A myolipoma is an extremely rare benign neoplasm, occurring most frequently in adults in the deep soft tissue of the abdomen or retroperitoneum. We experienced a case of an anal myolipoma occurring in a 30-year-old woman, and it was surgically resected. To our knowledge, this is the first reported case of a myolipoma arising from the anus, so such a possibility needs to be considered in the differential diagnosis.
Abdomen ; Adult ; Anal Canal ; Angiomyolipoma ; Diagnosis, Differential ; Female ; Humans

PURPOSE: This study was done to develop and evaluate the Integrated Stress Management Program (ISMP) for elders in rural communities. METHOD: ISMP consists of 6 educational programs to improve self-management behavior and therapeutic recreational activities and was developed by analyzing the published reports and through multidisciplinary cooperation.Effectiveness of the ISMP was evaluated by implementing the program with 53 rural elders living at home, one session a week of, 2 hours per session over, 6 weeks from March 14 to April. 22, 2005. RESULTS: After participating in the program, participants' perceived levels of stress decreased(t=2.940, p<.05), and mood state (t=4.229, p<.001), life satisfaction(t=-4.911, p<.001), and perceived social support (t=-2.891, p<.05) increased significantly. CONCLUSION: The results of this study demonstrated that the ISMP is an effective program for relieving stress level, and increasing positive mood, life satisfaction, and social support for elders in a rural community.
Rural Population* ; Self Care

Autonomic hyperreflexia is a syndrome of massive reflex sympathetic discharge that occurs in patients with chronic spinal cord lesions above the major sympathetic splanchnic outflow (T 4 -T6). We experienced autonomic hyperreflexia that occured in a patient with spinal cord trans-section at T5 level during general anesthesia with O2-N2O-halothane. Hypertension was controlled with intravenous infusion of sodium nitroprusside (1-2 ug/kg/min) and ventricular arrhythmia was treated with intra- venous lidocaine. We recommend that direct acting vasodilators are useful drugs to control hypertension in autonomic hyperreflexia during anesthesia in patients with chronic spinal cord injury.
Anesthesia ; Anesthesia, General* ; Arrhythmias, Cardiac ; Autonomic Dysreflexia* ; Humans ; Hypertension* ; Infusions, Intravenous ; Lidocaine ; Nitroprusside* ; Reflex ; Sodium* ; Spinal Cord Injuries* ; Spinal Cord* ; Vasodilator Agents

OBJECTIVE: We undertook this study to determine the clinical characteristics and the prognostic factors of neonatal survival in patients with fetal anemia who were treated by intraumbilical venous transfusion (IUT). METHODS: From July 2000 to March 2009, 16 cases of fetal anemia were diagnosed at Asan Medical Center in Seoul, Korea. These patients underwent intraumbilical venous transfusions and were thus included in our study. Doppler measurement of the middle cerebral artery peak systolic velocity was performed before and after cordocentesis in all fetuses. RESULTS: The gestational age at the time of the diagnosis of anemia ranged from 21.3 to 33.6 weeks. There was a linear correlation between pre- and post-procedure fetal hemoglobin (Hb,MoM, (x)) and the MCA-PSV (MoM, (y)), i.e., y=0.810-0.229x, r2=0.542, CI 0.316-0.141, p<0.005; and y=1.374-0.391x, r2=0.499, CI 0.584-0.197, p<0.005. The survival was better in patients with severe anemia than those with mild to moderate anemia (p<0.05), and survival was better in patients with anemia of a known cause than those with anemia of an unknown cause (p<0.001). CONCLUSION: In fetuses with anemia, the severity of the anemia before IUT and the change of hemoglobin concentration after IUT, can be estimated noninvasively using Doppler ultrasonography, on the basis of an increase in the peak velocity of systolic blood flow in the middle cerebral artery. Both severity and etiology were meaningful factors for the survival of neonates with fetal anemia who were treated by intraumbilical venous transfusion. Although fetuses have severe anemia, they expected improved survival through IUT. These data are valuable information for use when counseling the parents of an affected fetus.
Anemia ; Blood Transfusion, Intrauterine ; Cordocentesis ; Counseling ; Fetal Hemoglobin ; Fetus ; Gestational Age ; Hemoglobins ; Humans ; Hydrops Fetalis ; Infant, Newborn ; Korea ; Middle Cerebral Artery ; Parents ; Ultrasonography, Doppler

