Choriocarcinoma is a relatively rare malignancy of which characteristic is rapid metastasis to the other organs. It is related to the previous gestation or originated from the teratoma. Choriocarcinoma is mostly originated from the intrauterine chorionic villi, but it is rarely originated from the utreine cervix, fallopian tube, ovary, vagina and pelvic cavity. Primary choriocarcinoma of the fallopian tube is exceedingly rare and it is originated from ectopic tubal pregnancy, tubal migration from the intrauterine pregnancy or intratubal teratoma. 9 Symptoms and signs of the choriocarcinoma originated from the ectopic pregnancy are abdominal pain, vaginal bleeding, palpable adnexal mass, positive pregnancy test and amenorrhea. Thus it is difficult to distinguish choriocarcinoma from ectopic pregnancy on the basis of symptoms before the microscopic diagnosis presented.20 Effective treatment of choriocarcinoma is chemotherapy. Additional operation is possible. B-HCG is a useful measure for the follow up. We experienced a 36-year-old multigravida Korean woman who was diagnosed as the rupture of ectopic pregnancy after left salpingectomy in our hospital and then confirmed primary choriocarcinoma of the fallopian tube without metastasis on microscopic finding. Postoperative chemotherapy was performed with methotrexate. The follow up of disease is still on going at two month intervals and she has remained healthy, We report this case with review of literatures.
Abdominal Pain ; Adult ; Amenorrhea ; Cervix Uteri ; Choriocarcinoma* ; Chorionic Villi ; Diagnosis ; Drug Therapy ; Fallopian Tubes* ; Female ; Follow-Up Studies ; Humans ; Methotrexate ; Neoplasm Metastasis ; Ovary ; Pregnancy ; Pregnancy Tests ; Pregnancy, Ectopic ; Pregnancy, Tubal ; Rupture ; Salpingectomy ; Teratoma ; Uterine Hemorrhage ; Vagina

Decerebrate rigidity, in which there is an exaggereted posture with continuous spasm of muscles, especially the extensors, was first produced in 1898 by Sherrington in animals by transection of the brain at a prepontine level. Since it was shown that intact vestibular nuclei were necessary for decerebrate ridigity to persist, the disorder was believed to be caused by release of vestibular nuclei from higher extrapyramidal control. We have experienced 42 cases of the presence of decerebrate ridigity following head injury who were admitted to the Chosun University Hospital from March 1972 to February 1976. Although no one doubts the prognostic gravity of the decerebrate state following cranial trauma, a surpring number of patients in this study survived in a reasonably functional state. The particular factors we have evaluated are the duration of decerebration, the presence or absence of an intracranial hematoma of surgical proportions, the time of surgical intervention in relation to onset of decerebration and the use of corticosteroids. 42 consecutive parients with traumatic decerebration were studied to determine factors that influence the recovery from the decerebrate state. All these cases were diagnosed by clinical findings and cerebral angiography and assessed the prognostic factors on the result of treatment. Although the data did not lend themselves to precise statistical analysis, it is our option that the following conclusions be inferred ; 1. Intracranial hematoma was found in 25 patients (about 60%) from 42 patients who were presence of decerebrate rigidity, among these the sites of intracranial hematoma were as follows ; a) Epidural hematoma was found in 8 patients(32%). b) Subdural hematoma was found in 13 patients(52%). c) Intracerebral hematoma was found in 4 patients(16%). 2. The mortality of decerebrate patients(65%) with direct damage to the brain stem was greater than that of those supratentorial hematoma(52%). However the quality of survival was better in the latter group, indicating the likehood that brain stem compression is often reversible after evacuation of the hematoma even though with residual neurological deflicit. 3. The mortality and morbidity were greater with traumatic intracerebral and subdural hematoma than with epidural hematoma. This correlation was probably related to the amount of associated diffuse brain damage. 4. A progressive increase in the mortality rate in the surgical group could be correlated with the duration of decerebrate rigidity prior to surgical intervention. 5. Patients who recovered from the decerebrate state usually survived even though with residual sequelae. 6. There was an increase in the mortality rate when decerebration persisted for more than on weeks, but there was one survivor after even 35 days of decerebrate state. 7. The mortality rate was highest over 40 years old and was on the contrary under 20 years old. 8. There was no specific effectiveness in the patients with the presence of decerebrate state with the use of parenteral corticosteroid therapy.
Adrenal Cortex Hormones ; Adult ; Animals ; Brain ; Brain Stem ; Cerebral Angiography ; Craniocerebral Trauma ; Decerebrate State ; Gravitation ; Hematoma ; Hematoma, Subdural ; Humans ; Mortality ; Muscles ; Posture ; Spasm ; Survivors ; Vestibular Nuclei ; Young Adult

