PURPOSE: The study was a non-equivalent control group, quasi-experimental study to find out the effect of the laughter therapy on anxiety and depression of burn patients. METHODS: Study subjects were 60 hospitalized patients with the diagnosis of 2nd degree burn (30 experimental group; 30 control group). Experimental group received laughter therapy by the certificated therapist. STAI questionnaire, blood pressure and pulse were checked before and after the laughter therapy. RESULTS: Before and after the laughter implementation, the experimental group's anxiety decreased, however, the comparison group's anxiety did not show significant difference. Moreover, experimental group's anxiety decreased after the implementation. Experimental group's systolic blood pressure and diastolic blood pressure did not decrease pre/post laughter therapy mediator. The comparison group showed that systolic blood pressure increased, and diastolic blood pressure did not show significant difference. Also, experimental group's systolic blood pressure and diastolic pressure did not show significant difference after the treatment. Pre/post laughter therapy mediation did not decrease the experimental group's pulse and comparison group's pulse. Furthermore, the experimental group's pulse did not show the significant difference after the treatment. In pre/post laughter therapy mediation, the experimental group's depression was decreased, however, the comparison did not how significance difference in pre/post depression score after the treatment. Moreover, the experimental group's depression was decreased after the treatment. CONCLUSION: According the results above, the laughter therapy had effect on decreasing anxiety and depression of the burn patients and it is efficient mediator for the burn patient. Repetitive research was needed to investigate the effect of laughter on cardiovascular system since it did not have decreasing effect on the blood pressure and pulse.
Anxiety* ; Blood Pressure ; Burns* ; Cardiovascular System ; Depression* ; Diagnosis ; Humans ; Laughter ; Laughter Therapy* ; Negotiating ; Surveys and Questionnaires

In Table 6, the unit concentration of phthalates was not correctly indicated.

The enzyme, 17 -hydroxylase, is necessary for both cortisol and estrogen synthesis. Deficiency of the hormone results in increased adrenocorticotrophic hormone (ACTH), follicle-stimulating hormone (FSH). Synthesis of progesterone, 11-deoxycorticosterone (DOC), corticosterone and aldosterone don't require the enzyme. The lack of estrogen results in primary amenorrhea and absent sexual maturation. The replacement of dexamethasone and estrogens has lowered the blood pressure and produced feminization. A 19-year-old female had 46,XX genotype and presented amonorrhea, absence of sexual characteristics, hypertension and hypokalemia. Endocrinologic studies demonstrated increased plasma progesterone, ACTH levels and low production of 17 -hydroxyprogesterone and testosterone. We report a rare case of 17 -hydroxylase deficency with a brief history and review of the literature.
Adrenal Hyperplasia, Congenital ; Adrenocorticotropic Hormone ; Aldosterone ; Amenorrhea* ; Blood Pressure ; Corticosterone ; Dexamethasone ; Estrogens ; Female ; Feminization ; Follicle Stimulating Hormone ; Genotype ; Humans ; Hydrocortisone ; Hypertension ; Hypokalemia ; Plasma ; Progesterone ; Sexual Maturation ; Testosterone ; Young Adult

A 40-year-old woman just had started to take propylthiouracil for Graves disease, However, the treatment had to be interrupted because she developed skin rash, arthritis, chest pain, fever and proteinuria after 2 months. The serologic study revealed antineutrophil cytoplasmic antibody(ANCA) positivity, especially showing perinuclear pattern. The anti-myeloperoxidase titer was high. The hematoxylin & eosin stain of the specimen obtained from kidney was compatible with pauci-immune glomerulonephritis with crescent formation. There were no immune complex deposits under electron microscope. Such findings suggested propylthiouracil-induced vasculitis. Vasculitis is a rare side effect of propylthiouracil. Recently more cases of vasculitis associated with anti-thyroid drug with ANCA positivity are being reported up to about 36 cases worldwide. There are possibilities of underdiagnosis of this side effect, meaning more cautions on the patients under anti-thyroid drug treatment. We present a case with review of related literature.
Adult ; Antibodies, Antineutrophil Cytoplasmic ; Antigen-Antibody Complex ; Arthritis ; Chest Pain ; Cytoplasm* ; Eosine Yellowish-(YS) ; Exanthema ; Female ; Fever ; Glomerulonephritis ; Graves Disease ; Hematoxylin ; Humans ; Kidney ; Neutrophils* ; Propylthiouracil* ; Proteinuria ; Vasculitis*

