Reactive mesothelial cells are frequently found in the smear, of body fludid dffusion when associated with liver cirrhosis, pulmonary tuberculosis, congestive heart failure or pulmonary infarction. But it is not easy to differentiate these reactive mesothelial cells from macrophages or various types of malignant cells. In order to investigate the morphology of hyperplastic mesothelial cells, in comparison with the various types of malignant cells in the effusion, this experiment was designed. The tissue reaction was evoked by intraperitoneal injection of 2.5 ml of 2% Talcum suspension. The results obtained were as follows: 1) On light microscopic observation of the tissure, until 5 days, cytoplasm and nucleus of mesothelial cells became larger and nucleoi became prominent. After then, cytoplasm and nucleus became smaller and at 28 days after injection of Talcum suspension, cellular features became similar to those of normal ones. 2) On cytologic observation of touch print specimens, hyperplastic mesothelial cells became round to oval, and their cytoplasm became conspicuous. Nuclei were vesicular, and nucleoi were prominent. N/C ratio was decreased than normal. 3) On electron microscopic observation, hyperplastic mesothelial cells did not have microvilli, but had a few cytoplasmic globular projections, loosely approximated cellular junctions, larger and more abundant intracytoplaomic vesicles when compared with normal one. Chromatin clumping, irregular thickening of nuclear membrane and prominent nucleoi were also noted.

The expression of p62"' and p2l can be seen in many solid tumor, but the pattern and incidence of expression were different according to organ, countries, and examiners, thus it is not definitely defined. Total 67 colorectal carcinoma in paraffin sections are analysed by immunohistochemically for evaluation of the p62and p21- expression according to the age, sex, chief complaints, location, differentiation, modified Dukes stage, using the specific monoclonal antibodies. The results were summarized as follows : The age of patients ranged from 32 years to 82 years. The mean age was 57.6 years. The expression of p 62y' and p21 was not correlated with age. Male was 29 cases(43.3%) and female was 38 cases(56.7%). The male to female ratio was 1:1.31. The and 95.0% in moderately differentiated adenocarcinoma, 90.0% and 90.0% in poorly differentiated <,;, adenocarcmoma, 100.0% and 100.0% in mucinous carcinoma. The positive rate of p62!and and p2l' was 94.1% and 88.2% in Dukes stage B,, 96.0% and 96.0% in Dukes stage B,, 100.0% and 100.0% in Dukes stage C,, 100.0% and 88.9% in Dukes stage C, and 100.0% and 100. o% in Dukes stage D. The expression of p62 y' in metastatic colorectal carcinoma showed diffuse and strongly positive reaction than primary colorectal carcinoma. The expression of p21 in primary colorectal carcinoma showed diffuse and strongly positive reaction than metastatic colorectal carcinoma.
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Antibodies, Monoclonal ; Colorectal Neoplasms* ; Female ; Humans ; Immunohistochemistry ; Incidence ; Male ; Oncogene Proteins* ; Oncogenes* ; Paraffin

PURPOSE: The prognosis of non-Hodgkins lymphoma (NHL) in elderly patients seems to be poorer than that in patients aged less than 60 years. This may be due to the lower tolerance for combination chemotherapy in the elderly. Aggressive combination chemo-therapy, which is the treatment of choice in intermediate and high grade NHL of adulthood, may be associated with unpredictab1y severe and lethal toxicity and worsened quality of life in the elderly. We investigated the treatment responses, toxicities and prognostic factors of NHL in elderly patients treated with combination chemotherapy. MATERIALS AND METHODS: We treated 116 elderly (>60 yrs) patients with NHL between January 1986 and June 1996 with adriamycin-containing regimens, such as CHOP (cyclo- phosphamide, adriamycin, vincristine, prednisolone), BACOP (bleomycin, adriamycin, cyclophosphamide, vincristine, prednisolone), and mBACOP (methotrexate, bleomycin, adriamycin, cyclophosphamide, vincristine, prednisolone). Patients in this study ranged from 60 to 81 (median 67) years of age. Fifty-five percent of patients were in stage I or II and the rest (45%) were in stage III or IV. The histologic grade was predominantly (91%) of intermediate and high grade type. RESULTS: The treatment responses were complete (CR) in 55% and partial (PR) in 25%. The median durstion of CR was 32 (3-132) months. The CR rate was significantly higher in patients treated with RDI (relative dose intensity) > 75% than that in the patients treated with RDI < 75% (p 0.003), but there was no significant difference in CR rate between treatment regimens (p-0.38). At a median follow up of 48-months (range, 12 to 132 months), the estimated 5-year ovetall survival was 46%. Ann Arbor Stage (I, II vs III, IV), ECOG performance (0-1 vs 2-3), RDI (>75% vs <75%) and the treatment response were important prognostic factors in the univariate analysis, and the treament response (CR vs non-CR) was the only independent prognostic parameter in the multivariate analysis. The most frequent and severe toxicity associated with chemotherapy was infection with or without neutropenia. The rate of severe infection was significantly decreased in the patients supported with G/GM-CSF but not in the dose-reduction group (RDI<75% vs >75%). CONCLUSION: Our data suggests that achievement of the CR after combination chemotherpy is the most important prognostic factor in the elderly patients with NHL. Suboptimal chemotherapy (RDI<75%) reduced the complete remission rate without reducing the likelihood of developing severe toxicities. Optimal chemotherapy with supportive cares involving the use of hematopoietic growth factors may be needed to improve the treatment response and the survival in the elderly patients with aggressive NHL.
Aged ; Bleomycin ; Cyclophosphamide ; Dimethoate ; Doxorubicin ; Drug Therapy ; Drug Therapy, Combination ; Follow-Up Studies ; Hodgkin Disease* ; Humans ; Intercellular Signaling Peptides and Proteins ; Lymphoma, Non-Hodgkin ; Multivariate Analysis ; Neutropenia ; Prognosis* ; Quality of Life ; Vincristine

