BACKGROUND: Flecainide is an antiarrhythmic agent that is used primarily in the treatment of cardiac arrhythmias. Some evidences also suggest that flecainide can participate in alveolar fluid clearance and inflammatory responses. This experiment was aimed to evaluate the effects of flecainide on sepsis induced acute lung injury in a rat model. METHODS: Rats were treated with subcutaneous infusion of saline or flecainide (0.1 or 0.2 mg/kg/hr) by a mini-osmotic pump. Subcutaneous infusion was started 3 hours before and continued until 8 hours after intraperitoneal injection of saline or endotoxin. Animals were sacrificed for analyses of severity of acute lung injury with wet to dry (W/D) ratio and lung injury score (LIS) in lung and inflammatory responses with level of leukocyte, polymorphonuclear neutrophils (PMNs) and inteleukin-8 (IL-8) in bronchoalveolar lavages fluid (BALF). RESULTS: Flecainide markedly improved dose dependently sepsis induced acute lung injury as analysed by W/D ratio (from 2.24 ± 0.11 to 1.76 ± 0.09, p < 0.05) and LIS (from 3 to 1, p < 0.05), and inflammatory response as determined by leukocyte (from 443 ± 127 to 229 ± 95, p < 0.05), PMNs (from 41.43 ± 17.63 to 2.43 ± 2.61, p < 0.05) and IL-8 (from 95.00 ± 15.28 to 40.00 ± 10.21, p < 0.05) in BALF. CONCLUSIONS: Flecanide improve sepsis induced acute lung injury in rats by controlling inflammatory responses.
Acute Lung Injury* ; Animals ; Arrhythmias, Cardiac ; Bronchoalveolar Lavage ; Flecainide* ; Infusions, Subcutaneous ; Injections, Intraperitoneal ; Interleukin-8 ; Leukocytes ; Lung ; Lung Injury ; Models, Animal ; Neutrophils ; Rats ; Sepsis*

Purpose: To report a case of contact lens-related infectious keratitis caused by three different bacterial species.Case summary: A 40-year-old man presented with pain and redness in his left eye. His best-corrected visual acuity (BCVA) in the affected eye was 20/25. Slit-lamp examination revealed a 3 × 3 mm corneal epithelial defect with infiltration located 1 mm inferior to the pupil. Following admission, a microbial culture test was performed, and empirical antibiotic therapy was initiated. On the fourth day, Pseudomonas aeruginosa was isolated from the corneal sample and the contact lens, while Serratia marcescens and Stenotrophomonas maltophilia were isolated from the contact lens case. Based on the results of the antibiotic susceptibility tests, 0.5% moxifloxacin, fortified amikacin, and ceftazidime were administered topically and intravenously. The corneal epithelial defect reduced to 1 × 1 mm by the eleventh day of admission. After two months, BCVA improved to 20/20 with no remaining corneal epithelial defect, although an inactive corneal opacity persisted at the previous ulcer site. Conclusions Contact lens wear can be associated with polymicrobial keratitis involving three distinct Gram-negative bacteria, which may present greater treatment challenges compared to monomicrobial keratitis. Microbial culture testing of the contact lens, its case, and corneal scrapings is essential for identifying the causative organisms and selecting appropriate antibiotic therapy.

Purpose: To report a case of contact lens-related infectious keratitis caused by three different bacterial species.Case summary: A 40-year-old man presented with pain and redness in his left eye. His best-corrected visual acuity (BCVA) in the affected eye was 20/25. Slit-lamp examination revealed a 3 × 3 mm corneal epithelial defect with infiltration located 1 mm inferior to the pupil. Following admission, a microbial culture test was performed, and empirical antibiotic therapy was initiated. On the fourth day, Pseudomonas aeruginosa was isolated from the corneal sample and the contact lens, while Serratia marcescens and Stenotrophomonas maltophilia were isolated from the contact lens case. Based on the results of the antibiotic susceptibility tests, 0.5% moxifloxacin, fortified amikacin, and ceftazidime were administered topically and intravenously. The corneal epithelial defect reduced to 1 × 1 mm by the eleventh day of admission. After two months, BCVA improved to 20/20 with no remaining corneal epithelial defect, although an inactive corneal opacity persisted at the previous ulcer site. Conclusions Contact lens wear can be associated with polymicrobial keratitis involving three distinct Gram-negative bacteria, which may present greater treatment challenges compared to monomicrobial keratitis. Microbial culture testing of the contact lens, its case, and corneal scrapings is essential for identifying the causative organisms and selecting appropriate antibiotic therapy.

