, Hyung-Lae Kim, Hae-Young Park, Young-Sook Pae, Sang-Shin Park Cytochrome P-450(CYP) enzymes are important in catalyzing the hiotransffrmation on manyendogeneous compounds and xenobiotics, including drugs and carcinogens. In the presentstudy, effect of nifedipine a voltage dependent calcium channel blocker on the induction ofCYP1A1 and 2B1 was investigated. Change of CYP1A1 and 2B1 activities were measuredby using specific enzyme activities and Western blot analysis. CYP1A1, as quantified by ethoxyresorufin-0-deethylase activity and Western blot with monoclonal antibody 1-7-1, increasedin liver microsome of nifedipine-treated spontaneous hypertensive rat(SHR. 30mg/kg.b.w, twicea day for 3days) but not in kidney microsome. CYP2B1, as quantified by benzyloxyresorufin-O-dealkylase activity and Western blot wit]1 monoclonal antibody 2-66-3, markedly increasedin liver microsome of nifedipine-treated SHR but slightly in kidney microsome. The resultsdemonstrate that nifedipine is a potent inducer of CYP2B1 in SHR.
The histopathology of the brains of rats killed was studied, fo11owing various doses of 20 to 30 Gy X rays with or without cisplatin (cis-diamminedichloroplatinum II) treatment. Choroid plexus in lateral ventricles, neuropil, and neuronal changes were evaluated in coronal sections of the brain. The changes were different depending on survival days regardless of dosage of irradiation or cisplatin treatment. At 4 days after irradiation, the changes of choroid plexus were marked and associated with diffuse perivascular edema. At 6 days after irradiation, choroid plexus showed congestion of blood vessels with no changes in epithelial cells and neuropil.The degenerative changes in neurons were marked at 6 days and minimal after 7 days, which suggests the reversible changes of neurons in radiation damage of rat brain. Those rats with 20 Gy irradiation, killed at 3 or 9 days, showed mild to moderate vacuolizatlon of epithelial cells and dilatation of capillaries with no perivascular edema. Cisplatin treatment showed mild to moderate changes in choroid plexus with no changes in neurons and neuropil.
This paper reports a study on 246 cases of upper gastrointestinal(UGT) hemorrhage thatwere treated in the Department of Internal Medicine of the Ewha Womans University(Mokdong Hospital) over a period of 18 months from September of 1993 to May of 1995.
The results were as follows.
1) The causes of UGI hemorrhage were 156 peptic ulcer cases(63.4%) including 71 gastriculcer,82 duodenal ucler, and 3 marginal ulcer ; 44 esophageal varix cases(17.9%) ; 18 MalloryWeiss syndrome cases(7.3%) : 15 stomach cancer cases(6,1%) ; 7 acute gastric mucosal lesioncases(2.8%) ; 2 unknown causes ; and 4 other causes.
2) There were 204 males and 42 females(4.8 : 1). The age distribution was 51 in fifties(20.7%),49 in forties(19.9%), 44 in thirties(17.9%), 40 in sixties(16.2%), 24 in twenties(9.5%), and 24 in seventies(9.8%) resulting in 58.5% of the total cases from the thirties to fifties. Agedistribution of duodenal ulcer and Mallory-Weiss tear was younger than stomach cancer andgastric ucler(P<0.05).
3) The seasonal distribution showed spring 78 cases(31.7%), summer aS cases(10.1%), autum67 cases(27.2%), and winter 74 cases(30.1%) with peak incidence in spring.
4) The severity of UGI hemorrhage according to Palumbo's criteria was mild bleeding in 71 cases(28.8%), moderate bleeding in 115 cases(46.7%), and massive bleeding in 60 cases(24.4%)
5) The mean amount of transfusion for treatment was 4.2±2.4 unit for peptic ulcer, 3.2±1.8unit for varix, 5.9±3.1 unit for stomach cancer, and 0.3±0.2 unit for Mallory-Weiss tear.
6) Ninety one peptic ulcer was received endoscopic treatment(58.4%). Among them, therewere 13 rebleeding cases(14.3%) and 9 cases required surgical opertaion(9.8%). Thirly fivevarix cases received endoscopic treatment(79.5%) and there were 3 rebleeding cases(8.6%).
7) The motality was 4.1%(10 cases). The main causes of deaths were 1 sepsis case, 3 hepaticcoma cases, and 6 hepatoma intraperitoneal rupture cases.
, Soon Nam Lee Paroxysmal nocturnal homoglobinuria is an uncommon acquired hemolyticanemia and characterized by increased sensitivity of erythrocytes to the lytic action of comptement system, developing intravascular hemolysis. PNH is complicated by anemia, infectionand thrombosis. The more prolonged survival comparable to literature was noted and so, weperformed this study.
