Graves disease occur in association with myasthenia gravis is rare. We report a case of Graves disease and myasthenia gravis treated by bilateral subtotal thyroidectomy and total thymectomy simultaneously. A 37 year old woman was admitted with anterior neck mass and ptosis. Various examinations were compatible with combined Graves disease and myasthenia gravis. The bilateral subtotal thyroidectomy and total thymectomy were done simultaneously. The pathologic diagnosis was Graves disease and thymic hyperplasia. The patients postoperative course was uneventful. The thyroid function of patient became euthyroid and the clinical symptoms related with myastenia gravis resolved during follow up period.
Adult ; Diagnosis ; Female ; Follow-Up Studies ; Graves Disease* ; Humans ; Myasthenia Gravis* ; Neck ; Thymectomy* ; Thymus Hyperplasia ; Thyroid Gland ; Thyroidectomy*

Spontaneous renal allograft rupture is an uncommon complication of renal transplantation, but it represents a life-threatening emergency that requires prompt recognition and treatment. The incidence of spontaneous renal allograft rupture is variable and range between 3.6 and 9.6 percent of all transplants. In the majority of cases the rupture is associated with acute rejection episodes and with renal vein thrombosis. Most frequently, the allograft rupture occurs within the first 2 weeks of transplantation. in addition, most ruptures reported have occurred in cadaveric renal allograft. Debate on the management of such allograft salvage versus transplant nephrectomy. It appears that the recent trend is toward performing surgical repair of the graft if the rupture is secondary to rejection and oo evidence of renal vein thrombosis ; otherwise, graft nephrectomy be done. We report a case of spontaneous renal allograft rupture due to renal vein thrombosis occurred in a 21-year-old woman 6 days after transplantation. Unusual severe localized pain, swelling over at allograft site, and hypotension, a triad frequently seen in renal allograft rupture, were present. Management by graft nephrectomy was inevitable because of the patient's downhill course.
Allografts* ; Cadaver ; Emergencies ; Female ; Humans ; Hypotension ; Incidence ; Kidney Transplantation ; Nephrectomy ; Renal Veins ; Rupture ; Rupture, Spontaneous* ; Thrombosis ; Transplants ; Young Adult

A majority of human lung cancer cell lines have developed resistance to growth inhibition via the activation of transforming growth facter-beta (TGF-beta). Previous studies have reported that growth inhibition of TGF-beta is linked to the expression of transforming growth factor-beta receptor type I (TGF-betaRI). Immunohistochemical studies of TGF-beta1 and TGF-betaRI have been carried out in 43 cases of lung neoplasm; including 25 cases of squamous cell carcinoma, 13 cases of adenocarcinoma, 2 cases of adenosquamous cell carcinoma, and 1 case each of undifferentiated carcinoma, small cell carcinoma and neuroendocrine carcinoma. Reverse transcriptase polymerase chain reaction (RT-PCR) for TGF-beta1 mRNA was also performed in 40 cases of tumors and 14 control cases of normal parenchyme. Immunohistochemically, TGF-beta1 and TGF-betaRI expression were noted in the cytoplasm of all type of tumor cells. The staining intensity and areas were examined and scored from 0 to 5. As a whole, TGF-beta1 staining scores in the neoplastic lesions were higher than that of the adjacent normal parenchyme, bronchial epithelium or alveolar epithelium. However, TGF-betaRI staining scores were generally lower than that of the adjacent normal components. The TGF-beta1 mRNA showed a higher percentage of expression in tumors than in normal control. Tumor size, lymph node metastasis, histological differentiation and histological type of tumors did not correlated with the staining score of TGF-beta1 and TGF-betaRI. These results indicate that although various types of human lung carcinoma cells produce TGF-beta1, they show a reduction in TGF-betaRI, resulting in an escape from growth inhibition by TGF-beta1.
Adenocarcinoma ; Carcinoma ; Carcinoma, Neuroendocrine ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Cell Line ; Cytoplasm ; Epithelium ; Humans* ; Lung Neoplasms* ; Lung* ; Lymph Nodes ; Neoplasm Metastasis ; Receptors, Transforming Growth Factor beta* ; Reverse Transcriptase Polymerase Chain Reaction ; RNA, Messenger ; Transforming Growth Factor beta* ; Transforming Growth Factor beta1* ; United Nations

