No abstract available.
Cesarean Section* ; Female ; Pregnancy

BACKGROUND: This study aimed to investigate bradycardia as an adverse effect after administration of dexmedetomidine during 33degrees C target temperature management. METHODS: A retrospective study was conducted on patients who underwent 33degrees C target temperature management in the emergency department during a 49-month study period. We collected data including age, sex, weight, diagnosis, bradycardia occurrence, target temperature management duration, sedative drug, and several clinical and laboratory results. We conducted logistic regression for an analysis of factors associated with bradycardia. RESULTS: A total of 68 patients were selected. Among them, 39 (57.4%) showed bradycardia, and 56 (82.4%) were treated with dexmedetomidine. The odds ratio for bradycardia in the carbon monoxide poisoning group compared to the cardiac arrest group and in patients with higher body weight were 7.448 (95% confidence interval [CI] 1.834-30.244, p = 0.005) and 1.058 (95% CI 1.002-1.123, p = 0.044), respectively. In the bradycardia with dexmedetomidine group, the infusion rate of dexmedetomidine was 0.41 +/- 0.15 microg/kg/h. Decisions of charged doctor's were 1) slowing infusion rate and 2) stopping infusion or administering atropine for bradycardia. No cases required cardiac pacing or worsened to asystole. CONCLUSIONS: Despite the frequent occurrence of bradycardia after administration of dexmedetomidine during 33degrees C target temperature management, bradycardia was completely recovered after reducing infusion rate or stopping infusion. However, reducing the infusion rate of dexmedetomidine lower than the standard maintenance dose could be necessary to prevent bradycardia from developing in patients with higher body weight or carbon monoxide poisoning during 33degrees C targeted temperature management.
Atropine ; Body Weight ; Bradycardia* ; Carbon Monoxide Poisoning ; Dexmedetomidine* ; Diagnosis ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Hypothermia, Induced ; Logistic Models ; Odds Ratio ; Retrospective Studies

No abstract available.
Leiomyoma*

The diagnosis of acute pancreatitis occurred in CAPD patients is quite difficult due to its clinical similarity with acute peritonitis. Delayed diagnosis and treatment of acute pancreatitis in CAPD patients may result in fatal complication. We experienced a case of acute pancreatitis in a CAPD patient. A 62 years old female visited the hospital with acute abdominal pain and cloudy effluent for 3 days. She has been on CAPD for 3 years and had two episodes of peritonitis at 6 months and 1 year before the admission. The causative organism was Streptococcus viridans in each episode. The peritonitis symptoms and peritoneal leukocyte count incresed despite of using Vancomycin(R) and Netilmicin(R). Causative organism was not isolated from dialysis. Serum amylase concentrations increased from 105mg/dL at the admission to 1,052mg/dL on day 10 of admission. Abdominal ultrasonography and abdominal computerized tomogram revealed fat infiltration, focal necrosis and multiple cyst formation at pancreas area. Computerized tomogram guided aspiration cytology revealed acute inflammation and necrosis. Bacteria were not found in the aspirate. Clinical symptoms were improved after discontinuation of CAPD and intraperitoneal use of antibiotics. The patient restarted CAPD on the day 18 and remained without complications. We report this case with a brief review of literatures.
Abdominal Pain ; Amylases ; Anti-Bacterial Agents ; Bacteria ; Delayed Diagnosis ; Diagnosis ; Dialysis ; Female ; Humans ; Inflammation ; Leukocyte Count ; Middle Aged ; Necrosis ; Pancreas ; Pancreatitis* ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Renal Dialysis ; Ultrasonography ; Viridans Streptococci

The antiphospholipid antibodies are characterized by prolonged phospholipid-dependent coagulation test (known as APTT or Russel viper venom), thrombosis, thrombocytopenia, and fetal loss. The association of antiphospholipid antibodies with one or more of these characteristic clinical features has been termed the i antiphospholipid syndrome. We have experienced a case of successful live birth after treated a woman with heparin and aspirin who has experienced spontaneous abortion four times with antiphospholipid antibodies and present it with the review of literature.
Abortion, Spontaneous ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Aspirin ; Female ; Heparin ; Humans ; Live Birth* ; Pregnancy ; Thrombocytopenia ; Thrombosis

