Comparison of Different Gum-Based Thickeners Using a Viscometer and Line Spread Test: A Preliminary Study

OBJECTIVE: To compare fluid thickeners composed of starch polysaccharide (STA), guar gum-based polysaccharide (GUA), and xanthan gum-based polysaccharide (XAN) with the use of a viscometer and a line spread test (LST) under various measurement conditions. METHODS: The viscosity of thickened fluid with various concentrations (range, GUA 1%-4%, XAN 1%-6%, STA 1%-7%, at intervals of 1%) was measured with a rotational viscometer with various shear rates (1.29 s-1, 5.16 s-1, 51.6 s-1, and 103 s-1) at a temperature of 35degrees C, representing body temperature. The viscosity of STA showed time dependent alteration. So STA was excluded. Viscosities of GUA and XAN (range of concentration, GUA 1%-3%, XAN 1%-6%, at intervals of 1%) were measured at a room temperature of 20degrees C. LST was conducted to compare GUA and XAN (concentration, 1.5%, 2.0%, and 3.0%) at temperatures of 20degrees C and 35degrees C. RESULTS: The viscosities of 1% GUA and XAN were similar. However, viscosity differences between GUA and XAN were gradually larger as concentration increased. The shear thinning effect, the inverse relationship between the viscosity and the shear rate, was more predominant in XAN than in GUA. The results of LST were not substantially different from GUA and XAN, in spite of the difference in viscosity. However manufacturers' instructions do not demonstrate the rheological properties of thickeners. CONCLUSION: The viscosities of thickened fluid were different when the measurement conditions changed. Any single measurement might not be sufficient to determine comparable viscosity with different thickeners. Clinical decision for the use of a specific thickener seems to necessitate cautious consideration of results from a viscometer, LST, and an expert's opinion.

Predicting the Effect of Stellate Ganglion Block on the Lymphoscintigraphic Findings for Lymphedema in Post-Mastectomy Patients

OBJECTIVE: To evaluate the effect of stellate ganglion block (SGB) on the lymphoscintigraphic findings in patients with secondary lymphedema after breast cancer treatment. METHOD: Fourteen patients were included in this retrospective study. Consecutive SGBs were performed three times, once every two weeks. The parameters for the lymphoscintigraphic findings included the extent of dermal backflow (small extent/large extent group), the presence of a washout pattern (washout/non-washout group) and visualization of lymph nodes on the 3-hour image (visualized/non-visualized group). The upper arm and forearm circumferences were used as the outcome parameters. We investigated the relationship between the lymphoscintigraphic findings and the arm circumferences. RESULTS: Regardless of the extent of dermal backflow, significant decreases of the upper arm and forearm circumferences were observed between the initial and final follow-up data. The small extent group showed a significant decrease of the forearm circumference at the first follow-up. The large extent group showed a pattern of significant decrease of the forearm circumference since the second follow-up. The washout group showed a decrease in both the upper arm and forearm circumferences, while the non-washout group showed a decrease only in the forearm circumference at the last follow-up. No difference was observed between the visualized and the non-visualized group. CONCLUSION: The extent of dermal backflow and the presence of a washout pattern on lymphoscintigraphy showed correlation with the change of arm circumference. Lymphoscitigraphy prior to performance of SGB for lymphedema patients might be helpful to predict the outcome of SGB.

