In 41 cases of breast cancers, the aneuploidy measured by Image Analyzer was compared with that of flow cytometric analysis, and estrogen and progesterone receptor(ER/PR) and Her-2/neu oncoprotein were immunohistochemically stained and measured by Image Analyzer. In ER/PR, the positive nuclear area(PNA, %) was measured, and in Her-2/neu, the content of oncoprotein was expressed as pg/cell. To assess the usefulness of these parameters as a prognostic factor, the author evaluated the results in relation with tumor size, nuclear grade and lymph node metastasis. The obtained results are summarized as follows: 1) The detection rate (90%) of aneuploidy by image analysis was higher than that (70%) of flow cytometric analysis. The concordance rate of both method was 80%. 2) The positivity of ER was 73% and PR was 34%, and the high PNA of ER and PR was related with high nuclear grade. There was an inverse correlation of the ER PNA with tumor size and PR PNA with negative lymph node. 3) Her-2/neu oncoprotein overexpression was found in only 2 cases and another two showed borderline overexpression. All four cases had DNA tetraploidy. From the above results, it was concluded that the image analyzer could be used in DNA analysis and in quantitation of immunostained ER/PR and Her-2/neu oncoprotein, providing the important information in the management of the breast cancer patients.
Breast Neoplasms

Rapid progress in modern medical technology has made it possible to sustain life and/or delay death using 'heroic' treatments. The availability of life-sustaining treatment brings several issues in end-of-life care such as 'dying with dignity' and an radical increase in health care costs. The use of Advance Directives(AD) have been widely heralded by health care providers, gerontologists, and advocacy groups as means of protecting patients' right to accept or refuse life-sustaining treatment in end-of-life care. The use of AD can not only improve patients' autonomy and quality of life but also bring efficiency in distributing health care resources. The proportion of older persons in Korean population has been increasing. Those 65 years of age or over were about 7 percent of the population. Death and dying is not limited to older persons, but it is more prevalent among them. In conjunction with an aging population and the increasing prevalence of death, the issues of death and dying will become crucial in near future in terms of 'dying with dignity', 'autonomy', and 'self-control'. This paper attempts to explode and establish the concept of advance directives (AD) based on literature review. Data sources are computer searches with the MEDLINE database. Due to the lack of prior study on AD for a Korean cases, studies abroad are reviewed. This paper suggests the need for future study on the possibility of the use of AD in Korea.
Advance Directives* ; Aging ; Surveys and Questionnaires ; Delivery of Health Care ; Health Care Costs ; Health Personnel ; Humans ; Korea ; Patient Rights ; Prevalence ; Quality of Life

BACKGROUND: To know the effect of droperidol and ondansetron on nausea and sedation in postoperative patients, we studied 120 gynecological patients receiving patient-controlled analgesia (PCA) with morphine and droperidol or ondansetron. METHODS: Subjects were randomly allocated to one of four groups according to PCA regimen, morphine 0.5 mg/cc alone (group M); morphine plus droperidol 0.034 mg/morphine 1 mg (group D); morphine plus ondansetron 0.132 mg/morphine 1 mg (group O1); morphine plus ondansetron 0.066 mg/morphine 1 mg (group O2). The PCA device, WalkMed was set at basal rate 2 ml/hr (1 mg/hr), bolus dose 1 ml (0.5 mg), lockout time 10min, 1 hour maximum dose 4 mg. The severity of nausea, sedation and pain were assessed at 1h, 4h, 8h, 12h, 24h, and 48h postoperatively. RESULTS: The occurrence of nausea was not different among groups. But there were statistical differences in the nausea severity (p<0.05). The group D and group O1 had lower nausea scores, and between them there was no difference. The scores for sedation were significantly lower in the group O1 compared with group M and group D (p<0.05). Overall pain scores were not different among groups. CONCLUSIONS: Ondansetron and droperidol are effective in reducing nausea. Ondansetron is superior to droperidol in avoiding excessive sedation.
Analgesia, Patient-Controlled* ; Droperidol* ; Humans ; Morphine ; Nausea ; Ondansetron* ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting*

Sertolifonn endometrioid carcinoma (SEC) is a very rare malignant neoplasm arising from the surface epithelium of the ovary. We report one case of SEC occuring in the left ovary of a 73-year-old woman. The left ovary was totally replaced by a yellowish tan lobulated solid mass with focal cystic areas. Small tubules and elongated solid cord-like structures resembling a Sertoli-Leydig cell tumor or a Sertoli cell tumor were found microscopically. In some areas, confluent typical endometrioid carcinoma, adenofibromatous stroma, squamoid foci, and lutenizing stromal cell nests were noted. The tumor also demonstrated strong immunoreactivity with EMA (epithelial membrane antigen). Certain points of differentiation between SEC and SertoliLeydig or Sertoli cell tumors are discussed.
Aged ; Carcinoma, Endometrioid* ; Epithelium ; Female ; Humans ; Immunohistochemistry ; Membranes ; Ovary ; Sertoli Cell Tumor ; Sertoli-Leydig Cell Tumor ; Stromal Cells ; Triacetoneamine-N-Oxyl

No abstract available.