This study was conducted to develop an education program of hospice care for the professional in order to care for nurses for terminally ill patients facing death and their families. The Modified Tyler-Type Ends-Means model was used to guide the curriculum development of the study. The curriculum include a philosophical conception of hospice education, fundamental concepts, purpose, objective and the educational contents. The content was developed based upon a 70% or more demand in educational demand analysis. The education program has a total of 360 hours consisting of 172 hours of theoretical study and 188 hours of practice including fundamental nursing care for hospice.
Curriculum ; Education* ; Fertilization ; Hospice Care* ; Hospices* ; Humans ; Models, Theoretical ; Nursing Care ; Terminally Ill

The purpose of this study is to develop the first domestic professional hospice educational program. We investigated the present condition of Korean hospice education and analyzed the prerequisite need for a dedicated hospice course in the professional education process. Research was conducted between June and November 1996 for nursing professors teaching at each nursing education institute to find out how much hospice is being discussed and by whom, in which course it is being discussed, and also to find out the contents that needed to be include in the professional education process. From a total of 49 colleges(29 three year colleges, 20 four year colleges) out of 99, 162 nursing professors replied, the collection rate was 49.5%. The conclusions are as follows: 1. The present condition of the hospice nursing education. 1) Whether hospice is included in the education program. (1) 89-65% of 3 year colleges and 90% of 4year colleges included hospice education in their education program. (2) In graduate studies three schools included hospice their program and three schools expressed their plans to include hospice education. 2) Hospice related education were commonly discussed in adult nursing(26.3%), fundamental nursing(22.8%), and psychiatric nursing(20.2%). In 3 year colleges its commonly discussed in the first and second year and in 4 year colleges it is taught in the second and third year. 3) Hospice related theory/practical education hours were averages of 6.5/7.0 hrs in 3 year colleges and 14.2/11.3 hrs in 4 year colleges. 4) The majority of professors in charge of hospice education were in the following order adult nursing, psychiatric nursing, and fundamental nursing. 5) The courses that are thought to be adequate to manage hospice related education were adult nursing(29.3%), community health nursing(21.7%) and the described method education was the method currently being used(36.5%). 2. The demand for hospice nursing education. 1) Over 70% demanded professional hospice education program, the highest demand was for the value and meaning of life followed by the role and qualification of the hospice team and the mental maintenance of a dying patient. 25 categories showed over 90% demand. 2) The highest demand was for the value and meaning of life(98.2%) and the lowest demand were for danjeon breathing(71.0%) and acupuncture(71.0%). 3) Other contents that need to be discussed in the professional hospice education program were hospice nursing, the attitude and reaction of death, bereavement care, and the prospect of hospice.
Adult ; Curriculum* ; Education ; Education, Nursing ; Education, Professional ; Hospice and Palliative Care Nursing ; Hospice Care ; Hospices* ; Humans ; Korea* ; Nursing ; Psychiatric Nursing

PURPOSE: Plasma levels of renin, angiotensin II and aldosterone are increased during normal pregnancy. However, these values in preeclampsia are decreased to nearly that of a nonpregnant subject, and vascular sensitivity to angiotensin II is increased. In preeclampsia, aldosterone is decreased less than rennin. Therefore current studies were undertaken to determine the relationship between aldosterone to renin ratio (ARR) and uterine artery perfusion via RI value. MATERIALS AND METHODS: In this study, the relationship between plasma aldosterone and renin concentration was determined in 27 preeclamptic women and 50 normal pregnant women, whose gestational weeks were matched. The aldosterone to renin ratio was calculated and compared between the two groups. Doppler velocimetry of the uterine artery, which was used to calculate resistance index (RI), was performed on all subjects. The relationship between ARR and RI value was reviewed. RESULTS: In the preeclampsia group, RI value of the uterine artery was significantly higher than that of normal pregnant women. Both plasma renin and aldosterone concentrations were lower in the preeclampsia group. However, the ratio of these two parameters was significantly higher (38.3 vs. 16.1, p < 0.001); the greater ARR, the higher the RI of the uterine artery (r(2)=0.053, p=0.048). CONCLUSION: This study demonstrates that a high aldosterone to renin ratio may have a negative effect on perfusion of the uterine artery and play an important role in the pathophysiology of preeclampsia.
Adult ; Aldosterone/*blood ; Arteries/metabolism ; Case-Control Studies ; Female ; Gestational Age ; Health ; Humans ; Pre-Eclampsia/*blood ; Pregnancy ; Renin/*blood ; Uterus/*blood supply/*metabolism

