Influence of progestrone receptor and vascularity in leiomyoma to the growth and clinical symptoms / 대한산부인과학회지

OBJECTIVE: Myoma is the most frequent benign tumor in women's pelvic cavity. Myoma causes a lot of symptoms that degrade the life quality of the patients. If the patient with leiomyoma does not require the treatment, regular follow-up is recommended. However, there is no definite method to predict the clinical outcome of leiomyoma patients. So we evaluate if the hormone receptors and vascular viability can predict the clinical outcomes in leiomyoma patients. METHODS: We perform the leiomyoma biopsy and ultrasonogram in leiomyoma patients who are symptomatic, premenopaused, and unnecessary to receive treatment. The patients were grouped into two as the results of progesterone receptor status of leiomyoma ; strong positive (> or = 75% positive to progesterone receptor), trace and negative (<25% positive to progesterone receptor). Also, we evaluates the vascular state and the resistance index (RI) of feeding arteries of myoma with doppler ultrasonogram. The severities of clinical symptoms are interpreted by using Uterine fibroid symptom and health-related quality of life questionnaire (UFS-QOL). RESULTS: After 8 months, the strong positive group shows the greater increasement of myoma volume than the trace and negative group. Also, the patient's symptoms and scores of life-quality decrease in strong positive group. In contrast, the trace and negative group show the improvement in clinical symptoms and life-quality. CONCLUSION: As a result, we concluded the status of hormonal receptor and feeding arteries can predict the clinical change of leiomyoma.

Clinical symptom of premenstrual syndrome in Korean women acorrding to tissue mineral concentration / 대한산부인과학회지

OBJECTIVE: Premenstrual syndrome (PMS) is a disease with specific psychologic and physical symptoms on luteal phase. Its incidence is variable in 20~80%, but its cause is not definitely proved. Because progesterone and estrogen affect the balance of the body mineral, the alteration of progestorone and estrogen in the patients with PMS may effect the imbalance of tissue mineral, that can induce the specific symptoms of PMS. This study examines the relationship between symptoms of PMS and mineral count by tissue mineral test. METHODS: Women who volunteered for the tissue mineral test completed MMDQ questionnaire and checked blood test for Ca, Mg, Na, K, Cu, Zn. The tissue mineral test used the hair not treated within 3 weeks and not washed within 3 hours. The hair was send to TEI for the analysis. We used SPSS (14.0) for statistical analysis. RESULTS: The MMDQ score of the normal Mg group is significantly higher than the high Mg group (22.5+/-17.8 vs. 13.9+/-11.1), and the behavioral disorder score of the normal Na group is significantly lower than the low Na group (2.2+/-1.7 vs. 3.4+/-2.2). The MMDQ score of the normal Cu group is significantly lower than abnormal group (15.7+/-11.9 vs. 24.9+/-16.9). CONCLUSIONS: Total score of MMDQ showed difference according to magnesium and copper concentrations in tissue, and scores of behavioral disorder was affected by sodium concentration of tissue. Additional study about cause and effect relationship is required.

Correlation of transvaginal radiofrequency myolysis and estrogen, progesteron receptor in uterine myoma / 대한산부인과학회지

OBJECTIVE: The aim of this study was to investigate the changes in hormone receptors of myoma cells and volume decrement of myoma after radiofrequency myolysis. METHODS: From 2005 January to 2006 January, thirty patients who have had high-frequency myolysis were included in this study. Needle aspiration biopsy was done at the central portion of myoma pre- and 6 months post-operation. Radiofrequency myolysis were done for 20 minutes until discoloration of myoma was accomplished to 80%. The stain intensity of estrogen receptor (ER) and progesterone receptor (PR) was classified into "negative", "trace", "weak", "moderate" and "strong". RESULTS: The volume decrement was 96.4% in the group that showed trace to week stain intensity (under 50% stain intensity), but it decreased to 66.6% in the group that showed strong stain intensity (over 50%, moderate to strong)(P<0.05). ER showed moderate to strong positive response in 79% of patients before operation, but it showed negative to week response in 83% of patients after the operation. Also, PR showed moderate to strong positive response in 80% of patients before operation, but it showed negative to week response in 86% of patients after the operation. CONCLUSIONS: To coagulate entire myoma, we suggested that controlling the intensity of operation by lengthening the time or expanding the extent of operation was more effective in treatment, because the volume decrement of myoma was larger in case that ER and PR was under 50% before the operation.

