Purpose: Acute promyelocytic leukemia (APL) is a rare disease in children and there are some different characteristics between children and adult. We aimed to evaluate incidence, clinical characteristics and treatment outcomes of pediatric APL in Korea. Materials and Methods: Seventy-nine pediatric APL patients diagnosed from January 2009 to December 2016 in 16 tertiary medical centers in Korea were reviewed retrospectively. Results: Of 801 acute myeloid leukemia children, 79 (9.9%) were diagnosed with APL. The median age at diagnosis was 10.6 years (range, 1.3 to 18.0). Male and female ratio was 1:0.93. Thirty patients (38.0%) had white blood cell (WBC) count greater than 10×109/L at diagnosis. All patients received induction therapy consisting of all-trans retinoic acid and chemotherapy. Five patients (6.6%) died during induction chemotherapy and 66 patients (86.8%) achieved complete remission (CR) after induction chemotherapy. The causes of death were three intracranial hemorrhage, one cerebral infarction, and one sepsis. Five patients (7.1%) suffered a relapse during or after maintenance chemotherapy. The estimated 4-year event-free survival and overall survival (OS) rates were 82.1%±4.4%, 89.7%±5.1%, respectively. The 4-year OS was significantly higher in patients with initial WBC < 10×109/L than in those with initial WBC ≥ 10×109/L (p=0.020). Conclusion This study showed that the CR rates and survival outcomes in Korean pediatric APL patients were relatively good. The initial WBC count was the most important prognostic factor and most causes of death were related to serious bleeding in the early stage of treatment.

Staphylococcus lugdunensis is a coagulase-negative staphylococcus. However, it causes various clinically important human infections and behaves similar to Staphylococcus aureus. S. lugdunensis reportedly causes infective endocarditis, skin and soft tissue infection, bone and joint infection, septicemia, endarteritis, urinary tract infection, ocular infection, and peritonitis. There are no reports of septic arthritis by this organism in Korea. We presented a case of septic arthritis due to S. lugdunensis in an elderly patient with diabetes mellitus after an intra-articular injection.
Aged ; Arthritis* ; Arthritis, Infectious ; Diabetes Mellitus ; Endarteritis ; Endocarditis ; Eye Infections ; Humans ; Injections, Intra-Articular* ; Joints ; Knee Joint ; Knee Prosthesis ; Knee* ; Korea ; Peritonitis ; Sepsis ; Skin ; Soft Tissue Infections ; Staphylococcus ; Staphylococcus aureus ; Staphylococcus lugdunensis* ; Urinary Tract Infections

The distinction between benign and malignant thyroid tumors is critical for the management of patients with thyroid nodules. We applied immunohistochemical staining for galectin-3, HBME-1, cytokeratin 19 (CK19), high molecular weight cytokeratin (HMWCK), cyclin D1 and p27(kip1) in 295 thyroid lesions to determine their diagnostic accuracy. The expression of all markers was significantly associated with differentiated thyroid carcinoma (DTC).The sensitivity for the diagnosis of DTC was 94.7% with galectin-3, 91.3% with HBME-1, and 90.3% with CK19. The specificities of these markers were 95.5%, 69.7%, and 83.1%, respectively. Combining these markers, co-expression of galectin-3 and CK19 or galectin-3 and HBME-1 was seen in 93.2% of carcinomas but in none of the benign nodules. Comparing follicular variant of papillary carcinoma (FVPC) with follicular carcinoma (FC), the expression of galectin-3, CK19, and HMWCK was significantly higher in FVPC. When comparing FC with FA, the expression of galectin-3 and HBME-1 was significantly higher in FC. These results suggest that 1) galectin-3 is a useful marker in the distinction between benign and malignant thyroid tumors, 2) the combined use of HBME-1 and CK19 can increase the diagnostic accuracy, and 3) the use of CK19 and HMWCK can aid in the differential diagnosis between PC and FC.
Adenocarcinoma, Follicular/diagnosis/metabolism ; Carcinoma, Papillary, Follicular/diagnosis/metabolism ; Cyclin D1/analysis ; Cyclin-Dependent Kinase Inhibitor p27/analysis ; Diagnosis, Differential ; Galectin 3/analysis ; Humans ; Immunohistochemistry ; Intracellular Signaling Peptides and Proteins/analysis ; Keratin-19/analysis ; Keratins/analysis ; Sensitivity and Specificity ; Thyroid Gland/chemistry/*pathology ; Thyroid Nodule/*diagnosis/metabolism ; Tumor Markers, Biological/*analysis

