Renal allograft recipients are at risk for Pneumocystis carinii pneumonia (PCP) within the first year following transplantation and during treatment for graft rejection. We experienced two cases of PCP in renal allograft recipients. The first case was a 39-year-old female who had received renal allograft 7 years before. At the time of traosplantation, she was a carrier of hepatitis B surface (HBs) antigen. After transplantation, she had been received the rnaintenance dose of cyclosporine and oral prednisolone. Three months before adrnission, dosage of prednisolone was increased because of the increased serum creatinine level and gene-ralized edema. A week before admission, syrnptom of exertional dyspnea, dry cough, and fever was developed. Chest X-ray film showed streaky interstitial infiltration in both lung fields and chest CT showed diffuse ground-glass appearance. Rroncho- alveolar lavage revealed positive Grocott's methenamine silver stain for numerous clumps of pneumocystis carinii cysts. Despite the aggressive treatment, she died of respiratory and hepatic failure and GI bleeding. Another case was a 40-year-old male who had received renal allograft S years before. He had been received maintenance immune suppressive therapy with cyclosporine and oral prednisolone. He was admitted for evaluation of hypertension and elevated serum creatinine level. After several days of admission, he complained fever, dry cough and dyspnea. X-ray film showed pneumonic infiltration and the bronchial brushing and washing fluid revealed the Pneumocystis carinii cysts that were stained by methenamine silver. He was treated with the full dose of trimethoprim-sulfamethoxazole and clindamycin. Sacrificing the renal allograft, he recovered from Pneumocystis carinii pneumonia.
Adult ; Allografts* ; Clindamycin ; Cough ; Creatinine ; Cyclosporine ; Dyspnea ; Edema ; Female ; Fever ; Graft Rejection ; Hemorrhage ; Hepatitis B ; Humans ; Hypertension ; Liver Failure ; Lung ; Male ; Methenamine ; Pneumocystis carinii* ; Pneumocystis* ; Pneumonia, Pneumocystis* ; Prednisolone ; Therapeutic Irrigation ; Thorax ; Tomography, X-Ray Computed ; Transplantation ; Trimethoprim, Sulfamethoxazole Drug Combination ; X-Ray Film

OBJECTIVE: The purpose of this study is to investigate the combined effects of ginkgo biloba extract, ginkgolide A and B and aspirin on SK-N-MC, human neuroblastoma cell viability and mRNA expression of growth associated protein43 (GAP43), Microtubule-associated protein 2 (MAP2), B-cell lymphoma2 (Bcl2) and protein53 (p53) gene in hypoxia and reperfusion condition. METHODS: SK-N-MC cells were cultured with Dulbecco's Modified Eagle's Medium (DMEM) media in 37degrees C, 5% CO2 incubator. The cells were cultured for 8 hours in non-glucose media and hypoxic condition and for 12 hours in normal media and O2 concentration. Cell survival rate was measured with Cell Counting Kit-8 (CCK-8) reagent assay. Reverse transcriptase polymerase chain reaction (RT-PCR) was used to estimate mRNA levels of GAP43, MAP2, Bcl2, and p53 genes. RESULTS: The ginkgolide A and B increased viable cell number decreased in hypoxic and reperfused condition. The co-treatment of ginkgolide B with aspirin also increased the number of viable cells, however, there was no additive effect. Although there was no increase of mRNA expression of GAP43, MAP2, and Bcl2 in SK-N-MC cells with individual treatment of ginkgolide A, B or aspirin in hypoxic and reperfused condition, the co-treatment of ginkgolide A or B with aspirin significantly increased GAP43 and Bcl2 mRNA levels. In MAP2, only the co-treatment of ginkgolide A and aspirin showed increasing effect. The mRNA expression of p53 had no change in all treating conditions. CONCLUSION: This study suggests that the combined treatments of Ginkgo biloba extracts and aspirin increase the regeneration of neuroblastoma cells injured by hypoxia and reperfusion.
Anoxia ; Aspirin ; B-Lymphocytes ; Cell Count ; Cell Line ; Cell Survival ; Ginkgo biloba ; Ginkgolides ; Humans ; Incubators ; Lactones ; Microtubule-Associated Proteins ; Neuroblastoma ; Regeneration ; Reperfusion ; Reverse Transcriptase Polymerase Chain Reaction ; RNA, Messenger

