PURPOSE: Partial obstruction of the rat bladder outlet induces a rapid hypertrophy characterized by increased smooth muscle content and collagen deposition. This increased collagen is likely to reduce the quality of the contraction and compliance of the bladder wall. Also it has been reported that an alteration in the ratio of type I and III collagen may be more important than the amount of collagen in determining compliance. To evaluate the genetic basis of collagen deposition in the partially obstructed rat bladder, the author observed the change of proalpha1(I) collagen, proalpha1(III) collagen, proalpha(IV) collagen and matrix-metalloproteinase(MMP)-2 mRNA after partial urethral obstruction. MATERIALS AND METHODS: Female Sprague-Dawley rats weighing 150-200g were used. Individual bladders were obtained from unoperated rats, and from rats at 6, 12, 48, 72, hours, 5 and 7 days after partial urethral obstruction and sham operation. Total RNA was extracted from each of these tissue, The expression of mRNAs were assessed by Northern blot analysis. The band intensities of the autoradiographs measured by densitometry were compared between the obstructed and sham group. RESULTS: Partial urethral obstruction induced a gradual increase in bladder weights, The expression of mRNA for proalpha1(I) collagen was generally attenuated within 24hours after obstruction. In extended period of obstruction, the expression of mRNA for proalpha1(I)collagen reached a peak at day 3-5(219% increase), and remained elevated through day 7. The expression of mRNA for proalpha1(I)collagen was coregulated with that of pro alpha1(I) collagen, however, the mean ratio to control value of band intensity for proalpha1(III)collagen mRNA was 2 times higher than that of proalpha1(I) collagen, during days 3-7. The expression of mRNA for proalpha1(IV)collagen showed a sharp increase at 48 hours(438% increase)after obstruction earlier than proalpha1(I)collagen and proalpha1(III)collagen mRNA. In extended period of obstruction the expression reached a peak at 72 hours(883% increase) and the mean ratio to control value of band intensity for proalpha alpha collagen mRNA was much higher than those of proalpha1(I) collagen and proalpha1(III) collagen. The expression of MMP-2 mRNA increased from 48hours after obstruction, and reached a peak at day 3-5. CONCLUSIONS: These results sugges that the increase of collagen in the rat bladder after partial urethral obstruction results from an increase of expression of collagen genes, and the decrease of bladder wall compliance results from an increased transcription of type I collagen gene and increase of the ratio of proalpha1(III)collagen to proalpha1(I)collagen mRNA. Because expression of proalpha1(I), (III), (IV) collagen and MMP-2 mRNA increased sharply after 48hours, it is suggested that genetic events leading to remodeling of bladder start at 48hours after partial urethral obstruction.
Animals ; Blotting, Northern ; Collagen Type I* ; Collagen* ; Compliance ; Densitometry ; Female ; Humans ; Hypertrophy ; Muscle, Smooth ; Rats* ; Rats, Sprague-Dawley ; RNA ; RNA, Messenger* ; Urethral Obstruction ; Urinary Bladder* ; Weights and Measures

Persistent vesical dysfunction is often encountered after long term bladder overdistension caused by urinary retention. Experimentally, acute overdistension has also been implicated in the pathogenesis of the response to partial outlet obstruction. In the present study, we evaluated the expression of iNOS in the partially obstructed rat bladder and presupposed that NO is responsible for the prolonged micturition problem after partial outlet obstruction of the rat bladder. Female Sprague-Dawley rats weighing 150~200g were used. Individual bladders were obtained from unoperated control rats, and from rats at 6, 12, 48, 72 hours, 5 and 7 days after partial urethral obstruction. Total RNA was extracted from each of these tissue. The expression of mRNAs were assessed by Northern blot analysis. The band intensity of the autoradiographs measured by densitometry were compared between the obstructed and control group. The expression of mRNA for iNOS was detected in the control rats. The expression showed a sharp increase at 6 hours (342% increase) after obstruction and returned to normal by 24 hours. In this study, we show that iNOS increases in the rat bladder after operation and these results suggest that overproduction of NO may be a possible mechanism for the prolonged bladder dysfunction after partial bladder outlet obstruction.
Animals ; Blotting, Northern ; Densitometry ; Female ; Humans ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type II* ; Rats* ; Rats, Sprague-Dawley ; RNA ; RNA, Messenger* ; Urethral Obstruction ; Urinary Bladder Neck Obstruction* ; Urinary Bladder* ; Urinary Retention ; Urination

