BACKGROUND: In order to improve the quality of life of dying patients so that they may die with dignity, they need to receive not only the physical, psychological, social, and spiritual care, but also systematic and continuous care. However, their is no adequate medical service at present. We studied terminal cancer patients'behavior patterns of health care utilization, the problems of caring for the patient, and medical services that bereaved families suggested for terminal cancer patients and their families. METHODS: From 271 patients'families who participated in our hospice program from March 1991 to February 1996, 108 bereaved families whom we able to had been contact were interviewed by three student nurses with a structured questionnaire. RESULTS: The terminal cancer patients received their medical care through admission to hospital(45.4%), outpatient clinic(22.2%), emergency room(16.7%), and oriental medicine(12.0%). But during their terminal phase of the illness, 32.4% of patients never received medical care including oriental medicine, and 28.7% received alternative medicine care such as intake of mushroom and elm tree. 26 bereaved families(24.1%) pointed out the indifference of the medical team as a problem receiving proper hospital care, and 22 bereaved families(20.4%) emphasized emotional strain of their helplessness with the patient's suffering as a problem of caring for the patient at home. Over 90% of bereaved families from their experience suggested needs of continuous care, hospice care, home care, and 24hr telephone service. CONCLUSIONS: There were inappropriate behavior patterns of health care utilization which resulted in large proportion of terminal cancer patients received alternative medicine never receiving proper medical care. Therefore, there is a need to develop the continuous and comprehensive care for terminal cancer patients and their family, such as hospice.)
Agaricales ; Complementary Therapies ; Delivery of Health Care* ; Emergencies ; Home Care Services ; Hospice Care ; Hospices ; Humans ; Medicine, East Asian Traditional ; Outpatients ; Quality of Life ; Telephone ; Ulmus ; Surveys and Questionnaires

The diffuse large B-cell lymphoma category of the Revised European American Classification of Lymphoid Neoplasms (REAL) encompasses different morphologic lymphoma subtypes in a single entity, especially the diffuse large cell (DLC) and the immunoblastic (IBL) subtypes by Working Formulation (WF). The aim of this study is to determine the influence of the morphologic subdivision within this category with respect to clinical outcome and proliferative index using Ki-67 immunostainig combined with image analysis. We retrospectively reviewed 74 patients from 1990 to 1996, who were diagnosed with diffuse large B-cell lymphoma. All cases were reclassified according to REAL and Working Formulation (WF), and Ki-67 immunostaining was performed in all the cases. Fifty-eight cases (78.4%) were classified as DLC and 16 cases (21.6%) as IBL, according to WF. Twenty one cases (28.4%) showed nodal involvement and 53 cases (71.6%), extranodal involvement. All cases were found to display a variable degree of nuclear Ki-67 staining. A proliferative index of 50% or higher identified a group of patients (77%) who had poor clinical results. Overall survival was significantly reduced in these patients displaying high Ki-67 associated proliferative index compared to those with a low proliferative index (p=0.007). 5-year survival estimates were 93% in the low proliferative index group and 55% in the high proliferative index group. A multivariate regression analysis incorporating commonly used clinical prognostic factors confirmed the independent effect of proliferation index on survival. Moreover, all of the 16 IBL cases showed Ki-67 positivity of 50% or higher, which correlates with the poor clinical outcome compared to 70.7% of DLC (p=0.014). We conclude that subdivision of the diffuse large B-cell lymphoma category of the REAL classification is necessary in terms of prognostic significance in correlation with Ki-67 proliferative index.
B-Lymphocytes* ; Classification ; Humans ; Lymphoma ; Lymphoma, B-Cell* ; Lymphoma, Large B-Cell, Diffuse ; Retrospective Studies

