No abstract available.
Blood Platelets* ; Leukocytes* ; Plateletpheresis*

Anesthesia for the patients with mediastinal mass may be associated with significant respiratory and cardiovaacular complications due to compression of traeheobronchial trees, the pulmonary artery, heart and superior vena cava The authors present a case of a 6-year-old girl with a large mediastinal tumor located in anterior and superior mediaetinum. Preoperatively, the patient was asymptomatic and anesthesia was induced and maintained uneventfully. Operative finding was that 8 X 14 cm sized hemangioma was extended superiorly over thoracic outlet, posteriorly aorta and SVC, medially pericardium and right hilum and inferiorly right upper lung and pleura. Because difficulties in removal of the hemangioma were expected, exploratory thoracotomy was discontinued. On emergence, as soon as the patient was extubated due to irritability, the patient became cyanotic and was noticed bulging mass on right supraclavicular area, Intubation was attempted and during direct laryngoscopy, anesthesiologist also noticed a bulging mass in right oral cavity. Postoperatively, the patients airway was kept with endotracheal tube, but cyanosis appeared on the face and skin over the chest, but not below the abdomen. Bulging mass on right supraclavicular area, distension of neck vein and conjunctival edema were noticed only when the patient was crying or suctioned. Symptoms improved by deep sedation. We assumed that enlargement of hemangioma due to increased central blood volume occasionally compressed tracheobronchial tree and sup. vena cava when patient was irritable, crying and coughing. On 11th postoperative day, patient was transferred to the another hospital for the better treatment with endotracheal intubation.
Abdomen ; Airway Obstruction* ; Anesthesia ; Aorta ; Blood Volume ; Child ; Cough ; Crying ; Cyanosis ; Deep Sedation ; Edema ; Female ; Heart ; Hemangioma ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopy ; Lung ; Mouth ; Neck ; Pericardium ; Pleura ; Pulmonary Artery ; Skin ; Suction ; Thoracotomy ; Thorax ; Veins ; Vena Cava, Superior

BACKGROUND: Obstructive sleep apnea (OSA) is known to be an independent risk for cardiovascular diseases. The carotid intima.media thickness (IMT) is a surrogate marker of subclinical atherosclerosis. The aim of this study was to measure the carotid IMT in subjects with or without OSA and quantify its correlation with OSA severity. METHODS: Subjects were categorized into OSA and non-OSA groups based on polysomnography findings. The carotid IMT was considered a marker of atherosclerosis. The independent relationship between carotid IMT and OSA severity was analyzed using multiple linear regression. The presumed confounders were age, sex, body mass index, blood pressure, blood lipid and glucose profiles, smoking and alcohol drinking statuses, medications, being overweight, and having hypertension, diabetes mellitus, or hyperlipidemia. RESULTS: The carotid IMT was larger in OSA subjects (n=82, 0.620+/-0.096 mm [mean+/-SD]) than in non-OSA subjects (n=22, 0.551+/-0.078 mm; p=0.006), and was independently correlated with OSA severity (p<0.001). However, it was not affected by any of the other variables investigated. CONCLUSIONS: Subjects with OSA showed an increased IMT, with the thickness being correlated with the OSA severity. This finding suggests that accelerated atherosclerosis in OSA is the mechanism linking OSA and future cardiovascular events.
Alcohol Drinking ; Anoxia ; Atherosclerosis ; Biomarkers ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Carotid Arteries ; Carotid Intima-Media Thickness ; Diabetes Mellitus ; Glucose ; Hypertension ; Linear Models ; Overweight ; Polysomnography ; Sleep Apnea, Obstructive ; Smoke ; Smoking ; Ultrasonography, Doppler