OBJECTIVE: The aim of this study was to evaluate the clinical experiences of patients with the primary tubal cancer diagnosed and treated in the Department of Obstetrics and Gynecology, Gacheon Medical School from January 1996 to December 2000. METHODS: Age, symptoms, Pap smear, CA-125, preoperative diagnosis, mode of surgery, stage, additional pathologic finding, mode of adjuvant therapy and survival periods of patients were reviewed retrospectively. RESULTS: The mean age of patients was 57.4 years. The symptoms were vaginal spotting, leukorrhea and pelvic mass. Three patients were treated by simple hysterectomy and both salpingoophorectomy. Staging laparotomy was done in 4 patients. Three patients were in stage I, 2 patients were in stage II and 2 patients were in stage III. Endometrial adenocarcinoma was present in 1 patient and endometrial hyperplasia was present in 1 patient. The mean follow-up period of five patients were 25.4 months and 2 patients were lost for follow-up. Conclusions: The primary tubal cancer was rare gynecologic malignancy and the preoperative diagnosis was difficult due to non-specific symptoms and signs. Staging laparotomy and adjuvant chemotherapy should be done like in ovarian cancer. More studies may be needed for the associated endometiral diseases.
Adenocarcinoma ; Chemotherapy, Adjuvant ; Diagnosis ; Endometrial Hyperplasia ; Fallopian Tubes* ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Hysterectomy ; Laparotomy ; Leukorrhea ; Metrorrhagia ; Obstetrics ; Ovarian Neoplasms ; Retrospective Studies ; Schools, Medical

BACKGROUND: Insulin resistance in obesity constitutes an independent risk factor for the development of type 2 diabetes mellitus (DM). Insulin resistance in obese DM can be improved by a decrease in visceral fat and an increase in skeletal muscle which may influence insulin sensitivity via its capacity to uptake glucose load. Diet restriction as a treatment for obesity causes protein catabolism which results in a decrease in muscle mass. Growth hormone (GH) therapy accelerates a lipolysis and promotes protein conservation. We evaluated the effects of GH therapy with diet restriction on lipolysis and anabolism, which can change body composition, insulin resistance and lipid metabolism in obese DM. METHODS: Eighteen newly-diagnosed obese type 2 DM patients (42-56 yrs) were treated with recombinant human GH (GH; 0.06 unit/kg ideal body weight#/day, 3 times/wk) and with diet restriction (25 kcal/kg ideal body weight/day) for 12 weeks. They underwent anthropometric measurement, bioelectrical impedence for total body fat and lean body mass, as well as computed tomography for visceral and subcutaneous fat at the umbilicus level and the muscle area at the mid-thigh level. All subjects underwent a standard oral glucose tolerance test (OGTT) and GH response to L-dopa stimulation. The glucose disposal rate was measured during an euglycemic hyperinsulinemic clamp study. RESULTS: 1. The fraction of body weight lost as fat was significantly greater and the visceral fat area was decreased more in the GH-treated group than in the control group. There was a significant loss of lean body mass and muscle area in the control group, whereas there was an increase in lean body mass and muscle area in GH-treated group. 2. The glucose disposal rate was significantly increased only in the GH-treated group and it was negatively correlated with the ratio of the visceral fat area/muscle area. The serum glucose levels, insulin-area under the curve (AUC) and free fatty acid (FFA)-AUC during OGTT and HbAlc were significantly decreased after GH treatment. The decrease in FFA-AUC was positively correlated with the decrease in the visceral fat area. 3. Total cholesterol and triglyceride were decreased in both groups. LDL-cholesterol was decreased in only the GH-treated group. 4. The GH response to L-dopa stimulatian was blunted in aU subjects and after treatment, the GH response was increased. The insulin-like growth factor-I level was inereased 1.6-fold after the GH treatment. CONCLUSION: This study suggested that in obese DM fed a hypocaloric diet, GH treatment exerted a decrease in visceral fat and an increase in muscle mass via accelerated lipolytic and anabolic effects which could result in the improvement of insulin resistance, glucose metabolism and dyslipidemia.
Adipose Tissue ; Anabolic Agents ; Blood Glucose ; Body Composition ; Body Weight ; Cholesterol ; Diabetes Mellitus, Type 2* ; Diet* ; Dyslipidemias ; Glucose ; Glucose Tolerance Test ; Growth Hormone* ; Humans ; Insulin Resistance ; Intra-Abdominal Fat ; Levodopa ; Lipid Metabolism ; Lipolysis ; Metabolism ; Muscle, Skeletal ; Obesity ; Risk Factors ; Subcutaneous Fat ; Triglycerides ; Umbilicus

