PURPOSE: Tension-free hernioplasty has become the most popular procedure for the repair of groin hernias in the United States and United Kingdom. The purpose of this study is to describe a 7-year personal experience with Lichtenstein's tension-free groin hernia repair under local anesthesia. METHODS: We retrospectively studied the clinical outcome of 321 cases of Lichtenstein repairs, performed consecutively by an experienced surgeon between Jan. 1994 and Dec. 2000. RESULTS: Of the 321 cases, 242 (75.4%) were indirect, 34 (10.6%) were direct, 8 (2.5%) were femoral, 7 (2.2%) were pantaloon, and 30 (9.3%) were recurred hernias. The mean age was 55 years; 91% were male. The mean number of injections of analgesics required in the postoperative period was 3.2. The mean hospital stay following repair was 2.7 days. Complications occurred in 23 cases (7.1%). Most of these were minor, consisting of five cases of bruising or hematomas (1.6%), four superficial infections (1.3%), three seromas (0.9%), two hydroceles (0.6%), six patients with persisting groin pain for more than a month (1.8%), one foreign body granuloma, one urinary retention, and one testicular atrophy. There were no recurrences or operative deaths. CONCLUSION: Lichtenstein's tension-free hernioplasty is an easy and simple technique with less pain, minor complications and only rare instances of recurrence. This procedure can be performed on a same-day basis under local anesthesia. Lichtenstein repair may be the most promising technique for the repair of groin hernias.
Analgesics ; Anesthesia, Local ; Atrophy ; Granuloma, Foreign-Body ; Great Britain ; Groin* ; Hematoma ; Hernia* ; Herniorrhaphy ; Humans ; Length of Stay ; Male ; Postoperative Period ; Recurrence ; Retrospective Studies ; Seroma ; United States ; Urinary Retention

The developmental changes of the lingual salivary glands in the postnatal rats were examined by lectin histochemical methods. For the morphological changes, H-E and PAS staining were used. The biotinylated lectins used in the study were DBA, SBA, PNA, BSL-1, sWGA, RCA-1, UEA-1, Con A and LCA. The promordia and undifferentiated acini of the lingual glands were found in the mucous glands at 0 day suckling rat and the von Ebner's glands at 3 day suckling rat, respectively. The differentiation and maturation of the lingual glands were faster than those of the von Ebner's gland. The differentiation and proliferation of both glands were occurred remarkably at suckling periods rather than weaning periods. The lectin binding pattern of glandular promordia and undifferentiated serous acini in von Ebner's gland was weak in BSL-1 and weak to moderate in RCA-1. DBA and sWGA showed tendency to increase in 1 week suckling rat, but The binding reactivity of other lectins was disappeared except BSL-1 that was reacted tracely in 2 and 3 weak suckling and 4 week weaning rat. RCA-1, PNA, sWGA, BSL-1 and SBA of the differentiated serous acini were appeared in the 2 week suckling rat and SBA and sWGA was more intense. Especially, the reactivity of these lectins of suckling periods was showed more tendency to increase than that of weaning periods. The increase of PNA, SBA and BSL-1 was prominent during suckling and weaning periods. RCA-1 and sWGA were decreased in 5 week rat, increased in 6 week rat, and then decreased in adult rat. UEA-1 which was not shown from 0 day to 2 week was showed trace to moderate reactivity in some serous acini. Con A and PNA of glandular promordia and undifferentiated mucous acini were appeared trace or weak, and absent at 0 day suckling rat, but PNA reactivity was showed tendency to incerase at 3 day suckling rat. Other lectins of these promordia and acini were not showed reactivity. In the differentiated mucous acini at 0 day suckling rat, all mucous acini were weak to moderate with DBA, and some of mucous acini also were weak to moderate with BSL-1. Most mucous acini showed weak reactivity with SBA, but some mucous acini showed trace or weak reactivity with RCA, PNA, sWGA and BSL-1. The reactivity of BSL-1 and sWGA was increased from birth to 2 week and then decreased, and absent at 5 week. But it increased at 6 week. RCA-1 and PNA also increased in the acini up to 1 week. However, PNA reactivity was absent at 5 and 6 week. With RCA-1, the intensity of reactivity was increased. Differentiated mucous acini was reacted to increase with SBA from birth, the intensity was strong in weaning periods rather than suckling period. UEA-1 reactivity was showed to decrease from 1 week to 2 week and moderately increased from 3 week to 5 week, and thereafter decreased. DBA binding pattern was somewhat changed throughout the observation periods but it was predominent.
Adult ; Animals ; Glycoconjugates* ; Humans ; Lectins ; Parturition ; Rats* ; Salivary Glands* ; von Ebner Glands ; Weaning

