No abstract available.
Constriction, Pathologic* ; Neurologic Manifestations* ; Spinal Canal*

Bisphosphonate is used widely for osteoporosis management. On the other hand, some studies have reported that prolonged use of bisphosphonate without a proper resting period can cause insufficiency fracture and, in rare cases, fractures on the femur neck. This paper reports a case of an elderly patient who suffered bilateral femur neck insufficiency fractures induced by non-stopped long-term bisphosphonate therapy. The patient complained of pain in her buttocks at the first visit. During the admission period, inguinal area pain newly developed. Both a femur neck insufficiency fracture was observed on the hip radiographic image. Hip pinning and postoperative parathyroid hormone treatment were performed. The patient was discharged without specific complications and reported improvement in symptoms on the last follow-up. Several authors have reported one-sided femoral neck insufficiency fractures due to bisphosphonate use, but the present case is uncommon in that it occurred simultaneously in both femur necks. In addition, in the case of bilateral femur fractures, the walking ability after surgery is lower than that of one-sided fracture cases, so active rehabilitation is necessary.

The incidence of ectpic pregnancy has increased rapidly over the past decade. Currently, the complications of this disorder make it one of the leading causes of maternal mortality and morbidity. In the late 1980s, reports of successful use of methotrexate (MTX) as a non surgical treatment for ectopic pregnancy (EP) also began to appear in the literature. With MTX emerging as a possible alternative management of selected women with an EP, an analysis of its comparative costs is now needed. We examined retrospectively the costs associated with management of EP in our hospital. We selected 30 women with EPand divided them into two groups of MTX treated group (n= l0) and surgically treated group (n=20). There were no statistically significant differences in the doctors fee, room, charge and cost of laboratory and radiologic examination between two groups. But We found significant reduction in cost with regard to pharmacy, injection, procedure and operation of MTX treated group compared to surgically treated group (p<0.05). Consequently the use of MTX for EP should still be considered investigational; we recognize and agree that the evolution of this remedial option should be based primarily on its ability to decrease morbidity and mortality rather than on its ability to reduce costs. If medical treatment proves to be effective, the potential cost savings demonstrated in this report will become an important influential factor on selecting alternative remedy.
Cost Savings ; Fees and Charges ; Female ; Humans ; Incidence ; Maternal Mortality ; Methotrexate ; Mortality ; Pharmacy ; Pregnancy ; Pregnancy, Ectopic* ; Retrospective Studies

No abstract available.
Lung Neoplasms* ; Lung* ; Muscle, Skeletal* ; Neoplasm Metastasis*

OBJECTIVE: To assess the reliability of triple marker screening test in midtrimester pregnancy for fetal Down syndrome. METHODS: From October 1, 1996 to May 31, 1998 at Nowon Eulji Hospital, 3700 Pregnant women underwent serum tiple marker screening for Down syndrome during 15-20weeks of gestational age. The results of serum triple marker screenig tests for Down syndrome and the outcomes of pregnancies were retrospectively assesed. RESULTS: Sixty seven of 3700 cases(1.81%) were positive in screening test, and 3633(98.18%) cases were negative. Among 67 cases of positive screening test, 1 case(1.49%) was diagnosed as Down syndrome. Among 3633 cases of negative screening test, 4 cases(0.1%) were diagnosed as chromosomal abnormalies postnatally. Two of these 4 cases of chromosomal abnormalies were Down syndrome. CONCLUSION: With this results, sensitivity of triple marker screeing test for Down syndrome is very low as 33.3%. In order to increase the sensitivity, some compensatory adjustment is required in triple marker screening test.
Down Syndrome* ; Equidae ; Female ; Gestational Age ; Humans ; Mass Screening* ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second* ; Pregnant Women ; Retrospective Studies

PURPOSE: A cross-calibration equation is needed to compare bone mineral density measured by different dual X-ray absoptiometry systems. We performed this study to establish appropriate cross-calibration equations between two different dual X-ray absorptiometry systems. MATERIALS AND METHODS: Bone mineral density of anterior-posterior lumbar spine (L2-4 level) and femoral neck were measured in 109 women (55+/-11yr) using two different dual X-ray absorptiometry systems (Lunar EXPERT-XL) and Hologic QDR 4500-A). Bone mineral density values measured by two systems, including area, bone mass content, bone mineral density and percentile of young normals were compared and cross-calibration equations between two systems derived. RESULTS: The bone mineral density values of 109 women measured by Lunar system were 0.958+/-0.17 g/cm2 at L2-4 and 0.768+/-0.131 g/cm2 at femur neck, which were significantly higher (13+/-6% at L2-4 and 19+/-7% at femur neck, p<0.001) than those (0.851+/-0.144 g/cm2 at L2-4 and 0.649+/-0.108 g/cm2 at femur neck) by Hologic system. Bone mineral content and percentile of young normals measured by Lunar system were also significantly higher than those by Hologic system (p<0.001), whereas there was no difference in area (p>0.05). There was a high correlation between bone mineral density values of L2-4 and femoral neck obtained with both dual X-ray absortiometry systems (r=0.96 and 0.95, respectively). Cross-calibration equations relating the bone mineral density were Lunar=1.1287xHologic-0.0027 for L2-4 and Lunar=l.1556xHologic+0.0l82 for femoral neck. CONCLUSION:: We obtained cross-calibration equations of bone mineral density between Lunar EXPERT-XL and Hologic QDR 4500-A. These equations can be useful in comparing bone mineral density obtained by different dual X-ray absorptiometry systems.
Absorptiometry, Photon* ; Bone Density* ; Female ; Femur ; Femur Neck ; Humans ; Osteoporosis ; Spine

