OBJECTIVE: To evaluate the changing pattern of serum leptin level and the correlation between estradiol level during the clomiphene citrate challenge test(CCCT) or controlled ovarian hyperstimulation(COH) cycle. METHODS: Twenty-seven women who underwent CCCT and fourteen women who underwent controlled ovarian hyperstimulation were recruited to measure the serum leptin level. After correction of serum concentration with body mass index(BMI), changes of leptin level and correlation with serum estradiol level during CCCT and COH cycle were analyzed. RESULTS: Circulating leptin levels were significantly correlated with BMI at each time point in CCCT cycle(P<0.01). In CCCT cycle, leptin/BMI level was significantly increased at midluteal phase compared to that of menstrual cycle day 3 and 10(p<0.05). In women with regular menstruation, leptin/BMI level at midluteal phase was significantly higher than that of menstrual day 3 and 10, but this difference was not seen in women with irregular menstruation. The leptin/BMI level in COH cycle showed increasing tendency throughout ovarian stimulation. But there was no significant correlation between leptin/BMI and estradiol level in CCCT and COH cycle. CONCLUSION: There is a significant correlation between BMI and circulating leptin level. Midluteal leptin level is significantly higher than that of follicular phase in CCCT cycle, and there is an increasing tendency in leptin level after ovarian stimulation in CCCT and COH cycle without statistical significance. These findings suggest that circulating estradiol concentration has no major influence on circulating leptin level.
Clomiphene* ; Estradiol ; Female ; Follicular Phase ; Humans ; Leptin* ; Menstrual Cycle ; Menstruation ; Ovulation Induction

PURPOSE: In order to recognize predictive factors of the recurrent seizure attacks with benign epilepsy of childhood with centrotemporal spike(BECCT), we have studied the factors such as age of seizure onset, sex of the patient, frequency and duration of seizure Prior to therapy, initial antiepileptic drug, which are presumed to influence the recurrence of seizure attack. METHODS: Among the children with BECCT, who visited the department of pediatrics, Chuncheon Sacred Heart hospital, Hallym University from Jan. 1985 to Dec. 1997, 52 patients who were followed up for more than 12 months after disappearance of the seizure, have been studied. The patients were divided into three groups, (group I; seizure duration is less than 3 months, groups II; seizure duration less than 12 months, group III; seizure duration more than 12 months) by duration of seizure recurrence, and compared with difference of seizure recurrence by predicting factor in each group. Data were analysed by using DBSTAT version 1.0 by ANOVA. RESULTS: 1) Age onset of seizure The age onset of seizure in group I is 8.6+/-2.0 years and 7.9 +/-3.5 years in group II, 6.2+/-1.7 years in group III. The younger the seizure standted, the more seizures recurred(p<0.05). Our study revealed no age differences of the seizure remission in 3 groups. 2) Sex : Among the 52 patients, 30 patients were male, 22 patients were female. The ratio of the male to female was 1:1(12/12) in group I, 1:1.5(2/3) in group II, 2.3: 1(16/7) in group III. The recurrence rate was higher in male than in female. But no statistically difference in recurrence rate by the sex was revealed. 3) Seizure duration and seizure frequency prior to therapy : In group I, pretreatment duration was 1.6+/-3.5 months, frequency of the attacks was 2.0+/-1.0. In group II, duration 1.3+/-1.2 months, frequency 3.2+/-0.5. In group III, duration 3.5+/-6.9 months, frequency 3.5+/-1.8. Our study revered statistically significant differences in values of frequencies and durations in each groups(p<0.05). 4) Initial anticonvulsant and seizure recurrence : Seizure recurred in 36% of patients treated by carbamazepine, and 55.6% of valproate, 66.7% of phenobarbital, 37.5% of diphenylhydantion. There was no significant relation between initial anticonvulsant and seizure recurrence in each group. CONCLUSION: Our data support that age onset and seizure frequency were predictive factor fort seizure recurrence. BECCT Is a age dependent genetic disorder with variable penetrance, having longer duration of seizure with earlier onset. Clinical seizures and abnormal EEG trait tend to remit at certain age, regardless of onset age and treatment.
Age of Onset ; Carbamazepine ; Child ; Electroencephalography ; Epilepsy ; Epilepsy, Rolandic* ; Female ; Gangwon-do ; Heart ; Humans ; Male ; Pediatrics ; Penetrance ; Phenobarbital ; Recurrence* ; Seizures* ; Valproic Acid

