BACKGROUND: Mounting evidence implicates an association between ambient air pollution and impaired reproductive potential of human. Our study aimed to assess the association between air pollution and ovarian reserve in young, infertile women. METHODS: Our study included 2276 Korean women who attended a single fertility center in 2016-2018. Women's exposure to air pollution was assessed using concentrations of particulate matter (PM RESULTS: The mean age was 36.6 ± 4.2 years and AMH level was 3.3 ± 3.1 ng/mL in the study population. Average AMH ratio was 0.8 ± 0.7 and low AMH was observed in 10.3% of women (n=235). The average concentration of six air pollutants was not different between the normal ovarian reserve and low AMH groups for all averaging periods. In multivariable models, an interquartile range (IQR)-increase in 1 month-average PM CONCLUSIONS In a cohort of infertile Korean women, there was a suggestive evidence of the negative association between ambient PM concentration and ovarian reserve, highlighting the potential adverse impact of air pollution on women's fertility.
Adult ; Air Pollutants/adverse effects* ; Air Pollution/adverse effects* ; Environmental Exposure/adverse effects* ; Female ; Humans ; Infertility, Female/etiology* ; Ovarian Reserve/physiology* ; Republic of Korea

PURPOSE: Increased maternal age is a major risk factor for chromosomal abnormalities. The maternal age-specific risk of fetal trisomy was theoretically calculated. We investigated the actual frequency of fetal trisomy between 16 and 24 gestational weeks in pregnant women over the age of 34 at delivery. MATERIALS AND METHODS: We retrospectively, over a four-year period, reviewed the medical records of women with singleton pregnancies that started their antenatal care before the 10th week of pregnancy. Pregnant women aged 34 to 45 years at the time of delivery were enrolled and divided into groups of one-year intervals. We investigated the frequency of Down syndrome and all trisomies as a function of the maternal age and compared with the theoretical maternal-age-specific risk. RESULTS: Of the 5,858 pregnant women enrolled in the study, the rate of trisomy 21 was 0.29% (17 cases). The observed frequencies of trisomy 21 in women with maternal ages of 35 years and 40 years were 1:1,116 and 1:141, respectively. The rate of all trisomies was 0.39% (23 cases). The observed frequencies of all trisomies in women with maternal ages of 35 years and 40 years were 1:372 and 1:56, respectively. CONCLUSION: The frequencies of Down syndrome and all trisomies were proportional to the maternal age. However, the observed frequencies of Down syndrome and all trisomies between the 16 and 24 gestational weeks were lower than the theoretical rates.
Chromosome Aberrations ; Down Syndrome ; Epidemiology ; Female ; Humans ; Maternal Age ; Medical Records ; Pregnancy ; Pregnant Women* ; Retrospective Studies ; Risk Factors ; Trisomy*

BACKGROUND/AIMS: Advances in endoscopic submucosal dissection (ESD) techniques have led to the development of expanded criteria for endoscopic resection of early gastric cancer (EGC). The aim of this study was to evaluate the short- and long-term outcomes for ESD using indication criteria. METHODS: A total of 1,105 patients underwent ESD for EGC at six medical centers. The patients were classified into the following two groups based on the lesion size, presence of ulceration and pathological review: an absolute criteria group (n=517) and an expanded criteria group (n=588). RESULTS: The curative resection rates (91.1% vs 91.3%, p=0.896) were similar in the absolute criteria group and the expanded criteria group. The en bloc resection rates (93.4% and 92.3%, respectively; p=0.488) and complete resection rates (98.3% and 97.4%, respectively; p=0.357) did not differ between the groups. The cumulative disease-free survival rates and the overall survival rates were similar between the groups (p=0.778 and p=0.654, respectively). Independent factors for the curative resection of EGC included tumor location (upper vs middle and lower, 2.632 [1.128-6.144] vs 3.497 [1.560-7.842], respectively) and en bloc resection rate 12.576 [7.442-21.250]. CONCLUSIONS: The expanded criteria for ESD in cases of EGC is comparable with the widely accepted pre-existing criteria.
Adult ; Aged ; Aged, 80 and over ; Disease-Free Survival ; Dissection/*methods ; Female ; Gastric Mucosa/*surgery ; Gastroscopy/*methods ; Humans ; Male ; Middle Aged ; *Response Evaluation Criteria in Solid Tumors ; Stomach Neoplasms/pathology/*surgery ; Survival Rate ; Treatment Outcome

