Surgery for Pulmonary Sclerosing Hemangioma: Lobectomy versus Limited Resection

BACKGROUND: Pulmonary sclerosing hemangioma is a rare thoracic tumor, and pathophysiology or clinical course of this tumor is not yet fully described. Furthermore, there is no consensus on the standard operative procedure for this tumor. MATERIAL AND METHODS: Medical records of thirty-two patients, who underwent surgical resection of pulmonary sclerosing hemangioma from 1996 to 2007, were retrospectively reviewed. RESULTS: Nineteen patients underwent lobectomy and thirteen patients underwent limited resection. Video-assisted thoracoscopic surgery was performed in 9 patients in the latter group. Lymph node dissection was done in 21 patients, and one patient was found to have lymph node metastasis of the tumor. There was no postoperative complication, no early death and no tumor-related late mortality. The mean follow-up duration was 39.3 months (2 months~129 months), and all patients were free of local recurrence and distant metastasis during this period. There was no significant difference in patient's characteristics between the two groups, except that the mean hospital stay was shorter in limited resection group than in lobectomy group (p=0.0031). CONCLUSION: Pulmonary sclerosing hemangioma usually requires surgical resection for both diagnosis and treatment. Limited resection can decrease hospital stay with a surgical outcome comparable to lobectomy, and may be preferred to lobectomy if sufficient resection margin can be achieved.

Plasma proGRP Concentration is Sensitive and Specific for Discriminating Small Cell Lung Cancer from Nonmalignant Conditions or Non-small Cell Lung Cancer

To date, most clinical data on pro-gastrin-releasing peptide (proGRP) have been based on serum concentrations. This study evaluated the agreement between proGRP levels in fresh serum and plasma in patients with various lung diseases. Pairs of serum and EDTA plasma were collected from 49 healthy individuals. At the same time, EDTA plasma of 118 lung cancer patients and 23 patients with benign pulmonary diseases were prospectively collected. Compared to serum, plasma proGRP concentrations were higher by an average of 103.3%. Plasma proGRP was higher in malignancy (336.4 +/- 925.4 pg/mL) than in benign conditions (40.1 +/- 11.5 pg/mL). Small cell lung cancer (SCLC) patients showed higher levels of proGRP (1,256.3 +/- 1,605.6 pg/mL) compared to other types of lung cancer. Based on the ROC curve analyses at a specificity of 95%, the diagnostic sensitivity of plasma proGRP was estimated to be 83.8% in distinguishing SCLC from all the other conditions, and 86.5% for discriminating SCLC from the nonmalignant cases. Among the SCLC cases, limited stage disease had lower levels of plasma proGRP than extensive disease. When measuring circulating levels of proGRP, the use of plasma is preferred over serum. Plasma proGRP has a potential marker for discriminating SCLC from nonmalignant conditions or non-small cell lung cancer.

Relationship between the Levels of Holotranscobalamin and Vitamin B12 / 대한진단검사의학회지

To date, the determination of serum vitamin B12 levels has been the most common laboratory test for the assessment of vitamin B12 status; however, the diagnostic accuracy of this test is low. To obtain a more sensitive marker, a new test to measure holotranscobalamin (holoTC) levels has been introduced. In this study, we assessed 45 patients for whom a vitamin B12 test had been requested and 139 anemic patients. We investigated the associations between the levels of homocysteine (Hcy) and those of holoTC, serum vitamin B12, and folate and assessed the diagnostic value of holoTC levels as a marker for vitamin B12 deficiency. We also determined the precision of the AxSYM holoTC assay by calculating the coefficient of variance (CV). The within-run and between-run precision values were excellent, as all CV values were less than 3.5%. The holoTC levels were low (12 micromol/L) indicated vitamin B12 deficiency. Thus, the holoTC levels were more sensitive than the serum vitamin B12 levels for indicating vitamin B12 status. If the serum vitamin B12 level is 151-300 pmol/L, the levels of holoTC alone or in combination with serum vitamin B12 levels are likely to be more useful markers than serum vitamin B12 levels alone.

