PURPOSE: This prospective study was performed to evaluate the usefulness of preoperative radioimmu-noscintigraphy and intraoperative scintimetric examination (radioimmunoguided surgery: RIGS) using (99m)Tc-anti-CEA F(ab')(2), fragment. MATERIALS AND METHODS: Nineteen patients with rectal cancer underwent preoperative whole body planar scintigraphy at 4 hours after injection of (99m)Tc-anti-CEA F(ab')(2), fragment and SPECT imaging at 18 hours. Surgical operation was performed at 24 hours after injection. During laparotomy, radioactivities from intraabdominal viscera were measured by gamma probe. The radioac-tivities from excised tumor and lymph nodes were also measured and compared with pathology. RESULTS: All nineteen patients were confirmed to have adenocarcinomas in the rectum. Twenty-seven of 97 excised lymph node groups had metastasis and 2 patients had liver metastasis in pathology. Preoperative radioim- munoscintigraphy detected primary tumors in 11 patients (sensitivity 55%) and it couId not detect any lymph nodes or liver metastasis. All patients showed high radioactivity in the kidneys, liver, spleen, and major vessels in intraoperative measurement by gamma probe, and tumor activity was not discriminated from background activity. However, ra4ioactivity from excised tumor was higher than normal rectum (T/B ratio; 3.47+/-2.25). When excised lymph node activity/background activity ratio > 1,5 was considered as positive criteria of metastasis, sensitivity, specificity, positive and negative predictive values were 78.6%, 73.9%, 55.0% and 89.5%, respectively. CONCLUSION: Radioimmunoscintigraphy using (99m)Tc-anti-CEA F(ab')(2). has no additional value for preoperative staging and use of early RIGS using (99m)Tc-anti-CEA F(ab')(2)is inappropriate. For early RIGS using (99m)Tc labeled antibodies in rectal cancer patients, further development of more specific antibodies and methods to reduce background activity are needed.
Adenocarcinoma ; Antibodies ; Humans ; Kidney ; Laparotomy ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Pathology ; Pilot Projects* ; Prospective Studies ; Radioactivity ; Radioimmunodetection* ; Radionuclide Imaging ; Rectal Neoplasms* ; Rectum ; Sensitivity and Specificity ; Spleen ; Tomography, Emission-Computed, Single-Photon ; Viscera

The limb-body wall malformation complex is a sporadic congenital anomaly characterized by protean manifestations. The diagnosis is based upon the presence of at least two out of craniofacial anomaly, body wall defect, and limb abnormalities. We present a case of limb-body wall malformation complex. This case shows abdominal and pelvic wall defects with eventration of the viscera. It also shows an absence of right kidney, polycystic left kidney, absence of external genitalia and anus, and lower extremity abnormalities. The right lower extremity is absent and the deformed left leg shows malformed foot-like structure attached to the shin in addition to a normally positioned left foot. Our patient is the first case of complete absence of the external genitalia associated with limb-body wall malformation complex in Korean publications and the seventh in English publications.

No abstract available.
Neoplasm Metastasis*

Laparoscopy is a frequently used technique in surgery and gaining wide popularity replacing laparotomy. The advantages of laparoscopy are shorter hospital stay, faster recovery, more decreased postoperative pain and smaller scar than laparotomy. But inducing artificial pneumoperitoneum with gas causes various complications. Among them, gas embolism is a rare but fatal complication and may occur more frequently when laparoscopy is performed simultaneously with hysteroscopy. We experienced one case of gas embolism during diagnostic laparoscopy for secondary infertility and hysteroscopic resection of uterine myoma under general anesthesia. Early diagnosis and prompt treatment seem to be the keys to prevent catastrophic outcome and the anesthesiologist should know about it's patho- physiology, preventive methods, diagnosis and treatment.
Anesthesia, General ; Cicatrix ; Diagnosis ; Early Diagnosis ; Embolism, Air* ; Hysteroscopy ; Infertility ; Laparoscopy* ; Laparotomy ; Leiomyoma ; Length of Stay ; Pain, Postoperative ; Physiology ; Pneumoperitoneum, Artificial

We report a case of pulmonary LAM occurring in a 24-year-old pregnant woman in whom large areas of air-space consolidation partly masked interstitial lung disease on plain radiography. For correct dignosis, high resolutionCT was considered to still be a potent method for the disclosure of typical interstitial lung changes, including thin-walled cysts. Follow-up CT showed progressive worsening of these interstitial lung lesions.
Disclosure ; Female ; Follow-Up Studies ; Humans ; Lung Diseases, Interstitial ; Lung* ; Lymphangioleiomyomatosis* ; Masks* ; Pregnant Women ; Radiography ; Young Adult

