We conducted this cohort analytic study to determine whether women with unexplained elevations of maternal serum hCG at 15-18 weeks' gestation are at increased risk for pregnancy complications and adverse perinatal outcomes. The inclusion criteria were a singleton gestation, a confirmed gestational age, and an hCG level greater than 2.0 multiples of the median (MoM). The exclusion criteria were fetal anomalies, an abnormal karyotype, molar pregnancy, and an MSAFP level greater than 2.5 multiples of the median (MoM). A group of randomly selected women with hCG levels under 2.0 MoM served as controls. Patients with elevated levels of hCG had a significantly higher risk for PIH (17.9% versus 4.5%; P <.05) and preterm delivery (17.9% versus 3.5%; P<, 05) than control. But no significant differences were observed in the incidence of intrauterine growth restriction and low birth weight and in the newborn weight. We suggested that pregnancies with unexplained elevated hCG levels should be regarded as high-risk pregnancies. And these patients require careful monitoring with adequate obstetric management.
Abnormal Karyotype ; Chorionic Gonadotropin* ; Cohort Studies ; Female ; Gestational Age ; Humans* ; Hydatidiform Mole ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome* ; Pregnancy* ; Pregnancy, High-Risk

No abstract available.
Blood Pressure* ; Echocardiography* ; Hypertension*

A 55-year-old female presented to Pusan National University Yangsan Hospital with left neck and shoulder pain. An anterior mediastinal mass was detected on chest CT and there were no other specific lesions in the lung or pleural cavity. An infected pericardial cysts was suspected and excision was performed through a left-sided VATS approach. The patient was discharged on the second post-operative day with left diaphragm palsy and praziquantel was prescribed after paragonimaisis was confirmed on pathology. The patient has not shown any particular problems at my outpatient clinic.
Ambulatory Care Facilities ; Diaphragm ; Female ; Humans ; Lung ; Mediastinal Cyst ; Mediastinum ; Middle Aged ; Neck ; Paragonimiasis ; Paralysis ; Pleural Cavity ; Praziquantel ; Shoulder Pain ; Thoracic Surgery, Video-Assisted ; Thorax

Mineralocorticoids influences on acid-base homeostasis by the regulation of urine acidification. But its mechanism of acion is not well known in human. This study compared the acid-base status and the indices of urine acidification before and after mineralocorticoid administration in human, and analyzed the effect of mineralocorticoids on human acid-base homeostasis. We administered 9a-fludrocortisone in 6 chronic renal failure patients and 6 normal controls 0.5mg daily for 7 days. The results were as following: 1) After administration of 9a-fludrocortisone in patients group, serum aldosterone level changed from 120.2+/-71.0pg/mL to 44.8+/-32.2pg/mL(mean+/-SD, p< 0.05). Serum HCO- level was not changed. Urine ammonium excretion was incresed from 24.6+/-12.3 mmol/day to 43.7+/-19.0 (p<0.05), but there were no change in urine pH and urine anion gap, Serum potassium level decreased from 5.5+/-0.7mBq/L to 4.1+/-0.5mEq/L (p<0.05), and TTKG increased from 3.9 to 8.9(p<0.05). 2) After administration of 9a-fludrocortisone in control group, serum aldosterone level changed from 99.7+/-44.5pg/mL to 25.1+/-3 mL(p<0.05). Serum HCO- level was not changed. Urine ammonium excretion was incresed from 44.3+/-21.6mmoVday to 76.3+/-19.6(p<0.05), but there were no change in urine pH and urine anion gap. Serum potassium level decreased from 4.8+/-0.5mEq/L to 3.9+/-0.2mHq/L(p< 0.05), but there was no change in TTKG. 3) No patient or control showed any discomfort after 9-fludrocortisone administration, and there was no elevation in diastolic blood pressure, increase in body weight, electrolyte abnormality. In summary, after 9alpha-fludrocortisane administration, urinary ammonium excretion increased in both patients and control group, and this phenomenon occured with correction of hyperkalemia without urine pH change. This result implies urinary ammonium excretion increase by mineralocorticoid. In human increase in renal distal acidification by mineralocorticoid is due to increase in renal ammoniagenesis rather than stimulation on proton excretion.
Acid-Base Equilibrium ; Aldosterone ; Ammonium Compounds* ; Blood Pressure ; Body Weight ; Homeostasis ; Humans ; Hydrogen-Ion Concentration ; Hyperkalemia ; Kidney Failure, Chronic ; Mineralocorticoids ; Potassium* ; Protons