PURPOSE: Circular skin lesions between 10 and 35 mm in diameter generate problems often. Direct closure of the lesion risks excessive wound tension or wound dehiscence. Skin grafts heal slowly and often remain unsightly. Traditional skin flaps have a limited role. We treated this circular medium-sized skin lesion(10 - 35 mm sized) by reducing opposed multilobed(ROM) flap. METHODS: ROM flap involves a series of semicircular lobes extending both cephalic and caudal from the defect. Direction of the semicircular multilobed flap is set parallel to relaxed skin tension line(RSTL) to minimize scar formation. First semicircle is drawn 60% in diameter of the defect. Second semicircles are drawn at the cephalic and caudal aspects of the original semicircles. These semicircles are 60% in diameter of the first semicircle. Additional semicircles are repeatedly drawn until the tension of skin flaps becomes free. ROM flap has a length-to-base ratio of 0.5 resulting in lower theoretical risk of end flap necrosis than a random pattern flap with a large ratio. The technique involves lobes most distant from the primary defect being transposed in turn closer to the defect. RESULTS: The ROM flap reduces skin tension concerns, lowers the risk of flap necrosis and allows for quicker and more aesthetic healing. Results were generally good and major complications, such as dehiscence, infection, or delayed healing, did not occur. CONCLUSION: ROM flap repair allows the plastic surgeon an additional option when faced with a circular medium-sized skin lesion.
Cicatrix ; Necrosis ; Skin* ; Transplants ; Wounds and Injuries

OBJECTIVE: X-linked inhibitor of apoptosis (XIAP) is the most potent member of IAP family that exerts antiapoptotic effects by interfering with activities of caspases. Recently, XIAP-associated factor 1 (XAF1) and two mitochondrial proteins, Smac/DIABLO and HtrA2, have been identified to negatively regulate the caspase-inhibiting activity of XIAP. We explore the candidacy of XAF1, Smac/DIABLO and HtrA2 as a tumor suppressor in cervical carcinogenesis and determine the mechanisms of altered XAF1 expression. METHODS: We investigated the expression and mutation status of the genes in 64 cervical cancer tissues, 5 cervical cancer cell lines and 10 normal cervical tissues. RESULTS: XAF1 transcript was not expressed or extremely low levels in 40% (2/5) of cancer cell line and in 31% (20/64) of primary carcinomas whereas Smac/DIABLO and HtrA2 are normally expressed in all cells. As somatic mutations of the gene was not detected, expression of XAF1 transcript was reactivated in all nonexpressor cell lines after 5-aza-2-deoxycytidine treatment. Bisulfite DNA analysis for CpG sites in the promoter region revealed a strong association between CpG sites hypermethylation and gene silencing. CONCLUSION: XAF1 undergoes epigenetic silencing in a considerable proportion of cervical carcinomas by aberrant promoter hypermethylation rather than genetic alterations, and closely associated with reduced gene expression. Although additional studies are required to determine the biological significance of XAF1 inactivation, it will be valuable to examine the expression status of XAF1 could be a clinically useful marker for cancer treatment.
Apoptosis ; Carcinogenesis ; Caspases ; Cell Line ; DNA ; Epigenomics* ; Gene Expression ; Gene Silencing ; Humans* ; Mitochondrial Proteins ; Promoter Regions, Genetic ; Uterine Cervical Neoplasms

OBJECTIVE: This study was undertaken to analyze the demographic profile and clinicopathologic characteristics of the patients with invasive cervical cancer who had undergone radical hysterectomy. METHODS: Records of 285 patients with invasive cervical cancer who had undergone radical hysterectomy and pelvic lymph node dissection at Kyung Hee University Hospital from January 1986 to March 2001 were reviewed retrospectively. In this study, we analyzed the clinicopathologic characteristics such as age, FIGO stage, histologic type, nodal metastasis, treatment modalities, complications, recurrence rates, and the overall 5-year survival rates et al. by using univariate anaysis and Kaplan-Meier method. RESULTS AND CONCLUSION: Ages ranged from 28 to 78. The mean age was 50.6. The number of patients of 285 being in FIGO stage Ia was 34 (11.9%), Ib 146 (51.2%), IIa 78 (27.4%), IIb 27 (9.5%). In the distribution of histological type, the number of squamous cell carcinoma was 258 (90.5%), adenocarcinoma 20 (7.0%), adenosquamous carcinoma 7 (2.5%). LN involvement was present in 5.9% with stage Ia, 16.4% with Ib, 24.4% with IIa, 25.9% with IIb. Obturator LN was the most frequently involved among pelvic lymph node. Urinary tract infection was the most common complication after surgery, occupying 15.1%. 26 cases (9.1%) developed recurrence. The recurrence rate was 0% in stage Ia, 8.2% in stage Ib, 11.5% in stage IIa, 18.5% in stage IIb. The overall 5-year survival rate was 100% in stage Ia, 89.4% in stage Ib, 80.0% in stage IIa and 72.2% in stage IIb. FIGO stage, tumor mass size, resection margin, lymph node involvement had a statistical prognostic significance (P<0.01).
Adenocarcinoma ; Carcinoma, Adenosquamous ; Carcinoma, Squamous Cell ; Humans ; Hysterectomy* ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Survival Rate ; Urinary Tract Infections ; Uterine Cervical Neoplasms*

