Esophageal perforation is a rare disease, which require emergent diagnosis and therapeutic procedure. In this paper, we present one case of esophageal perforation by traction of toothbrush which was swallowed during pharyngeal irritation. After the toothbrush was inserted to stomach by gastroscope, gastrostomy was performed for removal of toothbrush and the esophageal perforation was repaired by operation.
Diagnosis ; Esophageal Perforation* ; Gastroscopes ; Gastrostomy ; Rare Diseases ; Stomach ; Traction

Primary cardiac sarcoma is a rare disease in adults. It is also associated with poor prognoses, due to diagnostic delay, therapeutic difficulty, and high metastatic potential. The coincidence of pregnancy and a primary cardiac intimal sarcoma is extremely rare. We report a pregnant woman at 27(+5) weeks gestation who was admitted to the hospital with acute-onset dyspnea. A mass was found on the left atrium by transthoracic echocardiography. Subsequently, the intracardiac mass was removed, and mitral valve replacement and modified DeVega tricuspid annuloplasty were performed. The patient was diagnosed with a undifferentiated sarcoma, and gave birth to a 1,230 g living baby boy by Caesarean section from preterm contraction at 29(+5) weeks gestation. The patient then received systemic chemotherapy. However, 10 months after the initial clinical onset, the patient suddenly died. Surgery is the standard treatment for cardiac tumors, and their removal should always be attempted, even in pregnant women. Although the overall survival rates of the patients are rather poor, palliative cardiac surgery allows the prolonging of pregnancy, until an acceptable fetal viability level is reached.
Sarcoma/*surgery ; Pregnancy Complications, Neoplastic/*surgery ; Pregnancy ; Humans ; Heart Neoplasms/*surgery ; Female ; Cardiopulmonary Bypass ; Adult

PURPOSE: This study was carried to examine the temporal trend and geographical distribution of the childhood cancers in Taegu and Kyungpook province and to postulate an etiological hypothesis for development of the childhood cancer. METHODS: A total of 799 childhood cancer patients whose addresses were either Taegu or Kyungpook province were diagnosed at 5 major hospitals in Taegu from January 1982 to December 1996. The types, sexes, years, and frequencies of the childhood cancer and regional distributions were analyzed, based on the hospital records of these patients. RESULTS: The most common childhood cancer was leukemia that accounted for 49.2% of all childhood cancer cases and it was followed by CNS tumor (12.3%), lymphoma (8.4%), neuroblastoma (7.4%), Wilms tumor (3.9%), retinoblastoma (3.4%), rhabdomyo sarcoma (2.7%), bone tumor (2.4%), embryonal carcinoma (1.9%), hepatoblastoma (1.3%) and others (7.1%). Male to female ratio of the cases was 1.5:1. The changes of the annual incidence rates over 15 years in Taegu and Kyungpook area were not consistently increasing but rather variable. Cancer incidence rate of Taegu was significantly higher than that of Kyungpook province (P<0.005). The incidence rates of industrialized cities around Taegu were significantly higher than those of agricultural regions of northern Kyungpook (P<0.05). CONCLUSION: Geographical difference in cancer incidence rate suggested that certain environmental factors may be associated with the childhood cancer. To identify such factors an analytical epidemiologic study is warranted. For the analytical epidemiologic study, a detailed history of residential area and occupational history of parents should be recorded uniformly for all the new childhood cancer cases.
Carcinoma, Embryonal ; Daegu* ; Epidemiologic Studies ; Epidemiology ; Female ; Gyeongsangbuk-do* ; Hepatoblastoma ; Hospital Records ; Humans ; Incidence ; Leukemia ; Lymphoma ; Male ; Neuroblastoma ; Parents ; Retinoblastoma ; Sarcoma ; Wilms Tumor

