Kasabach-Merritt syndrome: treatment with epsilon-aminocaproic acid and assessment by indium 111 platelet scintigraphy.
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Administration, Oral↗
Biomedical subjects
K J Cho
Publications and source records attributed to K J Cho.
Effect of somatostatin analogue (octreotide) on blood flow to endocrine tumors metastatic to the liver: angiographic evaluation.
The effect of an octapeptide analogue of somatostatin, octreotide, on tumor blood flow was evaluated with angiography in eight patients with hepatic endocrine tumors; one patient had primary intrahepatic gastrinoma, two patients had hepatic metastases from gastrinomas, two patients had VIPomas (vasoactive intestinal polypeptide-secreting tumor), and three patients had carcinoid tumors. Octreotide caused a marked decrease in tumor blood flow in two patients with gastrinomas and two with VIPomas. One patient could not be evaluated due to the lack of a tumor blush on a control angiogram. In patients with carcinoid tumors, octreotide caused a slight reduction in blood flow through the tumors in two patients, while there was no change in one patient. Octreotide markedly decreased gastrin and gastric acid secretion in two of three patients with gastrinomas, lowered VIP and stopped the diarrhea in patients with VIPomas, and controlled symptoms in two of three patients with carcinoid tumors. The vasoactive effect of octreotide on hepatic endocrine tumors may be a direct action on tumor blood supply or secondary to inhibition of the endocrine tumor cell secretion and consequent decreased blood flow.
Adult↗
The enhancing effect of ethanol on the development of glutatione S-transferase placental form-positive foci induced by diethylnitrosamine in F344 rat.
The effects of ethyl alcohol and pig serum administration on the development of preneoplastic hepatic enzyme-altered foci were examined in an in vivo mid-term assay system. Rats were initially given a single dose (200 mg/Kg) intraperitoneal injection of diethylnitrosamine (DEN). Two weeks later, treatment was started with 10% ethanol + 10% sucrose solution, 10% sucrose solution, or tap water as drinking water for 6 weeks with or without intraperitoneal injection of porcine serum twice a week. All rats were subjected to a two-thirds partial hepatectomy at week 3. The modification potentials were evaluated by comparing the number and area per cm2 of glutathione S-transferase placental form-positive (GST-P+) foci in the liver of each group. As a result, ethanol significantly enhanced the development of GST-P+ foci. Unfortunately, the porcine serum injection produced no hepatic fibrosis and no significant alteration in GST-P+ foci.
Animals↗
Abdominal Burkitt's lymphoma diagnosed by fine needle aspiration cytology--a case report.
A case of abdominal Burkitt's lymphoma diagnosed through aspiration cytology is described. This 9-year-old boy presented with abdominal pain and distention for three months accompanied by fever and night sweat during the last month. An abdominal sonography and CT scan showed hepatosplenomegaly and an intrahepatic mass with celiac lymph node enlargement, ascites, and pleural fluid. A peripheral blood smear showed a few blast cells. Aspiration of the abdominal mass revealed very cellular aspirates consisting of diffusely scattered small monotonous round cells. The cells had little cytoplasm, along with round nuclei that showed clear-cut nuclear membrane, coarse chromatin pattern, and multiple small prominent nucleoli. Differential diagnoses considered were small round cell sarcomas such as malignant lymphoma, neuroblastoma, Ewing's sarcoma, and rhabdomyosarcoma. Of these, malignant lymphoma of the small noncleaved cell type was most consistent with the results of several studies including immunohistochemical staining, peripheral blood smear, and bone marrow biopsy. The cells were positive for leukocyte common antigen (LCA) and showed finely vacuolated basophilic cytoplasm in both the peripheral blood smear and bone marrow biopsy, characteristic of Burkitt's lymphoma cells.
Biopsy, Needle↗
Carcinosarcoma of the stomach. A case report with light microscopic, immunohistochemical, and electron microscopic study.
A carcinosarcoma of the stomach in a 66-year-old man is reported. The tumor which had a diameter of 4 cm was an ulcerofungating mass in the posterior wall of the antrum. Histologically it was composed of well-differentiated adenocarcinoma admixed with sarcomatous elements which showed chondrocytic differentiation on light and electron microscopy. The sarcomatous areas were multifocally scattered in the central portion of the tumor and intimately blended with adenocarcinoma cells. CEA immunoreactivity was found not only in the adenocarcinoma but also in the transitional sarcomatous cells, supporting the hypothesis that this tumor might derive from mesenchymal metaplasia of a primarily epithelial neoplasm.
