We examined the ultrastructural features of the lung parenchyma and the expression of apoptosis of the respiratory cells by TUNEL technique. Male Sprague-Dawley rats (n=30) were intra-tracheally injected with cadmium (2.5 mg/kg) into both lungs. The light and electron microscopic features of the lung tissues were examined on Days 1, 3, 7 and 10 after the injection of cadmium. Specimen preparations for the light and electron microscopic TUNEL stains were performed. Ultrastructurally, on Days 1 and 3, the alveolar spaces were filled with edematous fluid, and desquamated type I epithelial cells. On Days 7 and 10, the alveolar spaces and interstitium were patchy infiltrated with young fibroblasts and some collagen deposition. The light microscopic TUNEL stain showed that apoptosis of the alveolar cells was most prominent on Day 1, and then the number of apoptosis was markedly decreased on Days 3, 7 and 10. The electron microscopic TUNEL stain showed the electron dense homogenous nuclear expression, and the formation of intra-nuclear blebs which protrude to the outside of nuclei. On Days 7 and 10, there are frequent apoptotic nuclear bodies in the alveolar macrophages. We could examine the identification of the equivocal apoptotic cells and various morphologic expression of apoptotic nuclei on the electron microscopic TUNEL stain.
Acetone/pharmacology ; Animals ; Apoptosis ; Cadmium/metabolism/*pharmacology ; Cell Nucleus/metabolism ; *In Situ Nick-End Labeling ; Lung/*cytology/*injuries/pathology/*ultrastructure ; Male ; Microscopy, Electron ; Microscopy, Electron, Scanning ; Pulmonary Alveoli/metabolism ; Rats ; Rats, Sprague-Dawley ; Support, Non-U.S. Gov't ; Time Factors

A Case of primary malignant lymphoma in the uterine cervix of a 58-year-old multigravidwoman is reported. Primary malignant lymphoma localized in the uterine cervix is a rare condition.Previously, treatment of this disease has been radiation therapy, surgery or chemotherapyeither alone or in combination.We experienced one case of primary malignant lymphoma of the uterine cervix, stageI b according to FIGO, which was treated with radiation therapy and CHOP chemotherapy.The patient first underwent radiation therapy. This was followed by an chemotherapyconsisting of cyclophosphamide, adriamycin, vincristine, and prednisone.No evidence of recurrent lymphoma has been observed in 3 year after the treatment.
Cervix Uteri* ; Cyclophosphamide ; Doxorubicin ; Female ; Humans ; Lymphoma* ; Middle Aged ; Vincristine

BACKGROUND: Midazolam is often used as an anxiolytic premedication before surgery, but it is difficult and complex to assess its effect. This study evaluated the bispectral index as an objective indicator of midazolam premedication and the relation of cardiovascular response to anesthetic induction. METHODS: Forty patients (aged 20 to 60 and in ASA class I or II) to undergo simple elective surgery under general anesthesia entered the study. The patients were divided into the midazolam group (n = 20) that received midazolam (0.08 mg/kg IM) and glycopyrrolate (0.2 mg IM) premedication, and the control group (n = 20) that received glycopyrrolate (0.2 mg IM) only. Then, anesthetic induction (fentanyl 1 microgram/kg, propofol 2 mg/kg, succinylcholine 1 mg/kg) was done. The bispectral index of the electroencephalogram, blood pressure, and heart rate were measured under unanesthetized conditions, after fentanyl, propofol injection, and intubation. RESULTS: The bispectral index was significantly lower in the midazolam group as compared with the control group before anesthetic induction, after fentanyl injection, and intubation. Blood pressure was not significantly different in the two groups. Heart rate was significantly lower in the midazolam group compared with the control group before anesthetic induction and after fentanyl injection. CONCLUSIONS: Midazolam-premedicated patients appear to maintain stable hemodynamics during anesthetic induction and intubation. The bispectral index can be objectively used in midazolam-premedicated patients when evaluating the degree of sedation. (Korean J Anesthesiol 2000; 38: 947~953)
Anesthesia, General ; Blood Pressure ; Electroencephalography ; Fentanyl ; Glycopyrrolate ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Midazolam* ; Premedication* ; Propofol ; Succinylcholine

