Small bowel obstruction from distant metastasis of primary breast cancer: a case report

Gastrointestinal (GI) tract metastasis of primary breast cancer is very rare. We present a patient with small bowel obstruction from distant metastasis of primary breast cancer. Each characteristic features of concern of GI tract distant metastasis from many pervious studies has been reported differently. We should remember that GI tract metastasis may coexist when patients with breast cancer have intermittent or recurrent abdominal pain with or without obstructive symptoms.

Analysis of Relationship between Prognostic Factors and Number of Fine-Needle Aspiration Cytology (FNAC) Prior to Surgery for Papillary Thyroid Microcarcinoma According to Size / 대한내분비외과학회지

PURPOSE: Papillary thyroid microcarcinoma (PTMC) is defined as a papillary thyroid carcinoma 10 mm. Indication of FNAC based only on tumor size is still in debate. Some favor the criteria of a size 5 mm, n=156) and the prognostic factors and number of pre-surgical FNAC procedures were compared. RESULTS: There were no significant differences in gender, age, site, accompanying benign disease, multifocality and bilaterality. Group 2 patients displayed more advanced features than group 1 patients concerning capsular invasion, lymph node metastasis and tumor stage. The number of FNAC procedures prior to the decision of surgery was not different in the two groups. CONCLUSION: PTMC exceeding 5 mm in size showed advanced features than smaller tumors. Further study about the use of FNAC according only to the size of thyroid nodules is warranted.

The Efficacy of Core Decompression for Treating Avascular Necrosis of the Femoral Head

PURPOSE: We evaluated the efficacy of core decompression (CD) for treating early avascular necrosis of the femoral head (ANFH), as well as the effect of an autogeneous bone graft and an DBM graft on the results of CD. MATERIALS AND METHODS: This study included 37 patients (40 cases) who were initially diagnosed as suffering with early ANFH, and they were treated with CD and followed up for a minimum of two years. The average patient age was 47.8 years and the average follow up period was 62.4 months., The Ficat & Arlet (F&A) stage and the ARCO stage were used for the radiological staging. RESULTS: The failure rate was 65% (26 case), and 32.5% (13 cases) underwent THA due to clinical and radiological failure. According to the F&A stage, there were 10 stage I hips, 22 stage IIA hips and 8 stage IIB hips, and the success rate (SR) of core decompression was 60%, 36.4% and 0%, respectively. The differences were statistically significant. The cases of ARCO stage II were divided into subgroups: A 2 hips, B 13 hips and C 12 hips and the SR of each were 50%, 46%, and 33.3%, respectively. The differences were statistically significant. CONCLUSION: CD should be carefully considered for treating the advanced stages above F&A stage IIA and ARCO stage IIB.

Sciatic nerve regeneration using calcium phosphate coated conduit and brain-derived neurotrophic factor gene-transfected schwann cell in rat

