Neurilemmomas of the trachea are extremely rare. The most common site of them is the distal third of the trachea and the age of the patients at presentation varied from 6 to 78 years old. They usually have a freqeuntly very long natural history, causing symptoms only after they have attained a considerable size. We experienced a case of near-total obstruction of the trachea by an intraluminal sessile neurilemmoma. The patient was a 66-year-old man with 2-year history of progressive exertional dyspnea and had several episodes of pneumonitis associated with productive cough. Grossly, the tumor was a well-circumscribed mass. Microscopically, typical cellular Antoni A and myxoid Antoni B areas were revealed.
Aged ; Cough ; Dyspnea ; Humans ; Natural History ; Neurilemmoma* ; Pneumonia ; Trachea

Although intramedullary nailing is mostly used in the management of fractures in the long bone shaft, plate fixation is still alternative option in periprosthetic or metaphyseal fractures. For the rigid fixation during plating, sometimes we need wiring. Many surgeons experience slippage of wire resulting in loss of rigid fixation because plate and wire is so slippery and the diameter of bone is changing by level especially in the metaphyseal area. Wiring plate(CHO plate) was designed to prevent slippage. This plate has transverse holes for wires between screw holes on traditionally used dynamic compression plate. Sixteen fractures of long bone shaft were fixed with wiring plate and 11 cases which were followed up for more than one year were evaluated. There were periprosthetic fractures(4 cases), spiral or butterfly fractures(4 cases) and fractures of poor bone quality(two cases of malignancy and one case of osteoporosis). Nine cases were successfully reduced and the healed without loss of fixation. In two cases, delayed union and nonunion were observed due to wire breakage with plate loosening. Preliminarily, wiring plate fixation can be used for the periprosthetic fracture and one of alternative option in butterfly or spiral fracture and fracture in osteoporotic bone or pathologic fracture.
Butterflies ; Fracture Fixation, Intramedullary ; Fractures, Spontaneous ; Periprosthetic Fractures

PURPOSE: To identify the effect of insufficient lymph node dissection (LND) on the survival of patients with pT2 gastric cancer. MATERIALS AND METHODS: A total of 340 patients (120 patients with insufficient LND and others with D2 LND) who underwent gastrectomy for pT2 gastric cancer between January 2008 and December 2010 were included. RESULTS: The incidence of preoperatively diagnosed early gastric cancer was higher and there were fewer metastatic lymph nodes (LNs) in the insufficient LND group than the D2 group, but there was no survival difference between two groups (p=0.365). Among the 89 patients with metastatic LNs after D2 LND, 13 patients (14.6%) had metastatic LNs at selected N2 stations (#10, 11, or 12a), but none of these patients were in the pN1 category. One patient had five metastatic LNs at station #11p with no metastatic LNs at any other stations. The number of metastatic LNs was identified as the only risk factor for LN metastasis at selected N2 stations by logistic regression. CONCLUSION: If a patient has pN0 or pN1 category after insufficient LND for pT2 gastric cancer, the surgery can be regarded as secure. However, for patients with pN2 or pN3 category, more careful examination is required.
Aged ; Female ; Gastrectomy ; Humans ; Lymph Node Excision/*methods ; Male ; Middle Aged ; Stomach Neoplasms/*diagnosis/*surgery

Connective tissue growth factor (CTGF) is known to be a profibrotic growth factor, which mediate the fibrotic effect of transforming growth factor-beta(TGF-beta) and to stimulate cell proliferation and matrix production. CTGF has been shown to be hypoxiainducible in several cell types. Here we investigated the effect of hypoxia on CTGF gene expression in cultured mouse renal tubular cells (MTC). Quiescent cultures of MTC were exposed to hypoxia (1% O2) or normoxia in serum-free medium. The effects on hypoxia-induced CTGF expression were evaluated by Northern blot and real-time PCR. The roles of mitogen-activated protein kinase (MAPK) and TGF-beta were also determined using specific biochemical inhibitors. Exposure of quiescent tubular cells to hypoxia for 24 hr in a conditioned medium resulted in a significant increase TGF-beta. Hypoxia caused a significant increase in CTGF mRNA expression in MTC. Either JNK or ERK inhibitor did not block the hypoxia-induced stimulation of CTGF, whereas an inhibitor of p38 MAPK reduced the hypoxia-induced changes of CTGF. Although hypoxia stimulated TGF-betaproduction, neutralizing anti-TGF-beta1 antibody did not abolish the hypoxia-induced CTGF mRNA expression. The data suggest that hypoxia up-regulates CTGF gene expression, and that p38 MAPK plays a role in hypoxic-stimulation of CTGF. We also demonstrated that hypoxia induces CTGF mRNA expression via a TGF-beta1-independent mechanism.
Animals ; *Anoxia ; Connective Tissue Growth Factor/*metabolism ; Culture Media, Conditioned/metabolism ; Enzyme-Linked Immunosorbent Assay ; *Gene Expression Regulation ; Kidney/metabolism ; Kidney Tubules/cytology ; MAP Kinase Signaling System ; Mice ; Models, Biological ; RNA, Messenger/*metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Time Factors ; Transforming Growth Factor beta/metabolism

