BACKGROUND AND OBJECTIVES: Cilostazol is an anti-platelet and arterial vasodilating drug that inhibits phosphodiesterase type III, an enzyme that breaks down cyclic AMP in platelets, vascular smooth muscle cells, cardiac myocytes and adipocytes. Several animal and human studies have shown that cilostazol has the potential to reduce restenosis after coronary angioplasty, but the precise mechanism by which the inhibition of vascular smooth muscle cell growth occurs from an increase in cyclic AMP is not yet clear. MATERIALS AND METHODS: We investigated the effects of cilostazol on cell proliferation and expression of iNOS and p21 by western blotting with the cultured aortic vascular smooth muscle cells stimulated with platelet-derived growth factor BB. RESULTS: In comparison to the control, treatment with cilostazol significantly inhibited (p<0.05) the increase in cell number. Inducible nitric oxide synthase (iNOS) and p21 expression increased with cilostazol treatment, and these effects of cilostazol were eliminated by simultaneous incubation with the NOS inhibitor, L-NAME. These results indicate that cilostazol increases p21 expression at least partially through an iNOS-dependent pathway in cultured vascular smooth muscle cells stimulated with PDGF-BB. CONCLUSION: These findings suggest that cilostazol has a direct inhibitory effect on abnormal proliferation of vascular smooth muscle cells accompanied by the induction of iNOS-dependent p21 expression, and cilostazol may have potential to prevent restenosis after percutaneous coronary intervention by this mechanism.
Adipocytes ; Angioplasty ; Animals ; Blotting, Western ; Cell Count ; Cell Proliferation ; Cyclic AMP ; Humans ; Muscle, Smooth, Vascular* ; Myocytes, Cardiac ; NG-Nitroarginine Methyl Ester ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type II ; Percutaneous Coronary Intervention ; Platelet-Derived Growth Factor

E.S.T. is performed not only for the treatment but also for the diagnosis of biliary tract diseases. E.S.T. serves as a diagnostic aid for some of biliary tract diseases which require such procedures as a peroral cholangioscopy or biopsy of the biliary duct for precise diagnosis and further differential diagnosis. The diseases of our patients were diagnosed by clinical findings and such diagnostic maneuvers as abdominal ultrasonography, intravenous cholangiography, percutaneous transhepatic chorangiography(P.T.C.), endoscopic retrograde chorangiopancreatography(E.R.C.P.), In all the two cases, abdominal ultrasonography revealed dilated extrahepatic duct, but biliary trees were not visualized at E.R.C.P. In one of the two cases, P.T.C. revealed a filling defect with dilated common bile ducts(CBD) but we could not make a differential diagnosis of CBD stone from CBD cancer. In another of the two cases, on which intravenous cholangiography was done, we could not see CBD. For the purpuse of precise diagnosis and further differential diagnosis, we performed EST and then ERCP thraugh widened papillae. With those procedures, CBD stones were shown.
Bile ; Biliary Tract Diseases ; Biopsy ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Diagnosis, Differential ; Humans ; Ultrasonography

No abstract available.
Aspergillosis* ; Autopsy* ; Humans ; Lupus Nephritis* ; Tuberculosis*

Objective: Management of heavily pre-treated platinum-resistant ovarian cancer remains a therapeutic challenge. Outcomes are poor with non-platinum, single-agent chemotherapy (CT); however, molecularly targeted anticancer therapies provide new options. Methods: This open-label, investigator-initiated, phase 2 umbrella trial (NCT03699449) enrolled patients with platinum-resistant ovarian cancer (at least 2 prior lines of CT and Eastern Cooperative Oncology Group 0/1) to receive combination therapy based on homologous recombination deficiency (HRD) and programmed death ligand 1 (PD-L1) status determined by archival tumour sample assessment. HRD-positive patients were randomised to either olaparib 200mg bid tablet + cediranib 30mg qd (arm 1) or olaparib 300mg bid tablet + durvalumab 1,500mg q4w (arm 2). HRD-negative patients were allocated to either durvalumab 1,500 mg q4w + pegylated liposomal doxorubicin (PLD) or topotecan or weekly paclitaxel (6 cycles; arm 3, those with PD-L1 expression) or durvalumab 1,500 mg q4w + tremelimumab 75mg q4w (4 doses) + PLD or topotecan or weekly paclitaxel (4 cycles; arm 4, those without PD-L1 expression). Arm 5 (durvalumab 1,500 mg q4w + tremelimumab 300mg [1 dose] + weekly paclitaxel [60 mg/m2 D1,8,15 q4w for 4 cycles] was initiated after arm 4 completed. The primary endpoint was objective response rate (ORR; Response Evaluation Criteria in Solid Tumours 1.1). Results: Between Dec 2018 and Oct 2020, 70 patients (median 57 years; median 3 prior treatment lines [range 2–10]) were treated (n=16, 14, 5, 18, and 17, respectively). Overall ORR was 37.1% (26/70, 95% confidence interval=25.9, 49.5); 2 achieved complete response. ORR was 50%, 42.9%, 20%, 33.3%, and 29.4%, respectively. Grade 3/4 treatment-related adverse events (TRAEs) were reported in 37.5%, 35.7%, 20%, 66.7%, and 35.3% of patients, respectively. No TRAEs leading to treatment discontinuation and no grade 5 TRAEs were observed. Conclusion This study, the first biomarker-driven umbrella trial in platinum-resistant recurrent ovarian cancer, suggests clinical utility with biomarker-driven targeted therapy. All treatment combinations were manageable, and without unexpected toxicities.

