Although methotrexate(MTX) has been known to have many side effects, especially toxicity on the hemopoietic cells and the liver, it has been used as a potent anticancer drug and for the treatment of psoriasis or rheumatoid arthritis. The severity of hepatotoxicity varies from mild fatty change to chronic active hepatitis(CAH) and cirrhosis. We experienced two cases of MTXinduced CAH in patients with psoriasis, which prompted us to report in view of the absence of biopsy proven MTX hepatotoxicity in the Korean literature. Microscopically, the liver showed a distorted lobular architecture with portal fibrous expansion, piecemeal necrosis and bridging necrosis/fibrosis. The hepatic lobules revealed fatty changes of hepatocyte, focal hepatocytolysis, delicate collagen deposits along the space of Disse and the characteristically marked polyploid nuclear change of hepatocytes.
Biopsy

No abstract available.
Heel* ; Melanoma, Amelanotic* ; Ulcer*

The multistage maximal exercise test was performed to 135 cases with various heart disease and 207 control group between jan. 1980 and Dec. 1980 in KoreaGeneral Hospital. The change of heart rate, blood pressure and ST segment in various heart disease were compared with those in control group. The results were followings; 1. There were 130 male and 77 female of cases with control group, whose mean age were 50 years old. 2. General check up was the most common underlying disease of control group(67 patients) and the others were gastritis (28), neurosis (24), diabets mellitus (17), hepatitis (4) and peptic ulcer (4) frequency. 3. Change of heart rate, blood pressure and ST segment in control group during GXT were 89~154, 119/80~157/88 mmHg and 0.6~2 mm. 4. There were 81 male and 51 female of cases with various heart disease group, whose mean age were 50 years old. 5. Atherosclerotic heart disease was the most common underlying disease of various heart disease group (49 patients) and the others were hypertension (34), hypertensive cardiovascular disease (22), labile hypertension (14), angina (7), arrythmia (6) and others (3) in frequency. 6. Change of heart rate, blood pressure and ST segment in various heart disease group during GXT were 85~148, 140/93~178/102 mmHg and -0.7~1.3mm. ST segment in atherosclerotic heart disease, hypertension, hypertensive cardiovascular disease, valvular heart disease and myocardial infarction were significantly depressed(p<0.05) compared with ST segment in control group.
Arrhythmias, Cardiac ; Blood Pressure ; Cardiovascular Diseases ; Exercise Test* ; Female ; Gastritis ; Heart Diseases* ; Heart Rate ; Heart Valve Diseases ; Heart* ; Hepatitis ; Humans ; Hypertension ; Male ; Middle Aged ; Myocardial Infarction ; Peptic Ulcer

OBJECTIVE: Peripartum emergency cesarean hysterectomy of 28 cases at our hospital for 10years were reviewed that the clinical indication, history, and annual incidence change. METHODS: A retrospective descriptive analysis from January, 1988 to December, 1997 was carried out. RESULTS: There were 28 cases of emergency cesarean hysterectomy identified during this period among total 24, 689 deliveries. The annual incidence of emergency cesarean hysterectomy was significantly declined statistically(p<0.005). Cesarean hysterectomy was performed in 20 of 6, 671 cesarean section(0.30%) and in 8 of 18, 018 vaginal deliveries(0.04%), so more frequently after cesarean section than vaginal delivery. The cesarean hysterectomy rate was more frequent in multiparous women(0, 22%) than in nulliparous women(0, 02%). The most common indication of cesarean hysterectomy was 13 cases of uterine atony(46%), followed by 5 cases uterine rupture(18%), 5 cases of placenta previa with placenta accreta(18%), 3 cases of placenta previa(11%), 2 cases of uterine myoma(7%). No significant difference in length of operating time, amount of blood loss and operative complications were found between total abdominal hysterectomy and subtotal hysterectomy. The all patient who had cesarean hysterectomy recieved from 1200ml to 15840ml of blood transfusion with a mean of 3673ml. In aspect of fetal outcome, 3 cases of FDIU(Fetal death in utero) in uterine rupture and 1 case of stillbirth in preterm were found. The maternal complications were wound disruption, DIC, wound hematoma, ureter injury, vaginal stump bleeding, UTI(Urinary tract infection) and retroperitoneal bleeding, CONCLUSION: We conclude that the incidence of emergency cesarean hysterectomy declined with prediction of antenatal risk factor, preparing of sufficient fresh blood, prophylactic antibiotics, vigorous uterotonics and close observation after delivery.
Anti-Bacterial Agents ; Blood Transfusion ; Cesarean Section ; Dacarbazine ; Emergencies* ; Female ; Hematoma ; Hemorrhage ; Humans ; Hysterectomy* ; Incidence ; Peripartum Period* ; Placenta ; Placenta Previa ; Pregnancy ; Retrospective Studies ; Risk Factors ; Stillbirth ; Ureter ; Uterine Rupture ; Wounds and Injuries

