Colonic stenting has been suggested as an acceptable therapeutic option for the palliation of malignant colorectal obstruction or to achieve bowel decompression and preparation. It is effective as a bridge to surgery that is useful as an option to avoid emergency colostomy. However, it is associated with complications such as intestinal perforation, stent migration, bleeding, and failure of bowel decompression. Of all the complications, intestinal perforation and failure of bowel decompression are most serious and require surgical treatment. Here we report a case of abdominal compartment syndrome after stent insertion for obstructive colon cancer. The main causative factors for abdominal compartment syndrome were bowel distension associated with endoscopic gas inflation and failure to achieve bowel decompression.
Colon ; Colonic Neoplasms ; Colostomy ; Decompression ; Emergencies ; Hemorrhage ; Inflation, Economic ; Intestinal Perforation ; Intra-Abdominal Hypertension ; Stents

BACKGROUND: Biodegradable microspheres are a useful method of drug delivery because they are both injectable and biodegradable. Previous work in our group has characterized implantable preparations of local anesthetics in pellets for prolonged regional anesthesia. In this paper we evaluated injectable suspensions of lidocaine-polymer microspheres for extended period of percutaneous sciatic nerve blockade in rats. METHODS: Microspheres were prepared using poly (lactide-co-glycolide) loaded with 50 wt% lidocaine by a solvent evaporation method. In vitro release rate of lidocaine from microspheres was determined by high performance liquid chromatography (HPLC). Percutaneous blockade of the rat sciatic nerve was performed, and sensory blockade of the nerve was assessed using an analgesiometer. RESULTS: Lidocaine was released in a controlled manner in vitro. In general 60% of the drug released in the first day, 80% in two days. Sciatic nerve blockade duration ranged from 8 to 12 hours. Incorporation of dexamethasone 0.05 wt% into the microspheres resulted in significant prolongation of block. CONCLUSION: Prolonged percutaneous blockade of peripheral nerve is achieved using biodegradable polymeric lidocaine microspheres.
Anesthesia, Conduction* ; Anesthetics, Local ; Animals ; Chromatography, Liquid ; Dexamethasone ; Lidocaine* ; Microspheres* ; Peripheral Nerves ; Polymers* ; Rats ; Sciatic Nerve ; Suspensions

PURPOSE: The aim of this study was to obtain single cell-derived clones from human umbilical cord blood (hUCB) derived mesenchymal stem cell (MSC) population, to compare the gene expression patterns and differentiation characteristics among the hUCB derived MSC population and its monoclonal cell populations, and to determine if the MSC population is homogenous. MATERIALS AND METHODS: The single cells were isolated from a hUCB derived MSC population and cultured on each well of a culture plate. The gene expression pattern of each monoclonal cell population expanded from the single cells was detected by RT-PCR for osteogenic, chondrogenic, and adipogenic specific genes. The monoclonal cell populations were differentiated into osteogenic, chondrogenic, and adipogenic lineages and were confirmed by specific staining. RESULTS: Fifteen monoclonal cell populations were obtained from the total seeding of 864 single cells. The cell morphology and gene expression patterns among the hUCB derived MSCs and its monoclonal cell population were different. Tri-lineage differentiation potency was different among the monoclonal cell populations. CONCLUSION: The difference in the cell morphology, gene expression patterns, and differentiation characteristics among the monoclonal cell populations suggest heterogeneity of the MSC population isolated using the currently available method.
Clone Cells ; Fetal Blood* ; Gene Expression ; Humans* ; Mesenchymal Stromal Cells* ; Population Characteristics ; Umbilical Cord*

