OBJECTIVE: Oxygen free radical activity is elevated in diabetes mellitus and has been implicated in the etiology of vascular complications and diabetic nephropathy is a serious microvascular complication in patients with IDDM. Despite intensive investigation, the pathophysiology of diabetic renal disease has not been fully elucidated. However, several clinical and experimental studies have suggested that endothelial dysfunction and changes of peritubular microcirculation. I performed this study to examine the oxidative stress in IDDM patients with diabetic nephropathy. METHODS: Nine patients with IDDM (diabetic duration>5 years) and persistent albuminuria (albumin excretion<100mg/day) and 15 normal healthy controls were investigated prospectively for MDA (thiobarbituric acid assay), and antioxidant enzymes [SOD (Hyland et al.), catalase (Nelson and Kiesow), GPX (Palgia and Valentine)]. RESULTS: In RBC, levels of MDA were significantly higher in patients with diabetic nephropathy than in normal healthy controls and levels of antioxidant enzymes were significantly lower in patients with diabetic nephropathy than in normal healthy controls. In plasma, levels of MDA were significantly higher in patients with diabetic nephropathy than in normal healthy controls and levels of antioxidant enzymes except GPX were significantly lower in patients with diabetic nephropathy than in normal healthy controls. CONCLUSION: We conclude that increased oxidative stress and decreased antioxidative defense mechanism may be factors in the initiation of diabetic nephropathy.
Albuminuria ; Catalase ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Diabetic Nephropathies* ; Humans ; Malondialdehyde* ; Microcirculation ; Oxidative Stress ; Oxygen ; Plasma ; Prospective Studies

BACKGROUND: Although the mechanism of the increase in bone resorption induced by estrogen deficiency is still controversial, recent studies have suggested that estrogen may modulate the secretion of bone resorption cytokines that are produced in the bone microenvironment and influence bone remodeling. Among them, IL-1 and TNF-a promote bone resorption by stimulating the activity of mature osteoclasts and the differentiation of osteoclast precursors and the production of these cytokines are mediated by estrogen. We performed this study to evaluate the effect of ovariectomy on bone mineral density and levels of cytokines in the culture media of bone marrow monocytes. METHODS: The experimental animals were 23 female Sprague-Dawley rats that were 8 weeks of age and weighed an average of 176.8 gm at the beginning of the study. Bilateral ovariectomy (n=13) and sham-operation (n=10) were performed in all rats from a ventral approach. Bone mineral density (BMD) of the total body and levels of IL-1 and TNF-a of culture media of bone marrow monocytes were measured before and 8 weeks after operation with using DPX-L and ELISA assay, respectively. Serum levels of LH, FSH, E2 were measured by RIA assay. RESULTS: BMD of total body was lower after ovriectomy (0.24+-0.04g/cm) than before ovariectomy (0.27+-0.03g/cm), but there was no statistically significant difference in sham-operation group. Serum levels of LH, FSH were higher after ovariectorny (0.87+-0.36 mIU/mL, 9.47+-1.26 mIU/mL) than before ovariectomy (0.10+-0.06mIU/mL, 2.09+-0.41mIU/mL) (p<0.01) and serum level of E was lower after ovariectomy (10.98+-8.71pg/mL) than before ovariectomy (7350.77+-417.29 pg/mL) (p<0.01), respectively. Levels of IL-1 and TNF-a in culture media of bone marrow monocytes were higher after ovariectomy (23.48+-3.98pg/mL, 52.64+-5.31 pg/mL) than before ovariectomy (9.72+0.94pg/mL, 24.37+-3.39pg/mL) (p<0.01), but there were no statistically significant differences in the sharn-operation group. CONCLUSION: It is possible that increased production of IL-1 and TNF-a in estrogen deficiency induced by ovariectomy occures in the bone microenvironment and these cytokines may play a critical causal role in inducing bone loss.
Animals ; Bone Density* ; Bone Marrow* ; Bone Remodeling ; Bone Resorption ; Culture Media* ; Cytokines* ; Enzyme-Linked Immunosorbent Assay ; Estrogens ; Female ; Humans ; Interleukin-1 ; Monocytes* ; Osteoclasts ; Ovariectomy* ; Rats* ; Rats, Sprague-Dawley

