The purpose of this study is compare IVF cycle outcome in poor responders between clomiphene citrate (CC) stimulated and controlled ovarian hyperstimulation (COH) protocol. A total of 94 patients responding poorly in previous IVF cycles (estradiol<600 pg/ml or less than 3 oocytes retrieved) subsequently underwent either COH (COH group: 122 cycles, 68 patients) or CC-stimulated cycles (CC group: 43 cycles, 26 patients). CC was administered for five consecutive days starting on cycle day 3 at a dose of 100 mg daily. Serial transvaginal ultrasound examination was done from cycle day 8. Urine was collected 3~4 times before hCG injection for the detection of LH surge. The hCG was administered when serum estradiol reached greater than 150 Pg/ml and mean follicle diameter>16 mm. In COH group, ovarian stimulation was done using short protocol (GnRH-a/FSH/HMG/hCG). No difference in age or number of transferred embryos was found between CC group and COH group. COH group had significantly (p<0.05) higher mean peak level of E2 (810+/-112 vs 412+/-55 pg/ml) and greater number of retrieved oocytes (3.0+/-0.2 vs 2.0+/-0.2) than CC group. CC group had significantly embryos (1.8+/-0.2) compared with (2.1+/-0.2) in COH group. However, CC group had higher pregnancy rate than COH group per retrieval [26.9% (7/26) vs 6.2% (6/97)], or per transfer [31.8% (7/22) vs 7% (6/86)]. Although cycle cancellation rate in CC group (48.8%) was higher than that of COH group (21.3%), the pregnancy rate per cycle in CC group was still higher (16.3%) than COH group (4.9%). In addition, implantation rate in CC group was 17.5% (7/40), which was significantly p<0.01) higher than 3.9% (7/180) in COH group. These data suggest that oocyte and embryo quality are lower in COH cycles of poor responders than CC cycles. We suggest that clomiphene citrate stimulated IVF cycle may be more efficient than COH IVF cycle in poor responders in terms of lower costs and higher pregnancy performance.
Clomiphene* ; Embryonic Structures ; Estradiol ; Fertilization* ; Humans ; Oocytes ; Ovulation Induction ; Pregnancy ; Pregnancy Rate ; Ultrasonography

The purpose of this study was to provide fundamental data by figuring out fatigue differences in patients on hemodialysis and peritoneal dialysis. The subjects for this study were 49 patients on hemodialysis and 54 patients on peritioneal dialysis at C university medical center in Seoul Results were as follows: 1. The average fatigue score in peritoneal dialysis patients tended to be higher in patients on peritoneal dialysis(42.22) than in patients on hemodialysis(39.41). Peritoneal dialysis patients showed higher score than hemodialysis patients in some general characteristics in groups with male, ones in 20's, 40's, 50's, married, college degree, having religion, having occupation, and not take regular nap. 2. The percents of this subjects with feel fatigue at the time of survey was higher in peritoneal dialysis patients(68.5%) than in hemodialysis patients(57.1%). The percentages of the subjects who feel fatigue in peritioneal dialysis patients was higher than hemodialysis patients, and the high tendencies in peritoneal dialysis patients in were obsemed in groups with male, ones in 30's, to have college degree, periods so of 1-2years in peritoneal dialysis, region, men without occupation, regular exercises, regular nap etc.
Academic Medical Centers ; Dialysis* ; Exercise ; Fatigue* ; Humans ; Male ; Occupations ; Peritoneal Dialysis ; Renal Dialysis ; Seoul

No abstract available.
Embryonic Structures* ; Humans*

OBJECTIVES: This study is to compare psychopathology and their perceived parental rearing pattern of the children of mothers with major depression, bipolar disorder and those of normal control group. The correlation was also assessed between behavior problem and perceived parenting style. METHODS: The subjects were 30 children (age range 12-18) of mothers who met the DSM-IV criteria of major depressive disorder or bipolar I disorder and 30 children of normal mother group. All completed self-report questionnaires containing Child, adolescent Behavior Problem Checklist (K-CBCL), Youth Self Report (YSR) and Parental Bonding Instrument (PBI). RESULTS: 1) The mean score of the subscales of somatic complaints, anxious/depressed, internalizing problems in K-CBCL was significantly higher in the control subjects compared with that of the children of mothers with affective disorders (p<0.05). 2) In YSR, there was a tendency of increased behavior problems among the children of mothers with major depression compared with the control subjects. Compared with children of mothers with bipolar disorder, children of mothers with major depression had significantly more behavior problems (p<0.05). 3) Mothers with affective disorders tended to display less caring and fathers and mothers with affective disorders tended to display more overprotective parenting style than the control subjects. 4) There was positive correlation between paternal overprotection and behavior problems in the children of mothers with affective disorders. CONCLUSION: In summary, the author identified that the children of mothers with affective disorders have more behavior problems in social adjustment than normal control subjects. Parental rearing style is thought to have more negative influence on the children of mothers with affective disorders than normal control. It is surmised that less caring and more overprotective rearing style could influence behavior problems of their children.
Adolescent ; Adolescent Behavior ; Bipolar Disorder ; Checklist ; Child ; Depression ; Depressive Disorder, Major ; Diagnostic and Statistical Manual of Mental Disorders ; Fathers ; Humans ; Mood Disorders* ; Mothers* ; Parenting ; Parents ; Psychopathology ; Surveys and Questionnaires ; Self Report ; Social Adjustment

