Meningeal carcinomatosis is an important neurological complication of systemic cancer, and is increasingly being recognized as a cause of reurologic disability in life. Also there is evidenee that the incidence of this form of metastasis is increasing. We reported a case of 52-year-old female patient, who was diagnosed as early gastric cancer by biopsy under gastrofiberscopy. Other Lab. findings were all normal range except high alkaline phosphatase level. And then performed Billroth II operation. On 7th post-operative day, she was encountered severe headache and insomnia. Abnormal neurologic signs and subjective symptoms were developed and progressed, Repeated lumbar punture was done and CSF was examed. There findings were abnormal, but no specific finding of certain disease. She died of severe neurologic deficit and sudden respiratory arrest. Autopsy was done, and confirmed leptomeningeal carcinomatosis.
Alkaline Phosphatase ; Autopsy ; Biopsy ; Female ; Gastroenterostomy ; Headache ; Humans ; Incidence ; Meningeal Carcinomatosis* ; Middle Aged ; Neoplasm Metastasis ; Neurologic Manifestations ; Reference Values ; Sleep Initiation and Maintenance Disorders ; Stomach Neoplasms ; Stomach*

BACKGROUND: Women with end-stage renal disease have low fertility. Following renal transplantation, the reproductive function returns to normal, and pregnancy becomes possible. METHOD: At our medical center, between June 1990 and February 1998, 263 female patients underwent renal transplantations, and 14 of them later became pregnant. The outcomes from 23 pregnancies in these 14 kidney transplant recipients were analyzed. RESULT: Forty-three percent (43%) of the pregnancies ended in artificial (9 cases) or spontaneous abortion (1 case), and 11 of 13 deliveries were successful. A vaginal delivery was performed in 9 cases (69%) and a cesarian section was done in 4 cases (31%). All of the 11 pregnancies that continued over 30 weeks ended successfully. The mean age of the recipients at the first pregnancy was 29.4 +/- 4.6 years (23-37). The mean time to first pregnancy since renal transplantation was 22.6 +/- 12.3 months (1-50). Thirteen (13) recipients were maintained on cyclosporin-based immunosuppressive regimens before and during pregnancy. One recipient, who was considered to have developed immune tolerance later, stopped the immunosuppressive drug at 3 months prior to the first pregnancy. The renal function remained stable and unchanged in all the recipients, and no rejection episodes occurred during and after pregnancy in any of the recipients. Preeclamsia occurred in 8 cases (35%) and a previous rupture of membrane in 1 case (4%). Of the 11 live births, 4 (36%) were premature (<37 weeks), 1 (9%) had a lowbirth-weight (<2500 gm), 1 (9%) had transient apnea, and 3 (27%) had transient neutropenia. The mean Apgar score at 1 minute was 7.8 (7-9), with only 2 children having a score below 7. No congenital anomalies were documented. The later development and health of all of the children were good during a mean follow-up of 16.6 +/- 10 (1-38) months. Two (2) recipients who had a successful first pregnancy had a second baby. CONCLUSION: From these results, we can conclude that pregnancy does not adversely affect graft function and fetal development, provided that the graft function was stable at the time of conception and prudent fetal monitoring could be done.
Abortion, Spontaneous ; Apgar Score ; Apnea ; Child ; Female ; Fertility ; Fertilization ; Fetal Development ; Fetal Monitoring ; Follow-Up Studies ; Humans ; Immune Tolerance ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation ; Live Birth ; Membranes ; Neutropenia ; Pregnancy* ; Rupture ; Transplantation ; Transplants