BACKGROUND: Obstructive sleep apnea (OSA) contributes to the development of cardiovascular diseases. The aim of this study is to analyze the association between OSA and cardiovascular diseases in adult. METHODS: We recruited 718 consecutive subjects (611 male, 44.8+/-12.7 years old) diagnosed as OSA based on overnight polysomnography. The prevalence of hypertension, diabetes mellitus, myocardial infarction and stroke was defined and compared with that in general adult population (the Third Korea National Health and Nutritional Examination Survey, KNHANES III 2005). Correlation between the prevalence and OSA severity was analyzed after adjusting age, sex, body mass index, smoking, and alcohol consumption. RESULTS: Prevalence of vascular diseases was higher in OSA than general population. Prevalence of hypertension was 39.0% (13.0% from KNHANES III), diabetes 8.2% (5.2%), myocardial infarction 3.0% (0.6%) and stroke 7.2% (1.6%). Apnea-hypopnea index as the marker of OSA severity significantly correlated with hypertension (p=0.01). CONCLUSIONS: Cardiovascular diseases were more prevalent in OSA. Prevalence of hypertension increased proportionally to OSA severity.
Adult ; Alcohol Drinking ; Body Mass Index ; Cardiovascular Diseases ; Diabetes Mellitus ; Humans ; Hypertension ; Korea ; Male ; Myocardial Infarction ; Polysomnography ; Prevalence ; Respiration ; Sleep Apnea, Obstructive ; Smoke ; Smoking ; Stroke ; Vascular Diseases

Endometrial cancer is the third most common gynecologic cancer in the Korea and occurs mainly in menopausal women. Although it can develop in young premenopausal women cancer as well, an attack in the adolescent girl is very rare. A 13-year-old girl visited gynecology department with the complaint of abnormal uterine bleeding. An endometrial biopsy revealed FIGO (International Federation of Gynecology and Obstetrics) grade II endometrial adenocarcinoma. In the treatment of endometrial cancer, conservative management should be considered if the patient is nulliparous or wants the fertility preservation. Therefore, we decided to perform a hormonal therapy and a follow-up endometrial biopsy after progestin administration for eight months revealed no residual tumor. We report a case of endometrial cancer occurred in a 13-year-old girl with a brief review of the literature.
Adenocarcinoma* ; Adolescent* ; Biopsy ; Endometrial Neoplasms ; Female* ; Fertility Preservation ; Follow-Up Studies ; Gynecology ; Humans ; Korea ; Neoplasm, Residual ; Uterine Hemorrhage

Angiosarcomas are extremely rare in the nasal cavity and para-nasal sinus. Upto the present only nineteen cases have been reported in the literature. A 31-year-old male presented with right facial swelling and large oral cavity mass. He was treated with wide excision of the tumor by radical maxillectomy. The tumor was diagnosed as angiosarcoma by immunohistochemical staining with factor VIII-reactive antigen. No adjuvant radiotherapy after surgery was done. After 9 montbs from surgery, the tumor recurred in the primary sites of oral cavity and right maxillary sinus and metastasized to the both lungs. He was treated with palliative chemotherapy and showed a stable disease in follow-up magnetic resonance image of para-nasal sinus and simple chest X-ray after second cycle of chemotherapy. He is undergoing further chemotherapy without any problems. We report first in Korea a case of primary angiosarcoma of the right maxillary sinus in a 31-year-old male.
Adult ; Drug Therapy ; Follow-Up Studies ; Hemangiosarcoma* ; Humans ; Korea ; Lung ; Male ; Maxillary Sinus* ; Mouth ; Nasal Cavity ; Radiotherapy, Adjuvant ; Thorax

BACKGROUND: To develop surrogate insulin-producing cells for diabetes therapy, adult stem cells have been identified in various tissues and studied for their conversion into β-cells. Pancreatic progenitor cells are derived from the endodermal epithelium and formed in a manner similar to gut progenitor cells. Here, we generated insulin-producing cells from the intestinal epithelial cells that induced many of the specific pancreatic transcription factors using adenoviral vectors carrying three genes: PMB (pancreatic and duodenal homeobox 1 [Pdx1], V-maf musculoaponeurotic fibrosarcoma oncogene homolog A [MafA], and BETA2/NeuroD). METHODS: By direct injection into the intestine through the cranial mesenteric artery, adenoviruses (Ad) were successfully delivered to the entire intestine. After virus injection, we could confirm that the small intestine of the mouse was appropriately infected with the Ad-Pdx1 and triple Ad-PMB. RESULTS: Four weeks after the injection, insulin mRNA was expressed in the small intestine, and the insulin gene expression was induced in Ad-Pdx1 and Ad-PMB compared to control Ad-green fluorescent protein. In addition, the conversion of intestinal cells into insulin-expressing cells was detected in parts of the crypts and villi located in the small intestine. CONCLUSION: These data indicated that PMB facilitate the differentiation of mouse intestinal cells into insulin-expressing cells. In conclusion, the small intestine is an accessible and abundant source of surrogate insulin-producing cells.
Adenoviridae ; Adult Stem Cells ; Animals ; Endoderm ; Epithelial Cells ; Epithelium ; Fibrosarcoma ; Gene Expression ; Genes, Homeobox ; Insulin ; Intestine, Small* ; Intestines ; Mesenteric Arteries ; Mice* ; Oncogenes ; RNA, Messenger ; Stem Cells ; Transcription Factors

