An intussusception in adulthood is an unusual cause of bowel obstruction. It accounts for up to 5% of all intussusception. Approximately 90% of cases are secondary to a definite lesion such as malignancy or lipoma. Most patients are asymptomatic and the lesion is often detected incidentally at colonoscopy, operation and autopsy. Strangulated intussuscetion is a rare case and also requires emergency operation. A 32-year-old woman visited our emergency room because of severe epigastric pain. Abdominal CT revealed a low density mass in bowel loop and distended small bowel loops filled with fluid. Colonoscopic finding showed huge purple-colored coil-spring lesion in the ascending colon. From this findings, we diagnosed a strangulated intussusception. Surgically removed specimen revealed a small intestinal lipoma.
Adult ; Male ; Female ; Humans

BACKGROUND: Irinotecan is an active agent in colorectal cancer, producing 30~40% response rates when combined with 5-fluorouracil and leucovorin in metastatic colorectal cancer as first line therapy, however, the best combination schedules are not determined yet. We investigated the efficacy and toxicity of irinotecan combined with bolus 5-fluorouracil, continuous infusion 5-fluorouracil, and high-dose leucovorin every two weeks (LV5FU2 regimen) in recurrent or metastatic colorectal cancer in Korean patients. METHODS: Twenty-two patients with measurable diseases previously untreated with chemotherapy other than adjuvant chemotherapy for advanced colorectal cancer were enrolled onto this study and received the study drugs between June 2000 and December 2001. Treatment consisted of irinotecan (180 mg/m2 over two hours on day 1) followed by leucovorin (200 mg/m2 over two hours), bolus 5-fluorouracil 400 mg/m2 and continuous infusion of 5-fluorouracil (600 mg/m2 over next 22 hours) on day 1 and 2. Chemotherapy was repeated every two weeks until progressive disease. RESULTS: Of the 20 patients evaluable for response, 8 partial responses were observed with a response rate of 40%. Six additional patients achieved stable disease as their best response, and six progressed. The median time to progression was 5.0 months and median overall survival was 17.3 months. The most frequently observed grade 3~4 toxicities were neutropenia (18%) and diarrhea (4.8%). Two mortalities occurred, though not clearly related to treatment, before the end of chemotherapy. CONCLUSION: Irinotecan combined with LV5FU2 regimen was effective in advanced colorectal cancer with manageable side effects. Caution should be paid to elderly and poor performance patients to prevent treatment related mortality and morbidity.
Aged ; Appointments and Schedules ; Chemotherapy, Adjuvant ; Colorectal Neoplasms* ; Diarrhea ; Drug Therapy ; Drug Therapy, Combination* ; Fluorouracil* ; Humans ; Leucovorin* ; Mortality ; Neutropenia

Polyurethane foam dressings are becoming widely used in partial and full thickness skin wounds since they are safe and convenient for both patients and physicians. However, the influence of polyurethane foam dressings on epithelialization has not been fully determined yet. This study was designed to compare 2 internationally available polyurethane foams and 3 locally made polyurethane foams as to their effects on the epithelialization in vivo. Twenty white rats were used. A 5 mm punch was employed to excise skin and subcutaneous tissue in a round fashion at six sites in the back area of 10 rats. After creating 6 open wounds, above mentioned 5 polyurethane foams and gauze dressings were applied. On the 5th day the lengths of the nonepithelialized area were measured under light microscope. In addition, partial thickness wounds were created using carbon dioxide laser at six sites on the back of the another 10 rats. Six dressings were applied on the wounds as same as above. On the 4th day the degree of the epithelialization was measured and compared. In full thickness wound study the best wound closing was also seen in chitin mixed Medifoam-N group. In partial thickness wound study the best epithelialization was seen in chitin mixed Medifoam-N and chitosan mixed Medifoam-N groups. These results demonstrated that polyurethane foam dressings influenced the epithelialization, and chitin mixed Medifoam-N showed the best result.
Animals ; Bandages* ; Chitin ; Chitosan ; Humans ; Lasers, Gas ; Polyurethanes* ; Rats* ; Skin ; Subcutaneous Tissue ; Wounds and Injuries

