PURPOSE: This study was done to examine the difference in cancer screening with mammography and Papanicolaou smear according to Body Mass Index (BMI). METHODS: The participants in this study were 5,912 women ages 40 to 69 yr, selected from the Korean Genomic Regional Cohort in Kangwon province. Mammography and Papanicolaou smear were assessed by questionnaire and body weight (kg) and height (m) measured to calculate BMI. RESULTS: The distribution of BMI was as follows: low weight (1.5%), normal weight (31.1%), over weight (24.6%), mildly obese (36.4%) and severely obese (6.3%). After adjusting for age, education and monthly income, compared with normal weight women, overweight women (odds ratio [OR]=1.283, 95% confidence interval [CI]=1.089-1.513) and mildly obese women (OR=1.214, 95% CI=1.048-1.406) were less likely to have had mammography. In contrast to mammography, cancer screening with Papanicolaou smear was not significantly different by BMI. CONCLUSION: Obese women in rural areas are less likely to screen for breast cancer by using mammography than non obese women. To ensure regular screening for breast cancer, health care providers need to give scrupulous care to obese women and remove barriers originated from obesity. Also, educational and clinical implications are considered to increase the Papanicolaou smear rate.
Adult ; Aged ; *Body Mass Index ; Breast Neoplasms/prevention & control/*radiography ; Cohort Studies ; Demography ; Female ; Humans ; *Mammography ; Middle Aged ; Obesity/psychology ; Republic of Korea ; Rural Population ; Uterine Cervical Neoplasms/*pathology/prevention & control ; *Vaginal Smears ; Women's Health

PURPOSE: To investigate whether bone mineral density(BMD) occurs in association with fatty replacement oflower paraspinal muscles and whether it relates with the area ratio(Ps/V) of psoas muscle(Ps) divided by adjacentvertebral body(V). MATERIALS AND METHODS: For the evaluation of osteoporosis, 100 females underwent quantitativeCT. At L1,L2 and L3 levels, the fatty replacement of lower paraspinal muscles was numerically graded and therelationship between this and BMD of the vertebral body was evaluated. The correlation between BMD and Ps/V at L2and L3 levels was also evaluated, as was the relationship between the thickness of subcutaneous fat tissue at L1,L2 and L3 levels. RESULTS: BMD showed significant inverse correlations with the grade of the fatty replacement oflower paraspinal muscles at L1(p<.01), L2 level and L3 level(p<.001). In particular, significant differenceswere established between grade 0 and 2 (p<.05) at L1 level, and between grade 0 and 2, and 1 and 2 (p<.05) at L2and L3 levels. There was markedly low correlation (gamma=.33) between BMD and Ps/V at L3 level(p<.001) and lowercorrelation (gamma=.22) at L2 level(p<.05). At L2 and L3 levels, there was no correlation between the thickness ofsubcutanous fat tissue and BMD or Ps/V. CONCLUSION: The present study demonstrates that there was significantinverse correlation between BMD and fatty replacement of lower paraspinal muscles, and low correlation between BMDand Ps/V.
Bone Density* ; Female ; Humans ; Osteoporosis ; Paraspinal Muscles* ; Spine* ; Subcutaneous Fat