Thyroid carcinomas are uncommon in childhood and adolescence. The aim of this study was to analyze clinical features and clinical outcomes of thyroid cancer in the pediatric population treated in the Yonsei University Health System. From September 1982 to June 2009, 90 patients (75 females, 15 males; female:male ratio of 5:1) with differentiated thyroid carcinoma were identified in our institute. The mean age at diagnosis was 15.8 yr old (range 4.8-19.9 yr). Cervical masses were most common clinical manifestations at diagnosis in 65 patients (72.2%). Forty-two patients underwent less than total thyroidectomy and 18 patients underwent total thyroidectomy. Thirty patients (33.3%) had lateral neck lymph node metastasis and seven patients (7.8%) had lung metastasis at the time of surgery. Among the 90 patients, recurrence occurred in 14 patients (15.5%). Mean follow-up period for patients with differentiated thyroid carcinoma was 81.6 months (13-324 months). No patients died of differentiated thyroid carcinoma. Patients with differentiated thyroid carcinoma who were < 20-yr-of-age were present with aggressive local disease and a high frequency of lymph node and distant metastasis. It is recommended that pediatric thyroid cancer should be managed mostly using proper surgical approach with thyroidectomy and lymph node dissection when indicated.
Adolescent ; Age Factors ; Carcinoma/*pathology/surgery ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Hospitals, University ; Humans ; Iodine Radioisotopes/therapeutic use ; Lung Neoplasms/diagnosis/secondary ; Lymph Node Excision ; Lymph Nodes/surgery ; Lymphatic Metastasis ; Male ; Recurrence ; Survival Rate ; Thyroid Neoplasms/*pathology/radiotherapy/surgery ; Thyroidectomy ; Young Adult

OBJECTIVE: For the effective retrieval of clinical information, the elaborate indexing is essential. Two major types of indexing are the human indexing and the automatic or machine indexing. Human indexing shows higher quality but is time consuming, labor-intensive and inconsistent in term assignment activity. METHODS: Using the Unified Medical Language System (UMLS) MetaMap program, we mapped the free text from the diagnosis section of radiology reports into UMLS concepts. To improve the precision of UMLS concept indexing by MetaMap, we evaluated the UMLS subset mapping and semantic type filtering methods, determining the best combination for improved precision. RESULTS: After calculating the candidates from subset combinations, we obtained more enhanced results by semantic-type filtering. CONCLUSION: The results may be improved for the complete automation of indexing process.
Abstracting and Indexing as Topic* ; Automation ; Diagnosis ; Humans ; Semantics ; Unified Medical Language System*

PURPOSE: A completion thyroidectomy after less than total thyroidectomy is needed for the treatment of recurrent papillary thyroid carcinoma (PTC). The aim of this study is to evaluate the clinicopathological features and the postoperative complications of completion thyroidectomy for patients with recurrent PTC. METHODS: A total 94 PTC patients who had undergone prior less than total thyroidectomy underwent completion thyroidectomy for recurrence from March 1986 to June 2009. We retrospectively analyzed the clinicopathological features and postoperative complications. RESULTS: At the initial operation, the patients' mean age was 38.2 years old. Central node metastasis was found in 37 cases and extrathyroidal invasion was found in 12 cases. The mean interval time between the initial operation to the completion thyroidectomy was 76.6 months. Fifty six patients underwent completion thyroidectomy only and 38 underwent a completion thyroidectomy combined with a modified radical neck dissection. In the combined group, central neck node metastasis and extrathyroidal invasion at the time of the initial operation were significantly more frequent than those in the completion thyroidectomy only group. The postoperative complications were 14 cases of transient hypocalcemia and 8 cases of permanent hypocalcemia and there were no significant differences between the two groups. CONCLUSION: When performing completion thyroidectomy, it is important to check the lateral neck nodes for metastasis when central neck node metastasis or extrathyroidal invasion were present at the initial operation, and this can be done safely without severe complications even though it is combined with modified radical neck dissection.
Humans ; Hypocalcemia ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Postoperative Complications* ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy*

