No abstract available.
Diagnosis* ; Epilepsy*

Malignant melanoma is the most common intraocular tumor in whites but rare in orientals. We experienced a case of malignant melanoma of the choroid in 39-year-old female who had decrease of vision of her right eye. Slit lamp examination through the dilated pupil showed a well delineated pigment mass in the vitreous cavity and ophthalmoscopic examination showed a large inferior retinal detachment. Diagnosis was made by ultrasonography and computerized tomography. The right eye was enucleated and was found to have a large pigmented mass of the choroid. Histopathologic examination of the choroidal mass disclosed a malignant melanoma composed of epitheloid cells. At the last visit, 4 months after enucleation, the patient was doing well.
Adult ; Choroid* ; Diagnosis ; Female ; Humans ; Melanoma* ; Pupil ; Retinal Detachment ; Ultrasonography

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce glycosylated hemoglobin (HbA1c, 0.5% to 1.0%), and are associated with moderate weight loss and a relatively low risk of hypoglycemia. There are differences between Asian and non-Asian populations. We reviewed available data on GLP-1RAs, focusing on Korean patients, to better understand their risk/benefit profile and help inform local clinical practice. Control of postprandial hyperglycemia is important in Asians in whom the prevalence of post-challenge hyperglycemia is higher (vs. non-Asians). The weight lowering effects of GLP-1RAs are becoming more salient as the prevalence of overweight and obesity among Korean patients increases. The higher rate of gastrointestinal adverse events amongst Asian patients in clinical trials may be caused by higher drug exposure due to the lower body mass index of the participants (vs. non-Asian studies). Data on the durability of weight loss, clinically important health outcomes, safety and optimal dosing in Korean patients are lacking. Use of GLP-1RAs is appropriate in several patient groups, including patients whose HbA1c is uncontrolled, especially if this is due to postprandial glucose excursions and patients who are overweight or obese due to dietary problems (e.g., appetite control). The potential for gastrointestinal adverse events should be explained to patients at treatment initiation to facilitate the promotion of better compliance.
Appetite ; Asian Continental Ancestry Group ; Body Mass Index ; Compliance ; Diabetes Mellitus, Type 2 ; Glucagon-Like Peptide 1* ; Glucose ; Hemoglobin A, Glycosylated ; Humans ; Hyperglycemia ; Hypoglycemia ; Korea ; Obesity ; Overweight ; Postprandial Period ; Prevalence ; Weight Loss ; Glucagon-Like Peptide-1 Receptor

The aim of this study was to investigate the relationship between somatostatinergic tone (SST) and the size of growth hormone (GH)-producing pituitary tumors. GH levels of 29 patients with newly diagnosed acromegaly were measured using a 75-gram oral glucose tolerance test (OGTT), an insulin tolerance test (ITT), and an octreotide suppression test (OST). Differences between GH levels during the ITT and the OGTT (DeltaGH(IO)), and between the OGTT and the OST at the same time point (DeltaGH(OS)) were compared according to the size of the tumor and the response pattern to the OST. DeltaGH(IO) of macroadenomas (n=22) was non-significantly higher than those of microadenomas while DeltaGH(OS) of macroadenomas were significantly higher than those of microadenomas. According to further analyses of macroadenomas based on the response pattern to the OST, GH levels during the ITT were significantly higher in non-responders. DeltaGH(OS) showed near-significant differences between responders and non-responders. In conclusion, as the size of the pituitary tumor increases, the effect of glucose on SST appears to be attenuated. Macroadenomas that are non-responders to the OST possess a portion of GH secretion exceeding the range of regulation by SST.
Acromegaly/*diagnosis/*pathology ; Adenoma/drug therapy/*pathology ; Adult ; Aged ; Antineoplastic Agents, Hormonal/therapeutic use ; Female ; Glucose Tolerance Test ; Human Growth Hormone/*blood/secretion ; Humans ; Insulin/blood ; Insulin-Like Growth Factor I/analysis ; Male ; Middle Aged ; Octreotide/therapeutic use ; Pituitary Neoplasms/drug therapy/*pathology

