Prenature ovarian failure is a condition causing amenarrhea, hypoestrogenism, and elevated genadotropins in women younger than 40 years. A karyotype should be performed as part of basic laboratory evaluation for all patients with premature ovarian failure and prodromal premature ovarian failure. Development of a malignancy in a dysgenetic gonad is of major concern. The presence of a fragment of the Y chromosome is thought to be a key to the oncogenic potential of these gonads. The search for the testicular determining factor(TDF) has engendered much confusion about which part of the Y chromosome plays a role in malignancy. This was initially postulated to be the H- Y antigen. More recent data, however, localize the area near the centromere of the Y Chromosome, on the long arm(Yq). Malignant potential is clearly not linked to the testicular determining factor itself(SRY). This is a critical point in clinical medicine. Feilure to display SRY or a closely related sequence does not rule out the presence of the segment of the Y chromosome postulated to be associated with the development of malignancies. We have experienced a case of premature ovarian failure with chtomosomal abnormality involving Y chromosome fragment. So we report this case with a brief review of literatures.
Centromere ; Clinical Medicine ; Female ; Gonadal Dysgenesis* ; Gonads* ; Humans ; Karyotype ; Primary Ovarian Insufficiency* ; Y Chromosome

Polycystic ovary disease is a heterogenous endocrinopathy with many interacting causal factors. One potential such factor is chronic hyperinsulinemia. multiple, independent lines of evidence suppart the contention that chronic hyperinsulinemia causes ovarian hyperandragenism. This evidence includes: (1) mutations in the insulin receptor gene that cause severe hyperinsulinemia appear to be associated with ovarian hyperandrogenism, (2) insulin stimulates ovarian thecal and sttomal androgen seaetion in vitro, and (3) in some experimental models, manipulation of circulating insulin concentrations results in changes in circulating androgens. Although the association between hyperinsulinemia and hyperandrogenism remains to be fully explained at the molecular level, chronic hyperinsulinemia appears to be an important cause of hyperandrogenism. We have experienced a case of HAIR AN syndrome showing hyperandrogenism, insulin resistance and acanthosis nigricans in infertile patient. So we report this case with a brief review of literatures.
Acanthosis Nigricans ; Androgens ; Female ; Fibrinogen ; Hair* ; Humans ; Hyperandrogenism ; Hyperinsulinism ; Insulin ; Insulin Resistance ; Models, Theoretical ; Ovary ; Receptor, Insulin

OBJECTIVE: For the treatment of carotid cavernous fistula(CCF), transarterial detachable balloon occlusion(DBO) is the method of choice. When it has failed to occlude the fistula, various embolization methods are used to treat the fistula. Transvenous embolization through the superior ophthalmic vein(SOV) is another method of treatment. The venous approach through the SOV after surgical dissection and exposure of this vein has been recommended by some delete, but(here) delete delete(an) alternative treatment method by percutaneous puncture of the SOV without surgical dissection(is described). METHODS: A 19-year-old woman admitted to our hospital two months after accident, presented with proptosis, chemosis, occulomotor and abducens nerve palsies, and bruit of the right eye. The authors tried DBO via transarterial route in initial treatment and the fistula was occluded with subsequent disapearance of bruit. However, 2 weeks later, she complained of recurence of bruit. Transarterial approach was attempted again, but the fistula hole was too small for this approach. The venous approach via SOV by percutaneous puncture was then tried. Puncture was made at the medial one third of the superior orbital rim and the fistula was embolized with Guglielmi detachable coils (GDCs). RESULTS: The fistula was completely occluded and no early and late complications noted. The patient's clinical symptoms were improved within a few days. CONCLUSION: Treatment of CCF by percutaneous puncture of the SOV is an alternative and effective method when other approaches are not feasible.
Abducens Nerve Diseases ; Exophthalmos ; Female ; Fistula* ; Humans ; Orbit ; Punctures* ; Veins* ; Young Adult

Effects of thoracentesis on thoracic impedance and cardiac performance were studied in patients with uncomplicated unilateral tuberculous pleural effusion. The speed of the removal of the pleural effusion in thoracentesis was essentially similar to that of a generally used for therapeutic purpose in daily practice. Thoracic impedance was measured in 23 cases before, 4 and 10 minutes after thoracentesis to the amount of pleural effusion aspirated was observed. In 11 cases out of 23, the changes in cardiac performance as assessed by stroke volume, cardiac output, heart rate, heather index and ratio of pre-ejection period to left ventricular ejection time(PEP/LVET) were observed 4 minutes after 150 ml to 1,000 ml of thoracentesis. In these cases, stroke volume, cardiac output, and Heather index were determined from impedance cardiograms, and PEP/LVET from mechanocardiograms recorded simultaneously with the former. A significant increase in thoracic impedance was observed both 4 and 10 minutes after thoracentesis. There was a slight but a significant correlation between the changes in thoracic impedance and the amount of pleural fluid aspirated only 4 minutes after thoracentesis. Thoracentesis showed no consistent influence on cardiac performance as reflected to stroke volume, cardiac output, heart rate, heart index and PEP/LVET. These facts suggest that measurement of thoracic impedance may be a useful method reflecting alterations in pleural fluid volumes, particularly when it occurs in a relatively short period of time, and the effects of thoracentesis of less than one liter on the cardiac functions as determined by the above-mentioned parameters were variable.
Cardiac Output ; Electric Impedance* ; Heart ; Heart Rate ; Humans ; Pleural Effusion ; Stroke Volume