PURPOSE: The results for treatment of fistula-in-ano have much improved, along with the development of anatomical knowledge, classification, and operative techniques, during last several decades. The authors retrospectively reviewed the results for treatment of fistula-in-ano, especially complex fistulas, during the last 11 years. METHODS: A retrospective study of fistula-in-ano was performed for 229 patients who had been operated on in St. Benedict Hospital between January 1988 and December 1998. Complex fistulas (IIH, III & IV) were analyzed separately. RESULTS: The most common type was IILs (92 cases, 40.2%), and the most common horseshoe type was IIIBc (5 cases, 2.2%). The average hospital stay was 11.5 days for all fistula-in-ano types, but 15.1 days for complex fistulas. Non-specific inflammation (209 cases, 91.3%) was the most common pathologic finding. Various operative procedures were used : fistulotomy (80 cases, 34.9%), fistulectomy (74 cases, 32.3%), coring out fistulectomy (63 cases, 27.5%), seton technique (11 cases, 4.8%), and muscle-filling technique (1 case, 0.4%). There was no difference in the recurrence rate among the operative types. Various procedures were tried for complex fistulas, but the sphincter-preserving fistulectomy by Takano seemed to have a low recurrence rate and a short postoperative course. However, because of the small number of cases, this difference in recurrence rate and postoperative course was not statistically significant. The overall postoperative complication rate was 7%: anal infection (4 cases, 1.7%), anal bleeding (3 cases, 1.3%), and urinary retention (2 cases, 0.9%). CONCLUSIONS: The operations for most of the fistulae, IH, IL & IIL, were simple and uneventful. However, the operations for complex fistulae were complicated and more skill was required. We have thought Takano's operation to be a good curative procedure with less postoperative deformity and shortened postoperative course. However this research couldn't prove that with statistical significance, probably because of the insufficient number of patients. If further cases are collected and continuous follow-up is done, then a better result can be expected.
Classification ; Congenital Abnormalities ; Fistula ; Hemorrhage ; Humans ; Inflammation ; Length of Stay ; Postoperative Complications ; Recurrence ; Retrospective Studies* ; Surgical Procedures, Operative ; Urinary Retention

PURPOSE: Mistletoe extract was widely used for cancer treatment as complementary or alternative therapy in European area from early twenty century. It is currently used as alternative anti-cancer remedy by piecemeal in domestic medical group, however, the anti-cancer mechanism of mistletoe extract was not known precisely until now. In this study the effect of mistletoe extract on gastric cancer was studied vis cell line experiments. MATERIALS AND METHODS: The SNU719 gastric cancer cell line was used, and ABNOBAviscum-Q and ABNOBAviscum-F were treated to cells as mistletoe extract, or 5-FU and cisplatin were used with mistletoe extract. The cell viability and cell death rate were estimated by CCK-8 assay kit and lactate dehydrogenase (LDH) assay kit in each. Caspase 3 assay kit was used to measure caspase 3 activity. The protein expression amounts of Bcl2, p53, and PTEN were estimated through Western blot analysis. RESULTS: The co-treatments of mistletoe extract Q/F and 5-FU/cisplatin decreased lesser cell viability than only mistletoe treat. Caspase 3 activity was increased 4~6 times in co-treatment of mistletoe extracts and 5-FU than control. Bcl2 protein expression was reduced by mistletoe extracts or anti-cancer drugs, further more, the co-treatment of mistletoe extracts and 5-FU/cisplatin diminished more the expression than only mistletoe treatment. Mistletoe extracts did not affect the protein expressions of p53 and PTEN. CONCLUSION: It was concluded that the anti-cancer mechanism of mistletoe extracts was made by caspase 3 activation and lowered Bcl2 expression, and this apoptosis inducing mechanism was independent to p53.
Apoptosis ; Blotting, Western ; Caspase 3 ; Cell Death ; Cell Line ; Cell Survival ; Cisplatin ; Fluorouracil ; L-Lactate Dehydrogenase ; Mistletoe ; Sincalide ; Stomach Neoplasms

