BACKGROUND: One of the most frequent cytogenetic abnormality in acute myeloid leukemia (AML) is t(8;21) (q22;q22), with rearrangement of the AML1 gene on chromosome 21q22 and the ETO gene on chromosome 8q22. In adult AML1/ETO-associated leukemia patients, chemotherapy alone results in cure rates that are comparable to or better than those achieved with allogenic bone marrow transplantation. Despite the relatively good prognosis of AML1/ETO fusion transcript, relapse of leukemia remains the most common cause of treatment failure. Monitoring minimal residual disease (MRD) in leukemia has two main aims : to assess the effectiveness of treatment and to detect early signs of relapse. Reverse transcription-polymerase chain reaction (RT-PCR)- based methods is the rapid and sensitive method in the identification of this molecular abnormality. The purpose of this study is to ensure the usefulness of the RT-PCR technique for detecting MRD in AML1/ETO-associated leukemia patients in remission and to establish the correlation of the serial detection of AML1/ETO fusion transcripts after complete remission and long-term outcome. METHODS: From the bone marrow aspirates of 25 AML1/ETO positive AML patients, serial detection of AML1/ETO fusion trascripts was performed using RT-PCR. RESULTS: AML1/ETO fusion transcripts were positive in 14 cases who did not show t(8;21). In serial assay, AML1/ETO fusion transcripts was positive in 9 cases and negative in 13 cases at 10 weeks after complete remission. AML1/ETO fusion transcripts (+) group has 107.4+/-18.2 months suvival and AML1/ETO fusion transcripts (-) group has 47.3+/-18.0 months survival. However, there is no significance (P=0.11). CONCLUSION: This study suggests that the early negative conversion of AML1/ETO fusion transcript may be the good prognostic predictor. The RT-PCR technique is useful for detecting minimal residual disease in leukemia patients in remission and it may improve the therapeutic strategy for leukemia.
Adult ; Male ; Female ; Humans ; Bone Marrow Transplantation

OBJECTIVE: The purpose of this study was to review the incidence, types, chemotherapy regimens, operation methods, pregnancy rate and propiosis of the ov#arian malignancy under the age of twenty years old. METHODS: Retrospective reviews of the medical recordings for 22 patients with ovarian malignancy under the age of twenty years old in the Department of Obstetrics and Gynecology, Hanyang University from 1986 to 1997 were done. RESULTS: Gerin cell tumor accounts for the majority of cases (77%), whereas 5 patients(23%) belong to the common epithelial poup which were all mucinous type. Our experiences with 22 cases are as followings: 5 mucinous cystadenocarcinoma, 8 immature teratoma, 4 endodermal sinus tumor, 3 dysgernma and 2 mixed germ cell tumor. The incidence of this group was 8.2% (22/266) in all ovarian malignancy. Fourteen of them are stage I, each one is, stage II and IV, and six patients are stage III. The average age was 14.9 years old in germ cell tumor and 18.4 yems old in mucinous cystadenoearcinoma. Malignant ovarian cancer under the age of twenty can be treated with conservative surgery, followed by adjuvant chemotherapy. Commonly used chemotherapeutic regimens were VAC(Vincristine, Actinomycin-D; Cyclophosphamide), VBP(Vinblastine, Bleomycin, Cisplatin) and BEP(Bleomycin, Etoposide, Cisplatin). Second look operations were done in 11 patienth and histologic positive findings were detected in 4 of them. The length of follow-up ranged ftom 3 months to 137 months and median value was 44 rnonths. CONCLUSIONS: It is concluded that for young women who wish to preserve child-bearing capacity, regardless of the stage of the tumor, fertility preserving surgery with complete surgical staging, if necessary followed by combination chemotherapy is an appropriate treatment.
Bleomycin ; Chemotherapy, Adjuvant ; Cystadenocarcinoma, Mucinous ; Drug Therapy ; Drug Therapy, Combination ; Endodermal Sinus Tumor ; Etoposide ; Female ; Fertility ; Follow-Up Studies ; Gynecology ; Humans ; Incidence ; Medical Records ; Mucins ; Neoplasms, Germ Cell and Embryonal ; Obstetrics ; Ovarian Neoplasms ; Pregnancy Rate ; Retrospective Studies ; Teratoma

Methemoglobinemia is an uncommon but potentially fatal disorder. Most cases have no adverse clinical consequence and require no treatment, but methemoglobinemia is often overlooked as a cause of low oxygen saturation, and often mistaken for the more common causes of hypoxia by anesthesiologists despite simple bedside tests that indicate the presence of this treatable abnormality. We present a 68-year-old female patient who underwent gastrectomy for advanced gastric cancer with bleeding. In the preoperative period, the patient showed cyanosis and oxygen saturation was 85% by pulse oximeter, but oxygen saturation by arterial blood gas analysis was 100%. After tracheal intubation, the methemoglobin level was 18.3%. Ascorbic acid and methylene blue were administered. During preanesthetic evaluation, the patient had not informed the anesthesiologist that she had been taking dapsone.
Aged ; Anesthesia, General ; Anoxia ; Ascorbic Acid ; Blood Gas Analysis ; Cyanosis ; Dapsone ; Female ; Gastrectomy ; Hemorrhage ; Humans ; Intubation ; Methemoglobin ; Methemoglobinemia ; Methylene Blue ; Oximetry ; Oxygen ; Preoperative Period ; Stomach Neoplasms

