Authors compared surgical results of neurologic impaired esotropes(n=23, group I) and normal infantile esotropes(n30, groups II) following bilateral medialrecti recession. Inclusion criterias were earlier onset of esotropia than 6 months of age, more than 25 PD with comitant strabismus, and follow-up time more than 6 months. The mean age of each group was 26.3months in group I. 32.5 months in group II and mean preoperative deviation was 42.4PD, 43.2PD and mean follow-up was 20.6 months, 20.2 months respectively. We defined success as alignment maintained within 10 PD of orthophoria. Success rate was 78.3% and overcorrection was 21.7% in group I while success rate was 83.3%, with undercorrection of 16.7% in group II at the one month postoperatively(p=0.006). Success rate was 30.8% and overcorrection was 53.9% in group I and success rate 66.7% in group II at the 24 months postoperatively(p=0.013). We conclude that neurologic impaired esotropic patients showed more overcorrection and more poor long-term success rate than infantile esotropes following bilateral media recti recession.
Esotropia ; Follow-Up Studies ; Humans ; Strabismus

We compared Healon which is widely used as a viscoelastic with Hyal 2000, recently produced in Korea. We evaluated anterior chamber reaction, intraocular pressure, and specular microscopy after injection of 0.2ml Healon and Hyal 2000, respectively, into anterior chamber of 20 cats, and performed light microscopy and scanning electron microscopy 8 weeks later. We calculated the corneal swelling rate after 0.2ml Healon and Hyal 2000 were coated on the corneal endothelium of 10 rabbits and GBR solution with 0.5mM H2O2 was perfused. Anterior chamber reaction disappeared after 2 days of injections, and intraocular pressure(IOP) increased after 6 hours of infection but normalized after 24 hours in both 2 groups. Corneal endothelial cell count was 4956cells/mm2 in the Healon group and 5021cell.mm2 in the Hyal 2000 group on the first post-injection day. and 4827cells/mm2 and 4810cell/mm2, 1 week later, without a statistical difference. The histologic abnormality was not detectable in light microscopy or scanning electron microscopy in both groups. The corneal swelling rate with Healon was 15.85micrometer/hr and 12.72micrometer/hr with Hyal 2000, while it increased to 69.29micrometer/hr and 67.51micrometer/hr in controls(p<0.05), respectively. The clinical findings showed no difference and histologic findings appeared normal in both the Healon and the Hyal 2000 groups. The inhibitory effect on the corneal swelling was similar during in vitro perfusion in both groups.
Animals* ; Anterior Chamber ; Cats ; Endothelial Cells ; Endothelium, Corneal ; Hyaluronic Acid* ; Intraocular Pressure ; Korea ; Microscopy ; Microscopy, Electron, Scanning ; Perfusion ; Rabbits

PURPOSE: The purpose of this study is to investigate the correlations of various kinetic parameters derived from the time intensity curve in a xenograft mouse model injected with a prostate cancer model (PC-3 and LNCaP) using an ultrasound contrast agent with histopathologic parameters. MATERIALS AND METHODS: Twenty nude mice were injected with human prostate cancer cells (15 PC-3 and five LNCaP) on their hind limbs. A bolus of 500 microL (1 x 10(8) microbubbles) of second-generation US contrast agent (SonoVue) was injected into the retroorbital vein. The region of interest was drawn over the entire tumor. The time intensity curve was acquired and then fitted to a gamma variate function. The maximal intensity (A), time to peak (Tp), maximal wash-in rate (washin), washout rate (washout), area under the curve up to 50 sec (AUC50), area under the ascending slope (AUC(in)), and area under the descending slope (AUC(out)) were derived from the parameters of the gamma variate fit. Immunohistochemical staining for VEGF and CD31 was performed. Tumor volume, the area percentage of VEGF stained in a field, and the count of CD31 (microvessel density, MVD) positive vessels showed correlation with the parameters from the time intensity curve. RESULTS: No significant differences were observed between the kinetic and histopathological parameters from each group. MVD showed positive correlation with A (r=0.625, p=0.003), washin (r=0.462, p=0.040), AUC50 (r=0.604, p=0.005), and AUC(out) (r=0.587, p=0.007). Positive correlations were also observed between tumor volume and AUC50 (r=0.481, p=0.032), washin (r=0.662, p=0.001), and AUC(out) (r=0.547, p=0.012). Washout showed negative correlations with MVD (r=-0.454, p=0.044) and tumor volume (r=-0.464, p=0.039). The area percentage of VEGF did not show any correlation with calculated data from the curve. CONCLUSION: MVD showed correlations with several of the kinetic parameters. CE-US has the potential for prediction of tumor vascularity in a prostate cancer animal model.
Animals ; Extremities ; Humans ; Mice ; Mice, Nude ; Models, Animal ; Prostate ; Prostatic Neoplasms ; Transplantation, Heterologous ; Tumor Burden ; Vascular Endothelial Growth Factor A ; Veins

