The Effects of Menopausal Hormone Therapy on Serum Level of C-reactive Protein in Postmenopausal Korean Women

OBJECTIVES: Inflammation is a major mechanism underlying coronary heart disease (CHD) and C-reactive protein (CRP) is a marker of inflammation. When administered soon after menopause, menopausal hormone therapy (MHT) prevents CHD. This study was conducted to examine the impact of estrogen by administration route on CRP in postmenopausal Korean women using micronized progesterone (MP4) for endometrial protection. METHODS: This retrospective cohort study included 129 healthy women without CHD risk factors. Eighty-nine women took oral estrogen (conjugated equine estrogen, 0.625 mg/day or equivalent), and 40 women applied a 1.5-mg/day 0.1% percutaneous estradiol gel. MP4 was added in 82 women with an intact uterus. The CRP level was measured at baseline and three and six months after initiation of MHT. RESULTS: The baseline characteristics were comparable between the MHT groups except current age and age at menopause. After controlling for age, menopausal age, body mass index, and basal CRP, no significant change in CRP was observed in the oral estrogen group (n = 29). Follow-up CRP levels were also similar to the baseline in the percutaneous estrogen group (n = 18). However, three-month CRP was significantly lower than six-month CRP, and there was a significant time trend within the percutaneous estrogen group. However, the group difference did not reach statistical significance. CRP also did not differ by addition of MP4 in either group. CONCLUSIONS: In postmenopausal Korean women, no change in CRP was observed with oral estrogen, while percutaneous estrogen might decrease CRP. The estrogenic impacts were not influenced by adding MP4.

Primary Linitis Plastica of the Colon with Mucinous Adenocarcinoma in Young Woman

Adenocarcinoma is the most common pathologic diagnosis, representing >95% of colorectal cancers; mucinous adenocarcinoma (MA) accounts for 10-15% and SRC accounts for 0.1-2.4% of colorectal cancers. MA is defined as a tumor with > or =50% mucin. Patients with MAs have a poor prognosis, a higher proportion of peritoneal metastases, and present at a more advanced stage of disease. Linitis plastica involving the colon and rectum is usually a metastatic lesion from gastric cancer and other organs, such as the prostate, gallbladder, and breast. Primary linitis plastica of the colon is very rare. We managed a case of colon cancer occurring in a 19-year-old female with a histologic diagnosis of mucinous adenocarcinoma and morphologic features of linitis plastica. Herein we report a rare case of primary linitis plastica of the colon with a review of the literature.

Primary Linitis Plastica of the Colon with Mucinous Adenocarcinoma in Young Woman

Adenocarcinoma is the most common pathologic diagnosis, representing >95% of colorectal cancers; mucinous adenocarcinoma (MA) accounts for 10-15% and SRC accounts for 0.1-2.4% of colorectal cancers. MA is defined as a tumor with > or =50% mucin. Patients with MAs have a poor prognosis, a higher proportion of peritoneal metastases, and present at a more advanced stage of disease. Linitis plastica involving the colon and rectum is usually a metastatic lesion from gastric cancer and other organs, such as the prostate, gallbladder, and breast. Primary linitis plastica of the colon is very rare. We managed a case of colon cancer occurring in a 19-year-old female with a histologic diagnosis of mucinous adenocarcinoma and morphologic features of linitis plastica. Herein we report a rare case of primary linitis plastica of the colon with a review of the literature.

A Case of Interstitial Pneumonitis and Pancytopenia Following the Combination Therapy of Pegylated Interferon and Ribavirin / 결핵및호흡기질환

The combination therapy of pegylated interferon and ribavirin is the mainstay of treatment for chronic hepatitis C patients. Anti-viral therapy is commonly associated with side effects such as headache, fever, myalgia, and arthralgia. However, anti-viral therapy can continue because these side effects are mostly mild and can be improved with supportive management. Anti-viral therapy should be stopped promptly if serious side effects, such as interstitial pneumonitis or hemolytic anemia occur, although those serious side effects are rare. There were a few case reports of interferon-related interstitial pneumonitis worldwide. In Korea, one atypical case report of interstitial pneumonitis has been reported, which followed the combination therapy of interferon-alpha and ribavirin in a patient with chronic hepatitis C. We present a case of interstitial pneumonitis and pancytopenia following the combination therapy of pegylated interferon and ribavirin in a patient with chronic hepatitis C.

