The incidence of the tuberculosis infection has decreased worldwide, but it is still easy to find the patients in some areas or some races. And it is very difficult to diagnose and treat the patients who are infected by the atypical tuberculosis. Facial skin infection by atypical tuberculosis has not been reported. We report the case of a 62-year-old woman who developed facial skin and soft tissue necrosis caused by Mycobacterium abscessus after receiving liquid silicone injections and face lift operation. We cultured the pathogenic organism and treated the wound with radical curettage, debridement, skin graft and tuberculosis medication.
Continental Population Groups ; Curettage ; Debridement ; Female ; Humans ; Incidence ; Middle Aged ; Mycobacterium* ; Necrosis ; Rhytidoplasty ; Silicones ; Skin* ; Transplants ; Tuberculosis ; Tuberculosis, Cutaneous* ; Wounds and Injuries

PURPOSE: This study evaluated the effect and safety of photodynamic therapy (PDT) with verteporfin retreatment on patients with corneal neovascularization. METHODS: Corneal neovascularization was induced with a silk suture of the corneal stroma in 24 white rabbits (48 eyes). Four rabbits were examined histologically before performing PDT. Ten rabbits were chosen randomly, one eye from each rabbit was treated with PDT at 50 J/cm2, and the other eye was used as a control. Both eyes of the remaining 10 rabbits were treated with PDT at 150 J/cm2. One week later, one eye was further retreated with PDT at the same intensity. The area of corneal neovascularization was measured and evaluated histologically using light and electron microscopies. RESULTS: The least neovascularized area was observed in the retreated group (P=0.04). The histologic examination revealed fewer new corneal vessels in the retreated group, but the corneal epithelium, stroma, and endothelium showed a normal appearance. Results from electron microscopic examination demonstrated thrombi as well as destruction and nuclear fragmentation of the vascular endothelial cells. However, there were no other changes in the cornea except for vascular endothelial cells, even in the retreated group. CONCLUSIONS: In conclusion, these results suggest that PDT with verteporfin retreatment appears to be safe and significantly more effective in patients with regression of corneal neovascularization.
Cornea ; Corneal Neovascularization ; Corneal Stroma ; Electrons ; Endothelial Cells ; Endothelium ; Epithelium, Corneal ; Eye ; Humans ; Light ; Microscopy ; Photochemotherapy ; Porphyrins ; Rabbits ; Retreatment ; Silk ; Sutures ; Triazenes

Extensive hepato-biliary-pancreatic (H-B-P) surgery is still associated with a high postoperative morbidity and mortality than other intraabdominal organ operation. Especially, iatrogenic pseudoaneurysm of splanchnic artery after major H-B-P surgery, although not frequent, can be a devastating and often leads to fatal hemorrhage due to aneurysm rupture. In a series of 300 patients who underwent major hepato-biliary-pancreatic surgery between 1989 and 1995, 6 patients with iatrogenic pseudoaneurysm were reviewed retrospectively. There were 1 hepatic artery pseudoaneurysm after hepatopancreaticoduodenectomy and portal vein resection for Klatskin tumor, 1 proper hepatic artery pseudoaneurysm after extended right hepatectomy and bile duct resection for Klatskin tumor, 1 superior mesenteric artery and common hepatic artery pseudoaneurysm after pancreatoduodenectomy for periampullary cancer, 1 hepatic artery pseudoaneurysm after pancreatoduodenectomy for periampullary cancer,1 pseudoaneurysm of anastomotic site between hepatic artery and splenic artery after type II regional total pancreatectomy for periampullary cancer, and 1 pseudoaneurysm of iliac artery conduit for hepatic artery reconstruction after orthotopic liver transplantation. Five of these 6 pseudoaneurysms were resulted from aggressive radical surgery including skeletonization of hepatoduodenal ligament. Pseudoaneurysm should be highly suspected when continued leukocytosis, fever and gastrointestinal bleeding such as hematemesis or melena are shown. Celiac angiogram should be considered for the early detection of pseudoaneurysm. Angiographic embolization might be considered as a primary treatment, however, if it is not successful, early surgical intervention might be an another life-saving option.
Aneurysm ; Aneurysm, False* ; Arteries* ; Bile Ducts ; Fever ; Hematemesis ; Hemorrhage ; Hepatectomy ; Hepatic Artery ; Humans ; Iliac Artery ; Klatskin's Tumor ; Leukocytosis ; Ligaments ; Liver Transplantation ; Melena ; Mesenteric Artery, Superior ; Mortality ; Pancreatectomy ; Pancreaticoduodenectomy ; Portal Vein ; Retrospective Studies ; Rupture ; Skeleton ; Splenic Artery

