BACKGROUND: Most of adult patients with chronic immune thrombocytopenic purpura (ITP) that was refractory or relapsed to high-dose corticosteroid have been treated with splenectomy as a 2nd line treatment. However, these patients may have increased morbidity and mortality according to the operation and the increased risk of infection for a lifetime after splenectomy. Despite of the above risks, 30~40% of these patients can't maintain remission. Furthermore, the remission rate after splenectomy is relatively lower in patients with corticosteroid-refractory chronic ITP than that in those patients with corticosteroid-responsiveness. We studied whether danazol, an attenuated androgen, is useful or safe as 2nd line treatment for chronic ITP instead of splenectomy and which factors are associated with the response to danazol. METHODS: Among the patients with chronic ITP who failed corticosteroid therapy in our hospital, 28 patients who received danazol as the 2nd line treatment were analyzed retrospectively. A complete response was defined that the platelet count was increased to 150 x 10(3)/microL, and a partial response was defined that the platelet count was increased above 50 x 10(3)/microL or there was an increased platelet count of more than 20 x 10(3)/microL from the pre-treatment platelet count when the platelet count was above 50 x 10(3)/microL at the time of danazol therapy. RESULTS: The median age of patients was 44 years (range: 19~67) and the number of male patients was 9 (32.1%) and the number of females was 19 (67.9%). The starting daily doses of danazol were variable from 200 to 600mg, though most of the patients were treated with 400mg daily (18 cases, 64.3%). The median duration of danazol therapy was 201.5 days (range: 13~973) and the median duration from ITP diagnosis to danazol treatment was 56 days (range: 20~2,430). Among the accrued 28 patients, 22 patients showed a response to danazol (78.5%); there were 6 patients (21.4%) with a complete response and 16 patients (57.1%) with a partial response. The median duration from danazol treatment to response was 30 days (range: 0~180). The median response duration of danazol treatment was 330 days (95% CI: 182~478) by the Kaplan-Meiyer method. For the danazol-responsive patients, 9 patients (40.9%) remained in remission and 13 patients (59.1%) relapsed. Grade 3~4 toxicity was observed in two patients and three patients stopped danazol because of adverse effects. Hepatotoxicity was the most common toxicity. CONCLUSION: Our findings suggest that danazol is a beneficial, safe choice as the 2nd line treatment for patients with chronic ITP that was refractory or relapsed to corticosteroid.
Adult ; Danazol* ; Diagnosis ; Female ; Humans ; Male ; Mortality ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic* ; Retrospective Studies ; Splenectomy

PURPOSE: To evaluate the usefulness of the helical CT in the differentiation of periampullary malignanttumors. MATERIALS AND METHODS: Fifty-five periampullary carcinoma patients (pancreatic head carcinoma (n=18);distal CBD carcinoma (n=17) ; carcinoma of the ampulla of Vater(n=16) ; periampullary duodenal cancers,(n=4), alldiagnosed by histopathologic study] underwent helical CT with 5mm scan thickness and 5mm/sec table speed. Afterscanning, retrospective reconstruction was performed at 2mm intervals, followed by multiplanar reformation. Inboth retrospective reconstructed axial and multiplanar reformation images, the authors analyzed the detection rateand size of the mass, and associated findings including invasion of peripancreatic fat, dilatation of CBD and itsnarrowing pattern, dilatation of the pancreatic duct and its degree of dilatation, wall thickening of CBD,extension of dilated bile duct into the ampulla, and of protruding mass into the duodenal lumen, and lymph nodemetastasis all according to the origin sites of tumors. Differential points were thus determined. RESULTS: Thedetection rate of the masses was 96% (53/55). Their size was 1-5cm, with a mean size of 2.4 +/-0.5cm in carcinomaof of ampulla of Vater and 3.5 +/-1.0cm in pancreatic head carcinoma. Invasion of peripancreatic fat was mostcommonly observed in pancreatic head carcinoma (100%, 18/18) (P >0 . 0 5 ), dilatation of CBD was observed in allcases except one of periampullary duodenal cancer (98%, 54/55), and abrupt termination of dilated bile duct wasnoted in all cases except one of the pancreatic head carcinoma (98%, 53/54). Dilatation of pancreatic duct wascommonly observed in pancreatic head carcinoma (94%, 17/18) and carcinoma of the ampulla of Vater (75%, 12/16).Its degree of dilatation was mostly moderate in pancreatic head carcinoma (56%, 10/18) and mostly mild incarcinoma of the ampulla of Vater (63%, 10/16) ( P >0.05). Wall thickening of the distal CBD was most commonlyobserved in distal CBD carcinoma (76%, 13/17). Extension of dilated bile duct into the ampulla was commonlyobserved in the carcinoma of the ampulla of Vater (81%, 13/16) and periampullary duodenal cancer (75%, 3/4) (P>0.05). A mass protruding into the duodenal lumen was commonly observed in periampullary duodenal cancer (100%,4/4) and carcinoma of the ampulla of Vater (94%, 15/16) (P >0.05). Lymph node meatastasis was observed inpancreatic head carcinoma (17%, 3/18) and distal CBD carcinoma (6%, 1/17). CONCLUSION: Because of improvement inthe rate at which the mass is detected, and a clear demonstration of associated findings, helical CT is useful inthe differentiation of periampullary carcinomas.
Ampulla of Vater ; Bile Ducts ; Diagnosis* ; Dilatation ; Duodenal Neoplasms ; Head ; Humans ; Lymph Nodes ; Pancreatic Ducts ; Retrospective Studies ; Tomography, Spiral Computed*

