A number of noninvasive technics have been advocated as reflecting left ventricular performance. These methods include systolic time intervals, echocardiography and imaging of the left ventricular chamber with radionuclides during systole and diastole. Radionuclide evaluation of left ventricular function by means of the gamma camera and gating currently appears to be the most reliable noninvasive method for approximating angiographic evaluation of left ventricular performance. Utilizing the radionuclide angiography, we measured the left ventricular function in 19 normal healthy control, 60 patients with coronary artery diseases 7 patients with dilated cardiomyopathy, 5 patients with hypertension. 1) Left ventricular ejection fraction decreased in 12 patients with anterior myocardial infarction (39.9+/-11.6%), 17 patients with inferior myocardial infarction (49.9+/-8.4%) and 7 patients with dilated cardiomyopathy (19.0+/-5.8%), and there was a statistically significant difference compared with 19 normal control group (63.5+/-8.2%)(p<0.005). However there were no statistically significant difference between normal control group, patients with hypertension (58.8+/-7.6%) and patients with angina pectoris (60.1+/-6.5%). 2) Left ventricular ejection fraction decreased in both anterior and inferior myocardial infarction, and there was a statisically significant difference between both groups (p<0.01). All 13 patients with acute myocardial infarction had abnormal LVEF (40.5+/-9.1%) whcih was significantly lower than that of 16 patients with old myolardial infarction (50.1+/-10.5%)(p<0.01).
Angina Pectoris ; Cardiomyopathy, Dilated ; Coronary Artery Disease* ; Coronary Vessels* ; Diastole ; Echocardiography ; Gamma Cameras ; Humans ; Hypertension ; Infarction ; Inferior Wall Myocardial Infarction ; Myocardial Infarction ; Radioisotopes ; Radionuclide Angiography* ; Stroke Volume ; Systole ; Ventricular Function, Left*

No abstract available.
Epidermal Cyst ; Pilomatrixoma

The purpose of this study was to identify the relationship between the clinical response to neoadjuvant chemotherapy and PCNA and VEGF protein expression, apoptosis and its related gene expression such as Bcl-2 and Bax in cervical cancer. We retrospectively reviewed 30 patients with locally advanced or bulky cervical cancer treated with three courses of neoadjuvant chemotherapy followed by radical hysterectomy or radiation therapy at Seoul National University Hospital from June 1995 to June 1998. The specimen were obtained before chemotherapy by colposcopy directed biopsy. The protein expressions of Bcl-2, Bax, VEGF and PCNA were examined by immunohisto- chemical staining and the apoptosis was examined by TUNEL staining. These results were compared with chemotherapeutical response which was evaluated by colposcopy or CT/MRI. There were 2 CR(complete response), 19 PR(partial response) and 9 NC(no change) and there was no progressive disease. There was no significant difference between responder and nonresponder according to the age, tumor size and FIGO stage. The 3 year survival rates of responder and nonresponder were 90.0% and 66.7% respectively and there was significant difference between two groups(p=0,015). The expression of Bcl-2 and Bax was positive in 23.3%(7/30) and 46.7%(14/30). The expression of VEGF was positive in 83.3%(25/30). PCNA PI(positive index), defined as PCNA positive cells in percentage was more than 25.0% in 20 cases. Apoptotic index, defined as the number of the cells undergoing apoptosis per 1,000 tumor cells, ranged from 3 to 53(mean 22.3). Although there was no significant relationship between the clinical response to neoadjuvant chemotherapy and the expre- ssion of Bcl-2, Bax, VEGF and PCNA PI, apoptotic index was significantly higher in responder than nonresponder when the cutoff value of positive was defined as apoptotic index more than 5(p=0.032). In conclusion, the evaluation of the pattern of apoptosis before neoadjuvant chemothera- py is potentially useful for the prediction ofz tumor response to neoadjuvant chemotherapy for cervical cancer.
Apoptosis* ; Biopsy ; Colposcopy ; Drug Therapy* ; Gene Expression ; Humans ; Hysterectomy ; In Situ Nick-End Labeling ; Proliferating Cell Nuclear Antigen* ; Retrospective Studies ; Seoul ; Survival Rate ; Uterine Cervical Neoplasms* ; Vascular Endothelial Growth Factor A*

