Arthroscopic Meniscal Repair using Fibrin Clot for Horizontal Tear in Young Adults: A Case Report

To evaluate outcomes of arthroscopic meniscal repair using fibrin clot for horizontal tears in young adults, we investigated clinical and morphological results after the meniscal repairs were performed. Between August 1995 and August 1997, we treated five patients with horizontal tears of the meniscus, of which the meniscal tears were not accompanied any concomitant intra-articular lesions or meniscal degeneration. We assessed outcomes using Lysholm score, magnetic resonance imaging(MRI) and second-look arthroscopy. In all 5 cases, MRI showed the following results 1 complete healing, 1 incomplete healing, and 3 with no healing. Two patients underwent second-look arthroscopy, one complained of persistent pain for two years after surgery, showing meniscal tears on the MRI and received partial meniscectomy, while the other showed complete healing using second-look arthroscopy after 3 months postoperative recuperation and MRI 68 months after surgery. According to Lysholm score, two cases were assessed with less than 70 points. For the horizontal meniscal tears in young adults, arthroscopic meniscal repair using fibrin clot produced satisfactory clinical results however, it exhibited morphologically poor results.

The Protein Expressions of Apoptosis-associated Genes in the Obstructed Ureters of Rats / 대한비뇨기과학회지

PURPOSE: The role of apoptosis in the pathogenesis of ureteral damage from obstructive uropathy has rarely been studied. This study was performed to determine the protein expression of the apoptosis-associated genes in the pathogenesis of ureteral damage during the course of obstructive uropathy in ligated rat ureters. MATERIALS AND METHODS: After unilateral ligation of the ureter, each group of five Sprague-Dawley rats was sacrificed and examined at 1, 5, 10, 15, 20, 25, 30 and 35 days after ligation: five rats with normal ureters were also examined as controls. The protein expressions of the fas-associated death domain (FADD), Bax, Bcl-xL and cyclooxygenases (COX)-2 genes in obstructed ureters were assessed by performing Western blotting. RESULTS: The expressions of FADD protein in the 20 and 25 day-obstructed ureters (DOUs) were significantly higher than that in control ureters and the peak was reached in the 25 DOUs. The expressions of Bcl-xL protein in the 20, 25 and 30 DOUs were significantly higher than that in the control ureters and the peak was reached in the 25 DOUs. The expression of COX-2 protein in the 5, 10, 15, 25 DOUs were significantly higher than that in the control ureters and the peak was reached in the 10 DOUs. CONCLUSIONS: The FADD and Bcl-xL genes were involved in apoptosis of the obstructed ureter. The peaks of their expressions were at 25 DOUs. The expression of the COX-2 gene may be related with apoptosis in the obstructed ureter.

The Serial Microscopic Changes of Cell Proliferative and Apoptotic Phenomenon in Obstructed Ureters in the Rat / 대한비뇨기과학회지

Purpose: Obstructive uropathy due to a ureteral obstruction is one of the most common diseases of the urinary tract, and can lead to severe renal injury and ureteral damage. This study performed to elucidate the histological findings and serial changes in the apoptotic and proliferative phenomena in the pathogenesis of ureteral damage during the course of obstructive uropathy in ligated rat ureters. Materials and Methods: After unilateral ligation of the ureter, each group of five Sprague-Dawley rats was sacrificed, and examined 1, 5, 10, 15, 20, 25, 30 and 35 days after ligation: five rats with normal ureters were also examined as controls. The cell proliferation and apoptosis were detected with proliferating cell nuclear antigen (PCNA) immunohistochemistry and a terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuridine triphosphate (dUTP) in situ nick-end labeling (TUNEL) study, respectively, in 45 Sprague-Dawley rats. Results: The epithelial layer was thickened in the 5 day-obstructed ureters (DOUs). The severity of thickening of the fibrous and smooth muscle layers progressed consistently to the 15 DOUs, which was maintained until day 35. The expression of PCNA in the epithelial layer was present in every ureter, with a significant increase of labeled cells in the 1 and 5 DOUs. The expressions of PCNA in the fibrous and smooth muscle layers were present from day 10 after ligation and maintained until day 20, but then significantly declined at 25 DOUs. TUNEL-positive cells were shown in the epithelial layer in the 10, 15, 20, 25, 30 and 35 DOUs. The mean numbers of TUNEL-positive cells in the 20, 25 and 30 DOUs were significantly higher than those in the 10 DOUs, and reached their peak in the 25 DOUs. Positive cells were shown in the fibrous and smooth muscle layers in the 25, 30 and 35 DOUs. Conclusions: Apoptosis and cell proliferation may play an important role in the pathogenesis of ureteral damage in obstructed ureters. The peak of apoptosis was shown in the 25 DOUs.

