OBJECTIVE: To estimate the long-term skeletal responses to hormone replacement therapy(HRT) with or without active vitamin D(VD) by using short-term changes of bone markers in postmenopausal women (PMW). METHODS: Biochemical markers of bone formation(osteocalcin,OC) and (&) resorption(deoxypyridinoline, Dpd ) at 3 months & lumbar bone mineral density(BMD) at 1 year were measured in 64 natural PMW taking HRT(n=41) & HRT with calcitriol 0.25 microgram/day(n=23). The correlation of percent changes of bone markers after 3 months of Tx with those in lumbar BMD after 1 year was evaluated. RESULTS: 1. serum-OC & urine-Dpd showed decrease of 20.9% & 30.1% at 3months respectively & BMD increase of 3.8% after 1 year of Tx. 2. Among 58 PMW with decreased u-Dpd change, 49 (84.5%) revealed increase in BMD, while 40 (81.6%) among 49 PMW with decreased serum-OC change showed increased BMD. 3. Bone gainers showed significant decrease in changes of serum-OC(18.1% vs 9.2% p<0.05) & urine-Dpd(32.6% vs 20.4%, p<0.05) compared with those of bone losers. 4. No correlations of change of serum-OC (r=-0.174 p>0.05) & urine-Dpd (r=-0.091 p>0.05) at 3month with BMD changes at 1year were seen in total PMW, but urine-Dpd changes in HRT without active VD group revealed significantly inverse correlation(r=-0.376 p<0.05). CONCLUSION: Short-term changes of bone markers did not precisely predict the long-term changes of BMD in total PMW except urine- Dpd in HRT without active VD.
Biomarkers ; Bone Density* ; Calcitriol ; Estrogen Replacement Therapy* ; Female ; Humans ; Osteocalcin ; Vitamin D* ; Vitamins*

OBJECTIVE: To determine if birth weight greater than 4000gm can be predicted by ultrasound measurement of abdominal circumference(AC) and if shoulder dystocia in macrosomic infants can be predicted by ultrasound measurement of the difference between the abdominal diameter(AD) and biparietal diameter(BPD). METHODS: A Retrospective study was performed of births occuring from March, 1998 to August, 1999 at department of Obstetrics and Gynecology, College of Medicine, Chung-Ang University. Among neonates of birth weight greater than 4000 gm, 50 cases in that ultrasound examination was done within 2 weeks before delivery were selected for macrosomic group and 50 cases were selected for control group during the same period, among neonate of birth weight from 3100gm to 3900gm. RESULTS: 1) Normal spontaneous vaginal delivery(NSVD) was 41 cases in control group and 30 cases in macrosomic group. Among NSVD, shoulder dystocia was 1 case in 41 cases of control group and was 7 cases in 30 cases of macrosomic group. 2) On ultrasound measurement, 6 cases had AC greater than 35 cm in control group and 45 cases in macrosomic group. Among 30 cases in NSVD was done in macrosomic group, difference between AD and BPD was 2.9 0.271 cm when shoulder dystocia was existed and was 2.1 0.409 cm when shoulder dystocia was not existed. Between the two groups, statistically significant difference was detected. 3) When AC(cutoff value of 35cm) was used for screening of macrosomia, sensitivity for macrosomia was 88.2% and specificity was 89.8% and when AD-BPD difference(cutoff value of 2.6cm) was used for prediction of shoulder dystocia, sensitivity for shoulder dystocia was 66.6% and specificity was 95.2%. CONCLUSIONS: In prenatal ultrasound measurement, AC measurement at third trimester of pregnancy will be a valuable indicator for macrosomia screening. The AD-BPD difference of shoulder dystocia group was greater than uncomplicated group in macrosomia and the AD-BPD difference cutoff value of 2.6cm was significant value statistically.
Birth Weight ; Dystocia* ; Female ; Gynecology ; Humans ; Infant ; Infant, Newborn ; Mass Screening ; Obstetrics ; Parturition ; Pregnancy ; Pregnancy Trimester, Third ; Retrospective Studies ; Sensitivity and Specificity ; Shoulder* ; Ultrasonography*

