BACKGROUND: Major spine surgery can be associated with dramatic blood loss, thereby requiring a high-volume transfusion. Tranexamic acid inhibits fibrinolysis and it has been used in general surgery. The effect of tranexamic acid on blood loss and transfusion requirements during spine surgery was prospectively studied. METHODS: Twenty-two patients scheduled for orthopaedic surgery for spinal stenosis under general anesthesia were randomly selected to receive, either tranexamic acid administered as a bolus of 15 mg/kg, or the equivalent volume of saline, during the operation and postoperatively. The anesthetic and perioperative management were standardized. The total blood loss of each patient and transfusion requirements were noted. Hematocrit, PT, PTT, and platelet count measure were performed before and after surgery. RESULTS: The tranexamic acid group demonstrated a significantly less amount of blood loss (859.5 +/- 280.0 ml) compared to the placebo group (1366.0 +/- 333.7 ml). In addition the fluid and homologous transfusion requirements in the placebo group were greater than in the tranexamic acid group. CONCLSIONS: Tranexamic acid during major spine surgery significantly reduces both blood loss and consequent blood transfusion requirements.
Anesthesia, General ; Blood Transfusion ; Fibrinolysis ; Hematocrit ; Humans ; Platelet Count ; Prospective Studies ; Spinal Stenosis ; Spine* ; Tranexamic Acid*

Recent investigations have revealed that autocrine growth factors and their receptors are closely related and play an important role in controlling cancer cell growth. We performed an immunohistochemical study on the expression of epidermal growth factor (EGF), transforming growth factor-alpha (TGF-alpha), epidermal growth factor receptor (EGF-R), c-erbB-2, and PCNA labelling index in 60 cases of human gastric carcinomas. TGF-alpha was detected in 38 cases (63.3%), EGF in 26 cases (43.3%), EGF-R in 44 cases (73.3%), and c-erbB-2 in 18 cases (30%). These growth factors, EGF-R and c-erbB-2, were found more often in advanced gastric cancers. The PCNA labeling index was significantly higher in tumors with the expression of EGF-R or c-erbB-2. Tumors with simultaneous expression of EGF, TGF-alpha, EGF-R and c-erbB-2 was associated with a high PCNA labeling index. A correlation was observed between the synchronous expression of growth factors and its receptors and histological differentiation. The results suggest that the expression of EGF, TGF-alpha, EGF-R and c-erbB-2 are closely related and plays an important role in the growth and progression of human gastric carcinoma.
Epidermal Growth Factor* ; Humans ; Intercellular Signaling Peptides and Proteins ; Peptides* ; Proliferating Cell Nuclear Antigen ; Receptor, Epidermal Growth Factor ; Stomach Neoplasms ; Transforming Growth Factor alpha

A total of 48 cases of tuberculous lesion in the lymph nodes (43 cases), lung (3 cases) and soft tissue (2 cases), was subjected to fine needle aspiration cytology(FNAC). The age of the patients ranged from 19 to 77 year-old (average 33.6 years in age) and the male to female ratio was 1: 4. Thirty-four cases (70.8%) demonstrated distinct granulomatous reaction with or without caseation necrosis, nine cases (18.8%) showed no granulomas, but large amount of necrotic debris with numerous polymorphonuclear cells and histiocytes, and five cases (10.4%) revealed acellular material only. The overall AFB positivity in smears was 62.5%. In areas associated with granulomatous reaction and necrosis, AFB positivity was 55.8%, while it was 80.0% in cases with acellular necrotic material. There were 2 cases of parasitic infestation which could not be easily differentiated from tuberculosis based on aspiration smears only.
Aged ; Biopsy, Fine-Needle ; Child* ; Female ; Granuloma ; Histiocytes ; Humans ; Lung ; Lymph Nodes ; Male ; Necrosis ; Tuberculosis ; Vesico-Ureteral Reflux*