Background/Aims: Several clinical factors have been used to predict the response for concurrent chemoradiotherapy (CCRT); however, these factors are insufficient for prognostic predictions. We investigated clinical factors to assess whether they could be used to predict the response to CCRT and the survival of patients with esophageal cancer. Methods: Patients with esophageal cancer underwent CCRT from January 2005 to December 2015. Response to CCRT was classified as progressive disease (PD), stationary disease (SD), partial remission (PR), or complete remission (CR). Factors to predict the response to CCRT and patient survival were subsequently investigated. Results: A total of 535 esophageal cancer patients underwent CCRT. Four hundred ninety-three patients were followed up, and patient outcomes were investigated. In the adjusted analysis, patients with advanced stage disease (relative risk [RR], 0.28 in stage III and 0.12 in stage IV compared to stage I), poor performance status, circumferential involvement (RR, 0.61), and male sex (RR, 0.31) were less likely to achieve CR. Advanced stage disease (hazard ratio [HR], 1.71 in stage III/IV), poor CCRT response (HR, 2.82 in PR, 4.47 in SD, 4.77 in PD compared to CR), and poor performance status (HR, 1.38 in ECOG 2–4) were found to increase mortality. Conclusions Advanced stage disease, poor performance status, male sex, and circumferential involvement were independent predictive factors for a poor response to CCRT. Advanced stage, poor performance status, and poor CCRT response were independent factors for decreased survival.

BACKGROUND/AIMS: The aim of this study was to evaluate the outcome of endoscopic dilation for benign anastomotic stricture after radical gastrectomy in gastric cancer patients. METHODS: Gastric cancer patients who underwent endoscopic balloon dilation for benign anastomosis stricture after radical gastrectomy during a 6-year period were reviewed retrospectively. RESULTS: Twenty-one patients developed benign strictures at the site of anastomosis. The majority of strictures occurred within 1 year after surgery (95.2%). The median duration to stenosis after surgery was 1.70 months (range, 0.17 to 23.97 months). The success rate of the first endoscopic dilation was 61.9%. Between the restenosis group (n=8) and the no restenosis group (n=13), there were no significant differences in the body mass index (22.82 kg/m2 vs 22.46 kg/m2), interval to symptom onset (73.9 days vs 109.3 days), interval to treatment (84.6 days vs 115.6 days), maximal balloon diameter (14.12 mm vs 15.62 mm), number of balloon dilation sessions (1.75 vs 1.31), location of gastric cancer or type of surgery. One patient required surgery because of stricture refractory to repeated dilation. CONCLUSIONS: Endoscopic dilation is a highly effective treatment for benign anastomotic strictures after radical gastrectomy for gastric cancer and should be considered a primary intervention prior to proceeding with surgical revision.
Anastomosis, Surgical/adverse effects ; Constriction, Pathologic/etiology/therapy ; Dilatation/*methods ; Female ; Gastrectomy/*adverse effects ; Gastroscopy/*methods ; Humans ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Stomach Neoplasms/*surgery ; Treatment Outcome

