To identify significant prognostic factors in patients undergoing simple hysterectomy in the presence of invasive cervical cancer, the records of 45 patients who had taken such a procedure between 1993 and 1997 were reviewed. Overall relapse-free survival and 5-year survival rates were 91.1 and 92.1%, respectively. Factors found to be significantly related to survival were the retrospectively determined stage(p=0.0000), the presence of residual disease(p=0.0001), and cell type(p=0.0000). By multivariate analysis, factor emerging as significantly detrimental to survival was the cell type. The presence of residual disease was a marginally significant factor(p=0.067). The expectations for survival of patients with residual tumor mass and/or with adenocarcinoma after simple hysterectomy appear to be markedly worse than those with others, so radical reoperation should be considered in those patients.
Adenocarcinoma ; Humans ; Hysterectomy* ; Multivariate Analysis ; Neoplasm, Residual ; Reoperation ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms*

Fifty eight diabetic patients and 20 normal controls were studied by the method of nerve conduction studies(NCS) and sudomotor skin reponse(SSR), and the following results were obtained. 1. SSR was easily obtainable in all normal control. 2. The patients with abnormal NCV showed more numbers of abnormal SSR than the pat ients with normal NCV. 3. The patients with abnormal SSR were significantly older than the patient with normal SSR, but duration of disease was not different between the patients with normal SSR and with abnormal SSR. 4. The levels of sugar at fasting and postprandial 2 hours, and level of HbAlC in serum were not different between the patients of norrnal SSR and of abnormal SSR. 5. The incidence of autonomic symptoms, such as syncope, sweating abnormality, impotence in male, urinary disturbance, postural hypotension, was not different between the patient of norrnal SSR and of abnormal SSR. 6. Among the patients of diabets, the number of abnormal nerves in terminal latency motor and sensory nerve condcution velocity, and amplitude of compound motor and nerve action potentiaL were significantly correlated with the number of abnormal nerves in SSR. 7. The absolute values of motor terminal latency, motor and sensory conduction velocity and amplitude of compound motor and sensory action potential in the patient of abnormal SSR were significanly decreased thai. The patients with norrnal SSR. The values of terminal latency in abnormal SSR were significanly prolonged than the patients with normal SSR We concluded that the SSR test is a valuabe one for early detection of sympathetic nerve invasion in the diabetes' patients.
Action Potentials ; Asian Continental Ancestry Group ; Diabetic Neuropathies* ; Erectile Dysfunction ; Fasting ; Humans ; Hypotension, Orthostatic ; Incidence ; Male ; Neural Conduction* ; Skin* ; Sweat ; Sweating ; Syncope

Lymphomatous involvement of the heart, occurring at initial diagnosis and presentation, is extremely rare. We report here a case of 58 year old man who presented with generalized edema, pericardial effusion, and a large right atrial mass detected by transesophageal echocardiography. There is no other evidence of disseminated lymphoma in this patient. Tumor removal and pulmonary embolectomy was done. Pathologically, the mass was malignant lymphoma, diffuse large cell type. Unfortunately, we have no chance to perform the intensive chemotherapy. The patient discharged in moribund state.
Diagnosis ; Drug Therapy ; Echocardiography, Transesophageal ; Edema ; Embolectomy ; Heart ; Humans ; Lymphoma* ; Middle Aged ; Pericardial Effusion

