Diffuse pulmonary meningotheliomatosis (DPM) is an extremely rare condition. We herein report a unique case of DPM in a 54-year-old woman with a previous history of hepatocellular carcinoma. A chest computed tomography showed diffuse bilateral nodular infiltration, suggesting miliary spread of metastatic hepatocellular carcinoma. The patient underwent a video-assisted thoracoscopic surgery for diagnostic purposes. The cut surface of the lung specimen showed multiple dispersed small nodules, consisting of variably sized nests or whorls of bland epithelioid cells often along the walls of alveolar septa or in a perivascular network within the alveolar interstitium. The tumor cells showed immunoreactivity for epithelial membrane antigen, vimentin, and progesterone receptor. DPM should be included in the differential diagnosis of diffuse multiple small nodules or a reticular pattern in the radiologic studies.
Carcinoma, Hepatocellular ; Diagnosis, Differential ; Epithelioid Cells ; Female ; Humans ; Lung ; Lung Neoplasms ; Meningioma ; Middle Aged ; Mucin-1 ; Receptors, Progesterone ; Thoracic Surgery, Video-Assisted ; Thorax ; Vimentin

PURPOSE: To investigate changes of serum osteoblastic marker during fracture healing. MATERIALS AND METHODS: The study included 22 patients with fresh fractures. Serum alkaline phosphatase (ALP), bone specific alkaline phosphatase and osteocalcin were analyzed on the first day and 1, 2, 4 and 8 weeks after injury. The bone specific-ALP was quantified by electrophoresis. Osteocalcin was quantified by enzyme linked immunosorbent assay (ELISA). RESULTS: One, 2, 4 and 8 weeks after injury, mean values of serum ALP increased 1.26, 1.45, 1.63, and 1.2 times that on the first day after injury, respectively. Similarly, during the same period, bone specific ALP increased 1.38, 1.33, 1.73 and 1.25 times, and serum osteocalcins increased 1.32, 1.2, 1.64 and 2.09 times. CONCLUSION: Serum ALP increased during the early soft callus phase. However, serum osteocalcins increased during the late hard callus phase. Serum alkaline phosphatase and osteocalcin warrant further study as useful prognostic indicators of fracture healing.
Alkaline Phosphatase* ; Bony Callus ; Electrophoresis ; Enzyme-Linked Immunosorbent Assay ; Fracture Healing* ; Humans ; Osteoblasts ; Osteocalcin*

STUDY DESIGN: A case report and review of literature OBJECTIVE: Mostly operative treatment for pyogenic spondylits has been performed via anterior approach, which is often followed by greater morbidity and late sequelae. Efficacy of percutaneous drainage and posterior lumbar interbody fusion (PLIF), which are increasingly applied with favorable results, as an alternative of anterior surgery was investigated. MATERIAL AND METHOD: A case of pyogenic L4-5 spondylitis with psoas abscess but without neurologic deficit in a 66-year old lady was reviewed. Percutaneous drainage under fluoroscopic guide was performed. 7 weeks later, curettage of disc space and posterior lumbar interbody fusion using autogeous graft was performed to get rid of dead space and achieve stability. Administration of antimicrobial agents followed. RESULTS: Infection was controlled successfully. Clinical features including ambulatory function improved. Solid fusion was achieved. SUMMARY: In treating pyogenic spondylitis with moderate abscess, percutaneous drainage and posterior lumbar interbody fusion seemed to be one of alternatives of anterior surgery.
Abscess ; Aged ; Anti-Infective Agents ; Curettage ; Drainage* ; Humans ; Neurologic Manifestations ; Psoas Abscess ; Spondylitis* ; Transplants

