No abstract available.
Carcinosarcoma* ; Stomach*

OBJECTIVE: We investigated whether Disability Evaluation (DE) situations influence patients' neuropsychological test performances and psychopathological characteristics and which variable play a role to establish an explanation model using statistical analysis. METHODS: Patients were 536 (56.6%) brain-injured persons who met inclusion and exclusion criteria, classified into the DE group (DE; n = 300, 56.0%) and the non-DE group (NDE; n = 236, 44.0%) according to the neuropsychological testing's purpose. Next, we classified DE subjects into DE cluster 1 (DEC1; 91, 17.0%), DE cluster 2 (DEC2; 125; 23.3%), and DE cluster 3 (DEC3; 84, 15.7%) via two-step cluster analysis, to specify DE characteristics. All patients completed the K-WAIS, K-MAS, K-BNT, SCL-90-R, and MMPI. RESULTS: In comparisons between DE and NDE, the DE group showed lower intelligence quotients and more severe psychopathologic symptoms, as evaluated by the SCL-90-R and MMPI, than the NDE group did. When comparing the intelligence among the DE groups and NDE group, DEC1 group performed worst on intelligence and memory and had most severe psychopathologic symptoms than the NDE group did. The DEC2 group showed modest performance increase over the DEC1 and DEC3, similar to the NDE group. Paradoxically, the DEC3 group performed better than the NDE group did on all variables. CONCLUSION: The DE group showed minimal "faking bad" patterns. When we divided the DE group into three groups, the DEC1 group showed typical malingering patterns, the DEC2 group showed passive malingering patterns, and the DEC3 group suggested denial of symptoms and resistance to treatment.
Brain ; Brain Injuries ; Denial (Psychology) ; Disability Evaluation ; Humans ; Intelligence ; Malingering ; Memory ; MMPI ; Neuropsychological Tests

OBJETIVE: To elucidate 1) whether there are any differences in the urine concentrations of steroid hormone metabolites between patients with leiomyoma and normal controls 2) the correlation between urinary profiles of steroid hormones and leiomyomas of the uterus according to their type, location, volume, and weight. MATERIALS OF METHODS: The study population consisted of 37 premenopausal patients with uterine leiomyoma and the control group consisted of 25 premenopausal normal volunteer women without uterine leiomyoma. Confirmation of the existence of uterine leiomyoma was done by ultrasonography and histopathological examination after surgery. The volume of the leiomyoma was estimated by trans-abdominal and/or trans-vaginal ultrasonography. The Leiomyomas were divided into 3 types (subserosal, intramural and submucosal). Seventeen patients had subserosal type of leiomyoma, 10 with the intramural type and 10 with the submucosal type. The locations of the leiomyoma were also divided into 3 groups (fundus, body and isthmus). Seventeen patients showed a fundus location, 10 in body, and 10 in isthmus. We compared urinary profiles of the endogenous steroids between patients with leiomyomas and normal controls, and also investigated the relationship between urinary profiles of the endogenous steroids and leiomyomas according to their type, location, volume and weight by using highly sensitive Gas Chromatography-Mass Spectrometry (GC-MS) system. RESULTS: The mean ages of the patients with leiomyomas and the control group were 43.1+/-5.6 and 40.6+/-7.2 years, the weights were 63.4+/-7.3 and 59.4+/-8.1 kg, and their heights were 155.4+/-4.8 and 159.3+/-4.8 cm respectively. Seventeen patients had subserosal, 10 had intramural, and 10 had submucosal leiomyomas. There were 17 patients with leiomyoma located in fundus, 10 in body and 10 in isthmus. 17beta-estradiol, 5-AT, 11-keto ET, 11beta-hydroxy An, 11beta-hydroxy Et, THS, THA, THE, alpha-cortolone, alpha-cortol, beta-cortol, 11beta-OH Et/11beta-OH An and E2/E1 were significantly increased in patients with leiomyoma than in the control group. 17beta-estradiol was significantly increased in the intramural and the submucosal types than in the subserosal type. There was no significant difference in the concentrations of urinary steroids according to the locations of leiomyomas. There was no significant relationship between the concentration of urinary steroids and the volume of the leiomyomas. 17beta-estradiol significantly decreased as the weight of uterus increased (r=-0.322, p=0.04). CONCLUSION: The concentrations of steroid hormone metabolites were generally increased in patients with leiomyoma but were not significantly related to the volume and weight of the leiomyomas. Our study suggests that steroid hormones may be involved in the initiation of leiomyomas but may not be involved in their progression. In addition, the concentrations of steroid hormone metabolites are not related to the leiomyoma type and location.
Female ; Gas Chromatography-Mass Spectrometry ; Healthy Volunteers ; Humans ; Leiomyoma* ; Steroids ; Ultrasonography ; Uterus* ; Weights and Measures

