Delayed hemolytic transfusion reaction (DHTR) due to multiple red blood cell (RBC) alloantibodies has rarely been reported in Korea. We report a case of DHTR in a patient with anti-c, anti-E, and anti-Jk(b). A 45-year-old man visited the emergency room with flame burn injury over 61% of his entire body. He received six units of packed RBCs and three units of fresh frozen plasma during the operation for excision and glycerol-preserved allografting. His hemoglobin (Hb) level gradually decreased from 13.5 g/dL on the operation day to 7.8 g/dL on the 11th postoperative day in spite of receiving three and two additional units of packed RBCs on the 8th and 9th postoperative days, respectively. His laboratory data was total bilirubin/direct bilirubin 15.9/11.4 mg/dL, lactate dehydrogenase 983 IU/L, haptoglobin 5.93 mg/dL and plasma hemoglobin 8.0 mg/dL. The urinalysis revealed hemoglobinuria, and the peripheral blood film showed moderate spherocytosis. Both the direct and indirect antiglobulin tests were positive, and the follow-up antibody identification test showed anti-c, anti-E, and Jk(b). His Hb levels increased after he was transfused with two units of packed RBCs without c, E, and Jk(b) antigens. This is a case of DHTR due to alloimmunization, which developed within a short interval after the patient had received multiple transfusions.
Bilirubin ; Blood Group Incompatibility ; Burns ; Coombs Test ; Emergencies ; Erythrocytes ; Follow-Up Studies ; Haptoglobins ; Hemoglobins ; Hemoglobinuria ; Humans ; Isoantibodies ; Korea ; L-Lactate Dehydrogenase ; Middle Aged ; Plasma ; Transplantation, Homologous ; Urinalysis

PURPOSE: The purpose of this study is to analyze the usefulness of breast thermography in assessing the prognosis in breast cancer and to obtain correlative evidence between thermographic prognosis and prognostic factors for breast cancer. MATERIALS AND METHODS: Thermographic examinations were performed in a room maintained at 20C. The patient was undressed to the waist, with both arms elevated for 10 minutes prior to the examination in order to cool and equilibrate the breast skin at room temperature. Digital infrared thermographic system was used (NEC, San-ei, Therm Tracer 6T67). The thermographic prognosis was classified according to Dr. Hobbins (Sl good, S2=fair and S-poor) suggested by Dr. Hobbins. The results were analyzed by Chi-Squire. One hundred three patients of breast cancer were examined by digital infrared thermographic system between Jan 1992 and December 1996. RESULTS: The mean age was 48, with a range from 20 to 85. According to the TNM classification 25 (24%) were in stage I, 47 (46%) stage II, 29 (28%) stage III, and 2 (2%) stage IV. The tumor size ranged from 0.5 to 20 cm (mean 4 cm), On histologic examination, 43 (43.%) patients had metastasis in the axillary nodes, 40 (55%) patients was estrogen-receptor positive. The nuclear grade I was 46 (35%) patients, II 24 (28%) and III 16 (19%). The classification of thermographic prognosis were Sl in 47 cases (46%), 82 in 32 (31%) and 83 in 24 (23%). The classification of the thermographic prognosis was found to be statistically correlated with tumor size (p<0.0001), axillary node status (p<0.0001) and TNM tumor stage (p<0.0001). But nuclear grade and estrogen receptor were not statistically correlated with the thermographic prognosis. The correlation between thermographic prognosis and actual survival rate was not available. CONCLUSION: These results suggest that breast thermography would be useful as a predictor in breast cancer before surgery.
Arm ; Breast Neoplasms* ; Breast* ; Classification ; Estrogens ; Humans ; Neoplasm Metastasis ; Prognosis* ; Skin ; Survival Rate ; Thermography*

