OBJECTIVES: The early detection of ectopic tubal pregnancy in unruptured state is increased as the transvaginal sonography and sensitive serum hCG test are available. For this unruptured tubal pregnancy, the medical treatment using methotrexate via various routes and dosage is being tried. Our study was to evaluate the efficacy of single systemic injection of methotrexate in the treatment of unruptured tubal pregnancies. Material and METHODS: From the January 1997 to July 1999, of 152 ectopic pregnancy patients, 22 patients who were diagnosed as unruptured tubal pregnancies were treated with single-dose systemic methotrexate injection (50 mg/m2/IM). Exclusion criteria were unstable vital signs with hemoperitoneum, adnexal mass > 5-6 cm. Serum hCG titers were checked before injection and 4, 7 day after injection. If serum hCG titer declined more than 15% on 7 day after injection compared with titer on 4 day, the weekly hCG titer was followed until it was <10 mIU/ml .If the hCG titer did not decline more than 15 %, a second dose was given. If hCG titer was not decreased or vital signs became unstable after 1-2 injections, the treatment was considered failure and surgery was done. RESULTS: 18 cases (82%) of 22 were successfully treated with single-dose methotrexate. The mean size of ectopic mass and initial serum hCG titers were 2.7+/-1.3 cm (range, 1.5-5.4 cm) and 3,298+/-1,007 mIU/ml (range, 132-12,239), respectively. Of 22, 6 cases (28%) needed second dose of methotrexate. The mean time to resolution of serum beta-hCG titer was 27.5+/-13.6 days (range, 8-53 days). Elevation of liver enzyme did not occurred in all cases during treatment. Initial hCG titer was more important prognostic factor than ectopic mass size for successful medical treatment. CONCLUSION: Single-dose methotrexate appears to be an effective medical treatment for the unruptured tubal pregnancy. However, patients selection using strict criteria is needed to increase its success rate.
Female ; Hemoperitoneum ; Humans ; Liver ; Methotrexate* ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Tubal* ; Vital Signs

Objective : The breast-feeding rate has decreased in Korea despite of the active encouraging effort of breast-feeding for the last 10 years. So we investigated the factors that are related to breast-feeding failure. METHOD: 1807 specific questionares of mothers who visited the six university hospitals in Seoul from October 1993 to December 1995 were analysed by ANOVA and multiple logistic regression using SAS program. RESULTS: 1) Exclusive breast-feeding rate for the first 6 months was 20.0%. The factors of breast feeding success were antenatal plan for breast-feeding, the first successful breast-feeding and breast-feeding in the hospital after delivery (P<0.01). 2) The duration of breast-feeding was 5.2+/-4.4 months. It was significantly longer in the first successful breast-feeding (P<0.01). The earlier the first breast-feeding, the longer the breast-feeding duration (P<0.01). 3) The breast feeding rate for the first feeding after delivery was significantly higher in normal delivery (46.5%) and the rooming-in (57.4%) than in Cesarean section (37.1%) and the nursery (39.1%) (P<0.01). 4) The first time of breast-feeding was 64.8+/-62.8 hours after delivery and was significantly earlier in the local clinic, normal delivery and rooming-in than in the hospital, Cesarian section and the nursery (P<0.01). The first breast-feeding was successful in 46.9% and was significantly higher in antenatal education (P<0.01). 5) The reasons for the breast-feeding failure within postnatal one month were the insufficient milk (37.1%), the physician' s recommendation (18.8%), the inverted nipple (12.1%), the baby's poor suckling power (10.5%) and thin breast-milk (7.0%). The reasons to switch the successful breast-feeding to formula-feeding before 6 months of age were the return to work (25.1%), the convenience of formula-feeding (17.4%), the excellency of formula (10.0%) and maternal conveniency (6.2%). 6) The reasons to consider the breast milk insufficient were too frequent feeding with crying (38.7%) and poor sleeping with irritability (19.0%). The reasons to consider the breast milk thin were the loose stool (51.1%) and watery nature of breast milk (48.9%). The effort to increase the breask milk was present in 68.2%. The most frequent effort was to increase the maternal intake (67.6%) instead of the frequent baby' s suckling (25.6%). 7) Persons who recommended to stop breast feeding were family members 62.7%, pediatricians 25.5%, obstetricians 10.7%, nurses 1.1%. The maternal diseases to stop breast feeding by physician such as mastitis (11.1%), hepatitis B (4.9%) and tuberculosis (2.5%) were relatively appropriate. But the baby' s diseases such as jaundice (29.9%), loose stool (22.2%) and vomiting (2.8%) were inappropriate. CONCLUSIONS: To increase the breast-feeding rate, we recommend the antenatal plan for breast-feeding, the early breast-feeding as soon as possible and the exclusive breast-feeding in the hospital after delivery. The mothers should make an effort to increase the breast milk by frequent suckling. The physicians should be better prepared to assist the breast-feeding mothers and monitor continuously to resume even after the temporary hold of breast-feeding.
Breast Feeding ; Cesarean Section ; Crying ; Female ; Hepatitis B ; Hospitals, University ; Humans ; Jaundice ; Korea ; Logistic Models ; Mastitis ; Milk ; Milk, Human ; Mothers ; Nipples ; Nurseries ; Pregnancy ; Prenatal Education ; Return to Work ; Seoul ; Tuberculosis ; Vomiting