Mature cystic teratoma of the ovary are often diagnosed in women of reproductive age and account for 5-25% of all ovarian tumors. Due to continuous growth and possible complications, namely rupture, torsion, infection and malignancy, teratoma should be removed surgically. More complications are occurred in huge teratoma. We present here a case of a delayed operated huge mature cystic teratoma without any complication with a brief review of the literature.
Female ; Humans ; Ovary* ; Rupture ; Teratoma*

Endothelial cell have been shown to play an active role in many phases of immunologic process, including binding of T lymphocytes, neutrophils, platelets, and monocytes to the endothelium, as well as phagocytosis. Endothelial cells can also serve as targets that undergo cell injury. The most prominent mediators of endothelial cell activation are IL-1beta and TNF-alpha. VLA-4 was first identified as an endothelial cell surface receptor. We performed the culture of endothelial cells derived from human glomerular capillaries and studied the cytokine-regulated expression of VCAM-1, and the effect of dexamethasone and TGF-beta on the cytokine induced VCAM-1 expression using ELISA method. Expression of VCAM-1 was not detectable above background level in the basal unstimulated state. However, VCAM-1 was rapidly induced after exposure to IL-1beta (5ng/ml) or TNF-alpha (1, 10ng/ml) (O.D.=1.76+/-0.15, 1.95+/-0.35, 1.88+/-0.17, mean+/-S.E., control=0.36+/-0.028, n=8-24, P<0.05). But IFN-gamma did not increase the expression of VCAM-1. Addition of dexamethasone (10 micrometer) and TGF-beta1 (1ng, 10ng/ml) blunted IL-1beta and TNF-alpha induced expression of VCAM-1. Therefore, VCAM-1 could be inducible in human glomerular endothelial cells, and it was regulated by dexamethasone and TGF-beta1. The negative findings in histopathology may reflect the transience of VCAM-1 expression and does not necessarily exclude an important role of this molecule in the early stages of renal disease.
Capillaries ; Dexamethasone* ; Endothelial Cells* ; Endothelium ; Enzyme-Linked Immunosorbent Assay ; Humans ; Integrin alpha4beta1 ; Monocytes ; Neutrophils ; Phagocytosis ; T-Lymphocytes ; Transforming Growth Factor beta ; Transforming Growth Factor beta1 ; Tumor Necrosis Factor-alpha ; Vascular Cell Adhesion Molecule-1*

BACKGROUND: In the presence of anticipated or established acute tubular necrosis (ATN) immediately after cadaveric kidney transplantation, induction with monoclonal or polyclonal antibody is recommended in preparation of increased risk of acute rejection caused by ATN. Tacrolimus is a potent immunosuppressive agent than cyclosporine. In this study, we analyzed retrospectively the clinical outcome of patients who had taken tacrolimus as a replacement of cyclosporine in the period of delayed graft function(DGF) to determine the eligibility of tacrolimus instead of antilymphocyte antibody in this situation. METHODS: Between March 1, 1991 and August 31, 2000, DGF developed in eighteen first cadaveric renal transplant recipients in our center. During DGF period, twelve patients received tacrolimus based immunosuppression without OKT3. We reviewed the complete clinical course of the 12 patients. RESULTS: Among the 12 patients, 1 patient underwent graft nephrectomy at postoperative 27 days, because of poor renal function and concomitant aspergillosis infection. In the remaining 11 patients, however, for whom tacrolimus was maintained continuously without OKT3 therapy, renal function was recovered successfully. One acute rejection developed at postoperative 15 months. One patient died at postoperative 5 months with functioning graft. One-year graft survival rate was 83%. CONCLUSION: Tacrolimus could be used in replacement of cyclosporine for the prevention of acute rejection in DGF. This could provide a graft survival comparable to that by the monoclonal or polyclonal antibodies without the potential risk of life- threatening side effects in this situation.
Antibodies ; Antilymphocyte Serum ; Aspergillosis ; Cadaver* ; Cyclosporine ; Delayed Graft Function* ; Graft Survival ; Humans ; Immunosuppression ; Kidney Transplantation* ; Muromonab-CD3 ; Necrosis ; Nephrectomy ; Retrospective Studies ; Tacrolimus* ; Transplantation ; Transplants

