Apoptosis is a crucial mechanism for the selective elimination of mammalian cells and is involved in many physiological and pathological processes. The heightened awareness of the importance of apoptosis has increased the need for rapid and quantitative methods for measurement of apoptotic changes. Recently, 7-amino-actinomycin D (7-AAD) has been introduced as a valuable fluorescent dye for assessing apoptosis by flow cytometry. When the cells are stained with 7-AAD in the concentration of 10 - 20 ug/ml, live cells are not stained (7-AAD ) and early apoptotic cells are weakly stained (7-AAD ) while late apoptotic or dead cells are stained brightly (7-AAD). On scattergram of forward angle light scatter vs. 7-AAD fluorescence, the three populations can be discriminated not only between each other but also from cell debris or clumps. The apoptotic cells, defined as 7- AAD cells, were demonstrated as apoptotic by morphological observation of the sorted cells. The 7-AAD cell fraction was also demonstrated to be parallel with subdiploid fraction of cells stained with PL However, 7-AAD cells, whose definition is based on the alteration of membrane integrity, have never been demonstrated to be subdiploid fraction by simultaneous DNA staining. Here we directly demonstrate that 7-AAD cells, defined on the scattergram of forward angle light scatter vs. 7-AAD fluorescence, are subdiploid fraction by staining with DNA dye whose fluorescence is collected after 530/30 band pass filter (FL-1). We also demonstrate the effects of 7-AAD concentration, fixation of cells, and proliferation of cells, on the fluorescence pattern, for reference during assessment of apoptosis by simple and rapid method for flow cytometric analysis of cells stained with 7- AAD. We also present a flow cytometric analysis of cells stained with 7-AAD Eor sequential change in apoptotic fraction, with concurrent dual-color immunophenotyping.
Apoptosis* ; DNA ; Flow Cytometry* ; Fluorescence ; Fluorescent Antibody Technique* ; Immunophenotyping ; Membranes ; Pathologic Processes

No abstract available.
Korea* ; Tuberculosis*

We performed tendon transfer with a microvascular free flap for recovery of handicapped function and reconstruction for the skin and soft tissue loss. We review the clinical data of 11 children who underwent these operation due to injured foot by pedestrian car accident from January, 1986 to June, l994. The mean age of patients was 5.6 years old (3-8). Five cases underwent tendon transfer and microvascular free flap simultaneously. Another 6 cases underwent operations separately. The time interval between tendon trasnfer and microvascular free flap was average 5.8 months (2-15 months). The duration between initial trauma and tendon transfer was average 9.6 months (2-21 months). The anterior tibial tendon was used in 6 cases. Among these, the technique of splitting the anterior tibial tendon was used in 5 cases. The posterior tibial tendon was used in 3 cases and the extensor digitorum longus tendon of the foot in 2 cases. Insertion sites of tendon transfer were the cuboid bone in 3 cases, the 3rd cuneiform bone in 3 cases, the 2nd cuneiform bone in I case, the base of 4th metatarsal bone in I case, and the remnant of the extensor hallucis longus in 3 cases. The duration of follow-up was average 29.9 months (12-102 months). The clinical results were analyzed by Srinivasan criteria. Nine cases were excellent and 2 cases were good. The postoperative complications were loosening of the tranferred tendon in 2 cases, plantar flexion contracture in l case, mild flat foot deformity in I case and hypertrophic scar in 2 cases. So we recommend the tendon transfer with a microvascular free flap in the case of injured foot of children combined with nerve injury and extensive loss of skin, soft tissue and tendon.
Child* ; Cicatrix, Hypertrophic ; Congenital Abnormalities ; Contracture ; Disabled Persons ; Flatfoot ; Follow-Up Studies ; Foot* ; Free Tissue Flaps* ; Humans ; Metatarsal Bones ; Postoperative Complications ; Skin ; Tarsal Bones ; Tendon Transfer* ; Tendons*

