PURPOSE: The aim of this study was to investigate the effects of extracorporeal shock wave therapy (ESWT) an lateral epicondylitis of the elbow. MATERIALS AND METHODS: Twenty-four patients with refractory lateral epicondylitis were treated with shock waves. The patients were evaluated by assessing of pain using visual analog scale (VAS) and a simple elbow test (SET). Overall clinical outcomes were evaluated using Roles and Maudsley scores at 12 months after ESWT. RESULTS: Significant symptom improvement were observed in 20 (83%) patients at the 12 months follow up according to the Roles and Maudesley scores. Average SET and VAS scores were also significantly improved after ESWT (p<0.05). CONCLUSION: This study suggests that shock waves therapy could be considered as an effective and noninvasive treatment modality for refractory lateral epicondylitis of the elbow.
Elbow ; Follow-Up Studies ; Humans ; Shock ; Tennis Elbow* ; Tennis* ; Visual Analog Scale

Gastric metastasis from invasive lobular breast carcinoma is rare. Mostly gastrointestinal metastasis presents as one among multiple metastases, several years after primary diagnosis of breast carcinoma. Herein, we report a synchronously diagnosed gastric metastasis from invasive lobular carcinoma, mimicking primary gastric linitis plastica with pyloric obstruction. We reviewed clinical and pathological findings of gastric carcinoma metastatic from the breast. In particular, we focused on immunohistochemical studies of selected antibodies, including those for estrogen receptors, gross cystic disease fluid protein-15, and caudal-type homeobox transcription factor 2, for accurate differential diagnosis. Clinical suspicion, repeat endoscopic biopsy, and detailed histological analysis including immunohistochemistry are necessary for diagnosis of gastric carcinoma metastatic from the breast.
Antibodies ; Biopsy ; Breast Neoplasms* ; Breast* ; Carcinoma, Lobular ; Diagnosis ; Diagnosis, Differential ; Genes, Homeobox ; Immunohistochemistry ; Linitis Plastica ; Neoplasm Metastasis* ; Receptors, Estrogen ; Stomach ; Transcription Factors

Myotonic dystrophy is the most common manifestation of mytonic disease. It is a systemic disease and its most serious complications after general anesthesia result from respiratory failure. We report a case of prolonged respiratory failure after general anesthesia for cesarean section in a presumed myotonic dystrophy patient. A 36-year-old parturient underwent emergency cesarean section under general anesthesia for premature rupture of the amniotic membrane with fetal distress. At the end of the operation, the recovery of respiratory muscle from paralysis was insufficient to maintain spontaneous ventilation despite the administration of reversel agents. Her TOF count was 3/4 and she was reintubated in the PACU. The patient was transferred to the ICU for proper respiratory care and her respiration fully recovered after 21 hours of conservative supportive care.
Adult ; Amnion ; Anesthesia, General* ; Cesarean Section* ; Emergencies ; Female ; Fetal Distress ; Humans ; Myotonic Dystrophy* ; Paralysis ; Pregnancy ; Respiration ; Respiratory Insufficiency* ; Respiratory Muscles ; Rupture ; Ventilation

