Parathyroid Adenoma Causing Spontaneous Cervical Hematoma: A Case Report and Review of Literature / 대한두경부종양학회지

Parathyroid adenoma can cause extracapsular bleeding. In 1934, Capps first reported a case of massive hemorrhage secondary to rupture of a parathyroid adenoma. Recently, we experienced a 73-year-old female presented with pharyngeal discomfort and extensive ecchymosis over the neck without history of trauma. Endoscopic investigation revealed submucosal hemorrhage in the posterior wall of the hypopharynx. CT scan and ultrasonography demonstrated the presence of a mass below the left thyroid lobe. Serum calcium level was normal and PTH level was elevated. We underwent left thyroidectomy and parathyroidectomy 2 weeks later from first visit. During the operation, hypopharyngeal mucosa was teared and it was treated with pharyngostoma formation and L-tube feeding. We report a rare case of normocalcemic parathyroid adenoma with spontaneous hemorrhage and propose the proper management period with a literature review

A Case of Neurofibroma of the Vocal Cord

Solitary neurofibroma of the glottis is extremely rare and accounts for only 0.1–1.5% of benign laryngeal tumors. Aryepiglottic fold is the most frequent involved site followed by arytenoids and ventricular folds. There have been few reports of neurofibroma of the true vocal cord. We report a case of neurofibroma which was deeply embedded in the vocal cord and misdiagnosed as muscle tension dysphonia with a review of literatures.

Large Cell Neuroendocrine Carcinoma of the Colon With Carcinomatosis Peritonei

Colorectal large-cell neuroendocrine carcinomas (NECs) are extremely rare and have very poor prognosis compared to adenocarcinomas. A 74-year-old man presented with abdominal pain, diarrhea and hematochezia. The histopathologic report of colonoscopic biopsy performed at a local clinic was a poorly differentiated carcinoma. An abdominopelvic computed scan revealed irregularly enhanced wall thickening at the sigmoid colon with regional fat stranding and lymphnode enlargement. He underwent a laparoscopic high anterior resection with selective peritonectomy for peritoneal carcinomatosis, intraoperative peritoneal irrigation chemotherapy, and early postoperative intraperitoneal chemotherapy for 5 days. The tumor had a high proliferation rate (mitotic count > 50/10 HPFs and 90% of the Ki-67 index) and lymph-node metastases had occurred. On immunohistochemistry, the tumor cells expressed CD56 and synaptophysin. Large-cell NEC was confirmed. Systemic chemotherapy with cisplatin/etoposide was done. The patient is still alive after 3 years with no evidence of recurrence.

Synchronously Diagnosed Gastric Metastasis from Invasive Lobular Breast Carcinoma, Mimicking Primary Gastric Carcinoma

Gastric metastasis from invasive lobular breast carcinoma is rare. Mostly gastrointestinal metastasis presents as one among multiple metastases, several years after primary diagnosis of breast carcinoma. Herein, we report a synchronously diagnosed gastric metastasis from invasive lobular carcinoma, mimicking primary gastric linitis plastica with pyloric obstruction. We reviewed clinical and pathological findings of gastric carcinoma metastatic from the breast. In particular, we focused on immunohistochemical studies of selected antibodies, including those for estrogen receptors, gross cystic disease fluid protein-15, and caudal-type homeobox transcription factor 2, for accurate differential diagnosis. Clinical suspicion, repeat endoscopic biopsy, and detailed histological analysis including immunohistochemistry are necessary for diagnosis of gastric carcinoma metastatic from the breast.

The True Deep Femoral Artery Aneurysm: A Case Report

A 55-year-old man with a palpable pulsatile mass and pain in his left thigh was presented to us. He had no history of trauma in his left leg, interventions, operation, or medical diseases, including cardiac valve disease, endocarditis, and systemic infection. The size of the aneurysm was 10 cm×7 cm with a mural thrombus in ultrasonography and multidetector computer tomography. There was no evidence of other aneurysms or occlusive lesions in the other arteries. The aneurysm was resected without a vascular reconstruction of the deep femoral artery. The patient’s symptom improved rapidly. The patient had an uneventful postoperative recovery without complications. We report a case of true deep femoral artery aneurysm, which was successfully treated with resection of an aneurysm without a vascular reconstruction.

