PURPOSE: TRAM flap surgery has settled down as a common method for breast reconstruction after mastectomy. We investigated how TRAM flap surgery influences on the patients' physical movement capability by observing their capability of sit-ups as well as exercises they usually enjoy. METHODS: A total of consecutive 375 patients were investigated who had breast reconstruction with unilateral pedicled TRAM flap surgery at Asan Medical Center from July 2001 to August 2005. The patients were asked to sit up right before the surgery and do it again 6 months later and 1 year later. 221 patients were followed up 6 month after the surgery. And 132 patients were followed up 1 year after the surgery. In addition, 155 patients who used to exercise before the surgery were also asked to show us the change in their physical movement capability one year after their surgery. RESULTS: 139 patients showed decrease in the counted number of sit-ups, 48 increase, and 34 showed no change between 6 months in the first group of 221 patients. Among the second group of 132 patients, 64 showed decrease, 39 increase, and 29 no change a year later. There was a statistical significant decrease in the number of sit-ups between pre-operation and six months later and between pre-operation and one year later. According to the research on the exercise that 155 patients participated, 3 of them showed improvement in athletic ability, 7 showed decrease, while the rest, 145 patients, showed no change at all. CONCLUSION: Considering no difference in usual exercise ability, some patients' increase in the number of sit-ups and the effect of anticancer treatment, we found that the loss of abdominal wall function on this research is not too serious to exclude TRAM flap surgery in the field of breast reconstruction
Abdominal Wall* ; Breast* ; Chungcheongnam-do ; Exercise ; Female ; Humans ; Mammaplasty* ; Mastectomy ; Prospective Studies* ; Sports

We report a case of rare cervical isthmic spondylolisthesis of C6-7 combined occult spinal bifida at C6, and review the radiologic finding, different diagnosis and treatment. A 23-year old female presented nuchal, back pain after traffic accident. Radiologic finding showed the 6th cervical isthmic defect, spondylolisthesis and dysplasia. The patient was conservatively treated about 8 weeks, and 10 months after injury, she was symptom free with full range of motion of cervical spine and she was followed up. Cervical spondylolysis is a very rare condition. This clinical importance is vulnerable to trauma. For whatever reasons, symptomatic patients need to be treated by conservative or surgical option.
Accidents, Traffic ; Back Pain ; Cervical Vertebrae ; Female ; Humans ; Range of Motion, Articular ; Spine ; Spondylolisthesis ; Spondylolysis

PURPOSE: To report a case of toxic optic neuropathy caused by chlorfenapyr ingestion accompanied by central nervous system involvement. CASE SUMMARY: A 44-year-old female visited our clinic complaining of reduced visual acuity in both eyes for 7 days. She had ingested a mouthful of chlorfenapyr for a suicide attempt 2 weeks prior to the visit. Gastric lavage was performed immediately after ingestion at the other hospital. Her best-corrected visual acuity was finger count 30 cm in the right eye and hand motion in the left eye. Both pupils were dilated by 5.0 mm and the response to light was sluggish in both eyes. A relative afferent pupillary defect was detected in her left eye. Funduscopy revealed optic disc swelling in both eyes. Magnetic resonance imaging of the brain showed a symmetric hyper-intense signal in the white matter tract including the internal capsule, corpus callosum, middle cerebellar peduncle, and brainstem. The patient was diagnosed with toxic optic neuropathy induced by chlorfenapyr ingestion, and underwent high-dose intravenous corticosteroid pulse therapy. Three days later, the best-corrected visual acuity was no light perception in both eyes. Three months later, optic atrophy was observed in both eyes. Optical coherence tomography revealed a reduction in the thicknesses of the retinal nerve fiber layer and ganglion cell and inner plexiform layer in the macular area. CONCLUSIONS: Ingestion of even a small amount of chlorfenapyr can cause severe optic nerve damage through the latent period, despite prompt lavage and high-dose steroid treatment.
Adult ; Brain ; Brain Stem ; Central Nervous System ; Corpus Callosum ; Eating ; Female ; Fingers ; Ganglion Cysts ; Gastric Lavage ; Hand ; Humans ; Internal Capsule ; Magnetic Resonance Imaging ; Middle Cerebellar Peduncle ; Mouth ; Nerve Fibers ; Optic Atrophy ; Optic Nerve ; Optic Nerve Diseases ; Poisoning ; Pupil ; Pupil Disorders ; Retinaldehyde ; Suicide ; Therapeutic Irrigation ; Tomography, Optical Coherence ; Visual Acuity ; White Matter