BACKGROUND/AIMS: Advances in endoscopic submucosal dissection (ESD) techniques have led to the development of expanded criteria for endoscopic resection of early gastric cancer (EGC). The aim of this study was to evaluate the short- and long-term outcomes for ESD using indication criteria. METHODS: A total of 1,105 patients underwent ESD for EGC at six medical centers. The patients were classified into the following two groups based on the lesion size, presence of ulceration and pathological review: an absolute criteria group (n=517) and an expanded criteria group (n=588). RESULTS: The curative resection rates (91.1% vs 91.3%, p=0.896) were similar in the absolute criteria group and the expanded criteria group. The en bloc resection rates (93.4% and 92.3%, respectively; p=0.488) and complete resection rates (98.3% and 97.4%, respectively; p=0.357) did not differ between the groups. The cumulative disease-free survival rates and the overall survival rates were similar between the groups (p=0.778 and p=0.654, respectively). Independent factors for the curative resection of EGC included tumor location (upper vs middle and lower, 2.632 [1.128-6.144] vs 3.497 [1.560-7.842], respectively) and en bloc resection rate 12.576 [7.442-21.250]. CONCLUSIONS: The expanded criteria for ESD in cases of EGC is comparable with the widely accepted pre-existing criteria.
Adult ; Aged ; Aged, 80 and over ; Disease-Free Survival ; Dissection/*methods ; Female ; Gastric Mucosa/*surgery ; Gastroscopy/*methods ; Humans ; Male ; Middle Aged ; *Response Evaluation Criteria in Solid Tumors ; Stomach Neoplasms/pathology/*surgery ; Survival Rate ; Treatment Outcome

BACKGROUND: Excessive catecholamine release in pheochromocytoma is known to cause transient reversible left ventricular (LV) dysfunction, such as in the case of pheochromocytoma-associated catecholamine cardiomyopathy. We investigated patterns of clinical presentation and incidence of LV dysfunction in patients with pheochromocytoma. METHODS: From January 2004 to April 2011, consecutive patients with pheochromocytoma were retrospectively studied with clinical symptoms, serum catecholamine profiles, and radiologic findings. Patterns of electrocardiography and echocardiography were also analyzed. RESULTS: During the study period, a total of 36 patients (21 males, 49.8 +/- 15.8 years, range 14-81 years) with pheochromocytoma were included. In the electrocardiographic examinations, normal findings were the most common findings (19, 52.8%). LV hypertrophy in 12 cases (33.3%), sinus tachycardia in 3 (8.3%), ischemic pattern in 1 (2.8%) and supraventricular tachycardia in 1 (2.8%). Echocardiographic exam was done in 29 patients (80.6%). Eighteen patients (62.1%) showed normal finding, 8 (27.6%) revealed concentric LV hypertrophy with normal LV systolic function, and 3 (10.3%) demonstrate LV systolic dysfunction (LV ejection fraction < 50%). Three showed transient LV dysfunction (2 with inverted Takotsubo-type cardiomyopathy and 1 with a diffuse hypokinesia pattern). Common presenting symptoms in the 3 cases were new onset chest discomfort and dyspnea which were not common in the other patients. Their echocardiographic abnormalities were normalized with conventional treatment within 3 days. CONCLUSION: Out of total 36 patients with pheochromocytoma, 3 showed transient LV systolic dysfunction (catecholamine cardiomyopathy). Pheochromocytoma should be included as one of possible causes of transient LV systolic dysfunction.
Cardiomyopathies ; Dyspnea ; Echocardiography ; Electrocardiography ; Humans ; Hypertrophy ; Hypokinesia ; Incidence ; Male ; Pheochromocytoma ; Prevalence ; Retrospective Studies ; Tachycardia, Sinus ; Tachycardia, Supraventricular ; Thorax ; Ventricular Dysfunction, Left

BACKGROUND AND OBJECTIVES: Before the introduction of transnasal endoscopic sinus surgery, transorbital approach with an external incision used to be one of the representative reconstructive surgical repairing method of blow out fracture. The important advantages of transnasal endoscopic technique are magnified direct visualization and easy accessibility to the medial orbital wall. Nasopore Forte(R) is a slowly absorbable material and provides excellent durability. The purpose of this study is to evaluate outcomes of endoscopic endonasal reduction (EER) of medial blow out fracture using Nasopore Forte(R). SUBJECTS AND METHOD: A retrospective study was performed on 26 patients with medial blowout fracture who had undergone EER using Nasopore Forte(R) from January to December of 2010 at our clinic. A review of medical records included demographic data, preoperative ocular symptoms and signs, and surgical outcomes including postoperative symptom improvement and complications. RESULTS: Of 26 patients, 5 had persistent diplopia, 5 enophthalmos, and 3 both diplopia and enophthalmos preoperatively. Seventeen patients were asymptomatic, but had large defects with the mean defect size of 2.4 cm2. Postoperative computed tomography scan showed excellent (22) to good (4) reduction. Preoperative symptoms were resolved in all of 13 symptomatic patients and there was no enophthalmos during the follow-up period. No significant complications including sinusitis or synechia were found. CONCLUSION: EER is a highly effective and safe procedure for the reduction of medial blow out fracture. Nasopore Forte(R) is easy to handle and can be tailored to individual defects, and is useful for securing the reduction and preventing adhesion after EER.
Diplopia ; Enophthalmos ; Follow-Up Studies ; Humans ; Medical Records ; Orbit ; Retrospective Studies ; Sinusitis

