A case of carcinoma of the parathyroid gland causing hyperparathyroidism was experienced at the department of orthopaedic surgery, C.A.F.G.H. This patient, a 23 years old male, had complained of a left shoulder pain during the past 3months. And weakness of the lower extremities causing walking disturbance, multiple bone pain, and polyuria had occurred sinoe one month before admission. Physical examination revealed a hard palpable mass in the right anterior region of the neck. Radiologic examination revealed subperiosteal bone resorption in phalanges of the hands and feet, generalized osteoporosis and cystic lesions, and pathologic fracture of the ribs, left humerus, and left femur. Laboratory studies demonstrated hypercalcemia, hypophosphatemia, increased alkaline phosphatase and PTH, hypercalciuria, and hyperphophaturia. Sonogram and C-T scan of the neck revealed a mass in the right inferior portion of the thyroid. Rib biopsy revealed the findings of ostitis fibrosa cystica, and parathyroid gland and regional lymph node biopsy revealed a parathyroid carcinoma with regional lymph node metastasis.
Alkaline Phosphatase ; Biopsy ; Bone Resorption ; Femur ; Foot ; Fractures, Spontaneous ; Hand ; Humans ; Humerus ; Hypercalcemia ; Hypercalciuria ; Hyperparathyroidism ; Hypophosphatemia ; Lower Extremity ; Lymph Nodes ; Male ; Neck ; Neoplasm Metastasis ; Osteoporosis ; Parathyroid Glands ; Parathyroid Neoplasms ; Physical Examination ; Polyuria ; Ribs ; Shoulder Pain ; Thyroid Gland ; Walking

OBJECTIVES: The objectives of this study is to compare the differences of fetal heart rate (FHR) variables between preterm and term pregnancies after acoustic stimulation using computerized analysis of fetal heart rate. METHODS: Eighty-two normal pre-term and term pregnancies entered to this study after conventional 20-minutes nonstress test(NST) and 10-minutes acoustic stimulation test (AST). Acoustic stimulations were performed using Fetal Acoustic Stimulator (Model 146, Corometrics, US). We analyzed the FHR response after acoustic stimulation using our on-line computerized FHR analysis system, HYFM-I & II software. The changes of loss of signal, baseline FHR, variability, number of fetal movements, and number of FHR accelerations were analyzed numerically. RESULT: The mean baseline FHR was increased in term pregnancies from 141+/-7.0bpm to 152.7+/-9.7bpm, and in preterm pregnancies from 144.6+/-6.8bpm to 156.8+/-10.2bpm, respectively. The mean baseline FHR was significantly increased in both term and preterm pregnancies (p<0.01. paired t-test). The variability of FHR was increased in term pregnancies from 18.2+/-6.4bpm to 22.6+/-5.0bpm and in preterm pregnancies from 17.8+/-5.5bpm to 22.7+/-5.9bpm, respectively. The variability of FHR was also significantly increased in both term and preterm pregnancies. (p<0.01. paired t-test) CONCLUSION: The mean baseline FHR and the variability of FHR was significantly increased both preterm and term pregnancies. But the difference of each FHR variables between preterm pregnancies and term pregnancies was not statistically significant in this study.
Acceleration ; Acoustic Stimulation* ; Acoustics* ; Female ; Fetal Heart* ; Fetal Movement ; Heart Rate, Fetal* ; Pregnancy

No abstract available.
Saphenous Vein*

The recent introduction of chemotherapy in the treatment of the gynecologic malignancies has gained wide acceptance along with preoperative and postoperative adjuvant therapy and with preradiation and concurrent chemoradiaton therapy. But, the side effects of chemotherapy including bleeding and infection due to bone marrow suppression have resulted in increased morbidity and mortality of the patients and delayed treatment and a reduction in the chemotherapeutic agents used. In spite of the development of antibiotics and the supportive care of infection, sustained leukopenia in the patients during chemotherapy accounts for the high mortality rate due to sepsis. The early detection of the leukopenia during chemotherapy may enable clinicians to overcome infection problems by timely use of prophylactic broad spectrum antibiotics and G-CSF or GM-CSF. The author investigated the grade, duration, time of onset and other clinical features of the leukopenia and the effects of the age (> or =60 years vs <60 years), the number of the cycle of chemotherapy (> or =3 cycles vs < 3 cycles), fever and performance scale on the leukopenia. 79 cases (32 patients) of the leukopenia during chemotherapy of various gynecologic malignancies at the Department of Obstetrics and Gynecology at Hanyang University between January, 1996 and December, 1998 entered to this study. The results were as follows; 1. Leukopenia occurred at 14.2+/-6.1 day from the first day of chemotherapy, 2. The duration of leukopenia was 2.5+/-1.6 days 3. No significant difference was found between eldely patients ( > or =60 years, n=13) and younger patients ( <60 years, n=66) about the severity, duration and time of onset of leukopenia. 4. No significant difference was found between the patients with more than 3 cycles of chemotherapy (n=40) and less than 3 cycles (n=39) about the severity, duration and time of onset of leukopenia. 5. Febrile leukopenic cases (n=6) had significantly lower granulocyte count, longer leukopenic period and earlier onset of leukopenia than afebrile (n=73). 6. It is thought that performance status scale does not affect the grade of leukopenia, onset of leukopenia and the leukopenic period.
Anti-Bacterial Agents ; Bone Marrow ; Drug Therapy* ; Fever ; Granulocyte Colony-Stimulating Factor ; Granulocyte-Macrophage Colony-Stimulating Factor ; Granulocytes ; Gynecology ; Hemorrhage ; Humans ; Leukopenia* ; Mortality ; Obstetrics ; Sepsis

