BACKGROUND: Recent studies revealed that inhalational anesthetics (IA) attenuate NO production. But the hemodynamic changes produced by IA in septic syndrome patient are still sufficient to threaten patient, surgeon and anesthesiologist. So we examined which IA is proper to maintain vascular contractile force and evaluated the effects of NOS inhibitors on contractile force of septic rat aorta under IA. METHODS: Aortic ring preparation was obtained from LPS-treated (1.5 mg/kg, i.p. for 18h) rats. The development of sepsis was confirmed by iNOS activity and iNOS expression using RT-PCR. Contractile responses of aorta to phenylephrine admministation in the presence or absence of halothane, enflurane and isoflurane were evaluated. We also evaluated the effects of NOS inhibitors, one is NG-nitro-L-arginine methyl ester (L-NAME) and the other is aminoguanidine. Statistical significances (p<0.05) were analyzed according to data characteristics by unpaired t-test and paired t-test. RESULTS: The contractile responses to phenylephrine admministration were attenuated in LPS-treated rings. Isoflurane, even at the dose of 2 MAC, didn't affect the contractile response while both halothane and enflurane decreased the contractile response even at the dose of 1 MAC. The potentiation of contractile responses by NOS inhibitors were not affected during administeration of IA. CONCLUSIONS: From these results, it is suggested that isoflurane is the safest inhalational anesthetic and NOS inhibitors, especially L-NAME, may be very useful in the therapy of septic shock patients during general anesthesia.
Anesthesia, General ; Anesthetics* ; Animals ; Aorta ; Enflurane ; Halothane ; Hemodynamics ; Humans ; Isoflurane ; NG-Nitroarginine Methyl Ester ; Nitric Oxide Synthase* ; Nitric Oxide* ; Phenylephrine ; Rats* ; Sepsis ; Shock, Septic

Transitional cell carcinoma of the urinary bladder is the most common cancer of the genitourinary tract in Korea and its prognosis is determined by the histologic grade and clinical stage present at initial diagnosis. Recently, an extensive search for a more objective and reproducible method to evaluate the proliferation activity of cancer cells has been done. The p53 gene is located on the short arm of the chromosome 17 and acts as a cancer suppressor gene. Mutant p53 gene induces malignant transformation. Recent studies reveal that the level of mutant p53 protein is elevated in some human tumor and many diverse transformed cell lines. Heat shock proteins(HSPs) are present constitutively in normal cells, where they play an important role in normal cell metabolism. In mammalian cells, they are induced by a variety of physical and chemical stimuli. A protein that belongs to the hsp70 family, called hsc70, is only slightly heat inducible and is found at a higher level in growing cells than in the resting cells. The mutant p53 protein binds with hsc70 and the p53-hsc70 complex has functional significance in the transforming capacity of the mutant p53. We investigated the correlation between the p53 and hsc70 by immunohistochemical methods and with better defined prognostic indicators such as histologic grade, clinical stage, and DNA ploidy pattern in 42 transitional cell carcinomas of the urinary bladder. The results are summarized as follows. p53 expression rate was higher in the DNA aneuploid group than in the DNA diploid group(p=0.061), but there was no significant difference in the histologic grade(p=0.861) or clinical stage(p=0.154). The higher the hsc70 expression rate was, the poorer the tumor differentiation(p=0.000) and the deeper the invasion(p=0.001). The aneuploid group showed a higher hsc70 expression rate than the diploid group(p=0.017). 27 of 42(64.3%) carcinomas showed positivity of both p53 and hsc70. Though statistically insignificant, their correlation showed a relatively low correlation coefficient (P=0.059). In conclusion, we suspect that p53 and hsc70 are closely correlated to each other by comparing the results of this immunohistochemical study, and hsc70 will be a useful prognostic marker in transitional cell carcinomas of the urinary bladder after sufficient follow up studies are performed.
Humans ; Follow-Up Studies ; Genes, p53

