Although a higher incidence of ectopic pregnancy has been reported after in vitro fertilization(IVF) and embryo transfer(ET), five ectopic pregnancies in one patient is very rare. We experienced a case of combined interstitial and intrauterine pregnancy as fifth ectopic pregnancies after in vitro fertilization and embryo transfer in one patient with history of bilateral salpingectomy due to previous four tubal pregnancies. Repeated transvaginal ultrasound examinations confirmed heterotopic pregnancy. In IVF-ET, bilateral salpingectomy does not remove the risk of interstitial or cornual pregnancy.
Embryo Transfer* ; Embryonic Structures* ; Female ; Fertilization in Vitro* ; Humans ; Incidence ; Pregnancy* ; Pregnancy, Ectopic* ; Pregnancy, Heterotopic ; Pregnancy, Tubal ; Salpingectomy* ; Ultrasonography

No abstract available.
Antibodies* ; Humans ; Leprosy*

OBJECTIVE: The implantation failure after embryo-transfer (ET) is a major continuing problem in in vitro fertilization (IVF). This study was undertaken to determine the effectiveness of intravenous immunoglobulin for treatment of individuals experiencing repeated unexplained in vitro fertilization-embryo transfer (IVF-ET) failure. METHODS: A total of nine consecutive infertile patients who failed to become pregnant after previous IVF-ET replacing at least three or more normal developed embryos each were included in our study. During the subsequent new IVF-ET cycle, each women received intravenous immunoglobulin 500mg/kg before the embryo transfer. RESULTS: Only one implantation occurred. There were no remarkable side effects. A specific effect of intravenous immunoglobulin for patients with repeated IVF-ET failure could not be demonstrated. CONCLUSION: High-dose intravenous immunoglobulin may not be useful for patients with repeated failure of embryo transfer.
Embryo Transfer ; Embryonic Structures ; Female ; Fertilization in Vitro ; Humans ; Immunoglobulins*

No abstract available.
Coxiella burnetii* ; Coxiella* ; Korea* ; Milk*

BACKGROUND: Diagnosis of tuberculous pleurisy is sometimes difficult using conventional diagnostic methods. We have investigated the utility of pleural fluid cell IFN-gamma production assay in the diagnosis of tuberculous pleurisy. METHODS: We prospectively performed pleural fluid cell IFN-gamma production assay in 39 patients with tuberculous pleural effusions (TPE) and in 26 patients with nontuberculous pleural effusions (NTPE) (13 malignant pleural effusions and 13 parapneumonic effusions). Pleural fluid cells were cultured in DMEM media and stimulated with purified protein derivatives (PPD), and phytohemagglutinin (PHA) for 24 hr. The amount of IFN-gamma released in the culture supernatant was quantitated by IFN-gamma ELISA assay. We have also measured adenosine deaminase (ADA) activities and IFN-gamma concentrations in the pleural fluid. RESULTS: 1) The pleural fluid levels of ADA activity and IFN-gamma concentrations were significantly higher in TPE than NTPE (p<0.01). 2) IFN-gamma production in TPE cells stimulated by PPD (755,266+/-886,636 pg/ml) was significantly higher than NTPE cells (3,509+/-6,980 pg/ml) (p<0.01). By considering the fact that IFN-gamma concentrations over 10,000 pg/ml is a criteria for the diagnosis of TBE, sensitivity and specificity of the test were 97.4 and 92.3%, respectively. 3) The ratios of IFN-gamma production by the stimulation with PPD and PHA (PPD/PHA) were significantly higher in TPE cells (59+/-85) than NTPE cells (5+/-18)(p<0.01). Considering the criteria for the diagnosis of TBE as PPD/PHA ratio over 5, sensitivity and specificity of the test were 76.9 and 92.3%, respectively. CONCLUSION: Pleural fluid cell IFN-gamma production assay may be useful for the diagnosis of tuberculous pleurisy.
Adenosine Deaminase ; Diagnosis* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Pleural Effusion ; Pleural Effusion, Malignant ; Pleurisy ; Prospective Studies ; Tuberculosis ; Tuberculosis, Pleural*

