Vulvar glassy cell carcinoma (GCC) is a very rare neoplasm. Although GCC is considered to be a poorly differentiated variant of adenosquamous carcinoma, its real nature is still debatable. We report a case of GCC of the vulva in a 53-year-old woman and review the literatures. The patient had bleeding from the lesion of the vulva and pelvic MRI revealed left inguinal lymph node enlargement. Histologically a cytoplasm of ground glass appearance was observed with a distinct cell wall and large nucleus containing prominent nucleoli. The clinical stage of the tumor was III as classified by the International Federation of Gynecology and Obstetrics (FIGO). She was treated by a left hemivulvectomy and bilateral inguinal lymphadenectomy and followed by external irradiation to the pelvis and left inguinal area. The patient was still alive without evidence of disease after 12 months treatment.
Carcinoma, Adenosquamous ; Cell Wall ; Cytoplasm ; Female ; Glass ; Gynecology ; Hemorrhage ; Humans ; Lymph Node Excision ; Lymph Nodes ; Magnetic Resonance Imaging ; Middle Aged ; Obstetrics ; Pelvis ; Vulva ; Vulvar Neoplasms

PURPOSE: To establish new in vitro model systems that better reflect in vivo condition, multicellular tumor spheroids(MTS) and raft culture were developed using cell lines of squamous cell carcinoma(SCCHN) of the head and neck. In these 3-dimensional systems, the expression of cell surface molecules which are important for modulation of physiology of tumor cells were studied with or without the treatment of interferon(IFN)-gamma. MATERIALS AND METHODS: Four SCCHN cell lines were used for MTS and raft culture. The effects of interferon-gamma on SCCHN cells were examined by immunohistochemistry. RESULTS: All cell lines formed MTS, but only Tu-138 showed a good stratification at the air-liquid interface in the raft culture system. Immunohistochemical studies of MTS using monoclonal antibodies revealed a strong staining for MHC class I, no staining for MHC-DR, a weak patch expression of ICAM-1 and a central strong staining for integrin a 6. Staining patterns were similar for the raft cultures except integrin a 6(intense full-thickness positivity). In both systems, IFN-gamma enhanced the expression of MHC-DR and ICAM-1. No significant change was found in the expression of MHC class I and integrin a 6. CONCLUSIONS: MTS and raft culture system were established successfully from the SCCHN cell lines. IFN-gamma can modulate the surface molecules of tumor cells in the 3-dimensional culture systems.
Antibodies, Monoclonal ; Carcinoma, Squamous Cell* ; Cell Line ; Head* ; Immunohistochemistry ; Intercellular Adhesion Molecule-1 ; Interferon-gamma ; Neck* ; Physiology

Depression is a common psychiatric illness with a high lifetime prevalence in the general population. Serious problem, such as suicide is commonly occurring in the patients with depression. Till now, the monoamine hypothesis has been the most popular theory of pathogenesis for depression. However, the more specific pathophysiology of depression and cellular molecular mechanism underlying action of commercial antidepressant has not been clearly defined. Several recent studies demonstrated that neural plasticity, epigenetic and mammalian target of rapamycin signaling are promising answers to the pathophysiology of depression. In this article, current understanding of biology and molecular mechanisms of depression and new research on the pathophysiology of depression will be discussed.
Biology ; Depression ; Epigenomics ; Humans ; Molecular Biology ; Plastics ; Prevalence ; Sirolimus ; Suicide

Depression is a common mental illness with a high lifetime prevalence rate in the general population. However, the pathophysiology of depression is still poorly understood. Recent studies showed that environmental factors can affect gene expression by modifying epigenetic factors. Early life stress (ELS) is likely a risk factor of lifetime vulnerability to stress and development of depression. ELS or stressful lifetime can induce changes in gene expression through epigenetic mechanism, such as DNA methylation or histone modification. In this article, recent researches on the epigenetic mechanisms of depression will be discussed.
Depression* ; DNA Methylation ; Epigenomics* ; Gene Expression ; Histones ; Prevalence ; Risk Factors ; Stress, Psychological

Loeys-Dietz syndrome (LDS) is an autosomal dominant connective tissue disorder that is characterized by aggressive arterial and aortic disease, often involving the formation of aortic aneurysms. We describe the cases of two children with LDS who were diagnosed with aortic root aneurysms and successfully treated by valve-sparing aortic root replacement (VSRR) with a Valsalva graft. VSRR is a safe and suitable operation for children that avoids prosthetic valve replacement.
Aneurysm ; Aorta ; Aortic Aneurysm ; Aortic Diseases ; Child* ; Connective Tissue ; Humans ; Loeys-Dietz Syndrome* ; Transplants

PURPOSE: The success rate for the replantation of an amputated digit in children is low. It demands precise anastomosis of vessels and nerves and expert technique. This paper reports upon cases of digital replantation in children. MATERIALS AND METHODS: From April 1994 to December 1999, 34 amputated digits of 30 patients were replanted. According to the age distribution, there were 18 children under 5 years of age, 5 between 6 and 10, and 7 between 11 and 15. Guillotine type of amputation was dominant and 19 cases were at zone I. End to end anastomosis of the digital artery and dorsal vein, vein graft, and the external bleeding method and epineurial suture were performed. RESULTS: The overall success rate was 88.2%, in zone I 16/19 cases, in zone II 10/11 cases and zone III 4/4 cases. CONCLUSION: The rate of survival of the amputated part in children was 88.2%. Although it is difficult to perform anastomosis of small vessels, postoperative physical therapy and the external bleeding method, digital replantation in children is recommended, when feasible, in order to prevent functional and growth disturbances for cosmetic reasons.
Age Distribution ; Amputation ; Arteries ; Child* ; Fingers* ; Hemorrhage ; Humans ; Replantation* ; Sutures ; Transplants ; Veins

