Gastric-type extremely well-differentiated adenocarcinoma (EWDA) is a rare type of gastric adenocarcinoma characterized by infiltration of well-formed mucinous glands with little or no nuclear atypia, which resemble foveolar epithelium or pyloric glands. Because of its high degree of differentiation, preoperative biopsy diagnosis of gastric-type EWDA is very difficult. We encountered a case of gastric-type EWDA, manifesting as a Borrmann type 4 lesion, in a 47-year-old man. Despite four repeated biopsies, the preoperative biopsy diagnosis was not conclusive due to the scarcity of diagnostic tumor cells and lack of knowledge regarding the unusual histologic findings of gastric-type EWDA. We herein describe the histologic findings of gastric-type EWDA in detail, with the aim of facilitating a preoperative biopsy diagnosis and understanding of this rare type of gastric adenocarcinoma.
Adenocarcinoma* ; Biopsy ; Diagnosis* ; Epithelium ; Gastric Mucosa ; Humans ; Middle Aged ; Mucins ; Stomach Neoplasms ; Stomach*

BACKGROUND: An epidemiologic study was performed after the outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) in the medical intensive care unit (MICU) from December 2006 to May 2007. METHODS: A retrospective case-control study was performed using the medical records of the patients. The case and control patients were compared for age, gender, total length of stay in MICU, prior carbapenem use, Acute Physiology and Chronic Health Evaluation II (APACH II) score, presence of central line, effect of mechanical ventilation, and sputum suction. Environmental and hand-washing studies were performed during the outbreak. RESULTS: Ten CRAB-affected patients and 29 controls were enrolled in this study. Univariate analysis showed that the age, total length of stay in MICU, presence of central line, and prior carbapenem use were associated with the CRAB outbreak. However, multivariate analysis showed that only prior carbapenem use was associated with the CRAB outbreak (odd ratio: 8.67, P=0.01). The outbreak disappeared after implementing a combined infection control strategy, including the sequential disinfection of MICU and strict compliance with cross-transmission prevention protocols. CONCLUSION: The use of carbapenem was associated with an increased risk of CRAB infection. This study suggests that the MICU contamination and infection transmission by health-care workers played a major role in the CRAB outbreak. Novel strategies such as restricted use of broad-spectrum antibiotics, strict hand hygiene, strict isolation of the patients, and MICU disinfection may be required to prevent the CRAB outbreak.
Acinetobacter ; Acinetobacter baumannii ; Anti-Bacterial Agents ; APACHE ; Case-Control Studies ; Compliance ; Disease Transmission, Infectious ; Disinfection ; Epidemiologic Studies ; Hand Hygiene ; Humans ; Infection Control ; Critical Care ; Intensive Care Units ; Length of Stay ; Medical Records ; Multivariate Analysis ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Sputum ; Suction

BACKGROUND: Although surgical resection with chemotherapy is considered effective for patients with advanced gastric cancer, it remains the third leading cause of cancer-related death in South Korea. Several studies have reported that mesothelial markers including mesothelin, calretinin, and Wilms tumor protein 1 (WT1) were positive in variable carcinomas, associated with prognosis, and were evaluated as potential markers for targeted therapy. The aim of this study was to assess the immunohistochemical expression of mesothelial markers (mesothelin, calretinin, and WT1) in gastric adenocarcinoma and their relations to clinocopathological features and prognosis. METHODS: We evaluated calretinin, WT1, and mesothelin expression by immunohistochemical staining in 117 gastric adenocarcinomas. RESULTS: Mesothelin was positively stained in 30 cases (25.6%). Mesothelin expression was related to increased depth of invasion (p = .002), lymph node metastasis (p = .013), and presence of lymphovascular (p = .015) and perineural invasion (p = .004). Patients with mesothelin expression had significantly worse disease-free survival rate compared with that of nonmesothelin expression group (p = .024). Univariate analysis showed that mesothelin expression is related to short-term survival. None of the 117 gastric adenocarcinomas stained for calretinin or WT1. CONCLUSIONS: Mesothelin expression was associated with poor prognosis. Our results suggest that mesothelin-targeted therapy should be considered as an important therapeutic alternative for gastric adenocarcinoma patients with mesothelin expression.