A Case of Aortic Dissection Ocurring in a Hypertensive Patient

Primary aldosteronism is present in approximately 1% of unselectd hypertensive patients. Adrenal adenoma is a known as one of the surgically curable form of the hypertension. Hypertension is one of the contributing factors for the development of aortic dissection. Cincurrence of aortic dissection in patient with primary aldosteronism is extemely rare. Only one case wasconfirmed by autopsy and reported in the world literature. We report a case of DeBakey type 3 anortic aneursm in a 49-year old hypertensive female patient with primary aldosteronism due to left adrenal adenoma. She underwent left adrenalectomy uneventfully after stabilization of her blood pressure with maximal medical management including nitroprusside, aldactone, enalapril and inderal.

Significance of Serum Cortisol and Peripheral Blood Leukocyte Differential for the Early Differential Diagnosis of Acute Chest Pain Syndrome

OBJECTIVES: The stress response involves the activation of the hypothalamic-pituitary-adrenal(HPA) axis and the sympathetic nervous system. Corticosteroids have been clearly demonstrated to cause anti-inflammatory and/or immnosuppressive effects in man including granulocytosis in part by decreasing migration into tissue, especially damaged tissues(myocardium), and circulating relative lymphocytopenia. To test whether automated measurements of the the increased serum cortisol-induced hematologic changes in the leukocyte differential significance or not in the initial differential diagnosis of acute myocardial infarction in acute chest pain syndromes. METHODS: 101 consecutive patients with myocardial infarction or myocardial ischemia presenting to the emergency room of Seoul Adventist Hospital with acute chest pain from January 1993 to August 1995(Retrospective group) and from December 1995 to March patients compatible with exclusion criteria in myocardial infarction were excluded. We measured automated leukocyte differential and serial CK-MB level in both groups, and the intial serum cortisol levels in prospective infarction group. RESULTS: 1) Total leukocyte and granulocyte counts were increased in acute myocardial infarction(p<0.01). 2) In acute myocardial infarction group, lymphocyte counts were slightly increased(p<0.05), but relative lymphocytes percentage more significantly decreased(p<0.01). 3) Serum cortisol levels are significantly raised early in the course of the acute myocardial infarction and prior to the elevation of the specific cardiac enzymes on the basis of analytic results of prospective infarction group. 4) Cortisol-induced changes in leukocyte differential were noted with time passes into reverse approximately 4 days later in our study. 5) The leukocyte differential does not shows significant changes in the retrospective myocardial ischemia group, so we arrive in careful conclusion that serum cortisol level seems does not increase. 6) No sexual differences were noted in leukocyte differential. CONCLUSIONS: The serum cortisol level and cortisol-induced leukocyte differential are helpful for initial differential diagnosis of acute myocardial infarction in acute chest pain sysdrome.

A Case of Endoscopically Removed Granular Cell Tumor of the Esophagus / 대한소화기내시경학회지

The first case report of granular cell tumor was by Abrikossoff in 1926, the tumor has been named with more than 20 different synonyms. It is found usually in the tongue, oral cavity, and the skin. It occurs rarely in the esophagus. Esophageal granular cell tumor is a benign lesion which can be diagnosed by endoscopic biopsy. Large symptomatic lesion can be removed by polypectomy. A 29-year-old female visited our hospital for intermittent epigastric pain and anterior chest discomfort. Endoscopy showed a 0.6 *0.4 cm whitish yellow nodule in the mid-esophagus, 25 cm from the incisor teeth. Endoscopic polypectomy was performed with "O"-type rubber band for endoscopic variceal ligation(EVL). A case of esophageal granular cell tumor conformed by S-100 protein stain is reported with the review of literature.

Two Cases of Eyelid Sebaceous Carcinoma

Sebaceous carcinoma is a particularly common malignant tumor of the eyelid. Therefore, this lesion is important to ophthalmologist. Recently, there appears to have been an increased incidence or recognition of sebaceous carcinomas of the eyelid, which had been previously believed to be very rare. Frequently mistaken for a recurrent chalazion, invasion by sebaceous carcinoma is frequently enhanced by repeat curettage and forms of therapy that obscure the true diagnosis. This tumor is difficult to completely resect due to intraepithelial widespread, so its prognosis is poor. The authors experienced two cases of sebaceous carcinoma of the eyelid. One was a 57 year old female patient who was treated with surgical resection and the other was a 71 year old male with cervical lymph node metastasis. He was treated with surgical resection, but he rejected radiotherapy.