Relationship of End tidal PCO2 a n d Arterial PCO2 in Acute Critically Ill Patients

BACKGROUND: The CO2 concentration in exhaled gases is intrinsically linked to tissue metabolism, ventilation, and pulmonary circulation. In hemodynamically stable patients, the end-tidal CO2(PetCO2) is known to be a good index of arterial CO2 (PaCO2). However, the PetCO2 has some limitations in predicting PaCO2 in emergent patients with unstable vital signs. OBJECTIVE: We evaluated the relationship of PetCO2 and PaCO2 and the validity of the difference between PetCO2 and PaCO2(PaCO2-PetCO2) for various clinical situations. MATERIAL AND METHOD: A prospective analysis was performed in endotracheally intubated patients, who presented at the Korea University Emergency Medical Center during a 14-month period from January 2003 to February 2004. Patients were divided into three groups; respiratory insufficiency of cardiopulmonary cause (Group A), respiratory insufficiency of extracardiopulmonary cause (Group B), cardiac arrest with any cause (Group C). Group A was subdivided into two subgroups; A1 with a history of chronic lung disease disease and A2 with no history of chronic lung disease history. In each group, the mean of PaCO2-PetCO2 was calculated and multiple comparison was performed in each groups by using a one-way ANOVA test, and the 95% confidence interval of PaCO2 - PetCO2 was calculated. P a C O2 and PetCO2 were evaluated by using a linear regression analysis. The calculation was performed using the SPSS for windows version 10.0, and p values of less than 0.05 were considered significant. RESULT: A total of 59 patients were included in this study. Twenty-five patients were in Group A, (18 in A1 and 7 in A2), 26 in Group B, and 8 in Group C. The linear regression data showed the relation between PaCO2 and PetCO2 to be statistically significant in the Groups A2, B, and C. The values of the difference of PaCO2-PetCO2 were 22.1+/-3.26 mmHg in Group A, 33.7+/-7.21 mmHg in Group A1, 17.6+/-3.06 mmHg in Group A2, 5.3+/-1.45 mmHg in Group B, and 21.2+/-4.73 mmHg in Group C. The 95% confidence intervals of PaCO2-PetCO2 were 15.37- 28.81 mmHg in Group A, in group A1, 16.07-51.35 mmHg in group A1, 11.11-24.03 mmHg in Group A2, 2.33-8.31 mmHg in Group B, and 10.03-32.42 mmHg in Group C. CONCLUSION: In patients with chronic pulmonary disease, who are endotracheally intubated for assisted ventilation, the PetCO2 do not reflect the PaCO2 and also the value of PaCO2-PetCO2 is not a good parameter for determining pathological status. However, in patients with acute cardiopulmonary disease and during cardiopulmonary resusciatation, the PetCO2 does not reflect the quantitative value of PaCO2, but may be used in predicting the tendency of PaCO2 to increase. In endotracheally intubated patients with extracardiopulmonary cause, PetCO 2 reflects the quantitative index of PaCO2 and the value of PaCO2-PetCO2 may be a good index for monitoring pathological conditions.

Anticholinesterase Therapy for Patients with Ophthalmoplegia Following Snake Bites: Report of Two Cases

Although ophthalmoplegia following snake bites is not indicative of a serious neurotoxic complication, symptoms of diplopia, dizziness and ocular discomfort can be emotionally devastating for patients. The authors experienced two cases of ophthalmoplegia following snake bites in Korea. The patients complained of diplopia that had developed several hours after the snake bites. The diplopia did not improve with antivenom treatment, but resolved completely after several injections of neostigmine.

Assessment of Disparity in the Blood Pressure of Both Arms

PURPOSE: Inter-arm blood pressure differences of more than 10 mmHg are measured not only in patients who have vascular diseases, such as aortic dissections, and aortic aneurysms, but also in heathy patients. We investigated the degree of and the factors for normal inter-arm blood pressure variations in our country. METHODS: We prospectively studied the cases of 351 patients who visited the Emergency Department of Korea University Hospital between May 1 and July 31, 2001. we collected clinical and demographic data, including age, sex, right/left handedness, and bilateral blood pressure. After we divided the cases into a Normal blood pressure group and a High blood pressure group, we compared the inter-arm blood pressure difference and influencing factors between the two group. RESULTS: The variation in the inter-arm blood pressure was unrelated to age, sex, right/left handedness, and right/left arm in both groups. In the Normal blood pressure group (n=180), the systolic inter-arm blood pressure difference was 3.9+/-0.4 mmHg, and the diastolic inter-arm blood pressure difference was 3.6+/-0.4 mmHg. In the High blood pressure group (n=171), the systolic inter-arm blood pressure difference was 5.2+/-0.5 mmHg, and the diastolic interarm blood pressure difference was 4.8+/-0.5 mmHg. CONCLUSION: The variation in the inter-arm blood pressure was unrelated to age, sex, right/left handedness, and right/left arm. But inter-arm blood pressure difference was significant among subjects without exclusion criteria and was measured as about 5 mmHg in two groups.