OBJECTIVES: This study aimed to develop a high-risk drinking scorecard using cross-sectional data from the 2014 Korea Community Health Survey. METHODS: Data were collected from records for 149,592 subjects who had participated in the Korea Community Health Survey conducted from 2014. The scorecard model was developed using data mining, a scorecard and points to double the odds approach for weighted multiple logistic regression. RESULTS: This study found that there were many major influencing factors for high-risk drinkers which included gender, age, educational level, occupation, whether they received health check-ups, depressive symptoms, over-moderate physical activity, mental stress, smoking status, obese status, and regular breakfast. Men in their thirties to fifties had a high risk of being a drinker and the risks in office workers and sales workers were high. Those individuals who were current smokers had a higher risk of drinking. In the scorecard results, the highest score range was observed for gender, age, educational level, and smoking status, suggesting that these were the most important risk factors. CONCLUSION: A credit risk scorecard system can be applied to quantify the scoring method, not only to help the medical service provider to understand the meaning, but also to help the general public to understand the danger of high-risk drinking more easily.
Breakfast ; Commerce ; Data Mining ; Depression ; Drinking* ; Health Surveys ; Humans ; Korea* ; Logistic Models ; Male ; Motor Activity ; Occupations ; Research Design ; Risk Factors ; Smoke ; Smoking

Tuberculous arachnoiditis is a rare complication of tuberculous meningoencephalitis. Few cases of diffuse involvement of tuberculous arachnoiditis are reported. We describe a 35-year-old HIV-negative male with diffuse tuberculous arachnoiditis aggravated during the steroid tapering. The arachnoiditis accompanied the meningoencephalitis and involved the entire surface of the brainstem and whole segments of the spinal cord. The patient showed flaccid quadriplegia and paradoxical respiration, which are thought to be due to arachnoiditis.
Adult ; Arachnoid* ; Arachnoiditis* ; Brain Stem ; Humans ; Male ; Meningoencephalitis* ; Quadriplegia ; Respiration ; Spinal Cord ; Tuberculosis

BACKGROUND: The effect of epidural analgesia for labor on obstetric outcome is controversial. The purpose of this study is evaluating the influence of epidural analgesia on cesarean section in nulliparous women. METHODS: We retrospectively investigated 979 nulliparous women ASA graded I - II. EPI (n = 230) was received epidural analgesia with 0.2% ropivacaine and 75microgram fentanyl. N-EPI (n = 749) was received no epidural analgesia but nalbuphine 10 mg intramuscularly. We compared the rate and causes of cesarean section, instrumental delivery rate and fetal outcomes between EPI and N-EPI. RESULTS: Cesarean section rate was not different between the EPI (18%) and N-EPI (23%). Causes of cesarean section were progress failure (83% in EPI and 80% in N-EPI) and fetal distress (17% in EPI and 20% in N-EPI) and there were no differences between two groups. Instrumental delivery rate was higher in EPI (8%) than N-EPI (5%). Fetal outcome was not different between two groups. CONCLUSIONS: Epidural analgesia did not increase cesarean section rate and did not influence on causes of cesarean section. But epidural analgesia increased the vacuum delivery rate.
Amides ; Analgesia, Epidural ; Cesarean Section ; Female ; Fentanyl ; Fetal Distress ; Humans ; Nalbuphine ; Pregnancy ; Retrospective Studies ; Vacuum

PURPOSE: The gastric cancer is most frequent malignant disease in Korea. With increase of GNP and social welfare, lot of people pay attention to that. But many of gastric cancer patients who were diagnosed, are advanced -stage III or more- case and produces poor result of treatment. Nowadays many surgeons report that the resection of cancer mass and radical lymph node dissection, which called systematic lymph node dissection, can increase the longterm survival rate and curability of patients. For this purpose Maruyama and his colleagues made a program to predict the 5 year survival rate, cause of death, and the status of lymph node metastases. We put the basic datas of pateints in AGC into Maruyama's program and compare its result to final histologic reports. We would check sesitivity, specificity, positive predictive value, negative predictive values between Maruyamas program and hitologic reports. MATERIALS AND METHODS: From Sep. 1995 to Sep. 1996, We operated 55 patients with gastric cancer with this program in GNUH. We checked the histopathologic reports and put the data into the prediction program. The datas were sex, age, maximal size of tumor, differentiation, gross type and location. We compared status of lymph node metastases, TNM stages between the reports of histopathology and that of predictive program. RESULTS: In early stages the sensitivity and specificity of the program showed poor result but in advanced stages did not. The distribution of lymph node metastasis showed a same pattern. The patterns of perigastric lymph node metastasis were somewhat different according to the location of tumor. But its significance was not confirmed. We analysed the metastaic rate between lymph node groups and compared with the results between two reports. The sensitivity, and negative predictive value were 100% in each groups, and positive predictive value was also high. CONCLUSION: The systematic lymph node dissection is an effective and safe procedure in the surgical treatment of gastric cancer. We suggest that the techniques should be standardized and popularized in Korea. This procedure will improve the survival rate of gastric cancer patients and decrease the local recurrence of gastric cancer.
Cause of Death ; Humans ; Korea ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis* ; Recurrence ; Sensitivity and Specificity ; Social Welfare ; Stomach Neoplasms* ; Survival Rate

