A Case of Mobile Thrombus in Ascending Aorta as an Embolic Source of Stroke / 대한내과학회지

Plaque in the ascending aorta can be an important embolic source of stroke. Diagnostic tests for identifying embolic sources are critical for preventing the occurrence of other devastating complications before the initiation of treatment. Here, we report the case of a patient with mobile thrombi attached to the distal ascending aortic wall that were identified by transesophageal echocardiography (TEE). The mobile thrombi in the ascending aorta were treated with anticoagulants and statins. The TEE images we obtained for this case were noteworthy because complex atheromas of the ascending aorta are very rare.

High Cardiac Output Heart Failure Induced by Chronic Severe Anemia / 대한내과학회지

High cardiac output heart failure (HCOHF) occurs in the setting of increased cardiac output, such as with chronic anemia, hyperthyroidism, beriberi, pregnancy, and an arteriovenous (AV) fistula. Of these, chronic anemia is a rare cause of HCOHF and its pathophysiology remains unknown. This report is about a patient with chronic anemia who presented with heart failure and severe tricuspid regurgitation. The severity of the tricuspid regurgitation and the patient's symptoms and signs were improved on correcting the anemia.

The Correlation Between Left Ventricular Failure and Right Ventricular Systolic Dysfunction Occurring in Thyrotoxicosis

BACKGROUND AND OBJECTIVES: Heart failure rarely occurs in patients with thyrotoxicosis (6%), with half of the cases having left ventricular dysfunction (LVD). Although a few studies reported isolated right heart failure in thyrotoxicosis, there has been no evaluation of relationship between LVD and right ventricular dysfunction (RVD). SUBJECTS AND METHODS: We enrolled 12 patients (mean age: 51+/-11 years, 9 females) diagnosed as having thyrotoxicosis with heart failure and LVD {left ventricular ejection fraction (LVEF) <40%}, and divided them into two groups {Group I with RVD defined as tricuspid annular plane excursion (TAPSE) less than 15 mm and Group II without RVD}. Clinical features, laboratory variables, and echocardiographic parameters were compared between two groups. RESULTS: RVD was found in 6 (50%) patients. On admission, there were no significant differences between the two groups in clinical features, laboratory variables, or echocardiographic parameters including atrial fibrillation {6 vs. 5, not significant (NS)}, heart rate (149+/-38 vs. 148+/-32/min, NS), LVEF (36.7+/-9.5 vs. 35.1+/-6.3%, NS), or the tricuspid regurgitation peak pressure gradient (TRPPG, 30.9+/-2.0 vs. 36.3+/-9.3 mmHg, NS). After antithyroid treatment, all achieved an euthyroid state and both ventricular functions were recovered. All data, including the recovery time of LVEF and the change of heart rate between two groups, displayed no significant differences. CONCLUSION: In half of patients, RVD was combined with thyrotoxicosis-associated LVD. There were no differences in clinical factors or hemodynamic parameters between patients with and without RVD. This suggests that RVD is not secondary to thyrotoxicosis-associated LVD.

Correlation between Stroke and Spontaneous Echo Contrast by Tissue Harmonic Imaging in Patients with Dilated Cardiomyopathy

BACKGROUND: Spontaneous echo contrast (SEC) has been considered as a predisposition to thromboembolism and cerebrovascular accident. However, there have been few reports on the prevalence and role of SEC in dilated cardiomyopathy (DCM). The aim of this study was to investigate the prognostic usefulness of SEC in predicting a stroke in patients with DCM. METHODS: Between October 2001 and January 2008, transthoracic echocardiography with tissue harmonic imaging (THI) was performed for recognition of SEC in patients with DCM. Patients were divided into 2 groups according to the presence of SEC. Clinical characteristic data, echocardiographic parameters were compared between two groups. RESULTS: In this retrospective study, 220 patients (136 men, age 62.8+/-15.4 years) with DCM (left ventricular ejection fraction 27.8+/-7.8%) were included. SEC in the left ventricle (LV) was observed in 24 patients (10.9%). Stroke occurred in 4 (16.7%) of patients with SEC and in 9 (4.6%) of patients without SEC. There were no differences in LA dimension (p=0.24) and LV end-diastolic dimension (p=0.88) between both groups. On univariate analysis, SEC and coronary heart disease at presentation had statistical significance of risk factors for stroke in these groups (p<0.05). On multivariate analysis, only SEC was an independent predictor for stroke (OR 4.393, 95% CI 1.116-17.290, p=0.03). CONCLUSION: These results suggest that SEC by THI through transthoracic echocardiography has a strong association with stroke in patients with DCM. Therefore, this study may help in the risk stratification of cardiac embolism in patients with DCM.