The developmental changes of the lingual salivary glands in the postnatal rats were examined by morphological and prelectin histochemical methods. For the morphological changes, H -E and PAS staining were used. The mucosubstances stained with PAS, AB pH 2.5, AB pH 1.0 and AF pH 1.7 -AB pH 2.5. The promodia and undifferentiated acini of the lingual glands were detected the mucous glands at o day suckling rat, the von Ebner 's glands at 3 day suckling rat, respectively. The differentiation and maturation of the lingual glands were appeared rapidly than that of the von Ebner 's gland, and that of both glands were occurred remarkably suckling periods more than weaning periods. von Ebner 's gland contained only neutral mucins during postnatal developmental rat. The undifferentiated serous acini of these gland contained a small amounts of neutral mucins from 3 day suckling rat, and the amounts of these mucins were increased continuously according to the differentiation of these glands. The amounts of these mucins predominated at weaning periods more than suckling periods. The lingual mucous glands contained the mixture of neutral and acid mucins, and the amounts of these mucins were tended continuously to increase according to the glandular differentiation. In these glands, the suckling periods were predominant with neutral mucins, but weaning periods were abundant in acid mucins. The differentiated mucous acini of the lingual gland contained large amounts of neutral mucins and small to moderate amounts of acid mucins from 0 day suckling rat, but the undifferentiated mucous acini contained small to moderate amounts of neutral mucins and trace amounts or none of acid mucins in the suckling rat. The amounts of sulfomucin and sialomucin of the differentiated mucous acini was increased in both suckling and weaning periods. The increase of these mucins was markable in weaning periods than suckling periods. The amount of sialomucin was abundant at 0 day suckling rat, but the amount of sulfomucin very increased after 3 day suckling rat, and these mucins strikingly increased after 2 weeks suckling rat.
Animals ; Glycoconjugates* ; Hydrogen-Ion Concentration ; Mucins ; Rats* ; Salivary Glands* ; Sialomucins ; Weaning

PURPOSE: Peroxisome proliferator-activated receptor gamma (PPARgamma) has become a potential target for the prevention and treatment of human cancers. PPARgamma ligands inhibit cell proliferation of estrogen receptoralpha(ERalpha)-positive breast cancer cells. However, it has recently been shown that ERalpha-negatively inhibits PPARgamma signaling in breast cancer cells, indicating that PPARgamma ligand may be more useful for treating ERalpha-negative breast cancer cells compared to ERalpha-positive breast cancer cells. In this study, we attempted to elucidate the role of PPARg in ERalpha-negative breast cancer cells. METHODS: The effect of PPARgamma ligand on the growth of MDA-MB-231 cells was measured by MTT assay and flow cytometric analysis. TUNEL staining and Hoechst 33342 fluorescent staining were used to observe the effects of PPARgamma ligand on cell apoptosis. The regulatory proteins of the cell cycle were measured by Western blot. RESULTS: The treatment of MDA-MB-231 human breast cancer cells with the PPARgamma ligand, trgoglitazone, was shown to induce inhibition of cell growth in a dose-dependent manner. Cell cycle analysis showed a G1 arrest in MDA-MB-231 cells exposed to troglitazone. The apoptotic effect by troglitazone demonstrated that apoptotic cells were elevated from 2.5-fold of the control level at 10 mM, to 3.1-fold at 50micrometer and to 3.5-fold at 75 mM of troglitazone. Moreover, troglitazone treatment dose-dependently caused a marked decrease in the pRb, cyclin D1, cyclin D2, cyclin D3, cdk2, Cdk4 and Cdk6 expressions and there was a significant increase in the p21 and p27 expressions. CONCLUSION: These results indicate that trgoglitazone induces cell-cycle G1 arrest and apoptosis in ERalpha-negative MDA-MB-231 breast cancer cells. Collectively, this paper shows that PPARgamma ligand is an important player as a member of the chemotherapeutic candidates for treating ERalpha-negative breast cancer.
Apoptosis* ; Blotting, Western ; Breast Neoplasms* ; Breast* ; Cell Cycle ; Cell Proliferation ; Cyclin D1 ; Cyclin D2 ; Cyclin D3 ; Estrogens ; Humans ; In Situ Nick-End Labeling ; Ligands ; Peroxisomes* ; PPAR gamma*

