The incidence of uterine arteriovenous malformation (AVM) is rare. However, it is clinically significant in that it can cause life-threatening vaginal bleeding. We report a case of a large uterine AVM with positive serum beta-human chorionic gonadotropin. A presumptive diagnosis was made; a uterine AVM accompanied by, early pregnancy or retained product of conception. Because this uterine AVM was extensive, transcatheter arterial embolization of both uterine arteries and extra-uterine feeding arteries was performed. Three months after undergoing transcatheter arterial embolization, complete resolution of the uterine AVM was confirmed without major complication.
Arteries* ; Arteriovenous Malformations* ; Chorion* ; Chorionic Gonadotropin* ; Diagnosis ; Fertilization ; Incidence ; Pregnancy ; Uterine Artery* ; Uterine Hemorrhage

OBJECTIVE: The management of cervical intraepithelial neoplasia (CIN) and early invasive cancer of the uterine cervix is very difficult to approach, especially in case of young woman who wants to preserve her fertility. Conization of the cervix may have various kinds of disadvantage. The objective of this clinical retrospective study is to investigate the therapeutic effects and clinical efficacy of photodynamic therapy (PDT) including combined chemo-photodynamic therapy in patients with pre-malignant CIN and malignant invasive cervical cancer. METHODS: Total number of PDT trial case was 50 cases and total number of patient was 22 patients who registered to PDT clinic. We used photogem sensitizer and 632 nm diode laser in early two cases. After then we performed PDT using photofrin sensitizer and 630 nm diode laser in other cases. We used flat-cut, microlens, cylindrical diffuser, and interstitial type optic fibers in order to irradiate the lesions. 240 J/cm² energy was irradiated to the lesions. RESULTS: CIN 2 were 4 cases (18.2%) and CIN 3 were 15 (68.2%) and invasive cervical cancer were 3 (13.6%). Complete remission (CR) was found in 20 patients (91%). One case of 19 patients with CIN lesion recurred at 18 months after PDT treatment. CR was found in 18 cases in the patients with CIN lesions (95%). CR was found in 2 cases in the patients with invasive cervical cancer (67%). CONCLUSION: Our data showed that CR rate was fantastic in CIN group (95%). This study suggests that PDT can be recommended as new optimistic management modality on the patients with pre-malignant CIN lesions including carcinoma in situ and relatively early invasive cancer of the uterine cervix. Combined chemo-photodynamic therapy is essential in case of invasive cervical cancer. For the young age group who desperately want to preserve their fertility and have a healthy baby, PDT can be a beacon of hope.
Carcinoma in Situ ; Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Conization ; Dihematoporphyrin Ether ; Female ; Fertility ; Hope ; Humans ; Lasers, Semiconductor ; Photochemotherapy* ; Retrospective Studies ; Therapeutic Uses ; Treatment Outcome* ; Uterine Cervical Neoplasms

Uterine rupture during pregnancy does not occur frequently, but is associated with high rates of maternal and perinatal morbidity and mortality. As a non-invasive and conservative approach, high-intensity focused ultrasound (HIFU) has received attention from both gynecologists and patients for the treatment of fibroids, especially women who wish to preserve uterus. However, there are not enough studies about complication and prognosis related pregnancy after HIFU. We present a case of uterine rupture that occurred in second trimester who had been HIFU 3months before pregnancy.
Female ; Humans ; Leiomyoma ; Mortality ; Pregnancy ; Pregnancy Trimester, Second* ; Prognosis ; Ultrasonography* ; Uterine Rupture* ; Uterus

Vertical transmission from mother to child, the main route of chronic hepatitis B virus (HBV) infection in the East Asia, is considered one of the most important predictors for the response to antiviral therapies as well as its complications such as cirrhosis and hepatocellular carcinoma. Therefore, it is critical in both etiologic and prognostic aspects to confirm whether or not chronic HBV infection is acquired vertically. This study investigated whether mother-to-child infection could be proved by the phylogenetic analyses of HBV pre-S/S genes ever since several decades have elapsed in mother-child pairs with presumed vertical transmission. The pre-S and S regions of HBVs were compared and analyzed phylogenetically in a total of 36 adults (18 mother-child pairs) with chronic HBV infection. All of the isolates of HBV were genotype C and serotype adr. The divergence between mothers and offsprings was 0 to 1.5%. Phylogenetic trees revealed that 17 of 18 pairs (94%) with presumed vertical transmission were grouped into the same cluster. Vertical transmission from mother to child could be strongly suggested even in adults with a history of several decades of HBV infection using the phylogenetic analyses of pre-S and S genes.
Adult ; Aged ; DNA, Viral/analysis ; Female ; Genotype ; Hepatitis B Surface Antigens/classification/*genetics ; Hepatitis B virus/classification/*genetics/metabolism ; Hepatitis B, Chronic/diagnosis/*virology ; Humans ; Infectious Disease Transmission, Vertical ; Male ; Middle Aged ; Mothers ; Phylogeny ; Polymerase Chain Reaction ; Sequence Analysis, DNA ; Serotyping ; Young Adult

