A Study for Apoptosis and Its Mechanism of Allogeneic Activated T Lymphocytes Induced by Mouse Liver Immature Dendritic Cells

PURPOSE: Mouse liver nonparenchymal cells play an important role in the development of active apoptosis in graft- infiltrating cytotoxic T lymphocytes, and this apoptosis can be an explanation for liver graft acceptance. We intended to clarify whether immature mouse liver dendritic cells can induce apoptosis in allogeneic activated T cells and determine which mechanism is involved in this phenomenon. METHODS: A radiometric DNA fragmentation test ("JAM" assay) was used to determine whether mouse liver dendritic cells were able to induce activated T-cell apoptosis in vitro. In addition, immunohistochemical staining for Bax and Bcl-2 was examined to clarify whether Bax or Bcl-2 was involved in this apoptosis. RESULTS: Immature mouse liver dendritic cells were quite strong inducers of activated T cell apoptotic death in allogeneic mice in vitro (39.2+/-13.2% at E/T ratio=12.5/1) compared with spleen cells as effectors (4.7+/-13.4% at E/T ratio=12.5/1) (P<0.0001). By using immunohistochemical staining, we also showed that Bax might play some role in this phenonenon, but that Bcl-2 might not. CONCLUSION: Our data indicate that immature mouse liver dendritic cells might have a strong apoptotic activity toward activated T cells in allogeneic mice in vitro through a Bax-involved mechanism.

A Preliminary Gastric Emptying Study Using 99mTc-DTPA Scan after Pylorus-Preserving Pancreatoduodenectomy

PURPOSE: Pylorus-preserving pancreatoduodenectomy (PPPD) is an alternative surgical procedure for periampullary lesions. Early delayed gastric emptying is the most common and frustrating complication in the immediate postoperative period after PPPD and late delayed gastric emptying has been reported in some long-term follow-up studies. We evaluated the incidence of early delayed gastric emptying and analyzed temporal changes in gastrointestinal function after PPPD. METHODS: The incidence of early delayed gastric emptying was retrospectively evaluated from the medical records of 15 patients who underwent PPPD. Gastric emptying tests (GETs) using 99mTc-DTPA scan were performed on 11 of the patients every three months until 1 year, where possible. RESULTS: The incidence of early delayed gastric emptying was 6.7%. Five of the eight patients (62.5%) and six of the eight (75%) who underwent scintigraphy at 3 months and 6 months respectively, showed delayed gastric emptying. But at 12 months, all of the four patients who underwent GETs showed normal gastric emptyings. CONCLUSION: The incidence of early delayed gastric emptying after PPPD was 6.7%. Though there were few symptoms in long-term follow-up study using 99mTc-DTPA scan, delayed gastric emptying was frequently observed 3 to 9 months after PPPD. However, gastric emptying might be normalized in almost all patients around 1 year after PPPD.

Coil Embolization in Right Superior Thyroid Artery Pseudoaneurysm by Stab Wound

A case of coil embolization in right superior thyroid artery pseudoaneurysm by stab wound is reported. A fifty-six-year old female, laceration and some bulging in right neck side. Aortic arch angiography, right common carotid angiography was done. Angiography shows 4 2 cm sized right thyroid artery pseudoaneurysm (Fig. 1) and (Fig. 2). We selected right superior thyroid artery by 3F micorofert (CooK, Bloomington, Ind.) and embolized by 2 4 mm (diameter), 2 cm (length) sized micro tornaido coil (CooK, Bloomington, Ind.). Post procedure right common carotid angiography was done. Angiography shows no visualized right thyroid artery pseudoaneurysm (Fig. 3).

A Clinical Differences between Asymptomatic Varicose Vein and Symptomatic Varicose Vein

PURPOSE: This study was designed to describe clinical differences between symptomatic and asymptomatic group in varicose vein. METHOD: We reviewed 59 cases of varicose vein managed in our hospital. The retrospective review of clinical records was done from March, 1999 to October, 1999. All patients were put into two groups:those were symptomatic and asymptomatic. RESULT: Analysis showed that varicose vein was more frequent in women than in men. 27.1% were asymptomatic and 72.9% were symptomatic. The mean age was 39.1 years in asymptomatic group and 52.1 years in symptomatic group. In asymptomatic group, the mean age of the male patients was 45.2 years and that of the female patients was 35.4 years. In symptomatic group, the mean age of the male patients was 49.6 years, that of the female patients was 54.2 years. The age difference between the two groups were 5.4 years in male in comparison with 19.8 years in female. In the symptomatic group, the frequency of association with deep vein thrombosis (DVT) was 21% (male:28% vs female:8.3%). CONCLUSION: The varicose vein appears to be a gradually progressive disease. In female patients, aging factor may be more important for the development of symptom. DVT is one of major causes of development of symptom.