BACKGROUND: Although current dietary guidelines recommend to increase the consumption of whole grain, these recommendations are mainly derived from the belief that replacing fats with carbohydrate may reduce risk of coronary artery disease (CAD) by improving serum lipids. Our objective was to evaluate whether the isocalorical replacement of refined rice with whole grain reduce CAD risk factors such as insulin demand and lipid peroxidation in CAD patients. METHODS: Thirty-eight male patients with CAD were provided with 70 g powder of whole grain (220 kcal) for 16 weeks, replacing cooked refined rice as a carbohydrate source of breakfast. An oral glucose tolerance test (OGTT) was performed in all subjects to determine the effect of whole grain consumption on serum concentrations of insulin and glucose in CAD patients with different degree of glucose tolerance. RESULTS: With the substitution of whole grain for refined rice, serum glucose concentrations decreased by 24% without altering body weight and energy intake. Estimates of daily fiber and vitamin E intakes increased by 24% and 50%, respectively. Whole grain consumption in CAD patients without diabetes decreased fasting glucose (22%) and the area under the curve (AUC) for insulin (26%) and glucose (19%) during an OGTT. CAD patients with diabetes also showed reductions in fasting glucose (27%) and AUC for glucose (25%) during the OGTT, compared with baseline values. Whole grain consumption reduced plasma malondialdehyde and homocysteine and urinary 8-epi-prostaglandin F 2alpha concentrations by about 30%. Lipid-corrected concentrations of alpha-carotene, retinol, alpha- and gamma-tocopherol and lycopene increased by 22-46%, compared with baseline values. Whole grain consumption decreased the percentage composition of w6 fatty acids of serum phospholipid increased by 14%. CONCLUSION: The replacement of refined rice with whole grain as a carbohydrate source of a meal showed significant beneficial effects on glucose, insulin and homocysteine concentrations and lipid peroxidation in CAD patients. These effects are likely to substantially reduce the risk factors of CAD and diabetes in CAD patients.
Area Under Curve ; Blood Glucose ; Body Weight ; Breakfast ; Edible Grain* ; Coronary Artery Disease* ; Coronary Vessels* ; Energy Intake ; Fasting ; Fats ; Fatty Acids ; gamma-Tocopherol ; Glucose ; Glucose Tolerance Test ; Homocysteine* ; Humans ; Insulin* ; Lipid Peroxidation* ; Male ; Malondialdehyde ; Meals ; Nutrition Policy ; Plasma* ; Risk Factors ; Vitamin A ; Vitamin E ; Vitamins

To clarify the exact role of endomyocardial biopsy in the diagnosis and monitoring of adriamycin-induced cardiotoxicity and to observe the actual relationship between pathologic changes and cardiac dysfunction, a cross-sectional clinical study was conducted. Echocardiography was used to evaluate cardiac dysfunction in 18 patients who had received chemotherapy including adriamycin(mean dose : 410mg/m2 of B.S.A.) without clinical evidence of congestive heart failure, and in 19 normal controls. Six patients receiving adriamycin underwent 7 transfemoral endomyocardial biopsy procedures, and the specimens were evaluated by light and electron microscopy for evidence of drug-related cardiotoxicity. Indexes of cardiac systolic function obtained by M-mode echocardiography(left ventricular dimension, excursion of interventricular septum and left ventricular posterior wall, shortening fraction and ejection fracton) did not show any statistically significant difference between patients who received adriamycin and normal controls. In transmitral flow-velocity curves recorded by Doppler echocardiography with a 2.25MHz probe, the patients showed less E peak velocity and decreased E/A ratio compared with normal controls, which suggests left ventricular diastolic dysfunction in the patients who received adriamycin. All the specimens of the endomyocardial biopsy showed significant pathologic changes of adriamycin indnced cardiotoxicity which was characterized by myofibrillar loss and vacuolization of the cytoplasm. In 2 specimens, pathologic grade was II, while 5 specimens showed pathologic changes of grade III and further chemotherapy with adriamycine was not done in thse 5 cases. From these results it is suggested that pathologic changes precede the clinical onset of congestive cardiomyopathy in the patients receiving adriamycin and left ventricular diastolic dysfunction occurrs before ejection fraction falls to subnormal levels. We conclude that sequential endomyocardial biopsy is absolutely indicated for exact diagnosis and monitoring of adrinamycin-induced cardiotoxicity to prevent the development of irreversible and often fatal cardiomyopathy.
Biopsy ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cytoplasm ; Diagnosis ; Doxorubicin* ; Drug Therapy ; Echocardiography ; Echocardiography, Doppler ; Heart Failure ; Humans ; Microscopy, Electron