Purpose: To report a case of contact lens-related infectious keratitis caused by three different bacterial species.Case summary: A 40-year-old man presented with pain and redness in his left eye. His best-corrected visual acuity (BCVA) in the affected eye was 20/25. Slit-lamp examination revealed a 3 × 3 mm corneal epithelial defect with infiltration located 1 mm inferior to the pupil. Following admission, a microbial culture test was performed, and empirical antibiotic therapy was initiated. On the fourth day, Pseudomonas aeruginosa was isolated from the corneal sample and the contact lens, while Serratia marcescens and Stenotrophomonas maltophilia were isolated from the contact lens case. Based on the results of the antibiotic susceptibility tests, 0.5% moxifloxacin, fortified amikacin, and ceftazidime were administered topically and intravenously. The corneal epithelial defect reduced to 1 × 1 mm by the eleventh day of admission. After two months, BCVA improved to 20/20 with no remaining corneal epithelial defect, although an inactive corneal opacity persisted at the previous ulcer site. Conclusions Contact lens wear can be associated with polymicrobial keratitis involving three distinct Gram-negative bacteria, which may present greater treatment challenges compared to monomicrobial keratitis. Microbial culture testing of the contact lens, its case, and corneal scrapings is essential for identifying the causative organisms and selecting appropriate antibiotic therapy.

Purpose: To report a case of contact lens-related infectious keratitis caused by three different bacterial species.Case summary: A 40-year-old man presented with pain and redness in his left eye. His best-corrected visual acuity (BCVA) in the affected eye was 20/25. Slit-lamp examination revealed a 3 × 3 mm corneal epithelial defect with infiltration located 1 mm inferior to the pupil. Following admission, a microbial culture test was performed, and empirical antibiotic therapy was initiated. On the fourth day, Pseudomonas aeruginosa was isolated from the corneal sample and the contact lens, while Serratia marcescens and Stenotrophomonas maltophilia were isolated from the contact lens case. Based on the results of the antibiotic susceptibility tests, 0.5% moxifloxacin, fortified amikacin, and ceftazidime were administered topically and intravenously. The corneal epithelial defect reduced to 1 × 1 mm by the eleventh day of admission. After two months, BCVA improved to 20/20 with no remaining corneal epithelial defect, although an inactive corneal opacity persisted at the previous ulcer site. Conclusions Contact lens wear can be associated with polymicrobial keratitis involving three distinct Gram-negative bacteria, which may present greater treatment challenges compared to monomicrobial keratitis. Microbial culture testing of the contact lens, its case, and corneal scrapings is essential for identifying the causative organisms and selecting appropriate antibiotic therapy.

