The stress or fatigue fracture is well known in military medicine, but it is an unusual occurrence in civilian practice. The stress fracture of metatarsal bone is familiar to most, but in the tibia it is unusual. The clinical symptoms of pain, swelling and limping following strenuous activity were seen in the affected lower leg and proceeded radiological evidence of fracture. 17 cases of stress fracture of tibia were investigated in a military hospital between March 1973 and May, 1974. The results of this study are as follows, 1. The fractures mainly occurred in the upper one third of the tibia (13 cases among 17). 2. The cases with only callus formation were more frequent than the cases with fracture line on the tibia (11 cases among 17). 3. If pain occurs in the lower leg after strenuous activity, there should be attention with serial radiological checking.
Bony Callus ; Clinical Study ; Fractures, Stress ; Hospitals, Military ; Leg ; Metatarsal Bones ; Military Medicine ; Tibia

The recent development of microsurgical tissue transfer has enabled any defect in any area to be reconstructed with free flaps. However, the need for a more functional and thinner flap has been raised due to bullkiness of the flap and donorsite morbidity. For better functional and aesthetic results, various perforator flaps excluding muscles or adjacent subcutaneous tissue have been recently reported. We report 44 cases of perforating artery pedicled flaps from April 1995 to August 1998, including 21 cases of anterolateral thigh flap, 12 cases of gluteal artery perforator flap, 4 cases of posterior interosseous flap, and 7 cases of paraumbilical perforator flap for various soft tissue defects. Even though marginal necrosis of flap occurred in 9 cases, complete healing without significant problem was possible. The advantages of perforator flaps are as follows: 1. It is possible to obtain a relatively thin fasciocutaneous flap, but still with sufficient volume 2. Donor site morbidity was reduced without damage of main artery. 3. In spite of diverse vascular pattern of the perforator, the location of perforating arteries can be Detected with relative ease and mapped preoperatively with an ultrasound Doppler. The need of meticulous and tedious dissection could be a sole disadvantage of these flaps. This report describes the clinical experience with a perforator-based flap, anticpating applications of many other types of perforator flap in the future.
Arteries* ; Free Tissue Flaps ; Humans ; Muscles ; Necrosis ; Perforator Flap ; Subcutaneous Tissue ; Surgical Flaps* ; Thigh ; Tissue Donors ; Ultrasonography

OBJECTIVE: This study was performed to investigate whether 1) estrogen induces the change of vascular tone in endothelium-denuded human uterine artery, and 2) endothelium-independent vascular reactivity may be mediated by intracellular calcium ion modulation. METHODS: The uterine arteries from 34 premenopausal women were obtained at the time of hysterectomy due to various indications and endothelium was denuded. Vascular reactivity was monitored by using Isometric force transducer and recorded by physiograph. Endothelial integrity was assessed by sequential administration of 1micrometer norepinephrine(alpha-adrenergic stimulant) and 10 micrometer acetylcholine (endothelium -dependent vasorelaxant). Integrity of smooth muscle was measured by administration of 10 micrometer sodium nitroprusside (endothelium - independent vasorelaxant) and 10 micrometer tamsulosin(alpha-adrenergic blocker). A dose-dependent action of estrogen was measured on denuded uterine arteries, pretreated with norepinephrine and potassium chloride. In media contained denuded uterine arteries pretreated with 70mM potassium chloride and estradiol(3X10-5M), nitric oxide and its inhibitor, N-nitro-L-arginine methyl ester(L-NAME) was administered, respectively, in order to verify the vasodilation effect. Statistical tests were performed at the 5% level of significance using the SPSS PC+ package. RESULTS: Acethylcholine has little effect but sodium nitroprusside & talmsulosin showed marked relaxation, which suggested loss of endothelial function and adequacy of smooth muscle function. The contraction by norephinephrine(1 M) revealed estrogen induced relaxation which was concentration-dependent from 3 10-8M to 3 10-5M in concentration of 17 -estradiol. The contraction by high potassium solution 70mM was also inhibited by estrogen in concentration-dependent manner. This vasorelaxant effect of estrogen on endothelium-denuded uterine artery was not affected by addition of nitric oxide(NO) precursor, L-arginine and nitric oxide synthase(NOS) inhibitor, L-NAME. CONCLUSION: The results of this study revealed that estrogen has vasorelaxant effect on endothelium endothelium-denuded uterine artery by calcium antagonistic property through direct inhibitory effect on receptor- and voltage dependent calcium ion channels of smooth muscles. This vasorelaxant effect of estrogen on endothelium-denuded uterine artery was NO independent.
Acetylcholine ; Arginine ; Calcium ; Calcium Channels ; Endothelium* ; Estrogens* ; Female ; Humans* ; Hysterectomy ; Muscle, Smooth ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Nitroprusside ; Norepinephrine ; Potassium ; Potassium Chloride ; Relaxation ; Transducers ; Uterine Artery* ; Vasoconstriction* ; Vasodilation