BACKGROUND: Recurrent aphthous stomatitis (RAS) is usually the earliest sign of Behcet's disease. Hyperhomocysteinemia can damage endothelial cells and progress to obstructive vascular disease. It has been reported that hyperhomocysteinemia is a marker of activation in Behcet's disease. Enzyme 5,10-methylenetetrahydrofolate reductase may be one of the main factors that regulates plasma homocysteine levels. Homozygosity for the C677T (MTHFR C677T) mutation is associated with reduced activity of this enzyme and considered the most common genetic cause of elevated serum homocyteine levels. However its relationship to vascular injury in Behcet's disease remains controversial, and its relationship to RAS is unknown. Apolipoprotein E (Apo E) has both immunoregulatory and anti-infective features. Search for Apo E polymorphism and lipid composition in RAS patients might be a clue to pathogenesis of RAS. OBJECTIVE: To analyze the relationship of MTHFR gene C677T polymorphism, several epidemiologic factors such as age and sex, smoking, lipid composition and Apo E polymorphism to vasculitis in RAS, we assessed the MTHFR gene C677T polymorphism, Apo E polymorphism and lipid composition in RAS and normal population. METHODS: We analyzed data from the General Health survey conducted on 1,243 participants (M:F=281:962) over a 20 year-old in Incheon city. Medical interview and laboratory test for methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism, apolipoprotein E polymorphism were completed. Statistical significance was analyzed by chi-square test and multistep logistic regression analysis. RESULTS: Among normal population over the age of twenty, a total of 34.2% (426/1,243) had RAS. Female predominance (4.5:1, p=0.003) was noted. The incidence of RAS in age group 20 to 39 year old is higher than the over 40 age group. The incidence is higher in smoking group compared to the nonsmoking group in multistepwise logistic regression analysis. Frequency of the MTHFR C677T genotypes was highest at CT compared to CC and TT homozygous genotype in normal and RAS patients group. There was no significant statistical differences in MTHFR genotypes in RAS patients compared to the control group. Similarly, Apo E genotype analysis revealed no significant statistical differences either. Apo E genotype and total cholesterol, HDL-cholesterol, triglyceride level didn't show any associations. CONCLUSION: This study revealed insignificant association between the MTHFR C677T mutation and RAS. Apo E genotype didn't show a significant statistical difference in RAS patients compared to normal controls.
Apolipoproteins ; Apolipoproteins E ; Cholesterol ; Endothelial Cells ; Epidemiologic Factors ; Female ; Genotype ; Health Surveys ; Homocysteine ; Humans ; Hyperhomocysteinemia ; Incidence ; Logistic Models ; Methylenetetrahydrofolate Reductase (NADPH2) ; Oxidoreductases ; Plasma ; Smoke ; Smoking ; Stomatitis, Aphthous ; Tetrahydrofolates ; Vascular Diseases ; Vascular System Injuries ; Vasculitis

A desmoplastic small round cell tumor (DSRCT) is a rare and aggressive neoplasm with an extremely poor prognosis. It primarily affects children and young males. The most common sites are the abdomen areas, particularly the pelvic region. Usually, it is a large tumor mass accompanied by extensive peritoneal seeding. Microscopically, the typical appearance is a well-defined nests or clusters of small round tumor cells with an undifferentiated type, surrounded by a prominent desmoplastic stroma. Immunohistochemically, the tumor cells show a primitive uncertain histogenesis that can simultaneously express the epithelial, mesenchymal, and neural phenotype. There is no definitive treatment modality. Although a surgical resection, chemotherapy and radiotherapy are to the main treatments, the prognosis is poor. We experienced a case of a desmoplastic small round cell tumor at the retroperitoneal space. A 42-year-old woman was admitted for a palpable mass in the left upper abdomen for 1 months. Compoterized tomography revealed a retroperitoneal tumor. A complete excision of the tumor was performed. The histological examination confirmed the diagnosis of a desmoplastic small round cell tumor. The tumor recurred 3 months later. She received the first chemotherapy regimin with high-dose cyclophosphamied, adriamycin and vincristine. Computed tomography showed that the recurred tumor disappeared after 6 cycles of chemotherapy, but it relapsed 6 months later. She died of sepsis during the second chemotherapy regimen. The survival time was 21 months.
Abdomen ; Adult ; Child ; Desmoplastic Small Round Cell Tumor* ; Diagnosis ; Doxorubicin ; Drug Therapy ; Female ; Humans ; Male ; Pelvis ; Phenotype ; Prognosis ; Radiotherapy ; Retroperitoneal Space ; Sepsis ; Vincristine

