BACKGROUND/AIMS: We explored the effects of intermittent normobaric hyperoxia alone or combined with chemotherapy on the growth, general morphology, oxidative stress, and apoptosis of benzo[a]pyrene (B[a]P)-induced lung tumors in mice. METHODS: Female A/J mice were given a single dose of B[a]P and randomized into four groups: control, carboplatin (50 mg/kg intraperitoneally), hyperoxia (95% fraction of inspired oxygen), and carboplatin and hyperoxia. Normobaric hyperoxia (95%) was applied for 3 hours each day from weeks 21 to 28. Tumor load was determined as the average total tumor numbers and volumes. Several markers of oxidative stress and apoptosis were evaluated. RESULTS: Intermittent normobaric hyperoxia combined with chemotherapy reduced the tumor number by 59% and the load by 72% compared with the control B[a]P group. Intermittent normobaric hyperoxia, either alone or combined with chemotherapy, decreased the levels of superoxide dismutase and glutathione and increased the levels of catalase and 8-hydroxydeoxyguanosine. The Bax/Bcl-2 mRNA ratio, caspase 3 level, and number of transferase-mediated dUTP nick end-labeling positive cells increased following treatment with hyperoxia with or without chemotherapy. CONCLUSIONS: Intermittent normobaric hyperoxia was found to be tumoricidal and thus may serve as an adjuvant therapy for lung cancer. Oxidative stress and its effects on DNA are increased following exposure to hyperoxia and even more with chemotherapy, and this may lead to apoptosis of lung tumors.
Animals ; Apoptosis ; Carboplatin* ; Caspase 3 ; Catalase ; DNA ; Drug Therapy ; Female ; Glutathione ; Humans ; Hyperoxia* ; Lung Neoplasms* ; Lung* ; Mice ; Oxidative Stress ; RNA, Messenger ; Superoxide Dismutase ; Tumor Burden

BACKGROUND/AIMS: The meaning of specialized intestinal metaplasia (SIM) in the diagnosis of Barrett's esophagus (BE) is not clear. This study was designed to determine the clinical significance of SIM in the diagnosis of Barrett's esophagus. MATERIALS AND METHODS: Biopsies were taken from 601 subjects with endoscopically suspected columnar-lined esophagus. Under light microscopy with Alcian-blue stain, SIM was identified. Demographic characteristics, gastroesophageal (GE) reflux symptoms and endoscopic findings were compared between the SIM-present group and the SIM-absent group. RESULTS: Among 601 subjects, 184 (30.6%) were confirmed by pathology to have SIM. Age over 40 years (P<0.001) and a medication history of proton pump inhibitor or H2 blocker were found more frequently in the SIM-present group (P=0.01) than in the SIM-absent group. Any of 7 GE reflux symptoms (heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough and epigastric soreness) were more frequent in the SIM-present group than SIM-absent group (P<0.001). Specifically, heartburn, chest pain and cough were significantly more common in the SIM-present group. There was no clinically significant difference associated with endoscopic findings or other clinical characteristics. CONCLUSIONS: When subjects with endoscopically suspected BE are analyzed based on the presence or absence of SIM, the SIM-present group was significantly associated with GE reflux symptoms suggestive of frequent GE reflux. However, the presence of SIM did not correlate with endoscopic findings.
Barrett Esophagus ; Biopsy ; Chest Pain ; Cough ; Esophagus ; Gastroesophageal Reflux ; Heartburn ; Hoarseness ; Light ; Metaplasia ; Microscopy ; Prospective Studies ; Proton Pumps ; Sensation

