OBJECTIVE: To evaluate the efficacy of low dose gonadotropin releasing hormone agonist(GnRH-a) therapy combined with high dose human menopausal gonadotrpin(hMG) following estrogen & progesteron therapy for poor responders. METHODS: From May 1997 to Feb 1999, 36 patients who were defined as poor responders on previous consecutive two and more superovulation cycles were randomly allocated to lowdose GnRH-a short protocol with high dose hMG protocol pretreated with estrogen & progesterone(E/P therapy)(n=16)(study group) and the clomiphene citrate with hMG(n=20)(control group). All patients were planned to undergone in-vitro- fertilization(IVF) and embryo transfer(ET) after controlled ovarian hyperstimulation(COH). RESULTS: Two groups were similar with respect to clinical features and basal FSH and E2 levels. The mean level of E2 on day 5, 304.3+/-148.ng/ml in study group was significantly higher than that in control group, 182+/-34.9ng/ml. The mean levels of E2 on hCG day was also significantly higher in study group than control group(1324+/-320ng/ml, vs 414+/-168ng/ml). The mean day of hCG day in study group, 12.3+/-0.3 was shorter than that in control group, 13.8+/-0.4. The concellation rates of cycles were significantly lower in study group than control group(13.2% vs 84.2%). But clinical pregnancy rates did not showed the significant difference between two groups. CONCLUSION: The study suggested that a lowdose GnRH-a short protocol with high dose hMG pretreated with estrogen & progesterone can improve the ovarian response in poor responder group.
Clomiphene ; Embryonic Structures ; Estrogens ; Gonadotropin-Releasing Hormone* ; Humans ; Pregnancy Rate ; Progesterone ; Superovulation

Background: It is well known that the addition of CO2 gas during cardiopulmonary bypass (CPB) can increase cerebral blood flow (CBF). In this study, we tried to find whether the increase of CBF by CO2 gas could be expressed on the measurement of body temperatures. Methods: This study included 22 adult patients who underwent CPB with moderate hypothermia and were assigned randomly to two groups by adding CO2 gas (CO2 group and Air group). We measured each tympanic (TM), nasopharyngeal (NP), oral, forehead, finger, rectal and CPB arterial line temperatures of CPB circuit for 20 times during cooling in every one minute for 20 minutes and during rewarming every two minutes for 40 minutes. Results: During cooling and rewarming, the TM, NP and oral temperatures changed more rapidly than the rectal and finger temperatures. In TM temperature, as time changed, the percent changes of temperature varied more prominently in the CO2 gas group than in the Air group. The statistical differences were significant especially during 13 minutes to 20 minutes in cooling and 8 minutes to 20 minutes during rewarming. Conclusion: From this data, we can postulate the effect of CO2 gas on CBF indirectly by measuring several sites of body temperatures.
Adult ; Body Temperature* ; Carbon Dioxide ; Cardiopulmonary Bypass* ; Fingers ; Forehead ; Humans ; Hypothermia ; Rewarming* ; Vascular Access Devices

A case of huge endometrioma at right ovary in 31-year old woman treated with pelviscopic surgery is presented with a brief review of literature. This tumor was measured 15 X 15 X 16 cm and its content amount was about 1800 cc. The pathologic diagnosis was endometrioma of right ovary.
Adult ; Diagnosis ; Endometriosis* ; Female ; Humans ; Ovary

BACKGROUND: Various ictal manifestations of temporal lobe epilepsy have possibly the value of both lateralizing and localizing the epileptogenic zone. Some ictal manifestations such as hand automatism, dystonic limb posture, head turning, and speech phenomenon might distinguish patients with good surgical outcomes from patients with poor out-comes. METHODS: To determine ictal behavioral differences in patients from these groups, we analyzed 207 seizures from 75 patients (group A) who were seizure free after surgery and 172 seizures from 60 patients (group B) who experienced seizures after surgery. All patients had received an anterior temporal lobectomy with amigdalohippocampectomy, and were followed up for at least 1 year. RESULTS: The lateralizing value of ictal semiology was evaluated in group A. Head turning (HT) was shown in 42% of seizures and had a lateralizing significance. Forced HT indicated a contralateral epileptogenic region. Non-forced HT suggested an ipsilateral epileptogenic region. Unilateral dystonic limb posture with or without automatism of the other side occurred in 53% of seizures and had a lateralizing significance, localizing the seizure onset to the contralateral hemisphere. Abnormal speech and vocalization did not have any lateralizing significance. Contralateral dystonic limb posture without ipsilateral automatism was significantly more frequent in group B (p=0.003) as abnormal speech was more frequent in group A (p=0.001). Non-versive head turning had a higher tendency to occur in group A (p=0.0051). There were no statistically significant differences between the two groups in incidences of versive head turning, unilateral hand automatism without dystonic limb posture, vocalization, and normal speech. CONCLUSIONS: Some ictal manifestations might be helpful in predicting the surgical outcome of temporal lobe epilepsy(TLE) patients. The presence of unidentifiable ictal speech could reflect good surgical outcome in TLE patients. When presurgical video analysis reveal an ictal semiology of contralateral dystonic arm posture without ipsilateral hand automatism, careful presurgical evaluation of the epileptogenic region should be contemplated.
Anterior Temporal Lobectomy ; Arm ; Automatism ; Epilepsy, Temporal Lobe* ; Extremities ; Hand ; Head ; Humans ; Incidence ; Posture ; Seizures ; Temporal Lobe*

