Intersphincteric resection (ISR) is the ultimate sphincter saving procedure for low rectal cancer. Hemorrhoids are a common benign condition. We present and discuss a case of ISR which developed painful edematous hemorrhoids after ISR. A 62-year-old female with low rectal cancer received neoadjuvant chemoradiotherapy with successful down staging of tumor before undergoing robot assisted ISR with coloanal hand-sewn anastomosis. She had pre-existing external hemorrhoids which were not excised. She developed painful and edematous external hemorrhoids 4 days after surgery. These were treated conservatively before discharge. Many colorectal surgeons performing ISR have experienced similar situations in their patients, but none have reported on this phenomenon. We discuss the possible factors that may contribute to this situation. A possible solution is prophylactic excision of the hemorrhoids during coloanal anastomosis. Painful hemorrhoids may occur after ISR and if managed conservatively, the outcome is skin tags.
Chemoradiotherapy ; Female ; Hemorrhoids ; Humans ; Middle Aged ; Rectal Neoplasms ; Skin

Human leukocyte antigen (HLA) class II molecules are polymorphic cell surface glycoproteins that are crucial for the cellular interaction in immune response. The expression of class II molecules is regulated in a tissue-specific and cytokine-inducible manner, and is mainly restricted to the antigen presenting cells. However, some tumor cells also express class II molecules, and in some class-II-negative tumor cells, class II expression is inducible by interferon (IFN)-gamma. However, their expression varies, even though the tumor cells originate from the same histological origin; some tumor cells show strong expression, others show weak or no expression. To determine whether this differential expression of class II molecules on tumor cells is transcriptionally regulated, FACS analysis and Northern hybridization were performed using a panel of melanoma cell lines, IGR3, Malme-3M, SK-Mel-24, and SK-Mel-28 to analyze the cell surface expression and mRNA transcription rate of HLA-DR before and after treatment with IFN-gamma. FACS analysis showed that before IFN-gamma treatment, IGR3 and Malme-3M cells barely expressed HLA-DR. On the contrary, almost all of the SK-Mel-24 cells (> 90%) and a relatively high rate (> 50%) of SK-Mel-28 cells expressed HLA-DR. After IFN-gamma treatment, HLA-DR expression was induced in Malme-3M cells and SK-Mel-28 cells which displayed elevated levels of HLA-DR expression in a time-dependent manner. However, IGR3 cells never responded to IFN-gamma. Northern analysis showed that treatment with IFN-gamma led to the steady-state mRNA augmentation of the HLA-DR gene in Malme-3M and SK-Mel-28, whereas in IGR3, IFN-gamma did not augment the transcriptional rate of the HLA-DR gene. To further clarify this differential modulation, sequencing analysis of PCR product of the HLA-DR proximal promoter region was done, since the transcription rate of the class II gene is controlled by the well-conserved proximal promoter region. Six independent clones from PCR products of the HLA-DRA proximal promoter region and 16 clones from PCR products of the HLA-DRB proximal promoter region were isolated from the above cell lines and sequenced. Comparison of the nucleotide sequences of all 6 clones of DRA promoter showed that the sequences are extremely similar in both regulatory sequences and their intervening sequences. Sixteen clones of HLA-DRB promoter showed sequence variations such as substitution and insertion/deletion, and these 16 clones could be further grouped into 6 homologues with sequence homology. These data established that the melanoma cell lines studied here showed a differential susceptibility to IFN-gamma on the modulation of HLA-DR molecules, that this modulation is transcriptionally regulated, and that the difference in promoter activity by sequence variation might contribute to such a differential transcriptional regulation at the promoter level.
Base Sequence ; Gene Expression Regulation, Neoplastic/drug effects* ; HLA-DR Antigens/genetics* ; Human ; Interferon Type II/pharmacology* ; Melanoma/genetics* ; Molecular Sequence Data ; Polymerase Chain Reaction ; Promoter Regions (Genetics) ; RNA, Messenger/analysis ; Tumor Cells, Cultured

Two human malignant melanoma cell lines, Malme-3M and SK-Mel-28, were analyzed for their ability to induce the expression of intercellular adhesion molecule 1 (ICAM-1) and human leukocyte antigen (HLA)-DR molecules on their cell surfaces as well as at the transcriptional level before and after treatment with interferon (IFN)-gamma. Both cell lines demonstrated a high percentage(> 99%) of ICAM-1 expression regardless of IFN-gamma treatment. Before IFN-gamma treatment, Malme-3M cells barely expressed HLA-DR molecules (< 2%) and SK-Mel-28 cells demonstrated a relatively high percentage(> 50%) of HLA-DR expression. Both cell lines displayed elevated levels of HLA-DR expression in a time dependent manner after IFN-gamma treatment. However, these two cell lines have been shown to respond differentially to IFN-gamma. The molecular mechanism underlying such a differential behavior was investigated, and HLA-DR gene regulation was studied at the transcriptional level. Treatment with IFN-gamma led to the steady-state mRNA augmentation of the HLR-DR gene. The HLA-DRA mRNA augmentation was similar in both cell lines, whereas in Malme-3M, IFN-gamma did not augment the rate of transcription of the HLA-DRB gene as much as in SK-Mel-28. Data from this study established the fact that the melanoma cell lines displayed a differential susceptibility to IFN-gamma on the modulation of HLA-DR molecules, and this modulation was transcriptionally regulated.
Genes, MHC Class II ; HLA-DR Antigens/*metabolism ; Human ; Intercellular Adhesion Molecule-1/*metabolism ; Interferon Type II/*pharmacology ; Melanoma/*metabolism/pathology ; Support, Non-U.S. Gov't ; Transcription, Genetic ; Tumor Cells, Cultured

