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

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

A calcified structure blocking the flow of saliva into the mouth is a major cause of salivary dysfunction. If a stone is detected, the goal of treatment would be to remove it. Furthermore, the fundamental treatment for preventing recurrence, although depending on the location and size of the stone, is salivary gland resection. The submandibular gland duct and hilum stone is usually removed by transoral approach. If there are multiple stones in the submandibular gland and the duct, it would be necessary to carry out resection of submandibular gland, using the intra-oral approach. We recently experienced a case of multiple stone in the submandibular gland and the duct in a 73-year-old man, who presented with the right submandibular area swelling after meals. We removed the submandibular gland and duct stone without intra-oral approach and present this case with a review of the literature.

PURPOSE: We wanted to determine if the analysis and categorization of breast lesions with using BI-RADS for US would be useful. MATERIALS AND METHODS: We retrospectively reviewed 1,024 cases (976 persons), in which US-guided core needle biopsy had been performed. The breast lesions were described and categorized according to the BI-RADS for US. Each US characteristic was analyzed in order to determine its association with a benign versus malignant tissue diagnosis. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value, and the accuracy of breast US were examined. RESULTS: Logistic regression analyses of the US features in terms of their ability to distinguish between benign and malignant breast lesions showed that all eight US features (shape, orientation, margin, echogenicity, posterior acoustic features, surrounding tissue, calcification and special cases) were statistically significant. Moreover, the shape, margin, microcalcification and enlarged axillary lymph nodes were found to be the most useful diagnostic features. In addition, a clinically palpable mass increased the diagnostic accuracy up to 92.7%. The positive predictive value of a category 3 lesion was 0.8%, and those of category 4 and 5 lesions were 30.4% and 99.4%, respectively. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy of breast US were 99.0%, 57.2%, 49.5%, 99.3% and 69.6%, respectively. CONCLUSION: Using BI-RADS for US in breast can be successful for characterizing and differentiating both the malignant and benign lesions of the breast.
Acoustics ; Biopsy, Large-Core Needle ; Breast Neoplasms ; Breast* ; Diagnosis ; Logistic Models ; Lymph Nodes ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography*

BACKGROUND: The human papillomavirus (HPV) is the most common etiologic factor of cervical cancer. It was reported that the incidence of cervical intraepithelial neoplasia and cervical carcinoma was increased when normal women was infected with HPV. To date, for detection and classification of HPV, it were used by hybridization method using the DNA probe specific for HPV and in situ hybridization method for fixed paraffinized tissue, but reported that these methods were inadequate for detection of HPV DNA because of low sensitivity and complex procedure. Compared with these methods, polymerase chain reaction (PCR) was reported as a highly sensitive molecular biologic technique which could detect the HPV DNA in the cervical epithelial cell of women. Thus we used PCR for the investigation of detection rate of HPV 16 and 18, and its relationship with Pap smear class in normal women. METHODS: In 86 normal women, we had extracted the HPV DNA from cervical swab samples and then detected the presence of HPV DNA by nested PCR. RESULTS: In the cases of 86 normal women, the detection rate for HPV DNA was about 7.0%. In the cases of 26 women with Pap smear class I, the HPV DNA was not detected. And in the cases of 60 women with Pap smear class II, the detection rate for HPV DNA was about 10.0%; HPV subtype 16 about 6.7%; HPV subtype 18 about 1.7%; and the coinfection rate of HPV subtype 16 and 18 about 1.7%. CONCLUSIONS: We think that women who was previously infected with high-risk HPV should be examined for Pap smear test in regular time interval, and if the result of Pap smear was abnormal, then should be examined for the presence of the HPV DNA.
Cervical Intraepithelial Neoplasia ; Classification ; Coinfection ; DNA ; Epithelial Cells ; Female ; Human papillomavirus 16 ; Humans* ; In Situ Hybridization ; Incidence ; Papillomavirus Infections* ; Paraffin ; Polymerase Chain Reaction* ; Uterine Cervical Neoplasms