The ocular manifestations of rheumatoid arthritis (RA) are common and they can vary from patient to patient. However, necrotizing anterior scleritis without inflammation (scleromalacia perforans) is a rare and serious opthalmic complication, and it is typically associated with long-standing RA. Although the etiology and pathogenesis of scleromalacia perforans are diverse and they are not completely understood, ophthalmic surgery is one of the well known causes of scleromalacia perforans. Patients with systemic autoimmune disease such as RA have an especially higher risk of scleromalacia perforans after opthalmic surgery. Because scleromalacia perforans is a potential threat not just to eyesight, but to life as well, early diagnosis and prompt treatment are required for its successful management. We experienced a case of scleromalacia perforans that developed after scleral excision of pterygium in a 58 year old woman who had a 7 year history of RA, and this was well treated with an early screral graft. We report here on this case along with a review of the relevant literature.
Arthritis, Rheumatoid ; Autoimmune Diseases ; Early Diagnosis ; Female ; Humans ; Inflammation ; Polyenes ; Pterygium ; Scleritis ; Transplants

OBJECTIVE: Endodermal sinus tumor or yolk sac tumor is an uncommon malignant germ-cell neoplasm. This tumor was originally described as a germ cell tumor of the ovary or the testis. Intracranial endodermal sinus tumor is extremely rare and usually develop in the pineal or suprasellar regions. The authors evaluated the effect of adjuvant therapy(chemotherapy combined with radiotherapy) and radical removal of intracranial endodermal sinus tumors. MATERIAL AND METHODS: Between 1996 and 2001, four patients of intracranial endodermal sinus tumor were diagnosed with tumor marker(AFP) and biopsy. Three patients were treated with surgical removal and chemotherapy with cisplatin(20mg/m2), etoposide(100mg/m2) and bleomycin(15mg/m2) as well as external beam radiation therapy. We compared the management problems for these tumors. RESULT: In all three patients the tumor size and the level of tumor marker decresed during initial adjuvant therapy. However, Tumors showed regrowth with elevated AFP of serum and CSF possibly related to delayed chemotherapeutic treatment or inadequate administration of chemotherapeutic drugs due to severe bone marrow suppression. An additional chemotherapy and external radiation therapy were given, but tumors could not be controlled with leptomeningeal seeding. CONCLUSION: Radiotherapy is considered to be less effective. The combination chemotherapy with PVB(cisplatin, vinblastine, bleomycine) or PE(cisplatin, etoposide) is considered to be value in prolongation of the survival rate. But the role of chemotherapy in this tumor has not yet been clarified due to bone marrow suppression and drug resistance. Further study with large series of this tumor is necessary to establish the optimal management.
Biopsy ; Bone Marrow ; Drug Resistance ; Drug Therapy ; Drug Therapy, Combination ; Endoderm* ; Endodermal Sinus Tumor* ; Female ; Humans ; Neoplasms, Germ Cell and Embryonal ; Ovary ; Radiotherapy ; Survival Rate ; Testis ; Vinblastine

Clinical features, laboratory and operative findings were reviewed in 17 cases adult Ebstein's anomaly admitted to Seoul National University Hospital from Feburary,1979 to October, 1987. 1) Mean age of first diagnosis was 28.6 tears old(range ; 14-57 years old). 2) Exertional duspnea(88.2%) and palpitation(64.7%) were the predominant symptoms, and PSVT was documented in 4 cases among 11 patoents with palpitation. 3) Echocardiogram showed displacement or delayed closure of the tricuspid valve in 13 cases. 4) On similtaneous recording of the intracardiac ECG and pressure, right ventricular electrogram with atrial pressure in atrialized right ventricle was observed in all cases. 5) Right ventriculogram revealed displacement of the tricuspid valve in 9 cases and tricuspid regurgitation in 10 cases. 6) Interatrial communication via ASD(8) and PFO(3) was present in 11 cases(64.7%). 7) Operative finding of 9 cases showed abnormalities of septal leaflet in 9(100%), posterior leaflet in 8(88.8%), and anterior leaflet in 2 cases(22.2%).
Adult* ; Atrial Pressure ; Diagnosis ; Ebstein Anomaly* ; Electrocardiography ; Heart Ventricles ; Humans ; Seoul ; Tricuspid Valve ; Tricuspid Valve Insufficiency

