OBJECTIVE: To assess the difference of baseline hormonal status and pathophysiology, and confirm the risk factors for long term complication according to Body Mass Index in women with polycystic ovary syndrome. MATERIALS AND METHODS: Serum level of LH, FSH, Estradiol, Prolactin, Testosterone, DHEA-S, fasting insulin were measured and 100 gm oral glucose tolerance test and endometrial biopsy were performed in total 75 chronic anovulation patients and 20 normal cycling infertility patients. 95 evaluated patients were divided into 3 groups including patients with chronic anovulation having BMI below 25, BMI beyond 25.1, normal cycling infertility patients, Group 1 (n=39), Group 2 (n=36), Group 3 (n=20), respectively. Statistical analysis was performed respect to relationship between BMI and measured hormone level, sum of glucose level during 100 gm OGTT, insulin resistance using t-test, ANOVA test, Post Hoc test, Mann-Whitney test. p<0.05 was considered as statistically significant. RESULTS: Serum LH level and LH/FSH ratio was significantly higher in Group 1, compared than Group 2 or 3 (p<0.05), BMI and LH, LH/FSH ratio was negatively correlated (r=-0.351, r=-0.318). There was no significant difference according to BMI in FSH, testosterone, estradiol, prolactin, DHEA-S level. Fasting insulin and sum of glucose level during 100 gm OGTT were significantly higher in Group 2 compared than Group 1 or Group 3 (p<0.05), there was no significant difference between Group 1 and Group 3. Insulin resistance was more frequently identified in Group 2 compared than Group 1 (p=0.001). CONCLUSIONS: BMI and LH, LH/FSH ratio were negatively correlated, so clinical significance of LH, LH/FSH ratio in diagnosis of PCOS may be attenuated by increasing body weight. Overweight patients with chronic anovulation may be the risk group for developing insulin resistance, hyperinsulinemia, glucose intolerance, later type 2 DM. Hyperinsulinemia may operate mainly in overweight chronic anovulation patients in development of hyperandrogenism.
Anovulation* ; Biopsy ; Body Mass Index* ; Body Weight ; Diagnosis ; Estradiol ; Fasting ; Female ; Glucose Intolerance ; Glucose Tolerance Test ; Glucose* ; Humans ; Hyperandrogenism ; Hyperinsulinism ; Infertility ; Insulin ; Insulin Resistance ; Metabolism* ; Overweight ; Polycystic Ovary Syndrome ; Prolactin ; Risk Factors ; Testosterone

No abstract available.
Anesthesia* ; Humans ; Outpatients*

BACKGROUND: Therapeutic drug monitoring (TDM) has been shown to be effective in minimizing the risk for toxicity and maximizing the efficacy of the drugs. The application of pharmacokinetics principles to indiviualization and optimization of dosage is necessary. We evolved interpretative report system of digoxin determination in a view of individual's pharmacokinetics. The alto of the present study is to validate the effectiveness of the interpretative report system in digoxin therapeutic monitoring service. METHODS: We reviewed 125 inpatients of two groups. 4 group, before interpretative reporting, had 86 inpatients from February 1996 to March 1996. B group included 39 inpatients from September 1996 to October 1996 after the practice of the sytem. Digoxin concentrations were measured in serum by TDxFlex (Abbott Laboratories, U.S.A.). Each patient's digoxin pharmacokinetics was determined by using the Abbott-base Pharmacokinetics system (Abbott Laboratories, U.S.A.) . The interpretation for the assayed digoxin level, the recommendation of maintenance dosage and the simulation graph with predicted serum levels were included in the report. The effectiveness of the reporting system was evaluated by comparing the appropriateness of digoxin level measurement between both groups. RESULTS: It revealed that appropriate measurements of digoxin level were 59.5 % of the tests in A group and 77.1% of those in B group (p=0.006). Evaluation of serum digoxin concentrations stratified by digoxin concentration showed also significant difference among the percentage of tests in each concentration range between both groups (p=0.011). CONCLUSIONS: Interpretative report system for the assayed results caused to increase in the appropriateness of digoxin measurement. The report system with some improvement which is achieved through the active approach to physician helps us use TDM effectively. The system can be applied to the other TDM drugs.
Digoxin ; Drug Monitoring* ; Humans ; Inpatients ; Pharmacokinetics

