No abstract available.
Korea*

BACKGROUND: Even though there were developments in various treatment techniques for acute arterial occlusion this disease still has high rate of mortalities and limb amputations. We investigated the combined diseases symptoms location of occlusion type of treatment complication and prognosis in our patients. MATERIAL AND METHODS: This study recruited 48 patients (42 men, 6 women, mean age 57.7 years) who received the operation from January 1995 toDecember 1998. We investigated the post-operation course via medical record review or telephone interview with patients or their family members. RESULT: The most common combined diseases were atherosclerosis in 30 patients. other diseases were 17 diabetes mellitus 16 hypertension and 12 atrial firillation. Pain and clod sensation were noticed in all patients paresthesia in 5 patients fibrillation. Pain and cold sensation were noticed in all patients paresthesia in 5 patients and lower extremity paralysis in 11 patients. In 29 patients the time interval from the onset of symptom to admission was over 72 hours and 15 patients were admitted within 24 hours. The distribution of arterial occlusion location was at 28 femoral arteries 14 popliteal arteries and 6 iliac arteries. All the patients were received embolectomy and 5 patients were received additional bypass grafting. Postoperative complications were 12 reocclusions. 6 compartment syndromes 6 skin necrosis and 2 acute renal failure. The mortality rate was 16.7% (8/48) and the amputation rate was 25%. CONCLUSION: This study revealed 25% reocclusion 25% limb amputation and 16.7% mortaliyt. To improve the prognosis of acute lower extrements arterial occlusion early diagnosis and understand the underlying diseases prompt treatment and operation additional operation including interventional radiologic examination and thorough postoperative care would be appreciated.
Acute Kidney Injury ; Amputation ; Atherosclerosis ; Compartment Syndromes ; Diabetes Mellitus ; Early Diagnosis ; Embolectomy ; Extremities ; Female ; Femoral Artery ; Humans ; Hypertension ; Iliac Artery ; Interviews as Topic ; Lower Extremity ; Male ; Medical Records ; Mortality ; Necrosis ; Paralysis ; Paresthesia ; Popliteal Artery ; Postoperative Care ; Postoperative Complications ; Prognosis ; Sensation ; Skin ; Transplants

No abstract available.
Evoked Potentials* ; Spinal Cord* ; Spine*

OBJECTIVE: We investigated the expression of uPA and uPAR in eutopic endometrium of advanced stage endometriosis and control patients. METHODS: The 33 endometriosis patients and 32 controls were enrolled. Endometrial samples were obtained from 65 premenopausal women aged 29~44 years, undergoing laparoscopic surgery or hysterectomy for non-malignant lesions. Sufficient samples were collected from 33 patients with endometriosis stage III and IV and 32 controls without endometriosis confirmed by laparoscopic surgery. The mRNA expression of uPA and uPAR from eutopic endometrium were analyzed by RT-QC PCR. RESULTS: The mRNAs of uPA and uPAR were expressed in eutopic endometrium from endometriosis and normal controls throughout the menstrual cycle. Uterine endometrium from women with endometriosis expresses significantly (p<0.05) higher levels of u-PA mRNA than endometrium from normal women without endometriosis in the proliferative phase. There were no significant differences in expression of uPAR in eutopic endometrium between controls and endometriosis patients. CONCLUSION: These results suggest that eutopic endometrium from endometriosis patients may be more invasive and prone to peritoneal implantation because of greater u-PA mRNA expression than endometrium from women without endometriosis. Thus, increased proteolytic activity may be one etiology for the invasive properties of the endometrium resulting in the development of endometriosis.
Endometriosis* ; Endometrium* ; Female ; Humans ; Hysterectomy ; Laparoscopy ; Menstrual Cycle ; Polymerase Chain Reaction ; Proteolysis ; RNA, Messenger* ; Urokinase-Type Plasminogen Activator

