Primary gastric lymphorna represents one to 7% of all gastric cancer and is the most common type of extranodal lymphoma. In attempt to evaluate the endoscopic characteristics, we analysed clinical and endoscopic findings in 35 patients with primary gastric lymphoma between January 1980 and August 1994 at the Yonsei Medical Center. The results were as follows: 1) The mean age of patients was 47.1 years with male to female ratio of 1.5: l. 2) Gastroscopy was performed in all 35 patienits, which revealed polypoid lesion in one case(2.9%), ulcerative lesion in 15 cases(42.9%), ulcero-infiltrative lesion in 6 cases(17.1%) and diffuse infiltrative lesion in 2 cases(5.7%). Gastric lymphoma was suggested in 6 cases, advanced gastric cancer in 21 cases, early gastric cancer in 5 cases and benign gastric ulcer in 3 cases. Pathologic diagnosis of biopsy specimens were gastric lymphoma in 24 cases, adenocarcinoma in 5 cases and chronic superficial gastritis in one case. 3) The characteristics of the endoscopic findings in gastric lymphoma were intractable or recurrent ulcer in 10 cases, thickened and mounded ulcer margin in 9 cases, multiple ulcers in 9 cases, giant rugae in 7 cases and polypoid or depressed lesion with central ulceration in 4 cases. In conclusion, recognition of specific endoscopic findings such as intractable or recurrent ulcer, volcano-like ulcer, multiple ulcers, giant rugae and combined lesion, the possibility of a lymphoma should be considered and vigorous biopsy attempts should be carried out. Then if the first microscopic report does not suggest this diagnosis, a second investigation including jumbo biopsies, perhaps by diathermy, should be undertaken.
Adenocarcinoma ; Biopsy ; Diagnosis* ; Diathermy ; Female ; Gastritis ; Gastroscopy ; Humans ; Lymphoma ; Male ; Stomach Neoplasms ; Stomach Ulcer ; Ulcer

OBJECTIVE: Left ventricular ejection fraction is an important clinical variable with respect to diagnosis, treatment and prognosis in various cardiovascular diseases. Measurement of left ventricular ejection fraction is performed by three commonly used methods, M-mode and two dimensional echocardiography, radionuclide angiography and contrast cineangiography. We compared echocardiographic and contrast cinean-giographic ejection fraction by correlation coefficiency to determine the accuracy of echocardiography determined ejection fraction at our institution and to assess the agreement of left ventricular ejection fraction between two methods. METHODS: We measured left ventricular ejection fraction by M-mode, two-dimensional echocardiography and contrast cineangiography in 144 cases of normal and cardiovascular heart disease patients from September 1993 to April 1995 in the cardiology division of Ewha Womans University hospital. The echocar-diography and contraat cineangiography were performed within 7 days of each other. RESULTS: M-mode echocardiographic ejection fraction correlated with contrast cineangiographic ejection fraction (r=0.7841). M-mode echocardiographic ejection fraction corrected with two-dimensional echocardiography in the presence of regional wall motion abnormality correlated with contrast cineangiographic ejection fraction (r=0.8149). By agreement analysis, the difference of mean of ejection fraction measured by M-mode echocardiography and contrast cineangiography was within 95% confidence limits. The mean was 4.08% and the standard deviation was 8.29%. The difference of mean of ejection fraction corrected by two-dimensional echocardiography and contrast cineangiography was within 95% confidence limits. The mean was -3.19% and the standard deviation was 7.74% CONCLUSION: The values of left ventricular ejection fraction by echocardiography showed good correlation with those of contrast cineangiographic ejection fraction, Therefore, echocardiography would be a useful tool as contrast cineangiography in evaluating the left ventricular function.
Cardiology ; Cardiovascular Diseases ; Cineangiography* ; Diagnosis ; Echocardiography* ; Female ; Heart Diseases ; Humans ; Prognosis ; Radionuclide Angiography ; Stroke Volume* ; Ventricular Function, Left