BACKGROUND: Identification of the genes expressed differentially in renal cell carcinoma (RCC)but not in the non-cancerous kidney is important for understanding the molecular basis ofrenal cell carcinoma and for defining possible prognostic value and therapeutic intervention.We investigated the changes in gene expression accompanying the development and progression of kidney cancer by cDNA microarrays. METHODS: To identify molecular alterations in renal cell carcinoma, we measured expression profiles for paired neoplastic and noncancerouskidney samples from an individual by means of a cDNA microarry representing 7, 500genes. Of the differentially expressed genes, we assessed the decorin gene at the proteinlevel using immunohistochemistry. RESULTS: The 60 genes were noted to have more than a fivefold change in expression (either increased or decreased) in RCC compared to the noncancerouskidney. The changed genes are those associated with signal transduction, metabolizingenzymes, the cytoskeleton, cell adhesion, cell cycle control, modulation of transcription, the tumor suppressor gene and tumor antigens. Under immunohistochemistry, the expressionof decorin was significantly decreased in the tumor than in the non-cancerous kidney.The expression rate of decorin was not associated with the patient's sex, age, histologic type, Fuhrmann nuclear grade and T stage. CONCLUSION: The author predicted that these geneexpression profiling experiments will lead to improvements in the basic understanding of renaltumor pathogenesis and will promote the discovery of novel molecular markers for renal tumordiagnosis and therapy.
Antigens, Neoplasm ; Carcinoma, Renal Cell* ; Cell Adhesion ; Cell Cycle Checkpoints ; Cytoskeleton ; Decorin* ; DNA, Complementary* ; Gene Expression* ; Genes, Tumor Suppressor ; Immunohistochemistry ; Kidney ; Kidney Neoplasms ; Oligonucleotide Array Sequence Analysis* ; Signal Transduction

BACKGROUND: Because of the relative paucity of data regarding the clinical outcome in adult patients with acute lymphocytic leukemia (ALL) in Korea, we analyzed clinical courses in adult ALL patients treated with VPD (L) regimen (vincristine, prednisolone, daunorubicin, L-asparaginase) at the Seoul National University Hospital, and evaluated prognostic factors influencing the outcome. METHODS: Patients with ALL newly diagnosed between October 1994 and June 2000 at our hospital were analyzed retrospectively. Fifty-three patients were evaluable. Induction chemotherapy consisted of VPD with (46 cases) or without L-asparaginase (7 cases). After complete remission (CR), consolidation therapy, CNS prophylaxis and maintenance chemotherapy were administered. RESULTS: Ages ranged from 16 to 67 (median 30). CR rate was 86.8% (46/53) and no significant prognostic factor was found for the CR rate. With a median follow-up time of 27.2 months (range 12.9~83.0 months) in living patients, the median overall survival (OS) for all cases was 16.7 months (13.4~20.1 months, 95% C.I.) and the estimated 4-year OS rate was 25.4%+/-8.9%. The median relapse-free survival (RFS) was 12.2 months (8.4~16.0 months, 95% C.I.), and 3-year RFS rate was 29.9%+/-10.2%. Poor prognostic factors for OS were Ph chromosome (p=0.005) and T-cell immunophenotype (p=0.03). For RFS they were Ph chromosome (p=0.01) and the presence of a mediastinal mass (p=0.03). CONCLUSION: Despite an initial excellent response to the VPD (L) regimen, newer therapeutic strategies, including more intensive postremission therapies, are urgently needed because of the high relapse rate. Future therapeutic approaches need to be stratified according to several prognostic factors.
Administration, Oral ; Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/*administration & dosage/adverse effects ; Asparaginase/*administration & dosage/adverse effects ; Disease-Free Survival ; Dose-Response Relationship, Drug ; Doxorubicin/*administration & dosage/adverse effects ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Humans ; Infusions, Intravenous ; Male ; Maximum Tolerated Dose ; Middle Aged ; Multivariate Analysis ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis/*drug therapy/*mortality ; Prednisone/*administration & dosage/adverse effects ; Probability ; Remission Induction ; Retrospective Studies ; Survival Analysis ; Treatment Outcome ; Vincristine/*administration & dosage/adverse effects

We report an uncommon case of pyogenic hepatic abscess with hepatobronchial fistula. A 59 year-old male was admitted because of purulent sputum and cough. Ultrasonography and abdominal computed tomography showed an abscess on the superior segment of right hepatic lobe. Diagnostic and therapeutic percutaneous trans-hepatic abscessography disclosed hepatobronchial fistula. Liver abscess with hepatobronchial fistula was managed with percutaneous abscess drainage and antibiotics. The abscess was resolved and he is being on the follow-up with symptom free status.
Abscess ; Anti-Bacterial Agents ; Cough ; Drainage ; Fistula* ; Follow-Up Studies ; Humans ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver* ; Male ; Middle Aged ; Sputum ; Ultrasonography

