CD44 is a hyaluronic acid receptor that exists as a standard 90-kd form (CD44H) as well as several CD44 variants isoforms are produced through alternative splicing. Alternatively spliced variants of the CD44 molecule have been found to be associated with invasive and metastatic potential of cancer cells and poor prognosis in several types of carcinoma. The purpose of the present study is to define the expression of CD44H and CD44v6 in ovarian tumors and to investigate whether the expression of these molecules is associated with adverse prognosis. We evaluated the expression of CD44 isoforms in 58 ovarian tumors by means of immunohistochemistry, and correlated between CD44 expression and the histologic types, tumor grade, peritoneal implants, pseudomyxoma peritonei and FIGO stage. While the CD44H was commonly expressed in ovarian tumors, the CD44v6 was expressed in a minor proportion of serous tumors in comparison with frequent expression of v6 isoform in mucinous tumors. The CD44H expression was significantly higher in stage I/II than in stage III. However, there was no correlation between the expression of CD44 and the presence of peritoneal implants or pseudomyxoma peritonei. These results suggest that CD44H could play an important role in the adhesive function in the lower stage of the ovarian tumor and reduced expression in the higher stage might be related to the metastasis and widespread invasion of ovarian carcinoma cells.
Adhesives ; Alternative Splicing ; Female ; Hyaluronic Acid ; Immunohistochemistry ; Mucins ; Neoplasm Metastasis ; Ovary ; Prognosis ; Protein Isoforms ; Pseudomyxoma Peritonei

A case of Wegener's granulomatosis is described, with special attention focused on the typical histologic findings and involvement of both middle ear and lung. The patient is a 37-year-old man presented with four-month history of cough and sputum. He had a past history of surgery of both ears because of otitis media followed by left facial palsy. Chest radiographs showed variable sized ill defined nodules in both lower lobes with internal airspace consolidation. Histologic preparations of the open lung biopsy specimens demonstrated a diffusely scattered palisading micro and macrogranulomas with central focus of neutrophils and necrotic collagen surrounded by histiocytes, histiocytic giant cells. Fibrinoid necrosis involved blood vessels and lung parenchyma. Chronic inflammation, diffuse granulation tissue formation and irregular fibrosis are also found in the lung parenchyma. The histologic findings of middle ear which was previously biopsied showed scattered palisading ill defined microgranulomas mixed with fibrotic tissue.
Adult ; Biopsy ; Blood Vessels ; Collagen ; Cough ; Ear ; Ear, Middle* ; Facial Paralysis ; Fibrosis ; Giant Cells ; Granulation Tissue ; Granuloma ; Histiocytes ; Humans ; Inflammation ; Lung* ; Necrosis ; Neutrophils ; Otitis Media ; Radiography, Thoracic ; Sputum ; Vasculitis ; Wegener Granulomatosis*

Objective: This study aimed to develop texture-modified soups and classify them based on the International Dysphagia Diet Standardization (IDDSI) and National Dysphagia Diet (NDD) criteria. Methods: Ten soups were selected, and a xanthan gum-based thickener was added to adjust their viscosity. Flow tests with a 10 ml syringe and viscosity measurements using a rheometer were carried out according to the IDDSI and NDD criteria. Results: The addition of 1 g of thickener to the selected commercial soups resulted in different viscosity levels depending on the soup type. Under the IDDSI framework, seven soups (R SMG, BMG, KHG, SLT, B SUG, BGG, DGT) were categorized as level 1, two soups (B MYG, ADG) as level 2, and one soup (R DJJ) as level 3. As per NDD guidelines, seven soups (R SMG, BMG, KHG, SLT, B SUG, BGG, DGT) were classified as Nectar-like and three soups (R DJJ, B MYG, ADG) as Honey-like. However, the addition of 2 g of thickener decreased the fluidity of the soups, with two soups (R SMG, SLT) being classified as level 2 and eight soups (R BMG, DJJ, KHG, B SUG, MYG, ADG, BGG, DGT) as level 3 under the IDDSI criteria. Meanwhile, all soups were classified as Honey-like under the NDD criteria. Conclusion The viscosity was different due to the varying compositions of guk/tang/jjigae, the concentration of the thickener, and time. Swallowing standardsands and other guidelines applicable specifically to Korean-food for dysphagia patients need to be developed in a further study.

