OBJECTIVES: The present study was performed to investigate whether estrogen and progesterone induce the change of vascular tone in endothelium-denuded human uterine artery and vascular reactivity may be mediated by intracelluar calcium modulation through receptor- and voltage-dependent calcium channels. METHODS: The uterine arteries were obtained at the time of hysterectomy from 28 women followed by denudation of endothelium. After confirmation of functional integrity of endothelium-denuded uterine artery, vascular reactivity was measured by using isometric force transducer and recorded by physiograph. Contraction was induced by 10-6 M norepinephrine and 35mM high concentrated potassium chloride solution which activated receptor-dependent calcium channel and voltage-dependent calcium channel, respectively.Thereafter estradiol of 4 different concentrations from 3x10-11M to 3x10-8M was administered. Progesterone was also administered to endothelium-denuded uterine artery which was contracted by 10-6M norepinephrine and high potassium chloride solution. To evaluate the effect of additional progesterone on vascular smooth muscle relaxation effect of estrogen,4 different progesterones in concentrations from 3x10-8M to 3x10-5M were given to vascular smooth muscle which was initially pretreated with norepinephrine followed by relaxation of estradiol. RESULTS: Estradiols from 3x10-11M to 3x10-8M showed in significant dose-dependent vascular relaxation. Progesterones result in significant decrease in vascular contraction in concentration dependent manner. Additional progesterone on estrogenic effects also results in significant decrease in vascular contraction. CONCLUSION: Estradiol may have endothelium independent vasorelaxation effect in human uterine artery. These vasorelaxant effects may be mediated through antagonistic action for receptor-and voltage-dependent calcium channels in vascular smooth muscle. Progesterone also bring about vasorelaxation by same action in endothelium-denuded vascular smooth muscle. On estrogen induced vascular relaxation, progesterone results in additional vasorelaxation.
Calcium ; Calcium Channels ; Endothelium ; Estradiol ; Estrogens* ; Female ; Humans* ; Hysterectomy ; Muscle, Smooth, Vascular ; Norepinephrine ; Potassium Chloride ; Progesterone* ; Relaxation ; Transducers ; Uterine Artery* ; Vasodilation

Eosinophilia is a common finding in premature babies during the neonatal period. Serial eosinophil counts were determined in 94 hospitalized, appropriately grown premature in fants whose gestational ages ranged form 28 to 36 weeks. The incidence, severity and etiologic factors of eosinophilia were retrospectively studied in premature infants, who were divided into three groups according to their gestational age. The results were as follows: 1) Absolute eosinophilia (>700/mm3)was documented in 46.8%(44/94). 2) The duration of TRN and antibiotics was cignificantly higher in infants with eosinophilia than withour eosinophilia (p<0.05). The gestational age of the infants with eosinophilia was significantly shorter than that of the infants without eosinophilia (p<0.05). The infants with eosinophilia started with bottle feeding significantly earlier than the infants without eosinophilia (p<0.05). 3) The infants younger than 30 weeks of gestational age have greater incidence of eosinophilia (75%) than the infant with the gestational age between 34 and 36 weeks (34.3%)(p<0.05). 4) The incidence of mild eosinophilia was higher in the group with gewtational age 30 weeks or below(37.5%)than in the group with gestational age between 34 and 36 weeks(17.1%)(p<0.05).Also, the incidence of severe eosinophilia was significantly higher in the group with gestational age 30 weeks or below(37.5%)than in the group with gestational age between 34 and 36 weeks(17.1%)(p<0.05). 5) Eosinophilia was more prevalent in the infants who received parenteral nutrition composed of glucose, amino acid and lipid(77.8%) than the infants who received only glucose(34.1%)(p<0.05). 6) Gestational age and birth weight were significantly lower in infants with severe eosinopilia than those of mild or moderate eosinophilia. The duration of TRN and antibiotics were significantly longer in infants with severe eosinophilia than those of mild or moderate eosinophilia (p<0.05). 7) The peak eosinophil count was observed significantly later in severe eosinophilic group (26.5 13.1 days)than in non-eosinophilic group(14.4 9.0 days)(p<0.05). The above results suggest that eosinophilia in premature infants may be the effecto of immature immunologic responses to the intravenous administration of extemal antigens like amino acid, lipid and antibiotics.
Administration, Intravenous ; Anti-Bacterial Agents ; Birth Weight ; Bottle Feeding ; Eosinophilia* ; Eosinophils ; Gestational Age ; Glucose ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature* ; Parenteral Nutrition ; Retrospective Studies