Quality of life changes during adjuvant chemotherapy in patients with colon cancer

PURPOSE: The survival of advanced colon cancer patients has increased due to the development of surgical techniques and adjuvant chemotherapy. The administration of adjuvant chemotherapy after curative resection is generally accepted as a standard of care. The primary endpoint of chemotherapy should include not only tumor response and survival, but also impact on the quality of life (QoL). We evaluated changes in QoL during adjuvant chemotherapy in patients with colon cancer.METHODS: Between October 2009 and February 2012, 56 patients with stage II and III colon cancer received the combination adjuvant chemotherapy 5-flurouracil/folinic acid with oxaliplatin (FOLFOX). Patients were asked to complete the QoL questionnaire QLQ-C30 version 3 before and after 6 cycles of adjuvant chemotherapy.RESULTS: There was no significant difference in the QoL between the start of chemotherapy and after the completion of 6 cycles. After completion of 6 cycles, global QoL was worse in patients >70 years of age. The functional scale score was low in patients with chemotherapy schedules delayed more than 2 times due to adverse events. Patients with body weight increases greater than 5% scored lower on symptom scales. Interestingly, patients with peripheral neuropathy scored higher on symptom scales.CONCLUSION: QoL changes during adjuvant chemotherapy did not show significant differences. After the sixth chemotherapy, QoL was affected by age, body weight gain, delay of the scheduled chemotherapy, and peripheral neuropathy. Therefore, the proper attitude of physicians focused on reassurance and education of patients is very important during chemotherapy.

Intensive Long Distance Running as a Possible Cause of Multiple Splanchnic Arterial Aneurysms: A Case Report

This is a case report that suggests the possible association between multiple splanchnic arterial aneurysms and long-distance running. The clinical features of one patient admitted at Chungbuk National University Hospital for treatment of multiple splanchnic arterial aneurysms were reviewed. A 54-year-old man had a recurrent, intermittent and epigastric pain for 2 months. There was no abnormality in gastroscopy and colonoscopy. An abdominal computed tomography angiography documented calcified superior mesenteric artery (SMA) and splenic artery aneurysms. The patient had a history of recreational long-distance running for over 10 years. His average running time per week was more than 10 hours. There was no evidence of systemic arteritis, connective tissue disorder or infectious process that may have caused the aneurysms. He did not take any drugs. The SMA aneurysm was opened, and the aneurysmal segment of SMA was replaced with a vein graft. The splenic aneurysm was observed. The patient recovered without any sequelae.

Comparing the osteogenic potential of canine mesenchymal stem cells derived from adipose tissues, bone marrow, umbilical cord blood, and Wharton's jelly for treating bone defects

Alternative sources of mesenchymal stem cells (MSCs) for replacing bone marrow (BM) have been extensively investigated in the field of bone tissue engineering. The purpose of this study was to compare the osteogenic potential of canine MSCs derived from adipose tissue (AT), BM, umbilical cord blood (UCB), and Wharton's jelly (WJ) using in vitro culture techniques and in vivo orthotopic implantation assays. After canine MSCs were isolated from various tissues, the proliferation and osteogenic potential along with vascular endothelial growth factor (VEGF) production were measured and compared in vitro. For the in vivo assay, MSCs derived from each type of tissue were mixed with beta-tricalcium phosphate and implanted into segmental bone defects in dogs. Among the different types of MSCs, AT-MSCs had a higher proliferation potential and BM-MSCs produced the most VEGF. AT-MSCs and UCB-MSCs showed greater in vitro osteogenic potential compared to the other cells. Radiographic and histological analyses showed that all tested MSCs had similar osteogenic capacities, and the level of new bone formation was much higher with implants containing MSCs than cell-free implants. These results indicate that AT-MSCs, UCB-MSCs, and WJ-MSCs can potentially be used in place of BM-MSCs for clinical bone engineering procedures.

