Separation of symphysis pubis during vaginal delivery is rare condition with incidence ranging from 1/500 to 1/30000 deliveries. The injury is caused by fetal head exerting pressure on pelvic ligaments that have been relaxed by progesterone and relaxin. The separation might be associated with considerable pain, swelling and tenderness over the pubic area. Diagnosis is based on clinical findings and X-ray findings. The condition is treated conservatively with bed rest, analgesics and physical therapy. Prognosis is exellent. We experienced 3cases of separation of symphysis pubis during vaginal delivery and report these cases with a brief review of literature.
Analgesics ; Bed Rest ; Diagnosis ; Head ; Incidence ; Ligaments ; Progesterone ; Prognosis ; Relaxin

BACKGROUND: Relaxin is a transforming growth factor β1 antagonist. To determine the effects of relaxin on scar reduction, we investigated the scar remodeling process by injecting relaxin-expressing adenoviruses using a pig scar model. METHODS: Scars with full thickness were generated on the backs of Yorkshire pigs. Scars were divided into two groups (relaxin [RLX] and Control). Adenoviruses were injected into the RLX (expressing relaxin) and Control (not expressing relaxin) groups. Changes in the surface areas, color index and pliability of scars were compared. RESULTS: Fifty days after treatment, the surface areas of scars decreased, the color of scars was normalized, and the pliability of scars increased in RLX group. CONCLUSION: Relaxin-expressing adenoviruses improved the surface area, color, and pliability of scars. The mechanism of therapeutic effects on scar formation should be further investigated.
Adenoviridae* ; Cicatrix* ; Genetic Therapy ; Pliability ; Relaxin* ; Swine ; Therapeutic Uses ; Transforming Growth Factors

PURPOSE: Of various effects of relaxin, we assumed that anti-fibrotic effects, neovascularization effects and vasodilatation effects of relaxin might enhance the survival rate of skin flap. In the current study, we used adenovirus expressing relaxin genes to examine whether these genes could enhance the survival rate of a skin flap. METHODS: A total of 30 Sprangue-Dawley rats were divided into three groups: RLX group (10; relaxin virus injected group), CTR group (10; no gene coded virus injection group), and PBS group (10; PBS injected group). Each group was intradermally injected with the virus (107 PFU) and PBS 48 hours before and immediately before the flap elevation. A distally based flap 3 x 9 cm in size was elevated on the dorsal aspect of each rat. Following this, a flap was placed in the original location and then sutured using a #4-0 Nylon. A surviving area of the flap was measured and then compared on postoperative days 3, 7 and 10. Using a laser Doppler, the amount of blood flow was measured. On postoperative day 10, tissues were harvested for histologic examination and the number of blood vessels was counted. RESULTS: There was a significant increase in the area of the flap survival in the RLX group on postoperative days 3 and 7. The Doppler measurement also showed significantly increased blood flow immediately after the operation and on postoperative days 7 and 10. The number of blood vessels was significantly greater in the RLX group in the tissue harvested on postoperative day 10. The VEGF concentration was significantly higher in the RLX group than others in the tissues harvested on postoperative day 10. CONCLUSION: Following an analysis of the effects of relaxin-secreting adenovirus on the survival of a flap, the surviving area of the flap and the blood flow also increased. A histopathology also showed an increase in the number of blood vessels and the concentration of VEGF.
Adenoviridae ; Animals ; Blood Vessels ; Genetic Therapy ; Nylons ; Rats ; Relaxin ; Skin ; Survival Rate ; Vascular Endothelial Growth Factor A ; Vasodilation ; Viruses