BACKGROUND: Solid tumors require neovasculization for growth and metastasis. Recently, several angiogenic factors have been identified. Vascular endothelial growth factor (VEGF) is thought to be one such angiogenic factor and is also thought to be a selective mitogen for endothelial cells. In this study, we examined the expression of VEGF and its relationship with microvessel density, and we also determined its prognostic significance in gastric cancer patients. METHODS: One hundred one specimens resected from patients with gastric carcinomas were investigated by staining with a polyclonal antibody against VEGF. Correlations between the expression of VEGF, the microvessel density, various clinicopathologic factors, and the patient's survival were studied. RESULTS: The normal gastric mucosa was not immunoreactive with an anti-VEGF antibody. VEGF was mainly localized to the cytoplasm or the membrane of the carcinoma cell. Of the 101 tumors, strong VEGF expression was detected in 48 (47.5%) tumors. VEGF expression was correlated with depth of tumor invasion, lymph-node metastasis, and stage. Microvessel density, determined by immunohistochemical staining for CD31, was significantly higher in VEGF-strong tumors than in VEGF-weak tumors. Also, patients with VEGF-strong tumors had a significantly poorer prognosis than those with VEGF-weak tumors. However, multivariate analysis indicated that the expression of VEGF was not an independent prognostic factor in patients with gastric cancer. CONCLUSIONS: The fact that VEGF expression in gastric carcinomas was more prevalent in more advanced tumors means that VEGF may contribute to the progression of the tumor. Further study is needed to evaluate the significance of VEGF as a prognostic factor.
Angiogenesis Inducing Agents ; Cytoplasm ; Endothelial Cells ; Gastric Mucosa ; Humans ; Membranes ; Microvessels ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis* ; Stomach Neoplasms ; Vascular Endothelial Growth Factor A*

BACKGROUND AND OBJECTIVES: Since statins and angiotensin receptor blockers are a frequently prescribed combination in patients with atherosclerotic cardiovascular diseases, we tested the interactive effects of simvastatin and losartan on atherosclerosis in apolipoprotein E (apoE)-/- mice. MATERIALS AND METHODS: Apolipoprotein E-/- mice were fed a high-fat, high-cholesterol (HFHC) diet for 12 weeks, with and without simvastatin (40 mg/kg) and/or losartan (20 mg/kg). The mice were divided into 5 groups and were fed as follows: regular chow (control diet, n=5), HFHC diet (n=6), HFHC diet with losartan (n=6), HFHC diet with simvastatin (n=6), and HFHC diet with both losartan and simvastatin (n=6). RESULTS: Losartan treatment in apoE-/- mice significantly decreased atherosclerotic lesion areas in whole aortic strips stained with Oil Red O. The plaque area measured at the aortic sinus level was reduced significantly by 17% (HFHC; 346830.9+/-52915.8 microm2 vs. HFHC plus losartan; 255965.3+/-74057.7 microm2, p<0.05) in the losartan-treated group. Simvastatin and simvastatin plus losartan treatments reduced macrophage infiltration into lesions by 33% (HFHC; 183575.6+/-43211.2 microm2 vs. HFHC plus simvastatin; 120556.0+/-39282.8 microm2, p<0.05) and 44% (HFHC; 183575.6+/-43211.2 microm2 vs. HFHC plus simvastatin and losartan; 103229.0+/-8473.3 microm2, p<0.001, respectively). In mice fed the HFHC diet alone, the smooth muscle cell layer in the aortic media was almost undetectable. In mice co-treated with losartan and simvastatin, the smooth muscle layer was more than 60% preserved (p<0.05). Given alone, losartan showed a slightly stronger effect than simvastatin; however, treatment with losartan plus simvastatin induced a greater inhibitory effect on atherosclerosis than either drug given alone. Serum lipid profiles did not differ significantly among the groups. CONCLUSION: Losartan displayed anti-atherosclerotic effects in apoE-/- mice that were equivalent to or greater than the effects of simvastatin. Combined treatment with these drugs had greater effect than either drug alone.
Angiotensin Receptor Antagonists ; Animals ; Apolipoproteins ; Atherosclerosis ; Azo Compounds ; Cardiovascular Diseases ; Diet ; Humans ; Losartan ; Macrophages ; Mice ; Mice, Knockout ; Models, Animal ; Muscle, Smooth ; Myocytes, Smooth Muscle ; Simvastatin ; Sinus of Valsalva

