In spite of the extensive use of antibiotics over several decades, Streptococcus pneumoniae still remains as one of the most serious human bacterial pathogens. In order to clone the pneumococcal genes whose expression is induced when pneumococcus causes infection in mice, S. pneumoniae strain ATCC 6303 was subcultured on blood agar plates (BAP) ten times to reduce the virulence first, and then passaged through BALB/c mice three times to restore the virulence. Subtractive hybridization was performed using the total RNA preparations isolated from BAP-cultured and mouse-passaged strains. Complementary DNAs corresponding to any mRNA species that were differentially expressed in the mouse- passaged strain were used as the probes to screen the genomic library of pneumococcus. Positive recombinants were selected and sequenced partially to identify the genes located within the cloned DNA. GenBank search of the sequence data has identified several genes including two heat shock genes (dnaK and dnap, a transposase-encoding gene, and a sequence which is very homologous to that of the ftsH gene.
Agar ; Animals ; Anti-Bacterial Agents ; Clone Cells* ; Cloning, Organism* ; Databases, Nucleic Acid ; DNA ; DNA, Complementary ; Genomic Library ; Hot Temperature ; Humans ; Mice ; Pneumonia ; RNA ; RNA, Messenger ; Shock ; Streptococcus pneumoniae* ; Streptococcus* ; Virulence

No abstract available.
Lithotripsy* ; Shock*

No abstract available.

A retrospective quality assurance study of intraoperative consultation (frozen section) was carried out to assess the accuracy and to determine the reasons of discordance. Of 14,977 surgical pathology cases accessioned over a 6-month period in Asan Medical Center, frozen sections were done on 1,270 (8.5%) patients and 2,392 frozen sections (1.88 frozen sections/case) were performed. Discordance was noted in 106 cases (4.4%) and diagnosis was deferred in 26 cases (1.1%). All deferred cases were reviewed with the result of 53.8% justified and 46.2% unjustified. The discordant cases were divided into three categories as to their clinical significances: category A (no affect on patient care) 61.3%, B (minimal affect) 9.4%, and C (major affect) 29.2%. Of 31 category C cases, 7 cases were false positive and 24 cases were false negative. Misinterpretation (70.8%) was the leading cause of discordance, followed by sampling error (15.1%), failure to identify lesion (8.5%), and technical problem (5.7%). More than one-third (35.8%) of all discordances were of central nervous system cases. Total central nervous system cases were 403 (16.8%) with a significantly higher disordance rate (9.8%) and deferral rate (2.5%) in comparison to the other cases with 3.4% discordance rate and 0.8% deferral rate. There were 43 colorectal cancer cases of intraoperative consultation for adequacy of resectional margins. The surgical margins were between 0.4 cm and 28 cm (mean: 6.7 cm) away from the tumor and there was no tumor-positive case. The study indicates surgical pathology should 1) promote interpretative skills in cases involving minute fragments of neurosurgical cases, 2) defer the diagnosis and ask for more tissue on inadequate or inappropriate specimens and 3) give only gross opinions without unnecessary frozen section procedures in the event of simple, clear-cut cases.
Abscess ; Anti-Bacterial Agents ; Biopsy ; Central Nervous System ; Chungcheongnam-do ; Colitis, Ulcerative ; Colorectal Neoplasms ; Diagnosis ; Diagnosis, Differential ; Endoscopy ; Enterocolitis, Pseudomembranous* ; Frozen Sections* ; Humans ; Mucous Membrane ; Necrosis ; Pathology ; Pathology, Surgical ; Retrospective Studies ; Selection Bias

PURPOSE: The loss of estrogen and progesterone receptors appeats to be associated with a progression to less differentiated and hormone-independent tumors. The gain of hormone independency over time even in estrogen receptor-positive tumors has become another obstacle to endocrine therapy for breast cancer. We tried to regain the hormone dependency in estrogen receptor-negative breast cancer cells by lipofecting estmgen receptor cDNA. MATERIALS AND METHODS: The mutant human estrogen receptor cDNA (pSGS-HEO) was lipofected into estrogen receptor-negative human breast cancer cell line MDA-MB-231, in an attempt to restore their sensitivity to antiestrogen. Then the effects of 17p-estradiol and tamoxifen were studied by counting viable cell numbers after treating the lipofected cell line with either one or together. RESULTS: Culture medium cantaining phenol red, a weak estrogen, has growth advantages compared with culture medium without it. In both culture conditions, cell growth was most profoundly inhibited in 4 days after lipofection with mutant human estrogen receptor cDNA, which was overcome after that day. Tamoxifen, as an antiestrogen, showed a growth inhibitory effect slightly stronger tban combined conditions of tamoxifen and 17- estradiol compared to estrogen-treated group and to control, and the inhibitory effect was lasted 4 days. CONCLUSION: The temporary induction of estrogen receptor by lipofection with pSGS-HEO on estrogen receptor-negative human breast cancer cell line MDA-MB-231 showed negative growth control on these cells by tamoxifen, indicating that liposome-mediated estrogen receptor transfection may be used as a novel therapeutic strategy for hormane independent human breast cancers in the near future.
Breast Neoplasms* ; Breast* ; Cell Count ; Cell Line ; DNA, Complementary ; Estradiol ; Estrogen Receptor Modulators ; Estrogens* ; Genetic Therapy ; Humans* ; Phenolsulfonphthalein ; Receptors, Progesterone ; Tamoxifen ; Transfection

