BACKGROUND: Although clinicopathologic characteristics of acral lentiginous melanoma (ALM) is well established, immunohistochemical study on ALM has rarely been reported. OBJECTIVE: Our purpose is to evaluate the usefulness of several immune markers in the diagnosis of ALM. METHODS: An immunohistochemical study was performed on paraffin sections of 20 ALMs using S-100 protein, HMB-45, vimentin, epithelial membrane antigen (EMA), and CAM 5.2. RESULTS: 1. Nineteen (95%) and 16 (80%) out of 20 ALM showed reactivity with S-100 protein and HMB-45, respectively. 2. Melanin bleaching was useful for diagnosing heavily pigmented ALM using both S-100 protein and HMB-45. 3. The immunoreactivity of S-100 protein and HMB-45 did not correlate with tumor thickness or level of invasion of ALM. The intensity of HMB-45 correlated well with the melanin content. 4. One and 2 out of 20 cases stained focally with EMA and CAM5.2 respectively, but these cases stained also with HMB-45 and/or S-100 protein. CONCLUSION: S-100 protein and HMB-45 were relatively sensitive markers for diagnosing ALM. Despite the occasional positivity for the epithelial markers in ALM, all epithelial marker-positive cases stained also with HMB-45 and/or S-100 protein. Therefore, S-100 protein and HMB-45 are very useful markers for diagnosing ALM.
Biomarkers ; Diagnosis ; Melanins ; Melanoma* ; Mucin-1 ; Paraffin ; S100 Proteins ; Vimentin

Thirty eight patients with stage Iand II primary gastrointestinal non-Hodgkin's lymphoma were treated in the Department of Therapeutic Radiology, Seoul National University Hospital between 1979 and 1984. There were 6 systemic disseminations during radiotherapy, and the overall failure rate were 31% in the cases with tumor bulk less than 5 cm in diameter before radiotherapy and 75% in the cases with tumor bulk greater than 5 cm in diameter (p<0.05). The overall 5 year survival rate were 69.2% in 28 patients who completed radiotherapay and 72% in 24 patients with tumor bulk less than 5 cm in diameter (small or no tumor bulk). The 5 year disease free survival rate were 71% in cases with tumor bulk less than 5 cm in diameter and 25% in cases with tumor bulk greater than 5 cm in diameter (p<0.01). But the initial stage was not related with treatment result in all cases or subgroups of cases. Thus the cases with small or no tumor bulk were shown to be curable with combined surgery and postoperative radiotherapy, but for the control of the cases with large tumor bulk that had a guarded prognosis combined radiotherapy and chemotherapy should be tried.
Disease-Free Survival ; Drug Therapy ; Humans ; Lymphoma, Non-Hodgkin* ; Prognosis ; Radiation Oncology ; Radiotherapy* ; Seoul ; Survival Rate

To assess the effect of postoperative radiotherapy on tumor recurrence and patient survival, 133 patients who received adjuvant postoperative radiotherapy for adenocarcinoma of the rectum were retrospectively analyzed. Sixty-one percent of the patients were in stage C2 by Astler-Coller staging system. A significant statistical difference was noticed in failure rates for lymph node negative vs lymph node positive patients;26%(9/35) vs 50%(49/98). The incidence of local failure was found to be strongly dependent on the pathologic stages; with 9%(3/35) of recurrence in stage B and 21% (21-98) in stage C. Distant metastasis has occurred in 29% (38/133) of the patients; 2% (7/35) in stage B and 32%(31-98) in stage C. The actuarial Survival at 3 years for patients in stage B2, stage C1, and stage C2, were 78%, 47%, and 38%, respectively. In conclusion, the postoperative adjuvant radiotherapy for rectal carcinoma appears to reduce local recurrence significantly.
Adenocarcinoma ; Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Radiotherapy* ; Radiotherapy, Adjuvant ; Rectal Neoplasms* ; Rectum ; Recurrence ; Retrospective Studies