Co-infection with Giardia lamblia and Salmonella species after travel abroad / 대한내과학회지

As many Koreans now travel abroad, they are at increased risk for a variety of infectious diseases that are endemic to developing countries in the tropics and subtropics. We report two cases of co-infection with Giardia lamblia and Salmonella species not susceptible to nalidixic acid, after travel abroad.

A case of acute drug-induced hepatotoxicity after albendazole treatment / 대한내과학회지

Drug-induced hepatotoxicity is injury to the liver as a result of drug exposure. Due to their unpredictable nature, drug-induced liver injuries pose a serious problem for clinicians, health agencies, and pharmaceutical firms. Albendazole is a benzimidazole with wide spectrum coverage as an antiparasitic drug. Very few cases of high-dose albendazole-induced hepatotoxicity have been reported so far, and no case in response to a single dose. A 25-year-old man presented to our hospital with dark urine. Twenty days prior to presentation, he took a tablet of albendazole (400 mg) as a prophylactic treatment for lumbricosis. Upon laboratory analysis, aspartate aminotransferase (AST) was 748 IU/L, alanine transaminase (ALT) was 939 IU/L, and total/direct bilirubin was 9.3/7.3 mg/dL. The patient was negative for viral markers (HAV, HBV, and HCV) and autoantibodies. Abdominal ultrasonography revealed no evidence of chronic liver damage. The pathology was compatible with drug-induced hepatotoxicity. The patient improved with conservative management only.

A Case of Duodenal Intramural Hematoma and Hemoperitoneum after Therapeutic Endoscopy in a Patient with Chronic Renal Failure / 대한소화기내시경학회지

Duodenal intramural hematoma is mostly caused by blunt abdominal trauma. It is also less commonly reported as a complication of anticoagulation therapy or as a blood dyscrasia, and as a complication of diagnostic/ therapeutic endoscopy. The presentation of these patients is abdominal pain, vomiting, fever and hematochezia, and this is rarely accompanied with intestinal obstruction, severe pancreatitis and acute peritonitis as its complications. The diagnosis is made clear by performing abdominal ultrasonography and abdominal computed tomography. We reported here on one case of intramural duodenal hematoma and hemoperitoneum after performing endoscopic hemostasis in a chronic renal failure patient who was on maintenance hemodialysis.

A Case of Recurrent Hydramnios in Association with Congenital Myotonic Dystrophy / 대한산부인과학회잡지

Hydramnios is a serious complication of pregnancy associated with a marked increase in perinatal mortality. A variety causes of this condition have been described, the majority of which relate to abnormalities of the fetus. Myotonic dystrophy is a progressive degenerative disease of the neuromuscular system, usually inherited in an autosomal dominant fashion. The disease is variable onset and clinical manifestations and usually severe in the male. Especially congenital myotonic dystrophy is a disease characterized by profound hypotonia. Affected infants present with varying degrees of respiratory failure, often necessitating immediate and prolonged ventilatory assistance. These neonates also have feeding difficulties due to impaired sucking and swallowing. The diagnosis of myotonic dystrophy in pregnancy is made retrospectively, following the birth of a severely affected neonates. A documented case of congenital myotonic dystrophy associated with hydramnios in two successive pregnancies is presented. The evidence suggests that myotonic dystrophy should be considered as a rare cause of recurrent hydramnios. We report a case of recurrent hyramnios in association with congenital myotonic dystrophy with a brief review of literatures.

A Case of Fetal Intracranial Hemorrhage Diagnosed by Antenatal Ultrasonogram / 대한산부인과학회잡지

Fetal intracranial hemorrhage is quite rare. It refers to the bleeding that occurs antenatally from a blood vessel into ventricles, subdural space, or parenchyme of the brain. Factors that may place the fetus at risk for intracranial hemorrhage include maternal drug exposure history, various maternal and fetal conditions. The majority of reported antenatally detected cases of intracranial hemorrhage have occurred during the third trimester. Residual changes may include development of a porencephalic cyst or ventricular enlargement. Intracranial hemorrhage has a broad spectrum of manifestations with diverse prognosis. We report a case of fetal intracranial hemorrhage that was diagnosed antenatally in the third trimester with a brief review of literatures.

