BACKGROUND: Up to now, sleep stages have traditionally been determined by the visual inspection of individual EEG waves. However, the exact physiological meaning of the sleep waves is not known. The purpose of this study was to try and find out the physiological parameters of the EEG of the sleep and wakefulness states by calculating one of the non-linear chaos parameter, the largest Lyapunov exponent (LLE), of EEG time series. METHODS: The digital EEG of the wakefulness with eye opening (WEO), wakefulness with eye closure (WEC), stage1 (S1), stage2 (S2), stage3 or 4 (S34) were recorded at centroparietal region (C4-P4 bipolar derivation) in 10 normal subjects. Lyapunov exponents of 50 EEG time series in different states were compared. RESULTS: LLE's of WEO, WEC, S1, S2, S34 showed an increas-ing tendency as states switched from wakefulness to sleep. LLE of sleep was larger than that of awake state. CONCLUSIONS: The EEG of the sleep state appeared to be more chaotic than that of the awake state. This nonlinear chaos parameter can be used as a physiological parameter of normal sleep and awake states.
Electroencephalography* ; Sleep Stages ; Wakefulness*

Background: This study was performed to evaluate etiologies and secular trends in primary amenorrhea in South Korea. Methods: This retrospective multi-center study analyzed 856 women who were diagnosed with primary amenorrhea between 2000 and 2016. Clinical characteristics were compared according to categories of amenorrhea (hypergonadotropic/hypogonadotropic hypogonadism, eugonadism, disorders of sex development) or specific causes of primary amenorrhea. In addition, we assessed secular trends of etiology and developmental status based on the year of diagnosis. Results: The most frequent etiology was eugonadism (39.8%). Among specific causes, Müllerian agenesis was most common (26.2%), followed by gonadal dysgenesis (22.4%). Women with hypergonadotropic hypogonadism were more likely to have lower height and weight, compared to other categories. In addition, the proportion of cases with iatrogenic or unknown causes increased significantly in hypergonadotropic hypogonadism category, but overall, no significant secular trends were detected according to etiology. The proportion of anovulation including polycystic ovarian syndrome increased with time, but the change did not reach statistical significance. Conclusion The results of this study provide useful clinical insight on the etiology and secular trends of primary amenorrhea. Further large-scale, prospective studies are necessary.

OBJECTIVE: We investigated the clinical efficacy and safety of transvaginal ultrasound-guided aspiration in treatment of benign pelvic cyst. METHODS: We analyzed medical records of the 343 women with pelvic cyst who underwent transvaginal ultrasound-guided aspiration between 1996 and 2004. We investigated the age, parity, tentative diagnosis, size of the cyst at short-, and long- term follow up, type of aspiration, character and cytology of the aspirated contents, and complication. RESULTS: Mean diameters were significantly reduced after transvaginal ultrasound-guided aspiration at short-, and long-term follow up in all types of cysts except lymphocele (p<0.05). However, at long-term follow up, the proportions of the cysts that were completely resolved or reduced in size greater than 50% after ultrasound-guided aspiration were only 37%, 24.8%, 28%, and 30% in simple cyst, endometrioma, pseudocyst, and lymphocele, respectively. No serious aspiration related complication was identified except two cases. One was ovarian abscess and the other was bladder puncture during aspiration. CONCLUSION: This study suggests that transvaginal ultrasound-guided aspiration of benign pelvic cyst is a simple and safe procedure, but the application of aspiration to simple cyst, pseudocyst, lymphocele should be prudent because of the limited therapeutic efficacy. But for patients with endometrioma who wish to be pregnant, transvaginal ultrasound-guided aspiration could be a good treatment option to preserve ovarian reserve function.
Abscess ; Diagnosis ; Endometriosis ; Female ; Follow-Up Studies ; Humans ; Lymphocele ; Medical Records ; Parity ; Punctures ; Urinary Bladder