PUPOSE: Recently, because of the increasing numbers of early gastric cancer patients and improvements in their survivals, greater attention has been directed towards the quality of life and nutritional status of gastric cancer patients after surgery. However, conventional reconstructions, Billroth- I, -II (B-I and B-II) or Roux-en-Y, have proven to have certain limitations, such as a small reservoir, and a malabsorption for iron, fat, calcium, and carotene. To overcome these limitations, we used a jejunal pouch interposition(JPI) after a distal gastrectomy not only to substitute for the small reservoir but also to maintain a physiologic pathway for ingested foods. MATERIALS AND METHODS: A total of 196 gastric cancer patients who underwent a distal gastrectomy between March 2001 and February 2004 were divided into 3 groups: JPI group (n=100), B-I group (n=29), and B-II group (n=67). We assessed the patient's nutritional status, gastric emptying time, and gastrofiberscopic findings. RESULTS: The percents of body weight loss at 6 months, 1 year, and 2 years postoperatively in the JPI group (5.14%, 3.01%, 2.37%) were significantly less than those of the conventional B-I (8.41%, 6.69%, 5.90%) and B-II groups (7.50%, 7.65%, 5.86%) (P=0.011, 0.000, 0.013). The laboratory findings showed no significant differences between the 3 groups, except for a higher total protein level in the JPI group after 6 months postoperatively. Especially, stage I and II cancers in the JPI group showed much higher total protein levels after 1 year postoperatively. The gastric emptying times in the 99mTc- semisolid scans at 6 months, 1 year, and 2 years postoperatively were 102.5, 83.1, and 58.1 minutes in the JPI group, 95.5, 92.0, and 58.5 minutes in the B-I group, and 53.9, 69.1, and 50.2 minutes in the B-II group, respectively. Also, the symptomatic gastric stasis detected with a gastrofiberscope during the early postoperative period (6 months) was gradually improved. CONCLUSION: From a nutritional aspect, a jejunal pouch interposition after a distal gastrectomy could be an alternative reconstruction method, especially in stage I and II gastric cancer patients, in spite of the longer operation time and the probable delayed gastric emptying.
Body Weight ; Calcium ; Carotenoids ; Gastrectomy* ; Gastric Emptying ; Gastroparesis ; Humans ; Iron ; Nutritional Status ; Postoperative Period ; Quality of Life ; Stomach Neoplasms*

Pylephlebitis is defined as septic thrombophlebitis of the portal vein or one of its tributaries, and is usually secondary to an infection in the region drained by the portal venous system. Pylephlebitis is extremely rare today but high mortality still persists. It is a severe complication of acute appendicitis and other intraabdominal and pelvic infections. The patient presents with high fever, chills, leukocytosis, altered liver function, and sometimes jaundice. We describes two cases of pylephlebitis with acute appendicitis. One patient had pylephlebitis with multiple liver abscess and the other had superior mesnteric vein thrombi without liver abscesses. Both the patients had favorable outcomes with medical and surgical therapy. The early diagnosis and treatment with the timely administration of antibiotics and surgical therapy is most important for pylephlebitis.
Anti-Bacterial Agents ; Appendicitis* ; Chills ; Early Diagnosis ; Fever ; Humans ; Jaundice ; Leukocytosis ; Liver ; Liver Abscess ; Mortality ; Pelvic Infection ; Portal Vein ; Thrombophlebitis ; Veins