BACKGROUND: Therapeutic drug monitoring (TDM) has been shown to be effective in minimizing the risk for toxicity and maximizing the efficacy of the drugs. The application of pharmacokinetics principles to indiviualization and optimization of dosage is necessary. We evolved interpretative report system of digoxin determination in a view of individual's pharmacokinetics. The alto of the present study is to validate the effectiveness of the interpretative report system in digoxin therapeutic monitoring service. METHODS: We reviewed 125 inpatients of two groups. 4 group, before interpretative reporting, had 86 inpatients from February 1996 to March 1996. B group included 39 inpatients from September 1996 to October 1996 after the practice of the sytem. Digoxin concentrations were measured in serum by TDxFlex (Abbott Laboratories, U.S.A.). Each patient's digoxin pharmacokinetics was determined by using the Abbott-base Pharmacokinetics system (Abbott Laboratories, U.S.A.) . The interpretation for the assayed digoxin level, the recommendation of maintenance dosage and the simulation graph with predicted serum levels were included in the report. The effectiveness of the reporting system was evaluated by comparing the appropriateness of digoxin level measurement between both groups. RESULTS: It revealed that appropriate measurements of digoxin level were 59.5 % of the tests in A group and 77.1% of those in B group (p=0.006). Evaluation of serum digoxin concentrations stratified by digoxin concentration showed also significant difference among the percentage of tests in each concentration range between both groups (p=0.011). CONCLUSIONS: Interpretative report system for the assayed results caused to increase in the appropriateness of digoxin measurement. The report system with some improvement which is achieved through the active approach to physician helps us use TDM effectively. The system can be applied to the other TDM drugs.
Digoxin ; Drug Monitoring* ; Humans ; Inpatients ; Pharmacokinetics

BACKGROUND: Methylmalonic aciduria can be caused by inherited defects in the methylmalonyl-CoA mutase enzyme, Inherited defects in the metabolism of vitamin Bl2 and acquired or inherited vitamin Bl2 deficiency. Quantitation of urinary methylmalonic acid (MMA) is very useful In diagnosis of methylmalonic acidemia and cobalamin deficiency. We evaluated a quantitation method of urinary MMA and determined reference values. METHODS: The method involved stable isotope dilution gas chromatographymass spectrometry (GC-MS) with (methyl 2H3)-MMA as the internal standard. We determined the detection limit, linearity and periodic variations of the assay. Urinary MMA levels were measured in 70 individuals of ages newborn to 58 years with no metabolic disorders. RESULTS: The lower limit of detection calculated from blank runs (mean+/-3SD) was 2.62nmo1/m1. One control urine tramp)e analyzed 23 times within 3 weeks game results of 7.83+/-1.09 (mean+/-SD, CV=13.8%) nmol/mL. The linearity at four different concentrations of MMA was acceptable (R2=0.9992). The concentration of urinary MMA in 70 individuals was 2.33+/-2.19 mmol/mol creatinine (mean+/-SD). Age related reference values which decreased with age were also reported (p=1.23x10-9). CONCLUSIONS: The described method is sensitive, specific and noninvasive, which is considered the gold standard method for measuring MMA. The method could be used as a screening test for cobalamin deficiency and inherited methyl malonic acidemia. On the basis of the narrow range of normal concentration, it is expected that the method would readily detect mild cobalamin deficiency.
Chromatography, Gas* ; Creatinine ; Diagnosis ; Gas Chromatography-Mass Spectrometry* ; Humans ; Infant, Newborn ; Limit of Detection ; Mass Screening ; Metabolism ; Methylmalonic Acid* ; Methylmalonyl-CoA Mutase ; Reference Values ; Spectrum Analysis ; Vitamin B 12 ; Vitamins

A congenital salivary gland tumor, sialoblastoma, is extremely rare. A sialoblastoma of the parotid gland, occurring in a 28-week old fetus, is described. The histologic, immunohistochemical, and ultrastructural features of this tumor were studied. The tumor was characterized by solid nests or sheets of tumor cells intermingled with ductal structures lined by a columnar cells. Some of the tumor cells showed squamous differentiation. Immunohistochemically, these epidermoid cells reacted positively with anti-cytokeratin. But anti-S-100, anti- vimentin, anti-smooth muscle actin, anti-GFAP positive cells were not found. The ultrastructure was characterized by primitive epithelial cells. Although various names have been proposed, we favored the term "sialoblastoma". The histogenesis of this tumor is also discussed.
Actins ; Epithelial Cells ; Fetus ; Parotid Gland ; Salivary Glands ; Vimentin

Major concerns in cleft palate repair are improved speech results and adequate maxillary growth. In these respects, Furlow's double reversing Z-plasty which requires minimal hard palatal dissection and redirects palatal muscles to produce an overlapping muscle sling is theoretically optimal method to close the cleft palate. However, it often requires backcut around the maxillary tubercle even dissection around the pedicle on oral mucosal Z-plasty flap. Raw surface heals secondarily but leads to scarring within the soft palate. In the current study, IIpatients all had incomplete cleft palate and were operated double reversing Z-palatoplasty using intraoperative rapid mucosal expansion (IRME), from November, 1996 till July, 1997. With the IRME, we reduced the incidence of backcut or dissection on the oral mucosal flap. Only three patients need small backcut incision and two of these were closed primarily with V-Y fashion. To examine the histologic changes and expansion rate with the IRME, same procedures were performed to palatal mucosa of three cats. Expanded mucosal size was increased to 33.3% and histologically, change of mucosal architecture was not found except capillary dilatation. As a result, intraoperative mucosal expansion offers sufficient mucosal size, reduce incidence of backcut, therefore minimizes palatal scar formation. Balanced maxillofacial growth and normal occlusion are expected with this procedure.
Animals ; Capillaries ; Cats ; Cicatrix ; Cleft Palate ; Dilatation ; Humans ; Incidence ; Mucous Membrane ; Palatal Muscles ; Palate, Soft