BACKGROUND AND OBJECTIVES: The BNP concentration varies considerably after the onset of AMI, and this makes it difficult to determine the right time to measure the BNP as a valid prognostic marker. The aim of this study was to examine the early changing patterns of BNP and to decide on the suitable time for measuring the BNP as a prognostic marker after the onset of AMI. SUBJECTS AND METHODS: From Feb 2002 to May 2005, we analyzed the changing patterns of BNP in 321 AMI patients. BNP (Triage(R)) was measured at the acute phase (< or = 24 hr), the early phase (2 to 6 day), the late phase (1 to 4 week) & the long-term phase (>4 week) after the onset of AMI. The end points were major adverse cardiac events (MACE) and cardiovascular death (CVD). RESULTS: The mean BNP was 306.2+/-802.8 at the acute phase (mean: 9.5 hours), 251.9+/-592.8 at the early phase (mean: 5.1 days), 103.1+/-172.9 at the late phase (mean: 26.8 days) and 179.7+/-353.3 pg/mL at the long-term phase (mean: 45.9 days). There were no significant differences of the demographic factors between the MACE and Non-MACE group. Multivariative analysis showed that early phase BNP (p=0.007) and male gender (p=0.009) were significant risk factors for MACE. The early phase BNP (p=0.037) and age (p=0.022) were the significant risk factors of CVD. On the ROC curve, the early phase BNP for predicting the CVD risk was 186 pg/mL (AUC=0.87, p<0.001). The Kaplan-Meier survival curve showed that the survival rate was higher for the patients with an early phase BNP<186 pg/mL than it was for those patients with a BNP> or = 186 pg/mL (p=0.000). CONCLUSION: The early levels or changing patterns of the BNP concentrations following AMI showed different patterns of change depending on several prognostic factors. The early phase (2 to 6 day) BNP concentration after the onset of AMI could be used as a significant prognostic marker.
Demography ; Humans ; Male ; Myocardial Infarction* ; Natriuretic Peptide, Brain* ; Prognosis ; Risk Factors ; ROC Curve ; Survival Rate

BACKGROUND: This study was conducted to evaluate risk factors for infection and treatment outcome of bloodstream infection due to extended spectrum beta-lactamases(ESBL)-producing K. pneumoniae. METHODS: ESBL production was evaluated by NCCLS guidelines and/or double-disk synergy test in K. pneumoniae blood isolates stored from January, 1998 to April, 2002. Sixty patients with bloodstream infection due to ESBL-producing K. pneumoniae (case patients) were compared with 159 matched control patients with bloodstream infection of non-ESBL-producing K. pneumoniae. Retrospective case-control study was performed. RESULTS: There were no significant differences in age, sex, APACHE II score, and the primary site of infection between the case and control groups. In multivariate analysis, significant independent risk factors associated with bloodstream infection due to ESBL-producing K. pneumoniae were urinary catheterization, invasive procedure within previous 72 hours, and the number of antibiotics administered within previous 30 days. In clinical response at 72 hours after initial antibiotic treatment, complete response rate was higher in the controls (13.3% vs. 40.3%, respectively, P<0.001), however, treatment failure rate was higher in the cases (33.3% vs. 11.9%, respectively, P<0.001). Overall 7- day mortality rates in the cases and the controls were was 20% (12/60) and 15.7% (25/159) (P= 0.451), respectively, and overall 30-day mortality rates were 30% (18/60) and 24.5% (39/159), respectively (P=0.410). When the patients with bloodstream infection of ESBL-producing organism were evaluated and the patients who received inadequate definitive antibiotic treatment were excluded, delayed effective antibiotic treatment was found to be not associated with higher mortality. CONCLUSION: In patients infected with ESBL-producing K. pneumoniae bacteremia, clinical response rate at 72 hours after antimicrobial therapy was lower, but the increase of mortality rate was not significant. Delayed effective antibiotic treatment was not associated with higher mortality, when definitive appropriate antibiotic treatment was prescribed.
Anti-Bacterial Agents ; APACHE ; Bacteremia ; beta-Lactamases* ; Case-Control Studies ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Mortality ; Multivariate Analysis ; Pneumonia ; Retrospective Studies ; Risk Factors* ; Treatment Failure ; Treatment Outcome* ; Urinary Catheterization ; Urinary Catheters