BACKGROUND: Exercise testing is a standard noninvasive method used in the evaluation and management of patients with suspected coronary artery disease. However, patients with lower limb impairment are unable to undergo a standard bicycle or treadmill test. Alternative methods of exercise testing are needed for patients with vascular, orthopedic or neurologic conditions who cannot perform leg exercise. This study was aimed to determine the diagnostic accuracy of arm exercise thallium-201 SPECT for evaluating chest pain in patients unable to perform leg exercise. METHOD: Twenty-five anginal patients performed arm ergometry testing in conjunction with thallium-201 SPECT. Thereafter all underwent coronary angiography. RESULT: Significant coronary artery disease (> or =50% stenosis) in at least one vessel was present in 22 (88%) of the 25 patients. The sensitivity of thallium-201 SPECT for detecting coronary artery disease was 91%, which was significantly higher than the 32% sensitivity found with the electrocardiographic response alone (p <0.001). Thallium-201 SPECT yielded a sensitivity of 88, 86 and 100% for one, two, and three vessel diseases, respectively, and an 84% sensitivity and 81% specificity for detecting individual vessel stenosis. CONCLUSION: Arm exercise thallium-201 SPECT is useful for detecting coronary artery disease in patients unable to perform leg exercise. In addition, it provides an information regarding exercise tolerance. Therefore, this test appears to be reliable and useful and should be considered in the detection of coronary artery disease in nonambulatory patients.
Angina Pectoris ; Arm* ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Electrocardiography ; Exercise Test ; Exercise Tolerance ; Humans ; Leg ; Lower Extremity ; Orthopedics ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

Complex choristoma with a predominance of lacrimal gland tissue is known as unusual congenital and developmental abnormality. Several cases of ectopic lacrimal gland have been reported in Korea. But complex choristoma with ectopic lacrimal gland on both eyes has never been reported. The authors have experienced a case of complex choristoma with ectopic lacrimal gland in lower and lateral quadrant of bulbar conjuntiva on both eyes in a 12-year-old boy.
Child ; Choristoma* ; Humans ; Korea ; Lacrimal Apparatus* ; Male

Stem cells in adult pancreas and their specific marker are poorly characterized. We hypothesized that pancreatic stem cells could evolve from the duct system in response to neogenic stimulation. Following partial pancreatectomy (Px), we found extensive formation of ductules consisting of nestin-positive epithelial cells with higher replicating ability in the neogenic foci after Px. The neogenic ductules were isolated for the culture of nestin-positive duct cells. These nestinpositive duct cells were numerous and displayed extensive self-replication in the duct cell explants, thus depicted as nestin-positive duct stem (NPDS) cells. Endocrine cells, mostly insulin cells were present in the explants at day 2 as single cells or as small clusters adjacent to the NPDS cells, and formed islet-like masses at day 3 of culture, implying islet cell differentiation from NPDS cells. We found transient up-regulation of PDX-1 expression by RT-PCR at day 3 after Px in pancreatic tissue. We investigated the effect of clusterin overexpression on differentiation of insulin beta cells from duct cells We found that the number of insulin producing cells increased 11.5 fold when clusterin was overexpressed. Insulin expression, both insulin mRNA and peptide levels, was increased in clusterin cDNA transfected cells. In conclusion, we suggest that NPDS cells could be generated from adult pancreas by neogenic motivations and they may differentiate into insulin-secreting-cells, and clusterin could stimulate not only differentiation of precursor cells in the pancreatic duct, but also proliferation of predifferentiated beta cells. Those differentiated beta cells are functional cells secreting insulin in response to glucose stimulation.
Adult* ; Cell Differentiation* ; Clusterin ; DNA, Complementary ; Endocrine Cells ; Epithelial Cells ; Glucose ; Humans ; Insulin ; Islets of Langerhans ; Nestin ; Pancreas* ; Pancreatectomy ; Pancreatic Ducts ; RNA, Messenger ; Stem Cells* ; Up-Regulation