PURPOSE: Sodium butyrate (NaBT) is principally a histone deacetylase (HDAC) inhibitor, and it has the potential to arrest HPV-positive carcinoma cells at the G1 to S phase transition of the cell cycle. The aim of study was to determine whether phosphatidylinositol 3-kinase (PI3K) inhibition can enhance the inhibitory effect of NaBT on a human cervical cancer cell line (HeLa). MATERIALS AND METHODS: Cervical cancer cells (HeLa) were treated with NaBT alone or in combination with the PI3K inhibitors wortmannin or LY294002. Cell viability analysis and FACS analysis were carried out. The expressions of the cell cycle related proteins were evaluated by Western-blot analysis. RESULTS: Inhibition of PI3K enhanced NaBT-mediated apoptosis and this decreased the HeLa cell viability. Either wortmannin or LY294002, combined with NaBT, enhanced the activation of caspase 3 and caspase 9, and this enhanced the subsequent cleavage of poly (ADP-ribose) polymerase (PARP). Cervical cancer cells were arrested in the subG1 and G2/M phase, as was detected by FACS analysis. NaBT treatment in combination with PI3K inhibitors showed the increased expression of the CDK inhibitors p21(Cip1/Waf1) and p2(7Kip1), in a p53 dependent manner, and also the increased dephosphorylation of Rb whereas there was a reduction in the expression levels of cyclin A, cyclin D1 and cyclin B1. CONCLUSION: The results demonstrate that inhibition of PI3K enhances NaBT-mediated cervical cancer cell apoptosis through the activation of the caspase pathway. Moreover, these findings will support future investigation using the PI3K inhibitors in combination with adjuvant treatment for treating carcinoma of the cervix.
Apoptosis* ; Butyric Acid ; Caspase 3 ; Caspase 9 ; Cell Cycle ; Cell Line ; Cell Survival ; Cervix Uteri ; Cyclin A ; Cyclin B1 ; Cyclin D1 ; Female ; HeLa Cells ; Histone Deacetylases ; Humans* ; Phosphatidylinositol 3-Kinase* ; Phosphatidylinositols* ; S Phase ; Sodium* ; Uterine Cervical Neoplasms*

OBJECTIVE: The purpose of this study was to analyze the clinical and radiological outcomes of dynamic stabilization with DIAM implants. METHODS: We evaluated 24 cases in which lumbar decompressive surgery was performed with dynamic stabilization using DIAM and having more than 24 months of follow up. Indications consisted of spinal stenosis with or without a herniated disc and transition level stenosis of the instrumented fusion segment. Operative data, clinical outcome, and plain and flexion/extension radiographs were obtained and compared to preoperative and postoperative data. RESULTS: The mean age at operation was 56.2 years(range 47-68); the mean follow-up duration was 28.4 months(range 24-37 months).The mean pain and function scores improved significantly from baseline to follow-up, as follows: back pain VAS score from 6.2 to 2.5, leg pain VAS score from 7.2 to 2.4, and Prolo's economic and functional rating score from 5.8 to 8.2. Radiological data demonstrated that the heights of the intervertebral foramen and the posterior disc increased significantly after the procedure. There were no implant-associated complications except for two spinous process fractures which occurred during DIAM insertion, and one case of wound infection. Flexion instability and spondylolisthesis occurred in two cases during the follow-up period. CONCLUSION: These mid-term results suggest that DIAM is a safe and effective alternative surgical option in the treatment of degenerative lumbar stenosis without flexion instability. Careful follow-up is needed to watch for the development of flexion instability and spondylolisthesis.
Back Pain ; Constriction, Pathologic ; Follow-Up Studies ; Intervertebral Disc Displacement ; Leg ; Spinal Stenosis ; Spondylolisthesis ; Wound Infection