A Case of Interstitial Pneumonitis and Pancytopenia Following the Combination Therapy of Pegylated Interferon and Ribavirin / 결핵및호흡기질환

The combination therapy of pegylated interferon and ribavirin is the mainstay of treatment for chronic hepatitis C patients. Anti-viral therapy is commonly associated with side effects such as headache, fever, myalgia, and arthralgia. However, anti-viral therapy can continue because these side effects are mostly mild and can be improved with supportive management. Anti-viral therapy should be stopped promptly if serious side effects, such as interstitial pneumonitis or hemolytic anemia occur, although those serious side effects are rare. There were a few case reports of interferon-related interstitial pneumonitis worldwide. In Korea, one atypical case report of interstitial pneumonitis has been reported, which followed the combination therapy of interferon-alpha and ribavirin in a patient with chronic hepatitis C. We present a case of interstitial pneumonitis and pancytopenia following the combination therapy of pegylated interferon and ribavirin in a patient with chronic hepatitis C.

Diagnosis and management of primary malignant melanoma of the lung: a case report / 대한내과학회지

Melanoma develops in the skin or the mucosa of organs. It spreads via lymphatic channels or the bloodstream to the regional lymph nodes or organs such as the brain, liver, and lung. Melanoma of the lung is nearly always metastatic, and primary malignant melanoma of the lung is very rare, with only 30 cases reported in the English literature. The possibility of skin lesions that have disappeared, or of undetected primary sites, makes it difficult to confirm true primary tumors. Therefore, a thorough workup is needed to make the diagnosis. Since metastatic melanoma is incurable, the goal of treatment is palliation. However, because of the rare experience of primary melanoma of the lung, it is difficult to predict the prognosis. We experienced one patient with primary malignant melanoma of the lung with metastases who had been managed with surgery, interferon-alpha, chemotherapy, and radiation therapy over 5 years. This case report presents the diagnosis and management of primary malignant melanoma of the lung.

A Case of Wernicke's Encephalopathy Occurring in a Patient with Aspiration Pneumonia: A Case Report / 대한구급학회지

Wernicke's encephalopathy is a neurologic complication of thiamine deficiency, presenting with acute confusion, oculomotor dysfunction, and gait ataxia. While most often associated with chronic alcoholism, Wernicke's encephalopathy occasionally occurs in the setting of poor nutritional status, such as malabsorption, increased metabolic requirements, or increased loss of the water-soluble vitamins. Patients with critical illnesses can present with excessive catabolic status because of activation of the sympathetic nervous system and the pituitary-adrenal axis. In addition, inappropriate nutritional evaluation and lack of concerns for adequate nutrient support can increase the morbidity and mortality in such patients. However, the importance of adequate nutritional support is often disregarded during treatment of the patient's primary illness. We have recently managed a patient with Wernicke's encephalopathy and pneumonia who did not receive adequate nutritional support during hospitalization. We report this case to call attention to the importance of nutritional support in critically ill patients.

A Case of Ischemic Colitis Associated with Colonic Carcinoma / 대한소화기내시경학회지

The rare association of obstructing colorectal carcinoma and ischemic colitis in patients without an antecedent history of inflammatory bowel disease has been documented intermittently since the early 1960s after first case was described by Kremen in 1945. The etiology is not clear, but it is thought that sluggish mucosal blood flow and consequent ischemia occurs secondary to raised intraluminal pressure distally. The radiologic features are typically 'thumbprinting' appearence by the barium study, but maybe variable according to the stage of ischemic colitis. In many cases, radiologic features may be similar inflammatory bowel disease such as ulcerative colitis and may mask the presence of the predisposing carcinoma. Sigmoidoscopy or colonoscopy may detect irregular ulceration, mucosal friability, submucosal hemorrhage and bulging folds. The mucosa is usually covered by hemorrhagic and purulent exudate. We report a case of the ischemic colitis associated with sigmoid colon adenocarcinoma in 75-year- old man.

Comparing the Efficiency of 75 gm Oral Glucose Tolerance Test to 100 gm Oral Glucose Tolerance Test in Diagnosing Gestational Diabetes in Korean Women / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare one-step 2 hour 75 gm oral glucose tolerance test (OGTT) proposed by the World Health Organization (WHO) with two-step 3 hour 100 gm OGTT of National Diabetes Data group (NDDG) criteria for determining gestational diabetes. METHODS: Data for 111 pregnant Korean women who were diagnosed of gestational diabetes either by 75 gm OGTT or 100 gm OGTT and 100 normal controls were reviewed and analyzed retrospectively. The effectiveness of the two tests was determined by comparing the frequency of diabetes-related pregnance outcomes such as macrosomia, cesarean delivery, and preterm birth. Chi-square, Fisher's Exact test, and T-tests were used for statistical analysis. RESULTS: Among 111 gestational diabetic women, 59 (53.2%) were diagnosed by WHO criteria of 75 gm OGTT and 52 (46.8%) were diagnosed by 100 gm OGTT of NDDG criteria. Frequency of macrosomia and cesarean section was higher in 75 gm test group than in 100 gm test group (12.3% vs 5.8% and 35.1% vs 21.2%, respectively), but the difference was statistically not significant. When compared to the control group, 75 gm test group reached statistical significance in having higher incidence of macrosomia (12.3% vs 3%, p<0.05) whereas 100gm test group did not. CONCLUSION: Efficacy of the diagnostic criteria of WHO was comparable to that of NDDG for diagnosing gestational diabetes. This suggests WHO's 75 gm OGTT to be an efficient diagnostic tool for gestational diabetes in Korean women.