Uterine leiomyoma is the most common solid pelvic tumor, occurring in 20~30% of women who are over 30 years of age1 and it accompanies with the symptoms such as uterine bleeding, dysmenorrhea, pain and the pressure on the urinary tract lead to blockage of the urinary tract. it some-times becomes a factor in sterility.2 Leiomyoma is a benign neoplasm that arises from uterine smooth muscle. it is hypothesized that leiomyoma originates from the somatic mutations in myometrial cells, resulting in progressive loss of growthregulation.3,4 Ovarian hormones are believed to stimulate the growth of leiomyoma because there is an increased incidence of leiomyoma after menarche and these tumors enlarge during pregnancy and regress after menopause. The growth of leiomyoma is variable among women with regular menstruation cycles and even among myoma nodules in the same uterus. One possible reason for this variation is thaovarian hormones, especially estrogen, stimulate individual myoma nodules by varying degree. 5 Therefore, therapeutic attempt based on over-come the state of hyperestrogenism have been tried. Treatment with competitive inhibitors of estrogen receptors (ER)6,7 or gonadotropin-releasing hor-mone agonist2,8,9 has been studied for those reasons. it was found that mean ER content was significantly greater in leiomyoma than in myometrium. 10~14 And ER content of the fibroid was reported to signifIcantly correlate wIth the myoma-shrinkage.15 But there were no consistent results as the concentration of estrogen in uterine leiomyoma.16,17 in this study, we determined the concentrations of urinary steroids, including estrogens as well as androgens, which are closely related to the estrogen biosynthesis, in premenopausal women with leiomyoma using Gas Chromatography-Mass Spectrometry (GC-MS). The urinary levels of the same endogenous steroids in age-matched healthy premenopausal women were also estimated by comparing urinary steroid levels between the two groups. From these results, we studied the effect of endogenous steroids and the metabolic changes in the leiomyoma, and we especially observed the difference in the estrogen level between the two groups to predict the role of estrogens in the prevention of and the therapy for leiomyoma
Androgens ; Animals ; Dysmenorrhea ; Estrogens ; Female ; Gas Chromatography-Mass Spectrometry ; Humans ; Incidence ; Leiomyoma* ; Menarche ; Menopause ; Menstruation ; Mice ; Muscle, Smooth ; Myoma ; Myometrium ; Pregnancy ; Receptors, Estrogen ; Steroids* ; Urinary Tract ; Uterine Hemorrhage ; Uterus