No abstract available.
Antibodies, Monoclonal* ; Borrelia burgdorferi* ; Borrelia* ; Lyme Disease*

PURPOSE: We report the results of arthroscopic ACL reconstruction using a bone-patellar tendon-bone (BPTB) autograft and a bioab-sorbable interference screw (Bioscrew, poly L-lactic acid, Linvatec co., USA). MATERIALS AND METHODS: From January 1998 to December 1998, we performed 39 cases of arthroscopic ACL reconstruction using BPTB autograft and a bioabsorbable interference screw. The average follow-up period was 2 years and 8 months. We performed KT-2000 testing and measured the IKDC, Tegner and Lysholm scores preoperatively and compared these with the results of a final evalua-tion. We performed second-look arthroscopy on 4 cases and observed the degree of degradation of the bioabsorbable interference screw. RESULTS: Preoperative evaluation revealed an average range with a KT-2000 of 8.1 +/-3.4 mm, a Lysholm score of 66.2 +/-16.3, an IKDC score below C in all cases and a Tegner score of 3.7 +/-0.9, but final results showed a KT-2000 of 2.8 +/-2.2 mm, a Lysholm score of 91.7 +/-7.5, an IKDC score above B in all except 3 cases and a Tegner score of 6.9 +/-1.1. Second-look arthroscopy at 3 and 12 months post-operatively showed no degradation of the bioabsorbable interference screw, but there was partial degradation of the bioabsorbable inteference screw at 21 and 33 months. CONCLUSION: Bioabsorbable interference screws seems a reasonable alternative to metallic screws in ACL reconstruction. Bioab-sorbablescrew implanted in humans may take much longer to degrade than expected, more study is needed.
Arthroscopy ; Autografts* ; Follow-Up Studies ; Humans ; Lactic Acid

The finite element method was utilized to find the rigidity of the device in changing the parameters, such as geometrical configuration, material property, and loading condition in an external fixation. In the experimental analysis, a universal testing machine(UTM) was used to evaluate the rigidity of EBI, Monofixator and Hoffmann under the different type of lodings, such as axial compression, bending and torsion in changing the parameters. The result was compared with those of the experimental work. The results were as follows: 1) In standard condition, the yielding loads in axial compression were 85Kg in the EBI, 55Kg in the Hoffmann, and 100Kg in the Monofixator, The rigidity figures were 2930N/cm in the EBI, 764N/cm in the Hoffmann, and 2391M/cm in the Monofixator. Z) The experimental method was adapted to figure out the effect of parametric change on the stiffness of 3 different external fixation apparatus(Monofixator,EBI, Hoffmann). A Monofixator with a parametric change of pin diameter from 6mm to 5mm indicated 40% reduction of stiffness in axial compression and 60% reduction of stiffness in torsion. Also, in the case of the change of pin group separation from 20cm to 15cm it showed 64% increase of stiffness in, AP bending. EBI with the increase of the distance between pin and aluminum bar to 8cm showed 32% decrement of stiffness in axial compression and 38% decrement of stiffness in AP bending. The stiffness of the Hoffmann device was remarkable according to the number of the pin used and the distance between the pin and the aluminum bar. 3) Concerning the difference between the experimental analysis and finite element method in a Monofixator, the results of the experimental analysis were 10% to 37% lower than those of the finite element method. The reason is thought to be caused by complete binding. The obtained data shed light on the future guide-lines and future alterations of the design factors in external fixation device. Approprate use of the obtained information is desirable for the optimal,treatment of the fractured long bone.
Aluminum ; External Fixators ; Methods

