OBJECTIVE: This study was performed to investigate whether 1) progestogens induce changes of vascular tone in endothelium-denuded smooth muscles of human uterine artery, 2) endothelium-independent vascular reactivity is mediated by intracelluar calcium ion modulation through 2 types of calcium channel, both voltage- and receptor-dependent and 3) 3 kinds of progestogen such as a progesterone, C19 nortestosterone(norethindrone acetate ; NETA) and C21 progestogen(medroxyprogesterone acetate ; MPA), have a different vasoreactivity. METHODS: The uterine arteries were obtained at the time of hysterectomy from 24 women who had no cardiovascular disease risk factors and the endothelium was denuded. Vascular reactivity was monitored by using isometric force transducer and recorded by physiograph. Endothelial integrity was assessed by adding 10micrometer acetylcholine(endothelium-dependent vasorelaxant) to the specimens, which were pretreated with 1micrometer norepinephrine(alpha-adrenergic stimulant). The integrity of smooth muscle was assessed by adding 10micrometer sodium nitroprusside(endotelium -independent vasorelaxant) and 10micrometer tamsulosin(alpha-adrenergic blocker) to the specimens, pretreated with 1micrometer norepinephrine. The uterine smooth muscles were pretreated with 35mM and 70mM potassium chloride and 10-7M and 10-6M norepinephrine. Three kinds of progestogen - progesterone, NETA and MPA - each at 5 different concentrations(10-9g/ml, 10-8g/ml, 10-7g/ml, 10-6g/ml and 10-5g/ml) were used. RESULTS: The loss of endothelial function and adequacy of smooth muscle function were confirmed. Three kinds of progestogen had concentration-dependent inhibitory effects on vascular smooth muscle contr action induced by high potassium solution and norepinephrine, respcetively. There were no siginificant differences noted among the inhibitory effects of three progestogens in 35mM concentration of potassium solution and 10-6M norepinephrine induced muscular contraction. In 70mM potassium solution, there were significant differences among the three progestogens-induced inhibitory effects. Progesterone showed the most potent inhibitory effect, NETA was intermediate, and MPA had the mildest effect. In 10-7M norepinephrine, progesterone had more potent inhibitory effect than NETA or MPA. The difference between progesterone and NETA/MPA was statistically siginificant, with no significance between NETA and MPA. CONCLUSION: The results of this study revealed that progestogens have a concentration-dependent vaso-relaxant effect on endothelium-denuded vasular smooth muscles via a calcium antagonistic mechanism of direct inhibitory effects on receptor- and voltage-dependent calcium ion channels. This vaso-relaxant effect of progestogens differed among a variety of progestogens. In conclusion, the progestogens combined with estrogens have not antagonistic effect on vaso-relaxation at least and maybe have synergistic effect with estrogens, in vivo.
Calcium ; Calcium Channels ; Cardiovascular Diseases ; Endothelium ; Estrogens ; Female ; Humans* ; Hysterectomy ; Muscle Contraction ; Muscle, Smooth ; Muscle, Smooth, Vascular* ; Norepinephrine ; Potassium ; Potassium Chloride ; Progesterone ; Progestins* ; Risk Factors ; Sodium ; Transducers ; Uterine Artery