No abstract available.
Neurofibromatoses* ; Neurofibromatosis 1*

PURPOSE: Early diagnosis of neonatal sepsis is very difficult because of no specific clinical and laboratory findings. It also takes at least 48 hours of incubation period to isolate the organism by culture study. So several laboratory tests have been evaluated for their usefulness in rapid detection of the neonatal sepsis. Those are evaluated either singly or in combination with a defined scoring system include leukocyte count with differential count, platelet count, C-reactive protein level, erythrocyte sedimentation rate, haptoglobin level, fibronectin level, leukocyte alkaline phosphatase and so on. But no single test or combination with others has proved superior to the leukocyte count and differential count as a reliable indirect indicator of neonatal bacterial infection. We performed this study to determine the appropriate screening test for early detection of neonatal sepsis. METHODS: During the period of May 1991 through April 1997, we selected 200 neonates who were admitted to the neonatal intensive care unit of Kon-Kuk University Medical Center Seoul Hospital. All of the cases were retrospectively evaluated and divided two groups; sepsis group-88 neonates who were confirmed by blood cultures, and control group-112 neonates who had no evidence of neonatal bacterial infection. RESULTS: The results were as follows; 1) The sex ratio of male to female was 1.5:1 in the sepsis group and showed significant difference between two groups (P<0.05). The incidence of neonatal sepsis in prernature infant was higher in sepsis group than control group (P<0.05), and mean body weight was lower in sepsis group (2351.4148.3g) than control group (Z821.8 142.6g) significantly (P<0.05). 2) Predisposing perinatal factors associated with neonatal sepsis were premature rupture of membrane (> or = 24hrs) (14.5%) meconiurn staining (6.8%), asphyxia (Apgar score < or = 6 at 5mins) (5.7%), eclampsia and preeclampsia (4.5%), maternal infection (3.4%) and bleeding (including placenta previa, abruptio placenta) (1.1%) in order of frequency. Among th, only premature rupture of membrane was significant difference between two groups (P<0.05). Others risk factors including umbilical catheterization, endotracheal intubation, ventilatory care, total parenteral nutrition were also signi- ficant difference between two groups (P<0.05). 3) The common presenting symptoms of neonatal sepsis were jaundice (48.9%), poor feeding (45.5%), ternperature instability (43.2%), lethargy (30.7%), irritability, dyspnea, diarrhea, vomiting, tachypnea, and cyanosis in order of frequency. Among the above symptoms, poor feeding, dyspnea and cyanosis were significant difference between two groups (P<0.05). 4) The peripheral blood findings (leukocyte count, platelet count, ESR) showed no significant differences between two groups (P>0.05). The acute phase reactants (APR) score above two (37/88) and positive C-reactive protein (51/88) in the sepsis group were regarded as significantly high compared to the control group. 5) In the cases with APR score above two including positive C-reactive protein and abnormal total leukocyte count, sensitivity was 17.0%, specificity 97.3% positive predictive predictive value 83.3%, and negative predictive value 60.0%. CONCLUSIONS: The higher frequency of neonatal sepsis was proved in the cases of APR score above two including positive C-reactive protein. In the cases with abnormal total leukocyte count and APR score above two including positive C-resctive protein, the specificity was 97.3% and the positive predictive value was 83.8%. So APR score above two including positive C-reactive protein and abnormal total leukocyte count could be regarded as an useful test method for early detection of neonatal sepsis.
Academic Medical Centers ; Acute-Phase Proteins ; Alkaline Phosphatase ; Asphyxia ; Bacterial Infections ; Blood Sedimentation ; Body Weight ; C-Reactive Protein ; Catheterization ; Catheters ; Cyanosis ; Diarrhea ; Dyspnea ; Early Diagnosis* ; Eclampsia ; Female ; Fibronectins ; Haptoglobins ; Hemorrhage ; Humans ; Incidence ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Intubation, Intratracheal ; Jaundice ; Lethargy ; Leukocyte Count ; Leukocytes ; Male ; Mass Screening ; Membranes ; Parenteral Nutrition, Total ; Placenta Previa ; Platelet Count ; Pre-Eclampsia ; Pregnancy ; Retrospective Studies ; Risk Factors ; Rupture ; Sensitivity and Specificity ; Seoul ; Sepsis* ; Sex Ratio ; Tachypnea ; Vomiting