Detailed mechanism of uterine cervical cancer progression still remains unclear. Altered programmed cell death (apoptosis) and cellular proliferation are associated with the development of neoplasia. The authors investigated the expressions of bcl-2, which inhibit apoptosis, and caspase-3, which is involved in the induction of apoptosis and has been considered to be correlated with apoptosis, and proliferating activity according to the degree of malignancy in the squamous neoplasia of the uterine cervix. Correlation between bcl-2 and caspase-3 expression and proliferating activity was done. The materials were low grade squamous intraepithelial lesions (LSIL, n=15), high-grade squamous intraepithelial lesions (HSIL, n=15), microinvasive squamous cell carcinoma (n=15), and squamous cell carcinoma (n=15). Immunohistochemical stainings for bcl-2, caspase-3, and MIB-1 were done. bcl-2 and MIB-1 expressions were progressively increased in accordance with the increasing degree of malignancy, but caspase-3 immunoreactivity was higher in LSIL than invasive cancers. There was an inverse relationship between bcl-2 and caspase-3 expression, but the difference did not reach statistical significance. No significant correlation between MIB-1, bcl-2, and caspase-3 expressions was observed. These results suggest that an inhibition of apoptosis and the augmentation of proliferating activity of tumor cells might be separately involved in the development of the cervical squamous neoplasia.
Apoptosis ; Carcinoma, Squamous Cell ; Caspase 3* ; Cell Death ; Cell Proliferation ; Cervix Uteri* ; Female ; Uterine Cervical Neoplasms

No abstract available.
Arthritis, Juvenile* ; Fractures, Compression* ; Humans

Estrogen and progesterone receptors exist in the epithelial and stromal cells of the endometrium. Proliferative disorders of the endometrium may be associated with autocrine and paracrine actions of estrogen and progesterone in epithelial and stromal cells. This study was performed to evaluate the differences estrogen and progesterone receptor(ER/PR) expression in the epithelial and stromal cells of endometrial hyperplasias and adenocarcinomas using immunohistochemical methods. Immunohistochemical analysis of proliferating cell nuclear antigen(PCNA) was done to evaluate a possible correlation between PCNA and hormone receptor expression. Evaluation was based on samples from 31 simple hyperplasias, 30 complex hyperplasias, and 32 adenocarcinomas. The immunohistochemical expression of ER, PR and PCNA in epithelial and stromal cells were examined according to a scoring system based on the percentage of positive cells and the staining intensity. The results were as follows; 1) The expression of ER and PR in epithelial cells showed a graded, significant decreases in simple hyperplasia, complex hyperplasia and endometrial carcinoma, in that order(ER: P=0.008, PR: P= 0.026). 2) PR expression in the stromal cells showed a significant decrease between hyperplasia and adenocarcinoma(P=0.003). The difference in ER expression was not significant. 3) In stromal cells, the decrease in PR expression was more prominent than the decrease in ER expression when complex hyperplasia was compared to simple hyperplasia. 4) The PCNA expression in simple and complex hyperplasia and adenocarcinoma was not higher than the expression of PCNA in nomal proliferative endometrium. There was no significant difference in PCNA expression between simple and complex hyperplasia and adenocarcinoma(P=0.073). 5) A negative correlation between PCNA and ER/PR expression was not demonstrated in simple and complex hyperplasia, or in adenocarcinoma. Endometrial hyperplasia and adenocarcinoma are probably related to a paracrine action of estrogen and progesterone in epithelial and stromal cells. A progressive loss of PR expression in stromal cells may induce abnormal proliferation of endometrium due to a disrupted hormonal balance.
Adenocarcinoma

