No abstract available.
Chungcheongnam-do* ; Gallstones*

PURPOSE: The main purpose of bypass surgery in unresectable distal gastric cancer is the improvement in the quality of life (QOL) of the patient. However, the results of a conventional gastroenterostomy are very dismal often as a consequence of continuous bleeding due to the contact of food material on the tumor surface and early obstruction of the stoma by the tumor growth. The development of more effective surgery is warranted for the improvement of the QOL in such patients. METHODS: Surgery was performed in 1, 158 cases gastric cancer, between March 1993 and July 2002, at the Hanyang University Medical Center. 54 of these cases (4.7%) were unresectable. Various kinds of gastro-jejunostomy (G-Jstomy) including conventional G-Jstomy (CGJ)(n=18), antral exclusion G-Jstomy (AEGJ) (n=7), and gastric partitioning G-Jstomy (GPGJ) (n=17) were performed. In this study, comparisions of the survival and postoperative QOL were performed between the CGJ and GPGJ group. RESULTS: The median survival durations were 120 and 209 days in the CGJ and GPGJ groups, respectively, and the difference the 2 groups was statistically significant (P=0.046). The postoperative body weight losses were 9.3% and 3.1% in the CGJ and GPGJ groups, respectively, with the differences showing borderline significance (P=0.067). In the GPGJ group, the volume of the blood transfusion during the postoperative period was much decreased compared to that of the preoperative period, but this was not found in the CGJ group. Although the numbers of cases were small and the clinicopathological profiles between two groups differnt, a GPGJ could minimize the food contact on the tumor surface, resulting in a decrease in the volume of postoperative blood transfused, smaller weight losses, and longer survival duration, compared to those with a CGJ. CONCLUSION: A gastric partitioning gastrojejunostomy can be recommended as the choice of bypass surgery in unresectable distal gastric cancer due to the superiority of the various clinical aspects.
Academic Medical Centers ; Blood Transfusion ; Body Weight ; Gastric Bypass* ; Gastroenterostomy ; Hemorrhage ; Humans ; Postoperative Period ; Preoperative Period ; Quality of Life ; Stomach Neoplasms* ; Weight Loss

Transfusion requirement or hemoglobin level has been a major indicator of the erythropoiesis of CRF patients. However, the more objective and earlier detectable parameters to monitor the erythropoiesis has been required. We investigated the significance of immature reticulocyte count(IRC) with flowcytometry in CRF patients as a convenient index of erythropoietin(EPO) therapy. We evaluated CRF patients undergoing hemodialysis(n=35) and normal control group(n=14). The 26 patients of CRF have been under EPO therapy, the others(n=9) have not been under therapy. 1) The response of IRC to EPO therapy : IRC increased daily 4.95% in average upto 3rd day and decreased daily 3.7% in average since then. 2) The similar IRC was maintained in similar hemoglobin state : IRC, total reticulocyte count(TRC) and hemoglobin were compared between CRF patients with low dose EPO therapy and those who weren't needed EPO administration from the beginning. 3) The increase of IRC depends on the dose of EPO : 4) Correlation between IRC and other hematologic parameters : IRC was significantly correlated with TRC and serum iron level(R value : 0.736, 0.522 respectively). Taken together, these results suggest that maintenance of IRC level, 8-10%, was necessary at a minimum to obtain 8g/dL of hemoglobin level. However, IRC level could be readjusted more than 20% with higher EPO therapy to maintain 8g/dL of hemoglobin in severe case. In conclusion, the measurement of IRC in CRF is clinically more objective, useful, earlier indicator for estimating erythropoiesis than hemoglobin and TRC.
Erythropoiesis* ; Humans ; Iron ; Kidney Failure, Chronic ; Reticulocyte Count* ; Reticulocytes*

The incidence of acute leukemia in pregnancy is rare. The treatment of acute leukemia during pregnancy is complicated and therapeutic options must be made with each individual patient. Complete remission can now be achieved in 60 to 70% of previously untreated adults with acute myelogenous leukemia (AML). Antileukemic chemotherapy can be administered safely during the second and third trimesters. Cytarabine (ara-C) and anthracycline has not been associated with birth defect. When a pregnant woman presents with acute leukemia, chemotherapy should be recommended as vigorously as in the non- pregnant woman. We reported a case of AML during pregnancy. The patient recieved induction chemotherapy with ara-C and idarubicin. The baby was delivered at 33 weeks of gestation and had transient neutropenia. The mother received consolidation chemotherapy after achievement of complete remission.
Adult ; Congenital Abnormalities ; Consolidation Chemotherapy ; Cytarabine ; Drug Therapy ; Female ; Humans ; Idarubicin ; Incidence ; Induction Chemotherapy ; Leukemia ; Leukemia, Myeloid, Acute* ; Mothers ; Neutropenia ; Pregnancy Trimester, Third ; Pregnancy* ; Pregnant Women