Immunohistochemical Study on the Expression of Thymidine Phosphorylase and Ki-67 in the Uterine Cervical Neoplasia / 대한산부인과학회잡지

OBJECTIVE: We evaluated the relationship between the expression of Ki-67 and thymidine-phosphorylase (TP) according to the cancerous progression of uterine cervical cancer with immunohistochemical method. METHODS: The material was obtained from hysterectomized uterus and punched cervical specimen for two years from 1998 to 1999 at the Soonchunhyang Chunan hospital. The material included 15 normal epithelium, 13 CIN I/II, 21 CIN III, 15 microinvasive carcinoma and 13 invasive carcinoma. Monoclonal antibodies of Ki-67 and TP were used for immunohistochemical determination of cellular proliferation and angiogenic activity. RESULTS: 1. The positive rate of thymidine phosphorylase in each group of normal epithelium, CIN I/II, CIN III, microinvasive carcinoma and invasive carcinoma were 6.7%, 23.1%, 38.0%, 73.3%, 84.6% respectively. 2. The labeling indexes of Ki-67 in each group of normal epithelium. CIN I/II, CIN III, microinvasive carcinoma and invasive carcinoma were 2.0+/-0.7, 26+/-5.4, 41.2+/-10.1, 74.7+/-9.3 respectively. 3. There was statistically significant relationship between TP and Ki-67 expression. CONCLUSION: The above results indicates that the angiogenic activities and cellular proliferation indices increase according to the invasiveness of cervical cancer. We were able to reveal the expression of TP and Ki-67 and their relationship in cervical carcinoma.

An Immunohistochemical study on the Expression of EGFR, TGF-alpha and Ki-67 in the Uterine Cervical Neoplasia / 대한산부인과학회잡지

OBJECTIVE: Cervical carcinoma of the uterus, the most common maliganacy among women in Korea, which its etiology and pathogenesis are not yet determined. Recently, since it has been found about the function of the growth factor and its receptor, involved in the regulation of cellular growth and differentiation, many studies have been undertaken about the role of growth factors and its receptors in the growth and differentiation of the tumor cell. METHODS: In this study, we examined the expression of EGFR, TGF-alpha and Ki-67 in 50 CINs and 20 invasive cervical cancers using immunohistochemical stain. RESULTS: Positive rate of EGFR was 92% in CIN, 80% in invasive cancer, negative rate of TGF-alpha was 74% in CIN, 80% in invasive cancer and Ki-67 labelling index(LI) in normal basal cell, CIN I-II, CIN III were 5+/-0.7, 13+/-2.5, 65+/-5.4 repectively and in invasive cancer, LI was over 90. from this result as cervical carcinoma progresses, the expression of EGFR and Ki-67 increase while that of TGF-alpha decreases. CONCLUSION: As cervical carcinoma progress, the expression of EGFR and Ki-67 increase while that of TGF-alpha decreases. Further studies on the expression of EGFR and TGF-alpha and its growth-stimulation mechanism in cervical carcinoma are warranted to establish the pathogenesis of the cervical carcinoma.

A Study on the Methylation of p 16 Gene Promotor in the Uterine Cervical Neoplasia / 대한산부인과학회잡지

No abstract available.

The Clinical Effectiveness of Cervicography in Cervical Cancer Screening / 대한부인종양콜포스코피학회잡지

In an effort to reduce the false-negative rate of PAP smear, several new technologic screening methods have recently evolved. Cervicography is one of these methods. The purpose of this study was to evaluate the screening use of cervicography as an adjunctive method and the clinical effectiveness of cervicography in korean reports, compared with other countries. And we estimated the specificity and sensitivity of cervicography in cervical cancer screening in several korean reports. The results were : 1. The sensitivity of cervicography and pap smear was 89.2% and 85.7%. 2. The false negative rate of cervicography and pap smear was 3.8% and 22.4%. 3. When cervicography and Pap smear were used conjointly, the sensitivity was higher than for cervicography or pap smear used alone(95.7% vs 89.2%, 95.7% vs 85.7%) Cervicography is one of the useful screening method for detect cervical cancer, However when cervicography are used in conjunction with Pap smear, the detection rate of cervical cancer will be increased.

A Study of the Effect of Changes in Ano-Rectal Function after Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: It has been suggested that hysterectomy has a disturbing influence on bowel function, mainly constipation. We performed a prospective study to assess the changes of ano-rectal physiology after hysterectomy. METHODS: Fourteen consecutive patients were assessed before and two months after hysterectomy. A detail questionnaire was devised to allow assessment of bowel function and ano-rectal pressure test and balloon expulsion test were performed before and after hysterectomy. The parameters measured in ano-rectal pressure test included the minimal sensible volume, ano-rectal resting pressure, maximal squeezing pressure, recto-anal inhibitory reflex and balloon expulsion test. Data analysis was carried out by paired t-test. Statistical significance was inferred when the p value was0.05). There were no significant changes in ano-rectal pressure test after hysterectomy. The disturbance of balloon expulsion capacity was increased in four patients after hysterectomy(29%). CONCLUSION: Our results demonstrate that hysterectomy does not cause a decrease in ano-rectal pressure and rectal sensitivity, but has an adverse effect on rectal expulsion capacity in a some of patients.

