Colorectal carcinoma in patients under 40 years and over 70 years of age is unusual but not rare. The prognosis of these two groups, compared with remainder of patients, is thought to be unfavorable. From Jan. 1981 to Dec. 1997, 541 patients with primary colorectal cancer who were treated by surgical resection were analyzed retrospectively. They were divided into three age groups according to the age at admission, i.e. under 40 years, over 70 years and between 40 and 69 years(control group). Among three age groups, sex ratio, tumor characteristics(size, location , depth of invasion, lymph node metastasis, liver metastasis, peritoneal metastasis, histopathologic classification, stage, DNA ploidy pattern), serum CEA level and survival were compared and analyzed. The results were as follows: 1) In the young patient group(52 cases), female predominence, large tumor size, high proportion of mucinous adenocarcinoma in histopathologic classification, more frequent metastasis to regional lymph node, frequent peritoneal metastasis and high incidence in tumor location at transverse colon were noted(p<0.05). 2) In the elderly group(69 cases), deep invasion of tumor(T4) was noted (p<0.05). In addition, among them, concomittent diseases were presented in 25 patients(36%). They were diabetes(8), cardiac arrhythmia(4), old myocardial infarction(2), liver cirrhosis(5), COPD(3), previous cancer(3). 3) The 5-year survival rates of the young patient group and that of elderly patient group were lower than that of the other(p<0.01). 4) There was no significant differences in liver metastasis, tumor stage, DNA ploidy pattern, serum CEA level among three age groups.
Adenocarcinoma, Mucinous ; Aged* ; Classification ; Colon, Transverse ; Colorectal Neoplasms* ; DNA ; Female ; Humans ; Incidence ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Ploidies ; Prognosis ; Retrospective Studies ; Sex Ratio ; Survival Rate

Reactive airways dysfunction syndrome (RADS) is a syndrome as a persistent bronchial hyperreactivity with asthmatic dyspnea which occurs after one or more inhalation exposures to a high concentration of irritant gasses, smokes or vapors in subjects who had preciously had no respiratory disease. We report a case of a 34 years old female worker suffering from reactive airways dysfunction syndrome who had been taking charge of guest room cleaning at a condominium. 7 months before, she inhaled high concentration of chlorine gas in confined and poor ventilated working space of bathroom at the condominium. As she was washing a bathroom with a bleaching agent (6 % sodium hypochlorite) without dilution, dyspnea, dizziness, headache, nausea, and coughing developed after work. She still suffer from dyspnea and coughing. All functional tests were normal except for methacholine challenge test which reveals bronchial hyperreactivity. She has some symptoms of dyspnea and coughing when exposed to perfume, cold air, and heavy work.
Adult ; Bronchial Hyperreactivity ; Chlorine* ; Cough ; Dizziness ; Dyspnea ; Female ; Headache ; Humans ; Inhalation Exposure ; Methacholine Chloride ; Nausea ; Perfume ; Smoke ; Sodium

No abstract available.
Follow-Up Studies* ; Pneumonectomy*

Sildenafil citrate (Viagra(R); Pfeizer US Pharmaceutical Group, New York, NY, USA) is a potent vasodilating agent to treat male erectile dysfunction. Among its adverse effects, hemorrhagic stroke has not been widely reported yet. We present a case of a 33-year-old healthy man who ingested 50 mg sildenafil a half hour before onset of headache, nervousness and speech disturbance. Head computed tomogram of this stuporous man showed huge intracerebral hemorrhage and thick subarachnoid hemorrhage, but angiography failed to disclose any vascular anomalies. Subsequent surgical procedure was followed, and rehabilitation was provided thereafter. Sildenafil seems to act by redistributing arterial blood flow, and concurrent sympathetic hyperactivity, which lead to such hemorrhagic presentation. Extreme caution should be paid on even in a young adult male patient wven without known risk factors.
Adult ; Angiography ; Anxiety ; Cerebral Hemorrhage ; Citric Acid ; Eating ; Erectile Dysfunction ; Head ; Headache ; Hematoma ; Humans ; Male ; New York ; Piperazines ; Purines ; Risk Factors ; Stroke ; Stupor ; Subarachnoid Hemorrhage ; Sulfones ; Young Adult ; Sildenafil Citrate

