OBJECTIVE: To determne whether abnormal results of doble saeening tests for Down syndrome with MSAFP and free B-hCG are associated with adverse pregnancy outcome. METHODS: Between October 1994 and September 1997, 205 among 1731 who were screened had increased risk for Down screening program of CIS biointernational, Fetuses with Chromosomal abnormality or congenital anomalies and less than 35 years of maternal age were excluded from this study. Down syndrome screening test was performed between 14-22 weeks of gestation. RESULTS: Of 1731 women, 205 (13.4%) had increased Down syndrome risk. The pregnancy outcome of women with increased Down syndrome risk were compared with those of women without such risk There were no significant difference in the incidence of preterm labor (6[2.9%] vs 112[7.3%)), premature rupture of the membranes (2[0.9%] vs 56[3.6%]), pregnancy induced hypertension (2[0.9%] vs 36[2.3%]), abruptio placentae (0[0%] vs 2[0.1%]), low birth weight (2[0.9%] vs 21[1.3%]), oligohydramnios (4[1.9%] vs 10[0.6%]), intrauterine fetal death (0[0%] vs 2[0.1%]). CONCLUSION: False positive results of Down syndrome screening test in the 2nd trimester do not appear to be associated with adverse pregnancy outcome. But there are statistically significant increases of adverse pregnancy outcome in wemen with elevation of MSAFP or elevation of free B-hCG.
Abruptio Placentae ; Chromosome Aberrations ; Down Syndrome ; Female ; Fetal Death ; Fetus ; Humans ; Hypertension, Pregnancy-Induced ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Mass Screening* ; Maternal Age ; Membranes ; Obstetric Labor, Premature ; Oligohydramnios ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Rupture

Multiple myeloma, solitary bone plasmacytoma, extramedullary plasmacytoma, plasmablastic sarcoma, and multifocal form of multiple myeloma belong to plasma cell tumors. Among them, extramedullary plasmacytoma consists of 4% of all plasma cell tumors and is found predominantly in the head and neck region. This tumor is a solitary tumor consisting of monoclonal plasma cell proliferation that occurs in soft tissues other than bone. The frequent sites in the upper aerodigestive tract are the paranasal sinus and the nasal cavity. Because the diagnosis is based on immunophenotypical finding of monoclonal plasma cells and there are many differential diagnoses, the exact diagnosis is difficult. To our knowledge, extramedullary plasmacytoma originating in the nasopharynx has rarely been reported. We experienced a case of nasopharyngeal extramedullary plasmacytoma which was treated with combined therapy. So we report this case with a review of literatures.
Diagnosis ; Diagnosis, Differential ; Head ; Multiple Myeloma ; Nasal Cavity ; Nasopharynx* ; Neck ; Plasma Cells ; Plasmacytoma* ; Sarcoma

PURPOSE: The laparoscopic cholecystectomy has become a common procedure for treating gallbladder disease. The objectives of this study was to evaluate the learning curve by reviewing 145 patients treated with laparoscopic cholecystectomy, between Group A (From January 1991 to December 1995) and Group B (From January 1996 to December 2000). METHODS: We retrospectively analyzed 145 laparoscopic cholecystectomies performed at the Department of General Surgery, National Medical Center, from January 1991 to December 2000. The sex, age, operation time, associated disease, previous operation history, hospital stay, and pathology were reviewed. RESULTS: The ratio of Females to males was 1.9:1, and their age ranged from 18 to 80 years with the majority in their fifties and sixties. Most of the operative indications were cholelithiasis. The mean operative time was 89 minutes, which varied between 40 and 180 minutes, and the average admission time was five days. The operation times of Group A and Group B were statistically significant with respect to learning curve (p value<0.000). A linear regression test of the operation time and operation cases was also significant. The postoperative analgesic injection and hospital stay were improved in Group B, but had no statistical significance. A conversion to open cholecystectomy was done in four cases due to bleeding, severe adhesion, or clip migration of the cystic duct during surgery. CONCLUSION: The laparoscopic cholecystectomy was a safe and effective treatment for gallbladder disease, and wepredict that the operation time will become shorter with more experience.
Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholelithiasis ; Cystic Duct ; Female ; Gallbladder Diseases ; Hemorrhage ; Humans ; Learning Curve ; Length of Stay ; Linear Models ; Male ; Operative Time ; Pathology ; Retrospective Studies

