was inserted into the peripheral vein at the dorsum of the hand. The patient's vein was occluded by a rubber tourniquet at mid-forearm, and we then administered 2 ml of the pretreatment drug. One minute after venous occlusion, we released the tourniquet and administered LCT/MCT propofol 2 mg/kg for 10-15 seconds. The degree of pain on propofol injection was evaluated using a 4-point scale. RESULTS: The incidence of moderate-to-severe pain in the control, palonosetron, and lidocaine groups was 9.1, 15.6, and 12.1%, respectively. The incidence of overall pain was lower in the lidocaine group than in the control or palonosetron group. CONCLUSIONS: Palonosetron and lidocaine pretreatment does not reduce moderate-to-severe pain on injection of 1% LCT/MCT propofol. Lidocaine pretreatment reduced the overall incidence of injection pain.
Anesthesia, General ; Catheters ; Double-Blind Method ; Hand ; Humans ; Incidence ; Lidocaine* ; Propofol* ; Prospective Studies ; Rubber ; Serotonin ; Tourniquets ; Triglycerides ; Veins

Systemic lupus erythematosus (SLE) is a chronic and multisystemic disease. Pleuropulmonary disease in SLE has various clinical manifestations, such as immunologic pneumonia, infectious pneumonia, interstitial lung disease, pulmonary hypertension, pulmonary hemorrhage, pleuritis and pleural effusion. It can manifest as an initial clinical finding of SLE. We experienced two cases; one case of pulmonary hemorrhage and one case of atypical pneumonia as an initial clinical manifestation of SLE.
Hemorrhage ; Hypertension, Pulmonary ; Lung Diseases ; Lung Diseases, Interstitial ; Lupus Erythematosus, Systemic* ; Pleural Effusion ; Pleurisy ; Pneumonia

Spontaneous intestinal perforation is characterized by isolated mucosal ulceration with acute inflammation, submucosal edema and serosal inflammation, and considered as a separate clinical entity from necrotizing enterocolitis. The causes of spontaneous intestinal perforation are administration of indomethacin, dexamethasone, umbilical artery catheterization, defect of intestinal musculature, and systemic candidasis. Intestinal perforation caused by defects of intestinal musculature is rare, and its pathogenesis remains uncertain. The authors report one case of a premature infant with defect in intestinal musculature confirmed through postoperation biopsy who was misdiagnosed as intestinal perforation due to necrotizing enterocolitis.
Biopsy ; Catheterization ; Catheters ; Dexamethasone ; Edema ; Enterocolitis, Necrotizing ; Humans ; Indomethacin ; Infant, Newborn ; Infant, Premature ; Inflammation ; Intestinal Perforation* ; Ulcer ; Umbilical Arteries

Fixed drug eruption (FDE) is an eruption, which recurs at the same site or sites on each administration of the causative drug, and heals with residual hyperpigmentation. FDE is caused by many drugs, barbiturates, tetracyclines, sulfonamide, and phenolphthalein. Salicylate and nonsteroidal anti-inflammatory drugs (NSAIDs) also cause FDE, but acetaminophen does so only rarely. A 9-year-old girl presented with a 3-year-history of symptomatic pigmented macules on her face, abdomen, and extremities. The eruption was first appeared three years ago, which was when she took medicine after she was discharged following suspicions of Kawasaki disease. Thereafter, she had the same eruption on the same sites when she took medicine for common colds including acetaminophen and ibuprofen. The oral challenge provocation test for ibuprofen was negative, whereas for acetaminophen it was positive. We report a rare case of FDE due to acetaminophen with clinical findings and results of oral challenge test.
Abdomen ; Acetaminophen* ; Barbiturates ; Child* ; Common Cold ; Drug Eruptions* ; Extremities ; Female ; Humans ; Hyperpigmentation ; Ibuprofen ; Mucocutaneous Lymph Node Syndrome ; Phenolphthalein ; Tetracyclines

