No abstract available.
Acute Kidney Injury* ; Carbon Monoxide* ; Carbon* ; Rhabdomyolysis*

PURPOSE: Hypertrophic osteoarthropathy(HOA) is a clinical syndrome consisting of clubbing, periostitis and synovitis. Most frequent causes of hypertrophic osteoarthropathy are intrathoracic neoplasms, among which the bronchogenic carcinoma ranks the highest. But computed tomographic evaluation of intrathoracic neoplasm associated with HOA has been seldom reported. The purpose of this study is to evaluate CT findings of intrathoracic neoplasm associated with HOA, and to infer possible mechanism. MATERIALS AND METHODS: Seven cases of intrathoracic neoplasm associated with HOA were included in our study. Diagnoses of HOA were made by Tc99m bone scintigraphy or plain radiography. The findings of chest CT scans were reviewed retrospectively, with main interests on their size, location and internal characteristics, ect. RESULTS: Seven cases of intrathoracic neoplasm consisted of five bronchogenic carcinomas and two thymic tumors. The size of intrathoracic tumors were relativelY, large ranging from 6cm to 13cm(average 8.0cm). All thoracic neoplasms showed wide pleural contact, and one of them invaded thoracic wall. The range of length of pleural contact was 5-18cm(average 9.9cm). All of seven patients had internal necrosis, and one of them showed cavitation in thoracic mass. CONCLUSION: lntrathoracic neoplasms associated with HOA had a tendency to be large, to contain internal necrosis, and to widely abut the thoracic pleura.
Carcinoma, Bronchogenic ; Diagnosis ; Humans ; Necrosis ; Periostitis ; Pleura ; Radiography ; Radionuclide Imaging ; Retrospective Studies ; Synovitis ; Thoracic Neoplasms ; Thoracic Wall ; Thymus Neoplasms ; Tomography, X-Ray Computed

PURPOSE: This study investigated the natural course of strabismus associated with thyroid ophthalmopathy. METHODS: A retrospective review was performed on the medical records of 31 patients with strabismus associated with thyroid ophthalmopathy who had been followed up for more than 6 months and had not received surgery. For the purpose of this study, a significant change of deviation angle was defined as more than 10 prism diopters in the primary position. RESULTS: Forty-two percent of patients showed a significant change in deviation angle during the observation period of 23.8+/-17.7 months. The direction of the change was vertical in 32%, horizontal in 3%, and vertical and horizontal in 6% of patients. A significant change of deviation angle developed in 30% of patients within 6 months from the initial ophthalmologic examination, in 24% between 6 and 12 months, and in 13% of patients between 12 and 18 months from the initial examination. CONCLUSIONS: Although the deviation angle of strabismus associated with thyroid ophthalmopathy tended to stabilize with time, it nonetheless was susceptible to change even 12 months after the initial ophthalmologic examination. In addition, a vertical change in the deviation angle was more frequent than a horizontal change.
Humans ; Medical Records ; Retrospective Studies ; Strabismus* ; Thyroid Gland*

OBJECTIVE: The purpose of this study attempts to determine the endocrinologic characteristics and changes in glucose metabolism before/during pregnancy according to different body weights in women with Polycystic ovarian syndrome (PCOS). METHODS: 94 women dia with PCOS were evaluated through measuring serum hormone levels and oral glucose tolerance tests preconceptionally and gestationally. RESULTS: In patients who were of normal weight showed significantly increased serum LH levels compared to those who were overweight (12.8+/-0.9 Vs. 7.1+/-0.8 mIU/ml, p= 0.000), and the serum levels of insulin was increased significantly in the overweight group (7.1+/-0.7 Vs. 15.2+/-2.8 ulU/ml, p= 0.000). the IGFBP-I (32.8+/-10.6 Vs. 8.3+/-2.5 ng/ml, p=0.034) and SHBG (55.8+/-4.2 Vs. 37.1+/-3.1 nmol/ml, p= 0.001) were significantly lower in the ovnweight group. The oral glucose tolerance test before/after pregnancy showed increased frequency of abnormal glucose metabolism, in both of the non-obese group (38.8%, 26,9%) and the obese group (64.2%, 53.9%) compared with normal population. CONCLUSION: It is thought that in the normal weight group with polycystic ovarian syndrome androgen production is stimulated in the theca cells by abnormally high LH secretion, while in the overweight group the hyperinsulinemia state which decreases the SHBG and IGFBP-I, lead to increase biologically active hee androgens and IGF-I and increase insulin binding to its receptor. And during/before pregnancy, women with PCOS showed that incidence of abnormal glucose metabolism was significantly increased in both of non-obese and obese groups.
Androgens ; Body Weight ; Female ; Glucose Tolerance Test ; Glucose* ; Humans ; Hyperinsulinism ; Incidence ; Insulin ; Insulin-Like Growth Factor I ; Metabolism* ; Obesity ; Overweight* ; Polycystic Ovary Syndrome* ; Pregnancy* ; Theca Cells

