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 patulous eustachian tube is not a common otorhinolaryngological disease, for which a standard therapy is not established yet. It is considered benign, but symptoms affecting the patient should not be overlooked or ignored. Using an acellular dermal graft (Collagen), we gained positive results in treating a patient, and thus report this case with a review of the literature.
Collagen* ; Eustachian Tube* ; Humans ; Otorhinolaryngologic Diseases ; Transplants*

BACKGROUND AND OBJECTIVES: There have been some reports suggesting that the malignant and benign clinical courses are separable on the basis of HPV subtypes in the sinonasal inverted papilloma. The E6 protein of high risk HPV subtype including types 16 and 18 is known to be associated with p53. The viral E6 protein-p53 complex is responsible for the functional loss of p53 which then becomes immunohistochemically negative. The aim of this study was to determine the prevalence and types of HPV in this neoplasm and evaluate the relationship between expressions of the oncogenes and HPV. MATERIALS AND METHOD: The material was composed of 11 cases of inverted papilloma and 7 cases which were associated with carcinoma. Immunohistochemical staining for p53 was performed. A molecular study of the E6 gene of HPV DNA types 6, 11, 16 and 18 was also performed with separate nest-PCR on squamous cell lesions stainned p53 and papillomatous lesions by use of microdissection technique with paraffin embedded materials. RESULTS: The carcinomatous and dysplastic areas were diffusely positive for p53 in all cases associated with carcinoma, whereas the control group was negative for p53. HPV types 6 and 11, generally known as the lower risk types were presented in the 80% of all cancers and papilloma lesions. A HPV DNA type 18 was solely positive in 2 cases on the p53 overexpressed lesion, associated with carcinoma. CONCLUSION: p53 and HPV may be involved in the pathogenesis of malignant transformation in the inverted papilloma. Therefore, it can be disproved that the HPV subtypes are directly related to either benign or malignant clinical course. However, functional loss of the wild type p53 gene is deeply associated with malignant transformation. In addition to the classical E6 of HPV 16,18-p53, another mechanism could be involved in the functional inactivation of p53.
DNA ; Genes, p53 ; Humans* ; Microdissection ; Oncogenes ; Papilloma* ; Papilloma, Inverted* ; Paraffin ; Prevalence

PURPOSE: The purpose of this study was to evaluate the usefulness of contrast enhancement in assessing thedepth of stromal invasion in patients with uterine cervical tumors by comparing dynamic and late contrast-enhancedT1-weighted MR imaging with T2-weighted MR imaging. MATERIALS AND METHODS: Of 58 surgically proven uterinecervical cancer patients, 31 in whom tumors were seen on MRI were included in this study. Using a 1.5 T magnet,T2-weighted contrast-enhanced dynamic, and T1-weighted MR imaging were performed. In each MR imaging sequence,tumor visualization, margin delineation, enhancement pattern and depth of stromal invasion were evaluated onsagittal images and were correlated with pathological findings of resected uterus, focusing on the depth ofstromal invasion. RESULTS: Surgical FIGO stages were IB1 in 20 patients, IB2 in three, IIA in six, and IIB intwo. A tumor was detected in 29 (94%) patients on T2-weighted images, in 26 (84%) on dynamic contrast enhancedimages, and in 28 (90%) on contrast enhanced T1-weighted images. The tumor demonstrated a clear margin in 22 (71%)patients on late contrast-enhanced T1-weighted images, in 21 (68%) on dynamic images, and in 13 (42%) onT2-weighted images. Correlated with pathologic findings, the depth of stromal invasion was overestimated onT2-weighted images in eight (26%) patients, and on dynamic and late contrast-enhanced T1-weighted images in three(10%) and three (10%) respectively. CONCLUSION: Tumor margins are clearer and the extent of tumors may be moreaccurately evaluated on dynamic MR and late contrast-enhanced T1-weighted imaging. These sequences thas seem to beuseful, and superior to T2-weighted imaging, for assessing the depth of stromal invasion in patients with cervicalcarcinoma.
Cervix Uteri* ; Female ; Humans ; Magnetic Resonance Imaging* ; Uterus