PURPOSE: To identify possible predictors of pathologic complete response (pCR) of rectal cancer after preoperative concurrent chemoradiotherapy (CCRT). MATERIALS AND METHODS: We conducted a retrospective review of 53 patients with rectal cancer who underwent preoperative CCRT followed by radical surgery at a single center between January 2007 and December 2012. The median radiotherapy dose to the pelvis was 54.0 Gy (range, 45.0 to 63.0 Gy). Five-fluorouracil-based chemotherapy was administered via continuous infusion with leucovorin. RESULTS: The pCR rate was 20.8%. The downstaging rate was 66%. In univariate analyses, poor and undifferentiated tumors (p = 0.020) and an interval of ≥7 weeks from finishing CCRT to surgery (p = 0.040) were significantly associated with pCR, while female gender (p = 0.070), initial carcinoembryonic antigen concentration of <5.0 ng/dL (p = 0.100), and clinical stage T2 (p = 0.100) were marginally significant factors. In multivariate analysis, an interval of ≥7 weeks from finishing CCRT to surgery (odds ratio, 0.139; 95% confidence interval, 0.022 to 0.877; p = 0.036) was significantly associated with pCR, while stage T2 (odds ratio, 5.363; 95% confidence interval, 0.963 to 29.877; p = 0.055) was a marginally significant risk factor. CONCLUSION: We suggest that the interval from finishing CCRT to surgery is a predictor of pCR after preoperative CCRT in patients with rectal cancer. Stage T2 cancer may also be an important predictive factor. We hope to perform a robust study by collecting data during treatment to obtain more advanced results.
Carcinoembryonic Antigen ; Chemoradiotherapy* ; Drug Therapy ; Female ; Hope ; Humans ; Leucovorin ; Multivariate Analysis ; Pelvis ; Polymerase Chain Reaction ; Radiotherapy ; Rectal Neoplasms* ; Rectum ; Retrospective Studies ; Risk Factors

PURPOSE: To evaluate CT findings which may help differentiate benign from malignant parotid tumors. MATERIALS AND METHODS: The CT findings of seventy-one cases with surgically-proven parotid tumors were retrospectively analysed for size, location, margin, internal density, adjacent tissue plane and lymphadenopathy. RESULTS: The margin of the mass was smooth and sharp in most benign tumors (89.5%), and irregular or indistinct in twelve which were malignant (75%, p<0.01). With regard to internal density, 70.2% of benign tumors were homogeneous (similar to muscle) and 81.3% of malignant tumors were heterogeneous (p<0.01). When analysing low density patterns within the mass, focal low densities in benign tumors (11/17) and diffuse or scattered multifocal low densities in those which were maligant (8/13) were frequently seen. Three malignant tumors invaded adjacent muscles, the parapharyngeal space, and bones, each in one case, and twelve malignant and one benign tumor infiltrated the adjacent fascia or subcutaneous fat layer. In five patients with a malignant tumor, obliteration by the mass of the fat plane between the mastoid tip and styloid process was noted, suggesting facial nerve invasion, while in three cases of malignancy, lymphadenopathy greater than 1cm was seen. CONCLUSION: In differentiating malignant and benign parotid tumors, the presence of irregular or indistinct margin of the mass, and invasion of adjacent structures, are important. Lymph node enlargement greater than 1cm and diffuse internal low densities, which may suggest necrosis or cystic change were also helpful in differential diagnosis.
Diagnosis, Differential* ; Facial Nerve ; Fascia ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Mastoid ; Muscles ; Necrosis ; Retrospective Studies ; Subcutaneous Fat