BACKGROUND: A newly-found mitochondrial toxin, 3-nitropropionic acid (3-NP), has been proved to induce apoptosis in the striatum. Although striatal lesions produced by 3-NP could develop through an excitotoxic mechanism, the exact relationship between apoptosis induction and excitotoxicity after 3-NP treatment is still not clear. We investigated the role of excitotoxicity and oxidative stress on apoptosis induction within the striatum following intra-peritoneal injection of 3-NP. METHODS: 3-NP was injected for 5 days intra-peritoneally in three month-old mice. One day after the last injection, animals were decapitated. To confirm the presence of apoptosis, we performed in-situ detection of DNA fragmentation by using TUNEL technique and agarose gel elctrophoresis after DNA extraction from striatum. To examine the effect of frontal cortex removal on 3-NP-indeced apoptosis, we removed left frontal cortex by aspiration. For excitotoxicity, NMDA-receptor antagonist-MK 801, non-NMDA antagonist-NBQX, and saline were injected intraperitoneally before 3-NP treatment To detect superoxide, we administered hydroethidium (HEt: 200 ul; 1mg/ml) into the jugular vein 2 days after 3-NP, and the density of oxidized HEt in samples were examined under flouscent microscope. We performed caspase staining to test immunoreactivity of caspase 3 in samples. RESULTS: The TUNEL positive cells were not observed in the striatum ipsilateral to the frontal cortex-removed side, but found in the contralateral striatum. Superoxide radicals measured by using HEt and caspase immunoreactivity were also significantly weaker in the striatum ipsilateral to the frontal cortex-removed side than the contralateral striatum. TUNEL staining revealed less apoptotic changes in the striatum of MK801-treated group than NBQX-or saline-treated groups. DNA laddering on agarose gel electrophoresis was observed in the striatum of NBQX- or saline-treated mice, but not found in MK 801-treated group. CONCLUSION: We demonstrated that removal of the corticostriatal glutamate pathway reduced superoxide production as well as apoptosis induced by 3-NP and NMDA receptor antogonist, but not non-NMDA antagonist, prevented 3-NP-induced apoptosis in the striatum. These results suggest that NMDA-mediated glutamatergic excitotokicity plays an important role in 3-NP related striatal damage.
Animals ; Apoptosis ; Caspase 3 ; DNA ; DNA Fragmentation ; Electrophoresis, Agar Gel ; Glutamic Acid ; In Situ Nick-End Labeling ; Injections, Intraperitoneal* ; Jugular Veins ; Mice* ; Mitochondria ; N-Methylaspartate ; Oxidative Stress ; Sepharose ; Superoxides

No abstract available.
Dislocations* ; Tendons*

Epinephrine ; Pulmonary Edema

PURPOSE: Food protein-induced enterocolitis syndrome (FPIES) is a symptom complex of vomiting and diarrhea caused by non-IgE mediated allergy to cow's milk and/or soy in young infants. Transforming growth factor (TGF)-beta has been reported to protect the epithelial barrier of the gut from foreign antigens. We studied the expression of type 1 and 2 TGF-beta receptors in the mucosa of small intestine to investigate their roles in the pathogenesis of FPIES. METHODS: Twenty-eight patients, aged 7 to 120 days (mean 49 days) who were diagnosed with FPIES by clinical criteria and challenge tests were included. Immunohistochemical stainings for type 1 and 2 TGF-beta receptors were performed on endoscopic duodenal biopsy specimens. RESULTS: Type 1 and 2 TGF-beta receptors were expressed in the villous and crypt epithelial cells but nearly absent in the lamina propria in both patients and controls. Type 1 TGF-beta receptor expression was significantly lower in the patients who had villous atrophy than in the patients who had not and in controls. The expression of type 1 TGF-beta receptor was negatively correlated with the severity of villous atrophy. Type 2 TGF-beta receptor expression showed no significant difference between the patients and controls. CONCLUSION: Our results suggests that the decreased activity of type 1 TGF-beta receptor is implicated in the pathogenesis of FPIES in young infants.
Atrophy ; Biopsy ; Diarrhea ; Enterocolitis* ; Epithelial Cells ; Humans ; Hypersensitivity ; Infant ; Intestine, Small ; Milk ; Mucous Membrane ; Receptors, Transforming Growth Factor beta ; Transforming Growth Factors ; Vomiting

BACKGROUND: Theophylline has been used in the treatment of asthma for decades as a broncho- dilator, but recent studies suggested that it has anti-inflammatory and immunomodulatory properties. OBJECTIVE: The aim of this study was to determine the effect of theophylline therapy on urinary excretion of leukotriene B4 (LTB4) and C4 (LTC4), which have been known to play a role in the airway inflammation in asthmatic patients. METHODS: Fifty-one patients, aged 13 months to 6 years, who were hospitalized with asthma were randomized in to 3 groups according to treatment regimen. Twenty-one patients were administered theophylline with budesonide and salbutamol inhalation (Group 1). Fifteen patients were treated with budesonide and salbutamol inhalation (Group 2) and the other fifteen patients with salbutamol inhalation only (Group 3). Urine samples for the determination of LTB4 and LTC4 were collected on admission and on the fifth hospital day in each patient. The concentrations of urinary leukotrienes were measured by ELISA (Neogen, U.S.A.) and corrected by urinary creatinine levels. Ten controls were also studied. RESULTS: The initial urinary LTC4 levels in asthmatic children were significantly higher than in controls. Urinary LTC4 was significantly decreased after treatment compared with the initial level in group 1 (p<0.05), but not in groups 2 and 3. Urinary LTB4 did not show significant difference between patients and controls on admission and showed no significant change after treatment compared with the initial levels in all three groups. CONCLUSION: These results suggest that the suppression of LTC4 synthesis is one of the anti-inflammatory mechanisms of theophylline and support the use of theophylline as a the rapeutic agent in asthmatic patients.
Albuterol ; Asthma* ; Budesonide ; Child* ; Creatinine ; Enzyme-Linked Immunosorbent Assay ; Humans ; Inflammation ; Inhalation ; Leukotriene B4* ; Leukotriene C4 ; Leukotrienes ; Theophylline*