PURPOSE: Although hydrocelectomy is commonly performed in general urological practice, the incidence of complications and the outcomes of this procedure seem to be underreported in the literature. We evaluated the incidence of complications and the outcomes of patients who underwent hydrocelectomy. MATERIALS AND METHODS: Between January 1996 and December 2005, 289 patients with hydrocele were retrospectively assigned into three groups according to the degree of dissection or the amount of the excision of the hydrocele sac. Group 1 included 78 patients who were treated by dissection and excision of the entire hydrocele sac. Group 2 consisted of 149 patients who were treated by dissection and eversion of the hydrocele sac. The 62 patients in group 3 underwent operations in which there was little or no dissection of the hydrocele. We analyzed the complications, the effects of surgical treatment and the results according to the surgical techniques. RESULTS: The duration of recovery showed no differences among the three groups. The overall complication rate was 36.3%. Transient scrotal swelling occurred in 28.0% of the patients, hematoma in 2.7%, wound infection in 1.7%, and injury to the epididymis or testis, chronic pain and persistent swelling occurred in 1.3%. The overall incidence of postoperative complications was significantly lower among the patients in group 3. The rate of scrotal swelling was significantly correlated to the volume of the hydroceles and the amount of the excision of the hydrocele sac. CONCLUSIONS: The long term results of hydrocelectomy were good. The most common complications following scrotal surgery for hydroceles were scrotal swelling, hematoma, wound infection and injury to the epididymis and testis. Most of the complications were treated by conservative management.
Adult ; Chronic Pain ; Epididymis ; Hematoma ; Humans ; Incidence ; Male ; Postoperative Complications ; Retrospective Studies ; Testis ; Wound Infection

Benign perivascular epithelioid cell tumor (PEComa) of the lung is a rare benign neoplasm, a sclerosing variant of which is even rarer. We present a case of 51-year-old man who was diagnosed with benign sclerosing PEComa by percutaneous fine needle aspiration cytology and biopsy. The aspirate revealed a few cell clusters composed of bland-looking polygonal or spindle cells with fine granular or clear cytoplasm. Occasional fine vessel-like structures with surrounding hyalinized materials were seen. The patient later underwent wedge resection of the lung. The histopathological study of the resected specimen revealed sheets of polygonal cells with clear vacuolated cytoplasm, variably sized thin blood vessels, and densely hyalinized stroma. In immunohistochemical studies, reactivity of tumor cells for human melanoma black 45 and Melan-A further supported the diagnosis of benign sclerosing PEComa. To the best of our knowledge, this is the first case of benign sclerosing PEComa described in lung.
Biopsy ; Biopsy, Fine-Needle ; Blood Vessels ; Cytoplasm ; Diagnosis ; Epithelioid Cells* ; Humans ; Hyalin ; Lung Neoplasms ; Lung* ; MART-1 Antigen ; Melanoma ; Middle Aged ; Perivascular Epithelioid Cell Neoplasms ; Solitary Pulmonary Nodule

The expression patterns of CD44s and CD44v6 were immunohistochemically compared with those of normal, hyperplastic and malignant endometrium. In normal endometria (n=37), endometrioses (n=46) and adenomyoses (n=20), the surface and glandular epithelial cells were negative for CD44s and CD44v6 in a proliferative pattern and positive in a secretory pattern, whereas the stroma was only positive for CD44s in both proliferative and secretory patterns. The endometrial hyperplasia (4 simple and 9 complex) had the identical patterns with normal proliferative phase of endometrium. Only one case showing complex hyperplasia with atypia was focally positive for CD44s and CD44v6 in glandular epithelia. CD44s and CD44v6 were positive in all endometrial adenocarcinomas (13), except one CD44s-negative case. In summary, the expressions of CD44s and CD44v6 in endometriosis and adenomyosis recapitulated those of normal cyclic endometrium. The expression patterns in endometrial hyperplasia were similar to those in normal proliferative endometrium, whereas the endometrial adenocarcinoma showed abnormal expressions for CD44s and CD44v6. Thus it was considered that the ectopic endometrium in endometriosis and adenomyosis was not aberrant as in endometrial carcinoma on the aspects of immunohistochemical expressions of CD44s and CD44v6.
Adenocarcinoma/*metabolism/pathology ; Antigens, CD44/*metabolism ; Comparative Study ; Endometrial Hyperplasia/*metabolism/pathology ; Endometrial Neoplasms/*metabolism/pathology ; Endometriosis/*metabolism/pathology ; Endometrium/metabolism/pathology ; Female ; Glycoproteins/*metabolism ; Human ; Immunoenzyme Techniques ; Immunohistochemistry ; Ovarian Diseases/*metabolism/pathology ; Staining and Labeling/methods

A 61-year-old woman visited our hospital for bilateral multiple lung nodules and a mass in her thorax. She had a long history of multiple metastatic recurrences of solid pseudopapillary neoplasm (SPN); 24 years previously, the patient had undergone pylorus-preserving pancreaticoduodenectomy for a 9.9 × 8.6 cm mass in the pancreatic head. The tumor was diagnosed as an SPN. Nine years later, metastatic nodules were found on computed tomography in the patient's liver and peritoneum and were excised. She subsequently underwent an additional eight metastatectomy procedures in diverse organs. For the presented event, the lung nodules were removed. The prevalence of malignant SPN in the general population is 5%–15%. However, multiple metastatic recurrence of malignant SPN is rare; the lung is a particularly rare site of metastasis, found in only three cases in the literature. Here, we describe this exceptional case and provide a literature review.
Female ; Head ; Humans ; Liver ; Lung ; Middle Aged ; Neoplasm Metastasis ; Pancreas* ; Pancreaticoduodenectomy ; Peritoneum ; Prevalence ; Recurrence ; Thorax