Treatment of a Recurrent Rectourethral Fistula by Using Transanal Rectal Flap Advancement and Fibrin Glue: A Case Report

Rectourethral fistulas (RUFs) in adults are rare and could result from complicated trauma, and prostatic or rectal surgery. RUFs have been treated initially by using primary repair and omental interposition with or without a colostomy during surgery. Recurrent RUFs require complex surgery, such as a low rectal resection and coloanal anastomosis, an interposition flap of the datos muscle or gracilis muscle, and others. Recently, transanal rectal flap advancement and fibrin glue injection have provided an effective occlusion of RUFs. However, no reports about this technique exist for cases of recurrent RUFs. We report a case of a recurrent RUF successfully repaired by using transanal rectal flap advancement combined with fibrin glue injection into the fistula tract. The postoperative course was uneventful without complications. At the 1-year follow-up, no complications such as urethral stricture or recurrence existed, and voiding was normal without anal incontinence.

Sonic Hedgehog Protein Expression in Various Thyroid Tissues and Its Clinical Implication / 대한내분비외과학회지

PURPOSE: The Hedgehog (Hh) signaling pathway is important in embryonic development including cell differentiation and proliferation. Recently, activation of this pathway has been implicated in several forms of solid cancers. We investigated sonic hedgehog (Shh) protein expression and its relation to differentiation and clinicopathologic characteristics in thyroid cancer cell lines and tissues. METHODS: FTC-236, FTC-238, and XTC-1. We made tissue microarray slides using 80 thyroid surgical specimen: 40 benign and 40 malignant lesions. Immunohistochemical staining was performed using anti-Shh antibody. mRNA expression of NIS, thyroglobulin, and CD97 were evaluated by RT-PCR. Cyclopamine was used as a Shh signal inhibitor. RESULTS: Shh expression was more prominent in TPC-1, FTC-133, and XTC-1 cell lines than the others. Cyclopamine downregulated CD97 and upregulated thyroglobulin mRNA expression, but did not induce mRNA expression of NIS. Thyroid tissues showed varied expression of Shh in both benign and malignant diseases. Shh expression was detected in 38 of 50 (76%) normal, in 18 of 25 (72%) non-neoplastic benign, in nine of 15 (60%) benign tumors, and in 31 of 40 (77%) malignant tumors. Shh over-expression was significantly less frequent in papillary thyroid carcinomas than in normal or benign thyroid tissues. In addition, Shh protein expression did not relate to clinicopathologic characteristics in papillary thyroid carcinomas. CONCLUSION: Thyroid tissues and cell lines vary in expression of Shh. Cyclopamine can induce redifferentiation in thyroid cancer cell lines. Shh protein expression, however, is unrelated to clinicopathologic characteristics in papillary thyroid carcinomas.

64-Channel multi-detector row CT angiographic evaluation of the micropigs for potential living donor lung transplantation

Micropigs are the most likely source animals for xenotransplantation. However, an appropriate method for evaluating the lung of micropigs had not been established. Therefore, this study was performed to evaluate the feasibility of 64-channel multi-detector row computed tomography (MDCT) to measure the diameter of the pulmonary arteries and the lung volume in micropigs. The mean diameters of the trachea, and left and right bronchi were 1.6 +/- 0.17, 1.18 +/- 0.14, and 1.1 +/- 0.11 cm, respectively. The mean diameters of the main, right, and left pulmonary arteries were 1.38 +/- 0.09, 1.07 +/- 0.26, and 0.98 +/- 0.13 cm and the diameters of right, left, and common inferior pulmonary veins were 0.97 +/- 0.20, 0.76 +/- 0.20, and 1.99 +/- 0.26 cm, respectively. The mean lung volume was 820.3 +/- 77.11 mL. The data presented in this study suggest that the MDCT may be a noninvasive, rapid, and accurate investigational method for pulmonary anatomy in living lung donors.