Marchiafava-Bignami Disease is a rare disorder characterized pathologically by demyelination of the corpus callosum. This disease could be related with chronic alcoholism although a proven etiology has not been reported. Marchiafava-Bignami Disease (MBD) could cause the fatal acute phase symptoms (seizure, coma, and death), various neurological symptoms (tremor, dysarthria, gait disturbance, apraxia), and cognitive impairments (memory impairment, disorientation). It is also reported that MBD causes a dementia. Approximately 250 cases have been reported regarding the MBD since it was first reported in 1903. However, only 20 cases have revealed a favorable prognosis. We found a case of MBD with personality change and chronic alcoholism subsequent to the repeated improvement and aggravation for 4 years. This case is demonstrated a atrophy of splenium of corpus callosum by Magnetic Resonance Imaging. The case also is diagnosed the personality changes, such as emotional irritability, impulsivity, and indignation-expose due to general medical condition, as described in Diagnostic and Statistic Manual of Mental Disorder 4th edition (DSM-IV). However, in early phase this diagnosis did not revealed. The patient was improved in impulse control and behavior by treatment with the Carbamazepine. We investigate the etiology, pathogenesis, symptom &sign, and treatment regarding the MBD in neuropsychiatric aspect.
Alcoholism ; Atrophy ; Carbamazepine ; Coma ; Corpus Callosum ; Dementia ; Demyelinating Diseases ; Diagnosis ; Dysarthria ; Gait ; Humans ; Impulsive Behavior ; Magnetic Resonance Imaging ; Marchiafava-Bignami Disease* ; Mental Disorders ; Prognosis

PURPOSE: Nutritional as well as genetic and hormonal factors play an important role in the bone mineralization during childhood and adolescence. There are several physical and metabolic changes in obese children, and these changes may influence on the mineralization of the skeleton. The studies about bone mineralization of obese children are rare and contradictory. This study was performed to evaluate the influence of childhood obesity on bone mineral density(BMD). METHODS: The BMD of 49 obese and 41 non-obese children were measured at lumbar spines(L2-L4) using dual energy X-ray bone absorptiometry. Then, the results were assessed and compared according to the degree of obesity and pubertal sex maturation. RESULTS: There were no significant differences in BMD between obese children and non-obese children(0.87+/-.19 g/cm2 vs 0.81+/-.13 g/cm2). BMD increased according to the Tanner' pubertal staging, and the most marked increment was observed at overt puberty. No sex difference in BMD was seen in both obese and non-obese children. BMD was highly correlated with age, height, weight and body mass index(BMI), but there was no significant correlation between BMD and osteocalcin. CONCLUSION: BMD of obese children was not significantly different from that of non-obese children, and BMD also was not changed according to the degree of obesity. These findings suggest that BMD is not influenced by obesity in children.
Adolescent ; Bone Density* ; Calcification, Physiologic ; Child* ; Humans ; Obesity* ; Osteocalcin ; Pediatric Obesity ; Puberty ; Sex Characteristics ; Sexual Maturation ; Skeleton

BACKGROUND: The purpose of this study is to investigate 1) whether equol has the direct modulation on vascular tone of endothelium-denuded human uterine artery, and 2) if present, whether this equol-induced modulation of vascular tone is mediated by intracellular calcium modulation through Ca2+ & K+ channels on vascular smooth muscle cell membrane. METHODS: The uterine arteries were obtained at the time of hysterectomy from 15 women. The uterine smooth muscles were pretreated with phenylephrine, 10(-5) M & high KCl solution 70 mM. The equol at 6 different concentrations from 10(-11) to 10(-6) M were used for the evaluation of modulatory action of equol on precontracted vascular smooth. The cumulative concentration-response for equol were determined on phenylephrine-induced contractions and compared with the results without pretreatment. RESULTS: Equol 10(-11) to 10(-6) M in concentration showed relaxation effect on vascular smooth muscle contraction which was induced by phenylephrine 10(-5) M. This relaxation effect of equol was dose-dependent. Equol in same concentrations showed no significant effects on vascular smooth muscle contraction induced by high KCI solution. Phenylephrine-induced contraction was markedly reduced from 10(-7) to 10(-4) M in concentration by pretreatment of equol, but high KCI-induced contraction was not affected by pretreatment of equol. CONCLUSIONS: This vasodilatation effect of equol may be induced by calcium antagonistic action, which was mediated through antagonistic action for receptor-dependent Ca2+ channel, but not for voltage-dependent Ca2+ channel. As far as we know, this is the first report of phytoestrogen equol on vascular reactivity of human vessels.
Calcium ; Cell Membrane ; Equol ; Female ; Humans ; Hysterectomy ; Muscle, Smooth ; Muscle, Smooth, Vascular ; Phenylephrine ; Phytoestrogens ; Relaxation ; Uterine Artery* ; Vasodilation*

