Tamoxifen is an oral triphenylethylene antiestrogen that has been used for breast cancer, but also inhibits protein kinase C(PKC) in a minority of malignant gliomas. Tamoxifen was administered orally in very high dose to a female brain stem glioma patient who had failed treatment with external beam hyperfractionated radiaton therapy and additional chemotherapy. Tumor reduction on MRI with clinical improvement occurred. Complications were mild thrombocytopenia, elevaton of transaminases and profuse production of hairs around both nipples and face. Although several patients with brain stem glioma had been treated with tamoxifen in our hospital, only one patient responded. Further study for the mechanism of tamoxifen activity to malignant glioma and patient characteristic evaluation will be required.
Brain Stem* ; Brain* ; Breast Neoplasms ; Drug Therapy* ; Estrogen Receptor Modulators ; Female ; Glioma* ; Hair ; Humans ; Magnetic Resonance Imaging ; Nipples ; Protein Kinases ; Radiotherapy* ; Recurrence* ; Tamoxifen* ; Thrombocytopenia ; Transaminases

Traumatic injury can result not only in physical disability but also in mental and behavioral sequelae. It is very important to properly judge the severity of disability as well as the need for assistance and future medical treatment. It is very difficult to establish objective guidelines for assessing mental and behavioral disabilities due to the inherent peculiarity of the disabilities. This study uses reports generated for court because they need to be more judicious than reports for other types of evaluation. We analyzed reports concerning the facts and problems associated with evaluation of mental and behavioral disabilities. We hope this study will help further our understanding of mental and behavioral disabilities.

OBJECTIVES: The clinical manifestations of gout in Korea would be changed lately according to the rapid economical development and the development of diagnostic methods. This study was done to reveal the late clinical features of gout in Korea. METHODS: A retrospective study was done for the 90 gout patients who had been treated in Seoul Paik Hospital from March 1974 to August 1994. Age of onset, sex, duration of disease, serum uric acid level, uric acid concentration of 24 hour urine, joint of first attack, recurrently involved joints, X-ray of involved joint, frequency of tophi, renal ultrasonography, and associated diseases were analyzed. The uric acid levels of the 808 civilians who visited our hospital for the periodic health examination were used as a control value. RESULTS: 1) The serum uric acid level in Korean adults was 5.2+/-1.1mg/dL in male, 3.8+/-0.7mg/dL in female, and 4.7mg/dL in general. The serum uric acid concentration of the gout patients was 8.6+/-2.2mg/dL in male, 6.1+/-2.1mg/dL in female, and 8.5+/-2.3mg/dL in general. The age of onset was 46.4+/-12.9 years old and male to female ratio was 44: 1 2) The renal excretion of uric acid was 470+/-173 mg/day in gout patients. 3) The sites of first attack were first MTP joint(76%), tarsal joint(13%), knee(5%), and other MTP joints(5%) 4) The involved joints during the repeated attacks were first MTP joint(84%), tarsal joint(23%), and fingers(23%), The duration of disease was significantly longer and the serum uric acid concentration was higher in the patients with tophi than they are in the patients without. 5) The 4l% of patients showed hone change in X-ray. 6) The renal ultrasound examinations were abnormal in 42% of the patients and the serum uric acid concentrations were significantly higher. 7) Obesity was found in 68% of patients, hypertension in 39%, hyperlipidemia in 16%, and chronic renal disease in 12%. CONCLUSION: The clinical features of gout in our study were similar to those of others done in and out of Korea, except that the frequency of hypertringlyceridemia was much lower than that of the foreign countries.
Adult ; Age of Onset ; Arthritis, Gouty ; Female ; Gout* ; Humans ; Hyperlipidemias ; Hypertension ; Hyperuricemia ; Joints ; Korea* ; Male ; Obesity ; Renal Insufficiency, Chronic ; Retrospective Studies ; Seoul ; Ultrasonography ; Uric Acid

