Microvascular tissue transfers have facilitated primary closure of various complex defects after radical ablation of head and neck cancers. From Oct 1991 to Feb 1992, we used forearm free flap in two patients and delto-pectoral flap in one patient who had preoperative irradiation for pharyngoesophageal reconstruction. The stricture and fistula formation were most troublesome complication in forearm free flap, so we designed as lazy S shape in distal flap margin to prevent circular contraction and longitudinal margin was deepithelialized (5 mm) and sutured double layer to withstand fistular formation and this can be considered useful in place of a free jejuna transfer.
Constriction, Pathologic ; Fistula ; Forearm ; Free Tissue Flaps ; Head ; Humans ; Neck

PURPOSE: This study was conducted to define the main factors influencing depression of climacteric women. METHOD: The data was analyzed using a SAS 6.12 PC+ program for descriptive statistics, Pearson correlation coefficients and stepwise multiple regression. Two hundred seventy climacteric women between 40 and 59 years old were recruited from 6 areas in Korea from Oct. 5, 2002 to Dec. 13, 2002. The reliability of the 7 instruments were tested with Cronbach's alpha which ranged from .82 to .95. RESULT: The results were as follows : The mean depression score was 14.17, which was slightly high. The depression was influenced significantly by occupation, economic status, and menopause status. There were significant correlations between all the predictive variables and the depression(r=.73~ -.17, p <.05). Stepwise multiple regression analysis showed that 59% of the variance in depression was significantly accounted by stress(53%), climacteric symptoms(3%), marital adjustment (2%), and health promotion behavior(1%). CONCLUSION: In reducing the climacteric women's depression, the above major influencing factors should be considered.
Climacteric* ; Depression* ; Female ; Health Promotion ; Humans ; Korea ; Menopause ; Methods ; Occupations

PURPOSE: This meta-analysis was conducted to evaluate the effects of a self-efficacy promoting program and analyze its components. METHOD: The material used for this study were 18 self-efficacy promoting program studies carried out from Jan. 1980 to Oct. 2003. The studies were analyzed in different categories: 1) types of dependent variables 2) sample characteristics 3) types of experimental treatment conditions 4) types of self-efficacy source and 5) total amount of time RESULT: 1) The weighted mean of a self-efficacy promoting program ranged from 1.383 to 0.015 2) for the experimental treatment condition, exercise had a much larger effect in increasing general self-efficacy and self-care than education 3) the studies using 3 sources had a much larger effect in increasing self-care than the studies using 4 sources 4) a time period longer than 900 minutes had a much larger effect in increasing specific self-efficacy, general self-efficacy and self-care than in a time period shorter than 900 minutes. 5) effect size of specific self-efficacy was significantly higher than general self-efficacy. CONCLUSION: These results can be used to guide the development of a self-efficacy promoting program for nursing practice.
Humans ; *Patient Education as Topic ; *Self Care ; *Self Efficacy

PURPOSE: This study was done to investigate the relationship among the variables, chronic pain, pain coping, fatigue, self-esteem, and depression in elders. METHOD: Data were collected by self-reported questionnaires from 270 older adults. Data analysis was done with SPSS 10.1 for descriptive statistics and a PC LISREL program for covariance structural analysis. RESULTS: According to modified model, chronic pain was found to have a significant direct and total effect on pain coping. Chronic pain and pain coping were found to have a significant direct and total effect on fatigue. Chronic pain, pain coping and fatigue were found to have a significant direct and total effect on self-esteem. Chronic pain, pain coping, and self-esteem were found to have a significant direct effect on depression. CONCLUSION: This modified model is considered appropriate for explaining the relationship among chronic pain, pain coping, fatigue, self-esteem, and depression in elders. Also, the findings support the development of an intervention strategy to relieve chronic pain in elders.
Adult ; Chronic Pain* ; Depression* ; Fatigue* ; Humans ; Surveys and Questionnaires ; Self Concept ; Statistics as Topic