PURPOSE: The favorable types of the breast cancer - medullary, mucinous, papillary and tubular carcinoma are uncommon subtypes and their incidences in different series ranges between 2.0% and 8.0%, 1% and 2%, 0.3% and 3%, less than 2% of all breast cancers, respectively. In westem countries these subtypes have been reported to have good prognosis and slow growth rate. Clinically, these tumors have lower frequency of axillary nodal involvement and better 5-year or 10-year surviral rate than the other common types of breast cancer. MATERIALS AND METHODS: To determine the clinical characteristics and to evaluate the correlation between the progrostic factors and survival rate of these tumors, the medical records of 83 women with medullary, mucinous, papillary and tubular carcinoma treated at Korea Cancer Center Hospital between Jan. 1987 and Dec. 1997 were reviewed retrospectively. RESULTS: The incidences of medullary, mucinous, papillary and tubular carcinoma were 0.51%, 1.45%, 0.71% and 0.14% of all breast cancer, respectively. There were 1 case of local recurrence and 5 cases of systemic relapse during the follow-up (median follow-up peroid of 56 months). Overall 5-year survival and 10-year survival rate were 98.5% and 94.2%, respectively. No significant difference in overall survival rate was detected according to histologic types of these tumors but disease-free survival was significantly lower in papillary carcinoma than the other types of these tumors (p=0.042). Standard prognostic factors of breast cancer such as tumor size, lymph node status, age of the patient and ER status did not affect the prognosis of these tumors. CONCLUSION: Medullary, mucinous, papillary and tubular carcinoma revealed very excellent prognosis in this study regardless of tumor size, lymph node status, age of the patients and ER status.
Adenocarcinoma* ; Breast Neoplasms* ; Breast* ; Carcinoma, Papillary ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Lymph Nodes ; Medical Records ; Mucins* ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

BACKGROUND: The deleterious cardiopulmonary side effects immediately after positioning in reverse Trendelenburg and CO2 intra-abdominal insufflation during a laparoscopic cholecystectomy are well tolerated in healthy patients but can lead to serious morbidity and mortality in patients with a limited cardiopulmonary reserve. Using a continuous and non-invasive cardiac output monitor based on partial CO2 rebreathing method, we investigated the immediate cardiopulmonary changes caused by positioning in reverse Trendelenburg and CO2 intra-abdominal insufflation during a laparoscopic cholecystectomy, and assessed the applicability of the partial CO2 rebreathing method for the measurement of cardiac output in a laparoscopic cholecystectomy. METHODS: The investigation was carried out on 11 patients undergoing a laparoscopic cholesystectomy. The control values of cardiac index (CI), cardiac output (CO), mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), systemic vascular resistance (SVR), dynamic compliance (Cdyn), airway resistance (Raw), peak inspiratory pressure (PIP) and end tidal CO2 partial pressure (PETCO2) were measured in the supine position after induction with target-controlled infusion of propofol (5 microgram/ ml). Five minutes after positioning in reverse Trendelenburg and CO2 insufflation, the same cardiopulmonay variables were measured and compared with the control values. RESULTS: CI, CO and CVP were reduced 33.3%, 31.9% and 29.0%, respectively (P < 0.05). MAP and SVR were increased 39.8% and 154.1%, respectively (P < 0.05). Cdyn was reduced 38.0% (P < 0.05). Raw and PIP were increased 22.8%, and 34.8%, respectively (P < 0.05), whereas HR and PETCO2 remained unchanged. CONCLUSIONS: The non-invasive cardiopulmonary monitor using partial CO2 rebreathing method, could be used with ease and safety in a laparoscopic cholecystectomy.
Airway Resistance ; Arterial Pressure ; Cardiac Output ; Central Venous Pressure ; Cholecystectomy, Laparoscopic ; Compliance ; Heart Rate ; Humans ; Insufflation ; Mortality ; Partial Pressure ; Propofol ; Respiratory System* ; Supine Position ; Vascular Resistance

