Clinical and Histopathological Study of Pheochromocytoma Arising in the Adrenal Gland / 대한내과학회지

BACKGROUND/AIMS: The diagnosis and prognosis of malignant pheochromocytoma are important. Other than distant metastasis, the pathology is insufficient to diagnose malignant versus benign pheochromocytoma. METHODS: We analyzed 33 pheochromocytoma cases using the histological grade on the Thompson and Kimura scales. We compared the Thompson and Kimura scores with the degree of immunohistochemical staining for Ki-67 and heat shock protein 90 (Hsp90). RESULTS: The most frequent symptom was hypertension (17 cases; 51.5%) and four patients had accompanying tumors: one case each of multiple endocrine neoplasm, papillary carcinoma of the thyroid, gastric adenocarcinoma, and neurofibroma. The mean Thompson score was 3.67 in benign pheochromocytoma and 10 in malignant pheochromocytoma, and the Kimura score was 2.17 and 5, respectively. The average immunohistochemical staining for Ki-67 was 5.77 and 10.44 in benign and malignant pheochromocytoma, respectively, while Hsp90 immunohistochemical staining was positive only in the cytoplasm of malignant pheochromocytoma. CONCLUSIONS: Immunohistochemical staining for Ki-67 and Hsp90 was seen in malignant pheochromocytoma. The Thompson and Kimura scales and immunohistochemical results could help to differentiate benign and malignant pheochromocytoma.

Comparison between Tissue Adhesive and Suture by Using Modified Hollander Score for Facial Wounds Treated in the Emergency Department

PURPOSE: The object of this study is to compare the patient satisfaction in the view of scarring, cost, and hospital stay between the conventional suture method and a method using Histoacryl(R) (2-N-butylcyanoacrylate) adhesive for treating facial lacerations in the emergency department. METHODS: This study is a randomized prospective trial, which was conducted from December 2009 to January 2010. The participants include 109 patients who visited the emergency room in Deajon Eulji Medical Center. The ages ranged from 1 to 59 (mean age of 18.7), and all had facial lacerations of less than 3 cm. In order to treat the facial lacerations, an emergency medicine doctor used tissue adhesive (2-N-butylcyanoacrylate, Histoacryl(R)) for 41 patients in the experimental group, and a plastic surgeon performed conventional suturing for 68 patients in the control group. The ER-stay and the primary treatment fee were compared in the two groups, and the scarring was evaluated 10 to 11 months from suturing by using the Modified Hollander Method and the 10-cm scaled VAS (visual analogue scale: score 0=no scar, score 10=very severe scar). RESULTS: The ER stay was 76 minutes for the experimental group and 107 minutes for the control group, showing that statistically significantly less time of 31 minutes was taken in the experimental group. The cost of the experimental group was 40000 won (50.1%) more expensive than the control group, with an average cost of 121900 won for the experimental group and 81200 won for the control group. As for scar evaluation, 10.56 months after suturing, the experimental group showed a better result with a score of 2.6 compared to a score of 3.4 in the control group; however, this difference was not statistically significant (p<0.05). As to a detailed evaluation of scar characteristics, the experimental group had a statistically significantly better result in scar elevation, with a score of 0.6 compared to a score of 1.65 for the control group. CONCLUSION: If appropriate patients are selected, the method using tissue adhesive directly applied by an EM doctor not only decreases ER stay but also creates similar patients satisfaction, with statistically better result in scar elevation, compared to the conventional suture method; thus, ultimately general patient satisfaction is increased.

Comparison between Tissue Adhesive and Suture by Using Modified Hollander Score for Facial Wounds Treated in the Emergency Department

PURPOSE: The object of this study is to compare the patient satisfaction in the view of scarring, cost, and hospital stay between the conventional suture method and a method using Histoacryl(R) (2-N-butylcyanoacrylate) adhesive for treating facial lacerations in the emergency department. METHODS: This study is a randomized prospective trial, which was conducted from December 2009 to January 2010. The participants include 109 patients who visited the emergency room in Deajon Eulji Medical Center. The ages ranged from 1 to 59 (mean age of 18.7), and all had facial lacerations of less than 3 cm. In order to treat the facial lacerations, an emergency medicine doctor used tissue adhesive (2-N-butylcyanoacrylate, Histoacryl(R)) for 41 patients in the experimental group, and a plastic surgeon performed conventional suturing for 68 patients in the control group. The ER-stay and the primary treatment fee were compared in the two groups, and the scarring was evaluated 10 to 11 months from suturing by using the Modified Hollander Method and the 10-cm scaled VAS (visual analogue scale: score 0=no scar, score 10=very severe scar). RESULTS: The ER stay was 76 minutes for the experimental group and 107 minutes for the control group, showing that statistically significantly less time of 31 minutes was taken in the experimental group. The cost of the experimental group was 40000 won (50.1%) more expensive than the control group, with an average cost of 121900 won for the experimental group and 81200 won for the control group. As for scar evaluation, 10.56 months after suturing, the experimental group showed a better result with a score of 2.6 compared to a score of 3.4 in the control group; however, this difference was not statistically significant (p<0.05). As to a detailed evaluation of scar characteristics, the experimental group had a statistically significantly better result in scar elevation, with a score of 0.6 compared to a score of 1.65 for the control group. CONCLUSION: If appropriate patients are selected, the method using tissue adhesive directly applied by an EM doctor not only decreases ER stay but also creates similar patients satisfaction, with statistically better result in scar elevation, compared to the conventional suture method; thus, ultimately general patient satisfaction is increased.

