Eosinophilia is a common finding in premature babies during the neonatal period. Serial eosinophil counts were determined in 94 hospitalized, appropriately grown premature in fants whose gestational ages ranged form 28 to 36 weeks. The incidence, severity and etiologic factors of eosinophilia were retrospectively studied in premature infants, who were divided into three groups according to their gestational age. The results were as follows: 1) Absolute eosinophilia (>700/mm3)was documented in 46.8%(44/94). 2) The duration of TRN and antibiotics was cignificantly higher in infants with eosinophilia than withour eosinophilia (p<0.05). The gestational age of the infants with eosinophilia was significantly shorter than that of the infants without eosinophilia (p<0.05). The infants with eosinophilia started with bottle feeding significantly earlier than the infants without eosinophilia (p<0.05). 3) The infants younger than 30 weeks of gestational age have greater incidence of eosinophilia (75%) than the infant with the gestational age between 34 and 36 weeks (34.3%)(p<0.05). 4) The incidence of mild eosinophilia was higher in the group with gewtational age 30 weeks or below(37.5%)than in the group with gestational age between 34 and 36 weeks(17.1%)(p<0.05).Also, the incidence of severe eosinophilia was significantly higher in the group with gestational age 30 weeks or below(37.5%)than in the group with gestational age between 34 and 36 weeks(17.1%)(p<0.05). 5) Eosinophilia was more prevalent in the infants who received parenteral nutrition composed of glucose, amino acid and lipid(77.8%) than the infants who received only glucose(34.1%)(p<0.05). 6) Gestational age and birth weight were significantly lower in infants with severe eosinopilia than those of mild or moderate eosinophilia. The duration of TRN and antibiotics were significantly longer in infants with severe eosinophilia than those of mild or moderate eosinophilia (p<0.05). 7) The peak eosinophil count was observed significantly later in severe eosinophilic group (26.5 13.1 days)than in non-eosinophilic group(14.4 9.0 days)(p<0.05). The above results suggest that eosinophilia in premature infants may be the effecto of immature immunologic responses to the intravenous administration of extemal antigens like amino acid, lipid and antibiotics.
Administration, Intravenous ; Anti-Bacterial Agents ; Birth Weight ; Bottle Feeding ; Eosinophilia* ; Eosinophils ; Gestational Age ; Glucose ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature* ; Parenteral Nutrition ; Retrospective Studies

PURPOSE: We analyzed the expression of vasoactive intestinal peptide (VIP), pituitary adenylate cyclase activating peptide (PACAP), VIP receptor 1 (VIPR1), VIP receptor 2 (VIPR 2) and PACAP receptor (PACAPR) genes in human neuroblastoma, neuroblastoma cell line, human stomach cancer, and human stomach cancer cell lines using RT-PCR and Sourthern hybridization. The results should permit identification of potential clinical applications for VIP and PACAP. METHODS: We isolated RNA from 1 neuroblastoma cell line, 8 stomach cancer cell lines, 13 neuroblastoma, and 10 stomach cancer tumor specimens. And then we performed RT-PCR, Sourthern hybridization, and sequencing. RESULTS: We detected the RNAs coding for VIP, VIPR1, VIPR2, PACAP, and PACAPR in 1, 11, 2, 12, and 13 out of 13 neuroblastoma tumor specimens, respectively. VIP and PACAPR RNA was expressed in SKNSH. VIPR1 RNA was expressed in 4 of 8 the stomach cancer cell lines and 6 of 10 stomach cancer tumor specimens. CONCLUSION: VIP/PACAP RNA and VIP/PACAP receptors RNA were expressed in SKNSH and neuroblastoma tumor specimens. VIPR1 was expressed in stomach cancer cell lines and tumor specimens. The present results suggested that VIP/PACAP analogues could be a candidate as the growth inhibitor of neuroblastoma and stomach cancer.
Adenylyl Cyclases* ; Cell Line ; Clinical Coding ; Humans ; Neuroblastoma* ; Pituitary Adenylate Cyclase-Activating Polypeptide ; Receptors, Peptide* ; Receptors, Pituitary Adenylate Cyclase-Activating Polypeptide ; Receptors, Vasoactive Intestinal Peptide ; RNA ; Stomach Neoplasms* ; Stomach* ; Vasoactive Intestinal Peptide