The previously reported twenty nine cases and six cases were collected at EwhaWontons University Hospital from Dec.1979 to Dec.1994 and were analyzed for clinical characteristics and progress.
1) The age distribution was ranged from 16 to 61 years with mean of 30 years andmale to female ratio was 1.5 : 1. The duration from the onset of symptoms to diagnosis wasranged from 3 days to 40 years and above 5 years was 22.9%. The subjective symptoms attributable to anemia were in 13 cases, to dark urine after sleep in 10 cases, to jaundice in 5 cases,to abdominal pain in 3 cases, to hemorrhage in 4 cases. The various diagnoses made beforePNH were aplastic anemia in 14 cases, hernolytic anemia in 5 cases, liver disease in 4 cases,iron deficiency anemia in 3 cases, idiopathic thrombocytopenic purpura in 1 cases, reversedcases from aplastic anemia to PNH in 2 cases.
2) Laboratory data showed ;
(1) anemia(Hg below 12g/dL) in 35 cases with mean of 7.3g/dL.
(2) leukocytopenia(below 4,000/mm3) in 5 cases, leukocytosis in 1 case with mean 4,100/mm3 except patient with chronic myelocytic leukemia.
(3) thrombocytopenia(below 150,000/mm3) in 10 cases with mean 106,000/mm3.
(4) reticulocytosis(over 2.0% ) in 20 cases with mean 4.3%.
(5) Bone marrow examination revealed hypocellular in 2 cages, normocellular in 4 cases, hypercellular in 3 cases and erythroid hyperplasia in all cases.
(6) positive Ham's test in 13 cases among 14 cases.
(7) positive sucrose hemolysis test in 10 cases anions 10 cases.
(8) decreased serum haptoglobin in 2 cases among 3 cases.
3) The treatment was consisted of blood transfusion in 26 cases among 35 cases, especiallywashed RBC in 13 cases, iron in 14 cases, folic acid in 10 cases, dextran in 5 cases, busulfanin 1 case, corticosteroid in 26 cases, androgen in 15 cases and anticoagulant in 3 cases.
4) The observed complications were infection in 3 cases, cerebral infarct in 2 cases andacute renal failure in 2 cases.
5) The nineteen patients were still alive, four patients dead, ten patients were lost duringfollow-up period. The duration of most prolonged survival case was 41 years 10 months. Theywere fo11owed from 0.3 to 115 months.
In analyzing the characteristics of PNH patients and prolonged survivals, thedata reported suggest, although the laboratory abnormalities persisted in the prolonged survival,the prognosis will be good if conservative tretment and prevention of complication is tried.
Citations
, Nan Ho Kyung The purpose of this study is to investigate the clinical efficacy and stabilityof human insulin therapy compared with conventional animal insulin therapy in respect ofadverse reactions, glycemic control, insulin requirement and subjective satisfaction.
To investigate the clinical efficacy and stability of human insulin therapy, weconducted this study in 55 university hospitals and goneral hospitals in Korea nationwide,for a period of 32 months from January 4, 1990 through December 31, 1992. The study wasset out to replace conventional animal insulin with human insulin(HumulinR) and observedadverse reactions, changes in blood glucose levels, HbA1C, insulin requirement and subjectivesatisfaction after replacement.
Results are given as fo11ows.
1) Blood glucose level, HbAlc, and insulin requirement were significantly decreased afterreplacement animal insulin with human insulin(p<0.05).
2) As for adverse reactions, hypoglycemia was observed more frequently and the incidenceof chills and local allergic reaction at the site of insulin injection were decreased after replacement animal insulin with human insulin.
3) As for subjective satisfaction of the patients, number of patients with subjective satisfactionwere significantly increased after replacement animal insulin with human insulin(p<0.O5).
These results suggest that human insulin is preferable to animal insulins interms of glycemic control, insulin requirement and subjecive clinical response.
The aim of this work was to measure the distress of psychosomatic symptoms in the nonscreened college students. The SUNYA Revision of the psychosomatic symptom checklist was administered to the 133 college students. The mean total frequency and intensity scores and PSCtotal scores of all subjects were higher than the normative data of college students. Femalesubjects scored higher than male subjects for a11 three PSC scores, especiatlly significantly higherfor mean total intensify scores. The scores of items of fatigue, depression, general stiffnesswere highest of all items in both sexes.44.4% of all subjects scored above 40 PSC total score.
The results of this study support the use of the PSC as a measure of psychosomatic distressin the college students.