BACKGROUND: This study was conducted to evaluate risk factors for infection and treatment outcome of bloodstream infection due to extended spectrum beta-lactamases(ESBL)-producing K. pneumoniae. METHODS: ESBL production was evaluated by NCCLS guidelines and/or double-disk synergy test in K. pneumoniae blood isolates stored from January, 1998 to April, 2002. Sixty patients with bloodstream infection due to ESBL-producing K. pneumoniae (case patients) were compared with 159 matched control patients with bloodstream infection of non-ESBL-producing K. pneumoniae. Retrospective case-control study was performed. RESULTS: There were no significant differences in age, sex, APACHE II score, and the primary site of infection between the case and control groups. In multivariate analysis, significant independent risk factors associated with bloodstream infection due to ESBL-producing K. pneumoniae were urinary catheterization, invasive procedure within previous 72 hours, and the number of antibiotics administered within previous 30 days. In clinical response at 72 hours after initial antibiotic treatment, complete response rate was higher in the controls (13.3% vs. 40.3%, respectively, P<0.001), however, treatment failure rate was higher in the cases (33.3% vs. 11.9%, respectively, P<0.001). Overall 7- day mortality rates in the cases and the controls were was 20% (12/60) and 15.7% (25/159) (P= 0.451), respectively, and overall 30-day mortality rates were 30% (18/60) and 24.5% (39/159), respectively (P=0.410). When the patients with bloodstream infection of ESBL-producing organism were evaluated and the patients who received inadequate definitive antibiotic treatment were excluded, delayed effective antibiotic treatment was found to be not associated with higher mortality. CONCLUSION: In patients infected with ESBL-producing K. pneumoniae bacteremia, clinical response rate at 72 hours after antimicrobial therapy was lower, but the increase of mortality rate was not significant. Delayed effective antibiotic treatment was not associated with higher mortality, when definitive appropriate antibiotic treatment was prescribed.
Anti-Bacterial Agents ; APACHE ; Bacteremia ; beta-Lactamases* ; Case-Control Studies ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Mortality ; Multivariate Analysis ; Pneumonia ; Retrospective Studies ; Risk Factors* ; Treatment Failure ; Treatment Outcome* ; Urinary Catheterization ; Urinary Catheters

BACKGROUND: The aim of this study was to determine whether the conventional subcostal approach is suitable for emergency pericardiocentesis in patients with cardiac tamponade or impending cardiac tamponade. METHODS: This study was a prospective, observational study conducted at the emergency department of a tertiary hospital. Patients who had symptomatic pericardial effusion and who needed emergency pericardiocentesis in the emergency department were included in this study. We measured the epicardium-to-pericardium distance at the subcostal, parasternal, and apical area with two-dimensional echocardiography to determine the appropriate puncture site for pericardiocentesis. An epicardium-to-pericardium distance of more than 1.0cm was considered as the primary safety factor in determining the puncture site for pericardiocentesis. The skin-to-pericardium distance was considered as secondary safety factor. RESULTS: Ninety-five consecutive patients(55 males and 40 females; total mean age: 53 year old) with cardiac tamponade or impending cardiac tamponade were enrolled in this study. The puncture site for pericardiocentesis, as determined by echocardiography, was the subcostal area in 43 patients(45%), the apical area in 40 patients(42%), the left parasternal area in 11 patients(12%), and the right parasternal area in one patient(1%). Pericardiocentesis failed in 2 patients(2%) with the subcostal approach and in one patient(1%) with the apical approach. The average epicardium-to-pericardium distance was 31+/-21mm in patients with the subcostal approach and 21+/-8mm in patients with other approaches. There were no differences in the amount of pericardial fluid and in the intrapericardial pressure among patients groups according to puncture site. There were two procedure related complications: a puncture of the right ventricle with the subcostal approach and a ventricular tachycardia with the apical approach. CONCLUSION: The puncture site for emergency pericardiocentesis should be determined by using two-dimensional echocardiography because approaches from other areas can be safer than the subcostal approach.
Cardiac Tamponade ; Echocardiography ; Emergencies* ; Emergency Service, Hospital ; Female ; Heart Ventricles ; Humans ; Male ; Observational Study ; Pericardial Effusion ; Pericardiocentesis* ; Prospective Studies ; Punctures ; Tachycardia, Ventricular ; Tertiary Care Centers