In order to ascertain the role of TNF-alpha in pulmonary tuberculosis, we determined the TNF-alpha productivity of alveolar macrophages(AMs) obtained by bronchoalveolar lavage(BAL), along with the level of TNF-alpha in the serum of patients with tuberculosis including pulmonary, miliary, and endobronchial tuberculosis, healthy controls, and pulmonary diseases such as diffuse interstitial lung disease (DILD) and pneumonia. AMs from patients with pulmonary tuberculosis did not produce a larger amount of TNF-alpha than did those from the healthy control subjects. However, among the patients with pulmonary tuberculosis, the AMs from the fresh and reactivated groups produced a larger amount of TNF-alpha than those from the inactive group. AMs from patients showing positivity in culture produced a larger amount of TNF-alpha than those showing negativity. The average level of serum TNF-alpha in patients with pulmonary tuberculosis was slightly higher than that of the healthy control group. Among patients with pulmonary tuberculosis, significantly increased levels of serum TNF-alpha were noted in the reactivated group compared to those of the fresh and inactive group. Patients with moderate to far-advanced infiltration on their chest X-rays, showed a significantly higher level of serum TNF-alpha than those with minimal involvement on the chest X-ray. Smokers from the healthy control group showed a significantly higher level of serum TNF-alpha than non-smokers from the same group. These results suggest that an increase in the production of TNF-alpha may correspond with the severity of pulmonary tuberculosis.
Bronchoalveolar Lavage Fluid/metabolism ; Humans ; Macrophages/metabolism ; Pulmonary Alveoli/metabolism ; Tuberculosis, Miliary/metabolism ; Tuberculosis, Pulmonary/etiology/*metabolism ; Tumor Necrosis Factor-alpha/*biosynthesis

OBJECTIVE: This study was designed to investigate the efficacy in the combination of haloperidol and clonidine with chronic schizophrenia. Moreover, we evaluated the effects of clonidine to the plasma haolperidol and reduced haloperidol concentration 36 patiens were entered on 4 weeks by the double blind trial. METHOD: The patients (male=11, female=25) were randomly divided into two groups of eighteen patients each. Their antipsychotic medication was fixed for 2 weeks before double blind trial with haloperidol and clonidine or placebo. Clonidine was started at 0.15 mg/day and then raised 0.6mg/day during 4 days, and the placebo was applied by same method as clonidine. The clinical assessment of the patients was assessed with BPRS and NOSIE. The plasma concentrations of haloperidol and reduced haloperidol were measured by HPLC (UV detector). RESULTS: 1) There were no statistical differences in sex distribution, age, duration of illness, dosages of haloperidol, plasma concentration of haloperidol and reduced haloperidol of each groups before clonidine or placebo trial. 2) On total and subcluster scores of BPRS and total score of NOSIE, there were decreased tendencies over the time, but there was no statistical significance in both groups. 3) Plasma concentrations of haloperidol and reduced haloperidol after 4 weeks of clonidine trial were revealed statistically significant increasement as compared to baseline. CONCLUSION: The combination of haloperidol and clonidine for 4 weeks did not reveal the improvement. In our opinions the reasons of those results were that our samples were not made of paranoid type of schizophrenia, the duration of clonidine trial was not good enough. So we should suggest that more specifying design will be needed.
Chromatography, High Pressure Liquid ; Clonidine* ; Haloperidol* ; Humans ; Norepinephrine ; Plasma ; Schizophrenia* ; Sex Distribution