Extramammary Paget's disease is an uncommon intraepithelial malignancy that usually presents as a well circumscribed, reddish eczematous patch on the apocrine-bearing regions such as the genital and perineal areas. It progresses slowly with local extension. However, it may become invasive and may be associated with internal malignancies. Extramammary Paget's disease has high local recurrence rates after complete surgical excision and therefore, long-term follow-up is necessary. Extramammary Paget's disease of the axilla is extremely rare, with few reported cases. We report here a case of extramammary Paget's disease of the axilla in a 68-yr-old man, with a review of the literature.
Axilla ; Follow-Up Studies ; Paget Disease, Extramammary ; Recurrence

A 37-week gestation female neonatal infant presented with lower abdominal distension. Ultrasonography showed a hydrocolpos, measuring 8.3 cm x 6.9 cm x 6.1 cm in size and on perineal examination, vaginal atresia was noticed. On a follow-up ultrasonography performed 41 days after aspiration, the hydrocolpos was enlarged to 10 cm x 8 cm x 7 cm in size, and compressed adjacent small bowel significantly with concomitant bilateral hydronephrosis. Temporary tubed vaginostomy was carried out with the provision of excellent drainage and easy access for contrast studies to outline the pathologic anatomy. We are planning to perform vaginal reconstructive surgery on her age around 2 years, when her vaginal structure might grow sufficiently for reconstructive surgery.
Drainage ; Female ; Follow-Up Studies ; Gynecological Examination ; Humans ; Hydrocolpos* ; Hydronephrosis ; Infant ; Pregnancy ; Ultrasonography

BACKGROUND: Ventricular remodeling after myocardial infarction increase mortality and morbidity. Two-dimensional echocardiography in acute myocardial infarction provides a useful diagnostic tool for evaluation of ventricular remodeling. The aims of this study were to verify whether follow-up two-dimensional echocardiography could detect ventricular enlargement after acute myocardial infarction and to find early echocardiographic predictors and clinical charateristics of ventricular enlargement. METHODS: Two-dimensional echocardiography was done prospectively at 2 week, 3 month, and 6 month after the first Q-wave acute myocardial infarction in 18 patients. The control group was 11 patients of a normal chest roentgenogram and echocardiogram who were studied for chest pain or arrhythmia. The patients were divided by the mean value of the control group left ventricular end-diastolic volume index(LVEDVI) 56.8ml/m2. The group A was more than 60ml/m2(the control group LVEDVI 56.8ml/m2) and the group B was less than 60ml/m2 of LVEDVI at 2 week post myocardial infarction. The left vantricular volume was measured by the modified disk method at the apical four chamber view. The wall motion abnormality of left ventricle was examined by the recommendation of the American Society of Echcardiography. RESULTS: The left vntricular end-diastolic volume and the left ventricular end-systolic volume were enlarged after 3 month of acute myocardial infarction in the group A compare with those of the control group. There was no ventricular enlargement during 6 month after myocardial infarction in the group B. The frequency of ventricular enlargement was increased in anterior myocardial infarction. There was no difference in left ventricular ejection fraction at 2 week post myocardial infarction between the group A(51.4+/-15.7%) and the group B(50.8+/-10.3%). The wall motion score index more than 1.5 at 2 week post myocardial infarction means the enlarged LVEDVI more than 60ml/m2 and the group of ventricular enlargement. CONCLUSION: The left ventricular enlargement could be diagnosed by the follow-up two-dimensional echocardiography in acute myocardial infarction. The echocardiographic early predictors of ventricular enlagement were the left ventricular end-diastolic volume greater than 60ml/m2 and increased wall motion score index more than 1.5 at 2 week post myocardial infarstion. The anterior myocardial infarction was the electrocardiographic predictor of ventricular dilatation. Therefore these early predictors could identify the patients of ventricular enlargement and these patients could be a candidate of follow-up echocardiography and of a specific treatment for limiting ventricular remodeling.
Arrhythmias, Cardiac ; Chest Pain ; Dilatation ; Echocardiography* ; Electrocardiography ; Follow-Up Studies ; Heart Ventricles ; Humans ; Mortality ; Myocardial Infarction* ; Prospective Studies ; Stroke Volume ; Thorax ; Ventricular Remodeling

