No abstract available.
Humans ; Liver Cirrhosis* ; Liver* ; Sepsis* ; Vibrio cholerae* ; Vibrio*

The causes of pneumomediastinum during perioperative period are trauma to the airway from intubation or other manipulation, raised airway pressure during anesthesia, rupture of a bleb or other intrapulmonary lesion, upper airway damage during neck surgery, infiltration of the tonsillar fossa or adenoid bed with air under pressure, increased airway pressure after nausea and vomiting, and coughing during awakening. This paper is represents and discusses a case of pneumomediastinum, pneumothorax, extensive subcutaneous and retroperitoneal emphysema which occurred suddenly a few minute after several times of bucking and straining in the intubated state with oxygen catheter after tonsillectomy and adenoidectomy at recovery room. The complieation was thought to be a infiltration of air through tonsillar fossa under pressure or alveolar rupture due to increased airway pressure after coughing. The patient was treated with high concentration of oxygen and recoverd uneventfully.
Adenoidectomy ; Adenoids ; Anesthesia ; Blister ; Catheters ; Cough ; Emphysema ; Humans ; Intubation ; Mediastinal Emphysema* ; Nausea ; Neck ; Oxygen ; Perioperative Period ; Pneumothorax ; Recovery Room ; Rupture ; Subcutaneous Emphysema* ; Tonsillectomy* ; Vomiting

The diffuse large B-cell lymphoma category of the Revised European American Classification of Lymphoid Neoplasms (REAL) encompasses different morphologic lymphoma subtypes in a single entity, especially the diffuse large cell (DLC) and the immunoblastic (IBL) subtypes by Working Formulation (WF). The aim of this study is to determine the influence of the morphologic subdivision within this category with respect to clinical outcome and proliferative index using Ki-67 immunostainig combined with image analysis. We retrospectively reviewed 74 patients from 1990 to 1996, who were diagnosed with diffuse large B-cell lymphoma. All cases were reclassified according to REAL and Working Formulation (WF), and Ki-67 immunostaining was performed in all the cases. Fifty-eight cases (78.4%) were classified as DLC and 16 cases (21.6%) as IBL, according to WF. Twenty one cases (28.4%) showed nodal involvement and 53 cases (71.6%), extranodal involvement. All cases were found to display a variable degree of nuclear Ki-67 staining. A proliferative index of 50% or higher identified a group of patients (77%) who had poor clinical results. Overall survival was significantly reduced in these patients displaying high Ki-67 associated proliferative index compared to those with a low proliferative index (p=0.007). 5-year survival estimates were 93% in the low proliferative index group and 55% in the high proliferative index group. A multivariate regression analysis incorporating commonly used clinical prognostic factors confirmed the independent effect of proliferation index on survival. Moreover, all of the 16 IBL cases showed Ki-67 positivity of 50% or higher, which correlates with the poor clinical outcome compared to 70.7% of DLC (p=0.014). We conclude that subdivision of the diffuse large B-cell lymphoma category of the REAL classification is necessary in terms of prognostic significance in correlation with Ki-67 proliferative index.
B-Lymphocytes* ; Classification ; Humans ; Lymphoma ; Lymphoma, B-Cell* ; Lymphoma, Large B-Cell, Diffuse ; Retrospective Studies

Survivin, the recently discovered apoptosis inhibitor of inhibitor of apoptosis (IAP) family is located in chromosome 17q25. It is found only in fetal tissue and transformed tissue but is never found in normal adult tissue. Several authors reported survivin expression in various cancer tissues, which suggested the role of survivin in cancer development. This study intended to find the degree of survivin expression making use of RT-PCR technology and to compare the expression pattern of survivin, caspase 3, and PARP. METHODS: The cell lines known to have survivin expression such as HL60, Daudi, THP1, and colon cancer cell lines such as COLO 201, WiDr and breast cancer cell line ZR-75-1 were used for the positive control. For the negative control, normal colon tissues were included. The total RNAs from the frozen tissue of 6 normal colon, 36 specimens of colorectal cancer, and cell lines were used in RT-PCR. The 20 paraffin embedded tissues were used in immunohistochemical study in order to find out the degree of protein expression of caspase 3 and PARP. Western blotting was conducted on same tissues for caspase 3 as usual manners. RESULTS: The survivin expression by RT-PCR techniques was found in the 22 cases (61.1%). As a result of the immunohistochemical staining, 13 cases (65%) in caspase 3, 17 cases (85%) in PARP showed reduced staining. In western blotting, 32 kDa inactive form of caspase 3 was expressed in 16 cases (80%), but the band of active split form was not found. No significant relationship was found between survivin expression and clinicopathologic data of colorectal carcinomas, and expression of caspase 3 and PARP. CONCLUSIONS: These result suggest that apoptosis mechanism is depressed in colorectal cancer tissues and survivin plays a role in the inhibition of apoptosis of colorectal cancer. More profound study could confirm the apoptosis mechanism in tumorigenesis.
Adult ; Apoptosis ; Blotting, Western ; Breast Neoplasms ; Carcinogenesis ; Caspase 3 ; Cell Line ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms* ; Fetus ; Humans* ; Paraffin ; RNA

