BACKGROUND: The circadian rhythm of circulating melatonin is regulated by the endogenous oscillators, the suprachi-asmatic nuclei, and entrained by the light-dark cycle of the environment, but it seems that the rhythm can be affected by variable lesions outside the retina-pineal pathway. We intended to know how acute cerebral infarction affects on the cir-cadian rhythm of plasma melatonin secretion. METHODS: Plasma melatonin level was measured from 64 patients with acute cerebral infarction. On admission, blood samples were collected by venipuncture at 2AM, 4AM, 10AM, and 2PM and melatonin level was measured by radioimmunoassay. The state of consciousness of each patient was assessed clini-cally and the infarction site and size were evaluated clinically and radiographically. RESULTS: Among 64 patients with acute cerebral infarction, dramatic blunting or obliteration of nocturnal melatonin surge in the blood was found in 29 patients. The circadian rhythm of melatonin secretion was absent in 12 of 35 alert patients, in 10 of 20 drowsy patients, and in 5 of 7 stuporous patients. Melatonin secretion into plasma was markedly decreased in all 2 comatose patients. Of 14 patients with brainstem lesions, 8 patients showed decreased melatonin levels with the absence of a nocturnal rise, although most of them were alert. CONCLUSIONS: This study suggests that brainstem and the initial mental state might contribute to the regulation of the circadian rhythm of plasma melatonin even though the lesion does not involve the retina-pineal pathway, but further extensive study is required to elucidate it. (J Korean Neurol Assoc 19(4):359~363, 2001)
Biological Clocks ; Brain Stem ; Cerebral Infarction* ; Circadian Rhythm* ; Coma ; Consciousness ; Humans ; Infarction ; Melatonin* ; Phlebotomy ; Photoperiod ; Pineal Gland ; Plasma ; Radioimmunoassay ; Stupor

To evaluate the nutritional status according to the degree of metabolic acidosis(MA) and determine that MA is a risk factor for malnutrition, we screened the laboratory data of 37 hemodialysis(HD) patients who were clinically stable for more than 6 months and taken bioelectrical impedence analysis(BIA) twice 6 months apart to check lean body mass (LBM). Mean age of patients was 49.1+/-15.0 years and sex ratio 1:2.4. Mean serum albumin level was 3.97+/-0.36g/dl and weekly Kt/V and normalized protein catabolic rate(nPCR) were 3.04+/-0.85 and 0.99+/-0.21g/kg/day. According to mean total CO2 content during the periods between BIA, the patients were divided to three groups[group 1(n=16):&18mEq/L, group 2(n=9):18< or =tCO2&21mEq/L, group 3(n=12):> or =21mEq/L). Group 1 had significantly higher body weight gain than group 2 and 3(1.82+/-1.62 vs. 0.77+/-3.13 and 1.35+/-3.85kg, P<0.05), and higher LBM gain(1.99+/-4.38 vs. 3.35+/-7.99kg, P<0.05), nPCR(1.05+/-0.20 vs. 0.91+/-0.13g/kg/day, P<0.05), intact parathyroid hormone(88.4+/-78.7 vs. 32.0+/-26.5pg/ml, P< 0.05), and phosphate(5.4+/-1.3 vs. 3.9+/-1.3mg/dl, P< 0.05) than group 3. There were no differences in age, serum albumin, BUN, creatinine and weekly Kt/V among three groups. Mean total CO2 level was inversely correlated with body weight gain and LBM gain. In conclusion, metabolic acidosis in stable HD patients may be the result of high protein intake and not related to decrease of body weight by protein catabolism.
Acidosis* ; Body Weight ; Creatinine ; Humans ; Malnutrition ; Metabolism ; Nutritional Status ; Renal Dialysis* ; Risk Factors ; Serum Albumin ; Sex Ratio