PURPOSE: Estrogen, various polypeptide hormones and growth factors are associated with the development and progression of breast cancer. Coregulatory proteins are also associated with estrogen receptor (ER) transcriptional activity and tamoxifen resistance. Therefore, it is necessary to investigate the change of coregulator mRNAs and various cell proliferation proteins and cell cycle-related proteins after treatment with estrogen or antiestrogen. METHODS: MCF-7 cells were maintained in dextran-coated charcoal stripped 10% Dulbecco's Modified Eagle Medium (DMEM). To measure the change of the coactivators' (src-1, P/CAF, CBP, AIB1) mRNAs and corepressors' (SMRT, N-coR) mRNAs, multiple PCR was carried out using specific primers. In addition, intracellular proteins related to cell proliferation and cell cycle regulation were measured by performing Western blotting after treatment with estrogen or tamoxifen. The change of mitogen activated protein kinases was also measured by performing Western after tamoxifen treatment for 4 weeks. RESULTS: Coactivator mRNAs expression rapidly decreased in 15 min after estrogen treatment but this recovered to the initial level in 3 hr. The pattern was similar for the case of tamoxifen treatment. Corepressor mRNAs expression rapidly decreased in 15 min after estrogen treatment and it remained at a lower level until 24 hr after estrogen treatment. With tamoxifen treatment, the initial response was similar to the cases of estrogen treatment, but the xpression gradually increased 3 hr after tamoxifen treatment. Treatment of estrogen induced intracellular concentrations of c-myc and Ki-67 and it increased nuclear translocation of NF-kappaB and phosphor-ERK and it decreased the intracellular cell cycle suppressor p27/kip1. Tamoxifen treatment increased nuclear p27/kip1 but it decreased c-myc, NF-kappaB and phosphor-ERK. Long-term (4 weeks) treatment of tamoxifen was associated with decrease of activated ERK and p38 but there was no change in phospho-Akt level. CONCLUSION: Estrogen induced cell proliferation and the survival pathway-related factors, but it decreased the cell cycle suppressor p27/kip1. Long-term treatment with antiestrogen tamoxifen might decrease the MAPK activities in ERalpha-expressing tumor cells.
Blotting, Western ; Breast ; Breast Neoplasms ; Cell Cycle ; Cell Line ; Cell Proliferation ; Charcoal ; Eagles ; Estrogen Receptor Modulators ; Estrogens ; Intercellular Signaling Peptides and Proteins ; MCF-7 Cells ; Mitogen-Activated Protein Kinases ; NF-kappa B ; Peptide Hormones ; Phosphotransferases ; Polymerase Chain Reaction ; Proteins ; RNA, Messenger ; Tamoxifen

PURPOSE: Until recently, breast cancer carcinogenesis has not been fully understood, but the roles of estrogen receptors(ERs) and growth factor receptors(like HER2) were known to be important. Growth factors have been shown to synergize in the E2 signaling pathway, although the actual molecular mechanism remains largely unknown. To investigate the effect of HER2 overexpression on the ERE(estrogen responsive element)-mediated transcriptional activity of the ERs, this study was designed. METHODS: NIH3T3 cells, T6-17 cells (NIH3T3 cells with stably transfected with HER2), and MCF-7 cells were maintained in dextran-coated charcoal stripped 10% Dulbecco's Modified Eagle Medium (DMEM). Transient transfection of constructs (pcDNA3-ER alpha, pcDNA3-ER beta, pERE-luc, pAP-1-luciferase, and pcDNA-HER2) into each cells was performed using the Lipofectamine PLUS(TM) system. Reporter gene assays using ERE-luciferase or AP-1-luciferase were used to measure the ER transcriptional activities after treatment with estradiol (E2) and tamoxifen. RESULTS: Reporter gene assay using ERE-luciferase in both ER alpha and ER beta, showed much less responsiveness to estrogen in HER2 overexpressing T6-17 cells than in NIH3T3 cells, but there was no remarkable difference after treatment with tamoxifen. The AP-1-mediated transcriptional activity was increased in ER beta after tamoxifen treatment, but it disappeared in HER2-expressing T6-17 cells. The responsiveness to estrogen in HER2-transfected MCF-7 cells was also slightly less than in the control MCF-7 cells, and the ERE-mediated transcriptional activity of estrogen in MCF-7 cells was decreased, in a dose-dependent manner, after HER2 transfection. CONCLUSION: Coexpression of HER2 and ER seems to make cells less responsive to estrogen stimulation, and decrease the ERE-mediated transcriptional activity in both ER alpha and ERbeta. These results suggest that the expression of HER2 reduces the estrogen dependency in cell growth and eventually induces estrogen independent-growth.
Breast Neoplasms ; Carcinogenesis ; Charcoal ; Eagles ; Estradiol ; Estrogen Receptor alpha ; Estrogen Receptor beta ; Estrogens* ; Genes, Reporter ; Intercellular Signaling Peptides and Proteins ; MCF-7 Cells ; Tamoxifen ; Transfection

