OBJECTIVE: The purpose of this study is to evaluate the clinical usefulness of serum level of CA125 and CA19-9 to assess the severity of endometriosis. METHODS: The study was conducted on 80 patients with histologically diagnosed endometriosis and 20 patients in control group. Preoperative serum CA125 and CA19-9 levels were measured by immunoradiometric assay and the severity of disease was staged according to the revised American Fertility Society (1985) classification system. RESULTS: Both serum level of CA125 and CA19-9 in endometriosis patient (81.7+/-120.44 U/mL, 47.1+/-80.74 U/mL, Mean+/-SD) were higher than control group (10.8+/-6.48 U/mL, 11.7+/-8.82 U/mL, Mean+/-SD)(p=0.001, p=0.054). The serum CA125 level increased significantly according to stages (p=0.051), but serum CA19-9 level showed an increasing trend (p>0.05). With the cutoff value of CA125 with 35 U/mL and CA19-9 with 37 U/mL, overall positive rate for CA125, CA19-9, and CA125 combined with CA19-9 was 45.1%, 33.8%, and 52.5%. There was no difference between the positive rate with CA125 combined with CA19-9 (52.5%) and that with CA125 alone (45.1%)(p>0.05). With the cutoff value of CA125 with 15 U/mL and CA19-9 with 9 U/mL, overall positive rate for CA125, CA19-9, and CA125 combined with CA19-9 was 82.5%, 76.3%, and 92.5%, the positive rate with CA125 combined with CA19-9 (92.5%) was higher than that with CA125 alone (82.5%)(p=0.056). CONCLUSION: Because the positive rate with combined serum CA125 and CA19-9 level is not higher than that with serum CA125 alone for the severity assessment of endometriosis, it is recommended to use serum CA125 level alone.
Classification ; Endometriosis* ; Female ; Fertility ; Humans ; Immunoradiometric Assay

Synchronous multiple primary neoplasm is defined as more than 2 cancers are independently developed in one individual and are diagnosed simultaneously or within 6 months interval. The most common form of synchronous multiple primary neoplasm of female reproductive tract is that of uterine endometrium and ovary. Synchronous multiple primary neoplasm involving uterine cervix and endometrium is rare. Recently we experienced a case of synchronous multiple primary malignant neoplasm of the uterine cervix and endometrium. We report this case with revewing of other literature.
Cervix Uteri* ; Endometrial Neoplasms ; Endometrium* ; Female ; Humans ; Neoplasms, Multiple Primary ; Ovary

The acronym CHARGE (Coloboma, Heart defects, Atresia choanae, Retarded growth and development, Genital hypoplasia, and Ear abnormalities) was coined by Pagon et al. in 1981. The prevalence of CHARGE syndrome was estimated to be approximately 1/10,000 - 1/15,000. The cause of the CHARGE syndrome remains unknown but several observations support the role of genetic factors and a significantly higher paternal age at conception and several chromosomal abnormalities. The clinical spectrum of this multiple congenital anomaly and mental retardation is broad and variable, therefore the treatment of the CHARGE syndrome was not definitive and conservative. We hereby report, with reviewing other literature, a case of CHARGE syndrome diagnosed after delivery.
CHARGE Syndrome* ; Chromosome Aberrations ; Ear ; Fertilization ; Growth and Development ; Heart ; Intellectual Disability ; Nasopharynx ; Numismatics ; Paternal Age ; Prevalence