BACKGROUND AND OBJECT: Immunostimulatory CpG-oligodeoxynucleotides (ISS CpG-ODN) up-regulate the TH1-type immune response and down-regulate the TH2-type response. This study was performed to investigate the immune response changes resulting from ISS CpG-ODN on bronchial hyperrestponsiveness, eosinophilic inflammation and mucus hypersecretion in rat asthma. MATERIALS AND METHODS: 10 normal controls(NC) and 26 asthmatic rats, which were generated by ovallbumin(OVA) sensitization and challenge, were studied. The asthmatic rats were randomized into 11 asthma controls(AC) and 15 in the asthma-CpG treatment group(CpG). The CpG group was administered ISS CpG-ODN intramuscularly and the AC group was administered a placebo(0.9% NaCl)on day 15 and 20. After CpG-ODN or placebo administration, we measured the IFN-(TH1-type cytokine) and IL-4(TH2-type cytokine) levels in the bronchoalveolar lavage fluid(BALF), the specific airway resistance(sRaw), eosinophilic fraction in BALF, eosinophilic infiltration, goblet cell dysplasia and MUC5AC gene expression in the lung tissue. RESULTS: In the BALF of the CpG group, the IFN-γ concentration was significantly high and the IL-4 concentration was significantly low when compared with the AC group. Both the sRaw and eosinophilic fraction, and infiltration into the BALF and lung tissue significantly lower in the CpG group when compared with the AC group. However, little difference in goblet cell dysplasia and MUC5Ac gene expression was observed between the CpG group and the Ac group. CONCLUSION: ISS CpG-ODN decreases bronchial hyperresponsiveness and eosinophilic inflammation in the rat asthma model through the up-regulation of the TH1-type immune response with the down-regulation of the TH2-type response. However, the effect of these immune response changes on mucus hypersecretion was is not remarkable in this study.
Animals ; Asthma* ; Bronchoalveolar Lavage ; Down-Regulation ; Eosinophils ; Gene Expression ; Goblet Cells ; Inflammation ; Interleukin-4 ; Lung ; Mucus ; Rats* ; Up-Regulation

BACKGROUND: Noninvasive ventilation has been used extensively for the treatment of patients with neuromuscular weakness or restrictive chest wall disorders complicated by hypoventilatory respiratory failure. Recently, noninvasive positive pressure ventilation has been used in patients with alveolar hypoventilation,chronic obstructive pulmonary disease(COPD),and adult respiratory distress syndrome. Sanders and Kern reported treatment of obstructive sleep apnea with a modification of the standard nasal CPAP device to deliver seperate inspiratory positive airway pressure(IPAP) and expiratory positive airway pressure(EPAP).Bi-level positive airway pressure (BiPAP) unlike nasal CPAP, the unit delivers a different pressure during inspiration from that during expiration The device is similar to the positive pressure ventilator or pressure support ventilation. METHOD AND PURPOSE: Bi-level positive airway pressure(BiPAP) system(Respironics, USA) was applied to seven patients with acute respiratory failure and three patients on conventional mechanical ventilation. RESULTS: 1) Two of three patients after extubation were successfully achieved weaning from conventional mechanical ventilation by the use of BiPAP ventilation with nasal mask. Five of seven patients with acute respiratory failure successfully recovered without use of conventional mechanical ventilation. 2) PaO2 lhour after BiPAP ventilation in acute respiratory failure patients significantly improved more than baseline values(p<0.01)). PaCO2 lhour after BiPAP ventilation in acute respiratory failure patients did not change significantly more than baseline values. CONCLUSION: Nasal mask BiPAP ventilation can be one of the possible alternatives of conventional mechanical ventilation in acute respiratory failure and supportive method for weaning from mechanical ventilation.
Humans ; Intermittent Positive-Pressure Ventilation* ; Masks ; Noninvasive Ventilation ; Positive-Pressure Respiration ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Sleep Apnea, Obstructive ; Thoracic Wall ; Ventilation ; Ventilators, Mechanical ; Weaning

Functional upper airway obstruction due to vocal cord dysfunction is being increasingly recognized and has been variously described as "Munchausen's stridor", "Emotional laryngeal wheezing", "Nervous asthma". It's features are symptoms of acute reversible recurrent dyspnea associated with an inspiratory stridor, normal anatomy of the upper airway, demonstration of variable severe exthrathoracic upper airways obstruction with pathologic adduction of the vocal cord at bronchoscopy. The patients with this condition are frequently misdiagnosed as asthma and the diagnosis is often delayed. So they can present a serious medical problem and are exposed to the complication of treatment and investigation. We report a case of functional upper airway obstruction due to vocal cord dysfunction who showed paradoxical vocal cord motion at bronchoscopy and typical features of variable exthrathoracic obstruction on Flow-volume loop during a symptomatic period.
Airway Obstruction* ; Asthma ; Bronchoscopy ; Diagnosis ; Dyspnea ; Humans ; Respiratory Sounds ; Vocal Cord Dysfunction* ; Vocal Cords*

A 31-year-old woman had a history of fatigue and hypokalemia and metabolic alkalosis and hypocalciuria. The patient had a subtotal thyroidectomy and denied ingestion of diuretic medication. Her clinical and laboratory findings were consistent with Gitelman's syndrome. Normal blood pressure, hypokalemic metabolic alkalosis, hypocalciuria were present. She confessed to us that she had been taking a pill due to constipation for 7 years. She was afraid that her husband know it. But we don't know the reason why she had concealed it Surreptious ingestion of diuretics must be excluded in any adult patient in whom a diagnosis of Bartter's or Gitelman's syndrome is considered.
Adult ; Alkalosis ; Bartter Syndrome ; Blood Pressure ; Constipation ; Diagnosis ; Diuretics ; Eating ; Fatigue ; Female ; Gitelman Syndrome* ; Humans ; Hypokalemia ; Spouses ; Thyroidectomy