OBJECTIVE: Our purpose was to evaluate potential efficacy of selective estrogen receptor modulators (raloxifene and tamoxifen) to human uterine leiomyoma cells. METHODS: The samples were collected from ten hysterectomized specimen. we evaluated the estrogen-responsive growth of human uterine leiomyoma and normal myometrial cells. The potential efficacy of Selective Estrogen Receptor Modulators (SERMs: raloxifene and tamoxifen) to human uterine leiomyoma cells were conducted by MTS, cell count assay and Western-blot. RESULTS: Human uterine leiomyoma and normal myometrial cells that expressed estrogen receptor (ER) showed increases the cell number in the presence of estrogen compared with ER negative uterine leiomyoma cells. Raloxifene and tamoxifen inhibited estrogen-stimulated proliferation of ER-containing human uterine leiomyoma and normal myometrial cells. Raloxifene was more effective in inhibiting estrogen-induced increases of cell number compared with tamoxifen. CONCLUSION: The effect of SERMs on leiomyoma was inhibited the cell proliferation without apoptosis or cell cycle arrest. These data suggest that SERM should be examined as candidate of nonsurgical therapeutic agents for uterine leiomyoma.
Apoptosis ; Cell Count ; Cell Cycle Checkpoints ; Cell Proliferation ; Estrogens ; Humans* ; Leiomyoma* ; Raloxifene Hydrochloride ; Selective Estrogen Receptor Modulators* ; Tamoxifen

PURPOSE: In other countries, government guidelines related to chronic illness are being used to enhance supportive care of renal patients. In Korea, the number of old ages and hemodialysis patients with many complications has been increased. But we don't have any guidelines for palliative care of end stage renal disease. This paper reports a study exploring decisions about end-of-life treatment (e.g. cardiopulmonary resuscitation, renal replacement therapy) via routine use of advance directives in people with end stage renal disease undergoing hemodialysis. METHODS: 1) We revised advance directives in Seoul Medical Center. 2) We recommended the routine use of advance directives to patients who were treated in hemodialysis room of Seoul Medical Center from Jan, 2007 to Jun, 2007. So 35 patients were enrolled. 3) They had been interviewed about end- of-life treatment plans and filled up advance directives. RESULTS: 23 males and 12 females in total were enrolled. The advance directives include 18 questions about patient preferences for treatment of end-of-life. The majority of hemodialysis patients replied "I will follow doctor's decisions including cardiopulmonary resuscitation and renal replacement therapy" 8 females (67%), 15 diabetes (53%) and 11 geriatric patients above 60yrs old (52%), however, were against cardiopulmonary resuscitation. CONCLUSION: Routine use of advance directives will provide basic sources for end-of-life decisions in the care of end stage renal patients. And they would like to keep the high quality of life with the help of prepared therapeutic plan of care and well-dying presented advance directives.
Advance Directives ; Cardiopulmonary Resuscitation ; Chronic Disease ; Female ; Humans ; Kidney Failure, Chronic ; Korea ; Male ; Palliative Care ; Patient Preference ; Quality of Life ; Renal Dialysis