BACKGROUND AND OBJECTIVES: Failure of vascular smooth muscle apoptosis and inflammatory response in pulmonary arterial hypertension (PAH) is a current research focus. The goals of this study were to determine changes in select gene expressions in monocrotaline (MCT)-induced PAH rat models after human umbilical cord blood derived mesenchymal stem cells (hUCB-MSCs) transfusion. MATERIALS AND METHODS: The rats were separated into 3 groups i.e., control group (C group), M group (MCT 60 mg/kg), and U group (hUCB-MSCs transfusion) a week after MCT injection. RESULTS: TUNEL assay showed that the U group had significantly lowered positive apoptotic cells in the lung tissues, as compared with the M group. mRNA of caspase-3, B cell leukemia/lymphoma (Bcl)-2, interleukin (IL)-6, tumor necrosis factor (TNF)-alpha and vascular endothelial growth factor (VEGF) in the lung tissues were greatly reduced at week 4 in the U group. Immunohistochemical staining of the lung tissues also demonstrated a similar pattern, with the exception of IL-6. The protein expression of caspase-3, Bcl-2 VEGF, IL-6, TNF-alpha and brain natriuretic peptide in the heart tissues were significantly lower in the U group, as compared with the M group at week 2. Furthermore, the protein expression of VEGF, IL-6 and BNP in the heart tissues were significantly lower in the U group at week 4. Collagen content in the heart tissues was significantly lower in the U group, as compared with M group at weeks 2 and 4, respectively. CONCLUSION: hUCB-MSCs could prevent inflammation, apoptosis and remodeling in MCT-induced PAH rat models.
Animals ; Apoptosis ; Caspase 3* ; Collagen ; Fetal Blood* ; Gene Expression* ; Heart ; Humans* ; Hypertension ; Hypertension, Pulmonary* ; In Situ Nick-End Labeling ; Inflammation ; Interleukin-6* ; Interleukins ; Lung ; Mesenchymal Stromal Cells* ; Models, Animal* ; Monocrotaline ; Muscle, Smooth, Vascular ; Natriuretic Peptide, Brain ; Rats* ; RNA, Messenger ; Stem Cells ; Tumor Necrosis Factor-alpha* ; Umbilical Cord* ; Vascular Endothelial Growth Factor A*

BACKGROUND: The purpose of this research was to compare one hospital family practise residents' diagnostic and therapeutic behavior with a Dupont et al described Guidelines on acute infectious diarrhea in adults and HARRISON'S PRINCIPLES OF INTERNAL MEDICINE 15th edition's algorithm for the management of acute diarrheal patients. METHODS: From March 1, 2003 to April 30, 2003, we reviewed 82 acute diarrheal patients (3.19% of the total patients) who had visited one hospital's emergency room which was located in Jeonju district. Doctor's diagnostic and therapeutic approaches were reviewed on the basis of history and physical exam. Then we compared with the standard algorithm referred above. RESULTS: Inpatients were 36.6% (30 patients) among the total of 82 and 63.4% (52 patients) returned home after symptomatic treatment. Among the 52 return home patients, doctors did not entirely conduct stool exam. Among the 30 hospitalized patients, doctors conducted stool exam in 25% among 4 of 16 high fever patients, in 25% among 2 of 8 moderately dehydrated who had diarrhea more than 10 times per day, and in 60% among 6 of 10 patients whose symptom duration was more than 48 hours. Doctors did not use antibiotics in 76.9% (40 patients) of 52 return home patients. Quinolone and Augmentin tablets were administered to each 6 patients of 12 return home patients. Among the 30 inpatients, Augmentin injection were given to 80% (24 patients) and second-generation cephalosporin with aminoglycoside combination injection to 13.3% (4 patients) and quinolone injection to 6.7% (2 patients). CONCLUSION: Compared with standard algorithm, doctors neglected testing stool examination that may be the most important way to diagnose the specific etiology of acute diarrhea. If we actively utilize the stool exam, it may help in providing the correct diagnosis and suitable treatment.
Adult ; Amoxicillin-Potassium Clavulanate Combination ; Anti-Bacterial Agents ; Diagnosis ; Diarrhea ; Emergency Service, Hospital ; Fever ; Humans ; Inpatients ; Internal Medicine ; Jeollabuk-do ; Tablets