Multidetector row computed tomography evaluation of the micropig kidney as a potential renal donor

Multidetector row computed tomography (MDCT) provides anatomical information about the kidney and other internal organs. Presently, the suitability of 64-channel MDCT to assess the kidney of healthy micropigs was evaluated. Morphological evaluations of the kidney and the major renal vessels of six healthy micropigs were carried out using MDCT, recording kidney volume and the diameter and length of renal arteries and veins. The mean diameters and lengths of the renal artery were 0.44 +/- 0.05 and 4.51 +/- 0.55 cm on the right side and 0.46 +/- 0.06 and 3.36 +/- 0.27 cm on the left side, respectively. The mean diameters and lengths of the renal vein were 1.44 +/- 0.52 and 4.22 +/- 1.29 cm on the right side and 1.38 +/- 0.17 and 5.15 +/- 0.87 cm on the left side, respectively. The mean volume of the right kidney was 79.3 +/- 14.5 mL and of the left kidney was 78.0 +/- 13.9 mL. The data presented in this study suggest that the MDCT offers a noninvasive, rapid, and accurate method for the evaluation of the renal anatomy in living kidney donors. It also provides sufficient information about extra-renal anatomy important for donor surgery and determination of organ suitability.

Clinical Significance in Expression of p53, Bcl-2, PCNA and VEGF in Head and Neck Squamous Cell Carcinoma: Relationships with Cisplatin Chemosensitivity and Prognosis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Many researchers have attempted to correlate tumor marker expression with the response of chemoradiotherapy and prognosis of head and neck cancer. But no clear markers are available that can predict responses to treatment or survival in head and neck cancer. This study investigates the relationship between tumor marker expressions and prognosis. SUBJECTS AND METHOD: Thirty-eight patients who received cisplatin and 5-fluorouracil (5-FU) chemotherapy for the treatment of head and neck cancer were enrolled in this study. Author evaluated the relationship between the response of chemotherapy and the immunohistochemical expression of p53, Bcl-2, VEGF, PCNA. The relationship between survival and tumor marker expression was evaluated in twenty five patients who received chemotherapy and radiotherapy. RESULTS: Expression rates of p53, Bcl-2, VEGF, PCNA were 65%, 26%, 26%, 68%, respectively. Of the markers examined, while the expression of p53 was associated with chemosensitivity (p=0.02), other markers was not associated with chemosensitivity (p>0.05). The recurrent rate was 52%. T stage seemed to be associated with recurrence (p=0.07), tumor markers and other clinical parameters were not associated with recurrence (p>0.05). Five year survival rate was 60%. The primary site of tumor seemed to be associated with the overall survival rate of (p=0.07). Any other clinical characteristics and tumor markers were not associated with survival. CONCLUSION: The expression of p53 may be a clinically useful predictor of chemosensitivity in this group of patients. Further studies using a larger group is needed to establish the relationship between tumor markers and prognosis of head neck cancer.

Cyclopamine Inhibits Cancer Cell Proliferation in Thyroid Cancer Cell Lines / 대한내분비외과학회지