BACKGROUND: Successful revascularization and reperfusion of ischemia are associated with high systemic complication rates and severe tissue injuries. Such complications with nonfunction are primarily related to the injuries that occur in the reperfusion process, but to date the exact mechanism is not clear. Anoxia or hypoxia and reoxygenation are principal components of ischemia and reperfusion (I/R) and have distinctive effects on the tissue. In the I/R injury model, endothelial cell injury is known to be an initial event, the microvasculature is highly sensitive, and the hyperadhesiveness of leukocytes to endothelial cells contributes to I/R-induced tissue injury. METHODS: Experimental groups were divided into 4 groups: a control group without any treatment, an anoxia group (A-G) treated with anoxic air (93% N2, 5% CO2, 2% H2) for 20 minutes, reoxygenation group (RO-G) treated with 100% O2 for 90 minutes, and a superoxide dismutase (SOD) group treated with SOD just before reoxygenation. Endothelial cells were isolated from human umbilical vein and cultured in an M-199 medium. Their purity was determined by immunofluorescent staining of factor VIII related antigen, phase-contrast, and scanning electron microscopy. Using a microelectrode, radio immunoassay, and Emzyme-linked immunosorbent assay (ELISA), we studied the time-course changes of the levels of nitric oxide (NO), prostaglandin I2 (PGI2), intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule (VCAM) of the 4 groups. RESULTS: 1) Endothelial cell detachment was found in the A-G and more detachment with lysis was found in the RO-G but no significant detachment and lysis were noted in the SOD group. 2) The concentration of NO in the A-G was lower than that of the control group (P<0.05). The NO concentration of the RO-G reached its highest level of 4809.01+/-444.69 nM/1x10(5) cells/ml at 30 minutes(P<0.005) and decreased after that. 3) The concentration of PGI2 in the A-G was higher than that of the control group (P<0.05). The PGI2 concentration of the RO-G reached its highest level of 64.25+/-2.39 pg/1x10(5) cells/ml at 45 minutes (P<0.005) and decreased after that. 4) The concentration of ICAM-1 in the A-G was higher than that of the control group (P<0.005). The ICAM-1 concentration of the RO-G reached its highest level of 7.18+/-0.62 ng/1x105 cells/ml at 15 minutes (P<0.005), then decreased to its lowest level of 2.53+/-0.31 ng/1x105 cells/ml at 60 minutes, but after 75 minutes increased again. 5) The concentration of VCAM in the A-G was higher than that of the control group (P<0.005). The VCAM concentration of the RO-G reached its highest level of 5.50+/-0.55 ng/1x10(5) cells/ml at 15 minutes (P<0.05), then decreased to its lowest level of 3.15+/-0.40 ng/1x10(5) cells/ml at 45 minutes, but after 60 minutes increased again. 6) The SOD group showed little change of NO, PGI2, ICAM-1, and VCAM concentration compared with both the A-G and the RO-G. CONCLUSION: This study showed that cell destruction in the reoxygenation group was more severe than that in the anoxia group and that the endothelial cell function of the reoxygenation group decreased signi ficantly compared with that of the anoxia group. In the anoxia and the reoxygenation groups, the levels of the two adhesion molecules ICAM-1 and VCAM increased faster than those of NO and PGI2 and the change in the level of ICAM-1 was more sensitive than that (in the level) of VCAM. In reoxygenation group, SOD treatment could inhibit the changes in the levels of NO, PGI2, ICAM-1, and VCAM.
Anoxia* ; Endothelial Cells* ; Epoprostenol ; Humans ; Immunoassay ; Intercellular Adhesion Molecule-1 ; Ischemia ; Leukocytes ; Microelectrodes ; Microscopy, Electron, Scanning ; Microvessels ; Nitric Oxide ; Reperfusion ; Reperfusion Injury ; Superoxide Dismutase ; Umbilical Veins* ; Vascular Cell Adhesion Molecule-1 ; von Willebrand Factor

PURPOSE: Laparoscopic gastrectomy has oncologic unreliability, technical problems, and is expensive. To overcome these drawbacks, we performed operations through a small laparotomy without using a laparoscopic procedure. METHODS: From March to August, 2003, we successfully performed distal gastrectomy with minilaparotomy for 21 patients diagnosed with early gastric cancer in our hospital. An additional 24 patients with advanced gastric cancer underwent conventional laparotomy for distal gastrectomy. We performed distal gastrectomy with lymph node dissection, moving the abdominal window to the surgical site. We compared BMI, operating time, bleeding volume, and postoperative pain, and followed minilaparotomy patients for an average of 48 months. RESULTS: There were no postoperative complications in minilaparotomy patients. The minilaparotomy group had a shorter hospital stay lower analgesic use than conventional laparotomy, but there were no differences in BMI, bleeding volume, or the number of harvested lymph nodes. Minilaparotomy alleviated the severity of postoperative pain, and there were no recurrences during follow-up. CONCLUSION: Minilaparotomy for early gastric cancer improved postoperative outcome without oncologic inadequacy compared with conventional laparotomy. Therefore, distal gastrectomy via a minilaparotomy may become a minimally invasive therapeutic strategy for early gastric cancer.
Bleeding Time ; Gastrectomy ; Hemorrhage ; Humans ; Laparotomy ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Pain, Postoperative ; Postoperative Complications ; Recurrence ; Stomach Neoplasms

Telomeres are the ends of the linear chromosomes of eukaryotes and consist of tandem GT-rich repeats in telomere sequence i.e. 500-3000 repeats of 5'-TTAGGG-3' in human somatic cells, which are shortened gradually with age. The G-rich overhang of telomere sequence can adopt different intramolecular fold-backs and tetra-stranded DNA structures, in vitro, which inhibit telomerase activity. In this report, DNA binding agents to telomere sequence were studied novel therapeutic possibility to destabilize telomeric DNA sequences. Oligonucleotides containing the guanine repeats in human telomere sequence were synthesized and used for screening potential antitumor drugs. Telomeric DNA sequence was characterized using spectral measurements and CD spectroscopy. CD spectrum indicated that the double-stranded telomeric DNA is in a right-handed conformation. Polyacrylamide gel electrophoresis was performed for binding behaviors of antitumor compounds with telomeric DNA sequence. Drugs interacted with DNA sequence caused changes in the electrophoretic mobility and band intensity of the gels. Depending on the binding mode of the anticancer drugs, telomeric DNA sequence was differently recognized and the efficiency of cleavage of DNA varies in the bleomycin-treated samples under different conditions. DNA cleavage occurred at about 1% by the increments of 1 mM bleomycin-Fe(III). These results imply that the stability of human telomere sequence is important in conjunction with the cancer treatment and aging process.
Antineoplastic Agents/*metabolism ; Bleomycin/metabolism/pharmacology ; Circular Dichroism ; Comparative Study ; DNA/chemistry/drug effects/*metabolism ; DNA Damage ; Dactinomycin/metabolism ; Doxorubicin/*analogs & derivatives/metabolism ; Human ; Nogalamycin/metabolism ; Nucleic Acid Conformation ; *Repetitive Sequences, Nucleic Acid ; Telomere/drug effects/*genetics

