Until recently, the cervical pregnancy have been treated with surgery, usually hy- sterectomy, because of uncontrollable heavy vaginal bleeding. The development of sophisticated ultrasound which allows early diagnosis of cervical pregnancy and methotrexate chemotherapy opened up new therapeutic options in the management of this unusual but potentially life threatening complication of pregnancy which have been always a nightrnare for the gynecologist. We are reporting a case of cervical pregnancy diagnosed in 12 weeks of gestation. The patient was successfully treated with alternative administration of methotrexate (1 mg/kg, intramuscularly) and leucovorin (0.1 mg/kg, intramuscularly) without surgical intervention, in order to preserve both the uterus and fertility. Follow up was done with serum beta hCG and pelvic ultrasonography. Complete resolution of the cervical pregnancy was obtained at 50 days after starting methotrexate treatment. This case gave us the opportunity to review the recent literature on cervical pregnancy.
Drug Therapy ; Early Diagnosis ; Fertility ; Follow-Up Studies ; Humans ; Leucovorin* ; Methotrexate* ; Pregnancy* ; Ultrasonography ; Uterine Hemorrhage ; Uterus

OBJECTIVES: A common problem with analyzing survey data involves incomplete data with either a nonresponse or missing data. The mail questionnaire survey conducted for collecting lifestyle variables on the members of the Korean Elderly Phamacoepidemiologic Cohort(KEPEC) in 1996 contains some nonresponse or missing data. The proper statistical method was applied to evaluate the missing pattern of a specific KEPEC data, which had no missing data in the independent variable and missing data in the response variable, BMI. METHODS: The number of study subjects was 8,689 elderly people. Initially, the BMI and significant variables that influenced the BMI were categorized. After fitting the log-linear model, the probabilities of the people on each category were estimated. The EM algorithm was implemented using a log-linear model to determine the missing mechanism causing the nonresponse. RESULTS: Age, smoking status, and a preference of spicy hot food were chosen as variables that influenced the BMI. As a result of fitting the nonignorable and ignorable nonresponse log-linear model considering these variables, the difference in the deviance in these two models was 0.0034(df=1). CONCLUSION: There is a lot of risk if an inference regarding the variables and large samples is made without considering the pattern of missing data. On the basis of these results, the missing data occurring in the BMI is the ignorable nonresponse. Therefore, when analyzing the BMI in KEPEC data, the inference can be made about the data without considering the missing data.
Aged ; Body Mass Index ; Humans ; Life Style ; Linear Models ; Postal Service ; Surveys and Questionnaires ; Smoke ; Smoking

The authors performed combined trabeculectomy-cataract extraction on eyes of 8 patients with coexisting glaucoma and cataract. Posterior chamber lens implantation was performed in 2 of 9 eyes. The follow-up period ranged from 6 to 12 months. Visual acuity was improved in 8 eyes. The mean intraocular pressure was reduced by approximately 53%, from 28 mmHg preoperatively to 13 mmHg postoperatively. No medications were required in 6 of the 8 eyes, but 2 needed one medication for adequate control of intraocular pressure, postoperatively. No greater incidence of complications were evident with the combined procedure, from that expected with routine cataract extraction or trabeculectomy alone.
Cataract Extraction* ; Cataract* ; Follow-Up Studies ; Glaucoma ; Humans ; Incidence ; Intraocular Pressure ; Trabeculectomy ; Visual Acuity

BACKGROUND: Melasma is an acquired, symmetrical hypermelanosis that occurs on sun-exposed areas of the skin. It has significant emotional and psychological effects on those affected with the condition. Melasma Quality of Life Scale (MELASQOL) is a specific questionnaire to identify the most impaired areas of melasma patient's life. OBJECTIVE: Our purpose of this study is to investigate the changing of MELASQOL after the treatment of melasma. METHODS: A total of 27 volunteers with melasma were enrolled in this 8-week treatment study. The patients were instructed to apply an arbutin-containing cream, once a day for 8 weeks. The assessment of outcomes included the colorimetric value (L*) and MELASQOL score. RESULTS: The arbutin-containing cream group increased more in the colorimetric values (L*) after the 8-week treatment (p<0.01). The MELASQOL score was decreased (p=0.02). No significant adverse reactions were observed. CONCLUSION: The treatment of melasma improves the QOL of melasma patients.
Humans ; Hyperpigmentation ; Melanosis ; Quality of Life ; Skin ; Surveys and Questionnaires