OBJECTIVE: The aims of this study were 1) to evaluate the indications of chorionic villus sampling CVS) and the positive predictive value for fetal chromosomal abnormalities, 2) to evaluate the reliability of CVS at Asan Medical Center, 3) to find out the risk factors of procedure-related fetal loss, 4) to find out the risk factors of culture failure, and 5) to compare transabdominal with transvaginal approaches. METHODS: Medical records of the 429 out of 461 patients in whom the CVS for prenatal cytogenetic diagnosis were performed were reviewed retrospectively for the period of June 1998 to June 2006. RESULTS: (1) The most common indications of CVS were abnormal ultrasonic findings including increased nuchal translucency (153/429, 35.7%), a previous history of cytogenetically abnormal baby (125/429, 29.1%), old maternal age (100/429, 23.3%), family history of genetic disease (22/429, 5.1 %), and parental abnormal karyotype (11/429, 2.6%). (2) The positive predictive value of abnormal karyotyping according to the indication of CVS was highest in the cases showing abnormal USG findings, including increased fetal nuchal translucency (28.3%). (3) The trial success rate of CVS was 99.5%(427/429). Culture failure rate was 1.9%.(4) Of the 427 cases, normal karyotype was revealed in 349 cases (81.7%), abnormal karyotype in 66 cases (15.2%), maternal cell contamination in 6 cases (1.4%), and pseudomosaicism and confined placental mosaicism (CPM) in 6 cases (1.4%). (5) Procedure-related fetal loss rate was 1.6% (7/419). (6) The significant risk factor of fetal loss was presence of preprocedure vaginal bleeding. (7) The significant risk factor of culture failure was a small amount (less than 10 mg) of tissue. (8) The gestational age at procedure was significantly different between transabdominal and transvaginal methods. In the transabdominal approach group, the incidence of fundal location of placenta was significantly more common. CONCLUSION: If CVS is performed by an expert operator and at a good quality of genetic laboratory, CVS is a very safe and reliable procedure for prenatal genetic diagnosis.
Abnormal Karyotype ; Chorion ; Chorionic Villi ; Chorionic Villi Sampling ; Chromosome Aberrations ; Cytogenetics ; Female ; Gestational Age ; Humans ; Incidence ; Karyotype ; Karyotyping ; Maternal Age ; Medical Records ; Mosaicism ; Nuchal Translucency Measurement ; Parents ; Placenta ; Pregnancy ; Pregnancy Trimester, First ; Prenatal Diagnosis ; Retrospective Studies ; Risk Factors ; Ultrasonics ; Uterine Hemorrhage

Though nephrotic syndrome is associated with various thromboembolic phenomena, acute pulmonary thromboembolism is a rare complication. We experienced a case with acute pulmonary thromboembolism in a patient with generalized edema and profound proteinuria. Subsequent investigation revealed that the pulmonary thromboembolism was secondary to nephrotic syndrome due to membranous glomerulonephritis. This thromboembolic complication was successfully treated with thrombolysis and anticoagulation.
Edema ; Glomerulonephritis ; Glomerulonephritis, Membranous ; Humans ; Nephrotic Syndrome* ; Proteinuria ; Pulmonary Embolism*

Though nephrotic syndrome is associated with various thromboembolic phenomena, acute pulmonary thromboembolism is a rare complication. We experienced a case with acute pulmonary thromboembolism in a patient with generalized edema and profound proteinuria. Subsequent investigation revealed that the pulmonary thromboembolism was secondary to nephrotic syndrome due to membranous glomerulonephritis. This thromboembolic complication was successfully treated with thrombolysis and anticoagulation.
Edema ; Glomerulonephritis ; Glomerulonephritis, Membranous ; Humans ; Nephrotic Syndrome* ; Proteinuria ; Pulmonary Embolism*

OBJECTIVE: To evaluate the benefits of maternal corticosteroid therapy in infants delivered before 33 weeks of gestation after premature rupture of membranes (PROM). METHODS: This retrospective study included the pregnant women complicated by preterm delivery within 32 weeks of gestation after PROM at the Asan Medical Center between 1997 to 1999. Patients were divided into 2 groups according to the gestational age at delivery, i.e., one group who delivered within 28 weeks of gestation and the other group who delivered between 29 and 32 weeks of gestation. Within each group, we evaluated the effect of maternal dexamethasone therapy on the perinatal and neonatal outcomes based on the medical records. Data were analyzed with pearson's chi-square test, Fisher's exact test, and two sample t-test. p<0.05 was considered statistically significant. RESULTS: One hundred and fifteen pregnancies complicated by preterm delivery within 32 weeks of gestation after premature rupture of membranes were included. Preterm deliveries occurred within 28 weeks of gestation in 48 cases (41.7%) and between 28 and 32 weeks of gestations in 67 cases (58.3%). Antenatal dexamethasone therapy was done in 27 out of 48 mothers (56.3%) who delivered within 28 weeks of gestation and in 47 out of 67 mothers (70.1%) who delivered between 29 and 32 weeks of gestation. Antenatal dexamethasone therapy did not affect the selected perinatal outcome variables (gestational age at delivery, birth weight, Apgar scores, cesarean section rate, and maternal and neonatal WBC counts and serum C-reactive protein concentrations). Incidences of neonatal complications (respiratory distress syndrome, intraventricular hemorrhage, retinopathy of prematurity, and periventricular leukomalacia) between the groups who did and did not received antenatal dexamethasone were not significantly different in pregnancies who delivered within 28 weeks of gestation. However, incidences of respiratory distress syndrome and intraventricular hemorrhage were significantly lower in a group who received antenatal dexamethasone than in a group who did not in pregnancies who delivered between 29 and 32 weeks of gestation (p<0.05). CONCLUSION: Antenatal corticosteroid therapy may be beneficial to the infants delivered between 29 and 32 weeks of gestation after PROM. However, it may have no therapeutic advantage to the group who delivered within 28 weeks of gestation after PROM.
Birth Weight ; C-Reactive Protein ; Cesarean Section ; Chungcheongnam-do ; Dexamethasone ; Female ; Gestational Age ; Hemorrhage ; Humans ; Incidence ; Infant* ; Medical Records ; Membranes* ; Mothers ; Pregnancy* ; Pregnant Women ; Premature Birth ; Retinopathy of Prematurity ; Retrospective Studies ; Rupture*

