No abstract available.
Induction Chemotherapy*

No abstract available.
Genetic Loci* ; Loss of Heterozygosity* ; Stomach Neoplasms*

Recently the adenomaatous polyposis coli(APC) gene, a tumor suppressor gene, was identified and the cDNA was cloned from chromosome 5q21. Allelic deletion or point mutation of tumor suppressor genes(TSGs) has been considered as an important mechanism in development of human tumor. Point mutations affecting APC gene are seen in the hereditary syndrome, adenomatous polyposis and spordic colon cancer. However, the mutation of APC gene and other TSGs have not been described in gastric cancer. In order to identify the mutation of exon 11 of APC gene for gastric cancer, we amplified DNA extracted from paraffin-embedded tissues by polymerase chain reaction(PCR) and digested the PCR products with restriction enzyme Rsa I. We examined the DNA extracted from paraffin-embedded 44 gastric cancer tissues with lymph nodes. Eighteen(41%) among 44 were informative for the study exon 11 of the APC gene, and we found loss of heterozygosity(LOH) for APC in 6/18(33.3%). These data suggest that the point mutation or the base change of APC gene commonly occurs in gastric cancer. We conclude that the mutation of APC gene is strongly connected with development of human gastric cancer.
Humans ; Genes, Tumor Suppressor ; Stomach Neoplasms

BACKGROUND: This is the studies about "If the soldiers expose in the paraquat, how much have it influenced on themselves who participated in the Vietnam War and their second generation?" and this is also researched about the factors that "How differents do the symptoms according to their health conditions and a class of diseases?". First of all, We divided them into 3 groups as exposure duration and exposure degree of the paraquat and We gave marks against each steps, too. (< point 10: low group, point 11-19: middle group, > point 20: high group). We've focused in "Does the high score really involves with their descendants who suffers from paraquat?" as direct damages men during from June 1965 to February 1971 (72 persons) and their descendants (266 persons) who are in the Pusan veterans hospital and outpatients. METHODS: It is completed by direct interview, telephone interview, army records, army history, and medical records with them. We've tried to minify sample bias as analyzing their information. We could contact only a few people among living in Pusan or Kyongnam province. Generally, someone including persons who couldn't get a damaging proofs from paraquat hardly joined us and the others strongly rejected the interview for this research. RESULTS: Among the 72 participating soldiers in the Vietnam war, average age of patient is 53 years old (the youngest: 46 years old, the oldest: 64 years old), average of exposure score is 16 point (minimum: 1.9 point, maximum: 31.9 point), average of pregnant frequency is 5.2 persons, and average degree of smoking is 14.382 single cigarette (minimum: 4 single cigarette, maximum: 60 single cigarette). The second generation is suffering from abortion, skin disorder, still birth, congenital anomalies, weakness, visual disturbance, peripheral neuropathy in frequency. CONCLUSION: There's no relation between exposure score of paraquat and diseases of the descendants.
Bias (Epidemiology) ; Busan ; Gyeongsangnam-do ; Hospitals, Veterans ; Humans ; Interviews as Topic ; Male ; Medical Records ; Middle Aged ; Military Personnel ; Outpatients ; Paraquat* ; Parturition ; Peripheral Nervous System Diseases ; Skin ; Smoke ; Smoking ; Tobacco Products ; Vietnam*

BACKGROUND: Currently the most common treatment modality of refractory ascites in patients with liver cirrhosis was large volume paracentesis, but this procedure usually needed albumin infusion and occasionally developed unwanted complications. By reason of albumin shortage in Korea and occasional unfavorable complications, we studied the usefulness of dialytic ultrafiltration as an another treatment modality of refractory ascites. METHODS: Dialytic ultrafiltration was done in 10 patients (total 48 times) with liver cirrhosis or hepatocellular carcinoma. Two drainage conduit (via 16 gauge angio-catheter) of input and output were made by puncture of patient's right and left lower quadrant abdomen. The initial ultrafiltration rate of dialyser was 250mL/min. Ascitic fluid was removed continuously until the filtration rate down at 50mL/min. After ultrafiltration, ascitic fluid contained concentrated albumin and large molecules was reinfused via input conduit. Pre-treatment and post-treatment level of blood chemistry, plasma renin concentration, aldosterone, and electrolytes in serum; total protein and albumin in ascites were measured. During the ultrafiltration, we closely observed the change of blood pressure, heart rates and mental status. RESULTS: The mean ultrafiltration time was 231+/-28min, ultrafiltrated volume was 5.15+/-1.41 L. During dialytic ultrafiltration, patient's blood pressure and heart rate were stable and there was no change of mental status. After dialytic ultrafiltration, blood urea nitrogen level significantly decreased from 30.5+/-23.7mg/dL to 25.7+/-20.2mg/dL; serum aldosterone level decreased from 807.3+/-301.1pg/ml to 431.1+/-187.2pg/ml in serum (P<0.01). The albumin level in the ascitic fluid significantly increased from 0.67+/-0.28g/dL to 1.90+/-1.16g/dL (P<0.01). Plasma renin concentration level tend to decreased (P=0.06). The patient's serum total protein, albumin, electrolytes, and creatinine were not changed. Complications of dialytic ultrafiltration were peritonitis (one case) and hypotension (one case). But these unwanted complications were readily managed by adequate antibiotics and intravenous fluid therapy. CONCLUSION: The dialytic ultrafiltration can be used effectively without albumin infusion in the treatment of refrartory ascites in patients with advanced liver cirrhosis.
Abdomen ; Aldosterone ; Anti-Bacterial Agents ; Ascites* ; Ascitic Fluid ; Blood Pressure ; Blood Urea Nitrogen ; Carcinoma, Hepatocellular ; Chemistry ; Creatinine ; Drainage ; Electrolytes ; Filtration ; Fluid Therapy ; Heart Rate ; Humans ; Hypotension ; Korea ; Liver Cirrhosis* ; Liver* ; Paracentesis ; Patient Rights ; Peritonitis ; Plasma ; Punctures ; Renin ; Ultrafiltration*

