BACKGROUND: Established risk factors for coronary artery disease include smoking, hypertension, diabetes mellitus and hypercholesterolemia. However, these account for less than 50% of the actual incidence of coronary artery disease and the importance of other risk factors is being increasingly realized. It has been known that insulin resistance associated with hyperinsulinemia is a pivotal link to several risk factors of coronary artery disease, including hypertension, glucose intolerance, dyslipidemia and obesity. Recently both experimental and clinical studies have produced evidence suggesting that high plasma insulin level may promote the development of atherosclerotic vascular diseasa. Several prospective studies showed independently that high plasma insulin is associated with an increased risk of major coronary artery disease. In our study, plasma glucose, insulin and C-peptide level were determined with oral glucose tolerance test to assess the insulin resistance or hyperinsulinemia as a risk factory of coronary artery disease. METHOD: From September 1993 to April 1995, after excluding patients with hypertension, diabetes mellitus, hypercholesterolemia and obesity, 17 patients with significant coronary artery stenosis and 10 control subjects with normal coronary finding were selected among the 226 patients who undertook coronary angiography. In the 17 cases(M:F=15:2) of coronary artery disease group, the mean age was 54+/-10 years, and in the 10 cases(M:F=8:2) of control group, 51+/-9 years. All were matched for age, gender and body mass index. Blood pressure, lipid and lipoprotein were measured and smoking history was assessed. Glucose, insulin and C-peptide responses to oral glucose tolerance test were also determined. RESULT: 1) There was no significant difference in systolic and diastolic and diastolic blood pressure, total-cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, ApoA and smoking history except ApoB between the subjects with coronary artery disease and normal control subjects. 2) In oral glucose tolerance test, the plasma glucose levels were not significantly different in the two groups. plasma insulin and C-peptide levels at 60 and 120 minutes were higher in the patient group than control, but the results lack statistical significance. The area under the insulin curve and C-peptide curve were larger in patient group than control, but the result lack statistical significance also. CONCLUSION: Although our study dose not prove the hypothesis that insulin resistance or hyperinsulinemia is statistically an independent risk factor for coronary artery disease, this study showed the tendency of insulinresistance to be correlated with development of coronary artery disease. As this study has limitations due to small sample size, further study is required to confirm the role of hyperinsulinemia using a larger sample size.
Apolipoproteins A ; Apolipoproteins B ; Blood Glucose ; Blood Pressure ; Body Mass Index ; C-Peptide ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Diabetes Mellitus ; Dyslipidemias ; Glucose ; Glucose Intolerance ; Glucose Tolerance Test ; Humans ; Hypercholesterolemia ; Hyperinsulinism ; Hypertension ; Incidence ; Insulin Resistance* ; Insulin* ; Lipoproteins ; Obesity ; Plasma ; Prospective Studies ; Risk Factors* ; Sample Size ; Smoke ; Smoking ; Triglycerides

Esophageal cancers are highly malignant neoplasms. Prognosis of esophageal cancer treated by external irradiation alone is rather poor because of local recurrence and distant metastasis. Recently intracavitary irradiation has been used as a boost therapy after external irradiation to obtain better local control. One case of esophageal cancer has been treated by high dose rate remote-controlled after loading unit as boost therapy after external irradiation. The result was excellent in short term follow up esophagogram but esophageal bleeding and esophagotracheal fistula were noted in further follow up examination after inappropriate posttreatment management including insufficient chemotherapy due to poor general condition. We reviewed possible causes of esophageal bleeding and esophagotracheal fistula after external irradiation and high dose rate ICR.
Drug Therapy ; Esophageal Neoplasms* ; Follow-Up Studies ; Hemorrhage ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Tracheoesophageal Fistula