BACKGROUND: This study investigated the association between the frequency of growth hormone receptor (GHR) exon 3 polymorphism (exon 3 deletion; d3-GHR) and metabolic factors in patients with acromegaly in Korea. METHODS: DNA was extracted from the peripheral blood of 30 unrelated patients with acromegaly. GHR genotypes were evaluated by polymerase chain reaction and correlated with demographic data and laboratory parameters. RESULTS: No patient had the d3/d3 genotype, while four (13.3%) had the d3/fl genotype, and 26 (86.7%) had the fl/fl genotype. Body mass index (BMI) in patients with the d3/fl genotype was significantly higher than in those with the fl/fl genotype (P=0.001). Age, gender, blood pressure, insulin-like growth factor-1, growth hormone, fasting plasma glucose, triglycerides, high density lipoprotein cholesterol, and low density lipoprotein cholesterol levels showed no significant differences between the two genotypes. CONCLUSION: The d3-GHR polymorphism may be associated with high BMI but not with other demographic characteristics or laboratory parameters.
Acromegaly* ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Cholesterol, HDL ; Cholesterol, LDL ; DNA ; Exons ; Fasting ; Genotype ; Growth Hormone* ; Humans ; Korea ; Polymerase Chain Reaction ; Receptors, Somatotropin* ; Triglycerides

BACKGROUND: The effect of opioids on nitric oxide (NO)- and peroxynitrite-induced neuronal cell death is largely unknown. In the present study, we examined the effect of morphine on NO- and peroxynitrite-induced cell death using a human neuroblastoma SH-SY5Y cell line, which abundantly expresses micro, delta, kappa-opioid receptors. METHODS: The cultured cells were pretreated with morphine and exposed to 3-morpholinosydnonimine (SIN-1) that simultaneously generates NO and superoxide, thus possibly forming peroxynitrite. The cell damage was assessed by using MTT assay and crystal violet staining. Morphological nuclear changes and enzymatic evidences of apoptosis of the cells after exposure to SIN-1 for 24 hours were evaluated by using 4', 6-diamidino-2-phenylindole (DAPI) staining and the measurement of pro-apoptotic protease (caspase-3) activity, respectively. Levels of reduced glutathion (GSH) were measured by monochloronimane (MCB) assay. RESULTS: Pretreatment of SH-SY5Y with morphine significantly inhibited the apoptotic cell death. Morphine also inhibited SIN-1-induced caspase-3 (pro-apoptotic protease) activity in a dose-dependent manner. However, naloxone (20 microM) could not antagonize completely the effect of morphine in SIN- 1-induced cell death. Pre-administered GSH and N-acetylcysteine (NAC) have been found to protect SIN-induced apoptosis, and the neuroblastoma cells treated with morphine had significantly elevated the levels of GSH. CONCLUSIONS: The present study shows that morphine protects the human neuroblastoma cell line SH- SY5Y from peroxynitrite-induced apoptotic cell death through elevated GSH levels. The protective actionof morphine seems to be associated with inhibition of the apoptotic pathway. However, it is suggested that morphine protects the cells possibly via other unknown mechanisms in addition to the activation of opioid receptors.
Acetylcysteine ; Analgesics, Opioid ; Apoptosis* ; Caspase 3 ; Cell Death ; Cell Line ; Cells, Cultured ; Gentian Violet ; Humans* ; Morphine* ; Naloxone ; Neuroblastoma* ; Neurons ; Nitric Oxide ; Peroxynitrous Acid ; Receptors, Opioid ; Superoxides