We analyzed alcoholic extracts of herbs possessing anti-neosporal activity against Neospora (N.) caninum. To identify the chemical components of Sophora (S.) flavescens and Torilis (T.) japonica associated with anti-neosporal activity, specific fractions were isolated by high-performance liquid chromatography (HPLC). In vitro activity of the fractions against N. caninum was then assessed. Gas chromatography/mass spectrometry (GC/MS) was used to identify and quantify specific anti-neosporal molecules in the herbal extracts. Almost all HPLC fractions of S. flavescens and T. japonica had higher levels of anti-neosporal activity compared to the not treated control. Active constituents of the extracts were sophoridane, furosardonin A, and tetraisopropylidene-cyclobutane in S. flavescens; 5,17-beta-dihydroxy-de-A-estra-5,7,9,14-tetraene, furanodiene, and 9,12-octadecadienoic acid (Z,Z)-(CAS,1) in T. japonica.
Apiaceae/*chemistry ; Chromatography, High Pressure Liquid ; Coccidiostats/*chemistry ; Fruit/chemistry ; Gas Chromatography-Mass Spectrometry ; Neospora/*drug effects/growth & development ; Plant Extracts/*chemistry ; Plant Roots/chemistry ; Sophora/*chemistry

BACKGROUND: In a noisy hospital setting, it is not easy to induce hypnosis or sedation calmly. Although the noise stress has been neglected, it seems to disturb a patient's sleep or induction of sedation. Therefore, we tried to evaluate the effects of loud operating room (OR) background noise on bispectral index (BIS) during monitored anesthesia care (MAC) by using an audiometer and BIS monitor. METHODS: Thirty adult patients (ASA class I) were scheduled two times for nasal or dental procedures at an interval of two or three days. In a randomized, cross-over study design, we prospectively compared the BIS values according to the loudness of OR noise in two different depths of sedation during MAC. Propofol target controlled infusion (TCI) was started at a propofol target concentration (CT) 2.0 microgram/ml using a DiprifusorTM with flash mode until a BIS 80 and/or a modified Observer's Assessment of Alertness/Sedation (mOAAS) score of 4 (group 1), and BIS 75 and/or mOAAS score 3 (group 2) was obtained. We evaluated the effect site concentrations and the elapsed time and checked the BIS at 50, 80, 110, and 120 dB of sound pressure level (SPL) in both groups. RESULTS: The BIS at 80, 110 and 120 dB of SPL in group 1 was significantly increased compared to those at 50 dB (P < 0.05). Similarly, the BIS at 110 and 120 dB of SPL in group 1 was significantly increased compared to those at 80 dB (P < 0.05). The patients in their twenties were most susceptible to loud OR noise during sedation. CONCLUSIONS: The loud OR background noise might be possible to interfere with induction of sedation to a degree, which was more noticeable on light to moderate sedation than for deep sedation.
Adult ; Anesthesia* ; Conscious Sedation ; Cross-Over Studies ; Deep Sedation ; Humans ; Hypnosis ; Noise* ; Operating Rooms* ; Propofol ; Prospective Studies