Choriocarcinoma is an aggressively growing and widely metastasizing tumor that originates from trophoblastic cells. A primary gastric choriocarcinoma (PGC), however, is very rare. A 76-year-old female patient visited the emergency department of Wonkwang University Hospital with abdominal discomfort and melena. Esophagogastroduodenoscopy revealed a huge ulceroinfiltrative mass lesion with blood clots on the boundary between the greater curvature side and the posterior wall side of the stomach lower body. CT showed a 3-cm exophytic mass lesion with heterogeneous enhancement, an ulcer lesion at the posterior wall side of the stomach lower body, and multiple enlarged lymph nodes at the splenic artery and left gastric artery nodal stations. She underwent a radical subtotal gastrectomy with a D2 lymph node dissection. The final diagnosis was PGC coexisting with adenocarcinoma based on the pathology results. This paper reports a rare case of primary gastric choriocarcinoma coexisting with adenocarcinoma and discusses the characteristics of this neoplasm with reference to the literature.
Adenocarcinoma ; Aged ; Arteries ; Choriocarcinoma ; Chorionic Gonadotropin ; Diagnosis ; Emergency Service, Hospital ; Endoscopy, Digestive System ; Female ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Melena ; Pathology ; Pregnancy ; Splenic Artery ; Stomach ; Trophoblasts ; Ulcer

Choriocarcinoma is an aggressively growing and widely metastasizing tumor that originates from trophoblastic cells. A primary gastric choriocarcinoma (PGC), however, is very rare. A 76-year-old female patient visited the emergency department of Wonkwang University Hospital with abdominal discomfort and melena. Esophagogastroduodenoscopy revealed a huge ulceroinfiltrative mass lesion with blood clots on the boundary between the greater curvature side and the posterior wall side of the stomach lower body. CT showed a 3-cm exophytic mass lesion with heterogeneous enhancement, an ulcer lesion at the posterior wall side of the stomach lower body, and multiple enlarged lymph nodes at the splenic artery and left gastric artery nodal stations. She underwent a radical subtotal gastrectomy with a D2 lymph node dissection. The final diagnosis was PGC coexisting with adenocarcinoma based on the pathology results. This paper reports a rare case of primary gastric choriocarcinoma coexisting with adenocarcinoma and discusses the characteristics of this neoplasm with reference to the literature.
Adenocarcinoma ; Aged ; Arteries ; Choriocarcinoma ; Chorionic Gonadotropin ; Diagnosis ; Emergency Service, Hospital ; Endoscopy, Digestive System ; Female ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Melena ; Pathology ; Pregnancy ; Splenic Artery ; Stomach ; Trophoblasts ; Ulcer

Since maxillofacial injury is frequently accompanied by other diseases, its evaluation and treatment are open delayed. When the evaluation is delayed, the surgical treatment can be difficult or impossible. A 21-yr-old man presented with right facial swelling and deformity after injury. We planned immediate surgical repair for his right tetrapod fracture, but the operation was delayed for two months due to severe hyperthyroidism. During the operation, we reducted and fixed the deviated bone after refracture of the zygomatic arch with an osteotome to achieve mobility. The facial deformity and difficulty in mouth opening were improved after the operation. Even in the presence of accompanying fractures, early evaluation and proper management can prevent complications and achieve acceptable cosmetic outcomes in maxillofacial trauma patients. In patients with malunion of fracture sites, fixation after refracture using an osteotome can be a good treatment option for obtaining good mobility.
Congenital Abnormalities ; Cosmetics ; Facial Injuries ; Fracture Fixation ; Humans ; Hyperthyroidism ; Maxillofacial Injuries ; Mouth ; Zygoma