Strong corrosive acid is accidentally ingested by children or by psychiatric patients for the purpose of suicidal attempt. Late complications include chemical burn to pharyunx, perforation and stricture of upper gastrointestinal tract, respiratory insufficiencyand renal failure caused by hemoglobinuria following hemolysis. Acetic acid is difficult to ingestion large volume in a time because it is a strong irritant, provocating painful pharynx, and its autopsy case is rare. We report an autopsy case of acetic acid intoxication with acute disseminated intravascular coagulation (DIC) in several hours. We present pathogenesis of acetic acid intoxication and the associated forensic problems. A comatous 39-year-old female was admitted to emergency room 6 hours after she swallowed 90 gm of acetic acid. She was treated with gastric lavage but she was expired 9 hours after swallowing acetic acid. She was consulted to Department of Forensic Medicine of Kyungpook National University School of Medicine. She was grossly icteric and livor mortis was generally dark red. External wounds were 10 hemorrhagic lesions with 5 x 3.7cm and 3 x 2.8cm on the left arm and hand dorsum and facial abrasions. Internal gross examination revealed several purpural lesions in the gastric serosal surface and greater omentum. Microscopically, the stomach showed diffuse mucosal coagulation necrosis and intravascular hyalinized or fibrinoid thrombi in submucosal blood vessels. Liver showed necrosis of periportal area (zone I) and intracellular cholestasis around the central vein. Sections from renal tissue frequently show hemoglobin casts in the tubules and RBCs in the Bowman's capsules. Acetic acid of a remnant bottle, sampled blood and bloody necrotic tissues in the stomach were toxicologically examined in National Science Laboratory. The purity of ingested acetic acid is 98%, the concentration of acetic acid ion in blood is 734ppm and the content in gastric juice is 0.09%. In patients after acetic acid ingestion, DIC is most probably caused by procoagulants, produced by extensive acid-induced necrosis of the upper gastrointestinal tract. In this case, several purpural lesions were revealed on the arm, around facial abrasion and intravenous injection sites of the wrists. These are important to differentiate with contusion because she was battered before acetic acid ingestion. Purpurae in DIC are poorly demarcated, dark purple elevations with spreading margin but subcutaneous hemorrhage in contusion is grayish black or dark red with well demarcation (Table 2). But careful examination should be considered because traumatic hemorrhage is also exaggerated and mixed in DIC. (The Korean Journal of Legal Medicine)
Acetic Acid* ; Adult ; Arm ; Autopsy ; Blood Vessels ; Burns, Chemical ; Capsules ; Child ; Cholestasis ; Constriction, Pathologic ; Contusions ; Dacarbazine ; Deglutition ; Disseminated Intravascular Coagulation ; Eating ; Emergency Service, Hospital ; Female ; Forensic Medicine ; Gastric Juice ; Gastric Lavage ; Gyeongsangbuk-do ; Hand ; Hemoglobinuria ; Hemolysis ; Hemorrhage ; Humans ; Hyalin ; Injections, Intravenous ; Liver ; Necrosis ; Omentum ; Pharynx ; Postmortem Changes ; Purpura ; Renal Insufficiency ; Stomach ; Upper Gastrointestinal Tract ; Veins ; Wounds and Injuries ; Wrist

Aged ; Contrast Media ; adverse effects ; Electrocardiography ; Heart Arrest ; therapy ; Humans ; Male ; Myocardial Infarction ; therapy

One lung ventilation(OLV) during thoracotomy is frequently used for the purpose of facilitating surgical exposure by collapsing the lung in the operative hemithorax. But severe hypoxemia may occur during OLV inspite of higher inspired oxygen concentration. This study was performed to evaluate the effect of positive end-expiratory pressure(PEEP) level to the ventilated lung on the arterial oxygenation in the thoracotomy patients(n-10) who showed PaO2 below 100 mmHg during one lung ventilation (OLV) at the F1O2 = 1.0 . After measuring control value of arterial blood gas(ABGA), peak inspiratory pressure and hemodynamic parameter (mean arterial pressure and heart rate), PEEP device 5 cmH2O and then 10 cmH2O was applied to the expiratory breathing circuit for 10 min at each pressure setting. Data of above parameter was collected after 10 min each PEEP application. There were no siginificant changes in the mean arterial pressure and heart rate between control, PEEP 5 cmH2O and PEEP 10 cmH2O. Although PaO2 did not significantly increased with PEEP 5 cmH2O compared to control value, the application of PEEP 5cmH2O increased PaO2 in 6 patients and decreased in 4 patients. In the PEEP 10 cmH application, PaO2 was significantly improved compared to control and PEEP 5 cmH2O values (78.4+/-11.6 mmHg, 84.6+/-19.2 mmHg vs. 95.3+/-18.5 mmHg). It is concluded that it may be necessary to adjust PEEP level to the ventilated lung to improve oxygenation when hypoxemia occurs during OLV.
Anesthesia* ; Anoxia ; Arterial Pressure ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Lung* ; One-Lung Ventilation ; Oxygen* ; Positive-Pressure Respiration* ; Respiration ; Thoracotomy