Hantaan (HTN) virus and Seoul (SEO) virus, two murid rodent-borne hantaviruses harbored by the striped-field mouse (Apodemus agrarius) and the Norway rat (Rattus norvegicus), respectively, were known to cause hemorrhagic fever with renal syndrome (HFRS). After inoculation of HTN and SEO viruses into suckling mice intracerebrally, mice became ill and were morbibund by 15 or 16 days postinfection. Viral antigens were present in brain, heart, lung, liver, kidney, spleen, pituitary gland, thymus, lymph nodes, adrenal, pancreas, salivary glands, trigeminal ganglia, adipose tissue, intestine and muscle. Moreover, the time period appearing illness and morbidity were gradually decreased from 15 or 16 days to 8 or 9 days postinfection increasing the passage number. Therefore to evaluate the relationship between these adaptation process and genomic change of HTN and SEO viruses, we sequenced corresponding regions of the 3' G1 and 5' G2 encoding M genomic segments of two HTN and six SEO virus strains, and compared the nucleotide changes between the original stocks and five to nine passed virus strains in suckling mice brains. There was no nucleotide changes in HTN virus strains and zero to four nucleotide changes in SEO virus strains. However, only one base change resulted in amino acid change at the position 1691 (Gln to Glu) of 5' G2 encoding M genomic segment. This amino acid change didn't effect any conformational change in the beta-sheet, hydrophilicity, antigenicity and surface probability of protein structure of G2 glycoprotein. Our present data suggested that the genomic changes in the 3' G1 and 5' G2 encoding M genomic segment was not related with adaptation process of HTN and SEO viruses passed in suckling mice brains.
Adipose Tissue ; Animals ; Antigens, Viral ; Base Sequence* ; Brain* ; Glycoproteins ; Hantavirus ; Heart ; Hemorrhagic Fever with Renal Syndrome ; Hydrophobic and Hydrophilic Interactions ; Intestines ; Kidney ; Liver ; Lung ; Lymph Nodes ; Mice* ; Muridae ; Norway ; Pancreas ; Pituitary Gland ; Rats ; Salivary Glands ; Seoul virus* ; Seoul* ; Spleen ; Thymus Gland ; Trigeminal Ganglion

This study was conducted to evaluate the influence of the C-factor on the bond strength of a 6th generation self-etching system by measuring the microtensile bond strength of four types of restorations classified by different C-factors with an identical depth of dentin. Eighty human molars were divided into four experimental groups, each of which had a C-factor of 0.25, 2, 3 or 4. Each group was then further divided into four subgroups based on the adhesive and composite resin used. The adhesives used for this study were AQ Bond Plus (Sun Medical, Japan) and Xeno III (DENTSPLY, Germany). And composite resins used were Fantasista (Sun Medical, Japan) and Ceram-X mono (DENTSPLY, Germany). The results were then analyzed using one-way ANOVA, a Tukey's test, and a Pearson's correlation test and were as follows. 1. There was no significant difference among C-factor groups with the exception of groups of Xeno III and Ceram-X mono (p < 0.05). 2. There was no significant difference between any of the adhesives and composite resins in groups with C-factor 0.25, 2 and 4. 3. There was no correlation between the change in C-factor and microtensile bond strength in the Fantasista groups. It was concluded that the C-factor of cavities does not have a significant effect on the microtensile bond strength of the restorations when cavities of the same depth of dentin are restored using composite resin in conjunction with the 6th generation self-etching system.
Adhesives ; Composite Resins ; Dentin ; Dentin-Bonding Agents ; Humans ; Molar

p27Kip1 protein, a negative cell cycle regulator in G1 progression, has been reported to be related with human cancers including colon, breast and non-small cell lung carcinomas. To elucidate a possible prognostic indicator, we studied 49 cases of human breast carcinoma for expression of p27Kip1 protein using an immunohistochemical method, and compared these results with known prognostic parameters of the breast cancer. p27Kip1 protein was intensely stained in nuclei of carcinoma cells in 26 cases (53.1%). The expression rate of p27Kip1 protein was significantly higher in higher nuclear grade (p<0.05), lower histologic grade (p<0.01), lower N classification (p<0.001) and lower clinical stage (p<0.05) than in lower nuclear grade, higher histologic grade, higher N classification and higher clinical stage, respectively. p27Kip1 protein expression was significantly correlated with progesterone receptor status (p<0.05) or cyclin D expression (p<0.05). No statistical correlations were found between expression of p27Kip1 protein and other parameters including tumor size, estrogen receptor status, p53 overexpression and c-erbB-2 expression. The results suggest that reduced expression of p27Kip1 protein plays a role in biologically aggressive behavior of breast carcinoma and might contribute in predicting breast cancer patient's survival.
Breast Neoplasms* ; Breast* ; Cell Cycle ; Classification ; Colon ; Cyclin D ; Cyclin-Dependent Kinase Inhibitor p27 ; Estrogens ; Humans* ; Lung ; Phosphotransferases* ; Prognosis ; Receptors, Progesterone