NAG activity has been measured in the urine of hypertension, diabetes mellitus and renal disease subjects. Results have shown significantly higher levels of Urinary NAG in hypertension, diaetes and renal disease subjects compared to normal control Subjects group(P<0.001). Urinary NAG measurement is simple and accurate and it provides a valuable information in the early detection of renal dysfunction in hypertension and diabetes subjects and also in the follow up of these patients.
Acetylglucosaminidase* ; Diabetes Mellitus* ; Follow-Up Studies ; Humans ; Hypertension*

Hypercalcemia is a relatively common complication of cancer that is clinically important because, left unattended, it is associated with symptomatic deterioration and even death. So hypercalcemia can afflict the quality of life and complicate management of the cancer patients with anorexia, lethargic, stuporous mentality, and severely dehydrated. Nonetheless, most cancers are at an advanced stage by the time hyperclacemia develops, many clinicians share doubts about the role of antihypercalcemic therapy in this situation. Furthermore, because the symptoms of hypercalcemia may mimic that of progressive malignant disease or the toxic effects of chemotherapy and radiation therapy, this may not always be recognized. So concerns are needed for active management of patients with malignant hypercalcemia. The authors reviewed the morbidity and mortality in 20 patients with malignant hypercalcemia out of 219 patients with bone metastasis, who were treated at the department of orthopaedic surgery, Catholic University Medical College from January 1989 through December 1992. The results were as follows. 1. The overall incidence of malignant hypercalcemia was 8.6% of bone metastases (20 out of 219 cases).: lung cancer 11.2% (10 out of 89 cases), breast cancer 22.5% (7 out of 31 cases), stomach cancer 6.3% (3 out of 47 cases). 2. The underlying diseases associated with hyprecalcemia were 10 cases of lung cancer(50%), 7 cases of breast cancer(35%) and 3 cases of stomach cancer(15%). Out of lung cancers, 8 cases were squamous cell cancers, the other 2 cases were oat cell cancers. 3. Only 7 out of 20 patients were treated with hydration, diuretics, steroid, calcitonin and mithramycin. And the mean survival duration after recognition of hypercalcemia was 11.3 weeks independent of treatment. In conclusion, the authors emphasize that inspite of grave prognosis, when treated actively, calcium lowering therapy may allow patients to be discharged during terminal period of their illness.
Anorexia ; Avena ; Breast ; Breast Neoplasms ; Calcitonin ; Calcium ; Diuretics ; Drug Therapy ; Humans ; Hypercalcemia ; Incidence ; Lung ; Lung Neoplasms ; Mortality ; Neoplasm Metastasis ; Neoplasms, Squamous Cell ; Plicamycin ; Prognosis ; Quality of Life ; Stomach ; Stomach Neoplasms ; Stupor

PURPOSE: Phyllodes tumors are characterized by a double-layered epithelial component arranged in cleft-like ducts surrounded by a hypercellular spindle-celled stroma. Currently, phyllodes tumors are classified as benign, borderline, or malignant based on microscopic features. The relatively high rate of recurrence is an unsolved management problem. If a malignant phllodes tumor is treated inadequately, it may show a propensity for rapid growth and metastatic spread. However, benign phyllodes tumor are often indistinguishable from fibroadenoma, and can be cured by local surgery. Percutaneous removal of benign breast tumors using the Mammotome system has recently been regarded as a feasible, safe method without serious complications. The Mammotome system has an expanding role in the surgical treatment of benign breast disease, and may further extend its role to the excision of small malignant lesions. The aim of this study was to evaluate the efficacy and the safety of the Mammotome biopsy device in the treatment of benign phyllodes tumor, and to identify whether surgical excision is necessary for benign phyllodes tumors diagnosed and excised by Mammotome. METHODS: From Jan. 2003 to Feb. 2007, a total of 2,751 US- guided mammotome excisions were performed in 2,226 patients at Kangnam Cha hospital. Out of 2,751 lesions, 30 lesions were proved to be benign phyllodes tumors. All lesions were removed using an 8-gauge probe without any residual lesions. Ultrasonographic follow-up was performed at a 3- to 6-month interval to assess recurrence. The mean follow-up period was 33.2 months (max, 51 months; min, 2 months). RESULTS: The mean patient age was 31.4 years. The average size of the lesion was 1.5 cm (SD+0.43 cm). The majority of lesions, 73.3% (22 cases), were palpable, and 26.7% (8 cases) were nonpalpable. Twenty-two lesions (73.8%) were classified as BIRADS category 3, eight lesions (26.7%) were classified as category 4A by ultrasound. During the follow-up period, local recurrence developed in only one patient, making the local recurrence rate 3.3%. No distant metastasis was observed. CONCLUSION: Benign phyllodes tumors found on mammotome excision may not require surgical reexcision if surgeons are sure that the targeted lesions were excised completely and the follow-up ultrasound does not show any residual lesions, especially in small phyllodes tumors, the greatest dimension of which is less than 3 cm.
Biopsy* ; Breast Diseases ; Breast Neoplasms ; Breast* ; Fibroadenoma ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Phyllodes Tumor* ; Recurrence ; Ultrasonography

