A C2-3 zygapophygeal joint is a major source of cervicogenic headache. Radiofrequency (RF) neurotomy is preformed widely for zygapophygeal joint pain. Conventional RF denervation technique is generally performed under fluoroscopic control. Recently, ultrasound-guided radiofrequency on zygapophygeal joint has emerged as an alternative method. We report our experiences of two successful ultrasound-guided pulsed radiofrequencies on 39-year-old and 42-year-old males, who complained occipital headache and posterior neck pain.
Arthralgia ; Denervation ; Headache ; Humans ; Joints ; Male ; Neck Pain ; Post-Traumatic Headache

OBJECTIVE: The purpose of this study was to compare with pregnant and non-pregnant women for homocysteine and vitamin B12 and to determine effecting factors on serum homocysteine and vitamin B12 level. METHODS: From March 2001 to February 2002, 202 pregnant (24-28 wks) women and 237 non- pregnant women were included in this study. Blood sample for homocysteine, vitamin B12, folate and questionaires about life style and nutrition were done. Homocysteine was measured by HPLC and vitamin B12, folate were measured by RIA. RESULT: Concentrations (mean+/-8D) of homocysteine and vitamin B12 in pregnant women were 8.2+/-3.1 micromol/L, 449.4+/-212.3 pg/ml, and in non-pregnant women were 12.5+/-6.3 micromol/L, 1017.1+/-296.8 pg/ml, respectively. Risk group of homocysteine was 6.5% in pregnant women (n=12/185), and 26.4% in non- pregnant women (n=57/216). In pregnant women, homocysteine have a negative correlation with folate, vitamin B12 (p<0.05). Non- pregnant women were divided to three groups (smoker, ever been smoker but stop smoking now, non- smoker) and concentrations of homocysteine were 13.6+/-7.0, 13.0+/-6.7, 11.9+/-7.6 micromol/L, respectively. They were divided to two groups (drinker, non-drinker) and concentrations of homocysteine were 12.9+/-7.0, 10.4+/-3.0 micromol/L respectively (p<0.05). Pregnant women who take nutrients have a higher concentration of folate than in women do not (8.8+/-5.1 vs. 7.9+/-3.9 pg/ml, p<0.05). CONCLUSION: Homocysteine in women during pregnancy is decreased by about 35% compared with that of non-pregnant women. In pregnant women, as homocysteine increases, as folate and vitamin B12 decrease. Among the non-pregnant women, higher level of homocysteine demonstrated in smokers than in non-smokers and in drinkers than non-drinkers. In pregnant women who take nutrients have a significant higher level of folate than do not, but have no significant relationship in homocysteine level.
Chromatography, High Pressure Liquid ; Female ; Folic Acid ; Homocysteine* ; Humans ; Life Style ; Pregnancy ; Pregnant Women ; Smoke ; Smoking ; Vitamin B 12* ; Vitamins*

OBJECTIVE: The purpose of this study was to compare one-step 2 hour 75 gm oral glucose tolerance test (OGTT) proposed by the World Health Organization (WHO) with two-step 3 hour 100 gm OGTT of National Diabetes Data group (NDDG) criteria for determining gestational diabetes. METHODS: Data for 111 pregnant Korean women who were diagnosed of gestational diabetes either by 75 gm OGTT or 100 gm OGTT and 100 normal controls were reviewed and analyzed retrospectively. The effectiveness of the two tests was determined by comparing the frequency of diabetes-related pregnance outcomes such as macrosomia, cesarean delivery, and preterm birth. Chi-square, Fisher's Exact test, and T-tests were used for statistical analysis. RESULTS: Among 111 gestational diabetic women, 59 (53.2%) were diagnosed by WHO criteria of 75 gm OGTT and 52 (46.8%) were diagnosed by 100 gm OGTT of NDDG criteria. Frequency of macrosomia and cesarean section was higher in 75 gm test group than in 100 gm test group (12.3% vs 5.8% and 35.1% vs 21.2%, respectively), but the difference was statistically not significant. When compared to the control group, 75 gm test group reached statistical significance in having higher incidence of macrosomia (12.3% vs 3%, p<0.05) whereas 100gm test group did not. CONCLUSION: Efficacy of the diagnostic criteria of WHO was comparable to that of NDDG for diagnosing gestational diabetes. This suggests WHO's 75 gm OGTT to be an efficient diagnostic tool for gestational diabetes in Korean women.
Cesarean Section ; Diabetes, Gestational* ; Female ; Glucose Tolerance Test* ; Humans ; Incidence ; Pregnancy ; Premature Birth ; Retrospective Studies ; World Health Organization

