BACKGROUND: Thyroid status in uremia is still inconclusive due to the complexicity of the system. No single pathogenetic event may explain the thyroid function abnormalities in end stage renal disease (ESRD). Defects at all levels of the hypothalamic-pituitary-thyroid axis have been identified. Regarding the thyroid dysfunction in ESRD it is well recognized that the TSH response to TRH is blunted and serum concentrations of thyroid hormones are decreased in patients with ESRD. Whether or not on maintenance hemodialysis. Restoration of renal function with renal transplantation resulted in normalization of all parameters of thyroid function with exception of blunted TSH response to TRH. We evaluated the long-term changes of the thyroid function in 10 patients to know whether the thyroid function and the hypothalamo-pituitary axis were improved with the recovery of the renal function under maintenance low-dosage steroid administration after renal transplantation. METHODS: These tests were performed during the morning in the fasting state in 10 ESRD patients before, 1 month and 6 years after renal transplantation (RT). Thyroid function tests. Serum T3, T4 were measured by RIA kit and serum TSH was measured by IRMA kit. TRH stimulation test. Serum blood samples were obtained 0, 30, 60, 90, 120 min after TRH (400microgram) administration. Statistical analysis. All grouped data were expressed as mean+/-SD. Student t-test was used to assess the statistical difference between any two means. RESULTS: 1) The mean basal level of serum T3 was reduced in ESRD patients (53.6+/-33.2ng/dL) and increased to the low normal level 1 month after RT (87.8+/-25.4ng/dL), improved to the normal level 6 years after RT (116.3+/-28.8ng/dL). 2) The mean basal level of T4 was within normal range before RT (5.9+/-1.1microgram/dL), after 1 month (6.2+/-1.2microgram/dL) and after 6 years (6.5+/-1.4microgram/dL) of RT. 3) The mean basal level of TSH was within normal range before RT (2.0+/-1.2microU/mL), after 1 month (1.1+/-0.7microU/mL), and after 6 years (0.7+/-0.5microU/mL) of RT. Rut the mean TSH level of 6 years of RT was significantly decreased within the normal range. 4) In ESRD the TSH response to TRH was blunted, had a diminished peak and delayed fall before RT. After 1 month of RT, the TSH response to TRH was persistently blunted, however showed more rapid fall of TSH. After 6 years of RT, the TSH response to TRH normalized, but the absolute level of TSH and the peak level of TSH to TRH were less than before and after 1 month of RT. CONCLUSIONS: The abnormalities of thyroid hormones in uremic patients were improved partially after 1 month of RT and almost completely after 6 years of RT. But the level of T3H and the peak level of TSH to TRH were low within normal range, these results may be a direct consequence of low-dosage and long-term glucorcorticoid administration.
Axis, Cervical Vertebra ; Fasting ; Follow-Up Studies* ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Reference Values ; Renal Dialysis ; Thyroid Function Tests ; Thyroid Gland* ; Thyroid Hormones ; Uremia

BACKGROUND: Lipoprotein(a)[Lp(a)] is a subspecies of low-density lipoprotein and has been shown to be associated with pathogenesis of thrombosis-related disease. It is already known that patients with diabetic nephropathy are usually complicated by vascular complications such as coronary artery diseases and cerebrovascular accidents. According to the recent data, Lp(a) level tends to be increased as the proteinuria is increased and renal function are decreased. We evaluated the Lp(a) level to know whether its level is correlated to the severity of diabetic nephropathy. METHODS: We investigated Lp(a) levels in eighty-one patients with Type 2 (non-insulin-dependent) diabetic patients. They were divided into four groups according to the level of urinary albumin excretion and serum creatinine level: Group 1 (n=30): normal renal function + urine microalbumin or=1.5mg/dL. Blood samples were obtained during the morning in the fasting state and separated serum from the it and reserved at -70degrees C. Lp(a) concentration was checked by one-step sandwich ELISA test. All grouped data were expressed as mean+/-SD. ANOVA and unpaired t-test was used to assess the statistical difference between any two means. RESULTS: Lp(a) levels were 30.2+/-4.6mg/dL in Group 1, 42.7+/-8.2mg/dL in group 2, 73.4+/-19.7mg/dL in group 3, and 80.7+/-14.8mg/dL in group 4. The level of Lp(a) in group4, group 3, and group 2 was significantly higher than that of group 1 respectively (P=0.009, 0.001, 0.038). However, no significant correlation was observed between the level of Lp(a) and that of total cholesterol, triglyceride and total lipid in all groups. CONCLUSIONS: these results indicate that Lp(a) concentrations are increased in the patients with diabetic nephropathy with microalbuminuria or overt proteinuria. So, the presence of albuminuria may be the important determinant for the elevated Lp(a) level in diabetic nephropathy.
Albuminuria ; Cholesterol ; Coronary Artery Disease ; Creatinine ; Diabetic Nephropathies* ; Enzyme-Linked Immunosorbent Assay ; Fasting ; Humans ; Lipoprotein(a)* ; Lipoproteins* ; Proteinuria ; Stroke ; Triglycerides ; Urinalysis

