OBJECTIVE: To evaluate the changing pattern of serum leptin level and the correlation between estradiol level during the clomiphene citrate challenge test(CCCT) or controlled ovarian hyperstimulation(COH) cycle. METHODS: Twenty-seven women who underwent CCCT and fourteen women who underwent controlled ovarian hyperstimulation were recruited to measure the serum leptin level. After correction of serum concentration with body mass index(BMI), changes of leptin level and correlation with serum estradiol level during CCCT and COH cycle were analyzed. RESULTS: Circulating leptin levels were significantly correlated with BMI at each time point in CCCT cycle(P<0.01). In CCCT cycle, leptin/BMI level was significantly increased at midluteal phase compared to that of menstrual cycle day 3 and 10(p<0.05). In women with regular menstruation, leptin/BMI level at midluteal phase was significantly higher than that of menstrual day 3 and 10, but this difference was not seen in women with irregular menstruation. The leptin/BMI level in COH cycle showed increasing tendency throughout ovarian stimulation. But there was no significant correlation between leptin/BMI and estradiol level in CCCT and COH cycle. CONCLUSION: There is a significant correlation between BMI and circulating leptin level. Midluteal leptin level is significantly higher than that of follicular phase in CCCT cycle, and there is an increasing tendency in leptin level after ovarian stimulation in CCCT and COH cycle without statistical significance. These findings suggest that circulating estradiol concentration has no major influence on circulating leptin level.
Clomiphene* ; Estradiol ; Female ; Follicular Phase ; Humans ; Leptin* ; Menstrual Cycle ; Menstruation ; Ovulation Induction

Thromboembolism is the most common serious complication following total hip arthroplasty and most common cause of death after total hip arthroplasty. A prospective randomized study in 170 cases of elective cementless total hip arthroplasty was carried out to examine the incidence of deep vein thrombosis and pulmonary embolism after cementless total hip arthroplasty from Aug. 1993 to May 1995. Laboratory study, clinical symptoms and signs, chest roentgenograph and precipitating factors were analysed. Venography and lung perfusion scan using radionuclide scan were used for this study. The weight, height, sex, habitus of alcohol and smoking, hypertension, diabetes mellitus, previous operation history of ipsilateral lower extremity, etiology of hip joint disease, and transfusion of blood were not precipitating factors, but the age over 40 and previous history of pulmonary embolism had a significant effect on the incidence of deep vein thrombosis. There was no significant relationship between the incidence of deep vein thrombosis and the laboratory assay, clinical symptoms and signs. Deep vein thrombosis was detected in 29 cases(17.0%), pulmonary embolism in 22 cases(12.9%), and fatal pulmonary embolism in 1 case(0.6%). The most common location of deep vein thrombosis was the popliteal area.
Arthroplasty, Replacement, Hip* ; Cause of Death ; Diabetes Mellitus ; Hip Joint ; Hypertension ; Incidence ; Lower Extremity ; Lung ; Perfusion ; Phlebography ; Precipitating Factors ; Prospective Studies ; Pulmonary Embolism* ; Smoke ; Smoking ; Thorax ; Thromboembolism ; Venous Thrombosis*