In traffic accidents, wearing a seatbelt can cause abdominal aortic injury due to an abrupt deceleration. We report a case of abdominal aorta dissection caused by a seat belt in a frontal motor vehicle collision. The initial symptoms and signs were vague or uncertain. However, he complained severe abdominal pain with seat belt sign below the umbilicus. Abdominal computed tomography scans showed an initial flap of the abdominal aorta with hematoma and hazy stranding of the mesentery.
Abdominal Pain ; Accidents, Traffic ; Aorta, Abdominal* ; Deceleration ; Hematoma ; Mesentery ; Motor Vehicles* ; Seat Belts* ; Umbilicus

Human placenta synthesizes bioactive corticotropin releasing factor(CRF), a 41 amino acid peptide, which displays identical immunological, biological, and chemical characteristics to hypothalamic CRF. Placental CRF enters the maternal circulation and stimulates release of local placental prostaglandin E2 and F2alpha that have a central role in the mechanisms controlling uterine contractility and cervical softening. A large number of clinical investigators has suggested that placental CRF may be involved in mechanisms leading to labor. As well as CRF`s rises in term pregnancy, maternal serum CRF levels are also elevated in pregnancies complicated by preterm labor. So the clinical use of maternal serum CRF levels as a predictor of preterm labor was proposed. Therefore, we have carried out a prospective study on the efficacy of maternal serum CRF levels in diagnosis of preterm labor. In this study, the subjects consisted of 30 women admitted for the treatment of preterm labor and another 30 women with normal pregnancies between 28 and 36 completed weeks of gestation, and their serum CRF levels were assessed. The results were as follows: 1. In both groups, serum CRF levels were increased as being associated to gestational ages, especially in late pregnancy. 2. In a comparative study between two groups, the serum CRF values of pregnancies complicated by preterm labor were significantly higher than their values of control group(p<0.05). 3. In pregnancies complicated by preterm labor, the serum CRF values of preterm delivery were not significantly elevated comparing with their values of other pregnancies complicated bypreterm labor(p>0.05).
Adrenocorticotropic Hormone* ; Corticotropin-Releasing Hormone* ; Diagnosis* ; Dinoprostone ; Female ; Gestational Age ; Humans ; Obstetric Labor, Premature* ; Placenta ; Pregnancy* ; Prospective Studies ; Research Personnel

BACKGROUND: Severe acute lung injury(ALI), also known as the adult respiratory distress syndrome(ARDS), is a heterogenous nature of dynamic and explosive clinical synrome that exacts a mortality of approximately 50%. Endotoxin(ETX) is an abundant component of the outer membrane of gram-negative bacteria capable of inducing severe lung injury in gram-negative sepsis and gram-negative bacterial pneumonia, which are among the most common predisposing causes of ARDS. The influx of PMNs into airway tissue is a pathological hallmark of LPS-induced lung injury. And th3re is a substantial evidence suggesting that cytokines are important mediators of lung injury in gram-negative sepsis. However, the kinetics of phagocytes and cytokines by an exact time sequence and their respective pathogenic importance remain to be elucidated. This study was performed to investigate the role of phagocytes and proinflammatory cytokines in ETX-induced ALl through a time course of changes in the concentration of protein, TNFa and IL-6, and counts of total and its differential cells in BALF. The consecutive histologic findings were also evaluated. METHOD: The experimental animals, healthy male Sprague-Dawley, weighted 200+/-50g, were divided into controland ALI-group. ALI was induced by an intravenous administration of ETX, 5mg/kg. Above mentioned all parameters were examined at 0(control), 3, 6, 24, 72 h after administration of ETX. TNFa and IL-6 conc. in BALE were measured by a bioassay. RESULTS: The protein concentration and total leukocyte count(TC) in BALF was significantly increased at 3h compared to controls(p<0.05). The protein conc. was significantly elavated during observation period, but TC was significantly decreased at 72h(p<0.05 vs. 24h). There was a close relationship between TC and protein cone. in BALF(r = 0.65, p <0.001). The PMN and monocyte count was well correlated with TC in BALF, and the correlation of PMN(r=0.97, p<0.001) appeared to be more meaningful than that of monoeyte(r = 0.61, p<0.001). There was also a significant correlation between protein cone. and PMN or monocyte count in BALF(PMN vs. monocyte r = 0.55, p<0.005 vs. r = 0.64, p<0.001). The count of monocyte was significantly elavated during observation period though a meaningful reduction of PMN count in BALF at 72h, this observation suggested that monocyte may, at least, partipate in the process of lung injury steadly. In this sudy, there was no relationship between IL-6 and TNFt conc., and TNFa but not IL-6 was correlated with TC(r 0.61, p <0.05) and monocyte(r = 0.67, p<0.05) in BALF only at 3, 6h after ETX introduced. In particular, the IL-6 cone. increased earlier and rapidly peaked than TNFz cone. in BALF. In histologic findings, the cell counts of lung slices were increased from 3 to 72h(p<0.001 vs. NC). Alveolar wallthickness was increased from 6 to 24h(p<0.001 vs. NC). There was a significant correlation between the cell counts of lung slices and alveolar wall-thickness(r= 0.61, p<0.001). This result suggested that the cellular infiltrations might be followed by the alterations of interstitium, and the edematous change of alveolar wall might be most rapidly recovered to its normal condition in the process of repair. CONCLUSION: We concluded that although the role of PMIN is partly certain in ETX-induced ALI, it is somewhat inadequate to its known major impact on ALL Alveolar macrophage and/or non-immune cells such as pulmonary endothelial or epithelial cells, may be more importantly contributed to the initiation and perpetual progression of ETX-induced ALI. The IL-6 in ETX-induced ALI was independent to TNFa, measured by a bioassay in BALF. The early rise in IL-6 in BALF implies multiple origins of the IL-6.
Acute Lung Injury* ; Administration, Intravenous ; Adult ; Animals ; Biological Assay ; Cell Count ; Cytokines ; Epithelial Cells ; Gram-Negative Bacteria ; Humans ; Interleukin-6 ; Kinetics ; Leukocytes ; Lung ; Lung Injury ; Macrophages, Alveolar ; Male ; Membranes ; Monocytes ; Mortality ; Phagocytes* ; Pneumonia, Bacterial ; Rats, Sprague-Dawley ; Sepsis