BACKGROUND: Long-term oral itraconazole and terbinafine are widely used in the treatment of onychomycosis. Accelerated nail growth in patients with itraconazole has been described in several reports. However, there has been no report regarding the effect of antifungal agents on cultured nail matrix cells(NMCs). OBJECTIVE: We applied several antifungal agents on cultured human NMCs and epidermal kera- tinocytes(EKs) to compare the cytotoxicity of several antifungal agents and also to verify possible stimulating effects of itraconazole and 6-hydroxyitraconazole on nail growth. METHODS: To evaluate the effect of antifungal agents, the 3-(4,5-dimethylthiazo1-2-yl) 2,5-diphenyl- tetrazolium bromide(MTT) test, tritiated thymidine incorporation test, and lactic dehydrogenase(LDH) leakage test were used. RESULTS: Dose dependent decreases in cell viability and DNA synthesis, and dose dependent increases in LDH liberation were observed in cultured human NMCs and EKs after exposure to several antifungal agents. The dose-response reaction patterns for NMCs and EKs to antifungal agents were similar. The cytotoxicity potency of several antifungal agents measured by each method were slightly different. Itraconazole and 6-hydroxyitraconazole did not show stimulating effects on cell proliferation in in vitro monolayer cell culture systems. CONCLUSION: These observations suggest that itraconazole appeared less cytotoxic but showed no stimulating effects on nail matrix cell proliferation in vitro. Cultured human EKs as well as NMCs may be useful in evaluating the effects of agents which are involved in nails.
Antifungal Agents* ; Cell Culture Techniques ; Cell Proliferation ; Cell Survival ; DNA ; Humans* ; Itraconazole ; Keratinocytes* ; Onychomycosis ; Thymidine

Polyethylene glycol (PEG)-3350 is the most frequently used lavage solution for bowel cleansing prior to colonoscopy or elective surgery because its large molecular weight means that it is poorly absorbed. However, if it leaks into the peritoneal cavity, complications may arise. Few published studies have assessed the absorption, distribution, metabolism and excretion of PEG. Moreover, no published clinical data regarding complications due to the intra-peritoneal leakage of PEG-3350 could be found. We report on an elderly patient who developed the poisoning caused by leaking of PEG-3350 during bowel preparation. It resulted in severe metabolic acidosis, hypernatremia, hyperosmolality and a high anion gap, but it was effectively treated with early continuous renal replacement therapy after surgery.
Absorption ; Acid-Base Equilibrium ; Acidosis ; Aged* ; Colonoscopy ; Humans ; Hypernatremia ; Metabolism ; Molecular Weight ; Peritoneal Cavity ; Poisoning* ; Polyethylene Glycols* ; Renal Replacement Therapy ; Therapeutic Irrigation

In recent years the rate of the spine Injury tends to be on the increase year by year as the rate of traffic and industrial accidents are increased. During industrial, sports and automobile accidents are occurred, the various forces were exerted by the mechanism, “flexion, extension, flexlon-rotation, vertlcal compression and shearing.” These exercise their effects on the vertebral bodies, the neural arches and intervertebral disc and the contents of the spinal cord, depending on direction and intensity of the trauma, and the posture and muscular attitude existent at the movement. Once the neurological Iesion has been diagnosised and the type of vertebral injury has been established and particularly after a decision has been made as to whether the spinal injury is stable or unstable, a rational method of treatment can be decised upon: Our treatment consists of providing the best condition for recovery from the spine injury, preventlng further neurologlcal damage in the unstable area, achieving stable bone and llgament heallng ln satisfactory position, preventing metabolic compllcations from being fatal, mobllizing the patient early, and rehabilitating to provide maximum fuctlonal independence with the remaining-muscle power avallablc to the cord injury patient. One hundred and fifty seven spine fracture and dislocation patients were clinically observed and evaluated from Jan. 1972 to Dec. 1978 in our study. The result of this study may be summerized as follows: 1. Out of the patients, there were 135 male and 22 female cases. The ratio between male and female was 6.1:1. The majority (84.7%) of the spine injuries was found in the age of 20 to 50 years. Fifty-two percent of the cases was caused by industrial accidents. 2. The most common site of the lesion occurred between T-11 and L-2 vertebrae (71.8%). 3. In cervical injury, fracture dislocation type was most common (50%), and especially, pure dislocation by extension mechanism was 12.5% but in thoracolumbar iniury, simple anterior wedge compression fracture was most common (66.6%) and there were no pure dislocations just like cervical spine injury cases. 4. Fifty seven cases of the total were complicated by paraplegia, of which 62.5% in cervical region and 31.6% in thoracolumbar region were noticed. The most frequent type of the injury in which paraplegia developed was the fracture dislocation (73.8%) and the most common site of the lesion was between the T-12 and the L-2 vertebrae. 5. Open reduction was performed in 9 cases out of 24 cervical spine injury patients and in 41 cases out of 133 thoracolumbar injury patients. 6. Prognosis of neurologic recovery in initially complete lesion was poor, regardness of treatment. In the cervical lesion cases there were no patients who were recovered. But in the other sites about 10.5% of initially complete lesion showed partial neural recovery comparing to 62.5% of initially incomplete lesions. 7. Progressive deformity is often noted as a complication of spine fracture or dislocation when solid fusion fails to develop. The increment of kyphosis after treatment is as follows: Simple wedge fracture
Accidents, Occupational ; Automobiles ; Catheterization ; Catheters ; Clinical Study ; Congenital Abnormalities ; Diagnosis ; Dislocations ; Female ; Fractures, Compression ; Humans ; Intervertebral Disc ; Kyphosis ; Laminectomy ; Male ; Methods ; Paraplegia ; Posture ; Prognosis ; Spinal Cord ; Spinal Injuries ; Spine ; Sports ; Urinary Bladder

