Balancing the rates of cell proliferation and cell death is important in maintaining normal tissue homeostasis. The relationship among apoptosis, cell proliferation and factors influencing apoptosis according to the histologic types in chemically induced mammary tumorigenesis appears important in understanding the pathogenesis of breast carcinoma. In this study, we investigated alterations in the kinetics of cell proliferation and apoptosis during rat mammary tumorigenesis induced by 7, 12-dimethylbenzanthracene (DMBA) and we related these changes to the expressions of bcl-2, p53, and TGF-beta. Seven-week-old female Sprague-Dawley rats were divided into an experimental group (20 mg/ml DMBA by oral intubation) and a control group. The results were as follows. 1. In the experimental group, breast tumors occurred in twenty two of fifty nine rats(37.3%, 22/59), and the total number of tumors was 100 (4.5 2.0/rat). The histological classification was infiltrating ductal carcinomas (n=5), ductal carcinomas with focal invasion (n=10), intraductal carcinomas (n=36), adenomas accompanied with intraductal proliferation (n=35), intraductal proliferation (n=9), and adenomas (n=5); 2. The differentiation of terminal end bud into alveolar bud (AB) in the experimental group was significantly lower than that of the control group (p<0.05); 3. BrdU labeled tumor cells were mainly located at the peripheral portion of tumor cell nests. BrdU labeling indices were highest in ductal carcinomas, less pronounced in intraductal proliferation, and lowest in adenomas, whereas apoptosis levels were highest in adenomas, less pronounced in intraductal proliferation, and lowest in ductal carcinomas (p<0.05); 4. p53 protein was not expressed in any breast tumors. Although the expression of bcl-2 protein was highest in infiltrating and focal infiltrative ductal carcinomas (58.3%), compared with adenomas, intraductal proliferation, and intraductal carcinomas (p<0.05), the extent of its expression was less than 1% of all tumor cells; 5. TGF-beta was mainly expressed in the central portion of tumor cell nests rather than in peripheral portion, and TGF-beta immunoreactive tumor cells displayed good differentiation and did not reveal BrdU immunoreactivity. TGF-beta labeling index of infiltrating and focal infiltrative ductal carcinomas was significantly higher than that of intraductal carcinomas, intraductal proliferation, and adenomas (p<0.05). Based on these results, it is thought that high cell proliferation and the suppression of apoptosis are closely associated with DMBA-induced rat mammary carcinogenesis. However, the suppression of apoptosis is not related to p53 mutation, bcl-2, and TGF-beta. TGF-beta seems to be reversely related to tumor cell proliferation but closely associated with the progression of the tumor, especially an invasion of breast carcinomas.
9,10-Dimethyl-1,2-benzanthracene ; Adenoma ; Animals ; Apoptosis* ; Breast Neoplasms ; Bromodeoxyuridine ; Carcinogenesis* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Cell Death ; Cell Proliferation* ; Classification ; Female ; Homeostasis ; Humans ; Kinetics ; Rats* ; Rats, Sprague-Dawley ; Transforming Growth Factor beta

Purpose: To report a case of both ocular perforation due to periocular acupuncture therapy with vitrectomy in the right eye andbarrier laser photocoagulation without vitrectomy in the left eye.Case summary: A 58-year-old female presented with ocular pain and decreased visual acuity in both eye. She had received periocularacupuncture therapy 4 days earlier. Dilated fundoscopy revealed vitreous hemorrhage. B-scan ultrasonography revealedvitreous opacity. Thus, at the request of the patient, vitrectomy was performed in only the right eye, and did not performed in theleft eye. Intraoperatively, we identified retinal laceration in the temporal and inferior retina. In the left eye, the sites of retinal hemorrhagewere observed in the temporal and inferior retina in the fundus examination, and a barrier laser photocoagulation wasperformed around the lesion. At the three-month postoperative follow-up, the patient’s visual acuity was 0.5 in the right eye withoutmacular edema. In the left eye, visual acuity was 0.01 with macular edema observed on optical coherence tomography. Conclusions Authors present a case of a patient with vitreous hemorrhage and ocular perforations caused by periocular acupuncturetherapy in both eye, able to compare the results of eyes that performed vitrectomy and that did not performed vitrectomyin a same patient. The recovery of visual acuity in eye that performed vitrectomy was better than eye that did not performedvitrectomy. Therefore, we consider performing vitrectomy in patients with eye perforation.