, Haing-Won Woo The author compared plasma lipid levels in 74 patients with panic attack with those innormal controls. SCL-90-R was performed to evaluate the relationship between psychiatricsynlptoms and serum levels of cholesterol and triglyceride in Panic patients. The resultswere :
1) No significant differences in levels of serum cholesterol(mg/d1) and triglyceride(mg/dl) were found between the two groups. But in male panic patients level of serum triglyceridewas somewhat higher than in controls without statistical significance(169.9±79.5 : 136.1±54.6)(0.05<p<0.1).
2) Serum levels of cholesterol and triglyceride were not significantly different in patientswith Higher depression and anxiety score from those in normal controls. The level of serumcholesterol was higher in patients(178.3±93.3) with higher phobic score than in controls(136.1±54.6, p<0.O5) but that of serum triglyceride was somewhat higher in patients with higher phobicscore without statistical significance(0.05<p<0.1).
3) Serum cholesterol level was significantly higher in male patientts(202.5± 46.3) with higherphobic score than those(158.0±21.6) with lower score(p<0.05). But in the same patient groupsthe triglyceride level was not significantly different(178.3±93.3 : 106.4±25.5).
Twenty-four children with congenital muscular torticollis, who were treated by the Ferkel'sbitermlinal tenotomy, were evaluated after an average follow-up of 1.4 years. The operativeprocedure was consisted of the biterminal strrnocleidomastoid release and the z-pasty lengthsning of the sternal tendon. Twenty-three patients(96 per cent) reported satisfactory correctionof their head tilt. Z-plasty of the sternal head appears to help in maintenance of the normalcontour of the neck We recommend that biterminal release be performed for those childrenwith severe deformity as well as the secondary facial changes.
, Kyu Man Shin The assessment of the vasoreactivity measured with transcranial doppler(TCD) provides information regarding to the reserve capacity of the cerebral circulation in patients with acute head injuries, which has important therapeutic consequencies because it allows for the diagnosis of impending ischemia and for the control of the effect of initiated corrective measures.
The authors performed TCD study to measure the CO2 reactivity to the entire basal cerebral arteries in 30 cases of control group and 14 cases of head inury group between the 3rd and the 7th day after insult. All patients were examined by single photon emission computed tomography and their results were compared to CO2 reactivities at 8 basal cerebral arteries. All of these results were analyzed by statistical analysis system(SAS).
The increase of MBFV(mean blood flow velocity) and decrease of PI(pulsatility index)were noted in the cerebral arteries with decreased CO2 reactivity. It meant that the arterial walls were dilated. There was no close relationship between region of interest(ROI) index and CO2 index but CO2 reactivity was remarkably decreased in the region which showed abnormal regional cerebral blood flow in SPECT(single photon emission computed tomogram)(P=0.04). In the relationship between the variables, ROI increased as the clinical status worsen(r=0.5, P=0.0008), the prognosis of the patients had positive correlation with CO2 index(r=0.32, P=0.04) or clinical status had negative correlation with ROI index(r=0.40, P=0.0094).
The doppler CO2 test in patients with head injury provides useful information regarding hemodynamic state, prognosis and determination of beneficial effects of specific therapy, especially during subacute stage. In the various TCD parameters CO2 index was correlated well with prognosis.
Toe transplantation is a reliable and effective means of reconstruction for patients who havelost fingers or thumbs. Hand function is restored to a high degree because of the anatomic sinlilarities between the fingers and the toes. We have transplanted 11 great toes to the thumbsand 6 toes to the fingrs in 16 patients. There were no failures but exploration was performed in one patient due to arterial insufficiency.
The sensory recovery was excellent within 15mm of two point discrimination and range of motion was also sufficient enough, and in most case it was aesthetically acceptible. Fortunately the transplant is accomplished with relatively minimal donor site problems.
The relation between clinically obvious polyhydramnios and poor perinataloutcome has been described. The purpose of the present investigation was to relate polyhydramnios to etiology and perinatal outcome.
Mild and severe polyhydramnios was defined sonographically as an amnioticfluid index of 240~300, and more than 300 respectively. We diagnosed polyhydramnios in 16 cases of 3160 patients(0.5%) undergoing fetal testing at 26-42 gestational weeks. We compared mild and severe polyhydramnios in aspect of perinatal outcome.
The severe polyhydramnios group showed a significantly higher incidence of neonatal death and associated congenital anomaly than mild polyhydramnios group.
We conclude that severe polyhydramnios is associated with an increased risk of adverse perinatal outcome.
There are many suggestive risk factors f3r the development of open angle glaucoma including age, race, family history, myopia, diabetes, systemic hypertension and migrain. Myopia is a common clinical entity and the importance of low tension glaucoma seems to be increasing recently.
