No abstract available.

No abstract available.
Breast Neoplasms* ; Breast*

PURPOSE: Many investigators suggested that changes in hormonal environment in the postmenopausal women functionally or histologically effect the clitoris and vagina. We investigated the mechanism of female se xual dysfunction occurring in the decreased hormonal status, and aimed to establish and experimental base for the hormone replacement in postmenopausal women to correct sexual dysfunction. MATERIALS AND METHODS: Twenty mature female New Zealand white rabbits were randomly divided into three groups; control group, oophorectomy group, estrogen replacement group after oophorectomy. Nitric oxide synthase (NOS) activity and the degree of expression of neuronal NOS (nNOS) and endothelial NOS (eNOS), collagen content in clitoral tissues were analysed. RESULTS: nNOS and eNOS were significantly increased in the oohporectomized group while decreased in the estrogen replacement group (p<0.01). NOS activity showed the similar pattern of change (p<0.05). Oophorectomy induced a significant increase in collagen content, while the ratio of smooth muscle content was increased significantly after the estrogen replacement (p<0.01). CONCLUSIONS: Estrogen deficiency induces collagen synthesis and decreases the content of smooth muscle in clitoris, resulting in a structural relaxation difficulty. We believe that NOS becomes more active to improve the relaxation difficulty and that hormone replacement helps to restore the normal state of smooth muscle relaxation. Considering these findings, we suggest that estrogen down-regulates NOS and its activity.
Clitoris* ; Collagen ; Estrogen Replacement Therapy ; Estrogens* ; Female ; Humans ; Muscle, Smooth ; Neurons ; Nitric Oxide Synthase ; Ovariectomy ; Rabbits ; Relaxation ; Research Personnel ; Vagina

Multiple gastric caner, now considered to be a sort of multiple primary cancer by Moertel's classification, is a special type of cancer in which two or more tumor lesions arise independently from the stomach. Although its incidence is rare and it has never been reported in Korea yet, the report of multiple gastric cancer is increasing with lengthened life survival and improved diagnostic method. We recently experienced two cases of triple gastric cancer, the one in 53-years-old male who had well differentiated adenocarcinoma(EGC IIb+c) on antrum, poorly differentiated adenocarcinoma on cardia and moderately differentiated adenocarcinoma on mid-body, and the other in 65-years-old female who had two poorly differentiated adenocarcinoma on cardia and anterior wall of low body and moderately differentiated adenocarcinoma (EGCIIc) on posterior wall of low body. Triple gastric cancer is rare, so we reported 2 cases of triple gastric cancer.
Adenocarcinoma ; Cardia ; Classification ; Female ; Humans ; Incidence ; Korea ; Male ; Stomach ; Stomach Neoplasms*

Brachial plexus block, axillary approach appears to be a safe and reliable technique for upper extremity surgery from shoulder to hand. However, the maximum dose of lidocaine that is recommended by the manufactured is 4 mg per kg (approximately 300 mg) regardless of the injection site. The maximum recommended dose for lidocaine with epinephrine is 7 mg per kg (approximately 500 mg). These maximum recommended amounts are insufficient for brachial plexus block. We question the logic behind these recommended dosages and may exceed them. The aim of this study was to determine whether commonly acceptable dosages used in brachial plexus block within a safe range. The time courses of the plasma concentration were observed in 20 healthy patients to whom were axillary injected with 1.5% lidocaine mixed 1: 200,000 epinephrine. The plasma concentrations were measured by immunofluororesence assay at the intervals of 5, 10, 20, 30 and 60 minutes. The values of plasma concentration were 2.65+/-75, 4.29+/-2.75, 5.95 +/-2.02, 4.76+/-1.91 and 4.48+/-1.90 pg/ml in group 1, and 3.71+/-1.68, 4.76+/-1.91, 6.68+/-3.43, 5.57+/-3.08 and 5.56+/-2.86 ug/ml in group 2, and 2.86+/-1.82, 5.08+/-3.74, 5.92+/-3.84, 6.82+/-3.84 and 5.49+/-3.29 ug/ml in group 3 (Mean+SD). The peak plasma concentration was 5.95+/-2.02 and 6.68+/-3.43 ug/ml at 20 minutes in group 1 and 2 respectively and 6.82+/-3.84 ug/ml at 30 minutes in group 3. These results indicated that the lidocaine 750 mg with epinephrine (5 ug/ml) in brachial plexus block is considered to be safe because plasma concentration dose not exceed the toxic level.
Brachial Plexus* ; Epinephrine ; Hand ; Humans ; Lidocaine* ; Logic ; Plasma* ; Shoulder ; Upper Extremity