PURPOSE: To determine the diagnostic performance of contrast-enhanced multidetector CT (MDCT) and the Alvarado score for acute appendicitis. MATERIALS AND METHODS: MDCT and determination of the Alvarado score were prospectively performed in 282 patients with 146 pathologically proven cases of acute appendicitis and 136 pathologically proven or clinically diagnosed cases of non-acute appendicitis. To compare the diagnostic performance of MDCT and the Alvarado score, the patients were subdivided according to age and sex, and receiver operating characteristics (ROC) analysis and Spearman rank correlation were performed. RESULTS: ROC analysis revealed that the optimal cut off value of the CT appendicitis grades was 2 in all patients, resulting in a sensitivity of 96.6% and a specificity of 94.9%. The optimal cut off values of the Alvarado score was different according to age and sex, resulting in a sensitivity of 85.6% and a specificity of 48.5%. There was a significant correlation between the CT appendicitis grades and the surgical-pathological grades (r=0.496, p<.0001). However, no significant correlation was observed between the Alvarado score and the surgical-pathological grades. CONCLUSION: Contrast-enhanced MDCT has a higher diagnostic accuracy and significant correlation with pathological findings than those of the Alvarado score in patients with acute appendicitis.
Acute Disease ; Appendicitis* ; Humans ; Prospective Studies* ; ROC Curve ; Sensitivity and Specificity

The degree of correlation between sequencing and immunohistochemisty (IHC) for detecting mutations of p53 has not been well established in human hepatocellular carcinoma (HCC). We analyzed 36 HCCs from Korean people for p53 mutation at exons 4-10 by PCR-SSCP and sequencing, and compared the results with the IHC positivity. p53 mutations were identified in 7 out of 36 HCCs (19.4%). These mutations were found widely throughout exons 4-8. No mutation was detected in codon 249. Among the 7 mutations, 6 missense mutations were detected in 15 HCCs with >or=5% immunoreactive tumor cells and one nonsense mutation was in 21 HCCs with <5% immunoreactive tumor cells. The sensitivity for p53 mutation was 85.7% (6/7), the specificity 69.0% (20/29), the predictive value of positive IHC 40.0% (6/15), and the predictive value of negative IHC 95.2% (20/21). Two missense mutations were detected in 25 cases with <10% immunoreactive tumor cells. Predictive values of both positive IHC and negative IHC were higher in >or=5% overexpression group than in >or=10% overexpression group or >0% overexpression group. This study suggests that 5% immunoreactivity is a reliable immunohistochemical threshold value to detect p53 mutations in HCCs and the spectrum of p53 mutations in HCCs in Korean people is different from that of high aflatoxin B1 exposure areas.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/*genetics/*metabolism ; Exons ; Female ; *Genes, p53 ; Humans ; Immunohistochemistry ; Korea ; Male ; Middle Aged ; *Mutation ; Mutation, Missense ; Polymorphism, Single-Stranded Conformational ; Sequence Analysis, DNA ; Tumor Suppressor Protein p53/*biosynthesis

No abstract available.
Female ; Hashimoto Disease/*complications/diagnosis ; Humans ; Polymyositis/*complications/diagnosis ; Young Adult

