A 50-year-old female was referred to our clinic with visual disturbance, hyphema and increased intraocular pressure (IOP) in her right eye 7 days after experiencing blunt trauma in that eye. She had undergone uncomplicated laser in situ keratomileusis (LASIK) on both eyes 10 years earlier. At initial examination, the best corrected visual acuity (BCVA) in her right eye was counting fingers at 2 feet with no correction. Central Goldmann applanation tonometry (GAT) showed an IOP of 7 mm Hg. Peripheral digital tonometry showed the IOPs in her right eye superiorly, nasally, temporally, and inferiorly were 36 mm Hg, 35 mm Hg, 34.5 mm Hg and 36.5 mm Hg, respectively. Slit-lamp examination showed diffuse epithelial and stromal edema and a blood clot 1 mm in height in the anterior chamber. Spectral domain scanning laser ophthalmoscope/optical coherence tomography (SD-SLO/OCT) images showed a pocket of fluid between the LASIK flap and the underlying stroma. The patient was started on anti-inflammatory agent and IOP lowering agents. After 15 days of treatment, IOP measured with GAT was 10 mm Hg, slit-lamp examination showed that epithelial and stromal edema had disappeared, and OCT showed no fluid between the corneal flap and stroma.
Anterior Chamber ; Edema ; Female ; Fingers ; Foot ; Humans ; Hyphema* ; Intraocular Pressure ; Keratomileusis, Laser In Situ* ; Manometry ; Middle Aged ; Visual Acuity

OBJECTIVES: A healthcare decision-making support model and rule management system is proposed based on a personalized rule-based intelligent concept, to effectively manage chronic diseases. METHODS: A Web service was built using a standard message transfer protocol for interoperability of personal health records among healthcare institutions. An intelligent decision service is provided that analyzes data using a service-oriented healthcare rule inference function and machine-learning platform; the rules are extensively compiled by physicians through a developmental user interface that enables knowledge base construction, modification, and integration. Further, screening results are visualized for the self-intuitive understanding of personal health status by patients. RESULTS: A recommendation message is output through the Web service by receiving patient information from the hospital information recording system and object attribute values as input factors. The proposed system can verify patient behavior by acting as an intellectualized backbone of chronic diseases management; further, it supports self-management and scheduling of screening. CONCLUSIONS: Chronic patients can continuously receive active recommendations related to their healthcare through the rule management system, and they can model the system by acting as decision makers in diseases management; secondary diseases can be prevented and health management can be performed by reference to patient-specific lifestyle guidelines.
Chronic Disease* ; Decision Support Systems, Clinical ; Delivery of Health Care* ; Expert Systems ; Health Records, Personal ; Humans ; Knowledge Bases ; Life Style ; Mass Screening ; Self Care

OBJECTIVES: Brain transplantation has emerged as an effective treatment for patients suffering from neurodegenerative diseases, including Parkinson's disease, Huntingtons disease and Stroke. We evaluated that cytokine inducted human mesenchymal stem cells (Ci-hMSCs) transplanted in brain differentiated into neural cells and improved neurological functions after stroke in rats. MATERIALS AND METHODS: In the adult female Sprague-Dawley rats, ischemic lesion was induced by transient MCA occlusion lasted for 2 hours. One day later, Ci-hMSCs carrying LacZ gene were implanted via tail vein. The animals were assessed for sensorymotor function and sacrificed for Immunohistochemical staining at 7, 14, 28, 56 days after transplantation. RESULTS: A large number of X-gal positive hMSCs were observed in the ischemic core and ischemic boundary zone. Some hMSCs were reactive for the astrocytic marker - glial fibrillary acidic protein (GFAP) and neuronal marker - neuronal nuclear antigen (NeuN). The ischemic rats that were transplanted with Ci-hMSCs exhibited better functional improvement than control groups and the rats with hMSCs, which was statistically significant. CONCLUSION: The neuronal differentiation of CihMSCs suggested that transplantation of the Ci-hMSCs may provide the possibility of the clinical implication for cerebral stroke.
Adult ; Animals ; Brain ; Female ; Glial Fibrillary Acidic Protein ; Humans* ; Lac Operon ; Mesenchymal Stromal Cells* ; Models, Animal* ; Neurodegenerative Diseases ; Neurons ; Parkinson Disease ; Rats* ; Rats, Sprague-Dawley ; Stroke ; Veins

