INTRODUCTION: Apoptosis is a naturally occurring cell suicide pathway. The absence of a survival factor, such as a particular hormone or growth factor, will induce a cell to initiate its own cell death. This process induced in osteoblast is thought to play a role in the pathophysiology of postmenopausal osteoporosis. Estrogen plays an important role and exerts direct effects on bone cells, but the role in the maintenance of cell survival and apoptosis is poorly understood. Based on the importance of survival factors and cytokines in bone remodeling, some studies suggest that estrogen acts on bone cell by modulation of cytokine production that increases bone resorption. However other studies have not investigated the effect of estrogen on the apoptosis of osteoblast cells. OBJECTIVE: To understand how estrogens regulate the apoptosis of osteoblast cells, the physiologically active etrogen metabolite 17 beta-estradiol was tested to determine its effects on the well characterized murine osteoblastic cell-line MC3T3-E1. METHODS: Experiments were designed to identify the effects of estrogen on TNF-alpha induced apoptosis and cytokine gene expression, and collagen synthesis. RESULTS: 1.Within 48 hours of exposure, recombinant murine at 10(-11)M - 10(-10)M TNF-alpha increased the rates of DNA synthesis and 10(-11)~M - 10(-9)M TNF-alpha reduces cell proliferation. 2.Estrogen treatment coordinately increased DNA contents, cell proliferation and collagen synthetic activity. 3.10(-10)M TNF-alpha increased the IL-1beta, IL-6 gene expression. 4.Estrogen attenuated the TNF-alpha- dependent increase in these gene expression. 5.Murine osteoblastic MC3T3-E1 cells underwent apoptosis following removal of serum, or addition of TNF-alpha, as indicated by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling and DNA fragmentation studies. 6.Estrogen inhibited the apoptosis of osteoblast cells induced by 10(-10)M TNF-alpha but not to the levels observed in those control. CONCLUSION: This in vitro evidence suggests that estrogen might exert at least part of antiapoptotic inflence on the bone cells.
Apoptosis* ; Bone Remodeling ; Bone Resorption ; Cell Death ; Cell Proliferation ; Cell Survival ; Collagen ; Cytokines ; DNA ; DNA Fragmentation ; Estradiol ; Estrogens* ; Female ; Gene Expression* ; Humans ; Interleukin-6 ; Necrosis* ; Osteoblasts* ; Osteoporosis, Postmenopausal ; Suicide ; Tumor Necrosis Factor-alpha

BACKGROUND: Irbersatan, an orally active antihypertensive agent, effectively reduce blood pressure by directly blocking angiotensin II receptors without any significant adverse effects. The purpose of this study is to evaluate the efficacy and safety of irbesartan in patients with mild to moderate hypertension. METHODS: This study enrolled 83 patients who had diastolic pressure above 95 mmHg and below 110 mmHg on two measurements. Sixty eight patients were administered 150mg of irbesartan, an angiotensin II receptor blocker, daily for four weeks as an initial dosage. If the sitting diastolic pressure was equal to or greater than 90 mmHg after a 4 week treatment period, the dosage was doubled until the end of 8 weeks. Baseline pressures, antihypertensive effect, side effects, laboratory findings were compared before and after treatment. RESULTS: Fourty two patients out of 53 patients having completed this study showed decreased blood pressure equal to or more than 5 mmHg of the sitting diastolic pressure (response rate=79%). Twenty one patients out of 53 patients showed normalized blood pressure below 90 mmHg of the sitting diastolic pressure (normalization rate=40%). The extent of decrease in diastolic and systolic blood pressure after eight week treatment was an average 11.7+/-10.1 mmHg and 16.3+/-18.9 mmHg, respectively (p<0.05). Nineteen ontoward side effects was observed in 17 patients out of 68 patients with medication (frequency of ontoward effects=25%). Only one case with headache was considered to be related to the medication. Abnormal laboratory findings were observed in eight patients, and only one case with elevation of bilirubin and ALT levels was considered to be related to the medication. CONCLUSION: In conclusion, irbesartan is a safe and effective antihypertensive drug in patients with mild to moderate hypertension with tolerable side effects.
Bilirubin ; Blood Pressure ; Headache ; Humans ; Hypertension* ; Receptors, Angiotensin

Sixteen multiple primary carcmomas were found in 674 patients with gynecologic malignancies who were treated in our departiment from 1980 to 1992. Cases with possible metastasis or recurrence were not included in this study, The incidence of rnultiple primary carcinomas in gynecologic rnalignancies was 2.1%, Multiple primary carcinomas were encountered in 2.4% of 674 cervical cancers, 1.4% of 73 ovarian cancers respectively. The most frequent sites of uther cancers were seen in the stomach(5/16) and lung(3/l6).
Humans ; Incidence ; Neoplasm Metastasis ; Ovarian Neoplasms ; Recurrence