We evaluated the recent trend in the incidence of premalignant and malignant skin lesions between 1991 and 2006. Among 571,057 newly registered dermatology out-patients from our 8 affiliated university hospitals, 2,598 were diagnosed with a premalignant (899, 0.16%) or malignant skin lesions (1,699, 0.30%). Of 899 premalignant cases, 71.2% were actinic keratosis (AK), and 24.6% were Bowen's disease. Of 1,699 malignant cases, 46.2% were basal cell carcinoma, followed by squamous cell carcinoma (19.1%) and melanoma (7.1%). This 16-yr survey was divided equally into two time periods to compare the incidence of premalignant and malignant skin lesions at different time settings. Between 1991 and 1998, the incidence of cutaneous premalignancy was 0.10% which doubled during 1999-2006. For cutaneous malignancy, the incidence was 0.25% during 1991-1998 and 0.34% in 1999-2006. Incidence of AK among the new outpatients was 0.07% in 1991-1998 which staggered up to 0.15% in 1999-2006. These findings show an increase of both premalignant and malignant skin lesions, AK in particular in the dermatology outpatient-based incidence.

PURPOSE: Authors applied multiple punctures and steroid injection as a modified treatment of ganglion cyst and report objective and subjective outcomes. MATERIALS AND METHODS: We prospectively evaluated 40 patients with ganglion cysts of hands and wrists who underwent multiple punctures and steroid injection. Symptom improvement, recurrence rate and complications were evaluated after minimum follow-up period of 12 months. RESULTS: Pain and discomfort improved in 31 patients (78%), however, recurrence was observed in 32 patients (80%). The factors associated with low recurrence rate included ganglions located at the hand or palm, with small diameter, and with short period of symptoms. CONCLUSION: Multiple punctures and steroid injection resulted in relatively high recurrence rate of mass itself in the treatment of ganglion cyst. However, from the view point of symptom improvement, this procedure could be considered as a simple modified treatment before surgical excision.
Follow-Up Studies ; Ganglion Cysts ; Hand ; Humans ; Prospective Studies ; Punctures ; Recurrence ; Wrist

PURPOSE: In Korea, pregnancy termination is frequently reported among women who took medications for an acute or chronic disease during pregnancy, for fear of teratogenic risk. We have previously shown that a service providing evidence-based information is helpful for women who week counseling to make a rational decision regarding their pregnancies. This study aimed to evaluate whether termination of pregnancy based on such perceptions, is justified using the 'DRug Exposure and risk Assessment in Moms' (DREAM) registry. METHODS: The study included 5,032 consenting pregnant women from the clinic and call center at the Korean Motherisk Program, from November 1999 to October 2008. The DREAM registry recorded the pregnancy outcomes (preterm birth, low birth weight, intrauterine fetal death, and congenital anomaly) of 3,328 women. RESULTS: Among women exposed to medications, time of exposure ranged from 3.5-4.6 weeks of gestation. There were 1,308 different drugs prescribed to these women. The drug most frequently prescribed was acetaminophen followed by chlorpheniramine maleate, and pseudoephedrine. There were 4.7% (n=156/3,328) women who underwent a voluntary abortion for fear of birth defects. We compared frequency of birth defects between exposed women and unexposed pregnant women in our institution during gestation. The frequency of major congenital malformations was 2.5% (n=74/2,977) in exposed group and 2.9% (n=75/2,573) in unexposed group (P=0.32). There was no statistically significant difference between exposed and control group in the rate of preterm births, intrauterine fetal death and low-birth weight babies. CONCLUSION: We did not observe increased risk of congenital malformations and adverse pregnancy outcomes in a population of pregnant women exposed to a variety of medications. Therefore these medications are not considered teratogen.
Acetaminophen ; Chlorpheniramine ; Chronic Disease ; Congenital Abnormalities ; Counseling ; Female ; Fetal Death ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Korea ; Maleates ; Parturition ; Pregnancy ; Pregnancy Outcome ; Pregnant Women ; Premature Birth ; Pseudoephedrine ; Risk Assessment

Acute pulmonary embolism is usually caused by deep vein thrombosis of the lower extremities. However, vegetations of the tricuspid valve (TV) can cause embolic occlusion of the pulmonary vasculature and hence pulmonary embolism. We experienced a case of acute pulmonary embolism caused by subacute infective endocarditis of the TV. The computerized tomographic scans showed huge vegetations on the patient's TV and obstruction of the bilateral pulmonary arteries. He was successfully treated with intravenous antibiotics and TV replacement.
Anti-Bacterial Agents ; Endocarditis ; Lower Extremity ; Pulmonary Artery ; Pulmonary Embolism ; Tricuspid Valve ; Venous Thrombosis