No abstract available.
Closing Volume* ; Humans ; Posture* ; Pulmonary Ventilation*

Several reports have described the usefulness of tumor markers detected in pancreatic juice for diagnosis of pancreatic cancer. We performed this study to evaluate the usefulness of tumor markers in pure pancreatic juice collected by duodenoscopic cannulation of pancreatic duct before and after injection of secretin. From April 1993 to July 1995, 8 cases of pancreatic cancer, 5 cases of benign pancreatic lesions, and 5 cases of benign biliary diseases without pancreatic lesion were involved. CEA and CA 19-9 immunoreactivity were measured by radioimmunoassay. Concentrations of CA 19-9 in pure pancreatic juice were significantly higher in patients with pancreatic cancer(median value; 3582, range 88.4-10410 IU/ml) than in control patients(median value 231, range 30.4-682 IU/ml)(p<0.05). Concentrations of CEA in pure pancreatic juice were not significantly different between patients with pancreatic cancer(median value: 6,5, range 1.0-152ng/ml) and control patients(median value: 4.0, range 1-17.2 ng/ml)(p>0.05). There was no significant correlation between levels of CA19-9, CEA in pancreatic juice and those levels in serum. The amounts of juice collected by duodenoscopic cannulation in patients with pancreatic cancer were 1.5+/- 0.9ml during 5 minutes before infusion of secretin, 11.3+/- 3.9ml, 10.8+/- 4.0ml, 10.6+/- 4.0ml in 5 minute interval after infusion of secretin. These results indicated that measurement of CA19-9 in pure pancreatic juice may be used as a marker for pancreatic cancer. Adequate amount of pancreatic juice was collected by duodenoscopic cannulation for evaluation of tumor marker, enzyme studies and cytology.
Catheterization ; Diagnosis ; Humans ; Pancreatic Diseases ; Pancreatic Ducts ; Pancreatic Juice* ; Pancreatic Neoplasms ; Radioimmunoassay ; Secretin ; Biomarkers, Tumor

OBJECTIVE: Trichomonas vaginalis is the common cause of sexually transmitted diseases. The present study was performed to find the possibility of other transmission mode of T. vaginalis than sexual transmission. METHODS: Survivals of trophozoites suspended in various environmental conditions were measured by haemocytometer after trypan blue staining. Also, drying time of vaginal secretion exposed at different temperatures such as 4 degrees C, 26 degrees C, 30 degrees C were observed. RESULTS: The survival rates of T. vaginalis decreased as the temperatures of tap water increased. The survival rates of trophozoites were less than 10% at 30 min-exposure at 4d degrees C or 15 min-exposure at 26 degrees C water. Hot water above 45 degrees C killed trichomonads in 5 minutes or so. T. vaginalis soaked in water from swimming pool and in cleaning solution deceased in about 5 minutes. When trophozoites were put into urines of six healthy person, the survival rates of T. vaginalis showed less than 10% after 24 hr exposure except KT4. The survival rates of trichomonads were changed according to individual urine on examined day, and isolate of T. vaginalis. The vaginal secretion was put on slide glass and leave alone until complete drying in 4degrees C refrigerator, 26 degrees C and 30 degrees C incubator. For drying of vaginal secretion, it took 70 minutes, 44 minutes and 26 minutes in 4 degrees C refrigerator, 26 degrees C and 30 degrees C incubators, respectively. The survival of trichomonads showed no change until complete dryness of vaginal secretion. T. vaginalis immersed in tap water for 5 minutes, was divided into two or many fragments. Some trichomonads were partially or completely destructed. CONCLUSION: From above results, it is supposed that transmission of T. vaginalis by contaminated fomites such as toilet stool, toilet seats is possible although this type of transmission may not occur frequently.
Fomites ; Glass ; Humans ; Incubators ; Sexually Transmitted Diseases ; Survival Rate ; Swimming Pools ; Trichomonas vaginalis* ; Trichomonas* ; Trophozoites ; Trypan Blue ; Water