A 54 year-old woman presented with bilateral fatigable blepharoptosis with diurnal fluctuation and diplopia for 10 days. She had a 3 year history of hypertension and showed symptoms of bilateral ptosis, supranuclear upward gaze palsy, and vertical diplopia with the pupils promptly constricting to light. Bell's phenomenon and vertical oculocephalic responses were intact but an impaired convergence was noted in both eyes. A intramuscular neostigmine test was negative. T1 and T2-wighted MRI of the brain showed a small round high signal intensity lesion in the periaqueductal gray (PAG) region. Therefore, she was diagnosed with a midbrain ptosis due to midbrain hemorrhage. The PAG lesion was suggested as contributing to the fatigable blepharoptosis and supranuclear upward gaze palsy in the patient. We recommend that patients with clinical features of myasthenia limited to the ocular muscles and, having risk factors for cerebrovascular disease, be thoroughly evaluated for intracranial lesions if warranted.
Blepharoptosis ; Brain ; Diplopia ; Female ; Hemorrhage* ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Mesencephalon* ; Middle Aged ; Muscles ; Neostigmine ; Paralysis ; Periaqueductal Gray ; Pupil ; Risk Factors

BACKGROUND: Alzhiemeranjx disease (AD) and vascular dementia (VD) are common types of dementia. As a result of the development of new specific agents for AD, and because vascular dementia is a potentially preventable dementia, differentiating these diseases is of great importance. The role of EEG spectral analysis in the differential diagnosis between Alzheimer type and vascular dementia is still controversial. Since there have been few studies concerning the differential diagnosis of dementia by EEG, the present study has focused on this aspect. Usefulness of EEG in differen-tial diagnosis of dementia will be elucidated by clarifying relationship between type of dementia and spectral profile of EEG. METHODS: We analyzed the power spectra taken from 16 derivations and spectral profile was constructed by averaging twenty 2 sec epochs in three study groups (normal controls, AD and VD). Spectral profile was divided into three groups; (I) type A, showing a dominant 6.5-12 Hz peak (ii) type B, lacking a dominant peak in the 6.5-12 Hz (iii) type C, corresponding to a flat, low voltage, spectrum. To elucidate the relationship between spectral profile and other factors including diagnosis, statistical test was done. RESULTS: (1) In AD, type C profile was statistically more prevalent than in VD and type A profile was reversed. (2) In AD, Mini-Mental State Examination (MMSE) score was statistically lower in type C profile. (3) Spectral profile was not associated with age, age of symptom onset, and symptom duration. CONCLUSIONS: This study suggested that spectral profile is a useful tool for the differential diagnosis of dementia (AD and VD) and correlated with the severity of disease in AD.
Dementia ; Dementia, Vascular* ; Diagnosis ; Diagnosis, Differential* ; Electroencephalography*