No abstract available.
Ataxia* ; Immunoglobulin G* ; Ophthalmoplegia*

PURPOSE: The postoperative hospital stay after gastric cancer surgery is usually 8 to 14 days. The main reason for a prolonged hospital stay may be the 3 to 4 day period of postoperative starvation. The aim of this study is to investigate the feasibility of a critical pathway for early recovery after gastric cancer surgery, and this pathway included early postoperative feeding. MATERIALS AND METHODS: One hundred three consecutive patients who underwent gastric resection and reconstruction for gastric cancer from October 2007 to June 2008 at St. Mary's Hospital were prospectively enrolled in a fast-track critical pathway. The pathway included minimal preoperative procedures, optimal pain relief, proper fluid administration, early mobilization and early enteral nutrition at postoperative 1 day. The exclusion criteria were determined preoperatively, intraoperatively and postoperatively. RESULTS: Of the 103 patients, 19 patients were excluded for preoperative (5), intraoperative (7) and postoperative (7) reasons. Eighty-four patients (81.6%) were included in the fast-track critical pathway. Sixty-eight (88.6%) of 84 patients were discharged at the planned 8 day after surgery during the initial period of the study, and the postoperative hospital stay was shortened up to 6 days during the more recent period. Postoperative complications occurred in 22 patients (26.2%), and these were gastrointestinal track-related complications in 6 cases (3 cases of ileus, 1 case of stasis and 2 cases of leakage) and infection-related complications in 8 cases. There was no statistical difference in the incidence of morbidity according to the clinic-operative features that included age, gender, stomach resection and lymphadenectomy. CONCLUSION: The fast-track critical pathway with using the available exclusion criteria was a valid option for patients who underwent gastric cancer surgery.
Critical Pathways ; Early Ambulation ; Enteral Nutrition ; Humans ; Ileus ; Incidence ; Length of Stay ; Postoperative Complications ; Preoperative Care ; Prospective Studies ; Starvation ; Stomach ; Stomach Neoplasms

BACKGROUND AND OBJECTIVES: Compared to bare metal stent, drug-eluting stent has improved the clinical and angiographic outcomes for de novo, simple lesions. In real world clinical practice, we often encounter more complex, long lesions, which increase the rate of restenosis and cardiovascular events. The aim of this study was to evaluate the clinical and angiographic outcome of sirolimus-eluting stent (SES) for the treatment of very long lesions in real world clinical practice. SUBJECTS AND METHODS: We implanted multiple SESs (>40 mm in total length) in 113 de novo lesions in 113 patients. The average length of the implanted stents was 58+/-14 mm (range: 41-112 mm) and a mean of 2.2 stents were implanted in each lesion and the average stent diameter was 3.0+/-0.3 mm. RESULTS: Procedural and angiographic success were achieved in all the patients without death or coronary artery bypass surgery. Non-Q wave MI (CK-MB > or = 3 times the normal value) developed in 13 patients (11.5%). Two patients experienced late stent thrombosis after discharge (1.8%). The major adverse cardiac events (MACE)-free survival was 94% at 12 months. There were two sudden cardiac deaths. Six months follow up angiography was performed on 76 patients (67%) and angiographic binary restenosis developed in 7 patients (9.2%). All of them were the focal type in-stent restenosis and these were found to be located at the distal stents. CONCLUSIONS: In conclusion, long lesion coverage with SESs is feasible with a favorable mid-term outcome in real world clinical practice.
Angiography ; Coronary Artery Bypass ; Death, Sudden, Cardiac ; Drug-Eluting Stents ; Follow-Up Studies ; Humans ; Stents* ; Thrombosis