Utilization and Satisfaction of Rehabilitation Service in Patients with Brain Disorders in Korea

OBJECTIVE: To investigate the utilization of medical rehabilitation services and the degree of satisfaction about rehabilitation services in patients with brain disorders. METHOD: A total of 1903 patients agreed to participate in this study and were interviewed from September 2005 to May 2006. The subjects completed the questionnaires about the utilization of medical rehabilitation services and the degree of satisfaction with those treatments. Pearson's chi-square test, Student t-test and frequency analysis were used for statistical analysis. RESULTS: A 78.0 percent of patients received inpatient rehabilitation treatment. A 66.9 percent of all patients were served of only physical therapy and 31.6 percent received both physical and occupational therapy. The main reason why patients could not have a chance to experience rehabilitation treatment was associated with environmental problems, such as the ignorance of the need about rehabilitation treatment, or the insufficient communication between doctors and patients. Most patients (54.6%) were satisfied with the rehabilitation treatment. However, as the number of admission was increased, patients tended to be less satisfied with the rehabilitation treatment. CONCLUSION: The inpatient rehabilitation treatment was limitedly served to patients with brain disorders mostly when the patients required rehabilitation services. It is necessary to provide more effective and various rehabilitation services to patients under the comprehensive guideline of the process of rehabilitation services.

Clinical Outcomes of Cervical Stellate Ganglion Block in Patients with Secondary Lymphedema: A Pilot Study

OBJECTIVE: To investigate the clinical effect of stellate ganglion block in patients with secondary lymphedema after breast cancer treatment. METHOD: In a prospective clinical trial, the consecutive stellate ganglion block (SGB) was performed every two weeks to 10 patients (Mean age 46.0+/-9.4 (yr)) who was diagnosed as of secondary lymphedema after breast cancer treatment. The parameters were the circumstance of arm and the thickness of skin and subcutaneous tissue of the affected arm measured by ultrasonography. We measured these parameters with baseline value before SGB treatment and repeated the evaluation after each SGB treatment. And the subjective data of satisfaction, softness and improvement were obtained by questionnaires. RESULTS: 10 patients were treated with stellate ganglion block. The mean circumferences of upper arm and forearm after three consecutive SGB treatments reduced significantly: upper arm from 31.39 cm to 29.72, forearm from 25.14 cm to 23.64 cm (p <0.05). And the thickness of subcutaneous tissue of upper arm significantly decreased under no- compression measuring technique after three SGB treatments (p <0.05). The compliance of superficial tissue showed significant change with serial procedure. Almost all of the patients had a satisfaction and feeling of softness in their affected arm after treatments. CONCLUSION: The cervical stellate-ganglion block reduced the circumstance and the thickness of arm with lymphedema and satisfied almost lymphedema patients. So this treatment presents a favorable outcome to the breast cancer-related lymphedema patient clinically.

Long-term Survival after Surgical Resection for Liver Metastasis from Gastric Cancer: Two Case Reports / Journal of the Korean Cancer Association, 대한암학회지

Surgical resection of colorectal cancer metastasis to the liver results in a 5-year survival rate of around 40%. Liver metastasis from other cancers such as neuroendocrine carcinoma and genitourinary tumors are also treated effectively with combined liver resection. However, hepatic metastasectomy for liver tumor from gastric cancer hasn't been considered as a standard treatment, and the benefit for this treatment has not been established. We report here on two cases of gastrectomy and combined liver resection for synchronous liver metastasis without any evidence of other metastatic lesions, and these two patients have survived for more than 7 years without evidence of disease recurrence. In conclusion, for patients with hepatic metastasis from gastric cancer, combined surgical resection of the liver metastasis should be considered as a treatment option when metastasis to other sites can be excluded.