A Bednar tumor is a variant of dermatofibrosarcoma protuberans(DFSP). The clinical and histopathological findings of Bednar tumors are identical to DFSP except for the presence of melanin-containing cells scattered within the lesion, so called pigmented DFSP. The majority of Bednar tumors are seen as DFSP present as multinodular protuberant masses in the skin. They can also present as an atrophic depressed scar-like lesions without any nodularity. We report an uncommon clinical presented case of a Bednar tumor on the back in a 22-year-old female. She presented with an asymptomatic, firm, bluish, chestnut sized, depressed and atrophic lesion on the back which had been present for 6 years. A Histopathological examination revealed massive proliferation of spindle-shaped cells arranged in a tight storiform pattern mixed with scattered pigmented cells. On immunohistochemical staining, the tumor cells were positive for vimentin, a -l-antitrypsin, and CD34, but were negative for cytokeratin, neurofilament, and factor XIIIa. The majority of the tumor cells was negative and the pigment cells were positive for the S-100 protein. The patient was treated by a wide local excision of the lesion. There has been no evidence of recurrence after 20 months post-operative follow up.
Dermatofibrosarcoma* ; Factor XIIIa ; Female ; Follow-Up Studies ; Humans ; Keratins ; Recurrence ; S100 Proteins ; Skin ; Vimentin ; Young Adult

Malignant eccrine poroma, or eccrine porocarcinoma, is a rare malignant cutaneous appendageal tumor arising from the intraepidermal eccrine sweat duct(acrosyringium), and usually develops ia an eccrine poroma of long-standing. We report a case of malignant eccrine poroma on the left buttock in a 72 year-old female. She was presented with a slightly pruritic, well-defined, reddish, firm, 4.5 x 4.5 x 0.7cm sized, protruding, ulcerated tumor. Histopathological examination revealed well-defined tumor cell nests in the epidermis and dermis. The tumor nests consisted of areas of eccrine poroma cells with benign appearance adjoining areas of anaplastic cells. Duct-like structures were observed within the tumor nests and showed a PAS-positive, diastase-resistant reaction. On immunohistochemical staining, the tumor cells were, positive for EMA, and most of tumor cells were negative but the duct-like structures were positive for CEA. She was treated with surgical excision. During the three year follow up period after excision, there was no recurrence.
Aged ; Buttocks ; Dermis ; Eccrine Porocarcinoma* ; Epidermis ; Female ; Follow-Up Studies ; Humans ; Poroma ; Recurrence ; Sweat ; Ulcer

Carcinosarcoma is a rare malignant tumor composed of a mixture of neoplastic epithelial and mesenchymal elements, which has been reported in many organ systems, but its occurrence is very rare in the skin. An 81-year-old female patient presented with aml-year-history of a painful exophytic mass on the tip of the middle finger of the right hand involving the distal part of the nail bed. The mass was 1 × 1 × 0.6 cm in size, hard, flesh colored, ulcerated and easily bleeding. Microscopically, the epidermis at the margin of the tumor showed the characteristic findings of squamous cell carcinoma and the carcinomatous component was mixed with malignant mesenchymal components focally differentiating into chondrosarcoma. This combination of squamous cell carcinoma and chondrosarcoma has not been reported yet in the skin. She had a distal interphalanx amputation and no recurrence appeared for 1 year on follow-up.
Aged, 80 and over ; Amputation ; Carcinoma, Squamous Cell* ; Carcinosarcoma ; Chondrosarcoma* ; Epidermis ; Epithelial Cells* ; Female ; Fingers ; Follow-Up Studies ; Hand ; Hemorrhage ; Humans ; Recurrence ; Skin* ; Ulcer