No abstract available.
Cyclosporine* ; Fluorescence Polarization Immunoassay* ; Fluorescence Polarization* ; Fluorescence*

PURPOSE: The gastric cancer is a common malignancy worldwide. Developing a screening test for gastric cancer is important because early-stage gastric cancer has a good prognosis. So, we investigated the effect of the CYP2E1 and CYP2C19 polymorphisms on the susceptibility for gastric cancer. METHODS: We studied 92 patients who were diagnosed with gastric cancer at Hospital and 80 patients who were admitted during the same period. Polymerase chain reaction (PCR) was performed for the 96-bp insertion polymorphism of CYP2E1 and the poor metabolizer of CYP2C19. The expressions of CYP2E1 and CYP2C19 in case and control groups were compared by Student's t-test and logistic regression analysis. RESULTS: The distribution of the CYP2E1 96-bp insertion polymorphism was 61 (66.3%), 28 (30.4%) and 3 (3.3%) for insert 0, insert 1 and insert 2 in the study group, respectively, and 61 (76.3%), 18 (22.5%) and 1 (1.3%) in control group, respectively. The distribution of the CYP2C19 poor metabolizer was 12 (13.0%) and 5 (5.4%) for CYP2C19*2/*2 and CYP2C19*2/*3 in the study group, respectively, and 3 (3.7%), 1 (1.3%) and 7 (8.8%) for CYP2C19*2/*2, CYP2C19*3/*3 and CYP2C19*2/*3 in control group, respectively. The ORs for CYP polymorphisms on stomach cancer were 1.2 (95% CI: 0.8~3.2) in the CYP2E1 96-bp insert group and 1.4 (95% CI 0.6~3.2) in the CYP2C19 PM. For the patients younger than 50 years, the OR of the CYP2C19 poor metabolizer for stomach cancer was much higher than, but there was the limitation that the age and gender distribution in the 2 groups did not match (P=0.004). CONCLUSION: We noted that there was no significant correlation between the CYP2E1 and CYP2C19 polymorphisms and the gastric cancer group. Yet there was a tendency for the higher incidence of CYP2E1 and CYP2C19 polymorphisms in the gastric cancer group. Further well designed studies will be needed to conclude the effects of CYP2E1 and CYP2C19 polymorphisms on stomach cancer.
Cytochrome P-450 CYP2E1* ; Cytochrome P-450 Enzyme System ; Humans ; Incidence ; Logistic Models ; Mass Screening ; Polymerase Chain Reaction ; Prognosis ; Stomach Neoplasms*

PURPOSE: There is a need for sensitive, specific diagnostic and prognostic molecular markers that can monitor the early patterns of gene expression in non-invasive exfoliated colonocytes shed in stools. It has been estimated that approximately 10(10) normal adult colonic epithelial cells, each having a lifespan of 3~4 days, are shed from the lower two-thirds of colon crypts daily; thus, the development of a screening test using colonocytes is an realistic goal. Due to the characteristics of stools, few studies have been conducted on RNA based detection methods. Herein, a mass RNA analysis, using stools in colorectal cancer, is reported. METHODS: The study included 15 colorectal cancer patients, and 15 control patients without neoplastic disease. RNA was isolated from routinely collected stool samples using a modified method. The expression levels of survivin, livin, Akt-1, caveolin, histone deacetylase (HDAC)1, matrix metalloproteinases (MMP)-2, MMP-7, MMP-9, MMP-12, hepatoma derived growth factor (HDGF), peptideYY, hypoxia-inducible factor (HIF)-1, epidermal growth factor receptor (EGFR), N-cadherin, catenin-beta, inducible nitric oxide synthase (iNOS), ring-3, enolase-1beta, insulin-like growth factor binding protein (IGFBP)-2, tissue inhibitors of metalloproteinase (TIMP)-1 and EphB2 were determined by reverse transcriptase- polymerase chain reactions (RT-PCR). RESULTS: The rates of expression of fecal survivin, livin and Akt-1 assays for colorectal cancer were all 93%; whereas, those of the fecal caveolin, HDAC1, MMP-2, HDGF and peptideYY assays for colorectal cancer were 13, 6, 20, 6 and 6%, respectively. The remaining 13 assays did not show any expression in either the colorectal or normal groups. The expression levels of survivin, livin and Akt-1 were higher in the colorectal cancer than normal group in a semiquantitative analysis (P < 0.05). CONCLUSIONS: These fecal survivin, livin and Akt-1 assays had both high expression rate and levels (colorectal cancer as distinguished from normal group) for detecting colorectal cancer; although, a larger study will be necessary to assess the expression rates and levels.
Adult ; Biomarkers, Tumor* ; Cadherins ; Carcinoma, Hepatocellular ; Carrier Proteins ; Colon ; Colorectal Neoplasms ; Epithelial Cells ; Gene Expression ; Histone Deacetylases ; Humans ; Mass Screening ; Matrix Metalloproteinases ; Nitric Oxide Synthase Type II ; Polymerase Chain Reaction ; Receptor, Epidermal Growth Factor ; RNA

