Infection control of operating room and anesthesia for cesarean section during the COVID-19 outbreak in Daegu, the Republic of Korea -a case series- / 대한마취과학회지

Background@#The coronavirus disease-19 (COVID-19) was first reported in Wuhan, China, with Korea being subsequently exposed. In Korea, COVID-19 screening guidelines have been established in every hospital as an attempt to prevent its spread. There has been a previous report of a successful cesarean section of a confirmed mother; however, there remain no guidelines for suspected mothers. Cesarean section is often urgently operated without sufficient infection evaluations. We would like to suggest anesthetic management guidelines for cesarean section patients suspected of COVID-19.Case: Our hospital, which is located in Daegu, Korea, was designated as a quarantine and delivery facility for suspected mothers. We performed the cesarean section on seven suspected mothers and one confirmed mother. @*Conclusions@#This case report presents guidelines for infection control during surgery and anesthesia for cesarean section of mothers with suspected COVID-19 involving operating room preparation and protection strategy.

Infection control of operating room and anesthesia for cesarean section during the COVID-19 outbreak in Daegu, the Republic of Korea -a case series- / 대한마취과학회지

Background@#The coronavirus disease-19 (COVID-19) was first reported in Wuhan, China, with Korea being subsequently exposed. In Korea, COVID-19 screening guidelines have been established in every hospital as an attempt to prevent its spread. There has been a previous report of a successful cesarean section of a confirmed mother; however, there remain no guidelines for suspected mothers. Cesarean section is often urgently operated without sufficient infection evaluations. We would like to suggest anesthetic management guidelines for cesarean section patients suspected of COVID-19.Case: Our hospital, which is located in Daegu, Korea, was designated as a quarantine and delivery facility for suspected mothers. We performed the cesarean section on seven suspected mothers and one confirmed mother. @*Conclusions@#This case report presents guidelines for infection control during surgery and anesthesia for cesarean section of mothers with suspected COVID-19 involving operating room preparation and protection strategy.

Ultrasonography-guided Fine-needle Aspiration Biopsy for Thyroid Nodules: Effective Technique and a Peculiar Smear Method

PURPOSE: We wanted to evaluate the effective methods that are appropriate for an endemic area of thyroid disease and to compare the differences of cytologic diagnostic rates with and without using a peculiar smear technique. MATERIALS AND METHODS: We analyzed the incidence rate of insufficient results, complications and the total procedure times of 1,126 thyroid nodules in 776 patients who underwent US-FNAB (ultrasonography-guided fine-needle aspiration biopsy) from January to December 2005. We compared the diagnostic rate between the two groups; the groups' tests were performed with a peculiar smear technique (Group A, n = 313) or with a conventional smear technique (Group B, n = 250). RESULTS: According to the size of the thyroid nodule, the incidence rate of an insufficient result on US-FNAB and the mean total procedure time for 1126 thyroid nodules in 776 patients were measured as 16.9% (52/308) and 208 seconds for nodules under 0.5 cm, 9.8% (30/306) and 160 seconds for nodules between 0.5 cm-1.0 cm, and 6.0% (30/504) and 134 seconds for nodules over 1.0 cm. These 776 patients showed no significant complications, except for mild pain. In Group A, the incidence rate of an insufficient result was calculated as 15.1% (14/93) for the group with nodules under 0.5 cm, 5.3% (5/95) for the group with nodules between 0.5 cm-1.0 cm, 4.8% (6/125) for the group with nodules over 1.0 cm, and 8.0% (25/313) for the total A Group. In Group B, the incidence rate of an insufficient result was measured as 33.3% (15/45) for the group with nodules under 0.5 cm, 28.1% (25/89) for the group with nodules between 0.5 cm-1.0 cm, 21.4% (24/112) for the group with nodules over 1.0 cm, and 25.7% (63/245) for the total B group. There was a statistically significant correlation between the rate of an insufficient result and the peculiar smear technique or the size of the thyroid nodule. CONCLUSION: We consider that US-FNAB is very simple, safe and accurate diagnostic method for thyroid nodules, and US-FNAB with a peculiar smear technique is able to increase the diagnostic rate for thyroid nodules.