The vestibular system is a sensory motor system concerned with the sensation of linear or angular acceleration, eliciting several vestibular postural reflexes. This study was designed to figure out the functional relationship in vestibulocollic reflex. The electromyographic responses of the cervical muscles were observed during stimulation of the horizontal semicircular canal nerves. The sternomastoid muscle was inhibited by stimulation of the ipsilateral horizontal canal nerve and excited by stimulation of the contralateral horizontal canal nerve. The splenius capitis muscle was inhibited by stimulation of the ipsilateral horizontal canal nerve and excited by stimulation of the contralateral canal nerve. The semispinalis capitis revealed same pattern responses as splenius capitis or sternomastoid muscles to stimulation of the horizontal canal nerve. These experimental results indicate that the cervical extensor or flexor muscles respond in a uniform fashion to the stimulated horizontal canal nerve. And taken these results and other morphological study results together, the excitatory neural pathways from the vestibular nucleus in brain stem to cervical motoneurons are crossed to the opposite side but the inhibitory pathways from the nucleus to the cervical motoneurons are uncrossed.
Acceleration ; Animals ; Brain Stem ; Cats* ; Muscles ; Neck Muscles* ; Neck* ; Neural Pathways ; Paraspinal Muscles ; Reflex ; Semicircular Canals* ; Sensation

Clinically, the Rh blood group system is important since Rh antibodies are readily induced by transfusion or pregnancy in individuals negative for the antigert and may cause hemolytic reactions or hemolytic disease of the newborn. Since the D antigert is strongly immunogenic, donors and patients are routinely typed for D status and patients are generally given D compatible blood. But under several circumstances such as spontaneous agglutination of red blood cells coated with immunoglobulin, antisera with additives may cause false positive results in test using high-protein reagents. And facton in the patient' s own serum may also affect the test, since unwashed red blood cells suspended in their own serum or plasma are frequently tested. Therefore, manufacturers and American Association of Blood Banks(AABB) recommend that the Rh(D) control test with Rh(D) control reagent which contains the same additive present in high-protein anti-D except for the anti-D. This study was undertaken to evaluate the usefss of the Rh(D) control test in Korea where Rh(D) negative population is small. Red blood cells from 1115 in-patients and 468 out-patients at Korea University Medical Center were employed in Rh(D) typing and Rh(D) control test in parellel. 1580 cases are Rh(D) positive and 3 cases were Rh(D) negative. No agglutination was observed with Rh(D) control test. Though AABB and manufacturers recommended that the Rh(D) control test should be done in parellel with Rh(D) typing test, the authers concluded that there were no need to run the Rh(D) control test in Korea.
Academic Medical Centers ; Agglutination ; Antibodies ; Erythrocytes ; Humans ; Immune Sera ; Immunoglobulins ; Indicators and Reagents ; Infant, Newborn ; Korea ; Outpatients ; Plasma ; Pregnancy ; Tissue Donors

The Ilizarov fixator allows significantly more axial motion at the fracture site than the conventional monofixators. But the transfixing wires have inevitable problems of soft tissue impalement. Therefore the Rancho mounting technique, replacing the transfixing wires with half pins, has become a common place. But the increment of the axial stiffness secondary to replacing transfixing wires with half pins has not been defined clearly yet. The authors measured the axial stiffness of the Ilizarov fixator and two different configurations of the Rancho frame. The group I frame was the Ilizarov fixator composed of four rings and two transfixing wires on each ring. The group II frame was the Rancho frame and it was constructed same as the Ilizarov frame but a transfixing wire was replaced with a half pin from two central rings respectively. The group III frame was another type of Rancho frame which was constructed same as the second group but the remaining transfixing wire was replaced with a half pin from the two central rings respectively. The axial stiffness of the Group I , II and Group III frames were 71.54+/-7.21N/mm, 89.65+/-6.42N/mm, 101.01+/-7.92N/mm respectively. The axial stiffness difference between the Group I frame and the Group II frame was statistically significant(p<0.01). Also the difference between the Group I frame and the Group III frame was statistically significant(p<0.01). This study shows that the replacement of two transfixing wires with two stainless half pins resulted in significant increment of the axial stiffness of the Ilizarov frame.