Nine four eyes of Low tension glaucoma(LTG) were examined for intraocular pressure, visual field test fundus examination, gonioscopic examination and refractive state. We analysed the prevalence of myopia in patients with Low tension Glaucoma and compared with normal population of similar age.
The results were as fo11ows
1) There were ninety four eyes with LTG and more men(55.3%) than women(44.7%) had been affected, the mean age at diagnosis was 43.28±7.96 years in melt, 47.08±8.20 years in women and the mean IOP at diagnosis was 15.59±3.26 mmHg in men, 15.23±2.89 mmHg in women.
2) Seventy two eyes(76.6%) were refractive myopia, and the percentage of myopia in LTG was greater than reported for a normal population of similar age(72.9%).
3) The percentage of myopia greater than -3.12 diopter was 30.8% in LTG and only 8.7% in normal controls.
Accidental traums is the third most common cause of death in the Korea. Computed Tomography(CT) has been the champion diagnosis and management planning of abdominal injuries its use has decreased the number of negative exploratory laparotomies significantly, A CT-based injury severity of four grades was vised and applied in 24 patients with blond splenic injury as the sole or predominant intraperitoneal injury detedted with Preoperative CT. While patients with high grades of splenic injury generally required early surgery, eight(33%) of 24 patients with initial grade 3 or 2 injury were treated successfully without surgery. Thirteen(54%) or 24 patients with initial all grades ten injury wereted successfully wihtout surgery. Results show that while CT remains an accurate method of indeutifying and quantifying initial splenic injury, as well as documenting progression or healing of critical injury, all of went on to manifest splenic injury documented by repeat CT examination after onset of clinical symptom.
, Eun Cheol Chung, Jeong Soo Suh, Chung Sik Rhee Abdominal ultrasound for the health screen was performed in 4610 adults from the Jan. 1993 to Mar. 1995 at Ewha University Hospital Health Clinic. Gross abnormalities were noted in the 33.3% of examined persons. The most common finding was fatty liver(21.6%). And other abnormalities were renal cyst, gallbladder stone, hepatic cyst, and hepatic calcification in the order of frequency. It is concluded that abdominal ultrasound is an important screening modality in the adults.
, Si-Hoon Park, Gil Ja Shin, Woo Hyung Lee Femoral pseudoaneurysm is important complication after diagnostic femoral catheterizationor more complex procedure.
With the increasing use of larger-size percutaneous instruments and periprocedual anticoagulant or antiplatelet agent the incidence of postcatheterization femorl artery injuries ncluding pseudoaneuiysm has increased in the past few years.
Duplex ultrasonography and addition of color- flow Doppler provides an accurate, noninvasive. risk-free diagnosis and faster detection of intraaneurysrnal blood flow and the track betweenthe injured artery and the pseudoaneurysm.
Though early surgical repair of the arterial defect is usually recommended because of severeand life-threatening complication such as rupture, fhrornboembolism, compression neuropathyetc, Ultrasono-Guided Compression Repair(UGCR) is to be first-line treatment for its advantagesuch as high success rate, low morbidity and cost-effectiveness.
The authors report 2 cases of femoral psoudoaneurysrns treated using UGCR with nlanualcompression with C-clamp at the same time as a nonsurgical treatment.
, Soon Nam Lee, Young Yo Park, Kwang Ho Kim, Woon Sup Han Choriocarcinonla is very rare malignancy, accounting for less than 1% of all testicular germcell tumor. However, it is an important disease in the field of oncology, as it represents ahighly curable malignancy. and one in which the incidence is focused on young patients attheir peak of productivity. In nonserninomatous germ cell testis tumor, assessment of prognosticfactors is related to develop a basis for more rational therapy for each individual patient.Along with prognostic staging, appropriate treatment shoud be applied to each patient to improve disease-free survival. And. surgical resection of residual masses after cisplatin-based chemotherapy is an established adjuvant to chemotherapy, because complete remission can be improvedabout 10% with appropriately timed complete resection of residual diseases. So, we reporta case of a 27-year old male patient with testicular choriocarcinoma who presented with multiplelung metastases after radical orchiectomy. He recieved lung wedge resection after 8 cycles ofcisplatin, etoposide, ifosfamide combination chemotherapy. and complete remission was confirmed and maintained.
, Hae Young Choi, Ki Bum Myung We report a case of mixed connective tissue disease in a 35-year-old woman showing typicallaboratory and clinical features. Clinically she suffered from hand edema, arthritis, proximalmuscle weakness, loss of hair and Raynaud's phenomenon. FANA revealed a speckled epidermal nuclear staining pattern. Analysis of serum showed anti RNP antibody positive and antiSm antibody negative. Anti DHA antibody occurred in low titer. The patient showed a promptreponse to prednisone 0.5mg per body weight without any recurrence.
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