Gastrointestinal Stromal Tumor of Rectum: A Reoport of 7 Cases

PURPOSE: Gastrointestinal stromal tumors (GISTs) are rare. The aim of this study is to investigate and describe the clinicopathologic characteristics of rectal GISTs. METHODS: We retrospectively analyzed the medical records of seven patients who underwent surgery for GIST of the rectum from 1998 to 2003. RESULTS: Male and female patients were two and five respectively. The mean age was 55 years (range, 41~72 years) at the time of diagnosis. The median follow-up period was 23 months (range, 7~75 months). The chief complaints were hematochezia, constipation and anal pain. Curative resections were done in all cases. Abdominoperineal resection was done in five cases and transanal excision was done in one case. In one case, Hartmann's operation with prostatectomy was done. The mean size of tumor was 6.6 cm (1~12 cm). The pathologic feature of all cases were spindle cell type. The mitotic count shown > or =5 in 50 high power field was identified in four cases and that shown < or =5 in 50 high power field in three cases. Adjuvant radiation therapy was done in four cases. Two local recurrences occurred on 54 month and 23 month later after surgery, respectively. CONCLUSION: In cases of GIST of the rectum, the common symptom was same as other rectal tumors. Immuonhistiochemical staning of c-kit is helpful for differential diagnosis. Curative surgical resection should be done for treatment.

Prognostic Significance of p53, nm23 and VEGF Expression in Primary and Hepatic Colorectal Cancer Metastases Following Surgical Resection

PURPOSE: The aim of this study is to analyze a correlation between related molecular markers and prognosis after curative resection for primary and hepatic metastasis for colorectal cancer. METHODS: A total 63 patients who have been resected curatively for primary and metastatic colorectal cancer between 1989 and 2000. All patients were completely followed up and recurrence and survival rates were analyzed. All paraffin embedded tumor tissues in primary and metastatic tumors were used for microtissue array and immunohistochemical staining of p53, nm23 and VEGF. RESULTS: Mean follow up period was 30.9 months. Recurrence was noted in 39/63 (61.9%) and 5 year survival rates was 27.7%. 5 year survival rates according to protein expression in primary tumor: p53+/-: 24.6% vs 27.3%, nm 23 +/-: 17.6% vs 38.9%, VEGF +/-: 38.8% vs 21.6% (P=0.16, 0.06, 0.9, respectively). 5 year survival rates according to protein expression in metastatic tumor, p53 +/-: 18% vs 59.2%, nm 23 +/-; 38.2% vs 15.8%, VEGF +/-: 38.8% vs 21.6% (P=0.03, 0.35, 0.96, respectively). A patients recurred within 1 year after surgery (group I, N=23) were compared with patients who recurred 1 year after (group II, N=16). nm23 expression in primary tumor in each group of patients: ; 15/23 (65.2%), : 4/16 (25 %), : 8/23 (34.8%), : 12/16 (75%), respectively (P= 0.013). But, p53, VEGF expression in primary tumor showed no statistical significance. nm23 expression in metastatic tumor revealed no statistical significance between two group of patients. CONCLUSIONS: p53 expression in metastatic tumor and nm 23 expression in primary tumor can predict poor prognosis after curative resection for primary and metastatic colorectal cancer. Molecular marker expression in primary and hepatic colorectal cancer can give us a reliable prognostic values.

A Case of Embryonal Rhabdomyosarcoma of the Uterine Cervix in a 31 Year Old Woman / 대한산부인과학회잡지

Rhabdomyosarcoma is the most common soft tissue sarcoma in childhood and young adult. Rhabdomyosarcoma can be classified into one of four type; embryonal, alveolar, pleomorphic, undifferentiated. Embryonal rhabdomyosarcomas of the female genital tract are rare, malignant tumors derived from primitive myogenic precursor and generally occur during infancy and childhood. About twenty percent of rhabdomyosarcoma arise in the genitourinary tract, with slightly more than half being embryonal rhabdomyosarcoma. Vaginal primaries are 5-times more common than cervical primaries. Overall, cervical tumor may predominate in adolescent. In perimenopausal women, the uterus is the most common site of rhabdomyosarcoma. The management of rhabdomyosarcoma of genitourinary tract has changed slowly from pelvic exenteration without adjuvant therapy to neoadjuvant chemotherapy followed by less radical surgery and postoperative radiation. Embryonal rhabdomyosarcomas originates in the uterine cervix are extremely rare especially in the thirties. So, little information is available regarding its prognosis and therapy. We present a case of a woman 31 years old with embryonal rhabdomyosarcoma of the uterine cervix with a review of a literature.

