Cardiac Amyloidosis in Autopsy Case of Sudden Unexpected Death / 대한법의학회지

A 78-year-old woman with a medical history of hypertension and diabetes mellitus who underwent surgery for lumbar stenosis died of sudden cardiac arrest two days after the operation. An autopsy was performed; however, the cause of death was not identified macroscopically. Congo red staining detected amyloid deposits in the systemic organs, including the heart, lungs, liver, thyroid, and kidney. Immunohistochemical staining revealed an immunoglobulin lambda light chain, which can cause the primary form of systemic amyloidosis. The prognosis of patients with systemic amyloidosis is directly associated with cardiac involvement. In this case, amyloid formation was noted in the myocardial interstitium and intramyocardial vascular wall, which caused luminal narrowing, subsequently causing arrhythmia and ischemic heart disease in each tissue, respectively. We present a case of primary systemic amyloidosis with severe cardiac involvement that was diagnosed after a comprehensive postmortem examination.

Effect of Double-needle Stabilizer during Flanged Intrascleral Fixation of Intraocular Lens

Purpose@#We evaluated the difference in clinical outcome according to the use of double-needle stabilizer in flanged intrascleral fixation of intraocular lens (IOL).Method: We retrospectively analyzed the medical records of 44 patients (44 eyes) who underwent flanged intrascleral fixation of IOL. Groups 1 and 2 (respectively) underwent surgery that did not and did employ a double-needle stabilizer. We evaluated the best-corrected visual acuity (BCVA), intraocular pressure, spherical equivalent (SE), refractive prediction error (RPE), IOL tilt and decentration, and other complications. @*Results@#The postoperative BCVA, SE, and RPE did not differ between the two groups (p = 0.672, p = 0.131, p = 0.247). IOL tilt was significantly less in group 2 than in group 1 (p = 0.038, p = 0.015 [horizontal and vertical]) (3.96 ± 2.01° horizontally and 4.17 ± 2.07° vertically in group 1; 2.59 ± 2.02° horizontally and 2.50 ± 1.92° vertically in group 2). IOL decentration was also significantly less in group 2 than in group 1 (p = 0.001, p = 0.004 [horizontal and vertical]) (0.44 ± 0.21 mm horizontally and 0.45 ± 0.20 mm vertically in group 1; 0.25 ± 0.09 mm horizontally and 0.27 ± 0.13 mm vertically in group 2). @*Conclusions@#Use of a double-needle stabilizer during flanged intrascleral fixation of IOL significantly reduced postoperative IOL tilt and decentration, and may thus improve postoperative visual quality.

Primary testicular carcinoid tumor with marked lymphovascular invasion

Testicular carcinoid tumors are very rare, accounting for less than 1% of all testicular tumors. We report a rare case of a testicular carcinoid tumor with extensive lymphatic invasion. A 42-year-old man presented with a painless, enlarged right testicular mass. There was no history of injury or discomfort in this region. Right radical orchiectomy was performed, which showed a well-defined, non-encapsulated solid white mass with calcification (7.0 × 4.5 × 3.5 cm) and absence of cystic components. Microscopic examination using hematoxylin and eosin staining of the tumor sections identified organoid, trabecular, and solid patterns with rosette formation. Extensive multifocal lymphatic invasion was observed. Immunohistochemistry was positive for synaptophysin, chromogranin, and CD56. Testicular carcinoid tumors usually show good prognoses; however, there was extensive lymphovascular invasion in this case. Thus, in the case of unusual presentation of the disease, close follow-up is necessary.

A Pediatric Lenticular Cyst

Purpose@#We report a lenticular cyst in an 8-year-old boy.Case summary: An 8-year-old boy visited our clinic with reduced visual acuity. On slit lamp examination, an immobile lenticular cyst was evident on the posterior lens capsule of the left eye. There was no other abnormality. He had no history of ocular trauma or surgery. His Snellen best-corrected visual acuities (BCVAs) were 1.0 (-0.50 Dsph 0.50 Dcyl ×180°) in the right eye and 0.3 (+3.25 Dsph 1.00 Dcyl ×180°) in the left. After diagnosis of a primary lenticular cyst and anisometropic amblyopia, the child was prescribed glasses and occlusion therapy (8 hours daily). After 3 months, the BCVA improved to 0.9 in the left eye and was maintained. No change in lenticular cyst size was observed during 8 months of follow-up. @*Conclusions@#Primary lenticular cysts are very rare in children. When the cyst is too small to occlude the visual axis, amblyopia treatment (glasses and occlusion therapy) is preferable to surgery, being both non-invasive and effective.