PURPOSE: Conventional hemorrhoidectomy is inevitably painful as a result of an anodermal wound. Circumferential stapled hemorrhoidectomy may be associated with less postoperative pain than conventional hemorrhoidectomy. The aim of this study is to evaluate whether a circumferential stapled hemorrhoidectomy, which uses PPH (Procedure for Prolapse and Hemorrhoids), offers any advantage over the conventional hemorrhoidectomy. METHODS: We analyzed the clinical results of hemorrhoidectomy of 122 patients with symptomatic hemorrhoids. There were two categories of patients: those receiving a circumferential stapled hemorrhoidectomy (n=50) and those receiving a conventional hemorrhoidectomy (n=72). The majority of cases were carried out under spinal anesthesia. The operation time, hospital stay, pain score, complications, and the number of days before returning to normal activity were recorded. A follow up was done using a questionnaire or through a telephone interview two weeks and six weeks after the operation. RESULTS: The mean distance from the dentate line to the completion line of stapling was 1.3+/-0.1 cm. There were two cases of the incomplete doughnut. The circumferential stapled hemorrhoidectomy took less time to perform (20.5+/-4.5 vs. 24.3+/-7.1 min). The mean visual analogue pain score (0~10) on the 2nd day and two weeks after operation was lower in the stapled group (4.1 and 1.5 vs. 6.1 and 3.1)(P<0.05). The stapled group had a shorter duration of hospital stay (4.1 days vs. 5.3 days)(P<0.05) and had a faster recovery to normal activity (7.6 days vs. 13.6 days)(P<0.05). Circumferential stapled hemorrhoidectomy controlled the symptoms of prolapse, pain, and bleeding in all patients. There were 2 cases of urinary retention in both groups, respectively, but there were no postoperative bleeding. CONCLUSION: Even though long term follow up is required, no major complications were observed in our series. The results of our experience for circumferential stapled hemorrhoidectomy appear encouraging. We assume that circumferential stapled hemorrhoidectomy is a safer and faster technique which can replace conventional hemorrhoidectomy techniques.
Anesthesia, Spinal ; Follow-Up Studies ; Hemorrhage ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Interviews as Topic ; Length of Stay ; Pain, Postoperative ; Prolapse ; Surveys and Questionnaires ; Urinary Retention ; Wounds and Injuries

