OBJECTIVE: Angiogenesis is a critical factor in the progression of solid tumors. The mechanisms responsible for angiogenesis in cervical neoplasia, however, are not well defined. Our study was aimed to determine the expression of VEGF(Vascular Endothelial Growth Factor), its receptor(KDR), and TGF-beta1(Transforming Growth Factor-beta1) in cervical neoplasia, to determine the role of these angiogenic factors in preinvasive(dysplastic) process and the progression of cervical cancer and to investigate the progression of angiogenesis in the transition from normal cervix to invasive squamous cell carcinoma of the uterine cervix. METHODS: The cervical lesions of 76 patients were punch biopsied and paraffin embedded. Among these, 5 were normal cervix, 36 were cervical intraepithelial lesion I-III, and the other 35 were invasive squamous cell carcinomas. The tissues were immunostained with antiVEGF, antiKDR, and antiTGF-beta1 polyclonal antibody. RESULTS: The expression of VEGF, KDR, and TGF-beta1 in CIN III was stronger than those of CIN I(p<0.01). Their expression were not significantly different among the each staged cervical cancers(p>0.01). CONCLUSIONS: These observations suggest that VEGF, KDR, and TGF-beta1 are important angiogenic factors in cervical neoplasia, especially in an early event to neoplastic transformation of cervical tissues, but these angiogenic factors are not associated with the progression of cervical cancer.
Angiogenesis Inducing Agents ; Carcinoma, Squamous Cell ; Cervix Uteri ; Female ; Humans ; Paraffin ; Phosphotransferases* ; Transforming Growth Factor beta1 ; Uterine Cervical Neoplasms ; Vascular Endothelial Growth Factor A*

With the advent of duplex ultrasound imaging as a diagnostic tool of venous disease, radionuclide venography (RNV) is losing its popularity as a primary diagnostic method of venous disease. PURPOSE: We attempted to reassess the diagnostic role of RNV for the lower extremity venous disease as a primary and an adjuvant diagnostic method. METHODS: Radionuclide venography (Technetium- 99m-RBC venography) and duplex scan (DS) were compared in 80 limbs of 80 patients having clinically suspcious deep venous disease of lower extremities. The criteria for positive RNV included 1) nonfilling of deep vein, 2) abnormal venous collaterals, 3) slow ascending of isotope, and 4) residual hot spot. Abnormal RNV findings were compared with DS findings in 3 groups of patients based on DS findings. RESULTS: DS results can be divided as deep vein thrombosis (DVT) (n=46), chronic venous insufficiency (CVI) (n=18), and nonspecific (n=16). The concordance rates between RNV and DS were 79% in DVT group and 50% in CVI group. In 6 patients (7.5%) with negative or equivocal DS with positive RNV results, we could find clinically relevant findings of CVI on those limbs. CONCLUSION: RNV seemed to have an acceptable role in the diagnosis of leg venous thrombosis as an adjuvant diagnostic method with DS, especially for the patients showing equivocal DS results.
Diagnosis ; Extremities ; Humans ; Leg* ; Lower Extremity ; Phlebography* ; Ultrasonography ; Veins ; Venous Insufficiency ; Venous Thrombosis

Abnormal attachment of the gallbladder to the liver is the main cause for gallbladder torsion. However, the present study reports a rare case of gallbladder torsion in which a portion of fundus is rotated along the axis of body. So far, very few similar cases have been reported. An 87-year-old woman complaining right upper quadrant abdominal pain for 4 days was admitted. Her body temperature was 38.5degrees C with moderate dehydration. A large tender mass was palpated on the right abdomen extending to the right iliac fossa. Computed tomography of abdomen showed a large cavity with a diameter of 15 cm containing a big stone and a small normal looking gallbladder. Ultrasonographic scan showed a twisted portion of the gallbladder torsion. During emergency laparotomy, the middle portion of the gallbladder was found to be twisted counterclockwise with huge gangrenous gallbladder distal. The proximal body of the gallbladder was spared and attached firmly to the liver. Cholecystectomy was performed and the patient was discharged 2 weeks later without postoperative complications. Histological findings of specimen were consistent with operative findings. The current study reports on a rare case of gallbladder torsion by reviewing previous studies.
Abdomen ; Abdominal Pain ; Aged, 80 and over ; Axis, Cervical Vertebra ; Body Temperature ; Cholecystectomy ; Dehydration ; Emergencies ; Female ; Gallbladder* ; Gallstones ; Humans ; Laparotomy ; Liver ; Postoperative Complications