Adenocarcinoma↗
Evolution of hook design for fixation of the titanium Greenfield filter.
The titanium Greenfield filter was developed to facilitate operative and percutaneous insertion by a carrier (12F) smaller than that required for the standard stainless steel filter (24F). In preliminary clinical studies however, it proved to have an unacceptable rate of distal slippage and caval wall penetration. Therefore four modifications in hook design and base diameter have been tested in 20 sheep by implantation above and below the renal veins. In comparison to control titanium Greenfield filters (n = 8), neither changes in hook angle with smaller diameter base (type I, n = 4), elimination of limb flare (type II, n = 4), or 80 degree hook angle (type IV, n = 10) prevented migration and entry into venous tributaries or penetration. Penetration scores on the basis of autopsy findings did not correlate with antemortem predictions based on cavograms and showed 1.5 +/- 2.0/filter for controls, 1.0 +/- 1.15/filter for type I, 1.75 +/- 0.96/filter for type II and 1.67 +/- 1.37/filter for type IV. It was necessary to change the configuration of the hook completely to a recurved hook design providing a base pad for the 80 degree hook (type VI, n = 6) to limit migration and penetration with a score of 0.33 +/- 0.82/filter. Effects of experimental embolism were studied in six sheep (two acute, four chronic) and showed effective trapping by both type IV and type VI filters with no evidence of filter migration or damage to the caval wall. Persistent thrombus appeared to be caused by the remnants of oxidized cellulose used to induce thrombi, but there was no evidence of propagation proximal to the filter.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Preliminary clinical experience with the titanium Greenfield vena caval filter.
Preliminary clinical experience in 40 patients from three institutions is reported for a new titanium model of the Greenfield vena caval filter. The titanium filter is slightly larger than the standard stainless steel filter and can be loaded into a 12 F diameter carrier system as opposed to the 24 F stainless steel filter. In patients ranging from 17 to 94 years of age, percutaneous insertions were made from the right femoral vein in 24 patients, the left femoral vein in 11 patients, and the right internal jugular in 2 patients. Operative access was obtained in 1 patient each from the right femoral, right jugular, and a lumbar vein at laparotomy. Insertion was completed in all cases but 1 and only 1 patient (3%) showed postoperative femoral vein thrombosis. Distal filter migration was seen in 3 cases (7.5%) without sequelae, and there was no proximal migration. The titanium Greenfield vena caval filter provides improved ease of insertion, and the sheath technique should prevent misplacement. Distal migration should be preventable by techniques to promote hook engagement at the time of insertion.
Adolescent↗
Monomorphic adenomas of the salivary glands. A clinico-pathologic study of 12 cases with immunohistochemical observation.
Twelve cases of monomorphic adenoma of the salivary glands were histologically reclassified and their immunohistochemical reactivity for S-100 and cytokeratin was correlated. All patients underwent a benign clinical course. Individual tumors were well encapsulated and frequently showed a focal cystic change. Histologically, 9 cases were of the epithelial basaloid cell type and 3 cases were of the myoepithelioma variant. About one half of the epithelial type featured a mixture of trabecular and tubular patterns. The immunoreactivity to S-100 and cytokeratin varied. All basaloid cell adenomas were positive for cytokeratin, while S-100 positivity was found mostly in the stroma along with the varied reaction and intensity in the epithelial nests. In myoepitheliomas, cytokeratin was totally negative and S-100 was positive in 2 of 3 cases. The above findings suggest that the degree of participation of myoepithelial cells determines the phenotypic expression of monomorphic adenomas, and supports the hypothesis that the basaloid cell and myoepithelial types may be located on extreme ends of the same tumor spectrum with a wide range of pleomorphic adenoma in-between.
Adenoma↗
Combination chemo-radiation therapy for jaundice due to focal malignant obstruction of the major bile ducts.