Acrodysostosis is an extremely rare disorder characterized by short fingers and toes with peripheral dysostosis, nasal hypoplasia, and mental retardation. We report a 16-year-old Korean boy with acrodysostosis who had characteristic clinical features and cervical spine stenosis manifested by neurologic symptoms. On presentation, he complained of difficulty in raising his arms, and suffered from intermittent pain and weakness in both upper extremities. He had short stature and dysmorphic facial features, including a broad, depressed nasal bridge, small, upturned nose, bilateral epicanthal folds, and mild hypertelorism. Moderate mental retardation and sensorineural hearing loss in both ears were also present. Radiological findings included broad, short metacarpals and phalanges with cone-shaped epiphyses, bilateral Madelung deformities, hypertrophied first metatarsals, and thickening of the calvarium. Magnetic resonance imaging findings included stenosis of the cervical spine, platybasia with compression into the cervicomedullary junction, and downward displacement of the cerebellar tonsils. Here, we report a case of acrodysostosis with symptoms and signs of cervical spinal stenosis first in Korea. If it is diagnosed in the early stages, possible life-threatening complications, including spinal canal stenosis, can be managed properly and permanent neurologic sequelae might be avoided. Therefore, it is important to consider acrodysostosis in the differential diagnosis of peripheral dysostosis.
Adolescent ; Arm ; Congenital Abnormalities ; Constriction, Pathologic ; Diagnosis, Differential ; Displacement (Psychology) ; Dysostoses ; Ear ; Epiphyses ; Fingers ; Growth Disorders ; Hearing Loss, Sensorineural ; Humans ; Hypertelorism ; Intellectual Disability ; Korea ; Magnetic Resonance Imaging ; Metacarpal Bones ; Metatarsal Bones ; Neurologic Manifestations ; Nose ; Osteochondrodysplasias ; Palatine Tonsil ; Platybasia ; Skull ; Spinal Canal ; Spinal Stenosis ; Spine ; Toes ; Upper Extremity

Blunt chest trauma may cause a variety of cardiac injuries, such as cardiac contusion, congestive heart failure due to myocardial injury or disruption of intracardiac structures, and more severely, instantaneous death. Traumatic rupture of the interventricular septum secondary to blunt chest trauma is extremely rare. Rupture of the interventricular septum may occur almost immediately after injury or many days later. The most common site of rupture is in the muscular portion of the septum near the apex. The exact mechanism of ventricular septal rupture in blunt trauma is unknown but it is thought to occur by external compression of the heart between the sternum and the vertebrae or as a result of extreme changes in intrathoracic pressure during sudden deceleration. We report an autopsy case of intraventricular septum rupture due to blunt chest trauma. A comatous 28-year-old male was admitted to emergency room after blunt chest trauma by unidentified object. He was treated with supportive care but expired two days later. The autopsy findings were as follows. The dead boy was slightly slender. External wound and patterned bruise were not present. In submentopubic incision, both pleural fluid (right 700ml, left 450ml) and ascites (400ml) were noted. The posterior wall of left ventricle showed hemorrhage measuring 1cm in diameter. On opening the heart, there was interventricular septum rupture measuring 3.5cm in length. Other cardiac structures were unremarkable. On light microscopic examination, endothelial cell was not seen in ruptured portion and both lung showed severe congestion and edema.
Adult ; Ascites ; Autopsy ; Contusions ; Deceleration ; Edema ; Emergency Service, Hospital ; Endothelial Cells ; Estrogens, Conjugated (USP) ; Heart ; Heart Failure ; Heart Ventricles ; Hemorrhage ; Humans ; Lung ; Male ; Rupture* ; Spine ; Sternum ; Thorax* ; Ventricular Septal Rupture ; Wounds and Injuries