OBJECTIVE: To investigate the expression of fragile histidine triad (FHIT) protein and the possible relationship between FHIT expression and clinicopathological indices in cervical adenocarcinoma. METHODS: FHIT protein expression was examined in 40 cases of cervical adenocarcinoma stage Ia to IIa and 28 cases of corresponding normal endocervical tissue by immunohistochemical method. We analyzed the relationship between the reduction of FHIT protein expression and several prognostic factors such as histological grade, lymph node metastasis, tumor size, cervical invasion depth and parametrial invasion. We used Fisher's exact test for statistical analysis. RESULTS: The FHIT protein expression was positive in 77.5% (31/40) of cervical adenocarcinoma tissue, and reduced its expression in 22.5% (9/40) whereas positive in 100% (28/28) cases of adjacent normal endocervical gland. The FHIT expression was decreased in 14.3% (4/28) of cancers without lymph node metastasis but 55.5% (5/9) of those with metastasis (p=0.023). And the reduction of FHIT expression was found in 34.8% (8/23) of grade II and III cancers and only 6.3% (1/16) of grade I (p=0.056). CONCLUSION: Loss of FHIT protein expression may be associated with metastasis and poor prognosis of cervical adenocarcinoma.
Adenocarcinoma* ; Histidine ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis

The purpose of this study was to compare the performance of different commercial quality assurance (QA) systems for the pretreatment verification plan of stereotactic body radiotherapy (SBRT) with volumetric arc therapy (VMAT) technique using a flattening-filter-free beam. The verification for 20 pretreatment cancer patients (seven lung, six spine, and seven prostate cancers) were tested using three QA systems (EBT3 film, I’mRT MatriXX array, and MapCHECK). All the SBRT-VMAT plans were optimized in the Eclipse (version 11.0.34) treatment planning system (TPS) using the Acuros XB dose calculation algorithm and were delivered to the Varian TrueBeam® accelerator equipped with a high-definition multileaf collimator. Gamma agreement evaluation was analyzed with the criteria of 2% dose difference and 2 mm distance to agreement (2%/2 mm) or 3%/3 mm. The highest passing rate (99.1% for 3%/3 mm) was observed on the MapCHECK system while the lowest passing rate was obtained on the film. The pretreatment verification results depend on the QA systems, treatment sites, and delivery beam energies. However, the delivery QA results for all QA systems based on the TPS calculation showed a good agreement of more than 90% for both the criteria. It is concluded that the three 2D QA systems have sufficient potential for pretreatment verification of the SBRT-VMAT plan.
Humans ; Lung ; Prostate ; Radiosurgery* ; Spine

BACKGROUND: The current various case-finding instruments for detecting depression in Korea are too cucumbersome and time-consuming for routine use in primary care or student and soldier groups because of too many questions. We carried out this study in order to investigate the validity of the two-question case-finding instrument for detecting depression easily in the primary care or the mentioned groups. METHODS: We selected one boy high school in Seoul and 155 sophomer students answered the questionnaire by self-report. The questionnaire included two questions about depressed mood and anhedonia: (1) "During the past month, have you often been bothered by feeling down, depressed or hopeless?" (2) "During the past month, have you often been bothered by little interest or pleasure in doing things(e.g., studying, playing or talking with friends) ?". And then a resident of family medicine interviewed them and made a diagnosis for depression using the diagnostic criteria of DSM-IV. Simultaneously we compared the test characteristics of a two-question case-finding instrument with those of a previously validated Beck Depression Inventory as a currently world-wide used screening instrument for depression. RESULTS: The prevalence of major depression as determined by the interview was 6.6%(10 of 151). The two-question case finding instrument had a Cronbach's alpha of 0.663-internal consistency, a sensitivity of 100%, a specificity of 54.6%, a positive likelihood ratio of 2.20 and a negative predictive value of 1.00.(A "yes" answer to either of the two questions was considered a positive test.) And the BDI had a sensitivity of 90%, a specificity of 68.1%, a positive likelihood ratio of 3.63 and a negative predictive value of 0.99(cut-off point=15). Area under the ROC curves of the two-question case-finding instrument was 0.882, greater than that of the BDI, 0.834. CONCLUSIONS: The test characteristics of a two-question case-finding instrument were higher compared to those of BDI for major depression. Therefore, the two-question case-finding instrument is a useful measure for detecting depression and less time-consuming in primary care and certain groups.
Adolescent ; Anhedonia ; Depression* ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Korea ; Male ; Mass Screening* ; Military Personnel ; Pleasure ; Prevalence ; Primary Health Care ; ROC Curve ; Sensitivity and Specificity ; Seoul ; Surveys and Questionnaires