A Case of Successful Surgical Treatment of Migraine Headaches in a Patient with Sporadic Pulmonary Arteriovenous Malformations

Pulmonary arteriovenous malformations (PAVMs) are thin-walled aneurysms caused by abnormal communication between the pulmonary arteries and veins. Migraine headaches are sometimes the presenting clinical manifestation of PAVMs. Although embolotherapy, using detachable balloons or stainless steel coils, is generally accepted as the best choice for the treatment of multiple PAVMs, the mode of intervention for solitary PAVMs remains a subject of debate. We present a 43-yr-old woman with a 10-yr history of chronic migraines and dyspnea on exertion. She was discovered to have a large solitary centrally located PAVM, placing her at high risk of complications if she were to undergo percutaneous transcatheter embolization. She underwent successful surgical resection of her right middle lobe without complications, resulting in subsequent symptomatic improvement.

Equipment for Difficult Airways in 67 Korean Academic Emergency Departments

PURPOSE: In Korea, there has been no research about the devices that are used for dealing with difficult airways in emergency departments (ED). This study reports the results of the first research of this kind, assessing the equipment in Korean EDs that is used to manage patients with difficult airways. METHODS: We surveyed 92 EDs via the Internet from October 2007 to March 2008. All respondents were asked if they have the following categories of devices in their EDs; alternative intubation devices, alternative rescue ventilation devices, and surgical airway devices. Alternative intubation devices were defined as devices that do not use a direct laryngoscope for tracheal tube insertion. Alternative rescue ventilation devices were defined as ventilation devices that do not use a face mask. Surgical airway devices were defined as devices that use a surgical technique for the placement of endotracheal tube. RESULTS: We obtained data from 67 of the 92 (72.8%) EDs we contacted. Of those, 32 (47.8%) EDs have at least one alternative intubation device, 52 (77.6%) EDs have at least one alternative rescue ventilation device, and 59 (88.1%) EDs have at least one surgical airway device. A total of 30 (44.8%) EDs have equipment in all 3 categories, but 4 (6.0%) EDs do not have any equipment for dealing with difficult airways. The most common alternative intubation device was a flexible fiberscope (29.9%). CONCLUSION: The possession of devices to deal with difficult airways varies across EDs. It seems that not all Korean EDs have enough devices for difficult airways.

Clinical aspects of injury and acute poisoning in Korean pediatric patients / 소아과

Unintentional injuries are the most important cause of morbidity and mortality in the pediatric population, and the home is the most common site of injury for children in Korea. The most common cause of injury was slip down. Fall down and burn were frequent in infant/toddlers group, automobile and bicycle accident more frequent in preschool children. Findings from the survey could then be used to provide targets for direct educational efforts by medical services and to direct environmental safety modifications tailored to the unique situation of each family. Pediatric toxic ingestions are treated commonly by pediatricians and emergency physicians. Significant injury after these ingestions is infrequent, but identifying the dangerous ingestion is sometimes a difficult task. By performing a detailed history, focused physical examination, and directed laboratory evaluation, an estimation of risk can be developed. According to recent Korean poison papers, there were bimodal peak of age distribution in poisoned children patient on the whole: infant and adolescents group. Various types of materials belonged the classes of drugs, household products, and industrial solvents. Most of the poisoned children patients had been poisoned accidentally, while most cases of adolescents poisoning had been intentional. More than half of the adolescents group had a suicidal purpose in Korea, so an understanding of the demographic factors associated with self-harm poisoning may provide useful information to improve prevention and treatment strategies.