PURPOSE: Guardix-sol(TM) is solution type of anti-adhesion barrier, and it is composed of a mixture of hyaluronate (HA) and carboxymethylcellulose (CMC). The anti-adhesive effect was proved through several clinical trials with using this material, but the most efficient viscosity for this solution has not been shown by the previous research. The objective of this study was to evaluate the efficacy and safety of HA/CMC mixture solutions, with varying viscosities, in a rat model. METHODS: Three different viscosities (low=LV, mid=MV and high=HV) of the HA/CMC mixture solutions were prepared to evaluate their potential as a tissue adhesion barrier. The viscosity was measured by a Brookfield viscometer. To evaluate the anti-adhesion effect, a cecal-abdominal wall abrasion model was adopted. The denuded cecum was coated by a HA/CMC mixture of different viscosity or it was left uncoated (the negative control group) and then the denuded cecum was apposed to the abdominal wall (each group: n=10). All the rats underwent a second celiotomy after 14 days to evaluate the extent of their abdominal adhesions and tissue reactions (inflammatory response, granulation tissue formation and toxicity in organs). RESULTS: The viscosities of the HA/CMC mixture solutions were 248.+/-24.4 cps in the LV, 1,353.8+/-4.4 cps in the MV and 3,556.7+/-38.8 cps in the HV. The grade of adhesion and the adhesion area were significantly lower in the all HA/CMC mixture solution groups compared to the control regardless of their viscosity. The inflammatory responses were not remarkable at the application site and the major solid organs did not show histological change in the experimental groups. CONCLUSION: The difference of viscosity of HA/CMC mixture solutions did not affect the efficacy of the adhesion barrier. All the HA/CMC mixture solutions with varying viscosities showed a low inflammatory response and non-toxicity.
Abdominal Wall ; Animals ; Carboxymethylcellulose Sodium ; Cecum ; Granulation Tissue ; Rats ; Tissue Adhesions ; Viscosity