OBJECTIVE: Recently the treatment of endovascular coil embolization is gradually increasing compared to the traditional method of microsurgical clipping. However, both methods carry certain risks. The aim of this study was to compare each method's morbidity and complications in patients with ruptured cerebral aneurysms. METHODS: We investigated patients who underwent surgery for subarachnoid hemorrhage (SAH) due to cerebral aneurysm rupture between January 2007 to December 2009 in our hospital. Patients' medical records and radiologic images were referenced and initial grade, location and size of aneurysm, treatment method, complications, prognosis, hospital stay and the cost were retrospectively investigated. We divided the patients into two groups according to surgical METHODS: clipping group and coiling group. Treatment results were evaluated using Modified Rankin Scale (MRS). RESULTS: Total 187 aneurysms were treated in 149 patients. Sixty-five and 84 patients were classified as clipping group and coiling group, respectively. The ratio of patients with good outcome in clipping vs. coiling was 83.6% vs. 80.8%. The incidence of vasospasm was significantly lower in the coiling group compared to the clipping group. The length of hospitalization was shorter in the coiling group. The cost and operation time was also less in the coiling group. However, higher numbers of remnant sac and coil compaction were observed in the coiling group. CONCLUSION: Endovascular coil embolization for ruptured cerebral aneurysms had fewer vasospasms and complications. Also, it reduced the hospital stay, operation time, and cost compared with the clipping group. So, in addition to traditional microsurgical neck clipping, we think that endovascular coiling is a good alternative method to treat ruptured aneurysms.
Aneurysm ; Aneurysm, Ruptured ; Hospitalization ; Humans ; Incidence ; Intracranial Aneurysm ; Length of Stay ; Medical Records ; Neck ; Prognosis ; Retrospective Studies ; Rupture ; Subarachnoid Hemorrhage

IgA nephropathy can occur commonly in alcoholic liver cirrhosis and is the most common form of secondary IgA nephropathy. Defective clearance of IgA-containing complexes by liver is thought to contribute to the development of IgA nephropathy in alcoholic cirrhosis. Although IgA deposition is found up to 64% in autopsy cases of alcoholic cirrhosis, most patients have mild clinical symptoms, and nephrotic range proteinuria occurs rarely in these patients. We report a case of IgA nephropathy with a membranoproliferative pattern that is detected with unusual massive ascites in a patient with alcoholic liver disease. A 60-year-old male patient was referred to our hospital for evaluation and management of abdominal distension. Abdominal ultrasonographic findings were compatible with diffuse liver cirrhosis with splenomegaly and large amount of ascites. He had nephrotic range proteinuria, azotemia, hyperlipidemia, and hematuria in dipstick. Renal biopsy performed under the impression of acute nephritis revealed mesangial and endocapillary proliferative glomerulonephritis with double contour of capillary loop. Immunofluorescence findings showed mesangial IgA and C3 deposit, compatible with IgA nephropathy. He was treated with high dose steroid, and steroid was tapered during 2 months. Steroid treatment induced complete remission state, and ascites was resolved.
Alcoholics ; Ascites ; Autopsy ; Azotemia ; Biopsy ; Capillaries ; Fluorescent Antibody Technique ; Glomerulonephritis ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Hematuria ; Humans ; Hyperlipidemias ; Immunoglobulin A ; Liver ; Liver Cirrhosis ; Liver Cirrhosis, Alcoholic ; Liver Diseases, Alcoholic ; Male ; Middle Aged ; Nephritis ; Proteinuria ; Splenomegaly

PURPOSE: Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system. The pathogenesis is not well known, but it is thought to be an immune-mediated disease and may follow a viral infection or vaccinations. MRI demonstrates decreased signal on T1 weighting and increased signal on T2-weighted image. We report clinical features and characteristic MRI findings in seven patients with ADEM who confirmed the preceding infections serologically. METHODS: Patients admitted to the Department of Pediatrics at Asan Medical Center as having ADEM were evaluated for the preceding infections : CSF findings, MRI findings, effects of high-dose steroids and follow-up on changes of neurological symtoms and MRI findings. RESULTS: The onset of neurological symptoms from preceding infection was between 1-3 weeks. The etiologies were Epstein-Barr virus in two, mycoplasma pneumoniae in three, and measles virus in two cases. All lesions found in MRI were cerebral white matter lesions of which there were subcortical white matter in three, corpus callosum in three, deep white matter in two, periventricular white matter in one, internal capsule in one, and cerebral peduncle in one case. There were a total of 3 cases with gray matter lesions. Two cases were treated with high- dose methyl prednisolone, one which showed a good clinical response with much improved lesions on follow-up T2-weighted image, but no clinical response in the other with aggravated MRI lesions. There was 1 patient with gadolinium enhancement lesion in acute phase and the lesion was completely resolved after steroid treatment. CONCLUSION: MRI shows various features in ADEM and may be useful in diagnosis and evaluation of clinical course.
Central Nervous System ; Chungcheongnam-do ; Corpus Callosum ; Demyelinating Diseases ; Diagnosis ; Encephalomyelitis, Acute Disseminated* ; Follow-Up Studies ; Gadolinium ; Herpesvirus 4, Human ; Humans ; Internal Capsule ; Magnetic Resonance Imaging* ; Measles virus ; Mycoplasma pneumoniae ; Pediatrics ; Pneumonia, Mycoplasma ; Prednisolone ; Steroids ; Tegmentum Mesencephali ; Vaccination