The adverse effects of pain in post-surgery or trauma patients are well documented. A reliable, safe approach to achieving unilateral analgesia in multiple contiguous thoracic dermatomes would be of great benefit to anesthesiologists in acute pain setting following thoracic or upper abdominal surgery. The aim of this study of post-cholecystectomy pain was to compare two methods of postoperative analgesia with interpleural block and paravertebral block with bupivacaine. Thirty otherwise healthy patients who had undergone elective cholecystectomy through a subcostal incision were randomly allocated to two groups of fifteen patients each and given either interpleural block(group 1) or paravertebral block(group 2) with 20 ml 0.5% bupivacaine mixed with 1:200,000 epinephrine through a single catheter. The degree of analgesia was assessed by a verbal rating scale, Prince Henry pain score and a visual analogue scale(VAS 1-10 cm ; O=no pain, 10=worst pain). These pain scores and vital signs were assessed just before and 10, 20, 30, 60 and 120 minutes after injection of bupivacaine. The onset time of analgesia was similar in both groups(6.6+/-3.74 minutes in group 1 and 5.5+/-2.88 minutes in group 2), but the duration of analgesia was significantly longer in group 1(6.5+/-1.92 hours) than group 2(4.5+/-2.17 hours)(p<0.05). In both groups Prince Henry pain scores significantly decreased 10 minutes after injection of bupivacaine and VAS also significantly decreased 10 and 20 minutes after injection(p<0.05), but there was no significant difference between two groups. The systolic blood pressure decreased 10 minutes after the injection of bupivacaine in both groups(Group 1-3.7%, Group 2-6.5%) and the diastolic blood pressure decreased 10 minutes after the injection of bupivacaine only in group 1(2.5%), (p<0.05), however, these changes in arterial blood pressure were of minimal clinical significance. There is no complication in group 1, but 2 out of 15 patients in group 2 showed bilateral blockade without any serious hemodynamic derangement clinically. In conclusion, both techniques showed similarity in the onset and the degree of analgesia except the duration of analgesia, and presented only a few minor complications. Therefore, we feel that paravertebral block can be used in case that coexisting pulmonary or pleural pathology limits the use of interpleural block for post-cholecystectomy pain management. Furthermore, either of the two techniques may be used alternatively in management of thoracic or upper abdominal pain according to technical skill and preference of anesthesiologists.
Abdominal Pain ; Acute Pain ; Analgesia ; Arterial Pressure ; Blood Pressure ; Bupivacaine* ; Catheters ; Cholecystectomy* ; Epinephrine ; Hemodynamics ; Humans ; Pain Management ; Pathology ; Vital Signs

OBJECTIVE: To investigate the anatomy of the ulnar nerve according to the degree of elbow flexion and to obtain optimal elbow position for ulnar nerve conduction study. METHODS: Eleven elbows in nine cadavers were dissected. We estimated the 10 cm elbow segment to be the distance between 2 points, 4 cm distal and 6 cm proximal to the center of the cubital tunnel, which was determined to be the halfway point between the medial epicondyle and olecranon with elbow position in extension and 45o, 90o, 135o flexion. Anatomical measurements of the actual length of ulnar nerve, distance between medial epicondyle and ulnar nerve, and distance between medial epicondyle and olecranon were obtained in each position. The actual length of the ulnar nerve was measured between two points of the ulnar nerve closest to the landmarks of the estimated 10 cm with flexible ligature. RESULTS: The actual lengths of ulnar nerve were 10.23 cm, 10.00 cm, 9.44 cm, and 9.08 cm in elbow extension, and 45o, 90o, 135o flexion, respectively. The difference between actual length and estimated lengths were least in 45o elbow flexion (p=0.0001). The distance between medial epicondyle and olecranon increased with increasing elbow flexion (p=0.0001). However, there was no difference in the distance between medial epicondyle and ulnar regardless of the elbow position. As a result, the ulnar nerve seemed to have migrated anteriorly in the cubital tunnel with increasing elbow flexion. CONCLUSION: This study suggest that the optimal angle in ulnar nerve conduction study would be 45o flexion, under the condition that the distance measurement is through the halfway point between the medial epicondyle and olecranon.
Cadaver ; Elbow* ; Ligation ; Olecranon Process ; Ulnar Nerve*