PURPOSE: Providing an adequate amount of energy is important in patients with depleted nutrition. Indirect calorimetry is a portable tool that can measure the resting energy expenditure, the respiratory quotient, and the ratio of substrate utilization. Another way of getting the energy expenditure is through the use of equations, and that has been a more common way to get the basal energy expenditure. However, there has been a controversy that the energy expenditures calculated from equations are not the same as the values measured by indirect calorimetry. METHODS: Our study was to clarify this difference in two different groups with different physical conditions and growth. One was a normal-adult group (n=18), and their energy expenditure was calculated using the Harris-Benedict equations. The other was a normal-newborn group (n=7), and their energy expenditure was calculated using the Schofield equations. Calculated values were compared with the resting energy expenditure from indirect calorimetry (Deltatrac Metabolic Monitor, Datex Inc. Finland). RESULTS: In the adults, the basal energy expenditure was 1703.3+/-100.2 kcal/d according to the Harris-Benedict equations, and the resting energy expenditure was 1701+/-289.6 kcal/d according to indirect calorimetry (p>0.1). VO2 was 245.7+/-42.8 ml/min, VCO2 was 210+33.4 ml/min, and RQ was 0.86+/-0.05. In the neonates, the basal energy expenditure was 184.1+/-15.1 kcal/d according to the Schofield equations, and the resting basal energy expenditure was 154.3+/-32.1 kcal/d (p<0.05). VO2 was 21.9+/-4.3 ml/min, VCO2 was 18.7+/-4.0 ml/min, and RQ was 0.85+/-0.02. The ratios of substrate utilization were 192.1+/-58.8 g/d (48.03+/-16.8%) for carbohydrates, 69.7 +/-35.6 g/d (37.8+/-17.2%) for fats, and 55.8+/-14.9 g/d (14.3+/-3.9%) for proteins in the adults. In the neonates, the ratios were 18.6+/-5.6 g/d (50.3+/-7.0%) for carbohydrates, 18.6+/-1.1 g/d (47.7+/-6.2%) for fats, and 1+/-0 g/d (3.0+/-0.73%) for proteins. CONCLUSION: The difference between the basal energy expenditure obtained from equations and the resting energy expenditure obtained from indirect calorimetry could be identified only in the neonate group, but not in the adult group. It is speculated that resting energy expenditure was more reliable than the basal energy expenditure in neonates. Indirect calorimetry canbe a useful tool to correct the errors in the values obtained from equations, and other parameters, such as the respiratory quotient and the ratio of substrate utilization, should be evaluated in nutritional support.
Adult ; Calorimetry, Indirect* ; Carbohydrates ; Energy Metabolism* ; Fats ; Humans ; Infant, Newborn* ; Nutritional Support ; Young Adult*

Penile horn is a peculiar form of penile wart disclosing excessive keratosis with unknown etiology. A case of penile horn arising on the circumcised wound 2 years after circumcision is presented with review of literatures.
Animals ; Circumcision, Male ; Female ; Horns* ; Keratosis ; Male ; Warts ; Wounds and Injuries

No abstract available.
Diarrhea* ; Korea*

BACKGROUND : The incidence of breast cancer has steadily increased through the years. The establishment of the cause of breast cancer plays an important role for the diagnosis, management and prevention of breast cancer. METHODS : We analysed 241 cases of breast cancer that were treated during the 13 years from January 1985 to December 1997 at the Department of General Surgery, Inje University Paik Hospital, Seoul. RESULTS : The peak incidence of breast cancer was in the 5th decade (100 cases, 41.5%). The most common age of menarche ranged from 14 to 20 years (89.9%). The most common age of first full-term delivery ranged from 25 to 29 years (54.5%). The normal group was the most frequent body mass index (156 cases, 65.8%). The most common chief complaint was a painless palpable breast mass (166 cases, 68.9%). Most patients (181 cases, 75.1%) visited the hospital within 6 months of developing symptoms. The upper outer quadrant was the most frequent location for breast cancer (146 cases, 60.6%). The most common type of operative technique was a modified radical mastectomy (225 cases, 93.4%). The most common size of the breast mass ranged from 2 to 5 cm (151 cases, 62.7%). A pathologically positive axillary lymph node was present in 122 cases (52.4%). The predominant type of pathological classi fication was invasive ductal carcinoma (215 cases, 90.7%). According to the TNM system, the most common stage was stage II (161 cases, 66.8%). The five-year survival rates for the patients in stages I, II, III were 96.7%, 82.2%, 68.9%, respectively. CONCLUSIONS : We conclude that women with mass or mass-related symptoms needed more careful evaluation and aggressive approaches for discovering breast cancer.
Body Mass Index ; Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Diagnosis ; Female ; Humans ; Incidence ; Lymph Nodes ; Mastectomy, Modified Radical ; Menarche ; Seoul ; Survival Rate