Anti-f(ce) has been associated with hemolytic transfusion reaction (HTR) and hemolytic disease of the fetus and newborn (HDFN), however, anti-Cs(a) has not been associated with red blood cell (RBC) destruction. Although anti-Cs(a) has clinical insignificance as a high-titer low-avidity (HTLA) antibody, this antibody can cause confusion in interpreting an antibody identification test, particularly coexistence of a clinically significant antibody. A 65-year-old woman with liver metastases of Klatskin tumors and cholangitis was admitted to the hospital for abdominal pain. She developed hematochezia on hospital day 10. She was at the status of active bleeding and required transfusion. The result of antibody identification test was warm-reactive autoantibody and unidentifiable alloantibody, therefore, the least incompatible packed RBCs had to be transfused to the patient. No hemolytic transfusion reaction occurred and hemoglobin level was normalized. Thereafter, anti-f(ce) and anti-Cs(a) antibodies were identified in the patient's serum. To the best of our knowledge, this is the first report of anti-f and anti-Cs(a) antibodies in Korea.
Abdominal Pain ; Aged ; Antibodies* ; Blood Group Incompatibility ; Cholangitis ; Erythrocytes ; Female ; Fetus ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Infant, Newborn ; Klatskin's Tumor ; Korea ; Liver ; Neoplasm Metastasis

OBJECTIVE: This study was designed to investigate CD20dim expression on T cells between healthy control subjects and rheumatoid arthritis patients and to investigate the association between CD20dim T cells and clinical manifestations in rheumatoid arthritis. METHODS: Peripheral bloods from twenty seven healthy controls and twenty six rheumatoid patients were evaluated by dual color immunophenotyping. We used IgGla and IgG2a for negative control, then, divided T cells and B cells on CD3/CD19 combination. And we evaluated two subpopulation CD5+CD20dim T cell (CD20dim T cell) and CD5+CD20bright cell(CD5 B cell) on CD5/20 combination for comparison. In order to correlate the CD20dim T cell datas with patient's clinical status, patients charateristcs such as age, disease duration, morning stiffness, rheumatoid factor(RF), and antinuclear antibody(ANA) were reviewed. RESULTS: The mean percent positivity of T cells(CD3) and B cells(CD19) in 27 healthy control donors was 63.2+/-7.7%, and 11.4+/-2.6 %. The mean percentages of CD20dim T cell and CD5 B cell(Leul) were 2.3+/-1.0% and 1.4+/-0.9% and upper limit of reference values of CD20dim T cells and CD5 B cells(Leul) that calculated from normal healthy controls were 4.3%0 and 3. 2 %. Compared with healthy controls, CD20dim T cells were significantly elevated in total patient groups(4.4+/-2.7%, p(0.01). and significantly increased more than upper limit of reference values in eleven of 26 patients. Compared with CD20dim T cells according to disease duration, disease duration of most patients(10/11) with elevated CD20dim T cell were less than 2 years. CONCLUSION: The results indicated that CD20dim T cells were expressed at low levels in healthy controls but elevated levels of CD20dim T cells in rheumatoid arthritis patients were observed and close relationship to CD20dim T cells expression and disease duration was noted.
Arthritis, Rheumatoid* ; B-Lymphocytes ; Humans ; Immunoglobulin G ; Immunophenotyping ; Reference Values ; T-Lymphocytes ; Tissue Donors