A Case of Adenocarcinoma Presenting a Solitary Pulmonary Nodule That Showed No Growth Over 4 Years / 결핵및호흡기질환

A case of 51-year-old woman with a malignant solitary pulmonary nodule (SPN) that exhibited no growth over a period of 4 years is reported. Surgical wedge resection revealed an adenocarcinoma upon intra-operative frozen ex-amination. The operation was completed with a right upper lobectomy and complete lymphadenectomy. The authors recommend an early surgical procedure for any SPNs due to risk factors for developing lung cancer.

Detection of Recurrence with FDG-PET Scan in Patients with Endometrial Cancer / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the feasibility of 2-[18F]-fluoro-2-deoxy-D-glucose-Positron emission tomography (FDG-PET) scan for detecting early recurrence in patients with endometrial cancer who showed no evidence of the disease after primary treatment. METHODS: A total of 14 patients, diagnosed and treated for endometrial cancer with surgery and/or subsequent radiotherapy, were included. Whole-body FDG-PET scanning was performed on 14 patients. PET images were interpreted was suspicious for malignancy in areas of localized FDG uptake compared to the surrounding tissues. computed tomography (CT) or magnetic resonance imaging (MRI) and/or fine needle biopsy were performed to evaluate positive FDG uptakes, and all patients were closely followed up at least for 6 months. RESULTS: Of the 14 patients, 2 recurrences were detected by FDG-PET scan. One of these two patients had increased FDG uptake in abdomen, which was negative on CT, and was confirmed to be recurrent 3 month later on follow-up CT. The other patient had a single focus of hypermetabolic activity in right upper quadrant of abdomen, which was correspondent to 5 cm sized hypodense mass along the right anterior segment of the liver on CT scan, and was confirmed to have adenocarcinoma cell on a needle biopsy. CONCLUSION: These preliminary data demonstrate the feasibility of FDG-PET imaging in detection of early recurrence in patients with endometrial cancer. Further prospective evaluation of FDG-PET in larger numbers of patients with endometrial cancer is warranted to more precisely define its accuracy.

Detection of Recurrence with FDG-PET Scan in Patients with Endometrial Cancer / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the feasibility of 2-[18F]-fluoro-2-deoxy-D-glucose-Positron emission tomography (FDG-PET) scan for detecting early recurrence in patients with endometrial cancer who showed no evidence of the disease after primary treatment. METHODS: A total of 14 patients, diagnosed and treated for endometrial cancer with surgery and/or subsequent radiotherapy, were included. Whole-body FDG-PET scanning was performed on 14 patients. PET images were interpreted was suspicious for malignancy in areas of localized FDG uptake compared to the surrounding tissues. computed tomography (CT) or magnetic resonance imaging (MRI) and/or fine needle biopsy were performed to evaluate positive FDG uptakes, and all patients were closely followed up at least for 6 months. RESULTS: Of the 14 patients, 2 recurrences were detected by FDG-PET scan. One of these two patients had increased FDG uptake in abdomen, which was negative on CT, and was confirmed to be recurrent 3 month later on follow-up CT. The other patient had a single focus of hypermetabolic activity in right upper quadrant of abdomen, which was correspondent to 5 cm sized hypodense mass along the right anterior segment of the liver on CT scan, and was confirmed to have adenocarcinoma cell on a needle biopsy. CONCLUSION: These preliminary data demonstrate the feasibility of FDG-PET imaging in detection of early recurrence in patients with endometrial cancer. Further prospective evaluation of FDG-PET in larger numbers of patients with endometrial cancer is warranted to more precisely define its accuracy.