PURPOSE: To compare and confirm the impact of prepregnancy body mass index on pregnancy outcome in women with a singleton conceived by assisted reproductive technology and spontaneously conceived pregnancy. METHODS: A sample of 165 and 247 pregnant women with and without assisted reproductive technology were retrospectively recruited from electronic medical charts of C hospital. RESULTS: There were significant differences between the two groups for maternal age, paternal age, length of marriage, prepregnancy body mass index, parity, spontaneous abortion experience, and preterm delivery. A prepregnancy body mass index of > or =25 was associated with higher risk for maternal and neonatal complication in the assisted reproductive technology group. CONCLUSION: The results indicate that a higher prepregnancy body mass index is associated with increased risks for adverse pregnancy outcomes for women using assisted reproductive technology. So these women need appropriate care to compensate for the risk.
Abortion, Spontaneous ; Adult ; *Body Mass Index ; Case-Control Studies ; Female ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Odds Ratio ; Pregnancy ; Pregnancy Complications/etiology ; Pregnancy Outcome ; Premature Birth/etiology ; Reproductive Techniques, Assisted ; Retrospective Studies ; Risk Factors ; Weight Gain

Background: To test the hypothesis that Galphas gene mutation may suppress the expression of TRH-R gene, we investigated whether hTRH-R gene expression is lower in human GH-secreting pituitary adenomas with Galphas mutation than in tumors without the mutation. Method: TRH-induced paradoxical response of GH was observed in 8 acromegalic patients. The mutation of gene was identified by direct sequencing of the genomic DNA prepared from GH-secreting pituitary adenomas. The expression of hTRHT mRNA was quantitated by RT-PCR. Results: The transcript of hTRH-R gene was detected in 6 of 8(75%) tumors. Three of these(50%) showed the paradoxical GH response to TRH and the other three patients did not show the response. The relative expression of hTRH-R mRNA in the tumors from patients with the paradoxical response of GH to TRH did not differ from that in the tumors from patients without the paradoxical response. Direct PCR sequencing of Galphas disclosed a mutant allele and a normal allele only at codon 201 in 4 of 8 tumors. The paradoxical response to TRH was observed in 2 of 4 patients without the mutation, and 2 of 4 patients with the mutation. The hTRH-R gene expression of pituitary adenomas did not differ between the tumors without the mutation and those with mutation. Conclusion: This study suggests that the expression of TRH-R gene is not likely to be a main determinant for the paradoxical response of GH to TRH, and that Galphas mutation does not seem to suppress the gene expression of TRH-R in GH secreting adenoma.
Acromegaly ; Adenoma* ; Alleles ; Codon ; DNA ; Gene Expression ; Growth Hormone-Secreting Pituitary Adenoma ; GTP-Binding Proteins ; Humans ; Pituitary Neoplasms ; Polymerase Chain Reaction ; Receptors, Thyrotropin-Releasing Hormone* ; RNA, Messenger