Since the advent of extracorporeal shock wave lithotripsy(ESWL) provided an opportunity for a non-invasive method of treating urinary stones, it has been widely accepted that the ESWL is highly effective modality as the first line treatment method for the most urinary stones. However, there are still some controversies in establishing therapeutic strategy for the cases of large volume renal stones and lower ureteral stones. To evaluate the effectiveness of ESWL for these stones, comparative study about ESWL was performed with percutaneous nephrolithotomy(PNL) for the large volume renal stones and with ureteroscopic stone removal(URS) for the lower ureteral stones. For renal stone larger than 2.5 cm in long axis and lower ureteral stone, a total of 538 patients (542 organs) underwent treatment with ESWU using EDAP LT-01 machine) as outpatientbasis, PNL and URS under general anesthesia with admission from February in 1988to July in 1995. The patients were 318 in male and 220 in female. The average age of patient was 44.4 years, with the range of 10 to 81 years. The selection of treatment modality were decided largely by patients with their preference among the given options and with their economic status. They were analysed with respect to stone free rate, auxiliary procedure, complication, treatment duration and cost. The results were as follows ; 1. For renal stone larger than 2.5 cm in long axis, ESWL was undergone in 77 cases. The stone free rate was 63.6%(47.4% for the staghorn stones, 69.0% for the large renal stones excluding staghorn calculi). Mean time lost from work was 15.9+/-9.7 days(19.4+/-10.8 days for the staghorn stones, 14.8+/-9.1 days for the large renal stones excluding staghorn calculi). Mean treatment expense was 1,065,320 won. Complications that need additional treatment were occurred in 20.8%(21.2% for the staghorn stones, 20.7% for the large renal stones excluding staghorn calculi). PNL was performed in 42 cases. The stone free rate was 78.6%(55.6% for the staghorn stones, 84.8% for the large renal stones excluding staghorn calculi). Mean time lost from work was 19.8+/-3.7 days(20.4+/-4.7 days for the staghorn stones, 17.1+/-3.2 days for the large renal stones excluding staghorn calculi). Mean treatment expense was 911,390 won. Complications that need additional treatment were occurred in 28.6%(33.3% for the staghorn stones, 27.3% for the large renal stones excluding staghorn calculi) (Table 1). 2. For lower ureteral stone, ESWL was undergone in 214 cases. The stone free rate was 97.2%. Mean time lost from work was 3.2+/-2.1 days. Mean treatment expense was 645,680 won. Complications that need additional treatment were occurred in 4.7%. URS was performed in 209 cases. The stone free rate was 96.7%. Mean time lost from work was 10.8+/-3.2 days. Mean treatment expense was 701,850 won. Complications that need additional treatment were occurred in 7.2% (Table 2). For large volume renal stones excluding staghorn calculi, ESWL monotherapy resulted 15.8% less stone free rate than PNL monotherapy. For lower ureteral stone, ESWL was as effective as URS with respect to stone free rate and treatment expense. Moreover, time lost from work of ESWL cases was shorter than that of URS cases. Conclusively, it could be suggested that ESWL monotherapy is effective and preferentially applicable method for the lower ureteral stones and large volume renal stones excluding staghorn calculi. Whereas, it is not effective for the staghorn calculi.
Anesthesia, General ; Axis, Cervical Vertebra ; Calculi ; Female ; Humans ; Lithotripsy* ; Male ; Shock* ; Ureter* ; Ureteroscopy ; Urinary Calculi

Background: The importance of establishing a regional stroke safety net for the treatment of acute stroke is increasingly emphasized. In this study, we analyzed effectiveness of transferring the suspected acute ischemic stroke (AIS) patients through the 1899-0215 hotline system from 119 ambulances and nearby hospitals. Methods: From July 2015 to July 2022, we analyzed data from 632 suspected acute stroke patients through the hotline. Furthermore, we investigated the proportion of patients in the target population who were eligible for reperfusion therapy and compared cases transferred by 119 emergency services (EMS) with those transferred from nearby hospitals. Results: Six hundred thirty-two suspected acute stroke patients were transferred to our stroke center through the 1899-0215 hotline system. The accuracy of diagnosing acute stroke among transferred patients is 81.0% for 119 EMS and 80.5% for cases transferred from nearby hospitals. Of the 200 patients transferred from hospitals, they were transferred from 47 nearby hospitals with an average transfer distance of 38.2 km and an average transfer time of 65 minutes. Among 291 patients diagnosed with AIS, The onset-to-door time was significantly shorter (p<0.01) for patients transferred by 119 EMS. The proportion of patients who received reperfusion therapy was significantly higher (p<0.01) for those transferred by 119 EMS. Conclusions The hotline service will become a useful tool for establishing a regional stroke network in the Busan area, and its effectiveness will be particularly useful for 119 EMS. Measures are needed in the Busan metropolitan region to ensure the speediness of transferring acute stroke patients between hospitals.

No abstract available.
Heart* ; Thoracic Surgery*