OBJECTIVE: The objectives of this study were to analyze efficacy of immature and mature mouse oocytes after vitrification and warming by applying various combinations of cryoprotectants (CPAs) and/or super-rapid cooling using slush nitrogen (SN2). METHODS: Four-week old ICR female mice were superovulated for GV- and MII-stage oocytes. Experimental groups were divided into two groups. Ethylene glycol (EG) only group: pre-equilibrated with 1.5 M EG for 2.5 minutes and then equilibrated with 5.5 M EG and 1.0 M sucrose for 20 seconds. EG+dimethylsulfoxide (DMSO) group: pre-equilibrated with 1.3 M EG+1.1 M DMSO for 2.5 minutes and equilibrated with 2.7 M EG+2.1 M DMSO+0.5 M sucrose for 20 seconds. The oocytes were loaded onto grids and plunged into SN2 or liquid nitrogen (LN2). Stored oocytes were warmed by a five-step method, and then their survival, maturation, cleavage, and developmental rates were observed. RESULTS: The EG only and EG+DMSO groups showed no significant difference in survival of immature oocytes vitrified after warming. However, maturation and cleavage rates after conventional insemination were greater in the EG only group than in the EG+DMSO group. In mature oocytes, survival, cleavage, and blastocyst formation rates after warming showed no significant difference when EG only or EG+DMSO was applied. Furthermore, cleavage and blastocyst formation rates of MII oocytes vitrified using SN2 were increased in both the EG only and EG+DMSO groups. CONCLUSION: A combination of CPAs in oocyte cryopreservation could be formulated according to the oocyte stage. In addition, SN2 may improve the efficiency of vitrification by reducing cryoinjury.
Animals ; Blastocyst ; Cryopreservation ; Cryoprotective Agents ; Dimethyl Sulfoxide ; Ethylene Glycol ; Ethylenes ; Female ; Humans ; Insemination ; Mice ; Mice, Inbred ICR ; Nitrogen ; Oocytes ; Sucrose ; Vitrification

PURPOSE: Esophageal tolerance is needed to guide the safe administration of stereotactic radiosurgery (SRS). We evaluated comprehensive dose-volume parameters of acute esophageal toxicity in patients with spinal metastasis treated with SRS. MATERIALS AND METHODS: From May 2008 to May 2011, 30 cases in 27 patients with spinal metastasis received single fraction SRS to targets neighboring esophagus. Endpoints evaluated include length (mm), volume (mL), maximal dose (Gy), and series of dose-volume thresholds from the dose-volume histogram (volume of the organ treated beyond a threshold dose). RESULTS: The median time from the start of irradiation to development of esophageal toxicity was 2 weeks (range, 1 to 12 weeks). Six events of grade 1 esophageal toxicity occurred. No grade 2 or higher events were observed. V15 of external surface of esophagus was found to predict acute esophageal toxicity revealed by multivariate analysis (odds radio = 1.272, p = 0.047). CONCLUSION: In patients with spinal metastasis who received SRS for palliation of symptoms, the threshold dose-volume parameter associated with acute esophageal toxicity was found to be V15 of external surface of esophagus. Restrict V15 to external surface of esophagus as low as possible might be safe and feasible in radiosurgery.
Esophagus ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Radiation Tolerance ; Radiosurgery*

BACKGROUND: Both carotid intima-media thickness (IMT) and global risk score of cardiovascular disease were independent risk factors of stroke and heart disease. We assessed the correlation between the 10-year risk of Korean Stroke Risk Prediction model (KSRP) and carotid intima-media thickness. Additionally, from a perspective of carotid IMT measurement following KSRP risk stratification, we analyzed the difference of carotid IMT and plaque according to the KSRP risk strata. METHODS: Subjects were 282 persons who visited one hospital for the screening of stroke. The 10-year risk was calculated automatically based on the equation of KSRP model. The maximal carotid IMT and the plaque were adopted as the study variables. The sensitivity and the positive predictive value of the KSRP risk categories were calculated. RESULTS: The correlation coefficient between the KSRP risk and the maximal carotid IMT was 0.29 (p<0.01). The mean (+/-standard deviation) of KSRP risk of the group with carotid plaque was statistically significantly higher, 5.3 (+/-4.1), than that of the group without plaque, 3.3 (+/-3.1) (p< or =0.01). The sensitivity of the risk stratum with more than 6% of KSRP risk for the plaque was 28.2%. The positive predictive value of the above cut-point was 48.8%. CONCLUSIONS: The 6% of KSRP risk may be considered as the beginning point of intermediate risk stratum to recommend the carotid ultrasonography. However, generalization needs further studies for various populations.
Cardiovascular Diseases ; Carotid Intima-Media Thickness ; Generalization (Psychology) ; Heart Diseases ; Humans ; Mass Screening ; Risk Factors ; Stroke