A case of angioimmunoblastic T cell lymphoma in a patient with ichthyosis / 대한내과학회지

Angioimmunoblastic T cell lymphoma (AITL), which accounts for only 1~2% of non-Hodgkin's lymphomas, is commonly accompanied by skin lesions. Those associated with AITL include erythematous plaques, nodules or rashes. Histological examination of most lesions shows infiltration by malignant lymphocytes. Ichthyosis is a generalized skin disease characterized by hyperkeratosis, in which the skin acquires an appearance resembling fish scales. Some cases may be acquired, but most have a genetic basis. We report a case of AITL with associated ichthyosis that is considered to be inherited.

Iatrogenic Esophageal Submucosal Dissection: A Case Report / 대한소화기내시경학회지

Nasogastric tube insertion is a routine clinical procedure for nutritional support, gastric aspiration and decompression. Although it is generally a safe procedure, complication rates range from 0.3~8%. Submucosal esophageal dissection is a rare disorder caused by mucosal tearing and bleeding between the mucosal and muscular layers of the esophagus, leading to their separation. We report a case of submucosal esophageal dissection secondary to the accidental iatrogenic intramural insertion of a nasogastric tube.

A Case of Massive Duodenal Diverticular Bleeding Treated with Endoscopic Hemostasis

Duodenal diverticulum is commonly found at 2nd portion of duodenum undergoing duodenal procedure. It is generally asymptomatic and not harmful. But occasionally it causes massive upper gastrointestinal bleeding. Bleeding from duodenal diverticulum is very difficult to diagnose and manage since vision of the lesion by conventional direct endoscope is limited. Recently, emphasis has been placed on aggressive and careful endos- copic diagnosis and hemostasis with hemoclip or local injection. We report a case of massive duodenal diverti- cular bleeding on a senile patient which was treated successfully by endoscopic hemoclip therapy.

Expression of OB-R, Regulation of Mitogen Activated Protein Kinase Activity and Maturation by Leptin in Mouse Oocytes / 대한불임학회지

OBJECTIVE: To verify the expression of leptin receptor (OB-R) in oocytes and preimplantation embryos, the involvement of mitogen activated protein kinase (MAPK or Erk1/2) in the leptin signaling, and effect of leptin on the oocyte maturation in mice. METHOD: RT-PCR analysis of OB-R was conducted in germinal vesicle (GV)-intact and MII stage oocytes, and 1, 2, 8-cell embryos and blastocysts. Germinal vesicle breakdown (GVB), polar body extrusion, monitored in the presence or absence of leptin (1 microM). Following the leptin treatment, temporal changes in MAPK activity were verified by immunoprecipitation and in vitro kinase assay in MII oocytes. RESULTS: The expression of OB-R mRNA was found in GV and MII oocyte but not in the embryos. MAPK activity of the MII oocytes was significantly increased by brief incubation in the HTF supplemented with leptin (1 microM). Priming of PD098059, a MEK inhibitor to leptin treatment attenuated the activation of MAPK by leptin in MII oocytes. Following 24 hrs of culture of the GV oocytes, leptin significant increased the GVB and 1st polar body extrusion. CONCLUSION: This result suggested that functional interaction between leptin and OB-R resulted in potentiation of MAPK (Erk1/2) activity in MII oocytes through MEK activation and that leptin might be a local regulator of meiotic maturation of the mouse oocytes.

The Efficacy of Recombinant Human Follicle Stimulating Hormone (rhFSH) in Controlled Ovarian Hyperstimulation for In Vitro Fertilization and Embryo Transfer / 대한산부인과학회잡지

OBJECTIVE: To compare the efficacy and safety of recombinant human follicle stimulating hormone (rhFSH) versus highly purified urinary human FSH (uhFSH-HP) in women undergoing controlled ovarian hyperstimulation (COH) for in vitro fertilization and embryo transfer (IVF-ET). METHODS: Ninety-three women with tubal infertility, stage I/II endometriosis or unexplained infertility were admitted to this study. After pituitary desensitization using GnRH agonist, rhFSH (n=45) or uhFSH-HP (n=48) was administered with a step-down regimen in all patients. RESULTS: Patient's characteristics were comparable in both groups. Low responders were 20 in rhFSH group and 22 in uhFSH-HP group. The total dose of administered FSH was significantly lower in rhFSH group than that in uhFSH-HP grup (p<0.001). The days of stimulation were also significantly shorter in rhFSH group than those in uhFSH-HP group (p<0.05). However, there were no differences in IVF results such as the numbers of oocytes retrieved, oocytes fertilized, grade I/II embryos, embryos transferred between the two groups. There were also no differences in clinical pregnancy rate, miscarriage rate, and multiple pregnancy rate. Even in the low responder subgroup, COH using rhFSH was also associated with significant decreases in the total dose of FSH and the duration of stimulation required. IVF results and pregnancy outcomes were comparable in rhFSH and uhFSH-HP groups. CONCLUSION: These data suggest that the total dose of FSH and the duration of stimulation can be reduced by using rhFSH.