The recent introduction of chemotherapy in the treatment of the gynecologic malignancies has gained wide acceptance along with preoperative and postoperative adjuvant therapy and with preradiation and concurrent chemoradiaton therapy. But, the side effects of chemotherapy including bleeding and infection due to bone marrow suppression have resulted in increased morbidity and mortality of the patients and delayed treatment and a reduction in the chemotherapeutic agents used. In spite of the development of antibiotics and the supportive care of infection, sustained leukopenia in the patients during chemotherapy accounts for the high mortality rate due to sepsis. The early detection of the leukopenia during chemotherapy may enable clinicians to overcome infection problems by timely use of prophylactic broad spectrum antibiotics and G-CSF or GM-CSF. The author investigated the grade, duration, time of onset and other clinical features of the leukopenia and the effects of the age (> or =60 years vs <60 years), the number of the cycle of chemotherapy (> or =3 cycles vs < 3 cycles), fever and performance scale on the leukopenia. 79 cases (32 patients) of the leukopenia during chemotherapy of various gynecologic malignancies at the Department of Obstetrics and Gynecology at Hanyang University between January, 1996 and December, 1998 entered to this study. The results were as follows; 1. Leukopenia occurred at 14.2+/-6.1 day from the first day of chemotherapy, 2. The duration of leukopenia was 2.5+/-1.6 days 3. No significant difference was found between eldely patients ( > or =60 years, n=13) and younger patients ( <60 years, n=66) about the severity, duration and time of onset of leukopenia. 4. No significant difference was found between the patients with more than 3 cycles of chemotherapy (n=40) and less than 3 cycles (n=39) about the severity, duration and time of onset of leukopenia. 5. Febrile leukopenic cases (n=6) had significantly lower granulocyte count, longer leukopenic period and earlier onset of leukopenia than afebrile (n=73). 6. It is thought that performance status scale does not affect the grade of leukopenia, onset of leukopenia and the leukopenic period.
Anti-Bacterial Agents ; Bone Marrow ; Drug Therapy* ; Fever ; Granulocyte Colony-Stimulating Factor ; Granulocyte-Macrophage Colony-Stimulating Factor ; Granulocytes ; Gynecology ; Hemorrhage ; Humans ; Leukopenia* ; Mortality ; Obstetrics ; Sepsis

Liver has a dual blood supply from portal vein and hepatic artery. Hepatocellular carcinoma receive their blood supply almost exclusively from hepatic artery. Thus, the concept of treating hepatocellular carcinoma by chemoembolization through these arteries is very effective. However, there may be several collateral or parasitic vessels feeding them in case of huge tumor or previous chemoembolization. We experierced a case of huge tumor involving right upper posterior portion of liver fed by 9th, 10th, 11th right posterior intercostal arteries and an anomalous hepatic artery. We tried chemoembolization with Adriamycin-Lipiodol suspension and Gelfoam material through the right posterior intercostal arteries to treat the lesion. After the procedure, the patient(55 years old female) became paraplegic with voiding and defecation difficulty which could be due to spinal cord infarction .by anterior spinal arteri. al occlusion caused by embolic material through the artery of Adamkiewicz from a posterior intercostal artery. She recovered completely after 20 days of treatment.
Arteries* ; Carcinoma, Hepatocellular ; Defecation ; Gelatin Sponge, Absorbable ; Hepatic Artery ; Infarction ; Liver ; Portal Vein ; Spinal Cord Injuries* ; Spinal Cord*

The foreign bodies in the upper GI tract are produced chiefly by accidental swallowing and rarely produce symptoms. But it is recommended to remove the foreign bodies if they produce symptoms or retained in GI tract for long duration, and if they have the possibilities of producing complications. Nowadays the development of therapeutic endoscopy enables the removal of the foreign bodies easily. We have reviewed 88 cases of foreign bodies diagnosed by endoscopy from January, 1980 to July 1990 and had the following results. 1) The most common foreign bodies were coins and bezoars, common with the ages under 10 years and over 50 years. 2) The foreign bodies were found in the upper gastrointestinal tract in the order of stomach, esophagus and duodenum. 3) The esophageal stricture especially by lye was the most common underlying cause of upper gastrointestinal foreign bodies. 4) The symptoms and complications were more common with esophageal foreign bodies. 5) By therapeutic endoscopy, the success rate for removal of foreign bodies was 98%.
Bezoars ; Deglutition ; Duodenum ; Endoscopy* ; Esophageal Stenosis ; Esophagus ; Foreign Bodies* ; Gastrointestinal Tract ; Lye ; Numismatics ; Stomach ; Upper Gastrointestinal Tract*