PURPOSE: The usefulness of fast spin-echo MR imaging for the diagnosis of meniscal tear of the knee is amatter of debate. The purpose of this study was to evaluate the accuracy of diagnosis of meniscal tears by fastspin-echo MR imaging and the role of gadolinium enhancement. MATERIALS AND METHODS: Between October 1994 andDecember 1996, 68 consecutive patients with arthroscopically proven meniscal tears participated in this study. AllMR examinations performed on a 1.5-T MR imager with an extremity knee coil. All patients underwent sagittal andcoronal MR imaging, using a fast spin-echo sequence with echo train length(ETL) 8. Sagittal and coronal fatsuppressed T1-weighted MR images were obtained after gadolinium infusion. RESULTS: In 68 cases ofarthroscopically-proven meniscal tears, MR sensitivity to tear was 93% (63/68) for fast spin-echo alone and 96%(65/68) for combined fast spin-echo and fat-suppressed gadolinium enhanced T1-weighted MR images. MR sensitivityto medial meniscus tear was 98% (40/41) for fast spin-echo alone and 98% (40/41) for combined fast spin-echo andfat-suppressed gadolinum-enhanced T1-weighted MR images. MR sensitivity to lateral meniscus tear was 85% (23/27)for fast spin-echo alone and 93% (25/27) for combined fast spin-echo and fat-suppressed gadolinium-enhancedT1-weighted MR images. CONCLUSION: Fast spin-echo MR imaging with adequate imaging parameters is suitable for thediagnosis of meniscal tears, and additional fat-suppressed gadolinium-enhanced T1-weighted MR imaging may increasediagnostic sensitivity to such tears.
Diagnosis* ; Extremities ; Gadolinium ; Humans ; Knee* ; Magnetic Resonance Imaging* ; Menisci, Tibial

A large proportion of patients with systemic lupus erythematosus (SLE) are women of reproductive age. Their fetal outcome is undoubtedly less favourable than in healthy women. Although there is no evidence of an increase in congenital anomalies, increased frequencies of miscarriage, stillbirth, growth retardation, and preterm delivery are recognized. It mainly depends on the compromise of uteroplacental circulation such as renal disease, hypertension and thrombopoietic action of antiphos-pholipid antibody. Besides a small proportion of the newborn infants get a neonatal lupus sydrome, the most serious component being congenital heart block. This complication occurs almost exclusively in the offspring of women with anti-Ro/SSA antibodies. In order to find out the effect on fetus and newborn infants born to SLE mother, we reviewed clinical records of 11 infants born to 9 mothers with confirmed or suspected SLE at Seoul National University Hospital between June 1981 and May 1991. The results obtained were as follows: 1) Seven mothers among 9 were confirmed as SLE and 2 were suspected. 2) There were 6 spontaneous abortions (20.0%) and 5 stillbirths (16.7%) in 5 mothers among thirty pregnancies of 9 mothers. 3) Among 11 newborns, 4 (36.4%) were premature and 2 (18.2%) were small for gestational age. 4) Six mothers had proteinuria, over 4+, in Albustix. Four of these, including 3 preeclampsia mothers, delivered preterm babies. Two of premature babies were born through Cesarean section due to fetal distress and expired of hyaline membrane disease and its complications. The other 2 had thrombocytopenia and leukocytopenia at birth. One of these had intracranial hemorrhage at birth and seizure. 5) There were 2 mothers who had positive anticardiolipin antibody with SLE or without SLE. One with SLE was continuing positivity of the antibody during pregnancy and delivered premature baby who expired of HMD and PDA. The other who had seroconversion to negativity during the first trimester developed intermittently sinus bradycardia without apnea for 3 days. 6) Two of 11 newborns had only talipes equinovarus. 7) One mother who had anti-Ro/SSA antibody delivered monozygotic twin. The first baby was neonatal lupus erythematosus with complete heart block and skin pigmentation. All of them were suspected to right aortic arch and Kommerell's diverticulum on echocardiogram. As the above results, SLE mothers can cause serious effect on fetus and newborn when accompanied with active renal impairment, hypertension and positive antiphospholipid antibody. So we should treat mother with SLE even during pregnancy and it may give better outcome to mother and fetus. It will be useful for diagnosis and treatment of neonatal lupus erythematosus that the prenatal test for anti-Ro/SSA antibody, fetal monitoring, fetal echocardiogram and postnatal close observation for skin are taken.
Abortion, Spontaneous ; Antibodies ; Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid ; Aorta, Thoracic ; Apnea ; Bradycardia ; Cesarean Section ; Clubfoot ; Diagnosis ; Diverticulum ; Female ; Fetal Distress ; Fetal Monitoring ; Fetus ; Gestational Age ; Heart Block ; Humans ; Hyaline Membrane Disease ; Hypertension ; Infant* ; Infant, Newborn ; Intracranial Hemorrhages ; Leukopenia ; Lupus Erythematosus, Systemic* ; Mothers* ; Parturition ; Placental Circulation ; Pre-Eclampsia ; Pregnancy ; Pregnancy Trimester, First ; Proteinuria ; Seizures ; Seoul ; Skin ; Skin Pigmentation ; Stillbirth ; Thrombocytopenia ; Twins, Monozygotic