Colorectal cancer is rare in teenagers, especially without known risk factors. Colon cancer in young age is more likely to be diagnosed at advanced-stage, to present unfavorable tumor histology such as mucinous carcinoma, and poor outcome. We report a case of sporadic mucinous adenocarcinoma of the colon in a 19-year-old male patient without any risk factors. He complained of severe left abdominal pain that developed 1 month ago. He had a distended abdomen with severe tenderness on the left lower quadrant. A distal descending colon mass causing mechanical obstruction was observed on abdominal computed tomography. Emergency colonoscopy showed a large, fungating mass obstructing the lumen at 40 cm from the anal verge. Biopsy of the colonic mass suggested a mucinous adenocarcinoma. After decompression by colonic stent, the patient was transferred to the general surgery department for left hemicolectomy. The lesion was confirmed to be a mucinous adenocarcinoma (7.0x4.5 cm). For hereditary nonpolyposis colorectal cancer evaluation, immunohistochemical staining for MLH1 and MSH2 was normal. Reverse transcription polymerase chain reaction analysis did not detect microinstability in any of the markers tested. The patient had no familial history of cancer. Mucinous adenocarcinoma has high frequencies of poor differentiation, advanced tumor stage, loss of mismatch repair gene expression, and increased MUC2 expression. A mucinous histology is considerably more frequent in children and adolescent than in adults. Adequate invasive study is also necessary for young age patients.
Abdomen ; Abdominal Pain ; Adenocarcinoma, Mucinous ; Adolescent ; Adult ; Biopsy ; Child ; Colon ; Colon, Descending ; Colonic Neoplasms ; Colonoscopy ; Colorectal Neoplasms ; Colorectal Neoplasms, Hereditary Nonpolyposis ; Decompression ; DNA Mismatch Repair ; Emergencies ; Gene Expression ; Humans ; Male ; Mucins ; Polymerase Chain Reaction ; Reverse Transcription ; Risk Factors ; Stents ; Young Adult

PURPOSE: To assess the usefulness of MRI in the preoperative diagnosis of breast implant-relatedcomplications. MATERIALS AND METHODS: Thirty four breast implants in 17 patients were examined. Eight breasts hada history of repeated surgery due to rupture and in eight others, simultaneous interstitial silicone injection hadbeen performed. MR images of the 34 implants were prospectively analyzed for implant-related complications,without prior clinical information, and the findings were compared with the results of surgery. RESULTS: Theimplant-related complications seen on MRI were infections in three cases, seromas in two, and implant malpositionin two. The linguine sign was seen in eight cases and intraparenchymal silicone in 17. Among the 32 removedimplants, rupture was genuine in ten cases (nine, extracapsular; one, intracapsular). In evaluating the MRfindings of implant rupture, the linguine sign showed 80% sensitivity, 100% specificity and 93.8% accuracy.Intraparenchymal silicon also revealed high sensitivity (90%), but relatively low specificity and accuracy (63.7%and 71.9%, respectively); this was due to the difficulty of differentiating granulomas still present after aprevious rupture from injected silicone material. MRI was useful for visualization of implant migration, thedirect relationship of extended or extruded silicone in extracapsular rupture and the localization of siliconegranulomas, as seen on multiplanar images. The extent of infection was clearly demonstrated on contrast enhancedscan. There was relatively good correlation between the degree of contracture seen on physical examination andthat seen on MRI. CONCLUSION: MRI was an effective and useful method for the preoperative evaluation ofimplant-related complications; degree of contracture was successfully predicted.
Breast Implants ; Breast* ; Contracture ; Diagnosis ; Granuloma ; Humans ; Magnetic Resonance Imaging* ; Physical Examination ; Prospective Studies ; Rupture ; Sensitivity and Specificity ; Seroma ; Silicones

