No abstract available.
Hemorrhage* ; Humans ; Infant, Newborn*

Abdominal pregnancy that is a life threatening variant of ectopic pregnancy, has been a rare event with high maternal mortality. It is very difficult to diagnose a abdominal pregnancy clinically. We have experienced a case of early abdominal pregnancy diagnosed at emergency laparotomy and this case was presented with a brief review of the literatures.
Emergencies ; Female ; Laparotomy ; Maternal Mortality ; Pregnancy ; Pregnancy, Abdominal* ; Pregnancy, Ectopic

PURPOSE: To evaluate displacement and morphologic changes of the temporomandibular joint (TMJ) disc in patient with internal derangement using magnetic resonance imaging (MRI). MATERIALS AND METHODS: One hundred and forty five MR images of TMJs in 73 patients were evaluated. Positional and morphologic changes of the TMJ discs were assessed. Lateral or medial disc displacement was also evaluated on coronal images. RESULTS: Among 63 discs with anterior disc displacement, 37 discs were assessed as a biconcave disc and 21 as a deformed disc. Rotational disc displacement was observed in 35 discs. Anteromedial disc displacement was observed in 29 discs, and anterolateral direction in 6 discs. Among 35 rotational displacement, 5 biconcave discs and 21 deformed discs were observed. CONCLUSION: Rotational and sideways displacement of TMJ discs were found to be common and an important aspect of internal derangement. This study also suggests that sagittal and coronal images of the TMJ have complementary abilities for an assessment of joint abnormality.
Humans ; Joints ; Magnetic Resonance Imaging* ; Temporomandibular Joint Disc* ; Temporomandibular Joint Disorders ; Temporomandibular Joint*

BACKGROUND: To help medical students learn anatomy effectively in limited hours, a regional anatomy book enhancing students' memorization was developed.METHODS: Only anatomical terms essential for basic cadaver dissection are included along with schematic figures which enable memorization of complicated anatomical structures. Learning comics and comic strips that depict anatomy mnemonics and jokes were appended and sentences were written to be comfortably readable. The electronic book titled “Visually Memorable Regional Anatomy” has been distributed without payment or registration. With the help of 246 volunteer students from three Korean medical schools, the book's learning effects were evaluated.RESULTS: These students' book reading led to increase in their anatomy scores, including written examination scores and tag examination scores. It was an encouraging result that almost 20% of students spontaneously read the book no matter who presented their lecture or examination. A webpage version of the book was visited by thousands of users.CONCLUSION: The book with unique features may suggest a new perspective in the field of anatomy learning. After having acquaintance with essential structures from reading the book, students are able to and willing to study more from other resources.
Anatomy, Regional ; Books, Illustrated ; Cadaver ; Education ; Humans ; Internet ; Learning ; Schools, Medical ; Students, Medical ; Volunteers

BACKGROUND: To help medical students learn anatomy effectively in limited hours, a regional anatomy book enhancing students' memorization was developed. METHODS: Only anatomical terms essential for basic cadaver dissection are included along with schematic figures which enable memorization of complicated anatomical structures. Learning comics and comic strips that depict anatomy mnemonics and jokes were appended and sentences were written to be comfortably readable. The electronic book titled “Visually Memorable Regional Anatomy” has been distributed without payment or registration. With the help of 246 volunteer students from three Korean medical schools, the book's learning effects were evaluated. RESULTS: These students' book reading led to increase in their anatomy scores, including written examination scores and tag examination scores. It was an encouraging result that almost 20% of students spontaneously read the book no matter who presented their lecture or examination. A webpage version of the book was visited by thousands of users. CONCLUSION The book with unique features may suggest a new perspective in the field of anatomy learning. After having acquaintance with essential structures from reading the book, students are able to and willing to study more from other resources.