No Abstract Available.
Hidradenitis*

PURPOSE: 2003, Advances in medical-surgical technologies, histo-compatibility and immunosuppressive drugs, such as FK-506, MMF, have caused a dramatic increase in the rates of successful organ transplantation (TP). As the waiting list of patients requiring TP grows, there is a subtle donation. What is worse, its increased issues of ethics, for instance, definition of brain death, consent of living donation, paid organ donation, decreased altruism, living will, justice of sharing organ. Therefore, This study was done to develop on legal, ethical and philosophical for whole procedure of organ transplantation which is a life-saving treatment improvement the quality of life. METHODS: A survey questionnaire was used and received responses from TP doctors(59) and nursing coordinators(46) at 53 hospitals where TP were being done for this study. The basic data in TP were collected, 1) to identity the staffs in charge of TP and their jobs in the hospital, 2) committee of hospital ethics (CHE), 3) committee of brain death confirmation definition (CBDCD), 4) to research what consideration are appropriate donors and recipients, 5) the facility of hospital for TP, 6) to analyzed awaiting solution the problems for TP. The data were analyzed using SAS-program by descriptive statistics, t-test, ANOVA and Pearson correlation coefficient. RESULTS: The jobs of TP nursing coordinators were not only to give nursing information but also to take care of donors and recipients (62.8~84.4%). The job of TP has not been identified between CHE and CBDCD (62.8%). The mean score of CHE's members was 6.33 persons. The mean scores of the problems regarding the law of TP was 2.88 (full score:4). The high items of the problems regarding the law of TP were "the decreased TP, donation and brain death because of KONOS (Korea Network for Orgen Sharing) which operated TP". The mean score of the improvements regarding the law of TP was 2.97 (full score:4). The highest item of the improvements regarding the law of TP was "Compensation of loss should be paid by the KONOS. The procedure of confirm is a loose legal. Therefore that is concern about commercialization of human organ. Definition of brain death is rigid regulation. Sharing organs are a fair dealing. The problems were significantly correlated with the improvements (P<0.0001). CONCLUSION: The finding of the study suggested that a TP should manage donors and recipients in line with legal, ethical, philosophical, humanistic aspects. Various viewpoints, the CHE should be enacted from the principle of human dignity, conducted by CBDCD of professional members and the nursing coordinators played an important role. It is suggested that TP might meet the request of the time so that KONOS should be changed with the other organization of newly methods and responsibility.
Altruism ; Brain Death ; Ethics ; Ethics, Institutional ; Humans ; Jurisprudence* ; Living Wills ; Nursing ; Organ Transplantation* ; Personhood ; Quality of Life ; Surveys and Questionnaires ; Social Justice ; Tacrolimus ; Tissue and Organ Procurement ; Tissue Donors ; Transplants* ; Waiting Lists

PURPOSE: To analyze CT and follow-up chest radiographic findings in patients with necrotizing pneumonia and to evaluate clinical significance of the extent of necrosis. MATERIALS AND METHODS: We reviewed medical records and retrospectively analysed CT scans and follow-up chest radiographs of 22 patients with necrotizing pneumonia, confirmed by biopsy(n=7) and culture (n=15). Inclusion criteria for necrotizing pneumonia was necrotic low attenuation, with or without cavitation on postcontrast enhanced CT scan. The study group included 15 men and seven women, aged 11-66 years (average: 47years). RESULTS: The pathogens of necrotizing pneumonia were Klebsiella spp(n=7), Enterobacter spp(n=5), Actinomyces spp(n=4), Pseudomonas spp(n=4), Nocardia spp(n=4), and others(n=5). Average duration of pneumonia was 4.1 months. On CT scan, pneumonic consolidations were well-marginated in 14 patients and there were cavities on initial CT scan in 16 cases. Margins of the necrotic portion on CT scan were well-demarcated in majority of the patients(16/22). Low attenuation areas on initial CT scan resulted in cavitation, fibrosis and volume loss as shown on follow-up chest radiographs. The larger the necrotic areas on CT, the more the volume loss was. CONCLUSION: CT findings of necrotizing pneumonia were well-marginated air-space consolidation with low attenuation area, with or without cavity. The extent of necrotic area was closely related with the degree of fibrotic change later on. CT is important tool for diagnosis and prediction of parenchymal damage in necrotizing pneumonia.
Actinomyces ; Diagnosis ; Enterobacter ; Female ; Fibrosis ; Follow-Up Studies ; Humans ; Klebsiella ; Male ; Medical Records ; Necrosis ; Nocardia ; Pneumonia* ; Pseudomonas ; Radiography, Thoracic ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: To analyze CT and follow-up chest radiographic findings in patients with necrotizing pneumonia and to evaluate clinical significance of the extent of necrosis. MATERIALS AND METHODS: We reviewed medical records and retrospectively analysed CT scans and follow-up chest radiographs of 22 patients with necrotizing pneumonia, confirmed by biopsy(n=7) and culture (n=15). Inclusion criteria for necrotizing pneumonia was necrotic low attenuation, with or without cavitation on postcontrast enhanced CT scan. The study group included 15 men and seven women, aged 11-66 years (average: 47years). RESULTS: The pathogens of necrotizing pneumonia were Klebsiella spp(n=7), Enterobacter spp(n=5), Actinomyces spp(n=4), Pseudomonas spp(n=4), Nocardia spp(n=4), and others(n=5). Average duration of pneumonia was 4.1 months. On CT scan, pneumonic consolidations were well-marginated in 14 patients and there were cavities on initial CT scan in 16 cases. Margins of the necrotic portion on CT scan were well-demarcated in majority of the patients(16/22). Low attenuation areas on initial CT scan resulted in cavitation, fibrosis and volume loss as shown on follow-up chest radiographs. The larger the necrotic areas on CT, the more the volume loss was. CONCLUSION: CT findings of necrotizing pneumonia were well-marginated air-space consolidation with low attenuation area, with or without cavity. The extent of necrotic area was closely related with the degree of fibrotic change later on. CT is important tool for diagnosis and prediction of parenchymal damage in necrotizing pneumonia.
Actinomyces ; Diagnosis ; Enterobacter ; Female ; Fibrosis ; Follow-Up Studies ; Humans ; Klebsiella ; Male ; Medical Records ; Necrosis ; Nocardia ; Pneumonia* ; Pseudomonas ; Radiography, Thoracic ; Retrospective Studies ; Tomography, X-Ray Computed