PURPOSE: The tumor suppressor gene p53 has been shown to be a factor in the carcinogenesis or progression of gastric cancer. The mutant p53 has been reported to cause a higher risk of lymph-node metastasis. Futhermore, mutation of the p53 has been linked to a poor prognosis for gastric cancer. The heat shock protein-27 (HSP27), a stress protein, has also been reported to be a poor prognostic factor in ovarian and breast cancers. However, in gastric-cancer patients, controversies exist as to its influence on the prognosis. In the present study, we used an immunohistochemical stain to observe the effects of p53 and HSP27 on the clinicopathological factors and on the prognosis for gastric-cancer patients. MATERIALS AND METHODS: To evaluate the significance of p53 and HSP27 in gastric cancer patients, we analyzed 212 cases of gastric cancer (stage I~IV). Tissue samples of 212 patients were stained immunohistochemically for the mutant p53 protein and for HSP27. The correlations between protein expression and the clinicopathological factors were investigated. RESULTS: The overall expression rates for p53 and HSP27 were 36.9% and 27.8%, respectively. p53 and HSP27 were correlated to each other because the HSP27 expression rate was higher in the p53-positive group (P=0.046). Statistically, the p53 and the HSP27 expression rates were significantly increased in the case of tumor invasiveness, lymphatic metastasis and vessel involvement. Therefore, they play a role in cancer progression. The 5-year survival rates of the p53-positive and the p53-negative groups were 62.8% and 60.1%, respectively (P=0.793) while the 5-year survival rates for the HSP27-positive and HSP27-negative groups were 54.2% and 63.1%, respectively (P=0.090). CONCLUSION: p53 and HSP27 were correlated to each other in our immunohistochemical study of gastric carcinomas and they were not independent prognostic factors in gastric- cancer patients. However, further studies are needed to determine their prognostic values for gastric-cancer patients.
Breast ; Carcinogenesis ; Genes, Tumor Suppressor ; Hot Temperature ; HSP27 Heat-Shock Proteins ; Humans ; Lymphatic Metastasis ; Neoplasm Metastasis ; Prognosis ; Shock ; Stomach Neoplasms ; Survival Rate

BACKGROUND: Glucocorticoids have anti-inflammatory effects and have been used to treat many types of nerve injury- associated chronic pain conditions. A randomized double-blind study was performed to determine if methylprednisolone could prevent the development of neuropathic pain after a peripheral nerve injury in rats. METHODS: Two groups of rats, one group (n = 50) injected intraperitoneally with methylprednisolone (100 mg/kg/day, for 7 days starting from 3 days prior to the nerve injury) and the other (n = 58) treated with saline with same manner, were compared in terms of the incidence and intensity of allodynia after a superior caudal trunk transection at the level between the 3rd and 4th sacral spinal nerves. The tail-flick responses to normally innocuous mechanical and thermal stimuli applied to the tail were observed as the behavioral signs of neuropathic pain. RESULTS: The proportions of rats exhibiting tail-flick responses to the mechanical (but not thermal) stimuli 7, 14 and 21 days after the nerve injury were significantly smaller in the methylprednisolone-treated group (2, 3 and 4 of 50 rats, respectively) than in the saline-treated, control group (11, 14 and 15 of 58 rats, respectively) (P = 0.009). However, the pain intensity was similar in mechanical allodynia developed rats of the two groups (P > 0.05), which was estimated based on the frequency and latency of the tail-flick responses after applying mechanical and thermal stimuli, respectively. CONCLUSIONS: These results suggest that a pre-emptive treatment with high methylprednisolone doses may be used to prevent the development of mechanical allodynia following peripheral nerve injuries.
Animals ; Axotomy ; Chronic Pain ; Double-Blind Method ; Glucocorticoids ; Hyperalgesia* ; Incidence ; Methylprednisolone* ; Neuralgia ; Peripheral Nerve Injuries* ; Peripheral Nerves* ; Rats* ; Spinal Nerves