BACKGROUND: Breast lesions in children and adolescents are rare and develop mainly in females. The management of breast masses in children and adolescents can be a perplexing problem for pediatricians and surgeons. It is well documented that breast lesions in females under 20 years of age rarely represent malignant disease. However, they frequently are a source of discomfort and anxiety for the patient, particularly when they do not resolve spontaneously. METHODS: To determine the frequency of different breast masses in females under 20 years of age on whom surgery was performed, we carried out a retrospective study of females under 20 years who were admitted to the Department. of Surgery of Soonchunhyang University Hospital for surgery between 1993 and 1995. RESULTS: The mean age was 17.9 years. A total of 44 surgical procedures were performed in 40 patients. The masses ranged in size from 0.8 cm through 7.0 cm. As to the location, the mass was in the right breast of 22 patients (50%) and in the left breast of 22 (50%). The most common location of the mass was in the right upper outer quadrant (13 patients, 29.5%). Of the 44 masses, fine-needle aspiration cytology was performed in 33 masses. Of them, 28 were fibroadenomas, 4 were fibrocystic disease, and 1 was a lipoma. Excisional biopsy was performed on 44 masses. Of them, 33 were fibroadenomas, 4 were fibrocystic disease, 5 was fibroadenoma and fibrocystic disease, 1 was a lipoma, and 1 was a lymphangioma. There were no malignancies. CONCLUSIONS: In female patients under 20 years of age, we suggest that benign breast should be studied for diagnosis, treatment, and histological feature.
Adolescent ; Anxiety ; Biopsy ; Biopsy, Fine-Needle ; Breast* ; Child ; Diagnosis ; Female* ; Fibroadenoma ; Humans ; Lipoma ; Lymphangioma ; Retrospective Studies

Surgery is the standard treatment for a primary gastrointestinal stromal tumor (GIST); however, surgical resection is often not curative, particularly for large GISTs. In the past decade, with imatinib mesylate (IM), management strategies for GISTs have evolved significantly, and now IM is the standard care for patients with locally advanced, recurrent or metastatic GISTs. Adjuvant therapy with imatinib was recently approved for use, and preoperative imatinib is an emerging treatment option for patients who require cytoreductive therapy. IM neoadjuvant therapy for primary GISTs has been reported, but there is no consensus on the dose of the drug, the duration of treatment and the optimal time of surgery. These are critical because drug resistance or tumor progression can develop with a prolonged treatment. This report describes two cases of large rectal malignant GISTs, for which a abdominoperineal resection was initially anticipated. The two patients received IM preoperative treatment; we followed-up with CT or magnetic resonance imaging to access the response. After 9 months of treatment, a multi-disciplinary consensus that maximal benefit from imatinib had been achieved was reached. We determined the best time for surgical intervention and successfully performed sphincter-preserving surgery before resistance to imatinib or tumor progression occurred. We believe that a multidisciplinary team approach, considerating the optimal duration of therapy and the timing of surgery, is required to optimize treatment outcome.
Benzamides ; Consensus ; Drug Resistance ; Gastrointestinal Stromal Tumors ; Humans ; Imatinib Mesylate ; Magnetic Resonance Imaging ; Mesylates ; Neoadjuvant Therapy ; Piperazines ; Pyrimidines ; Treatment Outcome

Antiphospholipid syndrome (APS) is a thrombophilic disorder characterized by recurrent abortion, thrombocytopenia, and prolonged activated partial thromboplastin time (aPTT) in which venous or arterial thrombosis, or both, may occur in patients with antiphospholipid antibodies. Antiphospholipid antibodies have been associated with a variety of neurological disorders, many of which, but not all are manifestations of cerebral or ocular ischemia. Recently, we experienced one case of a cerebral infarct due to APS in a 24-year-old female. She visited the emergency department and presented with dizziness and vomiting. After admission, we conducted a physical examination, blood tests, and brain computed tomography. Her blood tests revealed prolonged aPTT and thrombocytopenia, and brain computed tomography showed a right cerebellar and pons infarct. We treated her with anticoagulants. She was discharged with nearly a full recovery on the seventh hospital day.
Abortion, Habitual ; Antibodies, Antiphospholipid ; Anticoagulants ; Antiphospholipid Syndrome* ; Brain ; Cerebral Infarction* ; Dizziness ; Emergency Service, Hospital ; Female ; Hematologic Tests ; Humans ; Ischemia ; Nervous System Diseases ; Partial Thromboplastin Time ; Physical Examination ; Pons ; Pregnancy ; Thrombocytopenia ; Thrombosis ; Vertigo ; Vomiting ; Young Adult