BACKGROUND: A correct estimation of volume status and dry weight in dialysis patients remains a difficult clinical problem. Clinical status and chest X-ray are not sensitive enough, while invasively measured central venous pressures are not routinely available. Recently, the ultrasonographic determination of the diameter and collapse index of the inferior vena cava has been proposed as a noninvasive method for estimating intravascular volume. We tried to evaluate the clinical relevance of this method in dialysis patients by comparing it with alphahuman-atrial natriuretic peptide (alpha-h-ANP) and cyclic guanosine 3:5-monophosphate (cGMP) levels. METHODS: Using echocardiography, the diameter of the inferior vena cava (VCD) and its decrease on deep inspiration (collapse index : CI) were evaluated in 27 hemodialysis patients. Echocardiography of the inferior vena cava (IVC) was performed in the supine position after 10 minutes rest. The transducer was placed in the subxiphoid region and long and short axis views of the IVC were obtained just below the diaphragm in the hepatic segment. VCD was measured before the P-wave on the electrocardiogram to avoid interference with A-wave and V-wave on the venous pressure curve, and corrected for body surface area. Preand post-hemodialysis levels of the plasma alpha-h-ANP and cGMP were measured by radioimmunoassay. The relationship between VCD, CI determined by echocardiography, and alpha-h-ANP and cGMP concentrations were studied. RESULTS: The levels of alpha-h-ANP and cGMP were markedly elevated before hemodialysis and significantly lower values were found after hemodialysis (alpha-hANP : 162.7 102.6 pg/ml vs 90.6 61.0 pg/ml , cGMP : 35.3 8.8 pmol/ml vs 21.3 6.2 pmol/ml). A significant correlation was found between VCD and alpha-h-ANP before (r=0.81, p < 0.05) and after hemodialysis (r=0.65, p < 0.05). No such significant correlation was observed bet ween CI and alpha-h-ANP levels. Furthermore, a significant correlation was observed between VCD before hemodialysis and the change in alpha-h-ANP during hemodialysis (r=0.64, p < 0.05). The relationship between VCD and cGMP before hemodialysis was not significant (r=0.26, p> 0.05) and also no relation was observed between the decrease of cGMP during hemodialysis and VCD before hemodialysis (r=0.12, p > 0.05). A significant correlation between the percent change in body weight and the percent change in VCD during hemodialysis (r=0.91, p<0.05) and also significant relation was observed between the pecent change in body weight and the percent change in alpha-h-ANP levels (r=0.40, p , 0.05). CONCLUSION: Echocardiography of the inferior vena cava allow an estimation of changes of intravascular volume in ESRDpatients without cardiac filling impairment as shown by the correlation to other indices of intravascular volume, such as alpha-h-ANP. In this study, CI and cGMP levels were less informative. Inferior vena cava echocardiography is noninvasive and easily available and serial measurements of VCD and alphah-ANP levels allow an estimation of chages of intravascular volume in ESRD patients on maintenance hemodialysis.
Axis, Cervical Vertebra ; Body Surface Area ; Body Weight ; Central Venous Pressure ; Dialysis ; Diaphragm ; Echocardiography ; Electrocardiography ; Guanosine* ; Humans ; Kidney Failure, Chronic ; Plasma ; Radioimmunoassay ; Renal Dialysis* ; Supine Position ; Thorax ; Transducers ; Vena Cava, Inferior* ; Venous Pressure

PURPOSE: This study was performed to investigate whether rebamipide is useful in the treatment of male infertility due to oxidative damage. MATERIALS AND METHODS: 50 infertile males with elevated reactive oxygen species (ROS) in their semen were enrolled. All patients were given an oral daily dose of 900mg rebamipide for at least 3 months. The concentrations of rebamipide and ROS, and the levels of lipid peroxidation, sperm motility, vitality and fertilizing capacity were measured by a high-performance liquid chromatography (HPLC) fluorescent method, chemiluminescence, the thiobarbituric acid method, a computer assisted semen analyzer, eosin-nigrosin staining and hypo-osmotic swelling test, respectively. Additionally, the clinical outcomes, including pregnancy and delivery, were observed at the gynecology outpatient and IVF clinics. RESULTS: The rebamipide concentration in semen after medication was 220.77+/-327.84ng/ml (SD), with a large deviation, but this was higher than the level found in the serum, which was 126+/-76ng/ml (SD). The levels of seminal ROS and lipid peroxidation were significantly decreased according to the duration of treatment (p<0.05). The sperm vitality and fertilizing capacity were also significantly improved at 2-3 months post treatment (p<0.05). Out of the 41 cases with trial pregnancies, 20 (48.8%) became pregnant, consisting of childbirth, miscarriage or ongoing in 17, 2 and 1 case, respectively. Side effects were observed in only 1 case (2%) with self-limits. CONCLUSIONS: These results suggest that rebamipide is an effective free radical scavenger, which may be useful as an oral antioxidant in patients with male infertility due to oxidative damage caused by high tissue affinity to the male accessory organ, antioxidant effect and the improving effect of seminal parameters.
Abortion, Spontaneous ; Antioxidants ; Chromatography, Liquid ; Female ; Gynecology ; Humans ; Infertility, Male ; Lipid Peroxidation ; Luminescence ; Male ; Outpatients ; Oxidative Stress* ; Parturition ; Pregnancy ; Reactive Oxygen Species ; Semen ; Sperm Motility ; Spermatozoa