No abstract available.

Exercise is one of the most ubiquitous triggers of acute bouts of asthma. Late asthmatic responses(LARs) have been described following strenuous exercise, as in allergen-induced asthma. However, most studies have reported that airway responsiveness is not increased after exercise, even in subjects with LAR to exercise. This suggests that LAR after exercise may not be associated with inflammatory changes in the airways. We have frequently seen asthmatic children whose complaint is that symptoms are exacerbated at night after strenuous daytime exercise. Furthermore, airway responsiveness to allergen was reported to increase after LAR to exercise. Therefore, it is crucial to know whether exercise can induce airway inflammation, as in allergen-induced asthma. As an indirect measure to investigate it, we measured the activation status of eosinophil granulocyte in the peripheral blood during the early and late phase of exercise- or allergen-induced asthma. Eight subjects who showed early asthmatic response(EAR) and LAR(group 1), or EAR only (group 2) to allergen (Dermatophagoides pteronyssinus) challenge were selected. Similarly eight subjects who showed EAR and LAR(group 3), or EAR only (group 4) to exercise were selected. Blood samples were drawn at baseline, the early phase, the late phase, and 24 hours after each stimuli. Eosinofphil cationic protein (ECP) was measured in the serum. Eosinophil granulocytes were separated and the production of leukotriene C4 (LTC4) from purified eosinophfis was measured after stimulation with the calciumionophore. Serum levels of ECP were unchanged at EAR after allergen or exercise challenge. In the dual responder to allergen (group 1), serum ECP level was elevated at LAR and 24 hours after allergen challenge, as compared with the baseline level. On the other hand, in the dual responder to exercise (group 3), it remained unaltered up to 24 hours after exercise challenge. Eosinophils at EAR after allergen or exercise challenge in each group generated the similar amounts of LTC4 as baseline values. In group 1, the production of LTC4 was slightly increased though not significantly at LAR, and significantly increased 24 hours after allergen challenge. In group 3, it was increased significantly at LAR, but restored to the baseline values at 24 hours after exercise challenge. These results indicate that not only allergen but also exercise can activate eosinophils in accordance with LAR. The present findings suggest that LAR to exercise may also have the potential to induce airway eosinophilic inflammation although its duration may be shorter than that of LAR to allergen. Therefore exercise should be understood not only as a triggering factor of bronchoconstriction but also as one that incites or deteriorates airway inflammation.
Asthma* ; Bronchoconstriction ; Child ; Ear ; Eosinophils* ; Granulocytes ; Hand ; Humans ; Inflammation ; Leukotriene C4

Hereditary ovarian cancer accounts for about 5% to 10% of the total ovarian cancer bnurden, The discase has been observed in context with three types of hereditary ovarian cancer prone syndrome : (1) site-specific ovarian cancer, (2) hereditary breast/ivarian cancer syndrome, (3) hereditary nonpolyposis colorectal cancer(Lynch syndrome II). Each of these syndmmcs is chracterized by autosomal dominant transmission of cancer, sigrdficant early age of onset, and exeess of multiple Iprimary cancers. Auuthor expxeriencecl six families with hereditaty ovarian cancer, two families with a site-spxific. ovarian cancer and four with a breast/ovarian cancer syndrome, and report these families.
Age of Onset ; Chymopapain ; Humans ; Ovarian Neoplasms*

Hereditary ovarian cancer accounts for about 5% to 10% of the total ovarian cancer bnurden, The discase has been observed in context with three types of hereditary ovarian cancer prone syndrome : (1) site-specific ovarian cancer, (2) hereditary breast/ivarian cancer syndrome, (3) hereditary nonpolyposis colorectal cancer(Lynch syndrome II). Each of these syndmmcs is chracterized by autosomal dominant transmission of cancer, sigrdficant early age of onset, and exeess of multiple Iprimary cancers. Auuthor expxeriencecl six families with hereditaty ovarian cancer, two families with a site-spxific. ovarian cancer and four with a breast/ovarian cancer syndrome, and report these families.
Age of Onset ; Chymopapain ; Humans ; Ovarian Neoplasms*

