The aim of this study is to evaluate the clinical outcome. Between January 1, 2002 to September 30, 2002, we prospectively and retrospectively recruited 111 hospitalized patients who received Enteral Nutrition (ENgroup n = 52) and Total Parenteral Nutrition (TPNgroup n = 59) for more than seven days. The factors of clinical outcomes are costs, incidences of in-fection, lengths of hospital stay, and changes in weight. The characteristics of patients were investigated, which included nutritional status, disease severity (APACHE III score) and hypermetabolic severity (hypermetabolic score). Hypermeta-bolic scores were determined by high fever (>38 degrees C), rapid breathing (>30 breaths/min), rapid pulse rate (>100 beats/min), leukocytosis (WBC > 12000 mm3), leukocytopenia (WBC < 3000 mm3), status of infection, inflammatory bowel disease, surgery and trauma. There was a positive correlation between hypermetabolic score and length of hospital stay (ICU), medical cost, weight loss, antibiotics adjusted by age while APACHE III score did not show correlation to clinical outcome. Medical cost was higher by 18.2% in the TPN group than the EN group. In conclusion, there was a strong negative correlation between the clinical outcome (cost, incidence of infection, hospital stay) and hypermetabolic score. Higher metabolic stress caused more malnutrition and complications. For nutritional management of patients with malnutrition, multiple factors, including nutritional assessment, and evaluation of hypermetabolic severity are needed to provide nutritional support for critically ill patients.
Anti-Bacterial Agents ; APACHE* ; Critical Illness ; Cross Infection ; Enteral Nutrition* ; Fever ; Heart Rate ; Humans ; Incidence ; Inflammatory Bowel Diseases ; Length of Stay ; Leukocytosis ; Leukopenia ; Malnutrition ; Nutrition Assessment ; Nutritional Status* ; Nutritional Support ; Parenteral Nutrition, Total* ; Prospective Studies ; Respiration ; Retrospective Studies ; Stress, Physiological ; Weight Loss

This study evaluated the nutrition intake and changes in laboratory data of surgery patients with hypermetabolic severity on nutrition support. From January 2002 to September 2002, 66 hospitalized surgery patients who had received enteral nutrition (EN, n=19) and total parenteral nutrition (TPN, n=47) for more than 7 days were prospectively and retrospectively recruited. The laboratory data was examined pre-operatively, and on the post-operative 1, 3, 7 day and at the time of discharge. The characteristics of the patients were examined for the hypermetabolic severity, The hypermetabolic scores were determined by high fever (> 38 degrees C), rapid breathing (> 30 breaths/min), rapid pulse rate (> 100 beats/min), leukocytosis (WBC>12,000/microliter), leukocytopenia (WBC<3,000/microliter), status of infection, inflammatory bowel disease, surgery and trauma. The scores for the hypermetabolic status were divided into three groups (mild 0-10, moderate 11-40, severe>41). According to the results of the study, 38.3% (n=23), 45.4% (n=30) and 19.6% (n=13) were in the mild, moderate, and severe groups, respectively. There was a decrease in the serum albumin level and weight loss according to the hypermetabolic severity. However, the white blood cells (WBC), fasting blood sugar (FBS), c-reactive protein (CRP), total bilirubin, GOT, and GPT increased. The nutritional intake was TPN (32.5 kcal/kg, protein 1.2 g/kg, fat 0.25 g/kg), EN (28.1 kcal/kg, protein 1.0 g/kg, fat 1.01 g/kg). The serum albumin, hemoglobin and cholesterol were higher in the EN group than in the TPN group. But the FBS, total bilirubin, GOT and GPT were higher in the TPN group than the EN group. In conclusion, there was a negative correlation between the changes in the laboratory data and the hypermetabolic severity. There was an increase in the number of metabolic complications in the TPN group.
Bilirubin ; Blood Glucose ; C-Reactive Protein ; Cholesterol ; Enteral Nutrition* ; Fasting ; Fever ; Heart Rate ; Humans ; Inflammatory Bowel Diseases ; Leukocytes ; Leukocytosis ; Leukopenia ; Malnutrition ; Parenteral Nutrition, Total* ; Prospective Studies ; Respiration ; Retrospective Studies ; Serum Albumin ; Weight Loss