Sinus histiocytosis with massive lymphadenopathy known as Rosai-Dorfman disease is characterized by painless bilateral cervical lymphadenopathy. Extranodal manifestations are uncommon and spinal involvement is rare. A 15-year-old man presented with intermittent midthoracic back pain only. He had no specific findings on neurologic examinations, hematologic and biochemical laboratory tests. Radiological examination of thoracic spine revealed collapse of T6 vertebrae with thoracic kyphosis and osteolytic lesion of T12 vertebra body. He underwent a removal of bone tumor, anterior reconstruction with mesh and pedicle screw fixation via posterior approach for pathologic confirmation and stabilization. Histopathologic study of the lesion revealed focal infiltration of large histiocytes showing emperipolesis. Immunochemistry stain of histiocytes was positive for CD68 and S-100 but negative for CD1a. This report presents a rare case and literature review of extranodal Rosai-dorfman disease in thoracic spine.
Adolescent ; Back Pain ; Emperipolesis ; Fractures, Compression* ; Histiocytes ; Histiocytosis, Sinus* ; Humans ; Immunochemistry ; Kyphosis ; Lymphatic Diseases ; Neurologic Examination ; Spine*

No abstract available.
Gynecology*

No abstract available.
Gynecology* ; Laparoscopy*

Temporal lobe epilepsy is characterized by complex partial seizures with either primary intracranial neoplasms or other non-neoplastic lesions. We reviewed 64 cases of surgically resected temporal lobes and amygdalo-hippocampal regions for temporal lobe epilepsy ansed by non-neoplastic lesions to elucidate the incidence and histologic features of each histologic group for a period of 2 years. The patient's age ranged from 12 to 49 years and the ratio of male to female was 42:22. There were 37 cases(57.8%) with single pathology and an additional 20 cases(31.3%) with dual pathology. The emaining 7 cases(10.9%) had no structural alternations. The most common temporal lobe pathology was hippocampal sclerosis in 41 cases(64.1%), diagnosed alone in 21 cases and as dual lesions in 20 cases. The hippocampal neuron loss was most pro,omemt in CA1, followed by CA4, CA3, and CA2. Amygdaloid sclerosis was present in 28 cases(43.8%), lases had 13 dual lesions, 25 cases also had hippocampal sclerosis. The 20 dual lesions showed that 6 cortical dysplasia, 10 microdysgenesis, 1 chronic non-specific inflammatory lesion, and 3 cysticercosis were associated with the various degree of mesial temporal sclerosis. Neuronoglial malformative lesions were identified in 21 cases(32.8%) including 16 dual lesion cases, which composed of 15 microdysgenesis and 6 cortical dysplasia. Neurofilament immunostain for cortical dysplasia revealed abnormally beaded disarray of axons in dysplastic pyramidal cells. The remaining pathologic lesions observed were 1 cysticercosis, 1 chronic non-specific inflammatory lesion, 3 arteriovenous malformation, 2 fibrous nodule, and 1 fibrous adhesions of the arachnoid.
Female ; Male ; Humans ; Incidence

Background: Cognitive impairment has been reported to be closely associated with poor oral health, and the relationship is bidirectional, as older adults with poor oral health and chewing function are at a higher risk of cognitive decline (CD). This cross-sectional study aimed to determine whether masticatory discomfort in Korean elderly increases the risk of daily living difficulty (DLD) related to CD and whether there is a difference in risk according to gender and age. Methods: The data used were obtained from the Korean Community Health Survey (2019). The final analysis included 22,154 people aged 65 years and older who completed the survey and responded to all items on the variables used in the study. Chi-square test, trend test, and complex sample logistic regression were performed for statistical analysis, to clarify the purpose of this study. Results: As masticatory discomfort increased, the elderly’s DLD tended to increase (p-for trend, p＜0.001). For logistic regression, adjusting for all covariates, participants who reported masticatory discomfort as “discomfort” (adjusted odds ratio [AOR]=2.45, 95% confidence interval [CI]=2.11∼3.50) and “severe discomfort” (AOR=2.95, 95% CI=2.49∼3.50) had a more than a two-fold increased risk of CD-related DLD compared to participants who reported “no discomfort at all.” In age-stratified analyses, elderly men aged 75∼84 years and elderly women aged 65∼74 years had the highest risk of developing CD-related DLD. Conclusion Oral care interventions to improve masticatory function in older adults may slow CD and improve CD-related DLD. We hope that this study will raise awareness among caregivers and clinical professionals regarding the importance of oral care for older adults with CD.

No abstract available.
Humans ; Hypersensitivity* ; Phenytoin*