This study was undertaken for the clinical analysis and evaluation on 121 patients with incompetent internal os of the cervix, who were admitted and treated with McDonald operation or Shirodkar operation at the Soonchounhyang Medical Center from January 1991 to December 1995. The results of this study were as follows : 1. The incidence of this IIOC was 1.1% of 11,116 cases of total delivery. 2. The mean age of IIOC was 31.7 years old. 3. The average number of gravida was 3.2. 4. The most common contributary factor was previous history of artificial abortion (51.2 %), and midtrimester abortion (17.4 %), cervical laceration due to previous vaginal delivery (8.3 %) etc. was followed. 5. The success rate of operation was 76 %, and the highest success rate (85.7 %) was reveald with period from 15th weeks to 16th weeks of gestation. 6. When cervical dilatation was abscent or small, the success rate of operation was high. 7. The factors of failed operation were preterm labor (58.7 %), PROM (34.5 %), and PIH, bleeding. 8. The delivery method after operation was vaginal delivery in 83 cases (68.6%) and cesarean section in 38 cases (31.4 %).
Cervix Uteri* ; Cesarean Section ; Female ; Hemorrhage ; Humans ; Incidence ; Labor Stage, First ; Lacerations ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Trimester, Second

The successful revascularization and reperfusion of ischemia are still associated with high systemic complication rates and severe local tissue injuries. The morality rates after revascularization have been reported to range from 10% to 20% and the amputation rates from 12% to 22%. It is well recognized that the microvasculature is highly sensitive to ischemia-reperfusion (I/R) and that the initial damage of endothelial cells contributes to I/R-induced tissue injury. In an effort to define the mechanisms responsible for reperfusion-induced vascular injury number of in vitro models have been developed to stimulate the responses of endothelial cells to I/R. Because of its simplicity, many investigators have used monolayers of cultured endothelial cells exposed to anoxia and reoxygenation as a model system to minic I/R-induced vascular changes in vivo. The endothelium serves as an important modulator of vascular homeostases by secreting various levels of both thrombotic and antithrombotic agents. One of the important product of endothelial cells, prostaglandin I2 or prostacyclin (PGI2) helps to maintain hemostasis through its involvement in coagulation, platelet activation, leukocyte migration and adhesion, vascular tone regulation and growth control. PGI2 synthesis is a readily quantifiable index of endothelial cell perturbation and thus serves as a marker for the identification of injurious stimuli. Endothelial cells were isolated from human umbilical vein and cultured in M-199 medium plus 20% fetal calf serum. Purity of culture was determined by immunological fluorescent staining of factor VIII related antigen, phase-contrast microscopy. TRK 790 radio-immunoassay kit was used for the measuring of 6-keto-PGF1 alpha released by endothelial cells. The results were as follows: 1) The concentration of PGI(2) released from the cultured endothelial cells was 33.44 +/- 2.26 pg/1 105 cells/mL 2) Incubation of endothelial cells with anoxia and reoxygenation resulted in PGI(2) release of 42.98 +/- 2.29 pg/1x10(5) cells/ml and 62.44 2.11 pg/1 105 cells/ml, respectively. 3) Incubation of endothelial cells with allopurinol (20 mumol/L) decreased the PGI(2) release to 40.68 +/- 2.99 pg/1x10(5) cells/ml. In conclusion, our data showed that the damage of endothelial cells in reoxygenotion group was significantly increased comparing anoxia group (p<0.005) and that allopurinol can inhibit reoxygenation-induced injury of endotheial cells.
6-Ketoprostaglandin F1 alpha ; Allopurinol ; Amputation ; Anoxia ; Endothelial Cells ; Endothelium ; Epoprostenol ; Fibrinolytic Agents ; Hemostasis ; Humans ; Ischemia ; Leukocytes ; Microscopy, Phase-Contrast ; Microvessels ; Morals ; Platelet Activation ; Reperfusion ; Research Personnel ; Umbilical Veins ; Vascular System Injuries ; von Willebrand Factor

Adenoma, Pleomorphic ; Anesthesia, General ; Humans ; Lip ; Mandible ; Mouth Mucosa ; Palate ; Parotid Gland ; Research Personnel ; Salivary Glands ; Sublingual Gland Neoplasms ; Submandibular Gland

Carcinoma, Squamous Cell ; Diagnosis ; Humans ; Radioimmunoassay ; Sensitivity and Specificity ; Biomarkers, Tumor

