PURPOSE: The Sentinel lymph node (SLN) is the first draining node from the primary lesions, and is the first site of lymph node metastasis in malignancies. The aim of this study was to determine the feasibility of a SLN biopsy in patients with gastric cancer to assess the regional lymph node status. METHODS: A SLN biopsy was performed in 46 consecutive gastric cancer patients, with preoperative imaging stages of T1/T2, N0 and M0. Three hours prior to each operation, a (99m)Tc tin-colloid (2.0 ml, 1.0 mCi) was endoscopically injected into the gastric submucosa around the primary tumor. Subsequently, serial lymphoscintigraphy was performed using a dual head gamma camera. After the SLN biopsy had been performed using a gamma probe, the patients underwent a radical gastrectomy (D2 or D2+ alpha). The SLNs were cut and immediately frozen-sectioned. A paraffin block was then produced for permanent hematoxylin-eosin staining and immunohistochemistry (IHC). RESULTS: SLNs were successfully identified in 43 of the 46 patients (success rate, 93.5%), at an average of 2 (range, 1~8) per patient. The positive and negative predictive values, sensitivity and specificity of the SLN biopsy were 100 (11/11), 93.8 (30/32), 84.6% (11/13) and 100% (30/30), respectively. SLNs were located at the level I, I+II and II lymph nodes in 38 (88.4%), 2 (4.7%) and 3 (7.0%), respectively. No micrometastases of the SLNs was found on the IHC for cytokeratin. CONCLUSION: A sentinel lymph node (SLN) biopsy, using a radioisotope, in patients with gastric cancer is a technically feasible and accurate technique, and is a minimally invasive approach for assessing the nodal status in patients.
Biopsy* ; Gamma Cameras ; Gastrectomy ; Head ; Humans ; Immunohistochemistry ; Keratins ; Lymph Nodes ; Lymphatic Metastasis ; Lymphoscintigraphy ; Neoplasm Metastasis ; Neoplasm Micrometastasis ; Paraffin ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy ; Stomach Neoplasms*

Lacrimal fistula, a rare developmental disorder, may result from an abnormal budding of the epithelial cord of the lacrimal system. Most cases are unilateral, however, bilateral cases are still more rare, which are combined with other systemic diseases or accompanying disorders. This entity has so far been known only to ophthalmologist. We would like to illustrate lacrimal fistula in patients who were referred to our clinic for periorbital cosmetic surgery, such as blepharoptosis and epicanthus, from April 2005 to December 2007. Fistular orifices of all 6 patients were had been located inferomedial to medial canthi along the epicanthal fold. Out of 6 patients, 4 patients presented with unilateral lacrimal fistula; right side in 3 patients and left side in 1 patient, and bilateral lacrimal fistulas in 2 patients. Three cases were found to have positive connection between the nasolacrimal apparatus, and blind pouch type in 5 cases. Three out of six patients underwent fistulectomy with concurrent cosmetic periorbital surgery. In 2 patients who presented with connection with the nasolacrimal apparatus, fistulectomy and lacrimal sac or the common lacrimal canaliculi repair was performed as well. The remaining one patient with bilateral blind pouch type of lacrimal fistulas underwent a simple fistulectomy. There were no postoperative complications or any recurrences.
Blepharoptosis ; Cosmetics ; Fistula ; Humans ; Lacrimal Apparatus ; Lacrimal Apparatus Diseases ; Postoperative Complications ; Recurrence ; Surgery, Plastic

This is a case of a 56-year-old man with Castleman disease (CD) who improved after kidney transplantation (KTP). CD is an uncommon lymphoproliferative disorder that was found incidentally on biopsy during dialysis in the current patient and was followed up without further treatment. However, the lesion showed improvement after KTP. Therefore, active KTP can be considered even if CD is one of the lymphoproliferative disorders that can occur as a complication after KTP.
Biopsy ; Dialysis ; Giant Lymph Node Hyperplasia ; Humans ; Kidney Transplantation ; Kidney ; Lymphoproliferative Disorders ; Middle Aged ; Renal Dialysis