To evaluate the tissue expression rate and pattenr of HBsAg and HBcAg in tumors and peritumoral livers, an immunohistochemical study was undertaken on 47 surgically resected hepatocellular carcinomas(HCCs). The results are as follows. 1. Patient's sera were positive for HBsAg in 40 cases(85.1%). In the remaining 7 cases, the tumor and peritumoral liver expressed neither HBcAg nor HbSaG, suggesting that they were caused by other etiologies than hepatitis B virus. 2. The peritumoral liver had HBsAg and HBcAg in 95.0% and 27.5% among the 40 cases, respectively. But the tumor expressed HBsAg in 50.0% and HBcAg in none. 3. The expression of HBsAg within the tumor and both HBsAg and HBcAg in the peritumoral liver tended to be more frequent in the pretreated cases before surgery. 4. Edmondson-Steiner grade IV tumors revealed a lower expression rate of HBsAg than the low grade tumors(p<0.05). Incases with cirrhosis at peritumoral tissues, HBcAg was less frequently found than in those without cirrhosis. The majority of tissue HBsAg and HBcAg was represented as groups of positive cells. These results suggest that, during the development and progression of HCCs, the HBcAg containing cells are repeatedly removed and the HBcAg negative cells are selected, because cellular expression of HBcAg is the target of host immune response.
Carcinoma, Hepatocellular

No abstract available.
Female ; Fetal Heart* ; Heart Rate, Fetal* ; Pregnancy ; Pregnancy*

Maspin is a recently described gene with tumor suppressor activity. The gene product is a 42 kD protein with homology to the serpin family of protease inhibitors and may play a role as an inhibitor of tumor cell invasion. The prior observation that invasive breast cancers and their metastases showed decreased maspin protein expression by immunostaining supports this speculation. However, the role of maspin in breast cancer progression has not been studied in detail. We, therefore, studied maspin protein expression in a series of hyperplasia, atypical ductal hyperplasia, intraductal carcinoma and invasive carcinomas. Immunohistochemical staining (IHC) for maspin was performed on paraffin sections of 136 breast specimens using a commercially available monoclonal antibody. Among the 106 cases studied were 36 moderate/florid ductal hyperplasia, 11 atypical ductal hyperplasia (ADH), 29 intraductal carcinoma (IDC) (4 low grade, 13 intermediate grade, 12 high grade) and 30 invasive ductal carcinomas. Thirty cases of normal breast were also studied as control group. IHC stains were scored using a semiquantitative scoring system. The mean IHC scores for maspin for normal, moderate/florid hyperplasia, atypical ductal hyperplasia, intraductal carcinoma, and invasive carcinoma were 5.51 1.30, 7.36 0.72, 3.82 1.60, 4.48 2.69, 3.97 3.30, respectively. These scores for each category were statistically significant (p<0.05), except between ADH and IDC. Maspin protein expression was increased in most cases of moderate/florid hyperplasia, while maspin expression was more heterogeneous in ADH and IDC. In high grade IDC, maspin protein expression was stronger than low and intermediate grade IDC, and this suggests the possibility of a compensatory cellular response against the forces driving further tumor progression. Two thirds of invasive ductal carcinomas expressed maspin protein weakly and focally. All metastatic carcinomas of lymph nodes were negative for maspin. It is possible that high grade IDC with strong maspin expression may represent a subset less likely to progress to invasive cancer. This speculation merits investigation in clinical outcome studies.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Coloring Agents ; Humans ; Hyperplasia* ; Lymph Nodes ; Neoplasm Metastasis ; Outcome Assessment (Health Care) ; Paraffin ; Protease Inhibitors

No abstract available.
Humans ; Hypophosphatemia*

Late-life depression (LLD) refers to depressive syndromes defined in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) and in the International Classification of Diseases-10 (ICD-10) that arise in adults older than age 65 years. LLD often affects people with chronic medical diseases, cognitive impairment, or other forms of disability. The phenomenology of LLD differs in part from that of early-life depression. Antidepressants appear to have a neutral or protective effect against suicidal ideation or behavior in the elderly despite having the risk of opposite effect in children, adolescents, and young adults. The treatment of depression may be divided into acute, continuation, and maintenance phases. Currently available antidepressant medications represent several classes of agents with similar antidepressant efficacy. Differences in side effect profile, interactions, and out-of-pocket cost are important determinants in the choice of medication for an elderly patient. To minimize side effects, starting doses for older adults may be lower than those for younger adults, but older adults often require full adults doses for an adequate response. Antidepressants are as effective when given to elderly individuals as they are when given to younger adults. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) the antidepressants of choice, followed by bupropion, and mirtazapine. Tricyclic antidepressants (TCAs) are effective but are no longer considered to be first-line treatments because of their side effects.
Adolescent ; Adult ; Aged ; Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Bupropion ; Child ; Depression ; Depressive Disorder ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Mianserin ; Serotonin Uptake Inhibitors ; Suicidal Ideation ; Young Adult

No abstract available.
Child* ; Fever* ; Humans ; Infant*