A comparative study of rubber band ligation versus BANANA-Clip in grade 1 to 3 internal hemorrhoids

Purpose@#Rubber band ligation (RBL) for grade 1 to 3 internal hemorrhoids is a well-established modality of choice. But RBL is also a kind of surgical treatment; it is not free from complications (e.g., delayed bleeding [DB], rectal stenosis). This study aimed to investigate the results of the comparative treatment of RBL and BANANA-Clip (BC; Endovision). @*Methods@#Study participants were 632 consecutive patients with grade 1 to 3 internal hemorrhoids attended to Department of Colorectal Surgery at Wellness Hospital between January 2010 and May 2019. We retrospectively reviewed the incidence rate of complications, including DB between RBL and BC. @*Results@#There were 304 male and 328 female patients, whose ages ranged from 15 to 84 years, with a mean age of 45.7 years. The common symptom and cause of treatment was prolapse (70.1%). The number of ligated sites was 1.49±0.57 in the RBL group and 1.99±0.77 in the BC group. RBL showed a significantly higher incidence of DB (3.5%) compared to BC (0%) (P=0.001). The 1-year success rate was 95.9% in the RBL group and 99.7% in the BC group (P=0.005). @*Conclusion@#In our study, BC was more reliable in treating grade 1 to 3 internal hemorrhoids with higher success rates and less post-ligation complications, especially DB, compared to RBL.

Hemorrhagic disease caused by bovine viral diarrhea virus-2a in Korean Indigenous Cattle: case reports

Bovine viral diarrhea virus (BVDV), which is prevalent worldwide, is one of the most important viral pathogens and causes substantial economic loss to the livestock industry. Despite its importance, BVDV is largely unnoticed in the Republic of Korea (ROK). In this study, we report the case of a steer with BVDV that died suddenly due to severe enteritis. Two 1-year-old Korean indigenous cattle in the same herd presented severe hemorrhagic diarrhea. Case 1 had severe dehydration and died after 3 days, whereas case 2 had anorexia, depression, and severe diarrhea with mucus and blood. Only case 2 was necropsied, and BVDV2a was detected in the tissues of its alimentary tract. Gross lesions, including erosion, ulceration, and extensive hemorrhage, were observed in the digestive tract mucosa. Immunohistochemistry revealed marked positive staining for BVDV2a antigen in the large intestine. This report describes the first case of hemorrhagic disease caused by acute BVDV2a infection, which is characterized by high mortality in Korean indigenous cattle. This study will help establish vaccination and control strategies for BVDV in the ROK.

Establishment of minimal positive-control conditions to ensure brain safety during rapid development of emergency vaccines

With the increase in international human and material exchanges, contagious and infectious epidemics are occurring. One of the effective methods of epidemic inhibition is the rapid development and supply of vaccines. Considering the safety of the brain during vaccine development is very important. However, manuals for brain safety assays for new vaccines are not uniform or effective globally. Therefore, the aim of this study is to establish a positive-control protocol for an effective brain safety test to enhance rapid vaccine development. The blood-brain barrier's tight junctions provide selective defense of the brain; however, it is possible to destroy these important microstructures by administering lipopolysaccharides (LPSs), thereby artificially increasing the permeability of brain parenchyma. In this study, test conditions are established so that the degree of brain penetration or brain destruction of newly developed vaccines can be quantitatively identified. The most effective conditions were suggested by measuring time-dependent expressions of tight junction biomarkers (zonula occludens-1 [ZO-1] and occludin) in two types of mice (C57BL/6 and ICR) following exposure to two types of LPS (Salmonella and Escherichia). In the future, we hope that use of the developed positive-control protocol will help speed up the determination of brain safety of novel vaccines.

