Implantation of a blastocyst within the endocervical canal is termed a"cervical pregn-ancy", which is one of the most dangerous forms of ectopic pregnancy. It is even less common, but the incidence appear to be increasing, in part due to newer forms of assisted reproduction. Proper management is indicated as soon as the diagnosis is suspected. Hemorrhage may be massive and sometimes fatal. In the past, hysterectomy was often the only choice available because of profuse hemorrhage that accompanied attempts at removal of the cerv- ical pregnancy. We report two cases of cervical pregnancy treated conservatively without hysterect- omy. Hemorrhage from the implantation site was controlled by intracervical placement of a Foley catheter balloon without hemostatic cervical sutures at 3 and 9 o clock. Immediate insertion of a Foley catheter into the cervical canal and inflation of the catheter bulb after endocervical suction curettage appears to be a simple and effective technique of managing cervical pregnancy in a patient who wishes to maintain childbearing capacity.
Blastocyst ; Catheters ; Diagnosis ; Female ; Fertility ; Hemorrhage ; Humans ; Hysterectomy ; Incidence ; Inflation, Economic ; Pregnancy* ; Pregnancy, Ectopic ; Reproduction ; Sutures ; Vacuum Curettage

No abstract available.
Humans ; Mortality* ; Risk Factors*

BACKGROUND: Alopecia totalis and alopecia universalis are uncomman and developed from 5-10% of the patients with alopecia areata. OBJECTIVE: The authors perfcirmed a study for clinical obervations and the effects of treatments of alopecia totalis and alopecia universalis in order that this study may cointribute to further studies and treatments of them. MEHTODS: The author performed a clinical study of 42 patients with alopecia totalis and alopecia universalis retrospectively in order to evaluate the clinical manifestation. and the effects of treatments from January 1984 to March 1992 at the department of Dermatology, College of Medicine, Chung Ang University. RESULTS: 1. The incidence of alopecia totalis and alopecia universalis was 6.7% (42/623) among the alopecia patients who were occtipied 1.4% (623/44,839) among the all new dermatologic out patients. 2. The age distributions at the onset of disease showed a peak incidenced an age of less than 15 years (52.4%, 22/42) and the average age was 19.7 years. 3. The laboratory fi ndings showed decreased total T cell count in 1 case(1/10), inversed T/T ratio in 6 cases(6/10), poisitive anti-thyroglobulin anti-body in 3 cases(3/11), and abnormal serum levels of testosterone, esradiol and progesterone in 5 cases(5/22), 2 cases(2/14) and 8 cases(8/13), respectively. 4. The effects in the group treated with topical immunotherapy with DPCP(2,3-diphenylcyclopropenone) or DI CB(2,4-dinitrochlorobenzene) revealed no significant difference from those in the group treated with an intralesional injection of triamcinolone acetonide. 5. The response rates to treatment were make ily higher in the patients with alopecia totalis than alopecia uriiversalis, in cases where the duration of disease was less than 5 years, and in the patients associated with psychologic stress. CONCLUSION: These results suggested that alopecia totalis and alopepia aniversalis frequently occur in children, and some of them we eassociated with cell mediated immunity defects, autoantibody and endocrine factors. The patients with alopecia totalis, with short duration if disease and associated with emotional stress showed better therapeutic responses.
Age Distribution ; Alopecia Areata ; Alopecia* ; Cell Count ; Child ; Dermatology ; Humans ; Immunity, Cellular ; Immunotherapy ; Incidence ; Injections, Intralesional ; Outpatients ; Progesterone ; Retrospective Studies ; Stress, Psychological ; Testosterone ; Triamcinolone Acetonide

No abstract available.
Hypothyroidism* ; Immunoglobulin G* ; Receptors, Thyrotropin* ; Thyrotropin*

