Chordoid meningioma is a recently established meningeal tumor and is characterized by a chordoma like histologic appearance, peritumoral lymphoplasma cell infiltrates causing systemic manifestations similar to Castleman syndrome and having a good prognosis. We experienced a case of chordoid meningioma in a 25 year-old woman. The patient preoperatively manifested iron-resistant hypochromic microcytic anemia, polyclonal gammopathy with beta-gamma bridging and detected a huge mass in the right temporo-parietal convexity of the brain. Microscopically, the mass was composed of nests and cords of cuboid, partly vacuolated cells in a mucoid matrix, simulating chordoma. The tumor was surrounded by masses of lymphoplasma cells around vessels, many of the plasma cells contained Russell bodies. Ultrastructural findings showed intranuclear cytoplasmic invaginations, microvilli protruding from cytoplasmic surfaces and well formed desmosomes. Some portions of tumor cell surface were covered by stretches of basal lamina.
Female ; Humans ; Meningioma

Angiomyofibroblastoma is a rare, benign mesenchymal tumor of the vulva. Since it was described in 1992 by Fletcher, 15 cases have been reported in literature. We recently experienced a recurred angiomyofibroblastoma of the vulva. A 45-year-old woman was presented initially in 1991 with a mass of labium major and local excision of tumor mass had been performed. A histologic diagnosis was made of angiomyxoma, but this diagnosis was revised to angiomyofibroblastoma by the authors. The recurred mass was well circumscribed, measuring 2.5x1.6x1.5cm in dimensions. Microscopically the tumor was characterized by high cellularity, numerous blood vessels(which lack prominent hyalinization), and plump stromal cells. Immunohistochemically, the stromal cells were reactive for vimentin and desmin, but not alpha-smooth muscle actin, or S-100 protein. We thought that this case was a recurred angiomyofibrblastoma of the vulva due to incomplete surgical excision.
Female ; Humans

OBJECTIVES: After Women's Health Initiative (WHI) study had been published, the use of hormone therapy (HT) have been decreasing even though it is the most effective therapy for menopausal symptom. The survey was conducted to investigate Korean menopausal women's perception of HT and behavior when they are treated by HT. METHODS: During 4 weeks from September 2009 to October 2009, total 600 women aged 45~64 participated in the survey by face to face interview. Out of answering women, women who have visited clinic/hospital at least 1 time to treat their menopausal symptom during last 1 year were included. One hundred fifty women for each age group, 45~49, 50~54, 55~59 and 60~64, were recruited in consecutive order. RESULTS: Eighty percent women who have visited clinic/hospital to treat menopausal symptom, visited obstetrics and gynecology. Only 16% of these women were current user, and other 84% of these women had no experience of HT (53%) or stopped therapy (31%). Among current user, only 9% of women have used HT more than 5 years. Eighty percent of current user had used HT less than 2 years. Most distressing menopausal symptom is 'hot flush' regardless HT experience. When doctor recommend HT, 72% of patients accept HT in overall. Among women who had no experience of HT, the most common reason of not to take HT was concern of side effects (51%). And 67% of women who had concern of side effects worried about cancer incidence. CONCLUSION: Many women with menopausal symptom do not take HT even though it is the most effective therapy. Most of women who take HT stop treatment within 1 year. Most common reason of not to take HT is concern about side effect, increasing incidence of cancer related to HT. Therefore, HT should be considered to short-term relief of menopausal symptoms and at the minimal dose, if possible.
Aged ; Female ; Gynecology ; Humans ; Incidence ; Menopause ; Obstetrics ; Women's Health