OBJECTIVE: There is increasing evidence that the omega-3 polyunsaturated fatty acid, eicosapentanoic acid(EPA), induces relaxation in vessels from various animal models as cardiovascular protective nutrients. In vivo study was undertaken to investigate the potential therapeutic application of EPA to resolve vasospasm. METHODS: The basilar artery was visualized using transclival exposure, and its diameter monitored using videomicroscopy. Rabbits were divided randomly into seven groups:1) normal rabbits basilar artery treated with topical application of 100nM/L EPA only;2) normal rabbits basilar artery treated with 20nM/L phorbol dibutyrate(PDB), then 20 nM/L PDB+100nM/L EPA;3) normal rabbits basilar artery treated with 80mM/L KCL, then 80mM/L KCL+100nM/L EPA;4) normal rabbits basilar artery treated with 20nM/L endothelin 1(ET-1) only;5) normal rabbits basilar artery treated with 20nM/L ET-1, then 20nM/L ET-1+100nM/L EPA;6) subarachnoid hemorrhage(SAH) rabbits basilar artery treated with artificial CSF only;7) SAH rabbits basilar artery treated with 100nM/L EPA. RESULTS: In normal(non-SAH) rabbits, EPA:1) had no effect on basal tone;2) did not reverse KCL or PDB-induced constriction;and 3) substantially reversed ET-1-induced constriction. The diameter of normal rabbit basilar artery was 779.1+/-17.9nm(mean+/-standard error). After SAH, the mean diameter was 521.0+/-32.5nm. The addition of EPA reversed this SAH-induced constriction to 80.4% of baseline diameter. CONCLUSION: These results suggest that EPA induces relaxation in cerebrovascular arteries constricted with ET-1, and that it prevents and partially reverses SAH-induced vasoconstriction.
Arteries ; Basilar Artery ; Constriction ; Eicosapentaenoic Acid* ; Endothelins ; Microscopy, Video ; Models, Animal ; Rabbits ; Relaxation* ; Spasm* ; Subarachnoid Hemorrhage ; Vasoconstriction

OBJECTIVES: The early detection of ectopic tubal pregnancy in unruptured state is increased as the transvaginal sonography and sensitive serum hCG test are available. For this unruptured tubal pregnancy, the medical treatment using methotrexate via various routes and dosage is being tried. Our study was to evaluate the efficacy of single systemic injection of methotrexate in the treatment of unruptured tubal pregnancies. Material and METHODS: From the January 1997 to July 1999, of 152 ectopic pregnancy patients, 22 patients who were diagnosed as unruptured tubal pregnancies were treated with single-dose systemic methotrexate injection (50 mg/m2/IM). Exclusion criteria were unstable vital signs with hemoperitoneum, adnexal mass > 5-6 cm. Serum hCG titers were checked before injection and 4, 7 day after injection. If serum hCG titer declined more than 15% on 7 day after injection compared with titer on 4 day, the weekly hCG titer was followed until it was <10 mIU/ml .If the hCG titer did not decline more than 15 %, a second dose was given. If hCG titer was not decreased or vital signs became unstable after 1-2 injections, the treatment was considered failure and surgery was done. RESULTS: 18 cases (82%) of 22 were successfully treated with single-dose methotrexate. The mean size of ectopic mass and initial serum hCG titers were 2.7+/-1.3 cm (range, 1.5-5.4 cm) and 3,298+/-1,007 mIU/ml (range, 132-12,239), respectively. Of 22, 6 cases (28%) needed second dose of methotrexate. The mean time to resolution of serum beta-hCG titer was 27.5+/-13.6 days (range, 8-53 days). Elevation of liver enzyme did not occurred in all cases during treatment. Initial hCG titer was more important prognostic factor than ectopic mass size for successful medical treatment. CONCLUSION: Single-dose methotrexate appears to be an effective medical treatment for the unruptured tubal pregnancy. However, patients selection using strict criteria is needed to increase its success rate.
Female ; Hemoperitoneum ; Humans ; Liver ; Methotrexate* ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Tubal* ; Vital Signs