Isolated rectal adenomatous polyp without genetic background is rarely found in children. A 4-year and 5 month-old girl was admitted for intermittent bloody stools lasting 4 months. A 1.5x1.2 cm sized rectal polyp was found by air contrast barium enema. Endoscopic polypectomy was performed without complications. In histopathologic examination, it was found to be a tubulovillous adenoma. Typical radiologic, colonoscopic, and pathological pictures are presented.
Adenoma* ; Adenomatous Polyps* ; Barium ; Child* ; Enema ; Female ; Humans ; Infant ; Polyps ; Rectum*

PURPOSE: To evaluate the incidence, grade and extent of the degenerative changes in the femoral head articular cartilage in the elderly with hip fracture through gross, histological and immunohistochemical studies. MATERIALS AND METHODS: The study examined 30 femoral heads obtained from patients over 65 years with no arthrosis by radiograph, who had undertaken bipolar hemiarthroplasty due to hip fracture. The mean age of patients was 79.7 years and the study examined three weight bearing zones (anterior, middle and posterior) and one non-weight bearing zone (inferior) of each femoral head. RESULTS: The gross findings showed significant correlation with the Mankin grade for each zone (p<0.05). Twenty four cases (80%) showed mild degeneration according to the Mankin grade and the others moderate. The mean Mankin score at each zone of all femoral heads was 5 points, which indicated mild degeneration. No significant difference was found between the weight bearing zone and the non-weight bearing zone (p=0.75). The distribution of type II collagen antibody stainabilities mainly showed normal or mild degeneration (93.3%). CONCLUSION: Degeneration of the articular cartilage of the femoral heads in the elderly with hip fracture and no arthrosis by radiograph was mostly mild, and showed generalized changes regardless of the zone.
Aged* ; Cartilage* ; Cartilage, Articular ; Collagen Type II ; Head* ; Hemiarthroplasty ; Hip* ; Humans ; Incidence ; Weight-Bearing

Subacute necrotizing lymphadenitis, or Kikuchi's disease, primarily affects the cervical lyrnph nodes of lung adults and has a self-limited clinical course. Differential diagnoses are malignant lymphoma and systemic lupus erythematosus. Recurrence rate is low as 3.3%, and there have been a few reports describing the recurrence of the disease. The symptoms in almost all recurrent cases were similar to those of the early stages of the disease. The etiology of the disease remains unknown, but various viral infections and autoimmune processes have been postulated to be the cause. A 6-year-old boy presented with a fever of approximately 40C degrees, painless lumps on both sides of the neck, and intermittent abdominal pain for 2 weeks. Subacute necrotizing lymphadenitis was diagnosed 3 years before admission, which was reported by us in 1996. Diagnosis of recurred subacute necrotizing lymphadenitis was confirmed by histological examination of the lymph node. We report a recurred case of subacute necrotizing lymphadenitis during childhood.
Abdominal Pain ; Adult ; Child ; Diagnosis ; Diagnosis, Differential ; Fever ; Histiocytic Necrotizing Lymphadenitis ; Humans ; Lung ; Lupus Erythematosus, Systemic ; Lymph Nodes ; Lymphadenitis ; Lymphoma ; Male ; Neck ; Recurrence