Trauma is frequently not purely penetrating or purely blunt. Such mixed trauma can result from the mechanism of injury. Recently, we encountered a patient who accidentally shot himself with a shotgun. He had a 15 x 8-cm-sized penetrating injury on left flank that did not penetrate into the peritoneal cavity and a blunt splenic injury with hemoperitoneum. Surgical and interventional treatments were performed for each injury. We present this case with a review of the related literature.
Hemoperitoneum ; Humans ; Peritoneal Cavity

Mucous gland adenoma of the bronchus is a rare benign tumor arising from the bronchial mucous gland. It accounts for less than 0.5 % of all lung tumors. In adults, tracheal tumors are most often malignant. Among benign tumors arising in the trachea, mucous gland adenoma of the trachea is extremely rare. First case was reported by Ferguson and Cleeland in 1988, as "Mucous gland adenoma of the trachea". Microscopic study shows it to arise from normal submucosal mucous glands forming glandular or tubular structures composed of mucous secreting cells. Common symptoms were cough, hemoptysis, recurrent and protracted pneumonia, shortness of breath, and wheeze. Duration of symptoms before diagnosis varied from a few weeks to 10 years with prolonged symptoms being usual. Management of these tumors should be complete excision, including pulmonary resection because two instances of recurrence after local excision have been reported.
Adenoma* ; Adult ; Bronchi ; Cough ; Diagnosis ; Dyspnea ; Hemoptysis ; Humans ; Lung ; Pneumonia ; Recurrence ; Trachea*

BACKGROUND: The Acute Physiology and Chronic Health Evaluation (APACHE) II model has been widely used in Korea. However, there have been few studies on the APACHE IV model in Korean intensive care units (ICUs). The aim of this study was to compare the ability of APACHE IV and APACHE II in predicting hospital mortality, and to investigate the ability of APACHE IV as a critical care triage criterion. METHODS: The study was designed as a prospective cohort study. Measurements of discrimination and calibration were performed using the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test respectively. We also calculated the standardized mortality ratio (SMR). RESULTS: The APACHE IV score, the Charlson Comorbidity index (CCI) score, acute respiratory distress syndrome, and unplanned ICU admissions were independently associated with hospital mortality. The calibration, discrimination, and SMR of APACHE IV were good (H = 7.67, P = 0.465; C = 3.42, P = 0.905; AUROC = 0.759; SMR = 1.00). However, the explanatory power of an APACHE IV score >93 alone on hospital mortality was low at 44.1%. The explanatory power was increased to 53.8% when the hospital mortality was predicted using a model that considers APACHE IV >93 scores, medical admission, and risk factors for CCI >3 coincidentally. However, the discriminative ability of the prediction model was unsatisfactory (C index <0.70). CONCLUSIONS: The APACHE IV presented good discrimination, calibration, and SMR for hospital mortality.
APACHE* ; Calibration ; Cohort Studies ; Comorbidity ; Critical Care ; Discrimination (Psychology) ; Hospital Mortality ; Intensive Care Units ; Korea ; Mortality* ; Prospective Studies ; Respiratory Distress Syndrome, Adult ; Risk Factors ; ROC Curve ; Tertiary Care Centers* ; Triage