PURPOSE: Laparoscopic cholecystectomy (LC) is the standard management for acute cholecystitis. Percutaneous transhepatic gallbladder drainage (PTGBD) may be an alternative interim strategy before surgery in elderly patients with comorbidities. This study was designed to evaluate the safety and efficacy of PTGBD for elderly patients (>60 years) with acute cholecystitis. METHODS: We reviewed consecutive patients diagnosed with acute cholecystitis between January 2009 and December 2013. Group I included patients who underwent PTGBD, and patients of group II did not undergo PTGBD before LC. RESULTS: All 116 patients (72.7 +/- 7.1 years) were analyzed. The preoperative details of group I (n = 39) and group II (n = 77) were not significantly different. There was no significant difference in operative time (P = 0.057) and intraoperative estimated blood loss (P = 0.291). The rate of conversion to open operation of group I was significantly lower than that of group II (12.8% vs. 32.5%, P < 0.050). No significant difference of postoperative morbidity was found between the two groups (25.6% vs. 26.0%, P = 0.969). In addition, perioperative mortality was not significantly different. Preoperative hospital stay of group I was significantly longer than that of group II (10.3 +/- 5.7 days vs. 4.4 +/- 2.8 days, P < 0.050). However, two groups were not significantly different in total hospital stay (16.3 +/- 9.0 days vs. 13.4 +/- 6.5 days, P = 0.074). CONCLUSION: PTGBD is a proper preoperative management before LC for elderly patients with acute cholecystitis.
Aged* ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute* ; Comorbidity ; Drainage* ; Gallbladder* ; Humans ; Length of Stay ; Mortality ; Operative Time

The squamous cell carcinoma of ovary is very rare in the ovarian malignancy. The majority of squamous cell carcinomas of ovary are considered to be associated with mature cystic teratoma, Brenner tumor and malignant degenerated endometriosis. Therefore, pure ovarian squamous cell carcinoma is extremely rare. The pathogenesis, prognosis and proper treatment guideline of this malignancy are still unknown, because of it's rarity. Recently we experienced a case of primary squamous cell carcinoma without previously commented disease condition. After nearby cytoreductive surgery, postoperative chemotherapy with radiotherapy has been undergoing. We report this malignancy with a brief review of literature.
Brenner Tumor ; Carcinoma, Squamous Cell* ; Drug Therapy ; Endometriosis ; Female ; Ovary* ; Prognosis ; Radiotherapy ; Teratoma

Bone Morphogenetic Protein 1 ; Carrier Proteins ; Cell Count ; Cell Cycle ; DNA, Complementary ; Fibroblasts ; Gingival Hyperplasia ; Glutaminase ; Humans ; Keratin-7 ; Oligonucleotide Array Sequence Analysis ; Organ Transplantation ; Protein Kinases ; Protein Phosphatase 1 ; Receptor, Epidermal Growth Factor ; Ribosomal Proteins ; Transcription Factors ; Transplants

The silver nanocrystalline is widely used for biological field because of its biocompatibility and anti-microbial effect. The objective of this study was to evaluate the therapeutic efficacy of the silver nanocrystalline ointment on the temporomandibular joint (TMJ) capsulitis. Total 39 patients were included in this study and all patients were received single topical application of the silver nanocrystalline ointment (group A, n=30) or placebo ointment (group B, n=19). Measured variables were maximum mouth opening (MMO), visual analog scale (VAS) for pain, and VAS for function. In results, we could not assess any therapeutic efficacy of single application in the chronic TMJ capsulitis (p>0.05). However, the single application of silver nanocrystalline ointment showed significant improvement in MMO and VAS for pain compared to placebo effect in the acute TMJ capsulitis (p<0.05). We could not find any complications related to ointment application in both groups. In conclusion, the single application of silver nanocrystalline ointment was effective in improving patient's symptom in acute TMJ capsulitis without any noticing complications.
Humans ; Mouth ; Placebo Effect ; Silver* ; Temporomandibular Joint* ; Visual Analog Scale

PURPOSE: Extremely elderly patients who present with complicated gallstone disease are less likely to undergo definitive treatment. The use of laparoscopic cholecystectomy (LC) in older patients is complicated by comorbid conditions that are concomitant with advanced age and may increase postoperative complications and the frequency of conversion to open surgery. We aimed to evaluate the results of LC in patients (older than 80 years). METHODS: We retrospectively analyzed 302 patients who underwent LC for acute cholecystitis between January 2011 and December 2013. Total patients were divided into three groups: group 1 patients were younger than 65 years, group 2 patients were between 65 and 79 years, and group 3 patients were older than 80 years. Patient characteristics were compared between the different groups. RESULTS: The conversion rate was significantly higher in group 3 compared to that in the other groups. Hematoma in gallbladder fossa and intraoperative bleeding were higher in group 3, the difference was not significant. Wound infection was not different between the three groups. Operating time and postoperative hospital stay were significantly higher in group 3 compared to those in the other groups. There was no reported bile leakage and operative mortality. Preoperative percutaneous transhepatic gallbladder drainage and endoscopic retrograde cholangiopancreatography were performed more frequently in group 3 than in the other groups. CONCLUSION: LC is safe and feasible. It should be the gold-standard approach for extremely elderly patients with acute cholecystitis.
Aged* ; Bile ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute ; Conversion to Open Surgery ; Drainage ; Gallbladder ; Gallstones ; Hematoma ; Hemorrhage ; Humans ; Length of Stay ; Mortality ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome ; Wound Infection