The Synthesis of the Stable IVDU Derivative for Imaging HSV-1 TK Expression / 핵의학분자영상

PURPOSE: 5-iododeoxyuridine analogues have been exclusively developed for the potential antiviral and antitumor therapeutic agents. In this study, we synthesized carbocyclic radioiododeoxyuridineanalogue (ddIVDU) and carbocyclic intermediate as efficient carbocyclic radiopharmaceuticals. MATERIALS AND METHODS: The synthesis is LAH reduction, hetero Diels-Alder reaction as key reactions including Pd(0)-catalyzed coupling reaction together with organotin. MCA-RH7777 (MCA) and MCA-tk (HSV1-tk positive) cells were treated with various concentration of carbocyclic ddIVDU, and GCV. Cytotoxicity was measured by the MTS methods. For in vitro uptake study, MCA and MCA-tk cells were incubated with 1uCi of [(125)I]carbocyclic ddIVDU. Accumulated radioactivity was measured after various incubation times. RESULTS: The synthesis of ddIVDU and precursor for radioiodination were achieved from cyclopentadiene in good overall yield, respectively. The radioiododemetallation for radiolabeling gave more than 80% yield with > 95% radiochemical purity. GCV was more toxic than carbocyclic ddIVDU in MCA-tk cells. Accumulation of [(125)I]carbocyclic ddIVDU was higher in MCA-tk cells than MCA cells. CONCLUSION: Biological data reveal that ddIVDU is stable in vitro, less toxic than ganciclovir (GCV), and selective in HSV1-tk expressed cells. Thus, this new carbocyclic nucleoside, referred to in this paper as carbocyclic 2',3'-didehydro-2',3'-dideoxy-5- iodovinyluridine (carbocyclic ddIVDU), is a potential imaging probe for HSV1-tk.

Retrospective study for prognosis after open and closed reduction of the mandibular condyle fractures

0.05). The level of the fracture influenced the ramus length and the degree of coronal change in the closed reduction group(P0.05). From the results obtained in this study, fractured mandibular condyles, were treated by closed reduction, had a tendency that continuous condylar displacement was occurred with aspect to horozontal and coronal plane in treatment period including intermaxillary fixation. And then there was a correlation between the level of the fracture and the position change in close reduction group statistically. These result suggested that care must be taken in basing treatment decisions on the degree of displacement of the condyle and in treating the mandibular condyle fractures for a long time.

Introduction to Clinical Medicine Course for Teaching Basic Clinical Skills / 한국의학교육

BACKGROUND: One of major weakness in medical education in Korea is clinical skills has not been uniformly well taught during undergraduate period. To reinforce the basic clinical skill education, we developed introduction to clinical medicine(ICM) course In this study, we described the ICM course development process and the experience. METHODS: We performed comprehensive literature review related to ICM and doctoring curriculum. ICM/OSCE sub-commitee members discussed several time to develop the course. To assess the level of accomplishment of this course, we got feedback from 115 third year medical students by questionnaires. RESULTS: ICM was composed of 9 topics which covers the basic clinical skills. For each topic, three hours per week was allocated, one hour for didactic session and the other 2 hours for practical exercise. Standardized patients were used to teach interview skill. Most of students revealed history taking, abdominal examination, musculo-skeletal system, and interview skill session were valuable learning experience. However, for Gynecology and Pediatric session which were taught by mainly lectures, students evaluated them negatively. INTERPRETATION: This year, we focused on teaching basic clinical skills at ICM. However, our ultimate goal is to develop the ICM course which can allow the students to learn both the art and the science of Medicine.

Clinical Significance of Peripheral Blood CEA mRNA Expression in Gastric Cancer Patients Underwent Curative Resection / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Recent advances in molecular technology have made it possible to detect small numbers of circulating tumor cells in the peripheral blood or bone marrow. Carcinoembryonic antigen (CEA) is an oncofetal antigen that is expressed in epithelial tumor cells. CEA mRNA may be a reliable marker for the detection of tumor cells in the peripheral blood of patients with epithelial cancer. MATERIALS AND METHODS: We analyzed the peripheral blood of 46 patients with gastric cancer who had undergone curative resection. The presence of CEA mRNA was serially monitored using RT-PCR (Preop, Post op 15 day, 2 months (m), 4 m, 6 m, 8 m, 10 m, 12 m). The clinical characteristics, serum CEA level and immunohistochemical staining of tumor tissue were also evaluated. Patients were followed up for 6 to 12 months. RESULTS: There was no significant relationship seen between CEA mRNA RT-PCR positivity in the peripheral blood and sex, stage, serum CEA level or immunohistochemical staining for CEA antigen, During follow up,eight patients experienced recurrence; were positve for CEA mRNA RT-PCR recurrence was seen in 66.7% (6/9) of the patients who before clinical recurrence as compared to 5.4% (2/37) of patients who were negative (p=0.0002). Serial changes of CEA mRNA RT-PCR correlated with clinical recurrence; 100% in the positively converted group (3/3), 0% in the negatively converted group(0/18), 50% in all positive group (3/6) and 10.5% in all negative group (2/19) experienced recurrence, respectively. CONCLUSION: RT-PCR analysis of CEA mRNA in the peripheral blood seems to be a promising tool for the early detection of micrometastatic circulating tumor cells in gastric cancer patients and may be useful in determining patients at high risk for recurrence. However, definitive correlation with recurrence certainly requires a longer follow up duration in further studies.