BACKGROUND: Id proteins are a family of helix-loop-helix proteins and are regarded to be negative regulators of cell differentiation. In general, Id-1 and Id-2 expressions are upregulated during tumor development and progression in a variety of neoplasms, and these expressions may be associated with aggressive tumor behavior. However, little is known about the roles of Id-1 and Id-2 in thyroid neoplasms. METHODS: The expressions of Id-1 and Id-2 were assessed immunohistochemically in 310 normal, hyperplastic, and neoplastic thyroid tissues using tissue microarrays. RESULTS: Normal thyroid tissues rarely expressed Id-1 or Id-2. Moreover, whilst Id-1 expression was more elevated in malignant thyroid tissue than in hyperplastic thyroid tissue, Id-2 expression was more variable. No significant differences were observed between histologic subtypes of thyroid carcinomas with respect to Id-1 or Id-2 expression. Follicular adenomas showed higher expressions of Id-1 and Id-2 than thyroid carcinomas. No significant association was found between clinicopathological parameters and Id-1 expression, though Id-2 expression was significantly reduced in metastatic, stage IV tumors. CONCLUSION: The expressions of Id-1 and Id-2 were elevated in hyperplastic and neoplastic thyroid tissues. However, neither appears suitable as a marker of malignancy or an aggressive phenotype, although Id-2 expression in advanced thyroid carcinomas may reflect a favorable prognosis.
Adenocarcinoma, Follicular ; Adenoma ; Carcinoma, Papillary ; Cell Differentiation ; Humans ; Inhibitor of Differentiation Protein 1 ; Inhibitor of Differentiation Protein 2 ; Phenotype ; Prognosis ; Thyroid Gland* ; Thyroid Neoplasms*

OBJECTIVE: This study was performed to evaluate the efficacy, safety and complications of tension-free vaginal tape (TVT) combined with total hysterectomy under general anesthesia. METHODS: Retrospective comparison of 76 women treated by TVT procedure with total hysterectomy from January 2003 to December 2003. All patients had undergone preoperative evaluation including history taking, physical examination, pelvic examination, 1-hour pad test and urodynamic test, and then were operated under general anesthesia. There were 65 patients combined with LAVH (laparoscopic assisted vaginal hysterectomy), 6 patients combined with VTH (vaginal total hysterectomy) and 5 patients combined with TAH (total abdominal hysterectomy). RESULTS: The mean follow up and hospital day were respectively 13 months (range 6-18 months) and 7.6 days (range 6-15 days). Objective and subjective success rate were respectively 97.4% (cured 92.1%, improved 5.3%) and 97.4% (cured 88.1%, improved 9.3%). Preoperative and postoperative 1-hour pad test were respectively 36.4 gm and 4.1 gm (p<0.001). Complications were bladder perforation (6.6%), voiding dysfunction (7.9%) and overactive bladder syndrome (7.9%). CONCLUSION: Conclusively, the cure rate was 88.1% in the TVT combined with hysterectomy when performed under general anesthesia.
Anesthesia, General ; Female ; Follow-Up Studies ; Gynecological Examination ; Humans ; Hysterectomy* ; Physical Examination ; Retrospective Studies ; Suburethral Slings* ; Urinary Bladder ; Urinary Bladder, Overactive ; Urodynamics

BACKGROUND: Medullary thyroid carcinoma (MTC) that originates from C cells comprises about 10% of all the malignant thyroid tumors. Activating mutations of the RET proto-oncogene have been found to be involved in the anti-apoptotic pathway of MTC that harbors the RET mutation. We investigated the correlation between the clinicopathologic parameters and the expressions of survivin, a novel anti-apoptotic molecule, and the other apoptosis-related proteins, and the known prognostic markers. METHODS: Immunohistochemical staining was performed using antibodies for survivin, Fas, Fas ligand (FasL), bcl-2, calcitonin, CEA and cyclin A in 19 case of MTC; 10 sporadic MTCs, eight multiple endocrine neoplasia (MEN) type 2A MTCs and one familial MTC (FMTC). RESULTS: Survivin protein expression was found in five cases (26%) and this was correlated with the presence of angiolymphatic tumor emboli (p=0.019). FasL was expressed in 14 cases (74%) and it had correlation with the presence of lymph node metastases (p=0.029). The cyclin A-labeling indices were correlated with local invasiveness (p=0.001). CONCLUSIONS: Survivin and FasL might be involved in the lymphatic tumor spread of MTC.
Antibodies ; Calcitonin ; Carcinoma, Medullary ; Cyclin A ; Cyclins ; Fas Ligand Protein* ; Lymph Nodes ; Multiple Endocrine Neoplasia ; Neoplasm Metastasis ; Proto-Oncogenes ; Thyroid Gland* ; Thyroid Neoplasms*