Leptin, which is a plasma protein produced by the obese gene, is expressed and secreted by adipocytes. The clearance of lepdn from the circulation is unknown. But, markedly elevated serum leptin concentrations have recently been reported in patients with chronic renal failure. The purpose of the present study was to investigate plasma leptin concentration of patients with chronic renal failure and evaluate the factors affecting plasma leptin levels. Plasma leptin, insulin, and body mass index were determined in 34 patients with chronic renal failure and 55 control subjects. The plasrna leptin concentrations were not significantly different between patients with chronic renal failure and control subjects (9.4+/-11.8 vs 4.9+/-4.2ng/ml, P>0.05). The serum leptin concentrations were not significantly higher in both male and female CRF patients compared with control subjects (3.96+/-5.72 vs 2.48+/-1.65, P=0.1947, 17.07+/-14.02 vs 7.49+/-4.63ng/ml, P=0.07, respectively). And, there was no significant correlation between serum creatinine and plasma leptin. However, there was significant correlation between plasma leptin concentration and insulin level (P<0.05). We fit a multiple linear regre- ssion analysis with plasma leptin level as the dependent variable in CRF. Sex (male vs female) (P< 0.001) and insulin (P=0.004) were independently associated with plasma leptin level in CRF. These results suggested that plasma leptin level was regulated or affected by multiple factors inclu- ding sex and insulin resistance. Additional study is required to evaluate relationship between plasma leptin and insulin resistance in chronic renal failure.
Adipocytes ; Body Mass Index ; Creatinine ; Female ; Humans ; Insulin ; Insulin Resistance ; Kidney Failure, Chronic* ; Leptin* ; Male ; Plasma*

