PURPOSE: With an accumulation of surgical experience for endoscopic or video-assisted thyroidectomy and improvements in surgical techniques and endoscopic instruments, these procedures have become a valid option for patients with benign thyroid nodules. These applications are now being expanded even to selected patients with low risk thyroid carcinomas. This study was performed to suggest new modified methods of approach on the use of a gasless endoscopic thyroidectomy via an axillary approach and to evaluate the short-term outcomes. METHODS: Between May 2004 and March 2007, 66 female patients underwent a gasless endoscopic thyroidectomy via an axillary approach. Surgical outcomes were evaluated in terms of surgical time, length of hospital stay, the incidence of perioperative complications, and patient opinion at two and four months after surgery. RESULTS: No cases required conversion to open surgery. The mean surgical time was 136.5±31.8 minutes, and the mean length of hospital stay was 4.2±1.1 days. There were two transient recurrent laryngeal nerve palsies, two minor tracheal injuries without air leakage, and two postoperative hemorrhages that required a second surgery. Only one patient (1.9%) and five patients (9.4%) complained of slight hypesthesia or paresthesia in the neck and anterior chest wall, respectively, and only three patients (5.7%) complained of discomfort while swallowing 4 months after surgery. CONCLUSION: Gasless endoscopic thyroidectomy via an axillary approach is a feasible and safe procedure and providesa minimal degree of postoperative complaints. This procedure is now a valid option for the surgical treatment of benign thyroid disease and its applications will broaden in the near future.
Conversion to Open Surgery ; Deglutition ; Female ; Humans ; Hypesthesia ; Incidence ; Length of Stay ; Neck ; Operative Time ; Paralysis ; Paresthesia ; Postoperative Hemorrhage ; Recurrent Laryngeal Nerve ; Thoracic Wall ; Thyroid Diseases ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy*

The biological activities of PDGF include stimulation of mitogenesis, chemotaxis, and differentiation. In nervous system, previous studies have shown that PDGF has an important role in the generation of cells of a glial lineage. However, several studies demonstrated that mature and immature neurons could also synthesize PDGF-alphaR. In the present study, to analyze the distributional pattern of PDGF-alphaR during postnatal development of the canine cerebellum, we used immunohistochemistry. We found that neurons of cerebellum, including Purkinje cells and granules cells, showed immunoreactivity to PDGF-alphaR (IRPDGF-alphaR) as early as postnatal day 0. Whereas IRPDGF-alphaR immunoreactivity in the Purkinje cells were maintained at all postnatal ages. Our data support that PDGF may have the important roles during development and survival of neurons.
Animals ; Cerebellum* ; Chemotaxis ; Dogs ; Immunohistochemistry ; Nervous System ; Neurons ; Platelet-Derived Growth Factor* ; Purkinje Cells

Chronic endometritis (CE) is a condition involving the breakdown of the peaceful co-existence between microorganisms and the host immune system in the endometrium. A majority of CE cases produce no noticeable signs or mild symptoms, and the prevalence rate of CE has been found to be approximately 10%. Gynecologists and pathologists often do not focus much clinical attention on CE due to the time-consuming microscopic examinations necessary to diagnose CE, its mild clinical manifestations, and the benign nature of the disease. However, the relationship between CE and infertility-related conditions such as repeated implantation failure and recurrent miscarriage has recently emerged as an area of inquiry. In this study, we reviewed the literature on the pathophysiology of CE and how it may be associated with infertility, as well as the literature regarding the diagnosis and treatment of CE. In addition, we discuss the value of hysteroscopic procedures in the diagnosis and treatment of CE.
Abortion, Habitual ; Diagnosis ; Endometritis* ; Endometrium ; Female ; Fertilization in Vitro ; Hysteroscopy ; Immune System ; Infertility* ; Pregnancy ; Prevalence

PURPOSE: To evaluate the age-related risk factors, clinical manifestations, and prognosis in infectious keratitis. METHODS: Records of patients with infectious keratitis who visited one of the two tertiary medical centers at Jeolla-do from January 2000 to December 2007 were reviewed. Risk factors depending on patient age distribution standardized over and under the age of 60 were reviewed retrospectively by analyzing sex, age, previous history of trauma, systemic disease, previous ocular disease, causative organism and treatment. RESULTS: A total of 757 patients (757 eyes) visited either one of the two tertiary medical centers. The mean age was 58.2+/-18.0 (4 to 93) years, and patients included 437 males (57.7%), and 320 females (42.3%). The most common risk factor among all age groups was trauma, especially due to vegetable matter. The second most frequent risk factor among the younger patients was contact lens use (19.2%), and common risk factors among the elderly were previous ocular disease (20.0%), systemic disease (15.5%), and ocular surgery (9.7%). The most prevalent causative organisms among all age groups were Gram-positive bacteria, in particular Staphylococcus epidermidis. Elderly patients had a higher frequency of corneal perforation than did younger patients. In addition, elderly patients had a worse prognosis and more often required surgical treatment. CONCLUSIONS: Infectious keratitis has more severe clinical manifestations and complications and a worse prognosis in elderly than in younger patients. Elderly patients have more diverse risk factors. Prevention should aim at avoiding ocular trauma, especially by vegetable matter, and at controlling ocular surface diseases, such as exposure keratitis and bullous keratopathy.
Age Distribution ; Aged ; Corneal Perforation ; Female ; Gram-Positive Bacteria ; Humans ; Keratitis ; Male ; Prognosis ; Retrospective Studies ; Risk Factors ; Staphylococcus epidermidis ; Vegetables