Comparing the Efficiency of 75 gm Oral Glucose Tolerance Test to 100 gm Oral Glucose Tolerance Test in Diagnosing Gestational Diabetes in Korean Women / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare one-step 2 hour 75 gm oral glucose tolerance test (OGTT) proposed by the World Health Organization (WHO) with two-step 3 hour 100 gm OGTT of National Diabetes Data group (NDDG) criteria for determining gestational diabetes. METHODS: Data for 111 pregnant Korean women who were diagnosed of gestational diabetes either by 75 gm OGTT or 100 gm OGTT and 100 normal controls were reviewed and analyzed retrospectively. The effectiveness of the two tests was determined by comparing the frequency of diabetes-related pregnance outcomes such as macrosomia, cesarean delivery, and preterm birth. Chi-square, Fisher's Exact test, and T-tests were used for statistical analysis. RESULTS: Among 111 gestational diabetic women, 59 (53.2%) were diagnosed by WHO criteria of 75 gm OGTT and 52 (46.8%) were diagnosed by 100 gm OGTT of NDDG criteria. Frequency of macrosomia and cesarean section was higher in 75 gm test group than in 100 gm test group (12.3% vs 5.8% and 35.1% vs 21.2%, respectively), but the difference was statistically not significant. When compared to the control group, 75 gm test group reached statistical significance in having higher incidence of macrosomia (12.3% vs 3%, p<0.05) whereas 100gm test group did not. CONCLUSION: Efficacy of the diagnostic criteria of WHO was comparable to that of NDDG for diagnosing gestational diabetes. This suggests WHO's 75 gm OGTT to be an efficient diagnostic tool for gestational diabetes in Korean women.

Methylenetetrahydrofolate reductase polymorphism, homocysteine, lipid levels and susceptibility to preeclampsia in Korean women / 대한산부인과학회잡지

OBJECTIVE: The purpose was to test the hypothesis that the common missense mutation of 5,10-methylenetetrahydrofolate reductase(MTHFR) is more prevalent among preeclamptic women compared with control and also was to determine whether homocysteine and other lipid profile is changed in pregnant women with preeclampsia. METHODS: We measured plasma homocysteine, cholesterol, HDL, LDL, triglyceride, apoprotein B, vitamin B12, and folate in 48 pregnant women without preeclampsia and 22 women with preeclampsia. And the MTHFR genotype was determined with a polymerase chain reaction/restriction fragment length polymorphism method. Results were analyzed with a X2 contingency table and T-test. RESULTS: The prevalence of the MTHFR C677T mutation was not significantly different between the population studied. There was no significant difference in the level of plasma homocysteine, cholesterol, HDL, LDL, triglyceride, apoprotein B, and folate between controls and preeclamptic women. Furthermore, there was a significant difference in the level of plasma vitamin B12 between the population studied. CONCLUSION: These data suggest that the MTHFR C677T mutation is not a risk factor for preeclampsia in this population. Plasma homocysteine, cholesterol, HDL, LDL, triglyceride, apoprotein B, and folate level are not elevated in preeclamptic women. However, the plasma vitamin B12 level is elevated in preeclamptic women. Further studies are necessary to determine why the plasma vitamin B12 level is elevated in preelamptic women although they did not have vitamin drug.