BACKGROUND AND OBJECTIVES: Programmed cell death (apoptosis) is distinctive form of cell death manifested by characteristic chromatin condensation and DNA fragmentation, whose function is the deletion of cells in normal development, organogenesis, immune function, and tissue growth, but which can also be induced by pathologic stimuli. The purpose of this study was to analyze the relationship between apoptotic index and HPV, p53 and PCNA expression, and clinicopathological findings in laryngeal squamous cell carcinomas. MATERIALS AND METHODS: Fourty-one cases of laryngeal squamous cell carcinomas were analyzed for the detection of HPV DNA by in situ hybridization, the expression of p53 and PCNA by immunohistochemical technique, and detection of apoptotic bodies by in situ hybridization. RESULTS: HPV DNA was detected in 8 (19.51%), p53 was expressed in 26 (63.41%) out of 41 cases, and the PCNA expression rate was 48.39+/-21.06%. The average apoptotic index was 9.38+/-2.89, there was no relationship between apoptotic index and HPV and p53 expression (p>0.05). The apoptotic indices were 11.26+/-1.86, 8.17+/-2.55, and 4.32+/-2.41 in well differentiatied, moderately differentiatied and poorly differentiatied carcinoma, respectively. The histopathological differences were statistically significant (p<0.05). Also there was an inverse proportion between apoptotic index and PCNA expression. CONCLUSION: The apoptotic index was related to cellular differentiation regardless of HPV and p53 expression. Also these results suggest that the numbers of apoptotic bodies in the tumor tissues can make it possible to presume indirectly the malignant potentiality of the tumor and will help us to understand the biologic behavior of head and neck cancer.
Apoptosis* ; Carcinoma, Squamous Cell* ; Cell Death ; Chromatin ; DNA ; DNA Fragmentation ; Head and Neck Neoplasms ; In Situ Hybridization ; Organogenesis ; Proliferating Cell Nuclear Antigen*

BACKGROUND AND OBJECTIVES: Sialendoscopy is a minimally invasive technique that can be used to explore the salivary duct system and to treat obstructive salivary disease. The aim of this study was to investigate the safety and efficacy of sialendoscopy as a diagnostic and therapeutic tool for recurrent parotid swelling. SUBJECTS AND METHOD: We retrospectively evaluated the endoscopic findings of 41 patients who underwent diagnostic sialendoscopy between August 2003 and January 2008. Interventional sialendoscopy was performed to treat any abnormalities in the ductal system. Stones were fragmented or removed by using a basket or a grasper. Strictures were dilated and mucous plugs were removed endoscopically. RESULTS: Diagnostic sialendoscopy was successfully performed in all cases. Thirty four patients underwent interventional sialendoscopy. Among them, 8 patients (23.5%) had intraductal stones and 7 patients (87.5%) were successfully treated by endoscopic removal. Stenosis of parotid duct was observed in 26 patients (76.5%). Sixteen cases (61.5%) with stenosis were dilated with balloon catheter or endoscopy sheath successfully. Patients were closely observed during the median follow-up of 42 months (1-72 months). Symptomatic relief was achieved in 20 of 26 patients (77%) in parotid stenosis. There were no recurrences of parotid stone. Six patients (23.0%) among 26 patients with parotid ductal stenosis occasionally suffered from recurred parotid swelling. CONCLUSION: The sialendoscopy could be recommended as a useful tool for the diagnosis and treatment of recurrent parotid swelling with a minimally invasive technique.
Catheters ; Constriction, Pathologic ; Endoscopy ; Follow-Up Studies ; Humans ; Parotid Gland ; Recurrence ; Retrospective Studies ; Salivary Ducts ; Salivary Gland Calculi

In female infants, an inguinal hernia containing an ovary with or without Fallopian tubes is not uncommon. However, an inguinal hernia containing the entire uterus and both ovaries is extremely rare. Herein, we report on a case of an inguinal hernia containing the uterus, both ovaries, and both Fallopian tubes, diagnosed by ultrasonography. We discuss the case and review the relevant literature.
Fallopian Tubes ; Female ; Hernia, Inguinal ; Humans ; Infant ; Ovary ; Uterus

We experienced a case of aldosterone and cortisol secreting adrenal adenoma associated with pregnancy in a 23 year old female patient.The patient complained of severe thoraco-lumbar pain, weight gain, sweating, anxiety, and mild abdominal discomfort. On physical findings, hypertension, tachycardia, facial plethora, moon face, buffalo hump and truncal obesity were found.
Adenoma ; Aldosterone ; Anxiety ; Buffaloes ; Female ; Humans ; Hydrocortisone ; Hypertension ; Moon ; Obesity ; Pregnancy ; Sweat ; Sweating ; Tachycardia ; Weight Gain

A 29-year-old man has been presented with disseminated pulmonary tuberculosis and brain parenchymal tuberculous nodule. The CSF examination showed the features of subacute meningitis consistent with tuberculosis, and chronic granulomatous inflammation with acid-fast bacilli was found on pleural biopsy. He was treated with anti-tuberculous chemotherapy and showed subjective improvement of the symptoms. But rather rapidly progressive weakness of lower extremities and voiding difficulty were newly developed, and the thoracic spinal MRI showed diffuse epidural abscess along the entire thoracic segment. He showed excellent clinical improvement with additive steroid therapy.
Adult ; Biopsy ; Brain ; Drug Therapy ; Epidural Abscess* ; Humans ; Inflammation ; Lower Extremity ; Magnetic Resonance Imaging ; Meningitis ; Tuberculosis* ; Tuberculosis, Pulmonary