The role of multimodality therapy and surgery for the treatment of locally advanced pancreatic cancer remains to be determined. Although no randomized trials have been done to determine the optimal management of this difficult clinical problem, numerous series reporting successful surgical resection with negative (R0) or microscopic margin (R1) showing favorable long-term survival provide a basis for an aggressive approach in selected cases of advanced cancer of the pancreas. In the absence of conclusive clinical trials, neoadjuvant treatment followed by surgical resection seems to be the optimal approach for locally advanced pancreatic cancers when the potential for surgical resection is suggested by preoperative high quality CT imaging. In particular, when the tumor is within the criteria for borderline resectable pancreatic cancer, efforts to achieve R0 resection are warranted. For those selected cases invading the hepatic artery and superior mesenteric artery, combined arterial resection and reconstruction may be performed to achieve R0 resection. Nonetheless, such a complex procedure should be balanced by a high rate of postoperative complications. In contrast, in cases of tumors invading the celiac axis, R0 resection by combined celiac axis resection can be performed without a high rate of postoperative complications. Survival benefit needs to be verified by further studies in the future.
Axis, Cervical Vertebra ; Hepatic Artery ; Mesenteric Artery, Superior ; Neoadjuvant Therapy ; Pancreatic Neoplasms ; Postoperative Complications

The questions concerning storage temperature and storage duration of the fortified ophthalmic antibiotic solutions are raised. The aim of the current study is to evaluate the influence of fortified ophthalmic antibiotic solutions on its biological and physical properties according to the storage temperature and duration as time goes by. We examined the changes of pH, absorbance spectra, and anti-microbial activity of cefradine(63mg/ml)and gentamicin sulfate(13.6mg/ml) over a four-week period. The results were as follows: There was no difference between the potency of fortified GM solutions stored at 4 degrees C and that at 24 degrees C for 4 weeks. The cefradine stored 24 degrees C exhibited significant changes in both its tJotency and stability after ithe seventh day of storage. The cefradine stored at 4 degrees C exhibited changes in Its absorbance spectra day by day and potency after 14th day.
Cephradine ; Gentamicins ; Hydrogen-Ion Concentration ; Ophthalmic Solutions*

The management of blunt injuries to the liver still remains a significant challenge. The therapeutic options for liver trauma ranges from non-surgical management, surgical management and even to liver transplantation. Although a significant number of patients are treated non-surgically, most unstable patients require an immediate laparotomy. The preferred surgical techniques include resectional debridement, hepatotomy with direct suture ligation and perihepatic packing. In addition, an anatomical resection, hepatic artery ligation and various bypass techniques have a more defined role in selected injuries. This review discusses the various surgical options for unstable liver trauma patients.
Debridement ; Hepatic Artery ; Humans ; Laparotomy ; Ligation ; Liver Transplantation ; Liver* ; Sutures ; Wounds, Nonpenetrating

There are many factors that influence the response of strabismus surgery. This study was undertaken to evaluate the influence of axial length on the response to strabismus surgery. Axial length was determined preoperatively on 156 non-paralytic horizontal strabismus patients undergoing strabismus surgery from February, 1993 to April, 1994. The mean axial length in all patients was 22.29+/-1.35mm. In esotropia the mean axial length was 21.24+/-1.12mm and in exotropia the mean axial length was 22.68+/-1.23mm. A statistically significant inverse correlation was found between axial length and surgery response (prism diopters per millimeter of recuts recession) in esotropic patients (R=-0.51 p=0.0006). Especially in aquired esotropia, a more significant correlation was found between axial length and surgery respinse (R=-0.73 P=0.0001). The relationship in esotropia was linear and could be written as the approximate regression formula : surgery response=9.51-0.29* axial length (R=-0.454 P=0.03). However, a poor correlation was found between axial length and surgery response in exotropia. Therefore it is regraded as being effective that the amount of recession in esotropia should be graduated according to axial length.
Esotropia ; Exotropia ; Humans ; Strabismus*

PURPOSE: Central pancreatectomy (CP) may be indicated for the treatment of benign or low-grade malignant tumor in the neck and proximal body of the pancreas. Pancreatic fistula is one of the most common complications after CP. In this study, we suggested an inverted mattress pancreaticojejunostomy (IM-PJ) technique to decrease the risk of pancreatic fistula. METHODS: Between 2010 and 2015, CP was performed with IM-PJ for 10 consecutive patients with a benign or low-grade malignant tumor in the neck and proximal body of the pancreas. All clinical and pathological data were analyzed retrospectively. RESULTS: Median age was 56.4 years (range, 17–75 years). Median surgery duration was 286 minutes (range, 205–410 minutes). In all cases, the distal stump was reconstructed using the IM-PJ method. Median duration of hospital stay was 23.8 days (range, 9–53 days). No patient mortality occurred. Pancreatic fistula developed in 9 cases (90%); however, all fistulas were grade A and resolved without surgical or radiological intervention. Nine patients remain well with no recurrence or new endocrine or exocrine dysfunction. CONCLUSION: Our results demonstrate that the outcomes of CP with IM-PJ are reasonable for prevention of pancreatic fistula following CP.
Fistula ; Humans ; Length of Stay ; Methods ; Mortality ; Neck ; Pancreas ; Pancreatectomy* ; Pancreatic Fistula* ; Pancreaticojejunostomy* ; Recurrence ; Retrospective Studies