PURPOSE: The incidence of malignancies after an organ transplant has steadily increased along with a significant improvement of the long-term recipient survival. Eighty-seven variable post-transplant malignancies out of 2,140 renal transplantations were encountered at Yonsei University Medical Center. Among them, we recently experienced a Merkel cell carcinoma (MCC), a rare malignancy originates from neuro-endocrine cells. Herein, we report 6 MCC cases in cluding 5 that developed in non-transplant patients. METHODS: The medical records of 6 patients who have been diagnosed with a MCC since 1984 were reviewed. RESULTS: There were four males and two females. The mean age at the time of diagnosis was 57.7 (48-65). Five cases were a primary MCC and one was secondary in nature that was related to long-term immunosuppression after a kidney transplant. The extremities (n=3), the head and the neck (n=2) were the prevalent sites for MCC. Four patients are currently alive after mean follow-up of 33.3 months (2-67). The secondary case was a MCC that developed in a 49 years old male patient 16 years after receiving a living donor renal transplant. He noticed a mass on the antero-lateral side of the left thigh 1 month before admission. The mass was soft, round, red-violet in color and measured 5 cm in diameter. With 5 mm of skin margin, the mass was completely excised and was found to be a MCC. To rule out loco-regional and distant metastasis, thoraco-abdomino-pelvic CT scan was taken which showed no evidence of abnormal images. Considering the aggressive biological nature of the MCC, we radically excised more skin and muscular ascia, but no remnant malignant cells were found by pathology. CONCLUSION: MCC presents as a dermal mass mostly at the head, neck, and the extremities with characteristics of rapid aggressive metastasis and recurrence. Wide excision with a 3 cm margin is recommended in patients without a meta stasis. This is the first report of a MCC after a renal transplantat in Korea.
Academic Medical Centers ; Carcinoma, Merkel Cell* ; Diagnosis ; Extremities ; Female ; Follow-Up Studies ; Head ; Humans ; Immunosuppression ; Incidence ; Kidney ; Kidney Transplantation ; Korea ; Living Donors ; Male ; Medical Records ; Middle Aged ; Neck ; Neoplasm Metastasis ; Pathology ; Recurrence ; Skin ; Thigh ; Tomography, X-Ray Computed ; Transplants

OBJECTIVE: To identify 1) whether the endogenous steroid hormone metabolism in patients with pelvic organ prolapse was different from that of normal women, 2) the relationship between endogenous steroid hormone metabolites and the stage of the pelvic organ prolapse. METHODS: Twenty postmenopausal women who were clinically diagnosed as having pelvic organ prolapse and 20 volunteer postmenopausal women not having pelvic organ prolapse were included in the study. We compared the urinary profiles of endogenous steroids between the two groups and investigated the relationship between urinary profiles of the endogenous steroids and the degree of pelvic organ prolapse. Urinary profiles of the endogenous steroids were assayed by gas chromatography-mass spectrometry. RESULTS: The ages of the patients and control group were 64.6 +/- 6.5 and 63.5 +/- 3.9 years, and the Body Mass Index (BMI) was 23.96 +/- 3.14 and 24.11 +/- 2.73 kg/m2 in patients and in normal subjects, respectively. The number of patients in each stage were 4 in stage I, 4 in stage II, 6 in stage III and 6 in stage IV. 5-androstene-3beta, 16beta, 17beta-triol (5-AT), 11beta-hydroxy androstenedione (An) and 17beta-estradiol were significantly increased in patients with pelvic organ prolapse over that of the control group (0.76 +/- 0.67 vs 0.06 +/- 0.03 micro mole/g creatinine; p=0.002, 1.16 +/- 0.83 vs 0.65 +/- 0.23 micro mole/g creatinine; p=0.04, 15.08 +/- 9.81 vs 8.53 +/- 6.19 micro mole/g creatinine; p=0.04). However, tetrahydrocortisone (THE) was significantly increased in the control group over that in patients having pelvic organ prolapse (9.80 +/- 6.21 vs 5.22 +/- 4.89 micro mole/g creatinine; p=0.04). The androgen metabolites, 5-AT and THE significantly correlated with the POP-Q stage (R=0.418; p=0.027, R=0.46; p=0.016). Among the estrogen metabolites, 17beta-estradiol was correlated to the POP-Q stage but not mathematically significantly (R=0.38; p=0.05) and the 17beta-estradiol/estrone ratio weakly correlated to pelvic organ prolapse stage (R=0.14; p=0.49), by showing a low correlation coefficiency. CONCLUSION: The urinary concentrations of 17beta-estradiol, 5-AT and 11beta-hydroxy An increased in patients with pelvic organ prolapse over that of the control group and 5-AT, THE and 17beta-estradiol showed a relationship to the progression of pelvic organ prolapse in Korean women. The metabolites of endogenous steroid hormones could be contributing factors in the pathogenesis of pelvic organ prolapse.
Androstenedione ; Body Mass Index ; Creatinine ; Estrogens ; Female ; Gas Chromatography-Mass Spectrometry ; Humans ; Metabolism* ; Pelvic Organ Prolapse* ; Steroids ; Tetrahydrocortisone ; Volunteers

