OBJECTIVES: The purposes of this study were to determine the usefulness of transvaginal ultrasonographic assessment of the uterine cervix and to compare the diagnostic performance of ultrasonographic and digital examination of the cervix in predicting a successful induction of labor. STUDY DESIGN: One hundred-one singleton term pregnancies without ruptured membranes admitted for the labor induction were included in this study. Digital examination and transvaginal ultrasonography of the uterine cervix were performed at the time of admission. Cervical parameters evaluated included cervical length, presence of funneling, funnel length, and funnel width. Labor induction was underwent by prostaglandin E2 (PGE2) vaginal suppository and/or pitocin intravenous infusion. Outcome variable was a successful labor induction within 48 hours after beginning of the induction. RESULTS: The prevalence of induction failure was 10.9% (11/101). Receiver-operator characteristic (ROC) curve and multiple logistic regression analysis indicated a significant relationship between the successful induction of labor and cervical length <3.1 cm. The diagnositic indices of endocervical length was superior to those of Bishop's cervical score in predicting a successful induction of labor. In patients with cervical length <3.1 cm, the labor was induced successfully with fewer tablets of PGE2, less use of pitocin infusion, and shorter induction-delivery interval. CONCLUSION: Transvaginal ultrasonographical examination of the uterine cervix is more accurate than digital examination of the cervix in the prediction of a successful induction of labor in term gestation.
Cervix Uteri* ; Dinoprostone ; Female ; Humans ; Infusions, Intravenous ; Logistic Models ; Membranes ; Oxytocin ; Pregnancy* ; Prevalence ; Suppositories ; Tablets ; Ultrasonography

BACKGROUND: Surgical excision is generally recommended for the treatment of nodular fasciitis (NF) to rule out sarcoma. However, in cases of NF occurring on the face, the reported recurrence rate is higher and the surgical approach may result in considerable aesthetic concern. OBJECTIVE: To describe our experience with NF occurring on the face and evaluate the outcomes of surgical and nonsurgical methods of treatment. METHODS: We performed a retrospective review of 16 patients with NF on the face. The patients were treated with surgical excision or nonsurgical methods such as triamcinolone intralesional injection (TA ILI) and pinhole method with a carbon dioxide (CO2) laser. RESULTS: Among the 16 patients, surgical treatment was performed in 9 and recurrence occurred in 7 of these 9 patients (77.8%). The recurred lesions showed regression after repeated TA ILI. On the other hand, five patients underwent nonsurgical treatment after the histologic exclusion of malignancy. Their lesions showed regression after repeated pinhole treatment and TA ILI. In one case, NF spontaneously regressed. On a visual analogue scale, the nonsurgical approach showed superior results. However, the values were not statistically significant (6.90+/-1.56 vs. 5.61+/-1.36; p=0.163). The satisfaction level was lower in patients who experienced recurrence after surgical excision. CONCLUSION: Surgical treatment for NF on the face showed a noticeable recurrence rate and resulted in scarring. Therefore, considering the possibility of spontaneous regression, the nonsurgical method can be considered as an alternative treatment option for NF on the face.
Carbon Dioxide ; Cicatrix ; Fasciitis* ; Hand ; Humans ; Injections, Intralesional ; Laser Therapy ; Recurrence ; Retrospective Studies ; Sarcoma ; Triamcinolone

PURPOSE: To evaluate the safety and visual outcome of intravitreal triamcinolone acetonide combined with photodynamic therapy for subfoveal choroidal neovascularization in patients with age-related macular degeneration. METHODS: We evaluated 32 eyes of 32 patients with choroidal neovascularization due to age-related macular degeneration. The study group received photodynamic therapy and intravitreal triamcinolone acetonide (combined group), while the control group received photodynamic therapy only (PDT group). RESULTS: Three months after treatment, no difference was detected between the two groups in visual acuity changes (p>0.05), but the leakage in fluorescein angiography and macular edema in optical coherent tomography decreased (p<0.05) in the combined group. The retreatment rate in the combined group (6.0%) after 3 months was lower than that of the PDT group (53.3%). CONCLUSIONS: Photodynamic therapy with intravitreal triamcinolone acetonide to choroidal neovascularization reduced the retreatment rate at 3 months significantly. These results may have been be due to the short-term anti-inflammatory effect of steroids.
Choroid* ; Choroidal Neovascularization* ; Fluorescein Angiography ; Humans ; Macular Degeneration* ; Macular Edema ; Photochemotherapy* ; Retreatment ; Steroids ; Triamcinolone Acetonide* ; Triamcinolone* ; Visual Acuity

