Methylation Abnormality in Body Fluid Cytology: A Supplemental Molecular Marker for the Diagnosis of Malignant Mesothelioma / 대한세포병리학회지

Malignant mesothelioma (MM) is a highly lethal neoplasm arising in pleura and the peritoneum and a rapid and accurate diagnosis is crucial for treatment of the disease. However, the sensitivity of cytological analysis using pleural or ascitic fluid is relatively low, yielding an accurate diagnosis in only 32~79% of cases. We tested the diagnostic value of epigenetic alterations in body fluid cytology as a supplement to conventional methods. Paraffin-embedded tissue blocks from 21 MM patients and associated body fluid cytology slides considered no evidence of malignancy were used to test for epigenetic alteration. Using methylation-specific PCR, we detected methylation of RASSF1A and p16 in 47.6% (10/21) of both surgically resected tumor samples, respectively. Body fluid samples of MM also showed abnormal methylation of RASSF1A and p16INK4a genes in 38.1% (8/21) and 33.3% (7/21) of cases. The concordance in the rates of RASSF1A and p16INK4a gene-methylation abnormalities determined from cytology samples and tissue samples were 61.9% (13/21) and 66.7% (14/21), respectively. Combining both genes increases the sensitivity of the test to 57.1% (12 of 21) of cases. Our results suggest that testing for methylation abnormalities in selected individual genes or gene combinations has diagnostic value as an alternative or adjunct method to conventional cytological diagnosis.

Association of CXCR4 Expression with Metastasis and Survival among Patients with Non-small Cell Lung Cancer

BACKGROUND: Expression of CXCR4 chemokine receptor, initially described to be involved in the homing of lymphocytes in inflammatory tissue, on breast cancer cell lines is associated with the development of lung metastases. In the present study, we evaluated CXCR4 expression in patients with non-small cell lung cancer (NSCLC). METHODS: Tissue microarray blocks were constructed from 408 formalin-fixed, paraffin-embedded NSCLC samples and analyzed via immunohistochemical staining. RESULTS: We observed CXCR4 expression in 214 (66.3%) of the 323 tumors with cytoplasmic or nuclear staining patterns. These tumors were then divided into 109 negative, 166 weak-positive and 48 strong-positive expression groups. Strong expression of CXCR4 correlated with NSCLC recurrence (p=0.047) and distant metastasis (p=0.035). However, lymph node metastasis (p=0.683) and locoregional recurrence (p=0.856) were not associated with CXCR4 expression. Interestingly, the median overall survival times relative to CXCR4 expression were 71 months in the CXCR4-negative group, 43 months in the weakly positive CXCR4 group and 23 months in the strongly positive CXCR4 group. Strongly positive CXCR4 staining was associated with significantly worse outcomes (p=0.005, log-rank test). CONCLUSIONS: Expression of CXCR4 was associated with distant NSCLC metastases and shorter survival times.

The Analgesic Efficacy of a 5% Eutectic Mixture of Lidocaine and Prilocaine Prior to Insertion of Spinal and Epidural Block / 대한마취과학회지

BACKGROUND: We evaluated the analgesic efficacy of a 5% eutectic mixture of lidocaine and prilocaine (EMLA(R)) topically applied before performing skin puncture for spinal or epidural anesthesia. METHODS: The patient population consisted of 75 ASA physical status 1 and 2 adults scheduled for operations of the lower abdominal region, the perineal region or the lower extremities. The patients were randomly allocated to one of five groups of equal size: group A - topical application of EMLA(R) cream 120 min before spinal block; group B - subcutaneous infiltrationof 2 ml of 2% lidocaine immediately before spinal block; group C - no pretreatment before spinal block; group D - topical application of EMLA(R) cream 120 min before epidural block; and group E - subcutaneous infiltration of 2 ml of 2% lidocaine immediatelybefore epidural block. Pain experienced during the whole procedure was rated using a 10 cm visual analogue scale. RESULTS: Patients in group A experienced less pain compared with those in groups B and C (2.0 +/- 1.9 cm vs 4.1 +/- 1.9 cm and 3.9 +/- 2.2 cm, respectively; P < 0.05). However there was no significant difference between group D and group E (3.6 +/- 2.4 cm vs 4.1 +/- 2.5 cm). The patients in group A and group D were highly satisfied with the method of analgesia (P < 0.05). CONCLUSIONS: EMLA(R) cream is an effective alternative to subcutaneous infiltration of local anesthetic for analgesia during skin puncture using a 25 G spinal needle. It provides insufficient analgesia however for epidural anesthesia.

Acute Posthypoxic Myoclonus in Recovery Room: A case report / 대한마취과학회지

Acute posthypoxic myoclonus is not an uncommon complication of cardiopulmonary arrest. The presence of myoclonus early after hypoxia or anoxia has been reported as a poor prognostic factor. Especially posthypoxic myoclonus status epilepticus was defined as continuous myoclonic seizure activity lasting 30 minutes or more which is thought to reflect irreversible neocortical damage, but there have been very rarely reported complete recovery. We report a case of the patient who developed posthypoxic myoclonus status epilepticus and completely recovered without any complications.