PURPOSE: It is well known that cyclooxygenase-2 (COX-2) is associated with carcinogenesis in many human cancers. In thyroid cancers, COX-2 expression in aging patients is known as a powerful prognostic factor of differentiated thyroid cancer. Therefore, in this study, we investigated the expression of COX-2 in cases of papillary thyroid cancer (PTC), as well as its association with other prognostic factors of thyroid cancer. METHODS: A total of 213 cases of papillary thyroid cancer were enrolled in this study and their clinicopathological characteristics were investigated retrospectively by a review of medicalrecords. Immunohistochemical staining for COX-2 was performed in the malignant tissue of the cases and the resultsof were then evaluated to determine if they were associated with other prognostic factors. RESULTS: The mean age of patients was 46 years (Range: 17~77 years old) and the tumor sizesranged from 0.1 to 5 cm (mean 1.2±0.9 cm). The pathological findings were as follows; thyroid capsule invasion in 101 patients (47%), lymph node metastasis in 76 patients (36%), multiplicity in 47 patients (22%), and bilaterality in 36 patients (17%). Positive results of immunohistochemical staining for COX-2 were noted in 131 patients (62%), however, the statistical analyses showed no significant association between COX-2 expression and other prognostic factors of papillary thyroid cancer. CONCLUSION: No association of COX-2 expression and prognostic factors of papillary thyroid cancer were found in this study. However, a larger prospectivestudy with survival analyses would provide a better understanding of thesignificance of COX-2 expression in cases of papillary thyroid cancer.
Aging ; Carcinogenesis ; Cyclooxygenase 2* ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis* ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms*

BACKGROUND: Activation of the RET proto-oncogene, located on the long arms of chromosome 10, contributes to the development of thyroid cancers in two different ways. Somatic rearrangements of RET with variable genes of activation are frequently found in papillary thyroid carcinomas. And Ggerm-line point mutations are responsible for the development of medullary thyroid carcinoma and the multiple endocrine neoplasia type 2(MEN2). There are several conflicting reports on the influences of RET expression and RET/PTC rearrangements on the clinical outcome of thyroid cancer. Therefore, we performed an examination of RET expression and RET/PTC-1, -2, -3 rearrangements in papillary thyroid carcinomas and other thyroid diseases. METHODS: Twenty-six papillary thyroid carcinomas(PTCs), three follicular thyroid carcinomas (FTCs), one anaplastic thyroid carcinoma(ATC), five follicular adenomas(FAs), nineteen hyperplasias, and two normal thyroid tissues were included in this study. RT-PCR and immunohistochemistry analysis were done to identify RET gene, RET/PTC rearrangements, and ret RET protein expression. RESULTS: By RT-PCR, 89.4% of PTCs, 100% of FTCs, and 62.1% of hyperplasias expressed the RET gene, but no RET was observed in ATCs, FAs, and normal thyroid tissues. RET/PTC-1, -2,-3 rearrangements were not detected in any specimens. Immunohistochemical results revealed that 76.9% of PTCs, 50% of FAs, 52.3% of hyperplasias, and 20.6% of normal thyroid tissues expressed the RET ret protein, but FTCs and ATCs did not. Most PTCs showed strong cytoplasmic positivity in RET ret immunostaining, but the positive non- PTCs expressed weak and membranous staining. Overall, the two methods for detecting RET gene, RT-PCR and immunohistochemistry showed similar results. CONCLUSION: The RET gene was highly expressed in PTCs. In contrast to the previous reports of that theRET gene expression of RET gene is being limited to PTCs, RET was also expressed in hyperplasias, Fas, and normal thyroid tissues. However, the pattern and the degree of expression of the RET ret protein in non- PTCs were are different from those in PTCs.
Adenocarcinoma, Follicular ; Arm ; Chromosomes, Human, Pair 10 ; Cytoplasm ; Gene Expression ; Hyperplasia ; Immunohistochemistry ; Multiple Endocrine Neoplasia ; Point Mutation ; Proto-Oncogenes ; Thyroid Diseases* ; Thyroid Gland* ; Thyroid Neoplasms

Nocardia is a kind of aerobic Actinomycetes, gram positive organism that was acid-fast when stained with the modified Ziehl-Neelsen method. Nocardia is a soil saprophyte widely distributed throughout the world which usually introduced through the respiratory tract and may develop a disseminated infection, especially subcutaneous abscess and or central nervous system infection. Nocardiosis is an important opportunistic infection in immunosuppressed patients, lymphoma, sarcoidosis, and organ transplant patient. Sulfonamide therapy is known as a treatment of choice in nocardiosis. We report the two cases of nocardiosis in renal transplant recipient. Nocardia asteroides was isolated in our two cases. We treated sucessfully with Trimethoprim/Sulfamethoxazole(Bactrim).
Abscess ; Actinobacteria ; Central Nervous System Infections ; Humans ; Lymphoma ; Nocardia ; Nocardia asteroides ; Nocardia Infections ; Opportunistic Infections ; Respiratory System ; Sarcoidosis ; Soil ; Transplantation* ; Transplants