Identification of Pseudomonas Aeruginosa Isolated from Burn Patients by Nested Polymerase Chain Reaction: Special reference to comparison with conventional blood culture

PURPOSE: Pseudomonas aeruginosa has emerged as one of the most problematic bacteria in modern hospital settings, and this organism is increasingly isolated as a nosocomial pathogen. Burn patients are particularly susceptible to Pseudomonas infection. Therefore, the accurate and sensitive microbiologic tests are needed for strict management of this prevalent microorganism. METHODS: A nested polymerase chain reaction test based on consecutive amplification of the lipoprotein genes, oprL and oprI, was designed and evaluated, in comparison with the conventional blood culture, for its ability to detect Pseudomonas aeruginosa in clinical materials of burn patients. RESULTS: Positive results of PCR based on oprL gene were observed only for Pseudomonas aeruginosa. All other bacteria (n=4) tested by this amplification method were negative. Also the lowest detection level was 1X101 bacteria per ml of blood samples. In addition, PCR afforded a significantly higher detection rate for Pseudomonas aeruginosa than the conventional blood culture technique in clinical materials of burn patients (25.9% vs. 8.6%). CONCLUSION: This study suggests that the nested PCR technique is highly specific and sensitive test for detectionof Pseudomonas aeruginosa, and therefore it may be a useful adjunct tool, in combination with other conventional techniques, for detection of Pseudomonas aeruginosa infection.

The Effect of Long-term Tamoxifen Therapy on Endometrium Evaluated by Transvaginal Sonography in Postmenopausal Women Undergone Breast Cancer Surgery / 대한암학회지

PURPOSE: Tamoxifen is a non-steroidal antiestrogenic drug used mainly in the adjuvant therapy of breast cancer and it also has estrogenic effect to the endometrium. We investigated the effects of tamoxifen on endometrial thickening in postmenopausal women taking adjuvant tamoxifen therapy for breast cancer, and analyzed the correlation between sonographic findings, pathologic findings and duration of tamoxifen therapy. MATERIALS AND METHODS: Forty three patients previously operated and being treated by tamoxifen since July 1995 to August 1999 were involved in this study. Control group was selected from patients of postmenopausal syndrome visiting postmenopausal clinic more than 2 years after menopause since January 1994 to August 1997. Endometrial thicknesses of breast cancer patients taking tamoxifen were measured twice a year for 2 years and then once a year by transvaginal ultrasonography. They were considered abnormal when those thicknesses were greater than 6 mm. Sonographic mearsurements of control patients were done once at the first visit and which were compared with those of breast cancer patients. RESULTS: The mean endometrial thicknesses of breast cancer patients receiving tamoxifen therapy were 5.06 mm (4.86~5.21 mm) at 6th month, 5.1 mm (4.92~6.00 mm) at 12th month, 5.13 mm (4.89~5.32 mm) at 18th month, 5.15 mm (4.97~5.28 mm) at 24th month and 5.14 mm (4.96~5.21 mm) at 36th month. The mean thickness of control patients was 4.87 mm. The mean endometrial thickness of breast cancer patients and that of control patients were 5.07 mm and 4.87 mm respectively. Only one patient with stage I breast cancer showed endometrial thicknessof 6 mm during follow-up and endometrial biopsy showed atypical endometrial hyperplasia. Endometrial thickness significantly increased after 18 months of tamoxifen therapy, but the rate of increase was slow. CONCLUSION: The endometrial thickness increased with duration of tamoxifen therapy, but the rate of increase was slow and seldom exceeded 6 mm. So we concluded the risk of endometrial cancer is low.

Vascular Trauma Secondary to Orthopedic Procedure

Liability to vascular trauma in orthopedic procedures results from the close relation between bones and vessels and complicated use of sharp instruments and retractors. Prompt diagnosis and management are mandatory to avoid high mortality and morbidity. We report 6 vascular injuries secondary to orthopedic procedures performed between 1994 and 1998. Two injuries occurred as a consequence of intramedullary nailing and Ilizarov external fixation of a femur fracture, one injury from lumbar laminectomy, one injury as a result of total hip replacement, one from hip flexion contracture release and the other one secondary to knee flexion contracture release. Injury occurred to three femoral arteries, one femoral artery and vein, one popliteal artery, and one iliac artery and IVC. Four vascular injuries required bypass grafts, division was done in AV fistula following disc operation. Conservative treatment was given to one vascular injury. There was no significant complication and death in our series except one case of graft infection that was revised with extra-anatomic bypass. The goal of management of vascular trauma that occurs during the orthopedic procedure is to save the limb and even the life. Urgent management based on knowledge of vascular structure and skillful surgical technique are needed.

Bilateral Popliteal Artery Entrapment Syndrome: A case report

A case of symptomatic bilateral popliteal artery entrapment syndrome is reported. A twenty-one-year old male, a candidate of athlete, complained of coldness, weakness, pallor and cyanosis of right lower leg and intermittent claudication to both calves during walking or exercise for ten months. Studies revealed that the right popliteal artery was completely occluded, but the left popliteal artery was non-occlusive. An endarterectomy and onlay vein patch graft to the thrombosed and fibrotic right popliteal artery, and myotomies of bilateral medial heads of gastrocnemius muscle were done (May 20, 1998). Follow-up examinations for the last ten months showed a complete relief of symptoms with normal distal arterial flow. It is thought that even though the majority of patients present with unilateral calf claudication, the possiblity of bilateral problems need to be also considered.