Sheehan's syndrome is characterized by varying degrees of anterior pituitary dysfunction due to postpartum ischemic necrosis of the pituitary gland after massive bleeding. The spectrum of clinical presentation of Sheehan's syndrome is broad, with changes from nonspecific complaints, such as weakness, fatigue, and anemia, to severe pituitary insufficiency resulting in coma and death. Normochromic anemia is commonly associated with Sheehan's syndrome, but pancytopenia is rarely observed in patients with Sheehan's syndrome. We describe a 57-year-old woman with Sheehan's syndrome who presented with pancytopenia that was treated by hormone replacement with levothyroxine and glucocorticoid.
Anemia ; Coma ; Fatigue ; Female ; Glucocorticoids ; Hemorrhage ; Humans ; Hypopituitarism ; Middle Aged ; Necrosis ; Pancytopenia ; Pituitary Gland ; Postpartum Period ; Thyroxine

BACKGROUND: Early escharectomy has been shown to improve the survival rates and the treatment outcomes of major burn patients. However, its exact mechanism, especially in terms of the human immune system, has not been fully elucidated. This observational study, which placed a focus on adhesion molecules, was conducted to assess changes of soluble intercelluar adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), and E-selectin in major burn patients undergoing early eschar excision. METHODS: Seventeen ASA physical status II or III adult major burn patients, admitted for plastic and reconstructive surgery for burn wound care, were initially recruited. When early escharectomy was scheduled, a series of blood samples were obtained four times at 72 and 24 hours preop and 24 and 72 hours postop, respectively. Changing levels of sICAM-1, sVCAM-1, and E-selectin were measured using quantitative sandwich immunoassay techniques. RESULTS: All patients suffered from major burns. Early escharectomy does not appear to have any significant impact on the levels of sICAM-1 and sVCAM-1. On the other hand, E-selectin levels showed a significant decrease after escharectomy. CONCLUSIONS: Major burn injury certainly induces a systemic inflammatory response. Adhesion molecules behave in such a way that escharectomy has a limited immunomodulatory effect in major burns. This is probably related to the timing and extent of surgery, and the complex nature of burn related inflammation.
Adult ; Burns* ; E-Selectin ; Hand ; Humans ; Immune System ; Immunoassay ; Inflammation ; Observational Study ; Plastics ; Survival Rate ; Vascular Cell Adhesion Molecule-1 ; Wounds and Injuries

BACKGROUND: High model for end-stage liver disease (MELD) scores (> or =35) is closely associated with poor posttransplantation outcomes in patients who undergo living donor liver transplantation (LDLT). There is little information regarding factors that negatively impact the survival of patients with high MELD scores. The aim of this study was to identify factors associated with 3-month mortality of patients after LDLT. METHODS: We retrospectively analyzed 774 patients who underwent adult LDLT with right lobe grafts between 1996 and 2012. Exclusion criteria were re-transplantation, left graft, auxiliary partial orthotopic liver transplantation, and inadequate medical recording. Preoperative variables were analyzed retrospectively. RESULTS: The overall 3-month survival rate was 92%. In univariate analysis, acute progression of disease, severity of hepatic encephalopathy, Child-Pugh class C, hepatorenal syndrome, use of continuous renal replacement therapy, use of ventilator, intensive care unit (ICU) care before transplantation, and MELD scores > or =35 were identified as potential risk factors. However, only ICU care before transplantation and MELD scores > or =35 were independent risk factors for 3-month mortality after LDLT. Three-month and 1-year patient survival rates for those with no risk factors were 95.5% and 88.6%, respectively. In contrast, patients with at least one risk factor had 3-month and 1-year patient survival rates of 88.4% and 81.1%, respectively, while patients with two risk factors had 3-month and 1-year patient survival rates of 55.6% and 55.6%, respectively. CONCLUSIONS: Patients with both risk factors (ICU care before LDLT and MELD scores > or =35) should be cautiously considered for treatment with LDLT.
Adult ; End Stage Liver Disease ; Hepatic Encephalopathy ; Hepatorenal Syndrome ; Humans ; Intensive Care Units ; Liver Diseases ; Liver Transplantation* ; Living Donors* ; Medical Records ; Mortality* ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors ; Survival Rate ; Transplants ; Ventilators, Mechanical