The aortic dissection is an acute aortic syndrome, caused by an intimal tear and subsequent splitting of the media by the pulsatile blood flow. Though there would be differences in the origin of aortic dissection and therapeutic modalities, the intermediate and long-term prognoses are poor. Endovascular Stent-graft implantation is a revolutionary technique in the treatment of aortic dissection. The endovascular stent grafting in aortic dissection is less invasive and feasible method and is an effective tool for closing the entry site and promoting clot formation, reducing the size of the false lumen. Therefore, endovascular Stent-graft implantation makes possible the desirable remodelling of aorta. We report 33 year-old male with aortic dissection in the thoracic aorta, which was treated with endovascular Stent-graft implantation. Over the favorable remodelling, his dissection was healed completely by the endovascular treatment using Stent-graft.
Adult ; Aorta ; Aorta, Thoracic* ; Blood Vessel Prosthesis ; Humans ; Male ; Prognosis

Methods: In the breast cancer registry of our institution, 18,790 patients received curative surgery for stage I–III breast cancer between January 1995 and June 2016. Of those patients, only 87 (0.5%)underwent salvage local treatment for isolated nodal recurrence on the axillary lymph nodes (ALNs) (n = 58), supraclavicular lymph nodes (SCNs) (n = 17), or internal mammary lymph nodes (IMNs) (n = 12). Results: The median follow-up duration after regional oligo-recurrence was 49 months (range: 6–194 months). For patients with recurrence of ALN, SCN, or IMN, the 5-year progression-free survival (PFS) and overall survival (OS) rates were 40.0%, 32.1%, and 25.0%, respectively (p = 0.3) and 62.7%, 70.0%, and 58.3%, respectively(p = 0.97). In the multivariable analysis for PFS, age at recurrence ≥ 65 years, disease-free interval < 24 months, non-luminal A subtype, and in-field failure (marginally significant) were found to be risk factors (RFs). However, the location of the tumor was not a significant factor for PFS (p = 0.71). When we stratified patients by the number of RFs, the 5-year PFS rates were 67.5% for patients with ≤ 1 RF and 7.3% for those with > 1 RF (p < 0.01). For patients with ≤ 1 RF, the 5-year PFS rates were 73.5% in the ALN group and 51.1% in the SCN/IMN group (p = 0.09).For patients with > 1 RF, the 5-year PFS rates were 7.3% in the ALN group and 7.1% in the SCN/IMN group (p = 1.00). Conclusion In breast cancer patients with regional oligo-recurrence, clinical outcomes after salvage treatment were favorable in patients with ≤ 1 RF, while patients with > 1 RF had poor prognoses irrespective of the location of recurrence.

BACKGROUND/AIMS: Although proton pump inhibitors (PPIs) have been widely used for the prevention and treatment of stress gastric ulcers in hospital settings, there are concerns that PPIs increase the risk of Clostridium difficile infection (CDI). However, little is known about the risk of CDI following PPI and histamine-2 receptor antagonist (H2RA) use. We evaluated the comparative hospital-acquired CDI occurrence risk associated with the concurrent use of PPIs versus H2RAs. METHODS: A systematic search of PubMed, MEDLINE/Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Google Scholar through August 19, 2016, identified 12 studies that reported the hospital-acquired CDI occurrence following H2RA and PPI use for the prevention and treatment of stress gastric ulcers. Random-effects pooled odds ratios and 95% confidence intervals were estimated. Heterogeneity was measured using I², and a meta-regression analysis was conducted. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the overall quality of the evidence. RESULTS: A total of 74,132 patients from 12 observational studies were analyzed. Compared to H2RAs, PPIs increased the risk of CDI by 38.6% (pooled odds ratio, 1.386; 95% confidence interval, 1.152 to 1.668; p=0.001; I²=42.81%). Subgroup analyses of the purpose of study medication use, study site, and study design confirmed the consistency of a greater CDI risk with PPIs than with H2RAs. The overall quality of evidence was rated as low. CONCLUSIONS: The use of PPIs for both the prevention and treatment of stress ulcers was associated with a 38.6% increased risk of hospital-acquired CDI occurrence compared to H2RA use.
Clostridium difficile* ; Clostridium* ; Histamine Antagonists ; Humans ; Nursing ; Odds Ratio ; Population Characteristics ; Proton Pump Inhibitors* ; Proton Pumps* ; Protons* ; Stomach Ulcer ; Ulcer*

