Possible Antiphospholipid Syndrome Presenting as Peripartum Cardiomyopathy and Diffuse Alveolar Hemorrhage / 대한내과학회지

Antiphospholipid syndrome (APS) is an autoimmune disease characterized by the presence of circulating antiphospholipid antibodies in combination with at least one other clinical manifestation, such as vascular thrombosis or recurrent pregnancy loss. APS is further characterized by the presence of vasculitis affecting multiple organ systems, resulting in a wide variety of clinical outcomes. Common cardiac manifestations of APS include valve abnormalities, occlusive arterial disease, intra-cardiac emboli, ventricular dysfunction, and pulmonary hypertension, along with rare instances of dilated cardiomyopathy. Simultaneously diffuse alveolar hemorrhage and peripartum cardiomyopathy have also been reported, though these manifestations remain extremely rare. Here, we report a case of a 34-year-old woman with possible APS who presented with peripartum cardiomyopathy and diffuse alveolar hemorrhage.

Infective Endocarditis with Unusual Location of Vegetation in a Patient with Hemodialysis Followed by Recurrent Catheter-Related Blood Stream Infection

The incidence of infective endocarditis (IE) in hemodialysis patients is higher than the general population. Hemodialysis patients with IE have a poorer prognosis than other patients with IE. The most common sites of IE in hemodialysis patients are the mitral valve and aortic valve. A 47-year-old woman had suffered from recurrent catheter-related blood stream infection and she was strongly suspected of IE. Despite repeated transthoracic echocardiography and transesophageal echocardiography (TEE), IE was revealed several months later by TEE due to the unusual location of the vegetation. The vegetation was detected on the left ventricle outflow tract. She recovered well without any complication after mitral valve replacement surgery.

The Effect of Counseling for Interpersonal Relationship Using Myers-Briggs Type Indicator / 한국의학교육

PURPOSE: There are large differences between medical school curricula and those of other disciplines and graduate schools. Counseling program is designed to help participants understand their innate tendencies and have indirect experiences with the 16 Myers-Briggs Type Indicator (MBTI) types, which can lead to better interpersonal relationships. METHODS: The experimental and control groups, which were sampled randomly, comprised 34 students each. Each group was consisted of 17 females and 17 males. We implemented a counseling program (understanding oneself, understanding others) only to the experimental group, not the control group. The effects of the program were analyzed by t-test and analysis of covariance (ANCOVA). The data were analyzed using SPSS 17.0 Window. RESULTS: For the Human relationship scale as a whole, the experimental group showed an increase from 3.641 to 3.846 (p=0.001). With regard to the subcategories, satisfaction increased from 3.705 to 4.022 (p=0.000), trust increased from 3.480 to 3.715 (p=0.015), intimacy increased from 3.833 to 4.019 (p=0.007), and openness increased from 3.435 to 3.700 (p=0.006). CONCLUSION: This program improved interpersonal relationships by helping new students understand each other, build a rapport, and understand their personalities well with open minded attitudes. Their relationships gradually became more intimate than awkward through this program.

Endovascular Stent Placement for the Treatment of Superficial Femoral Artery Stenoses and Occlusions

PURPOSE: The aim of this study was to evaluate effectiveness of an endovascular stent placement in the treatment of superficial femoral artery stenoses and occlusions. MATERIALS AND METHODS: An angioplasty and stent placement was performed in forty four patients (42 men and 2 women; mean age: 71.2 years; age range: 50-82 years). A total of 27 patients were diagnosed with intermittent claudication, in addition to 8 patients with resting pain, and 9 patients with gangrene. A follow-up evaluation accompanied with a physical examination, catheter angiography, and a color Doppler sonography was performed. The patency rates were analyzed after 3 months, 6 months, 1 year and 2 years. The predictors of restenosis, according to the clinical and anatomical classification, risk factors, as well as the correlation of stent fracture and restenosis were analyzed. RESULTS: Initial technical success was achieved in all patients. The stent placement resulted in an initial improvement of the clinical category in more than one level for 95.5% of cases. Over the course of the follow-up period (mean: 17 months; range, 1-106 months), restenosis occurred in 16 patients (36.4%). The highest patency rates were 87.9% after 3 months, 81.5% after 6 months, 78.0% after 1 year, 54.2% after 2 years, and 46.0% after 3 years. No significant difference was found for the patency rates as a function of the clinical and anatomical classifications, or the risk factors. A stent fracture was identified on only two occasions; however, no clinical symptoms or good intra-stent blood flow was observed in a follow-up angiography. CONCLUSION: A mid-term patency after the stent placements for superficial femoral artery stenoses and occlusions was found to be unfavorable despite an initial success rate. Consequently, greater clinical experience and analysis is necessary.