Acute Organophosphorus Pesticide Poisoning

Organophosphate (OP) pesticides are the most common source of human toxicity globally, causing high mortality and morbidity despite the availability of atropine as a specific antidote and oximes to reactivate acetylcholinesterase. The primary toxicity mechanism is inhibition of acetylcholinesterase (AchE), resulting in accumulation of the neurotransmitter, acetylcholine, and abnormal stimulation of acetylcholine receptors. Thus, the symptoms (muscarinic, nicotinic, and central nervous system) result from cholinergic overactivity because of AchE inhibition. OP can also cause rhabdomyolysis, pancreatitis, parotitis, and hepatitis. OP therapy includes decontamination, supportive therapy, and the use of specific antidotes such as atropine and oximes. However, there has been a paucity of controlled trials in humans. Here we evaluated the literature for advances in therapeutic strategies for acute OP poisoning over the last 10 years.

Clinical Characteristics of Acute Dichlorvos Poisoning in Korea

Purpose: Dichlorvos has been in widespread use as an organophosphate (OP) insecticide compound. The purpose of this study was to access the epidemiology and clinical features of dichlorvos in Korea. Methods: This was a 38 multi-center prospective study of dichlorvos poisoning using surveys, a structural reporting system and review of hospital records from August 2005 to July 2006. A total of 54 patients with acute dichlorvos poisoning on a national basis were enrolled. We analyzed the epidemiologic characteristics and clinical manifestations of dichlorvos poisoning. In addition, the clinical features of dichlorvos poisoning were compared with others OP compounds. Results: During the study period, compounds involving pure OP poisoning were dichlorvos (22.7%), methidathion (8.4%), and phosphamidon (6.7%). In acute dichlorvos poisoning, all ingestion routes were oral. Intentional poisoning involved 74.1% of cases. The common initial complaints involved gastrointestinal (64.8%), systemic (61.1%), central or peripheral nervous system (53.7%), and respiratory symptoms (50.0%). The median arrival time to hospital after dichlorvos poisoning was 2.6 hours and mean hospitalization duration was 7.1 days. 2-PAM was administered in 35 patients in mean doses of 6.3 g/day intravenously. Atropine was administered in 30 patients with a mean dose of 62.8 mg/day (maximal 240 mg/day). Overall mortality rate for dichlorvos poisonings were 14.8% (8/54). Immediate causes for death included sudden cardiac arrest or ventricular dysrhythmias (50%), multi-organ failure (25%), acute renal failure (12.5%), and unknown causes (12.5%). Conclusion: When compared to previous reports, dichlorvos poisoning displayed relatively moderate severity. The presence of a lower GCS score, altered mental status, serious dysrhythmias, systemic shock, acute renal failure, and respiratory complications upon presentation were associated with a more serious and fatal poisoning.

Clinical Implication of Acetylcholinesterase in Acute Organophosphate Poisoning

Purpose: Acute organophosphate (OP) poisoning may be monitored by measuring the acetylcholinesterase (AChE). It is important to assess severity and establish prognostic tests in the early stage of OP poisoning. The aim of this study was to look at the relationship between various clinical aspects of the OP poisoning, prognostic indicators of OP poisoning including Simplified Acute Physiology Score (SAPS) 3, and the associated changes in AChE levels. Methods: Clinical data and initial AChE levels from thirty-seven patients with OP poisoning were prospectively reviewed from 12 teaching hospitals in South Korea from August 2005 to July 2006. Clinical manifestations at the time of arrival such as miosis, respiratory abnormality, salivation, urinary incontinence, GCS score, AVPU scale, need for intubation, and mechanical ventilation requirements were recorded. SAPS 3 was calculated using clinical data and laboratory results. Results: The median level of AChE was 9.8 (1.3-53.6) U/gHb. There was no significant difference in AChE levels between the groups with and without cholinergic symptoms. The median level of AChE of the patients who required intubation and those who did not were 3.5 U/gHb and it 19.7 U/gHb respectively (Mann-Whitney test; p<0.001). The AChE levels were also significantly different (p=0.007) in patients who needed mechanical ventilation compared to those who did not with AChE levels found to be 3.1 U/gHb and it was 14.8 U/gHb, respectively. Level of consciousness assessed using the AVPU scale was correlated with AChE levels (Kruskal-Wallis test; p=0.013). GCS score were correlated with AChE levels (p=0.007, Spearman's rho = 0.454). In addition, the lower the level of initial AChE, the longer the ICU stay (p=0.029, Spearman's rho=-0.380). SAPS 3 was inversely correlated with the initial AChE (p<0.001, Spearman's rho=-0.633). Conclusion: In the acute OP poisoning, low AChE levels appear to help indicate the severity of poisoning. The initial AChE level may be a useful prognostic parameter for acute OP poisoning.