Pain from cancer is a major problem of managing the oral cancer patients in terminal stage. Overall, pain is reported by about 50% of patients at all stages of cancer and by over 70% with advanced neoplasms. Unrelieved pain can be incapaciting and preclude a satisfying quality of life. But, pain is often poorly assessed, and many clinicians lack sufficient knowledge to optimize cancer pain treatment. There are three basic approaches to the control of pain : modifying the source of pain, altering the central perception of pain, and blocking the transmission of pain to the central nervous system. The optimal use of these approaches and an individualized plan for pain control can maximize both quality and duration of life in dying patients. Opioid analgesics are are the mainstay of pharmacologic treatment. Practical opioid therapy include selection of both drug and route, dose titration, and management of side effects. We present our experienced pharmacologic treatment protocol for cancer pain management that collaborated by Dept. of Hospice, Catholic Medical Center. It will acts as a guideline for our colleague to facilitate the translation of current knowlegde into the clinical practice.
Analgesics, Opioid ; Central Nervous System ; Clinical Protocols ; Hospices ; Humans ; Mouth Neoplasms* ; Pain Management ; Quality of Life

BACKGROUND: We previously demonstrated that a GRE/TRE composite sequence, which is located between 200 bp and 220 bp relative to the transcriptional start site of rat TRH gene, is responsible for the dexamethasone (DEX)- and TPA-induced transcriptional activation, and the transcriptional activation by DEX is mediated by interaction between glucocorticoid receptor (GR) and a TRE-binding transcriptional factor such as c-Jun. However, a non-specific binding with the transciption factors can not be excluded as the mutants used in the previous report could not inhibit the binding of GR and c-Jun completely, and it remains unclear which one of the two TRE-like sequences is critical for the interaction of the two transcription factors. METHODS: Luciferase expressing plasmids that contain a part of rat TRH promoter including the composite GRE sequence or its mutants were transfected into HeLa cells by Fugene 6. After the cells were incubated overnight with DEX or/and TPA, the luciferase activity was measured in a chemiluminometer. A gel retardation assay was performed after binding of the labeled composite sequence or its mutants with GR and c-Jun. RESULTS: DEX and TPA increased the transcriptional activity of the wild type composite sequence by 3 folds and 4 folds, respectively, and the combined stimulation increased the activity by 10 folds. The mutants of which all 6 nucleotides of the GRE half site were replaced and removed almost did not bind to GR and eould not enhance the transcriptional activity at all in response to DEX. The GRE-deleted mutant bound to c-Jun with a remarkably lower affinity and showed a lower response to TPA, whereas the GRE-replaced mutant bound to c-Jun with a similar affinity and showed a similar response to TPA compared to those of the wild type. In response to the combined simulation with DEX and TPA, the mutants showed 30-40% of the trancriptional activity of the wild type. Basal transcriptional activity of all the TRE mutants was significantly lower than that of the wild type. While they almost could not bind to c-Jun, their binding affinity to GR was comparable to that of the wild type. Whereas the DEX- and TPA-induced transcriptional activity of 5 TRE mutant was 10% and 15% of that of the wild type, it responded to those agents in a similar pattern as the wild type. The 3 TRE mutant and the mutant of both TRE sites did not respond to DEX and TPA. The GRE-deleted mutant hardly formed the DNA-protein complex as did the wild type, while the GRE -replaced mutant could form the complex in a less amount with nuclear extract of HeLa celL CONCLUSION: These results suggest that GRE/TRE composite sequence of rat TRH gene specifically binds to GR and c-Jun, providing a site for interaction between the two transcription factors, and that both TRE sites play an important role in basal transcription, and that the 3 TRE site is more critical in the interaction between GRE and TRE for DEX-induced transcriptional activation. (J Kor Endocrinol 14:278-292, 1999)
Animals ; Dexamethasone ; Electrophoretic Mobility Shift Assay ; HeLa Cells ; Humans ; Luciferases ; Mutagenesis, Site-Directed* ; Nucleotides ; Plasmids ; Rats* ; Receptors, Glucocorticoid ; Response Elements* ; Transcription Factors ; Transcriptional Activation

