BACKGROUND: Heat shock proteins (HSP), especially the HSP 70 family, may play certain roles in the immunophysiology of some skin diseases such as psoriasis, pemphigus, and lichen planus. HSPs generally induce down-regulation of the process of apoptosis that is considered to be one of the acantholysis-producing pathways in pemphigus. OBJECTIVE: We planned to examine possible roles of HSPs 70/105 in the blistering process in pemphigus vulgaris (PV) and pemphigus foliaceus (PF), in connection with the detection results of apoptosis in local tissue specimens. METHODS: Immunohistochemical stainings and Western blot analysis were performed for the detection and semiquantitation of HSPs 70/105 in skin specimens from lesional, nonlesional, and normal control sites. Hoechst 33342 staining was simultaneously carried out to examine features of apoptosis in lesional skin specimens. RESULTS: The findings on expression of HSP were as follows. In PV, the expression of HSP 70 was minimum or negative; however, in PF, the expression was obvious and recognizable in lesional and perilesional normal skin. In contrast, HSP 105 was not detected in all cases of PV and PF. The features of apoptosis were evident at the lesional skin of all cases of pemphigus with acantholytic changes. CONCLUSION: PV and PF had different relative intensities of HSPs in lesional tissue stainings, especially in cases with HSP 70. This suggests that there may be subtle differences in the mechanisms causing acantholysis between PV and PF.
Acantholysis ; Apoptosis ; Benzimidazoles ; Blister ; Blotting, Western ; Down-Regulation ; Heat-Shock Proteins ; Hot Temperature ; HSP70 Heat-Shock Proteins ; Humans ; Lichen Planus ; Pemphigus ; Psoriasis ; Skin ; Skin Diseases

Recent literatures suggest that pulmonary embolus secondary to renal cell cancer may be more common than previously suspected. A 63-year-old man, who suffered a massive tumor embolism to the right main pulmonary artery after surgery for renal cell carcinoma with vena caval and renal vein invasion, was treated by emergency pulmonary embolectomy using cardiopulmonary bypass. Renal cell carcinoma occasionally extends into the inferior vena cava as a tumor thrombus. In such patients, removal of the tumor thrombus from the inferior vena cava has to be performed in addition to radical nephrectomy. However, the massive pulmonary tumor embolism is a major potential hazard during radical surgical resection. To prevent intraoperative pulmonary embolisms, scheduled use of cardiopulmonary bypass with the cooperation of cardiovascular surgeons is recommended in addition to the standard proximal vena caval occlusion technique of clipping and clamping.
Carcinoma, Renal Cell* ; Cardiopulmonary Bypass ; Constriction ; Embolectomy ; Embolism ; Emergencies ; Humans ; Middle Aged ; Neoplastic Cells, Circulating* ; Nephrectomy ; Pulmonary Artery ; Pulmonary Embolism ; Renal Veins ; Thrombosis ; Vena Cava, Inferior

BACKGROUND/AIMS: Adequate bowel preparation is essential for full visualization of colonic mucosa because detection of small polyps and neoplasms depends on the quality of bowel cleansing. The aims of this study were to compare the efficacy, tolerability of preparation and side effect between two groups: clear-liquid diet with polyethylene glycol (PEG) solution versus no diet restriction with PEG solution. METHODS: This was a randomized single-blind prospective study. A total of 330 patients were randomly assigned to receive either 2 L PEG solution with a clear-liquid diet on the day before colonoscopy and another 2 L PEG solution on the day of the procedure (group 1) or 2 L PEG solution with a general diet on the day before colonoscopy and another 2 L PEG solution on the day of the procedure (group 2). RESULTS: 162 patients were assigned to group 1 and 168 patients to group 2. The satisfactory quality of bowel preparation was not significantly different between the two groups (80.2%, 78.6%, P=0.707). Patient's compliance of the clear-liquid diet in group 1 was 50%. The satisfactory quality of bowel preparation was weakly better when the clear-liquid diet was given 2 or 3 times a day (group 1A) than 0 or once a day (group 1B) (74.1%, 86.4%, P=0.048). The tolerability of the PEG solution and side effects of preparation were not significantly different in the two groups (P=0.573, 0.686). CONCLUSIONS: Bowel preparation with no diet restriction and split-dose PEG solution was similar to preparation with a clear-liquid diet in efficacy, tolerability and side effect. Therefore, the use of the clear-liquid diet protocol should improve patient's compliance.
Cathartics ; Colon ; Colonoscopy ; Compliance ; Diet ; Humans ; Mucous Membrane ; Polyethylene Glycols ; Polyps ; Prospective Studies