Ultrastructure of Different Types of Thymic Epithelial Cells in the Rat Thymus / 대한해부학회지

Thymic epithelial cells constitute a major component of the thymic microenvironment. The thymus is involved in the regulation of the proliferation, maturation and differentiation of thymocytes. There is some controversy about the classification of thymic epithelial cell types. Traditionally, thymic epithelial cells have been divided into cortical and medullary epithelial cell types. In general, the thymic epithelium can be broadly subdivided into subcapsular, cortical and medullary epithelial cells, and Hassall's corpuscles by immunocytochemical methods. Although a few studies were performed on the ultrastructural characteristics of the different types of thymic epithelial cells, there is still some controversy about the classification of thymic epithelial cell subsets. Thus, the present study was performed to investigate the ultrastructural features of thymic epithelial cell subsets in adult male Sprague-Dawley rats, which are the most commonly used species of rat for biological researches, using transmission electron microscopy to shed more light on the heterogeneity of thymic epithelial cells. On the basis of ultrastructural features, we could identify and classify eight subsets of epithelial cells in normal rat thymus. In particular, this study provided a clear and easy way to identify the type 3 epithelial cells by their characteristic 'perinuclear arrangement pattern of relatively short bundles of tonofilaments'. This is an important finding since the type 3 epithelial cells has been considered to be the most difficult type to identify among various thymic epithelial cell types. The results of the present ultrastructural study of thymic epithelial cells provided more insight into the heterogeneity of thymic epithelial cells, and can contribute to the understanding of roles played by different types of thymic epithelial cells.

Polyamines Regulate Growth Factor-Induced Protein Phosphorylation in MCF-7 Human Breast Cancer Cells / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Growth factors stimulate protein phosphorylation resulting in transmission of mitogenic signals. In breast cancer, protein kinases and their substrate proteins are importnat in cell proliferation and phathogenesis. Polymine is known as a mediator of stimuli-induced proliferation in many cell systems. In the present study, we report the importance of polyamines in protein phosphorylation in MCF-7 human breast cancer cells. MATERIALS AND METGODS: Protein phosphorylation study was done by incubating cells in the DMEM containing [gamma-(32)P]-ATP. Quantitation of phosphorylation was analysed by fluorescene image analyzer. Tyrosine phosphorylation was detected by anti-phosphotyrosine antibody. Shc was detected by radioimmunoprecipitation and Western blotting. RESULTS: E2, TGF-alpha, and EGF enhanced the protein phosphorylation in very similar pattern. Among those proteins, 67 kDa protein was most strongly phosphorylated. But the most prominent tyrosine phosphoprotein was 52 kDa protein. DFMO at 5 mM strongly inhibited the phosphorylation of the most proteins. Externally added polyamine could recover the inhibitory effect of DFMO in protein phosphorylation. Among the 5 major tyrosine phosphoproteins, 52 and 46 kDa proteins appeared to be Shc proteins. CONCLUSION: Polyamines modulate signal transduction in relation with estrogen receptor and EGF receptor through multiple steps of protein phosphorylations. Tyrosine phosphorylation of Shc proteins were most significantly influenced by polyamines in growth factor-stimulate breast cancer cell proliferation.

The effect of exercise on daily minor stress

BACKGROUND: Stress can be induced from minor daily life event, and it is widely accepted that this daily minor stress is better predictive factor for relationship between disease and stress. In a number of laboratory studies, investigator reported that perception of stress can be reduced by physical exercise. So in this study, we observed relationship between exercise and stress from minor daily life event, and tried to clarify the effect of exercise on daily stress. METHODS: Volunteer was recruited from health promotion center of one university hospital. and they were doing regular exercise in more than three days per week. Participants completed measures of daily stress inventory and amount of daily exercise for seven days. To compare the daily stress amount between exercise day and no exercise day, we used repeated measures analysis of variance. We used the Wilcoxon signed rank test to compare difference of stress in different sex and different trait anxiety group. RESULTS: There was significant difference in appraisal of daily stress between exercise days and no exercise days. The amount of daily stress was significantly reduced in continuous low level of anxiety group and male by exercise. CONCLUSION: Exercise is associated with a reduction of daily stress appraisal from minor life event. And there is different effect of exercise on daily minor stress in the different anxiety level group and different sex group.