OBJECTIVE: We studied relationship between average amount of fish consumption and blood mercury level in pregnant women, in addition we would like to know the blood mercury level in pregnant women in Korea and we compared the initial blood mercury level in pregnant women and followed up how much blood mercury level decreased after counseling and prenatal education. METHODS: Pregnant women who received prenatal care at the Yonsei medical center from March 2004 to September 2004, were targeted. They were divided into two groups. One was the study group who was educated to restrict the intake of fish, the other was the control group who was not given any prenatal education. We measured their blood mercury level and followed up until 2nd and 3rd trimester, to find out the differences between two groups. RESULTS: Out of the 63 pregnant women who participated in our study, we followed up 11 pregnant women in the study group and 13 pregnant women of control group. The initial mean blood mercury level of both groups was 2.94 (0.14-10.75) microgram/L. Blood mercury level in fish eating group of more than 4 times a month was higher than the others, which was statistically significant (p=0.02). Followed up blood mercury levels were increased in both groups, but there was not statistically significant between two groups. CONCLUSION: Pregnant women who consume a large amount of fish may have high blood mercury level. As fish intake seems to influence blood mercury level, to lower their blood mercury level, periconceptional education to decrease fish consumption might be necessary.
Counseling ; Eating ; Education ; Female ; Fishes ; Humans ; Korea ; Pregnancy ; Pregnant Women* ; Prenatal Care ; Prenatal Education

PURPOSE: To evaluate the role of bone marrow (BM) magnetic resonance(MR) imaging for assessment of theseverity of aplastic anemia (AA). MATERIALS AND METHODS: Eighty patients with AA, ranging in age from 16 to 44years underwent MR imaging. Fifty four patients had clinically severe AA (SAA),while in 26 the condition wasmoderate(MAA). Sagittal T1-weighted images (T1WI) and short tau inversion recovery(STIR) images of lumbarvertebral BM were analysed. Bulk T1, T2 and rho values (msec) were also measured, with mixed sequences. Signalintensity (SI) on both T1WI and STIR was classified into four patterns according to the amount of fatty marrow :pattern I, homogeneous fatty marrow ; II, fatty marrow with focal cellular nodules ; III, mixed fatty and cellularmarrow ; IV, cellular marrow with focal fatty nodules. These SI patterns and bulk T1, T2 and rho values of thelumbar BM were compared with the clinical severity of AA. RESULTS: On both T1WI & STIR sequences, MR imaging oflumbar vertebral BM in patients with AA showed various SI patterns. Pattern I, II and III were much frequently seenin the SAA group (48 of 54 patients on T1WI and 43 of 54 on STIR) and pattern IV was common in the MAA group (16of 26 patients on T1WI and 18 of 26 on STIR). The SI patterns of AA seen on both T1WI and STIR sequences closelycorrelated with clinical severity (x2 test, p = 0.0001). Bulk T1 value was significantly different between SAA andMAA ( SAA : 382.82 msec +/- 113.91; MAA: 517.99 msec +/- 151.92 ; t test , p = 0.0001). CONCLUSION: The SI patternseen on MR imaging, and T1 relaxation time of lumbar spinal BM can be useful for assessing the severity of AA.
Anemia, Aplastic* ; Bone Marrow ; Humans ; Magnetic Resonance Imaging* ; Relaxation