BACKGROUND: The number of patients of doxylamine overdose has increased, but there were little clinical reports. The purpose of this study is review the patients of doxylamine overdose for aid clinical decision making of patients disposition. METHODS: We reviewed medical records of patients who ingested doxylamine succinate retrospectively from Jan. 1, 1996 to Dec. 31. 1996. Data that was recorded were followed: age, sex, psychiatric history, amounts of ingestion, time interval from ingestion to arrival to hospital, initial vital signs and symptoms, EKG, chest PA, Lab. findings, treatment, patients disposition, length of hospital stay, complication. RESULTS : 1) Total number of patients was ninety and average dosage of ingestion was 1062mg. 2) Tachycardia was the most frequent anticholinergic symptom(46%). 3) Routine lab. findings was not abnormal except one patient who was diagnosed as Rhabdomyolysis. 4) Gut decontamination was performed in patients who had arrived at hospital in 2-3 hours, and who had ingested large dose of drug. 5) Five patients were admitted to Psychiatric dept. and one patient was admitted to emergency dept. for treatment of rhabdomyolysis. 6) The mean duration of hospital stay was 6.5 hours. CONCLUSION: The patients who ingested overdose of doxylamine was managed safely in emergency department, but we should warn against the possibility of rhabdomyolysis.
Decision Making ; Decontamination ; Doxylamine* ; Eating ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Humans ; Length of Stay ; Medical Records ; Retrospective Studies ; Rhabdomyolysis ; Succinic Acid* ; Tachycardia ; Thorax ; Vital Signs

Intersphincteric resection (ISR) is the ultimate sphincter saving procedure for low rectal cancer. Hemorrhoids are a common benign condition. We present and discuss a case of ISR which developed painful edematous hemorrhoids after ISR. A 62-year-old female with low rectal cancer received neoadjuvant chemoradiotherapy with successful down staging of tumor before undergoing robot assisted ISR with coloanal hand-sewn anastomosis. She had pre-existing external hemorrhoids which were not excised. She developed painful and edematous external hemorrhoids 4 days after surgery. These were treated conservatively before discharge. Many colorectal surgeons performing ISR have experienced similar situations in their patients, but none have reported on this phenomenon. We discuss the possible factors that may contribute to this situation. A possible solution is prophylactic excision of the hemorrhoids during coloanal anastomosis. Painful hemorrhoids may occur after ISR and if managed conservatively, the outcome is skin tags.
Chemoradiotherapy ; Female ; Hemorrhoids ; Humans ; Middle Aged ; Rectal Neoplasms ; Skin

BACKGROUND: Do-Not-Resuscitate(DNR) order has been used without specific legislation commonly in hospitals of Korea. We designed this study to assess the current use of DNR order in the emergency department and to make a database for establishing a policy for DNR order, especially in ER. METHODS: We retrospectively reviewed medical records of 164 patients who expired in the emergency department of Severance hospital from Sep. 1996 to Aug. 1997. We evaluated age, sex, diagnosis, specific department involved, whether written orders were made and medical care after decision of DNR. The patients were divided into 2 groups : DNR vs CPR. To determine factors influencing DNR decision, we searched for presence of malignancy, irreversible shock, unconsciousness and chronic illness. The logistic regression analysis was used for statistical significance. RESULTS: We found that 102(62.2%) out of 164 expired patients had a DNR order. But only in 59% of cases, were written DNR order on the chart. Factors which had the most influence on decision of DNR were malignancy and age. The sex, chronic illness, irreversible shock, and unconsciousness were not significant factors. CONCLUSION: We found malignancy and old age as an important factor when DNR order had been made. But further evaluation of other factors may be necessary to establish definitely a policy for DNR order.
Cardiopulmonary Resuscitation ; Chronic Disease ; Diagnosis ; Emergency Service, Hospital ; Humans ; Korea ; Logistic Models ; Medical Records ; Retrospective Studies* ; Shock ; Unconsciousness

No abstract available.
Abortion, Induced* ; Abortion, Spontaneous/genetics* ; Adult ; Chromosome Aberrations/epidemiology* ; Chromosome Disorders ; Female ; Human ; Korea ; Pregnancy ; Pregnancy Trimester, First