OBJECTIVE: Measure the over-expression of p73 and analyze as the prognostic as well as angiogenic factor of cervical cancer by comparing the degree of expression of VEGF and TSP-1 by RT-PCR. METHODS: 7 normal and 37 cervical cancer specimens were put through RT-PCR and the expression of p73, VEGF and TSP-1 were measured. After immunohistochemical staining, the number of microvessels was counted. With the level of expression, investigated the relationship with the clinicopathological characteristics and the number of microvessels. RESULTS: 57% of cancer tissues showed abnormally high levels of p73 mRNA. In quantitative genomic DNA PCR, the p73 was over-expressed in the transcription level. Through allotyping with Sty I polymorphism, the over-expression of p73 was due to the transcription activity of the silent allele. In RT-PCR-SSCP analysis of over-expressed specimens, sequence alterations was not seen. In 73%, VEGF was over-expressed while TSP-1 was under-expressed in 35%. There was no association between the number of microvessels with the over-expression of p73 and VEGF, but inversely associated with the under-expression of TSP-1. There was no correlation between the over-expression of p73 and the clinicopathological characteristics. The over-expression of p73 coincided 80% with the over-expression of VEGF, and 40% with the under-expression of TSP-1. CONCLUSION: These data support the expression of p73 was increased in cervical cancer tissues and was associated with the over-expression of the VEGF but not associated with the under-expression of TSP-1. The biological and clinical significance of the over-expression of p73 should be studied further in the future.
Alleles ; Angiogenesis Inducing Agents ; DNA ; Microvessels ; Polymerase Chain Reaction ; RNA, Messenger ; Thrombospondin 1* ; Uterine Cervical Neoplasms ; Vascular Endothelial Growth Factor A*

BACKGROUND: Recently, body composition analyzer has been used widely clinically. Various indirectly measured values of body are calculated without direct measuring. The abdominal circumference that is presented by such instrument may be used for diagnosing abdominal obesity, but the reliable evidence of the accuracy and the validity may be not be enough for application to general population. For this reason, the author investigated the usefulness of automatically produced abdominal circumference for diagnosing abdominal obesity. METHODS: The medical records of 5,555 outpatients who had undergone body composition analysis in a tertiary hospital was collected. The usefulness of the automatically presented abdominal circumference for diagnosing abdominal obesity among general population was investigated. RESULTS: There was a significant positive correlation between abdominal circumference measured by body composition analyzer and measuring tape in the normal, the overweight, and the obese groups of both gender. But, the results were the same only in females in the underweight group. The most significant difference between the two values were 4.8+/-5.0 cm in normal male group and -5.7+/-5.5 cm in female obese group. The difference of the male obese group was lesser than that of the overweight, the normal and the underweight groups. The difference of the male overweight group was lesser than that of the normal group. The difference of the female obese group was lesser than that of the overweight, the normal and the underweight groups. The sensitivity and specificity to detect abdominal obese person among the total subjects was 76.3% and 79.1%, respectively. The specificity was higher in all male and the normal female groups, wheras the sensitivity was higher in the obese and the overweight female groups. CONCLUSION: Physicians should confirm the accuracy of abdominal circumference, especially in normal males and obese female group, although the automatically presented value is convenient and reflects the manually measured one very well which is useful to diagnose abdominal obesity.
Body Composition* ; Body Mass Index* ; Female ; Humans ; Male ; Medical Records ; Obesity, Abdominal ; Outpatients ; Overweight ; Sensitivity and Specificity ; Tertiary Care Centers ; Thinness ; Waist Circumference