Hyperthyroidism is seen in 3.5-26% of subjects with acromegaly. Hyperthyroidism can be developed by thyroid stimulating hormone (TSH) dependent mechanism in TSH-secreting adenomas with acromegaly or by TSH independent mechanism through the stimulation of thyroid cells by growth hormone (GH). So, confirming the cause of hyperthyroidism is important to treat that. We report a case of a 56-year-old man who had acromegaly with iodine-induced thyrotoxicosis. He took the sea tangle for 4 years because he had constipation. His face and hands indicated acromegaly. Thyroid function test showed that T3 and free T4 were increased and TSH was decreased. Ultrasonography of neck showed diffuse enlargement of thyroid gland and thyroid scan showed decreased uptake of thyroid gland. So we could confirm iodine-induced thyrotoxicosis due to excessive iodine intake. Serum GH and insulin-like growth factor (IGF)-1 were markedly increased and brain MRI showed heterogenous 1 cm sized pituitary mass in right side. Acromegaly was confirmed by brain MRI, pituitary stimulation test and increased level of GH, IGF-1. He stopped iodine intake. After 6 months, T3, free T4 and TSH were normalized and he is waiting for the surgical removal of pituitary adenoma.
Acromegaly* ; Adenoma ; Brain ; Constipation ; Growth Hormone ; Hand ; Humans ; Hyperthyroidism ; Insulin-Like Growth Factor I ; Iodine ; Magnetic Resonance Imaging ; Middle Aged ; Neck ; Pituitary Neoplasms ; Thyroid Function Tests ; Thyroid Gland ; Thyrotoxicosis* ; Thyrotropin ; Ultrasonography

BACKGROUND AND OBJECTIVES: In head and neck reconstructive surgery, the stability of vital signs is important for patient recovery and flap outcome. We aimed to determine the better sedation protocol by comparing two protocols, namaely, midazolam/morphine (MM)-based and remifentanil (RF)-based sedation protocols, in the immediate postoperative settings of head and neck reconstructive surgery. SUBJECTS AND METHOD: We retrospectively reviewed the medical data of patients who underwent reconstructive surgery after the ablation of head and neck cancer involving MM sedation (n=34) or RF sedation (n=28). Parameters related to vital signs, flap outcomes, occurrence of delirium, length of stay and nursing burden were compared between the groups. RESULTS: The length of stay at the intensive care unit and flap outcomes were similar in the two groups. However, blood pressure as measured by frequency of variation was more stable in the RF group than in the MM group. In addition, the number of medical calls from the attending nurse due to the fluctuation of vital signs was less in the RF group than in the MM group. CONCLUSION: RF-based sedation for the postoperative intensive care unit care after head and neck reconstructive surgery is more effective in cases where vital signs are less stable. This type of sedation may decrease the nursing burden for these patients.
Blood Pressure ; Delirium ; Free Tissue Flaps ; Head and Neck Neoplasms ; Head* ; Humans ; Intensive Care Units* ; Critical Care* ; Length of Stay ; Neck* ; Nursing ; Postoperative Care ; Retrospective Studies ; Vital Signs

BACKGROUND/OBJECTIVES: The obese population is rapidly increasing because of reduced physical activity and a Westernized diet; consequently, various chronic diseases are more prevalent. With the increasing interest in body shape and appearance, research on body shape perceptions and accompanying weight control behaviors are needed for healthy weight management.SUBJECTS/METHODS: A cross-sectional survey was conducted on randomly selected 536 (209 men and 327 women) aged 20 to 65 years. Body mass index (BMI), body-shape perception, weight control behavior, quality of sleep, and place of residence were collected using self-reported questionnaires. Multivariable logistic regression analysis was conducted using complex design in each groups. Collected data were analyzed using the SAS 9.4 statistical package, and the significance level was set at P < 0.05.RESULTS: When these two variables were divided into four groups, they were found to influence dieting attempts. People with abnormal weights who were dissatisfied with their body shapes attempted dieting 5.23 times more than those with healthy weights and satisfaction with their body shapes. Further, those with normal weights but dissatisfaction with their bodies attempted dieting 4.45 times more than those who were satisfied with their shapes. Subjects in their 20s attempted dieting 2.53 times more than those in their 30s and 40s, and female subjects attempted dieting 2.24 times more than male subjects.CONCLUSIONS: A correct perception of one's shape can be an important factor for dietary behavior, as body shape perceptions and dieting attempts are strongly related. Additionally, healthy weight management and nutrition education are important elements to incorporate into a weight control program aimed at preventing excessive weight control behaviors and promoting correct perceptions of body shape.

BACKGROUND: Voltage-gated sodium channels are responsible for the initial-depolarization component of action potentials in brain neurons, and hence they are the target for widely used antiepileptic drugs such as carbamazepine (CBZ). With the working hypothesis that genetic defect in voltage-gated sodium channels can alter the response to CBZ, this study was performed to elucidate the relationship between single-nucleotide polymorphisms (SNPs) of the SCN1A, SCN1B, and SCN2A genes and CBZ resistance in Korean epileptics. METHODS: Candidate SNPs of SCN1A, SCN1B, and SCN2A were developed using the pooled DNA from healthy controls (n=200), of which representative SNPs of each of SCN1A, SCN1B, and SCN2A were determined based on theoretical functional values. Each representative SNP was genotyped for a CBZ-resistant group (CRE, n=168) and a CBZ- responsive group (CSE, n=154), and the frequencies of alleles and genotypes of each SNP were compared between the two groups. RESULTS: Eighteen SNPs were developed in SCN1A, SCN1B, and SCN2A. SCN1A-PM in exon 16 of SCN1A, SCN1B-PM in exon 3 of a splicing variant of SCN1B, and SCN2A-PM in the 7th intronic sequence of SCN2A were selected as the representative SNPs for these genes. The distributions of alleles and genotypes of each representative SNP did not differ between the CRE and CSE groups. CONCLUSIONS: In Korean epileptics, there appears to be no significant relationship between representative SNPs of SCN1A, SCN1B, and SCN2A and CBZ resistance.
Action Potentials ; Alleles ; Anticonvulsants ; Brain ; Carbamazepine ; DNA ; Drug Resistance ; Epilepsy ; Exons ; Genotype ; Introns ; Neurons ; Polymorphism, Single Nucleotide ; Sodium ; Sodium Channels ; Voltage-Gated Sodium Channels