PURPOSE: We investigated the hormonal control of OB gene expression and leptin secretion in cultured human visceral adipose tissue. METHODS: Visceral adipose tissues were cultured for up to 48 hrs in modified Eagle's medium with varying concentration of hormones : Control(no hormone), bovine insulin(100 nM), Dexamethasone(DEX, 100 nM), growth hormone(GH, 40 ng/mL), insulin + DEX(100 nM each), insulin + DEX + GH(100 nM insulin and DEX, 40 ng/mL GH). Quantitative analysis of leptin mRNA was performed by competitive reverse transcription polymerase chain reaction, and leptin secretion in culture medium was measured by IRMA using a commercial kit. RESULTS: The addition of dexamethasone to the medium significantly increased OB gene expression and leptin secretion(P<0.05). Unlike dexamethasone, insulin did not affect OB gene expression and leptin secretion. Both insulin and dexamethasone, at high concentration, significantly stimulated leptin secretion compared with basal values(P<0.05). Leptin gene expression was not significantly increased by GH treatment alone, however GH, in combination with high concentrations of insulin and dexamethasone, attenuated the stimulatory effects of high concentrations of insulin and dexamethasone. CONCLUSION: Insulin cannot increase leptin secretion without the presence of dexamethasone. The mechanism suggested is that insulin may increase leptin secretion in cytoplasm only after dexamethasone increases the expression of OB gene. Further studies are necessary to elucidate the mechanism of the action of insulin on leptin secretion after increasing OB gene expression by dexamethasone.
Cytoplasm ; Dexamethasone* ; Gene Expression* ; Growth Hormone* ; Humans* ; Insulin* ; Intra-Abdominal Fat* ; Leptin* ; Polymerase Chain Reaction ; Reverse Transcription ; RNA, Messenger

OBJECTIVE: We compared the expression pattern of progesterone receptor, integrin 3, cyclooxygenase-2 (COX-2) in in-phased endomerium of patient with the disease related implantation and control group, and tried to confirm the clinical efficacy of the immunohistochemical markers for discrimination of occult uterine receptivity defect in in-phase endometrium. STUDY DESIGN: Endometrial tissues were obtained from 60 women with normal (group 1; n = 20), uterine synechiae (group 2; n = 15), and endometriosis (group 3; n = 25). On 7 ~ 8 days after ovulation (POD 7 ~ 8), sex hormone levels were measured and immunohistochemical staining of PR, integrin 3, and COX-2 expression were performed. RESULTS: PR was decreased in the group 2 and increased in the group 3 comparing with the group 1. integrin 3 expression was significantly decreased in the group 2 and 3. COX-2 expression was significantly decreased in the group 2. But, in the group 3, COX-2 expression was slightly increased in glandular epithelial cells, and significantly increased in stromal cells. CONCLUSIONS: In-phase biopsies from patients with endometriosis and uterine synechiae showed different expression pattern of integrin 3, COX-2, and PR compared to the control. The aberrant expression of immunohistochemical markers be associated with occult uterine receptivity defect and produce the useful diagnostic method.
Biopsy ; Cyclooxygenase 2* ; Discrimination (Psychology) ; Endometriosis ; Endometrium* ; Epithelial Cells ; Female ; Gynatresia ; Humans* ; Ovulation ; Progesterone* ; Receptors, Progesterone* ; Stromal Cells