Rarely, rupture of a cerebral aneurysm causes an acute subdural hematoma(SDH) in addition to subarachnoid hemorrhage(SAH). We report clinical and radiological characteristics of five cases, as well as potential pitfalls in the diagnosis and the treatment of this life-threatening condition. The patients ranged in age from 42 to 76 years. The Hunt-Hess grade on admission was gradeIII in one patient, gradeIV in two, and grade V in two. All five patients underwent one-stage operation (both SDH evacuation and clipping of the aneurysm). The outcome was good recovery in two patients, persistent vegetative state in two, and death in one. Patients with a good outcome had a better Hunt-Hess grade on admission, with less amount of SDH.
Aneurysm* ; Diagnosis* ; Hematoma, Subdural, Acute* ; Humans ; Intracranial Aneurysm* ; Persistent Vegetative State ; Rupture

Glassy cell carcinoma is a histologic subtype of cervical cancer with distinct pathologic features and it has an aggressive biologic course. It was first described by Glucksmann and Cherry in 1956 as a poorly differentiated adenoquamous carcinoma and commented on its poor prognosis, unresponsiveness to traditional modes of therapy, and often associated with pregnancy. The characteristic histologic features are defined as follows: 1) cells with a moderate amount of cytoplasm resembling ground glass, 2) a fairly distinct cell membrane that stains with eosin or PAS, 3) large nuclei with prominent nucleoli. We present two cases of glassy cell carcinoma of the cervix successfullyl treated by neoadjuvant chemotherapy and radical hyterectorny, with a brief review of literatures.
Cell Membrane ; Cervix Uteri* ; Coloring Agents ; Cytoplasm ; Drug Therapy* ; Eosine Yellowish-(YS) ; Female ; Glass ; Hysterectomy* ; Pregnancy ; Prognosis ; Prunus ; Uterine Cervical Neoplasms

PURPOSE: We performed a retrospective study to compare effects of Surfacten(R) with HFV administration and meticulous conventional ventilatory support for neonatal RDS by analyzing clinical effects, complication and mortality between two groups. METHODS: Of 107 cases admitted to the nursery in Taegu Fatima hospital from February 1990 to June 1996, 52 neonates (admitted from January 1993 till June 1996) with RDS on high frequency ventilation after Surfacten(R) replacement were included as study group while 57 neonates(admitted from January 1990 till December 1996) with RDS on only conventional ventilation as control group. Serial change of FiO2, MAP, PaO2 and PaCO2 within 48hours after Surfacten(R) replacement, chest X-ray, clinical course, complication and mortality rate were propectively analyzed between two groups. RESULT: 1) After 24 hours Surfacten(R) replacement FiO2 had gradually decreased to 40% in the treated group, while in the control group, decreased to 50% within 48 hours. 2) MAP was maintained at 5.2cmH2O in the treated group, while in the control group, at 6.9cmH2O. 3) Serial change of PaO2 during weaning period after Surfacten(R) replacement between two groups were not significantly different(in the treated group : 74.5mmHg, in the conrol group : 76.1mmHg). 4) Serial change of PaCO2 during weaning period after Surfacten(R) replacement in the treated group were maintained significantly below the level of PaCO2 in the control group(in the treated group : 42.3mmHg, in the control group : 46.6mmHg). 5) In the treated group, complications were a series of PDA, IVH and pneumothorax, while in the control group, of PDA, Sepsis and IVH, and there were no differences between two groups with respect to mortality. CONCLUSION: It was concluded that the combined treatment with Surfacten(R) replacement and high frequency ventilation for neonatal RDS improved short term clinical effects than in the control group, but there were no significant difference in terms of complications and mortality rate between two groups
Daegu ; High-Frequency Ventilation* ; Humans ; Infant, Newborn ; Mortality ; Nurseries ; Pneumothorax ; Respiratory Distress Syndrome, Newborn* ; Retrospective Studies ; Sepsis ; Thorax ; Ventilation* ; Weaning