The purpose of this study is to compare the educational needs and perception of mothers of normal neonates and high risk infants. This research was designed as a descriptive study. Data were collected for two months from April 2002 to March 2002. Subjects were 41 mothers of high risk infants and 60 mothers of normal neonates in one general hospital in Seoul participated in the study. Measurement tools used in this study were the educational needs scale developed by Cho Kyoul Ja et al and the neonatal perceptive inventories scale developed by Broussard. They ask mothers to rate each item on a four point Likert type scale. The collected data were analyzed using SPSS 8.0 program. The variables were listed as frequency, mean, standard deviation, X2 test, t-test, ANOVA. The results were as follows: The educational needs of the mothers of primi pregnancy was higher than the mothers of multi pregnancy. The educational needs on management of diseases such as prevention of infection, symptoms of disease, mental development, attachment promotion, congenital metabolism test, management of convulsion, care of vomiting and fever were higher than general care of infants such as immunization, measurement of temperature, hiccough care, follow up care. The informations must be included in nursing intervention program to reduce the mothers' stress level. In conclusion, in order to promote positive mother infant relationship, nurse need to give information and educate the mothers of high risk infant and normal neonate.
Equipment and Supplies ; Fever ; Hiccup ; Hospitals, General ; Humans ; Immunization ; Infant* ; Infant, Newborn* ; Metabolism ; Mothers* ; Nursing ; Pregnancy ; Seizures ; Seoul ; Vomiting ; Child Health

BACKGROUND: Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, is known to have analgesic properties in subanesthetic doses and has been used as an analgesic in the postoperative period by variable routes. The effect of adding ketamine to analgesia using intravenous PCA morphine was evaluated in 90 women after cesarean section. METHODS: Ninety parturients were randomly allocated to three groups and each group had 30 women. The parturients in group 1 were given analgesics of morphine only, group 2 were given analgesics of the 2 : 1 mixture of morphine and ketamine, and group 3 were given analgesics of the 1 : 1 mixture of morphine and ketamine. We evaluated the analgesic requirement, numerical rating pain score, side effects and patient's satisfaction. RESULTS: The morphine requirement in group 3 was significantly lower than that in groups 1 and 2 at 3, 6, 12, 24 and 48 hours postoperatively. The pain score in group 2 was lower than that in group 1 at 3 and 6 hours and the pain score in group 3 was lowest of all groups at 3 and 6 hours. The incidence of dizziness was higher in group 3 than in groups 1 or 2. CONCLUSIONS: We concluded that adding ketamine with morphine in using an intravenous PCA can decrease analgesic requirements and improve analgesic property.
Analgesia ; Analgesics ; Cesarean Section* ; Dizziness ; Female ; Humans ; Incidence ; Ketamine* ; Morphine* ; N-Methylaspartate ; Passive Cutaneous Anaphylaxis* ; Postoperative Period ; Pregnancy

PURPOSE: Isolated noncompaction of the ventricular myocardium(INVM) can present as heart failure or arrhythmias in a child. It is a rare disorder, characterized by prominent trabecular meshwork and deep intertrabecular recesses. We still know little about the diagnosis, symptoms, and clinical outcomes of INVM. METHODS: We included in our study 6 patients who showed ventricular noncompaction on echocardiography. Patients were diagnosed as INVM were excessively prominent trabeculations with deep intertrabecular recesses were found on echocardiography. Patients who had other complex heart lesions such as pulmonary atresia with intact ventricular septum in addition to ventricular noncompaction, were excluded. RESULTS: Age at presentation ranged from 1 day 7 years, with follow up being as long as 6 years. Symptoms at initial presentation were heart murmur, paroxysmal supraventricular tachycardia, cyanosis, feeding intolerance, ventricular tachycardia, and cardiomegaly at fetal screening. Prominent trabeculations and intertrabecular recesses were observed at left ventricular apex in all six patients. All patients were alive at last follow-up. One patient showed WPW syndrome on electrocardiography. Echocardiography revealed decreased systolic function in 4 patients, and decreased systolic and diastolic function in 1 patient. One patient is currently asymptomatic. CONCLUSION: Six patients were diagnosed with INVM with various symptoms at initial presentation. Echocardiography is the most important tool in the diagnosis of INVM due to its morphological characteristics. INVM can rarely be the cause of long term systolic dysfunction, and early detection by echocardiographic screening may be beneficial.
Arrhythmias, Cardiac ; Cardiomegaly ; Child ; Cyanosis ; Diagnosis ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Heart ; Heart Failure ; Heart Murmurs ; Humans ; Isolated Noncompaction of the Ventricular Myocardium* ; Mass Screening ; Pulmonary Atresia ; Tachycardia, Supraventricular ; Tachycardia, Ventricular ; Trabecular Meshwork ; Ventricular Septum ; Wolff-Parkinson-White Syndrome