OBJECTIVES: Hearing loss, mainly a sensorineural hearing loss (SNHL), was frequently observed in patient with chronic renal failure. Although several causes and prevalence of this hearing loss had been proposed, the etiology and prevalence are still controversial. The purpose of the present study was another study to determine the prevalence, type and comparative degree of hearing loss in chronic renal failure according to various parameters. METHODS: Subjects for this study were 39 patients with hemodialysis and 10 chronic renal failure patients before hemodialysis. Pure tone audiometry was performed and pure tone average(PTA) was estimated. At same time, pure tone threshold were estimated at the range from 250 to 500(low frequency range), from 1000 to 2000(middle frequency range) and from 4000 to 8000 Hz(high frequency range). Significant hearing loss of PTA as well as the significant loss in pure tone threshold of each frequency range was defined when the loss of hearing ability was 25dB more than the normal value. The effect of alteration in age, sex, hemoglobin, lipid profile, duration of hemodialysis, underlying diseases and ototoxic drugs were evaluated. RESULT: 1) The main type of hearing loss was SNHL and it was asymptomatic and progressive. The prevalence of SNHL by means of PTA was 76% in the patient with chronic renal failure. The SNHL of high frequency range(89%), SNHL of middle frequency range(18%) and SNHL of low frequency range (45%) were observed on the basis of the pure tone threshold. 2) There was no significant difference of SNHL according to various parameters of sex, hemoglobin, lipid profile, BUN, and underlying diseases except age. 3) The patients under hemodialysis exhibited the more SNHL over all frequency ranges than those without hemodialysis and there was the more SNHL in patients of more than 2 years of hemodialysis and those of less than 2 years of hemodialysis 4) Furosemide was significantly ototoxic in patients with chronic renal failure. CONCLUSION: The type of hearing loss was mainly sensori-neural and high tone loss. The degree was slight to moderate. The prevalence was the higher than expected. Regular hemodialysis treatment seems to affect hearing loss during even 2 years of treatment. Therefore, hearing loss appeared to be related to the duration of hemodialysis. The more precise and regular audiometric monitorings were recommanded in hemodilalysis patients.
Audiometry ; Furosemide ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Kidney Failure, Chronic* ; Prevalence ; Reference Values ; Renal Dialysis

Chylous ascites in neonates is an unusual and etiologically poor understood entity. We report a male newborn who suffered from abdominal distension and respiratory distress after birth. Paracentesis was performed and ascitic fluid was obstained. Analysis of the fluid revealed cell count (RBC 10,000/mm3, WBC 800/mm3: segmented form-72%, lymphocyte form- 28%), protein 4,100 mg/dl, glucose 57 mg/dl, cholesterol 53 mg/dl, triglyceride 28 mg/dl. Culture of ascitic fluid grew no bacteria. A plain film of abdomen and abdominal sonogram showed massive ascites. On the 4th hospital day, gastrografin enema showed microcolon and ileal atresia. On the 6th hospital day, ileocolostomy has been performed and operative findings sho- wed blind pouch in terminal ileum, massive inflammation and extensive adhesion on peritoneum. After operation, he gained weight by continuous gavage feeding. He discharged on the 36th hospital day.
Abdomen ; Ascites ; Ascitic Fluid ; Bacteria ; Cell Count ; Cholesterol ; Chylous Ascites* ; Diatrizoate Meglumine ; Enema ; Glucose ; Humans ; Ileum ; Infant, Newborn ; Inflammation ; Lymphocytes ; Male ; Paracentesis ; Parturition ; Peritoneum ; Triglycerides

The most common site for the metastasis of osteosarcoma is the lung, and other sites of metastases include the bone, lymph node, pleura and liver. Although unusual extrapulmonary metastases have been reported with the improvement of the therapeutic results for the primary lesions, they are exceptionally rare. We report here on a case of prostatic metastasis of an osteosarcoma of the proximal tibia, and this developed seven years after successful resection, and four years after resection of a pulmonary metastasis. Radical prostatectomy was performed, and histological examination demonstrated metastatic osteosarcoma. To the best of our knowledge, this is the first case of prostatic metastasis of osteosarcoma in the medical literature.
Liver ; Lung ; Lymph Nodes ; Neoplasm Metastasis ; Osteosarcoma ; Pleura ; Prostate ; Prostatectomy ; Tibia

Adrenocortical carcinoma is a rare malignant endocrine tumor which accounts for about 0.05% to 0.2% of all carcinomas. Three clinical patterns can be encountered. In 30% of the cases, a mass syndrome without any clinical evidence of hypersecretion is presented as abdominal pain, a palpable abdominal mass, abdominal distension, and weight loss. In 60% of the cases, an overt clinical syndrome of hypersecretion is of almost purely hypercortisolism in 30% of such cases, vilirization in 22%, feminization in 10%, hyperaldosteronism in 2.5%, and a mixed secretion in 35%. In the remaining 10% of the cases, an adrenal `incidentaloma' is found incidentally during evaluation of the other disease. About 70% to 80% of patients are diagnosed with an advanced stage (III or IV) and metastasis has occured in 20% to 40% of the patients at the time of presentation. Early surgery an with adrenalectomy is the only means of cure. The prognosis is poor with a 5-years survival rate of 16% to 34% due to initial diagnosis at an advanced stage. Recently, we experienced two cases of adrenocortical carcinomas. In case I, a 62-year-old female patient presented with a clinical syndrome of hypercortisolism and had an extensive local invasion of stage IV; in case II, a 49-year-old male patient complained of abdominal pain and distension without any clinical syndrome of hypersecretion and had stage IV liver metastasis.
Abdominal Pain ; Adrenalectomy ; Adrenocortical Carcinoma* ; Cushing Syndrome ; Diagnosis ; Female ; Feminization ; Humans ; Hyperaldosteronism ; Liver ; Male ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Survival Rate ; Weight Loss