Due to the great deal of effort that has gone into the study of osteoclastic differentiation and activation over the last few decades, the mechanisms of these two events have been discovered gradually. Nitric oxide(NO-), which is produced from arginine by a nitric oxide synthase, opened up a new area of biological research. Recently, it has been reported that NO- is produced by osteoblasts stimulated by lipopolysaccharide and several other cytokines. In this study, the effect of sodium nitroprusside(SNP), a donor of nitric oxide(NO-), on osteoclast-like cell formation and on mature osteoclast function was examined. To determine the mechanism of the inhibitory effects of SNP decreased not only the basal 45Ca release but also thee bone resorption induced by PTH and l,25-dihydroxyvitamin D3 (I ,25[OH]2D3). The inhibitory effect of SNP on bone resorption induced by PTH appeared 2 days after treatment, whereas SNP effect on inhibiting bone resorption induced by l,25[OH]2D3 appeared at the third days. When chicken and rat osteoclasts were cultured on dentin slices, treatment of 300micronM SNP resulted in a significant decrease in dentin resorption by osteoclasts in terms of total resorption area and average individual area. We also examined the effect of SNP on formation of osteoclast-like cells that is TRAP-positive multinucleated cells from chicken and rat bone marrow cells in the presence or absence of 10(-8)M l,25[OH]2D3. The addition of 300 micronM SNP inhibited the formation of TRAP-positive multinucleated cells. The present data suggest that SNP, possibly as a NO- donor, inhibits the osteoclastic differentiation and osteoclastic activity.
Animals ; Arginine ; Bone Marrow Cells ; Bone Resorption ; Chickens ; Cytokines ; Dentin ; Humans ; Nitric Oxide Synthase ; Nitroprusside* ; Osteoblasts ; Osteoclasts* ; Rats ; Sodium* ; Tissue Donors

Pulmonary metastasis occurs frequently in patients with gestational choriocarcinoma and most of these patients achieve remission with chemotherapy alone. Thus, the indications for surgical intervention are limited, but in appropriately selected patients, resection of a chemotherapy-resistant lung lesion can be curative. We have experienced that pulmonary metastatic choriocarcinoma in a drug-resistant patient was cured by pulmonary resection. So we report this case with a brief review of literatures.
Choriocarcinoma* ; Drug Therapy ; Female ; Humans ; Lung ; Neoplasm Metastasis ; Pregnancy

PURPOSE: To determine whether gadolinium enhancement is helpful in rectal tumor staging determined by MRI and using an endorectal surface coil. MATERIALS AND METHODS: Between January 1995 and July 1996, we studied 17 MRI scans in which the scanning procedure had involved the use of an endorectal coil ; this was a prostate coil in six patients, and a colon coil in eleven. Eight patients were male and nine were female ; they were aged between 39 and 77 (mean, 59) years, and the tumors which had presented were adenocarcinoma (n=15), lymphoma (n=1) and villous adenoma (n=1). Precontrast scanning showing invasion of the rectal wall and perirectal fat were interpreted, and postcontrast T1WI and pathological findings were then compared. Fifteen patients underwent surgical resection but the other two (one adenocarcinoma and one lymphoma) underwent only an endoscopic biopsy. RESULTS: On precontrast scanning with the prostate coil, accurate staging was possible in three cases (one of stage T2, and two of stage T3) ; we overstaged two cases of stage T2 as stage T3. On postcontrast T1WI, however, we additionally understaged one case of stage T3 as stage T2. In a case of adenocarcinoma proven by biopsy, no definite difference was noted between pre- and postenhanced scan. On precontrast scan using a colon coil, accurate staging was possible in six cases (two of stage T1, one of stage T2 and three of stage T3). We overstaged a case of stage T2 as stage T3 and understaged three cases of stage T3 as stage T2. On postcontrast T1WI, however, we accurately diagnosed one additional case of stage T3, not diagnosed on precontrast scan. In one case of bioptically-proven lymphoma, no definite difference was noted between pre- and postenhanced scan. CONCLUSION: In rectal tumor staging, pre- and postenhanced scans are both 60% accurate. In MRI using an endorectal surface coil, gadolinium enhancement is not, therefore significantly helpful.
Adenocarcinoma ; Adenoma, Villous ; Biopsy ; Colon ; Female ; Gadolinium* ; Humans ; Lymphoma ; Magnetic Resonance Imaging* ; Male ; Prostate ; Rectal Neoplasms*