We report a patient who developed a Barrett,s esophageal ulcer 10 years after esophagomyotomy for achalasia. A-59-year-old female was admitted to the hospital with dysphagia for 2 months. In 1982, she had undergone a modified Heller esophagomyotomy for achalsia. After esophagogram, esophageal manometry, 24hr esophageal pH monitoring, esophagoscophy achalasia and Barrett,s esophageal ulcer was diagnosed. So, she had been treated with omeprazole and sucralfate and has been followed up in a asymtomatic state currently. In Barrett,s esophagus, there is a metaplasia of the normal stratified squamous mucosa to columnar epithelium, caused by the reflux of acid. It appears in approximately 10% of patients with chronic gastroesophageal reflux and is associated with increased probability of adenocarcinoma of the esophagus. Among the predis- posing factors of gastroesophageal reflux, there is treatment of esophageal achalsia by forceful dilatation or by the esophagomyotomy. The resultant ralaxation of lower esophageal sphinter, combined with deficient propulsive esophageal peristalsis, predisposed to gastroesophageal reflux. Actually an increased incidence of gastroesophageal reflux, esophagitis and stricture are well-known complications after esophagomyotomy. But in spite of higher risk of gastroesophageal reflux after esophagomyotomy the development of Barrett,s mucosa has been rarely reported and only recently recognized. Diagnosis of Barrett,s esophagus in such patients is difficult and the cumulative effects of achalasia and Barrett's esophagus predispose these patient to higher risk of developing esophageal carcinoma. So, high index of awareness and regular endoscopic surveillance are required.
Adenocarcinoma ; Barrett Esophagus ; Constriction, Pathologic ; Deglutition Disorders ; Diagnosis ; Dilatation ; Epithelium ; Esophageal Achalasia* ; Esophageal pH Monitoring ; Esophagitis ; Esophagus ; Female ; Gastroesophageal Reflux ; Humans ; Incidence ; Manometry ; Metaplasia ; Mucous Membrane ; Omeprazole ; Peristalsis ; Sucralfate ; Ulcer*

PURPOSE: We report a case of unilateral, focal, pigmented paravenous retinochoroidal atrophy (PPRCA). CASE SUMMARY: A 46-year-old female visited our clinic in complaint of a vague problem with her right eye identified during a general medical examination. The visual acuity (without correction) of both eyes was 1.0. Slit-lamp examination of both eyes revealed no specific signs. Fundus examination of the right eye revealed focal, bony-spicule-shaped retinochoroidal atrophy with pigmentation along the course of the superior retinal vein. A fundus autofluorescence examination revealed principally hypofluorescence with some hyperfluorescence at the margin of the atrophic retinochoroidal lesion. Optical coherence tomography revealed mixed clumping and atrophy of the retinal pigment epithelium (RPE) layer and thinning of the choriocapillaris layer. Fluorescence angiography revealed a window defect and blockage at the site of the lesion (the fluorescent material did not enter the lesion). The site of the window defect was in correlation with the atrophic RPE region. The site of the blockage at lesion also matched with the site of the regional pigment clumping. No definite leakage was observed. CONCLUSIONS: To the best of our knowledge, this is the first case of unilateral focal PPRCA reported from Korea.
Atrophy ; Female ; Fluorescein Angiography ; Humans ; Korea ; Middle Aged ; Pigmentation ; Retinal Pigment Epithelium ; Retinal Vein ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: The purpose of this study was to compare the differences in self-efficacy in clinical performance (SECP) between medical students and residents. METHODS: A total of 267 medical students and 110 residents participated in a survey on SECP with regard to seven factors: knowledge acquisition and application, clinical reasoning, clinical skills, communication with patients, relationships with other health professionals, medical ethics, and self-development. The data were examined by multivariate analysis of variance. RESULTS: Residents had higher scores for clinical skills than students (F[1, 372]=8.919, p<0.01), whereas students scored significantly higher for communication with patients (F[1, 372]=26.779, p<0.001), relationships with other health professionals (F[1, 372]=12.807, p<0.001), medical ethics (F[1, 372]=40.136, p<0.001), and self-development (F[1, 372]=32.380, p<0.001). There were no differences between genders or specialties of residents. CONCLUSION: There are differences in SECP between students and residents. These results can guide the design of self-efficacy improvement programs.
*Clinical Competence ; Communication ; Ethics, Medical ; Female ; Humans ; *Internship and Residency ; Interpersonal Relations ; Male ; *Self Efficacy ; *Students, Medical

PURPOSE: The purpose of this study was to identify the causal relationship between emotional intelligence, ego-resilience, coping efficacy, and academic stress. METHODS: Participants were 424 medical students from four medical schools in Korea. We examined their emotional intelligence, ego-resilience, coping efficacy, and academic stress using a t-test, an analysis of variance, correlational analysis, and path analysis. RESULTS: First- and second-year students scored higher on academic stress than did those from third- and fourth-year students. Further, coping efficacy mediated the relationships between emotional intelligence, ego-resilience, and academic stress. Academic stress was directly influenced by coping efficacy, and indirectly by emotional intelligence and ego-resilience. This showed that coping efficacy play an important role in academic stress. CONCLUSION: Our findings may help medical schools design educational programs to improve coping efficacy in students, and to reduce their academic stress.
*Adaptation, Psychological ; *Education, Medical ; *Emotional Intelligence ; Humans ; Republic of Korea ; *Schools, Medical ; *Stress, Psychological ; Students, Medical/*psychology