BACKGROUND: We have found abnormal expression of ICAM-1 in thyroid follicular cells from patients with Graves disease and Hashimoto disease. In this report, we present the hormonal regulation of ICAM-1 mRNA expression and the primary structure of 5-regulatory region which is important for transcriptional regulation of ICAM-1 gene. A I.S kb fragment of the 5-regulatory sequences are identified and linked to luciferase as a reporter. METHOD: Those reporter constructs were used to evaluate the expression in response to cytokines and hormones. Deletion analysis of 1.8 kb fragment of ICAM-1 promoter in FRTL-5 cells provide the evidence for the existence of several regulatory elements of enhancer and silencer in ICAM-1 gene transcription in thyroid cells. RESULTS: ICAM-1 mRNA is easily detected by Northern analysis using total RNA from FRTL-5 cells regardless of culture conditions. The transcripts of rat ICAM-1 showed single band of 2.6 kb in length. The FRT cells which was come from early FRTL cell culture did not show ICAM-1 mRNA with usual Northern analysis, We found differential regulation of ICAM-1 RNA level in different culture condition in FRTL-5 cells, The cells maintained at 3H (no hydrocortisone, no insulin, no TSH) condition showed the highest expression level compared to 4H, 5H, or 6H medium. Hydrocortisone markedly decreased the ICAM-1 RNA and insulin partially recovered the hydrocortisone induced repression. TSH which is important in growth and function of FRTL-5 cells could independently downregulate the ICAM-1 RNA levels. Forskolin (10 mM) could mimic the action of TSH on ICAM-1 mRNA. TNF-a and interferon-y increase ICAM-1 expression in FRTL-5 thyroid cells. TSH/forskolin inhibited maximal expression of ICAM-1 by TNF-a and interferon-r. Promoter activity of the ICAM-1 gene was positively regulated by cytokines, TNF-a and IFN-r and negatively regulated by thyroid stimulating hormone. The addition of TSH and FSK caused a 50% decrease in ICAM-1 promoter activity within 24 hour. The TSH and FSK action was mapped at 175 bp and 97 bp of the start of translation. The mutant construct pCAM-175 delGAS which has no GAS sequence showed no TSH mediated suppression of promoter activity. CONCLUSION: These findings suggested that hormones and cytokines differentially regulated the ICAM-1 gene expression and TSH downregulated ICAM-1 gene transcription by inhibiting the activation of IFN-r induced transcription factors which can bind the GAS of ICAM-1 promoter.
Animals ; Cell Culture Techniques ; Clone Cells* ; Cloning, Organism* ; Colforsin ; Cytokines ; Gene Expression ; Graves Disease ; Hashimoto Disease ; Humans ; Hydrocortisone ; Insulin ; Intercellular Adhesion Molecule-1* ; Luciferases ; Rats* ; Repression, Psychology ; RNA ; RNA, Messenger ; Thyroid Gland* ; Thyrotropin ; Transcription Factors

Malignant melanoma is an uncommon tumor in Korea. To the best of our knowledge, we could not find malignant melanoma with multiple myeloma in Korean literature. A 57-year-old male patient had a 4×5 cm sized, irregular bordered, dark brownish plaque on the left sole, which has extended gradually since about 1 year ago and showed an occasional bleeding tendency. Laboratory examinations revealed a low hemoglobin level, rouleaux formation on peripheral blood, monoclonal gammopathy of IgG-kappa type and Bence-Jones proteinuria. Bone marrow aspiration findings showed markedly increased immature plasma cells suggesting multiple myeloma. Histopathologic findings of the skin biopsy from the left sole revealed proliferation of atypical melanocytes. We performed a surgical excision with a skin graft for malignant melanoma and chemotherapy (melphalan, vincristine and prednisolone) for multiple myeloma.
Biopsy ; Bone Marrow ; Drug Therapy ; Hemorrhage ; Humans ; Korea ; Male ; Melanocytes ; Melanoma* ; Middle Aged ; Multiple Myeloma* ; Paraproteinemias ; Plasma Cells ; Proteinuria ; Skin ; Transplants ; Vincristine