Phantom limbs are usually observed after amputation of extremities. In patients after a stroke, a similar but rarely occurring phenomenon consisting of the patient experiencing the presence of an additional limb has been described. This phenomenon, generally called supernumerary phantom limb (SPL), may be caused by lesions in the right or left cerebral hemisphere, but has been predominantly reported in patients who have had a right hemispheric stroke. We report two cases of atypical SPL and phantom limb pain (PLP) after pontine hemorrhage. The patients were treated conservatively and their symptoms lasted more than 1 month. This is the first report of SPLs after left pontine hemorrhage, and phantom perception and pain lasted longer than those in previously observed cases. Our results indicate that SPL may be more common than reported; therefore, thorough examinations are essential for the care of stroke patients.
Cerebral Hemorrhage/*complications ; Cerebral Infarction/complications ; Female ; Humans ; Male ; Middle Aged ; Pain/etiology ; Phantom Limb/*diagnosis/etiology/therapy ; Psychomotor Performance/physiology ; Stroke/complications ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Based on the results of well designed clinical studies, intensive insulin therapy has been established to improve glycemic control in newly diagnosed diabetes. However, discrepancies exist between the findings of clinical trials and experiences in general practice. Furthermore, the efficacy of an early insulin therapy (EIT) - commonly used in general practice - on long-term glycemic control has not been established. Therefore, we evaluated the effects of EIT on pancreatic beta-cell function and glycemic control using insulin-based methods widely employed in general practice. METHODS: We performed a retrospective cohort study that initially involved reviewing patients' medical records. Following a thorough review, 61 patients who received either biphasic or prandial EIT at the time of diagnosis were enrolled. We then evaluated changes in beta-cell function and glycemic control during a 48-month follow-up period. RESULTS: Mean HbA1c decreased significantly as a result of EIT from 10.7 +/- 1.8% to 6.2 +/- 1.1% (p < 0.001). On average, 2.6 months was required to achieve an HbA1c value < 7%. EIT significantly improved the insulinogenic index. Glycemic control was well maintained for 48 months. More than 70% of patients were able to maintain glycemic control following lifestyle modifications or treatment with oral antidiabetic drugs. No significant differences were identified between patients receiving biphasic EIT and prandial EIT in terms of glycemic control or pancreatic beta-cell function. CONCLUSIONS: Our results suggest that regardless of the method of delivery, EIT significantly improves beta-cell function and facilitates long-term glycemic control in patients with newly diagnosed type 2 diabetes mellitus.
Administration, Oral ; Adult ; Blood Glucose/metabolism ; Cohort Studies ; Diabetes Mellitus, Type 2/blood/diagnosis/*drug therapy/*physiopathology ; Female ; Hemoglobin A, Glycosylated/metabolism ; Humans ; Hypoglycemic Agents/administration & dosage ; Insulin/administration & dosage/*therapeutic use ; Insulin Resistance ; Insulin-Secreting Cells/*drug effects/*physiology ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVE: We studied clinical characteristics of patients have endometriosis to provide basic knowledge for diagnosis, treatment, and futher study of endometriosis. METHODS: We have performed a retrospective clinical study on 163 patients diagnosed with endometriosis during laparotomy, cesarean section, laparoscopic surgery at our medical center from January, 2000 to December, 2004. RESULTS: Incidence of endometriosis was 4.38%. The more frequent occurrence was noted in the young women with low parity and in the nulliparous women. Most frequent symptom comprised dysmenorrhea and lower abdominal pain. 33.7% of patients were asymptomatic. And 82.3% of the patients were in stage III and IV. The frequent sites involved were ovaries, Cul-de sac, uterus, tubes, peritoneum and rectum in order. Frequently combind gynecologic disease were uterine myoma, benign ovarian tumor. In Stage III & IV, there are more patients, who had abnormal elevated serum CA 125 level than patients of stage I & II. CONCLUSION: Early diagnose and appropriate management of Endometriosis for young women can lowered the development of hihger stage case and it is important for fertility and better life quality.
Abdominal Pain ; Cesarean Section ; Diagnosis ; Dysmenorrhea ; Endometriosis* ; Female ; Fertility ; Genital Diseases, Female ; Humans ; Incidence ; Laparoscopy ; Laparotomy ; Leiomyoma ; Ovary ; Parity ; Peritoneum ; Pregnancy ; Quality of Life ; Rectum ; Retrospective Studies ; Uterus