Neuromuscular Pharmacodynamics of Mivacurium in Patients with Major Burns / 대한마취과학회지

BACKGROUND: Burned patients sometimes require rapid onset of neuromuscular paralysis to secure the airway in full stomach patients or to treat laryngospasm. Because of poor lung function and hypermetabolic state, they desaturate quite rapidly. Burned patients are usually resistant to the effects of nondepolarizing relaxants. Mivacurium can be potentially a good alternative for rapid onset of paralysis, since it is metabolized by plasma cholinesterase, an enzyme often decreased in subject with major burns. This prospective study was conducted to define the neuromuscular pharmacodynamic profile of a single bolus dose of mivacurium in adult patients with major burns. METHODS: Adults (M/F = 22/8), aged 44.0 +/- 10.2 years, with total body surface area (TBSA) burn of 35.0 +/- 12.5% were studied at 39.8 +/- 28.9 post burn days. Age and sex matched 30 non-burned patients served as controls. Anesthesia was consisted of propofol and fentanyl infusion with nitrous oxide and oxygen. Mivacurium 0.2 mg/kg was administered as a bolus. Using TOF Watch, neuromuscular block was monitored with T1 response after the initial tetanic stimulation to recruit all muscle fibers. Onset time was defined as the interval from the beginning of drug administration to maximal twitch suppression. Intubation was attempted at 1 minute after the drug administration to simulate the rapid sequence induction with recording of either failure or success of intubation. By allowing spontaneous recovery without reversal drug, recovery profiles of neuromuscular paralysis were also measured. RESULTS: Patients demographics were similar in both groups except for the burn. Onset times and all recovery profiles were significantly prolonged in the burned versus non-burned groups. Attempts at intubation at 1 minute after the drug administration were successful with difficulty in approximately 70% of patients in both groups. CONCLUSIONS: Mivacurium 0.2 mg/kg demonstrated the conflicting dual responses in the burned patients. The prolonged onset time suggests resistance to neuromuscular effects. The prolonged recovery suggests increased sensitivity. This can be partially explained by the acetylcholine receptor proliferation and decreased level of plasma pseudocholinesterase. In view of the prolonged onset time of almost two minutes for maximal paralysis, mivacurium does not appear to be a good drug for rapid onset of paralysis in burns.

Two Cases of Congenital Atrichia Associated with the Gastrointestinal Anomaly in Siblings

Congenital atrichia is an anomaly characterized by congenital absence of hair in varying degrees as well as the ypopigmentation & poor development of the abnormal residual hair on the scalp, eyebrows, eyelashes & body. Two cases of congenital atrichia in siblings were reviewed. The first case was associated with congenital megacolon and skin biopsy of scalp (esp. parietal region) was non-specific. The second case was associated with bilateral inguinal hernia. Congenital atrichia is inherited by autosomal dominant or recessive. Acording to the limited pedigree data, our cases were X-linked recessive inheritance We report these cases with a review of related literatures.

Two Cases of Congenital Atrichia Associated with the Gastrointestinal Anomaly in Siblings

Congenital atrichia is an anomaly characterized by congenital absence of hair in varying degrees as well as the ypopigmentation & poor development of the abnormal residual hair on the scalp, eyebrows, eyelashes & body. Two cases of congenital atrichia in siblings were reviewed. The first case was associated with congenital megacolon and skin biopsy of scalp (esp. parietal region) was non-specific. The second case was associated with bilateral inguinal hernia. Congenital atrichia is inherited by autosomal dominant or recessive. Acording to the limited pedigree data, our cases were X-linked recessive inheritance We report these cases with a review of related literatures.

A Clinical Study of Retinopathy of Prematurity

Among 666 premature infants or low birthweight infants who were admitted in NICU of St. Francisco General Hospital from January 1990 to Jun 1992, 96 infants were diagnosed as retinopathy of prematurity by indirect ophthalmoscope. The result were follows: 1) Among 666 patients, retinopathy of prematurity developed in 96 patients(14.1%) 2) The high incidence was observed in low birthweight and small gestational age. 3) Mean age of first diagnosing time was 42.0( 12 day of life and mean gestational age was 31.8 2.5 weeks and mean birthweight was 1646.5 (350.7gm. 4) In gestational age, birthweight and duration of oxygen therapy, there was statistically difference between cryotherapy group and spontaneous regression group. Other possible risk factors-hyaline membrane disease, apnea, anemia-were showed higher incidence in cryotherapy group. 5) Among the 20 infants who were treated with cryotherapy, 16 infants (80%) showed regression of neovascularization.

A Case of Hereditary Anhidrotic Ectodermal Dysplasia

Hereditary anhidrotic ectodermal dysplasia is a rare condition characterized by underdeveloped ectodermal structure including the skin, teeth or skin appendages. The patient has characteristic feature of anhidrosis, hypotrichosis and defective dentition. We experienced a case of hereditary anhidrotic ectodermal dysplasia in a l-month-old male infant who had unexplained recurring fever, anhidrosis and characteristic facial feature, so we established the diagnosis with clinical feature and skin biopsy.

Protecitve Effect of Breast Feeding for Infection

A Comparative study was retrospectively performed with 374 infants in order to find protective effect of breast feeding for infection. This study shows that breast feeding protect infant against gastrointestinal and respiratory infection. Breast feeding offers advantage by reducing gastraintestinal and respiratory infection when they should maintain breast feeding for at least three months. 1) First year morbidity increased with extent of artificial feeding and was nearly two fold for babies not breast-fed. 2) Prescence of older sibling, low birth weight and male sex are associated with increased morbidity. 3) Infant illness from 0~3 months, 4~6 months, 7~10 months, 11~12 moths was analyzed. Compared with the 108 bottle fed babies, the babies who had been partially (40) or fully (136) breast fed had significantly lower rate of gastrointestinal illness at 7~10 month (p<0.05), 11~12 month (p<0.005) and respiratory illness at 7~10 month (p<0.05). 4) Between the early weaning group (90) and the bottle group (108) showed no siggnificant difference. 5) Among the babies observed throughout the first year of life, 35 (9%) and 46 (12) were admitted to hospital with gastrointestinal and respiratory infection. Babies who were breast fed for more than 3 month had significant lower rate for hospital admission due to gastrointestinal and respiratory infection when compared with bottle fed babies. Breast feeding durning more than 3 month of life confers protection against gastrointestinal and respiratory infection.