No abstract available.
Benzalkonium Compounds* ; Dermatitis, Contact*

Alzheimer's disease (AD) is an age-related disorder. Both the prevalence and the incidence of AD double approximately every 5 years after the age of 60. This is a particularly serious problem considering that the Korean elderly population is rapidly growing. We present three illustrative cases of AD in mild, moderate, and advanced stages, respectively. Their initial symptoms were memory impairment which was followed by language disturbance and visuospatial dysfunction. Abnormal behaviors such as delusion and aggression occurred in moderate and severe cases. The presence and severity of dementia in these cases were established by history taking, neurological examination, standardized mental status assessment, and neuropsychological test. Laboratory investigations showed no abnormalities that could account for the cognitive deficits. Brain CT or MRI findings of the patients wee not remarkable except for a diffuse atrophy demonstrated by increased ventricular volume, narrowed gyri, and widened sulci, As an addendum, risk factors, clinical symptoms, clinical diagnosis, and natural history of AD were reviewed.
Aged ; Aggression ; Alzheimer Disease* ; Atrophy ; Brain ; Cognition Disorders ; Delusions ; Dementia ; Diagnosis ; Humans ; Incidence ; Magnetic Resonance Imaging ; Memory ; Natural History ; Neurologic Examination ; Neuropsychological Tests ; Prevalence ; Risk Factors

The influences of adrenal corticosteroid on the development and regression of neurons of dentate and hippocampus were studied by adrenalectomy and steroid overload in neonatal rats. The results obtained were as follows. 1. The cell death occurred naturally in numerous dentate granule cells and hippocampal pyramidal cells. 2. The number of dentate granule cells undergoing cell death decreased by injection of adrenal corticosteroid, but increased in adrenalectomized rat brains. The changes occurred prominently at postnatal day 6. 3. The number of hippocampal pyramidal cells undergoing cell death decreased in CA3 region by injection of adrenal corticosteroid, but was not changed in adrenalectomized rat brains. However, other regions exhibited no change by adrenal corticosteroid and adrenalectomy. 4. The cell death of pyramidal cells of CA3 region occurred in close relationship with the cell death of dentate granule cells, which was different from other CA regions. In summary, the cell death of dentate and hippocampal neurons occurred naturally but seemed to be influenced by other factors as well as adrenal corticosteroid.
Adrenalectomy ; Animals ; Brain ; Cell Death ; Hippocampus* ; Neurons* ; Pyramidal Cells ; Rats*

Congenital hepatic fibrosis is an inherited, congenital disorder of the liver, and is occasionally associated with cystic disease of the liver and kidney. We present a case of congenital hepatic fibrosis with Caroli's disease. A 21-year-old woman had suffered from an episodic fever with headaches for 3 years. In laboratory examination, the liver function test was within the normal limits. Esophageal varix was noted by an endoscopic examination. Hepatosplenomegaly and multiple dilated bile ducts were seen by abdominal CT scanning. An orthotopic whole liver transplantation was done. The liver was fibrotic and enlarged. Multiple cystically dilated intrahepatic ducts were noted. Microscopically, diffuse portal fibrosis and widening with proliferation of bile ductules were seen. Intrahepatic bile ducts were markedly dilated and tortuous. The liver cell cords were well preserved.
Bile ; Bile Ducts ; Bile Ducts, Intrahepatic ; Caroli Disease* ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Esophageal and Gastric Varices ; Female ; Fever ; Fibrosis* ; Headache ; Humans ; Kidney ; Liver ; Liver Function Tests ; Liver Transplantation ; Tomography, X-Ray Computed ; Young Adult

Primary hepatic carcinoid tumors are extremely rare although the liver is a frequent site of metastases from intestinal carcinoids. Recently we investigated a case of primary hepatic atypical carcinoid in a 47-year-old man who had infested with Clonorchis sinensis for 20 years. The resected right lobe of the liver was almost completely occupied by a huge tumor, measuring 20 x 19 x 12 cm. The cut surfaces of the mass were solid, soft and pale yellow, accompanied by several small satellite nodules, measuring up to 1.5 cm in diameter. Microscopically, the tumor consisted of polygonal to columnar cells with eosinophilic granular cytoplasm forming Lym-numerous small acini and large trabeculae. Their nuclei were round to polygonal with coarse stone chromatin, had obscure to small nucleoli and frequent mitoses. There were multiple necrotic foci of varing sizes. The surrounding dilated bile ducts contained several degenerating worms on in of Clonorchis sinensis. The tumor cells were argyrophil-positive but argentaffin-negative. Immunohistochemically, the tumor cells were positive for cytokeratin, chromogranin and somatostatin but were negative for CEA, AFP, insulin, glucagon, ACTH, growth hormone and volve-prolactin. Ultrastructually, the tumor cells contained variable-sized numerous electron dense of neurosecretory granules.
Male ; Humans ; Neoplasm Metastasis