No abstract available.
Porphyria, Acute Intermittent* ; Pregnancy*

OBJECTIVE: The fragile histidine triad (FHIT) gene is located at chromosome 3p14.2 and encompasses the common fragile site, FRA3B, which may contribute to chromosome breakage and rearrangement of cancer cells. In this study, we examined whether transcriptional alterations of FHIT gene play a role in the development of human cervical carcinomas and the possibility that hypermethylation of CpG islands serves for FHIT inactivation. We then analyzed FHIT expression status with clinical parameters to determine whether it has any prognostic significance. METHODS: The study group included 50 squamous carcinomas, 4 adenocarcinomas, 4 adenosquamous carcinomas, 7 noncancerous tissue and the clinical stage is composed of 4 Ia, 37 Ib and 17 II. Tissue specimens were snap-frozen in liquid N2 and stored at -70degrees C until used. To examine for abnormal transcripts of the FHIT gene, quantitative RT-PCR, genomic DNA-PCR and nonisotopic RT-PCR-SSCP analysis were performed using the standard method. The methylation status was determined by methylation specific PCR. RESULTS: The FHIT gene was down-regulated in 15 of 58 (25.9%) cervical carcinomas. FHIT promoter hypermethylation was detected in 15 of 15 (100%) abnormally expression in cervical carcinomas. CONCLUSION: In this study, gene mutation is not a main mechanism for FHIT inactivation, but the aberrant promoter hypermethylation may be correlated with decreased expression of the FHIT gene. The significance of decreased expression of FHIT does not appear to be an independent prognostic factor in cervical cancers, although a still larger sample of patients will be required to asses this issue definitively.
Adenocarcinoma ; Carcinoma, Adenosquamous ; Carcinoma, Squamous Cell ; Chromosome Breakage ; CpG Islands ; Equidae ; Histidine* ; Humans ; Methylation ; Polymerase Chain Reaction ; Uterine Cervical Neoplasms

OBJECTIVE: Vascular Endothelial Growth Factor (VEGF) is a potent stimulator of angiogenesis in solid tumors. Thrombospondin-1 (TSP-1) has inhibitory role in cancer cell proliferation and metastasis. To analyze the correlation with expression of VEGF and TSP-1 including microvessel density (MVD), the levels of VEGF/TSP-1 mRNA expression and microvessel count (MVC) were estimated in patients with invasive cervical carcinomas. METHODS: From 1996 to 1999, 37 carcinomas and 7 normal cervical tissues were collected, frozen and stored at -70 degrees C until used. The levels of VEGF and TSP-1 mRNAs were determined by quantitative RT-PCR. MVD was assessed by immunostaining for factor VIII-related antigen. The results are expressed as the largest number of microvessels present within a single x 40 field, and counted at x 100 field. RESULTS: Quantitative RT-PCR analysis demonstrated abnormally increased VEGF mRNA expression levels (>0.66) in 14 (37.8%) of 37 cervical carcinomas comparing to control groups (mean: 0.32+/-0.09) and abnormally low TSP-1 mRNA expression levels (<0.72) in 13 (35.1%) of 37 cervical carcinomas comparing to control groups (mean: 0.51+/-0.07). MVC was higher in tumors showing decreased expression of TSP-1 (but not statistically) (p<0.18) and overexpression of VEGF (p<0.05). When VEGF overexpression was accompanied with reduced TSP-1 expression, the microvessel density showed significantly increased pattern (p<0.05). CONCLUSION: Our study demonstrates that reduced expression of TSP-1 mRNAs and overexpression of VEGF mRNAs may be an important contributing factor in cervical carcinomas. Moreover, the inversed correlation of VEGF and TSP-1 mRNA expression can be an evidence of angiogenic role in cervical carcinomas.
Cell Proliferation ; Humans ; Microvessels* ; Neoplasm Metastasis ; RNA, Messenger* ; Thrombospondin 1 ; Uterine Cervical Neoplasms ; Vascular Endothelial Growth Factor A* ; von Willebrand Factor