Infiltrating lipoma is one of the most deep-seated benign soft tissue tumor which occupies less than 1% in lipomas. There are two different types of infiltrating lipoma, one intramuscular lipoma, and the other intermuscular lipoma. Nevus lipomatosus cutaneous superficialis is a very rare skin disease which is characterized by the ectopic presence of mature adipose tissue in the dermis. In this disease two clinical types are distinguished: The first classic type is the multiple lesions of zonal distribution usually on the buttocks or on the lower back area. The second type is the solitary papule or nodule with less restricted tendency in its distrubution. We described a 31-year-old man who had a relatively well-defined localized, skin colored, 20x20cm sized, subcutaneous mass partially covered with brown colored papules and plaque on the left subscapular area. The skin lesion began about 11 years ago with brown colored papules and gradually increased in size to 20x20cm mass. Histopathological and clinical findings showed ectopic fat lobules consisted of almost mature cells in the dermis, between the each muscle fibers, and each muscle bundles.
Adipose Tissue ; Adult ; Buttocks ; Dermis ; Fluconazole ; Humans ; Lipoma* ; Nevus* ; Skin ; Skin Diseases

BACKGROUNDS: Katz index of ADL and Barthel index of ADL have been used to evaluate the function of disabled elderly in Korea. But no ADL scale reflecting Korean's own language expression and culture has been developed and verified yet. METHODS: Descriptions of basic activities which needed others' help were collected from 190 Korean disabled elderly. The collected results were categorized into basic activities of daily living and instrumental activities of daily living, and then in each domain such as bathing, shopping, etc. Preliminary instrument items were selected by the judgement of the expert committee, considering the frequency of the responses and the importance of each item. A preliminary questionnaire was developed based on the selected items. The preliminary questionnaire was pretested twice, and corrected by the results. Finally a scholar on Korean literature verified the questionnaire on the grammar and context. RESULTS: A total of 408 basic activities of daily living and 242 instrumental activities of daily living were collected. The activities were categorized into 7 domains of ADL(dressing, washing face and hand, bathing, eating, transfer, toileting, continence) and 10 domains of IADL(decorating, housework, preparing meals, laundry, outgoing for a short distance, using transportation, shopping, handling money, using telephone, taking medicine) CONCLUSIONS: We developed a Korean Activities of Daily Living(K-ADL) scale and Korean Instrumental Activities of Daily Living(K-IADL) scale reflecting Korean elderly's own language expression and culture.
Activities of Daily Living ; Aged ; Baths ; Eating ; Hand ; Housekeeping ; Humans ; Korea ; Meals ; Surveys and Questionnaires ; Telephone ; Transportation

Arteriovenous malformation of the gut is well known to have been an important bleeding focus in past ages. We report a young Korean male patient, who had been known to have ventricular septal defect, presenting massive lower gastrointestinal bleeding from an arteriovenous malformation involving a long segment of the left colon. Angiographic, gross and histologic findings are presented and the literature is reviewed.
Adult ; Arteriovenous Malformations/pathology ; Arteriovenous Malformations/complications* ; Colon/blood supply* ; Gastrointestinal Hemorrhage/etiology* ; Heart Septal Defects, Ventricular/complications* ; Human ; Male

BACKGROUND/AIMS: Colonoscopic surveillance is currently recommended after polypectomy owing to the risk of newly developed colonic neoplasia. However, few studies have investigated colonoscopy surveillance in Asia. This multicenter and prospective study was undertaken to assess the incidence of advanced adenoma based on baseline adenoma findings at 3 years after colonoscopic polypectomy. METHODS: A total of 1,323 patients undergoing colonoscopic polypectomy were prospectively assigned to 3-year colonoscopy surveillance at 11 tertiary endoscopic centers. Relative risks for advanced adenoma after 3 years were calculated according to baseline adenoma characteristics. RESULTS: Among 1,323 patients enrolled, 387 patients (29.3%) were followed up, and the mean follow-up interval was 31.0±9.8 months. The percentage of patients with advanced adenoma on baseline colonoscopy was higher in the surveillance group compared to the non-surveillance group (34.4% vs. 25.7%). Advanced adenoma recurrence was observed in 17 patients (4.4%) at follow-up. The risk of advanced adenoma recurrence was 2 times greater in patients with baseline advanced adenoma than in those with baseline non-advanced adenoma, though the difference was not statistically significant (6.8% [9/133] vs. 3.1% [8/254], P=0.09). Advanced adenoma recurrence was observed only in males and in subjects aged ≥50 years. In contrast, adenoma recurrence was observed in 187 patients (48.3%) at follow-up. Male sex, older age (≥50 years), and multiple adenomas (≥3) at baseline were independent risk factors for adenoma recurrence. CONCLUSIONS: A colonoscopy surveillance interval of 3 years in patients with baseline advanced adenoma can be considered appropriate.
Adenoma ; Asia ; Colon ; Colonic Polyps ; Colonoscopy ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Male ; Prospective Studies ; Recurrence ; Risk Factors