BACKGROUND/AIMS: Vascular endothelial growth factor (VEGF) is one of the most potent angiogentic factors in several tumors including hepatocellular carcinoma (HCC). This study was planned to evaluate the correlation between the expression patterns of VEGF and the clinicopathologic features of patients with HCC. METHODS: Twenty-seven patients with curatively resected HCCs were included in this study. To determine the expression patterns of VEGF, western blotting and immunohistochemical staining were performed using polyclonal rabbit VEGF IgG (Santa Cruz, CA) as a primary antibody. These results were compared and analyzed to clinicopathologic features of patients. RESULTS: In Western blotting, Only 5 cases exhibited higher VEGF expression (T/N > or = 0.8) in tumorous region, which was well correlated to the immunohistochemical staining. Between higher and lower VEGF expression group, there were no significant differences in the hypervascularities on angiography or microangiogenic invasions on histologic finding. Other clinicopathologic factors had no significances on VEGF expression. Two year disease-free suvival rate in higher VEGF expression group was 20.0%, which was significantly lower than 73.7% in lower VEGF expression group (p=0.02). But, in two year overall suvival rate, there were no differences between two groups (80.0% vs 82.8%; p=0.80). CONCLUSION: In this study, higher VEGF expression seems to be correlated with higher recurrence rate of HCC. Wide-based prospective study is needed to confirm the potentiality of VEGF expression as a prognostic factor of HCC.
Angiography ; Blotting, Western ; Carcinoma, Hepatocellular* ; Humans ; Immunoglobulin G ; Immunohistochemistry ; Recurrence ; Vascular Endothelial Growth Factor A*

BACKGROUND: Sphingosine 1-phosphate (S1P) has been discovered to be a critical regulator of bone metabolism. Very recently, we found that higher circulating S1P levels were associated with higher rate of prevalent osteoporotic fracture in human. METHODS: This was a cross-sectional study of 16 patients who underwent hip replacement surgeries. Bone marrow fluids were obtained during hip surgeries, and the S1P levels were measured using a competitive enzyme-linked immunosorbent assay (ELISA) assay. Bone mineral densities (BMDs) at various skeletal sites were obtained using dual energy X-ray absorptiometry. RESULTS: Among 16 patients, 4 patients were undergone operations due to hip fractures, and the others were done by any other causes. Bone marrow S1P levels were significantly lower in patients with hip fractures than in those without, before and after adjusting for confounding factors (P=0.047 and 0.025, respectively). We failed to demonstrate significant associations between bone marrow S1P levels and any BMD values (gamma=0.026-0.482, P=0.171-0.944). CONCLUSIONS: In conjunction with our previous findings, these suggest that the effects of gradient between peripheral blood and bone marrow, but not S1P itself, may be the most critical on bone metabolism.
Blood ; Bone Density ; Bone Marrow* ; Cross-Sectional Studies ; Enzyme-Linked Immunosorbent Assay ; Hip Fractures* ; Hip* ; Humans ; Lysophospholipids ; Metabolism ; Osteoporotic Fractures ; Sphingosine*

Central nervous system cryptococcosis is common in the AIDS patients with reported incidences ranging from 1.9% to 11.0%. Cryptococcosis may be the initial manifestation of HIV infection or occur simultaneously with other opportunistic infections. HIV-infected patients with central nervous system cryptococcosis complain of fever, headache, nausea and vomiting, and cognitive dysfunction. Meningeal signs and photophobia are less common than in HIV-negative patients. Focal neurologic signs and seizures are uncommon. Disseminated cryptococcosis is often concomitantly found at the time of central nervous system cryptococcosis. We report a case of 49 year-old Korean female with HIV infection who died of disseminated cryptococcosis with autopsy findings.
Autopsy* ; Central Nervous System ; Cryptococcosis* ; Female ; Fever ; Headache ; HIV Infections ; Humans ; Incidence ; Middle Aged ; Nausea ; Neurologic Manifestations ; Opportunistic Infections ; Photophobia ; Seizures ; Vomiting