BACKGROUND: We previously demonstrated that the promoter of rat TRH gene has GRE half site (TGTTCT) between -210 bp and -205 bp flanking with similar sequences of TPA response element (TRE), TAGTCA, at a distance of several base pairs from the GRE half site. It promps us to hypothesize that this composite GRE/TRE sequence can provide a site for interaction between glucocorticoid receptor (GR) and c-Jun. Thus, we investigated whether the composite sequence mediates transcriptional regulation induced by dexamethasone (DEX) and 12-O-tetradecanoyl phobol-13-acetate (TPA), and whether it binds GR and c-Jun. METHODS: A luciferase expressing plasmids that contain a part of rat TRH promoter including the composite sequence or their mutants were transfected into HeLa cells by Fugene 6. After the cells were incubated overnight with DEX and TPA, the luciferase activity was measured in a chemiluminometer. A gel retardation assay was performed after binding of the labeled composite sequence or its mutants with GR and c-Jun. RESULTS: DEX increased the transcriptional activity of the plasmid containing the wild type GRE by 2.5 folds, and TPA increased the transcriptional activity by 4 folds. The simultaneous stimulation with DEX and TPA synergistically increased the transcriptional activity by 10 folds. Two mutants whose GRE half sits were altered showed no responses to DEX, and suppressed the TPA-induced or both agents-induced transcriptional activity by 50%. Two mutants whose TRE-like sites were altered suppressed the DEX-induced transcriptional activity by 20%, TPA-induced trarptional activity by 25%, and both agents-induced transcriptional activity by 50%. Gel retardation assay showed that the composite sequence fonned a complex with GR and its mutants bound to GR with remarkably less affinity. c-Jun also bound to the composite sequence to form two cornplexes with less affinity compared to the AP-1 consensus sequence. The mutants of the TRE-like sequence bound to c-Jun with a significantly lower affinity compared to that of the wild type. Simulateous binding of the composite sequence with GR and c-Jun did not form any larger complex. The complex of GR and the composite sequence was much smaller than that formed by c-Jun, suggesting that GR binds to the composite sequence as a monomer. CONCLUSION: These results suggest that the composite sequence of GRE half site and TRE-like site on the promoter of rat TRH gene provides binding sites for GR and c-Jun, which mediate the interaction between two signal transduction pathways. (J Kor Soc Endocrinol 14:265-277, 1999)
4-Acetamido-4'-isothiocyanatostilbene-2,2'-disulfonic Acid ; Animals ; Base Pairing ; Binding Sites ; Consensus Sequence ; Dexamethasone ; Electrophoretic Mobility Shift Assay ; HeLa Cells ; Humans ; Luciferases ; Plasmids ; Rats ; Receptors, Glucocorticoid ; Response Elements ; Signal Transduction ; Transcription Factor AP-1

Attention has been drawn to the possible deliterious effects on operating theatre personnel of breathing in an atmosphere polluted with anaesthetic vapour, in particular, halothane. Whether or not the relation of these effects of anaesthetic vapours has been adequately proved, there is unlikely to be any disagreement that pollution of theatre air with anaesthetic is undesirable. Comparable atmospheric pollution with halothane in the same theatre was studied with and without use of halothane absorber "Aldasorber". The theatre had no device for reducing air pollution. Anaesthetic exhaust fases were drained to the ground. An anaesthetic machine in a semiclosed circle with carbon dioxide absorber was used throughout the anaesthesia. Anaesthesia was maintained with halothane l.0% and 50% oxygen in nitrous oxide, free gas flow rate were oxygen l.5 liter/min and nitrous oxide 1.5 liter/min, Halothane concentrations at various sites of the operating theatre were studied using the method of gas chromatography. 1) Halothane concentrations in the atmosphere of the operating theatre were 0.11 +/-0.07 ppm without halothane absorber and 0.13 +/-0.14 ppm with halothane absorber at the level of 115cm above the operating theatre floor before anaesthesia. 2) Halothane concentrations in the atmosphere of the operating theatre were 7.50 +/-1.32ppm without halothane absorber and 2.82 +/-0.93 ppm with halothsne absorber at the level of 115cm above the operating theatre floor after 3 hours of anesthesia. 3) Comparing this data it was concluded that the concentration of halothane vapour in the operating theatre air after 3 hours of anesthesis could be reduced by 65% W1th halothane absorber Aldasorber.
Air Pollution ; Anesthesia ; Atmosphere ; Carbon Dioxide ; Chromatography, Gas ; Halothane* ; Nitrous Oxide ; Operating Rooms* ; Oxygen ; Respiration