PURPOSE: Conventional hemorrhoidectomy is inevitably painful as a result of an anodermal wound. Circumferential stapled hemorrhoidectomy may be associated with less postoperative pain than conventional hemorrhoidectomy. The aim of this study is to evaluate whether a circumferential stapled hemorrhoidectomy, which uses PPH (Procedure for Prolapse and Hemorrhoids), offers any advantage over the conventional hemorrhoidectomy. METHODS: We analyzed the clinical results of hemorrhoidectomy of 122 patients with symptomatic hemorrhoids. There were two categories of patients: those receiving a circumferential stapled hemorrhoidectomy (n=50) and those receiving a conventional hemorrhoidectomy (n=72). The majority of cases were carried out under spinal anesthesia. The operation time, hospital stay, pain score, complications, and the number of days before returning to normal activity were recorded. A follow up was done using a questionnaire or through a telephone interview two weeks and six weeks after the operation. RESULTS: The mean distance from the dentate line to the completion line of stapling was 1.3+/-0.1 cm. There were two cases of the incomplete doughnut. The circumferential stapled hemorrhoidectomy took less time to perform (20.5+/-4.5 vs. 24.3+/-7.1 min). The mean visual analogue pain score (0~10) on the 2nd day and two weeks after operation was lower in the stapled group (4.1 and 1.5 vs. 6.1 and 3.1)(P<0.05). The stapled group had a shorter duration of hospital stay (4.1 days vs. 5.3 days)(P<0.05) and had a faster recovery to normal activity (7.6 days vs. 13.6 days)(P<0.05). Circumferential stapled hemorrhoidectomy controlled the symptoms of prolapse, pain, and bleeding in all patients. There were 2 cases of urinary retention in both groups, respectively, but there were no postoperative bleeding. CONCLUSION: Even though long term follow up is required, no major complications were observed in our series. The results of our experience for circumferential stapled hemorrhoidectomy appear encouraging. We assume that circumferential stapled hemorrhoidectomy is a safer and faster technique which can replace conventional hemorrhoidectomy techniques.
Anesthesia, Spinal ; Follow-Up Studies ; Hemorrhage ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Interviews as Topic ; Length of Stay ; Pain, Postoperative ; Prolapse ; Surveys and Questionnaires ; Urinary Retention ; Wounds and Injuries

OBJECTIVE: During pregnancy, the impaired placental perfusion causes complications such as preeclampsia, intrauterine growth restriction and fetal death in utero. In order to investigate the maternal and fetal response to the impaired placental perfusion, the author induced the impaired placental perfusion by the ligation of the rat uterine artery and investigated its effect on the expression of VEGF (vascular endothelial growth factor) in the placenta and serum VEGF level. METHODS: The rats on day 15 of gestation were used for the experiment. They were divided into two groups. The control group consists of the 20 rats that underwent laparotomy without uterine artery ligation. The experimental group consists of the 20 rats that underwent laparotomy and the uterine artery ligation by silk on day 15 of gestation. On day 16, 17, 18 and 19 of gestation, the placental tissues were obtained. The mRNA expressions of the VEGF in the placenta were measured by the relative RT-PCR in the control and experimental group. The localization and intensity of immunohistochemical staining of VEGF in placenta were determined in both groups and the maternal serum levels of VEGF were also measured in both groups. RESULTS: The mRNA expressions of VEGF120 and VEGF164 were significantly increased 48 hours after the ligation (day 17 of gestation) but the mRNA expression of VEGF188 was not changed after the ligation. There was no difference in the location and intensity of immunohistochemical staining of VEGF in the placenta between control and experimental groups. The serum VEGF levels of control group were 9 times as high as those of non-pregnant rats. The significant increases of the serum VEGF levels were noted 48 and 72 hours after the ligation (day 17 and 18 of gestation) but the significant increase was not noted 96 hours after the ligation (day 19 of gestation) as compared to control group. CONCLUSION: This study demonstrated firstly that the experimentally induced reduction of placental perfusion increased expressions of VEGF in the placenta and maternal serum. The results support that the measurement of maternal serum VEGF levels in pregnancy may help the diagnosis of placental insufficiency.
Animals ; Diagnosis ; Fetal Death ; Laparotomy ; Ligation* ; Perfusion ; Placenta ; Placental Insufficiency ; Pre-Eclampsia ; Pregnancy ; Rats* ; RNA, Messenger ; Silk ; Uterine Artery* ; Vascular Endothelial Growth Factor A*