Multiple endocrine neoplasia type 1 (MEN 1) is the association of neoplastic transformation of parathyroid, pituitary, and pancreatic islet cells. This syndrome is inherited as an autosomal dominant trait. A 38-year-old woman presented with general weakness and mental changes. She had experienced same symptoms 7 years ago, after then her weight gradually increased. Insulinoma was suspected by markedly decreased blood glucose level (20mg/dL) and the increased insulin/glucose ratio (0.43) that sampled in emergency room at the time of mental change. Unusually large pancreatic tail mass and Lt, adrenal gland mass were detected by abdominal CT. Percutaneous transhepatic portal vein catheterization with insulin sampling showed sudden step up of insulin/glucose ratio at the middle portion of pancreas. Measuring of basal pituitary hormones as a screening procedure of MEN showed increased basal prolactin level. Combined pituitary stimulation test showed blunted response of prolactin to TRH and sellar magnetic resonance imaging showed intrasellar mass. Thyroid nodule was palpated on her anterior neck. Thyroid scintigram showed cold nodule, and there was no lymphadenopathy around the nodule by the thyroid sonogram. Fine needle aspiration cytology showed benign hyperplastic follicular cells only. Serum ionized calcium and parathyroid hormone level were normal. Under the impression of MEN type I, the distal pancreatectomy, splenectomy, Lt. thyroid lobectomy and Lt. adrenalectomy was performed at the same time. Histologic examination of the surgically removed tissues revealed pancreas islet cell tumor, adrenal cortical adenoma and thyroid adenoma. Transient hyperglycemia was developed after surgical intervention, but thereafter she never felt any symptoms of hypoglycemia till now and her blood glucose showed completely normal level with oral glucose tolerance tests. We present this case with a review of literature.
Adenoma, Islet Cell ; Adrenal Glands ; Adrenalectomy ; Adrenocortical Adenoma ; Adult ; Biopsy, Fine-Needle ; Blood Glucose ; Calcium ; Catheterization ; Catheters ; Emergency Service, Hospital ; Female ; Glucose Tolerance Test ; Humans ; Hyperglycemia ; Hypoglycemia ; Insulin ; Insulinoma ; Islets of Langerhans ; Lymphatic Diseases ; Magnetic Resonance Imaging ; Male ; Mass Screening ; Multiple Endocrine Neoplasia Type 1* ; Multiple Endocrine Neoplasia* ; Neck ; Pancreas ; Pancreatectomy ; Parathyroid Hormone ; Pituitary Hormones ; Portal Vein ; Prolactin ; Splenectomy ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Tomography, X-Ray Computed

BACKGROUND: The interest in robotic cardiac surgery has recently grown but there has not been much clinical research reported on this. The aim of this study is to examine our initial experience, since August 2007, with robotic cardiac surgery using the da Vince(TM) surgical system and to evaluate the feasibility and safety of it. MATERIAL AND METHOD: Between August and December 2007, a total of 20 patients underwent robotic cardiac surgery using the da Vinci surgical system. For mitral valve repair (n=11), tricuspid valve repair (n=1), and ASD repair (n=1), cannulation, antegrade cardioplegia and transthoracic aortic cross-clamping were conducted for the right femoral vessels and the right internal jugular vein. For minimally invasive direct CABG (MIDCAB) (n=7), the internal thoracic artery (ITA) was harvested with the da Vinci surgical system. RESULT: The mean age of the patients was 50.1 (range: 26~78) years. Three concomitant Maze procedures and one tricuspid annuloplasty were combined with mitral valve repair. The mean cardiopulmonary bypass time was 208.0+/-61.3 minutes and the aortic cross clamp time was 158.8+/-40.6 minutes. No patients showed more than mild mitral regurgitation after repair and the median hospital stay was 4 days. The robotic-harvested ITA was used for either left ITA (n=6) or bilateral ITA (n=1). The mean harvest time was 43.2+/-12.0 minutes. The harvested ITA showed good flow and it was anastomosed under direct vision after left anterolateral thoracotomy. The patency of all the grafts was 100% (18/18) in MIDCAB. CONCLUSION: Robotic cardiac surgery using the da Vinci surgical system was variously adapted to areas such as mitral and tricuspid valve repair, ASD repair and ITA harvest for MIDCAB. The early results of the robotic cardiac surgery showed its safety and feasibility. With this primary report, we anticipate that clinical applications and further studies on robotic cardiac surgery using the da Vinci surgical system will be actively conducted in Korea.
Cardiopulmonary Bypass ; Catheterization ; Heart Arrest, Induced ; Humans ; Jugular Veins ; Korea ; Length of Stay ; Mammary Arteries ; Mitral Valve ; Mitral Valve Insufficiency ; Research Report ; Robotics ; Thoracic Surgery ; Thoracotomy ; Transplants ; Tricuspid Valve ; Vision, Ocular