Upper gastrointestinal(UGI) bleeding was critical disease that was commonly found in emergency department and needed more early diagnosis and rapid treatment for decreasing mortality and morbidity. It's causes and frequencies here affected by many factors, but the majorities were caused by peptic ulcers and esophageal-gastric varices. With development of economy and medical services, new drugs and endoscopic interventions, the treatment of patients with UGI bleeding was more improved. So I would like to evaluate the change of causes and frequencies of UGI bleeding and the associated clinical findings. A total of 1,546 patients presented with UGI bleeding in emergency department of Yeungnam university hospital during the five years from Jan. 1991 to Dec. 1995 were clinically reviewed by charts and compared with previous seven years report from Jan. 1984 to Dec. 1990 in the same hospital. The ratio of male to female was 6.1:1 and slightly increased in comparison with previous seven years. The incidences in 6th and 5th decades were highest(54.4%) as like as previous seven years. Age distribution of duodenal ulcer bleeding, Mallory-Weiss tear and acute gastric mucosal lesion were developed in lower decades than the others. The causes of UGI bleeding were caused by esophageal varix(45.4%), peptic ulcer(38.8%), Mallory-Weiss tear(4.3%), gastric cancer(3.8%), others(3.1%), acute gastric mucosal lesion(2.7%), undetermined causes(1.8%) in defending order of frequencies. The proportion of esophageal varices was increased from 36.6% to 45.4%, but that of peptic ulcer was relatively decreased from 47.6% to 38.8%. And the annual distribution of varices was increased, however the annual distribution of peptic ulcers was increased. Although the ranking of annual distribution of gastric ulcers and duodenal ulcers were not changed compared to previous study and the frequency of gastric ulcers was increased since 1992, but additional follow-up was needed. Seasonal variations were found that upper gastrointestinal bleeding was increased in fall and peptic ulcer bleeding was increased significantly in summer and fall, however, varix bleeding was less frequent in summer time as like as previous seven years. Emergency endoscopic examination was performed within 6 hours far 54.5%, 24 hours for 90.8% and this reacts were to be like previous results, 57.5% and 90.7% respectively. Findings of emergency endoscopic examination were active bleeding focus(21.2%), blood clot(7.9%), exposed vessels(13.3%), flat blood spot(6.4%) and lesion without evidence of bleeding(51.3%). Endoscopic findings of active bleeding were easily seton when examination was perfomed within 24 hours. Blood transfusion was performed in 67.3% with average 2.1 units. When the causes of bleeding were due to varix and marginal ulcer, more amounts of blood were transfused than the others. In previous seven years, blood transfusions were performed in 71.2% with average 5 units and more amounts of blood were transfused in gastric cancer and varix bleeding.
Age Distribution ; Blood Transfusion ; Duodenal Ulcer ; Early Diagnosis ; Emergencies ; Emergency Service, Hospital ; Esophageal and Gastric Varices ; Female ; Follow-Up Studies ; Hemorrhage* ; Humans ; Incidence ; Male ; Mallory-Weiss Syndrome ; Mortality ; Peptic Ulcer ; Seasons ; Stomach Neoplasms ; Stomach Ulcer ; Varicose Veins

Involucrin is a recently recognized structural component of mature squamous epithelial cells and is considered as a marker of normal eratinocyte differentiation and ma.turation. In this study peroxidase-antiperoxidase techniques were used to assess involucrin expression in histologic sections of normal skin and a variety of epidennal tumors including squamous cell carcinomas(25 cases), keratoacanthomas(11 cases), basal cell carcinomas(20 cases), trichoepitheliomas(5 cases), Howens diseases(12 cases), arsenic keratoses(10 cases), actinic keratoses(10 cases) and Pagets diseases(2 cases). The results were as follows : l. In normal skin, the upper third of the viable epidermis showed diffuse cytoplasmic staining for involucrin. In hair follicles, the lower area of inner root sheath and inner area of the outer root sheath stained positively. The sebareous glands did not stain, but the ducts of sebaceous glands were positive. 2. Keratoacanthomas showed a relatively homogeneous staining pattern for inirolucrin ', all cells except basal cells stained with mild to moderate intensity. In contrast, squamous cell carcinomas disclosed a highly irregular involucrin staining pattern with marked variation in staining intensity from cell to cell. 3. Basal cell carcinomas were negative for involucrin except squamous horn cysts, and the epidermis overlying basal cell carcinomas showed the field effect, that is, the epidermis overlying the tumors exhibited diffuse, homogeneous positive staining of cells in all layers of the epidermis. 4. ln trichoepitheliomas, the involucrin reactivity was negative as in basal cell carcinoma.s, but the field effect was not observed. 5. In Elowens disease, actinic keratosis, arsenic keratosis and Pagets disease, the positivit.y for involucrin staining extended deeper into the stratum malpighii than was observed wit,h normal epidermis. And areas showing irregular patchy pattern of involucrin staining were considered to have the potentiality of malignant invasive change much more than the negative or homogeneous areas. Paget's cells were negative for involucrin as the adjoining keratinocytes in the lower portion af epidermis.
Actins ; Animals ; Arsenic ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Cytoplasm ; Epidermis ; Epithelial Cells ; Hair Follicle ; Horns ; Keratinocytes ; Keratoacanthoma ; Keratosis ; Keratosis, Actinic ; Sebaceous Glands ; Secobarbital ; Skin