Salmonella (S.) Typhimurium and S. Enteritidis are the major causative agents of food-borne illnesses worldwide. Currently, a rapid detection system using multiplex real-time polymerase chain reaction (PCR) has been applied for other food-borne pathogens such as Escherichia coli, Staphylococcus aureus and Streptococcus spp. A multiplex real-time PCR was developed for the simultaneous detection of Salmonella spp., especially S. Typhimurium and S. Enteritidis, in beef and pork. For the specific and sensitive multiplex real-time PCR, three representative primers and probes were designed based on sequence data from Genbank. Among the three DNA extraction methods (boiling, alkaline lysis, and QIAamp DNA Mini Kit), the QIAamp DNA Mini Kit was the most sensitive in this study. The optimized multiplex real-time PCR was applied to artificially inoculated beef or pork. The detection sensitivity of the multiplex real-time PCR was increased. The specificity of the multiplex real-time PCR assay, using 128 pure-cultured bacteria including 110 Salmonella isolates and 18 non-Salmonella isolates, was 100%, 100% and 99.1% for Salmonella spp., S. Typhimurium and S. Enteritidis, respectively. The sensitivity was 100%, 100% and 91.7% for Salmonella spp., S. Typhimurium and S. Enteritidis, respectively. The multiplex real-time PCR assay developed in this study could detect up to 0.54 +/- 0.09 and 0.65 +/- 0.07 log10 CFU/ml for S. Typhimurium and S. Enteritidis for beef, 1.45 +/- 0.21 and 1.65 +/- 0.07 log10 CFU/ml for S. Typhimurium and S. Enteritidis for pork, respectively, with all conditions optimized. Our results indicated that the multiplex real-time PCR assay developed in this study could sensitively detect Salmonella spp. and specifically differentiate S. Typhimurium from S. Enteritidis in meats.
Animals ; Cattle ; DNA, Bacterial ; *Food Microbiology ; Meat/*microbiology ; Polymerase Chain Reaction/*veterinary ; Salmonella/*isolation & purification ; Sensitivity and Specificity ; Swine

The level of P4 at the time of embryo transfer (ET) is important. P4 concentrations and numbers of corpora lutea for 126 recipients were evaluated. Nuclear transfer embryos were transferred into 126 surrogates. 11 maintained their pregnancy until full-term delivery, 17 miscarried, and implantation failed in 98 animals. P4 levels in the full-term group were significantly different from those of the pigs that aborted or in which implantation failed (p < 0.05). However, the numbers of corpora lutea were not significantly different. These findings indicate that the concentration of progesterone can be an important factor for successful ET in pigs.
Animals ; Corpus Luteum/*physiology ; Embryo Transfer/*veterinary ; Embryo, Mammalian/*physiology ; Female ; Nuclear Transfer Techniques ; Pregnancy ; *Pregnancy Rate ; Progesterone/*blood ; Retrospective Studies ; Sus scrofa/*physiology

A 57-year old man who was admitted to an emergency room of a tertiary hospital with hemoptysis developed malarial fever 19 days later and then died from severe falciparum malaria 2 days later. He had not traveled outside of Korea for over 30 years. Through intensive interviews and epidemiological surveys, we found that a foreign patient with a recent history of travel to Africa was transferred to the same hospital with severe falciparum malaria. We confirmed through molecular genotyping of the MSP-1 gene that Plasmodium falciparum genotypes of the 2 patients were identical. It is suggested that a breach of standard infection control precautions resulted in this P. falciparum transmission between 2 patients in a hospital environment. This is the first report of a nosocomial transmission of falciparum malaria in Korea.
Africa ; Amino Acid Sequence ; Animals ; Cross Infection/parasitology/*transmission ; Fatal Outcome ; Humans ; Korea ; Malaria, Falciparum/parasitology/*transmission ; Male ; Merozoite Surface Protein 1/chemistry/genetics ; Middle Aged ; Molecular Sequence Data ; Plasmodium falciparum/chemistry/genetics/*isolation & purification ; Protozoan Proteins/chemistry/genetics ; Sequence Alignment ; Travel