We evaluated the results of twelve total elbow arthroplasties that had been performed from Feb. 1986 to Mar. 1993 in ten patients. The duration of follow-up averaged three years two months(range, one year to seven years one month). There were six females and four males. Two females had bilateral procedures. The average age at the time of the operation was 35.3 years(range, 22 to 53). Five patients had severe rheumatoid arthritis, four patients had fracture sequelae around elbows and one patient had sequele of tuberculous arthritis. Total elbow arthroplasty had been performed for improving the range of motion and relief of pain. Total elbow arthroplasties had been performed in six cases of total ankylotic elbows and in six cases who complained severe painful limitation of motion of the elbow joints. Preoperatively, ankylotic group were fixed by 30 degrees of flexion on an average. In painful elbow group, the average total range of motion was 68 degrees. The prosthesis which were used in total elbow arthroplasties were semiconstrained type in nine cases and noncostrained in three cases. Most of the patients had relief of pain. Postoperative complications were permanent ulnar nerve palsy in one case, superficial infection in one case and dislocation in one case. Total gain of range of motion(ROM) was 17 degrees in painful elbow group and 102 degrees in ankylotic elbows. Total elbow arthroplasty was effective method for improvement of range of motion in ankylotic elbows and relief of pain in elbows which had painful limitation of motion.
Ankylosis ; Arthritis ; Arthritis, Rheumatoid ; Arthroplasty ; Dislocations ; Elbow Joint ; Elbow ; Female ; Follow-Up Studies ; Humans ; Male ; Methods ; Postoperative Complications ; Prostheses and Implants ; Range of Motion, Articular ; Ulnar Neuropathies

Conservative treatment is the main therapy for cervicobrachial syndrome, scapulohumeral periarthritis, and lumbago as diseases with both pain and myotonia. The-conservative treatment mainly consists of medication, physiotherapy, and kinesiotherapy. In the recent years, attempts have been made to give relief to myotonia through combination therapy with antiinflammatory analgesics and muscle relaxants. The muscle relaxants using in general are tolperisone hydrochloride, chlormezanone, and diazepam. Eperizone hydrochloride(Mulex tablet) is a beta-propriophenone derivatives and a central acting muscle relaxant, And it benefited subjective symptoms such as muscular pain (lumbago, neck pain) and a stiff muscle sensation (shoulder tension, tension feeling of lower limb). Among 22 patients, there were 14 lumbagos, two cephalobrachial syndromes, one scapulohumeral periarthritis, and five combined patients were chosen and duration of symptom was 5 years (3months-15years) in average. Mulex tablet was administered in a dose of 3 tablets (150rag) per day in 22 patients for 6 weeks prospectively. We analysed general improvement rating (GIR), general usefulness rating(GUR), and overall safety rating. The general improvement rate was 78% and the aggravation rate was 4%. The complication after, madication was infrequently gastrointestinal trouble. Incidence of side effect was 22%, but all these complications were insignificant. Hematology, blood chemistry, and urinalysis after medication were normal.
Analgesics ; Chemistry ; Chlormezanone ; Diazepam ; Hematology ; Humans ; Incidence ; Low Back Pain ; Myotonia ; Neck ; Periarthritis ; Prospective Studies ; Sensation ; Tablets ; Tolperisone ; Urinalysis

No abstract available.
Adenocarcinoma* ; Carcinoma, Squamous Cell*

PURPOSE: Mortality in emergency department sepsis (MEDS), sepsis-related organ failure assessment (SOFA), multiple organ dysfunction score (MODS), and serum lactate levels have shown their efficacy in the early detection of patients with a bad prognosis. However, those studies did not consider differences in treatment protocols and could not rule out the interference of these differences in treatment modalities. Hence, we aimed to assess the performance of MEDS, MODS, SOFA, and serum lactate levels for predicting a bad prognosis in patients scheduled for identical, standardized treatment protocols, EGDT. METHODS: Medical records of patients who visited a tertiary level teaching hospital and were enrolled in an EGDT program between October 2009 and May 2010, were retrospectively reviewed. MEDS, SOFA, and MODS scores were calculated and recorded along with serum lactate levels. Receiver operating characteristics (ROC) curves of those predictors of mortality were plotted, Bivariate correlation analyses with overall lengths of admission and ICU lengths of stay were done for surviving patients. RESULTS: None of the diagnostic methods (serum lactate level, MEDS, SOFA, MODS) showed a significant difference on ROC analysis (p=0.819, 0.506, 0.811, 0.873, respectively). Bivariate correlation analyses of MEDS, SOFA, MODS and overall lengths of admission showed significant results (p=0.048, 0.018, and 0.003, respectively. Pearson correlation coefficients were, 0.263, 0.312, and 0.381). Only MEDS showed a significant correlation with intensive care unit (ICU) length of stay (p=0.032, Pearson correlation coefficient = 0.332). CONCLUSION: Neither MEDS, SOFA, MODS, nor serum lactate level can predict mortality in EGDT-enrolled patients. MEDS may be correlated with ICU length of stay.
Clinical Protocols ; Emergencies ; Hospitals, Teaching ; Humans ; Intensive Care Units ; Lactic Acid ; Length of Stay ; Medical Records ; Multiple Organ Failure ; Organ Dysfunction Scores ; Prognosis ; Retrospective Studies ; ROC Curve ; Sepsis ; Severity of Illness Index ; Treatment Outcome