We reported localized amyloidosis involving seminal vesicles and vasa deferentia, which was found in two patients with prostatic adenocarcinoma. A 60-yr-old (Case 1) and a 59-yr-old (Case 2) man came to our hospital with elevation of serum prostate-specific antigen (PSA) and biopsy proven carcinoma, respectively. MRI revealed multiple irregular foci of low signal intensity in the prostates as well as in both seminal vesicles and vasa deferentia on T2-weighted imaging, suggesting prostatic carcinoma with extension to both seminal vesicles and vasa deferentia in both cases. Under the clinical diagnosis of stage III prostatic adenocarcinoma, a radical prostatectomy was performed in both patients. Microscopically, Gleason score 7 adenocarcinoma was observed in both patients. In addition, isolated amyloidosis of both seminal vesicles and vasa deferentia was found without carcinoma involvement. Localized amyloidosis in the seminal vesicles, which is considered as senile process, has been occasionally reported in the autopsy and in the surgical specimens. Amyloid deposition in the vas deferens has also been reported in the literature, however, the deposition mimicking extension of carcinoma has not been reported. In this report, two cases of isolated amyloidosis of the seminal vesicles and vasa deferentia are described with electron microscopic study and literature review.
Adenocarcinoma/complications ; Amyloidosis/complications/*pathology ; Human ; Male ; Middle Aged ; Prostatic Neoplasms/complications ; Seminal Vesicles/*pathology ; Vas Deferens/*pathology

Cone-beam digital tomosynthesis (CBDT) has greatly been paid attention in the image-guided radiation therapy because of its attractive advantages such as low patient dose and less motion artifact. Image quality of tomograms is, however, dependent on the imaging conditions such as the scan angle (beta(scan)) and the number of projection views. In this paper, we describe the principle of CBDT based on filtered-backprojection technique and investigate the optimization of imaging conditions. As a system performance, we have defined the figure-of-merit with a combination of signal difference-to-noise ratio, artifact spread function and floating-point operations which determine the computational load of image reconstruction procedures. From the measurements of disc phantom, which mimics an impulse signal and thus their analyses, it is concluded that the image quality of tomograms obtained from CBDT is improved as the scan angle is wider than 60 degrees with a larger step scan angle (Delta beta). As a rule of thumb, the system performance is dependent on . If the exact weighting factors could be assigned to each image-quality metric, we would find the better quantitative imaging conditions.
Artifacts ; Humans ; Image Processing, Computer-Assisted ; Radiotherapy, Image-Guided ; Thumb

BACKGROUND: Review of the outside pathology material is an important practice that provides useful information on patient managements and improves the diagnostic quality in surgical pathology. We report our experience with the frequency and types of diagnostic discrepancies in patients referred to the Asan Medical Center for treatment or a second opinion. METHODS: All referral pathology diagnoses (867 surgical cases) made from October 2001 to July 2002 at Asan Medical Center were compared with outside pathology diagnoses. RESULTS: Of the 867 surgical cases reviewed, 231 (26.7%) cases had a diagnostic discrepancy, which included 49 (5.7%) major and 182 (21.0%) minor discrepancies. The contents of the major discrepancies were a change in the diagnosis (34 cases), a change in the type of malignancy including small cell carcinoma and non-small cell carcinoma of the lung (10), a diagnosis of a metastasis as the primary lesion (4), and errors in interpreting the invasiveness (1). The causes or reasons for the major discrepancy were a difference in interpretation (81.6%), the availability of special studies (10.2%), a failure to identify the lesions (4.1%), and a lack of clinical information (4.1%). CONCLUSIONS: The major discrepancy rate (5.7%) was comparable to that of the other reports from western countries. Among the major discrepancies, a change in diagnosis was most commonly observed and difference in interpretation was the most common reason. A routine review of all the patients pathology material is recommended for all referral patients for an improvement in the pathologic diagnoses and to provide better medical care.
Carcinoma, Small Cell ; Chungcheongnam-do* ; Diagnosis ; Humans ; Lung ; Neoplasm Metastasis ; Pathology ; Pathology, Surgical* ; Referral and Consultation*