The ectopic ovary is a rarely reported gynecologic entity. A variety of synonymous terms have been used to describe this condition, such as supernumerary ovary, accessory ovary, and ovarian implant syndrome. The etiology of ectopic ovary is poorly understood. The ectopic ovaries may occur in two ways. First, in the embryonic theories, they are believed to result from abnormal separation of a small portion of the developing and migrating ovarian primordium. Second, the accessory ovary can occur from acquired conditions such as inflammation and operations. In this report, we describe a case of the ectopic ovary with a mature cystic teratoma autoamputated into the cul-de-sac and subsequently diagnosed by laparoscopy.
Female ; Inflammation ; Laparoscopy ; Ovary ; Teratoma

BACKGROUND/AIMS: Genetic variations of ethanol-metabolizing enzymes can affect alcohol drinking behavior. The aims of this study were to investigate and compare the distributions of these genetic polymorphisms between a healthy control group and a heavy drinker group which included an alcoholic liver cirrhosis group. METHODS: Genotypes of ADH2, ALDH2, CYP2E1, and catalase were identified by polymerase chain reaction and restriction fragment length polymorphism. Genomic DNA was extracted from peripheral leukocytes in 42 healthy controls, 12 heavy drinkers, and 30 alcoholic liver cirrhosis patients. RESULTS: 1) The genotype frequencies of ALDH2 (1*1), ADH2 (1*1), CYP2E1 (c1c1), and catalase1 (TT) were 69%, 55%, 38%, and 12%, respectively in healthy Korean males. 2) There was a significant difference in the distribution of the genetic polymorphism of ALDH2 between the control group and heavy drinker group (12 heavy drinkers and 30 alcoholic liver cirrhosis patients). The genotype frequency of ALDH2 mutant, ALDH2 (1*2) and ALDH2 (2*2) in the heavy drinker group (12%) was significantly lower than that in the control group (30%). 3) We didn't find anyone with ALDH2 homozygote mutant (DD) in the heavy drinker group. 4) There was no significant difference in the distribution of genetic polymorphisms in ADH2, CYP2E1 and catalase1 between the two groups. CONCLUSIONS: These results suggest that the absence of ALDH2 mutant genotype is strongly related to heavy drinking behavior. We can not prove, however, any evidence that the polymorphisms of other ethanol-metabolizing enzymes are associated with the determination of alcohol-drinking behavior.
Adult ; Alcohol Dehydrogenase/*genetics ; Alcohol Drinking ; Alcoholism/enzymology/*genetics ; Aldehyde Dehydrogenase/*genetics ; Cytochrome P-450 CYP2E1/*genetics ; Ethanol/metabolism ; Humans ; Liver Cirrhosis, Alcoholic/enzymology/*genetics ; Male ; Middle Aged ; *Polymorphism, Genetic

Endoscopic mucosal resection with a ligation device (EMR-L) has become important in the curative treatment of precancerous lesions and early gastric cancers (EGCs), but little is known of the long-term efficacy and survival rates of EMR-L compared with surgical resection. We analyzed the therapeutic efficacy and safety of EMR-L in cases of EGC and precancerous lesions and compared the results of EMR-L with those of gastrectomy in patients with EGC over the same periods. EMR-L was performed on 20 EGCs and 54 precancerous lesions including tubular adenomas with or without severe dysplasias in 74 patients. Macroscopic type, size and location of the lesion were determined by endoscope, and the depth of invasion in EGCs was determined by endoscopic ultrasonography and confirmed by pathologic examination of the resected specimens. All the EGC cases were endoscopically followed up for at least 18 months (range, 18-66 months). Patients were selected that underwent subtotal gastrectomy and the survival rates were compared with those that underwent EMR-L. Complete resection was made in a single EMR-L treatment session in 61 cases (82.4%; 91.5%, were precancerous lesions and 65% were EGCs). After a repeat trial of EMR-L, the total rate of complete resection of precancerous lesions and EGCs was 92.6% and 85.0%, respectively. The survival rate of EGCs showed that complete resection by EMR-L resulted in 2 and 5 year survival rates of 100% and 95%, which are comparable to those of surgery (100% and 100%). This study suggests that EMR-L is a technically simple, minimally invasive and highly safe and effective treatment modality for selective EGCs, and offers an alternative to surgical treatment.
Adult ; Aged ; Aged, 80 and over ; Comparative Study ; Endoscopy, Digestive System* ; Female ; Gastrectomy ; Human ; Ligation/instrumentation* ; Male ; Middle Age ; Precancerous Conditions/surgery* ; Stomach Neoplasms/surgery* ; Time Factors