The enhanced process of proteolysis of both the basement membrane and the stromal extracelluar matrix (ECM) contributes to the escape of breast cancer cells into the neighboring tissues, eventually leading to the formation of distant metastases. A group of enzymes thought to play a role in tumor cell invasion are the matrix metalloproteinases (MMPs). Much attention has been focused on MMP-2 and MMP-9, which are 2 members of the MMP family active against collagen of the basement membrane. The enzymatic activities of MMP-2 and MMP-9 are inhibited by the tissue inhibitors of metalloproteinases (TIMPs). TIMP-2, one member of TIMPs, inhibits MMP-2 and MMP-9. The imbalance between TIMPs and MMPs permits to tumor invasion and metastasis. Theretore, TIMPs constitute promising targets in the developmemt of anticancer terapies. Immunohistological stainings of MMP-2, MMP-9 and TIMP-2 were performed on paraffin-embedded tissue sections of 31 invasive breast carcinomas. MMP-2 and MMP-9 were associated with neoplastic cell cytoplasms in 65% of the cases and exhibited inter-tumoral variability of the staining intensity. The MMP-2 and MMP-9 stainings did not correlate with presence of metastases at time of diagnosis. TIMP-2 was detected in the peri-tumoral stroma and was present in 81% of the cases. Residual benign breast tissue was negative for TIMP-2 staining. Neoplasms with diffuse TIMP-2 staining (32%) have metastasis significantly more frequently (50% metastasis) than ceses with focal (20% metastasis) or absent (0% metastasis) TIMP-2. We conclude that the clinical outcome such as metastasis is more closely related to the presence of TIMP-2 than the corresponding MMPs. Enhanced TIMP-2 expression, therefore, may denote a stromal response to tumor invasion, indicative of aggressive behavior in the subset breast carcinoma.
Basement Membrane ; Breast Neoplasms* ; Breast* ; Collagen ; Cytoplasm ; Diagnosis ; Humans ; Matrix Metalloproteinases ; Metalloproteases ; Neoplasm Metastasis ; Proteolysis ; Tissue Inhibitor of Metalloproteinase-2 ; United Nations

BACKGROUND: Several factors, such as compromised cardiopulmonary function, anticoagulative therapy, or anatomical deformity in the elderly, prevent general anesthesia and neuraxial blockade from being conducted for total knee replacement arthroplasty (TKRA). We investigated the efficacy of femoral/sciatic nerve block with lateral femoral cutaneous nerve block (FSNB) as an alternative procedure in comparison with combined spinal epidural nerve block (CSE) in patients undergoing TKRA. METHODS: In this observational study, 80 American Society of Anesthesiologists physical status I-III patients scheduled for elective unilateral TKRA underwent CSE (n = 40) or FSNB (n = 40). Perioperative side effects, intraoperative medications, duration and remaining amount of intravenous patient-controlled analgesia, rate of satisfaction with the surgical anesthesia and postoperative analgesia, willingness to recommend the same surgical anesthesia and postoperative analgesia to others, and postoperative visual analog scale pain scores were assessed. Statistical analysis was done using Chi-square test, Student's t-test, and repeated-measures analysis of variances. RESULTS: There was significantly more use of antihypertensives, analgesics, and sedatives in the FSNB group. There were no significant differences of perioperative side effects, duration and remaining amount of intravenous patient-controlled analgesia, rate of satisfaction with the surgical anesthesia and postoperative analgesia, willingness to recommend the same surgical anesthesia and postoperative analgesia to others, and postoperative visual analog scale scores between the two groups. CONCLUSIONS: FSNB with a sophisticated use of antihypertensives, analgesics, and sedatives to supplement insufficient block offers a practical alternative to CSE for TKRAs.
Aged ; Analgesia ; Analgesia, Patient-Controlled ; Analgesics ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal ; Antihypertensive Agents ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Congenital Abnormalities ; Femoral Nerve ; Humans ; Hypnotics and Sedatives ; Nerve Block ; Sciatic Nerve