Frozen-Thawed RBCs transfusion in the Dog / 대한수혈학회지

The cryopreservation of Red Blood Cells has many advantages of which the most important one is that it can be stored for a long period. However, in Korea, Research regarding frozen blood is still in its early stage. We evaluated the effects of transfusion of the frozen-thawed RBCs in dogs. The whole bloods were collected from 5 dogs, and the packed RBCs were obtained by centrifugation method. We made the frozen RBCs by using 40% glycerol method and stored it in -80 degrees C refrigerate for 1 month. The frozen RBCs were thawed in the 37 degrees C water bath and washed by Cell washer according to the standard protocol, and evaluated the status of them being compared with that of the unfrozen. The majorirty of the results were satisfactory to the allowable limit except high plasma hemoglobin and potassium. The frozen-thawed bloods were transfused to the two dogs and carefully observed the effects and its complications. The results were that the average value of the hemoglobin was elevated about 0.6g/dL more after transfusion than before, and there were no significant complication related to the transfusion. Thus, The frozen thawed blood transfusions in case of the experiment with dogs were proved to be safe and as effective as fresh blood, and The above method appeared to be feasible to human blood.

Primary Lymphoma of the Cerebellum

Primary lymphoma is rare lesion of the intracranial neplasm. We have recently experienced a case of primary lymphoma invoving cerebellar vermis and hemisphere. The patient presented with headache, vomiting, ataxia and dysmetria. The brain CT scan and MR imaging revealed round mass lesion involving the left cerebellar hemisphere and vermis with minimal surrounding brain edema. On vertebral angiography, tumor stain appeared during the late arterial phase. Preoperative CSF analysis showed no specific abnormal findings. The CSF cytology was normal. The mass was surgically removed and the histological feature was diffuse histiocytic lymphoma. In the postperative and postradiation period, the metastasis occurred to the head of the caucate nucleus and cervical spinal cord. A case of primary lymphoma of the cerebellum is presented with review of literature.

Incidence and survival of cancer in Kangwha County (1983-1987)

To measure incidence and survival rates of cancer in Kangwha County, 663 cancer patients registered in the Kangwha County Cancer Registry Program for the past 5 years (1983-1987) were analyzed. The average annual cancer incidence rate per 100,000 population was 183.0 in males and 99.5 in females. The common cancers were stomach (37.3%), lung (14.8%), and liver cancer (11.1%) in males and stomach (25.6%), cervix uteri (20.9%), and liver cancer (9.7%) in females. The median survival times of all cancer patients after diagnosis and onset of the first symptom were 8.4 +/- 0.8 months and 15.0 +/- 1.1 months respectively. Female cancer patients survived significantly longer than male cancer patients. The median survival times of the stomach, lung, and liver cancer in males were 7.7 +/- 0.9, 4.9 +/- 0.9, and 2.3 +/- 0.4 months respectively. In females, the median survival times of the stomach and liver cancer patients were 9.2 +/- 1.5 and 2.5 +/- 0.5 months. The 5 year survival rate of cervical cancer was 67.1%. Those cancer patients who received anticancer therapy survived significantly longer than cancer patients without treatment.

