PURPOSE: At birth, as the fetus adjusts to the "new world", the fetal pulmonary circulation undergoes a striking transition, characterized by an immediate rise in pulmonary blood flow and a sustained decrease in pulmonary vascular resistance(PVR). In the factors which reduce PVR after birth, are ventilation of the lung by gas, increase of oxygen tension in pulmonary vascular system, and some vasoactive mediators. Nitric oxide(NO) is regarded as one of the vasoactive mediators. Therefore we attempted to determine endogenous NO formation in newborns by measuring urinary nitrite(NO2) and citrulline which are indexes of endogenous NO formation. METHODS: We measured the urinary excretion of NO2 and citrulline in 20 term and 15 preterm neonates at the age of 1, 3, 7 days. RESULTS: The urinary excretion of NO2 and citrulline in the neonate group was higher as compared with the older children group(P<0.05). And it increased from the 1st to the 3rd day in the neonatal period(P<0.05). Furthermore the urinary excretion of them and the gestational age were inversely related(P<0.05). CONCLUSION: These changes of the urinary excretion of NO2 and citrulline in the neonate group suggest the presence of an active physiological role of NO in the pulmonary vascular biology during neonatal transition.
Biology ; Child ; Citrulline* ; Fetus ; Gestational Age ; Humans ; Infant, Newborn* ; Lung ; Nitric Oxide* ; Oxygen ; Parturition ; Pulmonary Circulation ; Strikes, Employee ; Ventilation

A 69-year-old woman with dyspepsia and poor oral intake was diagnosed as advanced gastric cancer. Clinical staging was stage IV with inoperable status, and thus, three cycles of palliative chemotherapy with paclitaxel and cisplatin were performed. Follow up endoscopy and positron emission tomography with computed tomography (PET-CT) revealed marked decrease in the primary stomach lesion and metastatic lymph nodes. Distal gastrectomy and D2 lymph node dissection were performed with gastrojejunostomy. Later pathological examination demonstrated tumor invading submucosa. However, there was no pathologic evidence of lymph node metastasis. Only the necrotic areas without viable carcinoma cells were noted in regional lymph nodes located along the left gastric artery and common hepatic artery. Because of the excellent response to chemotherapy, R0 resection was carried out. Herein, we report a case of advanced gastric cancer showing complete remission of metastatic lymphadenopathy after palliative chemotherapy.
Aged ; Arteries ; Cisplatin ; Drug Therapy* ; Dyspepsia ; Endoscopy ; Female ; Follow-Up Studies ; Gastrectomy ; Gastric Bypass ; Hepatic Artery ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Lymphatic Diseases ; Neoplasm Metastasis ; Paclitaxel ; Positron-Emission Tomography ; Stomach ; Stomach Neoplasms*

Indomethacin, a prostaglandin synthetase inhibitor, is widely used for constriction or closure of patent ductus arteriosus in premature infants. Following indomethacin therapy, a majority of the infants develop transient renal dysfunction, as manifested by decrease in urine output, glomerular filtration rate, fractional excretion of sodium and free water clearance. A decrease in urinary excretion of prostaglandins also has been noted in premature infants following indomethacin therapy. Furosemide , on the other hand, has recently been shown to increase urinary excretion of prostaglandins. The hemodynamic and tubular effects of furosemide have been proposed to be mediated by renal prostaglandins. Therefore, the present study was conducted to determine if furosemide therapy would prevent the changes of renal blood flow which are considered indomethacin effects. The results obtained are as follows : 1) In the non-furosemide group, after indomethacin administration renal blood flow decreased to its lowest level, 30 minutes, and then recovered its baseline level at 90 minutes(P<0.05). But there were no significant changes in the furosemide-treated group. 2) After indomethacin administration, urinary prostaglandin E2 decreased to its lowest level at 90 minutes in the non-furosemide group(P<0.05), but there was no significant changes in the furosemide- treated group. 3) Plasma renin activity did not change in the non-furosemide group, while measuring significantly higher in the treated group(P<0.05). 4) Antidiuretic hormone(ADH) level was increased significantly in the non-furosemide group(P<0.05), while did not change in the furosemide-treated group. 5) There was no significant changes on plasma aldosterone blood pressure, electrolytes, BUN,and creatinine. These findings of our present study may have clinical implications when indomethacin is to be used to close the ductus in premature infants. In such cases, simultaneous administration of furosemide may prevent some effects on renal blood flow of indomethacin but further clinical studies are necessary to recognize whether this furosemide therapy may affect the efficacy of indomethacin in the closure of the ductus arteriosus.
Aldosterone ; Animals ; Blood Pressure ; Cats* ; Constriction ; Creatinine ; Dinoprostone ; Ductus Arteriosus ; Ductus Arteriosus, Patent ; Electrolytes ; Furosemide* ; Glomerular Filtration Rate ; Hand ; Hemodynamics ; Humans ; Indomethacin* ; Infant ; Infant, Newborn ; Infant, Premature ; Plasma ; Prostaglandin-Endoperoxide Synthases ; Prostaglandins ; Renal Circulation* ; Renin ; Sodium ; Water