Background: Melanoma arising from the scalp is rare and often diagnosed at advanced stages due to difficulty in detection. Objective: This is the first study that aimed to analyze the clinicopathological findings of scalp melanoma among Korean patients at a single institution. Methods: In this single-centered retrospective study, medical records were used to review data of patients with scalp melanoma between 2006 to 2021. Chronic sun damage (CSD) was evaluated by reviewing histopathological findings of scalp melanoma. Results: Fifteen patients were identified. Mean age at diagnosis was 53.93 years. In 14 cases, the tumors were located on hair-covered areas. Mean Breslow’s thickness was 6.06 mm. Nodular melanoma was the most common histologic type (n=9), followed by superficial spreading (n=5), and lentigo maligna (n=1). Ulceration was present in five cases. In nine cases, CSD was moderate. Elective neck node dissection was performed in 13 cases, with five revealing nodal involvement. At initial staging, three patients were in stage I, six were in stage II, four were in stage III, and two were in stage IV. Recurrence occurred in seven of the 15 cases. There were five confirmed mortalities during a mean follow-up period of 35 months. Conclusion In this study, the Breslow’s thickness of scalp melanoma was relatively deep, and the most frequent type was nodular melanoma. Since detection can be affected by black hair among Koreans, it may result in delayed diagnosis and poor prognosis. Therefore, more caution is needed when examining suspicious lesions on the scalp.

Congenital microphthalmia is a rare anomaly of the fetal orbit resulting from developmental defects of the primary optic vesicle. Chromosomal anomalies, genetic defect, infection, and prenatal drug exposure are the most common causes. Congenital microphthalmia is usually associated with other abnormalities, and cases of isolated microphthalmia are rarely reported. Congenital microphthalmia can be diagnosed by prenatal ultrasound by measuring the axial diameter of the eye ball, but the accuracy depends on fetal position and associated anomalies. We report a case of an isolated unilateral microphthalmia which was not diagnosed by prenatal ultrasound, because the only abnormal prenatal ultrasound finding was a small hyperechoic mass lesion in the eye ball and the subsequent scan of the orbits was limited due to fetal prone position. The hyperechoic mass lesion in the eye ball was finally diagnosed as a persistent hyperplastic primary vitreous with hemorrhage by neonatal magnetic resonance image.
Hemorrhage* ; Microphthalmos* ; Orbit* ; Persistent Hyperplastic Primary Vitreous ; Prone Position ; Ultrasonography*

