OBJECTIVE: This study was performed to evaluate the effect of cervical cerclage and the clinical characteristics in incompetent internal os of the cervix (IIOC). METHODS: A study was conducted on 170 patients with IIOC, 199 cases of IIOC were admitted and treated with McDonald operation or modified Shirodkar operation at department of Obstetrics and Gynecology Il Sin Christian Hospital from January 1. 1994 to December 31. 1998, of this 14 cases were follow up lost, so 185 cases were analyzed. RESULTS: 1) The incidence of IIOC was 0.43%, 1 in 233 deliveries. 2) The mean age of IIOC patients was 30.54yrs old and the most frequent age group was in 30-34yrs old group (43.78%). 3) The average number of gravida and parity before operation were 4.71 and 1.62. & the success rate of operation was low at high gravida & parity. 4) The predisposing factor was previous history of dilation & curettage (43.75%), Cx. laceration after delivery (6.49%), midtrimester termination (4.32%) etc. 5) The operation methods were McDonald operation (91.35%) and modified Shirodkar operation (8.65%) & the success rate of McDonald operation and modified Shirodkar operation were 85.80% and 87.50%. 6) The successful fetal salvage rate was 85.95% and the highest success rate was 87.50% in 14-16 weeks of gestation group. 7) The more cervix dilate, the more failure occurred. 8) The causes of operation failure were premature rupture of membrane (50.00%), preterm labor (34.62%), FDIU, anomaly, APH etc. 9) The delivery methods after operation were vaginal delivery (65.54%), cesarean delivery (34.46%). CONCLUSION: The 14-16th weeks of gestation group & no cervical dilatation have higher success rate indicating that early diagnosis and appropriate timing of operation is associated with a greater operation success rate.
Causality ; Cerclage, Cervical ; Cervix Uteri* ; Curettage ; Early Diagnosis ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Incidence ; Labor Stage, First ; Lacerations ; Membranes ; Obstetric Labor, Premature ; Obstetrics ; Parity ; Pregnancy ; Pregnancy Trimester, Second ; Rupture

Pulmonary actinomycosis is a rare yet important and challenging diagnosis to make. It is commonly confused with other lung diseases, such as tuberculosis and bronchogenic carcinoma, leading to delay diagnosis or misdiagnosis. A 49-year-old man presented with a chronic cough, hemoptysis, and pleuritic chest pain. His initial imaging studies including computed tomography (CT) was suggestive of bronchogenic carcinoma. A subsequent CTguided biopsy was consistent with pulmonary actinomycosis and excluded the possibility of bronchogenic carcinoma. He was treated with antibiotic therapy and achieved remission with complete radiological resolution upon follow-up.

OBJECTIVES: Using two stimuli, this study was designed to evaluate variations of P300 in relations to reaction time of pressing the button for target tones in patients with schizophrenia. METHODS: The auditory oddball paradigm was used for the patients (N=22) and normal controls (N=23). The two stimuli were composed of target (20%, 2000 Hz, 75 dB) tone and standard (80%, 1000 Hz, 75 dB) tone, with 2 sec inter-stimulus interval, 50 msec duration and 10 msec rise or fall time. In each subject, P300s were acquired for both fast reaction time (FRT) and slow reaction time (SRT) to target response. RESULTS: P300 amplitude in patients with schizophrenia was lower than controls across FRT and SRT (p<0.001), but P300 latency was not delayed (p>0.8). In this study, even though the reaction time for the button pressing task might be faster in patients with schizophrenia (p<0.1), the P300 to FRT in patients with schizophrenia was lower than the P300 to SRT in controls (p<0.01). CONCLUSION: These results suggest that the lower P300 in patients with schizophrenia might be due to cognitive dysfunction and the patient's performance in reaction time for pressing buttons, both independently. Thus, P300 as well as reaction time may be used to further explore a variety of domains of cognitive function.
Evoked Potentials* ; Humans ; Reaction Time* ; Schizophrenia*