BACKGROUND/AIMS: The most important adverse effect of azathioprine (AZA) is bone marrow toxicity (BMT). Many physicians have preferred a gradual dose increment (GDI) policy for the prevention of BMT. The aim of this study was to evaluate the efficacy of GDI for the prevention of AZA-induced BMT in inflammatory bowel disease (IBD) patients. METHODS: The medical records of IBD patients who received AZA in 6 university hospitals were reviewed. The patients were divided into two groups: the GDI group (initial dose <1.5 mg/kg, gradually increased to a therapeutic dose) and the non-GDI group (initial therapeutic dose > or =2 mg/kg). RESULTS: A total of 308 patients were enrolled (male to female ratio, 1:2.3; mean age, 34.91+/-14.19 years; ulcerative colitis, 43.5%; Crohn's disease, 55.2%; and intermediate colitis, 1.3%). The overall incidence of BMT was 16.2% (50/308). BMT developed most frequently between fourth to eighth week (26%, 13/50). The rate of BMT of the non-GDI group was significantly higher than that of the GDI group (27.5%, 11/40 vs. 14.6%, 39/268, P=0.038). A multivariate analysis showed that the only factor related to BMT was a non-GDI policy (P=0.036; odds ratio, 2.41; 95% confidence interval, 1.06-5.49). CONCLUSIONS: A GDI policy could be useful for reducing AZA-induced BMT in Korean IBD patients.
Azathioprine ; Bone Marrow ; Colitis ; Colitis, Ulcerative ; Crohn Disease ; Female ; Hospitals, University ; Humans ; Incidence ; Inflammatory Bowel Diseases ; Medical Records ; Multivariate Analysis ; Odds Ratio

Ulcerative colitis produces repeated improvements and relapses of chronic colonic inflammation. Complications of the disease can include bleeding, toxic megacolon, colon cancer, or colon stricture. While colonic strictures are common in Crohn's disease, this complication rarely appears in ulcerative colitis cases. Unlike in Crohn's disease, where strictures are commonly treated by endoscopic balloon dilatation, surgical management is the basis for treatment of strictures in ulcerative colitis because malignant strictures are common and because the stricture region is generally wide. We report the case of a patient who presented with decreased stool caliber while undergoing treatment for ulcerative colitis. We performed therapeutic balloon dilatation in this patient with a benign stricture caused by ulcerative colitis and experienced improvement of symptoms.
Colitis, Ulcerative ; Colon ; Colonic Neoplasms ; Constriction, Pathologic ; Crohn Disease ; Dilatation ; Hemorrhage ; Humans ; Inflammation ; Megacolon, Toxic ; Recurrence ; Ulcer

Argon Plasma Coagulation (APC), a new endoscopic hemostatic method of non-contact electrocoagulation, is widely used for ablation of Barrett's esophagus, residual tissue after polypectomy, palliation of malignancy and hemostasis of radiation proctopathy, bleeding peptic ulcers, prevention of esophageal varices. Although a safe and effective procedure, if used inappropriately, side effects such as failure of hemostasis, perforation, asymptomatic submucosal emphysema, and pneumoperitoneum can occur. Perforations progressing to peritonitis require surgery, but a pneumoperitoneum can recover with conservative treatment. Therefore, clinicians should distinguish these two different cases. There are no domestic cases of asymptomatic pneumoperitoneum caused by APC. In two cases treated by endoscopic submucosal dissection of polypectomy and early gastric cancer, asymptomatic pneumoperitoneum occurred after argon plasma coagulation treatment. We present these two cases of asymptomatic pneumoperitoneum treated successfully by conservative treatment without complications.
Argon ; Argon Plasma Coagulation ; Barrett Esophagus ; Electrocoagulation ; Emphysema ; Esophageal and Gastric Varices ; Hemorrhage ; Hemostasis ; Peptic Ulcer ; Peritonitis ; Pneumoperitoneum ; Stomach Neoplasms

Biliary adenoma is rarely found in the biliary tract, and there are currently few reported cases of tubular adenoma. Biliary adenoma most often occurs on the duodenal ampulla and the next most common site is on the common bile duct. Because the clinical signs, symptoms and the laboratory findings of these lesions may be similar to malignant biliary diseases, it is difficult to differentiate benign biliary adenoma from malignancy. Therefore, the diagnosis of these tumors tends to be delayed and physicians usually make the pathologic confirmation after a surgical operation. We experienced a case of the simultaneous occurrence of tubular adenoma of the common hepatic duct and gallbladder carcinoma, and all this was diagnosed and treated with common hepatic duct resection and a Roux-en-Y hepaticojejunostomy operation. To the best of our knowledge, this is the first report of biliary tubular adenoma accompanied with gallbladder carcinoma arising from tubulovillous adenoma.
Adenoma ; Biliary Tract ; Common Bile Duct ; Gallbladder ; Hepatic Duct, Common