PURPOSE: Although some limitations of conventional laparoscopy have been overcome by the enhanced dexterity of a robotic system, few studies have reported the use of robotic surgery for rectal cancer. This study analyzed prospectively the safety, morbidity, mortality and operation time of a robotic rectal resection for rectal cancer. METHODS: The data of 185 consecutive patients, who had undergone robotic rectal resection for rectal cancer at Korea University Aanam Hospital from July 2007 to April 2011, was analyzed prospectively. The postoperative outcomes and operative times were evaluated. RESULTS: Robotic rectal resection using a da Vinci surgical system was performed on 185 patients. There were 115 low anterior resections, 5 anterior resections, 1 Hartmann's operation, 10 ultra-low anterior resections, 43 intersphincteric resections and 11 abdominoperineal resections. The median hospital stay was 9 days. The overall morbidity rate was 33.4%. There was one conversion to open surgery. The mean passage of flatus was noted on postoperative day 2.0, diet was started on postoperative day 2.3 and the mean postoperative hospital stay was 13.7 days. The mean number of retrieved lymph nodes was 16. The total operation time decreased with increasing operator experience (306 min vs 285 min vs 268 min, p=0.009). CONCLUSION: A robotic rectal resection is feasible and safe for rectal cancer patients. The data showed an acceptable morbidity and mortality rate compared to the short term results of conventional laparoscopic and open surgery reported previously. Nevertheless, the oncologic and functional benefits of robotic colorectal surgery should be evaluated through a large scale study.
Colorectal Surgery ; Conversion to Open Surgery ; Diet ; Flatulence ; Humans ; Korea ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Operative Time ; Prospective Studies ; Rectal Neoplasms

We evaluated the efficacy of polymerase chain reaction(PCR)in the early diagnosis of Herpes simplex virus keratitis(HSK). Among 47 patients(47 eyes), 25 patients were clinically herpetic keratitis and the others were other kinds of keratitis clinically. Tear film specimens were taken from 32 eyes and corneal scrapings from 21 eyes with suspicious herpetic keratitis and clinically incongrous with HSK. PCR for tear and corneal scraping was performed with using DNA primer. 67% of corneal scrapings and 19%tear samples of suspicious herpetic keratitis showed PCR positive. Tear samples from keratitis clinically incongruous with HSK were all PCR negative but 40%of corneal scrapings from these patients represented PCR positive. From these results, PCR is a rapid and effective tool for the early diagnosis of herpetic keratitis and especially useful in cases of nonspecific corneal lesion. However, for the accurate diagnosis of HSK, not only PCR results but also patient's history and corneal findings should be well evaluated.
Diagnosis ; DNA ; Early Diagnosis* ; Humans ; Keratitis ; Keratitis, Herpetic ; Polymerase Chain Reaction* ; Simplexvirus ; Tears

PURPOSE: We evaluated ocular penetration and drug level in tear after topical ofloxacin instillation in rabbit eye with amniotic membrane transplantation(AMT). METHODS: In the first set of experiment, 24 rabbits(24 eyes) were divided into 4 groups according to the epithelial removal or AMT. Topical ofloxacin was instilled 4 times every 15 minutes and then, 1 hour after the last eyedrop, the samples of amniotic membrane(AM), cornea and aqueous humor were collected. In the second set of experiment, 24 rabbits(24 eyes) were divided into 6 groups according to the freshness of AM or its attached time. Topical ofloxacin was applied to eyes and then, tear samples were collected at 30 minutes, 1, 2, 4, and 6 hours. Ofloxacin concentration in the samples of two experiments were evaluated using high performance liquid chromatography. RESULTS: Mean ofloxacin concentrations in cornea and aqueous humor were statistically higher in deepithelized corneas regardless of AMT(P<0.05). And mean tear levels of ofloxacin in AMT groups were statistically higher than those in non-AMT groups(P<0.05). CONCLUSIONS: AMT seems to interfere with the ocular penetration of topical ofloxacin in normal rabbit cornea, but rather enhances ofloxacin penetration in the cornea with epithelial defect. And also the ofloxacin level in tear was higher in eyes with AMT up to 1 hour after topical ofloxacin use. Therefore it seems that AM has potential to act as an effective drug delivery system.
Amnion* ; Aqueous Humor ; Chromatography, Liquid ; Cornea ; Drug Delivery Systems ; Ofloxacin*