BACKGROUND: Leptin, the product of ob gene, is an important circulating hormone for the regulation of homeostasis of body weight and enegy expenditure. There was a previous reports that thyroid hormone is one of regulating factors of leptin gene expression in vitro. The aim of this study was designed to evaluate the role of thyroid hormone levels in the regulation of circulating leptin concentrations in human. METHODS: A total 16S subjects were studied; 76 patients with Graves disease, 49 patients with Hashimoto disease and 43 control sujjects. The correlation between thryoid hormone and leptin levels were analyzed and serum leptin levels were compared among the groups which was classified by thyroid functional status. Serum leptin concentratios were measured by radioimmunoassay. RESULTS: There were no significant differences in serum leptin levels between the groups of control, Graves disease and Hashimoto disease. The hypothyroid groups of Graves disease which was induced by excessive antithyroid drug treatment showed significant low levels(5.6 +/-2.8 ng/mL) compared to control(9.6 +/- 5.2 ng/ml) and thyrotoxic groups(10.0 +/- 5,0 ng/mL) CONCLUSION: The hypothyroid patients showed low levels of serum leptin concentrations it may indicate that thyroid horrnone play a role in the appropriate secretion of leptin in human.
Body Weight ; Gene Expression ; Graves Disease ; Hashimoto Disease ; Health Expenditures ; Homeostasis ; Humans ; Leptin* ; Radioimmunoassay ; Thyroid Gland*

No abstract available.
Heart Ventricles* ; Hemodynamics*

The Changes of soluble Fas levels in Patients with Autoimmune Thyroid Diseases BACKGROUD: Apoptosis was observed in thyroid tissue from Hashimoto disease but not those from Graves disease. Recently Fas and Fas ligand interactions among thyrocytes were suggested to development of clinical hypothyroidism in Hashimoto disease.Soluble Fas produced as the form lacking the tranmembrane domain due to alternative splicing, is supposed to inhibit Fas-Fas ligand interaction and blocks Fas mediated apoptosis. METHODS: In tbis study, we measured serum soluble Fas to determine the possible involvement of this molecule in the autoimmune thyroid disease by enzyme linked immunosorbant assay in 29 patients with Graves disease, 30 patients with Hashimotos disease and 19 normal controls. RESULTS: Compared with normal subjeets (4.26 +/- 1.00 U/mL), soluble Fas was not increased in patients with Graves disease (4.23 +/- 1.14 U/mL, p>0.05) but it was increased in throtoxic Graves patients (4.70 +/- 1.26 U/mL, p<0.05) compared to euthyroid Graves (3.72 +/- 0.73 U/mL, p<0.05) and normal subjects (4.26 +/- 1.00 U/mL, p<0.05). The euthyroid and hypothyroid patients with Hashimoto disease showed low soluble Fas levels, 2.94 +/- 0.54 U/mL and 2.74 U/mL, respectively compare to the patients with Graves disease and normal subjects. The thyroid hormone levels to (T3 T4 and free T4) showed positive correlation with the serum titers of antithyroid autoantibodies, antithyroglobuin antibodies, antiperoxidase antibodies and thyrotropin binding inhibitor immunoglobulins. CONCLUSION: We found that the patients with thyrotoxic Graves disease had increased level of serum soluble Fas and the patients with Hashimoto disease showed low levels of soluble Fas compared to normal controls. Increased soluble Fas in Graves disease suggests increased expression of alternatively spliced Fas mRNA variant and decreased soluble Fas in Hashimoto disease suggests decreased Fas mRNA variant and increased full length membrane Fas, so these findings are related to the promotion of apoptosis of thyroid cells during autoimmune reaction in Hashimotos disease.
Alternative Splicing ; Antibodies ; Apoptosis ; Autoantibodies ; Fas Ligand Protein ; Graves Disease ; Hashimoto Disease ; Humans ; Hypothyroidism ; Immunoglobulins ; Membranes ; RNA, Messenger ; Thyroid Diseases* ; Thyroid Gland* ; Thyrotropin

Krukenberg tumor is comparatively rate in metastatic ovarian tumor and is almost metastasized from gastrointestinal tract. We have experienced one case of tumor of unidentified primary focus and two coases of metastatic Krukenberg tmor from stomach and report this cases with a brief review of literatures.
Gastrointestinal Tract ; Krukenberg Tumor* ; Stomach