Heat-treated autogenous bone graft has been utilized in the cases with large hone defects associated with tumors, chronic osteomyelitis, and trauma. Conventional autoclaved autogenous bone grafting, however, has inherent disadvantages that included decreased biomechanical strength, and loss of osteogenesity. In contrast, despite devitalizing the tumor cells, low heat-treatment can render autogenous hone grafts to retain better biomechanical strength as well as to preserve osteogenesity by avoiding destruction of hone morphogenetic protein. To investigate biomechanical strength and osteogenesity of heat-treated autogenous bone grafts, rahbits were classified into three groups: groupl, in-situ implantation of autogenous graft in the diaphyseal defect of the tibia without any heat treatment; group 2, reimplantation of graft after low heattreatment; group 3, reimplantation of graft after autoclaving. Radiological, histological, and scintigraphic examination were performed postoperativeIy at 2nd, 4th, 6th, 9th, 12th weeks. And biomechanical test was performed postoperatively at 6th, 9th, 12th weeks. Biomechanical test revealed that there were no statistical differences among three groups at 6th week and 9th week. However, at 12th week postoperatively, there were significant differences between group 2 and group 3, and between group 1 and group 3. Radiological and histological examinations showed that new bone formation started earlier in groups l and 2, compared to group 3. Also bone remodeling was advanced in group I and 2, com- pored to group 3. Scintigraphically, the increase of 99mTc-MDP uptake was delayed in group3, compared to group l and 2. Based upon above findings, it was concluded that low heat-treated autogenous bone grafting was hetter than autoclaved autogenous bone grafting in promoting bone healing with retained biomechanical strength.
Bone Remodeling ; Bone Transplantation* ; Hot Temperature* ; Osteogenesis ; Osteomyelitis ; Replantation ; Technetium Tc 99m Medronate ; Tibia ; Transplants

No abstract available.

The non-invasive assessment of bone turnover has received increasing attention over the past few years, because of the need of sensitive markers in clinical investigation of osteoporosis. The purpose of this study was to assess the availibility of the bone resorption marker and bone formation marker in menopause and to assess the correlation of bone markers and osteoporosis. This study was undergone from January 1995 to October 1995 retrospectively for total 88 postmenopause women who were not treated by hormone replacemetn therapy. The subjects comprised 28 healthy perimenioausal women; 55 healthy natural postmenopausal women; 5 women with surgical menopause. We measured serum osteocalcin as a bone formation marker and urinary deoxypyridinoline as a bone resorption marker. Bone mineral densities were also measured by Dual Energy X-ray Absortiometry(DEXA). The mean serum osteocalcin level in perimenopausal women was 6.40+/-3.12ng/ml, and mean levels in potmenopausal women with duration of menopause for 12 to 48 months, 49 to 84 months, 85 to 120 months, over 121 months were 9.26+/-5.89ng/ml, 9.01+/-2.75ng/ml, 8.36+/-4.99ng/ml, 9.88+/-3.82ng/ml, respectively. The level in surgical menopausal women was 8.76+/-5.24ng/ml. The mean serum osteocalcin levels were significantly higher in post- menopausal women with duration of menopause for 12 to 48 months(p < 0.05), for 49 to 84 months(p < 0.05), and over 121 months(p < 0.01). The urinary deoxypyridinoline level in perimenopausal women was 5.67+/-1.26 nMDpD/ mMCr, and the levels in postmenopausal women with duration of menopause for 12 to 48 months, 40 to 84 months, 85 to 120 months, over 121 months were 7.13+/-1.35 nMDpD/mMCr, 5.14+/-0.83 nMDpD/mMCr, 5.04+/-1.11 nMDpD/mMCr, 6.09+/-1.86 nMDpD/mMCr, respectively. The level in surgical menopausal women was 6.26+/-1.35 nMDpD/mMCr. The urinary deox- pyridinoline level was significantly higher in postmenopausal women with duration of menopause for 12 to 48 months(p < 0.01). There was a tendency that osteocalcin levels were increasing according to decrease in bone mineral density but osteocalcin levels were not statistically significant among 3 groups such as normal, osteopenic, and osteoporotic groups and there was also no significance in deoxypyridinoline levels among 3 groups. As a conclusion, there were no significant correlation between bone formation and resorption markers, indicated that there was imbalance in bone formation and resorption in menopause period. Also bone loss of menopause was peak in 2 to 4 years after menopause.
Bone Density ; Bone Resorption ; Female ; Humans ; Menopause ; Osteocalcin ; Osteogenesis ; Osteoporosis ; Postmenopause ; Retrospective Studies