We describe a case of 43-year-old man who had a pseudoaneurysm of the medial superior genicular artery after arthroscopic partial meniscectomy with standard anterolateral and anteromedial portals. Pseudoaneurysm of the medial superior genicular artery has been reported at the previous superomedial portal site after arthroscopy. Described herein is a unique case that involved the medial superior genicular artery at the previous anteromedial portal site after arthroscopy. The pseudoaneurysm was successfully treated with transcatheter embolization.
Adult ; Aneurysm, False/*etiology ; Arteries ; Arthroscopy/*adverse effects/methods ; Humans ; Knee/*blood supply ; Male ; Menisci, Tibial/*surgery

MEN type 1 is characterized primarily by the presence of functioning and nonfunctioning tumors or hyperplasia of the pituitary gland, parathyroid glands, and pancreatic islet cells. Pancreatic islet tumors in MEN type 1 produce different kinds of hormone which were pancreatic polypeptide, gastrin, glucagon, insulin and so on. To date, ten cases had been reported in Korea. We report another case with MEN type 1 having prolatin-secreating pituitary adenoma, parathyroid hyperplasia and insulinoma. A 36-year-old woman was admitted because of long-standing amenorrhea and recently diagnosed osteoporosis. Otherwise, she had been in good health except experiencing one episode of loss of consciousness after skipped meal. The blood chemistries were normal except hypercalcemia and hypophosphatemia. Hormonal studies revealed elevated levels of intact PTH and prolactin and decreased value of estradiol with low LH and FSH. The neck CT revealed 1 cm-sized nodule at posterior portion of right thyroid gland and 99mTc-sestamibi sintigraphy showed a increased uptake in left lower and right lower parathyroid glands. The sella MRI showed 0.7 cm-sized enhanced lesion in the left pituitary gland. The ratio of immunoreactive insulin to glucose was elevated and 3-4 pancreatic masses of variable size were identified by endoscopic ultrasonography and angiography. Subtotal parathyroidectomy and pyrolus-preserving pancreaticoduodenectomy with spleen-preserving distal pancreatectomy was done. Postoperative she had been doing well with normocalcemia and normoglycemia. Transsphenoidal adenonectomy was done 5 months later. Histologic examination of removed tissues revealed a single insulinoma, prathyroid hyperplasia and prolactin-secreating pituitary adenoma.
Adult ; Amenorrhea* ; Angiography ; Endosonography ; Estradiol ; Female ; Gastrins ; Glucagon ; Glucose ; Humans ; Hypercalcemia ; Hyperplasia ; Hypophosphatemia ; Insulin ; Insulinoma ; Islets of Langerhans ; Korea ; Magnetic Resonance Imaging ; Male ; Meals ; Multiple Endocrine Neoplasia Type 1* ; Multiple Endocrine Neoplasia* ; Neck ; Osteoporosis* ; Pancreatectomy ; Pancreatic Polypeptide ; Pancreaticoduodenectomy ; Parathyroid Glands ; Parathyroidectomy ; Pituitary Gland ; Pituitary Neoplasms ; Prolactin ; Technetium Tc 99m Sestamibi ; Thyroid Gland ; Unconsciousness