OBJECTIVE: The purpose of this study was to examine the effects of VIP on the apoptotic neuronal death induced by serum deprivation and the necrotic(excitotoxic) neuronal death by the exposure of NMDA in primary murine cortical cell cultures. MATERIALS AND METHODS: Near-pure neuronal cell cultures were prepared by plating fetal mice cortical cells onto polyethyleneimine-coated 24 well vessels. At 7 days in vitro(DIV), serum was removed from culture media for 24 hrs in near-pure neuronal cultures. Mixed cortical cell cultures containing both neurons and glia were prepared by plating fetal mice cortical cells onto an established monolayer of glia. At 12-14 DIV, excitotoxic neuronal death was induced by the addition of NMDA into the mixed cortical cultures. The neuronal cell death was assessed by either MTT or LDH assay after microscopic examination. RESULTS: Near-pure neuronal cell cultures deprived of serum undergo neuronal apoptosis marked by cell body shrinkage, chromatin condensation and DNA ladders. The apoptotic neuronal death following serum deprivation was significantly attenuated by the inclusion of a membrane-permeable cAMP analogue(8-bromo-cAMP; 100nM), an adenyl cyclase stimulator(forskolin; 10nM), a protein synthesis inhibitor(cycloheximide; 0.1ng/ml) or cell membrane depolarization(25mM KCl) during serum deprivation, but was not affected by the addition of an NMDA antagonist (MK-801; 10nM) or an antioxidant(trolox; 100nM). The inclusion of VIP(1, 3, 10nM) during deprivation also significantly prevented the neuronal death without dose-dependency. The neuroprotective effect of VIP(1nM) was not reversed by concomitant treatment with a VIP receptor antagonist([D-p-Cl-Phe6, Leu17]-VIP; 10, 30nM). Neuronglia co-cultures exposed to 300nM NMDA for 5 min produced neuronal death marked by cell body swelling. The neuronal death induced by the exposure of NMDA was markedly attenuated by MK-801 but not affected by 8-bromo-cAMP, forskolin, cycloheximide, high potassium or VIP. CONCLUSION: These results provide an evidence that VIP prevent apoptotic neuronal death induced by serum deprivation and suggest that VIP may have therapeutic potential for diseases in central nervous system linked to apoptotic neuronal death.
8-Bromo Cyclic Adenosine Monophosphate ; Adenylyl Cyclases ; Animals ; Apoptosis ; Cell Culture Techniques* ; Cell Death ; Cell Membrane ; Central Nervous System ; Chromatin ; Coculture Techniques ; Colforsin ; Culture Media ; Cycloheximide ; Dizocilpine Maleate ; DNA ; Mice ; N-Methylaspartate ; Neuroglia ; Neurons* ; Neuroprotective Agents ; Potassium ; Receptors, Vasoactive Intestinal Peptide ; Vasoactive Intestinal Peptide*

PURPOSE: To compare power and conventional color Doppler sonography for depiction of the vasculature of solidbreast lesions, and to evaluate the usefulness of power Doppler sonography for differential diagnosis of malignantbreast lesions. MATERIALS AND METHODS: In order to detect vascularity, 82 cases of solid breast lesions wereevaluated by power and color Doppler sonography. Fifty-eight pathologically proven cases (37 benign and 21malignant lesions) were analyzed for the amount and patterns of Doppler signals, morphology of vessels, and thediagnostic accuracy. RESULTS: In 45 of 82 cases, power Doppler sonography depicted flow better than did colorDoppler sonography, while in 37 cases, depiction was equal. On power Doppler sonography, the incidence of markedblood flow in malignant lesions was three times higher than in benign lesions. The pattern of vasculature was morepredominantly central (85.5 %) and penetrating (61.9 %) in malignant lesions than in benign lesions. Branching(57.1 %) and disordered vessels (33.3 %) were more frequent in malignant lesions than in benign. For the diagnosisof malignancy, sensitivity for power Doppler sonography was 65 %, specificity was 79 % and diagnostic accuracy was74.1 % ; for color Doppler sonography, the corresponding figures were 76.9 %, 75.6 % and 75.9 %. CONCLUSION: Power Doppler sonography was more sensitive than color Doppler sonography for the detection of flow in solidbreast lesions. For the differentiation of benign from malignant lesions, however, there was no difference indiagnostic accuracy between the two modalities. findings of central and penetrating distribution patterns ofDoppler signals, and branching and disordered shapes of vessels, along with other sonographic criteria, arehelpful for predicting malignancy.
Breast* ; Diagnosis, Differential ; Incidence ; Sensitivity and Specificity ; Ultrasonography