OBJECTIVE: To evaluate the relationship of single umbilical artery with congenital anomaly, chromosomal anomaly & pregnancy outcome. METHODS: From January 1993 to December 2000, 143 cases of single umbilical artery were observed among 72,194 total deliveries at Ilsin christian hospital. Pregnancy and perinatal outcome data were retrieved by review of the medical records. RESULTS: The incidence of single umbilical artery (SUA) was 0.2% (143 cases). Isolated SUA without any anomaly were 89 cases (62.2%), SUA with anomaly were 42 cases (29.4%) ; with multiple anomaly were 20 (14%) and stillbirth were 12 (8.4%). Cardiovascular & musculoskeletal system anomalies were common congenital anomalies, 35.7% respectively. Among the 86 cases (60.1%) of chromosomal studies, chromosomal anomalies were observed in 4 cases (2.8%) ; 2 cases were Trisomy 18, 2 cases were 45,XX,-13,-14,+t (13q:14q), 46,XY,t(1:9) (q11:q11). No chromosomal anomaly was observed in isolated SUA without any other anomaly. On 74cases with obstetric complication, intrauterine growth restriction (n=27, 20.6%), preterm birth (n=12, 10%), hydramnios (n=11, 8.4%), oligohydramnios (n=7, 5.3%), preeclampsia (n=6, 4.6%), maternal gestational DM (n=5, 3.8%) were observed. CONCLUSION: When a single umbilical artery is identified during antenatal care, careful search such as targeted ultrasonography & fetal echocardiography should be taken for associated anomaly, and chromosomal study should be considered in case of SUA with any anomaly.
Echocardiography ; Female ; Fetus* ; Humans ; Incidence ; Infant, Newborn* ; Medical Records ; Musculoskeletal System ; Oligohydramnios ; Polyhydramnios ; Pre-Eclampsia ; Pregnancy ; Pregnancy Outcome ; Premature Birth ; Single Umbilical Artery* ; Stillbirth ; Trisomy ; Ultrasonography

Intraductal papillary mucinous neoplasms (IPMNs) are premalignant lesions that require a surgical resection. IPMN can cause abdominal pain or pancreatitis as a result of either mucin production or a papillary growth, resulting in a ductal obstruction. Most IPMNs arise from the main pancreatic duct. However, IPMNs arising from the accessory pancreatic duct are extremely rare. Pancreatic divisum occurs when the ventral and dorsal ducts of the pancreas fail to fuse during organogenesis. It is the most common congenital variant of pancreatic-ductal development, and occurs in approximately 10~14% of individuals. Although pancreatic divisum has no clinical relevance, some patients present with acute recurrent or chronic pancreatitis. In most cases, it is discovered incidentally during an examination of pancreatitis, and is occasionally accompanied by a pancreatic tumor. We report the first case of IPMN in a patient with an incomplete pancreatic divisum in Korea.
Abdominal Pain ; Humans ; Korea ; Mucins* ; Organogenesis ; Pancreas ; Pancreatic Ducts ; Pancreatitis ; Pancreatitis, Chronic

Recent studies have shown that circulating microRNAs are a potential biomarker in various types of malignancies. The aim of this study was to investigate the feasibility of using serum exosomal microRNAs as novel serological biomarkers for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). We measured the serum exosomal microRNAs and serum circulating microRNAs in patients with CHB (n=20), liver cirrhosis (LC) (n=20) and HCC (n=20). Serum exosomal microRNA was extracted from 500 mul of serum using an Exosome RNA Isolation kit. The expression levels of microRNAs were quantified by real-time PCR. The expression levels of selected microRNAs were normalized to Caenorhabditis elegans microRNA (Cel-miR-39). The serum levels of exosomal miR-18a, miR-221, miR-222 and miR-224 were significantly higher in patients with HCC than those with CHB or LC (P<0.05). Further, the serum levels of exosomal miR-101, miR-106b, miR-122 and miR-195 were lower in patients with HCC than in patients with CHB (P=0.014, P<0.001, P<0.001 and P<0.001, respectively). There was no significant difference in the levels of miR-21 and miR-93 among the three groups. Additionally, the serum levels of circulating microRNAs showed a smaller difference between HCC and either CHB or LC. This study suggests that serum exosomal microRNAs may be used as novel serological biomarkers for HCC.
Adult ; Aged ; Biomarkers, Tumor/blood/genetics ; Carcinoma, Hepatocellular/blood/diagnosis/*genetics ; Exosomes/genetics ; Female ; Gene Expression Profiling ; Humans ; Liver/pathology ; Liver Neoplasms/blood/diagnosis/*genetics ; Male ; MicroRNAs/blood/*genetics ; Middle Aged