PURPOSE: This study was designed to determine the influencing factors and clinical course of pathologically proven cases of radiation-induced brain injury (RIBI). MATERIALS AND METHODS: The pathologic records of twelve patients were reviewed; these patients underwent surgery following radiotherapy due to disease progression found by follow-up imaging. However, they were finally diagnosed with RIBI. All patients had been treated with 3-dimensional conventional fractionated radiotherapy and/or radiosurgery for primary or metastatic brain tumors with or without chemotherapy. The histological distribution was as follows: two falx meningioma, six glioblastoma multiform (GBM), two anaplastic oligodendroglioma, one low grade oligodendroglioma, and one small cell lung cancer with brain metastasis. RESULTS: Radiation necrosis was noted in eight patients and the remaining four were diagnosed with radiation change. Gender (p = 0.061) and biologically equivalent dose (BED)3 (p = 0.084) were the only marginally influencing factors of radiation necrosis. Median time to RIBI was 7.3 months (range, 0.5 to 61 months). Three prolonged survivors with GBM were observed. In the subgroup analysis of high grade gliomas, RIBI that developed <6 months after radiotherapy was associated with inferior overall survival rates compared to cases of RIBI that occurred > or =6 months (p = 0.085). CONCLUSION: Our study demonstrated that RIBI could occur in early periods after conventional fractionated brain radiotherapy within normal tolerable dose ranges. Studies with a larger number of patients are required to identify the strong influencing factors for RIBI development.
Brain ; Brain Injuries ; Brain Neoplasms ; Disease Progression ; Follow-Up Studies ; Glioblastoma ; Glioma ; Humans ; Meningioma ; Necrosis ; Oligodendroglioma ; Radiation Injuries ; Radiosurgery ; Retrospective Studies ; Small Cell Lung Carcinoma ; Survival Rate ; Survivors

PURPOSE: Buerger's disease (Thromboangiitis obliterans, TAO) is characterized by non- atheromatous inflammatory disease, and segmental inflammatory thrombotic occlusions of the small & middle-sized arteries and veins of the upper or lower extremities. Any epidemiological study of Buerger's disease in Korea has not been carried out until now. This study was undertaken to investigate the incidence of Buerger's disease in Korea among the patients suffering with arterial disease. METHODS: We collected and analyzed the data on 11,128 patients who were admitted to or visited the participating 22 hospitals for chronic arterial diseases throughout the major region of the South Korea from January 1986 to December 2003. The clinical diagnostic inclusion criteria for Buerger's disease were the followings: (1) a history of smoking or tobacco abuse; (2) an age of onset less than 50 years; (3) infrapopliteal, segmental arterial occlusions with sparing of the proximal vasculature; (4) frequent distal upper extremity arterial involvement (Raynaud's syndrome or digital ulceration) or-superficial phlebitis; and (5) the absence of arteriosclerotic risk factors other than smoking. RESULTS: The incidence rate of Buerger's disease among the arterial disease (11,128 patients) was 93 patients (0.83%) when the strict criteria of Shionoya was applied. 699 male-patients (6.55%) and 30 female patients (4.12%) who met the less strict criteria (the extended clinical diagnostic criteria group) were also reviewed. The 4th and 5th decades were the most common ages with-249 patients (34.2%) and 222 patients (30.5%) respectively, being found at these ages. The mean age was 40.4+/-1.6 years (age range: 16~83 years) and this was similar in both the strict criteria group and the less strict criteria group. CONCLUSIONS: This study suggests there was a low incidence of Buerger's disease in Korea among the patients who visited the participating hospitals when the strict diagnostic criteria were used. The incidence was lower than expected even when the less strict criteria were used. The more accurate incidence of Buerger's disease among the general population can be obtained by performing careful prospective study that is participated in by not only vascular surgeons, but also the other medical specialists with utilizing the strict diagnostic criteria.
Age of Onset ; Arteries ; Epidemiologic Studies ; Female ; Humans ; Incidence ; Korea* ; Lower Extremity ; Phlebitis ; Risk Factors ; Smoke ; Smoking ; Specialization ; Thromboangiitis Obliterans* ; Tobacco ; Upper Extremity ; Veins