PURPOSE: To evaluate the clinical results of corneal triple procedure, as well as the causes and the risk factors for graft failure. METHODS: Indications, survival period of graft, causes of graft failure, and risk factors for failure in 29 patients (29 eyes) who had undergone penetrating keratoplasty combined with cataract surgery and intraocular lens (IOL) implantation were retrospectively analyzed. RESULTS: The most common primary indication of corneal triple procedure was bacterial keratitis (24%), followed by corneal trauma, herpes simplex keratitis, and graft failure. The average survival period of corneal graft in corneal triple procedure was 29.2+/-23.2 months. The most common cause of graft failure was allograft rejection (56.3%). The risk factors of graft failure by an univariate analysis were preoperative unfavorable diagnosis (bullous keratopathy, corneal ulcer, and trauma), corneal neovasculization, intraoperative additional procedure (anterior vitrectomy, synechiolysis, and anterior chamber irrigation), immune rejection, and postoperative glaucoma, but were unrelated to methods of cataract surgery, graft size, or IOL position. In a multivariate analysis, graft rejection and corneal neovascularization were identified as risk factors for graft failure in patients undergoing triple procedure. CONCLUSIONS: Corneal graft in corneal triple procedure had various success rates according to the many factors. Risk factors for graft failure included graft rejection and corneal neovascularization.
Allografts ; Anterior Chamber ; Cataract ; Corneal Neovascularization ; Corneal Ulcer ; Diagnosis ; Glaucoma ; Graft Rejection ; Humans ; Keratitis ; Keratitis, Herpetic ; Keratoplasty, Penetrating ; Lenses, Intraocular ; Multivariate Analysis ; Retrospective Studies ; Risk Factors* ; Transplants* ; Vitrectomy

PURPOSE: This study examined the expression of clusterin and Ki-67 in human transitional cell carcinoma(TCC). In addition, the relationship of clusterin and Ki-67 expression with the clinicopathological factors and prognosis of human TCC was investigated. MATERIALS AND METHODS: 149 human TCC tissues were obtained from 149 patients who underwent a radical cystectomy(n=81) or transurethral resection(n=68). The expression of clusterin and Ki-67 was analyzed using immunohistochemical staining. The results were evaluated with respect to the clinicopathological factors. RESULTS: Positive clusterin expression was observed in 21.1% of the total TCC tissues. The expression of clusterin was not significantly related to age, gender, tumor stage and grade. However, recurrence-free survival rate of the patients with positive clusterin expression was significantly lower than that of patients with negative clusterin expression(p=0.02). The expression level of Ki-67 in the TCC tissues was associated with the tumor stage(p<0.001) and grade(p<0.001), but not with age and gender. Furthermore, the recurrence-free survival rate of patients with strong Ki-67 expression was significantly lower than that of patients with weak Ki-67 expression(p<0.001). The expression of clusterin was not significantly related to the level of Ki-67 expression. However, in the patients showing strong Ki-67 expression, the recurrence-free survival rate of the patients with positive clusterin expression was significantly lower than that of the patients with negative clusterin expression(p<0.001). CONCLUSIONS: These results suggest that the expression of clusterin and Ki-67 can be used as a useful predictor of the prognosis of patients with human TCC.
Carcinoma, Transitional Cell ; Clusterin ; Humans ; Prognosis ; Survival Rate

BACKGROUND: Air pollution causes many diseases and deaths. It is important to see how air pollution affects obesity, which is common worldwide. Therefore, we analyzed data from a smartphone application for intentional weight loss, and then we validated them. METHODS: Our analysis was structured in two parts. We analyzed data from a cohort registered to a smartphone application in 10 large cities of the world and matched it with the annual pollution values. We validated these results using daily pollution data in United States and matching them with user information. Body mass index (BMI) variation between final and initial login time was considered as outcome in the first part, and daily BMI in the validation. We analyzed: daily calories intake, daily weight, daily physical activity, geographical coordinates, seasons, age, gender. Weather Underground application programming interface provided daily climatic values. Annual and daily values of particulate matter PM10 and PM2.5 were extracted. In the first part of the analysis, we used 2,608 users and then 995 users located in United States. RESULTS: Air pollution was highest in Seoul and lowest in Detroit. Users decreased BMI by 2.14 kg/m2 in average (95% confidence interval, −2.26 to −2.04). From a multilevel model, PM10 (β=0.04, P=0.002) and PM2.5 (β=0.08, P < 0.001) had a significant negative effect on weight loss when collected per year. The results were confirmed with the validation (βAQI*time=1.5×10–5; P < 0.001) by mixed effects model. CONCLUSION: This is the first study that shows how air pollution affects intentional weight loss applied on wider area of the world.
Air Pollution* ; Body Mass Index ; Cohort Studies ; Mobile Applications ; Motor Activity ; Obesity ; Particulate Matter ; Seasons ; Seoul ; Smartphone ; United States ; Weather ; Weight Loss