OBJECTIVE: There have been few studies concerning the clinical pathology of malignant transformation arising from ovarian mature cystic teratoma. Thus, the objective of this study is to determine clinicopathologic factors affecting survival in this rare tumor. METHODS: From November 1992 to December 2002, 11 patients with malignant transformation arising from ovarian mature cystic teratoma were treated at Departments of Obstetric and Gynecology in Chonnam National University Hospital. Demographic characteristics, symptoms, signs, stage, mode of therapy and results of follow up were reviewed retrospectively. RESULTS: There were 11 cases of the malignant transformation of ovarian mature cystic teratomas out of 637 cases of mature cystic teratomas (1.7%). The average age was 50.6 years. Histologically, 7 out of the 11 cases were squamous cell carcinoma (63.7%). There was no specific clinical symptom but palpable abdominal mass was the most frequent complaint (5 cases, 45.4%). As for the stage of disease, 8 cases were in stage Ia (72.7%) and the other three cases were in stage Ic, IIb and IIc respectively. All the patients received surgery, and 7 of them had chemotherapy and 2 both chemotherapy and radiation therapy at the same time. All patients in stage I survived until the period of follow-up and their average survival time was 31.8 months. One patient in stage IIc died of intestinal obstruction in 9 month from the surgery and the average survival time of two patients in stage II was 8.5 months. CONCLUSION: The mechanism of the malignant formation arising in ovarian mature cystic teratomas is not clear but considering the fact that 80% of mature cystic teratomas are diagnosed during the reproductive age malignant transformation seems to be related to the long-term presence of non-removed mature cystic teratomas in abdomen. Accordingly, it is considered helpful for preventing and early detection of the malignant transformation to have regular ovary examination through pelvic ultrasonogram during the reproductive age.
Abdomen ; Carcinoma, Squamous Cell ; Drug Therapy ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Intestinal Obstruction ; Jeollanam-do ; Ovary ; Pathology, Clinical ; Retrospective Studies ; Teratoma* ; Ultrasonography

No abstract available.
Diagnosis*

OBJECTIVE: To evaluate the usefulness of percutaneous umbilical blood sampling (PUBS) and prevalence of fetal infection in the pregnant women with suspicious fetal rubella infection. METHODS: Between June 1996 and May 2002 in Chonnam National University Hospital, the rubella specific IgG, IgM antibody and RT-PCR were checked in fetal blood obtained from 31 pregnant women with high risk of rubella infection. Eighteen women (58.1%) had rubella specific IgM, 11 women (35.5%) high titer of rubella specific IgG, and 2 women had a history of recent rubella vaccination within 3 months. RESULTS: PUBS was performed in all cases, successful in 27 cases (87.1%) and failed in 4 cases (12.9%). Cardiocentesis was performed in failed cases. Performing the PUBS, fetal bradycardia was observed in 7 cases (25.9%), fetal tachycardia in 1 case (14.8%), and preterm labor in 2 cases (7.4%). Performing cardiocentesis, fetal bradycardia was observed in 1 case (25.0%), fetal tachycardia in 2 cases (50.0%), and preterm labor in 1 case (25.0%). There was no fetal death. All samples of fetal blood were positive for rubella specific IgG but rubella specific IgM was detected in only 1 case. RT-PCR was negative in all cases. CONCLUSION: Fetal blood sampling is relatively safe and a great precaution is necessary before termination of pregnancy with suspicious fetal rubella infection and without typical maternal rash to reduce unnecessary termination of pregnancy. Several tests such as rubella specific IgM and PCR from placental villi, amniotic fluid, and fetal blood should be considered before termination of pregnancy.
Amniotic Fluid ; Bradycardia ; Chorionic Villi ; Cordocentesis* ; Exanthema ; Female ; Fetal Blood ; Fetal Death ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Jeollanam-do ; Obstetric Labor, Premature ; Polymerase Chain Reaction ; Pregnancy ; Pregnant Women* ; Prenatal Diagnosis* ; Prevalence ; Rubella* ; Tachycardia ; Vaccination

PURPOSE: Cancer has become the major cause of deaths in Korea. Planning care for patients with terminal cancer is difticult. The prediction of length and prognostic factors of survival in the terminal cancer can facilitate the planning of a supportive care program aimed at patients need. The aim of this study was to identify length and those related factor of survival in the patients with terminal cancer. MATERIALS AND METHODS: This retrospective study was performed on 271 patients, who were diagnosed as terminal cancer in Seoul National University Hospital from March 1991 to February 1996. For getting the further informations about the patient, we interviewed with surviving relatives by telephone, and we requested administrative helps in order to take the informations about date of death. We examined the relations of 10 factors with survival in patients with terminal cancer. RESULTS: We could confirm 229 patients' death(84.5%) in 271 subjects. The median length of survival in patients with terminal cancer was 11 weeks(95%CI 10.0~14.0). By univariate analysis, history of surgery(p<0.01), performance(p<0.05), severity of pain(p <0.001), and dyspnea(p<0.05) were clinical factors in predicting survival. According to Cox's proportional hazard model including sex, age, history of surgery, performance, severity of pain, and dyspnea as variables, absence of surgery history(RR 1.398, 95%CI 1.038~1.882) and severity of pain(RR 1.398, 95%CI 1.044 ~1.872) showed independent prognostic value. CONCLUSION: The median survival was 11 weeks, and absence of surgery history and severity of pain were the independent prognostic factors for patients with terminal cancer.
Cause of Death ; Cohort Studies* ; Dyspnea ; Humans ; Korea ; Proportional Hazards Models ; Retrospective Studies ; Seoul ; Telephone