Effects of Polyamines on TNFalpha- or Tamoxifen-induced Apoptosis in Human Breast Cancer Cells / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: To investigate the effects of polyamines on tumor necrosis factor alpha (TNFalpha)-or tamoxifen (TAM)-induced apoptosis in estrogen receptor (ER)-positive MCF- 7 and ER-negative MDA-MB-231 human breast cancer cells. MATERIALS AND METHODS: Cell viability was assessed by using MTT assay. Reactive oxygen species (ROS) generation was measured using 2', 7'-dichlorofluorescin diacetste (DCFDA) by fluorescence plate reader. DNA fragmentation was assessed by 1.5% agarose gel electrophoresis. RESULTS: TNFalpah and TAM showed significant dose- and time- dependent inhibitory effects on the growth of MCF-7 human cells. However, the growth of MDA-MB-231 cells were not inhibited by TNFalpha or TAM treatment. The generation of ROS was increased in dose-and time-dependent manner by TNFalpha treatment in MCF-7 cells. Polyamines, especially spermine suppressed TNFalpha-induced ROS generation in MCF-7 cells. Antioxidant effects of polyamines were also demonstrated by DNA fragmentation, cell morphology as well as ROS generation assay. Polyamines also blocked TAM-induced cell death in MCF-7 cell. However, MDA-MB-231 cells showed resistance to the cytotoxic effects of TNFalpha or TAM. CONCLUSION: These results suggest that polyamines may prevent TNFalpha or TAM-induced apoptosis in MCF-7 human breast cancer cells.

Non-Hodgkin's Lymphoma of the Orbit and Ocular Adnexa: Clinical Analysis of 22 Cases / 대한혈액학회지

BACKGROUND: Non-Hodgkin's lymphoma presenting in the eye is a rare disorder. The aim of this study was to evaluate the clinical features, treatment outcome and complications of patients with non-Hodgkin's lymphoma of the eye. METHODS: We designed retrospective, observational case study. The participants included 22 consecutive patients with non-Hodgkin's lymphoma of the orbit and ocular adnexa treated at the Yeungnam University Hospital between 1992 and 2001. RESULTS: There were 16 males (73%) and 6 females (27%). The median age at ocular presentation was 47. The most common presenting complaint was slowly growing mass at the eye. Histopathologic studies revealed extranodal marginal zone B-cell lymphoma, MALT type in 19 cases (86%), B-cell small lymphocytic lymphoma in one case, diffuse large B-cell lymphoma in one case, and lymphoplasmacytoid lymphoma/immunocytoma in one case. The stages of lymphomas were IA(E) in 17 cases (82%), IIA(E) in 2 cases (9%), IIIA(E) in 2 cases (9%). Radiotherapy alone was employed in 17 cases, chemoradiotherapy was done in 3 cases, chemotherapy alone was administered in one case. Nineteen out of 21 cases (90%) achieved a complete remission, and 5 year survival rate was approximately 90%. Subgroup analysis of the patients with lymphomas in stage IA(E) revealed that complete response rate was 100% and 5 year survival rate was 100% CONCLUSION: Radiotherapy alone can produce durable remission in the majority of the patients with localized extranodal marginal zone B-cell lymphoma, MALT type. However, combination chemotherapy or chemoradiotherapy should be considered in the patients with aggressive lymphomas or indolent lymphomas with systemic manifestation.

A Case of Malignant Mixed M llerian Tumor of the Fallopian Tube / 대한산부인과학회잡지

No abstract available.

CT Findings of Primary Malignant Pulmonary Mesenchymal Tumors

PURPOSE: To describe the CT findings and charicteristic clinical manifestation of primary malignant pulmonarymesenchymal tumors. MATERIALS AND METHODS: This study involved nine histopathologically proven cases of malignantprimary pulmonary mesenchymal tumors, as follows : MFH(n=2), leiomyosarcoma(n=2), pulmonary blastoma(n=1),neurogenic sarcoma(n=1), rhabdomyosarcoma(n=1), liposarcoma(n=1) and hemangiopericytoma(n=1). Two patients weremale and seven were female; their median age was 45. We retrospectively analyzed tumor size, location,characteristic of the peripheral margin, relationship to airways, and whether there was distal atelectasis orobstructive pneumonitis and lymph node involvement. We also reviewed distant metastasis, tumor growth rate and theinterval between surgery and recurrence, as seen on follow-up CT scans(n=6). RESULTS: Lesions were located at theright upper (n=2), right middle (n=1), right lower (n=1) and left lower lobe (n=2); in three cases, the whole leftlung (left upper + left lower lobe) was involved. CT findings showed that in all cases, the largest diameter ofmasses ranged from 3 to 15 cm; a well-demarcated margin was seen (smooth in eight cases, psiculated in one) andthis was well enhanced(inhomogeneous in six cases, homogeneous in three). In six cases, masses encircled ordisplaced the peritumoral small bronchus, and in five cases, were located in the peripheral lung field. In fourpatients who underwent endobronchoscopy, no endobronchial lesions were present, and in six cases scans initial CTscans showed no lymph-node involvement. In two cases, mass size doubled within one month. On initial diagnosis,distant metastasis was seen in seven cases, and in three, recurrent lesions were detected within postoperative sixmonths. CONCLUSION: If in the differential diagnosis of lung cancer, a mass seen on CT images is well demarcated,large, peripheral, inhomogeneously enhanced, encircles or displaces the peritumoral small bronchus, shows earlydistant metastasis, is high locally invasive, and recurs early with relative sparing of the lymph nodes, thepossibility of primary malignant pulmonary mesenchymal tumor shouldbe considered.