PURPOSE: The expressions of low levels of ERCC1 (excision repair crosscomplementation group 1) and ERCC2/XPD (excision repair cross- complementation group 2) have been studied in order to find a potential marker for predicting the prognosis or treatment response in cancer patients. However, polymorphisms in these genes have been rarely evaluated in terms of predicting the survival of cancer patients. MATERIALS AND METHODS: We investigated whether these polymorphisms had an effect on the response to chemotherapy and on the survival in 109 patients, with non-small-cell lung cancer, treated with cisplatin plus gemcitabine, paclitaxel or docetaxel. The polymorphisms of ERCC1 Asn118Asn (C->T), ERCC2 Lys751Gln and Asp312Asn were evaluated using a SNaPshot kit. RESULTS: The treatment responses showed no statistically significant differences according to the polymorphisms of ERCC1 Asn118Asn, ERCC2 Lys751Gln or Asp312Asn. The median survival time was 376 days (95% CI, 291~488). The overall survival rate showed no significant difference according to age, sex, chemotherapy regimen, clinical stage or sequential radiation therapy. The polymorphisms of ERCC2 Lys751Gln and Asp312Asn did not affect the survival of the patients (p=0.4711 and 0.4542, respectively). The polymorphism of ERCC1 Asn118Asn, chemotherapy response, performance status and body weight loss had effect on the overall survival of the patients (p=0.0001, 0.0001, 0.0176 and 0.0082 respectively). As for survival rate, according to the polymorphism in ERCC1 Asn118Asn, the median survival time in those patients showing the wild genotype (C/C) was 480 days (95% CI, 333~544), which was statistically significant compared with the 281 days for the patients with the variant genotype (T/T, C/T) (hazard ratio 3.497) (95% CI, 214~376). CONCLUSION: It is suggested that the presence of the wild genotype in ERCC1 Asn118Asn, in non-small-cell lung cancer patients treated with cisplatin based chemotherapy, was a surrogate marker for predicting a better survival.
Biomarkers ; Body Weight ; Cisplatin* ; Complement System Proteins ; DNA Repair ; Drug Therapy* ; Genotype ; Humans ; Lung Neoplasms* ; Lung* ; Paclitaxel ; Prognosis ; Survival Rate

A 73-year-old man who had undergone a right pneumonectomy and open window thoracostomy due to tuberculous empyema, presented with purulent discharge from the previous operation site. The computed tomography of the chest showed diffuse pleural thickening and a low attenuated lesion, with air bubbles in a dependent portion of the right hemithorax. These air bubbles were revealed to be due to 7 pieces of retained surgical gauze by flexible bronchoscopy. The patient showed marked clinical improvement with diminished purulent discharge after removal of the foreign bodies.
Aged ; Bronchoscopy ; Empyema, Tuberculous ; Foreign Bodies ; Humans ; Pneumonectomy ; Thoracostomy* ; Thorax

OBJECTIVES: This retrospective study was conducted to analyze the hypothesis that with neoadjuvant chemotherapy of vinblastine, bleomycin, and cisplatin followed by radical hysterectomy or radiation therapy and concurrent chemoradiation with cisplatin based regimen would improve survival in patients with barrel-shaped or bulky-endophytic (Diameter > 4cm) cervical carcinomas than those of radiation alone or combined radiation and surgery. STUDY DESIGN: Eighty-eight patients with barrel-shaped or bulky-endophytic cervical carcinomas, treated at the Hanyang University Hospital from 1983 to 1997, were the subjects of this investigation. Fifty-six of these patients were treated by neoadjuvant chemotherapy followed by radical hysterectomy with bilateral pelvic lymphadenectomy ( Stage I b2, 8; IIa, 15; IIb, 20; III- IV, 13), twelve patients were treated by neoadjuvant chemotherapy followed by radiation therapy ( Stage Ilb, 4; IIJ-IV, 8), and twenty patients were treated by concurrent chemo-radiotherapy ( Stage IIb, 2; III-IV, 18). RESULTS: The incidence of parametrial extension and pelvic lymphnode metastases was higher in patients with barrel-shaped or bulky-endophytic cervical carcinomas than non-barrel-shaped cervix (p .025: .001). 5-years disease free survival rate was determined for patients treated by neoadjuvant chemotherapy followed by radical hysterectomy with bilateral pelvic lymphadenectomy was 73.3 %. For patients treated by neoadjuvant chemotherapy followed by radiation therapy it was 45.7%. For patients treated by concurrent chemo-radiotherapy it was 46.1%. CONCLUSION: These data support an improvement in survival of patients with barrel-shaped or bulky-endophytic cervical carcinomas treated by neoadjuvant chemotherapy followed by radical hysterectomy or radiation therapy and concurrent chemo-radiotherapy.
Bleomycin ; Cervix Uteri* ; Cisplatin ; Disease-Free Survival ; Drug Therapy* ; Female ; Humans ; Hysterectomy ; Incidence ; Lymph Node Excision ; Neoplasm Metastasis ; Retrospective Studies ; Vinblastine