PURPOSE: To find if the alpha adrenergic blocker, terazosin, changes the PSA in BPH patients. MATERIALS AND METHODS: Patients with a PSA level over 2.5ng/ml, who visited our hospital with lower urinary tract symptoms, were reviewed, and excluded from having prostate cancer (n=101). After a routine check up for BPH, included history taking, a physical examination, laboratory examinations and a transrectal ultrasound, on their first visit, the PSA level and IPSS were checked again after 4 weeks of alpha adrenergic blocker (terazosin) management. RESULTS: The average size of the prostates and age of the patients were 40.6ml and 67.7 years, respectively. Overall, the PSA levels before the treatment was 4.12+/-2.03ng/ml, which decreased significantly, to 3.57+/-1.99ng/ml, after the terazosin treatment (p=0.002). The subgroups, divided by age, prostate size and IPSS score, all showed meaningful declines in the PSA levels, but with no statistical differences. CONCLUSIONS: The results from this research shows that terazosin treatment reduces the PSA levels in BPH patients complaining of lower urinary tract symptoms, and the changes in the pattern of the level may help to differentiate prostatic cancer, and reduce the incidence of a prostatic biopsy.
Adrenergic Antagonists* ; Biopsy ; Humans ; Incidence ; Lower Urinary Tract Symptoms ; Physical Examination ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Ultrasonography

Heterotopic pregnancy is the coexistency of intrauterine and extrauterine pregnancy. The incidence of heterotopic pregnancy is about 1 to 30,000 pregnancy in a natural cycle. However, the frequency of heterotopic pregnancy has steadily increased because of rising incidence of pelvic inflammatory disease, pelvic surgery and the development of ovulation induction and assisted reproduction. Because heterotopic pregnancy is difficult to diagnose and it has high morbidity and mortality rate, one should always take this into consideration and should conduct careful and thorough gynecologic evaluation. We have experienced a case of heterotopic pregnancy in a 29-year old woman who presented with acute abdominal pain in a natural cycle and report this case with a brief review of literature.
Abdominal Pain ; Adult ; Female ; Humans ; Incidence ; Mortality ; Ovulation Induction ; Pelvic Inflammatory Disease ; Pregnancy ; Pregnancy, Heterotopic* ; Reproduction

The purpose of this study was to investigate setting and thermal expansion of dental soldering investments. In order to compare expansion rates and to investigate the effect of water/powder ratio on expansion, setting and thermal expansion of four dental soldering investments were measured under three different water/powder ratio conditions: standard, 20% decreased and 20% increased. Setting expansion of investments was measured by use of dialgauge method. Each measurement was started two minutes later from the beginning of spatulation and recorded every one minute for one hour. Thermal expansion of cylindrical test specimens, 10mm diameter, 50mm length, was recorded in a Thermodilatometer at heating rate of 10degrees C per minute from 25degrees C to 700degrees C. The results of this study were obtained as follows: 1. Setting expansion rates under the standard water/power ratio condition were 0.198% in Speed-E, 0.090% in Deguvest, 0.080% in CM and Hi-temp. Setting expansion of Speed-E was significantly different from those of CM, Deguvest and Hi-temp, and setting expansion of Deguvest was significantly different from those of CM and Hi-temp(p<.05). 2. Under the decreased water/powder ratio condition, there was significant increase in setting expansion of 4 dental soldering investments(p<.05). 3. There were no significant differences in setting expansions of investments except Hi-temp between standard and increased water/powder ratio condition(p<.05). 4. Thermal expansion rates under the standard water/powder ratio condition were 1.923% in Deguvest, 1.629% in Speed-E, 1.619% in Hi-temp and 1.580% in CM. No significant difference in thermal expansions under the standard water/powder ratio condition existed only between Speed-E and Hi-temp(p<.05). 5. Under the decreased water/powder ratio condition, there was significant increase in thermal expansion of CM and Deguvest but decrease in thermal expansion of Speed-E(p<.05). 6. Under the increased water/powder ratio condition, there was significant decrease in thermal expansion of CM, Deguvest and Speed-E but decrease in thermal expansion of Hi-temp(p<.05).
Dental Soldering* ; Heating ; Hot Temperature ; Investments*