Clinical Characteristics of Patients with Acute Organophosphate Poisoning Requiring Prolonged Mechanical Ventilation

Purpose: The major complication of acute organophosphate (OP) poisoning is respiratory failure as a result of cholinergic toxicity. Many clinicians find it difficult to predict the optimal time to initiate mechanical ventilation (MV) weaning, and as a result have tended to provide a prolonged ventilator support period. The purpose of this study is to determine any clinical predictors based on patients characteristics and laboratory findings to assist in the optimal timing of mechanical ventilator weaning. Methods: We reviewed medical and intensive care records of 44 patients with acute OP poisoning who required mechanical ventilation admitted to medical intensive care unit between July 1998 and June 2007. Patient information regarding the poisoning, clinical data and demographic features, APACHE II score, laboratory data, and serial cholinesterase (chE) levels were collected. Base on the time period of MV, the patients were divided into two groups: early group (wean time or =7 days, n = 16). Patients were assessed for any clinical characteristics and predictors associated with the MV weaning period. Results: During the study period, 44 patients were enrolled in this study. We obtained the sensitivity and specificity values of predictors in the late weaning group. APACHE II score and a reciprocal convert of hypoxic index but specificity (83.8%) is only APACHE II score. Also, the chE concentration (rho = -0.517, p = 0.026) and APACHE II score (rho = 0.827, p < 0.001) correlated with a longer mechanical ventilation duration. Conclusion: In patients with acute OP poisoning who required mechanical ventilation, the APACHE II scoring system on a point scale of less than 17 and decrements in cholinesterase levels on 1-3 days were good predictors of delayed MV weaning.

The Usefulness of Different Injury Scoring Systems in Trauma Patients with Altered Mental Status

PURPOSES: The causes of altered mental status (AMS) are varied. Trauma accounts for 6.5%-36.3% of all AMS cases, and the mortality in these instances ranges from 20~80.5%. Multiple injury severity scoring systems exist to assist in the prognosing of trauma patients. We investigated the degree of correlation between injury severity scoring systems and prognoses of patients with AMS due to trauma. METHODS: We reviewed the medical records of 188 patients admitted to the emergency department of Konyang University Hospital who had trauma with AMS. We investigated the clinical characteristics of these patients and evaluated the usefulness of four injury severity scoring systems: revised trauma score (RTS), injury severity score (ISS), new injury severity score (NISS), and trauma and injury severity score (TRISS). RESULTS: The average scores of ISS and NISS were higher and RTS and TRISS were lower in the non-survivor group than in the survivor group (p<0.01). The area under the curve (AUC) for the receiver operating characteristic (ROC) curve was 0.725 for ISS and 0.733 for NISS, but these scoring systems had only a fair predictive ability. Hosmer-Lemeshow statistics showed no predictive ability differences for death between the four scoring systems. The predictive ability of all injury severity scoring systems to identify survivors was high (88.1~94.0%). In contrast, their predictive ability to identify non-survivors was low (29.6%~63.0%). CONCLUSIONS: In the use of RTS, ISS, NISS, and TRISS for evaluating trauma patients with AMS, none of the four systems exhibited any distinguishing predictive features. All failed to reliably predict non-survivors, but all showed good predictive value for identifying survivors.