PURPOSE: We aimed to describe the clinical features of late-onset circulatory collapse (LCC) in preterm infants. METHODS: The records of preterm infants with a gestational age of <33 weeks who were admitted to a single neonatal intensive care unit and survived more than 72 hrs between March 2006 and August 2012 were reviewed retrospectively. RESULTS: Of the total of 659 patients, 44 (6.7%) were diagnosed with LCC. Their mean gestational age was 26.0+/-1.9 weeks and their median birth weight 830 g. The median time of onset of LCC was 16.5 postnatal days. The patients exhibited oliguria that responded to hydrocortisone but not to hydration or catecholamines. Other clinical features of LCC were hypotension (73%), hyponatremia (52%), and hyperkalemia (34%). These abnormalities resolved in sequence: oliguria resolved first, after a median of 2.2 hrs, followed by hypotension after a median of 3.0 hrs, and the serum Na level became normal after 12.9 hrs. The incidence of LCC increased as the gestational age and/or birth weight decreased. A total of 26 patients (59%) developed LCC within 2 weeks after the initiation of levothyroxine therapy. CONCLUSION: LCC in preterm infants was a relatively reversible condition but could be associated with severe morbidity. We therefore recommend the implementation of careful measures for early detection and prompt management of LCC, particularly after stressful events.
Adrenal Insufficiency ; Birth Weight ; Catecholamines ; Gestational Age ; Humans ; Hydrocortisone ; Hyperkalemia ; Hyponatremia ; Hypotension ; Incidence ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Life Change Events ; Oliguria ; Retrospective Studies ; Shock* ; Thyroxine

OBJECTIVE: To test whether the impact of thyroid-nodule size on the malignancy risk differs according to the ultrasonography (US) patterns of nodules. MATERIALS AND METHODS: This study is a post hoc analysis using data from the Thyroid Imaging Reporting and Data System (TIRADS) multicenter retrospective study which included 2000 consecutive thyroid nodules (≥ 1 cm) with final diagnoses. A total of 2000 consecutive thyroid nodules from 1802 patients (1387 women and 613 men; mean age, 51.2 ± 12.2 years) were enrolled in this study. The malignancy risk of the nodules was assessed according to the nodule size and US patterns (Korean-TIRADS). RESULTS: Overall, the malignancy risk did not increase as nodules enlarged. In high-suspicion nodules, the malignancy rate had no association with nodule size (p = 0.467), whereas in intermediate- or low-suspicion nodules there was a trend toward an increasing malignancy risk as the nodule size increased (p = 0.004 and 0.002, respectively). The malignancy rate of large nodules (≥ 3 cm) was higher than that of small nodules (< 3 cm) in intermediate-suspicion nodules (40.3% vs. 22.6%, respectively; p = 0.001) and low-suspicion nodules (11.3% vs. 7.0%, respectively; p = 0.035). There was a trend toward a decreasing risk and proportion of papillary carcinoma and an increasing risk and proportion of follicular carcinoma or other malignant tumors as nodule size increased (p < 0.001, respectively). CONCLUSION: The impact of nodule size on the malignancy risk differed according to the US pattern. A large nodule size (≥ 3 cm) showed a higher malignancy risk than smaller nodules in intermediate- and low-suspicion nodules.
Carcinoma, Papillary ; Diagnosis ; Female ; Humans ; Information Systems ; Male ; Retrospective Studies ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*

Purpose: There has been a lack of study on the pains of Korean archers, who have been getting remarkable results in international competitions. In this study, we investigated the epidemiology of shoulder pain, which is known as the most commonly complained symptom of Korean archers. Methods: The participants were 58 elite archers in the city of Gwangju, South Korea. The method of the study was a retrospective cohort study by questionnaire and ultrasound and physical examination. Variables of individual characteristics, training patterns, the character of pain were analyzed in different age groups. Furthermore, groups were divided into those with shoulder pain and those without pain to analyze each group’s shoulder function. Results: The most common injury was shoulder injury (65.6%), and hand injury was the second-highest prevalent injury (29.3%). These two injuries were most prevalent in all age groups. Among 58 participants, 40 showed shoulder pain, but most were mild (n=30, 51.7%) and severe pain was observed in some participants (n=2, 3.5%). Mild pain was most common in each group and it showed the highest prevalence in college students (70.0%). Pain was most observed in the drawing arm, and it was triggered most when drawing the bow. In the shoulder function test category, Constant-Murley score and American Shoulder and Elbow Surgeons score were observed the lowest in the group with shoulder pain with statistical significance. Conclusion Shoulder injury had a high prevalence in Korean archers. Correspondingly, those with shoulder pain had lower shoulder function test scores.