Warfarin-induced skin necrosis is a rare complication caused by transient hypercoagulable state. This state is a result of rapid decline of the protein C activity relative to that of coagulation factor II, IX, and X during initiation of oral anticoagulant therapy. We experienced a case of warfarin-induced skin necrosis involving both breasts in a patient who underwent double valve replacement 1 month before. Warfarin was replaced to a low- molecular weight heparin and the necrotic breast lesion was healed spontaneously. Low-dose warfarin was restarted and gradually increased, after which a low molecular weight heparin discontinued.
Breast ; Heparin ; Heparin, Low-Molecular-Weight ; Humans ; Molecular Weight ; Necrosis* ; Protein C ; Prothrombin ; Skin* ; Warfarin

No abstract available.
Plasmapheresis* ; Postpartum Period* ; Pregnancy*

BACKGROUND AND OBJECTIVES: Circulatory disturbance to vestibular organ has been regarded as one of the causes that bring about vertigo, and alteration of the platelet function is known to be an important factor inducing circulatory deficit. This study was designed to evaluate platelet aggregability in the patients with peripheral vestibulopathy, and to evaluate difference according to duration of illness. MATERIALS AND METHODS: Platelet aggregation tests to adenosine diphosphate (ADP), ristocetin, epinephrine and collagen were performed in 10 normal subjects and 15 patients with peripheral vestibulopathy. Maximum aggregation rates from aggregation curves were compared between the two groups, and also between the two groups of patients who had different duration of illness. RESULTS: In the patient group, platelet aggregations to ADP, ristocetin and collagen were increased compared to normal subjects and significant differences were found in aggregations to ADP and ristocetin. However, there was no significant difference according to different duration of illness in the patient group. CONCLUSION: These results suggest that platelet aggregability is increased in the patients with peripheral vestibulopathy, and duration of illness does not affect platelet aggregability.
Adenosine Diphosphate ; Blood Platelets* ; Collagen ; Epinephrine ; Humans ; Platelet Aggregation ; Ristocetin ; Vertigo

50 days old, 4.5kg male patient was admitted at department of pediatrics due to congenital heart disease with congestive heart failure. The echocardiographic finding was perimembranous type ventricular septal defect. The patient underwent open heart surgery for patch closure of VSD. Immediately postoperatively, junctional ectopic tachycardia developed and the patient was in hemodynamically unstable state with decreased urine output. We used inotropics, digitalis and diuretics, however these treatments were not effective in recovering the unstable state. Therefore, we tried a mild hypothermic treatment (34degree C). During the POD #2, mild hypothermia method was repeated four times. The junctional ectopic tachycardia was converted to normal sinus rhythm, hemodynamic state was stable, and urine output was increased. The patient was discharged at POD #8.
Digitalis ; Diuretics ; Echocardiography ; Heart Defects, Congenital ; Heart Failure ; Heart Septal Defects, Ventricular ; Hemodynamics ; Humans ; Hypothermia* ; Male ; Pediatrics ; Postoperative Complications ; Tachycardia, Ectopic Junctional* ; Thoracic Surgery

BACKGROUND: Thoracoscopic T2 sympathicotomy is an effective method for the treatment of palmar hyperhidrosis. Not only are the symptoms of hyperhidrosis abolished but also the temperature of the ipsilateral palm is elevated due to the sympatholytic vasodilation after the completion of the sympathicotomy on the first side. However little is known about the temperature changes in the contralateral palm. This study was performed to evaluate the changes in both palmar temperatures during the thoracoscopic T2 sympathicotomy for palmar hyperhidrosis. MATERIAL AND METHOD: Thoracoscopic T2 sympathicotomy was performed in 15 patients with primary palmar hyperhidrosis. Surface temperatures of both palms were monitored continuously and were recorded simultaneously during the 7 different stages of the operation. RESULT: When T2 sympathicotomy was performed on the first(left) side, an ipsilateral increase with a contralateral decrease of temperature was observed. The difference in the temperature of both palms was greatest just before the sympathicotomy on the contralateral(right) side(Lt. 34.6+/-0.9degree C vs. Rt. 31.6+/-1.3degree C, p<0.0001). After the sympathicotomy on the second(right) side, temperature of the right palm was elevated. The difference in the temperature of both palms was abolished at the end of the operation(Lt.34.7+/-0.9degree C vs. Rt.34.4+/-1.0degree C, P=0.415). CONCLUSION: When T2 sympathicotomy was performed on the first side, an ipsilateral palmar temperature increased due to the sympatholytic vasodilation. However contralateral palmar temperature decreased due to a vasoconstriction. Although the mechanism of vasoconstriction is still unknown, it is postulated that there may be a cross- inhibitory effect by the post-ganglionic neurons innervating blood vessels of the palm.
Blood Vessels ; Humans ; Hyperhidrosis* ; Neurons ; Vasoconstriction ; Vasodilation