OBJECTIVE: Our purpose was to evaluate and compare the Le Fort colpocleisis and conventional total vaginal hysterectomy in the uterine prolapse patients in the medically compromised or elderly patients. METHODS: This study was to analyze the data from 16 patients with uterine prolapse undergone Le Fort colpocleisis at the department of obstetrics and gynecology, Chung-ang university hospital from January 1991 to December 2000, and 36 patients with uterine prolapse undergone total vaginal hysterectomy from January 1999 to December 2000. We compared the age of patients, operation time, type of anesthesia, estimated blood loss, changes in hemoglobin, duration of hospitalization, occurrence of febrile morbidity, and medical complications based on the medical records. RESULTS: The mean operation time of 16 patients undergone Le Fort colpocleisis with uterine prolapse was 51+/-18 minutes, the estimated blood loss was 175+/-134 cc, hemoglobin change was 1.72+/-1.14 mg/dl, the mean days of hospitalization was 7.2+/-2.8 days, and the febrile illness occurred in 2 patients. In this group, general anesthesia was used in 10 patients (75%), local anesthesia in 4 patients (25%), and spinal and epidural anesthesia in 1 case respectively. The mean operation time of 11 patients undergone total vaginal hysterectomy with uterine prolapse was 86+/-29 minutes, the estimated blood loss was 366+/-154 cc, hemoglobin change was 2.36+/-1.22 mg/dl, the mean days of hospitalization was 7.8+/-1.6 days, and the febrile illness occurred in 3 patients. General anesthesia was done in total vaginal hysterectomy group and vulva hematoma was developed in 1 case postoperatively. There are significant difference (p<0.01) between the Le Fort colpocleisis and total vaginal hysterectomy in operational time, estimated blood loss, and type of anesthesia, but no significant difference in days of hospitalization, febrile morbidity. CONCLUSION: The assessment of Le Fort colpoclesis in uterine prolapse offers signinficant benefits in elderly or compromised patients and the method is safe for operation.
Aged ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Local ; Female ; Gynecology ; Hematoma ; Hospitalization ; Humans ; Hysterectomy, Vaginal* ; Medical Records ; Obstetrics ; Prolapse* ; Uterine Prolapse ; Uterus* ; Vulva

The spontaneous rupture of the ureter is a rare condition. Two cases are reported with a spontaneous rupture caused by ureteral calculi. The diagnosis was suspected by delayed post-CT KUB and confirmed by ureteroscopy. On the basis of the clinical evolution the authors discuss the diagnosis and pathogenesis of the observed ureteral rupture. Rupture of ureter must be considered as differential diagnosis of acute flank pain, especially when there is change of pain character or severity.
Diagnosis ; Diagnosis, Differential ; Flank Pain ; Rupture* ; Rupture, Spontaneous ; Ureter* ; Ureteral Calculi ; Ureteroscopy ; Urinary Calculi

OBJECTIVE: GnRH agonist used in the medical treatment of endometriosis, induces accelerated bone loss, which leads to osteoporosis. This study was performed to investigate the possibilities of prevention of bone loss by progestogen add-back therapy in GnRH agonist treatment. METHODS: Thirty patients, who were diagnosed as endometriosis from Apr 1996 to Jun 2001, were divided into GnRH agonist treatment group and progestogen add-back therapy group. The changes of lumbar spine and femur BMD were checked from the onset of treatment to 6 months later, and the changes of bone markers (serum osteocalcin, urine deoxypyridinoline) from the onset of treatment, to 3 months later, to 6 months later, respectively. RESULTS: In GnRH agonist group, the BMDs were decreased by 5.56%, 3.85%, 6.10% and 5.19% in lumbar spine, femur neck, ward triangle, and femur trochanter respectively. All of these changes were significant compared with basal BMDs at each sites. Basal serum osteocalcin level of 5.34+/-2.37 ng/ml was significantly and continuously increased to 8.87+/-3.06 ng/ml and 11.87+/-3.15 ng/ml at 3rd and 6th month of treatment respectively. Urinary deoxypyridinoline level was increased from basal 7.07+/-2.48 ng/ml to 9.56+/-3.13 ng/ml at 3rd month and 9.87+/-2.18 ng/ml respectively. The significant change was noted from 3rd month of treatment with no change between 3rd and 6th month of treatment. In MPA add-back therapy group, the BMDs after treatment were significantly decreased by 5.39% and 4.30% only in lumbar spine and ward triangle of femur compared with pretreatment basal BMD levels. But there was no significant change at femur neck and trochanter. Serum osteocalcin level was significantly increased from basal 8.02+/-3.25 ng/ml to 11.05+/-4.02 ng/ml at 6th month of treatment, while there was no change at 3rd month of treatment. Meanwhile urinary deoxypyridinoline level was not changed during treatment. CONCLUSION: Although the decrease of BMD and the increase of bone turnover rate are induced during GnRH agonist therapy for endometriosis, progestogen add-back therapy could prevent these changes to some degree.
Endometriosis* ; Female ; Femur ; Femur Neck ; Gonadotropin-Releasing Hormone* ; Humans ; Osteocalcin ; Osteoporosis ; Spine