OBJECTIVE: The purpose of this study was to compare one-step 2 hour 75 gm oral glucose tolerance test (OGTT) proposed by the World Health Organization (WHO) with two-step 3 hour 100 gm OGTT of National Diabetes Data group (NDDG) criteria for determining gestational diabetes. METHODS: Data for 111 pregnant Korean women who were diagnosed of gestational diabetes either by 75 gm OGTT or 100 gm OGTT and 100 normal controls were reviewed and analyzed retrospectively. The effectiveness of the two tests was determined by comparing the frequency of diabetes-related pregnance outcomes such as macrosomia, cesarean delivery, and preterm birth. Chi-square, Fisher's Exact test, and T-tests were used for statistical analysis. RESULTS: Among 111 gestational diabetic women, 59 (53.2%) were diagnosed by WHO criteria of 75 gm OGTT and 52 (46.8%) were diagnosed by 100 gm OGTT of NDDG criteria. Frequency of macrosomia and cesarean section was higher in 75 gm test group than in 100 gm test group (12.3% vs 5.8% and 35.1% vs 21.2%, respectively), but the difference was statistically not significant. When compared to the control group, 75 gm test group reached statistical significance in having higher incidence of macrosomia (12.3% vs 3%, p<0.05) whereas 100gm test group did not. CONCLUSION: Efficacy of the diagnostic criteria of WHO was comparable to that of NDDG for diagnosing gestational diabetes. This suggests WHO's 75 gm OGTT to be an efficient diagnostic tool for gestational diabetes in Korean women.
Cesarean Section ; Diabetes, Gestational* ; Female ; Glucose Tolerance Test* ; Humans ; Incidence ; Pregnancy ; Premature Birth ; Retrospective Studies ; World Health Organization

Thoracic paravertebral block is performed for the treatment of patients with chronic pain, such as complex regional pain syndrome (CRPS) and post-herpetic neuralgia. Thoracic paravertebral block can result in iatrogenic pneumothorax. Because pneumothorax can develop into medical emergencies and needle aspiration or chest tube placement may be needed, early diagnosis is very important. Recently, thoracic ultrasonography has begun to be used to diagnose pneumothorax. In addition, ultrasound-guided aspiration can be an accurate and safe technique for treatment of pneumothorax, as the needle position can be followed in real time. We report a case of iatrogenic pneumothorax following thoracic paravertebral block for the treatment of chronic pain due to CRPS, treated successfully by ultrasound-guided aspiration.
Chest Tubes ; Chronic Pain ; Early Diagnosis ; Emergencies ; Humans ; Needles ; Neuralgia ; Pneumothorax

Annular pancreas is a rare congenital anomaly in which a thin band of pancreatic tissue partially or completely surrounds the duodenum.It is challenging to diagnose due to its variable clinical presentation. Approximately two-thirds of patients have no symptoms in their lifetime, and most symptomatic cases are seen in neonates and infants. Symptomatic adult patients present with upper gastrointestinal symptoms, such as epigastric pain, vomiting, and postprandial fullness associated with gastric outlet obstruction. Complications associated with annular pancreas include peptic ulcer disease, pancreatitis, pancreatic head carcinoma, and biliary obstruction. Annular pancreas is also a rare cause of upper gastrointestinal bleeding in adults, but it should be considered as one of the differential diagnoses in patients presenting with a peptic ulcer and duodenal stricture. Here, we report the case of a 60-year-old man who presented with melena and was subsequently diagnosed with an annular pancreas.

OBJECTIVE: This study aimed to evaluate the clinical significance of CT or MRI in detecting parametrial invasion, pelvic or para-aortic lymph node metastasis. We also evaluated whether IVP, cystoscopy and sigmoiodoscopy could be replaced by CT or MRI. METHODS: The medical records of 130 patients with invasive cervical cancer who were histologically diagnosed from Jan 1994 to Feb 1999 at MokDong Hospital were reviewed. We compared the results of physical examination, CT or MRI, and surgical finding in detecting the prarmetiral invasion and pelvic or para-aortic LN metastasis. We also compared the results of IVP, cystoscopy, sigmoidoscopy with the finding of CT or MRI. Fishers exact test was used and p<0.05 was regarded as statistically significant. RESULTS: CT or MRI were clinically significant in detecting parametrial invasion, pelvic or para-aortic LN metastasis, ureter, bladder and rectosigmoid invasion (p<0.005). In detecting parametrial invasion and pelvic or para-aortic LN metastasis, the positive predictive value of CT or MRI were 33.3%, 70% and the negative predictive value were 98%, 91.5%, respectively. In detecting ureter, bladder, and rectosigmoid invasion, the positive predictive value of CT or MRI were 62.5%, 26% and 17% and the negative predictive value were 98%, 100% and 100%, respectively. CONCLUSION: CT or MRI can provide useful information as to parametrial invasion and pelvic or para- aortic lymph node metastasis. CT or MRI can substitude for IVP, cystoscopy, sigmoidoscopy. And only if bladder and rectosigmoid invasion is suspected on MRI, we must perform cystoscopy and sigmoidoscopy to confirm the invasion. Because CT is either superior or equal to IVP in evaluation of the urinary tract, it is not necessary to perform IVP when CT is performed.
Cystoscopy ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging* ; Medical Records ; Neoplasm Metastasis ; Physical Examination ; Sigmoidoscopy ; Ureter ; Urinary Bladder ; Urinary Tract ; Uterine Cervical Neoplasms*