OBJECTIVE: During pregnancy, the impaired placental perfusion causes complications such as preeclampsia, intrauterine growth restriction and fetal death in utero. In order to investigate the maternal and fetal response to the impaired placental perfusion, the author induced the impaired placental perfusion by the ligation of the rat uterine artery and investigated its effect on the expression of VEGF (vascular endothelial growth factor) in the placenta and serum VEGF level. METHODS: The rats on day 15 of gestation were used for the experiment. They were divided into two groups. The control group consists of the 20 rats that underwent laparotomy without uterine artery ligation. The experimental group consists of the 20 rats that underwent laparotomy and the uterine artery ligation by silk on day 15 of gestation. On day 16, 17, 18 and 19 of gestation, the placental tissues were obtained. The mRNA expressions of the VEGF in the placenta were measured by the relative RT-PCR in the control and experimental group. The localization and intensity of immunohistochemical staining of VEGF in placenta were determined in both groups and the maternal serum levels of VEGF were also measured in both groups. RESULTS: The mRNA expressions of VEGF120 and VEGF164 were significantly increased 48 hours after the ligation (day 17 of gestation) but the mRNA expression of VEGF188 was not changed after the ligation. There was no difference in the location and intensity of immunohistochemical staining of VEGF in the placenta between control and experimental groups. The serum VEGF levels of control group were 9 times as high as those of non-pregnant rats. The significant increases of the serum VEGF levels were noted 48 and 72 hours after the ligation (day 17 and 18 of gestation) but the significant increase was not noted 96 hours after the ligation (day 19 of gestation) as compared to control group. CONCLUSION: This study demonstrated firstly that the experimentally induced reduction of placental perfusion increased expressions of VEGF in the placenta and maternal serum. The results support that the measurement of maternal serum VEGF levels in pregnancy may help the diagnosis of placental insufficiency.
Animals ; Diagnosis ; Fetal Death ; Laparotomy ; Ligation* ; Perfusion ; Placenta ; Placental Insufficiency ; Pre-Eclampsia ; Pregnancy ; Rats* ; RNA, Messenger ; Silk ; Uterine Artery* ; Vascular Endothelial Growth Factor A*

This study demonstrates the ability of magnolol, a hydroxylated biphenyl compound isolated from Magnolia officinalis, to inhibit LPS-induced expression of iNOS gene and activation of NF-kappaB/Rel in RAW 264.7 cells. Immunohisto-chemical staining of iNOS and Western blot analysis showed magnolol to inhibit iNOS gene expression. Reporter gene assay and electrophoretic mobility shift assay showed that magnolol inhibited NF-kappaB/Rel transcriptional activation and DNA binding, respectively. Since p38 is important in the regulation of iNOS gene expression, we investigated the possibility that magnolol to target p38 for its anti-inflammatory effects. A molecular modeling study proposed a binding position for magnolol that targets the ATP binding site of p38 kinase (3GC7). Direct interaction of magnolol and p38 was further confirmed by pull down assay using magnolol conjugated to Sepharose 4B beads. The specific p38 inhibitor SB203580 abrogated the LPS-induced NF-kappaB/Rel activation, whereas the selective MEK-1 inhibitor PD98059 did not affect the NF-kappaB/Rel. Collectively, the results of the series of experiments indicate that magnolol inhibits iNOS gene expression by blocking NF-kappaB/Rel and p38 kinase signaling.
Adenosine Triphosphate ; Binding Sites ; Biphenyl Compounds ; Blotting, Western ; DNA ; Electrophoretic Mobility Shift Assay ; Flavonoids ; Gene Expression ; Genes, Reporter ; Imidazoles ; Lignans ; Macrophages ; Magnolia ; Models, Molecular ; Phosphotransferases ; Pyridines ; Sepharose ; Transcriptional Activation