Combined peginterferon and ribavirin therapy for chronic hepatitis C is associated with several adverse side effects, but sudden deafness is uncommon. Here we report the case of a 62-year-old female with chronic hepatitis C (genotype 1b) who developed sudden deafness after completing 12 months of treatment with peginterferon alpha2a (180 microg/week) and ribavirin (1,000 mg/day). Pure-tone audiometry revealed a right-sided sensorineural hearing loss, which did not respond to 2 weeks of systemic corticosteroid therapy. Six months after the end of treatment for chronic hepatitis C, her qualitatively determined hepatitis C virus RNA level was 121,000 IU/mL. Following therapeutic failure, the patient was observed without retreatment for chronic hepatitis C or her hearing loss for a period of 12 months, during which time her hearing recovered almost completely.
Audiometry, Pure-Tone ; Female ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden* ; Hepacivirus ; Hepatitis C, Chronic* ; Humans ; Middle Aged ; Retreatment ; Ribavirin* ; RNA

Small cell carcinoma (SCC) primarily arises in the lung. Cases of primary extrapulmonary small cell carcinoma are uncommon, and may develop in various different organs. In particular, small cell carcinoma of the urinary bladder is very rare in female nonsmokers, and its prognosis is poor. The main part of treatment in SCC is a chemotherapy, which is a critical factor in its prognosis. In the present report, we describe the case of an 82-year-old female non-smoker who underwent transurethral resection of bladder tumor (TURBT) without chemotherapy for small-cell carcinoma of the bladder, and experienced a relapse at a same area to the primary tumor site.
Aged* ; Aged, 80 and over ; Carcinoma, Small Cell* ; Drug Therapy ; Female* ; Humans ; Lung ; Prognosis ; Recurrence ; Urinary Bladder Neoplasms ; Urinary Bladder*

Placenta percreta occurs when chorionic villi penetrate through the myometrium up to the serosa. The incidence of placenta percreta is extremely rare (about 1/140000 deliveries) but it is accompanied by life threatening complication of pregnancy due to massive hemorrhage. Antepartum diagnosis and proper management is important to decrease the marternal mortality and morbidity. We present two cases of spontaneous uterine rupture due to placenta percreta with brief review of literature. The one is that a women with a history of previous ceasrean section and placenta previa was treated with cesarean hysterectomy due to the spontaneous uterine rupture with placenta percreta at GA 37(+2) weeks. The other is that a women with a bicornuate uterus had preserved the ruptured uterus with placenta percreta incidentally detected at emergency cesarean section at GA 39(+5) weeks.
Animals ; Cesarean Section ; Chorionic Villi ; Diagnosis ; Emergencies ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Incidence ; Mice ; Mortality ; Myometrium ; Placenta Accreta* ; Placenta Previa ; Placenta* ; Pregnancy ; Serous Membrane ; Uterine Rupture* ; Uterus

PURPOSE: The Korean National Cancer Screening Survey (KNCSS), a nationwide cross-sectional survey, has been conducted annually since 2004. The current study was conducted to report on the trends in screening rates among Korean men and women, and to evaluate policies regarding cancer screening programs implemented to reduce the burden of cancer. MATERIALS AND METHODS: The current study used KNCSS data. The eligible study population included men aged 40-74 years and women aged 30-74 years with no cancer history. The lifetime screening rate, screening rate with recommendation, and changes in annual rates were calculated for five major cancers (i.e., stomach, liver, colorectal, breast, and cervix uteri). RESULTS: The screening rates with recommendation increased by 4.2% (95% confidence interval [CI], 3.7% to 4.8%) annually for stomach cancer, 1.2% (95% CI, 0.1% to 2.4%) for liver cancer, 3.0% (95% CI, 1.8% to 4.1%) for colorectal cancer, 3.7% (95% CI, 2.7% to 4.8%) for breast cancer, and 1.3% (95% CI, 0.8% to 1.8%) for cervical cancer. In 2013, the screening rates with recommendation for stomach, liver, colorectal, breast, and cervical cancers were 73.6%, 33.6%, 55.6%, 59.7%, and 67.0%, respectively. CONCLUSION: Both the lifetime screening rates and screening rates with recommendation for the five above-mentioned cancers increased annually from 2004 to 2013.
Breast ; Breast Neoplasms ; Cervix Uteri ; Colorectal Neoplasms ; Cross-Sectional Studies ; Early Detection of Cancer* ; Female ; Health Care Surveys ; Humans ; Liver ; Liver Neoplasms ; Male ; Mass Screening ; Stomach ; Stomach Neoplasms ; Uterine Cervical Neoplasms

