It has been postulated that programmed cell death via apoptosis may be critical for remodelling of glomeruli after inflammatory injury. To understand the regulatory mechanism of apoptosis in experimental crescentic glomerulonephritis (CGN), we examined the MIB-1 score (proliferation index, PI) and apoptotic index during the progression of experimental CGN to end-stage renal failure. CGN was induced in New Zealand White rabbits by administration of guinea pig anti-GBM IgG after sensitization with guinea pig IgG and their kidneys were analyzed for the development of crescents through sequential renal biopsies. Serum creatinine levels progressively increased in a time course until day 45. The PI in glomeruli, tubular epithelial cells, and interstitium progressively increased during the progression of experimental CGN. The mean numbers of MIB-1 positive intraglomerular nuclei (PI) were significantly correlated with degrees of crescent formation and the numbers of apoptotic cells in the glomeruli, tubules, and interstitium. Significant apoptosis was present from day 1 (15.8 10.16 cells/glomerular cross section) and increased in number with the proliferative lesions as glomerular inflammation continued. Moreover, apoptosis increased during the resolution of the glomerular inflammation, and many apoptotic cells were present in the sclerotic lesions in day 17 (18.6 12.99 cells/glomerular cross section). As glomerular inflammation subsided, cellular crescents progressed to fibrous crescents with a reduction of cellularity by day 45. On day 45, the glomerular PI and the numbers of apoptotic cells were markedly decreased. The correlations found in CGN between the creatinine level and the percentage of crescents, between the percentage of crescent and PI, and between the PI and number of apoptotic cells support the hypothesis that there is a change in the glomerular and tubulo-interstitial apoptosis under pathologic conditions. These findings indicate that apoptosis plays an essential role in the resolution of intra- and extraglomerular inflammation and in the elimination of glomerular cells within the sclerotic regions for progressive CGN. The regulation of the apoptotic phenomenon and increased PI during CGN may be important in the progression of glomerular inflammation and the development of pathologic glomerular sclerosis.
Animals ; Anti-Glomerular Basement Membrane Disease ; Apoptosis* ; Biopsy ; Cell Death ; Creatinine ; Epithelial Cells ; Glomerulonephritis* ; Guinea Pigs ; Immunoglobulin G ; In Situ Nick-End Labeling ; Inflammation ; Kidney ; Kidney Failure, Chronic ; Rabbits ; Sclerosis

BACKGROUND: After uninephrectomy(UNX), proliferation and apoptosis of renal cells are regarded to be closely involved in glomerular hypertrophy and compensatory renal growth. However, exact mechanism has not been well elucidated in relation with the growing status. METHODS: In small, medium and large male New Zealand white rabbits, unilateral kidneys obtained 1, 7, and 30 days after Sham operation were used for control. In experimental groups, the rabbits were sacrificed, and residual kidneys were obtained 1, 7, and 30 days after UNX. Morphometric analysis of glomerular size were performed. Immunohistochemical staining for MIB-1 antigen and Tdt-mediated dUTP-digoxigenin nick end labelling(TUNEL) method were performed. RESULTS: Glomerular hypertrophy was demonstrated in all groups after UNX and pronounced in the small rabbits. The number of renal Ki-67 positive cells were progressively increased in all study groups. The number of TUNEL positive cells was relatively small in controls. however, the numbers of glomerular, tubular and interstitial TUNEL positive cells were progressively increased in all study groups. CONCLUSION: These results demonstrate that different results regarding the compensatory growth in uninephrectomized rabbits of different weights and ages. Apoptosis may play an important role in the regression of hypertrophic and proliferated glomerular and tubulointerstitial cells during compensatory renal hypertrophy.
Apoptosis* ; Cell Proliferation* ; Humans ; Hypertrophy ; In Situ Nick-End Labeling ; Ki-67 Antigen ; Kidney ; Male ; Rabbits* ; Weights and Measures