This study aims to find factors that affect variations in cesarean section frequency rates among OBGY clinics in Metropolitan areas. The factors include patient, medical supplier characteristics and economic factors. This study is a cross-sectional analysis using health insurance delivery claims from July to December 2000 and files of the NHIC(national health insurance corporation). Multiple regression was used to analyze the dependent variable of cesarean section frequency rate at each clinic. The results are as follows : Cesarean section frequency rate is increasing in proportion to the number of the following patients : repeated caesarean section, disproportion, obstructed labour, fetal distress, emergency caesarean section and self-employed patients. There are geographic variations as well. Cesarean section frequency rates are higher in Inchon and Gyonggi province than in Seoul. The higher number of total delivery the clinic has, the lower rate of cesarean section it has. Clinics with high frequency rates in 1999 showed higher rates the next year. Further research is required to develop evidence based delivery modes and change strategies for increasing normal delivery and activating midwife clinics.
Cesarean Section* ; Cross-Sectional Studies ; Emergencies ; Female ; Fetal Distress ; Humans ; Incheon ; Insurance, Health ; Midwifery ; Pregnancy ; Seoul ; Small-Area Analysis

The effect of androgen in the development of the normal prostate and the evolution of benign prostatic hypertrophy (BPH), and prostatic adenocarcinoma has been proven. In addition to androgen, estrogen and progesterone are also thought to play a role in the pathogenesis of BPH and carcinoma. However, their exact roles are not yet known because there is no conclusive evidence. Thirty cases of prostatic adenocarcinoma and 16 cases of BPH were studied. Immunohistochemical staining for estrogen receptor (ER) and progesterone receptor (PR) in epithelial and stromal cells, respectively was performed and the results were assessed semiquantitatively based on the number of positive cells per 100 total cells. Slides were scored as negative; less than 5% of cells, 1 ; 6~15% of cells, 2 ; 16~25% of cells, and 3 ; more than 26% of cells. The relationship between ER and PR expression and the patient's age, histologic grade, and clinical stage was evaluated in prostatic adenocarcinomas. ER was negative in epithelial and in stromal cells for all prostatic adenocarcinomas and BPH cases. The PR expression in epithelial cells and in stromal cells of BPH was noted in 15 (93.8%) and 16 (100.0%) out of 16, respectively. The PR expression of carcinoma cells and stromal cells in prostatic adenocarcinoma was found in 28 (93.3%) and 23 out of 30 (76.7%), respectively. The PR immunoreactivities of stromal cells around carcinoma were 3 in 18 cases, 2 in one case, and 1 in 4 cases, but those of epithelial and stromal cells of BPH and carcinoma cells of prostatic carcinoma were similar to each other with a value of 3 in most cases. The PR expression rate of stromal cells around carcinoma was significantly correlated with the patient's age (p=0.044), but not with histologic grade and clinical stage. In summary, estrogen does not have a direct effect on the biological behavior of BPH and prostatic adenocarcinoma, but progesterone appears to play a role in the pathogenesis of BPH and prostatic adenocarcinoma. Further studies should clarify the biological role of progesterone in the human prostate.
Adenocarcinoma* ; Epithelial Cells ; Estrogens* ; Humans ; Progesterone* ; Prostate ; Prostatic Hyperplasia* ; Receptors, Progesterone* ; Stromal Cells

BACKGROUND: This study aims to obtain basic data regarding the proper maintenance and potential role of humidifiers in the development of nosocomial pneumonia. We investigated into a spectrum of bacteria that grew after disinfection in humidifiers that were used in intensive care units (ICUs). The bacteria were isolated at different time points after disinfection. METHODS: We randomly selected 6 humidifiers that were used in an ICU and conducted a series of bacterial culture studies at 24 hr, 48 hr, 72 hr and 168 hr after disinfecting the six humidifiers. The fluid from the humidifider was cultured in the same manner as the dialysate. RESULTS: No bacteria were isolated in most of the 6 humidifiers 24 hr after the disinfection of the instruments. Gram-negative bacilli such as Acinetobacter baumannii, Burkholderia cepacia, and Stenotrophomonas maltophilia were cultured at 48 hr after disinfection. CONCLUSION: Regular and thorough disinfection of humidifiers is necessary to prevent possible spread of infection via humidifiers in the ICU.
Acinetobacter baumannii ; Bacteria ; Burkholderia cepacia ; Disinfection ; Critical Care ; Intensive Care Units ; Pneumonia ; Stenotrophomonas maltophilia