A Case of Cronkhite-Canada Syndrome with a Remission to Steroid Therapy / 대한소화기내시경학회지

Cronkhite-Canada syndrome is characterized by generalized gastrointestinal polyposis, ectodermal changes, and the eventual development of diarrhea and weight loss. The pathogenesis of the disease is unknown, and there is no established therapy. The disease has a poor prognosis because of malnutrition resulting from altered absorption in the gastrointestinal tract. We experienced a case of a 56-year-old female with Cronkhite-Canada syndrome. After enteral nutrition and administration of prednisolone for 3 months, clinical improvement was noted with cessation of diarrhea, increased serum protein, disappearance of pigmentation, and regrowth of the scalp hair, finger-and toenails. Endoscopy showed resolution of the gastrointestinal polyposis. So we report here a case of diffuse gastrointestinal polyposis which has been in remission with steroid therapy.

A Case of Epstein-Barr Virus-associated Primary Gastric T-cell Lymphoma with Rapidly Progressive Endoscopic Features and Clinical Course / 대한소화기내시경학회지

Primary gastric T-cell lymphoma is very rare. Only a few cases have been reported in the literature. Moreover, Epstein-Barr virus-associated primary gastric T-cell lymphoma is extremely rare. We report a case of Epstein-Barr virus-associated primary gastric T-cell lymphoma, which showed rapidly progressive endoscopic features. Three esophagogastroduodenoscopic examinations in a 26-day period revealed different findings at different locations. The lymphoma cells were positive for UCHL-1, but negative for L26 and Ki-1 in immunohistochemical staining.

Lymph Node Metastases and Tumor Deposits in the Mesorectum Distal to Rectal Cancer: A Need of Total Mesorectal Excision

PURPOSE: Total mesorectal excision has been advocated as the effective operation for patients with rectal cancer to reduce the local recurrence rate after curative resection. Its rationale is to remove possible tumor foci at the mesorectum distal to the level of the rectal cancer. This study was undertaken to clarify the rationale for total mesorectal excision. METHODS: Total mesorectal excision was performed in 72 patients with rectal cancer who admitted in Severance Hospital between December, 1996 and December, 1997. The obtained mesorectums were classified to M0 (from the proximal margin to the distal margin of the tumor), M1 (from the distal margin to 2 cm below the distal margin), M2 (from 2 cm to 5 cm below the distal margin), and microscopic examination was done. RESULTS: The nodal metastases were detected in 7 cases and tumor deposits in 4 cases. Especially in M2 with Dukes' C2, the rate of nodal metastases was 3.6 percent and the rate of tumor deposits was 7.1 percent. The nodal metastases and tumor deposits in the distal mesorectum have no correlation with gross finding, size, location and differentiation of the tumor. CONCLUSIONS: En bloc excision of all mesorectal tissue down to at least 5 cm below the lower margin of the tumor is required for patients with advanced rectal cancer to remove possible metastatic lymph nodes and tumor deposits in the distal mesorectum.