Massive eversion of the vagina is one of the most disturbing disorders confronting a woman. It is a complex disorder that always surgical, and all defects. The managements is always surgical, and all defects must be repaired concomitantly. Current surgical practice relies primarily on the strength of the endopelvic fascia and certain ligaments. Massive eversion of the vagina can be treated by a variety of transvaginal and transamdominal surgical technique. In most instances a transvaginal approach is useful. If strong cadinal and uteroscral support in not available fiocation of the vginal vault to the sacrospinous ligment is useful. In 1987, Miyazaki introduced his Miya Hook ligature carrier. With this instrume nt, introduction of the needle became safer and easier than with the Deschamp aneurysm needle. We had experienced two cases of massive eversion of vagina after the total abdominl hyst erectomy who were treated succesfully with sacrospinous ligement fixation by using Miya Hook. We report above two cases and review briefly.
Aneurysm ; Fascia ; Female ; Humans ; Hysterectomy* ; Ligaments* ; Ligation ; Needles ; Vagina*

OBJECTIVE: The purpose was to evaluate the effect of the intravaginal misoprostol(prostaglandin E1,) for termination after second trimester. METHODS: Thirty pregnant women with intrauterine fetal death and with indications for therapeutic termination of intrauterine pregnancy at least fourteen weeks of gestation were recruited. They were evaluated the mean time from induction to termination, maternal side effects, and total dose of the powdered 100ug misoprostol adminstered in the posterior vaginal fornix every six hours. RESULTS: The mean time from induction to termination was 21.1+/-8.2 hours after administration of the intravaginal misoprostol. Only two patients had not been delivered within 48hours. Vomiting, diarrhea, and fever were not accompanied except nausea. The total dosage of misoprostol was 412.5+/-156.1ug. CONCLUSION: This study shows that intravaginal misoprostol appears to be safe, effective and inexpensive method for the labor induction for termination of pregnancy in the second or third trimester of pregnancy.
Diarrhea ; Female ; Fetal Death ; Fever ; Humans ; Misoprostol* ; Nausea ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third* ; Pregnant Women ; Vomiting

Allopurinol-induced severe cutaneous adverse reactions (SCARs) such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome are reportedly associated with the HLA-B*58:01 genotype. Three patients who developed SCARs after allopurinol administration were subjected to HLA-B genotyping and lymphocyte activation test (LAT) to evaluate genetic risk and to detect the causative agent, respectively. All three patients given allopurinol to treat gout were diagnosed with DRESS syndrome. Symptom onset commenced 7-24 days after drug exposure; the patients took allopurinol (100–200 mg/d) for 2-30 days. HLA-B genotyping was performed using a polymerase chain reaction (PCR)-sequence-based typing (SBT) method. All patients had a single HLA-B*58:01 allele: HLA-B*13:02/*58:01 (a 63-year-old male), HLA-B*48:01/*58:01 (a 71-year-old female), and HLA-B*44:03/*58:01 (a 22-year-old male). Only the last patient yielded a positive LAT result, confirming that allopurinol was the causative agent. These findings suggest that patients with HLA-B*58:01 may develop SCARs upon allopurinol administration. Therefore, HLA-B genotyping could be helpful in preventing serious problems attributable to allopurinol treatment, although PCR-SBT HLA-B genotyping is time consuming. A simple genotyping test is required in practice. LAT may help to identify a causative agent.
Aged ; Alleles* ; Allopurinol ; Cicatrix ; Drug Hypersensitivity Syndrome ; Genotype ; Gout ; HLA-B Antigens ; Humans ; Lymphocyte Activation* ; Lymphocytes* ; Methods ; Middle Aged ; Polymerase Chain Reaction ; Stevens-Johnson Syndrome ; Young Adult

Antiepileptic drugs (AEDs) can induce severe cutaneous adverse reactions (SCARs) such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. We performed HLA genotyping and lymphocyte activation tests (LATs) for five AED-induced SCAR patients (three males and two females; aged 40–66 years old). Three patients were treated with carbamazepine (CBZ) for pain control, one was treated with phenytoin (PHT) for seizure prevention, and one was treated with valproic acid (VPA) for seizure prevention. One patient was diagnosed with CBZ-induced DRESS syndrome and the remaining patients were diagnosed with SJS. All patients recovered from SCARs after stopping suspicious drugs and supportive care. LATs were conducted to confirm the culprit drug responsible for inducing SCARs; and LAT results were positive for the suspected culprit drugs, in all except in one case. HLA-A,
Alleles ; Anticonvulsants ; Carbamazepine ; Cicatrix ; Drug Hypersensitivity Syndrome ; Female ; HLA-A Antigens ; Humans ; Long-Acting Thyroid Stimulator ; Lymphocyte Activation ; Lymphocytes ; Male ; Methods ; Phenytoin ; Seizures ; Stevens-Johnson Syndrome ; Valproic Acid

