SPARC, secreted protein acidic and rich in cysteine, is a extracellular matrix-associated protein implicated in the modulation of cell adhesion, migration, cell cycle regulation, and angiogenesis. SPARC is expressed in fibrocytes and endothelial cells involved in tissue repair and invasive malignant tumors in the gastrointestinal tract, breast, lung, kidney, adrenal cortex, ovary, and brain. This study was aimed to characterize the different expression of SPARC in the thyroid follicular adenomas and follicular carcinomas. Immunohistochemical staining was performed in paraffin-embedded tissues of 25 follicular adenomas and 15 follicular carcinomas of the thyroid gland. Immunohistochemically, SPARC was not expressed in the 19 follicular adenoma and 2 follicular carcinoma but highly expressed in the 6 follicular adenoma and 13 follicular carcinoma. These findings suggest that SPARC is a potential diagnostic marker of follicular carcinoma and is helpful to distinguish follicular carcinoma from follicular adenoma without vascular or capsular invasion.
Adenoma* ; Adrenal Cortex ; Brain ; Breast ; Cell Adhesion ; Cell Movement ; Cysteine ; Endothelial Cells ; Female ; Gastrointestinal Tract ; Kidney ; Lung ; Ovary ; Thyroid Gland*

PURPOSE: The purpose of this study was to investigate screw joint stability and sagittal fit between internal connection implant fixtures of two different manufacturers and customized abutments. MATERIALS AND METHODS: Internal connection implant systems from two different manufacturers (Biomet 3i system, Astra Tech system) were selected for this study (n=24 for each implant system, total n=48). For 3i implant system, half of the implants were connected with Ti ready-made abutments and the other half implants were connected with Ti CAD-CAM custom ones of domestic-make (Myplant, Raphabio Co., Seoul, Korea) and were classified into Group 1 and Group 2 respectively. Astra implants were divided into Group 3 and Group 4 in the same way. Micro-CT sagittal imaging was performed for fit analysis of interfaces and preloading reverse torque values (RTV) were measured. RESULTS: In the contact length of fixture-abutment interface, there were no significant differences not only between Group 1 and Group 2 but also between Group 3 and Group 4 (Mann-Whitney test, P>.05). However, Group 2 and Group 4 showed higher contact length significantly than Group 1 and Group 3 in abutmentscrew interface as well as fixture-screw one (Mann-Whitney test, P<.05). In addition, RTV was lower in CAD-CAM custom abutments compared to ready-made ones (Student t-test, P<.05). CONCLUSION: It is considered that domestically manufactured CAD-CAM custom abutments have similar fit at the fixture abutment interface and it could be used clinically. However, RTV of CAD-CAM custom abutments should be improved for the increase of clinical application.
Computer-Aided Design* ; Joints ; Seoul ; Torque

We describe an unusual case of extragastrointestinal stromal tumor (EGIST) presenting as a scrotal mass. A 71-year-old man presented with a gradually enlarging scrotal mass with a 20-year duration. Physical examination revealed a huge (as large as volleyball), round, nontender mass occupying the whole scrotum, which was resected completely. Clinical and radiological findings did not comply with any other primary site disease. Under histological examination, the tumor showed a spindle cell pattern with low cellularity, absence of necrotic and mitotic features. immunohistochemical analysis revealed the tumor reactive for CD117 and CD34, while negative for smooth muscle actin, desmin and S-100 protein. To our knowledge, this is the first reported case of an EGIST involving the scrotum.
Aged ; Antigens, CD34 ; analysis ; Gastrointestinal Stromal Tumors ; diagnosis ; Humans ; Immunohistochemistry ; Male ; Proto-Oncogene Proteins c-kit ; analysis ; Scrotum ; pathology ; Sex Cord-Gonadal Stromal Tumors ; chemistry ; pathology

No abstract available.
Exophiala* ; Phaeohyphomycosis*

Endoscopic thyroidectomy is being performed increasingly, because it is less invasive and more cosmetically advantageous, and thus improves the postoperative quality of life. However, the technical aspects of this procedure can increase the risk of certain complications, which include subcutaneous emphysema, hypercarbia, pneumothorax, and pneumomediastinum. This report describes the case of a 37-year-old female patient who had subcutaneous emphysema and hypercarbia due to increased carbon dioxide absorption during endoscopic thyroidectomy. After increasing minute ventilation, paying cautious attention to signs of other complications, the operation proceeded and blood gas findings improved. The operation ended successfully and she showed no further problems.
Absorption ; Adult ; Carbon Dioxide ; Female ; Humans ; Mediastinal Emphysema ; Pneumothorax ; Quality of Life ; Subcutaneous Emphysema* ; Thyroidectomy* ; Ventilation