The vast majority of foreign bodies (FBs) that enter the stomach pass through the gastrointestinal tract spontaneously. When the FB enters the small bowel-beyond the reach of conventional endoscopy-daily radiographs are needed to ensure its safe passage. However, endoscopic intervention is an appropriate management strategy for a sharp-pointed FB, because sharp FBs have a higher risk of intestinal perforation. We describe here a case in which a 1.5-cm, sharp-pointed screw nail in the proximal jejunum was removed successfully by double-balloon enteroscopy from a 19-year-old-male with autism. This case adds to the growing body of evidence demonstrating the value of therapeutic double-balloon enteroscopy in the field of FB ingestion
Autistic Disorder ; Double-Balloon Enteroscopy* ; Eating ; Foreign Bodies ; Gastrointestinal Tract ; Intestinal Perforation ; Jejunum* ; Stomach

A case of 23 years old boy having ureteral injury caused by accidental gunshot wound. He had successfully treated by side to side anastomosis of the ureter following removed the injuries side of the ureter under the splinting ureteral catheter and nephrostomy.
Humans ; Male ; Splints ; Ureter* ; Urinary Catheters ; Wounds, Gunshot* ; Young Adult

PURPOSE: Tumor recurrence after partial hepatectomy for hepatocellular carcinoma is a major cause of death from this disease. Among those recurrences, when it occurs immediate during the postoperative period, it may due to the overt expression of pre-existing micrometastases or circulating disseminated cancer cells. Therefore; we evaluate herein the risk factors for the immediate postoperative period fatal recurrence to help establish effective preventive countermeasures against these fatal recurrences. METHODS: From 1994 to 2004, the 269 patients in this study all had greater than 6 months of follow-up after curative resection for HCC at our medical center. Those patients who had a fatal recurrence that included diffuse intra-hepatic recurrence or multiple systemic recurrence within 6 months after hepatectomy, and all of the patients who didn't have a fatal recurrence within 6 month after resection of HCC were compared. The clinicopathological factors associated with immediate postoperative recurrence were then analyzed. RESULTS: The overall postoperative mortality was 1%. There were 30 patients in the immediate postoperative group (the subjective group) among the total 269 patients. Among the subjective group patients, 20 patients had diffuse intra-hepatic recurrence and remained 10 patients had multiple systemic recurrence. The mean disease free survival period of the subjective group was 3.9+/-1.7 months and the mean survival period after recurrence was 6.7+/-6.1 months. On multivariate analysis, a serum alpha-fetoprotein level greater than 1, 000 ng/ml (p=0.019; odds ratio: 2.98), a tumor size greater than 6.5 cm (p=0.03; odd ratio: 2.98), and the presence of microvascular invasion (p=0.01; odd ratio: 4.89) were associated with the risk factors for immediate postoperative fatal recurrence. CONCLUSION: These findings can be important indicators to establish countermeasures against immediate postoperative period fatal recurrence, and the high risk patients would also be good candidates for clinical trials with adjuvant anti-cancer treatments such as early postoperative TACE, immunotherapy, anti-angiogenic treatment and so on.
alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Cause of Death ; Disease-Free Survival ; Follow-Up Studies ; Hepatectomy ; Humans ; Immunotherapy ; Mortality ; Multivariate Analysis ; Neoplasm Micrometastasis ; Odds Ratio ; Postoperative Period ; Recurrence* ; Risk Factors*