A Study of Facial Fracture and Associated Injuries

PURPOSE: This study is to analyze the frequency and pattern of associated injuries in patients with facial fractures. METHODS: A retrospective method was used to study facial fracture patients visiting our emergency room from May 2002 to April 2003. The patient's age, sex, injury mechanism, location of facial fracture, and associated injuries, as well as the records of emergency procedures and emergency operations were examined. RESULTS: During the research, a total number of 206 patients with facial fractures were examined. As for the injury mechanism, traffic accidents were the primary cause with 40.3%. Orbital fracture was the most common overall facial fracture (44.7%). Ninety-seven (47.1%) patients had associated injuries. Fifty-nine of those patients had head injuries, 48 had extremity injuries, 17 had chest injuries, 14 had abdominal injuries, and 13 had spine injuries. Among the facial-fracture patients, patients with maxillary fractures had the most associated injuries (95.3%). Of those associated injuries, head injuries were the most commonly reported ones (48.3%). The emergency procedures used were intubations (9) and thoracostomies (4). The emergency operations performed were craniotomies (5) and exploratory laparotomies (2). Four patients died due to brain injuries. CONCILUSION: Associated injuries often occur in patients with facial fractures. Head and extremity injuries are the most common associated injuries. We believe emergency physicians can maximize the effectiveness of their treatment of patients with facial fractures and their associated injuries through a coordinated team approach, while minimizing the complications and sequelae.

Molecular Analysis of X-linked Chronic Granulomatous Disease in Five Unrelated Korean Patients

Chronic granulomatous disease (CGD) is a fatal genetic disorder in which phagocytes fail to produce antimicrobial superoxide because of NADPH oxidase deficiency. Molecular defects in CYBB gene causing X-linked CGD are responsible for about 70% of all cases. This study was done to confirm genetic defects of CYBB gene in five Korean patients who were highly suggestive of having CGD by clinical history. We performed initial screening for five unrelated Korean patients using single strand conformation polymorphism (SSCP) and then selective sequencing for the regions involving the abnormal bands. Activated NBT tests revealed that all patients were X-linked. SSCP analysis for CYBB gene showed abnormal bands in all patients. The molecular defects of five patients were as follows: c.1663insT, c.1111-1G>T, c.39_40insG, c.927delC and c.434T>C mutation. This result will help the families with prenatal diagnosis or genetic counseling.

Successful Treatment of Organ Malperfusion Caused by Acute Aortic Dissection: Report of 4 cases / 대한흉부외과학회지

Malperfusion of major organs which frequently accompanies acute aortic dissection is one of the major causes of death. Malperfusion does not only develop before surgery, but also during or after surgery in various manifestations according to the aortic branches involved. Expeditious diagnostic and therapeutic measures based on high degree of clinical suspicion are mandatory for successful treatment. The authors report four cases of acute aortic dissection accompanied by malperfusion of various organs that were successfully treated.

Comparison of Murex Candida albicans CA50 with the Germ Tube Test for Presumptive Identification of Candida albicans / 대한임상병리학회지

BACKGROUND: Rapid and reliable identification of Candida albicans becomes more important because the incidence of yeast infections has increased in recent years. Murex C. albicans 50(CA50) assay was developed for rapid and presumptive identification of C. albicans. We evaluated the CA50 assay to identify C. albicans. METHOD: Seventy four yeast isolates from clinical specimens were tested with CA50 and germ tube test. They were identified to species level by API 20C and chlamydospore agar test. RESULT: Of the 74 isolates, 52 were C. albicans and 22 were non-albicans Candida. The sensitivity and specificity for CA50 were 88.5% and 86.4%, respectively. The sensitivity and specificity of the germ tube test using human serum were 88.5% and 90.9% respectively, and those using fetal bovine serum(FBS) were 92.3% and 90.9% respectively. CONCLUSION: CA50 was a rapid and easy-to-perform test, and it was comparable to germ tube test in regard of sensitivity and specificity.