This report describes an uncommon case of hypertrophic obstructive cardiomyopathy (HOCM) accompanying infundibular stenosis of the right ventricle treated by alcohol ablation therapy, in a 28-yr-old male patient presenting with dyspnea on exertion. HOCM with infundibular stenosis was detected by echocardiogram and cardiac catheterization and patient has dynamic obstructions of both ventricular outflow tracts. We performed alcohol ablation therapy to improve clinical symptoms and to relieve dynamic obstructions of both ventriclular outflow tracts. This is the first case in which HOCM with infundibular stenosis of the right ventricle was treated by alcohol ablation therapy.
Adult ; Alcohols/therapeutic use ; Cardiomyopathy, Hypertrophic/*therapy ; Catheter Ablation ; Constriction, Pathologic/*therapy ; Echocardiography ; Heart Catheterization ; Heart Septum/pathology ; Heart Ventricles/pathology ; Human ; Male ; Pressure ; Ventricular Outflow Obstruction/therapy

The incidence of colorectal carcinoid tumor is recently increasing as screening colonoscopy increased. Traditional carcinoid tumor had been known as low grade, malignant neuroendocrine cell orign tumor. In 2000, World Health Organization (WHO) suggested that carcinoid was called well-differentiated neuroendocrine tumor (NET). It recently updated in 2010 by WHO; according to the differentiation and malignant potential, NET classified with NET Grade 1, Grade 2, and neuroendocrine carcinoma. They suggested that NET had malignant potential in accordance with histopathologic characteristics. Therefore, WHO recommended the behavior code of NET as malignant. However, European Neuroendocrine Tumor Society (ENETS) proposed the behavior of NET to four grades based on the histopathologic features; benign, benign or low grade malignant, low grade malignant, and high grade malignant. Also, American Joint Committee on Cancer (AJCC) suggested that topography codes of NET were defined as malignant. Korean Standard Classification of Diseases (KCD) described the different codings of carcinoid (NET). The discrepancies of behavior code or coding system exist among WHO, ENETS, AJCC and KCD. Also, there were differences in the perception for topographic coding system between clinicians and pathologists. NETs of colorectum were reported with the variable clinical characteristics (especially, metastasis) and long term prognosis from many studies. Especially, risk of metastasis and long term prognosis of small sized NET (<1 cm) had some discrepancies and should be investigated prospectively. Therefore, the consensus about topographic codes of NET should be needed with multidisplinary approach among gastroenterologists, pathologists and surgeons.
Carcinoid Tumor ; Carcinoma, Neuroendocrine ; Clinical Coding ; Colonoscopy ; Consensus ; Incidence ; Joints ; Mass Screening ; Neoplasm Metastasis ; Neuroendocrine Cells ; Neuroendocrine Tumors ; Prognosis ; World Health Organization

The Korean Standard Classification of Diseases (KCD), which reflects the International Classification of Diseases (ICD), is a fundamental coding system for the diagnosis of colorectal epithelial tumors. The KCD coding of colorectal lesions is entirely up to the clinician and is based on pathologic reports. However, coding discrepancies have arisen among physicians using the KCD and pathologists using the ICD for Oncology-3 (ICD-O-3). The Korean Society of Pathologists recently proposed a standardized pathology-reporting format and guidelines for the coding of colorectal cancer to decrease these discrepancies among pathologists. However, ICD and ICD-O are simple classification codes based on pathologic reports, and are neither intended nor suitable for indexing of distinct clinical entities. For appropriate diagnostic coding using the KCD, a corrected coding principle based upon pathologic reports is required, and unified coding between KCD and ICD-O is necessary. A standardized pathologic report format and communication with understanding between physicians and pathologists should be established. Additionally, the private medical insurance system for colorectal cancer should be revised to reduce conflicts among patients, clinicians, and insurance companies over the medical coding system.
Abstracting and Indexing as Topic ; Clinical Coding ; Colorectal Neoplasms ; Humans ; Insurance ; International Classification of Diseases