OBJECTIVES: Dysfunctional uterine bleeding(DUB) is defined as abnormal bleeding from the uterine endometrium unrelated to anatomic lesions of the uterus, and its incidence is 10-15% among gynecologic diseases. We conducted this study for understanding correlation between clinical aspecets and pathological findings of DUB. Methods: We conducted a retrospective review of 599 women with DUB who underwent endometrial biopsy with special regard to the relation between pathologic findings and presenting symtoms or complaints from Jan. 1988 to Dec. 1997. RESULTS: Age distribution of DUB was mainly 5th decade, mean age was 44.1years, among various bleeding patterns, intermenstrual bleeding was the most common pattern(31.6%) and the next was menorrhagia(25.0%). Histologic findings of endometrium were proliferative phase, 327 cases(54.6%), hyperplasia, 139 cases(23.2%), secretory phase, 74 cases(12.4%) in order of frequency, and there was no difference in distribution of histologic findings among various bleeding patterns. CONCLUSION: Compared to other previoius studies, our study showed more incidence of endometrial hyperplasia, especially at age group of 40 or more. So patients aged more than this age with abnormal uterine bleeding must undergo emdometrial biopsy for pathologic diagnosis. Patients who are diagnosed endometrial hyperplasia must be carefully followed up because there are possibilities of progression to endometrial carcinoma.
Age Distribution ; Biopsy ; Diagnosis ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Endometrium ; Female ; Genital Diseases, Female ; Hemorrhage ; Humans ; Hyperplasia ; Incidence ; Metrorrhagia* ; Retrospective Studies ; Uterine Hemorrhage ; Uterus

Aneurysm of the internal carotid artery is a rare disease and is known to be associated with congenital arterial anomalies such as neurofibromatosis type I (NF-I). NF-I is an autosomal dominant neurocutaneous disorder characterized by a variety of manifestations that involve the central and peripheral nervous systems, skin, vascular system, and skeleton. In particular, the involvement of vascular abnormalities in NF-I is well known. Any vessel may be affected by this condition, although the renal artery is most frequently involved. The vascular abnormality can be occlusive or an aneurysmal degenerative change. Therefore, symptomatic presentations might assume an indolent pathophysiologic course such as hypertension, or manifest as a catastrophic event such as arterial rupture that could result in sudden death. We report a rare autopsy case of an aneurysmal rupture of the internal carotid artery in a woman with suspected NF-I, who collapsed in her home.
Aneurysm ; Autopsy ; Carotid Artery, Internal ; Death, Sudden ; Female ; Glycosaminoglycans ; Humans ; Hypertension ; Neurocutaneous Syndromes ; Neurofibromatoses ; Neurofibromatosis 1 ; Peripheral Nervous System ; Rare Diseases ; Renal Artery ; Rupture ; Skeleton ; Skin

OBJECTIVES: The differentiation of tuberculous effusion from the other causes of exudative pleural effusion remained difficult even with aids of biochemical analyses and pleural biopsy. As the pathophysiology of tuberculous pleural effusion is an enhanced cell mediated immunity, Adenosine deaminase(ADA) and various cytokines including Inteferon-γ, tumor necrosis factor alpha(TNF-α) are considered as useful diagnostic tools in differentiating exudative pleural effusion The author would like to demonstrate the diagnostic usefulness of TNF-α in the differentiation of exudative pleural effusion, and compared the discriminating ability of TNF-α with ADA. METHODS: Pleural fluids obtained from 80 patients (tuberculous : 39, malignant : 31, parapneumonic : 10) with exudate pleural effusions were processed for cell counts and biochemical analysis including ADA and TNF-α RESULTS: Tuberculous pleural fluid showed higher levee of ADA and TNF-α, 48.7α 32.7U/L and 184.1±214.2pg/mL than that of non-tuberculous effusion 26.0α41.3U/L and 44.1α114.2pg/mL, respectively (ADA, TNF-α : p<0.05, p<0.01). Receiver operating characteristics(ROC) curves were generated for ADA and TNF-α, and the best cut-off value for adenosine deaminase and TNF-α were considered as 30U/L and 15pg/ml, respectively. Comparing the area under the ROC curves, there was no significant difference between ADA and TNF-α CONCLUSION: For the differential diagnosis of tuberculous pleural effusion from the other causes of exudative pleural effusions, TNF-α as well as ADA was considered as useful diagnostic method. However adding TNF-α to ADA has no further diagnotic benefit than ADA alone.
Adenosine ; Adenosine Deaminase ; Biopsy ; Cell Count ; Cytokines ; Diagnosis, Differential ; Exudates and Transudates ; Humans ; Immunity, Cellular ; Pleural Effusion* ; ROC Curve ; Tuberculosis ; Tumor Necrosis Factor-alpha*