Imperforate hymen is a rare congenital malformation, but it can make hematocolpometra and complications. In most cases definite finding is noticed after menarche as retention of menstrual flow results in abdominal pain, distension of the lower abdomen and often in acute urinary retention. A case of imperforate hymen associated with hematocolpometra at age of 12 was treated satisfactorily by simple crucial incision of hymen and drained of about 450 cc of tarry blood. We present a case of imperforate hymen with a brief review of literatures concerned.
Abdomen ; Abdominal Pain ; Female ; Hymen* ; Menarche ; Urinary Retention

BACKGROUND/AIMS: The standard polyethylene glycol (PEG) solution for colonic cleansing has a salty taste and a large volume of it is required, which can cause failure for the patient to ingest the required dosage. This has been a limitation for its usage. Sulfate free PEG (SF-PEG) has a less salty taste due to removal of the sodium sulfate, but the published studies in western countries about the preference and the degree of patient's satisfaction with these two solutions has shown conflicting results. The object of this study was to compare SF-PEG with PEG solution in regard to preference, the degree of patient's satisfaction and the adverse effects in Korean patients. We also attempted to determine whether these factors were associated with preference. METHODS: Ninety-four patients scheduled for colonoscopy were given one liter of both solutions (SF-PEG and PEG) and then the patients were allowed to select either of the two solutions for the further two liters intake under informed consent. Before colonoscopy, the preferred solution, the degree of patient's satisfaction, the adverse effects and other information were recorded by questionnaire. RESULTS: Fifty-nine patients among the 94 patients (63%) preferred the SF-PEG solution (p<0.05). Especially, the young patients under the age of 35 preferred the SF-PEG solution (83% vs 58%; p=0.045), and patients who had already experienced colonoscopy with PEG solution tended to prefer the SF-PEG (54% vs 78%; p=0.054). CONCLUSIONS: Korean patients preferred the SF-PEG over PEG, and especially young aged patients and the patients who had already taken the PEG solution. Similar results were obtained for both solutions concerning the adverse effects, cleansing quality and compliance, and the degree of satisfaction was not much improved, which was probably due to the same large volume of fluid that is required for colon cleaning.
Aged ; Colon ; Colonoscopy ; Compliance ; Humans ; Informed Consent ; Polyethylene ; Polyethylene Glycols ; Prospective Studies ; Sodium ; Sulfates ; Surveys and Questionnaires

PURPOSE: The purpose of this study is to evaluate imaging and histopathologic findings including the immunohistochemical characteristics of invasive micropapillary carcinoma (IMPC) of the breast. METHODS: Twenty-nine patients diagnosed with IMPC were included in the present study. Mammographic, sonographic, and magnetic resonance imaging (MRI) findings were analyzed retrospectively according to the American College of Radiology Breast Imaging Reporting and Data System lexicon. 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) findings were also evaluated. Microscopic slides of surgical specimens were reviewed in consensus by two pathologists with a specialty in breast pathology. RESULTS: Most IMPCs presented as a high density irregular mass with a non-circumscribed margin associated with microcalcifications on mammography, as an irregular hypoechoic mass with a spiculated margin on ultrasound, and as irregular spiculated masses with washout patterns on MRI. PET-CT showed a high maximum standardized uptake value (SUVmax) (mean, 11.2). Axillary nodal metastases were identified in 65.5% of the patients. Immunohistochemical studies showed high positivities for estrogen receptor and c-erbB-2 (93.1% and 51.7micro, respectively). CONCLUSION: Even though the imaging characteristics of IMPCs are not distinguishable from typical invasive ductal carcinomas, this tumor type frequently results in nodal metastases and high positivities for both estrogen receptor and c-erbB-2. The high SUVmax value that is apparent on PET-CT might be helpful in the diagnosis of IMPC.
Breast ; Carcinoma, Ductal ; Consensus ; Electrons ; Estrogens ; Humans ; Information Systems ; Magnetic Resonance Imaging ; Mammography ; Neoplasm Metastasis ; Retrospective Studies