As much as 29.3% of GLUT4, 45.1% of GLUT1, 58.5% of clathrin, and 17.2% of insulin receptor imrnunoreactivities in rat adipocyte plasma membranes(PM) were found to be insoluble upon 1% Triton extraction at basal state. By insulin treatment the distributions of insoluble fraction were changed by 16.2% of GLUT4, 48.5% of GLUT1, 65.3% of clathrin and 31.0% of insulin receptor, respectively. SDS-PAGE revealed that the Triton-insoluble PM fraction contains a number of protein species including 110,80,70,50 30-33 and 15 KDa polyeptides. When PM was prewashed with alkaline buffer and 0.5M Tris buffer, which removed most of extrinsic membrane proteins including clathrin and AP-2 from PM, virtually all of the GLUT4 and GLUT1 in PM became soluble in 1% Triton. Subcellular fractionation fo11owed by Western blot indicated that AP-2 distribute to 4.8% at PM/NM, 25.7% at HDM, 38.9% at LDM and 30.6% at cytosol, respectively. An insulin treatment which increased GLUT4 content in PM by 1.5 fo1d increased the AP-2 content in PM nearly 2.3 fold with a concomitant decrease in cytosol AP-2 contents. These findings suggest that subpopulations of GLUT4 and insulin receptor in the plasma membrane of adipocytes are in specific association with extrinsic proteins, possibly clathrin and/or AP-2, and this association may play a key role in the translocation mechanism of GLUT4 in rat epididymal adipocytes.

The metabolism of drug and arachidonic acid(AA) by diabetic rat ocular tissues was studied. Little information is available on drug metabolism enzymes in ocular tissues. I investigated the presence of various cytochrome P-450 isoenzymes by measuring different drug metabolizing enzymes. i.e., 7-ethoxycoumarin-0-deethylase and benzphetamine demethylase activities in cornea and choroid, retina or sclera.

This results demonstrate that choroid, retina or sclera possess the highest activities of drug metabolizing enzymes. The highest activities of 7-ethoxycoumarin-0-deethylase and benzphetamine demathylase were found in choroid, retina or sclera. The highest activities of drug metabolizing enzyrnes is accompanied by high activity of NADPH cytochrome P-45O(C) reductase, an integral component of this enzyme study. The choroid, retina or sclera possesses the high activity of metabolizing arachidonic acid to biologically active compounds, whereas the cornea has tow activity of metabolizing arachidonic acid. A form of cytochrome P-450 has appear rat ocular tissues in diabetes and the effect of diabetes on ocular tissues cytochrome P-450 expression can be reversed by insulin treatment.

The specialized location of cytochrome P-450 isozymes in ocular tissues suggests a physiological function related to activation of endogenous compounds such as arachidonic acid, in addition to detoxifiaction of drugs. Thus, the choroid, retina or sclera is the site of metabolism and detoxification of drugs are carried to ocular tissues via circulating blood.

PCPA is a drug which depletes serotonin by inhibiting tryptophan hydroxylase activity.

Recent evidence indicates that the ascending cholinergic projection from the basal forebrain and ascending serotonergic projections from the brain stem exert a powerful control over the generalized electrical activity of the hippocampus formation and neocortex. Cross & Dentin(1985) reported that destruction of ascending cholinergic neurons by injection of ibotenic acid into the basal forebrain results in a significant reduction in 5-HT₁ receptor in the denervated cortex.

Maura & Raiteri(1986) observed that the release of (³H) Ach was concentration depenendently inhibited by exogenous 5-HT in rat hippocampus.

So, we were interested in investigating whether PCPA which depletes the serotonin also affects the cholinergic system. The brain(cortex area 3, 4, 17 and hippocampus) were exised on the 3day and the 7day after single injection of PCPA 3mg/10µl into the cerebroventricle(Lateral ventricle AP+8.2mm ; L, 1.5mm ; DV+1.2mm).

5-HT and 5-HIAA contents were measured by HPLC-ECD and acetylcholine was measured by GC.