Laparoscopy is a procedure that uses a narrow telescope to view the interior of abdominal cavity. Medical endoscopy was introduced a long time ago, but rapid progress and technological advances in laparoscopy have been witnessed during past two decades. Operative laparoscopy was developed during the 1970s, and laparoscopy was first used during the early 1980s. And now, hynecologic surgery may be performed laparoscopically in 30% to 80% of patients currently undergoing laparotomy. More recently, with an improvement in our ability to maintain intraabdominal hemostasis, complex surgical precedures are able to be performed laparoscopically. We used laparoscopic hysterectomy from 1991. At that time, we experienced many complications byt now performed successful laparoscopic hysterectomy due to sdillful surgical technique and improvement in surgical devices. So, we report surgical experiences from April 1991 to October 1996 and divided the patients into 3 groups. The 1st, 2nd and 3rd group underwent laparoscopic hysterectomy were 1991-1992, 1993-1994, 1995-1996, respectively. The number of patient underwent laparoscopic hysterectomy was 300,300,300, respectively. The results were as follows.1) The mean age of each group patient was 41.4 +/- 7.3, 43.6 +/- 6.9, 44.4 +/- 7.1, respectively. 2) The mean parity of all group was 2.2 +/- 1.3, 2.5 +/- 1.2, 2.3 +/- 1.1, respectively. 3) The most common operative indication was myoma uteri in all group. The 2nd most common indication was chronic pelvic pain in 1st, 2nd group and intractable menorrhagia in 3rd group. Other indications were carcinoma in situ, uterine prolapse, adenomyosis, endometriosis, chronic or severe infection, adnexal mass,. etc. 4) The mean hemoglobin change of all group from preoperative day to postoperative 1 day was 2.1 +/- 1.5 g/dl, 1.9 +/-1.2 g/dl, 1.5 +- 1.1 g/dl, respectively. %5) The mean operative time of all group was 158.4 +/- 43.2 minutes, 116.9 +/- 36.5 minutes, 69.8 +/- 23.2 minutes, respectively. 6) The mean uterine weight of all group was 178.3 +/- 79 gm, 186.2 +/- 89 gm, 188.5 +/- 92.5 gm, respectively. 7) The most common complication was subcutaneous emphysema in all group. Other complications were ureteral injury, vesico-/uretero-vaginal fistula, intestinal injury, bladder dysfunction and injury, hemorrhage due to vessel injury, incisional hernia, peroneal nerve palsy. etc.
Abdominal Cavity ; Adenomyosis ; Carcinoma in Situ ; Endometriosis ; Endoscopy ; Female ; Hemorrhage ; Hemostasis ; Hernia ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Intestinal Fistula ; Laparoscopy ; Laparotomy ; Menorrhagia ; Myoma ; Operative Time ; Paralysis ; Parity ; Pelvic Pain ; Peroneal Nerve ; Subcutaneous Emphysema ; Telescopes ; Ureter ; Urinary Bladder ; Uterine Prolapse ; Uterus

BACKGROUND: To assess the current level of development of emergency medicine (EM) systems in Asia. METHOD: Survey of EM professionals from 12 Asian countries during a 90-day period from August to November 1998. 12 EM professionals from 12 Asian countries completed the survey. All participants were physicians. 7 participants (58%) gave presentations at an international EM conference during the study period. Respondents completed a 103 question questionnaire about the status of EM specialty, academic, patient care, information and management systems and the factors influencing the future of EM in their countries. RESULTS: 92% of respondents stated that their countries have hospital-based emergency departments (ED). More than 80% of respondents reported that their countries have EMS systems and ED systems for trauma care and patient transfer. More than 70% stated that their countries have national EM organizations, EM research, national EMS activation phone numbers, ED systems for pediatric emergency care, emergency physician (EP) training in ACLS and ATLS and peer review. More than 60% reported official recognition of EM as an independent specialty status, ED triage systems and systems for customer service. More than 50% reported EM residency training programs, EM journals and EP ability to perform rapid sequence intubation (RSI). 50% reported EP ability to perform thrombolysis for acute MI and 33% reported EP ultrasonography. 92% felt that a lack of funding posed a moderate or great obstacle to the future development of EM in their countries. CONCLUSION: Many essential systems of EM now exist throughout Asia. In the systems of administration and emergency medical information in many countries, there are some parts to be developed further.
Asia ; Asian Continental Ancestry Group* ; Surveys and Questionnaires ; Education ; Emergencies* ; Emergency Medical Services ; Emergency Medicine* ; Emergency Service, Hospital ; Financial Management ; Humans ; Internship and Residency ; Intubation ; Patient Care ; Patient Transfer ; Peer Review ; Triage ; Ultrasonography