BACKGROUND: The most commonly used regimen for the eradication of Helicobacter pylori is combination of a proton pump inhibitor, clarithromycin, and two other antibiotics, metronidazole and amoxicillin. The increase in resistance to antibiotics seems to result in a decrease in eradication efficacy for H.pylori. We investigated the prevalence of antibiotic resistance in H.pylori isolated in Daejeon area. METHODS: A total of 31 clinical isolates of H.pylori were collected from the patients who underwent upper gastrointestinal endoscopy in Keonyang University Hospital during the period from March to July 2004. Antibiotic susceptibility tests for metronidazole, amoxicillin, and clarithromycin were performed by the E test (AB Biodisk, Sweden) on an egg yolk medium containing triphenyltetrazolium. The resistance break points for amoxicillin, metronidazole, and clarithromycin were defined as 0.5 microgram/mL, 8 microgram/mL, 1 microgram/mL, respectively. RESULTS: Resistance to amoxicillin, metronidazole, and clarithromycin was detected in 7.4% (2/27), 25.8% (8/31), 3.6% (1/28), respectively. CONCLUSION: The resistance to amoxicillin and clarithromycin was uncommon in Daejeon area.
Amoxicillin ; Anti-Bacterial Agents ; Clarithromycin ; Drug Resistance, Microbial ; Egg Yolk ; Endoscopy, Gastrointestinal ; Helicobacter pylori* ; Helicobacter* ; Humans ; Metronidazole ; Prevalence* ; Proton Pumps

OBJECTIVES: This study was designed to observe the clinical and audiologic characteristics of patients diagnosed as low tone hearing loss (LHL) and to evaluate the treatment response and prognosis. SUBJECTS AND METHODS: A retrospective chart review of 61 patients who were diagnosed with LHL was performed. Result of various audiologic studies and therapeutic responses of medication have been evaluated. Data were statistically analyzed with variables such as age, sex, interval between onset and treatment, initial hearing levels, findings of electrocochleargraphy, and initial concomitant symptoms according to their treatment response. RESULTS: Frequent chief complaints of LHL were tinnitus and earfullness. Tinnitus was usually matched at lower frequencies. Treatment with low-dose steroids, diuretics, and betahistine produced a high response rate of 79.4%. Complete response occurred in 49 of the 68 ears (72.1%) and partial response occurred in five of the 68 ears (7.4%). Fourteen of the 68 ears (20.6%) were in the non-responder group. Patients treated within 7 days after the onset of symptoms all showed complete response. Statistically significant prognostic factors affecting treatment response were age and intervals between onset and treatment (p<0.05). CONCLUSION: Patients with acutely onset tinnitus or ear fullness should be carefully evaluated and promptly treated under the diagnosis of LHL.
Betahistine ; Diuretics ; Ear ; Hearing ; Hearing Loss ; Humans ; Prognosis ; Retrospective Studies ; Steroids ; Tinnitus

BACKGROUND AND OBJECTIVES: Dentigerous cysts arise from the reduced enamel epithelium and expand into the surrounding bone. They grow unnoticed to such extensive sizes as to occupy a considerable portion of the maxillary sinus. This study was designed to clarify the clinical, radiological and histopathological features of ten cases of the dentigerous cyst involving the maxillary sinus. MATERIALS AND METHODS: Medical records of ten patients, who were diagnosed with dentigerous cyst, were analyzed from June 1990 to May 2000 retrospectively. RESULTS: The greatest incidence of dentigerous cyst occurred between the ages of 10 and 30 years old (average age 29.6 years). Facial swelling and pain were the most common com-plaints, followed by oro-antral fistula, headache and facial numbness. CT scan of paranasal sinuses showed a slightly nonhomogeneous soft tissue density surrounded by an incomplete bony wall which occupied partially antral space. In the middle of the cyst, the isolated high density of unerupted tooth was seen. In the lining epithelium, the stratified squamous epitheliums were the most frequent. Six patients underwent cyst removal via Caldwell-Luc approach and four patients underwent cyst removal via intraoral approach. The postoperative course has been gone well without recurrence. CONCLUSIONS: The differential diagnosis and early detection of the dentigerous cyst in involving maxillary sinus are important. Rhinologist should be aware of this disease entity when encountered with patients presented with unilateral painful swelling of cheek.
Adult ; Cheek ; Dental Enamel ; Dentigerous Cyst* ; Diagnosis, Differential ; Epithelium ; Fistula ; Headache ; Humans ; Hypesthesia ; Incidence ; Maxillary Sinus* ; Medical Records ; Paranasal Sinuses ; Recurrence ; Retrospective Studies ; Tomography, X-Ray Computed ; Tooth, Unerupted