BACKGROUND: Positive correlations between bone mass and androgen levels have been observed in premenopausal and postmenopausal women as well as in men. Androgen production was decreased in women with osteoporosis compared to that in age-matched controls. We hypothesized that androgen metabolism might be also deranged in osteoporosis. To clarify our hypothesis, we investigated the relationship between urinary metabolites of androgen and bone mineral density (BMD) in Korean postmenopausal osteoporotics. METHODS: We examined the anthropometry and bone turnover marker in 67 postmenopausal women. BMD was measured by dual energy X-ray absorptiometry (DEXA). Serurn levels of estrone, estradiol, free testosterone were measured by radioirnmunoassay and serum level of sex hormone binding globulin (SHBG) was measured by two site immunoradiometric assay. The urinary metabolites of androgen were determined by gas chromatography-mass spectrometry (GC-MS) at Korean Institute of Science and Technology Doping Control Center. RESULTS: 1. Spinal BMD had a positive correlation with height (r 0.3049, p<0.05), weight (r=0.4114, p<0.001) and body mass index (BMI, r=0.2638, p<0,05). 2. Spinal and femoral neck BMD had no correlation with serum levels of estrone, estradiol and ten major urinary metabolites of androgen, but serum free testosterone had positive correlation with spinal BMD (r=0.3622, p<0.01) and SHBG had negative correlation with femoral neck BMD (r=-0.2625, p< (0.05). 3. Serum free testosterone in osteoporotics was lower than non-osteoporotics with spinal BMD (p<0.05) and SHBG in patients with osteopenia was higher than non-osteopenic subjects with femoral neck BMD (p <0.05). 4. In multiple stepwise regression analysis, weight and serum free testosterone were statistically significant for spinal BMD (R =0.3072). As for femoral neck BMD, weight was the independent determinant (R 0.1307). 5. Serum level of osteo#ealcin and urinary deoxypyridinoline/creatinine had a positive correlation with urinary 11-ketoandrosterone (p<0.05). SHBG was positive correlation with osteocalcin (r=0.3190, p<0.05). 6. Serum free testosterone (r=-0.2740, p<0.05) decreased with aging. CONCLUSION: Our data suggest that androgen metabolism is not deranged in osteoporotics, but serum free testosterone is important than estrogen on postmenopausal osteoporosis after 5-10 years menopause.
Absorptiometry, Photon ; Aging ; Anthropometry ; Body Mass Index ; Bone Density* ; Bone Diseases, Metabolic ; Estradiol ; Estrogens ; Estrone ; Female ; Femur Neck ; Gas Chromatography-Mass Spectrometry ; Humans ; Immunoradiometric Assay ; Male ; Menopause ; Metabolism ; Osteocalcin ; Osteoporosis ; Osteoporosis, Postmenopausal ; Sex Hormone-Binding Globulin ; Testosterone

BACKGROUND: Hyperprolactinemia has been linked with hyperandrogenism and hirsutism in some women. High plasma Dihydroandrosterone and DHA-S levels were reported in patients with hyperprolactinemia and a dissociation of adrenal androgen and cortisol secretion occurs in normal subjects. The mechanism has not been elucidated, but it has been suggested that pituitary factors other than ACTH modulate adrenal androgen synthesis, One candidate hormone is prolactin. Adrenal tissue has been found to possess prolactin receptors and prolactin has been shown to act synergistically with ACTH and lowers the activity of the enzyme 5a-reductase or 3B-hydroxysteroid dehydrogenase (3B-HSD). The aim of this study was to investigate the secretion of adrenal androgen metabolites in patients with idiopathic hyperprolactinemia and prolactinoma and to deterrnine the relationship with prolactin and androgens. METHODS: We measured 24 hour-urinary DHEA, androstenedione, androsterone, pregnenolone, tetrahydrocorticoid and cortisol in 16 normal controls and 5 patients with idiopathic hyperprolac-tinemia (HP) and 12 patients with prolactonoma in the early follicular phase. RESULTS: Urinary DHEA, AD (androsteredione), and androsterone, the metabolites of adrenal androgen, were significantly higher in both patients with idiopathic HP and prolactinoma compared with those in normal controls (p<0.05), whereas they were not different in both disease groups. Urinary pregnenolone levels, early metabolite of adrenal steroid synthesis, were lower in patients. In contrast, urinary tetrahydorcortisol and cortisol were higher in patients compared to controls. There was no difference in DHEA:androsterone ratio between patients and controls. And there were no correlation between prolactin levels and the levels of androgenic metabolites or clinical symptoms. CONCLUSION: Prolactin has a tropic effct on the secretion of androgens and steroids by the adrenal cortex. But prolactin levels were not correlated with androgen levels or clinical symptoms (amenorrhea), and it might have little effect on lowering the activity of 3B-HSD.
Adrenal Cortex ; Adrenocorticotropic Hormone ; Androgens ; Androstenedione ; Androsterone ; Dehydroepiandrosterone ; Female ; Follicular Phase ; Hirsutism ; Humans ; Hydrocortisone ; Hyperandrogenism ; Hyperprolactinemia* ; Oxidoreductases ; Plasma ; Pregnenolone ; Prolactin ; Prolactinoma ; Receptors, Prolactin ; Steroids