A Case of Discovery of Heterotopic Pregnancy After Missed Abortion / 대한산부인과학회지

Heterotopic pregnancy, the potentially fatal condition in which simultaneous gestations occurs at two or more implantation sites, was first reported in 1708 as an autopsy finding. In natural conception cycles it is a rare event, occuring less than 1:30,000 pregnancies. However, with assisted reproduction techniques, this incidence increase. Also the frequency of heterotopic pregnancy has steadily increased because of rising incidence of pelvic inflammatory disease, former tubal surgery. We report a case of discovery of heterotopic pregnancy after missed abortion with brief review of literature.

Expression of c-erbB-2 Oncoprotein and DNA Topoisomerase II-alpha in Premalignant Lesions and Invasive Squamous Cell Carcinomas of the Uterine Cervix / 대한산부인과학회잡지

OBJECTIVE: The relationship was studied between expression of c-erbB-2 oncoprotein and topoisomerase II-alpha as proliferating marker in precancerous lesions and invasive squamous carcinomas of the uterine cervix. METHODS: Total 81 formalin-fixed, paraffin-embedded sections of low-grade intrasquamous lesion (22 cases), high-grade intraepithelial lesions (42 cases) and invasive squamous cell carcinomas (17 cases) in the uterine cervix were stained by immunohistochemistry for expression of the c-erbB-2 oncoprotein and topoisomerase II-alpha. RESULTS: The expression of c-erbB-2 oncoprotein and staining index (mean+/-S.D) of topoisomerase II-alpha were statistically significant between precancerous lesions and invasive carcinoma. The expression of c-erbB-2 oncoprotein has correlation with staining index (mean+/-S.D) of topoisomerase II-alpha. CONCLUSION: There results suggest that the expression of c-erbB-2 protein has relationship with progression of squamous lesions and topoisomerase II-alpha is an useful proliferating marker in the uterine cervix. And, the expression of c-erbB-2 protein has correlation with expression of topoisomerase II-alpha.

Two cases of ovarian leiomyoma / 대한산부인과학회잡지

Ovarian myoma is a rare mesenchymal tumor, accounting for only 1% of benign ovarian neoplasm. These tumors only originate from smooth muscle on the walls of blood vessels in the cortical stroma, in the corpus luteum and in the ovarian ligaments at the point of attachment to the ovary. Most patients are asymptomatic and the tumors are usually found incidently during operations or at autopsies. Two cases of ovarian myoma experienced in our hospital recently are reported with a brief review of the literatures."

Stationary outward and transient Ca2+-dependent currents in hamster oocytes

The outward currents elicited in hamster eggs by depolarizing pulses were studied. The currents appeared to comprise at least two components, a transient outward component (Ito) and a steady-state outward component (Iinfin). Ito was transiently followed by the cessation of inward Ca2+ current (ICa), and its current-voltage (I-V) relation was a mirror image of that of ICa. Either blockade of ICa by Co2+ or replacement of Ca2+ with Sr2+ abolished Ito without change in Iinfin. Intracellular EGTA (10 mM) inhibited Ito but not Iinfin. suggesting strongly that generation of Ito requires intracellular Ca2+. Apamin (1 nM) abolished selectively Ito, indicating that Ito is Ca2+-dependent K+ current. On the other hand, Iinfin was Ca2+-independent. Both Ito and Iinfin were completely inhibited by internal Cs+ and external TEA. The estimated reversal potential of Ito was close to the theoretical EK. Taken together, both outward currents were carried by K+ channels. From these results, Ito is likely to be a current responsible for the hyperpolarizing responses seen in hamster eggs at fertilization.

