The expression of TRAIL and its receptors in human osteoarthritic cartilages / 대한내과학회지

BACKGROUND/AIMS: The apoptosis of chondrocytes is assumed to be involved in the pathogenesis of osteoarthritis (OA), and the TNF related apoptosis inducing ligand (TRAIL) is thought to have a pivotal role in the apoptosis of chondrocytes. We investigated the expression of TRAIL and its receptors in human osteoarthritic cartilages. METHODS: Human OA cartilage tissues were obtained from the medial side of the cartilage in the knee joints of 25 patients who underwent total knee replacement surgery, and the normal human cartilages of the knee joint were obtained at autopsy from seven young adults who had no history of joint diseases. The expressions of TRAIL and the death receptor were analyzed by immunohistochemistry or immunofluorscent staining. The concentration of TRAIL in the synovial fluid was measured by enzyme linked immunosorbent assay. RESULTS: TRAIL and its receptors were expressed in the OA cartilage, but not in the normal cartilage. TUNEL staining and immunohistochemistry for TRAIL on the serial sections showed that most TRAIL positive cells were TUNEL positive. The OA joint fluid contained concentrations of TRAIL that were readily detectable (80 and 120 microgram/ppm in the synovial fluid of each, respectively). However, the synovial fluid of the knee joint obtained at autopsy from the seven young adults contained low concentrations of detectable TRAIL (0~2 microgram/ppm). CONCLUSIONS: These results support the notion that TRAIL and its receptors are involved in the pathogenesis of human OA. A better understanding of TRAIL induced apoptosis in chondrocytes might lead to the development of a new therapeutic strategy for OA.

The Usefulness of the Endoscopic Findings for Predicting Depth of Invasion in Early Gastric Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) has been used as a treatment for early gastric cancer (EGC). This study was performed to evaluate the usefulness of the endoscopic findings for diagnosing the depth of invasion in EGC patients. METHODS: We retrospectively analyzed the endoscopic findings of 558 EGC patients who were diagnosed after gastrectomy, EMR or ESD at Dong-A University Hospital between 2000 and 2006, and we divided them into two groups (the mucosa group versus the submucosa group). Nine factors were assessed (Type I or IIa: surface color, surface irregularity, the Yamada type and pitting on the apex; Type IIb: surface color, surface irregularity and marginal definiteness: Type IIc or III: ulcer base irregularity, shape of the converging folds, center of the converging folds and marginal elevation). The tumor size and histologic type were assessed for all the EGCs. RESULTS: Ulcer base irregularity (p=0.005), marginal elevation (p=0.001), and the shape of the converging folds (p=0.018) showed significant correlation with the depth of invasion in type IIc or III EGCs. Tumor size ( <2 cm) showed a significant correlation with mucosal invasion for all the EGCs. CONCLUSIONS: These results support the usefulness of the endoscopic findings for making the therapeutic decision for performing EMR or ESD through predicting the depth of invasion of EGCs.

A Case of Recurred Retroperitoneal Fibrosis Treated by Combination Therapy of Steroids and Tamoxifen / 대한신장학회지

Idiopathic retroperitoneal fibrosis (IRF) is a rare disease characterized by inflammatory and fibrous tissue proliferation in the retroperitoneum, which often surrounds the adjacent retroperitoneal structure to cause compressive complications such as hydronephrosis. Its pathogenesis is still unknown, but recently the association with autoimmune disease is being suggested. Although the prognosis is generally good, if diagnosis or treatment is delayed, the disease can progress to acute or chronic renal failure. In the past, surgical procedures such as ureterolysis or transpositioning of the involved ureter were the mainstay of the treatment. But recent studies using steroids, immunosuppressants and tamoxifen have reported generally good results. However, the adequate dose or duration of medical treatment and the treatment for recurred disease have not been established yet. We report a case of that retroperitoneal fibrosis recurred 1 year after 2-weeks steroids therapy. It was successfully treated with combination therapy of steroids and tamoxifen.

Comparisons of the Short-Term Angiographic Outcomes of Cypher and Taxus Stents Implanted in the Same Patient

BACKGROUND AND OBJECTIVES: Drug-eluting stents (DES) have been shown to substantially reduce both angiographic and clinical restenosis. Cypher(R) (sirolimus-eluting stent, Cordis, Johnson and Johnson, Florida, USA) and Taxus(R) (paclitaxel-eluting stent, Boston Scientific, Boston, USA) are the two most widely used DESs, and they both have distinct pharmacological properties and release kinetics. It has been not studied whether these two DESs show different angiographic outcomes when they are simultaneously implanted in the same patient. SUBJECTS AND METHODS: We retrospectively analyzed the angiographic findings of the short-term follow-up in 34 patients (average age: 63 year old, 9 women) in whom both Cypher and Taxus stents were implanted at the same time for the treatment of obstructive coronary lesion. RESULTS: There was no significant difference in the basal angiographic characteristics of the lesions that had two stents deployed in terms of the AHA/ACC classification, reference diameter, the percent diameter stenosis and minimal luminal diameter. The post-procedure results were similar between the two stents. At 6 months follow-up, the Cypher stent displayed significantly less in-stent lumen loss compared with the Taxus stent (0.16+/-0.04 mm vs 0.27+/-0.04 mm; respectively, p=0.040) and a smaller percent diameter stenosis (15.9+/-1.3% vs 19.9+/-2.2%, respectively, p=0.049). CONCLUSION: The Cypher stent showed significantly less luminal loss during short term follow-up compared with the Taxus stent when implanted in the same patient. This result suggests that in a given individual patient, the Cypher stent induces less neointimal proliferation than does the Taxus stent.

