Sixty one cases of gastric adenocarcinoma were studied immunohistochemically for expression of HLA-DR and secretory component(SC) in order to analyze the relationship between expression of these in gastric cancer cells and the adjacent mucosa. Immunostaining was detected within the cytoplasm and on the cell memgrane. The rate of HLA-DR and SC expressions in cancer cells were 59.0% and 49.2%, respectively, and 52.5%/52.5% and 31.2%/50.8% the mucosa in adjacent/remote from the site of to cancer. The SC expression in the adjacent mucosa was lower than that of the remote mucosa(p=0.027). The HLA-DR expression in the cancer cells in the intestinal type of gastric adenocarcinoma(73.9%) was higher than that of the diffuse type(14.3%) and it was statistically significant(p=0.02). The presence of an increased amount of lymphoid infiltration in the gastric mucosa was closely related to the expression of HLA-DR and SC. Decreased or absent expression of SC at the transitional mucosal cells was possibly a result of exposure to genotoxic agents due to the lack of protective function of SC-IgA. From these results, one can postulate that the expression of HLA-DR and SC may play an important role in atleration in microenvironment with lymphoid infiltration.
Adenocarcinoma ; Stomach Neoplasms

We performed a randomized, prospective study to evaluate the effect of intraoperative, intracameral carbachol or acetylcholine on early postoperative intraocular pressure(IOP) after extracapsular cataract extraction(ECCE) and posterior chamber lens(PCL) implantation. Fifty-six eyes of 56 patients scheduled for routine ECCE and PCL implantation were randomly assigned into three groups: (1)carbachol infusion (19 eyes) (2) acetylcholine infusion (15 eyes) (3)balanced salt solution (BSS) infusion (control, 22 eyes). We compared the preoperative IOP, early postoperative IOP, postoperative 24 hours IOP and postoperative 1 week IOP. In the measurement of early postoperative IOP, IOP was measured at least twice at 3, 6 or 9 hours postoperatively. There was no significant difference in IOP between the three groups preoperatively, at postoperative 3 hours, and 1 week. At postoperative 6 hours, both the carbachol infusion group and acetylcholine infusion group were significantly different from the BSS infusion group. At postoperative 9 and 24 hours, only carbachol infusion group had a significant difference from BSS infusion group in suppression of postoperative IOP increase. Our results suggest that intraoperative, intracameral administration of carbachol or acetylcholine prevents early postoperative IOP increase, and that carbachol has a more lasting effect.
Acetylcholine/administration & dosage/*pharmacology ; Adult ; Aged ; Anterior Chamber/drug effects ; Carbachol/administration & dosage/*pharmacology ; Cataract Extraction/*adverse effects ; Female ; Humans ; Intraocular Pressure/*drug effects ; Lenses, Intraocular ; Male ; Middle Aged ; Ocular Hypertension/etiology/*prevention & control ; Postoperative Complications ; Prospective Studies

BACKGROUND: Xpert Flu (Cepheid, USA) allows for fully automated real-time RT-PCR using a single-use disposable cartridge. The aim of this study was to evaluate Xpert Flu for the detection of influenza A virus and subtype A/H1N1/2009 pandemic virus. METHODS: We conducted a prospective comparison study for Xpert Flu with the RealTime ready Influenza A/H1N1 Detection Set (Roche Diagnostics, Germany). Analytical specificities of the assays were determined by testing commonly encountered respiratory viral pathogens, including parainfluenza virus type 1/2/3, rhinovirus A, rhinovirus B, metapneumovirus, adenovirus, and coronavirus. The analytical sensitivities and workflow of both methods were also assessed. RESULTS: A total of 102 consecutive clinical specimens were tested by both methods. Total agreement between the two methods was estimated to be 99.0% (101/102): 11 A/H1N1/2009 and 3 seasonal influenza A by the RealTime ready Influenza A/H1N1 Detection Set; 10 and 3 by Xpert Flu. No cross-reactivity was observed between influenza A/H1N1/2009 and other respiratory viral pathogens in either method. The limits of detection of the RealTime ready Influenza A/H1N1 Detection Set and Xpert Flu were 500 TCID50/mL and 20 TCID50/mL, respectively. Xpert Flu required 85 minutes (10 minutes of hands-on time) for processing, while RealTime ready Influenza A/H1N1 Detection Set took 128 minutes (30 minutes of handson time). CONCLUSION: The results of Xpert Flu were comparable to those of the RealTime ready Influenza A/H1N1 Detection Set. It is of note that the fully automated and closed system of Xpert Flu could be advantageous for reducing hands-on time and for preventing cross-contamination during the testing process.
Adenoviridae ; Coronavirus ; Influenza A virus ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; Limit of Detection ; Metapneumovirus ; Pandemics ; Paramyxoviridae Infections ; Prospective Studies ; Rhinovirus ; Seasons ; Sprains and Strains ; Viruses