In performing needle localization breast biopsies(NLBB) under local anesthesia in an outpatient setting, we investigated, whether complication rates would be acceptable when compared with complications of the breast performed for palpable masses. We were also interested in determining whether our rate of missed biopsies would be acceptable or not. We performed the NLBB on 55 patients with a nonpalpable breast lesion, and open biopsy on 98 patients with a palpable breast mass under local anesthesia from 1992 to 1995. The missed biopsy rate was one (1.8%) of 55. Complication of NLBB occured in 4 cases(7.3%), including 1 case of seroma, 2 cases of hematoma, and 1 case of abscess. The complication rate was not statistically different from NLBB(7.3%) and open biopsy(6.1%). (P=0.25) Eleven carcinomas, including 8 cases of invasive and 3 cases of DCIS, were found with NLBB procedure.. But there was no in situ carcinoma among the palpable lesions. Needle localization breast biopsies can be performed under local anesthesia and complications rates were similar to those associated with biopsies of palpable lesions. But missed biopsy could occur if the localization was not performed exactly.
Abscess ; Anesthesia, Local* ; Biopsy* ; Breast Neoplasms ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Hematoma ; Humans ; Needles* ; Outpatients ; Seroma

Local anesthesia for arthroscopic procedure of the knee is an increasinglv popular technique that avoids the use of general anesthesia and the associated risks of respiratory depression, aspiration, and postoperative sedation. Many authors, for example McGinty etc., Martin, Yoshiya etc., advocated local anesthesia as safe and efficient method for arthroscopic procedures of the knee. We performed arthoroscopy of the knee under local anesthesia on 150 patients for diagnostic and operative purposes between January l993 and December l996. The technique of local anesthesia that we used was that 20cc of 0.5%; bupivacaine with I:200,000 epinephrine was injected into superolateral portal of the knee joint and additional 10-20cc ot 1% lidocaine into the arthroscopic portals. Pnevmatic tourniquet wa, not applied in all cases. We analysed the 150 cases and the results were as follows; The diagnostic arthroscopy was performed in 50 cases and the operative arthroscopy was in 100 cases. The duration ot local anethesia was from 4 hours to 12 hours, with an average of 6 hours. In 35 cases arthroscopy was performed as outpatient procedure and average hospital stay excluding other problem was 5 days. No complication related to systemic toxicity by local anesthetics was observed. Conclusively arthroscopy of the knee under local anesthesia is safe and effective procedure to avoid the risks of general anesthesia but patients selection is very important.
Anesthesia, General ; Anesthesia, Local* ; Anesthetics, Local ; Arthroscopy* ; Bupivacaine ; Epinephrine ; Humans ; Knee Joint ; Knee* ; Length of Stay ; Lidocaine ; Outpatients ; Respiratory Insufficiency ; Tourniquets

Although sacrococcygeal mass is rare and usually found in infants or children, adolescent or adult patients with protruding mass in sacrococcygeal region occasionally come to us simply for a cosmetic problem. In this situation, even though there is no definite neurological deficit, it should be evaluated whether or not the underlying bony pathology or dural defect exists. Few cases about the sacrococcygeal mass have been reported in adults. We reviewed our cases including preoperative evaluation methods and postoperative diagnosis. From March, 1993 to February, 1997, we experienced 6 adult patients with sacrococcygeal mass and no neurological abnormality. Preoperative evaluation were made by plain X-ray, myelogram, computed tomography(CT), and magnetic resonance imaging (MRI), as needed. Postoperative diagnoses were 2 meningoceles, 2 lipomyelomeningoceles, 1 desmoid tumor, and 1 teratoma. From our experiences, CT or MRI is essential to evaluate the sacrococcygeal mass preoperatively. These methods can visualize the precise anatomic location and extent of the mass, its relation to the spinal cord, and associated bony abnormalities. MRI is superior to CT, especially in defining the nature of the mass and involvement of the spinal cord. Conclusively, even a simple mass in the sacrococcygeal region in adults needs MRI or CT evaluation, and MRI is the most valuable method of evaluating the mass preoperatively and provides important information to establish a treatment plan.
Adolescent ; Adult* ; Child ; Diagnosis ; Fibromatosis, Aggressive ; Humans ; Infant ; Magnetic Resonance Imaging ; Meningocele ; Pathology ; Sacrococcygeal Region* ; Spinal Cord ; Teratoma