Rapid administration of solution containing dextroae results in marked hyperglycemia and osmotic diuresis hut a balanced electrolyte solution containing maltese does not increase blood sugar. 30 patients were chosen at random and divided into 3 groups j.e, one group received 5% dextrose in water, the second group received Hartmann solution and the third group, 5% maltose in a balanced electrolyte solution. The Patient's blood was collected in the operating room prior to the start l.V. infusion, for the measurement of blood sugar, insulin, osmolarity and electrolrtes in various conditions of N.P.O. Intravenous fluid was administered at a rate of 10 m1/kg/hour while anesthesia was induced and maintained with an endotracheal tube in place. Blood samples were taken one hour. 2 hours and 3 7ours f:on the time 1,V. infusion started, In the of 5% dextrose in water groups, the value of blood sugar and insulin was 88.5+/-12.1 mg% and 14.60+/-7.67 un/ml at NPO, 257.7+/-60.8mg% and 70.75+/-37.55 un/m1 at 1 hour, 298.8+/-84.4mg%: and 143.19+/-50.32 un/ml at 2 hours and 228.6+/-75.8% and 127.71+/-56.98 un/m1 at 3 hours. Although the b1ood sugar and insulin values increased markedly. but potassium and chloride were 4.74+/-0.55 mEq/l and 101.1+/-2.9 mEq/l and 4.11+/-0.31 mEq/l, 107.4+/-2.3 mEq/l and 3.75+/-0.41 mEq/l, 176.4+/-2.7mEq/l and 3.89+/-0.50mEq/l, 106.3+/-2.2 mEq/l and shoewed mild decrease, by the way, osmolarity and serum sodium did not changed. In contrast to the 5% dextrose in water groups, there are no changes in the blood glucose. insulin levels, osmolarity or and electrolrtes in the either Hartmann or Elitol (Elitol=5% maltose contained in a balanced electrolyte solution) groups. There was a slight increase in osmolarity with maltose but it was not significant. Accordingly it is concluded that rapid infusion of harmann or 5% maltose contained ina balanced electrolyte solution affects the blood sugar and insulin levels insignificantly compared to the dextrose cont5aining solution which increase the blood sugar and indulin levels markedly.
Anesthesia ; Blood Glucose* ; Diuresis ; Electrolytes* ; Glucose ; Humans ; Hyperglycemia ; Insulin* ; Maltose ; Operating Rooms ; Osmolar Concentration* ; Potassium ; Sodium ; Water

The congenital long-QT syndrome (LQTS) is characterized by recurrent syncope, prolonged QT intervals, QT interval lability, polymorphic ventricular tachycardia, and sudden death. We report a case of congenital long QT syndrome in a 28-day-old male infant who presented with syncope, bradycardia with 2: 1 pseudo-atrioventricular block and a markedly prolonged QT inteval. One episode occured after crying and degenerated into ventricular fibrillation and terminated after cardioversion. A VVI type cardiac pacemaker was implanted. Subsequently, the infant's heart rate was over 110/min and 2: 1 AV block and any other arrhythmia were absent. The infant recovered from the accompanied pneumonia and sepsis and was discharged 47 days after adrnission. However, 13 days after discharge, the infant returned to our hospital ER with syncope. Ventricular fibrillation ceased after cardioversion. Despite medication with propranolol, ventricular tachycardia persisted. The infant expired the day after he was discharged against medical advice.
Arrhythmias, Cardiac ; Atrioventricular Block* ; Bradycardia ; Crying ; Death, Sudden ; Electric Countershock ; Heart Rate ; Hospitals ; Humans ; Infant ; Long QT Syndrome ; Male ; Pneumonia ; Propranolol ; Sepsis ; Syncope ; Tachycardia, Ventricular ; Ventricular Fibrillation