Intussusception is rare in adult and usually caused by organic lesions, although there is a singnificant numbeof so-called idiopathic cases. The diagnosis of intussusception have been made by pali abdomen, barium enema andsmall bowel series. But recently ultrasound and CT make a contribution to diagnose intussusception. CT is not theprimary means for evaluation a gastrointestinal tract abnormality but also provides yaluable informations inevaluating disorders affecting the hollow viscera of the alimentary tract. CT image of intussusception demonstratea whirl like pattern of bowel loops separated by fatty stripe correlating to the intestinal walls. Abdominal ultrasonogram was used as the initial diagnostic test in 2 cases out of total 4 cases, with abdominal mass ofunknown cause. It revealed a typical pattern, composed of a round or oval mass with central dense echoes andperipheral poor echoes. We report 4 all cases of intussusception in adult who were performed by CT and/orultrasound. All cases were correlated with barium enema examination and/or surgical reports.
Abdomen ; Adult ; Barium ; Diagnosis ; Diagnostic Tests, Routine ; Enema ; Gastrointestinal Tract ; Humans ; Intussusception ; Ultrasonography ; Viscera

GTP-Binding Proteins ; Receptors, Thyrotropin-Releasing Hormone ; Thyrotropin-Releasing Hormone*

BACKGROUND: Preoxygenation is a standard anesthetic technique using 100% oxygen for the prevention of hypoxia during the induction of anesthesia. Measuring end-tidal oxygen is the most useful indicator for determining the end-point of preoxygenation. We studied the effects of preoxygenation between pregnant and non-pregnant patients during 5 min of tidal volume breathing. METHODS: Non-pregnant women who were scheduled for general surgery (Group I, n = 25) and pregnant women who were scheduled for elective cesarean section (Group II, n = 20) were explained the technique of preoxygenation, which was conducted with 100% oxygen during 5 min of tidal volume breathing. End-tidal oxygen concentration was measured at 10 sec intervals for 5 min, simultaneously. RESULTS: Group II showed significantly higher end-tidal oxygen concentration than Group I from 30 sec to 170 sec during preoxygenation (P < 0.05). The mean time required for end-tidal oxygen concentration > or =90% was 110.0 +/- 31.7 sec for Group II and 152.8 +/- 34.5 sec for Group I. Therefore, Group II showed a significantly shorter time than Group I (P < 0.05). CONCLUSIONS: We concluded that the time for complete preoxygenation was shorter in pregnant patients compared to non-pregnant patients.
Anesthesia ; Anoxia ; Cesarean Section ; Female ; Humans ; Oxygen ; Pregnancy ; Pregnant Women ; Respiration ; Tidal Volume

BACKGROUND/AIMS: This study was conducted to examine the relationship between family history of type 2 diabetes (T2DM) and risk of developing gestational diabetes mellitus (GDM) in Korean women. METHODS: We performed a 100-g oral glucose tolerance test in 858 pregnant women who had abnormal glucose tolerance in 50-g oral glucose challenge. In addition, we reviewed the incidence of T2DM in the parents and siblings and analyzed the association between the familial history of T2DM and the risk of GDM. RESULTS: Of the 858 subjects, 427 were normal, and 431 were diagnosed with GDM. Compared with women with no family history of T2DM, women with first degree family history of T2DM displayed higher risk of T2DM (odd ratio: parent only 1.91, sibling only 6.24, any 2.27). CONCLUSIONS: The risk of developing GDM was significantly increased in Korean women with a family history of T2DM in first-degree relatives.
Adult ; Cluster Analysis ; Diabetes Mellitus, Type 2/*genetics ; Diabetes, Gestational/diagnosis/*genetics ; Female ; Genetic Predisposition to Disease ; Glucose Tolerance Test ; Humans ; Korea ; Male ; Parents ; Pregnancy ; Risk Factors ; Siblings