PURPOSE: Since the discovery of estrogen receptor-beta(ER-beta, five C-terminal variants of ER-beta were identified. We designed this study to investigate the pattern and clinical implications of ER-betaand its splicing variants expression in normal and malignant mammary tissues. METHODS: Using reverse transcription polymerase chain reaction (RT-PCR), we examined the expression levels of ER-alpha and ER-betaand its five splicing variants (beta1, beta2, beta3, beta4, beta5) in 50 paired normal and cancer tissues. We measured the densities of RT-PCR products using Tina version 2.10 (Raytest, Germany). Firstly, the incidence and intensity of ER-alpha and ER-beta and its five splicing variants were compared. Then the expression of ER-betamRNA splicing variants was also analyzed with regard to the ER-alphaprotein expression measured by immuno-histochemical staining and the menopausal status of the patients. Chi-square test and paired samples t-test were used for statistical analysis. Differences were considered to be significant with a p-value of less than 0.05. RESULTS: The expression of ER-betamRNA variants in normal breast and cancer tissues were as follows: ER-beta2 (100%/100%), ER-beta4 (76%/74%), ER-beta5 (32%/58%), and ER-beta1 (14%/16%). ER-beta3 was not detected at all. In terms of intensity, we observed a significant decrease of ER-beta2 (P<0.001) and an increase of ER-beta5 (P=0.004) in the mRNA expression levels among breast cancers compared to the corresponding normal breast tissues. Compared to the corresponding normal tissues, a significant decrease of ER-beta2 in cancer tissues was observed in patients with ER-alpha-positive (P<0.001), with age over 50 (P=0.01), and under 50 (P=0.04) as well, but not in patients with ER-alpha-negative (P=0.48). ER-beta4 also significantly decreased in patients with ER-alpha-positive (P=0.004) and with age over 50 (P=0.07). ER-beta5 showed a significant increment only in patient aged over 50 (P=0.04). CONCLUSION: ER-alpha mRNA expression significantly increases but ER-beta mRNA expression decreases in the cancer tissues compared to the corresponding normal tissues. Among ER-beta variant forms, ER-beta2 is predominant in both normal and malignant mammary tissues and ER-beta4, ER-beta5, and ER-beta1 in descending order but ER-beta3 does not express in mammary tissues. The decrease of ER-beta2 and ER-beta4 expression is prominent in cancer tissue especially in ER-alpha-positive cancers, which suggests that ER-beta2 and ER-beta4 may possess a regulatory function in mammary carcinogenesis. Further investigations to verify the roles of ER-beta variants are mandatory.
Breast ; Breast Neoplasms ; Carcinogenesis ; Estrogens* ; Humans ; Incidence ; Polymerase Chain Reaction ; Receptors, Estrogen ; Reverse Transcription ; RNA, Messenger