The results are

1) 5-HT & 5-HIAA contents in the cortex & hippocampus were decreased gradually after PCPA injection but not significant.

2) Ach contents in the cortex & hippocampus were decreased significantly on the 3rd day & 7th day after PCPA injection.

3) We observed that the cerebral cortex has small amount of vesicles or no vesicles and coated vesicles in the axon terminals by electron microscope.

So, these results suggest that PCPA treatment results in significant changes of cholinergic system in the brain.

Simonic(1988) have investigated that hypothermic effect of oholinornimetics is mediated through an activation of muscarine cholinergic receptors. And also, Yamada(1987) injected trytamine into the lateral cerebroventricle in mice and observed hypothermic through 5-HT₁ receptor.

We have previously reported that PCPA(a serotonin depletor), has reduced 5-HT contents gradually, but had a marked reduction in Ach contents in the cortex and hippocampus.

After injection of PCPA and 5,7-DHT, a serotonergic toxin into the cerebroventricle in rats, we observed the colonic body temperature and Ach contents of cerebral cortex.

The results of our study are as follows :

1) Ach contents in the cortex were decreased significantly on the 3rd day & 7th day after PCPA i.c.v. injection.

2) Ach contents in the cortex were not changed on the 3rd day & 7th day after 5,7-DHT i.c.v. injection.

3) Increase in colonic body temperature was markedly observed in rats on 3rd day & 7th day after received intracerebral PCPA injection. During handling with rectal probe insertion there is a small changes of colonic body temperature with time.

4) Increase in colonic body temperature was observed in rats on 3rd day after received intracerebral 5,7-DHT injection. During handling with rectal probe insertion there is a small changes of colonic body temperature with time.

So, we concluded that serotonin depletion could cause a decrease in Ach contents of the cortex and also increase in colonic body temperature via cholinergic system in the brain.

To evaluste the efficacy and toxicity of IEP chemotherapy in locally advanced and metastatic non-small cell lung cancer, nineteen previously untreated patients with non-small cell lung cancer were studied.

Patients received ifosfamide 1000mg/m² with mesna, 20% of ifosfamide dose at 0,4, 8 hours after ifosfamide, etoposide 100mg/m², and cisplatin 20mg/m² with full hydration and mannitol diuresis intravenously on days 1-3 every 4 weeks.

Eighteen male and one female, two stage IIIA, 10 stage IIIB and 7 stage IV patients have been treated.

The response rate of IEP was 26% with no complete remission, 53% of stable disease, and 23% of progressive diasease.

The overall median survival was not reaced yet and 20 month survival rate was 51.4%, The duration of remission was at the range of 4⁺ to 40 weeks.

The toxicities were alopecia(100%), nausea and vomiting(47%), leukopenia(14%), infection(6%), renal dysfunction(6%) and oral mucositis(5%).

This phase II study of IEP in advanced non-small cell lung cancer is not superior to another combination regimens in terms of response but toxicity was tolerable. Other new chemotherapeutic drugs and newer trials should be developed further.

Reliable venous access is increasing serious problem in cancer chemotherapy Patients.

Thiry six implantable second generation catheter system(A. Port) were placed subcutaneously in 35 patients with cancer.

A. Port were in place for an average of 158 days(range 10-731⁺ days). Complications included infections in 3 cases, thrombosis in 1 case, skin laceration in 1 case and pneurnothorax in 1 case. Five ports were removed due to complication. One pneumothorax was managed conservatively;

It is concluded that A. Port implantation constitute a safe and convenient access with a low rate of complication for long term intravenous chemotherapy in cancer patients.

This study analyses 47 cases with acute postoperative adhesive intestinal obstruction who were treated under 15 years old at Ewha Womans University Hospital during Junuary 1985 to December 1992.