OBJECTIVE: In recent years, the neurosurgeon's role in managing cerebrovascular diseases (CVD) has becomes rapidly challenged and overlapped with other specialists. Furthermore, the patterns of CVD and patient recruitment have also changed. We conducted a retrospective study regarding the practical trends of CVD with reference to the management paradigms at our institute. METHOD: We reviewed all the available data, including the annual reports, the daily department records, the medical records and the radiographic films of the CVD patients who had been admitted to our Neurosurgery Department during the five years between Jan. 2004 and Dec. 2008. RESULTS: The total numbers of CVD operations showed a slight initial increase, but then they remained steady for the latter 3 years. The number of cases of non-angiomatous hemorrhage has been relatively steady, regardless of surgery. The total numbers of treated aneurysms increased, but the main body of this increment was attributed to the initiation of endovascular treatment and increased identification of unruptured vascular lesions. Vascular malformations were sustained with a small number of cases due to referring them to other institutes for radiosurgery, except for the cases that required urgent hemorrhagic evacuation. CONCLUSION: Hemorrhagic CVDs tended to decrease either due to increasing identification before rupture or shifting such patients into a large volume hospital. The increasing awareness of ischemic CVD, the early detection of unruptured aneurysms, and the separation of medical responsibilities from neurologists have all pushed neurosurgeons to make treatment plans in a more cooperative fashion, instead of a competitive way. Neurosurgeons should be furnished with several revolutionary surgical options to widen their scope of managing patients with CVD.
Academies and Institutes ; Aneurysm ; Hemorrhage ; Humans ; Infarction ; Intracranial Aneurysm ; Medical Records ; Neurosurgery ; Patient Selection ; Radiosurgery ; Retrospective Studies ; Rupture ; Specialization ; Subarachnoid Hemorrhage ; Vascular Malformations ; X-Ray Film

BACKGROUND: Sepsis is a clinical syndrome characterized by a systemic inflammatory and hemodynamic response to severe bacterial infections that involve various mediators. Endothelin (ET)-1, a potent vasocon strictor is associated with multiple organ failure, and interleukin (IL)-8, a proinflammtory cytokine, plays a major role in neurophil activation. Both have been reported to be useful parameters in the clinical assessment of sepsis. The levels of ET-1 and IL-8 in the blood were measured in patients with sepsis, and the correlation of both parameters and their relationship with the clinical data was assessed. METHODS: 19 sepsis patients and 17 controls were studied. Blood samples of the sepsis patients were drawn in day 1, 3, 7, and 14. the APACHE III scores were calculated in concurrent days. The ET-1 and IL-8 levels were measured using immunoassay methods. RESULTS: The ET-1 levels of patients with sepsis were significantly higher than in the controls. In patients with sepsis, non-survivors had higher ET-1 levels than survivors on day 1 and 7, and patients with shock also had higher ET-1 levels than normotensive patients on admission. The ET-1 levels were significantly correlated wit the creatinine levels in day 1, 7, and 14. The IL-8 levels showed a significant correlation with the ET-1 levels on day 14. CONCLUSION: ET-1 was found to be closely related with the clinical outcome, shock, and renal failure, and showed a correlation with IL-8. these mediators can be considered not only to play pathophysiologic roles but also as useful parameters in the clinical assessment of sepsis.
APACHE ; Bacterial Infections ; Creatinine ; Endothelin-1* ; Endothelins ; Hemodynamics ; Humans ; Immunoassay ; Interleukin-8* ; Interleukins ; Multiple Organ Failure ; Naphazoline ; Renal Insufficiency ; Sepsis* ; Shock ; Survivors