OBJECTIVE: Adult appendicitis (AA) with equivocal computed tomography (CT) findings remains a diagnostic challenge for physicians. Herein we evaluated the diagnostic performance of several clinical scoring systems in adult patients with suspected appendicitis and equivocal CT findings. METHODS: We retrospectively evaluated 189 adult patients with equivocal CT findings. Alvarado, Eskelinen, appendicitis inflammatory response, Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA), and adult appendicitis score (AAS) scores were evaluated, receiver operating characteristic analysis was conducted, and the optimal, low, and high cut-off values were determined for patient classification into three groups: low, intermediate, or high. RESULTS: In total, 61 patients were included in the appendicitis group and 128 in the non-appendicitis group. There were no significant differences between the area under the curve of the clinical scoring systems in the final diagnosis of AA for equivocal appendicitis on CT (Alvarado, 0.698; Eskelinen, 0.710; appendicitis inflammatory response, 0.668; RIPASA, 0.653; AAS, 0.726). A RIPASA score greater than 7.5 had a high positive predictive value (90.9) and an AAS score less than or equal to 5 had a high negative predictive value (91.7) in the diagnosis of AA. CONCLUSION: The accuracy of clinical scoring systems in the diagnosis of AA with equivocal CT findings was moderate. Therefore, a high RIPASA score may assist in the diagnosis of AA in patients with equivocal CT findings, and a low AAS score may be used as a criterion for patient discharge. Most patients presented with intermediate scores. The patients with equivocal CT findings may be considered as a third diagnostic category of AA.
Adult* ; Appendicitis* ; Classification ; Clinical Decision-Making ; Diagnosis ; Diagnostic Tests, Routine ; Humans ; Multidetector Computed Tomography ; Patient Discharge ; Retrospective Studies ; ROC Curve ; Skates (Fish)

No abstract available.

OBJECTIVE: Postoperative facet joint syndrome requiring radiofrequency neurotomy (RFN) is a relatively common problem following microscopic discectomy. However, the efficacy of repeated RFN after microscopic discectomy has not been clearly documented. The purpose of this study was to determine the success rate and symptom-free duration of repeated RFN for facet joint syndrome after microscopic discectomy. METHODS: Medical records from 56 patients, who had undergone successful initial RFN following microscopic discectomy, experienced recurrence of pain, and subsequently had repeated RFN, were reviewed and evaluated. Responses of repeated RFN were compared with initial radiofrequency neurotomy for success rates and duration of relief. The criterion for RFN to be successful was defined as greater than 50% relief from pain and sufficient satisfaction of patients with prior RFN to have repeated RFN. RESULTS: Fifty-six patients (41 women and 15 men; mean age=48 years) had repeated RFNs, which were successful in all except three patients. RFN denervated three bilateral segments (L3-L4, L4-L5, and L5-S1) in all patients. Mean duration of relief after initial RFN was 9.2 months (range 3-14). The mean duration of relief after secondary RFN in 53 patients was 9.0 months (range 4-14). The success rates and duration of relief remained consistent after subsequent RFNs. CONCLUSION: Repeated RFN for lumbar facet joint pain after microscopic discectomy is an effective palliative treatment. It provided a mean duration of relief of 9.0 months and >94% success rate.
Diskectomy* ; Female ; Humans ; Male ; Medical Records ; Palliative Care ; Recurrence ; Zygapophyseal Joint*