It is well known that tumor necrosis factor (TNF-a), interleukin-1, platelet-activating factor (PAF) and arachidonic acid metabolites, such as thromboxane and leukotriens, are major mediators involved in the pathogenesis of endotoxic shock. In this study, we have investigated the effect of pentoxifylline (inhibitor of TNF-a release), BN50739 (PAF antagonist), indomethacin (cyclooxygenase inhibitor) and diethylcarbamazine (lipoxygenase inhibitor) on LPS- induced lethality as well as the relationship between major mediators in endotoxic shock. All inhibitors described above except diethylcarbamazine significantly protected mice against LPS- induced lethality. BN50739 and indomethacin were also effective in protection of TNF-a-induced lethality. The elevation of circulating TNF-a by LPS was significantly blocked by BN50739, but not affected by indomethacin. Convulsion appeared shortly after LPS injection was prevented by BN50739 but not by indomethacin, whereas diarrhea and limited movement was prevented by indomethacin but not by BN50739. These results indicate that i) TNF-a, PAF and cyclooxygenase products are important mediators involved in the pathogenesis of septic shock and ii) TNF-a directly influenced the release or production of PAF as well as cyclooxygenase products, and strongly suggest that i) TNF-a and PAF stimulate the release of each other via positive feedback network but TNF-a and cyclooxygenase products do not form the network and ii) PAF and cyclooxygenase product appear not to affect the release of each other.
Animals ; Arachidonic Acid ; Diarrhea ; Diethylcarbamazine ; Gene Expression* ; Indomethacin ; Interleukin-1 ; Mice ; Pentoxifylline ; Prostaglandin-Endoperoxide Synthases ; Seizures ; Shock, Septic ; Tumor Necrosis Factor-alpha*

A retroperitoneal Synovial Sarcoma is defined as a tumor arising in the retroperitoneal space, with an origin of mesodermal structures. The majority of synovial sarcomas (85 to 95%) occur in the extremities, located near the large joints. They are uncommon, and usually appear as a non- specific soft tissue mass, with no specific imaging feature. However, in some cases, radiological findings and anatomic location of the tumor may help the diagnosis. On CT examination, these tumors may be shown as hypo-dense masses and have an irregular enhancement in the periphery, with a poor enhancement in the central area, reflecting the necrotic, cystic and hemorrhagic changes. Histologically, there are two types of synovial sarcoma: biphasic and monophasic. Both types have about a 40% mortality rate. The known prognostic factors are; frequent mitotic figures, extensive tumor necrosis, and poor differentiation. Surgical ablation remains the mainstay of their management. Regardless of adequate surgical and adjunctive therapies, the recurrence rate ranges from 28 to 36%. Here, we present a case of a retroperitoneal synovial sarcoma, with a review of the literature.
Diagnosis ; Extremities ; Joints ; Mesoderm ; Mortality ; Necrosis ; Recurrence ; Retroperitoneal Neoplasms ; Retroperitoneal Space ; Sarcoma, Synovial*