OBJECTIVE: A number of disease-modifying anti-rheumatic drugs (DMARDs) have been shown to be more effective than placebo in the management of rheumatoid arthritis (RA). However, most course of DMARDs, except methotrexate, are discontinued after 2 or 3 years, because of toxicity, lack of efficacy or escape from control. The multi-drug resistance (MDR) is a phenomenon in which cells develop cross-resistance to many agents such as anthracyclin, vinca alkaloids and colchicine. In our hypothesis, MDR phenomenon could be implicated in acquired resistance to DMARDs in RA. We have established a mdr1 cell line and tested whether DMARDs are substrate for P-glycoprotein (P-gp). METHODS: The mdr1-cDNA was cloned into retroviral vector, and the recombinant retroviral vector was transfected into PA317 cells. The target cells, NIH3T3, were infected with recombinant retroviruses. A colony most resistant to vinblastin was selected for the following experiments; expression of mdr1 gene in NIH3T3 cells was confirmed by RT-PCR, and biological function of mdr1 gene product, P-gp, was tested using Rhodamine-123 (Rh123) efflux assay. Resistance of the target cells expression P-gp which can survive against hydroxychloroquine (HCQ) and methotrxate (MTX) were measured by MTT assay. RESULTS: RT-PCR for mdr1 gene showed successful transfer of the gene into the NIH3T3 cells. Rh123 assay revealed expression of P-gp on the selected cells as follows; Rh123 efflux activity of uninfected NIH3T3 cells was 6%, that of PLXSN was 0.2%, and that of selected cells was 44%. The 50% proliferation inhibitory capacity of the selected cells were twice for HCQ but there was no difference of that for MTX. CONCLUSION: We established a mdr1 cell line and using the cell line, HCQ was a substrate of MDR, but MTX was not related to MDR.
Antirheumatic Agents* ; Arthritis, Rheumatoid ; Cell Line ; Clone Cells ; Colchicine ; Drug Resistance, Multiple ; Hydroxychloroquine ; Methotrexate ; P-Glycoprotein ; Retroviridae ; United Nations ; Vinca Alkaloids ; Zidovudine

BACKGROUND: About 20% of small cell lung cancer (SCLC) patients have bone marrow (BM) metastasis at the time of diagnosis and the remaining patients are also considered with micrometastasis. In an att empt to detect BM micrometastasis, we used cytokeratin (CK)-20 as a molecular marker, which is specific for epithelial cells. METHOD: A sensitive RT-PCR assay was used to compare CK-20 expression both in SCLC cell line H209 and normal leukocyte and to evaluate BM aspirates of 28 SCLC patients. RESULT: H209 cell line showed CK-20 expression but normal leukocyte did not, suggesting CK-20 expression is lung tissue-specific. Of 28 patients (11 limited disease, 17 extensive disease), only 2 (1/11, 1/17) samples tested revealed positive signal for CK-20. Two patients with CK-20 expression had BM metastasis or multiple bone involvement during follow-up. CONCLUSION: Although circulating tumor cells were detected in BM of small portion of patients with bone metastasis, CK-20 doesn't seem to be a reliable marker for the detection of micrometastasis in SCLC. This study emphasizes that identification of more specific marker for micromatastsis is mandatory prior to clinical application.
Bone Marrow* ; Cell Line ; Diagnosis ; Epithelial Cells ; Follow-Up Studies ; Humans ; Keratins ; Leukocytes ; Lung ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Neoplastic Cells, Circulating ; Small Cell Lung Carcinoma*

Uterine leiomyomas are the most common uterine tumors. They are estimated to be present in approximately 20% of all women of reproductive age. They may be present in subserosal, intramural, or submucosal in location within the uterus, or located in the cervix, in the broad ligaments, or on a pedicle. Many studies report that the malignant potential of a preexisting uterine leiomyoma is extremely rare, occuring in less than 0.5%. Uterine leiomyomas may cause a range of syptoms, for example, severe anemia from abnormal uterine bleeding, dysmenorrhea, constipation from rectosigmoid compression, dysuria, frequency, residual sensation due to bladder compression. Patients with those symptoms or "cancer phobia" should be treated. Rare but severe symptoms associated with uterine leiomyomas are rectosigmoid compression, with intestinal obstruction, thrombophlebitis of lower extremities from venous stasis, polycythemia, ascites, severe pain from torsion and infection of prolapsed pedunculated submucosal myoma and uterine inversion from prolase of pedunculated submucosal leiomyoma. Now we report a rare case of uterine inversion resulted from prolapse of huge pedunculated uterine submucosal leiomyoma, which caused hypovolemic shock due to massive uterine bleeding.
Anemia ; Ascites ; Broad Ligament ; Cervix Uteri ; Constipation ; Dysmenorrhea ; Dysuria ; Female ; Humans ; Intestinal Obstruction ; Leiomyoma* ; Lower Extremity ; Myoma ; Polycythemia ; Prolapse* ; Sensation ; Shock ; Thrombophlebitis ; Urinary Bladder ; Uterine Hemorrhage ; Uterine Inversion* ; Uterus

