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

Methemoglobinemia is an uncommon but potentially fatal disorder. Most cases have no adverse clinical consequence and require no treatment, but methemoglobinemia is often overlooked as a cause of low oxygen saturation, and often mistaken for the more common causes of hypoxia by anesthesiologists despite simple bedside tests that indicate the presence of this treatable abnormality. We present a 68-year-old female patient who underwent gastrectomy for advanced gastric cancer with bleeding. In the preoperative period, the patient showed cyanosis and oxygen saturation was 85% by pulse oximeter, but oxygen saturation by arterial blood gas analysis was 100%. After tracheal intubation, the methemoglobin level was 18.3%. Ascorbic acid and methylene blue were administered. During preanesthetic evaluation, the patient had not informed the anesthesiologist that she had been taking dapsone.
Aged ; Anesthesia, General ; Anoxia ; Ascorbic Acid ; Blood Gas Analysis ; Cyanosis ; Dapsone ; Female ; Gastrectomy ; Hemorrhage ; Humans ; Intubation ; Methemoglobin ; Methemoglobinemia ; Methylene Blue ; Oximetry ; Oxygen ; Preoperative Period ; Stomach Neoplasms

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

OBJECTIVE: In trauma patients, the distribution of time to death can be used in many ways. We examined the distribution of time to death in trauma patients who expired during a 10-year and analyzed the risk factors of early deaths. METHOD: From January 1994 to December 2003, trauma patients who had been admitted and had expired at tertiary hospitals were enrolled. A retrospective study was done to determine the distribution of trauma mortality and compared the differences between patients who succumbed during the first 5 years and those who succumbed during the second 5 years. We also analyzed the risk factors associated with early deaths that occurred within 6 hours after injury. RESULT: The distribution was bimodal for both the first and the second 5 years. During the second 5 years, there was about two times as many death within 1 hour after injury. The average ages were 36.5 years for the first 5 years and 43.6 years for the second 5 years (p<0.05). The transport times were 35 minutes for the first 5 years and 31.5 minutes for the second 5 years, and the transports by EMS (119) increased from 45.2% to 77.1%. Motor vehicle accidents were the most common mechanism of injury in both periods, but the number was lower in the second 5 years (p<0.05). The most common causes of death were injuries of head and spine and hemorrhages. Risk factor of early deaths were injury of nervous system and chest trauma. CONCLUSION: In our study, the distribution of trauma mortality was bimodal pattern. The trauma system in Korea should be improved to decrease the early and the late peak. To decrease early deaths, it is important to prevent accident, develop EMS for early transport and pre-hospital management, and connect effectively with the trauma center. To decrease late deaths, aggressive resuscitation, suitable antibiotic therapy, and conservative treatment are important.
Cause of Death ; Head ; Hemorrhage ; Humans ; Korea ; Mortality ; Motor Vehicles ; Nervous System ; Resuscitation ; Retrospective Studies ; Risk Factors ; Spine ; Tertiary Care Centers ; Thorax ; Trauma Centers

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

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

OBJECTIVE: The purpose of this study was to investigate the clinical features and outcomes of pediatric cavernous malformation (CM) in the central nervous system. METHODS: Twenty-nine pediatric patients with supratentorial CM underwent microsurgical excision. In selected cases, transparent tubular retractor system (TTRS) was used to reduce retraction injury and intraoperative neuromonitoring (IONM) was held to preserve functioning cortex. Patients' demographics and symptoms were reviewed and surgical outcomes were discussed. RESULTS: The main initial clinical manifestations included the following : seizures (n=13, 45%), headache (n=7, 24%), focal neurological deficits (n=3, 10%), and an incidental finding (n=6, 21%). Overt hemorrhage was detected in 7 patients (24%). There were 19 children (66%) with a single CM and 10 (34%) children with multiple CMs. In 7 cases with deep-seated CM, we used a TTRS to minimize retraction. In 9 cases which location of CM was at eloquent area, IONM was taken during surgery. There was no major morbidity or mortality after surgery. In the 29 operated children, the overall long-term results were satisfactory : 25 (86%) patients had no signs or symptoms associated with CMs, 3 had controllable seizures, and 1 had mild weakness. CONCLUSION: With the assistance of neuronavigation systems, intraoperative neuromonitoring, and TTRS, CMs could be targeted more accurately and excised more safely. Based on the satisfactory seizure outcome achieved, complete microsurgical excision in children is recommended for CMs presenting with seizures but removal of hemosiderin-stained areas seems to be unnecessary.
Central Nervous System ; Child ; Demography ; Headache ; Hemangioma, Cavernous, Central Nervous System* ; Hemorrhage ; Humans ; Incidental Findings ; Mortality ; Neuronavigation ; Seizures