Large Pleural Effusion Causing Right Atrial Collapse and Tachycardia

We observed one patient with large pleural effusion causing severe dyspnea, tachycardia, and severe right atrial collapse, which findings were completely resolved after thoracentesis. Our report shows that massive pleural effusion also can make severe right atrial collapse and symptom like cardiac tamponade, and thoracentesis can improve this condition.

A Case of Renal Parenchymal Hypertension in Child / 대한비뇨기과학회지

About 10-15% of hypertension is secondary to renal disease. Cause of renal hypertension is renal parenchymal disease or renovascular problem. Hypertension in children which estimate at 1-2 % of all hypertension is very rare. We experienced a ease of renal parenchymal hypertension due to unilateral chronic reflux pyelonephritis in 10 year old boy, treated by nephrectomy.

Correlation Between Histological Changes of Human Testis after and Fertility after Subsequent Vasectomy Reversal Vasectomy / 대한비뇨기과학회지

The aim of this study is to determine the correlation between any histological changes in the human testis after vasectomy and fertility after subsequent vasectomy reversal. A sample of 21 previous fertile, vasectomized, healthy volunteers with a mean age 35 years( range, 29 to 47) underwent open, unilateral testicular biopsy at the time of vasectomy reversal. The mean duration of obstruction was 3.8 years(range, 1 to 12). The vasovasostomy was performed by means of same technique. The qualitative and morphometric quantitative analysis were performed for the data obtained. Vasal patency was determined by the presence of sperm in the postoperative semen analysis in 18 patients. Pregnancy occurred in 9 of 18 couples( 50%). Statistical analysis was performed to compare the morphological findings in both fertile and infertile patients. No significant correlation was observed between the histologic changes and fertility in two groups. Similarily there was no significant correlation between the obstructive interval. We concluded that morphologic changes occurred in the human testis after vasectomy does not affect the fertility rate after successful vasectomy reversal.

Characteristic Changes of Cough Urethral Pressure Profile in Stress Urinary Incontinence / 대한비뇨기과학회지

Urodynamic study developed because physicians recognized that history, physical examination and previous testing modality were inadequate to differentiate between those patients with and those without stress urinary incontinence( SUI). The purpose of this study is to evaluate the practicability and usefulness of the test cough urethral pressure profiler in the evaluation of SUI with objective data. Between November 1991 and October 1993, 45 patients with symptoms of urinary incontinence were studied to determine the value of this test by using microtip transducers of Urocompact 8000 which is a computerized urodynamic system. Dynamic pressure profiles were obtained during cough by measuring the pressure at the proximal, middle and distal urethra. At rest, functional urethral length and maximal urethral closure pressure were 3.01+/-0.58cm, 52.0+/-17.8cmH2O respectively (control 3.66+/-0.35cm, 80.25+/-16.95cmH2Orespectively, p <0.05, p<0.05). During the cough, urethral closure pressure decreased to negative pressure in 41 of 42(98% ) patients who were available for analysis. Three of the 45 patients were not available due to the lack of experience of one. Six months after bladder neck suspension was performed, the urethral pressure profile of four patients were checked again and the results showed that the functional urethral length and maximal urethral closure pressure at rest were greater than those of the preoperative urethral pressure profile, but statistically not significant. In 3 patients who underwent successful treatment, the urethral closure pressure at cough did not decrease to a negative pressure. As a result, the cough urethral pressure profile is a useful and objective diagnostic method of SUI and evaluation of the postoperative state.

A case of metastatic retroperitoneal fibrosis from the gastric adenocarcinoma / 대한비뇨기과학회지

We report a case of 45-year-old woman of histologically proven malignant retroperitoneal fibrosis from signet ring cell type adenocarcinoma of the stomach. She had suffered from flank colicky pain for a duration of a month. We underwent ureterolysis with omental wrappine under the impression of retroperitoneal fibrosis due to miss-diagnosed chronic inflammation of periureteral tissue by frozen biopsy at the time of the operation. As urine leaks continued at the drain site for 22 days despite of nephrostomy tube placement, we underwent nephrectomy which revealed signet ring cell type adenocarcinoma. Gastrofiberscopic biopsy resulted in the same adenocarcinoma.