The cannabinoid (CB2) receptor type 2 has been proposed to prevent the degeneration of dopamine neurons in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated mice. However, the mechanisms underlying CB2 receptor-mediated neuroprotection in MPTP mice have not been elucidated. The mechanisms underlying CB2 receptor-mediated neuroprotection of dopamine neurons in the substantia nigra (SN) were evaluated in the MPTP mouse model of Parkinson's disease (PD) by immunohistochemical staining (tyrosine hydroxylase, macrophage Ag complex-1, glial fibrillary acidic protein, myeloperoxidase (MPO), and CD3 and CD68), real-time PCR and a fluorescein isothiocyanate-labeled albumin assay. Treatment with the selective CB2 receptor agonist JWH-133 (10 μg kg⁻¹, intraperitoneal (i.p.)) prevented MPTP-induced degeneration of dopamine neurons in the SN and of their fibers in the striatum. This JWH-133-mediated neuroprotection was associated with the suppression of blood-brain barrier (BBB) damage, astroglial MPO expression, infiltration of peripheral immune cells and production of inducible nitric oxide synthase, proinflammatory cytokines and chemokines by activated microglia. The effects of JWH-133 were mimicked by the non-selective cannabinoid receptor WIN55,212 (10 μg kg⁻¹, i.p.). The observed neuroprotection and inhibition of glial-mediated neurotoxic events were reversed upon treatment with the selective CB2 receptor antagonist AM630, confirming the involvement of the CB2 receptor. Our results suggest that targeting the cannabinoid system may be beneficial for the treatment of neurodegenerative diseases, such as PD, that are associated with glial activation, BBB disruption and peripheral immune cell infiltration.
1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine* ; Animals ; Blood-Brain Barrier ; Chemokines ; Cytokines ; Dopamine* ; Dopaminergic Neurons* ; Fluorescein ; Glial Fibrillary Acidic Protein ; Macrophages ; Mice ; Microglia ; Neurodegenerative Diseases ; Neuroprotection ; Nitric Oxide Synthase Type II ; Parkinson Disease* ; Peroxidase ; Real-Time Polymerase Chain Reaction ; Receptor, Cannabinoid, CB2* ; Receptors, Cannabinoid ; Substantia Nigra

Primitive neuroectodermal tumor (PNET) is a small round cell neoplasm that mainly develops in the central nervous system and soft tissue of children. Primary occurrence in the kidney is rare and the identification of immunopositivity for CD99 and t(11;22)(q24;q12) is essential in differential diagnoses. We report two cases of PNET developed in a 21-year-old woman and a 44-year-old man. Resected tumors were composed of sheets of round or ovoid cells with hyperchromatic nuclei and minimal eosinophilic cytoplasm. Rosette formations, more prominent in the first case, were observed. The tumor cells of both cases were diffusely positive for CD99, vimentin, and neuron specific enolase, while they were negative for cytokeratin, desmin, and chromogranin. Synaptophysin was focally expressed only in the first case. The EWS-FLI1 chimeric gene was identified by a reverse transcriptase-polymerase chain reaction in the first case. The first patient is alive with a recurrent tumor two years after the diagnosis, and has received combination chemotherapy. The second patient is alive with no evidence of recurrence or metastasis nineteen months after the diagnosis.
Adult ; Central Nervous System ; Child ; Cytoplasm ; Desmin ; Diagnosis ; Diagnosis, Differential ; Drug Therapy, Combination ; Eosinophils ; Female ; Humans ; Keratins ; Kidney* ; Neoplasm Metastasis ; Neuroectodermal Tumors, Primitive* ; Phosphopyruvate Hydratase ; Recurrence ; Rosette Formation ; Synaptophysin ; Vimentin ; Young Adult

