BACKGROUND: This study was designed to review the cases of patients who had undergone diffusionweighted magnetic resonance imaging(DWI) in the emergency department(ED), and to investigate its clinical usefulness and current indications. METHODS: We analyzed the cases of 152 consecutive patients who underwent DWI in the ED from Jan to Mar 2001. DWI was obtained with the use of a multislice, single-shot, spin-echo plana imaging technique(GE Signa(R)). Imaging time was less than one minute. The medical records, the DWI films and the computed tomography results were reviewed. We investigated the chief complaint, initial findings of physical examination, final diagnosis, decision-making department, interval from admission to imaging, and DWI findings. RESULTS: DWI showed positive findings of high signal intensity in 84 patients(55.3%). Among the 68 patients who yielded a negative result, false negative occurred with 12 patients(17.6%): 10 lacunar infarctions, a pons infarction, and a brainstem infarction. Eleven patients were determined as having a cerebral hemorrhage, all of whom showed the abnormal finding of a mixed signal in DWI. The sensitivity and the specificity of DWI to rule out stroke were 85.5% and 98%, respectively. Current indications for DWI in our ED are age older than 60, alert mental status, and one of the symptoms or signs among lateralyzing sign, language disturbance, and dizziness/vertigo. CONCLUSION: DWI was highly specific to rule out stroke, so emergency care professionals should be familiar with this new technology. Further prospective study is required to determine the proper indications and clinical usefulness of DWI in the ED.
Brain Stem Infarctions ; Cerebral Hemorrhage ; Diagnosis ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Medical Records ; Physical Examination ; Pons ; Sensitivity and Specificity ; Stroke ; Stroke, Lacunar

OBJECTIVES: Since Mountain proposed the new staging system of non-small cell lung cancer in 1986, the indications for operation of NSCLC have been extended. However, operative mortality is from 3 to 6%. Therefore it is important to reduce unnecessary operation and to evaluate unresectability of tumor correctly, preoperatively The purpose of this study is to find out the causes of unresectability in patients who were initially thought to be resectable preoperatively. METHODS: By retrospective analysis, 64 patients out of 291 NSCLC patients who were undergone operation for curative resection in Seoul National University Hospital from Jan. of 1987 to Dec. of 1991, ware found to be unresectable at operating roost were selected for this study. Out of 64 patients,42 were evaluable. The analysis was focused on the change of pre- & post-operative staging and the causes of unresectability of tumors. RESULTS: Among B2 patients with unresectable tumor who could be evaluated, preoperative CT finding showed resectable tumors in 55% (23 patients) and suspicious for unresectable tumors in 45% (19 patients). The causes of unresectability were technically unresectable T3 lesions in 7% (3 patients), T4 lesions in 62% (26 patients), N2 lesions in 17% (7 patients) and N3 lesions in 14% (6 patients). CONCLUSION: The major causes of unresectability of NSCLC were pulmonary artery invasions. It is suggested that careful evaluation of mediastinal structure, especially great vessels by additional imaging technique other than CT (like MRI) is indicated in selected NSCLC cases.
Carcinoma, Non-Small-Cell Lung* ; Humans ; Mortality ; Pulmonary Artery ; Retrospective Studies ; Seoul

PURPOSE: To evaluate the quality of the emergency medical care during doctors' strike at a hospital in Korea. METHODS: During a period of 7 consecutive days, from 20th to 26th June 2000, the training physicians in Korea were on strike against medical reform and the emergency medical care was provided by medical staffs without training physicians. We drew out convenient samples by systematic allocation method and reviewed the medical records. We evaluated the patients' severities, the number of diagnostic tests and therapeutic procedures, the admission rates, and the lengths of stay at emergency department(ED) in the strike period(SP) compared to control period(NSP) from 20th to 26th June, 1999. RESULTS: The two groups(SP: 191 vs NSP: 202 patients) showed significant differences in the proportion of emergent patients(17.3 vs 32.7%), ED length of stay(1.98 vs 4.47 hours), the number of diagnostic tests(1.47 vs 3.92), the injection rates(17.3 vs 35.1%), and the adverse event rates(4.5 vs 6.5%). CONCLUSION: This study suggested that the ED administration by medical staffs without training physicians improves medical quality of emergency care.
Diagnostic Tests, Routine ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Humans ; Korea ; Medical Records ; Medical Staff ; Strikes, Employee*