Although replacement therapy with insulin can prevent acute metabolic disorder in patients with IDDM (insulin dependent diabetes mellitus), it does not permanently restore glucose homeostasis. Recently it has been reported that islet transplantation could completely correct the glucose metabolic abnormalities and prevent further progression of the secondary complications of IDDM. For successful transplantation, the isolated islets should be prepared without loss of viability, while their immunogenicity being suppressed to reduce graft rejection. The present study was aimed to determine the optimal condition of islet culture, and to transplant them into the digestive organs including gastroin-testinal wall and salivary gland. For islet culture, pancreatic islets were isolated by a modified collagenase digestion technique from rats and cultured for 24, 48 and 72 hours in RPMI-1640 containing 0, 5.6 and 16.7 mM glucose. The viability of islets was evaluated by detection of insulin mRNA expressed in islet beta-cells using the in-situ hybridization and northern blot analysis, while their insulin content was examined by immunocytochemistry. Insulin mRNA was significantly reduced after 48 hours of culture in the islets incubated with absence of glucose, while distinct immunoreaction for insulin remained in the same islet. On the other hand, the islets cultured with normoglycemic (5.6 mM glucose) and hyperglycemic (16.7 mM glucose) conditions showed a normal or excessive transcription of insulin gene after 72 hours, respectively. These results indicate that biosynthetic activity of islets could be maintained longer than 72 hours without alteration of viability when they were cultured in normoglycemic condition. Therefore, we used islets cultured for 72 hours with 5.6 mM glucose for transplantation. The islets were implanted into the submucosal wall of the stomach and duodenum as well as into the parenchyme of the submandibular gland of the streptozotocin-induced diabetic rats. The transplanted islets in the gastrointestinal wall were abolished in 72 hours, while the islets injected into the submandibular gland retained normal cellular structure with viability for longer period. The beta-cell in the submandibular gland showed similar immunoreactivity for insulin compared to that of normal islets. However, they showed gradual infiltration of lymphocytes and beta-cell destruction at 10~14 days after transplantation. We suggested that the submandibular gland could be recommended as an alternative site for islet transplantation, because it is very easy to access for transplantation and provides the structural and functional similarities to pancreas in which the islets spontaneously grow.
Animals ; Blotting, Northern ; Cellular Structures ; Collagenases ; Diabetes Mellitus, Type 1 ; Digestion ; Duodenum ; Glucose ; Graft Rejection ; Hand ; Homeostasis ; Humans ; Immunohistochemistry ; Insulin ; Islets of Langerhans ; Islets of Langerhans Transplantation ; Lymphocytes ; Pancreas ; Rats* ; RNA, Messenger ; Salivary Glands ; Stomach ; Submandibular Gland ; Transplantation

OBJECTIVES: It is widely accepted that estrogen has favorable effects on cardiovascular diseases, especially in the postmenopausal women. Endothelin-1(ET-I), released from the vascular endothelium, is a 21-amino acid peptide with strong vasoconstrictor activity. However, the effect of estrogen on the vasoconstriction to ET-1 has not been extensively studied. METHODS: To investigate the effect of estrogen (175beta-estradiol) on the vascular contraction to ET-1, porcine coronary artery(PCA) rings were suspended in organ chambers(37 degrees C, 95% O2/5% CO2) for measurement of isometric tension change. Endothelium was removed mechanically if necessary. In acute experiments, vascular rings were preincubated for 15minutes with 3different concentrations of 170beta-estradiol(10(-6), 10(-5), 10(-4)M) and concentration-contraction curves to cumulative doses of ET-1 were constructed. In the experiments after a longer exposure to 17beta-estradiol, the vessels with endothelium were exposed in the 5% CO2 incubator to 3different concentrations of 17beta-estradiol(10(-9), 10(-8), 10(-7)M) for 44-50 hours, and then concentrationcontraction curves to ET-1 were obtained. RESULTS: Incubation for 15minutes with 170beta-estradiol(10(-4)M) inhibited ET-1-induced contraction in the vessels with endothelium(area under the curve and maximal contraction, p<0.05 compared with control). This effect persisted regardless of the sex and the presence or absence of the endotheliurn. Incubation of the vessels far a longer time with 170beta-estradiol(44-50 hours) resulted in the inhibition of maximal contraction to ET-1(p<0.05) by a lower concentration of 175beta-estradiol(10(-7)M) than in acute experiments in male PCA rings, but an enhanced contraction to ET-1(area under the curve; p<0.05) by 10M of 175beta-estradiol was observed in female PCA rings. CONCLUSION: Short-time incubation with 17Pbeta-estradiol has an inhibitory effect on the contraction to ET-1 in PCA rings. This effect is independent of the presence of the endothelium and the sex of the pigs. A longer incubation with 17beta-estradiol results in a similar inhibitory effect on male(but not female) PCA rings, suggesting that a sex-related difference may exist concerning the effect of 17beta-estradiol on ET-1-induced contraction.
Cardiovascular Diseases ; Coronary Vessels* ; Endothelin-1* ; Endothelins ; Endothelium ; Endothelium, Vascular ; Estrogens ; Female ; Humans ; Incubators ; Male ; Passive Cutaneous Anaphylaxis ; Swine ; Vasoconstriction