Bronchiolitis obliterans organizing pneumonia(BOOP) is a pathologic entity characterized by the formation of plugs of fibrous tissue in bronchioles and alveolar ducts. It had been described in association with several connective tissue diseases, i.e. systemic lupus erythematosus, Behcet's disease, polymyositis-dermatomyositis, polymyalgia rheumatica and Sjogren's syndrome. Recently, there were few additional reports on BOOP, anteceded by rheumatoid arthritis. We had experienced a case of 60 years old female patient who had been admitted for acute respiratory difficulty and abnormal chest roentgenographic findings. She was diagnosed as having rhematoid arthritis 20 years ago. On the course of our treatment, she did not respond to antibiotics. Moreover, no microorganism grew in the sputum and blood. Thus, the bronchoscopic biopsy was done. The patient showed a dramatic response to steroid therapy, and the pathologic findings of the bronchoscopic biopsy confirmed as BOOP. To our knowledge, this is the first reported case of BOOP anteceded by rheumatoid arthritis in Korea.
Anti-Bacterial Agents ; Arthritis ; Arthritis, Rheumatoid* ; Biopsy ; Bronchioles ; Bronchiolitis Obliterans* ; Bronchiolitis* ; Connective Tissue Diseases ; Cryptogenic Organizing Pneumonia* ; Dermatomyositis ; Female ; Humans ; Korea ; Lupus Erythematosus, Systemic ; Polymyalgia Rheumatica ; Sjogren's Syndrome ; Sputum ; Thorax

Cutaneous epidermal cysts are benign lesions commonly experienced in the outpatients department, but the occurrence of a squamous cell carcinoma arising within a cutaneous epidermal cyst is extremely rare. Herein, a case of a squamous cell carcinoma arising from a recurrent epidermal cyst is reported.
Carcinoma, Squamous Cell* ; Epidermal Cyst* ; Humans ; Outpatients

Inflammatory myofibroblastic tumor, histologically characterized by the presence of bland-looking spindle cells and infiltration of chronic inflammatory cells, is extremely rare in the gastric wall. We report a case of gastric inflammatory myofibroblastic tumor in a 27-month-old boy. The fine needle aspiration biopsy from the mass showed loose clusters or scattered spindle cells and inflammatory cells, predominantly of lymphocytes and plasma cells. The spindle cells resembled fibroblasts or myofibroblasts. Differential diagnosis from benign and malignant diseases involving abdominal cavity was discussed.
Abdominal Cavity ; Biopsy ; Biopsy, Fine-Needle* ; Child, Preschool ; Diagnosis, Differential ; Fibroblasts ; Humans ; Lymphocytes ; Male ; Myofibroblasts* ; Plasma Cells ; Stomach

PURPOSE: It is very important to detect hematogenous spread of cancer cells early in breast cancer patients in order to properly determine the prognosis and adjuvant therapy. In this study, we attempted to detect Cytokeratin-20 (CK-20) as a mRNA marker of cancer cells in peripheral blood and bone marrow using the reverse transcriptase-polymerase chain reaction (RT-PCR). METHODS: We obtained peripheral blood and bone marrow from 41 breast cancer patients who had been treated by Korea University Hospital. Using the RT-PCR method, we detected the CK-20 and compared the positive detection rate and concordance rate between two sources. Furthermore, we analysed the correlation with other known prognostic and predictive factors. RESULTS: The CK-20 detection rate was 36.5% in peripheral blood and in bone marrow. The concordance rate between both sources was 56%. In CK-20 detection, there was no significant correlation seen between peripheral blood and bone marrow (p>0.05). Additionally, there were no statistically significant correlations found between the other predictive factors (ER, PR, p53 protein expression, nm23 protein expression). Six cases who were CK-20 positive and were detected in both (peripheral blood, bone marrow) source showed advanced stage and axillary lymph node metastasis (p<0.05). CONCLUSION: The detection of CK-20 in peripheral blood and bone marrow correlated with stage and axillary nodal status. Therefore, this may suggest poor clinical prognosis if CK-20is detected in both sources in a breast cancer patient. The RT-PCR assay for detection of CK-20 is a very sensitive method, however the standardization and quality control of the RT-PCR method are important and multi-center trials are required.
Bone Marrow* ; Breast Neoplasms* ; Breast* ; Humans ; Keratin-20* ; Korea ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm Micrometastasis ; Prognosis ; Quality Control ; RNA, Messenger