The malignant potential of a tumor is related to its ability to dissociate invasion and seed other sites-metastasis. In either instance, the tumor cells are confronted with a barrier signif icantly composed of type IV collagen. This type IV collagen is a major structural protein of basement membranes. Using immunohistochemical method to detect type IV collagen, intensity of stain and continuity of basement membrane at the tumor-stromal border was studied in surgical specimens from 47 colorectal carcinomas at the Pusan Paik-Hospital. Immunoreactivity was evaluated semi-quantitatively as three categories; Type-1, thick or normal basement membrane with or without minimal discontinuity; Type-2, thin basement membrane with or without moderate discontinuity; Type-3, fragmented or absent basement membrane. Also, in each case the tumor morphologic features were identified. The histologic type, differentiated grade, desmoplastic response, lymphatic and vascular invasion, lymph node involvement, tumor size and modified Dukes' stage were estabilished. Type-1 immunoreactivity was significantly observed in well-differentiated, negative lymph node, Dukes' stage B1/B2 tumors, and Type-3 was in poorly differentiated, positive lymph node, Dukes' stage C2/D. The expres sion of collagen IV in basement membrane was statistically significant correlated with differentiated grade, lymph node metastasis and modified Dukes' stage. By contrast, no statistically significant correlation was found between paucity of type IV collagen and the other parameters. The result suggest that expression of type IV collagen in basement membrane may be a useful prognostic marker, and may play a part in the invasive and metastatic process of colorectal carcinomas.
Basement Membrane ; Busan ; Collagen Type IV ; Collagen* ; Colorectal Neoplasms* ; Lymph Nodes ; Neoplasm Metastasis

Treatments for restoring the function and esthetics of missing teeth include fixed bridge, partial denture, orthodontic movement, implantation and autotransplantation. However, there is no absolute indications for each techniques. Due to undevelopment of root and root resorption after autotransplantation, the success rate of autotrans-plantation over the past decades have been low. Recently. with the study on biological principles of the healing of periodontal ligament, the success rate of autotransplantation began to improve. We report the cases of successful autotransplantation which resulted in ideal healing of periodontal ligament, gingiva and alveolar bone.
Autografts* ; Denture, Partial ; Denture, Partial, Fixed ; Esthetics ; Gingiva ; Periodontal Ligament ; Root Resorption ; Tooth*

BACKGROUND: Colorectal cancer (CRC) is one of the most common malignant neoplasms and is a leading cause of mortality worldwide. Metastasis to the liver is a frequent event in patients with CRC. An essential step in the metastatic cascade is angiogenesis. METHODS: This study included 45 patients who underwent a partial colectomy with hepatic resection for CRC with hepatic metastases. Immunohistochemistry was performed using vascular endothelial growth factor (VEGF)-A, VEGF receptor (VEGFR)-1, VEGFR-2, and CD34 antibodies to examine the relationship between CRC with liver metastases and angiogenesis. RESULTS: CRC showed significantly stronger expression of VEGF-A, VEGFR-1, and VEGFR-2 than liver metastases (p < 0.05). Microvessel density was also higher in CRC than in liver metastases (p < 0.05). CONCLUSIONS: Compared with previous studies, we found a higher expression of VEGF-A, VEGFR-1, VEGFR-2, and microvessel density in CRC than in liver metastases, which could be ascribed to a difference in vessel distribution and blood supply in each organ. Given its profuse blood supply and distinct cell populations, the liver might provide a rich milieu for tumor cell growth with less expression of angiogenesis-inducing agents.
Antibodies ; Colectomy ; Colorectal Neoplasms ; Glycosaminoglycans ; Humans ; Immunohistochemistry ; Liver ; Microvessels ; Neoplasm Metastasis ; Receptors, Vascular Endothelial Growth Factor ; Thymus Gland ; Vascular Endothelial Growth Factor A ; Vascular Endothelial Growth Factor Receptor-1 ; Vascular Endothelial Growth Factor Receptor-2 ; World Health Organization