BACKGROUND: Lipid-emulsion propofol (LP) has cardioprotective effects against ischemia-reperfusion injury, but it has lipid-related side effects. Microemulsion propofol (MP) is a lipid-free propofol emulsified with 10% purified poloxamer 188 (PP188). PP188 is a nonionic surfactant and has cardioprotective effects. However, some reports have suggested that reduced cardioprotective effects were observed when the cardioprotective agents were used in combination even though each cardioprotective agent has cardioprotective effects. The aims of this study were to examine and compare the cardioprotective effects of MP and LP. METHODS: 50 isolated rat hearts were perfused with modified Kreb's solution. They were divided into 4 groups and underwent 30 minutes of ischemia and 60 minutes of reperfusion. Control group: ischemia-reperfusion was performed without treatment. LP, MP and PP groups: LP, MP and PP188 were infused during the pre-ischemic and reperfusion period, respectively. Hemodynamic parameters and coronary effluent flow rate (CEFR) were measured. Infarct size was determined using triphenyl-tetrazolium staining. RESULTS: In the MP group, systolic pressure was maintained near baseline, the systolic pressure was higher than that in the other groups and HR was lower than that in the other groups during reperfusion. Diastolic pressure was transiently increased in the PP group after treatment and at 5 minutes after reperfusion compared with that in the control group and in the the LP group. There were no differences in dP/dtmax and CEFR between groups. Infarct size in the LP, MP and PP groups was smaller than that in the control group, but there were no significant differences between these three groups. CONCLUSIONS: MP has cardioprotective effects similar to those of LP. MP can be used for cardiac anesthesia in cases with ischemia-reperfusion injury to avoid the lipid-related side effects of LP.
Anesthesia ; Animals ; Blood Pressure ; Cardiotonic Agents ; Heart ; Hemodynamics ; Ischemia ; Poloxamer ; Propofol ; Rats ; Reperfusion ; Reperfusion Injury

PURPOSE: The optimal time between neoadjuvant chemoradiotherapy (CRT) and surgery for rectal cancer has been debated. This study evaluated the influence of this interval on oncological outcomes. METHODS: We compared postoperative complications, pathological downstaging, disease recurrence, and survival in patients with locally advanced rectal cancer who underwent surgical resection <8 weeks (group A, n = 105) to those who had surgery > or =8 weeks (group B, n = 48) after neoadjuvant CRT. RESULTS: Of 153 patients, 117 (76.5%) were male and 36 (23.5%) were female. Mean age was 57.8 years (range, 28 to 79 years). There was no difference in the rate of sphincter preserving surgery between the two groups (group A, 82.7% vs. group B, 77.6%; P = 0.509). The longer interval group had decreased postoperative complications, although statistical significance was not reached (group A, 28.8% vs. group B, 14.3%; P = 0.068). A total of 111 (group A, 75 [71.4%] and group B, 36 [75%]) patients were downstaged and 26 (group A, 17 [16.2%] and group B, 9 [18%]) achieved pathological complete response (pCR). There was no significant difference in the pCR rate (P = 0.817). The longer interval group experienced significant improvement in the nodal (N) downstaging rate (group A, 46.7% vs. group B, 66.7%; P = 0.024). The local recurrence (P = 0.279), distant recurrence (P = 0.427), disease-free survival (P = 0.967), and overall survival (P = 0.825) rates were not significantly different. CONCLUSION: It is worth delaying surgical resection for 8 weeks or more after completion of CRT as it is safe and is associated with higher nodal downstaging rates.
Chemoradiotherapy ; Disease-Free Survival ; Female ; Humans ; Male ; Neoadjuvant Therapy ; Polymerase Chain Reaction ; Postoperative Complications ; Preoperative Period ; Rectal Neoplasms ; Recurrence