PURPOSE: Diffusion-weighted magnetic resonance imaging (DWI) has been known to visualize hyperacute ischemic stroke. And it takes only a few minutes to do. Moreover only a small amount of time and little cost is required to add T2-weighted imaging (T2WI) to DWI. The purpose of this study is to determine the usefulness of T2WI in addition to DWI as a primary imaging modality for patients with suspected ischemic stroke. METHODS: DWI plus T2WI was performed from January to May 2001 on the patients with suspected ischemic stroke. Two emergency physicians reviewed the films and medical records. The sensitivity and the specificity of DWI and T2WI for acute ischemic stroke were calculated. The agreement between DWI and T2WI was calculated using kappa statistics. RESULTS: A total of 241 patients were enrolled. Acute ischemic stroke was confirmed in 86 (35.7%) patients. The sensitivity and the specificity of DWI for acute ischemic stroke were 94.2% and 98.7%, and those for T2WI were 60.5% and 94.2%, respectively. The kappa value was 0.721 (p<0.01). Among the 86 acute ischemic stroke patients, the number of cases who presented less than 6 hours after symptom onset was significantly lower in the T2WI positive group (31% vs. 68.7%, p<0.05). CONCLUSION: This study suggests that the addition of T2WI to DWI as a primary imaging modality for acute ischemic stroke has little benefit compared to DWI alone, especially, when the symptom duration has been less than 6 hours.
Emergencies ; Humans ; Magnetic Resonance Imaging* ; Medical Records ; Sensitivity and Specificity ; Stroke*

Primary squamous cell carcinoma of the colon is very rare and its incidence is 0.025% to 0.05% among all colon cancers. We report a case of primary squamous cell carcinoma of the sigmoid colon in a 65year-old man. He had bowel habit change and hematochezia for 3 months. Colonoscopy with biopsy and left inguinal lymph node biopsy revealed squamous cell carcinoma. We confirmed the diagnosis of primary squamous cell carcinoma of the sigmoid colon with lymph node metastasis by diagnostic criteria. The patient was discharged against advice and expired.
Biopsy ; Carcinoma, Squamous Cell* ; Colon ; Colon, Sigmoid* ; Colonic Neoplasms ; Colonoscopy ; Diagnosis ; Gastrointestinal Hemorrhage ; Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis

Superficial siderosis of the central nervous system(SSCNS) is a rare disease characterized by hemosiderin deposition on the surface of the central nervous system. We report a case of SSCNS originating from the thoracic spine, presenting with neurological deficits including, sensorineuronal hearing loss, ataxia, and corticospinal and dorsal column tract signs. The patient underwent dural repair with an artificial dural patch. Clinical findings were elicited by neurological examination, imaging studies, and intraoperative findings, and these were addressed through literature review.
Ataxia ; Central Nervous System* ; Hearing Loss ; Hemosiderin ; Humans ; Neurologic Examination ; Rare Diseases ; Siderosis* ; Spine*

Methotrexate (MTX) has been widely used in the treatment of psoriasis and rheumatoid arthritis. But prolonged use of MTX can induce hepatic fibrosis and even cirrhosis. To date, in Korea, there have been very few reports on hepatotoxicity due to MTX, and no report on biopsy-proven chronic active hapatitis. We report one patient who developed chronic acitve hepatitis while taking long-term daily dose of MTX(10mg per day) for psoriasis for a prolonged period.
Arthritis, Rheumatoid ; Fibrosis ; Hepatitis ; Hepatitis, Chronic* ; Humans ; Korea ; Methotrexate* ; Psoriasis*

OBJECTIVES: Visualization of the left atrial appendage(LAA) by the transesophageal echocardiography(TEE) is excellent, but it is difficult to visualize the LAA by the modified parasternal short-axis view(MPSA) in transthoracic echocardiography(TTE). We studied to determine the usefulness of the apical horizontal view(AHV) abtained by the apical rotation method of the transducer for the detection of the LAA. METHODS: We studied the MPSA and AHV in 602 patients, The LAA was observed during diastole of the LAA. We obtained an apical horizontal view by 45 degree clockwise rotation of the transducer from the apical 2 chamber view and compared with the visualization of the LAA in AHV and MPSA. RESULTS: Among 602 patients, LAA could not be visualized in 88(14.6%) because of a poor echo-window. LAA was more clearly visualized in 222 patients by the AHV than the MPSA and 56 patients by the MPSA than the AHV. LAA was same degree visualization in patients by the AHV and MPSA. In male and female, more than 55 ages and less than 55 ages, visualization of inner margin of the LAA by the AHV was more clear than by the MPSA. CONCLUSION: The AHV was a useful, noninvasive and reproducible method for the visualization of the LAA.
Atrial Appendage* ; Diastole ; Female ; Humans ; Male ; Transducers*