Twenty patients with focal malignant obstruction of the major bile ducts (6 cholangiocarcinoma, 8 colorectal, 3 hepatoma, 2 unknown primary, and 1 gastric cancer) were treated on a protocol examining the toxicity and efficacy in relieving jaundice of external beam radiation therapy (4500 cGy in 300 cGy fractions) combined with continuous hepatic arterial (15 patients) or peripheral venous (5 patients) fluorouracil infusion. Toxicity of this regimen consisted of anorexia with mild nausea and vomiting in 55% of patients and gastric ulceration (responsive to medical management) in 15% of patients. One patient exhibited transient grade 2 hepatic toxicity and one had asymptomatic grade 4 leukopenia. Of 14 patients treated without prior biliary drainage, 8 exhibited a decrease in bilirubin levels from a mean of 14.5 mg/dl to 1.5 mg/dl. Four of six patients with biliary drainage catheters at the start of treatment were able to have them removed without reobstruction. For the 8 responding patients among those who did not have cholangiocarcinomas, the median response duration was 5 months with a median survival from treatment of 6.5 months. For the 4 responding patients with cholangiocarcinoma, the median response duration was 16 months with a median survival from treatment of 20 months. All responders did not have a return of jaundice due to reobstruction of the major ducts (until death or to the present). All responders who have died did so due to tumor progression outside of the treated field except for one who died of unrelated causes. The mean number of proven or presumed episodes of cholangitis per patient was virtually identical in those without (1.8) and those with stents/tubes (1.4, p = 0.561). This regionally focused combined modality cytotoxic therapy was able to relieve obstruction in the majority of patients without excess morbidity (including a lack of any detectable increase in sepsis). Thus, it appears feasible to consider randomized studies of this cytotoxic approach versus standard mechanical drainage procedures to define the relative risks and benefits of each.
Adult↗
Experimental hepatic artery embolization with a collagen embolic agent in rabbits. A microcirculatory study.
The authors used new fibrous collagen embolic material (5 by 75 microns in size) for flow-directed hepatic artery embolization in four rabbits; the purpose of the study was to examine the acute effects of the material on hepatic microcirculation. Extent of hepatic dearterialization, level of arterial occlusion, collateral formation and status of portal sinusoidal perfusion were evaluated under a dissection microscope after embolization. The collagen material produced proximal and peripheral hepatic arterial occlusion with complete hepatic dearterialization, including the bile duct. Portal sinusoidal perfusion appeared to be intact. No intrahepatic microcollaterals were observed.
Animals↗
Unsatisfactory hepatic perfusion after placement of an implanted pump and catheter system: angiographic correlation.
Thirty-five patients with scintigrams showing unsatisfactory hepatic artery perfusion after surgical placement of an implanted pump and catheter system were examined with selective angiography (33 cases) or digital subtraction angiography (DSA) during which the contrast material was injected through the side port of the pump (six cases). In 34 of 35 cases, the cause of the unsatisfactory (either extrahepatic or incomplete) hepatic perfusion was defined. DSA was definitive in only two cases, in which extrahepatic flow through collateral vessels was demonstrated. The cause of the perfusion defect was hepatic artery thrombosis in 14 cases, extrahepatic flow through collateral vessels in 14 cases, a misplaced catheter in four cases, and a short proper hepatic artery without adequate length for mixing in two cases. Although hepatic artery perfusion scintigraphy is the primary tool for evaluation of hepatic perfusion after catheter placement, angiography plays an important role in treating the subset of patients with unsatisfactory hepatic perfusion.
Antineoplastic Agents↗
Hepatic arterial chemotherapy: role of angiography.
Hepatic arterial infusion chemotherapy increases the hepatic concentration of chemotherapeutic agents without increasing systemic toxicity. Both percutaneous (most commonly left transbrachial) and surgical approaches are currently used for infusion catheter placement. Surgical catheter and pump placement has proved to be a reliable means of delivering drugs to the liver and has been commonly used for hepatic arterial chemotherapy for metastatic colorectal carcinoma. Meticulous angiographic evaluation of the hepatic vascular anatomy, its variations, and hemodynamics is necessary for correct catheter placement to achieve total liver perfusion without significant extrahepatic perfusion. Satisfactory hepatic perfusion should be documented before drug infusion. Hepatic arterial radionuclide flow imaging with technetium-99m-labeled macroaggregated serum albumin remains the most reliable means of assessing hepatic perfusion following catheter placement. Transcatheter techniques have been used to facilitate catheter placement, to prevent gastrointestinal drug toxicity, and to correct unsatisfactory perfusion following surgical catheter placement.