Malformations of the hand in newborn infants are comparatively uncommon, and the forms which these malformations assume are extremely varied, some being so bizzare as to almost defy description. The etiology of congenital anomalies of the hand has not been conclusively established, but at the present time the most acceptable theories are those of maldevelopment due to teratogens or of mutations which are subsequently inhereted. This paper is based upon our own series of 99 anomalies in 93 patients who were hospitalized and treated at Severance Hospital during the period between 1965 and 1979 and the following results were obtained. 1. There were 56 males and 37 females in 93 patients and the ratio between male and female was 1.5: 1. 2. Right hands were involved in 49 patients, left hands were in 33 patients, and both hands were in 11 patients. 3. The most common type of anomalies were polydactylism (60.6%), next were syndactylism (24.3%), and the following anomalies were found; congenital finger deficiency, congenital constriction band, camptodactyly, cleft hand, congenital clasped thumb, and symphalangism. 4. 33 associated congenital anomalies were found in 27 patients, in which, anomalies of the foot were most common. 5. Prenatal history such as drug ingestion, eclampsia or difficult labor, and prematurity were found, but no genetic or familial history could be obtainable. 6. Treatment was stressed upon the function of hand rather than cosmetic appearance.
Clinical Study ; Constriction ; Eating ; Eclampsia ; Female ; Fingers ; Foot ; Hand ; Humans ; Infant, Newborn ; Male ; Polydactyly ; Pregnancy ; Teratogens ; Thumb

PURPOSE: The purposes of this study were to analyze the MR findings of medulloblastoma, and to evaluate the subarachnoid dissemination and the significance of contrast enhanced MR of brain and spine for tumor.. MATERIALS AND METHODS: The preoperative brain MR studies of 18 patients (9 males, 9 females;mean age, 9.4 years) with surgically proved medulloblastomas were retrospectively reviewed to characterize these neoplasms with regard to their location, size, MR signal intensity, appearance after contrast enhancement, presence of cyst and necrosis, subarachnoid dissemination, and other associated findings. In 14 patients postoperative spine MR studies were evaluated for staging and therapeutic planning. RESULTS: The most frequent location of medulloblastoma was the inferior vermis and the mean tumor size was 4.1 x 3.6 x 3.9 cm. On Tl-weighted image, medulloblastomas generally had low to intermediate signal, predominantly hypointense relative to white matter. On T2-weighted image, medulloblastomas showed modetately high signal, hyperintense relative to white matter. Inhomogeneous contrast enhancement was demonstrated in 13 patients(72.2%) after injection of gadopentetate dimeglumine(Gadolinium). Cyst and necrosis within the tumor were visualized in 15 patients(83.3%). Subarachnoid disseminations of medulloblastomas were noted in 11 patients(61.1%), of which 6 demonstrated intracranial and 2 intraspinal dissemination. Three had both intracranial and intraspinal dissemination. In nine cases with intracranial lesions, there were intraparenchymal mass formation(7), subarachnoid nodules(5), infundibular lesions(2) and diffuse gyral enhancement(I). In five cases with intraspinal lesions, there were extramedullary intradural small nodules(3), central canal nodules(2), intradural masses(I)and fine nodular and sheet-like leptomeningeal enhancement(1). Other associated findings included intratumoral hemorrhage(11.1%), per/tumoral edema(44.4%), tonsillar herniation(44.4%), hydrocephalus(88.9%) and calcification(44.4%). CONCLUSION: Medulloblastomas revealed low to intermediate signal intensity on Tl-weighted image and intermediate to moderately high signal intensity on T2-weighted image, relative to cerebellar white matter. Medulloblastomas were solid tumors with cystic necrosis, which showed inhomogeneous enhancement and subarachnoid disseminations to the intracranial and intraspinal spaces after Gd-DTPA enhancement. Gd-enhanced MR of brain and spine was an useful diagnostic modality in preoperative diagnosis and in staging of postoperative cases of medulloblastomas, which was superior to postcontrast CT or precontrast MR.
Brain* ; Diagnosis ; Gadolinium DTPA ; Humans ; Male ; Medulloblastoma ; Necrosis ; Retrospective Studies ; Spine*