PURPOSE: Guardix-sol(TM) is solution type of anti-adhesion barrier, and it is composed of a mixture of hyaluronate (HA) and carboxymethylcellulose (CMC). The anti-adhesive effect was proved through several clinical trials with using this material, but the most efficient viscosity for this solution has not been shown by the previous research. The objective of this study was to evaluate the efficacy and safety of HA/CMC mixture solutions, with varying viscosities, in a rat model. METHODS: Three different viscosities (low=LV, mid=MV and high=HV) of the HA/CMC mixture solutions were prepared to evaluate their potential as a tissue adhesion barrier. The viscosity was measured by a Brookfield viscometer. To evaluate the anti-adhesion effect, a cecal-abdominal wall abrasion model was adopted. The denuded cecum was coated by a HA/CMC mixture of different viscosity or it was left uncoated (the negative control group) and then the denuded cecum was apposed to the abdominal wall (each group: n=10). All the rats underwent a second celiotomy after 14 days to evaluate the extent of their abdominal adhesions and tissue reactions (inflammatory response, granulation tissue formation and toxicity in organs). RESULTS: The viscosities of the HA/CMC mixture solutions were 248.+/-24.4 cps in the LV, 1,353.8+/-4.4 cps in the MV and 3,556.7+/-38.8 cps in the HV. The grade of adhesion and the adhesion area were significantly lower in the all HA/CMC mixture solution groups compared to the control regardless of their viscosity. The inflammatory responses were not remarkable at the application site and the major solid organs did not show histological change in the experimental groups. CONCLUSION: The difference of viscosity of HA/CMC mixture solutions did not affect the efficacy of the adhesion barrier. All the HA/CMC mixture solutions with varying viscosities showed a low inflammatory response and non-toxicity.
Abdominal Wall ; Animals ; Carboxymethylcellulose Sodium ; Cecum ; Granulation Tissue ; Rats ; Tissue Adhesions ; Viscosity

PURPOSE: Most recently developed anti-adhesive membranes are not suitable for laparoscopic surgery due to weak mechanical properties or adhesive characteristics. To overcome these problems, we prepared electrospun bioabsorbable nanofibrous poly (lactic-co-glycolic acid)-based membranes as an adhesion barrier. We evaluated the efficacy and safety of this material for laparoscopic surgery in a rabbit model. METHODS: A standardized laparoscopic surgical trauma was made on the rabbit's uterine horn and adjacent abdominal wall to induce adhesion formation. The injured uterus was covered by a nanofibrous barrier or it was left untreated (the negative control group) (each group: n=14). To evaluate acute toxicity of this material, blood sampling was made 3 and 7 days after laparoscopic surgery to check liver and renal function. Three weeks after laparoscopy, a second look laparoscopy was performed and the adhesions were scored according to Blauer's scoring system. Tissue between abdominal wall and uterus was obtained to examine microscopically. Liver, kidney and uterus were harvested to examine chronic toxicity. RESULTS: 36.4% of the nanofiber treatment group and 70% of the untreated control group showed severe adhesions (grade>3) after laparoscopic surgery but failed to get a statistical significance (P=0.198). Acute and chronic toxicity induced by this material were not noted in the blood and tissue exam. CONCLUSION: This study showed that nanofiber barrier seems to be a novel resorbable biomaterial for the reduction of postoperative adhesions. Easy placement and handling of this material make these membranes potentially successful candidates for laparoscopic surgery. But further study is needed to get a statistical significance.
Abdominal Wall ; Adhesives ; Animals ; Handling (Psychology) ; Horns ; Kidney ; Laparoscopy ; Liver ; Membranes ; Nanofibers ; Uterus

Avulsion fracture of the calcaneal tuberosity is an uncommon injury. Usually it occurs from indirect trauma, and can be seen in old patients with osteoporosis or in patients with diabetic neuropathy. Follow-up studies showed fracture healing in most cases, but skeletal deformity may develop in some cases. Therefore we should do plain X-ray evaluations in diabetic patients with foot and ankle pain, even though there have been no definite trauma history. Four cases of calcaneus avulsion fracture were treated operatively in diabetic patients, and reported.
Ankle ; Calcaneus* ; Congenital Abnormalities ; Diabetic Neuropathies ; Follow-Up Studies ; Foot ; Fracture Healing ; Humans ; Osteoporosis