Tamoxifen is widely used for the treatment of breast cancer and currently proposed for preventive strategies. However. there is evidence that tamoxifen may affect other hormone sensitive organs, such as uterus and ovary. It has been documented that tamoxifen treatment is associated with development of endometrial polyp, endometrial hyperplasia, ovarian and endometrial cancer. Uterine malignant mixed mullerian tumor is a neoplasm which apparently arises from undifferentiated mullerian stroma and is composed of a mixture of malignant epithelial and stromal component. We report a case of malignant mixed mullerian tumor of uterus which was developed in a patient treated with tamoxifen for 5 years following a modified radical mastectomy due to breast cancer.
Breast Neoplasms* ; Breast* ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Female ; Humans ; Mastectomy, Modified Radical ; Ovary ; Polyps ; Tamoxifen* ; Uterus*

OBJECTIVE: We report our experience with midtrimester amniocentesis. METHODS: This study was retrospectively reviewed 896 cases of midtrimester genetic amniocentesis from January 1997 to October 2003 in Yonsei university, Wonju Colleage of medicine. We analyzed the indications, distributions of gestational age, cytogenetic results, and the safety. RESULTS: The most common Indications for amniocentesis were abnormal maternal serum marker (52.7%) and advanced maternal age (36.6%). Most amniocentesis has been performed during second trimester from 16 to 20 weeks. The incidence of chromosomal abnormality was 3.9% (35 cases). There were 26 cases of numerical aberration, 6 cases of structural aberration and 3 cases of mosaicism. In chromosomal aberration, there was 9.0% (2/22) of chromosomal abnormalities in abnormal ultrasonographic finding group and 6.9% (2/29) in previous chromosomal anomaly. There were 3 cases of fetal loss (0.3%) after amniocentesis. CONCLUSION: Midtrimester amniocentesis is a useful and safe technique for the prenatal detection of genetic disorder.
Amniocentesis* ; Biomarkers ; Chromosome Aberrations ; Cytogenetics ; Female ; Gangwon-do ; Gestational Age ; Humans ; Incidence ; Maternal Age ; Mosaicism ; Pregnancy ; Pregnancy Trimester, Second* ; Retrospective Studies

PURPOSE: To evaluate the effect of adjuvant external beam radiation therapy (EBRT) on local failure-free survival rate (LFFS) for papillary thyroid cancer (PTC) invading the trachea. MATERIALS AND METHODS: Fifty-six patients with locally advanced PTC invading the trachea were treated with surgical resection. After surgery, 21 patients received adjuvant EBRT and radioactive iodine therapy (EBRT group) and 35 patients were treated with radioactive iodine therapy (control group). RESULTS: The age range was 26–87 years (median, 56 years). The median follow-up period was 43 months (range, 4 to 145 months). EBRT doses ranged from 50.4 to 66 Gy (median, 60 Gy). Esophagus invasion and gross residual disease was more frequent in the EBRT group. In the control group, local recurrence developed in 9 (9/35, 26%) and new distant metastasis in 2 (2/35, 6%) patients, occurring 4 to 68 months (median, 37 months) and 53 to 68 months (median, 60 months) after surgery, respectively. Two patients had simultaneous local recurrence and new distant metastasis. There was one local failure in the EBRT group at 18 months after surgery (1/21, 5%). The 5-year LFFS was 95% in the EBRT group and 63% in the control group (p = 0.103). In the EBRT group, one late grade 2 xerostomia was developed. CONCLUSION: Although, EBRT group had a higher incidence of esophagus invasion and gross residual disease, EBRT group showed a better 5-year LFFS. Adjuvant EBRT may have contributed to the better LFFS in these patients.
Esophagus ; Follow-Up Studies ; Humans ; Incidence ; Iodine ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Survival Rate ; Thyroid Gland* ; Thyroid Neoplasms* ; Trachea* ; Xerostomia