A Pediatric Lenticular Cyst

Purpose@#We report a lenticular cyst in an 8-year-old boy.Case summary: An 8-year-old boy visited our clinic with reduced visual acuity. On slit lamp examination, an immobile lenticular cyst was evident on the posterior lens capsule of the left eye. There was no other abnormality. He had no history of ocular trauma or surgery. His Snellen best-corrected visual acuities (BCVAs) were 1.0 (-0.50 Dsph 0.50 Dcyl ×180°) in the right eye and 0.3 (+3.25 Dsph 1.00 Dcyl ×180°) in the left. After diagnosis of a primary lenticular cyst and anisometropic amblyopia, the child was prescribed glasses and occlusion therapy (8 hours daily). After 3 months, the BCVA improved to 0.9 in the left eye and was maintained. No change in lenticular cyst size was observed during 8 months of follow-up. @*Conclusions@#Primary lenticular cysts are very rare in children. When the cyst is too small to occlude the visual axis, amblyopia treatment (glasses and occlusion therapy) is preferable to surgery, being both non-invasive and effective.

Anesthetic management of a patient with prune-belly syndrome : A case report

Prune-belly syndrome is characterized by absent abdominal wall musculature with wrinkled overlying skin, urinary tract dilatation and cryptorchidism. Prune-belly syndrome is also associated with diseases of the respiratory, cardiovascular, skeletal, gastrointestinal and central nervous system. Because the congenital disease is uncommon, it is difficult to collect the information of anesthetic management of prune-belly syndrome. We report a case of 4 year-old-boy with prune-belly syndrome who underwent abdominoplasty and Mitrofanoff operation under general anesthesia.

Effects of Mycoplasma Pneumoniae on Activation of Human Eosinophilic Leukaemia EoL-1 Cells / 소아알레르기및호흡기학회지

PURPOSE: Mycoplasma pneumoniae is a common cause of lower respiratory disease, especially in children and young adults. Several studies have suggested that respiratory infection by M. pneumoniae is associated with reactive airway disease and asthma. Though eosinophilia in peripheral blood are revealed in patients with mycoplasmal pneumonia, what is not known is the functional capacity of M. pneumoniae to activate human eosinophils. We investigated whether M. pneumoniae lysate (MPL) can activate human eosinophils to release inflammatory mediators. METHODS: Human eosinophilic leukemic cell lines, EoL-1 cells were incubated with MPL. Activation of EoL-1 cells was monitored by IL-8 production, superoxide production and surface expression of CD69, ICAM-1, CD11b, and CD49d. In addition, we examined the effect of MPL and the role of mitogen-activated protein kinases (MAPKs) on IL-8 expression in EoL- 1 cells. RESULTS: MPL induced IL-8 release in a time- and dose- dependent manner. However MPL did not induce superoxide anion production and CD69, ICAM-1, CD11b, and CD49d surface expression in EoL-1 cells. Pretreatment with mitogen-activated protein/extracellular signal- regulated kinase (ERK) [MEK] inhibitor PD98059, c-Jun N-terminal kinase (JNK) inhibitor II SP600125, and selective p38 MAPK inhibitor SB202190 inhibited MPL-induced IL-8 production, but the MPL stimulation had no effect on the activities of nuclear factor (NF)-kappaB. CONCLUSION: These observations suggest that MPL causes activation of EoL-1 cells, and activation of MAPKs by MPL may be one of the mechanisms that result in an increase of the production of IL-8.