Insomnia is one of the most common sleep disorders, which is leading to significant clinical distress and impairment of daytime functioning and decreasing quality of life. This article reviews the current clinical treatment options of insomnia. Non-pharmacological treatment including stimulus control, sleep restriction, cognitive therapy, relaxation training, and education of sleep hygiene should be considered first for treatment of insomnia. Psychological and behavioral interventions tend to have longer-lasting treatment benefits, while drugs show immediate improvement of sleep disturbance. In pharmacotherapy, benzodiazepine receptor agonist, melatonin receptor antagonist, and 'off-label' drugs to treat insomnia are reviewed.
Behavior Therapy ; Cognitive Therapy ; Drug Therapy ; Quality of Life ; Relaxation ; Sleep Initiation and Maintenance Disorders* ; Sleep Wake Disorders

Extrarenal Wilms' tumor is a very exceptional tumor which is defined as Wilms' tumor found anywhere other than in the kidneys. Until now less than 60 cases have been reported in the English literature. The tumor can be located in the retroperitoneum, inguinal canal, uterus, cervix, testes, skin and even in the thorax. The diagnosis is almost always made after surgical intervention. Distant metastasis of this tumor has only been reported in the case of a 6-year-old girl who developed Wilms' tumor in the inguinal canal with lung involvement. In this paper we report a case of extrarenal Wilms' tumor in retroperitoneum with distant metastasis to lungs, ribs and pelvic bone in a 6- year old male. The tumor was successfully removed without tumor cell spillage. The patient was diagnosed as favorable histologic group, in which the tumor consists of epithelial, blastemal and mesenchymal components without teratomatous elements. He received combination chemotherapy according to NWTS-IV guidelines and radiation to involved lungs, and has been alive and well for the last 6 months without severe complication or relapse.
Cervix Uteri ; Child ; Diagnosis ; Drug Therapy, Combination ; Female ; Humans ; Inguinal Canal ; Kidney ; Lung* ; Male ; Neoplasm Metastasis* ; Pelvic Bones ; Recurrence ; Ribs ; Skin ; Testis ; Thorax ; Uterus ; Wilms Tumor*

OBJECTIVE: This study was to evaluate the association of the G1691A mutation of factor V gene with preeclamptic patients in Korea. METHODS: Factor V genotype were determined in 113 preeclamptic patients and 100 normotensive pregnant women. A 267 base-pair DNA fragment of the factor V gene that includes nucleotide 1691 was amplified by PCR. PCR product was digested with MnlI restriction enzyme and the fragments were analysed by electrophoresis using 2% agarose gel. RESULTS: The difference of genetic and allelic frequencies between two groups could not be mentioned because all women were G1691G homozygotes. There was no individuals with mutant allele among preeclamptic patients and control women. CONCLUSION: There was no evidence of association between preeclampsia and factor V gene polymor- phism in Korean population.
Alleles ; DNA ; Electrophoresis ; Factor V* ; Female ; Genotype ; Homozygote ; Humans ; Korea* ; Polymerase Chain Reaction ; Pre-Eclampsia ; Pregnant Women ; Sepharose

PURPOSE: The measurement of radiation absorbed dose is useful to predict the response after I-131 labeled metaiodobenzylguanidine (MIBG) therapy and determine therapy dose in patients with unresectable or malignant pheochromocytoma. We estimated the absorbed dose in tumor tissue after high dose I-131 MIBG in a patient with pheochromocytoma using a gamma camera and Medical Internal Radiation Dose (MIRD) formula. MATERIALS AND METHODS: A 64-year old female patient with pheochromocytoma who had multiple metastases of mediastinum, right kidney and periaortic lymph nodes, received 74 GBq (200 mCi) of I-131 MIBG. We obtained anterior and posterior images at 0.5, 16, 24, 64 and 145 hours after treatment. Two standard sources of 37 and 74 MBq of I-131 were imaged simultaneously. Cummulated I-131 MIBG uptake in tumor tissue was calculated after the correction of background activity, attenuation, system sensitivity and count loss at a high count rate. RESULTS: The calculated absorbed radiation dose was 32-63 Gy/ 74 GBq, which was lower than the known dose for tumor remission (150-200 Gy). Follow-up studies at 1 month showed minimally reduced tumor size on computed tomography, and mildly reduced I-131 MIBG uptake. CONCLUSION: We estimated radiation absorbed dose after therapeutic I-131 MIBG using a gamma camera and MIRD formula, which can be peformed in a clinical nuclear medicine laboratory. Our RESULTS suggest that the measurement of radiation absorbed dose in I-131 MIBG therapy is feasible as a routine clinical practice that can guide further treatment plan. The accuracy of dose measurement and correlation with clinical outcome should be evaluated further.
3-Iodobenzylguanidine ; Female ; Follow-Up Studies ; Gamma Cameras ; Humans ; Kidney ; Lymph Nodes ; Mediastinum ; Middle Aged ; Neoplasm Metastasis ; Nuclear Medicine ; Pheochromocytoma