OBJECTIVE: The purpose of this study is to evaluate the clinical and hematological effects of tocilizumab in active rheumatoid arthritis (RA) patients. METHODS: Fourteen patients with active RA were enrolled in this study. The patients received tocilizumab 8 mg/kg intravenously every four weeks for 6 months. Disease activity, anemia-related factors including serum hepcidin-25, and hematological parameters were monitored at baseline and at 1, 3, and 6 months after the initiation of treatment. RESULTS: Significant reductions in tender joint count, swollen joint count, visual analogue scale, erythrocyte sedimentation rate (ESR), and C-reactive (CRP) protein plus reductions in a 28-joint disease activity score were observed within one month after the first tocilizumab treatment. These effects lasted throughout the six-month study period. In addition, significant improvements in anemia-related factors such as hepcidin-25, ferritin, iron, hemoglobin, red blood cell counts and mean corpuscular volume were observed during the treatment period. Hematological parameters were improved with reductions in counts for leukocytes, monocytes, neutrophils, and platelets. The lymphocyte counts and their subset numbers were unchanged. Changes in hepcidin levels showed significant correlation with changes in CRP, ESR, ferritin, hemoglobin and counts for red blood cells, leukocytes, and neutrophils during the treatment period. CONCLUSION: This study demonstrates that tocilizumab significantly and meaningfully reduces disease burden in patients with active RA. In addition, tocilizumab diminishes the levels of inflammatory anemia by inhibiting hepcidin production. These clinical data provide evidence of a favorable outcome from tocilizumab in RA.
Anemia* ; Arthritis, Rheumatoid* ; Blood Sedimentation ; Erythrocyte Count ; Erythrocyte Indices ; Erythrocytes ; Ferritins ; Hepcidins* ; Humans ; Iron ; Joints ; Leukocytes ; Lymphocyte Count ; Monocytes ; Neutrophils

Protein arginine methylation is important for a variety of cellular processes including transcriptional regulation, mRNA splicing, DNA repair, nuclear/cytoplasmic shuttling and various signal transduction pathways. However, the role of arginine methylation in protein biosynthesis and the extracellular signals that control arginine methylation are not fully understood. Basic fibroblast growth factor (bFGF) has been identified as a potent stimulator of myofibroblast dedifferentiation into fibroblasts. We demonstrated that symmetric arginine dimethylation of eukaryotic elongation factor 2 (eEF2) is induced by bFGF without the change in the expression level of eEF2 in mouse embryo fibroblast NIH3T3 cells. The eEF2 methylation is preceded by ras-raf-mitogen-activated protein kinase kinase (MEK)-extracellular signal-regulated kinase (ERK1/2)-p21(Cip/WAF1) activation, and suppressed by the mitogen-activated protein kinase (MAPK) inhibitor PD98059 and p21(Cip/WAF1) short interfering RNA (siRNA). We determined that protein arginine methyltransferase 7 (PRMT7) is responsible for the methylation, and that PRMT5 acts as a coordinator. Collectively, we demonstrated that eEF2, a key factor involved in protein translational elongation is symmetrically arginine-methylated in a reversible manner, being regulated by bFGF through MAPK signaling pathway.
Animals ; Arginine ; Cell Dedifferentiation ; Cyclin-Dependent Kinase Inhibitor p21/genetics/metabolism ; Elongation Factor 2 Kinase/*metabolism ; Fibroblast Growth Factor 2/*metabolism ; Fibroblasts/*metabolism/pathology ; Flavonoids/pharmacology ; MAP Kinase Signaling System/drug effects/genetics ; Methylation ; Mice ; Mitogen-Activated Protein Kinases/antagonists & inhibitors ; Myofibroblasts/pathology ; NIH 3T3 Cells ; Protein Methyltransferases/*metabolism ; Protein-Arginine N-Methyltransferases/*metabolism ; RNA, Small Interfering/genetics