OBJECTIVE: The aim of the present study was to evaluate changes of vascular endothelial growth factor levels in maternal circulating blood during normal pregnancies and examine their relationship with maternal platelet counts. METHODS: The 33 subjects were selected from healthy normotensive women from the antenatal clinic at Korea University Medical Center, Guro Hospital. Blood samples for VEGF were taken at 7 to 8 weeks' gestation, 16 to 18 weeks' gestation, 24 to 26 weeks' gestation, 30 to 32 weeks' gestation, 37 to 41 weeks' gestation. Serum and plasma were extracted from all samples, and VEGF concentrations were measured in duplicates by competitive enzyme immunoassay. The 23 of them, the platelet counts were performed with an automated blood Coulter counter. RESULTS: Serum VEGF levels during normal pregnancies were mean 6.73 ng/mL at 7-8 weeks' gestation, 7.88 ng/mL at 16-18 weeks' gestation, 7.18 ng/mL at 24-26 weeks' gestation, 8.42 ng/mL at 30-32 weeks' gestation, 14.03 ng/mL at 37-41 weeks' gestation. Plasma VEGF levels were mean 5.50 ng/ mL at 7-8 weeks' gestation, 7.23 ng/mL at 16-18 weeks' gestation, 7.98 ng/mL at 24-26 weeks' gestation, 7.35 ng/mL at 30-32 weeks' gestation, 14.05 ng/mL at 37-41 weeks' gestation. The trends in the mean VEGF levels were similar between serum and plasma, with stable levels until 30 to 32 weeks' gestation, and then the levels were increased. There was no significant difference between serum VEGF levels and plasma VEGF levels (p=0.236) and no correlation between circulating VEGF levels and platelet counts. CONCLUSION: Our data suggests that platelets may not be the origin of elevated VEGF levels in normal pregnancies because there was no correlation between VEGF levels and platelet counts.
Academic Medical Centers ; Blood Platelets* ; Female ; Humans ; Immunoenzyme Techniques ; Korea ; Plasma ; Platelet Count* ; Pregnancy* ; Vascular Endothelial Growth Factor A*

PURPOSE: Tamoxifen has been prescribed as a very effective hormonal agent not only for the treatment of breast cancer, but also for the prevention of the disease. The development of resistance to tamoxifen is one of the most important obstacles to hormonal therapy of breast cancer. HER2 or EGFR expression has been reported to be associated with the development of tamoxifen resistance. This study was performed to evaluate the effect of HER2 and EGFR inhibition on tamoxifen resistance using tamoxifen-resistant breast cancer cells (T47D:A18/4-OHT cells). METHODS: Tamoxifen-resistant T47D:A18/4-OHT cells were established by long-term treatment of 1micrometer 4-hydroxytamoxifen on T47D:A18 human breast cancer cells. The effect of HER2 and EGFR inhibition was investigated by the use of a cell proliferation assay with treatment of trastuzumab, a monoclonal antibody to the extracellular domain of the human HER2 receptor, and ZD1839, an ERFR tyrosine kinase inhibitor. RESULTS: In contrast to T47D:A18 cells, T47D:A18/4-OHT cells showed estrogen-independent proliferation and partial regulation by treatment with tamoxifen. With a single treatment of trastuzumab or ZD1839, T47D:A18/4-OHT cell growth was reduced to 77.8% (P=0.15) or 74.4% (P=0.034) respectively, as compared to untreated cells. Combinational treatment with 1 nM estradiol resulted in a further reduction of T47D:A17 cell proliferation by 83.6% (P=0.002) for trastuzumab and 77.7% (P=0.047) for ZD1839, as compared to the single treatments. CONCLUSION: Tamoxifen resistance could be partially regulated by inhibition of HER2 or EGFR in T47D:A18/4-OHT cells, especially in combination with a low dose of estradiol. This effect may provide an important clue to overcome tamoxifen resistance in the treatment of breast cancer.
Antibodies, Monoclonal, Humanized ; Breast ; Breast Neoplasms ; Cell Proliferation ; Estradiol ; Humans ; Protein-Tyrosine Kinases ; Quinazolines ; Tamoxifen ; Trastuzumab

PURPOSE: To assess the value of preoperative ultrasonography (US) - guided skin marking for the investigation of cervical lymph node (LNs) metastasis in papillary cancer patients who had not undergone evaluation of cervical LNs at the initial diagnosis. METHODS: We evaluated cervical lymph nodes in 40 patients with papillary thyroid cancer. Ultrasonography wasperformed just prior to surgery. The shape, echogenicity, size, and location of lymph nodes were noted and the location of lymph nodes was marked on the skin surface with a pen under ultrasound guidance. The retrieved lymph nodes underwent intraoperative frozen section analysis to plan the extent of surgery. RESULTS: One hundred thirty two LNs were detected on preoperative US, 1087 LNs were surgically removed. Of 40 patients, 28 patients had lymph node metastasis. The cystic appearance, the presence of calcifications, hyperechogenicity and the absence of an echogenic hilum were significantly greater in malignant LNs than in benign LNs (P< 0.001). Among these, the cystic appearance and the presence of calcifications showed a very high specificity and seemed to be the most reliable in indicating malignant LNs. CONCLUSION: In papillary thyroid cancer patients, preoperatively ultrasound-guided localization of cervical LNs with skin marking shows good potential to determine surgical extent. Ultrasound features of LNs help in the selection of the node to remove with intraoperative frozen section analysis.
Diagnosis ; Frozen Sections ; Humans ; Lymph Nodes* ; Neoplasm Metastasis ; Sensitivity and Specificity ; Skin* ; Thyroid Gland* ; Thyroid Neoplasms* ; Ultrasonography