Achalasia is a rare neurological deficit of the esophagus that produces an impaired relaxation of the lower esophageal sphincter and decreased motility of the esophageal body. Achalasia is generally accepted to be a pre-malignant disorder, since, particularly in the mega-esophagus, chronic irritation by foods and bacterial overgrowth may contribute to the development of dysplasia and carcinoma. We present a case of a 51-year-old man with achalasia combined with esophageal cancer who has had dysphagia symptoms for more than 20 years. Since there was a clinically high possibility of supraclavicular lymph node metastasis, concurrent chemoradiation therapy was scheduled. After the third cycle of chemoradiation therapy, transthoracic esophageolymphadenectomy was performed. Histopathological examination of the main esophagus specimen revealed no residual carcinoma. And the entire regional lymph node areas were free of carcinoma except for one azygos metastatic lymph node. In summary, achalasia is a predisposing factor for esophageal squamous cell carcinoma. Although surveillance endoscopy in achalasia patients is still controversial, periodic screening for cancer development in long-standing achalasia patients might be advisable.
Carcinoma, Squamous Cell ; Deglutition Disorders ; Endoscopy ; Esophageal Achalasia ; Esophageal Neoplasms ; Esophageal Sphincter, Lower ; Esophagus ; Humans ; Lymph Nodes ; Mass Screening ; Middle Aged ; Neoplasm Metastasis ; Relaxation

PURPOSE: To search for CT findings which helpfully differentiate mucinous from nonmucinousbronchi-oloalveolar carcinoma and to assess the difference in stages between the two types of tumors. Twenty-two patients with pathologically proven bronchioloalveolar carcinoma (BAC) were included inthis study. On the basis of CT findings, tumors were classified as either solitary or multiple and as eithermass/nodule, consolidation, or mixed type. CT stages of the tumors were determined by two radiologists andconclusions were reached by consensus. RESULTS: Twelve patients had nonmucinous BACs and ten had mucinous BACs.Among the ten cases of mucinous BAC, six were solitary and four were multiple. These were mass/nodule (n=3),consolidation (n=5), and mixed pattern (n=2). In contrast, among the twelve cases of nonmucinous BAC, six weresolitary and six were multiple. All were mass/nodule, except for one mixed type. Among the mucinous BACs, threewere operable and seven (above stage IIIa) were inoperable. Among the nonmucinous BACs, four were operable andeight were inoperable. CONCLUSION: Consolidation was more common in mucinous BAC and mass/nodule was more commonin non-mucinous BAC (p<0.05). There was no difference in tumor stages between mucinous and nonmucinous types ofBAC (p>0.05).
Adenocarcinoma, Bronchiolo-Alveolar ; Consensus ; Humans ; Mucins*

We experienced a rare case of colonic cryptococcosis in an apparently immunocompetent individual. A 27-year- old woman admitted our hospital for intermittent melena. Initial abdominal CT scan revealed a mass lesion obstructing most of the lumen in ascending colon. Colonoscopy showed huge ulcerofungating mass in proximal ascending colon. Colonoscopic biopsy was performed and pathologic diagnosis was made as colonic cryptococcosis with positive PAS stain. Laboratory test evaluating immune status and bone marrow examination was normal. The patient was treated with intravenous amphotericin B for four weeks and six months of oral fluconazole afterwards. Follow-up abdominal CT scan and colonoscopy were taken at four weeks and seven months after the beginning of treatment. On completion of intravenous amphotericin B treatment, the mass lesion was decreased in abdominal CT and colonoscopy. After seven months, abdominal CT and colonoscopy showed near-complete resolution of the colonic lesion so the treatment ended. Cryptococcosis in a healthy individual is a rare disease and there have been only several sporadic case reports on pulmonary or central nervous system involvement. Hence, we report a case of colonic cryptococcosis in an apparently immunocompetent individual.
Adult ; Amphotericin B/therapeutic use ; Antifungal Agents/therapeutic use ; Colonic Diseases/*diagnosis/drug therapy/pathology ; Colonoscopy ; Cryptococcosis/*diagnosis/drug therapy ; *Cryptococcus neoformans ; Female ; Fluconazole/therapeutic use ; Humans ; Injections, Intravenous ; Tomography, X-Ray Computed