BACKGROUND: We attempted to see if acute MRI can expand the time window of thrombolytic therapy in acute stroke. METHODS: We performed MRI protocol including diffusion-weighted image (DWI) and MR angiogram (MRA) for patients with stroke within 6 hours after symptom onset. We selected 58 patients who had occlusion of middle cerebral artery (MCA) on the initial MRA. Thrombolytic therapy was done only when the patients showed more severe neurological deficits than expected with DWI findings. We analyzed demographic features, initial and follow-up NIH stroke scale scores, recanalization, and hemorrhagic transformation after thrombolytic therapy in 2 groups which were classified according to time to check MRI (within or beyond 3 hours). We measured the initial and follow-up lesion volume detected by DWI. RESULTS: Thrombolytic therapy was done in 38 patients. Twenty-four patients underwent MRI within 3 hours, and 14 patients underwent MRI between 3 and 6 hours. There were no significant differences in baseline characteristics, recanalization rate, ratio of marked clinical improvement, and hemorrhagic transformation rate between 2 groups. Young age was a significant predictable factor for good clinical outcome (p<0.05), but the interval from onset to imaging time and treatment modalities were not. CONCLUSIONS: It is suggested that patients' age and DWI findings are more appropriate factors affecting the clinical outcome after thrombolytic therapy than time interval itself at least when the therapy is considered within 6 hours.
Diffusion Magnetic Resonance Imaging ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Middle Cerebral Artery ; Stroke* ; Thrombolytic Therapy*

PURPOSE: The survival after a pancreaticoduodenectomy, for a periampullary adenocarcinoma is limited. However, the improvement in perioperative management, and the development of interventional medicine have made the survival from that cancer favorable. Due to the anatomical proximity of periampullary tumors, surgeons perform same procedure. It is accepted that the outcome of periampullary cancers vary after resection. The purpose of this study was to evaluate the risk factors, and the differences in survival, from periampullary cancers according to the origin of the tumor. METHODS: From March 1992 to December 2000, 87 patients, with periampullary tumors, who underwent a pancreatico duodenectomy, were analyzed for the location of the tumor and the tumor status. Of the 87 patients, the 85 surviving more than 30 days were included in the statistic analysis. The survival was calculated using the Kaplan-Meier Method. The risk factors were also analyzed between the locations. RESULT: Of the 87 resected adenocarcinomas, 25 were pancreatic cancers, 30 distal CBD (common bile duct) cancers, 26 mpulla of Vater cancers and 6 duodenal cancers. The patients had a mean age of 60 (40~78) years. The total bilirubin, ALT, and CA 19-9 levels were statistically different for each cancer. There were no statistical differences between the cancer groups in operative methods, the amount of transfusion, postoperative hospital stay, and complications. The overall morbidity and mortality were 37 and 2%, respectively. The 5-year survival rates for the pancreatic, distal CBD, and Ampulla of Vater cancers were 9.6, 45.5, and 72.1%, respectively, was and were statistically significant (P<0.001). A univariate analysis of the 85 patients indicated that the predictors of long term survival included: a pathologic diagnosis of Ampulla of Vater cancer, absence of lymph node metastasis, tumor diameter<3 cm and complication. CONCLUSION: The factors influencing the survival were nodal metastasis, size of the tumor, age, and complications. The differences in the tumor biology will affect the survival, and although a pancreaticoduodenectomy remains the procedure of choice for periampullary tumors, adjuvant, or neoadjuvant, therapy for a pancreatic head tumor is especially needed.
Adenocarcinoma ; Ampulla of Vater ; Bile ; Bilirubin ; Biology ; Diagnosis ; Head ; Humans ; Length of Stay ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Pancreatic Neoplasms ; Pancreaticoduodenectomy* ; Prognosis* ; Risk Factors ; Survival Rate