Luteal phase defect (LPD) is an ovulatory disorder of considerable clinical importance that leads to delayed endometrial maturation and inadequate endometrium for blastocyst implantation. This disorder is implicated in infertility and recurrent spontaneous abortion. We analyzed the endometrial histological maturation, and the estrogen receptor(ER) and progesterone receptor(PR) status in patients with unexplained delayed ovulation, and in patients with ovulation induction by clomiphen citrate. The purpose of this study was to determine whether the length of the follicular phase influences the endometrial histological maturation and the hormonal receptor status, and to know the effect of clomiphen citrate on the endometrium. In the delayed ovulation group, the endometrium was characterized by an irregular outpouching and dilated lumina of the glands, a decreased secretory activity and predecidualization, and a decreased number of granulocytes in the stroma. In the clomiphen citrate-ovulation induction group, glandular proliferation was markedly diminished with poorly convoluted and narrow glands, secretory activity was decreased, stroma was undecidualized, and there was an absence of granulocytes. ER expression was increased in the glandular epithelium in the delayed ovulation group, and both ER and PR expressions were markedly decreased in the glandular epithelium and stromal cells in the ovulation induction group. Endometrial maturation and differentiation may be diminished by increased estrogenic and relatively deficient progesterone effects in patients with delayed ovulation. The hormonal receptor status might also be influenced by hormonal changes. Clomiphen citrate successfully induced ovulation in patients with delayed ovulation, however, endometrial proliferation and maturation were markedly suppressed. This might be related to the lower pregnancy rate and higher abortion rate in patients with clomiphen citrate induced ovulation.
Pregnancy ; Female ; Humans

The plasmepsins are the aspartic proteases of malaria parasites. Treatment of aspartic protease inhibitor inhibits hemoglobin hydrolysis and blocks the parasite development in vitro suggesting that these proteases might be exploited their potentials as antimalarial drug targets. In this study, we determined the genetic variations of the aspartic proteases of Plasmodium vivax (PvPMs) of wild isolates. Two plasmepsins (PvPM4 and PvPM5) were cloned and sequenced from 20 P. vivax Korean isolates and two imported isolates. The sequences of the enzymes were highly conserved except a small number of amino acid substitutions did not modify key residues for the function or the structure of the enzymes. The high sequence conservations between the plasmepsins from the isolates support the notion that the enzymes could be reliable targets for new antimalarial chemotherapeutics.
Amino Acid Sequence ; Animals ; Aspartic Endopeptidases/*genetics ; Base Sequence ; Cloning, Molecular ; Conserved Sequence ; DNA, Protozoan/chemistry/genetics ; Human ; Molecular Sequence Data ; Plasmodium vivax/*enzymology/genetics/isolation & purification ; Polymerase Chain Reaction ; Sequence Alignment ; Sequence Analysis, DNA ; Support, Non-U.S. Gov't

Erythromelalgia is a rare neurovascular pain syndrome characterized by a triad of redness, increased temperature, and burning pain primarily in the extremities. Erythromelalgia can present as a primary or secondary form, and secondary erythromelalgia associated with a myeloproliferative disease such as essential thrombocythemia often responds dramatically to aspirin therapy, as in the present case. Herein, we describe a typical case of a 48-year-old woman with secondary erythromelalgia linked to essential thrombocythemia in the unilateral hand. As this case demonstrates, detecting and visualizing the hyperthermal area through infrared thermography of an erythromelalgic patient can assist in diagnosing the patient, assessing the therapeutic results, and understanding the disease course of erythromelalgia.
Aspirin ; Burns ; Erythromelalgia ; Extremities ; Female ; Hand ; Humans ; Neuralgia ; Thermography ; Thrombocythemia, Essential