Effect of Remission Induction Chemotherapy with AD(Cytosine Arabinoside, Daunorubicin) in Adult Acute Myelogenous Leukemia / 대한혈액학회지

BACKGROUND: The goal of acute myelogenous leukemia(AML) therapy is to obtain the complete remission(CR) and to improve disease-free survival. Advances in chemotherapy and supportive care provided significant improvement in CR rate up to 60~85% patients with AML. METHODS: Forty two patients with previously untreated AML at Yeung Nam University Hospital from April 1985 through November 1996 were treated with AD(7-3) regimen for induction chemotherapy and followed by two courses of consolidation with AD(5-2) regimen. And the authors analyzed clinical factors related to the CR and overall survival. RESULTS: Twenty-four of the 42 patients achieved CR, and median duration of remission in 24 patients achieved CR was 56 weeks(4~ 305 +weeks). Median duration of survival in all 42 cases was 46 weeks(2~340 + weeks), and in 24 cases achieved CR was 73 weeks(12~340 +weeks). Causes of induction failure included infection in 9 cases, bleeding in 3 cases and drug resistance in 6 cases. Among the potential prognostic variables including age, initial WBC count, performance status, and presence of Auer rods and infection at the time of diagnosis, none was statistically significantly related to the prognosis. CONCLUSION: Further clinical trials for effective remission induction and postremission chemotherapy are necessary to overcome drug resistance and to increase the CR rate and duration.

Two Cases of Primary Papillary Serous Peritoneal Carcinoma / 대한산부인과학회잡지

The well-documented but rare primary papillary serous peritoneal tumors are difficult problems for the pathologist and the clinician. The peritoneal serous papillary tumors were morphologically identical to serous ovarian tumor of equivalent grade. Because of their unusual location, these tumor are often classified as mesothelioma or advanced epithelial ovarian carcinoma. We experienced two cases of primary papillary serous peritoneal carcinoma and report with brief review of literature.

The Analysis of MR Findings of the Postoperative Diskitis

PURPOSE: To evaluate MR findings of postoperative diskitis following operation for intervertebral disk herniation. MATERIALS AND METHODS: Twelve cases with postoperative diskitis following operation for intervertebral disk herniation were included in this study. MR findings of postoperative diskitis were analysed to determine 1) the extent and pattern of alteration of the involved disks, 2) the pattern of destruction of endplates and vertebral bodies, and 3) the pattern of inflammatory extension into the surrounding soft tissue. RESULTS: 1) Disk alteration developed mainly at the middle and posterior portions of the disk, and was characterized by loss of intranuclear cleft at the involved portion of the disk and intranuclear abscess formation 2) Vertebral bodies involved ware symmetrically adjacent to involved disks and in three cases, bone abscesses within the endplates were detected. 3) The extension of inflammation yielded prevertebral or pre-/paravertebral masses (7 cases), epidural abscesses (5 cases), arachnoiditis (6 cases), and inflammatory masses (2 cases) beneath the posterior longitudinal ligament. CONCLUSION: Disk involvement was mainly at the middle and posterior portions of the disks, and there was accompanying intranuclear cleft loss. Symmetric involvement of the vertebral bodies adjacent to the involved disks was noted.