Foreignbody Removal Using Goose Neck Snare

PURPOSE: To valuate the value of goose neck snare in removal of foreignbody in endovascular system. METHODS & MATERIAL: Foreignbody removal in endovascular system using goose neck snare were done in 4 cases. In one case, a broken guide-wire was located in left subclaviar vein and in three cases, guide-wires were located in vena cava. RESULTS: Technical success was achieved in all four cases. CONCLUSION: Goose neck snare technique is safe and effective in removal of Foreignbody in endovascular system.

Rupture of Femoral Artery by External Fixator

The authors report a case of superficial femoral arterial trauma caused by external fixator in 53 year-old male patient who had supracondylar fracture of femur due to automobile accident. After removal of external fixator, autogenous bypass graft was perfomed with reversed great saphenous vein. The occlusion of the graft occurred 3 months later, we thought that interposition graft in the chronic inflammatory and fibrotic tissue should be avoided.

Clinical Analysis of PTFE Graft Arteriovenous Fistula: The long-term patency rate and factors affecting the patency rate

Expanded polytetrafluoroethylene(PTFE) graft fistulas are widely used as secondary vascular access for patients receiving long-term hemodialysis. It is well known also that several factors should be considered in order to maintain PTFE graft fistula adequately. To elucidate these factors, we reviewed 71 cases of PTFE graft arteriovenous fistula that performed at Hallym University Hospitals from March 1991 to December 1995 and analysed it for regard to age, serum creatinine level, diabetes mellitus, hypertension, diameter of graft and operation site and method. The resultes were as follows: 1) The mean duration of patency of PTFE graft fistula was 10month and the 6 month, 12 month and 24 month patency rate was 64.9%, 39.4% and 36.1% respectively. 2) The complication rate was 45%. 3) Of these factors, diabetes mellitus was the only factor that decreased the patency rate(P<0.05).

A Case Report of Pelvic Congenital Vascular Malformation

Intraarterial embolization for a congenital vascular malformation can provide transient symtomatic relief but recurrence of the lesion occurs in most cases. The authors present a 29-year-old female patient with extensive pelvic vascular malformation who was underwent preoperative embolzation twice and a final operative intervention.

The Role of Intraperitoneal Insulin on Liver Regeneration in Rat

Insulin is well known to have a hepatotrophic effect, but exogenous insulin has a negative effect on liver regeneration because it decreases the level of endogenous insulin. Howerver intraportal exogenous insulin will have some differences. This study was set up to analyse the effect of portal insulin via intraperitoneal route on liver regeneration in rats which have a normal pancreas with or without liver cirrhosis after partial hepatectomy. Beforehand, insulin levels of the portal blood at the time intervals of 0, 30, 60, 120, and 240 minutes after intraperitoneal injection of insulin were measured and compared with those after subcutaneous injection. The results were: 1.5, 140.9, 58.6, 20.4, 14.3 g/ml in intraperitoneal group(n=14) and 1.5, 22.3, 27.1, 32.4, 29.1 g/ml in subcutaneous group(n=14). Intraperitoneally injected insulin was absorbed more rapidly than subcutaneously injected insulin. Thirty nine rats with normal liver were divided into 5 groups A(n=8): intraperitoneal saline, B(n=9): intraperitoneal insulin 2 IU/Kg, C(n=7): subcutaneuos insulin 2 IU/Kg, D(n=7): intraperitoneal insulin 5 IU/Kg, E(n=8): subcutaneous insulin 5 IU/Kg. They were all 2/3 partial hepatectomized and remnant livers were obtained after 24 hours after hepatectomy. Ninety minutes before sacrifice, 100 Ci,H3-thymidine was injected intraperitoneally and their C.P.M./ g of DNA was measured and compared with each other groups. The same procedures were done with another twenty seven rats with liver cirrhosis (A'(n=5), B'(n=6), C'(n=6), D'(n=5), E'(n=5)) which was induced by oral ingestion of CCl4 for 12 weeks. The results were: 38.29, 25.77, 14.37, 34.04, 23.83 C.P.M./ g in normal rat group and 23.76, 8.11, 10.89, 8.80, 12.22 C.P.M./ g. In normal rat, the C.P.M.'s of intraperitoneal groups were higher than those of subcutaneous group and the difference was statistically significant between A and C group (p<0.05). In cirrhotic group, there were not any significant differences between any two groups. It can be concluded that exogenous insulin has an inhibitory effect on liver regeneration. But intraperitoneal insulin exerts less inhibitory effect on liver regeneration than subcutaneous insulin because intraportal insulin is more potent in liver regeneration and has less negative feed back on endogenous insulin than systemic insulin.

A case of laparoscopic cholecystectomy in child

No abstract available.

Surgical management for sacral and presacral tumor / 대한암학회지

No abstract available.

Surgical treatment of mycotic aneurysm

No abstract available.

Surgical management for cystic neoplasms of the pancreas

No abstract available.