Alagille syndrome is characterized by chronic cholestasis, posterior embryotoxon, skeletal abnormalities, cardiovascular abnormalities, and a typical face with prominent forehead and pointed chin. Its histological feature includes paucity of interlobular bile ducts. We experienced a 49-day-old female infant presenting with frequent upper respiratory tract infection and persistent jaundice. She had a typical face and chronic cholestasis. Echocardiograms revealed peripheral pulmonary stenosis. The histological examination of liver revealed paucity of interlobular bile ducts.
Alagille Syndrome* ; Cardiovascular Abnormalities ; Chin ; Cholestasis ; Female ; Forehead ; Humans ; Infant ; Jaundice ; Liver ; Pulmonary Valve Stenosis ; Respiratory Tract Infections

Improved survival rate of premature infants requiring intensive care lead into an increased risk for nosocomial infections such as disseminated fungal infection. Neonatal candida sepsis has become one of the most important causes of neonatal morbidity and mortality. The most common site of end organ involvement in premature infants with candidemia is the kidney. But no consensus has been reached concerning the treatment of candidemia in the newborn. We recently experienced a case of premature infant who was diagnosed as renal candidiasis with microabscess formation due to Candida Albicans and patient was treated successfully with long term liposomal amphotericin B and fluconazole therapy without surgical drainage.
Amphotericin B ; Candida ; Candida albicans ; Candidemia ; Candidiasis* ; Consensus ; Cross Infection ; Drainage* ; Fluconazole ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight* ; Critical Care ; Kidney ; Mortality ; Sepsis ; Survival Rate

BACKGROUND: Laparoscopic cholecystectomy (LC) has traditionally been performed under general anesthesia, however, owing in part to the advancement of surgical and anesthetic techniques, many laparoscopic cholecystectomies have been successfully performed under the spinal anesthetic technique. We hoped to determine the feasibility of segmental epidural anesthesia for LC. METHODS: Twelve American Society of Anesthesiologists class I or II patients received an epidural block for LC. The level of epidural block and the satisfaction score of patients and the surgeon were checked to evaluate the efficacy of epidural block for LC. RESULTS: LC was performed successfully under epidural block, with the exception of 1 patient who required a conversion to general anesthesia owing to severe referred pain. There were no special postoperative complications, with the exception of one case of urinary retention. CONCLUSIONS: Epidural anesthesia might be applicable for LC. However, the incidence of intraoperative referred shoulder pain is high, and so careful patient recruitment and management of shoulder pain should be considered.
Anesthesia, Epidural ; Anesthesia, General ; Cholecystectomy, Laparoscopic ; Feasibility Studies ; Humans ; Incidence ; Pain, Referred ; Patient Selection ; Postoperative Complications ; Shoulder Pain

Placenta accreta during the first trimester of pregnancy is rare. Only a few cases of placenta accreta manifesting as a uterine mass have been published. Most patients with placenta accreta present with vaginal bleeding during or after pregnancy. This report describes a patient with placenta accreta that caused vaginal bleeding three years after a first trimester abortion. The patient had regular menstruation for three years after the abortion. Initially endometrial cancer or a uterine myoma with degeneration was suspected. This is the first report of a placenta accreta detected as a uterine mass long after a first trimester abortion with delayed vaginal bleeding.
Endometrial Neoplasms ; Female ; Humans ; Menstruation ; Myoma ; Placenta Accreta ; Placenta, Retained ; Pregnancy ; Pregnancy Trimester, First ; Uterine Hemorrhage ; Uterine Neoplasms