OBJECTIVE: A large body of evidence suggests that cyclooxygenase-2 (COX-2) is important in tumor growth and angiogenesis of gastrointestinal and other cancers. This was the study to determine the relationship between tumor vascularity and COX-2 expression in invasive cervical cancer. METHODS: We examined the expression of COX-2 and microvessel density (MVD) by immunohis- tochemical staining in 21 specimens collected from invasive cervical cancer patients. RESULTS: All specimens showed weak and strong immunoreactivity, with 52.4% strong reactivity. Microvessel count was higher (median 136) in the strong COX-2 immunoreactivity specimens than the weaks (median 90), and MVD was significantly correlated with the COX-2 immunoreactivity (P=0.002). CONCLUSION: These preliminary data indicate that overexpression of COX-2 may play an important role in carcinogenesis of cervical cancer and this could be partially attributable to modulation of angiogenesis by COX-2. COX-2 maybe a target for future research in the tumorigenesis of the invasive cervical cancer.
Carcinogenesis ; Cyclooxygenase 2* ; Humans ; Microvessels ; Uterine Cervical Neoplasms*

To investigate the relationship between the endogenous steroid hormones and the lower urinary tract function in postmenopausal women. Thirty postmeopausal volunteer women who did not have lower urinary tract symptoms or hormone replacement therapy were enrolled in this study. Urodynamic studies included uroflowmetry, multi-channel cystometry, and urethral pressure profilometry were conducted. Gas Chromatography- Mass Spectroscopy (GC-MS) was used to measure the urinary endogenous steroid hormone metabolites. The relationship between the urinary profile of the endogenous steroids and the urodynamic parameters of these patients were investigated. The mean ages of the patients were 60.6 +/- 5.5 years, and the Body Mass Index (BMI) averaged 24.56 +/- 2.23 (kg/m2). Of the progesterone metabolites, pregnandiol was significantly related to the residual volume in the uroflowmetry and the functional urethral length parameters (R=0.98, p=0.000; R= -0.65, p=0.04). Pregnantriol was significantly related to the maximum flow rate, the residual volume in uroflowmetry, the maximum urethral closure pressure and the functional urethral length (R=-0.64, p=0.04; R=0.82, p=0.01; R=0.04, p=0.04; R=- 0.79, p=0.01). In the androgen metabolites, androstenedione, 5-AT, 11- keto Et, 11-betahydroxy Et, THS, and THE were significantly related to the residual volume in uroflowmetry (R=0.92, p=0.001; R=0.84, p=0.008; R=0.99, p=0.000; R=0.72, p=0.03; R=0.97, p=0.000; R=0.85, p=0.00). beta-THF/alpha-THF was significantly related to the maximum flow rate, the residual volume in uroflowmetry, the maximum urethral closure pressure and the functional urethral length (R=-0.76, p=0.02; R=0.67, p=0.04; R=0.74, p=0.02; R=-0.92, p=0.000). alpha-cortol was significantly related to the residual volume in uroflowmetry, the maximum urethral closure pressure and the functional urethral length (R=0.81, p=0.01; R=0.71, p=0.03; R=-0.87, p=0.000). Of the estrogen metabolites, estrone (E1) was significantly related to the normal desire to void (R=0.68, p=0.04) and 17 beta-estradiol/estrone was also significantly related to the normal and strong desire to void (R=-0.70, p=0.03 and R=-0.74, p=0.02, respectively). The urinary progesterone and androgen metabolite concentrations were positively related to the residual volume in uroflowmetry and positively or negatively related to MUCP and FUL. However, the urinary estrone concentration was positively related to the normal desire to void and 17 beta-estradiol/estrone was significantly related to the normal and strong desire to void.
Aged ; Androgens/*metabolism ; Bladder/physiology ; Estrogens/*metabolism ; Female ; Human ; Mass Fragmentography ; Middle Aged ; Postmenopause/*physiology ; Progesterone/metabolism ; Urethra/physiology ; *Urodynamics