Gallbladder Cancer Incidentally Discovered after a Laparoscopic Cholecystectomy

A laparoscopic cholecystectomy has been accepted as one of the methods of treatment for patients with gallbladder(GB) pathology. Occasionally some cases can be diagnosed as cancer of the gallbladder incidentally after a laparoscopic cholecystectomy. We did 855 laparoscopic cholecystectomies from September 1991 to July 1996 and found 9 GB cancer patients after the operation. Most of the patients with GB cancer have a poor prognosis, but recently there have been some reports with good prognoses in this group of patients. The incidence of incidental GB cancer in laparoscopically resected GB specimens was 1.1% (9/855). The age distribution was between 44 and 72 yrs. Among the 9 cancer patients, 6 patients were found to have a GB mass as a result of the preoperative ultrasound examination. Four patients had mucosa-confined cancer and did not undergo any further treatment. One patient had mucosa confined cancer with a residual tumor in the cystic duct resection margin and underwent segmental resection of the liver (IVa & V) and segmental resection of the common bile duct, including dissection of the pericholedochal lymph node. The other four patients had advanced GB cancer with subserosal invasion. One patient underwent segmental resection of the liver (IVa & V) and segmental resection of the common bile duct, including dissection of the pericholedochal lymph node, and the other patient received a pericholedochal lymph node dissection only. The follow-up period ranged from 39 months to 3 months. Only one patient, who had mucosa-confined cancer with cystic duct invasion, died from lung metastasis with local recurrence of the midclavicular trocar site at 16 months after the laparoscopic cholecystectomy, but the other 8 patients have been doing well until now. We recommend a habit of opening the gallbladder, examining the gross pathologic features, and performing a frozen-section examination in patients where GB cancer is suspected. During that procedure, a careful isolation technique (careful dissection and delivery of the specimen in vinyl bag is vital) for preventing tumor implantation.

An Immunohistochemical Study of Tumor Angiogenesity and EMA Reactivity in Papillary Thyroid Carcinoma / 대한암학회지

PURPOSE: This study was carried out to investigate the correlation among tumor angiogenetic activity, epithelial membrane antigen (EMA) reactivity and various clinicopathologic parameters. We also evaluated the validity of both as an independent prognostic factor in patients with papillary thyroid carcinoma. MATERIALS & METHODS: We studied 120 patients out of 727 patients with papillary thyroid casrcinoma who underwent thyroidectomy at our institute from January 1986 to December 1994. The age of the patients ranged from 14 to 80 years with a mean of 48.2 years. There were 24 males and 96 females (M:F=1:4). The paraffin embedded tissues of these patients were stained with the monoclonal antibodies against factor VIII related antigen, antigen CD34 to highlight microvessels and against EMA to show immunoreactivity. We measured microvessel density (MVD) in the area of highest vascular density at 200 times of magnification (0.785 mm2 per field). The positive cells for EMA were counted as percentages of the whole cell population and the degree of reaction was rated on a five-point scale. RESULTS: Mean MVDs and EMA reactivities by location of tissue per field were 64.8+/-18.9, 1.97+/-0.74, in the center of the tumor; 41.3+/-15.3, 1.55+/-0.68 in the periphery of tumor; and 22.1+/-14.4, 1.09+/-0.75 in normal thyroid tissue, respectively. In relation to TNM stage, only the MVDs of patients with stage IV disease were higher than those of other disease stages with statistical significance (p<.05). In relation to DeGroot stage, the MVDs of patients with stage IV disease was also higher than others with statistical significance (p<.005). There were no significant differences in MVD and EMA reactivity between the two groups of low risk (n=77) and high risk (n=43) by AMES scale. The MVDs and EMA reactivities of patients with local recurrence (n=23) and death (n=7) during the follow-up period had no statistical significance against those patients without recurrence and living patients. CONCLUSION: Tumor angiogenic activity and EMA reactivity in papillary thyroid carcinoma did not correlate with TNM stage, DeGroot stage, AMES score, local recurrence, and patient death. However, MVD was significantly higher in patients with distant metastasis and may be useful in predicting the distant metastasis in papillary thyroid carcinoma.

Primary Sclerosing Cholangitis: Report of a Case with a Clinical Analysis of the Cases Reported in the Korean Literature / 대한내과학회지