BACKGROUND/AIMS: The prevalence and clinical characteristics of entecavir (ETV) resistance is not well known. The aim of this study was to determine the frequency of genotypic resistance in nonresponders and virologic breakthrough (VBT) patients. METHODS: The medical records of 76 chronic hepatitis B patients treated for a least 6 months from October 2006 to October 2008 were reviewed retrospectively. We divided patients into two groups: nucleoside analogue (NA)-naive patients (n=38) and LAM experienced patients (n=38). NA-naive and LAM experienced patients received ETV at 0.5 and 1.0 mg/day, respectively. The virologic response and VBT were investigated in both groups. We used the multiplex restriction fragment mass polymorphism (RFMP) method to test genotypic resistance at the rtI169, rtT184, rtS202, rtM204, and rtM250 sites. RESULTS: Age, gender, serum ALT, and HBV DNA level before treatment did not differ between the groups. Neither VBT nor nonresponse was observed in the NA-naive group, whereas VBT and nonresponse were observed in three patients each in the lamivudine (LAM)-experienced group; all six patients had YMDD mutation at study enrollment, all three patients with VBT had genotypic resistance to ETV, but the three nonresponse patients did not have genotypic resistance to ETV. CONCLUSIONS: We suspect that VBT is mostly associated with genotypic resistance to ETV. However, nonresponse might be associated with the continuance or reselection of the YMDD mutant in LAM-experienced patients.
Adult ; Antiviral Agents/*therapeutic use ; Drug Resistance, Viral/genetics ; Female ; Genotype ; Guanine/*analogs & derivatives/therapeutic use ; Hepatitis B/genetics ; Hepatitis B, Chronic/*drug therapy/virology ; Humans ; Lamivudine/therapeutic use ; Male ; Middle Aged ; Mutation ; Polymorphism, Restriction Fragment Length ; RNA-Directed DNA Polymerase/genetics ; Retrospective Studies

BACKGROUND: Although heart rate variability (HRV) and blood pressure variability (BPV) arise from many different influences, probably the most consistent external modulator is respiration. At rest, the heart rate increases on inspiration and decreases on expiration, a phenomenon called respiratory sinus arrhythmia (RSA). Spectral analysis of heart rate offers good and reproducible estimate of RSA and BPV. Many studies have been conducted on the effects of respiration on HRV and BPV during awake subject breathing spontaneously. However, little is known as to whether respiratory rate modulates HRV and BPV during general anesthesia with mechanical ventilation. Here, we studied effects of respiratory rate on HRV and BPV during general anesthesia. METHODS: We studied 40 patients undergoing general anesthesia with mechanical ventilation. Maintaining anesthesia with isoflurane, we recorded R-R interval and systolic blood pressure at respiratory rate of 15, 10 and 6 breaths/minute. Data was analyzed by the power spectral analyses of HRV and BPV, which were divided into low frequency (LF) and high frequency (HF) band. RESULTS: Respiratory rate did not affect RR interval, systolic blood pressure, and total spectral power HRV and BPV. Compared with its value at 15 breaths/minute, HF-HRV was significantly increased at 6 breaths/minute. HF-and LF-BPV at 6 breaths/minute were significantly increased versus 15 breaths/minute. CONCLUSIONS: Respiratory rate modulates HRV and BPV during general anesthesia with mechanical ventilation. We suggest that respiratory rate should be considered and controlled in studies of cardiovascular variability during general anesthesia.
Anesthesia ; Anesthesia, General* ; Arrhythmia, Sinus ; Blood Pressure ; Heart Rate ; Humans ; Isoflurane ; Respiration ; Respiration, Artificial* ; Respiratory Rate*