Symphyseal injury is increasing in number together with today's speed of development of car industry in Korea. However, this injury is not common in practice. Some authors reported that symphyseal injury is only 4 to 6% of all pelvic fractures. Symphysis pubis has characteristicsl anatomy to maintain mechanical integrity of the pe1vis with circumferential ligament. The pelvis is a ring structure with strong ligaments. This support include the symphysis pubis, the anterior and posterior sacroiliac ligaments, and the strong sacrotuberous ligaments. According to Peltier(1964), when symphysis is separated more than 1.0cm, pubic instability will be developed. However, Wild(1982) reported that pelvic instability develops when separation of the symphysis exceeds more than 2.5cm. Tile(1984) reported that anterior pubic rami acts as a strut to prevent anterior collapse of the pelvic ring during weight bearing. However, in the presence of intact posterior structures, it gives little effect on pelvic stability. In addition to trauma, pelvic instability develops congenitally or by pregnancy. During pregnancy, pregnancy-related hormones relsx the ligameritous stuctures of the pelvic girdle. In most instances, the major pelvic ring returns to normal when the effect of the relaxin hormones disappear. However, in rare instances, a major symphysis disruption may continuously persist. To evaluste the trauma-induced separation of the symphysis pubis, we analyzed the 19 cases with 15 months follow-up on an average, who were treated at the Orthopaedic Department, Kang-Nam St. Marys Hospital, from June 1981 to June 1986. The results were as follows 1. Among 19 cases, 9 cases(47.4%) were male, 10 cases(52.6%) were female. And average age of the patients was 30.2 years. 2. The main cause of the fracture was traffic accident in 18 out of 19 cases. 3. In cases of symphyseal separation more than 3.4cm, fracture-separation of both sacroiliac joint was certainly occured. However, in cases with separation more than 2.2cm, unilalateral fracture-dislocation of sacroiliac joint occurred. 4. Open reduction and interal fixatiopn including external fixation was performed in 9 og cases. As an indication of surgery, separation of the symphysis, which exceeds more than 2.2cm and which associated (1) with sacroiliac fracture-dislocation, (2) failed conservative treatment, and (3) when simultaneously emergency urological operation is indicated.
Accidents, Traffic ; Emergencies ; Female ; Follow-Up Studies ; Humans ; Korea ; Ligaments ; Male ; Pelvis ; Pregnancy ; Pubic Bone ; Relaxin ; Sacroiliac Joint ; Weight-Bearing

PURPOSE: The aim of this study was to investigate the anti-fibrotic effect of relaxin in subsynovial fibroblasts activated by transforming growth factor beta (TGF-β). MATERIALS AND METHODS: To test the anti-fibrotic effect of an adenovirus-relaxin construct (Ad-RLN) on subsynovial fibroblasts in vitro, cells from subsynovial connective tissue of patients with carpal tunnel syndrome were activated with TGF-β1 and exposed to Ad-RLN (as a therapeutic gene) or adenovirus-lacZ construct (as a marker gene) for four hours. Subsynovial fibroblast cultures without adenoviral exposure served as controls. RESULTS: We observed induction of gene expressions of collagen I, III and IV, as well as the abatement of alpha-smooth muscle actin (a-SMA) synthesis, Smad2 phosphorylation, and fibronectin at the protein level, in comparison to controls. In addition, protein expressions of matrix metalloproteinase (MMP) I was significantly induced, whereas the protein expressions of tissue inhibitor of metalloproteinases (TIMP) I and IV were reduced due to relaxin expression. CONCLUSION: RLN prevents excessive synthesis of extracellular matrix by reducing the expressions of its components, such as fibronectin, a-SMA, and phosphorylated Smad2, by increasing the expression of MMPs; and by decreasing the expression of TIMPs.
Actins ; Carpal Tunnel Syndrome* ; Collagen ; Connective Tissue ; Extracellular Matrix ; Fibroblasts* ; Fibronectins ; Gene Expression ; Humans ; In Vitro Techniques ; Matrix Metalloproteinases* ; Phosphorylation ; Relaxin* ; Tissue Inhibitor of Metalloproteinases ; Transforming Growth Factor beta

Relaxin is known to inhibit cardiac fibrosis. However, it is unclear whether relaxin could regulate the effects of Phorbol 12-myristate 13-acetate (PMA, PKC activator) on cardiac fibrosis. So the influence of relaxin on the cell proliferation and collagen expression induced by PMA in cultured cardiac fibroblasts was studied. It showed that PMA significantly increased cardiac fibroblasts proliferation, Type I pro-collagen protein expression, Type I pro-collagen mRNA expression, and rhRLX absolutely significantly decreased PMA induced effects on cardiac fibroblasts proliferation and Type I pro-collagen expressions, indicating that relaxin could inhibit cardiac fibrosis induced by PMA.
Animals ; Animals, Newborn ; Cells, Cultured ; Fibroblasts ; pathology ; Fibrosis ; Heart Diseases ; chemically induced ; pathology ; prevention & control ; Rats ; Rats, Sprague-Dawley ; Relaxin ; therapeutic use ; Tetradecanoylphorbol Acetate ; analogs & derivatives