No abstract available.
Astrocytoma* ; Encephalitis, Herpes Simplex* ; Herpes Simplex*

Broussonetia kazinoki Siebold. (B. kazinoki) has long been used in the manufacture of paper in Asian countries. Although B. kazinoki leaves (BK) have been employed in dermatological therapy, use of BK has not been tested in patients with atopic dermatitis (AD). Using Nc/Nga mice, which are genetically predisposed to develop AD-like skin lesions, we confirmed the efficacy of BK in AD treatment. BK extract was applied topically to Dermatophagoides farinae-induced AD-like lesions in Nc/Nga mice, and the effects were assessed both clinically and by measuring skin thickness on the back and ears. We measured the effects of BK extract on plasma levels of IgE and IL-4. We also measured the ability of BK extract to inhibit the secretion of hTARC in HaCaT cells after stimulation by TNF-alpha and IFN-gamma. We found that BK extract significantly reduced ear and dorsal skin thickness and the clinical signs of AD, as well as significantly down-regulating the plasma levels of IgE and IL-4 (p<0.01 for each comparison). Moreover, 500 mug/mL of BK extract inhibited hTARC secretion in HaCaT cells by activated TNF-alpha/IFN-gamma by about 87%. These findings suggest that topical application of BK extract has excellent potential in the treatment of AD.
Animals ; Asian Continental Ancestry Group ; Broussonetia* ; Dermatitis, Atopic ; Ear ; Humans ; Immunoglobulin E ; Interleukin-4 ; Mice* ; Mites* ; Plasma ; Pyroglyphidae ; Skin ; Tumor Necrosis Factor-alpha

Computerized tomography(CT) have been available for diagnosis and localization of intracerebral hematoma. CT-guided stereotactic evacuation of spontaneous intracerebral hematoma was performed in 34 cases; 25 basal ganglionic hematomas with or without ventricular perforation, 4 subcortical, 3 thalamic, 1 cerebellar and 1 pontine. The biplane CT image were taken to determine the coordinates of the target point, which was the center of the hematoma. The liquefied or solid portion of the hematoma was aspirated through a burr-hole under local anesthesia. And a silastic tube(3.3mm in outer diameter and 2.0mm in inner diameter) was then inserted into the center of the hematoma. Immediately after the first trial of hematoma aspiration, urokinase(6000IU/5ml saline) was administered through the tube. Subsequently, aspiration and infusion of urokinase were repeated every 6 or 12 hours until the hematoma was almost completely evacuated. The follow-up results indicate that this procedure was more superior over the conventional craniotomy. This CT-guided stereotactic operation has the following advantages; 1) the procedure is simple and safe; 2) the procedure can be performed under local anesthesia; and 3) the hematoma can be completely drained with the aid of urokinase. This procedure can be used as a standard treatment for intracerebral hematoma. We have draw the following conclusions; As a result of the above study 1) Stereotactic surgery is more effective in the patients with neurologic grade 3 than conservative one (p<0.05). 2) To use urokinase or perform the early surgery within 24 hours did not seem to be the cause of rebleeding. 3) In the case of pons or cerebellar hemorrhage, stereotactic surgery had definite benefit in the recovery of consciousness even if recovery of motor function was dismal. 4) In patients with spontaneuous ICH, the favorable prognostic indicatiors were as follows: the size of hematoma less thas 50ml, no signs of transtentorial herniation and patient's age under 60.
Anesthesia, Local ; Consciousness ; Craniotomy ; Diagnosis ; Follow-Up Studies ; Ganglion Cysts ; Hematoma* ; Hemorrhage ; Humans ; Pons ; Urokinase-Type Plasminogen Activator