Expressions of the cell proliferation Ag Ki-67, p53 and p21wa f1/cip1 in uterine cervical squamous tumor / 대한부인종양콜포스코피학회잡지

OBJECTIVE: To evaluate the expressions of Ki-67, p53 and p21 waf1/cip1 according to the age and the histologic type of preinvasive and invasive cervical lesions. MATERIAL AND METHOD: Microwave-oven-processed formalin-fixed, paraffin-embedded, cervical biopsy specimens and hysterectomy specimens were obtained from 1997 to 1998 at the Soonchunhyang university Chunan hospital. These included 55 cervical intraepithelial neoplasm(CIN I-III), 14 invasive squamous cell carcinoma and 3 adenocarcinoma, and immunohistochemically evaluated by monoclonal MIB-1 antibody, monoclonal p53 antibody, and monoclonal p21 antibody. Positive index was expressed as a percentage of strong staining cells per 300 counted cells in evenly strong staining area. RESULT: Ki-67, p53 and p21 protein were expressed in the nuclei. Ki-67 was specifically expressed in all phases of cell cycles in proliferating cells. p21 expression was not seen in CIN I and CIN II, but was increased with increasing histologic grade. According to the age, Ki-67 expression was significantly higher in 30 > or =aged group than 30 or =aged group. CONCLUSION: Conclusions of this study indicate that cell proliferating rate is higher in young age groups than old age groups. p53 expression was not significantly different according to age and histologic grade. These indicates that mutation of the p53 gene may be associated with the development of cervical cancer, but not associated with the progression of cervical cancer. Besides, p21 expression was increased in increasing histologic grade, but decreased in old aged women. Further study of this paradoxical increase in p21 expression in cervical carcinoma is necessary to clarify the mechanisms of p53 indepent pathway.

A case of Squamous cell carcinoma with transitional cell component of the Bartholin Gland / 대한부인종양콜포스코피학회잡지

A patient with squamous carcinoma of Bartholin gland including transitional component is reported and the literature related to this disease is reviewed. Carcinoma of the Bartholin gland is rare, comprising less than 1% of female genital tract cancer. This report was summurized a clinical experience of a 53 year old women with Bartholin gland carcinoma, FIGO Stage II. Histologically, this tumor is characterized by poorly differentiated squamous cell carcioma, individually cellular keratinizationa and transitional component. This patient was treated by modified radical vulvectomy with ipsilateral lymph node dissection and neoadjuvant chemotherapy(4 courses) and followed by radiation therapy.

A study on expression of Human Papillomavirus 16/18, E6/ E7 and Ki-67 in the cervical cancer / 대한부인종양콜포스코피학회잡지