Fourty-seven cases is 2.5 per cent of 1943 pediatric surgical cases who were treated during same period. In 47 cases, 29 cases were treated with surgical interventions(17 cases with the immediate operation and 12 cases with the delayed operation) and 18 cases were treated with nonsurgical management. Male to female sex ratio is 3 : 2. The incidence is higher in older age groups. The age distribution of 47 cases who underwent a previous peritoneal procedure were 4 cases in neonate, 13 cases in infants, 12 cases in preschool age and 18 cases in early school age & adolescence. Eighty-five per cent of the cases had only one prior peritoneal procedure and the most common previous condition necessitating laparotomy was acute appendicitis(57.4%), intussusception(21.3%), and developmental anomalies(19.1%). More than 50% of the intestinal obstructions developed more than 3 months later of prior laparotomy. The common clinical findings were similar to the intestinal obstruction developed by other causes and 85% of the cases were admitted within 72 hours of developing the symptoms of obstruction. The success rate of conservative trial was 60 per cent and in more than 60% of surgical treatment group, the only surgical interventions were lysis of fibrous band or adhesions caused intestinal obstruction. There was no death.

This results suggest that the need for too little late surgical intervention to prevent the circulatory disturbances can not be over emphasized. Because, there was no criteria to predict the success of conservative trial and there was no significant difference of clinical and radiologic findings between surgical and conservative treatment groups.

Arthroscopy of the knee joint is an essential diagnostic procedure of the knee joint lesions because of its high diagnostic accuracy, simple procedure, high safty and low morbidity. We applied arthroscopy in the diagnosis of 62 patients with pain, swelling, limitation of motion and giving way of the knee joint from Jan. 1987 to Dec. 1991 at Ewha Womans University Hospital. Only 49 patients of these were followed over 6 months and we analysed and compared with clinical diagnosis and rthroscopic findings.

The results were follows :

1) Patients with knee joint lesions were most common in 3rd and 4th decades.

2) Patients with traumatic history were 57.1% (28 patients).

3) Most common lesions were meniscal lesion and most commonly used method of treatment after arthroscopy was meniscectomy.

4) Three patients with internal derangement of knee were diagnosed meniscal injury after arthroscopy.

A series of 115 cases with intraventricular hemorrhage due to hypertension diagnosed by computed tomography was analyzed with the early conscious level(Glasgow Coma Scale), the site of hemorrhage, the grading of the severity of intraventricular hemorrhage, and the final outcome.

The mean systolic blood pressure was 195.7mmHg & the mean diastolic blood pressure was 119.6mmHg.

It is generally considered to be of grave prognostic significance.

The overall mortality rate was 70.4%.

Poor outcome was associated with increasing age, low admission Glasgow Coma Scale, hemorrhage in all four ventricles and very high blood pressure.

The surgical treatrnent including extraventricular drainage was not satisfactory as yet.

We performed this study to investigate the role of perivascular areolar tissue for the survival of single-ended venous flap using rat inferior epigastric pedicle. Five models of flap were studied ; Group A-flap based on an inferior epigastrie vien and areolar tissue ; Group B-flap with skeltonized vein ; Group C-flap based on an inferior epigastric artery and areolar tissue ; Grup D-flap with skeletonized artery ; Group E-flap based on perivascular areolar tissue alone. Each group included 40 flaps in 20 rats. Group A showed 25 totally survived flaps and 9 partially survived flaps, but other groups showed almost all necrotic flaps. Histological examination of the survived pedicle showed many small vascular channels around the inferior epigastric artery and vein. We belive that these vascular channels may play an important role for the survival of single-ended venous flap.

The postmenopausal state is characterized by an absence of ovulation and a reduction of ovarian estrogen secretion. Postmenopausal women is associated with several symptoms including vasomotor flushes, atrophic vaginitis, osteoporosis and increased risk of cardiovascular disease. Varying doses of estrogenic preparation have been used to treat these symptoms and have displayed changes in plasma lipoprotein level.

We administered different doses of oral conjugated estrogen to 30 postmenopusal women and made comparative analysis of lipoprotein changes by varying doses.

The results were as follows :

1) The changes of plasma estradiol after estrogen replacement therapy in group I and group II were increased by 54.96±11.36 pg/ml(p<0.01) and 68.37±16.91 pg/ml(p<0.01), but the difference of changes between two group was not statistically significant(p>0.05).