One Case of Displacement of Copper - T IUD into Urinary Bladder / 대한산부인과학회잡지

Uterine perforation is a serious complication in users of intrauterine devices for contraception. Authors encountered one case of displacement of Copper-T IVD into urinary blpossibly due to uterine perforation on insertion of the Copper-T IUD in a 28 year old 1-multipara, who experienced normal intrauterine pregnancy in the circumstances. This patient was in silent, asymptomatic condition and underwent cesarean section. And Copper-T IUD was removed under the cystotomy. So we report one case with brief review of literatures

Effects of bradykinin on intracellular calcium transients in cardiac myocytes

In spite many evidences has supported the cardioprotective effect of bradykinin, its direct effects at the cell level are still under question. We investigated the both effects of bradykinin (BK) on Ca2+-related ionic currents using whole cell voltage clamp technique in rabbit cardiomyocytes and on the intracellular Ca2+ transient using calcium sensitive fluorescence dye, indo-1AM. Simultaneously with recording intracellular Ca2+ transients, cell contractility was estimated from the changes in length of the electrical stimulated rat cardiac myocytes. L-type Ca2+ current decreased by bradykinin at the entire voltage range. Inward tail current increased initially up to its maximum about 4 min after exposing myocytes to BK, and then gradually decreased again by further exposure to BK. This tail current decreased remarkably at washing BK off but slowly recovered ca. 20 min later. The change in cell contractility was similar to that in tail current showing initial increase followed by gradual decrease. Removal of BK brought remarkable decrease in contractility, which was recovered 15~20 min after cessation of electrical stimulation. Bradykinin increased Ca2+ transient initially but after some time Ca2+ transient also decreased coincidentally with contractility. From these results, it is suggested that bradykinin exerts directly its cardioprotective effect on the single myocytes by decreasing the intracellular Ca2+ level followed by an initial increase in Ca2+ transient.

Modulation of ATP-induced activation of the muscarinic K+ channel activity by protein kinase C

The atrial acetylcholine-activated K+ (KACh) channel is gated by the pertussis toxin-sensitive inhibitory G (GK) protein. Earlier studies revealed that ATP alone can activate the KACh channel via transphosphorylation mediated by nucleoside-diphosphate kinase (NDPK) in atrial cells of rabbit and guinea pig. This channel can be activated by various agonists and also modulated its function by phosphorylation. ATP-induced KACh channel activation (AIKA) was maintained in the presence of the NDPK inhibitor, suggesting the existence of a mechanism other than NDPK-mediated process. Here we hypothesized the phosphorylation process as another mechanism underlying AIKA and was undertaken to examine what kinase is involved in atrial cells isolated from the rat heart. Single application of 1 mM ATP gradually increased the activity of KACh channels and reached its maximum 40 ~ 50 sec later following adding ATP. AIKA was not completely reduced but maintained by half even in the presence of NDPK inhibitor. Neither ADP nor a non-hydrolyzable ATP analogue, AMP-PNP can cause AIKA, while a non-specific phosphatase, alkaline phosphatase blocked completely AIKA. PKC antagonists such as sphingosine or tamoxifen, completely blocked AIKA, whereas PKC catalytic domain increased AIKA. Taken together, it is suggested that the PKC-mediated phosphorylation is partly involved in AIKA.

Pemphigus Foliaceus Complicating Eczema Herpeticum / 대한피부과학회지

Eczema herpeticum occurred in a patient with pemphigus foliaceus and esophageal cancer. The patient's initial skin lesions composed of large flaccid bullaes showed subcorneal bullae with typical acantholytic cells. Subsequent grouped small vesicles appeared widely on the erythematous base were diagnosed herpes simplex virus infection by Tzanck smear and histopathological findings. The patient died one week after the development of the widespread herpes virus infection.

Two cases of cystic hygroma / 대한산부인과학회잡지

No abstract available.

A case of atypical fibroxanthoma / 대한피부과학회지

A 43-year-old male patient showed well defined, irregular, dark eythematous, thick plaque and tumor with ulceration on the right chest, right axilla, pubis and scrotum, Histopathological findings rervealed atypical lymphocytes showing epidermotrophism and heavy infiltrations in the deep dermis and subcutaneous tissue. The infiltrative cells were positively stained with leukocyte common antigen and T-cell UCHL-1 antigen, but not with L26 antigen. This clinicohisto-pathological features were consstent with dermblade type of mycosis fungoides. The authors report clinicopathological findings of the case with its thrapeutic responses to systemic chemotherapy and radiation treatment.