No abstract available.
Pregnancy Rate* ; Pregnancy*

A female fetus with short rib(polydactyly) syndrome, Beemer-Langer type was terminated at 28 week's gestation because of abnormalities visualized on sonography. We present the clinical, radiological and autopsy findings of this case with a brief review of the literatures.
Autopsy ; Female ; Fetus ; Humans ; Polydactyly* ; Pregnancy ; Ribs*

Annexin-1 (ANX1) is a 37 kDa protein that is induced and secreted by glucocorticosteroid hormone. The secreted ANX1 has been believed to exert its function by binding to its putative rnembrane receptor. In this report we demonstrate that ANXl receptor (ANX1R) signal blocks the interleukin-1B (IL-1B) receptor signal pathway in human peripheral blood mononuclear cells (PBMCs). When PBMCs were treated with both IL-1B (100 ng/ml) and PMA (10 ng/ml) in the absence or presence of dexamethasone for 5 days, dexamethasone (100 nM) suppressed lymphocyte proliferation to 24% of the control. However addition of anti-ANX1 polyclonal antibody of 1:200 and 1:1,000 dilution to this system induced recovery of proliferation to 80% and 40%, respectively, when compared to the control. In the mixed lymphocyte reaction, dexamethasone suppressed lymphocyte proliferation to 9% of that of control when stimulated with IL-1B (100 ng/ml) and phorbol myristate acetate (10 ng/ml). Addition of anti-ANX1 polyclonal antibody (1:1,000) to this system also recovered the proliferation to 20% of that of the control system. In the ANX1 receptor induction experiment using flow cytometry, ANX1 receptor expression on lymphocytes, CD4+ T cells, CD8+ T cells and monocytes increased depending on the externally added IL-1B ranging from 10 to 1,000 ng/ml. From these results, it is evident that dexamethasone induces ANX1 secretion into the culture medium and anti-ANX1 polyclonal antibody abolishes the effects of dexamethasone. Furthermore these results imply that extracellular ANX1 exerts its effects by binding to the receptor on the cell membrane and the activated signal(s) of ANX1R block IL-1B receptor signal in the lymphocytes.
Cell Membrane ; Dexamethasone ; Flow Cytometry ; Humans ; Interleukin-1* ; Lymphocyte Culture Test, Mixed ; Lymphocytes* ; Monocytes ; Signal Transduction ; T-Lymphocytes ; Tetradecanoylphorbol Acetate*

Complications after a median sternotomy incision, which is used currently in most open heart surgery, are serious, although it is infrequent. Reconstruction of the sternal defect resulting from dehiscence of median sternotomy is still big challenge to the most plastic surgeons. Since vascularized greater omentum was transposed to eliminate mediastinal wound problems, many vascularized regional muscle flaps became mainstay in reconstruction of median sternotomy wound. We treated 13 patients with median sternotomy dehiscence between October of 1993 and March of 1998. In two patients, the wound problems were so confined to superficial tissue that debrided and closed primarily. Eleven patients with deep wound infection were managed with vigorous debridement of all necrotic tissues and resultant defects were covered with regional muscle flaps: rectus myocutaneous flap(3) and bilateral pectoralis advancement flap(8). We used the pectoralis major advancement flaps without counter incision at humeral insertion site and the dissections were limited only medial to the anterior axillary line to preserve the axillary fold. In five patients with larger defects, we elevated muscle and cutaneous flaps separately to make these flaps more mobile. Large portion of two rectus abdominis flaps could not survive, whereas pectoralis advancement flaps had mo special wound problems. Only one patient developed fistula due to remained wire, regardless to flap surgery.
Debridement ; Fistula ; Humans ; Omentum ; Rectus Abdominis ; Sternotomy* ; Thoracic Surgery ; Wound Infection ; Wounds and Injuries

We report a case of fixed-type sporotrichosis in a 12-month-old infant, who presented with a well-defined scaly erythematous patch on the right lateral nasal root area of approximately 2.5 months duration. Hiopsy revealed pseudoepitheliomatous hyperplasia with chronic granulomatous inflammation in dermis and PAS-positive fungal spores in the stroma. Sporothrix schenckii was identified with fungal culture of biopsy specimen. The lesion was responded to treatment. with itraconazole(3mg/kg) for 12 weeks, without relapse at 5-month follow-up.
Biopsy ; Dermis ; Follow-Up Studies ; Humans ; Hyperplasia ; Infant ; Inflammation ; Itraconazole ; Recurrence ; Spores, Fungal ; Sporothrix ; Sporotrichosis*