Purpose: Recent advances in the treatment of breast cancer have led to the improvement of breast cancer patient’s survival. With the prolonged survival of these patients, pregnancy became an important issue, especially in young cancer patient aged 35 years or under. Increased hormone levels during pregnancy, however, raise concerns about elevating the risk of cancer recurrence. The aim of this study was to validate the notion of increased risk associated with pregnancy after breast cancer treatment in young patients. Methods: From January 2009 to December 2020, newly diagnosed breast cancer patients 35 years old or under who underwent optimal surgery in Korea University Guro Hospital were enrolled in this study. Patients were categorized into 3 groups: nulliparous, pregnancy prior to treatment of breast cancer, and patients with pregnancy after breast cancer treatment. Their overall survival and disease-free survival were evaluated. Results: A total of 107 patients were enrolled in this study. Thirteen patients (12.1%) conceived and successfully delivered. The mean follow-up period after surgery was 58.9 (± 33.5) months. There was no significant difference in overall survival (P = 0.608) and disease-free survival (P = 0.591) among different groups. Conclusion In young patients, pregnancy after treatment for breast cancer did not affect their overall survival or diseasefree survival as compared to nullipara or previously delivered groups. Therefore, pregnancy counseling should not be prevented in young breast cancer patients 35 years old or under.

BACKGROUND: Routine hemodialysis is performed with systemic anticoagulation, usually with heparin, to prevent thrombosis in the extracorporeal blood circuit. However, systemic anticoagulation can produce hemorrhagic complications in patients at high risk of bleeding. To minimize the risk of bleeding, a number of alternative regimens has been proposed, however, each of those methods has its own limitations and complication. METHODS: 58 hemodialysis patients at risk for bleeding due to previous surgery or hemorrhagic complication were treated with Futhan as regional anticoagulant and compared with that of low-dose heparin anticoagulation. There were 29 (50%) postoperative cases and 29 (50%) cases of hemorrhage from various sites. RESULTS: The exacerbation of bleeding by hemodialysis was noted in only 4% in heparin treated group and none in Futhan group. Clotting times at site A (intracorporeal circulation) were not prolonged with Futhan, whereas those of heparin were prolonged slightly, which is not statistically significant. Degrees of residual blood in the dialyzer and blood clottings in the venous drip-chamber were less in Futhan than in heparin group. Adverse reactions related to Futhan therapy were minor and the incidence of adverse reactions was comparable in both groups. CONCLUSION: Futhan is a safe and effective regional anticoagulant for hemodialysis especially for patients with high bleeding risk.
Blood Coagulation ; Hemorrhage* ; Heparin ; Humans ; Incidence ; Mesylates* ; Renal Dialysis* ; Thrombosis

The nephrotic syndrome in association with extrarenal malignancy is not an uncommon event. The membranous nephropathy is most frequently associated with various carcinomas of the lung, breast, stomach and colon. Though the exact causal relationship has not been determined completely, deposition of the immune complexes composed of antitumor antibody and tumor antigens in the subepithelium is most favorably accepted. We experienced a patient with previously diagnosed membranous nephropathy and subsequently demonstrated early gastric cancer during patient follow-up. After surgical resection proteinuria improved significantly. All physicians are strongly recommended to examine thoroughly and search carefully for possibility of concomitant occult malignancy when an aged patient, especially over 40 years old, is diagnosed as a nephrotic syndrome.
Adult ; Antigen-Antibody Complex ; Antigens, Neoplasm ; Breast ; Colon ; Follow-Up Studies ; Glomerulonephritis, Membranous* ; Humans ; Lung ; Nephrotic Syndrome ; Proteinuria ; Stomach ; Stomach Neoplasms*

BACKGROUND: Postoperative residual curarization subsequent to the use of neuromuscular blocking drugs can cause respiratory problems. This study examined the incidence of postoperative residual curarization on the arrival of patients in the recovery room. METHODS: Two-hundred-fifty-nine patients were enrolled in the study. The neuromuscular blockade was maintained with vecuronium or rocuronium and all subjects were reversed with pyridostigmine. The train of four ratios (TR) was quantified by acceleromyography immediately upon their arrival in the recovery room. The residual curarization was defined as a TR of < 0.9. RESULTS: The incidence of residual curarization was 32.8% (84 patients). The time from the last dose of muscle relaxants to the TR assessment in the recovery room was significantly different between those with a TR <0.9 (74.9 +/- 35.3 min) and a TR > 0.9 (104.5 +/- 51.1 min) patients. The total dose of muscle relaxants corrected by the ED95 was significantly different between TR < 0.9 and TR > or = 0.9 patients. The total dose of vecuronium or rocuronium, and the dose of pyridostimine was similar in the TR < 0.9 and TR > or = 0.9 patients. CONCLUSIONS: Significant postoperative residual curarization waspresent in the majority of patients, even with the use of intermediate- acting neuromuscular blocking drugs. In addition, the time from the last dose of muscle relaxants to the TR assessment in the recovery room is a major factor that affects the residual curarization.
Humans ; Incidence ; Neuromuscular Blockade ; Pyridostigmine Bromide ; Recovery Room* ; Vecuronium Bromide*