The squamous cell carcinoma of the uterine cervix is the most common malignant tumor among women in Korea. Since 1976, when a research result that human papillomavirus(HPV) infection played some role in the carcinogenesis of the uterine cervical carcinoma had been published, numerous reports supporting the result have been released. Among the types of the HPV, type 16 and type 18 are classified as high risk types because they are frequently found in cervical lesions with high grade dysplasia and invasive carcinomas. However, it is impossible to ascertain by host histologic or cellular changes which type of HPV is infected. The HPV genome is composed of six open reading frames (ORF' s) named as E1, E2, E4, E5, E6 and E7 in the early region. Among these oncoproteins HPV E6/E7 have been strongly suggested to be important in carcinogenesis. When HPV infects the epithelial cells, it promotes cellular proliferation. The cellular proliferation can be evaluated by immunohistochemistry with the antibodies for proliferating cell nuclear antigen(PCNA) and Ki-67. Because PCNA has long half-life, and can be detected 48 hours after completion of mitosis, an estimation of proliferating cells by PCNA could be inaccurate. The expression of Ki-67 antigen is more correct than PCNA for the evaluation of proliferation cells due to its short half-life and rapid degradation after completion of the mitosis. In this study, immunohistochemical staining was conducted to determine the rate of expression of HPV E6, E7 and Ki-67, correlation with relationship in carcinoma in situ and invasive uterine cervical cancer. Fifty cases of carcinoma of in situ(CIS) and invasive carcinoma were immunohistochemically stained, and the results obtained were as follows: 1) E6 protein of HPV type 16/18 was expressed in 5 of 14 cases(35.7%) of carcinoma in situ, in 3 of 7 cases of microinvasive carcinoma (42.8%) and in 12 of 20 cases of invasive carcinoma(60%) but there was no significant difference in expression between the carcinoma in situ and invasive cancer group (p=0.138). 2) E7 protein of HPV type 16/18 was expressed in 10 of 14 cases(71.4%) of carcinoma in situ, in 6 of 7 cases of microinvasive carcinoma (85.7%), and in 18 of 20 cases of invasive carcinoma(90%) but there was no significant difference in expression between the carcinoma in situ and invasive cancer group (p=0.138). 3) The cell fraction expressing Ki-67 was expressed in 5 of 14 cases(35.7%) of carcinoma in situ, in 5 of 7 cases of microinvasive carcinoma (71.4%), and in 18 of 20 cases of invasive carcinoma.(90%) The cell fraction expressing Ki-67 increased according to the progress of cervical cancer. 4) There was no statistical significance between HPV type 16/18 E6 protein and the cell fraction expressing Ki-67(p=0.09). 5) There was no statistical significance between HPV type 16/18 E7 protein and the cell fraction expressing Ki-67(p=0.17). The above results suggest that the cell fraction expressing Ki-67 increases according to the invasiveness of cervical cancer and E6/E7 protein seem to play a role in the progression of cervical cancer. However we were not able to reveal a relation between E6/E7 protein and the cell fraction expressing Ki-67 in progress of cervical carcinoma, and it is recommended that further studies should be undertaken.

Expression of Cyclin A and Ki-67 in the Uterine Cervical Carcinoma / 대한부인종양콜포스코피학회잡지

The cell cycle is the set of events that is responsible for the duplication of the cells. Recent studies indicate that cell cycle regulatory proteins, mainly the cyclins and cyclin-related genes, can be critical targets during oncogenesis. The genes and gene products normally control specific events in the cell cycles, particularly during the late G1 and early S phase and G2/M phase. A large body of date implicates cyclins in oncogenesis. The first evidence came from human cyclin A in oncogenesis. Cyclin A is expressed from the late G1 phase through the M-phase of the cell cycle. Cyclin A is known as positive regulator of cell cycle and participates in the tumorigenesis. Overexpression of cyclin A has been reported in several cancers. Ki-67 is a nuclear protein expressed during the cell cycle except in Go. The labeling index of Ki-67 in the tumor cell nuclei has been used as a good prognostic factor. In this study, we compared labeling index of cyclin A and Ki-67 to assess the feasibility between them with 30 cases of cervical intraepithelial neoplasia(CIN) and 20 cases of invasive squamous cell carcinoma(SCC)by immunohistochemistry. The results were as follow; 1. Cyclin A expressed in normal parabasal cells and their labeling index was 0.8+/-0.4%, while in CIN and invasive SCC 65.5+/-9.4% and 86.5+/-12.3% respectively. Ki-67 expressed in normal parabasal cells as 1.3+/-0.7% while in CIN and invasive SCC as 77.8+/-12.9% and 92.2+/-17.6% respectively. 2. In CIN, the expression of cyclin A increased according to the grades of the CIN as 32.5+/-5.7%, 75.8+/-9.0%, and 83.2+/-13.4% in CIN I, II and III respectively. The expression of the Ki-67 also increased according to the grades of the CIN as 51.8+/-9.8%, 87.9+/-11.3%, and 93.6+/-17.5% respectively in CIN I, II and III. 3. There was no differences of cyclin A and Ki-67 expressions according to the histologic types of invasive SCC. Above results suggests that the cyclin A labeling index could be used as a marker of tumor progression in the uterine cervical carcinoma as Ki-67.

Significance of Preoperative Serum CA-125 and TPA Concentrations in Patients with Pelvic Tumors / 대한부인종양콜포스코피학회잡지

We measured serum levels of CA-125 and Tissue polypeptide antigen(TPA) in 135 patients with pelvic tumors(129 benign pelvic tumors and 6 malignant ovarian tumors) preoperatively. Each tumor marker was measured by immunoradiometric assay. Serum CA-125 levels of 35.0U/ml, 65.0U/ml and TPA levels of 80.0U/ml, 100.0U/ml were determined as cut-off values. The results were evaluated by each tumor marker and two tumor markers coincidently. The results were as follows : (continue)

A case of Behcet's syndrome treated by colchicine / 대한산부인과학회잡지

No abstract available.