We experienced a rare case of colonic cryptococcosis in an apparently immunocompetent individual. A 27-year- old woman admitted our hospital for intermittent melena. Initial abdominal CT scan revealed a mass lesion obstructing most of the lumen in ascending colon. Colonoscopy showed huge ulcerofungating mass in proximal ascending colon. Colonoscopic biopsy was performed and pathologic diagnosis was made as colonic cryptococcosis with positive PAS stain. Laboratory test evaluating immune status and bone marrow examination was normal. The patient was treated with intravenous amphotericin B for four weeks and six months of oral fluconazole afterwards. Follow-up abdominal CT scan and colonoscopy were taken at four weeks and seven months after the beginning of treatment. On completion of intravenous amphotericin B treatment, the mass lesion was decreased in abdominal CT and colonoscopy. After seven months, abdominal CT and colonoscopy showed near-complete resolution of the colonic lesion so the treatment ended. Cryptococcosis in a healthy individual is a rare disease and there have been only several sporadic case reports on pulmonary or central nervous system involvement. Hence, we report a case of colonic cryptococcosis in an apparently immunocompetent individual.
Adult ; Amphotericin B/therapeutic use ; Antifungal Agents/therapeutic use ; Colonic Diseases/*diagnosis/drug therapy/pathology ; Colonoscopy ; Cryptococcosis/*diagnosis/drug therapy ; *Cryptococcus neoformans ; Female ; Fluconazole/therapeutic use ; Humans ; Injections, Intravenous ; Tomography, X-Ray Computed

Rickettia typhi is an obligate intracellular organism and usually seen microscopically as gram-negative pleomorphic coccobacilli. Murine typhus is an acute febrile illness caused by R. typhi and transmitted to human by fleas. Fever, skin rash, headache, and myalgia characterize the clinical illness. The risk for laboratory personnel is from exposure to infectious aerosols, accidental inoculation, or exposure to bites by infected ectoparasites. A 27-year old man was admitted to the hospital because of fever and myalgia. He had worked with R. typhi in a laboratory and was exposed to R. typhi 10 days ago. The present illness began seven days before admission, when he developed high fever and conjunctival injection. One day before admission, he developed generalized erythematous skin rash and generalized edema. Immunofluorescence test with rickettsial antigen was positive at 1:4,096 on admission. He received 200 mg of doxycycline for 7 days and became afebrile on the third day after treatment.
Adult ; Aerosols ; Doxycycline ; Edema ; Exanthema ; Fever ; Fluorescent Antibody Technique ; Headache ; Humans ; Laboratory Personnel ; Myalgia ; Rickettsia typhi ; Siphonaptera ; Typhus, Endemic Flea-Borne*

PURPOSE: With the emergence of next-generation sequencing (NGS) technology, profiling a wide range of genomic alterations has become a possibility resulting in improved implementation of targeted cancer therapy. In Asian populations, the prevalence and spectrum of clinically actionable genetic alterations has not yet been determined because of a lack of studies examining high-throughput cancer genomic data. MATERIALS AND METHODS: To address this issue, 1,071 tumor samples were collected from five major cancer institutes in Korea and analyzed using targeted NGS at a centralized laboratory. Samples were either fresh frozen or formalin-fixed, paraffin embedded (FFPE) and the quality and yield of extracted genomic DNA was assessed. In order to estimate the effect of sample condition on the quality of sequencing results, tissue preparation method, specimen type (resected or biopsied) and tissue storage time were compared. RESULTS: We detected 7,360 non-synonymous point mutations, 1,164 small insertions and deletions, 3,173 copy number alterations, and 462 structural variants. Fifty-four percent of tumors had one or more clinically relevant genetic mutation. The distribution of actionable variants was variable among different genes. Fresh frozen tissues, surgically resected specimens, and recently obtained specimens generated superior sequencing results over FFPE tissues, biopsied specimens, and tissues with long storage duration. CONCLUSION: In order to overcome, challenges involved in bringing NGS testing into routine clinical use, a centralized laboratory model was designed that could improve the NGS workflows, provide appropriate turnaround times and control costs with goal of enabling precision medicine.
Academies and Institutes ; Asian Continental Ancestry Group ; DNA ; Humans ; Korea ; Methods ; Paraffin ; Point Mutation ; Precision Medicine ; Prevalence