Seventy-five patients with moyamoya disease were admitted at Kyung Hee University Hospital from 1978 to 1993. Of these, we followed up fourty-five cases who had been treated conservatively for the study of the natural history of moyamoya disease. Seven operated cases and six dead patients during admission were excluded in this study and sixteen cases were lost to follow-up. There were 16 males and 29 females. The hemorrhagic group was twenty-three cases and the non-hemorrhagic group was twenty-two cases. On angiographic findings, the typical type was twenty-eight cases and the atypical type was seventeen cases. Twenty-one cases(91%) of the hemorrhagic group were over twenty years old and sixteen cases(73%) of the non-hemorrhagic group were under twenty years old. The mean follow-up period was 66 months(range 6 months to 15 year 4 months). Nineteen cases had reattack, but most of them had good result except only two cases who died due to huge intracerebral hematoma. Of the sixteen cases, who were under twenty years old and manifested as transient ischemic attack, fifteen cases were improved only with conservative management. The good result of fourty-one cases out of fourty-five with conservative management. suggests that spontaneous collateral circulation had developed well to restore the function of ischemic brain in the natural course of moyamoya disease. Moyamoya disease seems to be not so worse in natural course than expected and further study about natural history will be necessary.
Brain ; Collateral Circulation ; Female ; Follow-Up Studies ; Hematoma ; Humans ; Ischemic Attack, Transient ; Lost to Follow-Up ; Male ; Moyamoya Disease* ; Natural History*

The excitotoxic effect of kainic acid on dendrites and neuronal cell bodies of hippocampus and dentate gyrus was studied with time (1, 4, 8, 16 hours, 2, 7, 14 days) light and electron microscopically by intraperitonial injection into rat. The results obtained were as follows. 1) The acute dendrotoxic effect was observed as laminar pattern of swelling along pyramidal cell body layer and dendritic fields and was most prominently at 2-4 hours after kainic acid injection. In ultractructural study, the acute change occurred in dendrites of pyramidal cells in hipocampus because the synapses between nerve terminals and swollen components were not destroyed and remained intact and, identified the swollen structures as dendrites. So, it was obvious from the results that the acute change by kainic acid was osmolysis and was continued till initial 4 hours but was finally faded out. 2) The distribution of kainic acid receptor within hippocampus was different because the prominent dendritic swelling occurred in proximal basilar dendritic field of CA 3 and 4 and the proximal and distal basilar dendritic fields of CA 1 and 2, and no change was observable in dentate granule cell. The sensitivity of hippocampal dendritic fields to kainic acid could be put in decreasing order as CA3, CA4, CA1, CA2 and dentate granule cell 3) With the elapse of time, the acute change disappeared and pyramidal cells began to degenerate by the chronic reaction about 7 days after kainic acid injury, and the pyramidal cell density in CA regions greatly decreased. Almost all pyramidal cells degenerated the dentate granule cells were not affected to kainic acid throughout the time. In conclusions, hippocampal neurons were postulated to be very sensitive to kainic acid, and in contrast to the gradual disappearance of acute change within several hours, the degeneration of pyramidal neurons by chronic change was developed within several days regardless of acute change.
Animals ; Brain* ; Dendrites ; Dentate Gyrus ; Hippocampus ; Kainic Acid* ; Neurons* ; Pyramidal Cells ; Rats* ; Receptors, Kainic Acid ; Synapses