The aim of this study was to validate a new paper and pencil test battery to diagnose minimal hepatic encephalopathy (MHE) in Korea. A new paper and pencil test battery was composed of number connection test-A (NCT-A), number connection test-B (NCT-B), digit span test (DST), and symbol digit modality test (SDMT). The norm of the new test was based on 315 healthy individuals between the ages of 20 and 70 years old. Another 63 healthy subjects (n = 31) and cirrhosis patients (n = 32) were included as a validation cohort. All participants completed the new paper and pencil test, a critical flicker frequency (CFF) test and computerized cognitive function test (visual continuous performance test [CPT]). The scores on the NCT-A and NCT-B increased but those of DST and SDMT decreased according to age. Twelve of the cirrhotic patients (37.5%) were diagnosed with MHE based on the new paper and pencil test battery. The total score of the paper and pencil test battery showed good positive correlation with the CFF (r = 0.551, P < 0.001) and computerized cognitive function test. Also, this score was lower in patients with MHE compared to those without MHE (P < 0.001). Scores on the CFF (32.0 vs. 28.7 Hz, P = 0.028) and the computer base cognitive test decreased significantly in patients with MHE compared to those without MHE. Test-retest reliability was comparable. In conclusion, the new paper and pencil test battery including NCT-A, NCT-B, DST, and SDMT showed good correlation with neuropsychological tests. This new paper and pencil test battery could help to discriminate patients with impaired cognitive function in cirrhosis (registered at Clinical Research Information Service [CRIS], https://cris.nih.go.kr/cris, KCT0000955).
Cognition ; Cohort Studies ; Diagnosis* ; Fibrosis ; Healthy Volunteers ; Hepatic Encephalopathy* ; Humans ; Information Services ; Korea* ; Liver Cirrhosis ; Neuropsychological Tests ; Reproducibility of Results

BACKGROUND: Recent studies suggest that serum Cystatin C is both a sensitive marker for renal dysfunction and a predictive marker for cardiovascular diseases. We aimed to evaluate the association between Cystatin C and various biomarkers and to find out its utility in estimating risk for cardiovascular diseases in type 2 diabetic patients. METHODS: From June 2006 to March 2008, anthropometric measurements and biochemical studies including biomarkers for risk factors of cardiovascular diseases were done in 520 type 2 diabetic patients. A 10-year risk for coronary heart diseases and stroke was estimated using Framingham risk score and UKPDS risk engine. RESULTS: The independent variables showing statistically significant associations with Cystatin C were age (beta = 0.009, P < 0.0001), hemoglobin (beta = -0.038, P = 0.0006), serum creatinine (beta = 0.719, beta < 0.0001), uric acid (beta = 0.048, P = 0.0004), log hsCRP (beta = 0.035, P = 0.0021) and homocysteine (beta = 0.005, P = 0.0228). The levels of microalbuminuria, carotid intima-media thickness, fibrinogen and lipoprotein (a) also correlated with Cystatin C, although the significance was lost after multivariate adjustment. Calculated risk for coronary heart diseases increased in proportion to Cystatin C quartiles: 3.3 +/- 0.4, 6.2 +/- 0.6, 7.6 +/- 0.7, 8.4 +/- 0.7% from Framingham risk score (P < 0.0001); 13.1 +/- 0.9, 21.2 +/- 1.6, 26.1 +/- 1.7, 35.4 +/- 2.0% from UKPDS risk engine (P < 0.0001) (means +/- SE). CONCLUSIONS: Cystatin C is significantly correlated with various emerging biomarkers for cardiovascular diseases. It was also in accordance with the calculated risk for cardiovascular diseases. These findings verify Cystatin C as a valuable and useful marker for predicting future cardiovascular diseases in type 2 diabetic patients.
Biomarkers ; Cardiovascular Diseases ; Carotid Intima-Media Thickness ; Coronary Disease ; Creatinine ; Cystatin C ; Fibrinogen ; Hemoglobins ; Homocysteine ; Humans ; Lipoprotein(a) ; Risk Factors ; Stroke ; Uric Acid