In general, medical school faculty have to perform clinical practice in addition to their educational and research activities, unlike the professors of other departments, while simultaneously playing an important role within the medical profession. However, some organizational or environmental factors decrease the job satisfaction of medical professors. This study aimed to determine the current status of medical schools professors' job activities, satisfaction level, factors related to job satisfaction, and so on. A structured questionnaire was used in the survey and 936 valid responses (response rate, 79.1%) were analyzed using SAS version 9.1. Items included in the questionnaire were work tasks, satisfaction with work and environment, fringe benefits, and future plans. Our study found that the satisfaction of respondents with research activities was not high, and they had negative perceptions of their work environment. Also, it was found that job satisfaction was most affected by work environment. In the section on fringe benefits, a variety of fringe benefits were provided to respondents but their actual satisfaction was not high. To enhance the overall job satisfaction of medical school faculty, all the matters related to their work tasks and environmental factors have to be considered in the aspect of their own role in medical school. The limitations of this study were a low response rate to the early online survey and a long duration of the survey period. However, these limitations were resolved by an additional mail survey modality and statistical techniques. It is meaningful that this study was an extensive survey aimed at medical school faculty and dealt with a comprehensive range of issues.
Education, Medical ; Faculty, Medical ; Humans ; Job Satisfaction ; Patient Care ; Personal Satisfaction ; Phenothiazines ; Postal Service ; Salaries and Fringe Benefits ; Schools, Medical ; Surveys and Questionnaires

BACKGROUND: Food exchange lists are one of the main methods of nutritional education. However, Korean food exchange lists have not been revised since 1994. Therefore, we surveyed the opinions of diabetes educators and patients with diabetes regarding the need for revision of the current food exchange lists. METHODS: For two weeks beginning on 10 March 2008, a 12-item questionnaire regarding the opinion and need for revision of the current food exchange lists was e-mailed to diabetes educators nationwide. Another 15-question survey was administered to patients with diabetes in 13 hospitals located in the Seoul and Gyeonggi regions of Korea. RESULTS: We obtained survey responses from 101 diabetes educators and 209 patients; 65 (64.3%) of the educators answered that the current food exchange lists should be revised. The items that needed revision were the glycemic index, addition of new foods and reaffirmation of exchange standard amounts. The patients demanded specific education about choosing appropriate foods, a balanced meal plan, proper snacks, and dining intake. CONCLUSION: Our survey results demonstrate the need to revise the Korean food exchange lists. This process should focus on glycemic index, the addition of new foods and reconfirmation of one exchange reference unit.
Electronic Mail ; Glycemic Index ; Humans ; Meals ; Snacks ; Surveys and Questionnaires

BACKGROUND: Langerhans cell histiocytosis (LCH) is a rare disease that involves a clonal proliferation of Langerhans cells. LCH has a predilection for hypothalamo-pituitary axis (HPA) dysfunction, and this leads to diabetes insipidus (DI) and/or anterior pituitary dysfunction. Here, we describe the endocrine dysfunction and clinical characteristics of adult patients with LCH and we analyzed the differences between an adult-onset type and a childhood-onset type. METHODS: The data was obtained from a retrospective chart review of the patients with LCH that involved the HPA and who attended Seoul National University Hospital. The patients were classified into the adult-onset type (age at the time of diagnosis > or = 16) and the childhood-onset type (age at the time of diagnosis < or = 15). RESULTS: Ten patients (9 males and 1 female) were diagnosed with LCH involving the HPA. Five patients were classified as an adultonset type and the other five patients were classified as a childhood-onset type. The median follow-up duration was 6 (3-12) years for the adult-onset type and 16 (15-22) years for the childhood-onset type. All the patients presented with DI as the initial manifestation of HPA involvement. Four adult-onset patients and three childhood-onset patients had a multi-system disease. Panhypopituitarism developed in three adult-onset patients and in one childhood-onset patient. The pituitary lesion of the three adult-onset patients had spread to the brain during the follow-up duration. In contrast, the pituitary lesion of the other two adult-onset patients without panhypopituitarism and all the childhood-onset patients had not changed. CONCLUSION: DI was the initial presentation symptom of HPA involvement. Anterior pituitary hormone deficiency followed in some patients. Compared with the childhood-onset patients, the adult-onset patients were more likely to have panhypopituitarism and a poor prognosis.
Adult ; Brain ; Diabetes Insipidus ; Follow-Up Studies ; Histiocytosis, Langerhans-Cell ; Humans ; Hypopituitarism ; Langerhans Cells ; Male ; Prognosis ; Rare Diseases ; Retrospective Studies ; Axis, Cervical Vertebra