Combining the stereotactic precise localization with open craniotomy can decrease post-operative morbidity and is helpful for total removal of small intra-axial lesion. The authors had good results by the stereotactic guided craniotomy. The method and results of the technique are discussed in reference to 8 patients.
Craniotomy ; Humans

Endoscopic retrograde cholangiopancreatography (ERCP)-related complications should be promptly and properly managed in accordance with the type and severity of the complication and the comorbidity of the patient. Neurologic complications occur very rarely, but despite of the prompt management, the patient status can severely deteriorate and sometimes result in fatality. A female patient visited SAM Medical Center for abdominal pain and yellow skin. She has taken a current medication for essential hypertension since 10 years ago. Initial laboratory findings showed obstructive jaundice and abdominal computed tomography (CT) showed two common bile duct stones with moderate dilation of bile duct. Her vital sign with oxygen saturation was stable until the first attack of seizure 12 hours later after removal of stones through the ERCP. Emergent brain CT and magnetic resonance imaging revealed multiple cerebral infarctions of both hemispheres with right predominance of middle cerebral artery territory and no evidence of air emboli. She died four days later despite of intensive care including high oxygen therapy and intravenous broad spectrum antibiotics with antiplatelet drug. We report a rare, delayed occurrence of a fatal multiple cerebral infarctions 12 hours after ERCP.
Abdominal Pain ; Anti-Bacterial Agents ; Bile Ducts ; Brain ; Cerebral Infarction* ; Cholangiopancreatography, Endoscopic Retrograde* ; Common Bile Duct ; Comorbidity ; Female ; Humans ; Hypertension ; Critical Care ; Jaundice, Obstructive ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Oxygen ; Seizures ; Skin ; Vital Signs

No abstract available.
Astrocytoma* ; Epidermal Growth Factor* ; Receptor, Epidermal Growth Factor*

Helical rim defects of the auricle are usually the result of injury or tumor excision. Acquired helical rim defects are eye-catching and cosmetically unacceptable. We experienced a case of squamous cell carcinoma at the helical rim. The lesion was resected with clear margin and the defect was successfully reconstructed with a helical rim chondrocutaneous advancement flap.
Carcinoma, Squamous Cell ; Ear Auricle ; Ear, External

The fourth branchial cleft cyst is rare and frequently unknown to clinicians. Misdiagnosis is common and definitive surgery is often made difficult by previous episodes of infection and incision. We have experienced a case of non-communicating dumbbell shaped fourth branchial cleft cyst. We performed complete excision of the entire epithelial tract after disarticulating the cricothyroid joint. There was no recurrence.
Branchial Region ; Branchioma ; Diagnostic Errors ; Joints ; Recurrence

BACKGROUND AND OBJECTIVES: Negative Pressure Wound Therapy (NPWT) has been used in many surgery to treat complicated wound and impaired wound healing by delivering negative pressure at the wound site through a patented dressing, which helps draw wound edges together, remove infectious materials, and actively promote granulation at the cellular level. Recently application of NPWT has been increased to treat deep neck infection. We aimed to retrieve indications and guidelines to treat deep neck infection from our cases and after reviewing articles. SUBJECTS AND METHOD: From our experience with 9 cases presented as deep neck abscess in which the application of a Vacuum-assisted closure device was used instead of common drainage tubes after surgical evacuation and journal review, indications and guidelines to apply NPWT as one of the tools to treat deep neck infection were retrieved. RESULTS: Indication and Guideline of NPWT. 1) For simple abscess involving single space excepting the mediastinum, intravenous administration of broad-spectrum antibiotics, needle aspiration or simple surgical drainage is recommended. 2) In the case of failure of previous treatments, NPWT will be necessary for immunocompromised hosts such as diabetic patients for whom more than two spaces are involved, the mediastinal involvement, compromised airway or disseminated intravascular coagulation. In severe cases involving the chest, video-assisted thoracoscopic surgery or mediastinoscopy could be used. 3) For patients with improving signs such as decreasing pus, increasing granulation formation, negative culture results from sponge, and normalized C-reactive protein, we can stop NPWT and convert to the regular wound care. CONCLUSION: Indication and Guideline of NPWT could be applied to treat deep neck infection.
Abscess ; Administration, Intravenous ; Anti-Bacterial Agents ; Bandages ; C-Reactive Protein ; Disseminated Intravascular Coagulation ; Drainage ; Humans ; Immunocompromised Host ; Mediastinoscopy ; Mediastinum ; Neck* ; Needles ; Negative-Pressure Wound Therapy* ; Porifera ; Suppuration ; Thoracic Surgery, Video-Assisted ; Thorax ; Wound Healing ; Wounds and Injuries

Interstitial pulmonary emphysema is a well-documented complication of assisted mechanical ventilation in premature infants with respiratory distress syndrome. Localized persistent interstitial pulmonary emphysema (LPIPE) confined to a single lobe was incidentally presented in a 4-day-old female infant. This patient was a normal full-term baby with no respiratory distress symptom and no experience of assisted mechanical ventilation. Chest radiograph showed radiolucent area in right lower lobe zone, which needed differential diagnosis from other congenital lesions such as congenital cystic adenomatoid malformation and congenital lobar emphysema. CT scan showed irregular-shaped air cystic spaces and pathologically, cystic walls primarily consisted of compressed lung parenchyma and loose connective tissue intermittently lined by multinucleated foreign body giant cells.
Diagnosis, Differential ; Female ; Human ; Infant, Newborn ; Infant, Newborn, Diseases/*pathology/radiography ; Pulmonary Emphysema/*pathology/radiography