PURPOSE: The pre-pregnancy body mass index (BMI) is associated with adverse neonatal outcomes. However, studies on very low birth weight (VLBW) infants are rare. This study aimed to investigate the effect of maternal pre-pregnancy BMI on VLBW infants. METHODS: This retrospective study evaluated singleton VLBW infants born at the CHA Gangnam Medical Center from 2006 to 2016. The neonates were classified into three groups according to the maternal pre-pregnancy BMI: underweight ( < 18.5 kg/m2), normal weight (≥18.5 to < 23 kg/m2), and overweight or obese (≥23 kg/m2). Clinical characteristics and morbidities of mothers and infants were analyzed. RESULTS: A total of 181 infants belonging to underweight (16.6%), normal weight (58.6%), and overweight or obese (24.8%) groups were enrolled. The pre-pregnancy BMI had a significant negative correlation with gestational age (r=−0.198, P=0.001) and a significant positive correlation with the z-score of the birth weight (r=0.078, P=0.001) and body length (r=0.067, P=0.008). The number of extremely preterm infants was significantly higher in the overweight or obese group. The proportion of risk of small for gestational age infants was higher in the underweight group (adjusted odds ratio [OR], 2.958; 95% confidence interval [CI], 1.113 to 7.864), whereas that of infants with severe retinopathy of prematurity was higher in the overweight or obese group (adjusted OR, 9.546; 95% CI, 1.230 to 74.109). CONCLUSION: In our population of VLBW infants, the pre-pregnancy BMI was associated with gestational age, intrauterine growth, and adverse neonatal outcomes. Therefore, proper weight control before pregnancy is important.
Birth Weight ; Body Mass Index* ; Gestational Age ; Humans ; Infant* ; Infant, Extremely Premature ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Mothers ; Odds Ratio ; Overweight ; Pregnancy ; Retinopathy of Prematurity ; Retrospective Studies ; Thinness

Myocarditis is an inflammatory disease of the myocardium caused by various infectious or noninfectious triggers. Although viral infections are important causes of myocarditis, some drugs or toxins can also cause myocarditis. We report a case of life-threatening fulminant myocarditis which followed an extensive coffee diet program. Despite medical treatment, the patient was not able to maintain hemodynamic stability. She was supported by extracorporeal membrane oxygenation and completely recovered 3 months later.
Coffee* ; Diet* ; Extracorporeal Membrane Oxygenation ; Hemodynamics ; Humans ; Myocarditis* ; Myocardium ; Toxoids

Systemic lupus erythematosus is a multisystemic autoimmune disease in which the kidneys are frequently involved. Clinical diagnosis of SLE is based on the criteria of American Rheumatism Association (ARA). A few cases who were classified as SLE by the ARA criteria but were antinuclear antibody (ANA)-negative have been reported. It was reported that critical factor in ANA positivity is the choice of substrate. It is generally accepted that the cultured cell of human origin, especially HEP-2 cell, is better than tissue section or animal cells. Thus, the ANA test is negative only in approximately 2M of SLE patients when human tissue culture cells are used as substrate. We report a 25-year-old man admitted to our hospital because of generalized edema. He was found to have active lupus nephritis(WHO class IV), photosensitivity and pancytopenia. The result of FANA test which used HEP-2 cell as substrate was repeatedly negative, but anti-ds DNA and anti-Ro antibody were positive.
Adult ; Animals ; Antibodies, Antinuclear ; Autoimmune Diseases ; Cells, Cultured ; Diagnosis ; DNA ; Edema ; Humans ; Kidney ; Lupus Erythematosus, Systemic ; Lupus Nephritis* ; Pancytopenia ; Rheumatic Diseases