We report an uncommon case of pyogenic hepatic abscess with hepatobronchial fistula. A 59 year-old male was admitted because of purulent sputum and cough. Ultrasonography and abdominal computed tomography showed an abscess on the superior segment of right hepatic lobe. Diagnostic and therapeutic percutaneous trans-hepatic abscessography disclosed hepatobronchial fistula. Liver abscess with hepatobronchial fistula was managed with percutaneous abscess drainage and antibiotics. The abscess was resolved and he is being on the follow-up with symptom free status.
Abscess ; Anti-Bacterial Agents ; Cough ; Drainage ; Fistula* ; Follow-Up Studies ; Humans ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver* ; Male ; Middle Aged ; Sputum ; Ultrasonography

Gastrointestinal stromal tumors (GISTs) were recently defined as spindle cell, epithelioid, or occasionally, pleomorphic mesenchymal tumors of the gastrointestinal tract that express the CD117 (proto-oncogene c-kit protein, stem cell factor receptor), as detected using immunohistochemistry. And they show a new tendency to include the CD117-positive mesenchymal spindle cell or epithelioid neoplasms primary in the omentum and mesentery, and is so termed extragastrointestinal stromal tumors (EGISTs). Omental EGISTs are very rare and similar to their gastrointestinal counterpart. We present a case of primary EGIST of the greater omentum in a 58-year-old man. The resected tumor mass measured 20X15X5 cm and weighed 1,150 g. The cut surface displayed a central cystic change and partial mural nodules. Microscopically, most parts of the tumor were composed of round or polygonal cells, with many of them containing perinuclear vacuoles. The mitotic count was less than one per 50 high-power-fields. Immunohistochemically, the tumor cells were diffusely positive for CD117 and vimentin, and focally for smooth muscle actin and CD34. Ultrastructurally, partially smooth muscle differentiation was confirmed in this case.
Actins ; Epithelioid Cells ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Immunohistochemistry ; Mesentery ; Middle Aged ; Muscle, Smooth ; Omentum* ; Proto-Oncogene Proteins c-kit ; Stem Cell Factor ; Vacuoles ; Vimentin

PURPOSE: To analyze the controversies surrounding therapeutic decision-making and the withholding of life- sustaining treatments, values held concerning therapeutic interventions of terminal cancer patients are compared between physicians and family members. MATERIALS AND METHODS: 42 advanced or terminal stage cancer patients were enrolled for the study. The questionnaires were administered to the duty doctor and the family of the patients. Questions included whether to use new agents with a 15% partial efficacy and whether to use opioid analgesics, intravenous nutrition, a feeding tube, antibiotics, and hemodialysis. Additionally, we asked about the administration of CPR, ventilator application, and euthanasia. If the family permitted, the same questionnaires were given to the patients. RESULTS: Of the 42 cases, 5 families refused to answer the questionnaire. Of the available 37 families, only 5 families permitted access to the patients. Of the 5 patients, 2 patients refused the questionnaire. Only 67.6% and 8.1% of families and the patients clearly understood the stage of cancer. The use of a new agent was accepted by 45.2% of the physicians and 45.9% of the families. The rankings of the acceptance of treatment in the physicians and in the families were similar. The concordance rate between the physicians and the families was lowest on ventilator application and CPR. 31% of the physicians and 43.2% of the families agreed on the issue of euthanasia. CONCLUSION: Values held on issues like therapeutic decision-making and the withholding of life-sustaining treatments in terminal cancer patients are discordant between physicians and family members. In order to resolve controversies on the role of physicians in end-of-life decisions, the values of physicians as well as patients and their family members should be considered in the final decision-making process.
Analgesics, Opioid ; Anti-Bacterial Agents ; Cardiopulmonary Resuscitation ; Euthanasia ; Humans ; Medical Futility ; Renal Dialysis ; Ventilators, Mechanical ; Withholding Treatment ; Surveys and Questionnaires

Chronic neutrophilic leukemia is a rare myeloproliferative disorder. We have experienced a typical case of chronic neutrophilic leukemia in a 76-year-old man who complained abdominal distension due to hepatosplenomegaly. White blood cell count of peripheral blood was 50,500/nL with 90% segmented neutrophils. The underlying disease for a leukemoid reaction had not been detected. Leukocyte alkaline phosphatase score and the serum levels of vitamin B12 and uric acid were elevated. Chromosome study showed a normal karyotype without Philadelphia chromosome or bcr/abl rearrangement. Phorbol myristate acetate-activated respiratory burst activity of neutrophils measured with chemiluminescence showed increased activity.
Aged ; Alkaline Phosphatase ; Humans ; Karyotype ; Leukemia, Neutrophilic, Chronic* ; Leukemoid Reaction ; Leukocyte Count ; Leukocytes ; Luminescence ; Myeloproliferative Disorders ; Myristic Acid ; Neutrophils* ; Philadelphia Chromosome ; Respiratory Burst* ; Uric Acid ; Vitamin B 12