PURPOSE: Leptin is a product of ob gene in adipose tissue. This is a important factor for regulation of body weight, especially body fat mass. So it is interested in correlation of leptin with obesity or various diseases related with obesity, particularly diabetes mellitus. It was demonstrated that leptin level was increased in type 2 diabetes and insulin was associated with increased leptin level. This study is to measure leptin levels in type 1 diabetes without insulin resistance, to validate whether insulin increases leptin level and to investigate correlation of leptin with degree of diabetic control and pubertal progression. METHODS: This study included 114 children(boys; 57, girls; 57) with type 1 diabetes, whose blood samples were taken to measure leptin level using RIA(radioimmunoassay). We observed the correlation of leptin with body mass index, HbA1c, insulin dose, duration of disease, and pubertal degree. RESULTS: Mean values of age, BMI, insulin dose, and HbA1c at the measurement of leptin were 13.0+/-5.04 years-old, 18.9+/-3.5kg/m2, 36U/day, and 8.9+/-2.1%, respectively. Thirty seven children were prepubertal and fifty seven children had pubertal characteristics and the rests were not confirmed. With increment of BMI, serum leptin levels were significantly increased in the all subjects, with the same correlation in pubertal female group, but not in pubertal male. There was a relatively weak correlation(r=0.29) of leptin levels with insulin doses. In prepubertal male, there was a significant positive correlation(r=0.55) of leptin with insulin dose, whereas in pubertal male there was shown negative correlation(r=-0.41). Female patients had a significantly higher leptin levels than male, irrespective of pubertal changes or BMI. There was not a significant correlation of leptin levels with duration of diabetes and HbA1c level. CONCLUSION: It is suggested that blood levels of insulin and sex hormones play an important roles in determining the levels of leptin.
Adipose Tissue ; Body Mass Index ; Body Weight ; Child* ; Diabetes Mellitus ; Diabetes Mellitus, Type 1* ; Female ; Gonadal Steroid Hormones ; Humans ; Insulin ; Insulin Resistance ; Leptin* ; Male ; Obesity

PURPOSE: Infiltrating lobular carcinoma (ILC) represents approximately 10% of all breast cancers. Its detection and staging for appropriate surgical planning may be difficult on account of its unique growth pattern, including a linear file arrangement of the tumor cells and a planar growth pattern and the resulting low density of the lesions. The purpose of this study was to evaluate the clinicopathological features of an ILC of the breast including multifocality, the preoperative accuracy of the pathological diagnostic tools, and its impact on the surgical procedure. METHODS: Between 1997 and 2003 at the Asan Medical Center, a group of 63 patients with a pathologically proven invasive lobular carcinoma who had undergone surgery were included. They were all in stage I~III, and their medical records, mammographic and sonographic results, and pathologic findings were reviewed retrospectively. RESULTS: Of the 63 patients with a mean age of 48 years (range 35 to 70), multifocal lesions were identified in 27.0% by a pathological examination. For a preoperative evaluation of a multifocal lesion, the sensitivity and positive prediction value were 21.4% and 50% by mammography, and 92.9% and 52.0% by ultrasonography, respectively. Only 27.0% of all patients were confirmed as having an ILC preoperatively; surgical excision or incision biopsies 75%, core-needle biopsy 36.4%, frozen biopsy 22.7%, FNA 5.9%. Conservative surgery was performed in only 14.3% and a mastectomy was performed on 85.5%. The mean tumor size was 3.0 cm, and according to the TNM stage, stage I was found in 22.2%, stage II in 58.7%, stage III in 19.1%. ER-positive was found in 83.9% and PR-positive was found in 74.2%. Seven out of 11 patients, who underwent the planed conserving surgery, had a positive resection margin, 1 case had re- excision, 2 cases underwent mastectomies, and 4 cases underwent radiation therapy without additional surgery. CONCLUSION: Since invasive lobular carcinomas have more often multifocal lesions and a preoperative accurate evaluation may be difficult pathologically or radiologically, a careful evaluation of the accurate tumor extent as well as the multifocal lesion is needed particularly for patients with an ILC considering conserving surgery.
Biopsy ; Breast* ; Carcinoma, Lobular* ; Chungcheongnam-do ; Diagnosis* ; Humans ; Mammography ; Mastectomy ; Medical Records ; Retrospective Studies ; Ultrasonography

