The p53 gene is a tumor suppressor gene and mutations in this gene play an import-ant role in the development of many human malignancies. The purpose of this study was to investigate the overexpression of p53 protein as a prognostic factor in invasive cervical cancer. Forty-three formalin fixed, paraffin wax embedded blocks of invasive cervical can-cers were examined using immunohistochemical staining with a monoclonal antibody against p53. The result were as follows : 1. Immunostaining for p53 consistent with overexpression was seen in 23.8%(5 of 21) of stage I cancers and in 13.7%(4 of 22) of stage II cancers. 2. Immunostaining for p53 consistent with overexpression was seen in 21.6%(8 of 37) of squamous cell carciomas and in 0%(0 of 6) of adenocarcinomas. 3. The incidence of p53 overexpression was 25.0%(1 of 4) in cases with lymph node metastasis, compared with 17.9%(7 of 39) in cases without lymph node metastasis. 4.. The incidence of p53 overexpression was 20.0%(8 of 40) in cases with less than 4 cm, compared with 0%(0 of 3) in cases with equal to or larger than 4cm. In conclusion, p53 overexpression was not associated with stage, histologic type, and tumor size. However, there were trend for p53 overexpression to increase in patients with lymph node metastasis.
Adenocarcinoma ; Formaldehyde ; Genes, p53 ; Genes, Tumor Suppressor ; Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Paraffin ; Staphylococcal Protein A ; Uterine Cervical Neoplasms*

BACKGROUND: The Glidescope Videolaryngoscope (GVL) is a newly developed video laryngoscope. It offers a significantly improved laryngeal view and facilitates endotracheal intubation in difficult airways, but it is controversial in that it offers an improved laryngeal view in normal airways as well. And the price of GVL is expensive. We hypothesized that intubation carried out by fully experienced anesthesiologists using the GVL with appropriate pre-anesthetic preparations offers an improved laryngeal view and shortened intubation time in normal airways. Therefore, the aim of this study was to compare the GVL with the Macintosh laryngoscope in normal airways and to determine whether GVL can substitute the Macintosh laryngoscope. METHODS: This study included 60 patients with an ASA physical status of class 1 or 2 requiring tracheal intubation for elective surgery. All patients were randomly allocated into two groups, GVL (group G) or Macintosh (group M). ADS (airway difficulty score) was recorded before induction of anesthesia. The anesthesiologist scored vocal cord visualization using the percentage of glottic opening (POGO) visible and the subjective ease of intubation on a visual analogue scale (VAS). The time required to intubate was recorded by an assistant. RESULTS: There was a significant increase in POGO when using the GVL (P < 0.05). However, there was no difference in the time required for a successful tracheal intubation using the GVL compared with the Macintosh laryngoscope. The VAS score on the ease of intubation was significantly lower for the GVL than for the Macintosh laryngoscope (P < 0.05). CONCLUSIONS: GVL could be a first-line tool in normal airways.
Anesthesia ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopes ; Vocal Cords

Intubating patients with a huge, fixed supraglottic mass causing an obstruction of the glottis is difficult to most anesthesiologists. We attempted awake fiberoptic orotracheal intubation assisted by Glidescope(R) Videolaryngoscope (GVL) following topical anesthesia with 4% lidocaine spray and remifentanil infusion. The glottis could not be identified by the GVL view. However, by entering toward the right side of the mass with bronchoscope, the glottis was found. Due to stiffness of the mass, we were unable to further enter the area using the bronchoscope. Alternatively, we attempted to expose the glottis by GVL blade and then successfully intubated the patient by manually pressing the cricoids cartilage. GVL is nonetheless an excellent instrument in airway management compared to fiberoptic bronchoscope for patients with a huge and fixed supraglottic mass.
Airway Management ; Anesthesia ; Bronchoscopes ; Cartilage ; Glottis ; Humans ; Intubation ; Lidocaine ; Piperidines

An avulsion fracture of the second metacarpal base by the extensor carpi radialis longus is rare. There have been only 7 reports (in 10 patients) of this injury in the literature. We report upon a case of avulsion fracture of the second metacarpal base, which was treated successfully by open reduction and internal fixation.

Pseudocholinesterase is an essential enzyme for hydrolysis of succinylcholine and some people has low activity. The pseudocholinesterase from a normal individual has a greater apparent affinity for the cholinester substrate than the enzyme from succinylcholine-sensitive individuals, who has genetic variants. The ideal situation would be one in which a single, simple test would detect and identify all the variant forms of enzyme, but no such test currently exsits. The inhibitors frequently used to identify variants are dibucaine, fluoride, chloride, urea or succinylcholine as inhibition numbers. The authors found that dibucaine, fluoride and chloride numbers in Korean adults (mean+/-SD, %) are 85.8+/-1.83, 46.5+/-2,05 and 3.53+/-1.64, respectively (substrate is butyrylthiocholine).
Adult* ; Dibucaine ; Fluorides ; Humans ; Hydrolysis ; Pseudocholinesterase* ; Succinylcholine ; Urea