The web of the common bile duct is an extremely rare condition and is attributed to obstructive jaundice. Most cases have been found incidentally during a surgical procedure, since no specific preoperative clinical manifestations exist. Typically, the web of the biliary tree appears as a slit- or shelf-like radiolucent narrowing on a cholangiography. We experienced a case of the web of the common bile duct with obstructive jaundice in a 62 year- old female who complained of right upper quadrant pain. The patient was diagnosed via an endoscopic retrograde cholangiopancreaticography, and treated by way of a cholecystectomy, membranectomy and T-tube insertion. Four months after the surgical procedure, the patient had a recurrence of the web-like structure in the common bile duct and was subsequently treated successfully using a retrievable covered metallic stent insertion.
Biliary Tract ; Cholangiography ; Cholecystectomy ; Common Bile Duct ; Female ; Humans ; Jaundice, Obstructive ; Recurrence ; Stents

No abstract available.
Bile Ducts* ; Bile* ; Carcinoma, Hepatocellular*

BACKGROUND AND PURPOSE: Evaluating instrumental activities of daily living (IADL) is an important part of procedure to diagnose dementia. The Korean-Instrumental Activities of Daily Living (K-IADL) has been used extensively in Korea. However, its cut-off score has not been reformulated since 2002. The purpose of this study was to yield a new optimal cut-off score for the K-IADL and confirm the validity of this new cut-off score with various dementia groups. METHODS: We retrospectively collected a total of 2,347 patients' K-IADL data from 6 general hospitals in Korea. These patients had mild cognitive impairment (MCI) or dementia with various etiologies for cognitive impairment. We also recruited a normal control group (n=254) from the community. Korean-Mini Mental State Examination, Short version of the Geriatric Depression Scale, Clinical Dementia Rating, and Global Deterioration Scale were administered to all participants. Caregivers completed K-IADL and Barthel Index. RESULTS: K-IADL scores were significantly different among dementia subgroups, but not significantly different among MCI subgroups. Based on internal consistency, correlations with other scales, and factor analysis, K-IADL showed excellent reliability and validity. The new optimal cut-off score to diagnose dementia was 0.40, which gave a sensitivity of 0.901 and a specificity of 0.916. Positive predictive value for dementia using the new cut-off score was 94.2% for Alzheimer's disease, 100% for vascular dementia, and 84% for Parkinson's disease. CONCLUSIONS: Our results illustrate that the new K-IADL cut-off score of 0.40 is reliable and valid for screening impairments of daily functioning resulting from various etiologies.
Activities of Daily Living* ; Alzheimer Disease ; Caregivers ; Cognition Disorders ; Dementia ; Dementia, Vascular ; Depression ; Hospitals, General ; Humans ; Korea ; Mass Screening ; Mild Cognitive Impairment ; Parkinson Disease ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Weights and Measures

PURPOSE: The N-myc amplification is one of well known poor prognostic markers in neurblastoma. Because the traditional detection method, Southern blot, is expensive, labor-intensive and time-consuming, the detection of N-myc amplification is not routinely performed in Korea. The purposes of this study are to develop polymerase chain reaction (PCR) for detecting N-myc amplification in neuroblastoma tumor tissue, and to elucidate the clinical significance of N-myc amplification. METHODS: The clinical data and paraffin embedded tumor specimen of 54 neuroblastoma cases were collected from 10 medical centers in Korea. We have developed semiquantitative method of estimating gene copy number that uses differential PCR. N-myc gene primers (RC N-myc, N-myc 7-1) are amplified together with primers from a single-copy internal control gene (beta-globin). After ethidium bromide-stained agarose gel electrophoresis, the ratio of the two PCR products, which stands for N-myc amplification, is determined. Kaplan-Meier survival analysis was performed to evaluate the prognostic significance of N-myc amplification. RESULTS: The differential PCR was very effective, less expensive, less labor-intensive, and simple detection method for N-myc amplification. The percentage of N-myc amplification was higher in the patients older than 1 year old (34.1%: 14/41), when they were compared to the patients younger than 1 year old (16.7%: 2/12). The percentage of N-myc amplification was higher in the patients who have primary tumor at adrenal gland (40.9%: 9/22) than who have primary tumor at retroperitoneum (17.6%: 3/17) or at mediastinum (16.7%: 2/12). In Stage I, II, and III patients, the mean survival time of N-myc amplified group was 18 months and that of N-myc umamplified group was 64 months (Log Rank 4.35, P=0.037). CONCLUSION: The differential PCR was very effective, less expensive, less labor-intensive, and simple detection method for N-myc amplification. The N-myc amplification is one of poor prognostic indicators in Neuroblastoma.
Adrenal Glands ; Blotting, Southern ; Electrophoresis, Agar Gel ; Ethidium ; Gene Dosage ; Genes, myc ; Humans ; Korea ; Mediastinum ; Neuroblastoma* ; Paraffin ; Polymerase Chain Reaction* ; Prognosis ; Survival Rate