PURPOSE: The purpose of this study was to evaluate the usefulness of computed tomography(CT) and magnetic resonance imaging(MRI) in experimental bacterial meningitis. MATERIALS AND METHODS: CT and MR images of experimental bacterial meningitis were obtained after inoculation of 1ml suspension of 106/ml Staphylococcusaureus directly into the supratentorial arachnoid space of 18 New Zealand white rabbits. Each animal was studied with both Pre-enhanced and post-enhanced CT and MRI at 12, 24, 48 hours and 1 week. Cerebrospinal fluid of all of18 rabbits were sampled and cultured for bacterial growth. RESULTS: All of 18 rabbits had the clinical symptoms such as neck stiffness and anorexia within 24 hours after the inoculation. Cerebrospinal fluid cultures werepositive for Staphylococcus sureus growth. Gd-enhanced MRI exhibited diffuse enhancement along the thickened supratentorial meninges earlier than CT. in Gd-enhanced MRI, the mean contrast enhancement ratio(CER) at supratentorial meninges increased to 1.93 at 12 hours and 2.99 at 24 hours from 1.06 at 0 hour. Histologic evaluation demonstrated inflammatory cell infiltration into the meninges. MRI also identified the complications of mening it is such as ependymitis and hydrocephalus more effectively than CT. CONCLUSION: These results indicatedthat Gd-enhanced MRI detected earlier the abnormal findings of bacterial meningitis and evaluated more effectively the complications of mening it is compared with CT. MRI was more useful than CT in evaluation of the bacterial meningitis.
Animals ; Anorexia ; Arachnoid ; Cerebrospinal Fluid ; Hydrocephalus ; Magnetic Resonance Imaging* ; Meninges ; Meningitis ; Meningitis, Bacterial* ; Neck ; Rabbits ; Staphylococcus

No abstract available.
Acalculous Cholecystitis* ; Churg-Strauss Syndrome* ; Colitis, Ischemic* ; Ulcer*

PURPOSE: Dickkopf 1 (DKK1) has been extensively investigated in mouse models of multiple myeloma, which results in osteolytic bone lesions. Elevated DKK1 levels in bone marrow plasma and serum inhibit the differentiation of osteoblast precursors. Present pharmaceutical approaches to target bone lesions are limited to antiresorptive agents. In this study, we developed a cyclized oligopeptide against DKK1-low density lipoprotein receptor-related protein (LRP) 5/6 interaction and tested the effects of the oligopeptide on tumor burden. MATERIALS AND METHODS: A cyclized oligopeptide based on DKK1-LRP5/6 interactions was synthesized chemically, and its nuclear magnetic resonance structure was assessed. Luciferase reporter assay and mRNA expressions of osteoblast markers were evaluated after oligopeptide treatment. MOPC315.BM.Luc cells were injected into the tail vein of mice, after which cyclized oligopeptide was delivered subcutaneously 6 days a week for 4 weeks. RESULTS: The cyclized oligopeptide containing NXI motif bound to the E1 domain of LRP5/6 effectively on surface plasmon resonance analysis. It abrogated the Wnt-β-catenin signaling inhibited by DKK1, but not by sclerostin, dose dependently. RT-PCR and alkaline phosphatase staining showed increased expressions of osteoblast markers according to the treatment concentrations. Bioluminescence images showed that the treatment of cyclized oligopeptide reduced tumor burden more in oligopeptide treated group than in the vehicle group. CONCLUSION: The cyclized oligopeptide reported here may be another option for the treatment of tumor burden in multiple myeloma.
Alkaline Phosphatase ; Animals ; Bone Density Conservation Agents ; Bone Marrow ; Lipoproteins ; Luciferases ; Magnetic Resonance Spectroscopy ; Mice* ; Multiple Myeloma* ; Osteoblasts ; Plasma ; RNA, Messenger ; Surface Plasmon Resonance ; Tail ; Tumor Burden* ; Veins

The annual incidence of hospital admissions for lower gastrointestinal bleeding in the United States and Europe is 0.02%. Massive hemorrhage from a solitary colon polyp is an extremely rare case. We report two consecutive patients with a single polyp, which was the source of bleeding. The first case is a 68-year-old male patient who visited Daejeon Sun Hospital with the chief complaint of considerable hematochezia. An 1.2 cm colon polyp with active bleeding was observed on the colonoscopy. The second case is a 74-year-old female patient with symptoms of hematochezia. A blood-clot attached, 3.0 cm sized Yamada type-IV colon polyp was examined on the colonoscopy. One case was a sessile polyp, and the other one was a thick-stalked pedunculated polyp. Both types of polyps were supplied with more vessels than other polyps, and both patients were taking aspirin. The two patients underwent snare polypectomy and were discharged without further bleeding evidence.
Aged ; Aspirin ; Colon ; Colonic Polyps ; Colonoscopy ; Europe ; Female ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Incidence ; Male ; Polyps ; SNARE Proteins ; Solar System ; United States