Incidence and survival of cancer in Kangwha County (1983-1987)

To measure incidence and survival rates of cancer in Kangwha County, 663 cancer patients registered in the Kangwha County Cancer Registry Program for the past 5 years (1983-1987) were analyzed. The average annual cancer incidence rate per 100,000 population was 183.0 in males and 99.5 in females. The common cancers were stomach (37.3%), lung (14.8%), and liver cancer (11.1%) in males and stomach (25.6%), cervix uteri (20.9%), and liver cancer (9.7%) in females. The median survival times of all cancer patients after diagnosis and onset of the first symptom were 8.4 +/- 0.8 months and 15.0 +/- 1.1 months respectively. Female cancer patients survived significantly longer than male cancer patients. The median survival times of the stomach, lung, and liver cancer in males were 7.7 +/- 0.9, 4.9 +/- 0.9, and 2.3 +/- 0.4 months respectively. In females, the median survival times of the stomach and liver cancer patients were 9.2 +/- 1.5 and 2.5 +/- 0.5 months. The 5 year survival rate of cervical cancer was 67.1%. Those cancer patients who received anticancer therapy survived significantly longer than cancer patients without treatment.

Histiocytosis X: A Clinical Study / 대한정형외과학회잡지

Letterer-Siwe disease, Hand-Schuller-Christian disease and eosinophilic granuloma of the bone are merely different clinical expressions of one disease. Lichtenstein grouped these three clinical syndromes and proposed that this disease be termed histiocytosis X. This grouping was based on the histologic similarities and the possibility of transformation of one syndrome into another. The cause of histiocytosis X remains unknown. Histiocytosis X is a condition that presents single or multiple lesions, distributed in the soft tissue, lymph nodes, various organ and bones, especially in the areas of marked reticuloendothelial activity. The authors reviewed the clinical findings, radiographs and the treatment of the twenty-six patients with histiocytosis X diagnosed on the base of pathologic findings at Severance Hospital, between January, 1971 and December, 1980. Among the twenty-six patients, twenty-one patients could be followed, ranging from one month to six years, with an average follow-up of 1.6 years. The results obtained were as follows: 1. There was a slight male predominance (61.6%). The age ranged from 2 months to 42 years (average 8.2 years). Sixty-five percents of patients were the child under 4 years of age. 2. Hand-Schuller-Christian disease (50%) was the most common form of this disease. Letterer-Siwe disease developed in the youngest (average 1.2 years) and eosinophilic granuloma in the eldest (average 20.4 years). 3. The common manifestations were hepatomegaly, skin rashes and anemia in Letterer-Siwe disease; palpable mass, pain and exophthalmos in Hand-Schuller-Christian disease; pain and mass in eosinophilic granuloma. 4. The common sites of the skeletal lesions were skull, spine and femur, etc. 5. The patients with single skeletal lesion improved regardless of the methods of treatment. 6. Vinblastine, methotrexate and/or prednisone were valuable agents for the multiply involved patients. 7. Prognosis was poor for the patients who were young at onest, or who had multiple systemic involvements, but in case only with skeletal involvement the prognosis was good. Eosinophilic granuloma is the most benign variant, while Letterer-Siwe disease is the most malignant type.

Histiocytic Medullary Reticulosis: A case record and literatures review

Histiocytic medullary reticulosis was first described as a clinical and pathological entity by Scott and Robb-Smith in 1939. The clinical pictures include progressive pancytopenia, fever, wasting, lymphadenopathy, hepatosplenomegaly, jaundice and purpura. The outstanding morphological features of the disease is proliferation of histiocytes throughout the reticuloendothelial system with frequent leucoerythrophagocytosis. In spite of uniform clinical and fistologcal pictures verified by additional case reports, the diagnosis has usually not been made until postmortem examination. Most patients die within six months because the disease runs a rapidly fatal course. Since the orginal report, approximately 90 cases have been reported in the literatures. In this ciuntry, Ko and others reported several cases of HMR in adults, and there has been only one report in childhood. Recently, we had the opportunity to observe a 9 year old girl at this hospital whose clinical course and antemortem pathological features were consistent with criteria for the disease. In spite of the remission after treatment with various anticancer drugs, patient expired six months after diagnosis.