Blunt chest trauma may cause a variety of cardiac injuries, such as cardiac contusion, congestive heart failure due to myocardial injury or disruption of intracardiac structures, and more severely, instantaneous death. Traumatic rupture of the interventricular septum secondary to blunt chest trauma is extremely rare. Rupture of the interventricular septum may occur almost immediately after injury or many days later. The most common site of rupture is in the muscular portion of the septum near the apex. The exact mechanism of ventricular septal rupture in blunt trauma is unknown but it is thought to occur by external compression of the heart between the sternum and the vertebrae or as a result of extreme changes in intrathoracic pressure during sudden deceleration. We report an autopsy case of intraventricular septum rupture due to blunt chest trauma. A comatous 28-year-old male was admitted to emergency room after blunt chest trauma by unidentified object. He was treated with supportive care but expired two days later. The autopsy findings were as follows. The dead boy was slightly slender. External wound and patterned bruise were not present. In submentopubic incision, both pleural fluid (right 700ml, left 450ml) and ascites (400ml) were noted. The posterior wall of left ventricle showed hemorrhage measuring 1cm in diameter. On opening the heart, there was interventricular septum rupture measuring 3.5cm in length. Other cardiac structures were unremarkable. On light microscopic examination, endothelial cell was not seen in ruptured portion and both lung showed severe congestion and edema.
Adult ; Ascites ; Autopsy ; Contusions ; Deceleration ; Edema ; Emergency Service, Hospital ; Endothelial Cells ; Estrogens, Conjugated (USP) ; Heart ; Heart Failure ; Heart Ventricles ; Hemorrhage ; Humans ; Lung ; Male ; Rupture* ; Spine ; Sternum ; Thorax* ; Ventricular Septal Rupture ; Wounds and Injuries

Multiple epiphyseal dysplasia (MED) is a clinically and genetically heterogeneous chondroplasia, characterized by delayed development of the ossification centers and, deformities of the extremities that involve only the epiphysis and result in mild short stature. Mutations in the cartilage oligomeric matrix protein (COMP) gene are most commonly found, and most of the mutations are located in the calmodulin-like repeats and the C-terminal domain. We report a Korean kindred of?12 family members with MED in four generations who were found to have a novel mutation in the COMP gene. A pedigree showed early onset osteoarthritis requiring arthroplasty that was an autosomal dominant inherited trait. Radiological examinations demonstrated the presence of osteochondral defects in the medial femoral condyles, and the knee and hip joints showed variable degrees of precocious degenerative changes. Mutation analysis of the COMP gene in the proband and five other affected family members identified a novel missense mutation, c.1280G>C (p.Gly427Ala) in exon 12, which was not found in three unaffected family members. Direct sequencing of the COMP gene may yield pathogenic mutations in dominantly inherited MED cases, and may provide opportunities of carrier detection among high-risk family members, leading to genetic counseling for early diagnosis and intervention before the onset of complications.
Achondroplasia ; Arthroplasty ; Cartilage ; Congenital Abnormalities ; Early Diagnosis ; Epiphyses ; Exons ; Extracellular Matrix Proteins ; Extremities ; Family Characteristics ; Genetic Counseling ; Glycoproteins ; Hip Joint ; Humans ; Knee ; Mutation, Missense ; Osteoarthritis ; Osteochondrodysplasias ; Pedigree