Background: We conducted a case-control study to identify high-risk occupations and exposure to occupational hazards for acute myeloid leukemia (AML). Methods: When patients with AML admitted to the Department of Hematology in the study hospital for the first time are referred to the Department of Occupational and Environmental Medicine, data on occupation are collected by investigators to evaluate work-relatedness. Community-based controls were recruited through an online survey agency, and four controls per case were matched. Occupational information was estimated using structured questionnaires covering 27 specific occupations and 32 exposure agents. Conditional logistic regression analysis was performed by pairing cases and controls. Results: In the analysis of the risk of AML according to occupational classification, a significant association was found in paint manufacturing or painting work (OR = 2.22, 95% CI: 1.03–4.81) and aircrew (OR = 6.00, 95% CI: 1.00–35.91) in males, and in pesticide industry (OR = 6.89, 95% CI: 1.69–28.07) and cokes and steel industry (OR = 2.00, 95% CI: 1.18–22.06) in ≥60 years old. Moreover, the risk of AML increased significantly as the cumulative exposure to thinners increased. In the analyses stratified by sex and age, the association between pesticide exposure and AML was significant in males (OR = 3.28, 95% CI: 1.10–9.77) and in ≥60 years old (OR = 6.22, 95% CI: 1.48–26.08). Conclusion This case-control study identified high-risk occupational groups in the Republic of Korea including paint manufacturers and painters, aircrew, and those who are occupationally exposed to pesticides or paint thinners.

BACKGROUND: Consultation and referral are important characteristics of modern medicine which has become more segmented and more specialized. In particular, they give essential value to family practitioners to coordinate patients accordingly for proper care. This study analyzed the referred patients in family practices under Cheonan practice based-research network (CPBRN). METHODS: The data was collected via questionnaire in ten family clinics under CPBRN system during the four weeks from June 15, 2006 to July 12, 2006. RESULTS: The total number of referred cases was 103 (0.7%) out of a total of 14,466 office visits. Among the total, 68.9% of referred cases was physician-drived and 31.1% was patient-requested. The reason for referral were 'to get a second opinion of specialist' (34), 'high severity' (20), 'lack of examination tool' (18), 'lack of skill' (10) and 'no response to treatment' (2) in physician-drived cases, whereas in patient-requested cases, they were 'request for advanced hospital' (26) and 'want to meet specialist' (2). The patients were referred to tertiary hospital in 66.7%, secondary hospital in 15.9%, and other specialists of primary setting in 10.1%. Overall, 66.7% of the referred hospital was located in the city area. The main health problems of referred patients was divided into 'gastrointestinal' (17.5%), 'musculoskeletal' (13.6%), 'dermatology' (10.7%) and so on. The speciality consulting physicians were 'internal medicine' (34%), 'pediatrics' (13.6%), and 'orthopedic surgery' (10.7%) specialists. CONCLUSION: The referral rate of family practice in Korea was 0.7%. The main reason for referral was 'to get a secondary opinion of a specialist'. The most common referral problem was 'gastrointestinal'. 'Internal medicine' was the most frequently consulted specialty.
Chungcheongnam-do* ; Family Practice ; History, Modern 1601- ; Humans ; Korea ; Office Visits ; Referral and Consultation* ; Specialization ; Tertiary Care Centers ; Surveys and Questionnaires