PURPOSE: Acute necrotizing pancreatitis (ANP) causes severe symptoms and shows a high mortality rate 10-40%. Proper operative strategies for the treatment of ANP are still disputed. The aim of this study was to review our experience of 29 cases of ANP, and to examine the possibility of using systemic inflammatory response syndrome (SIRS) criteria as a prognostic factor. METHODS: The medical records of 29 patients with ANP operated on at the Asan Medical Center between 1998 and 2005 were retrospectively reviewed. The patients were categorized by the presence or absence of SIRS before operation. 16 patients had SIRS preoperatively (SIRS group), and 13 did not (NSIRS group). The patients comprised of 27 men and 2 women, with a mean age of 44.7 years. RESULTS: The surgical indications were sepsis syndrome, persistent pancreatitis with severe pain and late complications. The infection rates were 94% and 62% in the SIRS and NSIRS groups, respectively. Diet was started 12.6 and 7.8 days after surgery in the SIRS and NSIRS groups respectively. Postoperative hospitalization in the SIRS and NSIRS groups were 57.8 and 30.9 days, with 3 and 1 mortalities respectively. In the SIRS group, 13 patients (81%) had necrosectomy and drainage, and 3 (19%) a pancreatic resection. In the NSIRS group, 7 patients (54%) had necrosectomy and drainage, and 6 (46%) a patinets resection. CONCLUSION: SIRS might be useful in predicting the prognosis of ANP after surgery. Necrosectomy and drainage procedures, but not in the early period of diseases, can be performed safely to avoid surgical complications and preserve the endocrine function.
Atrial Natriuretic Factor ; Chungcheongnam-do ; Diet ; Drainage ; Female ; Hospitalization ; Humans ; Male ; Medical Records ; Mortality ; Pancreatitis ; Pancreatitis, Acute Necrotizing* ; Prognosis ; Retrospective Studies ; Systemic Inflammatory Response Syndrome

PURPOSE: Mycophenolate mofetil (MMF) given orally as 1000 mg twice daily has shown to be effective in the suppression of acute allograft rejection following renal transplantation. However, Korean transplant patients are usually administered with a lower dose of MMF (1~1.5 gm/day) than the recommended dose due to high incidence of gastrointestinal intolerance. The purpose of this study was to characterize the pharmacokinetic parameters of the mycophenolic acid (MPA), the active form of MMF, in Korean kidney transplant recipients. METHODS: The plasma MPA concentrations of 10 Korean kidney transplant recipients (7 men and 3 women) administered with a suboptimal dose of MMF (750 mg twice a day) were measured at 2 weeks of the MMF therapy by HPLC method. RESULTS: Plasma MPA concentration-time curve pattern of patients taking lower doses of MPA was consistent with previously reported profiles of patients taking the fully recommended doses. The plasma MPA concentration-time curve was characterized by an early sharp peak within 1 hour and a small second peak in some patients at 4~12 hours postdose. The mean ( SD) Cmax was 8.73 4.65micro gram/ml, and the mean MPA AUC was calculated as 18.45 4.25micro gram hr/ml. The mean fraction of free MPA, which is pharmacologically active, was 1.60 0.23% and this value seemed similar to previously reported data. The patient's age, weight, body surface area, and renal function did not influence the MPA AUC. However, a difference in AUC according to sex was statistically significant (P=0.0227). Free fraction of MPA appeared not to be affected by serum albumin and renal function when creatinine clearance was above 40 ml/min. Correlation analysis between each plasma concentration and AUC for the limited strategy of MMF therapeutic drug monitoring (TDM) resulted that the concentrations of predose, 1 hr post-dose, and 8 hr post-dose were positively related with AUC value, and their coefficients of correlation were 0.74545 (P=0.0133), 0.68485 (P=0.0289), and 0.63636 (P=0.0479), respectively. CONCLUSION: This study have shown that the pattern of the time-concentration profile of MPA was similar to the results of other studies performed with Caucasians, although there was interindividual variability of MPA AUC, Cmax, and Tmax.
Allografts ; Area Under Curve ; Body Weight ; Chromatography, High Pressure Liquid ; Creatinine ; Drug Monitoring ; Humans ; Incidence ; Kidney Transplantation ; Kidney* ; Male ; Mycophenolic Acid* ; Plasma ; Serum Albumin ; Transplantation