Clinical Usefulness of Primary Broth Cultures / 대한임상미생물학회지

BACKGROUND: Although enriched broth cultures have been recommended as an adjuvant to the direct plating of tissue and body fluid specimens, the cost-effectiveness of broth cultures has been questioned in regard with the clinical significance of "broth only isolates(BOI)". The purpose of this study was to investigate the usefulness of thioglycollate broth(THIO) cultures. METHODS: We reviewed retrospectively results in the culture specimens of body fluids, tissue biopsies, and puses received during the month of July 1997. All specimens were inoculated into THIO in addition to agar plates. We reviewed the medical records of culture-positive patients to determine the clinical significance and relevance of their isolates. Clinically significant isolates were defined as those for which an appropriate antimicrobial therapy was done except one judged as contaminants by clinicians and clinically relevant isolates as the clinically significant one isolated first. RESULT: Of 2,008 specimens, 512(25.4%) from 365 patients grow 561 isolates 464 plate isolates and 97 BOI. Two hundred eighty nine(62.3%) of the 464 isolates from plate cultures were clinically significant, compared to only 12(12.4%) of 97 BOI (P<0.05). Only four (4.1%) BOI were clinically relevant, including one Pseudomonas aerugiosa from ascites. one Klebsiella pneumoniae and two Staphylococcus aureus from tissue specimens. CONCLUSION: A routine use of enriched broth culture rarely recover clinically relevant isolates. Considering the laboratory and medical costs of the recovery of contaminants and clinically irrelevant isolates, the enrichment broth cultures should be used more selectively.

Evaluation of chemical autoanalyzer Synchron LX20 / 대한임상병리학회지

BACKGROUND: Synchron LX20(Beckman Coulter, Fullerton, USA) is an automated chemical analyzer introduced in 1998. It is still not completely evaluated on clinical fields, is set in the Asan Medical Center for the first time in Korea. We evaluated the performance of the analyzer before routine use to prevent critical errors, to confirm the manufacturer's instructions, and to establish a specific data system for our institute. METHODS: For glucose, BUN, creatinine, total protein, albumin, uric acid, cholesterol, total bilirubin, direct bilirubin, ALT, AST, LD, gamma-glutamyltransferase(gamma-GT), CK, amylase, lipase, Na, K, Cl, CO2, Ca, phosphorus and Mg, within-day precision, between-day precision, degree of correlation, linearity, recovery rates and reportable ranges were completely or partly analyzed. Specimen selection, specimen preparation and the statistical methods followed the guidelines of National Committee for Clinical Laboratory Standards as much as possible. The calculations were performed with computer software, EP_Suite(MarChem Associates, Concord, USA). RESULTS: The within-day coefficients of variations(CVs) of most items were less than 5.0%. Ninety six percent of items showed between-day CVs less than 10.0%. All items had %relative nonlinearities less than 2.5%. The correlation coefficients of BUN, creatinine, AST, ALT, total bilirubin, direct bilirubin, gamma-GT, glucose and UA exceeded 0.975. The recovery rates were analyzed for BUN, creatinine, glucose and UA, and all were in the range of 98.2% to 102.3%. Reportable ranges were wide enough for all items. CONCLUSIONS: Linearity, precision, recovery rates and reportable ranges were satisfactory. A few CVs were relatively large due to the significant effects caused by the small differences among the measured values of low concentration specimens. Some items showed low correlation coefficients probably due to insufficient device familiarization period.