Little is known about the long-term prognosis of or predictors for the different clinical types of atrial fibrillation (AF) in Korean populations. The aim of this study was to validate a risk stratification to assess the probability of AF progression from paroxysmal AF (PAF) to persistent AF (PeAF) or permanent AF. A total of 434 patients with PAF were consecutively enrolled (mean age; 71.7 +/- 10.7 yr, 60.6% male). PeAF was defined as episodes that are sustained > 7 days and not self-terminating, while permanent AF was defined as an ongoing long-term episode. Atrial arrhythmia during follow-up was defined as atrial premature complex, atrial tachycardia, and atrial flutter. During a mean follow-up of 72.7 +/- 58.3 months, 168 patients (38.7%) with PAF progressed to PeAF or permanent AF. The mean annual AF progression was 10.7% per year. In univariate analysis, age at diagnosis, body mass index, atrial arrhythmia during follow-up, left ventricular ejection fraction, concentric left ventricular hypertrophy, left atrial diameter (LAD), and severe mitral regurgitation (MR) were significantly associated with AF progression. In multivariate analysis, age at diagnosis (P = 0.009), atrial arrhythmia during follow-up (P = 0.015), LAD (P = 0.002) and MR grade (P = 0.026) were independent risk factors for AF progression. Patients with younger age at diagnosis, atrial arrhythmia during follow-up, larger left atrial chamber size, and severe MR grade are more likely to progress to PeAF or permanent AF, suggesting more intensive medical therapy with close clinical follow-up would be required in those patients.
Aged ; Atrial Fibrillation/epidemiology/mortality/*pathology ; Atrial Flutter/*epidemiology/mortality/pathology ; Atrial Premature Complexes/*epidemiology/mortality/pathology ; Disease Progression ; Echocardiography ; Female ; Heart Atria/pathology/ultrasonography ; Humans ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Retrospective Studies ; Tachycardia, Ectopic Atrial/*epidemiology/mortality/pathology ; Tachycardia, Paroxysmal/*epidemiology/mortality/pathology ; Thromboembolism/epidemiology/mortality ; Treatment Outcome

A total of 82 pediatric renal transplants treated with cyclosporine and low dose prednisolone as the main immunosuppressive agents were used as the subjects of this study to find the risk factors whitch might influence the pediatric renal allograft survival in a single center from Feb. 1984 to Mar. 1996. The mean age of the recipients was 14.7 years ranging from ages 3.9 to 19.9. There were 19 cases of graft loss, and 3 recipient death. The major causes of the graft loss were acute and/or chronic rejection, poor compliance and patient's death. The 1-, 3- and 5-year graft survival were 94.9%, 86.2% and 70.7% respectively. The original renal deseases of ESRD were FSGS (14 cases), chronic pyelonephropathy and VUR (11 cases) and IgA nephropathy (8 cases) in order frequency. The significant risk factors for the outcome were the ABO incompatibility (ABO identical 89.6% vs compatible 26.9%, P=0.001) and development of more than 1 episode of acute rejection within 1 year (P=0.002) and after 1 year (P=0.004). Other factors such as recipient's age, donor-recipient relationship and type and duration of dialysis modalities before trasplantation (P>0.05). In conclusion, for the successful outcome of pediatric renal transplantation, strict ABO matching and development and application of more effective immunosuppressive agents such as mycophenolate or FK- 506 to combat the acute and/or chronic rejection is required in near future.
Allografts* ; Compliance ; Cyclosporine* ; Dialysis ; Glomerulonephritis, IGA ; Graft Survival ; Immunosuppressive Agents ; Kidney Failure, Chronic ; Kidney Transplantation ; Prednisolone ; Risk Factors* ; Transplants