Purpose: Acute organophosphate (OP) poisoning may be monitored by measuring the acetylcholinesterase (AChE). It is important to assess severity and establish prognostic tests in the early stage of OP poisoning. The aim of this study was to look at the relationship between various clinical aspects of the OP poisoning, prognostic indicators of OP poisoning including Simplified Acute Physiology Score (SAPS) 3, and the associated changes in AChE levels. Methods: Clinical data and initial AChE levels from thirty-seven patients with OP poisoning were prospectively reviewed from 12 teaching hospitals in South Korea from August 2005 to July 2006. Clinical manifestations at the time of arrival such as miosis, respiratory abnormality, salivation, urinary incontinence, GCS score, AVPU scale, need for intubation, and mechanical ventilation requirements were recorded. SAPS 3 was calculated using clinical data and laboratory results. Results: The median level of AChE was 9.8 (1.3-53.6) U/gHb. There was no significant difference in AChE levels between the groups with and without cholinergic symptoms. The median level of AChE of the patients who required intubation and those who did not were 3.5 U/gHb and it 19.7 U/gHb respectively (Mann-Whitney test; p<0.001). The AChE levels were also significantly different (p=0.007) in patients who needed mechanical ventilation compared to those who did not with AChE levels found to be 3.1 U/gHb and it was 14.8 U/gHb, respectively. Level of consciousness assessed using the AVPU scale was correlated with AChE levels (Kruskal-Wallis test; p=0.013). GCS score were correlated with AChE levels (p=0.007, Spearman's rho = 0.454). In addition, the lower the level of initial AChE, the longer the ICU stay (p=0.029, Spearman's rho=-0.380). SAPS 3 was inversely correlated with the initial AChE (p<0.001, Spearman's rho=-0.633). Conclusion: In the acute OP poisoning, low AChE levels appear to help indicate the severity of poisoning. The initial AChE level may be a useful prognostic parameter for acute OP poisoning.
Acetylcholinesterase ; Consciousness ; Hospitals, Teaching ; Humans ; Intubation ; Miosis ; Organophosphate Poisoning ; Prognosis ; Prospective Studies ; Republic of Korea ; Respiration, Artificial ; Salivation ; Urinary Incontinence

Purpose: Dichlorvos has been in widespread use as an organophosphate (OP) insecticide compound. The purpose of this study was to access the epidemiology and clinical features of dichlorvos in Korea. Methods: This was a 38 multi-center prospective study of dichlorvos poisoning using surveys, a structural reporting system and review of hospital records from August 2005 to July 2006. A total of 54 patients with acute dichlorvos poisoning on a national basis were enrolled. We analyzed the epidemiologic characteristics and clinical manifestations of dichlorvos poisoning. In addition, the clinical features of dichlorvos poisoning were compared with others OP compounds. Results: During the study period, compounds involving pure OP poisoning were dichlorvos (22.7%), methidathion (8.4%), and phosphamidon (6.7%). In acute dichlorvos poisoning, all ingestion routes were oral. Intentional poisoning involved 74.1% of cases. The common initial complaints involved gastrointestinal (64.8%), systemic (61.1%), central or peripheral nervous system (53.7%), and respiratory symptoms (50.0%). The median arrival time to hospital after dichlorvos poisoning was 2.6 hours and mean hospitalization duration was 7.1 days. 2-PAM was administered in 35 patients in mean doses of 6.3 g/day intravenously. Atropine was administered in 30 patients with a mean dose of 62.8 mg/day (maximal 240 mg/day). Overall mortality rate for dichlorvos poisonings were 14.8% (8/54). Immediate causes for death included sudden cardiac arrest or ventricular dysrhythmias (50%), multi-organ failure (25%), acute renal failure (12.5%), and unknown causes (12.5%). Conclusion: When compared to previous reports, dichlorvos poisoning displayed relatively moderate severity. The presence of a lower GCS score, altered mental status, serious dysrhythmias, systemic shock, acute renal failure, and respiratory complications upon presentation were associated with a more serious and fatal poisoning.
Acute Kidney Injury ; Atropine ; Death, Sudden, Cardiac ; Dichlorvos ; Eating ; Hospital Records ; Hospitalization ; Humans ; Korea ; Organothiophosphorus Compounds ; Peripheral Nervous System ; Phosphamidon ; Pralidoxime Compounds ; Prospective Studies ; Shock