PURPOSE: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been proposed for controlling peritoneal seeding metastasis in some kinds of cancers, including those of colorectal origin, but their safety and oncological benefits are subjects of debate. We present our early experience with those procedures. METHODS: Data were retrospectively collected from all patients with peritoneal carcinomatosis (PC) and pseudomyxoma peritonei (PMP) treated using CRS and HIPEC at Yonsei Cancer Center between July 2014 and July 2015. Short-term outcomes and risk factors for postoperative complications were analyzed. RESULTS: Twenty-three patients with PC (n = 18) and PMP (n = 5) underwent CRS and HIPEC. Median follow-up and age were 2 months and 54 years, respectively. The median peritoneal carcinomatosis index score was 15, and CC0-1 was achieved in 78.3% of all patients. The median operation time and bleeding loss were 590 minutes and 570 mL, respectively. Grade-IIIa/grade-IIIb complications occurred in 4.3% (n = 1)/26.1% (n = 6) of the patients within 30 days postoperatively, and no 30-day mortalities were reported. Factors related to postoperative complications with CRS and HIPEC were number of organ resection (P = 0.013), longer operation time (P < 0.001), and amount of blood loss (P = 0.003). All patients treated with cetuximab for recurred colorectal cancer had grade-III postoperative complication. CONCLUSION: Our initial experience with CRS and HIPEC presented about 30% grade-III postoperative complications. Therefore, expert surgeons need to perform those procedures with great caution in selected patients who might benefit from it.
Carcinoma ; Cetuximab ; Colorectal Neoplasms ; Cytoreduction Surgical Procedures ; Drug Therapy* ; Follow-Up Studies ; Hemorrhage ; Humans ; Mortality ; Neoplasm Metastasis ; Postoperative Complications ; Pseudomyxoma Peritonei ; Retrospective Studies ; Risk Factors ; Surgeons

Duplicated inferior vena cava (IVC) is a congenital anomaly seen rarely in the general population. Patients with IVC variants usually do not present any symptoms and are found incidentally in many cases. However, physicians are urged to recognize the presence of such anomalies during diagnostic or invasive procedures as these variants of blood vessel systems can impose substantial implications in certain clinical situations. Subsequently, information about IVC variants may become critical if surgical injuries or predisposing conditions act as life-threatening risks to patients during medical procedures. We present a case of duplicated IVC in a 68-year-old female patient with rectal cancer where an IVC anomaly was found during surgical resection of her tumor. From our experience, we emphasize the importance of having the knowledge of IVC variations in patients undergoing invasive surgical procedures which may involve large vessels.
Aged ; Blood Vessels ; Female ; Glycosaminoglycans ; Humans ; Intraoperative Complications ; Laparotomy ; Rectal Neoplasms ; Vena Cava, Inferior

Cushing's disease (CD) is a rare disorder characterized by the overproduction of adrenocorticotropic hormone due to a pituitary adenoma that ultimately stimulates excessive cortisol secretion from the adrenal glands. Prior to the detection of pituitary adenomas, various clinical signs of CD such as central obesity, moon face, hirsutism, and facial plethora are usually already present. Uncontrolled hypercortisolism is associated with metabolic, cardiovascular, and psychological disorders that result in increased mortality. Hence, the early detection and treatment of CD are not only important but mandatory. Because its clinical manifestations vary from patient to patient and are common in other obesity-related conditions, the precise diagnosis of CD can be problematic. Thus, the present set of guidelines was compiled by Korean experts in this field to assist clinicians with the screening, diagnoses, and treatment of patients with CD using currently available tests and treatment modalities.
Adrenal Glands ; Adrenocorticotropic Hormone ; Corticotropin-Releasing Hormone ; Cushing Syndrome ; Diagnosis* ; Hirsutism ; Humans ; Hydrocortisone ; Korea ; Mass Screening ; Mortality ; Obesity, Abdominal ; Petrosal Sinus Sampling ; Pituitary ACTH Hypersecretion ; Pituitary Neoplasms