No abstract available.
Animals ; Dogs* ; Heart* ; Heart-Lung Transplantation*

BACKGROUND AND OBJECTIVES: Plasma B-type natriuretic peptide (BNP) can be increased in patients with renal insufficiency (RI). The aim of this study was to evaluate the diagnostic value of BNP for systolic heart failure (HF) in patients with moderate to severe RI. SUBJECTS AND METHODS: Between Aug 2002 and May 2004, 433 patients found to have systolic HF or moderate to severe RI were included. The patients were divided into 3 groups (group I; only HF, group II; only RI, group III; HF and RI). The severity of RI was graded according to the calculated creatinine clearance (Ccr); moderate 30< or =Ccr<60, severe 15< or =Ccr<30 or end stage renal disease (ESRD) Ccr<15 mL/min. RESULTS: The mean age of the patients was 67.6+/-12, and 49% were male. There were significant differences in the mean BNP levels between group III and the other two groups (p<0.001); group I (n=65, 837.3+/-884), group II (n=137, 1049.4+/-1332) and group III (n=231, 1738.3+/-1501 pg/mL). A weak negative correlation was note between BNP and Ccr (r=-0.335, p<0.001) in patients with RI. As the renal function deteriorated, the mean BNP of groups II and III was found to be elevated (moderate 625.5+/-574, 1183.0+/-1056; severe 760.5+/-1211, 2205.4+/-1470; ESRD 2157.6+/-1831, 3209.9+/-1900 pg/mL, p<0.05), with the mean BNP of group III being higher than that of group II for each grade (p<0.05). From the ROC curve, the optimal cut-off point of BNP for the diagnosis of systolic HF in patients with RI was 829 pg/mL (accuracy 68%, sensitivity 66% and specificity 70%, p<0.001). CONCLUSION: In the case of patients with moderate to severe RI, a higher BNP cut-off point for the diagnosis of systolic HF and a relatively lower diagnostic accuracy of BNP should be considered.
Creatinine ; Diagnosis ; Heart Failure ; Heart Failure, Systolic* ; Humans ; Kidney Failure, Chronic ; Male ; Natriuretic Peptide, Brain ; Plasma ; Renal Insufficiency* ; ROC Curve ; Sensitivity and Specificity

Enteroviruses are the most common agents of myocarditis and have been implicates in the pathogenesis of dilated cardiopmyopathy. There are still discrepancies in the association of enterovirus and myocardial disease, partially due to lack of data on detection of virus antigen or viral culture in the tissue. For the treatment of fulminant myocarditis, aggressive hemodynamic support is warranted because of its excellent long-term prognosis. This 16 year-old girl was admitted because of anterior chest pain for a day. She had flu-like symptoms such as fever, sore throat and cough at 2 weeks ago. Electrocardiogram showed sinus tachycardia and ST segment elevations in lead II, III, aVF and V1-V4. Troponin T was positive and creatinine phosphokinase was elevated (1323 IU/L) at emergency room. On emergency echocardiogram, inferior wall motion was decreased and the ejection fraction (EF) was 70%. Coronary angiogram showed no thrombus and no significant stenosis in coronary artery, and spasm was not induced with ergonovine. Conventional treatment for congestive heart failure with digoxin (0.25 mg daily) and furosemide (20 mg t.i.d) was started under the impression of myocarditis. On the first hospital day, pulmonary edema and signs of shock were developed. The whole left ventricular(LV) wall motion were markedly decreased and EF was less than 20% on echocardiogram. Despite of intra-aortic balloon pump (IABP) for 4 hours, shock and pulmonary edema was progressed. Mechanical circulatory support was started with left ventricular assist device (LVAD, Bio-pump, Medtronic Bio-Medicus, USA). At the time of operation, central venous pressure was 24cmH20, systolic blood pressure was 75mmHg, left atrium(LA) and LV was dilated and the whole wall of LV showed almost akinesia , and LA appendage was biopsied. After 126 hours of LVAD, LV wall motion was restored and EF was 79% on echocardiogram. LVAD was removed 10 days after operation and she was discharged on 23 days of hospitalization without any heart failure symptoms. Immunohistochemistry of LA showed enteroviral VP1 capsid protein (primary antibody; NoVo Castra Laboratory, UK) over the entire LA wall. Her serum neutralized coxsackievirus B3 (CVB3, H3 variant of Woodruff strain) in neutralization test using horse anti-CVB3 (Nancy strain) antibody (ATCC, V030-501-560) as a positive control. The titer of neutralization Ab in her serum of 21 days increased more than 4 times than that of 2 days.
Adolescent ; Blood Pressure ; Capsid Proteins ; Cardiomyopathies ; Central Venous Pressure ; Chest Pain ; Constriction, Pathologic ; Coronary Vessels ; Cough ; Creatinine ; Digoxin ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Enterovirus ; Ergonovine ; Female ; Fever ; Furosemide ; Heart Failure ; Heart-Assist Devices* ; Hemodynamics ; Horses ; Hospitalization ; Humans ; Immunohistochemistry ; Myocarditis* ; Neutralization Tests ; Pharyngitis ; Prognosis ; Pulmonary Edema ; Shock ; Spasm ; Tachycardia, Sinus ; Thrombosis ; Troponin T