Bone is a dynamic tissue which is constantly remodelled by subsequent cycles of bone resorption and formation. Glucocorticoid and vitamine D3 are known as regulating substances in bone metabolism. In vitro experiments using bone tissue, it was suggested that glucoccorticoid inhibits bone resorption, whereas the effect of glucocorticoid on bone formation are complex- increasing or decreasing effect. The active form of vitamin D3, 1,25-dihydroxycholecalciferol [1.25-(OH)2D3], has been reported to stimulate osteoblastic activities including the production of ALP, type I collagen, and osteoclacin. The purpose of this study was to evaluate the effect of admixture of vitamin D3 and dexamethasone, one of glucocorticoids, on osteblastic cell line(MC3T#-E1). Alkaline phosphatase(ALP) and MTT assay were conducted in the cultivated cells with 1, 10, 100nm/ml of 1,25-(OH)2D3 and/or 10nM/ml, 100nM/ml, 1micrometer/ml of dexamethasone. The observed results were as follows. 1. The activity of osteoblastic cells with 1micrometer/ml of dexamethasone was significantly increased at 1-day cultivation with comparison to control group, but was decreased afterwards. But the activity of ALP was greatest in 1micrometer/ml of dexamethasone and increased with time lapsed. 2. The activity of osteoblastic cells with vitamin D3 was significantly increased dose-dependently at 1-day cultivation, but was significantly decreased in 10nM/ml or 100nM/ml at 2-day or 3-day cultivation, and was greatest in 100nM/ml at 3-day cultivation. 3. In case of admixture of dexamethasone and vitamin D3 at 2-day cultivation, but was increased again at 3-day cultivation, which was greater than that in control or dexamethasone only group. The activity of ALP was decreased at 1-day cultivation, but was increased in the admixture of 10nM/ml or 100nM/ml of dexamethasone with 100nM/ml of vitamin D3 at 2-day cultivation, and was again decreased at 3-day cultivation.
Bone and Bones ; Bone Resorption ; Calcitriol ; Cholecalciferol ; Collagen Type I ; Dexamethasone* ; Glucocorticoids ; Metabolism ; Osteoblasts* ; Osteogenesis ; Vitamins*

BACKGROUND: Disordered lactate metabolism which is due to tissue hypoxia and hypoperfusion is frequently encountered in critically ill patients. These patients suffer from a high hospital mortality rate and are at great risk of developing multiple organ failure. The present study was designed to evaluate the prognostic value of blood lactate as a determinant of mortality in comparison with the APACHE II score. METHODS: 29 adult ICU patients participated in this study. Blood lactate concentrations, arterial blood gas analysis, hemodynamic data and APACHE II scores were collected on the first and last days of ICU stay. These data were compared between survivor and non-survivor groups. RESULTS: On the day of admission, blood lactate concentrations and APACHE II scores of non-survivors were 48.5 +/- 27.0 mg/dl and 18.5 +/- 5.9, while those of survivors were 23.7 +/- 12.9 mg/dl and 6.7 3.1. On the day of discharge, arterial blood lactate concentrations and APACHE II scores of non-survivors were 143.2 +/- 54.0 mg/dl and 28.2 +/- 6.0, while those of survivors were 14.9 +/- 7.1 mg/dl and 4.7 +/- 2.2. There was a significant positive correlation between high arterial blood lactate concentration and fatal outcome in critically-ill patients. There was also a significant positive correlation between arterial blood lactate concentration and APACHE II score. Furthermore, decreases in arterial blood lactate levels during the course of ICU stay may indicate a favorable outcome. The mortality increased abruptly in critically-ill patients with an initial arterial blood lactate concentration higher than 40 mg/dl. CONCLUSIONS: The result shows that arterial blood lactate concentration can serve as a reliable prognostic predictor and clinical guide to therapy in critically ill patients.
Adult ; Anoxia ; APACHE* ; Blood Gas Analysis ; Critical Illness* ; Fatal Outcome ; Hemodynamics ; Hospital Mortality ; Humans ; Lactic Acid* ; Metabolism ; Mortality ; Multiple Organ Failure ; Survivors