Of the various types of ectopic pregnancies that have been reported, the retroperitoneal implantation probably represents the rarest. A search of the literature reveals only three other cases that appear to be true retroperitoneal pregnancies. We have experienced a case of the true retroperitoneal ectopic pregnancy, which was seen to be adherent to the anteromedial aspect of the left kidney. We report the case with a brief review of literatures.
Female ; Kidney ; Pregnancy ; Pregnancy, Ectopic*

BACKGROUND: Postoperative patients frequently associate postoperative backache with epidural anesthesia administered for the operation. Epidural steroids are often used for the treatment of low back pain. We performed this study to compare the effect of epidural triamcinolone on the incidence and severity of postepidural backache after cesarean section. METHODS: Eighty patients scheduled for cesarean section under epidural anesthesia using 2% lidocaine received 40 mg of triamcinolone (n=40) or 1ml of normal saline (n=40) epidurally via indwelling catheter after delivery. Backache were checked preoperatively and 24, 48, 72hr postoperatively using VAS score. A patient was considered to have postepidural backache when the postoperative VAS score was higher than the preoperative score. RESULTS: The incidence and severity of postepidural backache were much less in triamcinolone group than in control group (p<0.05). CONCLUSION: Epidural triamcinolone has a preventive effect on postepidural backache in cesarean section patients.
Anesthesia, Epidural* ; Back Pain* ; Catheters, Indwelling ; Cesarean Section* ; Female ; Humans ; Incidence ; Lidocaine ; Low Back Pain ; Pregnancy ; Steroids ; Triamcinolone*

Mal de Meleda (MDM), also known as keratoderma palmoplantaris transgrediens, is a rare inherited form of palmoplantar keratoderma. It is characterized by erythema and hyperkeratosis of the palms and soles, extending to the dorsal aspects of the hands and feet. A 15-year-old Korean female presented with sharply demarcated hyperkeratotic plaques on the palms and soles, which extended to the dorsal surfaces of the hands and feet, in a "glove-and-socks" distribution. The histopathologic study showed marked hyperkeratosis, acanthosis, and normogranulosis, without epidermolysis. Her genetic study detected compound heterozygous mutation in exon 3 of the ARS gene encoding SLURP-1. Family history did not reveal any other affected members and no consanguineous relationship was found. In view of these findings, we diagnosed this case as the first reported sporadic case of MDM in Korea, the farthest location from the endemic island of Meleda.
Adolescent ; Erythema ; Exons ; Female ; Foot ; Hand ; Humans ; Keratoderma, Palmoplantar ; Korea ; Papillon-Lefevre Disease

BACKGROUND AND OBJECTIVES: Conventional tonsillectomy with the naked eye has posed problems in obtaining a good surgical field and in minimizing damage to the adjacent tissue. Tonsillectomy using an operating microscope offers outstanding illumination and visualization of the surgical field, thereby reducing the incidence of complications associated with tonsillectomy. The objective of this study was to compare the surgical methods of the conventional and the microscopic tonsillectomies, and to evaluate the usefulness and effectiveness of the microscopic tonsillectomy. MATERIALS AND METHODS: Two hundred children between the ages of five and ten who received tonsillectomy between June 1995 and August 1998 at Korea University Hospital were divided into two groups,' one group underwent tonsillectomy using an operating microscope (Group 1, n=100) and the other group underwent tonsillectomy using the conventional dissection and snare technique (Group 2, n = 100). Duration of surgery, post-operative healing period, amount of intra and post-operative hemorrhage, post- operative pain score, and the incidence of post-operative cicatrical pharyngeal stenosis were compared between the two groups. RESULTS: There was no statistically significant diference in operating time and post-operative healing period between the two groups, but cicatrical pharyngeal stenosis due to post-operative scarring was more common in the group that underwent conventional tonsillectomy. The amount of hemorrhage both intra and post-operatively, and post-operative pain was significantly decreased in the microscopic tonsillectomy group. CONCLUSION: The widespread use of operating microscope in otolaryngological surgeries allows this technique to be applied to tonsillectomy with few problems. This technique affords decreased intra-operative bleeding, less post-operative complications, and decreased post-operative pain compared with conventional techniques. We believe that microscopic tonsillectomy is a safe, elegant and effective procedure that represents a new concept in tonsil surgery.
Child ; Cicatrix ; Constriction, Pathologic ; Hemorrhage ; Humans ; Incidence ; Korea ; Lighting ; Palatine Tonsil ; SNARE Proteins ; Tonsillectomy*

