Bone Biopsy of Atypical Subtrochanteric Fracture in Patient with Prolonged Bisphosphonate Therapy: A Case Report

Although alendronate was considered generally safe and effective to osteoporosis in short-long term studies, it remains the potential risk of severely suppressed bone turnover that causes insufficient fracture of femur. In this report, we describe a patient of atypical subtrochanteric fracture who treated with prolonged alendronate. A 68-years old woman who had a history of medication of alendronate for 12 years was presented to the outpatient clinic with right thigh pain. The radiographs revealed thickening and fracture line of the lateral side of subtrochanteric area of the right femur. She discontinued taking the medicine and follow up closely. After 1 month later, she sustained atypical subtrochanteric femoral fracture after simple fall, and underwent an internal fixation with compression hip screw. After operation, bone biopsy was done with tetracycline staining for valuation of bone metabolism and severe osteoporosis was observed. Although long-term use of bisphosphonate could increase bone mineral density, this case showed that it could lead insufficient fracture by decreasing bone strength through severely suppressed bone turnover, inhibition of normal bone formation and decreased bone quality.

Expression of MTA1 and nm23-H1 protein in ovarian carcinomas in relation to lymph node metastasis / 부인종양

OBJECTIVE: Cancer metastasis is a complex process involving a sequential series of multi-step genetic events, which produces an imbalance between stimulatory and inhibitory genes for metastasis. Presently, we examined the expression of metastatic tumor antigen 1 (MTA1) and nonmetastatic protein 23 homologue H1 (nm23-H1) proteins in metastasized epithelial ovarian cancer cells. METHODS: Fifty-one primary epithelial ovarian tumors and corresponding lymph nodes (LNs) were examined immunohistochemically for expression of MTA1 and nm23-H1. Expression of these proteins was statistically evaluated. RESULTS: The frequency of MTA1 expression was 30.3% (10/33) in stage III/IV LNs but was absent (0/18) in stage I/II LNs (p=0.01). MTA1 expression was observed in 50% (6/12) of metastasizing LNs but in only 10.3% (4/39) of non-metastasizing LNs (p=0.01). In contrast with MTA1, nm23-H1 expression was evident in 16 of 18 (88.9%) stage I/II ovarian cancer tissue samples but only in 20 of 33 (60.6%) stage III/IV tissues (p=0.05), and nm23-H1 production was also observed in 75.6% (34/45) of ovarian cancer tissue with residual tumors under 2 cm in diameter, but in 2/6 (33.3%) of cancer tissue with residual tumors exceeding 2 cm in diameter (p=0.03). CONCLUSION: The degree of expression and imbalance of MTA1 and nm23H1 are correlated with ovarian cancer LN metastasis.

Two Cases of the Uterine Torsion at Term Pregnancy / 대한산부인과학회지

Torsion of pregnant uterus is defined as rotation of more than 45 degrees about the long axis of the uterus. Double or bicornuate uterine malformation is common cause of uterine torsion in animal group. Torsion of the human pregnant uterus especially at full term, is very rare. The reason for the occurrence of uterine torsion during pregnancy is not known, but abnormal fetal presentations, uterine myoma, and other uterine anomalies are known to be more frequent in patients with uterine torsion; maternal age, parity, and gestational age seem to play no apparent role. Symptoms of torsion of the pregnant uterus include disclosing of the cervix, abdominal tenderness, vaginal bleeding, shock, urinary symptoms and intestinal complaints. As uterine torsion may be fatal to both the fetus and the mother, promptness of the diagnosis and subsequent emergency laparotomy are essential. In this report, the authors present two cases of torsion at full-term pregnant uterus with unilateral renal agenesis, double uterus, and a transverse fetal presentation with a brief review of the literature.

Expression of the serine protease matriptase and its inhibitor HAI-1 in epithelial ovarian cancer / 대한산부인과학회지

OBJECTIVE: The purposes of this study were to examine the expression of matriptase, and its inhibitor, HAI-1, in epithelial ovarian cancer and to assign clinicopathological correlations and to discuss the matriptase/inhibitor (HAI-1) system in the context of ovarian cancer and to examine the possibility that this system might be a useful therapeutic target in this disease. METHODS: A retrospective study was performed in 51 patients with primary epithelial ovarian cancer staged over Ic who have been diagnosed and treated at Kyung Hee university medical center from Jan. 1991 to Mar. 2003. They were managed with cytoreductive surgery and chemotherapy. This study was performed in paraffin embedded blocks of primary epithelial ovarian cancer of 51 patients by means of immunohistochemistry. In addition, to validate protein expression data at the gene level, matriptase/HAI-1 mRNA expression was evaluated by reverse transcriptase-polymerase chain reaction (RT-PCR) on frozen specimens from 10 ovarian cancers. Statistical analyses of immunohistochemistry (IHC) expression data with clinicopathological parameters and survival were then performed. RESULTS: Of 51 ovarian tumors tested, 25 (49%) and 37 (72.5%) were positive staining for matriptase and HAI-1 by IHC, respectively. Of 18 stage I/II tumors, 11 (61.1%) stained positive for matriptase, and 15 (83.3%) stained positive for HAI-1; Of 18 stage I/II tumors, 10 (55.6%) tumors showed coexpression. Of 33 stage III/IV tumors, 14 (42.4%) stained positive for matriptase and 22 (66.7%) stained positive for HAI-1; Of 33 stage III/IV tumors, 11 (33.3%) tumors showed coexpression. CONCLUSION: No relationship was found between the expression of either matriptase or HAI-1 with clinicopathological parameters and survival. However, stage I/II ovarian tumors are more likely to express matriptase and HAI-1 than are the more advanced disease stage III/IV tumors. Correspondingly, the low frequency of matriptase and HAI-1 coexpression is more likely to be associated with stage III/IV tumors than stage I/II tumors. Such an imbalance in the matriptase: HAI-1 ratio could promote the proteolytic activity of matriptase and, consequently, a more invasive phenotype in the advanced tumors.