Conceptions and uncomplicated pregnancies in patients with panhypopituitarism are rare especially after treatment of craniopharyngioma. We recently experienced a case of a patient with panhypopituitarism who became pregnant by gonadotropin therapy and gave birth to a healthy baby. A 33-year-old woman developed hypogonadotropic hypogonadism and diabetes insipidus because of craniopharyngioma which was surgically removed. Post-operative panhypopituitarism with diabetes insipidus was treated with adequate doses of L-thyroxin, prednisolone, desmopressin, medroxyprogesterone acetate (MPA), conjugated estrogen. To induce ovulation, human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG) were administered, and a single intrauterine insemination (IUI) procedure was performed. The patient became pregnant and gave birth to a healthy baby. This case suggests that ovulation induction using gonadotropins and comprehensive hormone replacement therapy can result in the successful pregnancy in patients with panhypopituitarism after treatment of craniopharyngioma.
Adult ; Chorionic Gonadotropin ; Craniopharyngioma* ; Deamino Arginine Vasopressin ; Diabetes Insipidus ; Estrogens ; Female ; Fertilization ; Gonadotropins ; Hormone Replacement Therapy ; Humans ; Hypogonadism ; Insemination ; Medroxyprogesterone Acetate ; Ovulation ; Ovulation Induction ; Parturition* ; Prednisolone ; Pregnancy*

PURPOSE: To determine the incidence of steroid-induced ocular hypertension following myopic vision correction. METHODS: This study retrospectively reviewed the medical records of 6,087 patients (12,164 eyes) who underwent myopic refractive surgery (laser-assisted in-situ keratomileusis [LASIK]/photorefractive keratectomy [PRK]/phakic intraocular lens [IOL] implantation) at Eyereum Eye Clinic between July 2011 and February 2013. Ocular hypertension was defined when post-operative intraocular pressure (IOP) was increased more than 30% compared to predicted IOP adjusted according to corneal thickness. All preoperative IOPs were measured using Goldmann applanation tonometer (GAT). Postoperative IOPs were measured using non-contact tonometer first and with GAT when the IOP was suspiciously increased. RESULTS: Steroid-induced ocular hypertension after a myopic refractive surgery occurred in 680 eyes (5.58%) of 404 patients (6.64%). The incidence based on surgery was LASIK (0.06%, 2/3, 514 eyes) followed by PRK (7.63%, 575/7,533 eyes) and phakic IOL implantation (9.2%, 103/1,117 eyes). The average increased IOP level in patients with steroid-induced ocular hypertension was 5.62 +/- 3.73 mm Hg after PRK and 9.35 +/- 4.95 mm Hg after phakic IOL implantation. A statistically significantly higher change in IOP was observed in the phakic IOL group (p < 0.001). However, the PRK group had a longer treatment period for ocular hypertension and used more antiglaucoma medications than the phakic IOL group (p < 0.05). Most patients with ocular hypertension were successfully treated with cessation of topical steroid or use of antiglaucoma medications. Only 2 eyes required glaucoma surgery because IOP was not controlled. CONCLUSIONS: IOP measurements should be initiated no later than 1 week after surgery because steroid-induced ocular hypertension following myopic refractive surgery can occur in approximately 5.58% of patients and most cases of ocular hypertension can be controlled with careful follow-up and use of antiglaucoma medications.
Glaucoma ; Humans ; Incidence* ; Intraocular Pressure ; Keratomileusis, Laser In Situ ; Lenses, Intraocular ; Medical Records ; Ocular Hypertension* ; Refractive Surgical Procedures* ; Retrospective Studies