PURPOSE: The Hedgehog (HH) signaling pathway is important in development. Recently,ectopic activation of this pathway has been implicated in several forms of solid cancer including basal cell carcinoma, pancreatic cancer, colon cancer, and prostate cancer. There are three HH proteins involved in the pathway: Sonic HH, Indiana HH, and Desert HH. Cyclopamine disrupts Sonic HH signaling by inhibition of the seven-transmembrane receptor Smoothened (SMO). Whereas cyclopamine is cytotoxic to several human cancer cells, its effect on thyroid cancer cellsis unknown. We therefore investigated the effect of cyclopamine on cell proliferation in human thyroid cancer cell lines. METHODS: We used fivethyroid cancer cell lines: TPC-1 (papillary), FTC-133, FTC-236, FTC-238 (follicular), and XTC-1 (Hurthle cell). The MTT assay and cell cycle analysis were used to evaluate anti-proliferative effects. Tomatidine, a structural analogue of cyclopamine, was used as a control agent. Statistical significance was tested by ANOVA. RESULTS: After 4 days of treatment, the percent inhibition of growth with a concentration of 5, 10, and 20 M cyclopamine in the cell lines were 23.6±4.9%, 66.4±4.7% and 69.3±1.3% in TPC-1 7.5±2.8%, 10.7±3.2% and 49.6±6.4% in FTC-133, 19.2±9.5%, 50.4±4.8% and 60.4±2.0% in FTC- 236 22.8±4.2%, 53.4±5.5% and 63.7±4.8% in FTC- 238 7.6±5.8%, 16.6±2.2%, 24.0±4.3% in XTC-1. Treatment with tomatidine at the same concentrations did not significantly affect cell growth. Exposure to cyclopamine, however, did not affect the cell cycle significantly CONCLUSION: Cyclopamine inhibits cancer cell proliferation in a dose dependent manner in thyroid cancer cell lines. The Hh signaling pathway might be a useful therapeutic target for thyroid cancer.

Antiproliferative Effect of Phenylbutyrate in AsPC-1 Pancreatic Cancer Cell Line

PURPOSE: Phenylbutyrate is an effective redifferentiating agent in several human cancers. Recently phenylbutyrate has been reported to inhibit histone deacetylase activity. We investigated the effects of sodium 4-henylbutyrate (Na-4-PB) on cell proliferation in a human pancreatic cancer cell line. METHODS: A human pancreatic cancer cell line, Aspc-1 was purchased from Korean Cell Line Bank. Antiproliferative effects of sodium 4-phenylbutyrate were measured by MTT assay and their mechanisms were evaluated by apoptosis assay and cell cycle analysis. RESULTS: After 3 days of treatment with Na-4-PB at the concentration of 2.5, 5, 7.5, and 10 mM, relative growth inhibition compared to control was 21.3+/-8.3% (mean+/-SD), 37.8+/-2.3%, 46.7+/-0.5%, and 56.7+/-1.7% respectively (p < 0.05). Antiproliferative effect of Na-4-PB was also time-dependent. Combination treatment with Na-4-PB and troglitazone, a PPARg agonist, increased antiproliferative effects but was not synergistic. After 48 hour treatment with Na-4-PB, early apoptotic cell population in control, 2.5, and 5 mM of Na-4-PB was 29.6%, 44.2%, and 65.9%, respectively. After 24 hour treatment with Na-4- PB, G0/G1 phase population in control, 2.5, and 5 mM of Na-4-PB was 55.0%, 67.4%, and 65.8%, respectively. CONCLUSION: Na-4-PB inhibited pancreatic cancer cell proliferation by inducing apoptosis and cell cycle arrest at G0/G1 phase in time- and dose-dependent manner. Combination treatment with Na-4-PB and other chemotherapeutic agents such as troglitazone, a PPARg agonist, can enhance antiproliferative effects. Na-4-PB might be a promising potential therapeutic agent for patients with pancreatic cancer.

Antiproliferative Effect of NS-398, a Cyclooxygenase-2 Inhibitor, in Pancreatic Cancer Cell Lines