A study in 51 healthy postmenopausal women was performed to assess the effect of estrogen replacement therapy continuously combined with progesterone for 6 months on bone mineral density and lipid metabolism.Seventeen hysterectomized women were treated with conjugated estrogen(0.625mg/D), 33 nonhysterectomized women with conjugated estrogen(0.625mg/D) and medroxyprogesterone(2.5mg/D), and 1500mg/day calcium supplementation was given to all patients.After 6 month-treatment, serum total cholesterol and LDL-cholesterol levels were reduced significantly (p<0.01) between the two groups. But lumber BMD and other lipid profiles were not changed significantly between the two groups. Our data suggest that continuously applied progesterone in combined hormone replacement therapy dose not annihilate the beneficial effects on bone mineral density and lipid metabolism induced by estrogen.
Bone Density ; Calcium ; Cholesterol ; Estrogen Replacement Therapy ; Estrogens ; Female ; Hormone Replacement Therapy ; Humans ; Lipid Metabolism ; Progesterone

Lymphocytic infiltration of the thyroid gland is a hallmark of the human thyroid autoimmune disease. Enhanced expression of immunoglobulin and adhesion molecules are consistently found in patients with autoimmune thyroid diseases. And cytokines are implicated in enhancing the expression of adhesion molecules.It has been suggested that adhesion-molecule expression within thyroid glands mediates lymphocyte homing events to the target of the autoimmune process. The expression of ICAM-1 was shown to be up-regulated on thyroidal perifollicular endothelial cells and thyrocytes in autoimmune thyroid diseases both in vitro and in vivo.Therfore, we investigated the correlation between thyroid hormone, TSH receptor antibodies, Interleukin-6 and soluble ICAM-1 in patients with Graves' disease before and 2 months after treatment with prophylthiouracil(PTU).Serum concentrations of soluble intercellular adhesion molecule-1(sICAM-1), T_3, T_4, TSH-receptor antibodies(TSH-R-Ab) and Interleukin-6(IL-6) of peripheral blood monocytes were measured in patients with Graves' disease.Serum levels of sICAM-1 were elevated in patients with Graves' disease before treatment with PTU, but serum levels of sICAM-1 did not correlate with the serum concentration of thyroid hormone and TSH-R-Ab before and after treatment. In addition, no correlation between serum levels of sICAM-1 and IL-6 of peripheral blood monocyte.We conclude that although the elevated serum levels of sICAM-1 may contribute to the autoimmune process in Graves' disease, we need more future studies for the role of sICAM-1 and correlation between adhesion molecule and thyroid hormone or cytokines in patients with Graves' disease.
Antibodies ; Autoimmune Diseases ; Cytokines ; Endothelial Cells ; Graves Disease ; Humans ; Immunoglobulins ; In Vitro Techniques ; Intercellular Adhesion Molecule-1 ; Interleukin-6 ; Lymphocytes ; Monocytes ; Receptors, Thyrotropin ; Thyroid Diseases ; Thyroid Gland ; Thyroid Hormones

The single enzyme P-450c17 hydroxylase catalyzes the 17a-hydroxylation of both pregnenolone and progesterone and the side-chain cleavage of 17a-hydroxypregnenolone and 17a-hydroxypro- gesterone to dehydroepiandrosterone and androstenedione. This enzyme is located in the endoplasmic reticulum and consists of a P-450c17 and a specific flavoprotein NADPH-cytochrome P-450 reductase. The clinical picture and hormonal pattern in 17a-hydroxylase deficiency have been consistent in both genotypic sexes with hypergonadotropic hypogonadism in whom the virtual absence of gonadal steroids results in a female phenotype with primary amenorrhea and pseudohermaphro- ditism in the male and underdeveloped secondary sex characteristics and hypermineralocorticoidism with hypertension, hypokalemia, suppressed renin-angiotensin system and extremely reduced aldo-sterone production. A 17-year-old girl visited endocrine clinic because of amenorrhea, absence of pubic and axillary hair, and hypertension. she had elevated levels of serum corticosterone, deoxycorticosterone(DOC), 18-hydroxycorticosterone(18-OHB). Stumulation with ACTH effected minimal increase in the elevated steroids and the ACTH-stimulated 18-OHB to aldosterone ratio was more than 280. These hormonal patterns appear to be homozygote in 17a-hydroxylase deficiency.
Adolescent ; Adrenocorticotropic Hormone ; Aldosterone ; Amenorrhea ; Androstenedione ; Corticosterone ; Dehydroepiandrosterone ; Endoplasmic Reticulum ; Female ; Flavoproteins ; Gonads ; Hair ; Homozygote ; Humans ; Hypertension ; Hypogonadism ; Hypokalemia ; Male ; Oxidoreductases ; Phenotype ; Pregnenolone ; Progesterone ; Renin-Angiotensin System ; Sex Characteristics ; Steroids