PURPOSE: To determine the incidence of steroid-induced ocular hypertension following myopic vision correction. METHODS: This study retrospectively reviewed the medical records of 6,087 patients (12,164 eyes) who underwent myopic refractive surgery (laser-assisted in-situ keratomileusis [LASIK]/photorefractive keratectomy [PRK]/phakic intraocular lens [IOL] implantation) at Eyereum Eye Clinic between July 2011 and February 2013. Ocular hypertension was defined when post-operative intraocular pressure (IOP) was increased more than 30% compared to predicted IOP adjusted according to corneal thickness. All preoperative IOPs were measured using Goldmann applanation tonometer (GAT). Postoperative IOPs were measured using non-contact tonometer first and with GAT when the IOP was suspiciously increased. RESULTS: Steroid-induced ocular hypertension after a myopic refractive surgery occurred in 680 eyes (5.58%) of 404 patients (6.64%). The incidence based on surgery was LASIK (0.06%, 2/3, 514 eyes) followed by PRK (7.63%, 575/7,533 eyes) and phakic IOL implantation (9.2%, 103/1,117 eyes). The average increased IOP level in patients with steroid-induced ocular hypertension was 5.62 +/- 3.73 mm Hg after PRK and 9.35 +/- 4.95 mm Hg after phakic IOL implantation. A statistically significantly higher change in IOP was observed in the phakic IOL group (p < 0.001). However, the PRK group had a longer treatment period for ocular hypertension and used more antiglaucoma medications than the phakic IOL group (p < 0.05). Most patients with ocular hypertension were successfully treated with cessation of topical steroid or use of antiglaucoma medications. Only 2 eyes required glaucoma surgery because IOP was not controlled. CONCLUSIONS: IOP measurements should be initiated no later than 1 week after surgery because steroid-induced ocular hypertension following myopic refractive surgery can occur in approximately 5.58% of patients and most cases of ocular hypertension can be controlled with careful follow-up and use of antiglaucoma medications.
Glaucoma ; Humans ; Incidence* ; Intraocular Pressure ; Keratomileusis, Laser In Situ ; Lenses, Intraocular ; Medical Records ; Ocular Hypertension* ; Refractive Surgical Procedures* ; Retrospective Studies

OBJECTIVE: To evaluate the cardiac function and to explore the importance of the evaluation of cardiac function in patients with Duchenne muscular dystrophy (DMD). METHOD: Thirty-nine patients with DMD without any symptoms of heart problems underwent physical examinations and cardiac monitoring including the arterial carbon dioxide (CO2) screening. Thirty one patients underwent pulmonary function test. RESULTS: Among 39 patients 27 showed abnormal electrocardiographic findings such as ventricular hypertrophy, ischemic change, atrial hypertrophy, T wave inversion, sinus tachycardia and ST elevation. 24 patients showed abnormal echocardiographic findings such as abnormal ejection fraction, dilated cardiomyopathy (DCMP), filling abnormality of left ventricle, global hypokinesia and reduced systolic function. 17 patients showed low ejection fraction (below 59%) and 4 of them were diagnosed as DCMP. There were significant correlations between age and ejection fraction (r= 0.552, p<0.01), between functional level and ejection fraction (r= 0.607, p<0.01) and between vital capacity and ejection fraction (r=0.547, p<0.01). However, ejection fraction showed no significant correlations with arterial CO2. CONCLUSION: Routine evaluation of the cardiac function, at least from 10 years of age, and proper treatment following early diagnosis of heart problems were necessary in patients with DMD, because they possibly have been severely affected by cardiac problems without any clinical symptoms.
Carbon Dioxide ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Deoxycytidine Monophosphate ; Early Diagnosis ; Echocardiography ; Electrocardiography ; Heart ; Heart Ventricles ; Humans ; Hypertrophy ; Hypokinesia ; Mass Screening ; Muscular Dystrophy, Duchenne* ; Physical Examination ; Respiratory Function Tests ; Tachycardia, Sinus ; Vital Capacity

Purpose: The use of antiplatelet and/or anticoagulant therapies has become common. In rare cases, these therapies may increase the risk of dangerous postoperative bleeding. We investigated the association of antiplatelets and/or anticoagulants with postoperative major bleeding risk in laparoscopic gastric cancer surgery. Methods: We retrospectively enrolled 3,663 gastric cancer patients (antiplatelet/anticoagulant group, 518; control group, 3,145) who had undergone laparoscopic surgery between January 2012 and December 2017. To minimize selection bias, 508 patients in each group were matched using propensity score matching (PSM) method. The primary outcome was postoperative major bleeding. Secondary outcomes were intraoperative, postoperative transfusion and early complications. Results: After PSM, postoperative major bleeding occurred in 10 (2.0%) and 3 cases (0.6%) in the antiplatelets/ anticoagulants and control groups, respectively (P = 0.090). Intraoperative and postoperative transfusions were not significantly different between 2 groups (2.4% vs. 1.4%, P = 0.355 and 5.5% vs. 4.3%, P = 0.469). Early complications developed in 58 (11.4%) and 43 patients (8.5%) in the antiplatelets/anticoagulants and control groups, respectively (P = 0.142). The mean amounts of intraoperative and postoperative transfusions were not significantly different between the groups (366.67 ± 238.68 mL vs. 371.43 ± 138.01 mL, P = 0.962; 728.57 ± 642.25 mL vs. 508.09 ± 468.95 mL, P = 0.185). In multivariable analysis, male (P = 0.008) and advanced stage (III, IV) (P = 0.024) were independent significant risk factors for postoperative major bleeding. Conclusion Preoperative antiplatelets and/or anticoagulants administration did not significantly increase the risk of postoperative major bleeding after laparoscopic gastric cancer surgery.