STUDY OBJECT: To date, the study of critical illness in the emergency department has been limited. The purpose of this study was to determine the length of stay and procedures performed on critical care patient in ED, and to be help to establish Emergency physicians' education program. METHOD: We reviewed patient's medical record, who visited ED, Korea Univ. Hospital from Jan. 1996 to Jun. 1996 and admitted to ICU. We analyzed data to age, sex, clinical diagnosis, length of stay, and critical procedures in ED. RESULTS: The 12,721 patients visited ED during the study period, the 441 of 12,721 (3.50%) patients admitted to ICU. 56 patients were excluded whose medical re cords were incomplete. The study populations consisted of 165 women and 220 men. The mean age were 52 year old (median,58 year old). The mean length of stays were 606.1 (1445.9 minutes (median, 180 minutes)). One hundred sixty one of these patients (41.8 %) received one or more critical procedures. The medical critical patients were 252 cases, and surgical critical patients were 133 cases. The mean length of stay of medical critical patients was 738.8 (1748.9 minutes (median, 177.5 minutes)) in medical department,44.0% of them received critical procedures in ED. The surgical critical patients averaged 354.9 (410.7 minutes (median, 190 minutes)) and 37.6% received critical procedures. CONCLUSION: Critical ill patients stay in the ED with a substantial amount of time, before addition to the ICU. Critical ill patients who have hemodynamiccal unstable conditions, compromised cardiopulmonary functions, and neurologic deficities, were managed in ED frequently. Typical critical care procedures are commonly performed by emergency physicians. Therefore, it is important for emergency physician to prepare to critical ill patients.
Critical Care* ; Critical Illness ; Diagnosis ; Education ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Korea ; Length of Stay ; Male ; Medical Records ; Middle Aged

BACKGROUND: Domestic violence once considered an infrequently occurring event existing only in deviant relationships, it has been more recently recognized as a widely distributed phenomenon resulting from multiple cultural, social, psycological factors. According to declining world economics, family violence rises with a simultaneous curtailment of agencies available to assist battered persons and there is increasing pressure on emergency departments to serve those who might otherwise have sought help from public agency. In Korea, we don't have any clinical data about domestic violence, and authors analysed clinical pictures of domestic violence victims who came to the emergency department of Korean University medical center. METHOD: We reviewed the victims of the domestic violence retrospectively, who visited in ED, Korean Univ. Hospital from Jan. 1996 to the Dec. 1996. We Analysed data to Age, sex, Injury severity score, location of injury, mechanism, perpetrator. RESULTS: During the study period, total 134 domestic violence victims were identified. The young, females were predominantly victimized. And married women were more commonly violated. (about 70%). ISS was relatively mild (2.491), face and head were mainly injured by punching and objects throwing. The Prevalence of domestic violence victims almost presented at Emergency department between 6:00/P.M. and 8:00 A.M.. CONCLUSION: Emergency physicians suspect domestic violence victims who injured at face and head by punching or hitted would. In these patients, we need more detail history and physical exam. And in case of repeated domestic violence, refer to neuropychatry dept and social workers with perpetratrs, and need mere concerte social programs for domestic violence.
Academic Medical Centers ; Domestic Violence* ; Emergencies* ; Emergency Service, Hospital* ; Female ; Head ; Humans ; Injury Severity Score ; Korea ; Prevalence ; Retrospective Studies ; Social Workers