Expression of Osteopontin in Osteoclast / 대한정형외과연구학회지

PURPOSE: This study was aimed to determine the relationship between osteopontin(OPN) and osteoclast, especially focused on whether ostecolast could produce osteopontin or not. MATERIALS AND METHODS: Osteoclasts were isolated from the giant cell tumor of proximal tibia and seeded on the 13 mm round cover slip resided in 24 multi-well plates for culture. After 2 days, osteclasts on the cover slip were fixed with cold acetone for 3 minutes and immunocytochemistry was done with rabbit osteopontin antibody. For in situ RT-PCR, osteoclasts on the cover-slips were fixed with 4% paraformaldehyde for 4 hours and were treated to pepsin. PR-PCR was done and the PCR producst were stained with anti-digoxigenin-AP. RESULTS: Osteopontins were found on the surface of the osteoclast by immunocytochemistry, and intense osteopontin mRNAs were found by in situ RT-PCR. CONCLUSION: We have identified that osteoclast could synthesize the osteopontin, and confirmed that in situ RT-PCR was a very useful method in expressing small amount of mRNA in case of mixed cell culture. Further study was needed to identify the action of the osteopontin produced by the osteoclast.

The Effect of Gamma Knife Surgery on Uveal Melanoma

The optimal management of uveal melanoma is still a matter of controversy. To determine the effect of Gamma Knife surgery on patients with uveal melanoma, the authors reviewed the outcome of five operations performed between September 1993 and August 1996. The mean age of the patients was 60.7(range 42 to 76) years; the median follow-up period was 10 months, and four patients were followed up for more than 6 months. The mean tumor volume was 3442mm3(mean diameter 15.3mm) and all patients were irradiated with a mean maximum dose of 74Gy (range 60-80Gy), using a 50% isodose on the tumor margin. In one patient, the tumor disappeared completely 32 months after Gamma Knife surgery; because the tumor did not regress, one patient subsequently required enucleation, and two remained stable. During a mean follow-up period of 10 months, vision was preserved in two patients, but one went blind; in one, enucleation was performed because the tumor did not regress. These results suggest that in cases of uveal melanoma Gamma Knife surgery can effectively control local tumors, can spare the eyeball, and may prevent loss of vision.

Thyrotropin secreating pituitary adenoma / 대한내분비학회지

No abstract available.

Delayed CT Guided Stereotaxic Evacuation of Hypertensive Intracerebral Hematoma

The authors analyzed 11 patients of hypertensive intracerebral hematoma who had undergone the delayed CT guided stereotaxic evacuation. this delayed stereotaxic evacuation seemed to be highly effective in improving the motor weakness rather than mental state. Such effect was appeared immediately after the procedures in most of the patients, even in very small amount of hematoma. In addition, we could shorten the total hospital periods. The most effective time of this delayed stereotaxic evacuation was seemed to be in around 2 weeks after the hemorrhage.

Microsurgical Transsphenoidal Approach in Sellar and Parasellar Lesions

Fifty seven transsphenoidal microsurgery was performed in 55 patients with pituitary tumors and other juxtasellar lesions during 4 years since 1976 at Yonsei University Hospital. The results were analyzed and evaluated as follows: 1) Fourty seven(85.5%) of 55 patients had pituitary tumors, most of whom were in third to fifth decade. 2) Main symptoms in the patients with pituitary tumors were headache(78.7%), visual symptoms(70.2%) and endocrine symptoms such as amenorrhea-galactorrhea(46.8%). 3) Endocrinological diagnosis of pituitary tumor revealed non-secreting adenomas in 30.8% and secreting adenomas in 69.2% of the patients. Prolactinomas were 71.8% of the secreting adenomas. 4) Improvement of the visual symptoms were seen in 57.9% of patients with diminished visual acuity and 70.9% of the patients with visual field defect. 5) Menstruation was returned in 4 patients among 5 patients of microprolactinoma treated by transsphenoidal microsurgery combined with Bromocriptine therapy. One of them delivered a normal baby and another patient is in pregnancy. 6) Mortality rate of transsphenoidal approach was 1.8%(1/57) and recurrence rate after transsphenoidal approach for pituitary tumors was 4.2%(2/47). 7) Trans-sphenoidal approach was thought to be relatively simple and safe for the surgery of pituitary and juxtasellar lesions.