The LH and FSH responses to synthetic LH-RH and the prolactin response to synthetic T-RH were evaluated during different phases of the mentrual cycle in order to understand secretory capacity of the pituitary during the menstrual cycle. Eleven regularly menstruating women between 22 and 35 years of age with a usual cycle length of 27 to 31 days volunteered for this Study. Volunteers received an intra-venous injection of 100 microgram synthetic LH-RH and 200 microgram synthetic T-RH during the early and the late follicular phases and during the early and midluteal phases of the menstrual cycle. LH-RH induced a prompt increase in circulating LH, reaching the peak concentration at 30 minutes following LH-RH administration in all phases of the cycle studied. A change in responsiveness with greater and more sustained LH release from the early to the late follicular phases was observed. The response during the luteal phase was significantly greater than the responses in both the early and the late follicular phases. A concomitant but a much smaller FSH response was observed. T-RH elicited a prompt increase in circulating prolactin within 30 minutes and decreased gradually thereafter, reaching the baseline level by 2 hours after T-RH administration. Maximum concentration of prolactin was reached in 30 minutes following T-RH during all phases of the menstrual cycle. No variation in pituitary responsiveness to T-RH, however, was observed during different phases of the menstrual cycle. These data indicate that the sensitivity of the pituitary gonadotrophs to LH-RH varies during different phases of the menstrual cycle.
Adult ; Female ; Follicle Stimulating Hormone/secretion ; Gonadorelin/pharmacology* ; Human ; Luteinizing Hormone/secretion ; Menstruation* ; Pituitary Gland/drug effects* ; Protirelin/pharmacology*

Candida albicans endophthalmitis following cataract surgery is fortunately rare complication, but once the infection is established, its course is unrelenting and the prognosis for a good visual result is usually very guarded. The authors experienced a case of culture-proved Candida albicans endophthalmitis following intracapsular cataract extraction in a 74-year old man. Endophthalmitis was resolved after treatment with intravitreal injection of amphotericin B, intravenous amphotericin B, oral Ketoconazole and 2% of topical Ketoconazole.
Aged ; Amphotericin B ; Candida albicans ; Candida* ; Cataract Extraction* ; Cataract* ; Endophthalmitis* ; Humans ; Intravitreal Injections ; Ketoconazole ; Prognosis