Among the enzymes which are responsible for basement membrane breakdown, matrix metalloproteinases (MMP) form a family of neutral proteases that are regulated at the levels of gene transcription, proenzyme activation by the cleavage of protein, and the inhibition of the active enzyme by tissue inhibitors of matrix metalloproteinases (TIMP). Recent reports have demonstrated that the expression of these proteolytic enzymes are elevated in several solid tumors and that it can be associated with invasiveness and poor prognosis. We examined the expression of MMP-2, MMP-9, TIMP-1 and TIMP-2 by immunohistochemistry in 160 cases of infiltrating ductal carcinoma. And we compared these data with the established prognostic parameters - tumor size, nodal status, clinical stage, hormonal receptor status, microvessel density, and TGF-beta1 expression in order to evaluate how MMP and TIMP expression are associated with breast cancer progression and prognosis. Microvessel density in invasive breast carcinoma was significantly correlated with tumor size and recurrence (p<0.05). The immunohistochemical expression of TGF-beta1 was significantly associated with tumor size, lymph node metastasis, and clinical stage (p<0.05). The microvessel density was significantly correlated with TGF-beta1 expression in more than 50% of tumor cells. The immunohistochemical expression of MMP-2 and MMP-9 were significantly correlated with nodal metastasis and absence of immunoreactivity for estrogen and progesterone receptors. The immunohistochemical expression of TIMP-1 was inversely correlated with clinical stage and microvessel density while that of TIMP-2 was inversely correlated with clinical stage (p<0.05). Small size of tumor, presence of progesterone receptor, highly differentiated histologic grade, and absence of immunoreactivity for MMP-9 were significantly associated with higher survival rate, but in multivariate analysis only tumor size and MMP-9 expression appeared to affect survival independently.
Basement Membrane ; Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Estrogens ; Humans ; Immunohistochemistry ; Lymph Nodes ; Matrix Metalloproteinases ; Microvessels ; Multivariate Analysis ; Neoplasm Metastasis ; Peptide Hydrolases ; Prognosis ; Receptors, Progesterone ; Recurrence ; Survival Rate ; Tissue Inhibitor of Metalloproteinase-1 ; Tissue Inhibitor of Metalloproteinase-2 ; Transforming Growth Factor beta1

No abstract available.
Biopsy, Fine-Needle* ; Fasciitis*

No abstract available.
Islets of Langerhans* ; Lymph Nodes* ; Neoplasm Metastasis*

Polyarteritis nodosa is systemic necrotizing vasculitis of medium and small-sized arteries and results in variable manifestations due to ischemia of the involving organs. Diagnosis can either be made pathologically by demonstrating necrotizing vasculitis of arteries or angiographycally by demonstrating small arterial aneurysm. We experienced a case of PAN with dilated cardiomyopathy, confirmed by clinical feature, renal biopsy, angiography and echocardiography.
Aneurysm ; Angiography ; Arteries ; Biopsy ; Cardiomyopathy, Dilated* ; Diagnosis ; Echocardiography ; Ischemia ; Polyarteritis Nodosa* ; Vasculitis

A retrospective review of 14 patients treated non-operatively or operatively for burst fractures of the low lumbar spine(L4-L5) between January 1992 and December 1997 was performed. Burst fractures of the low lumbar spine are rare and have not been well delineated in the literature. Average follow-up period for fourteen patients was 10.6 months. Ten patients were men and four were women. The average age at injury was 36.8 years(range 17-70 years). Seventy-one percent of the injuries were the result of fall from height and 29% were the result of motor vehicle accidents. Non-operatively treated six patients were presented with minimal canal compromise and minimal or no initial neurological deficit. They were treated 4-6weeks of bed rest before they were allowed to mobilize with orthosis. None of these patients had any significant complications. If patients showed neurological impairment associated with significant canal compromise or vertebral height loss, they were treated operatively to restore spinal stability and spinal height and also to decompress neural elements. Various types of combined surgical approaches were used for eight patients who met these criteria. Among these, two were treated in a staged fashion with the anterior transperitoneal approach done initially. Vertebrectomy and complete neural decompression in direct vision was possible and interbody fusion was performed using Mesh cage, which was filled with bone collected from sites of vertebrectomy. This combined approach seems to be the choice of procedure for complete decompression and interbody fusion of the low lumbar burst fracture(L4-L5) with severe canal compromise and vertebral height loss. Transperitoneal approach for the low lumbar vertebrectomy has advantage of less muscular damage compared to retroperitoneal approach. There were no major complications from surgery in the present series.
Bed Rest ; Decompression ; Female ; Follow-Up Studies ; Humans ; Male ; Motor Vehicles ; Orthotic Devices ; Retrospective Studies ; Spine