During the laparoscopic cholecystectomy, the ventilatory and hemodynamic changes could occur due to the peritoneal insufflation of CO2 as well as the position change. Various sults of the relationship between arterial and end-tidal PCO2 in different conditions have been reported. The authars studied to determine how closely end-tidal PCO2 reflects arterial PCO2 before, during, and after laparoscopic cholecystectomy. Peak inspiratory airway pressures, arterial blood pressures and heart rates were also measured simultaneously. Peritoneal insufflation of CO2 resulted in significant increase in peak inspiratory airway pressure and arterial blood pressure, but there were no significant changes in heart rates. Arterial and end-tidal PCO2 increased during laproscopy and, although there was no statistical significance in P(a-ET)CO2, P(a-ET)CO2 increased during laparoscopy and retumed to perinsufflation level after deflation of CO2. There was positive correlation between arterial and end-tidal PCO2 before CO2 insufflation, 10 minutes after CO2 insufflation and 10 minutes after deflation of CO2. However there was no correlation at 30 and 50 minutes after CO2 insufflation. These results suggested that the arterial PCO2 could not reflect end-tidal PCO2 exactly, and intermittent arterial blood gas studies should be warranted during laparoscopic cholecystectomy.
Arterial Pressure ; Cholecystectomy, Laparoscopic* ; Heart Rate ; Hemodynamics ; Insufflation ; Laparoscopy

We recently observed an unusual case of visual loss after periocular injection of silicone oil. A 31-year-old woman immediately experienced total loss of vision in the left eye with ipsilateral headache and ocular pain, dyspnea, abdominal pain, general weakness, and transient coma after subcutaneous injection of silicone oil on the glabellar area to reduce the facial wrinkles. We believe that the cause of blindness was multiple embolization in the central retinal artery and posterior ciliary branches of the ophthalmic artery.
Abdominal Pain ; Adult ; Blindness* ; Coma ; Dyspnea ; Female ; Headache ; Humans ; Injections, Intraocular ; Injections, Subcutaneous* ; Ophthalmic Artery ; Retinal Artery ; Silicone Oils*

In this study, 47 cases of tuberculous osteitis treated at Severance Hospital from March 1968 to February 1978 were analysed clinically and the following results were obtained.: 1) The sexual incidence was 23 ma1e and 24 female patients. 2) There were 18 cases in the pediatric group and 29 cases in the adult group. 3) The most frequent site was rib (36%), followed by the trochanter of femur (21%) and the proximal portion of humerus (15%). 4) Thirty-seven percent of the cases showed some form of pulmonary tuberculous infiltration. 5) Erythrocyte sedimention rate was increased in 33 cases (70%). 6) The condition was managed medically with triple antituberculosis drugs and surgically with curettage, curettage with bone graft, and partial resection of ribs, etc.
Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Human ; Infant ; Infant, Newborn ; Korea ; Male ; Middle Age ; Osteitis/epidemiology* ; Tuberculosis, Osteoarticular/epidemiology*

PURPOSE: Although androgens are the main steroids controlling the growth of prostate glands, estrogens are also important in the regulation of its growth. Prostate cancer cells, like other cancer cells, maintain high levels of polyamines. In LNCaP cells, apoptosis is induced by mifepristone. During the process of cell death, the regulation of ROS production, caspase-3 activation and poly (ADP-ribose) polymerase cleavage were investigated in the presence of estrogen and polyamines to identify their possible roles. MATERIALS AND METHODS: The cell growth was assessed using the MTT assay, and the intracellular ROS production by the DCFH-DA assay. The p53 protein expression, activation of caspase-3 and PARP cleavage were checked by Western blotting, with specific antibodies to each. RESULTS: The growth and viability of the cells were significantly inhibited, in a dose- and time-dependent manners, by mifepristone (MIF) treatment. The production of ROS were dependent on the MIF dosage. The activation of caspase-3 and cleavage of PARP also increased with the duration of MIF treatment. The expression of p53 protein also increased with increases in the MIF incubation time. E2 severely inhibited the ROS production, caspase-3 activation and PARP cleavage. However, polyamines only inhibited the ROS production, without influencing the caspase-3 activation or PARP cleavage. CONCLUSION: In LNCaP cells, MIF induces apoptosis through ROS production. The expression of p53 protein, caspase-3 activation and PARP cleavage accompanied the process of apoptosis. The apoptotic processes were inhibited by E2, but polyamines only inhibited the ROS production, implying the multifunctional role of E2, in addition to its role as a free radical scavenger.
Androgens ; Antibodies ; Apoptosis* ; Blotting, Western ; Caspase 3 ; Cell Death ; Estrogens* ; Mifepristone ; Polyamines* ; Prostate* ; Prostatic Neoplasms* ; Steroids