A 77-year-old woman presented with bilateral leg weakness, accompanied by severe axial back and radicular pain, after a L4–5 epidural injection. She had been receiving misappropriated epidural injections for the last few months. A contrast-enhanced magnetic resonance image showed rim enhancing, spinal canal compromising cystic lesion at the posterior epidural space of L4–5. During surgery, a severely central compromised non-communicating cystic lesion located at posterior epidural space was resected. A histological report of this lesion confirmed a pseudocyst containing a degenerated synovial tissue. Herein, we report our experience of cauda equine syndrome after epidural injection with successful treatment.
Aged ; Cauda Equina* ; Epidural Space ; Female ; Humans ; Injections, Epidural* ; Leg ; Polyradiculopathy* ; Spinal Canal

PURPOSE: The balance between cell death and proliferation is a key step in cellular homeostasis. Inhibition of apoptosis could trigger an abnormal malignant change. Survivin is a recently reported anti-apoptotic molecule that inhibits the caspase system along the apoptosis pathway. It is expressed in fetal tissue and transformed tissue, but not in normal tissues except durung the mitosis period. Some authors have described abnormal survivin expression in various cancer tissues. We performed western blotting in colorectal cancer to assess the expression pattern of survivin. METHODS: Thirty-four colorectal cancer tissues and adjacent normal colonic epithelia of patients operated an at KCCH from June 1998 were assessed. We used the common western blotting method with the polyclonal anti-survivin antibody. RESULTS: Survivin was expressed in all cases (34 cases, 100%) of cancer tissues and two cases (5.8%) of normal tissue. Seven of 34 cases showed a strong positive result. Univariate analysis of sex, age, stage, original site, lymphatic invasion, neural invasion, and vessel invasion between the positive group and the strongly positive group revealed no significant relationship except for neural invasion. CONCLUSIONS: Survivin should be a good tumor marker of colorectal cancer.
Apoptosis ; Blotting, Western* ; Cell Death ; Colon ; Colorectal Neoplasms* ; Fetus ; Homeostasis ; Humans ; Mitosis

Renal osteodystrophy is a leading cause of morbidity in patients with end stage renal disease(ESRD), including a diverse clinical spectrum and histologic lesions. Since the invasiveness and practical limitations of bone biopsy to diagnose the exact nature of bone disease in ESRD patients, many attempts have been made to investigate the biologic markers of bone disease. Bone-specific alkaline phosphatase(bAP) is localized in the plasma membrane of osteoblast to be involved in bone formation and skeletal mineralization. This study was undertaken to evaluate the value of bAP in the diagnosis of renal osteodystrophy and to examine the correlation between bAP (Immunoassay, Metra, U.S.A.) and other known markers of bone turn-over, total alkalilne phosphatase (tAP), intact parathyroid hormone(iPTH) and osteocalcin in 49 HD patients(M:F 29:20, mean age 51 years, mean HD duration 57 months). We also evaluated the impact of metabolic acidosis, which is known to stimulate the osteoclastic activity and bone resorption, on plasma levels of these bone markers. The median value of bAP in HD patients was 30.1ng/ml with a distribution of 8.8-140.1ng/ml (normal 12-23ng/ml). There was a significant positive correlation between the duration of HD and plasma levels of tAP, bAP, iPTH and osteocalcin. Significant positive correlaton was also observed between iPTH and other markers of bone turn- over-bAP, tAP and osteocalcin. bAP was correlated better with iPTH(r=0.8483, P<0.001) than tAP(r= 0.7588, P<0.01). In the patients group whose arterial blood bicarbonate below 20mEq/L(30 cases), plasma iPTH and bAP were significantly higher compared to the patients with arterial bicarbonate higher than 20mEq/L(19 cases). In conclusion, high bAP can be an useful marker of increased bone turn-over in HD patients. Increased concentrations of iPTH and bAP in patients with metabolic acidosis(arterial bicarbonate below 20 mEq/L) may reflect an increased bone resorption with resultant increase in osteoblast activity. However, a prospective study with alkali supplementation and bone biopsy will be necessary to define the exact role of metabolic acidosis in the development and progression of renal osteodystrophy.
Acidosis* ; Alkalies ; Alkaline Phosphatase* ; Biomarkers ; Biopsy ; Bone Diseases ; Bone Resorption ; Cell Membrane ; Diagnosis ; Humans ; Kidney Failure, Chronic ; Osteoblasts ; Osteocalcin ; Osteoclasts ; Osteogenesis ; Plasma ; Renal Dialysis* ; Renal Osteodystrophy