A Clinical Study of Multiple Primary Malignancies in Patients Treated for Cervical Carcinoma / 대한산부인과학회잡지

BACKGROUND: Knowledge about the degree of risk and location of multiple primary cancers can facilitate the targeting of screening and surveillance practices on follow-up after treatment of cervical cancer. PURPOSE: The retrospective study was performed to evaluate the characteristics of multiple primary malignancies in patients treated for cervical carcinoma. METHOD: From data base file of gynecologic cancer patients between 1976 and 1995, total 20 patients were found to have cervical cancer and another primary malignancy. Their medical records and pathologic slides were reviewed. Follow-up information was obtained from medical records or by telephone. RESULT: There were 8 synchronous and 12 metachronous multiple primary cancers (MPC) among 20 patients. Their mean age was 51 years (range 23 ~ 68 years). The distribution of FIGO stage of the patients with cervical cancer was classified into stage I, 6 patients; stage II, 9 ; and stage III, 5. All patients showed squamous cell type histology of cervical cancer. Eight(40 %) of 20 patients developed second cancer in uterus : 6 malignant mixed Mllerian tumors(MMMT), one endometrial stromal sarcoma, and one endometrial adenocarcinoma. Seven of 8 synchronous type MPC patients are alive (median follow-up, 27 months). In contrast, only one out of 12 metachronous type MPC patients is alive(median follow-up, 114 months). The occurrence of eight malignancies including 6 MMMT, one bladder cancer, and one rectal cancer might be related with previous radiation therapy for cervical cancer. CONCLUSION: These results suggest that routine screening and surveillance work-up might not be necessary in most of patients with cervical cancer. However, the patients with cervical cancer undergoing radiation treatment have to be followed carefully with the consideration of possibility for developing second cancer in the field of irradiation.

Polaroid Photoscreening for Amblyogenic Factors

We investigate the effect of a new photoscreening camera designed to detect amblyogenic factors including strabismus, asymmetric and abnormal refractive errors and media opacities. The photoscreener uses eccentric photorefraction principles and provides two meridian photographs of the retinal reflex. Pass/fail screening data from photograph of 58 nondilated children, determined by two masked observers, were compared with data from complete ophthalmologic examinations. Photoscreener had a sensitivity rate of 92.0%, a specificity rate of 72.2%, a positive predictive value of 94.8%, a negative predictive value of 61.9% and overall agreement rate of 90.5%. The new two-flash photoscreenig camera, which uses high-speed polaroid film, is an accurate and reliable method of detecting amblyogenic factors in undilated children, and the camera promise as a useful mass screening tool.

Eaton-Lambert Syndrome with Small Cell Lung Cancer: A case report / 영남의대학술지

Eaton Lambert Syndrome (ELS) is a disorder of neuromuscular transmission. The defect of neuromuscular transmission is due to decrease in the release of acetylcholine quanta from nerve terminal. This syndrome is frequently associated with bronchogenic carcinoma. The diagnosis is established by electromyography, which characteristically shows 1) low amplitude of evoked compound muscle potential to a single supramaximal stimulus on nerve, 2) significant decremental response at low rates of stimulation 3) marked incremental response at high rates of stimulation. Our patient is 52year old man with dyspnea, coughing and muscle weakness of proximal lower limbs. He has small cell lung cancer and associated with ELS, Superior vena cava syndrome and has metastatic lesion on right supraclavicular lymph node confirmed by pathology. Metastatic mass and SVC syndrome are marked improved following chemotherapy and radiotherapy, however follow up EMG finding does not improved. We are here reporting one case which considered compatible for ELS, with a few elementary reviewed literatures.

The Changes of Corneal Sensitivity in Myopic Patients with Daily Wear Soft Contact Lenses According to Duration

Corneal sensitivity was measured with the Cachet-Bonnet aesthesiometer in control group of 24 people with 24 eyes and in 36 people with 56 eyes who had worn daily wear soft contact lenses for various amount of years. The sensitivity in the control cornea of the normal eyes was 59 +/- 4mm and decreased gradually by duration in myopic patients with daily wear soft contact lenses. And corneal sensitivity in old aged group was lower than that in young aged group.