The Efficacy of Nebulized 3 Percent Hypertonic Saline Solution and Fenoterol in Infants with Bronchiolitis / 소아과

PURPOSE: To evaluate the effect of inhaled hypertonic saline solution in hospitalized infants with bronchiolitis. METHODS: A randomized double blind trial was performed from October 2003 to May 2004. A total of eighty patients <1 year of age with a clinical diagnosis of acute viral bronchiolitis were enrolled and assigned to receive either of the following:inhalation of 2 mL(0.5 mg) fenoterol added to 2 mL of 0.9 percent saline solution(group 1; n=40) or 2 mL(0.5 mg) fenoterol added to 2 mL of 3 percent saline solution(group 2; n=40). This therapy was repeated at six hours interval after admission. They were evaluated daily just before and 20 minutes after nebulization. The outcome measures included changes in clinical severity score(based on respiratory rate, presence of wheezing, retraction, and general condition) after nebulization and duration of hospitalization. RESULTS: In the clinical severity score, a significant improvement was observed during the 72 hours of hospitalization in both groups(P<0.05). The basic clinical severity scores before inhalation were decreased significantly faster in group 2 as compared to group 1 on each day of treatment(P<0.05). The mean duration of hospital stay was significantly reduced in group 2 than group 1(5.9+/-1.9 days versus 7.4+/-2.0 days, P<0.05). No adverse effects were associated with inhaled therapy. CONCLUSION: These results suggest that a nebulized 3 percent saline solution plus 0.5 mg fenoterol may be more effective than a 0.9 percent saline solution plus 0.5 mg fenoterol in accelerating the clinical recovery of infants with viral bronchiolitis.

Has Any Improvement been Made in the Clinical Outcome of Patients with Bleeding Peptic Ulcer in the Part 10 Years? / 대한소화기내시경학회지

BACKGROUND/AIMS: Bleeding still remains as one of the major medical problems in peptic ulcer diseases, despite of the advances in therapeutic options and endoscopic therapy. The aim of this study was to compare the clinical outcomes of bleeding peptic ulcer between two distinct periods in the past ten years. METHODS: We divided the among 10 years, we selected the two distinct periods; the first (1993~1995) and the second (2000~2002). The clinical and endoscopic characteristics in patients with bleeding peptic ulcer were compared between the two periods. We also analyzed the changes in the clinical outcomes as well. RESULTS: The age of patients during the second period was significantly older compare to the first period. In subgroup analysis, proportions of patients older than 60 years and of female patients were significantly higher in the second period. The percentage of the patients with co-morbid illness, such as diabetes mellitus, cardiovascular diseases, or users of non-steroidal anti-inflammatory drugs, was higher in the second period. Despite the decreasing the frequency of urgent surgery in the second period, there was no significant difference in the rate of re-bleeding and mortality between both periods. CONCLUSIONS: Despite the advances in therapeutic options in the second period, no significant difference was found in the prognosis of bleeding ulcer, compared to the first period. Old age, co-morbid illness, and increasing usage of NSAIDs has may contributed to this. Taken together, it might be more important to apply preventive measures to the patients who have risk factors for bleeding peptic ulcer.

Effectiveness of Estradiol and Sildenafil supplement therapy in IVF-ET patients with thin endometrium / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate the effect of estradiol (E2) only/and sildenafil supplement on controlled ovarian hyperstimulation and pregnancy outcome in patients undergoing IVF-ET cycles. METHODS: Total 104 cycles of IVF-ET patients were included in this study, which had been undergone controlled ovarian hyperstimulation (COH) with long protocol in Eulji infertility center and Ilsan Grace hospital between January 1999 and December 2000. Group 1 (COH only) consisted of 34 cycles, group 2 (COH+estradiol supplement) consisted of 35 cycles, and group 3 (COH+estradiol/sildenafil supplement) consisted of 35 cycles. RESULTS: With E2 and/only Sildenafil supplement, improvement of the endometrial thickness (P<0.05) and clinical pregnancy rate (P<0.05) were obtained. There was no significant increase in pregnancy rate with sildenafil supplement compared to E2 supplement only (20.0% versus 25.7%). However, rather short duration of controlled ovarian hyperstimulation (13.3+/-1.7 days versus 11.7+/-1.7 days) was found in the group that received E2 and sildenafil supplementation. (P<0.1) CONCLUSION: In patients with thin endometrium, the sildenafil supplement might lead to increase endometrial receptivity, and in consequence improvement of pregnancy rate. Sildenafil may augment the vasodilatory effect of nitric oxide by inhibition of cGMP hydrolysis, by improving ovarian perfusion, stimulates follicular development thus might shorten the duration of controlled ovarian hyperstimulation in IVT-ET cycles as we observed in our study.