Between March 1994 and March 1995, 10 patients with thoracolumbar burst fractures underwent a one-stage operation consisting of anterior decompression, reduction, bony fusion with iliac bone and stabilization with Kaneda device. The mean follow-up was 6.4 Months. Most patients with incomplete neurologic lesions showed postoperative improvement and were upgraded one or two steps in the Frankel scale. No patient showed neurological deterioration after surgery. Loss of reduction was 5.5 degree during follow-up period. Anterior decompression and strut fusion was used to effectively recover the neurological deficit and reduce the pain in a thoraco-lumbar burst fracture.
Decompression ; Follow-Up Studies ; Humans

Colorectal cancer is extremely rare in children. Unlike adult colorectal cancer, the overall prognosis of colorectal cancer in children is poor. Delayed diagnosis, advanced stages of the disease at presentation, and mucinous type of histology are the major determinants of poor outcome in childhood. A 13-year-old boy with abdominal pain visited our hospital. Physical examination andabdominal ultrasonography identified acute appendicitis with perforation. He underwent appendectomy and then the pathologic findings revealed mucinous adenocarcinoma. The cancer was located at the transverse colon and had metastases on peritoneal wall at 2nd laparotomy. Extended right hemicolectomy was performed. He underwent palliative chemotherapy. After 4 months later, hepatic metastasis and aggravated peritoneal seedings developed. He died of renal failure and pneumonia 13 months after operation. We need to have a high index of suspicion for the possibility of a malignant colorectal tumor in any childhood case with nonspecific signs and symptoms.
Abdominal Pain ; Adenocarcinoma, Mucinous ; Adolescent ; Adult ; Appendectomy ; Appendicitis ; Child ; Colon ; Colon, Transverse ; Colonic Neoplasms ; Colorectal Neoplasms ; Delayed Diagnosis ; Humans ; Laparotomy ; Mucins ; Neoplasm Metastasis ; Physical Examination ; Pneumonia ; Prognosis ; Renal Insufficiency ; Seeds

Pulmonary epithelioid hemangioendothelioma (PEH) is a rare, low-to-intermediate malignant tumor of endothelial origin. Computed tomography (CT) findings of PEH demonstrate multiple small bilateral nodules; however, to the best of our knowledge, there were no reports on PEH coexisting with other malignancies. Here, we reported on a case involving PEH in a patient with colon cancer and breast cancer which was misconceived as pulmonary meta-stasis. A 63-year-old woman who suffered from constipation for 2 weeks visited our hospital. Colonoscopy showed a large mass with obstruction on hepatic flexure. The histological diagnosis was adenocarcinoma of the ascending colon. Multiple nodules in both lungs and breast were observed on a chest CT scan. A core biopsy of a breast nodule was performed and a diagnosis of invasive ductal carcinoma of the left breast was made. Pulmonary nodules observed on the chest CT scan was considered as pulmonary metastasis from colon or breast cancer. Laparoscopic right hemicolectomy was performed. At the same time, wedge resection of the lung was performed and pathological diagnosis was PEH. Radiologic features of PEH were difficult to distinguish from lung metastasis. Therefore the author reported a rare case involving PEH in a patient with primary malignancy of colon and breast.
Adenocarcinoma ; Biopsy ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Colon ; Colon, Ascending ; Colonic Neoplasms ; Colonoscopy ; Constipation ; Diagnosis ; Female ; Hemangioendothelioma ; Hemangioendothelioma, Epithelioid* ; Humans ; Lung ; Middle Aged ; Neoplasm Metastasis* ; Tomography, X-Ray Computed

BACKGROUND: Several studies have been conducted on the role of the p63 gene family in non-small cell lung carcinoma (NSCLC). Nevertheless, the role of these genes in the development and progression of NSCLC remains controversial. This study was designed to examine the expression and clinicopathologic significance of the p63 family in NSCLC. METHODS: Immunohistochemical staining was performed on 92 cases of NSCLC (47 squamous cell carcinomas [SqCCs] and 45 adenocarcinomas [ACs]) using tissue microarray blocks. The results were analyzed and correlated with clinicopathologic data. RESULTS: The expression of delta Np63 (Delta Np63) was elevated in SqCC (39/47), but not in AC (2/45; p<0.01). Both p63 and Delta Np63 had high expression in 39 SqCCs; p63 and Delta Np63 also had a similar geomorphologic distribution in most positive tumors. The expression of Delta Np63 was correlated with histologic type, gender, pT stage, p53 expression, and p63 expression. pT and pN stages were independent factors in survival (p<0.05, respectively). CONCLUSIONS: The major p63 isoform in NSCLC, Delta Np63, had a strong correlation with p53 and p63, and was exclusively expressed in SqCC. However, our findings suggest that Delta Np63 was not an independent prognostic factor for NSCLC.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Humans ; Immunohistochemistry ; Lung