Background: To test the hypothesis that Galphas gene mutation may suppress the expression of TRH-R gene, we investigated whether hTRH-R gene expression is lower in human GH-secreting pituitary adenomas with Galphas mutation than in tumors without the mutation. Method: TRH-induced paradoxical response of GH was observed in 8 acromegalic patients. The mutation of gene was identified by direct sequencing of the genomic DNA prepared from GH-secreting pituitary adenomas. The expression of hTRHT mRNA was quantitated by RT-PCR. Results: The transcript of hTRH-R gene was detected in 6 of 8(75%) tumors. Three of these(50%) showed the paradoxical GH response to TRH and the other three patients did not show the response. The relative expression of hTRH-R mRNA in the tumors from patients with the paradoxical response of GH to TRH did not differ from that in the tumors from patients without the paradoxical response. Direct PCR sequencing of Galphas disclosed a mutant allele and a normal allele only at codon 201 in 4 of 8 tumors. The paradoxical response to TRH was observed in 2 of 4 patients without the mutation, and 2 of 4 patients with the mutation. The hTRH-R gene expression of pituitary adenomas did not differ between the tumors without the mutation and those with mutation. Conclusion: This study suggests that the expression of TRH-R gene is not likely to be a main determinant for the paradoxical response of GH to TRH, and that Galphas mutation does not seem to suppress the gene expression of TRH-R in GH secreting adenoma.
Acromegaly ; Adenoma* ; Alleles ; Codon ; DNA ; Gene Expression ; Growth Hormone-Secreting Pituitary Adenoma ; GTP-Binding Proteins ; Humans ; Pituitary Neoplasms ; Polymerase Chain Reaction ; Receptors, Thyrotropin-Releasing Hormone* ; RNA, Messenger

PURPOSE: Cervical lymph node metastases are quite common in papillary thyroid cancer and the spreading route of a metastasis is usually in a sequential fashion. However, skip metastasis is not uncommon in node-positive papillary thyroid cancer. The goal of this study was to evaluate the pattern of cervical lymph node metastases in papillary thyroid cancer. METHODS: A total of the 265 patients with papillary thyroid carcinoma that underwent a total thyroidectomy and cervical lymph node dissection between January 2006 and August 2007 were enrolled in the study. Medical records were reviewed for analyses of the pattern of cervical lymph node metastasis. RESULTS: Cervical lymph node metastases were noted in 39.2% of the total cases and in 27.9% of the 197 patients that had only central lymph node dissection and 48.5% of the 68 patients that had central and lateral lymph node dissections. Among the cases of central and lateral node dissection, skip metastasis, lateral lymph node metastasis without central lymph node metastasis, was observed in 4 (5.8%) of the cases and a false positive result of node dissection was confirmed in 19 (28.1%) cases. CONCLUSION: For complete surgery of papillary thyroid carcinoma, a thorough examination of the cervical lymph node is required. Acareful consideration of the possibility of skip metastasis and false positive results in cervical lymph node dissection, especially in the lateral compartment, is necessary.
Humans ; Lymph Node Excision ; Lymph Nodes* ; Medical Records ; Neoplasm Metastasis* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: For the accurate diagnosis of non-palpable breast lesions with microcalcification, a localization and biopsy procedure should be performed by using mammography. Recently, a stereotactic vacuum-assisted biopsy has been reported as a convenient and accurate method for a procedure. This study was performed to determine whether the upright add-on type stereotactic biopsy was suitable for the diagnosis of microcalcified breast lesions in Korean women. METHODS: Between April 2002 and March 2003, an upright add-on type stereotactic vacuum-assisted biopsy was performed in 21 cases with microcalcification; that had been categorized from 2 to 5 according to the BI-RADS (Breast Imaging Reporting and Data System). The microcalcified lesions in biopsy specimens were confirmed with tissue mammogram and a pathological review performed. RESULTS: The pathological findings revealed fibrocystic changes in 15 cases, intraductal papilloma in 1 and ductal carcinoma in situ (DCIS) in 5. There were no malignancy among the BI-RADS category 2 & 3 cases, but DCIS was found in 2 (25%) out of 8 BI-RADS category 4 cases, and in all 3 (100%) of BI-RADS category 5 cases. The malignancy detection rate among the cases with microcalcification with a BI-RADS category above 4 was 45.4% (5/11). CONCLUSION: An upright add-on type stereotactic vacuum assisted biopsy is an accurate, safe and very convenient tool for the diagnosis of breast lesions with microcalcification.
Biopsy* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Diagnosis* ; Female ; Humans ; Mammography ; Papilloma, Intraductal ; Vacuum