PURPOSE: To analyze the preoperative clinical and pathological characteristics of patients with pT0 prostate cancer. MATERIALS AND METHODS: We retrospectively reviewed the records of 702 patients who underwent radical prostatectomy (RP) at our institution between January 2004 and July 2008 for clinically localized prostate cancer. If there was no evidence of residual tumor in the pathological specimen of the prostate, a patient was staged as pT0. Patients with pT0 disease were compared with a control group of patients who were operated on during the same period. RESULTS: Overall, 9 (1.3%) patients were staged as pT0 on the pathologic examination. Significant differences were observed between the pT0 group and the control patients in the biopsy Gleason score (p=0.004), the number of positive cores on biopsy (p=0.018), the tumor length of positive cores (p<0.001), and prostate volume (p=0.015). Cutoff values predictive of pT0 tumor status were defined as a biopsy Gleason score sum < or =6, 2 or fewer positive biopsy cores, tumor length on biopsy < or =2 mm, and prostate volume >30 cm3. Whereas 8 of the 9 (88.9%) pT0 patients showed all of these characteristics, only 55 of the 693 (7.9%) control patients fulfilled the criteria. The combination suggested above afforded a sensitivity of 88.8% and a specificity of 92.1% for the prediction of pT0 status. CONCLUSIONS: The frequency of pT0 prostate cancer seen on RP was 1.3%. A combination of clinicopathological features, incorporating a biopsy Gleason score, the number of positive biopsy cores, tumor length on biopsy, and prostate volume, was useful to predict pT0 stage on RP.
Biopsy ; Humans ; Neoplasm Grading ; Neoplasm Staging ; Neoplasm, Residual ; Prostate ; Prostatectomy ; Prostatic Neoplasms ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND: Pathologic grading, one of the most important prognostic factors of papillary urothelial neoplasia (PUN) of the urinary bladder, has been revised continuously. The current study focused on the analysis of interobserver agreement on PUN of the urinary bladder bet- ween 1973 WHO classification (WHO 1973) and 1998 WHO/ISUP classification. METHODS: Seventy five cases from 15 institutions were collected, and after review by Korean Society of Urogenital Pathology (KSUP), 30 cases were selected as follows; group I, WHO grade 1 and papillary urothelial neoplasm of low malignant potential by ISUP (7 cases), group II, WHO grade 2 and low-grade papillary urothelial carcinoma (16 cases), and group III, WHO grade 3 and high-grade papillary urothelial carcinoma (7 cases). Seventy five general surgical pathologists who participated in this study were asked to grade the tumors based on WHO/ISUP classification. Interobserver agreement between the participants' diagnosis and KSUP consensus diagnosis was analyzed by kappa value. RESULTS: Interobserver agreement assessed by kappa value for all diagnostic groups was very low; for group I, kappa value was -0.900893722; for group II, -0.944650025, and for group III, -0.876728996. The overall kappa value of pathology residents was better than that of practicing pathologists. CONCLUSIONS: The 1998 WHO/ ISUP classification could not be easily translated from the 1973 WHO classification and because of poor interobserver agreement, it appears that further work would be needed before it can be practically applied.
Carcinoma, Transitional Cell ; Classification* ; Consensus* ; Diagnosis ; Pathology* ; Urinary Bladder Neoplasms ; Urinary Bladder*

The multiple correlation coefficient between the values determined by dry weight and those determined by fluorometer was observed with r = 0.96 and the standard error of calibration was 0.034. Using the best calibration data, in order to reconfirm the reliability of the fluorometer results in comparison with those obtained by dry weight on the cell concentration, fedbatch cultures were carried out. The results obtained by fluorometer measurements were in good agreement with those obtained by dry weight. The on-line monitoring of cell concentration by the fermentor system linked to a computer equipped with fluorometer was successfully carried out.
Bioreactors ; Calibration ; Pichia* ; Yeasts*