BACKGROUND: Post-ischemic myocardial dysfunction (myocardial stunning) is known to be associated with low reflow phenomenon or the reduction of coronary vasodilatory reserve. However, it remains controversial whether a relationship between myocardial stunning and post-ischemic impairment of coronary flow reserve exists. With increased influx of calcium into myocardial cells precipitated by ischemia and reperfusion known to be involved not only in the progression of myocardial tissue damage but also in the pathogenesis of post-ischemic myocardial dysfunction and impaired coronary vasodilatory reserve, it has been hypothesized that calcium channel blockers exert protective effects on post-ischemic myocardial dysfunction and microvascular dysfunction. PURPOSE: To investigate the effects of diltiazem, a calcium channel blocker, on post-ischemic myocardial dysfunction and coronary vasodilatory reserve, vehicle or diltiazem was administered before brief coronary artery occlusion in open chest dogs. Peak coronary flow and myocardial contractile function were measured after intracoronary infusion of endothelium-dependent vasodilator acetylcholine and endothelium-independent vasodilator adenosine. The parameters measured before and after reperfusion in control dogs and diltiazem-treated dogs were compared. METHOD: Open chest dogs (n-17) underwent 20 minutes occlusion of left circumflex artery followed by reperfusion for 60 minutes:the subjects were divided into two groups (n-10 in control group and n-7 in diltiazem group). Diltiazem dogs received diltiazem (0.2 mg/kg) intravenuously 15 minutes before coronary occlusion. Control dogs received vehicle-a saline solution. Coronary blood flow was measured with electromagnetic flow probe. Coronary flow reserve was determined by peak coronary flow after intracoronary infusion of acetylcholine (ACH, 0.01ug/kg) and adenosine (ADE, 1.5 mg/kg):it was also determined by reactive hyperemia (RH) measured after coronary occlusion for 20 seconds at baseline and 30 and 60 minutes after reperfusion. Segmental left ventricular function was assessed by 2-D echocardiography at the level of mid-papillary muscle, and changes of left ventricular function was expressed as % change of myocardial thickening and % change of endocardial thickening. RESULTS: Peak coronary flow and minimal coronary vascular resistance with ACH, ADE and RH were maintained at 30 and 60 minutes after reperfusion in the diltiazem group, but those in the control group were significantly impaired. There was no difference in reduction of % change of peak flow with ACH in both groups (p-0.44), but the reduction of % change of peak flow with ADE was attenuated in the diltiazem group when compared with the control group (p-0.03) 60 minutes after reperfusion. Total myocardial thickening and endocardial wall motion at 30 and 60 minutes after reperfusion were significantly reduced than those assessed before coronary occlusion in both groups, but the endocardial wall motion was less depressed in the diltiazem group than that in the control group. There was no correlation between % change of peak flow in response to ACH and to ADE and % change of myocardial thickening:there was also no correlation between % change of endocardial wall motion in the control group and % change of myocardial thickening in the diltiazem group. There was however good correlation between % change of peak flow and % change of endocardial wall motion in the diltiazem group. CONCLUSION: The findings that changes in peak coronary flow and minimal coronary vascular resistance do not correlate with the change in myocardial contractile function in the dog model with reperfusion after 20 minutes coronary occlusion suggest that microvascular and myocardial stunning develop independent of each other. The protective effect of diltiazem on impaired coronary flow reserve and contractile dysfunction following reperfusion after brief ischemia also suggests that calcium overloading plays a role in the pathogenesis of microvascular stunning as well as myocardial stunning.
Acetylcholine ; Adenosine ; Animals ; Arteries ; Calcium ; Calcium Channel Blockers ; Calcium Channels ; Coronary Occlusion ; Coronary Vessels ; Diltiazem* ; Dogs* ; Echocardiography ; Hyperemia ; Ischemia ; Magnets ; Myocardial Stunning ; Reperfusion ; Sodium Chloride ; Thorax* ; Vascular Resistance ; Ventricular Function, Left