The purpose of this study was to establish the normal values of tendon reflex in normal Korean adults. Ankle tendon reflex(ATR), patellar tendon reflex(PTR) and medial hamstring tendon reflex (MHTR) responses were recorded in 96 limbs of 48 normal Korean adults by delivering tendon taps with an electric reflex hammer. Latency to the onset of the triggered response, peak to peak amplitude and duration of the wave were measured after several repetitions. Minimum latency and duration of the elicited response were chosen to calculate normal means. Side differences were also evaluated. As amplitude showed a marked interindividual variation and side to side variation, lowest recorded value was selected to represent the lower limit of normal. Mean values of latency, duration and amplitude were 30.27?3.18 msec, 11.05?1.08 msec and 1.98?0.89 mV for ATR, 16.37?1.58 msec, 20.63?1.68 msec and 1.56?0.76 mV for PTR and 20.25?2.14 msec, 10.95?1.57 msec and 0.71?0.56 mV for MHTR. Age, height, and leg length showed significant correlation with the latency of ATR, PTR and MHTR latency(P<0.001). We believe our results can be used as guideline researches in clinical practice.
Adult* ; Ankle ; Extremities ; Humans ; Leg ; Patellar Ligament ; Reference Values* ; Reflex ; Reflex, Stretch* ; Tendons*

BACKGROUND: Bronchial hyperresponsiveness and abnormal response such as a loss of distensi- bility are pathophysiologic characteristics if bronchial asthma. The only means of direct in vivo measurement of airway size had been a tantalium bronchography, until high-resolution computed tomography(HRCT) enabled to measure noninvasively two dimensional airway area more accurately and reliably. METHOD: To investigate airway area responses to bronchial provocation with methacholine and evaluate the major sites of bronchial constriction in patients with bronchial asthma. We examined HRCT scans in five patients with bronchial asthma who had significant bronchoconstriction(20% or more decrease in FEV1) using CT scanner(5,000T CT, Shimadzu Co, Japan) before and in 3~5 min. after methacholine inhalation. Airways which were matched by parenchymal anatomic landmarks in each patient before and after methacholine inhalation were measured using film scanner(TZ-3X scanner; Truvel Co. Chatsworth CA, USA) and a semiautomated region growing method. RESULTS: 1) We identified 9 to 12 airways in each patient which were matched by parenchymal anatomic landmarks before and after methacholine inhalation. 2) Airway responses to methacholine are quite different even in a patient. 3) The constriction of small airways(average diameter <2 mm; area <3.14mm2) was 48.7% (8.3; SEM, n=43), being more prominant than that of large airways(average diameter >2 mm; area >3.14 mm2), 53.8% (4.4;SEM, n=10), but not significantly different(p>0.05). 4) There was no significant difference in the degree of constriction between upper(44.3% +5.8; mean + SEM, n=30) and lower lung regions(56.7% +4.5, n=23). CONCLUSIONS: Thus airway responses to methacholine bronchoprovocation is quite variable in a patient with bronchial asthma and has no typical pattern in patients with bronchial asthma.
Anatomic Landmarks ; Asthma* ; Bronchoconstriction ; Bronchography ; Constriction ; Humans ; Inhalation ; Lung ; Methacholine Chloride

Leptospirosis is a zoonotic disease of worldwide distribution that is caused by spirochetes known as Leptospira; more than 20 serogroups and more than 200 serovars are known. The disease has seasonal incidence occurring in the late summer or early fall. The typical severe case of leptospirosis is known as Weil's disease; it is characterized by hepatic and renal involvement and is common in Korea. Elevated amylase can be seen when ARF is associated but true acute pancreatitis is an uncomon complication of leptospirosis and only seven cases of well documented pancreatitis have been described abroad, with there was no case report in Korea yet. We experienced a 55-year old male patient who had Weil's disease associated with acute pancreatitis which was confirmed by elevated amylase and lipase with pancreatic swelling and peripancreatic fat infiltration on abdomen CT.
Abdomen ; Amylases ; Humans ; Incidence ; Korea ; Leptospira ; Leptospirosis ; Lipase ; Male ; Middle Aged ; Pancreatitis* ; Seasons ; Spirochaetales ; Weil Disease* ; Zoonoses