The coronoid process of the ulna surrounds the distal humerus and plays a vital role in posterior dislocation and posterolateral rotational instability. Elbow stability may not be possible if there is a more than 50% loss. Anteromedial facet fractures can lead to instability, radioulnar synostosis. ulnohumeral arthrosis, severe stiffness. Therefore, surgical fixation is required to ensure adequate elbow stability and decrease the risk of posttraumatic ulnohumeral arthrosis. There are several approaches for the repair of coronoid process fractures.In most cases, the posterior approach was used to make a transosseous tunnel connecting the posterior aspect of the olecranon to fix the fracture site. During surgery, the additional dissection required to repair the coronoid might increase the infection risk, nerve injury, heterotopic ossification, and elbow stiffness. The author performed a modified suture lasso and plate fixation with good outcomes. This paper reports this case with a review of the relevant literature.

We report two cases of supratentorial gangliocytomas mimicking an extra-axial tumor. MR imaging indicated that the tumors were extra-axial, and meningiomas were thus initially diagnosed. Relative to gray matter, the tumors were hypointense on T1-weighted images and hyperintense on T2-weighted images. On contrast-enhanced T1-weighted images, homogeneous enhancement was observed, while CT scanning revealed calcification in one of the two cases.
Adult ; Brain Neoplasms/*diagnosis/pathology ; Case Report ; Female ; Ganglioneuroma/*diagnosis/pathology ; Human ; *Magnetic Resonance Imaging ; Middle Age

To obtain adequate information of illumination and lens types for visual acuity test of low vision patient, the relation between various illumination and vision was evaluated. Visual acuity for near and effective lens types were examined. Among the 28 patients (of 36 eyes), intensities of illumination were set at 200, 500, 1000 and 2000lux and the lenses of biconvex, aspheric and aplanatic were tested. The best visible range of illumination for the low vision patients was 500-1000lux, with lower power diopter for the same visual acuity and with aspherin and aplantic lenses. Results attained by our study may be applied for appropriate condition of illumiation and type of lens in the low vision care.
Humans ; Lighting* ; Vision, Low ; Visual Acuity*

A diagnosis of gout is often straightforward because gout has well known clinical presentations, laboratory analyses, and radiologic features. On the other hand, gout can mimic other diseases by showing a range of atypical clinical manifestations. This paper reports a 35-year-old male with no prior history of gout who developed tophaceous gout at his previously repaired Achilles tendon 11 years after surgery. He was initially misdiagnosed with cellulitis because of his atypical clinical features. This case is presented with a review of the relevant literature.

Brachial plexus block is frequently used for surgery on the upper extremity. Unsuccessful brachial plexus block is usually caused either by injection outside the neurovascular sheath or by incomplete blockade inspite of injection within the neurovascular sheath. Studied by Winnie and Collines suggested that the extent of blockade following injection in the sheath surrounding the brachial plexus also should be directly proportional to the volume of local anesthetic injected. We therefore investigated the extent of blockade using different volume of bupivacaine with supraclavicular approach. The results were as follows. 1) Complete analgesia was observed between the group of 15 ml and 30 ml. 2) The interval of complaint of pain after a single injection ranged from 14.3 to 16.4 hours. Insignifi-cant difference was found between the group of 15 ml and 30 ml (p> 0.1) 3) There was no hematoma, shivering, but there was Horner's syndrome in 13, phrenic N.paralysis in 2, pneumothorax in 1 cases. No general seizure or other side effects were observed. Therefore we come to the conclusion that above the volume of 15 ml is sufficient to brachial plexus block with supraclavicular approach.
Analgesia ; Brachial Plexus ; Bupivacaine* ; Hematoma ; Horner Syndrome ; Pneumothorax ; Seizures ; Shivering ; Upper Extremity