Lack of IL-10 Release from Human Polymorphonuclear Leukocytes

PURPOSE: Polymorphonuclear leukocytes (PMNs) are the first line of cellular response for host defense during acute inflammation. The ability of PMNs to produce and release numerous pro-inflammatory cytokines is now estabilished and plays an important role in triggering and maintaining the inflammatory response. We studied the autocrine downregulation of this process by invesgating the potential production by human PMNs of the major anti-inflammatory cytokine, interleukine 10 (IL-10). METHODS: Human PMNs were isolated from the peripheral blood of health volunteers by using the modified boyum method. Human PMNs were incubated at 37 degrees Cwith and without formyl Met-Leu-Phe (fMLP) for 30 minute, 2 hours, 4 hours, and 20 hours. The level of IL-10 was determined in each of the cell-free supernatants by using the enzyme linked immunosorbent assay (ELISA) method. RESULTS: Non-stimulated PMNs generated 1.40 +/- 1.791pg/mL to 3.46 +/- 1.607 pg/mL of IL-10 over the time course. Stimulation with fMLP resulted in an increase in the constitutive PMN-derived IL-10 by 2.74 +/- 0.762 pg/mL, 1.27 +/- 0.262 pg/mL, 1.19 +/- 0.364 pg/mL, and 2.44 +/- 1.317 pg/mL at 30 min, 2 hr, 4 hr, and 20 hr after stimulation, respectively, but these increases were not statiscally significant. CONCLUSION: Human PMNs seem unable to induce release of the most potent anti-inflammatory cytokine, IL-10, and down-regulate inflammatory response due to the autocrine mechanism. This could partly account for the persistence of local inflammation, when PMNs are the main infiltrating cells.

Anti-inflammatory effects of IL-4 and IL-10 on Human Polymorphonuclear Leukocytes

Inflammatory responses are strictly regulated by coordination of pro-inflammatory and anti-inflammatory mediators. Interleukin-4 (IL-4) and interleukin-10 (IL-10) have typically the biologic anti-inflammatory effects on monocytes, but uncertain effects on polymorphonuclear leukocytes (PMNs). The PMNs are the first line of cellular response for host defense during acute inflammation. To modify hyper-inflammatory reaction with biologic anti-inflammatory mediators, we have determined the biologic anti-inflammatory activities of IL-4 and IL-10 on human PMNs. Human PMNs were pretreated with IL-4 or IL-10 and then stimulated with formyl methionyl leucyl phenylalanine (fMLP) for times indicated. The level of H2O2, interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-alpha) were determined in the each cell free supernatants. fMLP plays the role of a typical pro-inflammatory agent and, at least in determined conditions, down-regulated TNF release. IL-4 acts as an anti-inflammatory mediator but IL-10 did not show its anti-inflammatory activities on fMLP-stimulated human PMNs. IL-4 and IL-10 have different anti-inflammatory mechanisms. Perhaps, IL-10 needs co-factors to act as an anti-inflammatory mediator.

Limited Motion of Arms in Uncommunicable Children

PURPOSE: The study was designed to identify the necessity of radiographs and to decrease overutilization of radiographs in uncommunicable children who do not move their arms. This study provides clinical guidelines on radiographic evaluation and treatment of children with limited motion in the upper extremity. METHODS: The cases of one hundred thirteen pediatric patients under 36 months of age, who had visited the Emergency Center of Korea University Ansan Hospital from January 2000 to December 2001, were retrospectively reviewed. Pediatric patients with upper extremity injuries due to multiple trauma, laceration or motor vehicle accident were excluded. Parameters analyzed were age, sex, mechanism of injury, physical findings, radiographic finding, and injuried upper extremity region. We described focal tenderness and regional edema as physical finding. Each patient without regional edema was classified into an improved or a not-improved group depending on the outcomes after manual reduction. All statistical tests were conducted with twotailed levels of 0.05. RESULTS: Of the 113 patients, the mean age was 18.6+/-0.89 months. The most common injury mechanisms were unknown and traction. Minimal edema in the elbow joint was seen in 5 cases, and supracondylar fractures due to short falls were seen in 4 (80%) of those cases (p<0.05). The improved group was finally confined to radial head subluxation in 88 patients. Although all the not-improved-group patients had received radiographs, no abnormal findings were seen in the elbow. However, clavicle fracture due to fall above or from a level surface were seen in 4 cases (20%) of the not-improved group (p<0.05). No difference of injury mechanism existed between the improved and the not-improved groups. CONCLUSION: Recommand Radiographic evaluations in Children not-used arm with regional edema before manual reduction. But without regional edema, manual reduction of elbow is first. If children without regional edema do not improve after manual reduction of elbow and they are injuried due to fall, children should be assessed for fractures of clavicle.

Geographical Variation of Liver Cancer Mortality in Korea (1992-1998) / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The death rate of liver cancer in Korea has been reported as one of the highest in the world. This study was conducted to investigate geographical variations of liver cancer mortality in Korea in order to obtain insight into possible environmental factors related to liver cancer. MATERIALS AND METHODS: The sex-specific standardized mortality ratios (SMRs) of liver cancer were calculated for 168 basic administrative units in Korea based upon the vital statistics for the seven years 1992 to 1998, as well as the sex- and age-specific population of each area for 1995. The SMRs were classified into six categories and depicted on a map for each sex. RESULTS: The southern provinces showed clearly higher mortality rates as compared to the rest of the country in both males and females. Looking at the maps in detail, there was a geographical variation even within the southern provinces. The areas around large rivers, some costal areas, and costal islands showed a high mortality rate. Even in the middle and northern provinces, the eastern costal areas showed relatively higher mortality rates as compared to inland areas. Conversely, some southern areas known for low levels of pollution showed relatively lower mortality rates. CONCLUSION: This finding suggests a possible relationship between liver cancer and water-related foods from polluted rivers or seas. Further studies should be performed in order to clarify which factors cause this geographical variation.