INTRODUCTION: Understanding the normal distribution of the tracheal diameter and crross- sectional area is one of the key elements in the management of various tracheal pathologies or tracheal reconstruction for the patients in growing age. However, data for Korean standard has been lacking. This study was designed to analyze retrospectively the distribution of tracheal diameter and cross-sectional area in young Koreans, which can afford fundamental data for the management of tracheal diseases. MATERIAL AND METHOD: Of the patients who underwent computerized tomogram of the chest between May 1996 and August 1998, one hundred six young patients(age range: 0-20 years) were included. Patients with any conditions which might affect the tracheal cross-sectional area or diameter, such as tracheal disease, previous operation, mediastinal tumor, or obstructive lung disease were excluded from the study. Gender distribution was 69 males and 37 females. Tracheal diameters, anterior-posterior and transverse, were measured at the level of the thoracic inlet(level I) and the aortic arch(level II). Types of the trachea were divided into round, oval, or horseshoe shaped on cross-sectional view, and the dimension was calculated by using the equation of A=1/4(pi)ab(A; area, (pi); 3.14, a; anterior-posterior diameter, b; transverse diameter). We analyzed the distribution of the diameter at each level and compared the cross-sectional area with respect to age and gender. A p-value lower than 0.05 wa considered significant. RESULT: The trachea of patients less than 5 years old were round in shape at both of level I and II, and no differences in cross-sectional area was observed between the levels(p=NS). As the age increased, the trachea become oval in shape at level I while it remained round in shape at level II(p=0.020). The tracheal diameter and cross-sectional area increased as the age increased with a linear correlation(r>0.9). In patients less than 5 years of age, female patients showed larger cross-sectional area than male patients (p=0.020), and it was reversed in patients older than 15 years of age(p=0.002). CONCLUSION: From the above results, we suggest chest computerized tomogram as a safe and reliable tool in measuring the tracheal diameter and cross-sectional area. We also provide the data as a standard for distribution of the tracheal diameter and cross-sectional area in young Korean population.
Age Factors ; Child, Preschool ; Female ; Humans ; Lung Diseases, Obstructive ; Male ; Pathology ; Retrospective Studies ; Thorax ; Trachea ; Tracheal Diseases

BACKGROUND: As coronary arterial disease is increasing, we evaluated the patients who underwent CABG (Coronary Artery Bypass Grafting) and thus report the early results and risk factors related to mortality and morbidity. MATERIALS AND METHODS: Between July 1996 and February 1998, 42 patients underwent CABG. We analyzed age, sex, preoperative ejection fraction, Canadian heart classification, prevalence factors of CAD (Coronary Artery Disease), angiographic findings, graft vessel numbers, IMA (Internal Mallary Artery) use, ECC* (extracorporeal circulation) time and morbidity. We also evaluated the mortality rate and the causes of death. RESULTS: Complication was developed at 17cases. The average age of the complication group was 61+/-11.9 years and that of the noncomplication group was 51+/-10.5 years (p=0.004). ECC time was 198+/-42.5 (min) in the complication group and 158+/-47.4 (min) in the noncomplication group (p=0.008). The other factors had no correlation to the morbidity, statistically. The average follow up duration was 12.5 months and all the patients were alive except for the 2 expired cases. The mortality rate was 4.7%, among which one patient who underwent CABG with aortic valve replacement died due to multiorgan failure and the other died due to sepsis with pneumonia and wound infection. CONCLUSIONS: We conclude that the risk factors related to morbidity were age and ECC time, and that there were no correlations between other factors and morbidity.
Aortic Valve ; Arteries ; Cause of Death ; Classification ; Coronary Artery Bypass ; Follow-Up Studies ; Heart ; Humans ; Mortality ; Pneumonia ; Postoperative Complications ; Prevalence ; Risk Factors ; Sepsis ; Transplants ; Wound Infection