PURPOSE: Blood loss and transfusions during a liver resection are associated with higher morbidity and mortality rates. With applying hepatic vascular inflow occlusion (Pringle maneuver), persistent bleeding during a hepatic transection is caused by back flow from the hepatic veins. Therefore, low central venous pressure facilitates to reduce-bleeding from the hepatic veins by lowering the back flow pressure gradient. An intermittent hepatic vascular inflow occlusion was applied, with a lowering of the central venous pressure, during a hepatic resection in our series of patient. The effect of these maneuvers in reducing bleeding and the postoperative complication rates were analyzed. METHODS: Between December 2000 and September 2003, in 153 hepatic resection patients, where this technique was used, the intermittent vascular inflow occlusion and maintenance of the central venous pressure as low as possible were accrued in this study. The overall outcomes of patients that had a hepatic resection, focusing on the amount of bleeding, blood product transfusion and complication rates, were analyzed. RESULTS: The median blood loss was 652.5 ml, and 111 patients (72.5%) required no perioperative blood transfusion. The median units of blood required in the patients who needed a transfusion were 2.3 U. There was no evidence of renal derangement related with low blood flow into the kidney by keeping central venous pressure as low as possible. There were minor complications in 34 patients (22.4%) and two in-hospital mortalities (1.3%) associated with hepatic failure in cirrhotics. CONCLUSION: A hepatic resection, with an intermittent Pringle maneuver and a low central venous pressure, is a very simple and effective modality to reduce bleeding during a hepatic transection, with low morbidity and mortality rates and without hepatic and renal dysfunctions.
Blood Transfusion ; Central Venous Pressure* ; Hemorrhage ; Hepatic Veins ; Hospital Mortality ; Humans ; Kidney ; Ligation ; Liver ; Liver Failure ; Mortality ; Postoperative Complications

BACKGROUND AND OBJECTIVES: Tumor angiogenesis is an essential process required for growth and metastasis of cancer. Basic fibroblast growth factor (bFGF) is one of angiogenetic factors, and platelet endothelial cell adhesion molecule (CD-31) is the commonly used marker to identify the vessel. It is unclear that the degree of angiogenesis and expression of bFGF are related to the growth and metastasis in laryngeal squamous cell carcinoma. We examined the expression of bFGF and degree of angiogenesis in laryngeal squamous cell carcinoma and compared them to normal larynx. Relationship between bFGF and angiogenesis to growth and nodal metastasis in laryngeal squamous cell carcinoma was also evaluated. MATERIAL AND METHODS: Immunohistochemical study for bFGF and CD-31 were performed to detect the angiogenetic factor and degree of angiogenesis in 24 squamous cell carcinoma of larynx and 6 normal laryngeal tissue. Relationship of bFGF expression and degree of angiogenesis in laryngeal squamous cell carcinoma were compared to that in normal larynx. We evaluated relationship of expression of bFGF and degree of angiogenesis to primary stage and nodal stage in laryngeal squamous cell carcinoma. RESULTS: These expression of bFGF and degree of angiogenesis in laryngeal squamous cell carcinoma were significantly higher than in the normal control (p<0.05). The degree of angiogensis were significantly correlated with bFGF expression (p<0.05): the bFGF expression and degree of angiogenesis were not correlated to the nodal stage, but to the primary stage in laryngeal squamous cell carcinoma (p<0.05). CONCLUSION: These results indicate that bFGF and angiogenesis may play an important role in the growth of larygeal squamous cell carcinoma.
Blood Platelets ; Carcinoma, Squamous Cell* ; Endothelial Cells ; Fibroblast Growth Factor 2 ; Larynx ; Neoplasm Metastasis