2) The changes of plasma FSH after estrogen replacement therapy in group I and group II were decreased by 52.94±12.95 MIU/ml(p<0.O5), and 60.24±8.09 MIU/ml(p<0.01), and difference of changes between two groups was not statistically significant(P>0.05).

3) The changes of plasma cholesterol after estrogen replacement therapy in group I and group II were decreased 17.I±4.28 mg/dl(p<0.01) and 11.07±9.01 mg/dl(p>0.05), and differenee of changes between two groups was not statistically significant(p>0.05).

4) The changes of plasma triglyceride after estrogen replacement therapy in group I andgroup II were decresead by 145.3±20.3 mg/dl(p>0.05) and 35.4±13.87 mg/dl(p>0.O5), but difference of changes between two groups was not statistically significant(p>0.05).

5) The changes of plasma HDL after estrogen replacement therapy in group I and group II were increased by 3.0±3.50 mg/dl(p>0.05) and 11.05±5.30 mg/dl(p<0.05).

6) The change of plasma HDL/cholesterol after estrogen replacement therapy in group I and group II were increased by 5.9±1.33% (p<0.01) and 6.31±2.19% (p<0.05), but difference of changes between two groups was statistically significant(p>0.05).

7) The changes of plasma LDL/cholesterol after estrogen replacement therapy in group I and group II were decreased by 3.01±2.7% (p<0.01) and 7.71±2.13% (p<0.01), but difference of changes between two groups was not statistically significant(p>0.05).

8) The changes of plasma VLD/cholesterol after estrogen replacement therapy in group I and group II were increased by 1.81±2.54% (p>0.05) and 5.30±2.38% (p>0.O5) and difference of changes between two groups was statistically significant(p>0.O5).

9) The changes of plasma HDL/LDL after estrogen replacement therapy in group I andgroup II were increased by 0.21±0.04% (p<0.01) and 0.247±0.06(p<0.01), but difference of changes between two groups was statistically significant(p>0.05).

From Feb. 1989 to July 1993, 84 cases of microsurgical tubal reanastomosis were performed at the Department of Obstetrics and Gynecology, Ewha Womans University Hospital. And 49 cases of tubal reanastomosis were fo11owed-up more than 6 months after operation.

The charateristics of 84 reanastomosis and the results of 49 reanastomosis which have been fol1owed up more than 6 months are as follows :

1) At the time of reanastomosis, mean age of the patients was 32.5 years and average interval between sterilization and reanastomosis was 6.0 years. The mean postoperative tubal lengthwas 5.5cm.

2) The site of the reanastomosis in majority is isthmic to isthmic portion(85.7%) and cornus to isthmic(8.3%).

3) After more than 6 months of postoperative fo11ow-up, it revealed a pregnancy rate of 63.2% (31/49). And by the sterilization type, the pregnancy rate is 68.7% (11/16) in ring group, 63.3% (19/30) in cautery group.

4) The outcome of the 31 pregnancies after reanastomosis were 26 cases of full term delivery, 2 ongoing pregnancy, 2 abortion and 1 tubal pregnancy.

Presented study was conducted to determine that the hepatitis C virus(HCV) may play a role in the pathogenesis of chronic liver disease including hepatocellular carcinima and liver cirrbosis.

Using 2nd generation EIA author examined serum anti-HCV in total 2,641 cases, including liver disease, physical check-up subjects at EWHA Womans University Hospital during 1 year of 1992.

The results were as fo11ows : Among total 2,641 patients, overall prevalence of anti-HCV was 4.5%, 1.7% positive rate for subjects whose physical check-up. Among total 103 anti-HCV positive patients, the majority was chronic liver disease, liver cirrhosis, and hepatoma. The positivity of HBs Ag in anti-HCV positive patients was 4.4% and the anti-HBc was 49.5%. The mean ALT level was 69.3 U/L and the abnormal high level was found in 57.3% in anti-HCV positive patients.