STUDY DESIGN: In vitro experimental study OBJECTIVES: To examine the effect of a synovial supernatant on the cell viability, osteogenic phenotype, mRNA expression of the types collagen and various transcriptional factors on osteogenesis in ligamentum flavum (LF) cells stimulated with synovial fluid from a degenerated facet joint. LITERATURE REVIEW: In degenerative lumbar spinal stenosis, hypertrophied LF or osteoarthritic hypertrophy of a facet joint often causes neurogenic claudication. The facet joint is a synovial joint with hyaline cartilage on each side. Therefore, osteoarthritis of a facet joint eventually occurs with aging and other degenerative conditions of the spine. In lumbar spinal degeneration, inflammatory mediators or cytokines are released from the facet joint tissue, which consequently affects the adjacent LF because the LF covers posterolateral aspect of the spinal canal near facet joints. However, there are no reports on the relationship between a degenerated facet joint fluid and the LF in the lumbar spine. MATERIALS AND METHODS: LF surgical specimens were obtained from patients with a lumbar spine stenosis, and the cells were isolated by enzymatic digestion. Each of the synovium tissues were weighed and recorded. Each tissue was cut into small pieces with a pair of scissors and then washed 3 times with PBS. The washed tissue pieces were then cultured for 96 hr at 37degrees C, 5% CO2 in DMEM/F-12-0.1% FBS with a density of 200 mg/ml medium. The supernatant was collected after 96 hr. In order to measure quantitatively the proliferation of cells, the AlamarBlue assay was used. The total cellular RNA was extracted from the cells and amplification reactions specific to the following types of cDNA were performed: the osteogenic master transcription factors, Dlx5, Runx2, osterix, and types collagen and osteocalcin. Alkaline phosphatase staining for the biochemical assay and western blotting for osteocalcin protein expression were performed. RESULTS: Human LF cells cultured with the supernatant from the facet synovium showed a slightly stronger AlamarBlue staining than the intensity of the control culture. RT-PCR revealed the upregulation of the osteogenic master transcription factors, Dlx5, Runx2, and osterix in the synovium supernatant group from one hour to 72 hours, and an increase in osteocalcin, types collagen I, III, V, XI levels from one hour to one week. LF cells cultured with the supernatant from the facet synovium showed positive staining for alkaline phosphatase. The level of the osteocalcin protein in the LF cells cultured with the supernatant from the facet synovium was higher than the control group. Conclusions: The supernatant of the facet joint from patients with degenerative spinal stenosis affects LF cells by increasing the level of cellular proliferation, upregulating the mRNA expression of osteocalcin, types of collagen, osteogenic transcription factors, positive alkaline phosphatase staining, and osteocalcin protein expression. Therefore, degenerated synovial fluid from the facet joint is an important mechanism of LF hypertrophy and ossification.
Aging ; Alkaline Phosphatase ; Blotting, Western ; Cell Proliferation ; Cell Survival ; Collagen ; Constriction, Pathologic ; Cytokines ; Digestion ; DNA, Complementary ; Humans ; Hyaline Cartilage ; Hypertrophy* ; Joints ; Ligamentum Flavum* ; Osteoarthritis ; Osteocalcin ; Osteogenesis ; Phenotype ; RNA ; RNA, Messenger ; Spinal Canal ; Spinal Stenosis ; Spine ; Synovial Fluid* ; Synovial Membrane ; Transcription Factors ; Up-Regulation ; Zygapophyseal Joint

BACKGROUND: The Acute Physiology and Chronic Health Evaluation (APACHE) II model has been widely used in Korea. However, there have been few studies on the APACHE IV model in Korean intensive care units (ICUs). The aim of this study was to compare the ability of APACHE IV and APACHE II in predicting hospital mortality, and to investigate the ability of APACHE IV as a critical care triage criterion. METHODS: The study was designed as a prospective cohort study. Measurements of discrimination and calibration were performed using the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test respectively. We also calculated the standardized mortality ratio (SMR). RESULTS: The APACHE IV score, the Charlson Comorbidity index (CCI) score, acute respiratory distress syndrome, and unplanned ICU admissions were independently associated with hospital mortality. The calibration, discrimination, and SMR of APACHE IV were good (H = 7.67, P = 0.465; C = 3.42, P = 0.905; AUROC = 0.759; SMR = 1.00). However, the explanatory power of an APACHE IV score >93 alone on hospital mortality was low at 44.1%. The explanatory power was increased to 53.8% when the hospital mortality was predicted using a model that considers APACHE IV >93 scores, medical admission, and risk factors for CCI >3 coincidentally. However, the discriminative ability of the prediction model was unsatisfactory (C index <0.70). CONCLUSIONS: The APACHE IV presented good discrimination, calibration, and SMR for hospital mortality.
APACHE ; Calibration ; Cohort Studies ; Comorbidity ; Critical Care ; Discrimination (Psychology) ; Hospital Mortality ; Intensive Care Units ; Korea ; Mortality ; Prospective Studies ; Respiratory Distress Syndrome, Adult ; Risk Factors ; ROC Curve ; Tertiary Care Centers ; Triage