PURPOSE: Microfat graft is a common procedure for correcting tear trough deformity and dark circle. Because the tissue in this area is very thin, the grafted fat, sometimes, induces palpable lumps and uneven skin contour. When it happens, the surgical removal of the grafted fat is often needed. The authors made attempt of transconjunctival approach for removal, and this made infraorbital fat repositioning possible at the same time. METHODS: 15 female patients with history of microfat graft on lower eyelid, got operation for the grafted fat removal with transconjunctival approach from April of 2009 to July of 2010. The dissection was performed in accordance with infraorbital fat repositioning surgery. Through the transconjunctival incision, knotted fat on orbital septum and orbicularis oculi muscle was removed without damage on skin. After grafted fat removal, subperiosteal space was made 1~2mm below the inferior orbital rim by elevating periosteum. With preserving orbital septum, infraorbital fat was repositioned and anchored to subperiosteal space. Finally, transconjunctival incision was closed with absorbable suture material. RESULTS: 14 patients in the study showed satisfactory results. The problems like uneven skin contour and knotted fat mass, were all solved. In only one patient, incomplete correction was observed, as bulging on her right lower eyelid still remained. One patient complained of transient numbness on lower eyelid, but there was no specific complication other than this. CONCLUSION: The authors attempted the method of transconjunctival approach to remove former grafted fat in lower eyelid and reposition infraorbital fat simultaneously. Since the study brought great results, the method would be helpful to patients and surgeons.
Congenital Abnormalities ; Eyelids ; Female ; Humans ; Hypesthesia ; Muscles ; Orbit ; Periosteum ; Skin ; Sutures ; Transplants

BACKGROUND: This study was designed to determine the optimal sedative dose of propofol to start brain magnetic resonance imaging (MRI) in children with cerebral palsy (CP). METHODS: Twenty children, aged 0.5-5 years, were administered propofol to achieve a University of Michigan Sedation Scale (UMSS) score > or = 3 in the MRI room. The proper dose of propofol was determined using the up-and-down method. RESULTS: The ED50 and ED95 for successful sedation with a UMSS > or = 3 were 2.07 mg/kg (95% CI 1.69-2.56) and 2.69 mg/kg (95% CI 2.35-5.59). Respiratory events occurred in 5 patients and were resolved with neck extension, chin lift, or transient respiratory assistance with successful sedation. CONCLUSIONS: Low dose propofol can safely facilitate the initiation of MRI in children with CP.
Aged ; Brain ; Cerebral Palsy ; Child ; Chin ; Humans ; Magnetic Resonance Imaging ; Michigan ; Neck ; Propofol

Metastatic breast cancer from a primary cervical cancer is extremely rare with few cases reported. A diagnosis of breast metastasis can present difficulties due to various clinical, radiological, and histological manifestations. The important factors that suggest an appropriate diagnosis are the history of the cancer, specific mammographic or ultrasonographic findings and a correlation between the histology of the metastatic and primary tumor. Only an accurate diagnosis can avoid an unnecessary mastectomy and is required to institute an appropriate systemic oncological therapy. An metastatic breast cancer has a poor prognosis. We report a case of a 39-year-old woman with primary cervical cancer who developed a breast metastasis with a review of the literature.
Adult ; Breast Neoplasms* ; Breast* ; Diagnosis ; Female ; Humans ; Mastectomy ; Neoplasm Metastasis ; Prognosis ; Uterine Cervical Neoplasms*