INTRODUCTION: This study evaluated the capability of silk fibroin (SF) and recombinant human bone morphogenetic protein-2 loaded SF (SF-BMP) as a bone defect replacement matrix when grafted in a calvarial bone defect of rats in vivo. MATERIALS AND METHODS: A total 70 calvarial critical size defects (5.0 mm in diameter) made on 35 adult female Sprague-Dawley rats were used in this study. The defects were transplanted with (1) rhBMP-2 loaded silk fibroin graft (SF-BMP: 0.8+10 microg), (2) Silk fibroin (SF: 10 microg), and (3) no graft material (Raw). The samples were evaluated with soft x-rays, alkaline phosphatase activity, calcium/phosphate quantification, histological and histomorphometric analysis at postoperative 4 and 8 weeks. RESULTS: The SF-BMP group (48.86+/-14.92%) had a significantly higher mean percentage bone area than the SF group (24.96+/-11.01%) at postoperative 4 weeks.(P<0.05) In addition, the SF-BMP group (40.01+/-12.43%) had a higher % bone area at postoperative 8 weeks than the SF group (33.26+/-5.15%). The mean ratio of gray scale levels to the host bone showed that the SF-BMP group (0.67+/-0.08) had a higher mean ratio level than the SF group (0.61+/-0.09) at postoperative 8 weeks. These differences were not statistically significant.(P=0.168 and P=0.243, respectively) CONCLUSION: The rhBMP-2 loaded silk fibroin graft revealed fewer immunoreactions and inflammation as well as more new bone formation than the pure silk fibroin graft. Therefore, silk fibroin may be a candidate scaffold for tissue engineered bone regeneration.
Adult ; Alkaline Phosphatase ; Animals ; Bone Morphogenetic Protein 2 ; Bone Regeneration ; Female ; Fibroins ; Humans ; Inflammation ; Osteogenesis ; Rats ; Rats, Sprague-Dawley ; Recombinant Proteins ; Silk ; Tissue Scaffolds ; Transforming Growth Factor beta ; Transplants

OBJECTIVE: The purpose of this study was to assess the impact of vascular endothelial growth factor (VEGF) in pregnancies with mild and severe preeclampsia. METHODS: From January 1999 to June 2001, we studied the severity for pregnant women with pregnancy induced hypertension between 28 and 40 weeks gestation. In the mild (n=46) and severe preeclamptic women (n=28), the laboratory evaluation included liver function test, platelet counts, and serum creatinine. The systolic/diastolic (S/D) ratio of the fetal umbilical artery flow for placental resistance was measured by ultrasonographic doppler velocimetry. To detect the damage of vascular endothelial cells in all preeclamptic women, serum concentrations of VEGF were measured. RESULTS: Severe preeclampsia had more elevated liver enzymes, thrombocytopenia, high creatinine than mild preeclampsia. HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) was encountered in 8/28 (28.6%) of severe preeclampsia. Fifteen out of twenty-eight cases (53.6%) in severe preeclampsia had elevated S/D ratio from 3.0 to 4.5 including 6 cases with absent end diastolic velocity, whereas 4/46 (8.7%) was elevated SD ratio (>3.0) in mild preeclampsia. Serum concentrations of VEGF were elevated in both mild (7.5+/-4.9 ng/mL, p<0.05) and severe preeclampsia (19.3+/-8.8 ng/mL, p<0.05) compared to normal pregnancy (0.5~2.1 ng/mL). CONCLUSION: The higher serum concentration of VEGF and elevated S/D ratio of umbilical artery were responsible for the changes of the resistance of placental blood flow in severe preeclampsia. Furthermore, elevated S/D ratio of umbilical artery velocity was essential as a surveillance method of fetal health status with IUGR (Intrauterine growth restriction) by vascular declination of placenta.
Creatinine ; Endothelial Cells ; Female ; Fetal Growth Retardation ; HELLP Syndrome ; Humans ; Hypertension, Pregnancy-Induced ; Liver ; Liver Function Tests ; Placenta ; Platelet Count ; Pre-Eclampsia* ; Pregnancy ; Pregnant Women ; Rheology ; Thrombocytopenia ; Umbilical Arteries ; Vascular Endothelial Growth Factor A*