Aneuploidy results from nondisjunction in either the meiotic division of the parents or the early cleavage divisions of the affected individuals. The sex chromosomes show a wide range of viable aneuploidy than do the autosomes. The incidence of 47,XXY and 47,XYY children increases with maternal age, as does that of autosomal trisomies, whereas the incidence of 45,X children does not increase with maternal age. In the group of sex chromosome aueuploidies, the 47,XXY and 47,XYY conditions occur with nearly equal hequency at birth. Translocations between X or Y chromosomes and an autosome or between an X chromosome and the Y chromosome cause sterility in human males. It has been assumed that a translocation involving either(or both) of the sex chromosomes would interfere with inactivation of the XY bivalent and thaeby disturb spermatogenesis. We bave experienced a case of Y-autosome translocation in azoospermic patient. So we report this case with a brief review of literatures.
Aneuploidy ; Azoospermia* ; Child ; Humans ; Incidence ; Infertility ; Male ; Maternal Age ; Parents ; Parturition ; Sex Chromosomes ; Spermatogenesis ; Trisomy ; X Chromosome ; Y Chromosome

Infertility, defined as 1 year of unprotected coitus without conception, affects approximately 10 to 15% for couples of reproductive age. Approximately 35% of these cases are attributable to male factor infertility. A major cause of male infertility is chromosome abnormality, such as 47 chromosomes with an XXY karyotype. Early surveys of infertile males showed that the incidence of major chromosome abnormality in infertile males in azoospermic patients. When patients are treated for male infertility, a chromosome analysis including a search for abnormality at the DNA level, should be performed. We have experienced a case of autosomal reciprocal translocation in azoospermic patient. So we report this case with a brief review of literatures.
Azoospermia ; Chromosome Aberrations ; Coitus ; DNA ; Family Characteristics ; Fertilization ; Humans ; Incidence ; Infertility ; Infertility, Male ; Karyotype ; Male

No abstract available.
Snake Bites* ; Snakes*

No abstract available.
Snake Bites* ; Snakes*

Objectives: . The aim of the present study was to evaluate audiologic and vestibular functions in patients with lateral semicircular canal (LSCC) dysplasia/aplasia. Methods: . We conducted a retrospective study of a patients with LSCC dysplasia and aplasia at tertiary referral center. The subjects included 15 patients with LSCC dysplasia or aplasia, with or without combined inner ear anomalies. Medical history, temporal bone computed tomography scans, pure-tone audiograms, and vestibular function test results were analyzed. Results: . LSCC anomaly was identified in 15 patients (20 ears). Nine patients had unilateral LSCC dysplasia only and showed a mean pure-tone average of 45.5±28.7 dB, while three patients (33.3%) among them had normal hearing. Six patients had bilateral LSCC dysplasia/aplasia combined with other inner ear anomalies and profound bilateral hearing loss. Notably, only four out of 15 patients (26.7%) had dizziness symptoms. On caloric test, patients with isolated LSCC dysplasia showed a 51.8%±29.3% level of canal paresis (eight out of nine patients showed anomalies), whereas patients with bilateral LSCC dysplasia/aplasia presented bilateral vestibular loss. One patient with isolated LSCC underwent video-head impulse test; horizontal canal gain decreased to 0.62 (17% asymmetry) and anterior canal gain was 0.45 (52.6% asymmetry), whereas posterior canal gain was normal. Conclusion . Bilateral LSCC dysplasia/aplasia is comorbid with other inner ear anomalies and presents as profound bilateral hearing loss and vestibulopathy. In contrast, isolated unilateral LSCC dysplasia presents as ipsilateral horizontal canal paresis. Hearing function in isolated LSCC dysplasia is usually, but not always, impaired with varying severity.

BACKGROUND: Coronary artery bypass grafting without cardiopulmonary bypass (Off-Pump Coronary Artery Bypass Grafting, OPCAB) causes significant hemodynamic derangement by displacement of the beating heart. The purpose of this study was to analyze the hemodynamic changes caused in relation to grafted arteries by displacing the heart and stabilizing the coronary arteries in patients undergoing OPCAB. METHODS: Nineteen patients underwent OPCAB using two deep pericardial sutures and tissue stabilizers (Octopus Tissue Stabilization Syetem, Medtronic, USA). The hemodynamic variables were obtained after induction of anesthesia, after deep pericardial sutures, before and after anastomosis of each coronary artery during epicardial stabilizing, after sternal closure, and after postoperative 6 hours and 12 hours in the intensive care unit. RESULTS: The hemodynamic variables were maintained with the Trendelenburg position, volume loading and low dose vasopressors after deep pericardial stay sutures. Displacement of the heart and placement of the stabilizer on all coronary territories except the obtuse marginal artery before anastomosis showed no significant difference in hemodynamics compared with baseline. Positioning for the graft to the obtuse marginal artery decreased cardiac index (1.6+/-0.4 L/min/m2) and stroke index (27.6+/-9.9 L/beat/m2) and increased systemic vascular resistance (2318.9+/-673.7 dyne sec cm(-5)), resulting in hemodynamic compromise (P<0.01). There were no significant hemodynamic and electrocardiographic changes before or after grafting of other coronary arteries but there was a significant increase in cardiac index after postoperative 6 and 12 hours compared with baseline values (P<0.05). CONCLUSIONS: Although the complete revascularization of most coronary arteries is feasible on the beating heart without significant hemodynamic compromise with minimal vasopressor support, the positioning for the graft to the obtuse marginal artery needs special attention because two deep pericardial stay sutures and Octopus tissue stabilizers on the obtuse marginal artery territory induce significant hemodynamic disturbances.
Anesthesia ; Arteries ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Coronary Artery Disease ; Coronary Vessels ; Electrocardiography ; Head-Down Tilt ; Heart* ; Hemodynamics* ; Humans ; Intensive Care Units ; Octopodiformes ; Stroke ; Sutures ; Transplants* ; Vascular Resistance