Purpose: Compressive hip dressings have been used to decrease the amount of postoperative bleeding after total hiparthroplasty. However, there is no data showing that a compressive dressing is effective. This study evaluated the effect of compressive dressings on the level of postoperative bleeding after total replacement arthroplasty. Materials and Methods: This prospective randomized clinical trail included 80 consecutive primary total hip arthroplasties in 72 patients. The 80 hips were randomly assigned to a compressive dressing group or a non-compressive dressing group using a table of random numbers. Forty-two hips in 37 patients were treated using the compressive dressing and the remaining 38 hips in 35 patients were treated using a non-compressive dressing. The patients were followed up for an average of 10.3 months. In all patients, a hemovac suction drain was inserted postoperatively. Results: The mean level of bleeding was 626.6 mL in the compressive group and 693.8 mL in the non-compressive group. There was no statistical difference between the two groups (P=0.416). Moreover, the incidence of postoperative complications including dislocation, nerve injury, symptomatic deep vein thrombosis and heterotopic ossification was similar in both groups. Conclusion: These results suggest that the compressive dressing has no significant effect on the amount of postoperative bleeding and clinical results after total hip arthroplasty.
Arthroplasty* ; Arthroplasty, Replacement ; Arthroplasty, Replacement, Hip* ; Bandages ; Dislocations ; Hemorrhage* ; Hip ; Humans ; Incidence ; Ossification, Heterotopic ; Postoperative Complications ; Prospective Studies ; Suction ; Venous Thrombosis

PURPOSE: Early identification of alcohol use disorder (AUD) among patients coming to the emergency department (ED) for treatment is important in order to facilitate timely intervention and further evaluation. A number of brief screening tools have been developed for identifying patients with AUD. This study compared three brief screening tools for detecting DSM-IV-defined AUD. METHODS: A prospective study was performed from 20th of July 2004 to 20th of October 2004 at a university hospital emergency department (ED). We studied trauma patients including trauma patients who needed administration. Patients were screened by AUDIT, CAGE and RAPS test. Receiver operator characteristic analysis were used to evaluate the performance of the brief screens against the criterion of a DSM-IV AUD. RESULTS: One hundred and thirty-five patients were enrolled in this study. Of the existing screening tools, AUDIT had the best overall performance in identifying AUD (sensitivity 98%. specificity 84%) CONCLUSION: Of the existing screening tools used to identify AUD, AUDIT had the best overall performance in identifying AUD in the ED.
Alcohol Drinking ; Diagnostic and Statistical Manual of Mental Disorders ; Emergencies ; Humans ; Mass Screening ; Prospective Studies ; Surveys and Questionnaires ; Sensitivity and Specificity

OBJECTIVES: To clarify the clinicopathologic features of borderline malignancy of the ovary and analyze the treatment and survival characteristics through the study of our cases. Study METHODS: 102 patients with borderline tumors of the ovary, aged from 14 to 79 years, treated between 1982 and 1999 at Seoul National University Hospital, were analyzed retrospectively for clinicopathologic features. Most informations about stage, treatment modality and prognosis were obtained by hospital record or contacting patient with telephone. RESULTS: There were 77 patients (75.5%) with stage Ia, 5 stage Ib, 11 stage Ic, 4 with stage II and 5 with stage III by the classification of FIGO. 72 patients (70.6%) were mucinous type and 28 (27.5%) were serous type, 1 endometrioid type, 1 mixed. Total abdominal hysterectomy, bilateral adnexectomy, and omentectomy were performed in 43 (42.2%) patients and fertility saving surgery in 43 patients(cystectomy in 11 patients, USO in 32 patients). Twenty two patients (21.6%) were treated with postoperative adjuvant chemotherapy. The median duration of follow up was 54.0 months (1-204 months) and 6 patients developed recurrence after several years from the primary operation. The ten-year eumulative survival rate was 92.2% and the only independent prognostic factors evaluated by Cox analysis in regards to corrected survival were the FIGO stage (p=0.0197). There was no difference in the ten-year survival rate between surgery types - conservative surgery versus full surgical staging. And there was no difference in the 10-year survival rate between treatment groups - surgery only versus surgery followed by adjuvant chemotherapy. CONCLUSIONS: FIGO stage is the only independent prognostic factor in the borderline ovarian tumors. There was no difference in the 10-year survival rate of barderline ovarian tumors between surgery alone versus surgery followed by adjuvant chemothearpy. The slow clinical course, low recurrence rate and good prognosis in our patients explained again the reason for therapeutic approach relying on surgery alone.
Chemotherapy, Adjuvant ; Classification ; Female ; Fertility ; Follow-Up Studies ; Hospital Records ; Humans ; Hysterectomy ; Mucins ; Ovary* ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Survival Rate ; Telephone