No abstract available.
Hodgkin Disease* ; Lymphoma, Non-Hodgkin* ; Radiotherapy*

OBJECTIVES: Our purpose was to evaluate the efficacy of pelviscopic classic intrafascial supracervical hysterectomy (CISH) & compare it with total abdominal hysterectomy (TAH). METHODS: We analyzed retrospectively, the clinical data of 1126 patients admitted from January 1993 to December 1998, at 11 university or general hospitals in Korea, for CISH group and 363 patients admitted from January 1993 to December 1998, at Chung-Ang university hospitals, Seoul, Korea, for TAH group. These patients were operated on with the indication of benign uterine disease without cervical malignant lesion. The patients with malignant cervical lesion were excluded in this study. RESULTS: (1) The average age of CISH group was 42.2 (range 24-63) years old and TAH group was 46 (range 31-54) years old. (2) The mean operative time was 150.7+/-49.9 (mean+/-SD, range 55-395) minutes in CISH group and 133.8+/-35 (mean+/-SD, range 65-350) minutes in TAH group. The mean estimated blood loss was 206+/-183.6 (mean+/-SD, range 20-2000) ml in CISH group and 596+/-452.3 (mean+/-SD, range 100-6500) ml in TAH group. The mean hemoglobin change was 1.52+/-0.98 (mean+/-SD, range 0-7) g/dL in CISH group and 3.03+/-1.47 (mean+/-SD, range 0.2-8.4) g/dL in TAH group. The mean time in hospital was 6.3+/-1.43 (mean+/-SD, range 3-18) days in CISH group and 11.0+/-4.08 (mean+/-SD, range 7-37) days in TAH group. (3) Overall complications occured at 5.3% in CISH group and 9.1% in TAH group. (4) Pathologic findings of cervix were benign in 1121 patients (99.6%) and severe dysplasia or carcinoma in situ in 5 patients (0.4%) among CISH groups. In TAH groups, 351 patients (96.7%) had benign cervical lesion and 12 patients (3.3%) had more than oderate dysplasia or carcinoma in situ. In both groups, no invasive cervical cancer was found and the transformation zone of the cervix was included within the resection margin of the cervix in all cases. CONCLUSION: The pelviscopic CISH group has less operative blood loss, less postoperative hemoglobin change, shorter hospital stay and less operative complication than TAH group. Pelviscopic CISH is truly a minimally invasive and organ-preserving surgery and coring out the cervix with the calibrated uterine resection tool may prevent the development of cervical cancer. Therefore, we believe that pelviscopic CISH is preferred in cases of benign uterine diseases, because it lowers operative complications and it may have several benefits compared with total hysterectomy, especially, in women with no pathologic lesion of the cervix.
Carcinoma in Situ ; Cervix Uteri ; Female ; Hospitals, General ; Hospitals, University ; Humans ; Hysterectomy* ; Korea ; Length of Stay ; Operative Time ; Retrospective Studies ; Seoul ; Uterine Cervical Neoplasms ; Uterine Diseases

When the circumstance of a death seems to be related with electric shock, most of the forensic pathologists tend to diagnose the cause of death as electrocution if they see the electric mark(s) with the notincompatible histology, and find no other definite causes of death at autopsy. But admittedly forensic pathologists know that the so-called electric mark(s) and its histology is not pathognomonic to diagnose electrocution, so the diagnosis should be confirmed by the appropriate investigation of the death scene and the electric devices. We present a case of a man who had a likely current mark that could be diagnosed as natural by ruling out the possibility of electrocution with the examination of the electric lamp which had been under the dead body at the scene. This case gives us the importance of appropriate probe about scene evidences supplied by forensic science in diagnosing and ruling out the electrocution.
Autopsy ; Cause of Death ; Diagnosis ; Forensic Sciences ; Shock