PURPOSE: Selective cyclooxygenase (COX)-2 inhibitors have been reported to inhibit cancer cell proliferation. We investigated the effects of NS-398, a selective COX-2 inhibitor, on cell proliferation in human pancreatic cancer cell lines. METHODS: Human pancreatic cancer cell lines, Aspc-1, Capan-1, and Capan-2 were used. We used western blot and/or RT-PCR to evaluate COX-2 and vascular endothelial growth factor expression. Antiproliferative effects were measured by MTT assay, apoptosis assay and cell cycle analysis. Epidermal growth factor (EGF) and troglitazone were used for combined treatment. RESULTS: COX-2 was relatively overexpressed in Capan-1 and Capan- 2, but minimal in Aspc-1 cell line. COX-2 mRNA expression was upregulated by 50 microM of NS-398 in Aspc-1 cell line but was downregulated at 100 microM in all cell lines. Treatment with NS-398 increased cell population of G0/G1 phase and also induced early apoptotic changes in a dose-dependent manner in all three cell lines. Combined treatment with EGF or troglitazone did not seem to affect antiproliferative effects of NS-398. All three cell lines expressed vascular endothelial growth factor constitutively and its expression was downregulated by treatment with NS-398. Pretreatment with NS-398 prior to radiation exposure increased radiosensitivity in Capan-2 cells. CONCLUSION: COX-2 expression was variable in pancreatic cancer cell lines. NS-398 inhibited pancreatic cancer cell proliferation by inducing apoptosis and cell cycle arrest in a dose-dependent manner. Treatment with NS-398 also inhibited expression of VEGF and enhanced radiosensitivity in pancreatic cancer cell lines. COX-2 inhibitors might be promising potential therapeutic agents for patients with pancreatic cancer.

Current Status of Violence in the Emergency Centers: Frequency and Management

PURPOSE: The aim of this study is to describe the current status of violence in emergency departments (ED) in Korea, especially in the aspect of frequency and management. METHOD: A cross-sectional survey of 60 academic emergency departments was performed. The questionnaires were posted to the chief resident physicians of emergency medicine. RESULTS: Thirty-three EDs (55%) responded to the survey questionnaire. The responders were experienced 18.4 verbal insults, 5.5 physical threats, 0.4 threats by weapon, 1.8 physical violences and 3.3 facility damages per 100,000 patients in a month. All kinds of violence occurred more frequently in the ED which annual census was less than 30,000. The current coping strategies for violence were video surveillance (93.9%), security personnel (75.8%), access control (36.4%), and educational programs (18.2%). The rate of threat by weapon and facility damage was significantly lower in the ED having security personnel. CONCLUSION: This study suggested that ED violence occurred frequently. The rate of violence of the ED having high annual census was more higher, because violence events may be suppressed by security personnel.

TProtective effect of chlormethiazole, a sedative, against acetaminophen-induced liver injury in mice

OBJECTIVES: The hepatotoxicity of acetaminophen is not a result of the parent compound but is mediated by its reactive metabolite N-acetyl-p-benzoquinone imine. Cytochrome P4502E1 (CYP2E1) is the principal enzyme of this biotransformation, which accounts for approximately 52% of the bioactivation in human microsomes. Recently, chlormethiazole a sedative drug, is reported to be an efficient inhibitor of CYP2E1 activity in human beings. In this study we wished to evaluate whether chlormethiazole, an inhibitor of CYP2E1, could prevent acetaminophen-induced liver injury in mice. METHODS: Acetaminophen, at doses ranging from 200 to 600 mg/kg, was injected into the peritoneum of female C57BL/6 inbred mice fasted for four hours. Chlormethiazole (60 mg/kg) or 5% dextrose water was given 30 min before or 2 h after acetaminophen. Serum aminotransferase activities, histologic index score, survival rate and hepatic malondialdehyde levels were compared. RESULTS: Pretreatment with chlormethiazole 30 min before 400 mg/kg of acetaminophen completely inhibited acetaminophen-induced liver injury (median 118.5 U/L, range 75 to 142 vs. 14,070 U/L, range 5980 to 27,680 for AST; 49 U/L, range 41 to 64 vs. 15,330 U/L, range 13,920 to 15,940 for ALT). In mice receiving chlormethiazole 2 h after acetaminophen, the mean AST and ALT levels were also less elevated, reaching only 20% of the value of acetaminophen-only group. These protective effects were confirmed histologically. Whereas more than 50% of mice died at 500 mg/kg of acetaminophen, all the mice pretreated with chlormethiazole survived at the same dose. CONCLUSION: Chlormethiazole effectively reduces acetaminophen-induced liver injury in mice. Further studies are needed to assess its role in humans.