BACKGROUND: The results of previous studies suggest that portion size is a major factor dictating dietary energy intake. We investigated the relationship between frequencies of rice meals, bowl volumes, and dietary energy intake in a sample of patients with type 2 diabetes. METHODS: A total of 203 type 2 diabetes patients were enrolled in the study. A one-week food diary was collected from each patient and used to assess the types of meal consumed as well as the context of consumption. The volumes of the eating vessels (rice, soup and side dish bowls) used by each patient were obtained by comparisons to measuring cylinders, and dietary energy and macronutrient intake were estimated for each patient by consulting three-day dietary records. RESULTS: The mean age of the 203 subjects (male: 76, female: 127) was 53.9 +/- 9.1 years and the average body mass index (BMI) was 25.6 +/- 4.2 kg/m2. Among the subjects who ate three times per day, 96.4% consumed rice more than twice out of three meals. The median volume of rice bowls used by patients was 350 cc, of soup bowls was 530 cc and of side dish bowls was 260 cc. Portion size, as estimated by rice bowl volume, was not associated with BMI. Male subjects tended to eat out of larger rice and soup bowls (P < 0.001). Portion size was correlated with energy intake from rice (P = 0.021), but not with total energy intake (kcal/kg/day), especially in male subjects. CONCLUSION: Portion size of rice bowl was correlated with energy intake from rice, but not with total energy intake in male subjects with type 2 diabetes. To design effective meal planning methods for patients with type 2 diabetes, further prospective studies are warranted to investigate causative relationships between portion size andmetabolic conditions as well as variation by gender.
Body Mass Index ; Diabetes Mellitus, Type 2 ; Diet, Diabetic ; Diet Records ; Eating ; Energy Intake ; Humans ; Male ; Meals

The non-small cell lung cancer with activating epidermal growth factor receptor (EGFR) mutation eventually acquires resistant to either first or second-generation EGFR tyrosine kinase inhibitor (TKI). As the following option, targeting EGFR T790M with third-generation EGFR TKI is now established as a standard treatment option. In this study, we are reporting the first case of resistance mechanism to the novel third-generation EGFR TKI, lazertinib, which showed promising clinical efficacy in phase 1-2 study. The patients showed resistance to the treatment by acquiring the additional EGFR C797S mutation in cis which is also confirmed from the patient-derived cell lines.

Solitary malignant splenic metastasis is uncommon and usually occurs in association with widely disseminated metastatic disease. Splenic metastasis usually occurs late in the disease course, with widespread involvement of other organs and rarely shows any presenting symptoms. Virtually all primary tumors have been known to metastasize to the spleen. The common ones include melanoma, lung, breast and ovary cancer, but metastasis from gastric cancer is very rare. When solitary spleen metastasis is suspected in a clinical setting, aggressive treatment is indicated such as splenectomy followed by combined modality treatment to prevent dissemination of the disease. We experienced a case of solitary spleen metastasis and rupture after gastric cancer operation and reviewed the associated literatures.
Breast ; Lung ; Melanoma ; Neoplasm Metastasis* ; Ovarian Neoplasms ; Rupture ; Spleen ; Splenectomy ; Stomach Neoplasms*

Appendiceal intussusception is an uncommon type of intussusception with the incidence of 0.01% in children and adults. In many cases it was developed by secondary conditions, such as polyps, carcinoma or lymphoma. But some other cases was reduced after barium enema study and had none of initiating causes. Therefore, making an accurate diagnosis is important in providing the optimal treatment for the patient. We present an appendiceal intussusception spontaneously reduced after colonoscpic examination. A 61-year-old woman with indigestion, nausea and right lower quadrant abdominal tenderness was admitted for further evaluation and treatment. Colonoscopic exam revealed a invaginated appendix with normal appearing covring mucosa intraluminaly. Blind mucosal biopsies on the appendiceal orifice yielded mild inflammatory cell infiltration. Two days after the colonoscopic procedure, patient's abdominal symptoms and sign were disappeared. Abdominal CT scan revealed that appendiceal intussusception was spontaneously reduced and a few several reactive mesenteric lymphadenopathy was observed. The ultrasound scan revealed the appendiceal wall swelling. The patient was discharged after the relief of abdominal symptom without further treatment.
Adult ; Appendix ; Barium ; Biopsy ; Child ; Colonoscopy ; Diagnosis ; Dyspepsia ; Enema ; Female ; Humans ; Incidence ; Intussusception* ; Lymphatic Diseases ; Lymphoma ; Middle Aged ; Mucous Membrane ; Nausea ; Polyps ; Tomography, X-Ray Computed ; Ultrasonography