The congenital mesoblastic nephroma is the most common renal neoplasm seen in the first few months of life. This tumor usually benign, but local recurrences and metastases have been reported, and treatment is total nephrectomy. This entity must be differentiated from Wilm's tumor so as to avoid unnecessary postoperative irradiation and chemotherapy. Recently, we experienced a case of congenital mesoblastic nephroma in female newborn infant. Diagnosis was made with physical examination, plain roentgenogram of the abdomen, ultrasonography of the abdomen and I.V.P. and confirmed with microscopic examination. A brief review of the related literature was made on this subject.
Abdomen ; Diagnosis ; Drug Therapy ; Female ; Humans ; Infant, Newborn ; Kidney Neoplasms ; Neoplasm Metastasis ; Nephrectomy ; Nephroma, Mesoblastic* ; Physical Examination ; Recurrence ; Ultrasonography ; Wilms Tumor

The congenital mesoblastic nephroma is the most common renal neoplasm seen in the first few months of life. This tumor usually benign, but local recurrences and metastases have been reported, and treatment is total nephrectomy. This entity must be differentiated from Wilm's tumor so as to avoid unnecessary postoperative irradiation and chemotherapy. Recently, we experienced a case of congenital mesoblastic nephroma in female newborn infant. Diagnosis was made with physical examination, plain roentgenogram of the abdomen, ultrasonography of the abdomen and I.V.P. and confirmed with microscopic examination. A brief review of the related literature was made on this subject.
Abdomen ; Diagnosis ; Drug Therapy ; Female ; Humans ; Infant, Newborn ; Kidney Neoplasms ; Neoplasm Metastasis ; Nephrectomy ; Nephroma, Mesoblastic* ; Physical Examination ; Recurrence ; Ultrasonography ; Wilms Tumor

BACKGROUND: There are conflicting data in the literature regarding aspirin resistance. This study evaluated the effect of biochemical aspirin resistance on initial stroke severity in acute stroke patients who had taken aspirin. METHODS: We reviewed acute ischemic stroke patients who were already on aspirin. Biochemical aspirin resistance was defined as an aspirin reaction unit score of > or =550, as evidenced by the VerifyNow-Aspirin assay, which was performed after 4 days of continuous aspirin medication. Initial stroke severity was evaluated using National Institutes of Health Stroke Scale (NIHSS) scores at day 4, which were dichotomized into mild (0-7) and severe (> or =8). Modified Rankin Scale scores were determined at 3 months. The Alberta Stroke Program Early CT Scores (ASPECTS) were assessed on initial diffusion-weighted imaging (DWI). We examined the relationships between biochemical aspirin resistance and initial stroke severity. RESULTS: Nine of 106 patients (8.5%) had biochemical aspirin resistance. The initial stroke severity was significantly associated with DWI-ASPECTS (p<0.001), initial C-reactive protein level (p=0.005), biochemical aspirin resistance (p=0.009), and stenosis or occlusion of the relevant artery (p=0.029). Multivariate analysis showed that biochemical aspirin resistance [odds ratio (OR), 15.24; 95% confidence interval (CI), 2.49-93.31; p=0.003] and initial C-reactive protein level (per 1 mg/dL; OR, 2.43; 95% CI, 1.47-4.00; p=0.001) were independently associated with initial stroke severity (NIHSS score > or =8). However, biochemical aspirin resistance was not associated with clinical outcome at 3 months (p=0.366). CONCLUSIONS: Biochemical aspirin resistance was independently associated with initial stroke severity. This suggests that detection of biochemical aspirin resistance in acute ischemic stroke is useful when choosing the optimal treatment.
Alberta ; Arteries ; Aspirin ; C-Reactive Protein ; Constriction, Pathologic ; Humans ; Multivariate Analysis ; National Institutes of Health (U.S.) ; Stroke

PURPOSE: This study was performed to determine the rate of neonatal symptomatic spontaneous pneumothorax, and the corresponding clinical characteristics, co-morbidities, and outcomes. METHODS: The demographic characteristics, clinical symptoms and signs, associated abnormalities, methods of treatment, and outcomes were investigated in 22 neonates with symptomatic spontaneous pneumothorax in the neonatal intensive care unit (NICU) of Chonnam University Hospital between March 2003 and February 2008. RESULTS: The rate of spontaneous pneumothorax was 0.55%. Among the 22 neonates, the number of outborns was 15 (68.2%) and the number of males was 12 (54.5%). The main symptoms and signs were chest retraction, tachypnea, and cyanosis. The pneumothoraces were more frequent on the right side (59.1%) and all cases were diagnosed within 3 days of life. Four cases (18.2%) had urologic abnormalities and 7 cases (31.8%) had cranial abnormalities by ultrasonography. The treatments included oxygen (81.8%) and oxygen with chest tube drainage (18.2%). All of the infants survived and the overall outcomes were favorable. CONCLUSION: When respiratory symptoms and signs are develop abruptly in otherwise healthy newborns, the clinician should suspect a spontaneous pneumothorax and check a chest x-ray as soon as possible. Although the outcome of neonatal symptomatic spontaneous pneumothorax is favorable, renal and cranial ultrasonography are needed because of the higher possibility of urologic abnormalities and germinal matrix/intraventricular hemorrhage than in newborns without a pneumothorax.
Chest Tubes ; Comorbidity ; Cyanosis ; Drainage ; Hemorrhage ; Humans ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Male ; Oxygen ; Pneumothorax ; Tachypnea ; Thorax