PURPOSE: During sedated esophagogastroduodenoscopy (EGD), patients may not be able to perform inspiration, which is necessary to examine the esophagogastric junction. Therefore sedation may affect diagnosis of gastroesophageal reflux-related findings. The aim of our study was to investigate the effect of sedation on diagnosis of gastroesophageal reflux-related findings during EGD. MATERIALS AND METHODS: This retrospective study evaluated 28914 patients older than 20 years who underwent EGD at our institution between January 2011 and December 2011. Ultimately, 1546 patients indicated for EGD for health check-up and symptom evaluation were included. RESULTS: There were 18546 patients who had diagnostic EGD: 10471 patients (56%) by non-sedated EGD and 8075 patients (43%) by sedated EGD. After statistical adjustment for age, sex, and body mass index, minimal change esophagitis, and hiatal hernia were significantly less frequently observed in the sedated EGD group [odds ratio (OR), 0.651; 95% confidence interval (CI), 0.586 to 0.722 and OR, 0.699; 95% CI, 0.564 to 0.866]. Nevertheless, there was no significant difference in other findings at the gastroesophageal junction, such as reflux esophagitis with Los Angeles classification A, B, C, and D or Barrett's esophagus, between the two groups. Similarly, there were no differences in early gastric cancer, advanced gastric cancer, and gastric ulcer occurrence. CONCLUSION: Sedation can impede the detection of minimal change esophagitis and hiatal hernia, but does not influence detection of reflux esophagitis of definite severity and Barrett's esophagus.
Adult ; Aged ; Barrett Esophagus ; Body Mass Index ; Endoscopy, Digestive System/instrumentation/*methods ; Esophagitis, Peptic/*diagnosis ; Esophagogastric Junction/*pathology ; Female ; Gastroesophageal Reflux/*diagnosis ; Hernia, Hiatal/*diagnosis ; Humans ; Male ; Middle Aged ; Retrospective Studies

BACKGROUND/AIMS: Surgeons must be aware of risk factors for strictures before performing endoscopic submucosal dissection (ESD), to enable early interventions to prevent severe strictures. METHODS: This study was a single-center retrospective study. We reviewed the clinical data of patients who has undergone gastric ESD from January 2007 to December 2012. RESULTS: Among the 3,819 patients who had undergone gastric ESD, 11 patients (7.2%) developed pyloric strictures and received successful endoscopic balloon dilation. Significant differences were noted between the patients without and with post-ESD strictures for pretreatment of antral or pyloric deformities (46.4% vs 81.8%), the proportion of extension to the lumen circumference (>3/4, 9.4% vs 54.5%), the longitudinal extent of mucosal defects (27.9±10.1 mm vs 51.5±10.8 mm), and post-ESD bleeding (2.9% vs 27.3%). Multivariate analysis revealed that pretreatment antral or pyloric deformities (odds ratio [OR], 30.53; 95% confidence interval [CI], 1.476 to 631.565; p=0.027), larger longitudinal extent of mucosal defects (OR, 1.20; 95% CI, 1.074 to 1.340; p=0.001), and circumferential extension of 3/4 (OR, 13.69; 95% CI, 1.583 to 118.387; p=0.017) were independent risk factors for post-ESD stricture. CONCLUSIONS: Antral or pyloric deformities, sub-circumferential resection over more than 75% of the circumference and greater longitudinal extent of mucosal defects are independent risk factors for post-ESD stricture.
Congenital Abnormalities* ; Constriction, Pathologic* ; Early Intervention (Education) ; Hemorrhage ; Humans ; Multivariate Analysis ; Retrospective Studies ; Risk Factors* ; Surgeons