Cell cycle associated nuclear proteins such as proliferating cell nuclear antigen(PCNA), argyrophilic nucleolar organizer regions(AgNORs) and the family of nuclear proteins identified by the Ki-67 epitope, have been primarily utilized for estimating of growth potential of neoplasms. Although PCNA and AgNORs staining are possible in the paraffin-embedded tissue, Ki-67 staining had been only possible on frozen sections. Recently monoclonal antibody MIB-1 is available, and reacts with the Ki-67 epitope in paraffin-embedded tissue. Twenty eight astrocytic tumors in paraffin-embedded, archival materials were stained by immunohistochemical technique for the MIB-1, PCNA, and by silver colloid stain for AgNORs. The MIB-1 labeling indicies(LI) ranged from 2 to 25%(10+/-7.58) for 10 glioblastomas; from 2 to 15%(7+/-3.74) for 11 anaplastic astrocytomas; and from 1 to 5%(3+/-1.91) for low grade astrocytomas. Glioblastomas and anaplastic astrocytomas exhibited significantly higher MIB-1 LI than their benign counterparts(p<0.05). The AgNORs count per cell ranged from 1.3 to 3.1(1.96+/-0.57) for 10 glioblastomas: from 1.2 to 3.1(1.9+/-0.64) for 11 anaplastic astrocytomas: and from 0.8 to 1.5(1.2+/-0.26) for low grade astrocytomas. Glioblastomas and anaplastic astrocytomas exhibited significantly higher AgNORs count than their benign counterparts(p<0.05). The PCNA LI ranged from 10 to 40%(24.5+/-10.39) for 10 glioblastomas; from 5 to 20%(11.6+/-5.24) for 11 anaplastic astrocytomas; and from 5 to 10%(7.1+/-2.67) for low grade astrocytomas. The differences of PCNA LI between glioblastomas and anaplastic astrocytomas(p<0.01), and between glioblastomas and low grade astrocytomas(p<0. 001) were statistically significant. Linear regression analysis showed correlations between MIB-1 LI and AgNORs count(Spearmans r=0.4306, p<0.05), between PCNA LI and AgNORs count(Spearman's r=0.586, p<0.05) and between PCNA and MIB-1 LI(Spearman's r=0.4523, p<0.05). These findings suggest that LI of MIB-1, PCNA and AgNORs count are correlated each other, and can be used as helpful markers for differentiating astrocytic tumors in addition to conventional staining methods.
Astrocytoma ; Cell Cycle ; Colloids ; Frozen Sections ; Glioblastoma ; Humans ; Linear Models ; Nuclear Proteins ; Nucleolus Organizer Region ; Proliferating Cell Nuclear Antigen* ; Silver

The experienced surgeon can be surprised & challenged by the hazards of active bleeding during oral & maxillofacial surgical procedure, because of alterations in the surgical anatomy, bleeding disorders and surgical intervention of infected tissues. This is a report of two cases of active bleeding during surgical extraction of mandibular third molar, that had the pericoronitis, osteitis and adjacent neurovascular bundle in its apex. When the abrupt active bleeding was occurred during surgical extraction of mandibular third molar, pressure packing by hemostatic agent(bone wax) & wet gauze biting were applied into the extraction socket during 30 minutes. After 30 minutes, the wound was explored about the bleeding and active bleeding was then continued. In spite of repeated bleeding control method of the pressure dressing, the marked hemorrhage was generated continuously. Therefore, the author decised the bleeding as immediately uncontrollable hemorrhage and the pressure dressing was again applied for the more longer duration without wound closure. After 3 days, the pressure dressing was removed and iodoform gauze drainge was then established without the bleeding. The drain was changed as the interval of 3~5 days for prevention of infection & secondary hemorrhage and relatively good wound healing was then resulted in 6 weeks.
Bandages ; Hemorrhage* ; Molar, Third* ; Osteitis ; Pericoronitis ; Wound Healing ; Wounds and Injuries

Authors analysed the clinical characteristics and the surgical results of rhegmatogenous retinal detachment in 70 patients(71 eyes) who were operated GNUH from Feb. 1990 to Feb. 1992. The clinical characteristics of rhegmatogenous retinal detachment were as follows. The result was myopia(39.4%) as the most common associated ocular finding, one break(57.7%) as the number of break, two quadrants(33.8%) as the extent of retinal detachmenthole(53.5%) as the type of break and superior temporal portion(56.3%) and anterior portion including equator(83.1%) as the location of break. The success rate of first operation was 87.3% and the overall success rate of rhegmatogenous retinal detachment maintained anatomical attachment above 6 months and exeluded 3 cases of refused reoperation was 92.3%. The type of break extent of detachment and duration of detachment were not influenced to surgical success rate statistically(P>0.05). The most common cause of first operative failure was proliferative vitreoretinopathy(57%).
Reoperation ; Retinal Detachment* ; Retinaldehyde*

No abstract available.
Spleen*