PURPOSE: A lateral neck node metastasis is common in patients with papillary thyroid carcinoma. If a preoperative diagnosis is not made or is uncertain, an intraoperative biopsy for a frozen examination should be considered. The aims of this study were to evaluate the factors predicting a lateral neck node metastasis and to suggest guidelines for an intraoperative neck node biopsy. METHODS: From March 2003 to January 2006, 79 patients (7 males, 72 females) with 89 intraoperatively biopsied lateral neck nodes were enrolled in this study. The median age was 45 years. Among these patients, two or more lateral neck nodes were biopsied intraoperatively in 9 patients and one node was biopsied in the others. The clinicopathological features and radiological findings were reviewed. RESULTS: Among the 79 patients with 89 lateral neck nodes, 25 patients with 26 lateral neck nodes (29%) showed a metastasis. Univariate analysis revealed the computed tomography (CT) findings of lateral neck nodes such as a longitudinal size >1 cm (P=0.001), postcontrast Hounsefield Unit (HU) >110 (P<0.001), presence of necrosis (P<0.001), absence of hilum (P<0.001), and irregular margin (P<0.001) were found to be significant predicting factors. The pathologic findings of tumors such as multifocality (P= 0.006), bilaterality (P=0.001), tumor size >2 cm (P=0.008), extracapsular invasion (P=0.005) had significant impact on a lateral neck node metastasis. Multivariate analysis revealed a longitudinal size >1 cm (P=0.039), postcontrast HU >110 (P<0.001), and bilaterality of the tumor (P= 0.001) with a suspiciously enlarged lateral neck node in CT to have a significant impact on node metastasis. However, bilateral tumor with lymph nodes >110 HU were the most important factors. CONCLUSION: The most significant factors influencing lateral neck node metastasis were multifocal, bilateral, large size (2 cm < or = ), extracapsular invasion of the primary tumor, and the CT findings of lymph nodes such as a large longitudinal size (1 cm < or =), necrosis, the absence of hilum, irregular margin and increased postcontrast HU (110 < or =).
Biopsy ; Carcinoma, Papillary ; Diagnosis ; Humans ; Lymph Nodes ; Male ; Multivariate Analysis ; Neck* ; Necrosis ; Neoplasm Metastasis* ; Thyroid Gland* ; Thyroid Neoplasms*

Thromobotic thrombocytopenic purpura (TTP) is a multisystem disorder that's characterized by consumptive thrombocytopenia, microangiopathic hemolytic anemia,and neurologic symptoms. TTP is associated with many diseases and several therapeutic drugs. We report here on the first Korean case of a patient with rheumatoid arthritis (RA) and who developed TTP that was associated with trimethoprim-sulfamethoxazole (TMP-SMX) in Korea. She recovered from the TTP following daily sessions of therapeutic plasma exchange (TPE) with fresh plasma replacement and glucocorticoid therapy. Awareness of the possible development of TTP in patient with RA and who is being treated with TMP-SMX is important for making the early diagnosis and administering proper treatment.
Arthritis, Rheumatoid ; Early Diagnosis ; Humans ; Korea ; Neurologic Manifestations ; Plasma ; Plasma Exchange ; Purpura, Thrombocytopenic ; Purpura, Thrombotic Thrombocytopenic ; Thrombocytopenia ; Thymine Nucleotides ; Trimethoprim, Sulfamethoxazole Drug Combination

BACKGROUND/AIMS: Esophageal perforation is a rare but often a life-threatening condition. However, the incidence and clinical features of esophageal perforation caused by ingested foreign body are unknown. This study investigated the incidence of esophageal perforation caused by ingested foreign body and evaluated the clinical features and outcome of patients with esophageal perforation. METHODS: Among a total of 196 adult patients with confirmed esophageal foreign body and complained of at least one of the related symptoms at the emergency department between January 2000 and July 2008, 18 patients with esophageal perforation due to esophageal foreign body ingestion were included in the study. Data were collected by retrospectively reviewing the electric medical records. RESULTS: The incidence of esophageal foreign body and esophageal perforation in adults was 19.4% (196/1,009) and 1.8% (18/1,009), respectively. Chest pain was the most common symptom and fishbone was the most common foreign body causing esophageal perforation. Mediastinitis or mediastinal abscess occurred in 13 patients (13/18, 72.2%). About half (8/18) of the patients were admitted to the intensive care unit but there was no in-hospital mortality. CONCLUSIONS: The incidence of esophageal perforation in patients with foreign body ingestion was low but it increased up to 9.2% in patients with esophageal foreign body. However, prognosis was favorable with timely proper treatment. Chest pain can be an ominous sign indicating the presence of esophageal perforation in patients with esophageal foreign body.
Aged ; Chest Pain/etiology ; Emergency Medical Services ; Esophageal Perforation/*diagnosis/epidemiology/etiology ; Female ; Foreign Bodies/*complications ; Humans ; Incidence ; Intensive Care Units ; Male ; Middle Aged ; Prognosis ; Retrospective Studies