Medullary pyramid is the one place where corticospinal fibers are isolated as the pyramidal tract, and the result of such lesions has been a flaccid hemiplegia. Medial medullary syndrome may occur bilaterally, resulting in flaccid quadriplegia with facial sparing, bilateral lower motor neuron signs of the tongue, and complete loss of position and vibratory sensation affecting all for extremities. Occasionally, only the pyramid is damaged, resulting in a pure motor quadriplegia without other medullary signs. We report a 78-year-old man who suddenly developed flaccid quadriplegia without any other medullary signs. Brain MRI showed bilateral medial medullary infarctions that was probably due to anterior spinal artery occlusion.
Aged ; Arteries ; Brain ; Extremities ; Hemiplegia ; Humans ; Infarction ; Magnetic Resonance Imaging ; Motor Neurons ; Pyramidal Tracts ; Quadriplegia* ; Sensation ; Tongue

PURPOSE: To compare the effect of medial rectus recession in consecutive esotropes who had previous monocular medial rectus resection and lateral rectus recession and in non- accommodative esotropes (NAET) with small angle of deviation who had no prior operation. METHODS: We studied the results of unilateral medial rectus recession at postoperative 2 and 6 months in 7 consecutive esotropes and 19 NAET with deviation angle around 20 PD, and analyzed the corrected amount for 1 mm medial rectus recession. We regarded deviated angle of+/-8 PD at orthophoria as successful operation. RESULTS: The abosolute value of remained deviation in consecutive esotropes and NAET were 4.86+/-5.67 PD and 9.05+/-3.95 PD at postoperative 2 months, and 5.42+/-7.89 PD and 8.26+/-4.45 PD at postoperative 6 months, respectively. There were significant differences between at postoperative 2 and 6 months (p<0.05). The success rates in consecutive esotropes and NAET at postoperative 2 months were 86% and 42%, and 71% and 47%, respectively at postoperative 6 months, which were no significant differences (p>0.05). The average amount of corrected deviation for 1 mm recession at postoperative 6 months was 5.84 PD in consecutive esotropes and 2.97 PD in NAET, which were significant differences (p<0.05). CONCLUSION: Unilateral medial rectus recession in consecutive esotropes may be a useful and first choice of operation procedure when considering second operation. The amount of correction for 1 mm medial rectus recession is larger in consecutive esotropes than in NAET, possibly due to previous resection of medial rectus or release of fat adhesion. Therefore the amount of medial rectus recession in consecutive esotropia should be determined after considering the degree of abduction and operative findings.
Esotropia*

Orbital lymphangioma is a benign vascular hamartoma that may be found in the conjunctiva, eyelids, orbit, or elsewhere in the head and neck region. Deep lymphangiomatous lesions are classically characterized by acute onset of a fulminant proptosis resulting from spontaneous hemorrhage within the orbit. Complete surgical excision is often difficult because of the infiltrative nature of the tumor. Moreover, because of the hemorrhagic and friable nature of the tumor, conventional surgical techniques are frequently complicated by bleeding. We treated a case of pathologically-proven orbital lymphangioma with the ultrapulse CO2 laser. The ultrapulse CO2 laser permits a precise form of treatment with the ultimate form of hemostasis[tissue vaporization], resulting in minimal trauma, edema, and scarring, and thus offers a safe alternative to surgical excision of this lesion. The ultrapulse CO2 laser is an best ideal instrument for subtotal excision of this lesion because of its hemostatic cutting-vaporizing actions.
Cicatrix ; Conjunctiva ; Edema ; Exophthalmos ; Eyelids ; Hamartoma ; Head ; Hemorrhage ; Lasers, Gas* ; Lymphangioma* ; Neck ; Orbit* ; Volatilization*

No abstract available.

Carcinosarcoma is an uncommon pulmonary malignancy characterized by carcinomatous parenchyma and sarcomatous stroma. The cytologic, immunohistochemical and ultrastructural features of a case of pulmonary carcinosarcoma suspected by fine needle aspiration cytology is presented. Only bizarre spindle cells arranged in loose groups, in microtissue fragments and in a dissociate fashion were present in the aspiration smears. They were markedly positive for vimentin. The epithelial component was not found, which was probably due to marked paucity of carcinomatous component that was proved by histologic examination of the resected tumor. The diagnosis of pulmonary carcinosarcoma should be considered whenever poorly differentiated epithelial cell groups with a malignant mesenchymal component set in a myxoid background are seen in a pulmonary cytology specimen.
Biopsy, Fine-Needle* ; Carcinosarcoma* ; Diagnosis ; Epithelial Cells ; Immunohistochemistry ; Vimentin