PURPOSE: Lymph-node metastasis is one of the most important prognostic factors in gastric cancer. However, it can be missed with conventional histologic examination with hematoxylin-eosin staining. Several methods have been introduced to improve the detection rate of micrometastasis. Among them, immunohistochemical staining with the anti-cytokeratin antibody is known to be an easy and useful method. METHODS: We used immunohistochemical staining with the anti-cytokeratin antibody to evaluate the incidence of micrometastasis in 48 patients with advanced gastric cancer who had been diagnosed as lymph-node negative by H&E, and its relationship to various clinicopathologic factors. RESULTS: Lymph-node micrometastasis (anti-cytokeratin antibody positive) was found in 15 (31.3%) of the 48 patients and in 33 (1.75%) of 1884 lymph nodes. Among the clinicopathologic variables, only lymphatic invasion was significantly associated with micrometastasis status. The gender, the age, the tumor size, the location of the tumor, the histologic type, and the depth of invasion were not significantly associated with micrometastasis status. During the average follow-up period of 21 months, 6 patients suffered a recurrence, and 2 of these patients died of the cancer recurrence. The recurrence and mortality rates were not significantly associated with micrometastasis status. CONCLUSION: Micrometastasis in stomach cancer was frequent when the primary tumor had invaded the lymphatic vessels.
Follow-Up Studies ; Humans ; Incidence ; Keratins ; Lymph Nodes* ; Lymphatic Vessels ; Mortality ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Recurrence ; Stomach Neoplasms*

PURPOSE: An increased incidence of gallstones has been widely reported in patients who had undergone a gastrectomy. But, there has been little information about the pathophysiologic mechanism for the occurrence of gallstones after gastric surgery. Many investigators have considered the cause to be decreased gallbladder motility due to vagal denervation. We observed higher increase in the incidence of gallbladder stones in patients who underwent a Billroth II gastrojejunostomy than in those who underwent a Billroth I gastrojejunostomy after radical subtotal gastrectomy. METHODS: We prospectively studied the change in the motility of the gallbladder after a gastrectomy. The gallbladder ejection fraction (EF) was compared pre- and postoperatively by using gallbladder scintigraphy with 2,6-diisopropyl-iminodiacetic acid (DISIDA). RESULTS: Twenty patients underwent a Billroth(B) I anastomosis and twelve patients underwent a B-II anastmosis after the gastrectomy. The means of the EF of the B-I group were 75.9%, 46.4%, 68.1% at the preoperative period, at 1 month and 6 months after the gastrectomy respectively. Those of B-II group were 78.2%, 45.3%, 56.3%, respectively. There was no statistically significant difference of EF between the two groups at postoperative 1 month, but the difference at postoperative 6months was statistically significant. The differences of EF between preoperative period and postoperative 1 month, 6 months were significant in the B-I group andthe B-II group. CONCLUSION: At 6 months postoperative period, there was more recovered gallbladder motility after a gastrectomy with B-I anastomosis than with B-II anastomosis.
Denervation ; Gallbladder* ; Gallstones ; Gastrectomy* ; Gastric Bypass ; Gastroenterostomy ; Humans ; Incidence ; Postoperative Period ; Preoperative Period ; Prospective Studies ; Radionuclide Imaging ; Research Personnel