BACKGROUND: An adequate cerebral blood flow is critical in maintaining obligatory metabolic function of cerebral neurons. The occlusion of these flows may cause impairment of the cellular metabolic function. Therefore, the early detection and treatment of this can have a direct impact on the prognosis. This study is designed to determine the changes of electroencephalography (EEG) waves with power spectral analysis during and after cerebral blood flow impairment with reversible middle cerebral artery occlusion in rats. METHODS: Five rats were anesthetized with ketamine and the left middle cerebral artery was reversibly occluded. Neurologic deficit and the EEG were evaluated. The principal procedure consisted of the following: All branches of the external carotid artery and pterygopalatine artery of the internal carotid artery were interrupted. At this point, the internal carotid artery is the only branch of the common carotid artery. Afterwards, the external carotid artery was interrupted. A 4-0 monofilament nylon suture, its tip rounded, was introduced into the external carotid artery lumen and advanced to block blood flow into the middle cerebral artery. The suture was withdrawn to permit reperfusion after 2 hours. Monitoring of the EEG was performed before the occlusion, after 10, 30, 60, and 120 minutes of occlusion, and after 10, 30 and 60 minutes of reperfusion. The neurologic findings were scored on a five-point scale. RESULTS: In the spectral power analysis of EEG, the total power of the EEG amplitude decreased significantly after left middle cerebral artery occlusion, increased after 30 minutes of occlusion, and decreased significantly after reperfusion. The theta, alpha and beta waves changed significantly after occlusion. Theta and beta waves were reversed slowly. After reperfusion, theta and alpha waves decreased significantly. CONCLUSIONS: It is suggested that the spectral analysis of an EEG is useful in early detection and treatment of ischemia in patients with cerebrovascular disease.
Animals ; Arteries ; Carotid Artery, Common ; Carotid Artery, External ; Carotid Artery, Internal ; Electroencephalography* ; Humans ; Infarction, Middle Cerebral Artery* ; Ischemia ; Ketamine ; Middle Cerebral Artery* ; Neurologic Manifestations ; Neurons ; Nylons ; Prognosis ; Rats ; Reperfusion ; Sutures

Lumbar hernia is a relatively rare clinical phenomenon. They may be classified according to their anatomic location and they can be either congenital or acquired. These patients usually present with a protruding bulge in the posterolateral abdominal wall. Portions of the small and large intestine may be found in the sac. This may be asymptomatic or it can become incarcerated and strangulated. We report here on a rare case of secondary lumbar hernia combined with descending colon incarceration. The diagnosis of lumbar hernia was made by CT scan and barium enema. Excision of the sac was performed and the hernial defect in the fascia was repaired with polypropylene mesh reinforcement.
Abdominal Wall ; Barium ; Colon, Descending* ; Diagnosis ; Enema ; Fascia ; Hernia* ; Humans ; Intestine, Large ; Polypropylenes ; Tomography, X-Ray Computed

PURPOSE: The purpose of this study was to evaluate the clinicopathological significance of responders with metastatic colorectal cancer treated with oxaliplatin chemotherapy. METHODS: A total of 52 patients with unresectable metastatic colorectal cancer were enrolled for treatment between March 2000 and August 2005. Patients received first line chemotherapy consisted of oxaliplatin 85 mg/m2 or 130 mg/m2 as a 2-hour infusion on day 1, concurrently with leucovorin (LV) 20 mg/m2 as a bolus infusion on day 1~5, followed by continuous infusion of 5-fluorouracil (5-FU) 425 mg/m2 on day 1~5. This treatment was repeated in 2 or 3 week intervals. All responses were assessed after 4 cycles of therapy by independent radiologic experts and categorized into two groups: responder (major reduction of tumor) and non-responder group (no change or progression of the tumor. RESULTS: The response rate was 51.9 percent (27/52 patients). There were no significant differences in clinicopathologic parameters between two groups. The decrease of CEA value after chemotherapy was significantly more frequent in the responder group than in the non-responder group. CONCLUSIONS: We could not find any clinical differences between the two groups, but these results suggest that oxaliplatin chemotherapy has a beneficial effect on tumor shrinkage and serum CEA value can be an indicator for tumor response of oxaliplatin in advanced colorectal cancer.
Colorectal Neoplasms* ; Drug Therapy* ; Fluorouracil ; Humans ; Leucovorin