We experienced a case of primary sclerosing cholangitis(PSC) in a 40-year-old female who complained of jaundice and pruritus. Marked elevation of serum alkaline phophatase level, typical beaded appearance and pruned-tree appearance on endoscopic retrograde cholangiography, together with a finding of chronic obliterative fibrosing cholangitis on sono-guided gun biopsy specimen of the liver led to a confirmative diagnosis of PSC. The patient responded to ursodeoxycholic acid (UDCA), but was reluctant to treatment and died of hepatic failure 7 months later. PSC is a very rare disease in Korea. So far, only 5 cases including our present case have been reported in the Korean literature. Male-to-female ratio was 2:3 and the median age was 40(27-80 years old). Ulcerative colitis was associated in one case. Four cases involved both intra, and extrahepatic bile ducts and one case was reported to be confined in the intrahepatic bile ducts. Fatality was in 3 cases, 20 days, 36 days, and 7 months after the initial presentaion, respectively. The causes of death were acute cholangitis and sepsis in two, and hepatic failure in one. We herein report a case of PSC and clinical charateristics of the reported cases in Korea, and review the literature with an emphasis on UDCA treatment in PSC.

A case of flutamide-induced acute cholestatic hepatitis: a case report

Flutamide, an oral nonsteroidal, antiandrogenic, anilid compound which inhibits the uptake and binding of androgens to nuclear receptors in the prostate, is used with or without LH-RH analogues for treatment of patients with metastatic carcinoma of the prostate. Clinically significant hepatotoxicities such as toxic hepatitis, cholestatic hepatitis, hepatic failure, and even death have rarely been reported in the English literature, but no case has been reported in Korea. A 75-year-old man with metastatic carcinoma of the prostate had taken flutamide (750 mg/day) for 7 months and suddenly developed jaundice and general weakness. The findings of blood chemistries were compatible with cholestatic hepatitis, but ultrasonography, viral marker and auto-antibody studies did not reveal any attributable causes. Histologic examination of a sono-guided liver biopsy only disclosed centrilobular cholestasis, nuclear glycogenosis and mild sinusoidal lymphocytic infiltration. Discontinuation of flutamide resulted in an almost full recovery of the patient's liver function in 2 months. We, herein, report a case of flutamide-induced acute choestatic hepatitis with a brief review of the literature.

Intrapleural instillation of OK-432 for malignant pleural effusion / 대한암학회지

No abstract available.

Placental Site Trophoblastic Tumor(PSTT) with Vaginal Metastasis: A case report

PSTT has been established as a separate entity distinct from choriocarcinoma since 1983, because of its different morphological features, biologic behavior and response to chemotherapy. Most cases of PSTT have indolent clinical courses, but there have been several reports showing malignant behavior resulted in death of the patient. We report a case of PSTT showing vaginal metastatis. In biopsy specimen, it was difficult to make differential diagnosis from squamous cell carcinoma of uterine cervix due to uniform and mononuclear cytologic characteristics. Immunohistochemical stains for hPL and hCG were not typical for either PSTT or choriocarcinoma. We suggest that poorly differentiated PSTT may synthesize the lesser amount of hPL than typical PSTT and it may behave more aggressively.

Gastric carcinoid tumor / 대한암학회지

No abstract available.

Chronic Bullous Dermatosis of Childhood Showing Typical Clustering of Jewel-Like Blisters

No abstract available.

Peripheral Neuropathy Associated with Castheman's Disease

Castleman's disease, or giant Iymph node hyperplasia, is a Iymphoproliferative disorder which is characterized by Iymphoid hyperplasia with capillary proliferation, and divide histologically into two 0varieties, hyaline vascular and plasmal cell form. Some system manifestations are occasionally accompanied with the diseases, but peripheral neuropathy is a rarely reported manifestatlon of them and not in Korea. The present report describes a 40 year old female patient who had been admitted to Yonsei university medicai center because of progressive quadriparesis. On examination, she revealed various other manifestations such as hyperpigmentation, Iymphadenopathy, pitting edema, and bilateral papilledema. The electrophysiologic studies and sural nerve biopsy showed severe sensori-motor peripheral neuropathy showing features of mixed demyelinatlon and axonal degeneration. The Iymph node biopsy showed features compatible with Castleman's disease of hyaline vascular type. The recovery was poor over four month period despite of treatment with corticosterold.