The expectoration of blood is always a fearful experience for the patient and a matter of grave concern to the attending physician, because it may be the warning sign of serious diseases. When such bleeding occurs, the possibility of its being due to pulmonary tuberculosis, bronchiectasis or carcinoma of the lung is promptly suggested. Nowadays, with the advance of modern diagnostic studies, differential diagnosis has become possible for the hemoptysis patients to have appropriate treatment. This evaluation is based on the review of 75 cases of patients whom we performed emergency open thoracotomies for 6 years from March 1992 to February 1997 in the Department of Thoracic and Cardiovascular Surgery, Seoul Adventist Hospital. The mean age of the patients was 36.6 years old with a range from 19 to 68, and most prevalent age group was thirties. The most common underlying lung disease causing hemoptysis was tuberculosis(44%). Most accurate diagnostic study was bronchoscopy during hemoptysis(95%) and right middle and lower lobe(17.3%) was the most common site of lesion. Lobectomy(50%) was the most frequent operative method and recurrent hemoptysis(31.6%) was the most common postoperative complication. But most of the patients(82.6%) were completely recovered by surgical treatment. Now we concluded that the proper management of hemoptysis was completed by surgical approach with definite diagnosis and supportive medication.
Bronchiectasis ; Bronchoscopy ; Diagnosis ; Diagnosis, Differential ; Emergencies ; Hemoptysis* ; Hemorrhage ; Humans ; Lung ; Lung Diseases ; Postoperative Complications ; Seoul ; Thoracotomy ; Tuberculosis, Pulmonary

Screw-shaped implants of commercially pure (c.p.) titanium, c.p. niobium, c.p. zirconium, and stainless(Sus 304) were inserted in the rabbit tibial over 12 weeks of follow-up. New developed torque gauge instrument was used to evaluate the implant holding power and a image analysis program coupled to a microscope was used for histomorphometry. The three best consecutive threads of each implant were measured. Quantitative analyses at 12 weeks revealed a partial bone contact to the four kinds investigated metals. There were no obvious adverse tissue reactions to any of the biomaterials. At 12 weeks the average removal torques for titanium, niobium and zirconium were better than that needed for Sus 304 screws, on the other hand high score of bony contact ratio of titanium and niobium were showed in comparison to those of zirconium and Sus 304. There was no significant differences in the amount of interfacial bone of zirconium and Sus 304 whereas there was significant differences in the torque forces of niobium and Sus 304. Three months after implant insertion, the average removal torque was 6.64 Ncm for the titanium, 6.57 Ncm for the niobium, 6.38 Ncm for the zirconium, and 4.25 Ncm for the Sus 304. On average bone contacts there were 51.24% in the titanium, 48.19% in the niobium, 31.79% in the zirconium, 23.54% in Sus 304. Biocompatibility of the titanium, niobium and zirconium was acceptable level in comparison to the Sus 304.
Biocompatible Materials ; Follow-Up Studies ; Hand ; Metals ; Niobium ; Titanium ; Torque ; Zirconium

It has been held that excessive mechanical forces to the osseous and soft tissues of the TMJ result in joint dysfunction. Understanding the stress pattern on TMJ is very important in TMJ research. But, it is very difficult to measure directly the biomechanical stress distribution in the TMJ during functional movement was studied through animal experiment or mathematical model . It was observed and compared the stress distribution occuring in the working and balancing condyle when lower right canine, lower right first molar and lower right second molar were clenched by the three dimensional finite element analysis. Also, stress distribution in the working and balancing condyles were observed and compared when 20 forward and buccal bite forces were applied to the first molar The results were as follows : 1. Stress distribution in the condyles during unilateral clenching of the first molar, second molar, canine showed no difference. In the working condyle, tensile force was concentrated on the lateral aspect of the condylar articular surface and condylar neck. And compressive force was concentrated on the anteromedial and lateral aspect of condyle. In the balancing condyle, tensile and compressive force was concentrated on the lateral aspect of the condylar articular surface and stress transmission to the temporal bone was not observed. 2. When lateral force were applied to the first molar, tensile force were concentrated on the medial aspect of the condylar neck and condylar posterior surface in working and balancing condyle. Compressive force was concentrated on the anteromedial and lateral surface of condyle and stress transmission to the temporal bone was not observed. 3. During unilateral clenching, stress in the working condyle decreased as the occlusal load moved posteriorly while the stress in the balancing condyle increased when lateral forces were applied to the first molar, the incremental amount of stress was greater than vertical load. 4. During unilateral clenching, the average balancing/ working stress ratio was 2.52. There was a greater concentration of stress in the balancing condyle. The ratio increased at the occlusal load moved posteriorly and decreased considerably when lateral forces were applied to the first molar
Animal Experimentation ; Bite Force ; Finite Element Analysis ; Joints ; Mandibular Condyle* ; Models, Theoretical ; Molar ; Neck ; Temporal Bone ; Temporomandibular Joint