Uterine artery embolization for the treatment of uterine leiomyomas is gaining acceptance as an effective alternative to surgical treatment in preserving uterus and reducing symptoms. Vaginal expulsion of leiomyomas after UAE is uncommon, and has been regarded as a side effect of the procedure, as well as a natural phenomenon of treatment response. A-28-year-old unmarried woman who has been suffered from menorrhagia underwent UAE. MRI revealed the remnant leiomyomas were reduced in size and volume and also symptoms of leiomyomas were much improved. After 6 month, We've made sure about non-visualization of leiomyoma on follow-up pelvic dynamic MRI. We report this rare case of vaginal expusion of intramural leoimyoma with a brief literature.
Female ; Follow-Up Studies ; Humans ; Leiomyoma* ; Magnetic Resonance Imaging ; Menorrhagia ; Single Person ; Uterine Artery Embolization* ; Uterine Artery* ; Uterus

PURPOSE: To compare high-resolution CT (HRCT) findings of bronchiectasis caused by tuberculosis and due tocauses other than tuberculosis. MATERIALS AND METHODS: We retrospectively evaluated the HRCT findings of 93patients with bronchiectasis (in 40 patients caused by tuberculosis, and in 53 due to nontuberculous causes).Diagnostic bases for tuberculous bronchiectasis were positive sputum AFB or the presence of radiological findingsof pulmonary tuberculosis, plus a history of antituberculous chemotherapy. HRCT findings were analyzed andcompared in terms of disease extent, site, type, distribution of bronchiectasis, severity of bronchial dilatation,and bronchial wall thickening . RESULTS: Compared with nontuberculous bronchiectasis, the tuberculousbronchiectasis group showed more frequent upper lobe involvement, varicose type bronchiectasis, fibrotic band andcalcification, adjacent pleural thickening, bronchovascular distortion, and paracicatricial emphysema (p<0.05).The nontuberculous bronchiectasis group more frequently involved the lower lobe and showed a higher frequency ofcystic type bronchiectasis (p<0.05). The two groups showed no differences in the frequency of bilateral orwidespread involvement and in the severity of bronchial wall thickening and bronchial dilatation. CONCLUSION: Inpatients with bronchiectasis, HRCT findings of upper lobar distribution, fibrotic changes and calcification,traction or varicose type bronchiectasis, bronchovascular distortion, paracicatricial emphysema, and adjacentpleural thickening suggesta tuberculous origin.
Bronchiectasis* ; Dilatation ; Drug Therapy ; Emphysema ; Humans ; Inpatients ; Retrospective Studies ; Sputum ; Tuberculosis ; Tuberculosis, Pulmonary

Stenotrophomonas maltophilia (previously named Xanthomonas maltophilia) is an aerobic, non-fermentive, Gram-negative bacillus that is wide spread in the environment. It was considered to be an organism with limited pathogenic potential, which was rarely capable of causing diseases in human other than those who were in debilitated or immunocompromised state. More recent studies have established that Stenotrophomonas maltophilia can behave as a true pathogen. Endocarditis due to this organism is rare, and only 24 cases of Stenotrophomonas maltophilia endocarditis have been reported in the medical literature. Most cases were associated with risk factors, including intravenous drug abuse, dental treatment, infected intravenous devices, and previous cardiac surgery. We present a case with two episodes of Stenotrophomonas maltophilia endocarditis after mitral valve prosthesis implantation, which was treated with antibiotics initially, and a combination of antibiotics and surgery later. To our knowledge, this is the first case of repetitive endocarditis due to Stenotrophomonas maltophilia.
Adult ; Anti-Bacterial Agents/*therapeutic use ; Bioprosthesis/adverse effects/*microbiology ; Endocarditis, Bacterial/*drug therapy/physiopathology ; Gentamicins/therapeutic use ; Gram-Negative Bacterial Infections/*drug therapy/physiopathology ; Heart Valve Prosthesis/adverse effects/*microbiology ; Humans ; Male ; Mitral Valve ; Recurrence ; Stenotrophomonas maltophilia/*drug effects ; Treatment Outcome ; Trimethoprim-Sulfamethoxazole Combination/*therapeutic use ; Vancomycin/therapeutic use