Efficacy of estradiol supplement therapy for patients with thin endometrium in intrauterine insemination cycles / 대한산부인과학회잡지

OBJECTIVE: To evaluate the endometrial response and to compare the pregnancy outcome of estradiol supplement in patients with abnormally thin endometrium who are undergoing IUI. METHODS : From November 1st, 1998 to February 28th, 2001, 914 IUI cycles were studied and which were divided into several groups. In preparatory cycle, all of the patients were prepared with conjugated estrogen. The patients were divided into several groups according to the endometrial thickness (ET). Control I (n=734) was normal control group (ET>or=7 mm). Control II (n=67) was control group with abnormally thin endometrium (ETintrauterine insemination7 mm) without estradiol supplement. Group I (n=65) and group II (n=48) had thin endometrial thickness. However, in preparatory cycle, the endometrial thickness was more than 7 mm in group I and was less than 7 mm in group II. Uterine preparation consisted of 6-8 mg of estradiol valerate. The number of natural cycle was 234 and the hyperstimulation protocol used were clomiphene (n=250), clomiphene/ hMG (n=214), hMG (n=216). RESULTS: The average pregnancy rate in group I was 15.4%. There was no significant difference between control I (21.1%) and group I. The pregnancy rate in control II and group II was significantly decreased (3.0 vs. 6.3%) compared with control I and group I. In control I and group I, average endometrial thickness and pregnancy rate were decreased when clomiphene was used compared with hMG alone. (endometrial thickness control I 8.4 +/- 0.6 vs. 10.0 +/- 0.7 mm, group I 6.9 +/- 0.8 vs. 7.9 +/- 0.7 mm, pregnancy rate control I 14.6 vs. 29.8%, group I 9.1 vs. 31.3%). CONCLUSION: The adequate endometrial thickness is an important prognostic factor for implantation and is achieved with administration of estradiol supplement in patients with abnormally thin endometrium who responded to exogenous estradiol with endometrial thickness up to 7 mm in evaluation cycle.

Establishment of Three Dimensional in-vitro Culture System with Human Endometrial Cells: Induction of Differentiation by Sex Steroid Hormone & Characterization / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to establish three-dimensionally cultured endometrial cell model containing endometrial stromal cell (ESC), endometrial epithelial cell (EEC) and extracellular matrix (ECM) and to compare the morphological and biomolecular expression patterns of this model with mid-luteal endometrium in vivo. MATERIALS AND METHODS: The EEC and ESC was obtained from hysterectomy specimen and cultured separately. The EEC was overlayered in Matrigel layer on ESC embedded in collagen. The model had been cultured for 48 h in DMEM medium containing estrogen and progesterone. The ultrastructure was evaluated by electron microscopy. The expression of integrins, cyclooxygenases and matrix metalloproteinases were examined by immunohistochemistry and zymography. RESULTS: EEC in three-dimensional culture model grew with polarity and tight junction and desmosome between cells were found. The formation of pinopodes was also detected. In three-dimensionally cultured endometrial cell model, the expression of integrin alpha1, alpha4, beta3, MMP-1, -2, -3 and 9 was detected which was not expressed in monolayer culture of EEC, ESC or ESC embedded in collagen. CONCLUSION: The three-dimensionally cultured endometrial cell model possessed the morphological and biomolecular characteristics of in vivo endometrium of implantation period. These characteristics could be achieved by paracrine interactions between ESC and EEC. This model may contribute to the studies of differentiation of endometrium, process of implantation and pathophysiology of implantation-related diseases.