PURPOSE: Relaxin (RLX) is a transforming growth factor-β1 (TGF-β1) antagonist that is believed to function as a potent collagen re-arranger and a major suppressor of extracellular matrix components. Adenoviruses (Ads) are accepted vectors for cancer gene therapy. However, repeated treatments of Ad are limited by short-term biological activity in vivo. The efficacy of sustained RLX expression to scar remodeling was assessed using an injectable alginate gel-matrix system. MATERIALS AND METHODS: Pig scar tissue was treated with relaxin-expressing Ad loaded in alginate gel (gel/Ad-RLX). Surface areas, color, and pliability of scars were compared, and various factors influencing scar formation and collagen arrangement were analyzed. RESULTS: Gel/Ad-RLX decreased scar size, color index, and pliability. Immunohistochemistry showed decreased levels of major extracellular matrix proteins in the gel/Ad-RLX-treated group. Furthermore, treatment with gel/Ad-RLX reduced expression of tissue inhibitor of metalloproteinase-1 and alpha-smooth muscle actin and markedly increased expression of matrix metalloproteinase-1 in pig scar tissues. Gel/Ad-RLX also significantly downregulated TGF-β1 and upregulated TGF-β3 mRNAs in pig scar tissues. CONCLUSION: These results support a prominent role for RLX in scar remodeling and suggest that gel/Ad-RLX may have therapeutic effects on scar formation.
Actins ; Adenoviridae ; Cicatrix ; Collagen ; Extracellular Matrix ; Extracellular Matrix Proteins ; Genes, Neoplasm ; Genetic Therapy ; Immunohistochemistry ; Matrix Metalloproteinase 1 ; Pliability ; Relaxin ; RNA, Messenger ; Therapeutic Uses ; Tissue Inhibitor of Metalloproteinase-1

Ligamentum flavum (LF) is yellowish ligament tissue connecting the lamina of adjacent vertebra. Degenerative changes in the spine cause the hypertrophy of LF and facet joint and disc bulging and herniation. These changes results in a narrowing of the spinal canal. Neural decompression surgery by removing the hypertrophied lamina, LF and disc pathologies has been considered as successful treatment method in lumbar spinal stenosis. This surgery has showed relatively satisfactory clinical results and has increased life-expectancy in elderly patients. However, issues about post spinal surgery syndrome and re-stenosis after the surgery also have been reported. Because LF is one of the main mechanisms of spinal stenosis, accurate understanding about pathologic mechanism on the LF hypertrophy may suggest alternative treatment methods such as medical treatment or less invasive treatment than surgical decompression can be considered. Hypertrophy of the ligamentum flavum is generated from increase of collagen synthesis, fibroblast proliferation, and fibrosis caused by 1) the expression of growth factors (TGF-beta1 etc.) stimulated by the repeated mechanical tension, 2) inflammatory cytokines from spinal facet joint structure and LF 3) delayed cell death, and 4) inflammatory cytokine from hypertrophied and degenerated LF itself. After the middle ages, gradual and partial inhibition of LF hypertrophy can be expected by administration NSAIDs or selective cyclo-oxygenase-2 inhibitors because these drugs may cause reduction of the increased cytokines. Also, relaxin can be another new treatment material for spinal stenosis by the mechanism of melting hypertrophied LF and reducing synthesis of collagen.
Aged ; Anti-Inflammatory Agents, Non-Steroidal ; Cell Death ; Collagen ; Cytokines ; Decompression ; Decompression, Surgical ; Fibroblasts ; Fibrosis ; Freezing ; Humans ; Hypertrophy* ; Intercellular Signaling Peptides and Proteins ; Ligaments ; Ligamentum Flavum* ; Pathology ; Relaxin ; Spinal Canal ; Spinal Stenosis ; Spine ; Zygapophyseal Joint

OBJECTIVETo observe effect of porcine relaxin(pRLX) on NO production of human microvascular endothelial cells(HMVECs) and discuss its possible mechanism.

METHODSiNOS and cNOS expression of HMVECs with or without pRLX were detected using western blotting. NO production of HMVECs with pRLX at different concentration or different time were determined by method of Griess. NO production of pRLX of HMVECs plus Non-selective NOS inhibitor NG-monomethyl-L-arginine(L-NMMA), selective iNOS inhibitor aminoguanidine(AG) or nuclear factors-kappaB (NF-kappaB) inhibitor pyrrolidine dithiocarbamate(PDTC) were also analysed.

RESULTSpRLX promoted iNOS protein expression of HMVECs, but not cNOS protein expression. NO production of HMVECs was promoted by pRLX on concentration-dependent pattern instead of time-dependent one. AG, L-NMMA and PDTC were showed to block the effect of pRLX on NO production of HMVECs.

CONCLUSIONpRLX promote iNOS expression and NO production of HMVECs.

Animals ; Dose-Response Relationship, Drug ; Endothelial Cells ; cytology ; drug effects ; metabolism ; Humans ; Lung ; blood supply ; Nitric Oxide ; biosynthesis ; Nitric Oxide Synthase Type II ; biosynthesis ; Relaxin ; pharmacology ; Swine ; Time Factors