This cohort study is a collaborative effort of 8 institutions. The goal is to establish a large scale cohort that can be followed for 10 or more years to assess the relationship between life-styles and cancer occurrence, and to evaluate the role of environmental exposures in the development of six major sites of cancers(stomach, liver, lung, colorectum, uterine cervix and female breast) in the rural population. Since 1993, 11,304 men and women aged over 35 living in four areas have been recruited. The number of target population is 30,000 persons, which is expected to be successfully recruited until 1999. Each subject has completed a detailed questionnaire on general life-styles, reproductive factors, and agricultural chemical exposures through the interview. Anthropometric measurements with body fat composition and the routine clinical laboratories were examined. For the cancer-free cohort, physical examination by the physicians and serologic tests for hepatitis markers, some tumor markers, and lipid profile have been done, but not all. In order to provide an opportunity to incorporate barious biomarkers of exposure and effect as well as genetic susceptibility, a biologic tissue bank has been established from blood and urine sample(plasma, WBC buffy-coat, RBC clots, and urine supernatant) stored at-70degrees C. Re-examination of changes in exposere to risk factors will be done periodically. Disease occurrence will be ascertained by the active(mainly through diagnosis by physicians) and the passive surveillance(through both death certificate and screening of medical utilization records).
Adipose Tissue ; Biomarkers ; Cervix Uteri ; Cohort Studies* ; Death Certificates ; Diagnosis ; Environmental Exposure ; Female ; Genetic Predisposition to Disease ; Health Services Needs and Demand ; Hepatitis ; Humans ; Korea* ; Liver ; Lung ; Male ; Mass Screening ; Physical Examination ; Risk Factors ; Rural Population ; Serologic Tests ; Tissue Banks ; Biomarkers, Tumor ; Surveys and Questionnaires

OBJECTIVE: Adeno associated virus (AAV) is a human DNA virus and is included in the Parvovirus family. AAV has been detected in cervical tissues as well as cervical cancer cell lines. Previous studies showed that AAV infection has some negative effects on HPV infection and that the cervical cancer cell growth is inhibited by AAV infection. The aim of this study is to determine the prevalence of AAV 2 infection and its possible roles for influencing HPV 16 and 18 infection in Korean women by analyzing adjacent normal, CIN, and invasive cervical cancer tissue samples. METHODS: CIN I (20), CIN II (24), CIN III (25), invasive cervical cancer (23) tissues were investigated by microdissection and PCR analyses using primers of HPV 16, 18 and AAV 2 as well as beta- globin as an internal control. RESULTS: AAV 2 was detected in 57 out of 92 cervical lesion biopsies. Among these, mild dysplasia, moderate dysplasia, severe dysplasia and invasive cancer showed 55% (11/20), 95.8% (23/24), 52% (13/25) and 52.2% (12/23), respectively. However, HPV 16 was detected in 14 out of 92 cervical lesion biopsies. Among these, mild dysplasia, moderate dysplasia, severe dysplasia and invasive cancer showed 0% (0/20), 8.3% (2/24), 24% (6/25) and 26.1% (6/23), respectively. HPV 18 was detected in 3 out of 92 cervical lesion biopsies. Among these, mild dysplasia, moderate dysplasia, severe dysplasia and invasive cancer showed 0% (0/20), 4.2% (1/24), 8% (2/25) and 0% (0/23), respectively. In contrast, In 92 perilesional normal biopsies, AAV 2, HPV 16 and HPV 18 were detected to be 57.6% (53/92), 3.3% (3/92) and 0% (0/92), respectively. CONCLUSION: AAV 2 was detected in CIN and invasive cervical cancer biopsies by microdissection and PCR analyses in Korean women. It is difficult to confirm any significant roles of AAV 2 infection for developing cervical cancer. However, we observe that there is some correlation between AAV 2 and HPV infection in the carcinogenesis of cervical cancer. Further research remains to be done to further elucidate AAV 2 infection and its role for HPV infection and cervical cancer.
Biopsy* ; Carcinogenesis ; Cell Line ; Dependovirus* ; DNA Viruses ; Female ; Globins ; Human papillomavirus 16 ; Human papillomavirus 18 ; Humans* ; Microdissection* ; Papilloma* ; Parvovirus ; Polymerase Chain Reaction ; Prevalence ; Satellite Viruses ; Uterine Cervical Neoplasms