PURPOSE OF STUDY: Peripheral nerve regeneration depends on neurotrophism of distal nerve stump, recovery potential of neuron, supporting cell like Schwann cell and neurotrophic factors such as BDNF. Peripheral nerve regeneration can be enhanced by the conduit which connects the both sides of transected nerve. The conduit maintains the effects of neurotrophism and BDNF produced by Schwann cells which can be made by gene therapy. In this study, we tried to enhance the peripheral nerve regeneration by using calcium phosphate coated porous conduit and BDNF-Adenovirus infected Schwann cells in sciatic nerve of rats. MATERIALS AND METHODS: Microporous filter which permits the tissue fluid essential for nerve regeneration and does not permit infiltration of fibroblasts, was made into 2mm diameter and 17mm length conduit. Then it was coated with calcium phosphate to improve the Schwann cell adhesion and survival. The coated filter was evaluated by SEM examination and MTT assay. For effective allogenic Schwann cell culture, dorsal root ganglia of 1-day old rat were extracted and treated with enzyme and antimitotic Ara-C. Human BDNF cDNA was obtained from cDNA library and amplified using PCR. BDNF gene was inserted into adenovirus shuttle vector pAACCMVpARS in which E1 was deleted. We infected the BDNF-Ad into 293 human mammary kidney cell-line and obtained the virus plaque 2 days later. RT-PCR was performed to evaluate the secretion of BDNF in infected Schwann cells. To determine the most optimal m.o.i of BDNF-Ad, we infected the Schwann cells with LacZ adenovirus in 1, 20, 50, 75, 100, 250 m.o.i for 2 hours and stained with beta-galactosidase. Rats(n=24) weighing around 300g were used. Total 14mm sciatic nerve defect was made and connected with calcium phosphate coated conduits. Schwann cells(1x10(6)) or BDNF-Ad infected Schwann cells(1x10(6)) were injected in conduit and only media(MEM) was injected in control group. Twelve weeks after surgery, degree of nerve regeneration was evaluated with gait analysis, electrophysiologic measurements and histomorphometric analysis. RESULTS: 1. Microporous Millipore filter was effective conduit which permitted the adhesion of Schwann cells and inhibited the adhesion of fibroblast. We could enhance the Schwann cell adhesion and survival by coating Millipore filter with calcium phosphate. 2. Schwann cell culture technique using repeated treatment of Ara-C and GDNF was established. The mean number of Schwann cells obtained 1 and 2 weeks after the culture were 1.54+/-4.0*10(6) and 9.66+/-9.6*10(6). 3. The mRNA of BDNF in BDNF-Ad infected Schwann cells was detected using RT-PCR. In Schwann cell 0.69 microgram/microliter of DNA was detected and in BDNF-Adenovirus transfected Schwann cell 0.795 microgram/microliter of DNA was detected. The most effective infection concentration was determined by LacZ Adenovirus and 75 m.o.i was found the most optimal. CONCLUSION: BDNF-Ad transfected Schwann cells successfully regenerated the 14mm nerve gap which was connected with calcium phosphate coated Millipore filter. The BDNF-Ad group showed better results compared with Schwann cells only group and control group in aspect to sciatic function index, electrophysiologic measurements and histomorphometric analysis.

Peripheral nerve regeneration using polyglycolic acid conduit and brain-derived neurotrophic factor gene transfected Schwann cells in rat sciatic nerve

PURPOSE: The essential triad for nerve regeneration is nerve conduit, supporting cell and neurotrophic factor. In order to improve the peripheral nerve regeneration, we used polyglycolic acid(PGA) tube and brain-derived neurotrophic factor(BDNF) gene transfected Schwann cells in sciatic nerve defects of SD rat. MATERIALS AND METHODS: Nerve conduits were made with PGA sheet and outer surface was coated with poly(lactic-co-glycolic acid) for mechanical strength and control the resorption rate. The diameter of conduit was 1.8mm and the length was 17mm. Schwann cells were harvested from dorsal root ganglion(DRG) of SD rat aged 1 day. Schwann cells were cultured on the PGA sheet to test the biocompatibility adhesion of Schwann cell. Human BDNF gene was obtained from cDNA library and amplified using PCR. BDNF gene was inserted into E1 deleted region of adenovirus shuttle vector, pAACCMVpARS. BDNF-adenovirus was multiplied in 293 cells and purified. The BDNF-Adenovirus was then infected to the cultured Schwann cells. Left sciatic nerve of SD rat (250g weighing) was exposed and 14mm defects were made. After bridging the defect with PGA conduit, culture medium(MEM), Schwann cells or BDNFAdenovirus infected Schwann cells were injected into the lumen of conduit, respectively. 12 weeks after operation, gait analysis for sciatic function index, electrophysiology and histomorphometry was performed. RESULTS: Cultured Schwann cells were well adhered to PGA sheet. Sciatic index of BDNF transfected group was -53.66+/-13.43 which was the best among three groups. The threshold of compound action potential was between 800 to 1000microA in experimental groups which is about 10 times higher than normal sciatic nerve. Conduction velocity and peak voltage of action potential of BDNF group was the highest among experimental groups. The myelin thickness and axonal density of BDNF group was significantly greater than the other groups. CONCLUSION: BDNF gene transfected Schwann cells could regenerate the sciatic nerve gap(14mm) of rat successfully.