BACKGROUND: It is known that immunotherapy promotes the development of allergen-specific Thl-like lymphocytes whose products are effective in inhibiting clinical response of sensitized atopic patients to allergen exposure. At the single cell level in short term culture, however, IL-4 and IL-5 are co-expressed, while IL-4 and IFN-y are exclusively expressed. OBJECTIVE: IL-4, IL-5, and IFN-y mRNA were measured in Der pI-specific T-cell clones (TCCs) to evaluate whether expression of cytokine in allergen-specific TCC is fixed regardless of stimuli. METHOD: Seven Der pI-specific TCCs were made from two asthmatics sensitive to D. pteronyssinus. IL-4, IL-5, and IFN-y mRNA were measured by RT-PCR in these TCCs after antigen-specific (Der pI) and nonspecific (PHA + TPA) stimuli. RESULTS: IL-4 and IL-5 mRNA were expressed in four and six of seven TCCs, but IFN-y mRNA was not expressed in any TCCs after Der pI-specific stimuli. Meanwhile, after the stimulus of TPA plus PHA, IFN-y mRNA as well as IL-4 and IL-5 mRNA were expressed in four of seven TCCs, and in one TCC, only IFN-y mRNA was expressed without expression of IL-4 mRNA. CONCLUSION: The expression of cytokine may be variable in allergen-specific TCC according to the type and amount of stimuli.
Asthma ; Clone Cells* ; Humans ; Immunotherapy ; Interleukin-4* ; Interleukin-5* ; Lymphocytes ; RNA, Messenger* ; T-Lymphocytes*

The metastasis of uterine leiomyosarcoma to the neck node has not been reported previously and the radiotherapy has been rarely used for the metastatic lesion of the other sites. We report a case of neck metastasis from a uterine leiomyosarcoma, which developed 10 months after surgery and postoperative pelvic radiotherapy. It also involved the parapharyngeal space, adjacent spine, and spinal canal. The metastatic neck mass was inoperable, and was treated by neck radiotherapy (6,000 cGy) and chemotherapy including taxol and carboplatin. The mass has regressed progressively to a nearly impalpable state. She has never developed spinal cord compression syndrome, and has maintained good swallowing for eight months since the neck radiotherapy and chemotherapy. Since the extensive metastatic neck mass showed good local response to high dose radiotherapy and chemotherapy, both treatments may be considered for an unresectable metastatic leiomyosarcoma.
Carboplatin ; Deglutition ; Drug Therapy* ; Leiomyosarcoma* ; Lymphatic Diseases* ; Neck ; Neoplasm Metastasis ; Paclitaxel ; Radiotherapy* ; Spinal Canal ; Spinal Cord Compression ; Spine

Acute renal failure is a rare complication of acute pyelonephritis. Therefore, acute pyelonephritis is not usually considered in the differential diagnosis of acute renal failure. However, it is important to consider this entity because of potential for recovery of renal function if appropriate early antibiotics are instituted. We report a case of biopsy proven acute pyelonephritis which was manifested as acute renal failure. A 38 year old women was admitted to this hospital owing to abdominal distension and generalized edema. On admission she was started on hemodialysis because of severe hyperkalemia and marked uremic sypmtoms. She had pyuria and hematuria, but no organism was isolated at urine. We initially don't know the cause of renal failure. She was improved with antimicrobial therapy and hemodialysis. A kidney biopsy was performed on the 26th hospital day because of persistent proteinuria. Microscopic examination revealed focal tubular atrophy, necrosis or loss with heavy infilteration of leukocytes and histocytes in interstitium. Atrophic tubules contain pus casts. The patient was treated with ciprofloxacin for 4 weeks. At about 2 month follow up, proteinuria completely disappeared and serum creatinine level decreased to 1.0 mg/dL.
Acute Kidney Injury* ; Adult ; Anti-Bacterial Agents ; Atrophy ; Biopsy ; Ciprofloxacin ; Creatinine ; Diagnosis, Differential ; Edema ; Female ; Follow-Up Studies ; Hematuria ; Humans ; Hyperkalemia ; Kidney ; Leukocytes ; Necrosis ; Proteinuria ; Pyelonephritis* ; Pyuria ; Renal Dialysis ; Renal Insufficiency ; Suppuration