In 1960 Martin and his associates described another type of tumor of the stomach derived from the smooth muscle, which they named myoid tumor in a study of six patients. In 1962 Stout applied the term "lelomyoblastoma" to this interesting entity in a report of a collected series of 69 patients. Tumor cells are round or polygonal epithelioid cells, which contain perinuclear vacuole or clear zone. A 58 year-old female was admitted to this hospital because of epigastric discomfort for three months. At Upper gastrointestinal series and gastrofiberscope, a round hemispherical submucosal tumor was noted at posterior wall near the lesser curvature of gastric antrum. After subtotal gastrectomy, the submucosal tumor was diagnosed as leiomyoblastoma. Because leiomyoblastoma are rare and easily misdiagnosed as leiomyoma or leiomyosarcoma, careful histologic study is recommended.
Epithelioid Cells ; Female ; Gastrectomy ; Humans ; Leiomyoma ; Leiomyoma, Epithelioid* ; Leiomyosarcoma ; Middle Aged ; Muscle, Smooth ; Pyloric Antrum ; Stomach* ; Vacuoles

The activation of neurotrophic signaling pathways following the upregulation of glial cell line-derived neurotrophic factor (GDNF), a member of the transforming growth factor-β family, has a potential neuroprotective effect in the adult brain. Herein, we report that hippocampal transduction of adeno-associated virus serotype 1 (AAV1) with a constitutively active form of ras homolog enriched in brain [Rheb(S16H)], which can stimulate the production of brain-derived neurotrophic factor (BDNF) in hippocampal neurons, induces the increases in expression of GDNF and GDNF family receptor α-1 (GFRα-1), in neurons and astrocytes in the hippocampus of rat brain in vivo . Moreover, upregulation of GDNF and GFRα-1 contributes to neuroprotection against thrombin-induced neurotoxicity in the hippocampus. These results suggest that AAV1-Rheb(S16H) transduction of hippocampal neurons, resulting in neurotrophic interactions between neurons and astrocytes, may be useful for neuroprotection in the adult hippocampus.

The optimal management of lesions located in the brainstem(BS) is problematic. As an alternative to microsurgical resection, stereotactic radiosurgery employing the Gamma unit has been used to manage BS lesions, and this can provide relatively safe and effective management. This study describes our experience with 17 patients who underwent Gamma Knife radiosurgery(GKR) for vascular lesions of the brainstem between June 1989 and May 1996. Six of these had BS arteriovenous malformations(AVMs). The minimal radiation dose to the margin of AVMs ranged from 15 to 25Gy(mean, 18.9Gy). Four of six cases were partially obliterated, and on follow-up angiography, one small AVM was seen to be completely obliterated. Twelve months after GKR, one patient experienced a temporary neurologic deficit due to the effects of radiation and another patient, who had a large AVM, showed a permanent deficit as a direct result of treatment. There have been no instances of hemorrhage after GKR and all the patients are still alive. GKR was used to manage 11 patients with angiographically occult vascular malformations (AOVMs) of the BS. The periphery of the lesions received a radiosurgical dose of between 12 and 20Gy(mean, 15.5Gy). In four patients, the lesions became smaller, but in one, an increase was seen. In the remaining six, size change was not documented. One patient's neurological deficit worsened, though that might be related not to GKR but to non-fatal post-GKR rebleeding. At seven months, one patient developed a temporary neurologic deficit in association with perilesional edema that resolved over time. Three patients experienced post-GKR rebleeding, and none died during the follow-up period. We believe that GKR is an excellent option for patients with BS AVMs: when the risks of microsurgery are deemed too high, it is a course of action which seems reasonable. GKR does not, though, appear to obliterate AOVMs as effectively as it does AVMs. To assess the long-term effectiveness of the technique on these lesions, longer follow-up intervals will, however, be required.
Angiography ; Arteriovenous Malformations ; Brain Stem* ; Edema ; Follow-Up Studies ; Hemorrhage ; Humans ; Microsurgery ; Neurologic Manifestations ; Radiosurgery* ; Vascular Malformations