Primary duodenal carcinoma is rare. Duodenal mucinous adenocarcinoma (DMA) is even rarer, and its associated manifestations and typical endoscopic or imaging findings are not well characterized. Herein, we report a case of primary DMA in an asymptomatic 58-year-old man who visited our hospital for a regular health screening. Upper endoscopy revealed an approximately 4-cm lesion in the second portion of the duodenum, but the mass was not visualized on computed tomography. Biopsies revealed a tubular adenoma that was subsequently resected. Frozen biopsies demonstrated DMA with a background of low-grade tubular adenoma for which we performed Roux-en-Y duodenojejunostomy and jejunojejunostomy. To our knowledge, this is the first report of a patient with DMA in Korea.
Adenocarcinoma ; Adenocarcinoma, Mucinous* ; Adenoma ; Biopsy ; Duodenal Neoplasms ; Duodenum ; Endoscopy ; Humans ; Korea ; Mass Screening ; Middle Aged

OBJECTIVE: We aim to analyze each variable of FHR in high risk pregnancies, namely intrauterine growth restriction (IUGR) and pregnancy-induced hypertension (PIH) including chronic hypertensive vascular disease (CHVD), mild and severe preeclampsia to build an objective decision basis using correlation analysis. METHODS: The patients were divided into two groups (500 normal pregnancies and 500 high risk pregnancies related to IUGR, CHVD, mild and severe preeclampsia), and then subdivided into intrauterine pregnancy before 24 weeks, 25-39 weeks, and after 40 weeks. We compared the canonical correlation between each group using variables of FHR after nonstress test (NST). RESULTS: In high risk pregnancies, the linearity was 0.6-0.8 in intrauterine pregnancy before 24 weeks, 0.53-0.68 in 25-29 weeks, 0.50-0.60 in 30-34 weeks, 0.38-0.45 in 35-39 weeks and 0.42-0.55 in after 40 weeks. In normal pregnancies, the linearity was 0.44-0.52 in intrauterine pregnancy before 24 weeks, 0.38-0.45 in 25- 39 weeks which was stable, and there was no specific change in after 40 weeks. Before 32 weeks, canonical variates of FHR_D and FHR_I revealed highest (0.36, 0.47 respectively) in high risk pregnancy and fetal movement and signal loss was the most valuable factors in normal pregnancy. In between 33 to 37 weeks, fetal movement (0.40) and signal loss (0.48) were related most closely in high risk pregnancies and 0.34 and 0.49 respectively in normal pregnancies which show similar pattern. In contrast, FHR_D was most highly related to the duration of pregnancy and FHR_I to fetal movement (0.38) in high risk pregnancy. In normal pregnancies, fetal movement (0.40) and signal loss (0.52) showed the highest linearity. CONCLUSION: The pregnancy with intrauterine growth restriction and pregnancy induced hypertension has more linear relation and less complexity in each variable of FHR than the normal pregnancy group. The formal, functional underdevelopment of fetus may results in the increasement of the linear depedent relation in each variable of FHR in these type of high risk pregnancies.
Female ; Fetal Development* ; Fetal Growth Retardation ; Fetal Heart* ; Fetal Movement ; Fetus ; Heart Rate, Fetal* ; Humans ; Hypertension, Pregnancy-Induced* ; Pre-Eclampsia ; Pregnancy ; Pregnancy* ; Pregnancy, High-Risk ; Vascular Diseases