BACKGROUNDS/AIMS: Standard liver volume (SLV) is an important parameter that has been used as a reference value to estimate the graft matching in living donor liver transplantation (LDLT). This study aimed to determine a reliable SLV formula for Korean adult patients as compared with the 15 SLV formulae from other studies and further estimate SLV formula by gender and body mass index (BMI). METHODS: Computed tomography liver volumetry was performed in 1,000 living donors for LDLT and regression formulae for SLV was calculated. Individual donor data were applied to the 15 previously published SLV formulae, as compared with the SLV formula derived in this study. Analysis for confounding variables of BMI and gender was also performed. RESULTS: Two formulae, "SLV (ml)=908.204xBSA-464.728" with DuBois body surface area (BSA) formula and "SLV (ml)=893.485xBSA-439.169" with Monsteller BSA formula, were derived by using the profiles of the 1,000 living donors included in the study. Comparison with other 15 other formulae, all except for Chouker formula showed the mean volume percentage errors of 4.8-5.4%. The gender showed no significant effect on total liver volume (TLV), but there was a significant increase in TLV as BMI increased. CONCLUSIONS: Our study suggested that most SLV formulae showed a crudely applicable range of SLV estimation for Korean adults. Considering the volume error in estimating SLV, further SLV studies with larger population from multiple centers should be performed to enhance its predictability. Our results suggested that classifying SLV formulae by BMI and gender is unnecessary.
Adult* ; Body Mass Index ; Body Surface Area ; Confounding Factors (Epidemiology)* ; Humans ; Liver Transplantation ; Liver* ; Living Donors ; Reference Values ; Tissue Donors ; Transplants

No abstract available.
Adult ; Anti-Bacterial Agents/therapeutic use ; Bacterial Proteins/chemistry/genetics/metabolism ; Brucella melitensis/classification/genetics/*isolation & purification ; Brucellosis/*diagnosis/drug therapy/microbiology ; Doxycycline/therapeutic use ; Humans ; Magnetic Resonance Imaging ; Male ; Phylogeny ; Polymerase Chain Reaction ; Republic of Korea ; Rifampin/therapeutic use ; Sequence Analysis, DNA ; Spondylitis/diagnostic imaging

No abstract available.
Eosinophilia* ; Respiratory Insufficiency*

BACKGROUND: The proper use of sedation and analgesia in the intensive care unit (ICU) minimizes its physical and psychological impact. Otherwise, patients can suffer from recall, nightmares, and depression after discharge. We investigated the sedatives, analgesics, and muscle relaxants used in the ICU. METHODS: We visited 79 ICUs in 52 training hospitals and noted the use of sedatives, analgesics, and muscle relaxants from July, 2007, to December, 2007, using a 5-item questionnaire with 57 sub-questions. The survey evaluated the ICU system administration of analgesics and muscle relaxants. RESULTS: Most ICU management is done by the anesthesiology department (55%). Most have resident doctors (63.3%) and an ICU committee (60.8%) in charge of the ICU, as well as a special ICU chart (88.6%) and scoring system (65.8%). Most hospitals have a consulting system (94.9%). The standard ICU analgesics are fentanyl (65.8%), NSAIDs (53.2%), and morphine (48.1%). CONCLUSIONS: Adequate sedation is difficult to achieve in the ICU, but is important for patient comfort and to reduce ICU stay duration. Awareness of patient status and appropriate drug/protocol use are therefore important.
Analgesia ; Analgesics ; Anesthesiology ; Anti-Inflammatory Agents, Non-Steroidal ; Depression ; Dreams ; Fees and Charges ; Fentanyl ; Humans ; Hypnotics and Sedatives ; Critical Care ; Intensive Care Units ; Morphine ; Muscles