BACKGROUND: This study was designed to examine the interactions between mivacurium and vecuronium when administered during a standardized technique. METHODS: Eighty patients (ASA physical status I or II) were randomly assigned to one of four groups (n=20). Their neuromuscular function was measured in response to ulnar nerve supramaximal square-wave TOF stimulation at 10-sec intervals. After the attainment of a stable baseline neuromuscular response, the patients were randomly assigned to receive a rapid iv bolus of either: (1) 3M group (n=20): mivacurium 0.21 mg/kg. Alone, or (2) 2M1V group (n=20): mivacurium 0.14 mg/kg plus vecuronium 0.05 mg/kg, or (3) 1M2V group (n=20): mivacurium 0.07 mg/kg plus vecuronium 0.10 mg/kg, or (4) 3V group (n=20): vecuronium 0.15 mg/kg alone. The onset time of the neuromuscular block, time of recovery of T1 to 25% and reblock time (the time from the reinjection of vecuronium at the time of recovery of T1 to 25% to the time of recovery of T1 to 25%: T25-25) were measured. The intubating condition was evaluated clinically with a scoring system. RESULTS: The onset of block in the 3M group was 33% slower than in the 3V group. The time durations until 25% recovery in the 2M1V, 1M2V and 3V groups were longer than in the 3M group, and the durations in the 1M2V and 3V groups were longer than in the 2M1V group. The T25-25 reblock times of the 2M1V, 1M2V and 3V groups were prolonged in comparison to that of the 3M group. There was no difference in intubating conditions between any of the groups. CONCLUSIONS: A combination of mivacurium with vecuronium provides rates of onset and duration of block which are more effective than an equivalent dose of mivacuriun alone as an additive reaction.
Anesthesia, General* ; Humans ; Neuromuscular Blockade* ; Ulnar Nerve ; Vecuronium Bromide*

No abstract available.

Histopathological changes under occulsive dressing with 0.1% triamcinolone acetonide cream, 0 025% fluocinolone acetonide cream, and 1% hydrocortisone cream were compared each other and with the changes following topical application of 5% ammoniated mercury ointment without occulsion in five cases of psoriasis vulgaris. 1) The earliest changes noticed were the diminution of the papillary edema, the appearence of the granular layer and the disappearence of parakeratosis. 2) A week after treatment, the remarkable changes revealed were the thinning of the epidermis, the diminution of acanthosis, papil]ary edema and cell infiltration of the upper dermis and the appearence of the granular layer. 3)The capillary dilatation remained unchanged even two weeks after treatment in all groups. 4) Among these drugs, the best respanse revealed was triamcinolone cream, the next was fluocinolone cream. The response of hydrocortisone cream was poorer than fluocinolone cream and ammoniated mercury ointment was even more poorer than hydrocortisone cream.
Adrenal Cortex Hormones* ; Bandages* ; Capillaries ; Dermis ; Dilatation ; Edema ; Epidermis ; Fluocinolone Acetonide ; Hydrocortisone ; Parakeratosis ; Psoriasis* ; Triamcinolone ; Triamcinolone Acetonide

Urinary cytology is increasingly accepted as a diagnostic tool in the detection and follow-up of patients with bladder cancer. However, its value is reduced by several limitations, especially by the tack of cytologic criteria specifically reflecting the morphology of low-grade urothelial neoplasm. We reviewed histologically proven 50 cases of urine cytology with emphasis on cytologic findings of benign atypia and differential findings of urothelial neoplasm according to the grade. The diagnoses included 17 benign lesions (including 5 cases of urine calculi) and 33 malignant lesions(including 28 transitional cell carcinomas. 3 squamous cell carcinomas, 1 adenocarcinoma and 1 prostate adenocarcinoma). Diagnostic accuracy was 92%. Important cytodiagnostic criteria for benign atypia and low grade malignancy were cellularity, number of cell clusters, and morphology and arrangement of urothelial cells. The cytologic findings of urothelial neoplasms according to histologic grade were relatively well correlated with the histologic findings. However, the cytologic criteria were not sufficient to readily distinguish grade I from grade II. In view of this, we think that cytologic nomenclature "low-grade" and "high-grade" is a more reliable criterion. Recognition of subtle cellular morphologic features specific for urothelial lesions(including benign or malignancy) and proper fixation, processing and staining of specimen can expand the role of urinary cytology in detection and follow-up of patients.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Carcinoma, Transitional Cell ; Diagnosis ; Humans ; Prostate ; Urinary Bladder Neoplasms

Efforts from many different approaches have been made to cure Raynand's phenomenon, such as a dorsal sympathectomy, topical injection of nitroglycerin, phentolamin and procaine, and oral or parentral administration of various drugs. However, there has been no successful management proven yet. In recent years, it was reported that intra-arterial administration in normal subjects as well as patients with Raynaud's syndrome has demonstrated a significant rise in blood flow to the hands. We used intermittent stellate ganglion blocks in conjunction with intra-arterial injections of reserpine and procaine in 10 patients suffering from finger necrosis. The stellate ganglion block was performed in a paratracheal approach by injection of 1% lidocaine purposely mixed with adrenaline followed by the administration of reserpine 1mg and procaine 50mg through a butterfly needle inserted in the radial or brachial artery. The administration of reserpine and procaine was done only twice at intervals of 1 week because of the development of suspected arterisclerosis. The stellate ganglion block was carried out once a week for about 3 months, then once a month as needed for 6 to 12 months. AS the procedure was carried out and the necrotic tissue sloughed off, oozing appeared and new granulation tissue was observed. 5 out of 10 patients were healed completely and the rest improved considerably but were not followed to the end. We concluded that the intra-arterial administration of reserpine and procaine helped initiate and accelerate increasing blood flow to the hand and the stellate ganglion block continued to help revascularization by dilating the peripheral beds.
Brachial Artery ; Butterflies ; Epinephrine ; Fingers ; Granulation Tissue ; Hand ; Humans ; Injections, Intra-Arterial ; Lidocaine ; Necrosis ; Needles ; Nitroglycerin ; Procaine ; Reserpine* ; Stellate Ganglion* ; Sympathectomy