No abstract available.
Malacoplakia* ; Umbilical Cord*

Signal transducer and activator of transcription 4 (STAT4), a STAT family member, mediates interleukin 12 (IL12) signal transduction. IL12 is known to be related to calorie-restricted status. In the central nervous system, IL12 also enhances the production of nitric oxide (NO), which regulates food intake. In this study, the expression of neuronal NO synthase (Nos1), which is also related to food intake, was investigated in the hypothalamic areas of Stat4 knockout (KO) mice using nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) histochemistry, a marker for neurons expressing Nos1 enzyme. Western blots were also performed to evaluate Nos1 and Fos expression. Wild-type Balb/c (WT group, n=10 male) and Stat4 KO mice (Stat4 KO group, n=8 male) were used. The body weight and daily food intake in the WT group were 22.4+/-0.3 and 4.4 g per day, while those in the Stat4 KO group were 18.7+/-0.4 and 1.8 g per day, respectively. Stat4 mice had lower body weight and food intake than Balb/c mice. Optical intensities of NADPH-d-positive neurons in the paraventricular nucleus (PVN) and lateral hypothalamic area (LHA) of the Stat4 KO group were significantly higher than those of the WT group. Western blotting analysis revealed that the hypothalamic Nos1 and Fos expression of the Stat4 KO group was up-regulated, compared to that in the WT group. These results suggest that Stat4 may be related to the regulation of food intake and expression of Nos1 in the hypothalamus.
Animals ; Blotting, Western ; Body Weight ; Central Nervous System ; Eating ; Humans ; Hypothalamic Area, Lateral ; Hypothalamus ; Interleukin-12 ; Mice ; Mice, Knockout ; NAD ; Neurons ; Nitric Oxide ; Nitric Oxide Synthase ; Paraventricular Hypothalamic Nucleus ; Signal Transduction ; STAT4 Transcription Factor

Anti-Ma2-associated encephalitis is one of the paraneoplastic limbic and brainstem encephalitis characterized by decreased consciousness, parkinsonism and the limitation of vertical eye movement. It is usually associated with non-small cell lung cancer in male and female or germ cell tumor in male. Herein, we report a case of atypical anti-Ma2-associated encephalitis which presented with axonal sensorimotor polyneuropathy.
Autoantibodies ; Axons ; Brain Stem ; Carcinoma, Non-Small-Cell Lung ; Consciousness ; Encephalitis ; Eye Movements ; Female ; Humans ; Limbic Encephalitis ; Male ; Neoplasms, Germ Cell and Embryonal ; Paraneoplastic Syndromes ; Parkinsonian Disorders ; Polyneuropathies

The objective of our study was to evaluate the dietary intakes and eating habit for seniors utilizing ten different social welfare centers in Seoul, Korea. The total number of subjects of this study was 543 (male: 199, female: 344) of 60 years of age or older. The survey was performed through personal interview questionnaires from May 3rd to June 1st 2006. After assigning subjects to four categories based on family type, single, couple, joint family, and other, these categories were compared with the estimated total nutrient intakes and eating habit. Validity was assessed by comparison with 24-hour dietary recalls and dietary variety score (DVS). The results showed that senior in single family type was far lower than that of couple family type in terms of frequency of meal per day and intake of snacks. Dietary variety score represented that a single female with social security beneficiary showed the lowest variety score compared with other family type. The lunch meal provided by social welfare center turned out to be the most nutritious diet and had significant proportion of daily intakes in essential nutrients such as protein, iron, vitamin A, and vitamin C. Taken together, the family type was a significant factor and the accompaniment is another effector on dietary pattern in the elderly. We strongly suggest that the current lunch program in welfare center should be expanded to breakfast meal, and furthermore the small commodity program is also needed to provide the elderly with meal for social communication.
Aged ; Ascorbic Acid ; Breakfast ; Diet ; Eating* ; Female ; Humans ; Iron ; Joints ; Korea ; Lunch ; Meals ; Surveys and Questionnaires ; Seoul* ; Snacks ; Social Security ; Social Welfare* ; Vitamin A