PURPOSE: Anti-insulin antibodies develop within several months of initiation of insulin therapy in most of diabetic patients. The purpose of this study is to observe the relationship between the clinical factors and development of anti-insulin antibody METHODS: Serum was collected from 116 diabetic patients and 47 nondiabetic children for the measurement of anti-insulin antibody titer by radioimmunoassay (RIA). Retrospective analysis of the medical records of clinical factors were evaluated. RESULTS: There was no relationship of anti-insulin antibody titer with age, duration, HbA1c, insulin dose, and BMI in diabetic children. There was no difference in anti-insulin antibody titer according to the sex, the presence of family history, the presence of DKA, the presence of complications, the presence of puberty, species of insulin, duration of disease in diabetic children. The titers of anti-insulin antibody were significantly higher in type 1 diabetic children(30.3+/-17.9% in type 1 and 16.5+/-7.0% in type 2, P<0.05), in which the daily insulin doses were significantly higher than in type 2 DM patients. Additionally, anti-insulin antibody titers were significantly lower in well-controlled DM patients (HbA1c<7%), in which daily insulin doses also were significantly lower than in DM patients whose HbA1c>7%. The positive rates of anti-insulin antibody were higher in male patients with diabetes(73.2% in male and 53.3% in female, P<0.05). The positive rates of anti-insulin antibody were significantly higher in DM patients without diabetic ketoacidosis at DM onset than in DM patients with diabetic ketoacidosis at DM onset & also were higher in poorly-controlled group(HbA1c>7%). CONCLUSION: The results suggests that anti-insulin antibody developed more likely in type 1 DM and less likely in DM patients whose control had been good and who used less insulin doses, which remains to be studied further with more patients for longer duation.
Adolescent ; Antibodies ; Child* ; Diabetic Ketoacidosis ; Female ; Humans ; Insulin ; Male ; Medical Records ; Puberty ; Radioimmunoassay ; Retrospective Studies

Purpose: To assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) for additional MR-detected enhancing lesions and to determine whether or not kinetic pattern results comparable to dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) of the breast can be obtained using the quantitative analysis of CEUS. Materials and Methods: In this single-center prospective study, a total of 71 additional MR-detected breast lesions were included. CEUS examination was performed, and lesions were categorized according to the Breast Imaging-Reporting and Data System (BI-RADS). The sensitivity,specificity, and diagnostic accuracy of CEUS were calculated by comparing the BI-RADS category to the final pathology results. The degree of agreement between CEUS and DCE-MRI kinetic patterns was evaluated using weighted kappa. Results: On CEUS, 46 lesions were assigned as BI-RADS category 4B, 4C, or 5, while 25 lesions category 3 or 4A. The diagnostic performance of CEUS for enhancing lesions on DCE-MRI was excellent, with 84.9% sensitivity, 94.4% specificity, and 97.8% positive predictive value. A total of 57/71 (80%) lesions had correlating kinetic patterns and showed good agreement (weighted kappa = 0.66) between CEUS and DCE-MRI. Benign lesions showed excellent agreement (weighted kappa = 0.84), and invasive ductal carcinoma (IDC) showed good agreement (weighted kappa = 0.69). Conclusion The diagnostic performance of CEUS for additional MR-detected breast lesions was excellent. Accurate kinetic pattern assessment, fairly comparable to DCE-MRI, can be obtained for benign and IDC lesions using CEUS.