PURPOSE: We investigated the effect of 100-year-old mountain ginseng(Panax ginseng C.A. Meyer, PG-CAM) extract on patients with erectile dysfunction(ED). MATERIALS AND METHODS: A total of 35 patients with ED(23 patients in PG-CAM administration group, 12 in placebo group) were enrolled in this double-blind study. The drug was administered for 12 weeks. Before and after administration, patients took the self-administered IIEF-5 questionnaire and were tested for serum hormone levels(testosterone, LH, FSH, estradiol), complete blood count, liver and renal function test, and urinalysis. RESULTS: The IIEF-5 scores for the placebo group were 19.7+/-2.3 and 19.9+/-3.6 before and after treatment, respectively. For all patients taking PG-CAM, IIEF-5 scores increased 18.1+/-5.6 to 20.2+/-4.5. For those patients with initial scores below 17, IIEF-5 scores increased from 12.4+/-6.2 to 19.7+/-6.7. These results indicate that PG-CAM may increase erectile function in ED patients, particularly those with poor erection. No changes were detected in hormonal levels or blood tests. No toxic side effect were reported. CONCLUSIONS: IIEF-5 score improved significantly in ED patients treated with PG-CAM, suggesting that PG-CAM extract could be a treatment candidates for ED.
Blood Cell Count ; Double-Blind Method ; Erectile Dysfunction* ; Hematologic Tests ; Humans ; Liver ; Male ; Panax* ; Penis ; Surveys and Questionnaires ; Urinalysis

PURPOSE: We investigated the effect of 100-year-old mountain ginseng(Panax ginseng C.A. Meyer, PG-CAM) extract on patients with erectile dysfunction(ED). MATERIALS AND METHODS: A total of 35 patients with ED(23 patients in PG-CAM administration group, 12 in placebo group) were enrolled in this double-blind study. The drug was administered for 12 weeks. Before and after administration, patients took the self-administered IIEF-5 questionnaire and were tested for serum hormone levels(testosterone, LH, FSH, estradiol), complete blood count, liver and renal function test, and urinalysis. RESULTS: The IIEF-5 scores for the placebo group were 19.7+/-2.3 and 19.9+/-3.6 before and after treatment, respectively. For all patients taking PG-CAM, IIEF-5 scores increased 18.1+/-5.6 to 20.2+/-4.5. For those patients with initial scores below 17, IIEF-5 scores increased from 12.4+/-6.2 to 19.7+/-6.7. These results indicate that PG-CAM may increase erectile function in ED patients, particularly those with poor erection. No changes were detected in hormonal levels or blood tests. No toxic side effect were reported. CONCLUSIONS: IIEF-5 score improved significantly in ED patients treated with PG-CAM, suggesting that PG-CAM extract could be a treatment candidates for ED.
Blood Cell Count ; Double-Blind Method ; Erectile Dysfunction* ; Hematologic Tests ; Humans ; Liver ; Male ; Panax* ; Penis ; Surveys and Questionnaires ; Urinalysis

PURPOSE: The aim of this study was to assess whether the complete removal of a breast mass using ultrasound (US) guided mammotome biopsy was successful using a marginal biopsy after insuring the total visual excision of the breast mass on US images. The relationship of complete breast mass removal, and the hematoma, mass size and shape were also evaluated. MATERIALS AND METHODS: A US guided mammotome biopsy was performed in a total of 136 cases in 133 patients, with marginal biopsies also added when the complete removal of breast mass had been identified by sonography. The results of the marginal biopsies were serially dividing into three groups, as follows: group I were the cases in the initial 6 months, group II after the initial 6 months and group III having undergone two marginal biopsies. The marginal biopsies were performed in four directions around the probe, with "marginal positivity" defined as the same histopathological findings to that of the main mass in at least one direction. A statistical analysis was also used to evaluate between the marginal positivity and the hematoma, mass size and shape. RESULTS: The marginal positivities of groups I, II and III were 48.8, 29.4 and 45.5%, respectively. The marginal positivity of those with a lobular shaped mass was significantly higher (p=0.0121) than those with round or oval shaped masses (61.5 vs. 33.7 vs. 50%), but showed no statistical relationship with hematoma size of the lesions CONCLUSION: Although the lesions were removed by US using a US-guided mammotome biopsy, many residual lesions were still histologically present in the marginal samplings, especially in the lobular shaped masse
Biopsy* ; Biopsy, Needle ; Breast* ; Hematoma ; Humans ; Ultrasonography