N/AA case of retrograde intussusception of efferent limb into Braun side-to-side jejunojenunal anastomosis after gastric surgery is presented. Intussusception is an uncommon and well-recognized complication after gastric surgery. A 60-year old female was admitted to Hanyang University Hospital with a chief complaint of epigastric pain and hematemesis of 6 hours duration. Patient had a history of distal gastrectomy with gastrojejunostomy due to early gastric cancer(Stage I) 3 years ago. Emergency abdominal CT revealed jejunojejunal intussusception into Braun anastomosis. Exploration and segmental resection of jejunum with end-to-end reanastomosis were performed.
Emergencies ; Extremities ; Female ; Gastrectomy ; Gastric Bypass ; Gastroenterostomy* ; Hematemesis ; Humans ; Intussusception* ; Jejunum ; Middle Aged ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) is not commonly used in the colorectal area because of technical difficulty and due to the characteristics of the organ. We therefore wanted to determine the efficacy and safety of endoscopic submucosal dissection in colorectal neoplasms. METHODS: Colorectal tumor lesions resected by ESD in a single medical center were analyzed retrospectively. RESULTS: A total of 47 patients were treated for 50 lesions. Mean age was 64.3+/-9.8 (43~85) years. Laterally spreading tumors were the most common type (44, 88%) followed by Is+IIa type tumors (6, 12%). The en bloc resection rate was 76% and the complete resection rate was 74%. The mean procedure time was 81.1+/-44.7 (20~180) minutes. The mean size of resected specimen was 26.9+/-10.4 (10~50) mm. The histological diagnosis determined that 24 lesions (48%) were tubular adenoma, 18 lesions (36%) were intramucosal cancer, 7 lesions (14%) were sm1 cancer and 1 lesion (2%) was over sm2 cancer. Bleeding occurred in 6 (12%) and perforations in 13 (26%) of the patients and all were treated successfully by endoscopic or conservative treatment. The concordance rate of pre and post ESD pathological diagnosis was only 47%. CONCLUSIONS: ESD is a feasible technique for treating superficial colorectal tumors with a high complete resection rate, minor invasiveness, and a high safety rate. In addition, ESD might be useful in establishing the complete pathological evaluation of colorectal epithelial neoplasm.
Adenoma ; Colorectal Neoplasms ; Hemorrhage ; Humans ; Neoplasms, Glandular and Epithelial ; Retrospective Studies

PURPOSE: The purpose of this study was to evaluate the long-term efficacy of ultrasound (US)-guided steroid injections in patients with piriformis syndrome. METHODS: Between January 2010 and October 2012, 63 patients (23 men and 40 women; average age, 63.2 years; range, 24 to 90 years) were diagnosed with piriformis syndrome based on clinical history, electromyography, and flexion-adduction-internal rotation test results. They were divided into two groups. The first group (37 subjects) received a US-guided steroid injection around the piriformis muscle. The second group (26 subjects) received both piriformis muscle and spinal epidural injections. The therapeutic effect was categorized as improvement, partial improvement, or failure depending on the degree of symptom alleviation one month after injection, based on a review of each patient's medical records. RESULTS: In the first group, 15 patients (40.5%) showed improvement, seven (18.9%) showed partial improvement, and 15 (40.5%) failed to respond to the initial treatment. In the second group, eight patients (30.8%) showed improvement, 11 (42.3%) showed partial improvement, and seven (26.9%) failed to respond to the initial treatment. A second piriformis injection was performed in four cases, after which two patients showed improvement within 3 years, but the other two showed no therapeutic effect. CONCLUSION: US-guided steroid injection may be an effective treatment option for patients with piriformis syndrome.
Electromyography ; Female ; Humans ; Injections, Epidural ; Male ; Medical Records ; Piriformis Muscle Syndrome* ; Steroids ; Ultrasonography

Stickler syndrome is a connective tissue dysplasia disorder with characteristic midface hypoplasia, retromicrognathia, cleft palate, and a moon-shaped appearance. Incidence of the syndrome is estimated at around 1/10000 and the disorder is considered to be caused by mutations in the COL2A1, COL11A1, COL11A2, COL9A1 procollagen genes of type 2 and 11 collagen. Patients with a mandibular hypoplasia like Stickler syndrome present the anesthesiologist with considerable problems when mask ventilation or endotracheal intubation is attempted. We report a successful anesthetic experience, including blind endotracheal intubation with rigid laryngoscope without neuromuscular blockade, in a 9-year-old boy with Stickler syndrome for scleral buckling with cryotherapy.
Anesthesia, General ; Child ; Cleft Palate ; Collagen ; Connective Tissue ; Cryotherapy ; Humans ; Incidence ; Intubation, Intratracheal ; Laryngoscopes ; Masks ; Neuromuscular Blockade ; Procollagen ; Scleral Buckling ; Ventilation

BACKGROUND/AIMS: Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD) are novel techniques used for the treatment of early gastric cancer and precancerous lesions of the stomach. However, complications such as bleeding and perforation may occur during the procedure, and these complications may raise the morbidity and mortality rates. EMR/ESD-induced perforations can be treated with conservative medical or non-surgical methods. Furthermore, an increasing number of reports have addressed conservative management of EMR/ESD-induced perforations. We evaluated the effectiveness and safety of implementing conservative treatment for perforations associated with EMR and ESD. METHODS: We reviewed 482 patients with 507 lesions who underwent EMR or ESD due to early gastric cancers or gastric adenomas between February 2003 and December 2007. We identified 14 perforations occurring as complications of EMR/ESD and investigated their clinical outcomes. RESULTS: Fourteen perforations (14/507 [2.8%]) occurred, 11 of which were immediately clipped during the procedure, and 3 of which were diagnosed after the procedure when free air was visualized on the radiograph. All patients were managed conservatively with fluid resuscitation and antibiotics (mean, 5.8 days). They recovered without surgery and were discharged in stable condition at a mean of 7.2 days post-procedure. CONCLUSIONS: Endoscopic clip application might be an effective and safe option for conservative management of EMR/ESD-induced perforations.
Adenoma ; Anti-Bacterial Agents ; Hemorrhage ; Humans ; Resuscitation ; Stomach ; Stomach Neoplasms