BACKGROUND/AIMS: Midazolam is utilized as a premedication for uppoer gastrointestinal endoscopy. Midazolam has a more rapid onset of reaction than that of diazepam and its duration is shorter. But the Consciousness of premedicated patients has not been regained sooner. The Purpose of this study was to examine the effectiveness of flumazenil against midazolam as premedication for upper gastrointesinal endoscopy. METHODS: Sixty patients underwent upper gastrointestinal endoscopy. These patients were divided to three groups: Group I included twenty patients without premedication; Group II Included twenty patients with premedication of midazolam and then were not given an antisedative agent excluign of normal saline; and Group III included the others with midazolam and flumazenil as an antisedative agent. RESULTS: There was no change in vital signs after midazolam and flumazenil as an antisedative agent. RESULTS: There was no change in vital signs after midazolam injection, compared with presedation value. Modified Steward Coma Scale showed a significant increase after flumazenil injection as an antagonist of midazolam. The assessment of the endoscopist and the comfort of patients were satisfactory. When the 40 patients were asked about their willingness to undergo the same procedure in the future, thirty-four patients responded favorably. CONCLUSION: Midazolam was safe and effective for sedation for upper gastrointestinal endoscopy. There was rapid regaining of consciousness with flumazenil indection after midazolam, so the use of flumazenil against midazolam injection also appeared to be effective.
Coma ; Consciousness ; Diazepam ; Endoscopy ; Endoscopy, Gastrointestinal* ; Flumazenil* ; Humans ; Midazolam* ; Premedication* ; Vital Signs

OBJECTIVE: Preterm birth is one of the leading causes of infant death and a major contributor to early childhood morbidity. It has been recognized that numerous factors are responsible for the development of preterm delivery. Among these factors, environmental influences have been demonstrated in many studies. The purpose of this study was to analyze the regional variations of preterm birth rates and to reveal the association between environmental influences and preterm birth. METHODS: Based on the 2003 birth certificate data from National Statistical Office, we analyzed 475,680 singleton births with certain gestational age at delivery of seven metropolitan cities and nine provinces in Korea. Multiple logistic regression analysis was used to examine the relationship between preterm birth and regional differences, adjusting for other risk factors such as maternal age, sex of infants, order of the babies and mother's education. RESULTS: The rate of preterm delivery was 3.8 percent. The highest preterm birth rate was observed in Daegu metropolitan city (4.2%), and the lowest in Jeonbuk province (3.2%). Risk of preterm birth was higher in mothers with younger (<20 years) and older (> or =30 years) ages, with lower educational levels, and in male infants. There was a significant increase in the risk of preterm birth in Daegu metropolitan city (odds ratio (OR) 1.32, 95% confidence interval (CI), 1.19~1.47), Gangwon province (OR 1.27, 95% CI, 1.13~1.43), Gyeongbuk province (OR 1.26, 95% CI, 1.14~1.40), Jeonnam province (OR 1.22, 95% CI, 1.09~1.37), Busan metropolitan city (OR 1.21, 95% CI, 1.09~1.34), Ulsan metropolitan city (OR 1.19, 95% CI, 1.05~1.36), and Gyeonggi province (OR 1.15, 95% CI, 1.05~1.26) as compared with the incidence of preterm birth in Jeonbuk province. CONCLUSION: Regional variations of preterm birth rate was observed among metropolitan cities and provinces in Korea. Further larger scale studies are necessary to determine more specific factors associated with these differences.
Birth Certificates* ; Busan ; Daegu ; Education ; Gangwon-do ; Gestational Age ; Gyeonggi-do ; Gyeongsangbuk-do ; Humans ; Incidence ; Infant ; Jeollabuk-do ; Jeollanam-do ; Korea ; Logistic Models ; Male ; Maternal Age ; Mothers ; Parturition* ; Premature Birth* ; Risk Factors ; Ulsan

Despite improvements in dialysis care, the mortality of patients with end-stage renal disease(ESRD) remains high. One factor that has so far received little attention, but which might contribute to morbidity and mortality, is the timing of referral to the nephrologist. We performed a retrospective analysis in 358 patients(male 275, female 151) who were initiated renal replacement therapy first at this hospital from Jan 1995 to Dec 1996. Patients were defined by the time of first nephrology as early referral(E, n=163) encountered after more than 8 weeks; late early referral(LE, n=19) encountered between 8 weeks and 4 weeks; late referral(L, n=55) encountered from 1 week to 4 weeks; urgent referral(U, n= 121) encountered less than 1 week. There were no differences in age, gender, primary renal disease, cause of dialysis, and renal replacement therapy modalities. However, there were significant differences in rnean arterial pressure and serum phosphate levels between these 4 groups. The mean arterial pressures (mmHg) were 109.15 +/- 17.16, 105.37+/-18.76, 117.24 +/- 27.24 and 116.98+/-24.26 for E, LE, L and U, respectively(p<0.05, compared E to U). In the U group, serum phosphate levels were elevated at initiation of dialysis compared to the E group(6.39+/-1.72 vs 7.29 +/- 3.54mg/dL, p<0.05). One year mortality in the U group had on increased tendency compared to the E group, especially earlier mortality(7.4% vs 14.9N, p>0.05). In the E group, there was more controlled blood pressure and serum phosphate levels compared to the U group at initiation of renal replacement therapy, but other parameters were not significantly different among the 4 groups. Delays in initiation of renal replacement therapy may result in patients entering dialysis in a compromised state, therefore adequate long-term predialysis care by a nephrologist is important. Socioeconomic - and medical factors respon-sible for late referral and late initiation of dialysis need to be evaluated and corrected to further improve the outcome of these patients.
Arterial Pressure ; Blood Pressure ; Dialysis* ; Female ; Humans ; Mortality ; Nephrology ; Referral and Consultation* ; Renal Replacement Therapy ; Retrospective Studies