A case of candida cheiliis in a patient with extreme malaignment of the anterior maxillary teeth / 대한피부과학회지

Persistent burning and derythema were present for 10 months cin he lower lip of a 55-year-old woman, who had extreme melalignment of the anterior maxillary teeth. Candida albicans was identified not only from the surface material of the lower lip but also from tl.e malaigned dental cleft, which was thought to be the source of the organisms. We feel that the impor.ance of malaligned theeth as a source of candida albicans miist be kept in mind when we face persis ent cheilitis in a patient whose teeth arrangement is bad.

Clinical observation of aseptic meningitis associated with mucocutaneous lymph node syndrome

Clinical observation was carried out for 147 patients with mucocutaneous lymph node syndrome (MCLS) who were admitted to the Department of Pediatrics, Wonju Christian Hospital during the period from June, 1983 to June, 1992. A spinal tap was performed on 114 of these patients and the following results were obtained. 1) The incidence of aseptic meningitis in patients with MCLS was 52.6%. (60 cases of the 114 cases who had spinal taps (52.6%).) 2) The predominent age group for aseptic meningitis was 6 months to 1 year of age (35%). 3) For the majority, the value of glucose and protein in the CSF were within normal limit or only mildly elevated. 4) The neurologic manifestations associated with aseptic meningitis in patients with MCLS were irritability (78.3%), vomiting (25.0%), nuchal rigidity (11.7%), convulsion (5.0%) and facial nerve palsy (1.7%) in that order.

A case of primary carcinoma of the uterine tube / 대한산부인과학회잡지

No abstract available.

Two cases of virus associated hemophagocytic syndrome

Virus associated hemophagocytic syndrome, class ll histiocytoses, characterized by high fever, severe constitutional symptoms, abnormal liver function and coagulation, perigheral blood pancytopenia and histiocytic hyperplasis with prominent hemophagocytosis in bone marrow and lymph nodes has been reported and associated with active viral infection. It is non-malignant and reversible. It must be differentiated from histiocytic medullary reticulosis because of the inappopriateness of immunosuppressive of cytotozic therapy which is the therapeutic method for HMR, but is contraindicated in the treatment of VAHS. This paper describes two patients whose clinicopathology was compatible with the diagnosis of virus associated hemophagocytic syndrome.

An Observation on the Mortality Rates of Transport Accidents in Korea / 예방의학회지

This paper describes the incidence of transport accident for the period, 1955-1965. Transport accidents were classified into three categories, viz. railway(WHO Classification of Diseases, E-802), watercraft(E850-E858) and motor vehicle accidents(E810-E835, E840-E841, E844-E845). Crude data on the subject were collected from the various sources of Government Statistical Books including Statistical Year Books edited by the Central Office of Economic Planning Board, Annual Police Reports by the Ministry of Home Affairs, and the national and local associations for road traffic safety. From the data incidence and mortality rates by year, month and local province were computed and other variables relevant to the epidemiology of accidents were observed. The following summary could be drawn: 1. Death rates due to transport accidents per 100,000 population were 12.3 for 1955 and 9.7 and 1965. The incidence of injury due to the same cause were 34.0 for 1955 and 35.9 for 1965. 2. Death rates by transportation vehicle showed 9.0 due to motor vehicle accidents, 1.7 due to water-crafts, and 1.6 due to railway trains for 1955. In 1965 death rates were 6.0 due to motor vehicles, 1.2 to water-crafts and 2.4 to railway. 3. Seasonal distribution of transport accidents revealed that car accidents occur more frequently in spring and fall seasons while ship accidents do in winter and train accidents more in summer. 4. Both car and ship accidents slightly decreased during the past decade, 1955-1965, whereas the accidents of railway trains showed a tendency of increase. 5. Although the survey on railway accidents excluded the injuries of passengers or railway employees corresponding to WHO classification of diseases, E801, due to inaccuracy of data, it is roughly estimated that the same number of causalities as the incidence among pedestrians or any other than passengers or employees assumed to be at work(E 802).