Herein reported were three cases of papillary eccrine adenoma also called as tubular apocrine adenoma, characterized by dilated ducts containing eosinophilic secretion or kerain and intraluminal papillations. Case 1. A 23 year old male had a well defined erythematous nodule, measuring 1x1 cm. On the ankle of right leg over ten years. Clinical impression was dermatofibroma. Microscopic features were those of papillary ecrine adenoma. Case 2. A 53 year old female had a well demarcated dermal nodule, measuring 1.5x1 cm. On the buttock. Cut surface exhibited relatively well circumscribed tumor with yellowish brown color, Microscopic features were those of papillary eccrine adenoma with alcian blue positive materials in their lumens. Case 3. A 22 year old female had a showly growing hard painless small bean sized nodule at the metatarsal head area of right sole, measuring 2.3x1.8x0.7 cm. Clinical impression was calcinosis cutis. Microscopic features were those of papillary eccrine adenoma with foreign body granuloma and dystrophic calcification.
Female ; Male ; Humans ; Adenoma

Primary gallbladder carcinoma is generally assumed as uncommon but dismal malignancy. Only sporadic studies about pathologic features of the gallbladder carcinoma have drawn pathologists attention especially in association with cholelithiasis. Currently, we have focused much on the role of metaplastic changes in diseased gallbladders including cholecystitis with or without cholelithiasis, and raised its implication in the development of benign or malignant neoplasm. The authors reviewed 34 cholecystectomy cases with primary gallbladder carcinoma, and their histologic findings were analyzed with reference to the association of metaplastic changes both in tumor and adjacent nonneoplastic mucosal epithelium. Association with gallstones and metaplastic changes in the surrounding nontumorous mucosa is more frequent in intestinal typen than in non-intestinal type (P<0.05). Gallstones may play a role of irritant stimuli to the gallbladder mucosa which can be eventually reconstructed with more resistant cell type. And the subsequent increase in absorptive capacity and accumulation of carcinogenic substance may result in malignant transformation of (reserve) cells in replication zone. At this time we can assume that association of cholelithiasis and presence of metaplastic changes are in parallel relationshop in intestinal type adenocarcinoma. Intestinal type adenocarcinomas are usually papillary (72.7%) especially in superficial portion, but deeper area also shows infiltrative growth focally. This finding is comparable to intestinal type gastric carcinoma which represents frequently a polypoid and papillary growth pattern. With these results, as in the gastric carcinoma it is strongly supported that intestinal metaplasia may play a major role as a precancerous lesion in a minor group of the gallbladder adenocarcinoma. Controlled prospective study on biological behavior of intestinal type adenocarcinoma should be followed with more cumulative cases.
Adenocarcinoma