PURPOSE: To correlate clinical results of arthroscopic debridement of degenerative knee with preoperative factors. MATERIALS AND METHODS: A retrospective survey of 61 patients (81 knees) with degenerative arthritis of knee treated with arthroscopic debridement from June 1995 to June 1997 was conducted. The average follow-up period was 22.7 months (12-35 months). There were 6 male and 55 female patients. The average age was 61.1 years. The arthroscopic procedure included excision of osteophytes, removal of loose body, meniscal trimming, synovectomy and irrigation of the knee joint. Statistical analysis was done for parameters such as knee alignment, joint space narrowing, flexion contracture, meniscal tear, articular cartilage degeneration, age, follow-up period and preoperative Insall knee score. RESULTS: A statistically significant difference in clinical results was noted in the separate subgroups for radiographic alignment (chi-square test, P=0.007) and degree of cartilage degeneration (P=0.006). Those patients with joint space narrowing, flexion contracture, meniscal tear or low Insall knee score had poor results after arthroscopic surgery. CONCLUSIONS: Though the result of arthroscopic debridement of degenerative knee is known to be unpredictable, some preoperative factors are correlated with poor outcomes, and arthroscopic treatment should be carefully selected.
Arthroscopy ; Cartilage ; Cartilage, Articular ; Contracture ; Debridement ; Female ; Follow-Up Studies ; Humans ; Joints ; Knee Joint ; Knee* ; Male ; Osteoarthritis ; Osteophyte ; Retrospective Studies

Coronavirus disease 2019 (COVID-19) is a serious infectious disease with multisystem alteration including neurological complications. COVID-19 associated encephalitis is a potentially fatal viral infection of the brain. Diffusion-weighted images (DWI) are a useful evaluation modality of cytotoxic edema in patients with encephalitis. We report on the reversible DWI change in a patient with COVID-19 associated encephalitis, who had diffused cytotoxic edema in the affected temporal lobe and accompanied status epilepticus. Sequential imaging showed that the cytotoxic edema in DWI confirmed recovery to normal after 12 days in the presence of cortical edema in fluid-attenuated inversion recovery image after aggressive neurocritical management. Thus, prompt, proper management is indispensable during the acute period and DWI may be a valuable tool for reflecting the clinical course of COVID-19 associated encephalitis.

Objective: To determine the factors affecting the amount of weight-bearing during gait training in the elderly patients who underwent internal fixation after femur or pelvic fractures and how well they performed the weight-bearing restriction as directed by the physiatrist. Methods: In this retrospective chart review study, we measured the amount of weight-bearing on the affected side in 50 patients undergoing internal fixation surgery and rehabilitation after femur or pelvic fracture using a force plate. Patients receiving non-weight-bearing or partial weight-bearing education were considered to perform weight-bearing restriction well when the amount of weight-bearing was <50 lb. Furthermore, regression analysis was performed to determine the effects of postoperative complications, age, cognitive function, and pain on weightbearing restriction. Results: Variables affecting the amount of weight-bearing were age (r=0.581, p<0.001), weight-bearing education type (r=0.671, p<0.001), manual muscle strength of hip flexion on the non-affected side (r=-0.296, p=0.037), hip abduction (r=-0.326, p=0.021), knee extension (r=-0.374, p=0.007), ankle plantar flexion (r=-0.374, p=0.008), right hand grip strength (r=-0.535, p<0.001), Korean version of Mini-Mental State Examination (r=-0.496, p<0.001), Clinical Dementia Rating (r=0.308, p=0.03), and pain visual analog scale scores (r=0.318, p=0.024). The significant predictor of the amount of weight-bearing among these variables was age (β=0.448, p=0.001). The weight-bearing restriction adherence rate was significantly lower, at 22%, for patients aged ≥65 years as compared to 73% for those <65 years. Conclusion Age was a major variable affecting the amount of weight-bearing. Compliance with weight-bearing restriction was significantly lower in patients aged ≥65 years than in patients <65 years.

Acute mesenteric ischemia can result from emboli, arterial and venous thrombi or vasoconstriction secondary to low-flow states. Isolated spontaneous dissection of the superior mesenteric artery is a rare cause of acute mesenteric ischemia. The mortality rates of acute mesenteric ischemia averages 71% with a range of 59-93%. Diagnosis before the occurrence of intestinal infarction is the most important factor in improving survival rate for patients with acute mesenteric ischemia. A 68-year-old female presented with postprandial epigastric pain, and a dissection of the superior mesenteric artery and a gallbladder polyp were shown in abdominal computed tomographic scan. After the percutaneous metalic stent placement and laparoscopic cholecystectomy, her symptoms improved. We report a case of spontaneous dissection of main trunk of the superior mesenteric artery which was successfully treated by percutaneous stent placement with a review of literature.
Acute Disease ; Aged ; Aneurysm, Dissecting/complications/*therapy ; *Angioplasty, Balloon ; Female ; Humans ; Ischemia/etiology ; *Mesenteric Artery, Superior ; Mesenteric Vascular Occlusion/etiology ; *Stents