OBJECTIVE: The purpose of this study was to determine the feasibility of screw fixation in previously augmented vertebrae with bone cement. We also investigated the influence of cement distribution pattern on the surgical technique.METHODS: Fourteen patients who required screw fixation at the level of the previous percutaneous vertebroplasty or balloon kyphoplasty were enrolled in this study. The indications for screw fixation in the previously augmented vertebrae with bone cement included delayed complications, such as cement dislodgement, cement leakage with neurologic deficits, and various degenerative spinal diseases, such as spondylolisthesis or foraminal stenosis. Clinical outcomes, including pain scale scores, cement distribution pattern, and procedure-related complications were assessed.RESULTS: Three patients underwent posterior screw fixation in previously cemented vertebrae due to cement dislodgement or progressive kyphosis. Three patients required posterior screw fixation for cement leakage or displacement of fracture fragments with neurologic deficits. Eight patients underwent posterior screw fixation due to various degenerative spinal diseases. It was possible to insert screws in the previously augmented vertebrae regardless of the cement distribution pattern; however, screw insertion was more difficult and changed directions in the patients with cemented vertebrae exhibiting a solid pattern rather than a trabecular pattern. All patients showed significant improvements in pain compared with the preoperative levels, and no patient experienced neurologic deterioration as seen at the final follow-up.CONCLUSION: For patients with vertebrae previously augmented with bone cement, posterior screw fixation is not a contraindication, but is a feasible option.
Constriction, Pathologic ; Follow-Up Studies ; Humans ; Kyphoplasty ; Kyphosis ; Neurologic Manifestations ; Osteoporosis ; Spinal Diseases ; Spine ; Spondylolisthesis ; Vertebroplasty

PURPOSE: To evaluate the clinical performance through the Korean Medical Licensing Examination clinical skills assessment (KMLE CSA) this survey was done. METHODS: A survey of 130 interns and residents (46 applicants and 84 non-applicants for the KMLE CSA) at a university hospital in Seoul was conducted in January and February 2012. The data were gathered using a structured and self-administered questionnaire. For the items that assessed the clinical performance of these subjects, we selected 15 items that are mostly frequently used by Delphi's technique, and difficult procedural skills based on the results of medical students' performance. We also used subcomponents of the clinical problems test of the KMLE CSA. RESULTS: The total score on the KMLE CSA improved by 1.33 points (a perfect score is 10), 1.49 points for procedural skills, and 0.84 points for clinical problems by multiple regression analysis. The variables that influenced clinical skills were sex (females had 0.86 more points than males), experience in military or public services (1.04 points higher than persons without experience), and type of school (graduates of medical school had 1.41 more points than graduates of professional graduate school). CONCLUSION: Implementation of the KMLE CSA improved the clinical performance of medical graduates.
Clinical Competence ; Humans ; Licensure ; Military Personnel ; Schools, Medical ; Surveys and Questionnaires

PURPOSE: The management of prenatally detected bilateral ureteropelvic junction obstruction (UPJO) remains controversial. We attempted to develop a treatment plan for patients with severe bilateral UPJO. MATERIALS AND METHODS: We evaluated the records of 13 patients with prenatally diagnosed grade 3 or more bilateral hydronephrosis that led to the postnatal diagnosis of severe bilateral UPJO. Ultrasonography and (99m)technetium mercaptoacetyltriglycine ((99m)Tc-MAG3) renal scans were performed within 1 month. Four renal units had grade 3 and 22 had grade 4 hydronephrosis. All 13 patients were managed by unilateral pyeloplasty, and the patients' mean age was 3 months. At 1 month postoperatively, we decided whether delayed surgery in the opposite renal unit was necessary according to the findings of ultrasonography and (99m)Tc-MAG3 scans. RESULTS: Of 13 patients, 11 underwent initial pyeloplasty on renal units with more severe hydronephrosis or lower relative renal function (RRF) on (99m)Tc-MAG3 scans. The remaining 2 patients simultaneously underwent percutaneous nephrostomy on renal units with a lower RRF and initial pyeloplasty on renal units with a higher RRF. In 5 patients, contralateral hydronephrosis had spontaneously improved at 1 month postoperatively, and 8 patients underwent delayed contralateral pyeloplasty at 2 months postoperatively. CONCLUSIONS: In children with severe bilateral UPJO, the non-operated renal units with grade 3 and some with grade 4 hydronephrosis improved spontaneously after unilateral pyeloplasty. Therefore, delayed pyeloplasty of the opposite side should be considered at 1 month following initial pyeloplasty.
Child ; Humans ; Hydronephrosis ; Infant, Newborn ; Nephrostomy, Percutaneous ; Ureteral Obstruction