Tissue plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1) may be involved in the pathogenesis of peptic ulcers through suppression of fibrinolysis. This study was designed to investigate associations of t-PA and PAI-1 genes with clinical features of the patients with bleeding gastric ulcers. Eighty-four patients with peptic ulcers and 100 controls were studied between January 1998 and April 2000. We used polymerase chain reaction and endonuclease digestion to genotype for 4G/5G polymorphism in the promoter region of the PAI-1 gene and the Alurepeat insertion/deletion (I/D) polymorphism in intron h of the t-PA gene. Various clinical features, including lesion site, bleeding event, recurrence of ulcer, and rebleeding, were assessed using a multiple logistic regression model. The genotype distributions of both the t-PA and PAI-1 genes did not differ between the patient and control groups. The occurrence of the I/D or D/D genotype of t-PA was significantly higher in cases of duodenal ulcer (adjusted OR=4.39, 95% CI=1.12-17.21). When a dominant effect (i.e., 4G/4G or 4G/5G versus 5G/5G) of the 4G allele was assumed, the PAI-1 4G/4G genotype was independently associated with rebleeding after hemostasis (adjusted OR=5.07, 95% CI=1.03-24.87). Our data suggest that t-PA gene polymorphism is associated with duodenal ulcers, and that the PAI-1 gene may be a risk factor leading to recurrent bleeding after initial hemostasis.
Adult ; Aged ; Alu Elements/genetics ; DNA Mutational Analysis ; Duodenal Ulcer/complications ; Duodenal Ulcer/genetics* ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Genotype ; Human ; Male ; Middle Aged ; Mutagenesis, Insertional ; Peptic Ulcer Hemorrhage/etiology ; Peptic Ulcer Hemorrhage/genetics* ; Plasminogen Activator Inhibitor 1/genetics* ; Polymorphism (Genetics)* ; Promoter Regions (Genetics)/genetics ; Recurrence ; Sequence Deletion ; Stomach Ulcer/complications ; Stomach Ulcer/genetics* ; Tissue Plasminogen Activator/genetics*

Pheochromocytoma is a catecholamines secreting tumor that usually appears in the adrenal medulla, sympathetic ganglia and extra-adrenal chromaffin tissue. About 10% of this disease is detected in the extra-adrenal chromaffin tissue which is called paraganglioma. The three major clinical symptoms of pheochromocytoma are headache, syncope and hypertension. Approximately 0.1% of hypertensive patients have pheochromocytoma. The extra-adrenal paraganglioma is found in abdominal sympathetic nerve ganglion or Zukerkandle's organ with great frequency, but it also appears, albeit rare, in the cervical ganglion, thoracic cavity, bladder, and pelvic cavity. Some cases of paraganglioma in bladder are being reported internationally, but domestic reports are rare. We report a case of paraganglioma originating in the urinary bladder of patient who visited with acute renal failure associated with malignant hypertension. We treated him with phenoxybenzamine and later with partial cystectomy. High blood pressure was well controlled and acute renal failure was resolved.
Acute Kidney Injury* ; Adrenal Medulla ; Catecholamines ; Cystectomy ; Ganglia, Sympathetic ; Ganglion Cysts ; Headache ; Humans ; Hypertension ; Hypertension, Malignant ; Paraganglioma* ; Paraganglioma, Extra-Adrenal ; Phenoxybenzamine ; Pheochromocytoma ; Syncope ; Thoracic Cavity ; Urinary Bladder*

BACKGROUND/AIMS: The human leukocyte antigen (HLA) system is an integral component of immune response. Highly polymorphic HLA genes may play a pivotal role in the response of antiviral therapy. We investigated the effects of HLA gene polymorphism on the clinical outcome of chronic hepatitis B patients who received lamivudine treatment. METHODS: Depending on their clinical response to lamivudine therapy, a total of sixty one patients were divided into following groups; non-responders, viral breakthroughers, relapsers, and seroconverters. HLA-A, -B, -Cw, -DRB and HLA-DRB1 alleles typing was performed on each group through the polymerase chain reaction and the sequence-specific oligonucleotide hybridization method. The distribution patterns of HLA-A, HLA-B, HLA-Cw, HLA-DRB, and HLA-DRB1 were then analysed. RESULTS: When non-responders were compared to the other groups, high frequencies in HLA-Cw*1, HLA-DRB1*4 and HLA-DRB*4 (p=0.015, 0.033 and 0.004 respectively) were evident. When seroconverters were compared to viral breakthroughers, high frequencies in HLA-A*2 and HLA-DRB*4 (p=0.048, 0.025 respectively) were evident. CONCLUSIONS: Our data suggests that HLA-A*2, HLA-Cw*1, HLA-DRB1*4 genes are related to the clinical outcomes of lamivudine treatment in chronic hepatitis B patients. These genes may be used in the prediction of the clinical outcome of lamivudine therapy in chronic hepatitis B patients.