Prior to 1988, endometrial cancer was clinically staged but there was the considerable discrepancy between clinical and aetual stage. FIGO surgical staging classification of endometrial cancer(I988) provides the advanatage of recognizing the true disease distribution and extension, and more rational treatraent can be accomplished. This retrospective study was based on a clinical review of 73 patients with endometrial carcinoma from l982 through 1991 who underwent primary surgical evaluation. A11 cases were restaged ueing the newly adopted FIGO surgical staging. The distribution of FIGO clinical staging was as follows:85 patients(89.1%) were with stage I, 5(6.9%) with stage II, 2(2.7%) with stage III and 1(l.3%) with stage IV. Surgical restaging according new FlG0 classification reveald 56(76.7%) patients with stage I, 1(1.4%) with stage II, 14(19.2%) with stage III and 2(2.7%) with stage IV. Surgery upstaged 12.3% of clinical stage I patients, In clinical stage II patients, 80.0% was doenstaged. There wes no stage changing in cliaical stage III and IV patients. The acturial survival rates for surgical stages I a, I b, I c, and III were 80.0%, 77.2%, 68.4A%, and 35.0% respectively. By using FIGO surgical staging, the initial extent of endometrial cancer can be more accurately evaluated and we may predict prognosis and survival relatively well.
Classification ; Endometrial Neoplasms* ; Female ; Humans ; Prognosis ; Retrospective Studies ; Survival Rate

The Duodenal diverticulum is the rare cause of the common bile duct obstruction. We experienced a case of the diverticulum of the second portion of duodenum in a 59-year-old male, who complained recurrent attacks of right upper abdominal pain and fever since 16 months prior to admission. Duodenoscopic finding and UGI study revealed a typical duodenal diverticulum just side to the papilla of Vater. Diverticulectomy and cholecystectomy was performed and after than, he has been free front above mentioned symptoms. We reported a case of duodenal diverticulum which caused recurrent common bile duct obstruction.
Abdominal Pain ; Cholecystectomy ; Common Bile Duct* ; Diverticulum* ; Duodenum ; Fever ; Humans ; Male ; Middle Aged

PURPOSE: Tacrolimus (FK506) is a new potent immunosuppressive agent which has been used as a primary immunosuppressive agent and rescue therapy for refractory rejection in kidney transplantation. In vitro, on a molecular basis, tacrolimus is 10 to 100 times more potent than cyclosporine. Complications associated with tacrolimus are similar to those seen in cyclosporine, including nephrotoxicity. An early marker of tacrolimus-induced nephropathy is tubular vacuolization, whereas long-term administration of tacrolimus is associated with striped interstitial fibrosis and arteriolar hyalinosis. However, morphological changes and pathogenesis of fibrosis in chronic tacrolimus-induced nephropathy remain poorly understood. Transforming growth factor (TGF)-beta1 has been implicated in the fibrosis of a number of chronic diseases of the kidney and other organs. This study was designed to clarify the ultrastructural changes of tacrolimus-induced nephropathy, and to evaluate the relationship between tacrolimus- induced nephropathy and expression of TGF-beta1. METHODS: Male ICR mice received tacrolimus daily at a dose of 2.5 mg/kg by intraperitoneal route for 12 weeks and sacrified 1, 4, 8, 10, and 12 weeks after the initiation of the study, respectively. The kidneys were removed, the cortex is carefully dissected from the medulla, and the tissues are processed for evaluation by light microscopy, electron microscopy, immunohistochemistry and RT-PCR for RNA analysis. RESULTS: Characteristic histological changes of tacrolimus-induced nephropathy were peritubular capillary and intraglomerular capillary congestions, vacuolizations of the tubular epithelium, pericapillary focal fibrosis, and tubular atrophy. Tacrolimus- treated kidneys had a progressive increase in the expression of TGF-beta1, especially in the glomerular and interstitial capillary endothelial cells and atrophied tubular epithelial cells. TGF-beta1 mRNA is expressed persistently in tacrolimus- treated mice for 12 weeks. CONCLUSION: It can be concluded that TGF-beta1 may be involved in the fibrogenesis in the tacrolimus-induced nephropathy.
Animals ; Atrophy ; Capillaries ; Chronic Disease ; Cyclosporine ; Endothelial Cells ; Epithelial Cells ; Epithelium ; Estrogens, Conjugated (USP) ; Fibrosis ; Humans ; Immunohistochemistry ; Kidney ; Kidney Transplantation ; Male ; Mice ; Mice, Inbred ICR ; Microscopy ; Microscopy, Electron ; RNA ; RNA, Messenger ; Tacrolimus ; Transforming Growth Factor beta1 ; Transforming Growth Factors