OBJECTIVES: This study aims to evaluate and explain the socioeconomic inequalities of all-cause mortality after breast cancer surgery in South Korea. METHODS: This population based study included all 8868 females who underwent radical mastectomy for breast cancer between January 2002 and June 2003. Follow-up for mortality continued from January 2002 to June 2006. The patients were divided into 4 socioeconomic classes according to their socioeconomic status as defined by the National Health Insurance contribution rate. The relationship between socioeconomic status and all-cause mortality after breast cancer surgery was assessed using the Cox proportional hazards model with adjusting for age, the Charlson's index score, emergency hospitalization, the type of hospital and the hospital ownership. RESULTS: Those in the lowest socioeconomic status group had a significantly higher hazard ratio of 2.09 (95% CI =1.50 - 2.91) compared with those in the highest socioeconomic group after controlling for all the identifiable confounding variables. For all-cause mortality after radical mastectomy, all the other income groups showed significantly higher 3-year mortality rates than did the highest income group. CONCLUSIONS: The socioeconomic status of breast cancer patients should be considered as an independent prognostic factor that affects all-cause mortality after radical mastectomy, and this is possibly due to a delayed diagnosis, limited access or minimal treatment leading to higher mortality. This study may provide tangible support to intensify surveillance and treatment for breast cancer among low socioeconomic class women.
Adult ; Aged ; Breast Neoplasms/diagnosis/mortality/*surgery ; Cohort Studies ; Female ; Humans ; Mastectomy, Radical/mortality ; Middle Aged ; *Mortality ; Prognosis ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Socioeconomic Factors

Foregut surgery largely involves benign diseases, and not only malignant diseases. However, for foregut surgeons in Asia, this fact has not been extensively utilized in their clinical practice due to the high burden of gastric cancer surgery. Although the prevalence of gastroesophageal reflux disease (GERD) in Eastern Asia, including Korea, is increasing, antireflux surgery (ARS) is still a fairly rare procedure in Korea. ARS is effective as proton pump inhibitors and is cost-effective compared to continuous double-dose proton pump inhibitors in patients with severe GERD. Therefore, we should focus on ARS as a treatment option for GERD also in Asian population. Similarly, although bariatric/metabolic surgery is effective in weight reduction and diabetes mellitus (DM) remission in patients with morbid obesity or DM, bariatric/metabolic surgery is only performed in a limited number of patients. Given that the prevalence of obesity and DM is continuously increasing in Korea, bariatric/metabolic surgery should become an interest among Korean foregut surgeons and should be considered a treatment for obesity and DM. Furthermore, there are new surgical fields that can control both benign and malignant diseases. Oncometabolic surgery is a field under foregut surgery that treats both malignant and benign components of a condition, an example being the control of metabolic syndrome while performing gastric cancer surgery. Therefore, in future gastric cancer treatment, oncometabolic surgery can be applied to patients with gastric cancer accompanied by obesity or metabolic syndrome.

BACKGROUNR/AIMS: Heterogeneity of liver cell populations within the hepatic lobules can affect xenobiotic reaction. In this study, we attempt to clarify the stereological distribution of the y-GTP positive foci in hepatic lobule initiated by diethylnitrosamine and promoted by phenobarbital. METHODS/METERIALS: To the five Sprague-Dawley rats, one day after birth, diethylnitrosamine (0.15 pmole/pn) was intraperitoneally injected and by the weaning at four weeks of life, 0.035% phenobarbital in drinking water was fed for four weeks, at which time the rats were sacrified to obtain the livers. Livers were fixed in fresh cold ethanol acetic acid. Ihe 200 cotmecutive tissue sections were stained by histochemistry for y-GIP and countastained with toluidine blue ar HkE. Employing Zeiss microprojector, y-GTP foci wae traced. And then the largest cross-sectian (size class: 65-165 pm in diameter) of 52 y-GTP foci were selected. Using microscopic grid, distances fiom center of y-GlP foci to nearest centtal vein and bile ductule was measured. As a control group, out of 52 random points determined by rareken digit table, the distances were measured by the same romr. RESULT: the diameter Aom the central points of y-GIP positive foci to the neatest bile ductules was measured as 0.234620+0.14899mm (mean+SD) and the diameter from random points to the neatest bile ductules was measured as 0.303080+0.19582mm (mean+SD). Y-GTP positive foci located within 0.3mm diameter fram bile ductules were counted as 73.1% of 52 foci, whereas that of random points were only 55.8%. Accoring to Aequency table analysis by Shapiro-Wilk W test, there was significant difference by W-value (0.812065) and p-value (0.0144866). CONCLUSION: Stereologically, y -GTP positive foci initiated by diethylnitros;unine, promoted by phaxkarbital in neonatal Spague-Dawley rats were non-rarxlanly distributed in peripcetal atea (Rappaport zone I) in hepatic lobule during hepatocarcinogenesis.
Acetic Acid ; Animals ; Bile ; Diethylnitrosamine ; Drinking Water ; Ethanol ; Liver* ; Parturition ; Phenobarbital ; Population Characteristics ; Rats* ; Rats, Sprague-Dawley* ; Tolonium Chloride ; Veins ; Weaning