OBJECTIVES: The objectives of this study were to estimate the proportion of occupational lung cancer in the Busan area. METHODS: Occupational physicians of four university hospitals operating an occupational disease surveillance system in the Busan area actively interviewed all of the newly diagnosed, lung cancer cases about their characteristics and occupational histories through a survey questionnaire and chart review. To evaluate and agree on the work-relativity, the cases were presented in periodic meetings. RESULTS: A total of 301 lung cancer cases were interviewed, of which 50 (16.6%, all male, 27 probable and 23 possible) were related to occupational exposure. The exposure materials were asbestos, Cr, PAH etc. Pathologic findings included squamous cell carcinoma, adenocarcinoma and small cell carcinoma. CONCLUSIONS:The proportion of occupational lung cancer cases above the probable level was 9% and above the possible level was 17%. To develop the public health policy and to prevent further cancer death, the meaningful data from occupational cancer surveillance systems should be collected continuously for ongoing monitoring.
Adenocarcinoma ; Asbestos ; Busan* ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Hospitals, University ; Humans ; Lung Neoplasms* ; Lung* ; Male ; Occupational Diseases ; Occupational Exposure ; Occupations ; Public Health ; Questionnaires

BACKGROUND: BRCA1 (breast-cancer gene 1) is a tumor suppressor gene that accounts for nearly all families of both early onset breast and ovarian cancer and about 45% of families with breast cancer only. Sporadic nonhereditary breast cancer is recognized as the most common form of this malignancy. However, presence of germ-line mutations in the BRCA1 gene of these tumors is an infrequent event. The BRCA1 protein includes a ring domain and an acidic domain, both of which are characteristics of certain transcription factors, as well as two putative nuclear localization signals (NLS) that interact with importin-alpha. The normal BRCA1 protein is located in the nucleus of most breast-cell types whereas the BRCA1 protein of breast cancer cells is aberrantly localized in the cytoplasm. This mislocation of the BRCA1 protein in breast cancer cells may be due to defects in the NLS receptor-mediated pathway for the nuclear import of the BRCA1 gene product. Identification of importin-alpha mutations as a cellular protein responsible for the nuclear import of BRCA1 in breast-cancer cell lines and primary breast cancers is the focus of this investigation. METHODS: A series of 15 surgical samples of breast cancer and 3 samples of breast-cancer cell lines (Hs578T, ZR75-1, MCF-7) was assayed for the presence of the deletion mutant in importin-alpha by using both RT-PCR amplification of importin-alpha transcripts and sequencing analysis. RESULTS: Three of the 15 primary breast cancers and 1 of the 3 breast-cancer cell lines showing deletions in importin-alpha transcripts produced two different truncated transcripts. 1208 bp deletions were observed in transcripts from breast cancer (T-1, T-3) and ZR75-1, which is specified by the nucleotide 251-1458 of the transcript. Another transcript encoded by primary breast cancer (T-2) included a 1312 bp deletion in the nucleotide 61-1372 of the transcript. CONCLUSIONS: The deletions eliminated part of the importin-alpha transcript segment encoding the putative NLS-binding domain but not the importin-beta binding domain, suggesting that these deletion mutants could not bind to NLS of the BRCA1 protein. These results suggest that the composite effects of mislocationof the BRCA1 protein by deletion of the NLS-binding domain in importin-alpha may contribute to tumorigenesis in sporadic breast cancer.
Active Transport, Cell Nucleus ; alpha Karyopherins* ; Alternative Splicing ; beta Karyopherins ; BRCA1 Protein ; Breast Neoplasms* ; Breast* ; Carcinogenesis ; Cell Line ; Cytoplasm ; Genes, BRCA1 ; Genes, Tumor Suppressor ; Germ-Line Mutation ; Humans ; Nuclear Localization Signals ; Ovarian Neoplasms ; Transcription Factors