Two Cases of Bone Marrow Permeated Primary Gastric Mucosa-Associated Lymphoid Tissue Lymphoma / 대한임상병리학회지

Mucosa-associated lymphoid tissue (MALT) lymphoma has several characters different from those of nodal lymphoma. Histologically, MALT lymphoma is mainly composed of centrocyte-like cells and other heterogeneous cells, and is classified as high grade and low grade by the proportion of blasts. Most of MALT lymphoma is initially diagnosed as localized disease, and has slow progression and relatively longer disease-free survival time. The rate of bone marrow permeation of MALT lymphoma is reported variable from 8% to 45% by previous other country reports. We report 2 cases of bone marrow permeated MALT lymphoma, for MALT lymphoma has lower incidence than that of nodal lymphoma and no marrow permeated cases have been reported in Korea. Fifty six-year-old male who complained dyspepsia is diagnosed as MALT lymphoma by biopsy of gastric angle. His bone marrow biopsy showed well demarcated paratrabecular neoplastic lymphoid cell infiltration. The other case is 78-year-old female who had epigastric pain. She was diagnosed as MALT lymphoma of gastric angle, and her bone marrow biopsy showed poorly demarcated nodal infiltration of neoplastic lymphoid cells.

Development of WebBased Laboratory-Information-Accessing System / 대한의료정보학회지

There is still lack of a convinient system that connect referring physicians to the information system of referral hospitals, We proposed to develop the laboratory-information-accessing system(LISA) for physicians referred to AMC referral center with Web-based internet technology. We constructed the menu of AMC Referral Center as a part of Asan Medical Center(AMC) homepage. The information of the referred patients wee collected in the separate internal server and then transferred to the external network sever by a batch. Referring physicians was able to connect to AMC Referral Center via AMC homepage and then browse the list of their patients by putting their identification number and password. At the next, the physicians chose the patients and the test item to be displayed. In order that the referral system is established tin the medical part, the LISA world be more needed, in the society, which internet is getting popular. This LISA was introduced successfully now, and it could be a model of national standard for hospital information system.

The effect of the application of growth factors on wound contraction : An experimental study in a fibroblast-populated collagen lattice

Many investigators have reported that collagen gel contraction reflects the mechanism of wound contraction. In 1995, Tsai et al. reported that hypertrophic scar-derived fibroblasts in a connective tissue model possessed the greatest contraction potency when compared with those of normal skin and normal oral mucosa-derived CTMs. In this study, we studied the effect of collagen gel contraction by growth factors such as epidermal growth factor, platelet-derived growth factor, transforming growth factor-bata1, and transforming growth factor-bata3, Skin fibroblasts used in this study were obtained from the explant of rat skin culture. Fibroblasts were cultured in Dulbecco's modified Eagle's medium containing 10% fetal bovine serum. Growth factors were added per FPCL in the desired concentrations and we measured the collagen gel diameters in growth factor-treated FPCL on day 1,2,3, and 4 respectively after starting incubation. We examined the effects of EGF, PDGF, TGF-bata1, TGF-bata3 and the effects of combinations of TGF-bata1 + EGF, TGF-bata1 + PDGF, and TGF-bata1 + TGF-bata3 to contract a collagen gel. EGF has little influence on collagen gel contraction. TGF-bata1 and TGF-bata3 increase the collagen contraction. TGF-bata1 enhanced the contractility of collagen gel according to the concentrations. While TGF-bata3 alone had stimulatory contraction effects at low dose, high doses of TGF-bata3 decreased the potency of collagen gel contraction. A combination of TGF-bata1 and EGF minimally decrease TGF-bata1 activity. A combination of TGF-bata1and PDGF had an effect similar to TGF-bata1 activity. A combination of TGF-bata1 and TGF-bata3 decreased TGF-bata1 activity. According to reports that FPCL contraction is equivalent to the process of wound contraction, growth factors which enhance gel contraction may be related to wound contraction and wound healing. TGF-bata1 is reported to enhance scar formation in fetal wound. EGF accelerates wound healing and inhibits the promotion of hypertrophic scar formation. Compared to the effect of collagen gel contraction in this study, the combination of TGF-bata1 and TGF-bata3 that inhibited the promotion of collagen gel contraction are thought to diminish the formation of scar tissue. As well, EGF that has not enhanced collagen gel contraction is thought to diminish the production of scar tissue. We will study the interactive effects of TGF-bata3, EGF and TGF-bata1 on the contraction of collagen gels in the future.