OBJECTIVE: The aim of this study was to identify diffrentially regulated genes after the treatment of fluoxetine in rat C6 glioma cells using cDNA microarray chip techniques and real-time RT-PCR. METHODS: Cells were incubated for 24 hours, and for 72 hours with or without 10 uM fluoxetine. Total RNAs extracted from cells were reversely transcribed to cDNA. These cDNA were used to carry out cDNA microarray chip. A part of the up-/down-regulated genes in cDNA microarray result were confirmed by real-time RT-PCR. RESULTS: 1) Genes in fluoxetinetreated cells for 72 hours (chronic treatment) were more regulated than that in fluoxetine-treated cells for 24 hours (acute treatment). 2) The expression level of Gs gene in fluoxetine-treated cells for 24 hours hardly altered, but that of Gs in fluoxetine-treated cells for 72 hours significantly increased. The expression of Gi2 also decreased in 72 hours in relation to 24 hours after the administration of fluoxetine. 3) The expression level of NCAM140 gene in fluoxetine-treated cells was higher than that in control cells. CONCLUSION: We identified genes (Gs, Gi2 and NCAM140) related to neural plasticity and intracellular signal transduction cascade from our result. This implies that fluoxetine may inhibit atrophy or death of impaired neural cells by promoting neurite outgrowth.
Animals ; Atrophy ; DNA, Complementary ; Fluoxetine* ; Glioma* ; Neurites ; Oligonucleotide Array Sequence Analysis ; Plastics ; Rats* ; RNA ; Signal Transduction

A case of successful correction of subclavian steal syndrome by percutaneous transluminal angioplasty with stenting in a male patient who found incidentally significant interarm blood pressure difference. Small difference in blood pressure (BP) between two arms is a relatively common. Significant interarm BP difference is a potential marker of peripheral vascular disease such as subclavian artery stenosis and a predictor of cardiovascular disease. The subclavian steal syndrome is a condition that results from stenosis of subclavian artery proximal to the vertebral artery. The resulting symptoms are vertebrobasilar insufficiency symptoms due to reversal of blood flow from the contralateral vertebral and basilar artery into the ipsilateral upper extremity vessels and arm ischemic symptoms. Stenotic lesion of subclavian artery has traditionally been treated surgically. However recent trends are undergoing a paradigm shift from open surgery to endovascular approach. We report a patient with subclavian steal syndrome who found incidentally 35 mmHg interarm systolic BP difference. It was successfully treated by percutaneus transradial angioplasty with stenting on stenotic lesion of the subclavian artery.
Angioplasty ; Arm ; Basilar Artery ; Blood Pressure ; Cardiovascular Diseases ; Constriction, Pathologic ; Humans ; Male ; Peripheral Vascular Diseases ; Stents ; Subclavian Artery ; Subclavian Steal Syndrome ; Upper Extremity ; Vertebral Artery ; Vertebrobasilar Insufficiency

BACKGRUOND: Several angiogenic factors such as bFGF and VEGF have been shown angiogenesis of placenta. PGE2 and PGI2 may be important in successful establishment of pregnancy. OBJECTIVE: We studied to investigate whether PGE2 and PGI2 regulate expression of VEGF and bFGF gene in the cultured human trophoblast cells. METHODS: Human trophoblasts were isolated from the placenta of early gestation (6-12 weeks). Isolated trophoblasts were cultured in the different concentration of PGE2 and PGI2 and according to the different cultured time of PGE2 and PGI2, respectively. Total RNA was extracted and RT-PCR was performed. RESULT: Expression of bFGF was increased in 10-7M and 10-6M of PGE2 and was always increased in the all different concentration of PGI2. Four isoforms (VEGF121, VEGF165, VEGF189, VEGF206) were always expressed in the all different PGE2 and PGI2 concentration compared to the control group. However, there was no significant difference in the all different PGE2 and PGI2 concentration. In both PGE2 and PGI2 treatment group, expression of bFGF was decreased at 60 min compared to the control group and was gradually increased in time-dependent pattern. At 180 min, its expression was similar to the control group. CONCLUSION: Our data suggest that the expression of bFGF gene is influenced by cultured time and concentration of PGE2 and PGI2, although the expression of VEGF gene is not influenced.
Angiogenesis Inducing Agents ; Dinoprostone* ; Epoprostenol* ; Fibroblast Growth Factor 2* ; Humans* ; Placenta ; Pregnancy ; Protein Isoforms ; RNA ; Trophoblasts* ; Vascular Endothelial Growth Factor A*