Antineoplastic Agents↗
[The use of nursing diagnosis in practice].
This study was conducted to investigate the present situation and problems related to the use of nursing diagnosis in practice. The data were obtained from 332 subjects (27 director of nursing service, 302 staff nurses) who worked in university hospitals in Korea from July through August 1988 using a mailed questionnaire. Data were analyzed by frequency, X2 test and t-test. The findings were as follows: 1. Clinical use of nursing diagnosis by directors of nursing service and staff nurses. 1) The majority of the nursing departments (88.9%) conducted group education on nursing diagnosis during the last 5 years and 81.5% of them kept a record format for nursing diagnosis; 88.9% of them had had prior experience with the nursing diagnosis. 2) Most of nurses (97.0%) had received education on nursing diagnosis. 2. Factors related to the clinical use of nursing diagnosis in nursing service departments and by staff nurses. 1) The one factor related to the use of nursing diagnosis in the nursing service department was the existence of a record. 2) Factors related to the use of nursing diagnosis by the staff nurses were the organization style of the nursing service department, group education during the last 5 years, existence of a record, the attitude of the director of nursing service, and prior experience of the use of the nursing diagnosis as characteristics of nursing service department and educational experience of nursing diagnosis as a character of nurse. 3. Problems with the use of nursing diagnosis. 1) The primary problem was the lack of time and personnel (mean:3.757); the second problem was the lack of knowledge and will to use nursing diagnosis in practice by the staff nurses (mean:3.546). 2) There was no significant difference in problems expressed by the director of nursing services and the nurses. The majority of nurses who worked in the university hospitals expressed interest in and concern about the use of nursing diagnosis. Most of the nurses had had education about on nursing diagnosis but use in practice was limited. The primary problem was lack of time and manpower.(ABSTRACT TRUNCATED AT 400 WORDS)
Attitude of Health Personnel↗
[The effects of clinical application of a nursing diagnosis protocol].
This study was conducted to measure the effects of clinical application of a Nursing Diagnosis Protocol. The dependent variables were the degree of patient's satisfaction and the degree of nurse's satisfaction with the nursing activity. Analysis of the effect of the use of the nursing diagnosis protocol was based on the nursing record. The subjects for this study were 61 nurses (experimental group 31, control group 30) and 155 patients (experimental group 55, control group 100) on four internal medicine wards in K University Hospital in Seoul.
Clinical Protocols↗
Cholangiocarcinoma. Role of percutaneous transhepatic cholangiography in determination of resectability.
Exploratory laparotomy is frequently used to diagnose, treat, or palliate cholangiocarcinoma although surgery is rarely curative. In light of newly developed percutaneous and endoscopic approaches to diagnosis and therapy, we reviewed our experience with 35 cases of cholangiocarcinoma diagnosed and treated at the University of Michigan Medical Center from 1979 to 1984. Percutaneous transhepatic cholangiography (PTCA) was performed in 34 cases of which only four were resectable. All 22 patients who had preoperative cholangiograms suggesting unresectability had confirmation of this at surgery. Surgical palliation was accomplished with a combination of internal and percutaneous drainage in most cases. Angiographic, cytologic, and laboratory data are presented. PTCA accurately predicted unresectability of cholangiocarcinoma and is superior to angiography in this respect. In patients with cholangiocarcinoma, percutaneous and endoscopic approaches offer alternatives to surgery for diagnosis and palliation.
Adenoma, Bile Duct↗
Congenital absence of ductus arteriosus--an autopsy case.
Isolated absence of the ductus arteriosus is extremely rare condition although the ductus arteriosus may be hypoplastic or aplastic in association with other aortic arch anomalies. Authors described a case of isolated agenesis of the ductus arteriosus documented by postmortem examination of a newborn infant who died of pneumonia following operation for a large omphalocele. The heart showed ventricular septal defect. However, no other cardiovascular anomalies were associated in this case. There were three vessels that were taking off from the aorta consisted of the right brachiocephalic artery, left common carotid-artery and left subclavian artery. The anteriorly located pulmonary artery was divided into the right and left pulmonary arteries. There was no connection of vessel between the pulmonary artery and the aorta.
Abnormalities, Multiple↗
Fiberglass reinforced plastic orthotic appliances.
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Braces↗
[Study on the comparison of home environmental elements with self-concept & mental health in adolescence].
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Adolescent↗