Protein arginine methylation is important for a variety of cellular processes including transcriptional regulation, mRNA splicing, DNA repair, nuclear/cytoplasmic shuttling and various signal transduction pathways. However, the role of arginine methylation in protein biosynthesis and the extracellular signals that control arginine methylation are not fully understood. Basic fibroblast growth factor (bFGF) has been identified as a potent stimulator of myofibroblast dedifferentiation into fibroblasts. We demonstrated that symmetric arginine dimethylation of eukaryotic elongation factor 2 (eEF2) is induced by bFGF without the change in the expression level of eEF2 in mouse embryo fibroblast NIH3T3 cells. The eEF2 methylation is preceded by ras-raf-mitogen-activated protein kinase kinase (MEK)-extracellular signal-regulated kinase (ERK1/2)-p21(Cip/WAF1) activation, and suppressed by the mitogen-activated protein kinase (MAPK) inhibitor PD98059 and p21(Cip/WAF1) short interfering RNA (siRNA). We determined that protein arginine methyltransferase 7 (PRMT7) is responsible for the methylation, and that PRMT5 acts as a coordinator. Collectively, we demonstrated that eEF2, a key factor involved in protein translational elongation is symmetrically arginine-methylated in a reversible manner, being regulated by bFGF through MAPK signaling pathway.
Animals ; Arginine ; Cell Dedifferentiation ; Cyclin-Dependent Kinase Inhibitor p21/genetics/metabolism ; Elongation Factor 2 Kinase/*metabolism ; Fibroblast Growth Factor 2/*metabolism ; Fibroblasts/*metabolism/pathology ; Flavonoids/pharmacology ; MAP Kinase Signaling System/drug effects/genetics ; Methylation ; Mice ; Mitogen-Activated Protein Kinases/antagonists & inhibitors ; Myofibroblasts/pathology ; NIH 3T3 Cells ; Protein Methyltransferases/*metabolism ; Protein-Arginine N-Methyltransferases/*metabolism ; RNA, Small Interfering/genetics

BACKGROUNDS: Living-donor liver transplantation (LDLT) has been established as an efficacious option to resolve the shortage of cadaveric donor organs for pediatric recipients. This surgical innovation has significantly reduced the pretransplantation mortality for children, but the crisis of increasing scarcity of donor organs in our hospital has led us to extend LDLT to adult recipients. However, the extension of LDLT from pediatric recipients to adult recipients has been made only with limited success largely because of the inability of a relatively small-size left-lobe graft to meet the metabolic demands of an adult recipient. It has been postulated that a left-lobe graft smaller than 40% of the recipient's standard liver volume will not result in a successful adult-to-adult LDLT in chronic parenchymal liver disease. METHODS: From February 1997 to October 1997, 10 LDLTs, using 9 extended left-lobe grafts and 1 right-lobe graft, were performed on patients with end-stage parenchymal liver diseases (9 cases of B-hepatitis-induced cirrhosis with or without an associated hepatocellular carcinoma and 1 case of alcoholic cirrhosis) at the Department of Surgery, Asan Medical Center. The ratios of the graft to the standard liver volume of the recipients were in the range of 30% to 55%. RESULTS: All grafts showed immediate function, but delayed normalization of the serum total bilirubin was demonstrated in all recipients receiving left-lobe grafts. There were no mortalities and serious complications in donors. Two recipients died of sepsis 21 days and 40 days after transplantation, and 8 recipients (80%) are alive with good liver function at a median follow-up of 5.1 months (range 2~10 months). CONCLUSIONS: The aim of this article is to report our experience with adult-to-adult LDLT shows that a graft size greater than 30% of the recipient's standard liver volume is able to meet the metabolic demands of adult recipients with chronic parenchymal liver disease and that LDLT might open a new donor pool for adult recipients when the supply of cadaveric organs is severely restricted.
Adult ; Alcoholics ; Bilirubin ; Cadaver ; Carcinoma, Hepatocellular ; Child ; Chungcheongnam-do ; Fibrosis ; Follow-Up Studies ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Living Donors* ; Mortality ; Sepsis ; Tissue Donors ; Transplants