BACKGROUND/AIMS: Gastric dysplasia is generally accepted to be the precursor lesion of gastric carcinoma. Approximately 25% to 35% of histological diagnoses based on endoscopic forcep biopsies for gastric dysplastic lesions change following endoscopic resection (ER). The aim of this study was to determine the predictive endoscopic features of high-grade gastric dysplasia (HGD) or early gastric cancer (EGC) following ER for lesions initially diagnosed as low-grade dysplasia (LGD) by a forceps biopsy. METHODS: To determine predictive variables for upgraded histology (LGD to HGD or EGC). The lesion size, gross endoscopic appearance, location, and surface nodularity or redness as well as the presence of a depressed portion, Helicobacter pylori infection, and intestinal metaplasia were retrospectively investigated. RESULTS: Among 251 LGDs diagnosed by an initial forceps biopsy, the diagnoses of 100 lesions (39.8%) changed following the ER; 56 of 251 LGDs (22.3%) were diagnosed as HGD, 39 (15.5%) as adenocarcinoma, and 5 (2.0%) as chronic gastritis. In a univariate analysis, large lesions (>15 mm), those with a depressed portion, and those with surface nodularity were significantly correlated with a upgraded histology classification following ER. In a multivariate analysis, a large size (>15 mm; odds ratio [OR], 2.8; 95% confidence interval [CI], 1.46 to 5.43) and a depressed portion in the lesion (OR, 2.7; 95% CI, 1.44 to 5.03) were predictive factors for upgraded histology following ER. CONCLUSIONS: Our study shows that a substantial proportion of diagnoses of low-grade gastric dysplasias based on forceps biopsies were not representative of the entire lesion. We recommend ER for lesions with a depressed portion and for those larger than 15 mm.
Adenocarcinoma ; Biopsy ; Gastritis ; Helicobacter pylori ; Metaplasia ; Multivariate Analysis ; Odds Ratio ; Retrospective Studies ; Stomach Neoplasms ; Surgical Instruments

We report the case of a 68-year-old man with a stromal tumor of uncertain malignant potential (STUMP), which had metastasized to the lung. The patient complained of an enlarged mass in the anterior chest. Chest computed tomography (CT) showed a sternal abscess with multiple nodules in both lungs. A thoracoscopic lung biopsy of the nodules and incision/drainage of the sternal mass were performed simultaneously. CT of the pelvis revealed an enlarged prostate with irregular cystic lesions in the pelvis. Prostate biopsy was done and demonstrated hypercellular stroma with minimal cytological atypia, a distinct pattern of STUMP. The sternal abscess proved to be tuberculosis and the lung lesion was consistent with STUMP, which had spread from the prostate. However, to our knowledge, the tuberculous abscess might not be assoicated with STUMP in the lung. The patient refused surgical prostatectomy and was discharged with anti-tuberculosis medication. On one-year follow up, the patient had no evidence of disease progression.
Abscess ; Aged ; Biopsy ; Disease Progression ; Follow-Up Studies ; Humans ; Lung ; Neoplasm Metastasis ; Pelvis ; Prostate ; Prostatectomy ; Prostatic Neoplasms ; Stromal Cells ; Thorax ; Tuberculosis

A palpable mass in lower abdomen of a neonate or an infant can be most frequently considered as an inguinal hernia, whereas pediatric adnexal torsion is less commonly considered in differential diagnosis but can occur. Pediatric adnexal torsion may be difficult to diagnose clinically but the immediate diagnosis may lead to more frequent salvage of affected adnexa. Sonography is the preferred imaging study. It usually confirms a pelvic mass but may not establish the diagnosis. The correct diagnosis of adnexal torsion is often made at exploration. Therapy for adnexal torsion remains controversial. While extirpation has been the standard of treatment in the past, there are current proponents of conservative therapy with adnexal preservation.
Abdomen ; Diagnosis, Differential ; Hernia, Inguinal ; Humans ; Infant ; Infant, Newborn

Reports of bowing and pseudarthrosis of the humerus and clavicle are rare. Most patients with congenital pseudoarthrosis of the clavicle involving the right side and midportion of clavicle tended to heal better than congenital pseudoarthrosis of the tibia. We experienced a patient who had special features in terms of location, pseudoarthrosis pattern, and neurofibromatosis, and report on this case here.
Clavicle* ; Humans ; Humerus ; Neurofibromatoses* ; Pseudarthrosis* ; Tibia

Primary hepatocellular carcinoma (HCC) is one of the most common tumors in the world. HCC often metastases to the lung and the regional lymph nodes, but rarely to the bones. The most frequent sites of skeletal metastasis are the rib, spine, femur, pelvis and humerus, but the metastasis to the skull is very rare in HCC. Especially, the metastasis to the skull alone, or skull mass presented as first sign in HCC is extremely rare. We report a 74-year-old female who had HCC with the solitary skull metastasis and a 42-year-old male with HCC presented skull metastasis as the initial clinical manifestation.
Adult ; Aged ; Carcinoma, Hepatocellular* ; Female ; Femur ; Humans ; Humerus ; Lung ; Lymph Nodes ; Male ; Neoplasm Metastasis* ; Pelvis ; Ribs ; Skull* ; Spine