OBJECTIVES: In surgically treated non-small cell lung cancer, patients have a wide difference in prognosis even though they may be in the same stage. Therefore it is difficult to establish the prognosis for individual lung cancer patients. In this study, by using flow cytometric analysis of nuclear DNA content and S-phase fraction(SPF) of surgically treated non-small cell lung cancer patients, we proposed to establish other prognostic factors and their validity in comparison with the existing ones. METHODS: Paraffin-embedded tissue specimens from 81 surgically treated patients, diagnosed with non-small cell lung cancer ranging from stage I to stage IIIa, were analyzed by flow cytometrically determined nulear DNA content and S-phase fraction. Cellular DNA content stained with propidium iodide was analyzed by flow cytometry: histograms with a coefficient of variation exceeding 8% were not used. RESULTS: 1) DNA content analysis was carried out for 59 of 81 patients. Of the 59 patients who were investigated by flow cytometry, 45 (76.3%) of the tumors were DNA aneuploidy and 14 (23.7%) were DNA diploidy. The proportion of DNA aneuploidy tumors showed no significant difference between cell types or stage. 2) S-phase fraction was evaluated for 36 of 81 patients. Mean value of SPF was 19.2% (+/-12.62)%. The value of SPF had nothing to do with stage. 3) The proportion of the high SPF group (more than 10% of cell proliferation cycle) was 75% With advance staging, the proportion of the high SPF group increased. 4) Significant difference in the median survival time was observed between the low SPF group and the high SPF group (32 months in low SPF, 12 months in high SPF) (p<0.05). No significant difference in the median survival time was observed between the aneuploidy group and the diploidy group (19 months in aneuploidy, 34 months in diploidy). 5) Significant difference in the disease free median survival time was observed between the low SPF group and the high SPF group (5 months in low SPF, 19 months in high SPF) (p<0.05). No significant difference in the disease free median survival time was observed between the aneuploidy group and the diploidy group (12 months in aneuploidy, 34 months in diploidy). 6) Upon multivariate analysis, stage and high SPF (more than 10% of cell proliferation cycle) were significant prognostic factors in surgically treated non-small cell lung cancer patients. CONCLUSION: The TNM stage and high SPF were significant as prognostic factors in surgically treated non-small cell lung cancer patients. Therefore new treatment plan should be needed in the patients who have high SPF.
Aneuploidy ; Carcinoma, Non-Small-Cell Lung* ; Cell Proliferation ; Diploidy ; DNA* ; Flow Cytometry ; Humans ; Lung Neoplasms ; Multivariate Analysis ; Prognosis ; Propidium

OBJECTIVE: Terson's syndrome, a complication of visual function, has occasionally been reported in patients with aneurysmal subarachnoid hemorrhage (SAH), however the factors responsible for Terson's syndrome in aneurysmal SAH patients have not yet been fully clarified. In this study, we report on potential risk factors for prediction and diagnosis of Terson's syndrome in the earlier stage of the disease course in patients with aneurysmal SAH. MATERIALS AND METHODS: The authors retrospectively analyzed the data of 322 consecutive patients who suffered from aneurysmal SAH in a single institution between Jan. 2007 and Dec. 2013. Medical records including demographics, neurologic examination, and radiologic images were collected to clarify the risk factors of Terson's syndrome. Patients with visual problem were consulted to the Department of Ophthalmology. RESULTS: Among 332 patients with aneurysmal SAH, 34 patients were diagnosed as Terson's syndrome. Four individual factors, including World Federation of Neurosurgical Societies (WFNS) grade at admission, aneurysm size, method of operation, and Glasgow outcome scale showed statistically significant association with occurrence of Terson's syndrome. Of these, WFNS grade at admission, aneurysm size, and method of operation showed strong association with Terson's syndrome in multivariate analysis. Terson's syndrome accompanied by papilledema due to increased intracranial pressure led to permanent visual complication. CONCLUSION: In patients with aneurysmal SAH, the patients' WFNS grade at admission, the size of the aneurysms, particularly the diameter of the aneurysm dome, and the method of operation might influence development of Terson's syndrome.
Aneurysm* ; Demography ; Diagnosis ; Glasgow Outcome Scale ; Humans ; Incidence* ; Intracranial Pressure ; Medical Records ; Multivariate Analysis ; Neurologic Examination ; Ophthalmology ; Papilledema ; Retrospective Studies* ; Risk Factors* ; Subarachnoid Hemorrhage* ; Vitreous Hemorrhage