No abstract available.
Echocardiography, Doppler* ; Heart Septal Defects, Ventricular* ; Heart Ventricles*

This study was performed to observe the changes of glucose-related hormones and the morphological change including ultrastructure of the pancreatic islets in the male Otsuka Long-Evans Tokushima Fatty rat. Area under the curve (AUC) of glucose at the 30th (709 +/- 73 mg.h/dL) and at the 40th week (746 +/- 87 mg.h/ dL) of age were significantly higher than that at the 10th week (360 +/- 25 mg.h/ dL). AUC of insulin of the 10th week was 2.4 +/- 0.9 ng.h/mL, increased gradually to 10.8 +/- 8.3 ng.h/mL at the 30th week, and decreased to 1.8 +/- 1.2 ng.h/mL at the 40th week. The size of islet was increased at 20th week of age and the distribution of peripheral alpha cells and central beta cells at the 10th and 20th weeks was changed to a mixed pattern at the 40th week. On electron microscopic examination, beta cells at the 20th week showed many immature secretory granules, increased mitochondria, and hypertrophied Golgi complex and endoplasmic reticulum. At the 40th week, beta cell contained scanty intracellular organelles and secretory granules and apoptosis of acinar cell was observed. In conclusion, as diabetes progressed, increased secretion of insulin was accompanied by increases in size of islets and number of beta-cells in male OLETF rats showing obese type 2 diabetes. However, these compensatory changes could not overcome the requirement of insulin according to the continuous hyperglycemia after development of diabetes.
Animals ; Body Weight ; Diabetes Mellitus, Type 2/*metabolism/pathology ; Disease Models, Animal ; Glucagon/*metabolism ; Insulin/*metabolism ; Islets of Langerhans/*metabolism/pathology/ultrastructure ; Male ; Rats ; Rats, Inbred OLETF

Benign tumor in the cheek area such as hemangioma, lymphangioma and neurofibroma causes the drooping of affected side soft tissue involving cheek, mouth corner and nasolabial fold due to its heavy weight and bulkiness. The drooping of mouth corner may remain even after partial subcutaneous excision of the mass. The authors suspended the drooped mouth corner with dermal flap which could be elevated through the nasolabial fusiform de-epithelization simultaneously while the mass was removed by the incision. A total of 14 patients with hemangioma, lymphangioma and neurofibroma in the cheek area were operated between February 1998 and November 2001. The age distribution was 5 to 21-years-old and the follow-up period ranged from 5 to 37 months. There were 1 case of epidermal inclusion cyst and 1 case of hematoma, but no infection or facial nerve palsy was reported as complication. The aesthetic results were considered favorable. This technique prevents the drooping of mouth corner or asymmetry of mid-face without remaining any significant deformity at the donor site, and helps to make more normalized facial feature after the removal of soft tissue mass in the cheek.
Age Distribution ; Cheek* ; Congenital Abnormalities ; Facial Nerve ; Follow-Up Studies ; Hemangioma ; Hematoma ; Humans ; Lymphangioma ; Mouth* ; Nasolabial Fold ; Neurofibroma ; Paralysis ; Tissue Donors

As the incidence of early gastric cancer increases, laparoscopic surgery has become one of the treatments of choice for gastric cancer. With the increase of laparoscopic surgery, the chance of discovering aberrant anatomy during the operation also increases. We present a case of laparoscopic total gastrectomy in gastric cancer patients with intestinal malrotation. Intestinal malrotation occurs in one in every 500 births. We found that laparoscopic total gastrectomy in such patients can be performed successfully when it is performed with a proper Roux limb orientation through an alternative minilaparotomy.
Extremities ; Gastrectomy ; Humans ; Incidence ; Intestinal Volvulus ; Laparoscopy ; Laparotomy ; Orientation ; Parturition ; Stomach Neoplasms