Incontinentia pigmenti (IP) is an uncommon genodermatosis that usually occurs in female infants. It is characterized by ectodermal, mesodermal, neurological, ocular, and dental manifestations. The aim of this study was to clarify clinical symptoms, accompanying diseases, and complications of IP. Forty cases of IP have been reviewed by their medical records, laboratory data, clinical photographs, and telephone survey. Male-to-female ratio was 1 to 19 and their onsets were mostly in utero. They were usually diagnosed during the neonatal period owing to their early expression of skin manifestation. Central nervous system anomalies were found in 46.7%. Ocular disorders and dental defects were detected in 66.7% and 72.7% respectively. The most commonly diagnosed anomalies were hypodontia, retinopathy, and seizure. For better understanding of IP, long term and close cooperation between dermatologists, pediatricians, neuroscientists, genentic counselors, and even dentists is crucial.
Stomatognathic Diseases/complications ; Skin Diseases/complications ; Male ; Magnetic Resonance Imaging/methods ; Korea ; Infant, Newborn ; Infant ; Incontinentia Pigmenti/*diagnosis/pathology ; Humans ; Female ; Eye Diseases/complications ; Eosinophilia/complications ; Child, Preschool ; Child ; Central Nervous System Diseases/complications

OBJECTIVE: To investigate the relationships between respiratory muscle strength and conventional sarcopenic indices such as skeletal muscle mass and limb muscle strength. METHODS: Eighty-nine young adult volunteers who had no history of medical or musculoskeletal disease were enrolled. Skeletal muscle mass was measured by bioelectrical impedance analysis and expressed as a skeletal muscle mass index (SMI). Upper and lower limb muscle strength were evaluated by hand grip strength (HGS) and isometric knee extensor muscle strength, respectively. Peak expiratory flow (PEF), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) were evaluated using a spirometer to demonstrate respiratory muscle strength. The relationships between respiratory muscle strength and sarcopenic indices were investigated using Pearson correlation coefficients and multiple linear regression analysis adjusted by age, height, and body mass index. RESULTS: MIP showed positive correlations with SMI (r=0.457 in men, r=0.646 in women; both p<0.01). MIP also correlated with knee extensor strength (p<0.01 in both sexes) and HGS (p<0.05 in men, p<0.01 in women). However, PEF and MEP had no significant correlations with these sarcopenic variables. In multivariate regression analysis, MIP was the only independent factor related to SMI (p<0.01). CONCLUSION: Among the respiratory muscle strength variables, MIP was the only value associated with skeletal muscle mass.
Body Mass Index ; Electric Impedance ; Extremities ; Female ; Hand ; Hand Strength ; Humans ; Knee ; Linear Models ; Lower Extremity ; Male ; Muscle Strength ; Muscle, Skeletal ; Musculoskeletal Diseases ; Respiratory Muscles* ; Sarcopenia ; Spirometry ; Volunteers ; Young Adult*