Primary carcinoma of the fallopian tube is a rare malignancy of the female genital tract and infrequently diagnosed before an operation. The majority of patients have extensive disease at the time of diagnosis. We have experienced incidentally a case of a carcinoma of the fallopian tube coexisting with a benign cystic teratoma of the ovary in a 25-year-old woman. We report this case with a brief review of literatures.
Adenocarcinoma, Papillary/pathology* ; Adult ; Case Report ; Fallopian Tube Neoplasms/pathology* ; Female ; Human ; Neoplasms, Multiple Primary/pathology* ; Ovarian Neoplasms/pathology* ; Teratoma/pathology*

The coexistence of moyamoya disease (MMD) with an arteriovenous malformation (AVM) is exceedingly rare. We report two cases of AVM associated with MMD. The first case was an incidental AVM diagnosed simultaneously with MMD. This AVM was managed expectantly after encephalo-duro-arterio-synangiosis (EDAS) as the main feeders stemmed from the internal carotid artery, which we believed would be obliterated with the progression of MMD. However, the AVM persisted with replacement of the internal carotid artery feeders by new external carotid artery feeders from the EDAS site. The AVM was eventually treated with gamma knife radiosurgery considering an increasing steal effect. The second case was a de novo AVM case. The patient was initially diagnosed with MMD, and acquired an AVM eight years later that was slowly fed by the reconstituted anterior cerebral artery. Because the patient remained asymptomatic, the AVM is currently being closely followed for more than 2 years without further surgical intervention. Possible differences in the pathogenesis and the radiologic presentation of these AVMs are discussed with a literature review. No solid consensus exists on the optimal treatment of MMD-associated AVMs. Gamma knife radiosurgery appears to be an effective treatment option for an incidental AVM. However, a de novo AVM may be managed expectantly considering the possible risks of damaging established collaterals, low flow characteristics, and probably low risks of rupture.
Anterior Cerebral Artery ; Arteriovenous Malformations ; Carotid Artery, External ; Carotid Artery, Internal ; Child ; Consensus ; Humans ; Intracranial Arteriovenous Malformations* ; Moyamoya Disease* ; Radiosurgery ; Rupture

McCune-Albright syndrome (MAS) is characterized by a triad of poly/monostotic fibrous dysplasia, cafe-au-lait macules and hyperfunctioning endocrinopathies including human growth hormone excess. Acromegaly as a manifestation of endocrine hyperfunction with MAS is uncommon. Surgical excision may be challenging due to the associated severe fibrous dysplasia of the skull base. Through the endoscopic procedures, we treated a case of MAS presenting with compressive optic neuropathy due to fibrous dysplasia and acromegaly caused by growth hormone secreting pituitary adenoma. We reviewed the literature on GH excess in MAS to highlight its surgical and medical challenges.
Acromegaly ; Decompression* ; Fibrous Dysplasia, Polyostotic* ; Growth Hormone ; Human Growth Hormone ; Optic Nerve Diseases* ; Pituitary Neoplasms ; Skull Base

McCune-Albright syndrome (MAS) is characterized by a triad of poly/monostotic fibrous dysplasia, cafe-au-lait macules and hyperfunctioning endocrinopathies including human growth hormone excess. Acromegaly as a manifestation of endocrine hyperfunction with MAS is uncommon. Surgical excision may be challenging due to the associated severe fibrous dysplasia of the skull base. Through the endoscopic procedures, we treated a case of MAS presenting with compressive optic neuropathy due to fibrous dysplasia and acromegaly caused by growth hormone secreting pituitary adenoma. We reviewed the literature on GH excess in MAS to highlight its surgical and medical challenges.
Acromegaly ; Decompression* ; Fibrous Dysplasia, Polyostotic* ; Growth Hormone ; Human Growth Hormone ; Optic Nerve Diseases* ; Pituitary Neoplasms ; Skull Base

No abstract available.
Down Syndrome* ; Heart Defects, Congenital*