Methylenetetrahydrofolate reductase polymorphism, homocysteine, lipid levels and susceptibility to preeclampsia in Korean women / 대한산부인과학회잡지

OBJECTIVE: The purpose was to test the hypothesis that the common missense mutation of 5,10-methylenetetrahydrofolate reductase(MTHFR) is more prevalent among preeclamptic women compared with control and also was to determine whether homocysteine and other lipid profile is changed in pregnant women with preeclampsia. METHODS: We measured plasma homocysteine, cholesterol, HDL, LDL, triglyceride, apoprotein B, vitamin B12, and folate in 48 pregnant women without preeclampsia and 22 women with preeclampsia. And the MTHFR genotype was determined with a polymerase chain reaction/restriction fragment length polymorphism method. Results were analyzed with a X2 contingency table and T-test. RESULTS: The prevalence of the MTHFR C677T mutation was not significantly different between the population studied. There was no significant difference in the level of plasma homocysteine, cholesterol, HDL, LDL, triglyceride, apoprotein B, and folate between controls and preeclamptic women. Furthermore, there was a significant difference in the level of plasma vitamin B12 between the population studied. CONCLUSION: These data suggest that the MTHFR C677T mutation is not a risk factor for preeclampsia in this population. Plasma homocysteine, cholesterol, HDL, LDL, triglyceride, apoprotein B, and folate level are not elevated in preeclamptic women. However, the plasma vitamin B12 level is elevated in preeclamptic women. Further studies are necessary to determine why the plasma vitamin B12 level is elevated in preelamptic women although they did not have vitamin drug.

Expression of Epidermal Growht Factor Receptor in Cervical Tissue and Serum of the Patients with Cervical Neoplasia / 대한부인종양콜포스코피학회잡지

BACKGROUND: Epidermal growth factor receptor (EGFR) is overexpressed in the tissue of various malignancies including carcinoma of the breast, lung, esophagus, cervix, and ovary. In patients with cervical neoplasia, there may be a relationship between the expressions of EGFR in cervical neoplastic tissue and serum. METHODS: The expression of EGFR was determined in cervical tissues from 23 cervical intraepithelial neoplasia (CIN) patients and 16 invasive cervical carcinoma patients using immunohistochemical staining and the level of serum EGFR ECD (extracellular domain) was measured in serum from 17 CIN patients and 14 cervical carcinoma patients using ELISA (enzyme-linked immunosorbent assay). RESULTS: The expression of EGFR in cervical tissue was significantly increased as normal cervical tissue progressed to CIN then to invasive cervical carcinoma (p=0.009). And the mean level of serum EGFR according to the histologic diagnosis of normal cervix, CIN, invasive cervical carcinoma was 23.18+/-1.92 fmol/ml, 23.49+/-8.95 fmol/ml, and 30.46+/-19.72 fmol/ml, respectively. The mean level of serum EGFR was higher in invasive cervical carcinoma than that of normal cervix or CIN. But there was no significant statistical difference (p=0.471). Also the mean level of serum EGFR according to the intensity of immunohistochemical staining in negative (-), weakly positive (+), positive (++), and strongly positive (+++) staining was 19.36+/- 3.12 fmol/ml, 20.99+/-3.59 fmol/ml, 29.08+/-16.86 fmol/ml, and 24.34+/-10.35 fmol/ml, respectively. The mean level of serum EGFR in positive (++) and strongly positive (+++) staining was higher than in negative (-) staining, but there was no significant statistical difference (p=0.450). CONCLUSIONS: The authors believe that the expression of EGFR in cervical neoplastic tissue could be used as a marker for reflecting the malignant transformation of cervical epithelial cells. Although the mean level of serum EGFR in invasive cervical carcinoma was higher than in normal cervix and CIN, and the mean level of serum EGFR in positive (++) and strongly positive (+++) immunohistochemical staining was higher than in negative (-) staining, there was no significant statistical difference, possibly due to the limited number of cases in this preliminary study. So, the authors believe that the level of serum EGFR may have a similar role as a tumor marker like the EGFR expression in cervical neoplastic tissue. This study should be continued further with more cases and the relationship between the level of serum EGFR and prognostic parameters of uterine cervical carcinoma need to be analyzed.

Development of the Health-Information System using a Multimedia Tool

BACKGROUND: As people have been interested in healt,h and as the microcomputers with multimedia steeing have been supplied more and more, there is increasing need of multimedia information about health. The CD-ROM, which is a representative multimedia tool, is capable of interacting between information-provider and users, offering audiovisual interface, and saving great deal of knowledge. METHODS: We developed the health-information system to provide ordinary people with hea1th information using multimedia tools. It, has 7 parts ; self-diagnosis, exploring human body, drug information, hospital information, first-aid treatment, Q and A, and medical common sense. We got image data such as figures, photos, X-rays, electrocardiograms and pathologic specimens with scanner and film scanner, also moving image(video) with video-capturing program. RESULTS & CONCLUSIONS: We hope the multimedia health-information system to become a useful methodology of patient education and to be used as an information source in medical information network in the near future.