Purpose: Peritoneal carcinomatosis (PC) presents a major challenge in the treatment of latestage, solid tumors, with traditional therapies limited by poor drug penetration. We evaluated a novel hyperthermic pressurized intraperitoneal aerosol chemotherapy (HPIPAC) system using a human abdominal cavity model for its efficacy against AGS gastric cancer cells. Materials and Methods: A model simulating the human abdominal cavity and AGS gastric cancer cell line cultured dishes were used to assess the efficacy of the HPIPAC system. Cell viability was measured to evaluate the impact of HPIPAC under 6 different conditions: heat alone, PIPAC with paclitaxel (PTX), PTX alone, normal saline (NS) alone, heat with NS, and HPIPAC with PTX. Results: Results showed a significant reduction in cell viability with HPIPAC combined with PTX, indicating enhanced cytotoxic effects. Immediately after treatment, the average cell viability was 66.6%, which decreased to 49.2% after 48 hours and to a further 19.6% after 120 hours of incubation, demonstrating the sustained efficacy of the treatment. In contrast, control groups exhibited a recovery in cell viability; heat alone showed cell viability increasing from 90.8% to 94.4%, PIPAC with PTX from 82.7% to 89.7%, PTX only from 73.3% to 74.8%, NS only from 90.9% to 98.3%, and heat with NS from 74.4% to 84.7%. Conclusions The HPIPAC system with PTX exhibits a promising approach in the treatment of PC in gastric cancer, significantly reducing cell viability. Despite certain limitations, this study highlights the system’s potential to enhance treatment outcomes. Future efforts should focus on refining HPIPAC and validating its effectiveness in clinical settings.

Purpose: Peritoneal carcinomatosis (PC) presents a major challenge in the treatment of latestage, solid tumors, with traditional therapies limited by poor drug penetration. We evaluated a novel hyperthermic pressurized intraperitoneal aerosol chemotherapy (HPIPAC) system using a human abdominal cavity model for its efficacy against AGS gastric cancer cells. Materials and Methods: A model simulating the human abdominal cavity and AGS gastric cancer cell line cultured dishes were used to assess the efficacy of the HPIPAC system. Cell viability was measured to evaluate the impact of HPIPAC under 6 different conditions: heat alone, PIPAC with paclitaxel (PTX), PTX alone, normal saline (NS) alone, heat with NS, and HPIPAC with PTX. Results: Results showed a significant reduction in cell viability with HPIPAC combined with PTX, indicating enhanced cytotoxic effects. Immediately after treatment, the average cell viability was 66.6%, which decreased to 49.2% after 48 hours and to a further 19.6% after 120 hours of incubation, demonstrating the sustained efficacy of the treatment. In contrast, control groups exhibited a recovery in cell viability; heat alone showed cell viability increasing from 90.8% to 94.4%, PIPAC with PTX from 82.7% to 89.7%, PTX only from 73.3% to 74.8%, NS only from 90.9% to 98.3%, and heat with NS from 74.4% to 84.7%. Conclusions The HPIPAC system with PTX exhibits a promising approach in the treatment of PC in gastric cancer, significantly reducing cell viability. Despite certain limitations, this study highlights the system’s potential to enhance treatment outcomes. Future efforts should focus on refining HPIPAC and validating its effectiveness in clinical settings.