PURPOSE: To evaluate the MR imaging of Mullerian duct anomalies (MDA) and analyze its diagnostic accuracy associated gynecologic diseases and effect on treatment plan. MATERIALS AND METHODS: Twelve patients with suspected MDA and three with incidentally-found MDA were included. Axial, sagittal and coronal images of T1-, FSET2- or T2-, proton density- and Gadolinium-enhanced T1-weighted images were obtained with 1.5T (n=13) and 0.5T (n=2) MR machines. On the basis of Buttram and Gibbons' classification, MR images were analyzed and classified as laparotomy (n=7), hysteroscopy (n=7), laparoscopy (n=3) or hystersalpingography (n=2). These were analyzed in terms of external contour of the uterus, intercornual distance, signal intensity of the uterus and septum, associated genitourinary diseases, and the influence of MR imaging on treatment plan. RESULTS: A total of 15 cases of MDA were accurately classified by MR imaging, as follows: didelphyses (n=6: 40%); ageneses (n=3: 20%); septate uteri (n=3: 20%); bicornuate uteri(n=2: 13%) and unicornuate uterus(n=1: 7%). In 14 cases (93%) findings corresponded with those of other examinations. The external contour of the uterus was banana-shaped in the didelphyc and unicornuate uterus, a fundal cleft in the bicornuate, and normal in the septate; intercornual distance was greater in didelphyc and bicornuate uteri. Except in three cases of agenesis, the signal intensity of the uterus was normal; in the septum, on T2WI, this was isosignal in the bicornuate uterus and low in the septate, as compared with that of the myometrium. In four of five cases, associated gynecologic diseases were found on MR imaging; in five cases (33%), there were associated urologic anomalies, and in six (40%), MR imaging influenced the treatment plan. CONCLUSION: MR imaging was valuable for the diagnosis of MDA and the determination of associated gynecologic diseases, and also influenced the treatment plan.
Animals ; Classification ; Diagnosis ; Female ; Genital Diseases, Female ; Humans ; Hysteroscopy ; Laparoscopy ; Laparotomy ; Magnetic Resonance Imaging* ; Mice ; Myometrium ; Protons ; Uterus

Myasthenia gravis(MG) is an autoimmune disorder characterized by the presence of anti-acetylcholine receptor antibody and weakness of voluntary muscles. The pathogenesis of MG is decreased numbers of acetylcholine receptors at postsynaptic membranes of neuromuscular junctions. It has been reported that MG often coexists with other autoimmune disorders. This is a case report of systemic lupus erythematosus coexisting with MG in a 23 year old female patient presenting with dysarthria, dysphagia, and limb weakness. We report the case with relevant literature review.
Deglutition Disorders ; Dysarthria ; Extremities ; Female ; Humans ; Lupus Erythematosus, Systemic* ; Membranes ; Muscle, Skeletal ; Myasthenia Gravis* ; Neuromuscular Junction ; Receptors, Cholinergic ; Young Adult

Paragangliomas (PGs) of the thyroid are very rare tumors. Based on the medical literature, thyroid PGs invariably affected women and they were always thought to be benign, and they have always been mistaken for other more common lesions. We report here on the first case of PG of the thyroid in a 45-year-old man in Korea. Ultrasonographically, the tumor showed hypoechoic features. Microscopically, the tumor showed the typical zellballen pattern. The small to medium-sized tumor cells contained moderate amounts of finely granular eosinophilic cytoplasm and round to oval nuclei with fine chromatin. The tumor invaded the thyroid capsule and the extrathyroidal tissue with vascular and perineural invasion. Immunohistochemically, the tumor showed positivity for chromogranin, S-100 protein, CD56a, and synaptophysin and negativity for calcitonin, thyroglobulin, galectin-3, p53, CK19, and EMA. The Ki-67 labeling Index was 10%. We concluded that our case has a high potential of metastasis, and a close follow up would be important.
Female ; Male ; Humans