PURPOSE: The aim of our study was to determine the positive predictive value (PPV) and to evaluate the usefulness of ultrasound BI-RADS, as compared with the histologic results of breast lesions that were categorized and classified by the ultrasound BI-RADS lexicon. MATERIALS AND METHODS: Between January and December 2004, the ultrasound features of 471 breast lesions in 368 patients were analyzed and categorized with using ultrasound BI-RADS. All of the lesions were compared with the histological results. We categorized category 2 and 3 lesions as benign lesions, and category 4 and 5 lesions as malignant lesions. We then calculated the sensitivity, specificity, positive predictive value, negative predictive value and accuracy. RESULTS: The breast lesions were histologically diagnosed as 298 cases of category 2, 21 cases of category 3, 108 cases of category 4 and 44 cases of category 5. The categorical malignancy rate was 1% (3/298) in category 2 lesions, 4.7% (1/21) in category 3 lesions, 8.3% (9/108) in category 4 lesions and 90.9% (40/44) in category 5 lesions. Within category 4, the malignancy rate for category 4a lesions was 5.4% (5/92), the malignancy rate for category 4b lesions was 1.3% (1/8) and the malignancy rate for category 4c lesions was 50% (4/8). The sensitivity, specificity, positive predictive value and negative predictive value were 90.6%, 75.1%, 31.6% and 98.4%, respectively. The statistically valid ultrasound features that were correlated with malignancy were an ill defined margin, a microlobulated mass, an irregular mass, inhomogenic echogenicity, an echogenic halo and an older patient age. CONCLUSION: Ultrasound BI-RADS was useful in differentiating benign from malignant breast lesions.
Breast* ; Humans ; Sensitivity and Specificity ; Ultrasonography*

The enhanced process of proteolysis of both the basement membrane and the stromal extracelluar matrix (ECM) contributes to the escape of breast cancer cells into the neighboring tissues, eventually leading to the formation of distant metastases. A group of enzymes thought to play a role in tumor cell invasion are the matrix metalloproteinases (MMPs). Much attention has been focused on MMP-2 and MMP-9, which are 2 members of the MMP family active against collagen of the basement membrane. The enzymatic activities of MMP-2 and MMP-9 are inhibited by the tissue inhibitors of metalloproteinases (TIMPs). TIMP-2, one member of TIMPs, inhibits MMP-2 and MMP-9. The imbalance between TIMPs and MMPs permits to tumor invasion and metastasis. Theretore, TIMPs constitute promising targets in the developmemt of anticancer terapies. Immunohistological stainings of MMP-2, MMP-9 and TIMP-2 were performed on paraffin-embedded tissue sections of 31 invasive breast carcinomas. MMP-2 and MMP-9 were associated with neoplastic cell cytoplasms in 65% of the cases and exhibited inter-tumoral variability of the staining intensity. The MMP-2 and MMP-9 stainings did not correlate with presence of metastases at time of diagnosis. TIMP-2 was detected in the peri-tumoral stroma and was present in 81% of the cases. Residual benign breast tissue was negative for TIMP-2 staining. Neoplasms with diffuse TIMP-2 staining (32%) have metastasis significantly more frequently (50% metastasis) than ceses with focal (20% metastasis) or absent (0% metastasis) TIMP-2. We conclude that the clinical outcome such as metastasis is more closely related to the presence of TIMP-2 than the corresponding MMPs. Enhanced TIMP-2 expression, therefore, may denote a stromal response to tumor invasion, indicative of aggressive behavior in the subset breast carcinoma.
Basement Membrane ; Breast Neoplasms* ; Breast* ; Collagen ; Cytoplasm ; Diagnosis ; Humans ; Matrix Metalloproteinases ; Metalloproteases ; Neoplasm Metastasis ; Proteolysis ; Tissue Inhibitor of Metalloproteinase-2 ; United Nations