BACKGROUND AND OBJECTIVES: Several recent studies have shown that there is an inverse relationship between plasma B-type natriuretic peptide (BNP) and body mass index (BMI) in subjects with and without heart failure. Obesity frequently coexists with diabetes, so it is important to consider the relationship between diabetes and natriuretic peptide levels. We evaluated the influence of diabetes on the correlation of BNP and BMI. SUBJECTS AND METHODS: We examined 933 patients with chest pain and/or dyspnea undergoing cardiac catheterization between Feb. 2006 and Nov. 2007 in the Maryknoll cardiac center who had creatinine levels <2.0 mg/dL and normal systolic heart function. BMI was checked, transthoracic echocardiography was performed, and aminoterminal pro-brain natriuretic peptide (NT-proBNP) was sampled at the start of each case. RESULTS: In 733 non-diabetic patients, mean plasma NT-proBNP levels of non obese individuals (BMI <23 kg/m2), overweight individuals (23< or = BMI <25 kg/m2), and obese individuals (BMI > or =25 kg/m2) showed a significant negative correlation with increasing BMI (856.39+/-237.3 pg/mL, 601.69+/-159.6 pg/mL, 289.62+/-164.9 pg/mL, respectively, p<0.0001). However, in 200 diabetic patients, the correlation between BMI and NT-proBNP was not significant (r=-0.21, p=0.19), and NT-proBNP did not correlate with mitral E/Ea in obese diabetic patients (r=0.14, p=0.56). NT-proBNP was significantly correlated with mitral E/Ea in the non-obese (r=0.24, p=0.008) and non diabetic (r=0.32, p=0.003) groups. Left ventricular (LV) mass index was significantly correlated with NT-proBNP in all BMI groups (r=0.61, p<0.001), and patients with concentric cardiac hypertrophy showed the highest NT-proBNP levels. CONCLUSION: The present study demonstrates that obese patients have reduced concentrations of NT-proBNP compared to non obese patients despite having higher LV filling pressures. However, NT-proBNP is not suppressed in obese patients with diabetes. This suggests that factors other than cardiac status affect NT-proBNP concentrations.
Body Mass Index ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomegaly ; Chest Pain ; Creatinine ; Dyspnea ; Echocardiography ; Heart ; Heart Failure ; Humans ; Natriuretic Peptide, Brain ; Obesity ; Overweight ; Peptide Fragments ; Plasma

PURPOSE: Fas is a cell surface receptor that transduces apoptotic death signals. Interaction of extracelluar domain of Fas with Fas ligand(FasL) triggers the apoptotic process in many diseases. We investigated the expression of Fas and FasL in the hippocampus of 7-day-old newborn rat brains following hypoxia-ischemia injury. METHODS: The 7-days-old newborn rats were exposed to 8 percent oxygen for two hours after the ligation of right common carotid arteries. The newborn rats were killed and their brains were removed at 12, 14 and 48 hours after hypoxic-ischemic injury. The expressions of Fas and FasL of the right hippocampus were observed by western blotting and immunofluorescent staining. RESULTS: Fas and FasL were strongly expressed in the right hippocampus ipsilateral to the ligation of the common carotid artery by western blotting at 12 hours following hypoxic-ischemic injury, and then slowly decreased. The immunofluorescent expressions of Fas and FasL strongly increased in the CA1 area of the right hippocampus at 12 and 24 hours following hypoxic-ischemic injury. The immunofluorescent expression of Fas decreased at 48 hours, but the expression of FasL persisted strongly at 48 hours following hypoxic-ischemic injury. CONCLUSION: The interaction of Fas with FasL on the cell surface may be involved in neuronal injury following hypoxic-ischemic injury in the developing brain.
Animals ; Anoxia ; Blotting, Western ; Brain* ; Carotid Artery, Common ; Fas Ligand Protein ; Hippocampus* ; Humans ; Infant, Newborn ; Ischemia ; Ligation ; Neurons ; Oxygen ; Rats*

One hundred and forty-nine infertile women underwent hysterosalpingography and di-agnostic laparoscopy as a part of their infertility work up at the Kwangju Christian Hospi-tal. The diagnostic value of hysterosalpingography was compared with diagnostic laparos- copy. It was found that hysterosalpingography is a sensitive means to determine tubal pat- ency. However, diagnostic laparoscopy revealed peritubal adhesion in 25.5% of patients, wh- ereas hysterosalpingography made an accurate diagnosis in only 10.5%. And in 61.7% of the cases, there was complete agreement between hysterosalpingogr- aphy and diagnostic laparoscopy. It is concluded that hysterosalpingography is a simple and non-invasive and useful method of assessing the tubal patency, and should remain an integral part of female infert- ility investigation. Diagnostic laparoscopy is a more useful method to evaluate pelvic patho- logy than hysterosalpingography, and thus should always be performed whenever a periton- eal factor is suspected in female infertility.
Diagnosis ; Female ; Fibrinogen ; Gwangju ; Humans ; Hysterosalpingography ; Infertility ; Infertility, Female ; Laparoscopy*