BACKGROUND: Norepinephrine infusion has been reported to be associated with adverse events in ischemic heart disease due to elevation of afterload and cardiac oxygen consumption. During coronary artery bypass graft, we observed changes of hemodynamic and laboratory parameters in low dose norepinephrine infusion. Also, we investigated effects of norepinephrine on cardiac oxygen metabolism by calculating oxygen consumption and lactate extraction ratio. METHODS: Fifteen patients, ASA PS class IV-V, scheduled for elective coronary artery bypass graft were enrolled in this study. All of the operations were performed under general anesthesia. During harvesting of graft vessels, norepinephrine was infused at the rate of 0.02microgram/kg/min, and then at the rate of 0.05microgram/kg/min. We measured various hemodynamic and laboratory parameters in three periods (baseline, NE 0.02microgram/kg/min, NE 0.05microgram/kg/min). Also we calculated oxygen consumption and lactate extraction ratio of myocardium. RESULTS: In the baseline period(no norepinephrine infusion), oxygen consumption (VO2) is 159.2 +/- 78.6 ml/min, lactate extraction ratio (LER) is 33.1 +/- 13.0%. After norepinephrine infusion at the rate of 0.02microgram/kg/min, VO2 is 157.6 +/- 55.7 ml/min, LER is 29.9 +/- 10.7%. After norepinephrine infusion at the rate of 0.05microgram/kg/min, VO2 is 212.5 +/- 134.5 ml/min, LER is 27.9 +/- 13.4%. Although VO2 and LER are changed in relation to the rate of norepinephrine infusion, there was no statistical significance. CONCLUSIONS: In conclusion, infusion of low dose norepinephrine during coronary artery bypass graft did not produce significant differences in myocardial oxygen consumption and lactate extraction ratio associated with myocardial oxygen balance.
Anesthesia, General ; Coronary Artery Bypass ; Hemodynamics ; Humans ; Lactic Acid* ; Metabolism* ; Myocardial Ischemia ; Myocardium ; Norepinephrine* ; Oxygen Consumption* ; Oxygen* ; Transplants

Pseudopolyp is a common association of ulcerative colitis but may also occur in Crohn's disease, ischemic colitis and infective colitis. Pseudopolyps are results of the repair process, representing islands of granulation tissue surrounded by mucosa with ulceation. When a pseudopolyp is larger than 1.5 cm, it is often called a "giant pseudopolyp". Such lesions of inflammatory origin are often confused with polypoid carcinoma or infiltrating submucosal malignancy. We report a case of asymptomatic Crohn's disease as giant pseudopolyposis mimicking malignancy on sigmoid colon, with a review of relevant literatures.
Colitis ; Colitis, Ischemic ; Colitis, Ulcerative ; Colon, Sigmoid ; Crohn Disease* ; Fistula* ; Granulation Tissue ; Islands ; Mucous Membrane

OBJECTIVE: To evaluate planned pregnancy rate and associated factors related planned pregnancy. METHODS: We surveyed 1,396 cases from May 2002 to December 2002. The cases were derived from the Maternity school. They filled out questionnaire including planned pregnancy, medico-social-economic status. Then, we assessed the planned pregnancy rate with associated medico-social-economic state, through the prospective study. RESULTS: The planned pregnancy rate is 51.4%. The major factor which affected the planned pregnancy rate is the income of the family. The association with the planned pregnancy rate and the parity, age, and educational attainment of the women are not statistically significant. In unplanned group, exposure to alcohol, X-ray and medication is significantly increased in early pregnancy. CONCLUSION: The planned pregnancy can prevent induced abortion and reduce the birth defects due to early exposure to teratogen. Therefore it is important to make an effort to raise the planned pregnancy rate.
Abortion, Induced ; Congenital Abnormalities ; Family Planning Services* ; Female ; Humans ; Parity ; Pregnancy ; Prospective Studies ; Surveys and Questionnaire