BACKGROUND: The dysfunction of multiple organs is found to be caused by reactive oxygen species as a major modulator of microvascular injury after hemorrhagic shock. Hemorrhagic shock, one of many causes inducing acute lung injury, is associated with increase in alveolocapillary permeability and characterized by edema, neutrophil infiltration, and hemorrhage in the interstitial and alveolar space. Aggressive and rapid fluid resuscitation potentially might increased the risk of pulmonary dysfunction by the interstitial edema. Therefore, in order to improve the pulmonary dysfunction induced by hemorrhagic shock, the present study was attempted to investigate how to reduce the inflammatory responses and edema in lung. MATERIAL AND METHOD: Male Sprague-Dawley rats, weight 300 to 350 gm were anesthetized with ketamine (7 mg/kg) intramuscular. Hemorrhagic Shock (HS) was induced by withdrawal of 3 mL/100 g over 10 min. through right jugular vein. Mean arterial pressure was then maintained at 35~40 mmHg by further blood withdrawal. At 60 min. after HS, the shed blood and Ringer's solution or 5% albumin was infused to restore mean carotid arterial pressure over 80 mmHg. Rats were divided into three groups according to rectal temperature level (37 degrees C [normothermia] vs 33degrees C [mild hypothermia]) and resuscitation fluid (lactate Ringer's solution vs 5% albumin solution). Group I consisted of rats with the normothermia and lactate Ringer's solution infusion. Group II consisted of rats with the systemic hypothermia and lactate Ringer's solution infusion. Group III consisted of rats with the systemic hypothermia and 5% albumin solution infusion. Hemodynamic parameters (heart rate, mean carotid arterial pressure), metabolism, and pulmonary tissue damage were observed for 4 hours. RESULT: In all experimental groups including 6 rats in group I, totally 26 rats were alive in 3rd stage. However, bleeding volume of group I in first stage was 3.2+/-0.5 mL/100 g less than those of group II (3.9+/-0.8 mL/100 g) and group III (4.1+/-0.7 mL/100 g). Fluid volume infused in 2nd stage was 28.6+/-6.0 mL (group I), 20.6+/-4.0 mL (group II) and 14.7+/-2.7 mL (group III), retrospectively in which there was statistically a significance between all groups (p <0.05). Plasma potassium level was markedly elevated in comparison with other groups (II and III), whereas glucose level was obviously reduced in 2nd stage of group I. Level of interleukine-8 in group I was obviously higher than that of group II or III (p <0.05). They were 1,834+/-437 pg/mL (group I), 1,006+/-532 pg/mL (group II), and 764+/-302 pg/mL (group III), retrospectively. In histologic score, the score of group III (1.6+/-0.6) was significantly lower than that of group I (2.8+/-1.2)(p <0.05). CONCLUSION: In pressure-controlled hemorrhagic shock model, it is suggested that hypothermia might inhibit the direct damage of ischemic tissue through reduction of basic metabolic rate in shock state compared to normothermia. It seems that hypothermia should be benefit to recovery pulmonary function by reducing replaced fluid volume, inhibiting anti-inflammatory agent (IL-8) and leukocyte infiltration in state of ischemia-reperfusion injury. However, it is considered that other changes in pulmonary damage and inflammatory responses might induce by not only kinds of fluid solutions but also hypothermia, and that the detailed evaluation should be study.
Acute Lung Injury ; Animals ; Arterial Pressure ; Edema ; Fluid Therapy* ; Glucose ; Hemodynamics ; Hemorrhage ; Humans ; Hypothermia* ; Jugular Veins ; Ketamine ; Lactic Acid ; Leukocytes ; Lung* ; Male ; Metabolism ; Neutrophil Infiltration ; Permeability ; Plasma ; Potassium ; Rats* ; Rats, Sprague-Dawley ; Reactive Oxygen Species ; Reperfusion ; Reperfusion Injury ; Resuscitation ; Retrospective Studies ; Shock ; Shock, Hemorrhagic*

PURPOSE: In general, the depth of tumor invasion correlates with lymph node metastasis in gastric cancer, but some cases show a discrepancy between the tumor depth and nodal status. Therefore, this study was designed to investigate the factors affecting tumor growth patterns including the depth of invasion and lymph node metastasis. METHODS: The clinico-pathological characteristics of 1048 gastric cancer, from 1993 to 1999, were investigated. These cancer cases were divided into three groups: the early gastric cancer with lymph node metastasis (EP), the serosa infiltrated advanced cancer with no lymph node metastasis (SN), and the serosa infiltrated advanced gastric cancer with lymph node metastasis (SP) groups. The expression status of the proteins related with tumor growth, including matrix metalloproteinase-2 and 9 (MMP-2 and MMP-9), VEGF, nm23 and p53, were compared using immunohistochemical stain, p53 gene mutation, Microsatellite instability (MSI) and Loss of heterozygosity (LOH). RESULTS: There were 35 (3.4%) of the total cases in the EP group, and 10.1% in Early gatric cancer cases. The female ratio in the EP group was higher than in the SN group but this was not statistically significant. The most common gross types in the EP and SN groups were IIc and Borrmann type III, respectively, and the mean tumor size was largest in the SN group. The cell differentiation of the SN group was better than that in the EP group (68.6 vs. 41.2%). The levels of MMP-2 and -9 were higher in the SN and SP groups than those in the EP group. However, the levels of VEGF and nm23 between the groups were no different. The EP group had the highest degree of p53 mutation. There was no difference in the MSI and LOH expression status between the groups. CONCLUSION: There were some different growth patterns in the gastric cancers between the lymph node metastasis dominant (EP) and depth of infiltration dominant (SN) groups. MMP-2 and -9, tumor differentiation and mutated p53 gene exon may correlated with the tumor growth pattern. Further study is suggested to find the difference between the EP and SN groups, which could provide information on which factors determine nodal metastasis or the depth of a infiltration dominant growth pattern.
Cell Differentiation ; Exons ; Female ; Genes, p53 ; Humans ; Loss of Heterozygosity ; Lymph Nodes ; Matrix Metalloproteinase 2 ; Microsatellite Instability ; Neoplasm Metastasis ; Serous Membrane ; Stomach Neoplasms* ; Vascular Endothelial Growth Factor A