BACKGROUND AND OBJECTIVES: Angiotensin -converting enzyme (ACE) inactivates bradykinin, substance P, and neurokinin A, which are thought to play important roles in the pathogenesis of inflammatory diseases. An insertion/deletion (I/D) poly - morphism in the ACE gene was reported to be associated with atopy in a Czech population. MATERIALS AND METHODS: Using the polymerase chain reaction, we investigated the frequencies of the genotypes and alleles of the ACE gene in 137 patients with allergic rhinitis and 498 healthy control subjects. RESULTS: There was no difference in the frequencies of the genotypes in the controls and patients with allergic rhinitis (p>0.05). The D allele was more frequent in patients with allergic rhinitis, but the difference was not statistically significant (p>0.05). CONCLUSION: Our results indicate that I/D polymorphism in the ACE gene is not related to susceptibility to allergic rhinitis in the Korean population.
Alleles ; Angiotensins ; Bradykinin ; Genotype ; Humans ; Neurokinin A ; Polymerase Chain Reaction ; Rhinitis* ; Substance P

PURPOSE: A circular stapled hemorrhoidectomy involves the simultaneous excision of hemorrhoids and wound closure without perianal dissection, thereby eliminating a potential contamination of the anal wound. This study was designed to investigate whether a closed hemorrhoidectomy using the circular stapled technique offers any advantage over the conventional technique. METHODS: Twenty-three patients with prolapsed symptomatic hemorrhoids were treated by either a conventional (n=13) (conventional group) or a circular stapled (n=11) hemorrhoidectomy (stapled group). The operation time was recorded and the excised tissue was examined histologically. The pain score, any complications, the number of days before returning to normal activity and the patients' satisfaction were recorded. A follow up was done using a questionnaire or by telephone interview a week after the operation, and satisfaction was checked a month after the operation. RESULTS: The conventional operation was quicker to perform (mean 23.1 min vs 26.8 min), but did not reach a significant value (P>0.05). In the stapled group, the analgesic requirement was less than for the conventional group (4.4 times vs 6.9 times), but again did not reach a significant value (P>0.05). There were 4 cases of postoperative complications in the conventional group (30.7%) and 3 cases in the stapled group (27.3%) with no significant difference between two groups (P>0.05). The mean pain score was lower in the stapled group (3.5 vs 4.8)(P<0.05). The stapled group returned to normal activity sooner (13.7 days vs 24.4 days) (P<0.05). The patients' satisfaction was the same for the two groups (conventional group 69.2% vs stapled group 81.8%) (P>0.05). CONCLUSION: A circular stapled hemorrhoidectomy is an effective treatment for third and forth degree prolapsed hemorrhoids, offering the significant advantages of reduced postoperative pain and an earlier return to normal activity.
Follow-Up Studies ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Interviews as Topic ; Pain, Postoperative ; Postoperative Complications ; Surveys and Questionnaires ; Wounds and Injuries

We report herein a case of 72-year-old woman in whom liver metastasis of colon cancer was presented with a marked elevation of serum alpha-fetoprotein (AFP) level. She was transferred to our hospital for multiple liver masses found on ultrasonogram. Abdominal computed tomogram revealed multiple low-density masses in the liver and wall thickening of the hepatic flexure of colon. The serum AFP level was 10,718.8 ng/mL. Colonoscopic findings of ulcerofungating mass suggested liver metastasis from colon cancer. However, the possibility of combined hepatocellular carcinoma could not be ruled out due to serum AFP elevation. Both colon and liver biopsies revealed moderately differentiated tubular adenocarcinoma. Using an immunohistochemical staining, the adenocarcinoma in liver showed focal positive to AFP, but not in colon. This case represents a very rare case of colon cancer with a marked elevation of serum AFP.
Aged ; Colonic Neoplasms/*pathology ; Female ; Humans ; Liver Neoplasms/*diagnosis/radiography/*secondary ; Tomography, X-Ray Computed ; alpha-Fetoproteins/*analysis