OBJECTIVE: This present study was conducted to examine the effects on in vitro growth of pre-antral mouse follicles by thecal-stromal cells attached to around the follicular membrane in culture medium without hormones. METHODS: Pre-antral follicles (100-130 micro meter) used in our studies were isolated mechanically by fine 30 G needles attached to 1 ml insulin syringe from mice ovaries of 20-25 days old female ICR strain. Isolated pre-antral follicles were divided into three groups by attached status of thecal-stromal cell layers to follicular membrane. Follicular Initial diameters of group I was 112.5 (mean) +/- 6.2 (SD) micro meter (n=31), group II was 112.8 +/- 7.8 micro meter (n=23), and group III was 115.1 +/- 6.5 micro meter (n=27). Divided pre-antral follicles were washed in fresh Ham's F-10 medium and cultured in 20 micro liter droplets of DMEM with glutamine, glucose and pyruvate under mineral oil on the 60 mm culture dish. All experimental media were supplemented with 10% FBS without hormones. Media were exchanged wholly by fresh media every 2 days in culture. Diameters of intrafollicular oocytes and cultured pre-antral follicles were measured using an precalibrated cross ocular micrometer at X200 every day during 6 days in vitro culture. Results were considered statistically significant when p value was less than 0.05 using Student's t-test. RESULTS: The mean and standard deviation (SD) of initial diameters of pre-antral follicles was 113.5 +/- 2.2 micro meter in three groups. Follicular growth rate of group III was significantly (p<0.05) higher in whole culture periods than group I and group II. Rate of follicular growth between group I and group II were not significant difference in culture for 1 to 3 days. However, group II was significantly higher than group I in culture for 4 days. Diameters of grown follicles for 6 days was 155.2 +/- 18.7 micro meter, 196.9 +/- 24.1 micro meter and 284.2 +/- 47.6 micro meter in group I, group II and group III, respectively. Growth rate of intrafollicular oocytes between three groups were not difference and revealed to continuous growth patterns in whole culture periods. Follicular diameter after culture for 7 days were not measured because of disruption of follicular structure or outgrowth of granulosa cells. CONCLUSION: Pre-antral follicles were grown very well in DMEM medium without hormones. Thecal- stromal cells attached to the surface of follicular membrane has acted effectively in vitro growth of follicles.
Animals ; Female ; Glucose ; Glutamine ; Granulosa Cells ; Humans ; Insulin ; Membranes ; Mice* ; Mineral Oil ; Needles ; Oocytes ; Ovary ; Pyruvic Acid ; Stromal Cells ; Syringes

Heterotopic pregnancy is the coexistence of intrauterine and extrauterine pregnancy. It is a rare obstetrical phenomenon with an incidence rate about 0.003%. The risk factors of heterotopic pregnancy are IUD, PID, endometriosis, tubal surgery, etc resulting in functional and anatomical injury to tubes. Recently, the wide use of ovulation induction and in vitro fertilization has increased the incidence rate. The clinical manifestation are low abdominal pain, adnexal mass, peritoneal irritation signs, vaginal bleeding, etc. Early detecion of heterotopic pregnancy is very difficult. However, recently, due to development of pelviscopy, ultrasonogram and other diagnostic procedures, the diagnostic rate has increased.Because of the high maternal morbidity and mortality resulted from intraabdominal bleeding after rupture of ectopic pregnacy, immediate termination of ectopic pregnancy is required usually by operative methods. We experienced a case of heterotopic pregnancy after tubal reanastomosis and report this case with a brief review of literatures.
Abdominal Pain ; Endometriosis ; Female ; Fertilization in Vitro ; Hemorrhage ; Incidence ; Mortality ; Ovulation Induction ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Heterotopic* ; Risk Factors ; Rupture ; Sterilization Reversal* ; Ultrasonography ; Uterine Hemorrhage

OBJECTIVE: The purpose of this study was to examine the effects of vero cells co-culture system on the in vitro development of mouse preimplantation embryos in culture media with different composition of glucose and pyruvate. METHODS: Two-cell embryos were collected from 4-5 weeks old ICR mice. Seven hundreds twenty two embryos were cultured with or without vero cells monolayer in four media with different compositions that was manufactured by two DMEM media with (DMEM-GGP) or without (DMEM-G) glucose and pyruvate. In control, DMEM-G medium which is currently using for human embryo culture in our infertility clinic was used. Group I (DMEM-G(1/4)GP) was cultured in medium which was mixed three volume of DMEM-G and one volume of DMEM-GGP, and group II (DMEM-G(1/2)GP) was cultured in medium which was mixed same volume of DMEM-G and DMEM-GGP, and group III was cultured in DMEM-GGP. All media were added to 20% hFF. Results between different groups were analyzed using a Chi-square test, and considered statistically significant when p value was less than 0.05. RESULTS: The developmental rate into 3-cell Animals ; Blastocyst* ; Coculture Techniques* ; Culture Media ; Embryonic Development ; Embryonic Structures ; Female ; Glucose* ; Humans ; Infertility ; Mice* ; Mice, Inbred ICR ; Pregnancy ; Pyruvic Acid* ; Vero Cells*