OBJECTIVE: To determine whether the cause of sympathetic dysfunction is due to increased regional sympathetic outflow or receptor supersensitivity to circulating catecholamines in the pathogenesis of reflex sympathetic dystrophy in hemiplegia. METHOD: Ten hemiplegic patients with reflex sympathetic dystrophy were instructed to refrain from smoking or using caffeine and alcohol, and medications that influence catecholamine metabolism were witheld for 24 hours before blood sampling. Patients with cardiovascular disease, diabetes or abnormal liver and renal function tests were excluded from the study. Patients with a history of sympathectomy were also excluded. Ten hemiplegic patients without reflex sympathetic dystrophy served as the control group. Both groups of patients rested in supine position in a quiet room for 30 minutes. A needle with heparin cap was inserted into the dorsal venous arches of the affected hand and patients rested for another 20 minutes, after which blood was drawn through the heparin cap. The blood samples were assayed using high-performance liquid chromatography (HPLC) and norepinephrine and epinephrine were detected electrochemically. 24 hour urine was collected during rest and vanillylmandelic acid (VMA) and metanephrine were also detected using HPLC. RESULTS: The mean plasma norepinephrine levels were 1.05 0.24 ng/ml and 0.47 0.06 ng/ml in RSD affected and unaffected groups respectively, and the plasma norepinephrine level was significantly higher in the patient group with reflex sympathetic dystrophy (p<0.05). The plasma epinephrine and 24-hour urine VMA and metanephrine levels were not significantly different in two groups. CONCLUSION: These results may support a hypothesis of increased regional sympathetic outflow in the pathogenesis of reflex sympathetic dystrophy in hemiplegia.
Caffeine ; Cardiovascular Diseases ; Catecholamines ; Chromatography, High Pressure Liquid ; Chromatography, Liquid ; Epinephrine ; Hand ; Hemiplegia ; Heparin ; Humans ; Liver ; Metabolism ; Metanephrine ; Needles ; Norepinephrine ; Plasma ; Reflex Sympathetic Dystrophy* ; Reflex* ; Smoke ; Smoking ; Supine Position ; Sympathectomy ; Vanilmandelic Acid

OBJECTIVE: To evaluate how to influence static lumbar lordosis by different heel heights in normal adults and patients with spondylolisthesis. METHOD: The lumbolumbar angles, lumbosacral angles and slip angles were examined while standing on barefoot, on heel support with 5 cm heel, and with 10 cm heel in 14 normal adults and 10 patients with first grade of spondylolisthesis. Standing lumbar spine lateral view was performed by one half hour adaptation with corresponding shoe types. RESULT: The lumbolumbar angles (angles between upper margin of 2nd lumbar body and low margin of 5th lumbar body) and the lumbosacral angles (between upper margin of 2nd lumbar body and low margin of 1st sacral body) in normal are 36.8+/-6.5degrees, 50.1+/-9.5degrees on barefoot, 36.0+/-7.3degrees, 49.6+/-7.4degrees on heel support with 5 cm heel, and 36.1+/-7.6degrees, 49.7+/-8.3degrees with 10 cm heel. Lumbolumbar angles and lumbosacral angles in 10 patients with spondylolisthesis 38.8 8.3degrees on barefoot, 47.2+/-10.4degrees on heel support with 5 cm heel, 38.3+/-7.0degrees, 47.7+/-9.2degrees with 10 cm heel. The slip angles in 10 patients with spondylolisthesis are 29.8+/-1.2degrees on barefoot, 30.2+/-1.8degrees on heel support with 5 cm heel, and with 10 cm heel. CONCLUSION: The changes of heel height did not significantly influence the lumbar lordosis in normal adults and patients with spondylolisthesis. There were no significant differences in average slip angle according to heel height in patients with spondylolisthesis were found.
Adult* ; Animals ; Heel* ; Humans ; Lordosis* ; Shoes ; Spine ; Spondylolisthesis*