BACKGROUND/AIMS: Proton pump inhibitors (PPI) and H2-receptor antagonists (H2RA) are commonly prescribed for the treatment of mild to moderate reflux esophagitis (MMRE). There remains great controversy in their usefulness as the first choice and the appropriateness. We prospectively compared the efficacy and safety of the 8-week low-dose PPI vs. standard-dose H2RA in MMRE. METHODS: One hundred patients with MMRE were randomized to receive either low-dose of omeprazole (L-OMP: 10 mg, q.d.) or standard-dose of ranitidine (S-H2RA: 150 mg, b.i.d.) for 8 weeks. The H. pylori status using rapid urease test, histological examination and culture, reflux esophagitis (RE) grading, gastrointestinal symptoms using 4-point scale, adverse event and the standard laboratory examination were assessed at baseline and 8-week end point of therapy. RESULTS: Improvement rate of RE [intention to treat (n=82)/per protocol (n=72)] were shown in 69.1%/63.9% for L-OMP and 65.0%/63.9% for S-H2RA group (p=0.697, p=1.000). Complete healing rates of RE were 54.7%/50.0% for L-OMP and 42.5%/41.7% for S-H2RA. No significant difference in healing rate, the rapidity of symptom resolution, adverse events, and laboratory monitoring was found between the two groups. CONCLUSIONS: The low-dose omeprazole therapy produced similar healing rates and safety in the treatment of MMRE. In addition, L-OMP is advantageous in its once-a-day dosing and might be an alternative to S-H2RA, especially in Korean patients with MMRE.
Adolescent ; Adult ; Aged ; Anti-Ulcer Agents/*administration & dosage ; Comparative Study ; English Abstract ; Esophagitis, Peptic/*drug therapy/pathology ; Female ; Histamine H2 Antagonists/*administration & dosage ; Humans ; Male ; Middle Aged ; Omeprazole/*administration & dosage ; Ranitidine/*administration & dosage

This study was conducted to compare the severity of cannulation pain in hemodialysis patients after topical application of EMLA cream and local injection of lidocaine and evaluated side effects and problems accompanied by the former. Twenty patients, who were on hemodialysis from September 1 to October 15, 1994 at the Kangnam St. Mary's Hospital, Catholic University Medical College, were divided into two groups of ten. To conduct a cross over study, two groups were placed on four repeated methods with lidocaine followed by four repeated methods with EMLA cream and vice versa, respectively, while the severity of cannulation pain was being measured according to a Visual Analogue Scale with each methods. The results are follows : 1) The scale of pain was recorded as 4.56+/-1.38 and 2.05+/-1.36 points for methods with lidocaine and EMLA cream, respectively, indicating the less severe pain with EMLA cream. 2) Local side effects such as itching(4 cases, 5.0%) and pallor(5 cases, 6.3%) were observed with methods with EMLA cream but disappeared before the completion of hemodialysis. 3) Problems associated with local lidocaine were pain at the injection of anesthetic (27 cases, 16.9%) and fear for needle insertion (6 cases, 3.8%). The most frequent problems with EMLS cream application were an inconvenience in use (11 cases, 6.9%) and tedious long pretreatment time (11 cases, 6.9%), those associated with inconvenience in cream applying procedures. 4) Twelve out of twenty patients(60.0%) responded with yes to a continued use of EMLA cream in spite of problems with cream application and economical difficulties in purchasing. These results indicate that 5% EMLA cream used as a local anesthetic in hemodialysis significantly reduces cannulation pain and lacks side effects, thus serving as a suitable method for the alleviation of cannulation pain and inconvenience in hemodialysis and the relief of psychological stress of nurses.
Catheterization ; Humans ; Lidocaine* ; Needles ; Renal Dialysis* ; Stress, Psychological