OBJECTIVE: Estrogen is a major regulator/modulator of bone metabolism, and bone loss in estrogen deficiency is associated with increased bone turnover, But the mechanism for estrogen action on bone metabolism is still unknown. Recent studies have suggested that the increase in bone loss induced by estrogen deficiency is mediated by increased paracrine production of bone resorbing cytokines. Among cytokines, 1nterleukin-6(IL-6) is released from osteoblasts in estrogen deficiency and increases bone resorption by stimulation of osteoclastic activities and recruitment. Thus we performed this study to evaluate the effect of ovariectomies on bone mineral density and IL-6 in cultured monocytes of peripheral blood and bone marrow. METHODS: The experimental animals were 13 female Sprague-Dawley rats that were 8 weeks of age and weighed an average of 188.5 gram at the beginning of the study. Bilateral ovariectomies were performed in all rats from a ventral approach. Bone mineral density(BMD) of the total body, spine and level of IL-6 of cultured monocytes of peripheral blood and bone marrow were measured before and 8 weeks after ovariectomy. RESULTS: 1) BMD of total body and spine were lower after ovariectomy(0.257+/-0.069g/cm2, 0,208+/-0.005g/cm2) than before ovariectomy (0.276+/-0.005g/cm2, 0.229+/-0.011g/cm2), respectively (P<0.01). 2) Although IL-6 level of cultured monocytes in peripheral blood tended to be higher after ovariectomy than before ovariectomy, this difference was not statistically significant (P>0.05). 3) IL-6 level of cultured monocytes in bone marrow was higher after ovariectomy(82.78+/-4.99pg/ml) than before ovariectomy(48.85+/-2.42pg/ml)(P<0.05). CONCLUSION: It is possible that increased production of IL-6 in estrogen deficiency induced by ovariectomy occurs in the local environment of bone or bone marrow rather than in the pheripheral blood and stimulates bone resorption.
Animals ; Bone Density* ; Bone Marrow ; Bone Resorption ; Cytokines ; Estrogens ; Female ; Humans ; Interleukin-6* ; Metabolism ; Monocytes ; Osteoblasts ; Osteoclasts ; Ovariectomy* ; Rats* ; Rats, Sprague-Dawley ; Spine

The posterior cruciate ligament plays as basic stabilizer of the knee. Therefore the knee becomes unstable when tibial insertion of the posterior cruciate ligament is avulsed. The diagnosis may be delsyed or missed because of surgeon's 1sck of awareness or rare condition. The authors treated seven cases of avulsion fracture of posterior cruciate ligsment at the tibial attachment ares ranged from ten to thirty-two years. There were five male and two female. The results were as follows : 1. The cause of all seven cases injury was traffic accident. 2. The physical findings were seven positive posterior drawer test, seven cases of abrasion or laceration over the anterior proximal tibial surface and antero-medial surfsce of the knee joint. 3. The associated injury was comminuted fracture of the tibia and femur (1 case), rupture of collateral ligsment and comminuted fracture of the tibia (1 case) and zygomatic fracture (1 case). 4. The treatment methods were four cancellous fixation, one K-wire fixation after epiphyseal plate fusion but each one pull out wire and dexon suture before epiphyseal plate fusion. 5. The motion of knee joint was within normal limit and no instsbility was inspected at the three months after reduction.
Accidents, Traffic ; Diagnosis ; Female ; Femur ; Fractures, Comminuted ; Growth Plate ; Humans ; Knee Joint ; Knee ; Lacerations ; Male ; Posterior Cruciate Ligament ; Rupture ; Sutures ; Tibia ; Zygomatic Fractures

Since last August, 29 cases of synovial punch biopsy have been carried out with Franklin-Silverman needle which was used in liver biopsy, instead of the specialized needle for the synovium. Authors report the applicable utility of Franklin-Silverman needle for the synovial biopsy, diagnostic value of this procedure and histopathologic findings of the results. The rate of the technical success to abtain synovial tissue was about 76%. Complications after procedure have been very rarely encountered, consisting of mild transient hemarthrosis. In 17 cases, the histopathologic changes was compatible with their clinical findings. In the remainders, we experienced the failures to get synovial tiasue at all in 7 cases and to give the significant synovial changes in 5 successful specimens. Fortunately, the important diagnostic aid was achieved in 3 cases which were conformed early diagnosis of tuberculous arthritis. This needle biopsy was also thought to contribute to rule out the gouty arthritis from other hyperuricemic conditions. But the histologic changes were non specific inflammatory findings in the synovial mambrane of rheumatoid arthritis, osteoarthritis, traumatic and infectious arthritis.
Arthritis ; Arthritis, Gouty ; Arthritis, Infectious ; Arthritis, Rheumatoid ; Biopsy ; Biopsy, Needle ; Early Diagnosis ; Hemarthrosis ; Liver ; Needles ; Osteoarthritis ; Synovial Membrane