OBJECTIVE: To determine the effect of myomectomy as a treatment for infertility and to define the factors that influence reproductive outcomes MATERIALS AND METHODS: During the period from January 1995 to December 2001, on 39 patients who suffered from infertility and habitual abortion underwent transabdominal myomectomy at the Department of Obstetrics and Gynecology in Chonbuk National University Hospital. RESULTS: Pregnancy occurred in 31 women. The mean age was 32.3 years. The pregnancy rates in women with or without associated factors in addition to myoma were 55.5% and 71.4%, respectively, and those in women with <2 years versus >2 years of infertility were 73.7% and 55%, respectively. In case of women with myoma on lateral side, pregnancy rate was 33.3%. Considering the size, women with a myoma, 30~50 mm in size had higher pregnancy rate (81.2%). The 24-month cumulative probability of conception was 91% in patients <30 years of age, 55.5% in patients 30~35years of age, and 40% in patients >35 years of age. CONCLUSION: Our results suggest a benefit of myomectomy in infertile patients. Factors affecting the pregnancy rate after myomectomy in theses patients are the age of the patient, the duration of infertility, the site of myoma, and the size of myoma <50 mm. However, women should be counseled carefully before surgery because the determinants of outcome appear to be independent of treatment.
Abortion, Habitual ; Female ; Fertilization ; Gynecology ; Humans ; Infertility ; Jeollabuk-do ; Myoma ; Obstetrics ; Pregnancy ; Pregnancy Rate

BACKGROUND/AIMS: We conducted a prospective, randomized, double-blinded, placebo-controlled trial to investigate the effect of hyoscine-N-butyl bromide during colonoscopy. METHODS: A total of 133 patients undergoing colonoscopy were randomized to receive either 20 mg of hyoscine-N-butyl bromide (n=70) or normal saline solution (n=63) via intramuscular injection as premedication. RESULTS: The mean cecal intubation time and withdrawal time in the hyoscine-N-butyl bromide group were significantly shorter than those of the control group (5.26+/-2.78 min vs. 6.74+/-4.89 min; p=0.032, 5.42+/-1.54 min vs. 6.18+/-2.54 min; p=0.038, each). The spasm grade in the hyoscine-N-butyl bromide group was significantly lower than that of the control group (p<0.001). No significant differences were found in the polyp detection rate (15.7% vs. 28.6%; p=0.073) and adenoma detection rate (10.0% vs. 15.9%; p=0.311). Difficulty of colonoscopy for the endoscopists and nurses (p=0.853; p=0.732), the patient's comfort (p=0.891) and the patient's willingness to repeat colonoscopy (85.7% vs. 82.5%; p=0.932) were also similar in both groups. CONCLUSIONS: Premedication with intramuscularly administered hyoscine-N-butyl bromide do not demonstrate any additional benefits except reducing the colonoscopy insertion time.
Adenoma ; Colonoscopy ; Humans ; Injections, Intramuscular ; Intubation ; Parasympatholytics ; Polyps ; Premedication ; Prospective Studies ; Scopolamine Hydrobromide ; Sodium Chloride ; Spasm

PURPOSE: The critical pathway (CP) is to standardize the clinical practice of specialists working to optimize care. The objective of this study was to develop a critical pathway for the surgical treatment of patients with colorectal or gastric cancer and to evaluate the results of the CP. METHODS: Twenty-one patients with colorectal cancer, who were managed according to the CP between August 2005 and November 2005, were compared with 18 patients for whom this pathway had not been used between June 2004 and September 2004. Forty-eight patients with gastic cancer, who were managed according to the CP between June 2005 and September 2005, were compared with 49 patients for whom this pathway had not been used daring the same period in 2004. The length of stay and the cost per patients were compared between the CP group and the non-CP group. RESULTS: For patients with colorectal cancer, the postoperative hospital length of stay in the CP group was significantly shorter (9.0 vs. 12.3 days, P<0.001), but for patients with gastric caner, there was no difference (10.6 vs. 11.4, P=0.134). The mean hospital charges were won5,037,816 and won5,263,508 for colorectal cancer and for gastric cancer, respectively, and won4,808,602 and won4,674,329, for the CP and the non-CP groups, respectively, but these differences were not significant. CONSLUSIONS: The critical pathway in colorectal and stomach surgery decreased the length of stay and might regulate hospital charges. Such a pathway could be easily designed and implemented at hospitals and could standardize clinical practice.
Colorectal Neoplasms ; Critical Pathways* ; Hospital Charges ; Humans ; Length of Stay ; Specialization ; Stomach ; Stomach Neoplasms*