Mortality associated with human breast carcinoma is almost entirely due to subsequent cancer metastasis, but the molecular basis of this metastasis is not well established. The nm23 gene was originally identified by differential hybridization between two murine melanoma cell sublines which have low and high metastatic potential, and located in chromosome 17q22. This gene has been known to be involved in the metastasis of several cancers and its down-regulation usually associated with metastasis or disease progression in breast cancer. Tumor angiogenesis, the process leading to the formation of new vessels, plays a central role in tumor progression and distant metastasis. It is implicated in the phenomenon of dormant micrometastasis. This study was designed to determine the prognostic value of expression of the nm23 protein and tumor angiogenesis in breast cancer. Also, these two factors were compared with established clinicopathological prognostic factors and hormone receptors. 118 paraffin embedded surgical specimens of breast cancer were obtained from March, 1988 to February, 1994 and were selected for study. The expression of nm23 protein was studied by using immunohistochemical staining with anti-nm23/nuclear diphosphate kinase A. Tumor angiogenesis was quantified under light microscope by counting of the tumor microvessels(MVC) which were highlighted with anti-CD31 antibodies. The patient were allocated into two groups by mean number of MVC, one group was less 42 and the other was over 42. All the patients were female. The nm23 protein expression was positive in 74(63%) cases and was negative in 44(37%) cases. There was a significant correlation between nm23 protein expression and histologic grade(p=0.023). Positive expression of nm23 protein was correlated with positive estrogen(p=0.031) and progesterone receptors(p=0.001). Also Positive expression of nm23 protein was correlated with longer disease free survival(p=0.0026) and overall survival(p=0.0048). The group of MVC<42 showed better survival in overall(p=0.0195) and disease free survival(p=0.0014) than the other group of MVC>42. But the MVC and established clinicopathological prognostic factors did not show any correlation, neither with hormone status. When the nm23 protein and angiogenesis were considered together, 50 cases of negative nm23 protein and MVC<42 showed the best survival in overall(p=0.0111) and disease free survival(p=0.0114) among the four groups of each combination. In conclusion, the expression of nm23 protein and tumor angiogenesis can be used as new prognostic factors in conjunction with established other prognostic factors.
Antibodies ; Breast Neoplasms* ; Breast* ; Disease Progression ; Down-Regulation ; Female ; Humans ; Melanoma ; Mortality ; Neoplasm Metastasis ; Neoplasm Micrometastasis ; Paraffin ; Phosphotransferases ; Progesterone

A radioresistant cell line was established by fractionated ionizing radiation (IR) and assessed by a clonogenic assay, flow cytometry, and Western blot analysis, as well as zymography and a wound healing assay. Microarray was performed to profile global expression and to search for differentially expressed genes (DEGs) in response to IR. H460R cells demonstrated increased cell scattering and acidic vesicular organelles compared with parental cells. Concomitantly, H460R cells showed characteristics of increased migration and matrix metalloproteinase activity. In addition, H460R cells were resistant to IR, exhibiting reduced expression levels of ionizing responsive proteins (p-p53 and gamma-H2AX); apoptosis-related molecules, such as cleaved poly(ADP ribose) polymerase; and endoplasmic reticulum stress-related molecules, such as glucose-regulated protein (GRP78) and C/EBP-homologous protein compared with parental cells, whereas the expression of anti-apoptotic X-linked inhibitor of apoptosis protein was increased. Among DEGs, syntrophin beta 2 (SNTB2) significantly increased in H460R cells in response to IR. Knockdown of SNTB2 by siRNA was more sensitive than the control after IR exposure in H460, H460R, and H1299 cells. Our study suggests that H460R cells have differential properties, including cell morphology, potential for metastasis, and resistance to IR, compared with parental cells. In addition, SNTB2 may play an important role in radioresistance. H460R cells could be helpful in in vitro systems for elucidating the molecular mechanisms of and discovering drugs to overcome radioresistance in lung cancer therapy.
Apoptosis ; Blotting, Western ; Cell Line* ; Endoplasmic Reticulum ; Flow Cytometry ; Humans* ; Lung Neoplasms* ; Lung* ; Matrix Metalloproteinases ; Neoplasm Metastasis ; Organelles ; Parents ; Radiation, Ionizing ; RNA, Small Interfering ; Wound Healing ; X-Linked Inhibitor of Apoptosis Protein