BACKGROUND/AIMS: In spite of improved diagnostic and therapeutic methods, the prognosis of hepatocarcinoma( HCC) is still poor because of the high recurrence rate. Early detection and active treatment of recurrent HCC are important to improve the survival. The objective of this study is to compare the effectiveness of diagnostic tools for early detection of the recurrence of HCC. METHODS: We retrospectively studied 236 patients who underwent curative hepatic resection for HCC at SNUH between 1993 and 1995. Postoperatively, we checked radiologic studies every three months and serum alpha- fetoprotein level monthly first, then every three months to detect recurrence. The patients were divided into four group (Low-Low;L-L, Low-High;L-H, High-Low;H-L, High-High;H-H) according to the serum levels of pre- and post-operative(3 months) alpha-fetoprotein levels (Low ; <20ng/ml, High >20ng/ml). RESULTS: Overall recurrence rate was 55.1%. The recurrence rates in L-L gr., L-H gr, H-L gr., and H-H gr were 40.7%, 75.0%, 42.9% and 91.8% respectively. Increasing levels of alpha-fetoprotein at the time of dectection of recurrence were found in 13.6%, 66.7%, 25.9% and 92.9%, respectively(p<0.05). The 3- year disease-free survival rates are 62.1%, 25.0%, 57.8% and 6.3%, respectively(p<0.05). The 3-year overall survival rates are 79.2%, 50.0%, 83.6% and 51.1%, respectively(p<0.05). The detection rates of ultrasonography(US) and computed tomograpy(CT) were 82.4% and 97.2% respectively. Seven patients had lung metastasis on chest X-ray and two bone metastasis on bone scan, two spinal metastasis on spine X-ray and MRI and 2 adrenal metastasis by US and CT were detected. CONCLUSION: The patients who have high serum levels of alpha-fetoprotein postoperatively have a tendency to recur early. On the other hand, patients who have low serum levels of alpha-fetoprotein postoperatively recur late, usually without its elevation. Therefore, in former cases, early recurrence or remnant tumor should be suspected and in latter cases, regular US and/or CT is a more useful method for early detection of recurrent HCC than frequent checking of serum alpha-fetoprotein.
alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Disease-Free Survival ; Fetal Proteins ; Hand ; Humans ; Lung ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Prognosis ; Recurrence* ; Retrospective Studies ; Spine ; Survival Rate ; Thorax

PURPOSE: Transcatheter arterial embolization (TAE) is widely used as a diagnostic and therapeutic tool for hepatocellular carcinomas (HCC). Although there are many controversies about the effect of preoperative TAE, in some centers, it has been done in most patients with HCC. We investigated the effect of preoperative TAE on the prognosis for the patients who had undergone curative hepatic resection for HCC. METHODS: We retrospectively studied 541 patients who had undergone curative hepatic resection for HCC at the Department of Surgery in Seoul National University Hospital between 1988 and 1995. Among those, preoperative TAE was done in 489 patients (TAE (+) group) and was not done in 52 patients (TAE (-) group). We examined demographics, tumor-free survival rate, overall survival rate, and complications. RESULTS: There were no statistical differences of demographic data between TAE (+) and TAE (-) groups. The 1-year, 3-year and 5-year tumor-free survival rates for TAE (+)/TAE (-) groups were 72.9%/70.6%, 43.8%/36.7% and 35.7%/30.5%, respectively. There was no statistical difference. The 1-year, 3-year and 5-year overall survival rates for TAE (+)/TAE (-) group were 85.5%/86.0%, 69.1%/63.3% and 56.6%/51.7%, respectively. These differences were not statistically significant (p>0.05). The postoperative complication rates were 26.6% for patients undergoing pre operative TAE and 26.9% for patients not undergoing it; these differences were not statistically significant (p>0.05). In the patients who had preoperative TAE, the hospital stay was prolonged (24.4+/-11.4 days vs. 17.8+/-8.8 days) and cost increased significantly (about 1,300,000 won). CONCLUSION: Preoperative TAE shows no advantages in the treatment of resectable HCC. Rather, it prolongs hospital stay and increases cost. Therefore, preoperative TAE should be done only in selected patients.
Carcinoma, Hepatocellular* ; Demography ; Humans ; Length of Stay ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Seoul ; Survival Rate