No abstract available.
Animals ; Apoptosis* ; Collagen* ; Insulin* ; Rats* ; Streptozocin*

PURPOSE: After treatment of ureteral calculi, some patients will develop ureteral stricture at the identical site of the calculi. Therefore, we have retrospectively evaluated the records of patients who had been treated for ureteral calculi to determine the risk factors that lead to the development of ureteral stricture. MATERIALS AND METHODS: Between January 1995 and July 2004, 2,083 patients visited Chung-Ang University Hospital for treatment of ureteral calculi. They underwent extracorporeal shock wave lithotripsy (ESWL, 2,263 patients), ureteroscopic lithotripsy (URSL, 219 patients), laparoscopic ureterolithotomy or open ureterolithotomy (321 patients). Among these patients, 18 developed ureteral stricture at the identical site of the calculus, and they were managed by ureteroplasty or balloon dilatation. To define the risk factors of ureteral stricture, we examined the stone size, impaction of stone, the degree of hydronephrosis and the method of calculi treatment. RESULTS: The ureterolithotomy or laparoscopic ureterolithotomy (1.25%) that required ureterotomy was most common cause of ureteral stricture. The secondary common cause of the ureteral stricture was URSL (0.91%) and the third was ESWL (0.53%). The degree of hydronephrosis didn't affect the formation of ureteral stricture (p> 0.05). The stones larger than 1cm developed more frequent ureteral stricture than the stones smaller than 1cm (> 1cm: 0.31%, < or = 1cm: 1.39%, p=0.0022). The impacted stone developed more frequent ureteral stricture than the non-impacted stone (impacted stone 1.28%, non-impacted stone 0.13%, p=0.0004). CONCLUSIONS: Ureterolithotomy and laparoscopic ureterolithotomy led to the development of more frequent ureteral stricture than did URSL or ESWL. Therefore, ureterotomy was the main risk factor for developing ureteral stricture after the treatment of ureteral calculi. The stone larger than 1cm in diameter and the impacted stone were confirmed as the main risk factors of ureteral stricture after the treatment for ureteral calculi.
Calculi ; Constriction, Pathologic* ; Dilatation ; Humans ; Hydronephrosis ; Lithotripsy ; Retrospective Studies ; Risk Factors* ; Shock ; Ureter* ; Ureteral Calculi* ; Urethral Stricture

Congenital melanocytic nevi are considered to be precursors of malignant melanoma. Although the risk of malignant melanoma with medium and small congenital melanocytic nevi is uncertain, it is important to notice the possibility of malignant transformation in those lesions. We describe a 62-year-old woman who had had a brown soft verrucous tumor on her right lower back since birth. She first noticed a black nodule in the center of the tumor 5 years before which had ulcerated 3 months prior to presentation without healing. A biopsy specimen revealed malignant melanoma arising from a congenital melanocytic nevus.
Biopsy ; Female ; Humans ; Melanoma* ; Middle Aged ; Nevus, Pigmented* ; Parturition ; Ulcer

A study was made on the two cases of Klinefelter's Syndrome with review of literatures Two cases revealed findings characteristic of Klinefelter's Syndrome suck as small testes, hyalinization of seminiferous tubules. azoospermia, increased urinary gonadotropin, decreased urinary 17-ketosteroid, positive sex chromatin, gynecomastia and impotence.
Azoospermia ; Erectile Dysfunction ; Gonadotropins ; Gynecomastia ; Hyalin ; Klinefelter Syndrome* ; Male ; Seminiferous Tubules ; Sex Chromatin ; Testis

Rett syndrome is progressive neurodegenerative disorder in female patients, characterized by autistic behavior, mental retardation, loss of purposeful hand skills, stereotypic hand movement, breathing dysfunction, severely impaired language, ataxia, and seizure. The diagnosis of Rett syndrome is based on its characteristic clinical manifestation and course. The electroencephalographic (EEG) findings of Rett syndrome are nonspecific, but a progressive deterioration in the EEG, characterized by a slowing of background activity and spike sharp wave discharges, may be observed. We experienced one case of Rett syndrome in a 5 year old girl having mental retardation, loss of purposeful hand skills, stereotypic hand movements (clapping, washing, hand-to-mouth), breathing dysfunction (hyperventilation/apnea). Her EEG findings on Video-EEG monitoring are excessive slowing waves during awake state and frequent spike discharges from left or centrotemporal area during sleeping. We report a case of Rett syndrome with brief review of related literatures.
Ataxia ; Child, Preschool ; Diagnosis ; Electroencephalography ; Female ; Hand ; Humans ; Intellectual Disability ; Neurodegenerative Diseases ; Respiration ; Rett Syndrome* ; Seizures