Arthroscopic ACL Reconstruction Using Quadrupled Hamstring Graft-Result of Stump Preserving Technique: Follow-up More Than 3 Years

PURPOSE: This article describes the technique for ACL reconstruction using hamstring grafts and looped sutures to preserve the tibial remnant of injured ACL effectively and reports the clinical results. MATERIALS AND METHODS: From Feb. 1995 to May 1996, fourteen injured ACL knees were treated with arthroscopic reconstruction using a quadrupled hamstring autograft. At the last follow-up(average 41 months), subjective and OBJECTIVE assessments were evaluated. Two proprioceptive function tests(motion and position sense) were performed and statistically analysed(paired t-test). Clinical results were recorded by HSS rating scale. RESULTS: Average HSS score was improved from 56.2(preoperative) to 92.1(last follow-up). At the last follow-up, the average anterior displacement(side to side difference) was measured 3.1mm on stress x-rays and 3.4mm on KT-1000 arthrometer(maximum manual force). No significant differences in mean proprio-ceptive values were found between both knees(p<0.05). CONCLUSTION: The clinical results were satisfactory and we suggest the possibility of preservation of the proprioception is increased if integrity of tibial stump of the ACL is preserved. Further supportive studies for the proprioception will be needed.

The Effects of Longterm Stretching Exercise on Health Related Fitness of the Elderly Women

The purpose of this study was to investigate the influence of regular stretching exercise for 1 year on health related fitness of the elderly women. We also determined whether the weekly stretching exercise sessions followed by intensive stretching exercise program was beneficial to maintain the altered health related fitness status. The thirty elderly women (F, 80.1+/-6.6 yr) were participated in this study. Subjects had no serious orthopedic problems. During the study period, they did not perform any regular physical activity beside the stretching exercise. The 1 year stretching exercise programs included 3 days/week stretching exercise session for the first 12 weeks followed by 1 day/week stretching exercise for rest of the study period. The subjects were tested 6 categories of health related fitness factors which included % body fat, flexibility, hand grips, back strength, balance, and agility. The summary of the results of this study were as followed: 1) There were significant increase in FFM and slightly decrease in %BF and WHR after the 3 days/wk stretching exercise program. However, there were significant decrease in FFM and WHR after the 1 day/wk stretching exercise program (p<.05). 2) There were significant increase in flexibility, hand grip strength (Rt.) and balance after the 3 days/wk stretching exercise (p<.05) while hand grip strength (Lt.) and back strength were slightly increase after the exercise. However, there were significant decrease in hand grip strength (both) and reaction time after 1 day/wk stretching exercise program while flexibility, back strength, and balance were slighly decrease after the program. In conclusion, this study showed that the 3 days/wk stretching exercise for 12 weeks result in significant increase of all health related fitness factors (p<.05). However, it showed that some of the HRF factors were decreased after the weekly stretching exercise unexpectedly.

Diganostic Values of Bone Scan Followed by CT Scan in Undetected Pelvic bone Fracture / 대한정형외과학회잡지

Pelvic bone is complex in its shape, so we often miss to find the fractures in cases with unclear fracture line. We studied 25 patients who were suspected to have occult fractures in pelvic area. We were able to find lots of occult fractures with bone scan followed by CT scan. The results were as follows; 1. There were 31 unexpected hot spots in 25 patients in bone scan. 2. Six cases (19.3%j of new injuries were found on re-evaluation of plain film or additionally rechecked plain films. 3. Twenty-one new fractures (67.7%) were found on CT film study. 4. Total 27 additional fractures (89.1%) were found after bone scan followed CT scan. In conclusion Bone Scan followed by CT is a effective method of detecting occult fracture in pelvic area.

Two Cases of Krukenberg Tumors / 대한부인종양콜포스코피학회잡지

Krukenberg tumor of the ovary, originally described by Krukenberg as "Fibrosarcoma ovarii mucocellulare carcinomatodes", characterized as an infiltrative mucinous carcinoma of predominant signet-ring cell type, almost metastasize from gastrointestinal tract, is not common tumor. In recent years, we have experienced 2 cases of Krukenberg tumors on both ovaries metastasis from the stomach, and report these cases with brief review of the literatures.

Study on basic arginine amidase in human seminal plasma / 대한산부인과학회잡지

No abstract available.

Study on basic arginine amidase in human seminal plasma / 대한산부인과학회잡지

No abstract available.

Induction of ovulation by intermittent subcutaneous injection of pure follicle-stimulating hormone in polycystic ovarian syndrome / 대한불임학회지

No abstract available.

Consecutive scanning of ovulation via transvaginal sonography / 대한불임학회지

No abstract available.