OBJECTIVE: Endodermal sinus tumor or yolk sac tumor is an uncommon malignant germ-cell neoplasm. This tumor was originally described as a germ cell tumor of the ovary or the testis. Intracranial endodermal sinus tumor is extremely rare and usually develop in the pineal or suprasellar regions. The authors evaluated the effect of adjuvant therapy(chemotherapy combined with radiotherapy) and radical removal of intracranial endodermal sinus tumors. MATERIAL AND METHODS: Between 1996 and 2001, four patients of intracranial endodermal sinus tumor were diagnosed with tumor marker(AFP) and biopsy. Three patients were treated with surgical removal and chemotherapy with cisplatin(20mg/m2), etoposide(100mg/m2) and bleomycin(15mg/m2) as well as external beam radiation therapy. We compared the management problems for these tumors. RESULT: In all three patients the tumor size and the level of tumor marker decresed during initial adjuvant therapy. However, Tumors showed regrowth with elevated AFP of serum and CSF possibly related to delayed chemotherapeutic treatment or inadequate administration of chemotherapeutic drugs due to severe bone marrow suppression. An additional chemotherapy and external radiation therapy were given, but tumors could not be controlled with leptomeningeal seeding. CONCLUSION: Radiotherapy is considered to be less effective. The combination chemotherapy with PVB(cisplatin, vinblastine, bleomycine) or PE(cisplatin, etoposide) is considered to be value in prolongation of the survival rate. But the role of chemotherapy in this tumor has not yet been clarified due to bone marrow suppression and drug resistance. Further study with large series of this tumor is necessary to establish the optimal management.
Biopsy ; Bone Marrow ; Drug Resistance ; Drug Therapy ; Drug Therapy, Combination ; Endoderm* ; Endodermal Sinus Tumor* ; Female ; Humans ; Neoplasms, Germ Cell and Embryonal ; Ovary ; Radiotherapy ; Survival Rate ; Testis ; Vinblastine

Congenital anomalies of the coronary artery are associated with various symptoms including syncope, myocardial ischemia, and sudden cardiac death. The abnormality depends on the adjacent structure and pathway of the coronary artery. Most patients with an anomalous left coronary artery that arises from a right coronary sinus of the valsalva have no symptoms and are usually diagnosed at autopsy. Therefore, their first symptom might present as sudden death, particularly when the left coronary arterial course is between the aorta and the pulmonary trunk. Symptomatic patients could be diagnosed early with an anomalous coronary artery, and the risk of fatal events could be decreased by surgical correction. Here, we report the case of 62-year-old male who experienced a first episode of syncope with an anomalous left coronary artery arising from the right sinus of the valsalva with a separate orifice from the right coronary artery. He is alive and in good health receiving medical treatment, and has had no medical events for over 2 years.
Aorta ; Autopsy ; Coronary Sinus ; Coronary Vessel Anomalies ; Coronary Vessels* ; Death, Sudden ; Death, Sudden, Cardiac ; Humans ; Male ; Middle Aged ; Myocardial Ischemia ; Sinus of Valsalva ; Syncope*

PURPOSE: Disturbance in normal cell cycles by cell cycle control factors is an important process of cancer carcinogenesis. The aims of this dissertation were identify the influence of cyclin B1 and D1 on the growth and expression of gastric cancer and their effects on the prognosis. METHOD: The subjects were 128 patients selected from those who underwent gastric surgery for their gastric cancer between January 1995 and December 1998. Immunohistochemical staining was conducted for cyclin B1 and D1 using paraffin embedded tissues, followed by analysis of their protein expressions, possible prognostic factors and survival rate. RESULTS: Cyclin B1 expression was founded in 48 of the 128 patients (37.5%), and that of cyclin D1 in 96 (75%). Both cyclin B1 and D1 showed no statistical significance with T-stage, location of tumors or histologic types. However, for the case of any significance with lymph node metastasis, the higher the N-stage, the greater was the expression of cyclin B1 (P=0.014). For the case of any significance with life term, the Kaplan-Meier method showed the greater the expression of cyclin B1, the shorter the life term (P=0.042). CONCLUSION: An association was indicated between cyclin B1 and lymph node metastasis in gastric cancer, but has no relation with the T-stage, histologic type or location of tumors. Cyclin D1 shows no association with lymph node metastasis, T-stage, histologic type or location of tumors. However, cyclin B1 showed a significant association with the survival rate.
Carcinogenesis ; Cell Cycle ; Cell Cycle Checkpoints ; Cyclin B1* ; Cyclin D1 ; Cyclins* ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Paraffin ; Prognosis ; Stomach Neoplasms* ; Survival Rate*