PURPOSE: Effective hemodialysis for a patient with end-stage renal disease (ERDS) is dependent upon a durable, low-morbidity vascular access. Although It is generally agreed that the distal radiocephalic fistula originally discribed by Brescia and Cimino is the most effective primary access constrruction, no consensus exists regarding primary and secondary alternatives for patients with inadequate of failed rediocephalic prodedures. Many options are available, but the relative value of these alternative operations is unclear. Therefore the place of the basilic vein in secondary acccess construction needs to be assessed. We evaluated if the basilic vein can be used to construct a durable, low-morbidity access. METHODS: A native brachio-basilic arterio-venous fistula with superficial transposition has been performed, for lack of usuable vein on 54 forearm in 47 patients from August 1995 to October 1999 (Male: 15, female: 32) with mean age 51 years (26 to 70 years). RESULTS: The main cause of renal insufficiency were: diabetes 27 (57.4%), hypertensive 19 (40.4%), renal tuberculosis 2 (4.3%) and renal cyst 1 (2.1%). The waiting period before vascular access puncture has been 28 6 days. Eight (17.0%) stenosis has been detected and, forearm and/or hand edema occured in three (6.4%); thrombosis in two (4.3%); bleeding in two (4.3%); pseudoaneurysm in one. Through the follow-up periods of 50 months, the primary patency was 80.9% at 12 months and 78.7% at 24 months. CONCLUSION: The brachio-basilic fistula with superficial transposition of basilic vein is a valuable vascular access for diabetes, female old patients, and can remain an alternative method for even younger patients by avoiding the installation of artificial graft after failed forearm arteriovenous fistula.
Aneurysm, False ; Arteriovenous Fistula* ; Consensus ; Constriction, Pathologic ; Edema ; Female ; Fistula ; Follow-Up Studies ; Forearm ; Hand ; Hemorrhage ; Humans ; Kidney Failure, Chronic ; Ocimum basilicum* ; Punctures ; Renal Dialysis* ; Renal Insufficiency ; Thrombosis ; Transplants ; Tuberculosis, Renal ; Veins*

Oncogenic osteomalacia is a rare clinicopathological condition. The syndrome is characterized by hypophosphataemic osteomalacia with hyperphosphaturia, low plasma 1,25-dihydroxyvitamin D and normal plasma calcaemia and parathyroid hormone, associated with a tumor, generally of mesenchymal origin. Complete excision of the tumour results in cure of the whole syndrome. Recently we experienced 56-year-old woman with oncogenic osteomalacia caused by a chondromyxoid fibroma of the left foot. We report this case with the review of literatures.
Female ; Fibroma* ; Foot ; Humans ; Hypophosphatemia, Familial ; Middle Aged ; Osteomalacia* ; Parathyroid Hormone ; Plasma

PURPOSE: To determine the patterns of evaluation and treatment in the patient with early breast cancer treated with conservative surgery and radiotherapy and to improve the radiotherapy techiniques, nationwide survey was performed. MATERIALS AND METHODS: A web-based database system for Korean Patterns of Care Study (PCS) for 6 common cancers was developed. Two hundreds sixty-one randomly selected records of eligible patients treated between 1998~999 from 15 hospitals were reviewed. RESULTS: The patients ages ranged from 24 to 85 years(median 45 years). Infiltrating ductal carcinoma was most common histologic type (88.9%) followed by medullary carcinoma (4.2%) and infiltrating lobular carcinoma (1.5%). Pathologic T stage by AJCC was T1 in 59.7% of the casses, T2 in 29.5% of the cases, Tis in 8.8% of the cases. Axillary lymph node dissection was performed in 91.2% of the cases and 69.7% were node negative. AJCC stage was 0 in 8.8% of the cases, stage I in 44.9% of the cases, stage IIa in 33.3% of the cases, and stage IIb in 8.4% of the cases. Estrogen and progesteron receptors were evaluated in 71.6%, and 70.9% of the patients, respectively. Surgical methods of breast-conserving surgery was excision/lumpectomy in 37.2%, wide excision in 11.5%, quadrantectomy in 23% and partial mastectomy in 27.5% of the cases. A pathologically confirmed negative margin was obtained in 90.8% of the cases. Pathological margin was involved with tumor in 10 patients and margin was close (less than 2 mm) in 10 patients. All the patients except one recieved more than 90% of the planned radiotherapy dose. Radiotherapy volume was breast only in 88% of the cases, breast+supraclavicular fossa (SCL) in 5% of the cases, and breast+SCL+posterior axillary boost in 4.2% of the cases. Only one patient received isolated internal mammary lymph node irradiation. Used radiation beam was Co-60 in 8 cases, 4 MV X-ray in 115 cases, 6 MV X-ray in 125 cases, and 10 MV X-ray in 11 cases. The radiation dose to the whole breast was 45~9.4 Gy (median 50.4) and boost dose was 8~20 Gy (median 10 Gy). The total radiation dose delivered was 50.4~70.4 Gy (median 60.4 Gy). CONCLUSION: There was no major deviation from current standard in the patterns of evaluation and treatment for the patients with early breast cancer treated with breast conservation method. Some varieties were identified in boost irradiation dose. Separate analysis for the datails of radiotherapy planning will be followed and the outcome of treatment is needed to evaluate the process.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Carcinoma, Lobular ; Carcinoma, Medullary ; Estrogens ; Humans ; Korea* ; Lymph Node Excision ; Lymph Nodes ; Mastectomy, Segmental* ; Radiotherapy