OBJECTIVE: The purpose of this study was to evaluate the detection rate of human papillomavirus (HPV) DNA Test (type 16 and 18) and to investigate the clinical significance of HPV DNA test in patients with cervical neoplasia. METHODS: Of the 708 patients aged 21~83 years who had undergone both conventional Papanicolaou cervical cytologic test and HPV DNA test by polymerase chain reaction, 383 cases underwent histologic diagnoses. RESULTS: Of the 708 cytologic diagnoses, there were 11 positive HPV DNA test diagnoses in squamous cell carcinoma (SCC), 41 in high-grade squamous intraepithelial lesion (HSIL), 20 in low-grade squamous intraepithelial lesion (LSIL), 41 in atypical squamous cells (ASC), and 86 in negative cytology. Of the 383 histologic diagnoses, there were 24 positive HPV DNA test diagnoses in SCC, 42 in cervical intraepithelial neoplasia (CIN) 3, 12 in CIN 2, 12 in CIN 1, 7 in atypical change, and 45 in negative histology. Of the 239 patients with negative HPV DNA test, 28.5% cases showed histologic diagnoses of CIN 1 or worse lesion. Of the 46 patients with negative cytology and positive HPV DNA test, 50.0% cases showed histologic dianoses of CIN 1 or worse lesion. Pap cytology revealed sensitivity of 72.5%, specificity of 66.4%, and false negative rate of 27.5%, whereas HPV DNA test showed 57.5%, 76.7%, and 42.5%, respectively. CONCLUSION: This study confirmed that the primary standard Pap cytology and HPV DNA test were adjunctive. Also this study showed that physicians always should not overrate Pap cytology or HPV DNA test in managing the patient with cervical neoplasia. Combined test was a very effective diagnostic method for detecting cervical neoplasia.
Aged ; Carcinoma, Squamous Cell ; Cervical Intraepithelial Neoplasia ; DNA ; Human Papillomavirus DNA Tests ; Humans ; Polymerase Chain Reaction ; Sensitivity and Specificity

OBJECTIVE: The purpose of this study was to investigate the treatment effects of a topical application of 5-aminolevulinic acid (5-ALA) for photodynamic therapy (PDT) to treat cervical cancer. METHODS: We first investigated the effects of 5-ALA cream according to application time. And to find the effective 5-ALA concentration and the distribution times in vivo, 20% 5-ALA cream was topically applied to the tumor of the nude mouse. We then observed the distribution of 5-ALA via fluorescence measurement with using a 532 nm diode laser. 25 nude mice were divided into Control, ALA, Laser, and PDT group. To evaluate the PDT effect at cancer lesion, we applied 20% 5-ALA cream to the tumor by the same method, and the PDT was done by using a 632 nm diode laser at the time of the peak level of fluorescence. We checked the changes of the volume of cancer for 30 days, and then biopsy was done. RESULTS: The effective post-irradiation time after topical ALA application was 9 hours. In the PDT group, 40% (4/10) of the mice showed decreased tumor size. CONCLUSION: The maximum PpIX fluorescence at 9 hours after local applicationof 5-ALA cream was checked. And PDT group did not show any statistical difference than control group in the growth of tumor size than control group. However responding cases (4/10) of PDT group showed the meaningful decrease of tumor size than control group (P<0.05).
Animals ; Biopsy ; Fluorescence ; Lasers, Semiconductor ; Mice ; Mice, Nude ; Photochemotherapy ; Protoporphyrins ; Triazenes ; Uterine Cervical Neoplasms

Primary cardiac angiosarcoma is a very rare disease with a poor prognosis. We report a case of a patient with a primary cardiac angiosarcoma who presented with cardiac tamponade; the angiosarcoma was successfully resected surgically.
Cardiac Tamponade ; Heart Neoplasms ; Hemangiosarcoma ; Humans ; Pericardial Effusion ; Prognosis ; Rare Diseases