BACKGROUND: Bowen's disease(BD) is an in situ squamous cell carcinoma(SCC) of the skin, which clinically presents as a scaly slightly elevated erythematous plaque. Approximately two thirds of patients with BD have solitary lesions, whereas the remaining patients have multiple lesions. Lesions of BD have a wide distribution covering both sun-exposed and covered skin. Chronic sunlight exposure is an important etiological factor in many patients, and inorganic arsenicals can cause lesions on unexposed skin. If untreated, 3-5% of BD cases evolve into invasive carcinoma including SCC, basal cell carcinoma(BCC), and sebaceous carcinoma(SC), although the precise mechanism is not yet clear. OBJECTIVE: The purpose of this study was to investigate the factors which may be involved in the development of BD and progression to invasive carcinoma. METHODS: We performed immunohistochemical analysis using monoclonal antibodies for p53, mdm-2, and bcl-2 in 7 cases of multiple BD with invasive carcinoma. RESULTS: In four of 6 cases of SCC immunopositive for p53, at least one lesion of each BD was positive for p53. Among them, two cases showed the consistency of p53 staining between BD and its SCC and the localization of the lesions on sun-exposed areas. On the other hand, two cases of SCC and the associated BD were immunonegative for p53 and positive for mdm-2 and all the lesions developed on the UV-nonexposed areas. In one particular case which had a history of arsenic ingestion, SC was immunopositive for p53, whereas the associated SCC and BD were immunonegative for p53. In one case associated adenoid BCC, BD was immunopositive for p53 and negative for bcl-2, whereas BCC was immunonegative for p53 and strongly positive for bcl-2. CONCLUSION: These results suggest that UV light may play a role in the development of BD and its progression to SCC and in addition to p53, some additional factor or conditions are required in the progression towards these invasive carcinomas from BD.
Adenoids ; Antibodies, Monoclonal ; Arsenic ; Arsenicals ; Bowen's Disease* ; Eating ; Hand ; Humans ; Skin ; Sunlight ; Ultraviolet Rays

OBJECTIVE: A constituent of green tea, (-)-epigallocatechin-3-gallate (EGCG), has been known to possess anti-diabetes, anti-hypertension and anti-cancer properties. In this study, we investigated the anticancer effects of EGCG on human ovarian cancer cell lines. The growth inhibitory mechanism(s) and regulation of cell cycle-related proteins by EGCG were also evaluated. METHODS: To carry out cell counting assay to observe the anti-proliferative effects, we treated 25, 50, and 100 uM EGCG to both ovarian cancer cell lines SKOV-3 and OVCAR-3, respectively. Also, we treated EGCG to PA-1 cells with 6.25, 12.5 and 25 uM, respectively. Six days later, we examined the characteristics of apoptosis and changes in cell cycle regulation by cell counting assay, Annexin V-FITC staining and DNA fragmentation assay, and FACS analysis. In addition, protein and gene expression patterns in SKOV-3 cell were investigated by using cell cycle cDNA chip, RT-PCR, and Western blot analyses. RESULTS: Inhibition of cell growth by cell counts showed in SKOV-3 cells with 48.8%, 82.5%, 99.2% after six days of the treatment with 25, 50, 100 uM of EGCG, respectively. OVCAR-3 cells showed 53.9%, 84.8%, and 97.7% growth inhibition patterns. And PA-1 cells showed 17.1%, 48.4%, and 74.1%, as compared to control. When SKOV-3 cells were tested for EGCG-induced apoptosis, apoptotic cells were observed with 8.6, 11.4, and 23.3-fold at 25, 50, 100 uM EGCG, respectively. And PA-1 cells showed 1.7, 2.4, and 4.2-fold, as compared to control. In contrast, OVCAR-3 did not show EGCG-induced apoptosis. When SKOV-3 cells were tested for their gene expression using cell cycle cDNA chip after treatment with 24.5 uM of EGCG, up-regulations of p21, Bax and cyclin G were shown, while down-regulations of CDK6, E2F-4, and cyclin A were shown. In Western blot assay, up-regulations of Bax and p21 proteins were shown, while down- regulations of cyclin D1, Bcl-XL, Rb, CDK2, E2F-1, E2F-4, PCNA proteins were shown. CONCLUSION: These data support that EGCG can inhibit ovarian cancer cell growth through induction of apoptosis and cell cycle arrest as well as regulation of gene and protein expressions. Thus, EGCG likely provides an additional option for a new and potential drug approach for ovarian cancer.
Apoptosis ; Blotting, Western ; Cell Count ; Cell Cycle ; Cell Cycle Checkpoints ; Cell Line* ; Cyclin A ; Cyclin D1 ; Cyclin G ; DNA Fragmentation ; DNA, Complementary ; Gene Expression ; Humans ; Ovarian Neoplasms* ; Proliferating Cell Nuclear Antigen ; Social Control, Formal ; Tea*