A malignant granular cell tumor (MGCT) occurred in the left shoulder of a 62-year-old man. The patient underwent wide marginal excision followed by chemotherapy and radiotherapy. A metastatic tumor was identified in the axillary lymph node 22 months after the excision of the shoulder mass. The primary tumor was a poorly circumscribed mass measuring 5 5 4 cm. On cut section, it was a solid mass with yellowish tan color. Histologically, both primary and metastatic tumor consisted of polygonal cells with abundant granular cytoplasm and a vesicular nucleus with a prominent nucleolus. Two to three mitotic figures per ten high power fields at 200 were counted. Tumor cells were weakly stained with periodic acid-Schiff (PAS) preparation both before and after diastase digestion, and were positive for S-100 protein, neuron-specific enolase (NSE), and vimentin. By electron microscopy, the cytoplasm was filled with numerous autophagolysosomes containing myelin figures, mitochondria, and fragmented rough endoplasmic reticula. Basal laminae and angulated bodies were also noted. These findings suggest schwannian differentiation of this tumor.
Amylases ; Basement Membrane ; Cytoplasm ; Digestion ; Drug Therapy ; Granular Cell Tumor* ; Humans ; Immunohistochemistry ; Lymph Nodes ; Microscopy, Electron ; Middle Aged ; Mitochondria ; Myelin Sheath ; Phosphopyruvate Hydratase ; Radiotherapy ; S100 Proteins ; Shoulder* ; Triacetoneamine-N-Oxyl ; Vimentin

As the productive activities have vastly increased following industrialization and urbanization in the modem society, the resulting high mobility of people and goods have caused a sharp increase in the accidents in the work places as well as traffic accidents. In particular, deaths caused by injuries are generally concentrated in the economically active young peoples, producing incalculable losses to the society and nation as a whole. Advanced nations with superior medical care systems have succeeded in reducing incidents of such deaths by operating trauma centers. Especially noteworthy is the case of the United States where such specialized trauma centers have greatly contributed to reducing deaths from injuries in the non-urban areas with less access to medical facilities. At present Korea has no medical centers specializing in injuries. In large cities, the injuries are being treated tertiary medical facilities while in the provinces they are referred to small and medium-sized hospitals that constitute secondary medical facilities. Currently in Korea the Trauma patients are treated at general hospitals that consist of 726 secondary medical facilities and 40 tertiary medical centers nationwide. The secondary medical facilities which tend to take most responsibility for the treatment of trauma are generally deficient in medical staff and facilities (including operating and intensive care facilities). Despite such deficiency and limitations, no regulations exist regarding treatment or transportation of trauma patients. This article reports the outcome of a comparative analysis of the results of trauma treatments among different types of medical facilities based on objective data in the hope that such study would facilitate a comparison with the treatment systems of advanced countries and thereby contribute to a precise formulation of problems that must be addressed in this area.
Accidents, Traffic ; Hope ; Hospitals, General ; Humans ; Critical Care ; Korea ; Medical Staff ; Modems ; Social Control, Formal ; Transportation ; Trauma Centers ; United States ; Urbanization ; Workplace ; Industrial Development

The authors performed this preliminary study to investigate the effect of softening E.C.T. and propofol was compared to pentothal for induction of anaesthesia for E.C.T on seizure duration. The results were follows ' 1) E.C.T. was performed in 60 psychiatric inpatients who were admitted during the study period. Of them 51.7% were diagnosed as schizophrenia, 21.6% as major depressive disorder, 16.7% as bipolar I disorder, manic and 10% of others. 2) Mean number of E.C.T. was 12.2 times a patient. 3) The most common target symptoms were persecutory delusion in schizophrenia, psychomotor retardation or agitation in major depressive disorder, and violent aggressive behavior in bipolar I disorder, manic. 4) Pre-ECT medication usually used were atropine 0.0093mg kg(-1), pentothal 2.76mg kg(-1) or propofol 1.42mg kg(-1). 5) The duration of seizure, as measured clinically, was reduced with propofol(20.5 sec) in comparison with pentothal(35.7 sec)(p<0.001). This suggest the possibility that additional treatment may be needed for the same clinical effect in psychiatric illness when propofol is used as the induction agent.
Atropine ; Bipolar Disorder ; Delusions ; Depressive Disorder, Major ; Dihydroergotamine ; Electroconvulsive Therapy ; Humans ; Inpatients ; Propofol* ; Schizophrenia ; Seizures* ; Thiopental*