On the basis of the results above, anti-HCV test is very useful for the diagnosis and management in not only chronic liver disease such as hepatocellular carcinoma and cirrhosis, but also chronic hepatitis diagnosed as B-hepatitis.

The diffuse interstitial lung diseases are a heterogeneous group of diffuse inflammatory disorders of the lower respiratory tract characterized by derangements of the alveolar walls and loss of functional alveolar capillary units. The most common causes of diffuse interstitial lung diseases are idiopathic pulmonary fibrosis, sarcoidosis, collagen vascular disorders, hypersensitivity pneumonitis and pneumoconiosis. Especially, the miliary tuberculosis is also leading cause in Korea, but pulmonary tuberculosis presenting as diffuse interstitial lung disease except miliary tubercuaosis is rare. We report a case of pulmonary tuberculosis presenting as diffuse interstitial lung disease associated with the tyrnphadenopathy of mediastinum and abdomen.

Tuberculosis of the breast is an extremity rare disease in western countries and about 0.5% among entire breast in Korea and most of which involved persons between 20 to 40 years of age in female but it rarely developed in male, elderly patient and prepubertal woman. It may be primary-confined to the breast or secondary to tuberculosis elsewhere because of it's diagnostic difficult. Tuberculosis of breast, is confused to actinomycosis infection, abscess and carclnom.

So, it is only diagnosed by histopathologic finding or inoculation in experimental animal. I expirienced 3 cases of tuberculosis of the breast in 23 years which were treated with antibiotics, antituberculosis medication and combined with surgical excision.

Cross-leg flaps are used to provide thick skin coverage of bone and tendons. The calf is the donor site. The flap is based along the medial aspect of the tibia. Immobilization of both leg is essential. The commonly used cross-leg plaster casts cannot adjust the position of the legs when the flap is subjected to kinking or pressure. Author developed a External Fixator Brace with universal joint that enables the position of the legs to be controled. Six cases of cross leg flaps were immobilized by the External Fixator Brace and the fo11owing results were obtained.

1) Observation of the flap circulation was more feasible through the wider exposure when the External Fixator Brace was applied.

2) Cleansing of both the donor and recepient sites was easier because of the wider exposure when the Extemal Fixator Brace was applied.

3) Adjustment of position of the flap was possible using universal joint incorporated in the External Fixator Brace when the circulation of the flap was found to be compromised.

Ankle Arthrodesis has been regarded as a good operative treatment for post traumatic and Rheumatoid arthritis of ankle, and Ankle Arthroplasty has been also developed with several types, from 1970, by Lord & Marotte.

Ankle arthroplasty is more functional & less cosmetic troublesome than arthrodesis, and with more developed prosthesis design, more good result will come.

The authors operated 6 cases of Total Ankle arthroplasty for post traumatic and Rheumatoid Arthritis of ankle, which were also indications of arthrodesis, and introduce the results and operative problems of ankle arthroplasty.

Castleman's disease, giant lymph node hyperplasia, is a rare benign tumor which was originally reported by Castleman in 1956. It has two types of pathological characteristics of hyaline-vascular and plasma cell. Surgery is usually perferred because of the giant mass shadow on the chest roentgenogram rather than symptomes it causes. It is cured completely by resection without recurrence. We have experienced a case of Castleman's disease in the right anterosuperior mediastinum in a 36-year-old female. She was treated by surgical resection with good result She is well one year after surgeny.

Selective absence of serum IgA is the most commonly diagnosed form of human immnndeficiency disease, being reported in about one in 500-700 subjects in population surverys. Datailed clinical and laborattory studies of subjects with selective IgA deficiency generally reveal significantly increased incidence of sinopulmonary infection, gastrointestinal symptomatology, autoimmune disease and autoantibodies.

Authors experienced selective IgA deficiency associated with an scleroderma in a 25 years old young woman. She had pulmonary tuberculosis, high IgE level, reactive rheumatoid factor, positive for antinuclear antibody, and no presence of anti-IgA antibody.