OBJECTIVE: Delayed cerebral ischemia due to vasospasm after aneurysmal subarachnoid hemorrhage (SAH) is a leading cause of morbidity and mortality. Recent reports have confirmed that intra-arterial infusion of calcium-channel blockers, which are widely used to counteract vasospasm, is effective for treating SAH with a low risk of complications. Here we report on our experience with intra-arterial nicardipine angioplasty in a consecutive series of 32 patients with SAH. METHODS: This retrospective review evaluated a series of 32 consecutive patients with symptomatic vasospasm that was treated with intra-arterial nicardipine. The patients included in the study were diagnosed with aneurysmal SAH between January 2007 and February 2011. All the patients underwent microsurgical clipping or endovascular coiling. Angioplasty using intra-arterial nicardipine was performed in those patients who were refractory to medical therapy such as triple H therapy. RESULTS: The 32 patients underwent a total of 55 procedures. The total amount of nicardipine used in each angioplasty procedure did not exceed 12 mg, with a maximum dose of 3 mg for each vessel. The Glasgow Coma Scale (GCS) score improved in all patients with an average improvement of 2.4 (range : 1~5). During angioplasty, there were no complications such as thromboembolic events and/or acute transitory spasm. The clinical results were evaluated using the modified Rankin Scale (mRS). Good outcomes (mRS 0~2) were determined in 19 (63.3%) of the 30 patients. The 11 patients (36.7%) with poor outcomes initially had a high Hunt and Hess grade (III or IV) or they had intra-operative complications (mRS: 3~6). CONCLUSION: Our study results support the effectiveness and safety of low-dose nicardipine when performing intra-arterial angioplasty for the treatment of vasospasm after aneurysmal SAH.
Aneurysm ; Angioplasty ; Brain Ischemia ; Glasgow Coma Scale ; Glycosaminoglycans ; Humans ; Infusions, Intra-Arterial ; Nicardipine ; Retrospective Studies ; Spasm ; Subarachnoid Hemorrhage

Background : PTEN, located on chromosome 10q23.31, is a novel tumor suppressor gene. In the sporadic breast cancers, the incidence of the loss of heterozygosity of PTEN is approximately 10% to 40%, but the incidence of intragenic mutation of PTEN is less than 1%. To as- sess the role of the PTEN in the invasive ductal breast cancer, we studied the frequency of the loss of PTEN expression, its correlation with the commonly used prognostic factors of the breast cancer and with PTEN promoter hypermethylation status. Methods : Immunohistochemical staining with an anti-PTEN protein antibody was performed on the paraffin-embedded breast tissues from 129 women with a diagnosis of invasive ductal carcinoma. Methylation specific PCR was performed to detect hypermethylation in the PTEN gene on the 28 cases with the loss of PTEN expression. Results : Sixty-two (48%) of 129 breast tumors had the loss of PTEN expression. The loss of PTEN expression was correlated with lymph node metastasis and stage, and there was a near-significant correlation with the tumor size. PTEN promoter hypermethylation was found in five (18%) out of 28 patients. Conclusion : These results suggest that the loss of PTEN expression might play a role in the progression of the breast cancer and that the aberrant promoter methylation is one of the silencing mechanisms of PTEN.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Diagnosis ; Female ; Genes, Tumor Suppressor ; Humans ; Incidence ; Loss of Heterozygosity ; Lymph Nodes ; Methylation ; Neoplasm Metastasis ; Polymerase Chain Reaction