Nonhuman primate models are valuable in biomedical research. However, reference data for clinical pathology parameters in cynomolgus and rhesus monkeys are limited. In the present study, we established hematologic and biochemical reference intervals for healthy cynomolgus and rhesus monkeys anesthetized with ketamine hydrochloride. A total of 142 cynomolgus monkeys (28 males and 114 females) and 42 rhesus monkeys (22 males and 20 females) were selected and analyzed in order to examine reference intervals of 20 hematological and 16 biochemical parameters. The effects of sex were also investigated. Reference intervals for hematological and biochemical parameters were separately established by species (cynomolgus and rhesus) and sex (male and female). No sex-related differences were determined in erythrocyte-related parameters for cynomolgus and rhesus monkey housed in indoor laboratory conditions. Alkaline phosphatase and gamma glutamyltransferase were significantly lower in females than males in both cynomolgus and rhesus monkeys aged 48–96 months. The reference values for hematological and biochemical parameters established herein might provide valuable information for researchers using cynomolgus and rhesus monkeys in experimental conditions for biomedical studies.

BACKGROUND/AIMS: Thrombocytopenia is frequently found among patients with chronic liver disease, and its mechanism, especially among patients with decompensated liver cirrhosis had not been established. Therefore to elucidate the mechanism of thrombocytopenia, the relationship between thrombocytopenia and severity of hepatic dysfunction, splenomegaly was measured. We measured the peripheral blood components with splenic volume obtained from a computerized tomography of decompensated liver cirrhosis patients. METHODS: We studied 103 patients who had been diagnosed with decompensated liver cirrhosis with esophageal varices and ascites from January 1982 to August 1999. We checked their counts of platelets, albumin, bilirubin, splenic volume, degree of esophageal varices, hepatic encephalopathy and ascites by retrograde methods. RESULTS: In viral liver cirrhosis, thrombocytopenia and splenomegaly correlated well with disease severity but they didn't in alcoholic cirrhosis. Of special note, the platelet count was significantly lower and the splenic volume was larger in the Child C of viral cirrhosis patients group than in the alcoholic group(p<0.05). CONCLUSION: When we compared decompensated alcoholic with viral liver cirrhosis patients, the degrees of thrombocytopenia and splenomegaly were much less in the former group. The factors for this phenomena are Splenic Pooling theory, Platelet-associated IgG, Thrombopoietin and Toxic Marrow. We suggest that splenomegaly is an important factor among these, but the mechanisms involved in the pathogenesis of this hematologic phenomena are not completely understood. Especially in alcoholic liver cirrhosis, many other factors may be involved, including the direct effect of alcohol to bone marrow, so further studies will be needed to establish whether a causal relationship exists.
Alcoholics* ; Ascites ; Bilirubin ; Bone Marrow ; Child ; Esophageal and Gastric Varices ; Fibrosis ; Hepatic Encephalopathy ; Humans ; Immunoglobulin G ; Liver Cirrhosis* ; Liver Cirrhosis, Alcoholic ; Liver Diseases ; Liver* ; Platelet Count ; Splenomegaly ; Thrombocytopenia* ; Thrombopoietin

Pendred syndrome is an autosomal recessive genetic disorder, which is characterized by sensorineural hearing loss, goiter and a positive perchlorate discharge test. It is caused by mutations of the PDS gene, and its clinical characteristics vary widely. The thyroid function in most cases is normal, or shows only mild hypothyroidism. In Pendred syndrome, there is an organification defect that leads to defective thyroid hormone synthesis, followed by chronic TSH stimulation. Herein is reported a case of a follicular thyroid carcinoma associated with Pendred syndrome. To our knowledge, this is the first case reported in Korea. The patient presented with a huge anterior neck mass, sensorineural hearing loss and a positive perchlorate discharge test. Fine needle aspiration cytology suggested malignancy of the thyroid, and a total thyroidectomy, with central compartment node dissection, was performed. The pathology from the thyroid mass showed a poorly differentiated follicular thyroid carcinoma
Adenocarcinoma, Follicular* ; Biopsy, Fine-Needle ; Goiter ; Hearing Loss, Sensorineural ; Humans ; Hypothyroidism ; Korea ; Neck ; Pathology ; Thyroid Gland ; Thyroidectomy