BACKGROUND: Early recognition of fungemia is essential for successful treatment. However, methods to culture fungus specimen taken from fungemia patients are difficult and time consuming. To assess the clincal usefulness of beta-D-glucan in the detection of fungemia, we compared serum (1-->3)-beta-D-glucan concentrations in fungemia, bacteremia, and healthy persons. METHODS: From August 2001 to October 2002, serum (1-->3)-beta-D-glucan concentrations were measured by turbidometric assay in 16 fungemia patients, 13 bacteremia patients and 18 healthy persons. Differences in (1-->3)-beta-D-glucan concentrations between fungemia patients and other groups were compared by t-test. RESULTS: Fungemia patients were composed of 10 male and 6 female patients, and mean age was 52.9+/-16.2 years. The cut-off value for a positive result was 11 pg/mL. thirteen out of 16 fungemia patients had concentrations above the cul-off value (range:11.5-863 pg/mL, sensitivity:81.3%, specificity:100%), and mean concentration in fungemia was 217.8+/-273.8 pg/mL. Mean concentration in bacteremia was 0.1+/-0.3 pg/mL, and all the patients with bacteremia had the concentrations below the cut-off value. Mean concentration in the healthy persons was 0 pg/mL and all healthy persons had concentration below the cut-off value. The concentration in fungemia was statistically significantly higher than those of the other two groups(p-value: respectively 0.006, 0.006) CONCLUSION: We concluded that serum (1-->3)-beta-D-glucan is useful for the diagnosis of fungemia. Further study on the usefullness of serum (1->3)-beta-D-glucan for early detection of fungemia and therapeutic monitoring is warranted.
Bacteremia ; Diagnosis* ; Female ; Fungemia* ; Fungi ; Humans ; Male

Leptospirosis is a zoonotic disease of worldwide distribution that is caused by spirochetes known as Leptospira; more than 20 serogroups and more than 200 serovars are known. The disease has seasonal incidence occurring in the late summer or early fall. The typical severe case of leptospirosis is known as Weil's disease; it is characterized by hepatic and renal involvement and is common in Korea. Elevated amylase can be seen when ARF is associated but true acute pancreatitis is an uncomon complication of leptospirosis and only seven cases of well documented pancreatitis have been described abroad, with there was no case report in Korea yet. We experienced a 55-year old male patient who had Weil's disease associated with acute pancreatitis which was confirmed by elevated amylase and lipase with pancreatic swelling and peripancreatic fat infiltration on abdomen CT.
Abdomen ; Amylases ; Humans ; Incidence ; Korea ; Leptospira ; Leptospirosis ; Lipase ; Male ; Middle Aged ; Pancreatitis* ; Seasons ; Spirochaetales ; Weil Disease* ; Zoonoses

BACKGROUND: Early recognition of fungemia is essential for successful treatment. However, methods to culture fungus specimen taken from fungemia patients are difficult and time consuming. To assess the clincal usefulness of beta-D-glucan in the detection of fungemia, we compared serum (1-->3)-beta-D-glucan concentrations in fungemia, bacteremia, and healthy persons. METHODS: From August 2001 to October 2002, serum (1-->3)-beta-D-glucan concentrations were measured by turbidometric assay in 16 fungemia patients, 13 bacteremia patients and 18 healthy persons. Differences in (1-->3)-beta-D-glucan concentrations between fungemia patients and other groups were compared by t-test. RESULTS: Fungemia patients were composed of 10 male and 6 female patients, and mean age was 52.9+/-16.2 years. The cut-off value for a positive result was 11 pg/mL. thirteen out of 16 fungemia patients had concentrations above the cul-off value (range:11.5-863 pg/mL, sensitivity:81.3%, specificity:100%), and mean concentration in fungemia was 217.8+/-273.8 pg/mL. Mean concentration in bacteremia was 0.1+/-0.3 pg/mL, and all the patients with bacteremia had the concentrations below the cut-off value. Mean concentration in the healthy persons was 0 pg/mL and all healthy persons had concentration below the cut-off value. The concentration in fungemia was statistically significantly higher than those of the other two groups(p-value: respectively 0.006, 0.006) CONCLUSION: We concluded that serum (1-->3)-beta-D-glucan is useful for the diagnosis of fungemia. Further study on the usefullness of serum (1->3)-beta-D-glucan for early detection of fungemia and therapeutic monitoring is warranted.
Bacteremia ; Diagnosis* ; Female ; Fungemia* ; Fungi ; Humans ; Male