BACKGROUND: Primary empty sella syndrome (PES) is thought to arise from an incompetent diaphragma allowing progressive herniation of arachnoid membrane with secondary compression and atrophy of the pituitary gland. As a consequence of the improvement and widespread use of neuroradiological techniques, such as computerized tomography (CT) and magnetic resonance imaging (MRI), empty sella is more frequently disclosed. The aim of this study is to assess the associated clinical characteristics and endocrinologic disturbance in empty sella syndrome. METHODS: From January 1986 to June 1996, 171 patients with empty sella syndrome have undergone analysis for clinical characteristics and associated disease. RESULT: In our study, PES was diagnosed in 131 of the 171 patients (77%). Primary empty sella syndrome was frequent in middle aged women (female:male 115:16, mean age: 50.6+12.6 years). The common clinical features were headache (80.2%), obesity (72.5%), and hypertension (27.5%). Most of patients with PES have normal pituitary function (75%). The frequent pituitary dysfunction was hyperprolactinemia in PES (21%). Partial and total emptiness of sella on sella CT or MRI were in 111 (84.7%) patients, and in 20 (15.4%) patients, respectively. The most common associated disease with empty sella syndrome was pituitary adenoma. CONCLUSION: PES should be considered as a possible cause in obese middle aged women with unexplained headache. The combined pituitary function test should be considered for evaluation of pituitary dysfunction when clinically suspected.
Arachnoid ; Atrophy ; Empty Sella Syndrome* ; Female ; Headache ; Humans ; Hyperprolactinemia ; Hypertension ; Magnetic Resonance Imaging ; Membranes ; Middle Aged ; Obesity ; Pituitary Function Tests ; Pituitary Gland ; Pituitary Neoplasms

BACKGROUND: Cytokeratins are epithelial markers whose expressions are not lost during malignant transformation. The utility of cytokeratin fragment (Cyfra) 21-1, a new tumor marker, was investigated in 110 patients with lung cancer. The aims of this study were to confirm sensitivity of Cyfra 21-1 in detecting non-small cell cancer, to assess the potential relationship between Cyfra 21-1 and disease stage of the lung cancer. METHODS: We measured serum levels of four tumor marker (NSE, CEA, SCC Ag, Cyfra 21-1) in 110 patients with lung cancer. The measurement of serum level of Cyfra 21-1 was performed with a cut off value of 3.3 ng/mL. An immunoradiometric assay was used to detect a fragment of the cytokeratin 19. The patients were grouped according to the stage of the disease and tumor type. RESULTS: Overall sensitivity of Cyfra 21-1 was relatively high (51.8%) than others tumor markers. Sensitivity of this marker was especially high for adenocarcinoma (63.2%) and squamous cell carcinoma (54.1%). In contrast, sensitiviy of Cyfra 21-1 was relatively low for small cell lung carcinoma (40.0%). Serum levels of Cyfra 21-1 were higher in advanced nonsmall cell lung cancer than early stage disease. CONCLUSION: We conclude that Cyfra 21-1 is a sensitive tumor marker of nonsmall cell lung cancer, especially adenocarcinoma and also may be a useful adjunctive marker for disease monitoring.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Humans ; Immunoradiometric Assay ; Keratin-19 ; Keratins ; Lung Neoplasms* ; Lung* ; Small Cell Lung Carcinoma ; Biomarkers, Tumor