Autoimmune pancreatitis is a distinct disease characterized by the presence of autoantibodies and hypergammaglobulinemia, inflammation of the pancreatic parenchyma, and irregular stricture of the pancreatic duct. The involvement of distal common bile duct is frequently observed, but intrahepatic bile duct involvement is very rare, which seem to have similar feature to primary sclerosing cholangitis. We report a case of the patient with autoimmune pancreatitis combined with extensive involvement of extrahepatic and intrahepatic bile duct, which had a favorable response to steroid therapy.
Aged ; Autoimmune Diseases/complications/*diagnosis/drug therapy ; Bile Ducts, Extrahepatic/*radiography ; Bile Ducts, Intrahepatic/*radiography ; Humans ; Male ; Pancreatitis/complications/*diagnosis/radiography ; Prednisolone/therapeutic use ; Tomography, X-Ray Computed

OBJECTIVE: To investigate the effects of female age on in vitro maturation and fertilization of immature oocytes from controlled ovarian hyperstimulation (COH) in human IVF-ET program. METHOD: A total of 96 immature oocytes (GV & metaphase I) obtained from 40 cycles of IVF-ET (29 patients). The mean age of female patients was 31.8+/-3.1 years. Ovulation was triggered by urinary or recombinant hCG. Immature oocytes were cultured with YS medium containing 30% of patients' human follicular fluids, LH (1 IU/mL), FSH (1 IU/mL) and EGF (10 ng/mL), and then matured oocytes were fertilized by ICSI. In vitro maturation and fertilization of immature oocytes were analyzed according to age of female (< 34 or > or = 34 years). RESULTS: The maturation rate was similar between two groups (68% vs 64%). The fertilization rate of in?vitro-matured oocytes was higher in patients < 34 years old, but there was no statistical significance (64% vs 50%, p=0.347). The fertilization rate of in-vitro-matured oocytes was significantly lower compared with those of in-vivo-matured oocytes in both age groups (64% vs 79%, p=0.035, 50% vs 86%, p=0.007). CONCLUSION: In older female group, fertilization rate of in-vitro-matured oocytes seems to be decreased. Further investigations should be warranted to increase fertilization potential of in-vitro-matured oocytes.
Adult ; Epidermal Growth Factor ; Female ; Fertilization* ; Follicular Fluid ; Humans* ; Metaphase ; Oocytes* ; Ovulation ; Sperm Injections, Intracytoplasmic

OBJECTIVE: We tested the usefulness of swim-down technique using human follicular fluid (hFF) in sperm preparation. METHODS: Semen samples were obtained from twelve male partners showing asthenozoospermia (sperm motility < 50%) at the time of routine andrologic evaluation in Seoul National University Bundang Hospital. After dividing into two aliquots, each samples were processed either by swim-down using 100% hFF or density gradient using SpermGrad. Sperm quality was assessed by computer-assisted semen analyzer (CASA). RESULTS: Motility, Rapid motility, VCL (curvilinear velocity), ALH (amplitude of lateral head displacement), and hyperactivated sperms were significantly increased, and LIN (mean linearity) was decreased significantly after sperm preparation in both groups. Motility was significantly higher after swim-down using 100% hFF when compared with density gradient using SpermGrad (81.2+/-4.7 vs. 67.6+/-2.3, p=0.02). The other parameters assessed by CASA were not different between the two methods. CONCLUSION: Swim-down method with 100% hFF may be a useful method in preparation of sperm from asthenozoospermia.
Asthenozoospermia* ; Female ; Follicular Fluid* ; Head ; Humans* ; Male ; Semen ; Seoul ; Spermatozoa*

A chylous ascites, especially drug-induced, is very rare complication in CAPD. The diagnostic criteria for the drug-induced chylous peritoneal dialysate include 1) turbid dialysate developed within Chrs after the administration of causative drug, 2) no clinical symptoms being suggestive of peritoneal inflammation, 3) the fluid containing normal leukocyte counts and being negative for bacterial and fungal culture, and 4) it disappeared spontaneously after the withdrawal of the assumed causative agent and never recurred thereafter. We report a case of chylous ascites emerging after use of manidipine, dihydropyridine calcium channel blocker, in a patient undergoing CAPD. The chylous ascites in that patient was improved after discontinuation of manidipine.
Calcium Channels ; Chylous Ascites* ; Humans ; Inflammation ; Leukocyte Count ; Peritoneal Dialysis, Continuous Ambulatory*