PURPOSE: Hepatocyte growth factor (HGF) stimulates proliferation, migration, and morphogenesis of epithelial cells by specifically binding to its receptor c-met. Abnomalities of the c-met oncogene have been studied in cancers of many organs including thyroid, lung, pancreas, and stomach. However, little is known about the clinical significance of c-met oncogene abnormalities in colorectal carcinomas. In this study, we investigated over- expression of the c-met protein in colorectal adenomas and adenocarcinomas, and analyzed the clinicopathologic significance of this over-expression. METHODS: Expression of the c-met protein localized in colorectal adenoma and adenocarcinoma tissues was analyzed by using immunohistochemistry. The results were compared with clinicopathologic parameters to find clinical correlation. RESULTS: c-met protein was detected in 42.5% (17/40) of colorectal cancers and in 10.0% (4/40) of colorectal adenomas (P= 0.001). In colorectal cancer, the proportion of expression of c-met protein was 0% (0/40) in stage I, 47.6% (10/40) in stage II, 53.8% (7/40) in stage III and, 0% (0/40) in stage IV. c-met protein expression was 18.8% (3/40) in tumors with invasion into the muscularis propria (MP), and 58.3% (14/40) in tumors with invasion beyond the MP. The depth of tumor invasion was a statistically significant factor (P=0.022) for c-met expression. CONCLUSIONS: The c-met protein expression was related to the depth of invasion of colorectal cancer and showed a significant difference in its rate of expression between adenoma and adenocarcinomas.
Adenocarcinoma ; Adenoma* ; Colorectal Neoplasms* ; Epithelial Cells ; Hepatocyte Growth Factor ; Immunohistochemistry ; Lung ; Morphogenesis ; Oncogenes ; Pancreas ; Stomach ; Thyroid Gland

Pulmonary gangrene is a rare complication of severe pulmonary infection in which a pulmonary segment or lobe is sloughed. It is a part of a spectrum of disease in which lung tissue is devitalized(such as necrotizing pneumonia, pulmonary abscess), but apart from them, pulmonary gangrene has mo re extensive area of necrosis and thrombosis of large vessels plays a prominent role in the pathogenesis. We experienced a case of pulmonary gangrene in 71 year old female obstructive pneumonia patient with non-small cell lung carcinoma. She complained high fever, chill and despite treatment with antibiotics, pneumonia progressed to empyema. At that time chest radiograph showed a large cavity including sloughed lung tissue, freely moving to dependent position at both lateral decubitus view. RML and RLL were resected and compression of pulmonary vessels by enlarged lymph nodes was observed. Defervescence was obtained immediate postoperative period and the patient was discharged after infection control with antibiotics, chest tube drainage. The perivascular ly mph nodes dissected during lobectomy were proved to be reactive hyperplasias. We speculated that the carcinoma caused obstructive pneumonia, in turn, resulted in reactive hyperplasia of the draining lymph nodes surrounding the large vessels and finally the lung tissues supplied by them necrotized and sloughed.
Aged ; Anti-Bacterial Agents ; Chest Tubes ; Drainage ; Empyema ; Female ; Fever ; Gangrene* ; Humans ; Hyperplasia ; Infection Control ; Lung* ; Lymph Nodes ; Necrosis ; Pneumonia* ; Postoperative Period ; Radiography, Thoracic ; Thrombosis

Pulmonary gangrene is a rare complication of severe pulmonary infection in which a pulmonary segment or lobe is sloughed. It is a part of a spectrum of disease in which lung tissue is devitalized(such as necrotizing pneumonia, pulmonary abscess), but apart from them, pulmonary gangrene has mo re extensive area of necrosis and thrombosis of large vessels plays a prominent role in the pathogenesis. We experienced a case of pulmonary gangrene in 71 year old female obstructive pneumonia patient with non-small cell lung carcinoma. She complained high fever, chill and despite treatment with antibiotics, pneumonia progressed to empyema. At that time chest radiograph showed a large cavity including sloughed lung tissue, freely moving to dependent position at both lateral decubitus view. RML and RLL were resected and compression of pulmonary vessels by enlarged lymph nodes was observed. Defervescence was obtained immediate postoperative period and the patient was discharged after infection control with antibiotics, chest tube drainage. The perivascular ly mph nodes dissected during lobectomy were proved to be reactive hyperplasias. We speculated that the carcinoma caused obstructive pneumonia, in turn, resulted in reactive hyperplasia of the draining lymph nodes surrounding the large vessels and finally the lung tissues supplied by them necrotized and sloughed.
Aged ; Anti-Bacterial Agents ; Chest Tubes ; Drainage ; Empyema ; Female ; Fever ; Gangrene* ; Humans ; Hyperplasia ; Infection Control ; Lung* ; Lymph Nodes ; Necrosis ; Pneumonia* ; Postoperative Period ; Radiography, Thoracic ; Thrombosis