Pneumomediastinum can result from fractures involving paranasal sinuses, orbits, mandibles, other facial bones. This is a case report of an 25-year-old man who fell from a third floor. He suffered injuries to the maxillofacial region. Initial examination revealed a mandibular complex fracture and tooth loss, but the man developed neck swelling, dyspnea, and dysphagia over the next 3 days. Repeat examination revealed marked pneumomediastinum and subcutaneous emphysema.
Adult ; Deglutition Disorders ; Dyspnea ; Facial Bones ; Humans ; Mandible* ; Mediastinal Emphysema* ; Neck ; Orbit ; Paranasal Sinuses ; Subcutaneous Emphysema ; Tooth Loss

A primary signet ring cell carcinoma (PSRCC) of the urinary bladder is a rare variant of a mucin-producing adenocarcinoma. The prognosis of a PSRCC is poor, as silent progression in a linitis platica fashion leads to delayed diagnosis. Herein, the case of a PSRCC of the bladder, which extended to the prostate, which was treated with a cystoprostatectomy, is reported.
Adenocarcinoma ; Carcinoma, Signet Ring Cell* ; Delayed Diagnosis ; Prognosis ; Prostate* ; Urinary Bladder*

Wear of polyethylene liner and osteolysis appear to be topical problems after long-term follow-up in total hip arthroplasty(THA). Age and activity of patients, manufacturing procedure of polyethylene liner, thickness of the liner, position of acetabular cup, and material of artificial femoral head have of effects on the degree of wear. In addition, conformity, congruency and micromotion between liner and metal cup are likely to be related to the wear. The purpose of this study is 1) to determine the stress caused by contact between metal and polyethylene components, 2) to evaluate the effects of conformity, congruency, and fixation between metal and polyethylene components, on contact stress in acetabular cups and 3) to identify the design parameters of the commercial acetabular cup within the constraints imposed by the overall functional requirements of total joint replacement. The specimens applied to six different commercial cups made in five companies. The methods was performed on dynamic test and static test to rely on load conditions, estimated the gap between the components through LM. The results showed H-G II cup had the most excellent congruency because of the narrowest interval between two components.
Acetabulum ; Head ; Hip ; Humans ; Joints ; Osteolysis ; Polyethylene*

Streptococcal toxic shock syndrome with myonecrosis is a rapidly progressive process that kills 80% of patients in 72-96 h. Various bullae, hypotension, fever, and evidence of organ failure are late clinical manifestations. The symptoms and signs of myonecrosis can be nonspecific and misleading, not clearly revealing the involvement of deep skeletal muscle. Thus, the challenge to clinicians is to make an early diagnosis and to intervene with aggressive fluid replacement, emergent surgical debridement, and general supportive measures. We describe an presentation of myonecrosis of the lower extremities secondary to group A beta-hemolytic streptococcus infection in a 21-years-old woman. In addition, the patient had no history or evidence of trauma to the affected area.
Debridement ; Early Diagnosis ; Female ; Fever ; Humans ; Hypotension ; Lower Extremity ; Muscle, Skeletal ; Shock, Septic* ; Streptococcal Infections ; Streptococcus*