Cancer is the most frequent cause of death in both developing and developed countries, including Korea. The aim of this study was to present survival rates of Korean cancer patients. Survival analysis was carried out with data collected under the Korea Central Cancer Registry Program, which included all cancer patients diagnosed from January 1, 1997 to December 31, 1997. We have analyzed the effects of age at diagnosis and sex on cancer survival from the cancer registry data of 64,240 Korean patients diagnosed of cancer in 1997. The overall survival rate of all Korean cancer patients (both men and women) was 67% at 1 yr and 57% at 2 yr. The 1- and 2-yr survival rates for all cancers in men were 58% and 47%, respectively, while those in women were 77% and 69%, respectively. Men had a lower survival rate than women in most malignancies. The pancreatic cancer was shown the lowest 1-yr survival rate.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Korea ; Male ; Middle Aged ; Neoplasms/*mortality ; Survival Analysis ; Survival Rate

Postpartum ovarian vein thrombosis has been thought to be a rare disease of which clinical finding is not accurate. Most of postpartum ovarian vein thrombosis presents as symptoms consisting of fever, lower abdominal pain, abdominal mass. If the symptom does not response even with intravenous antibiotics therapy or diagnosis is inaccurate, a ultrasound or a CT scan should be obtained for diagnosis. We report a case of postpartum ovarian vein thrombosis after cesarean section diagnosed and treated, with a brief review of literatures.
Abdominal Pain ; Anti-Bacterial Agents ; Cesarean Section* ; Diagnosis ; Female ; Fever ; Postpartum Period* ; Pregnancy ; Rare Diseases ; Thrombosis* ; Tomography, X-Ray Computed ; Ultrasonography ; Veins*

Diabetes is the most common cause of erectile dysfunction (ED). Oxidative stress has been suggested to be a contributory factor in vascular complications of diabetes in various organs. In the present study, we investigated whether oxidative stress is associated with erectile function in non- insulin dependant diabetes mellitus (NIDDM) rats. Fifty-four Sprague-Dawley rats were the subjects of this study. In each rat, NIDDM was induced by an intraperitoneal injection of 90mg/Kg of streptozotocin on the second day after birth. Based on the diabetic period, they were classified into either short-term or long-term diabetics (avg. 22 weeks, n=18 and avg. 38 weeks, n=20), respectively, and their age-matched controls (n=16). To evaluate the erectile function in each rat, the intracavernous pressure, and latency to maximal pressure, following cavernous nerve stimulation (frequency: 1 Hz, intensity: 3 - 6 V, pulse width: 1 msec, pulse duration: 1 min.) was analyzed. To evaluate both oxidative stress from reactive oxygen species, and antioxidant function as a defense against them, total malondialdehyde and glutathione levels were measured in the corpus cavernosum of the penis, using a spectrophotometric assay. The intracavernous pressure following cavernous nerve stimulation was significantly lower in the long-term (49.8 +/- 9.4 cmH2O) than the short-term diabetics (75.9 +/- 14.8 cm H2O), and markedly decreased in the diabetic rats, compared with their age-matched controls (long-term controls; 60.7 +/- 17.2 cmH2O, short-term controls; 95.2 +/- 20.4 cmH2O). The malondialdehyde content in the corpus cavernosum was markedly increased in the diabetics (2.13 +/- 0.27 nM/mg protein) compared to the controls (1.48 +/- 0.22 nM/mg protein). Furthermore, the glutathione level was significantly decreased in the diabetics, compared to age-matched controls (short-term control; 218.3 +/- 25.6 microM/mg protein, long-term control; 150.2 +/- 9.8 microM/mg protein). In the diabetic groups, it was more significantly decreased in the long-term diabetics (134.8 +/- 11.3 microM/mg protein) than in short-term diabetics (182.1 +/- 18.8 microM/mg protein). NIDDM causes erectile dysfunction, which slowly progresses. Oxidative stress to cavernous tissue may be a contributory factor in erectile dysfunction in diabetics.
Animals ; Diabetes Mellitus, Experimental/*complications/metabolism ; Diabetes Mellitus, Type II/*complications ; Female ; *Free Radicals ; Glutathione/analysis ; Impotence/*etiology ; Lipid Peroxidation ; Male ; Rats ; Rats, Sprague-Dawley ; Streptozocin ; Support, Non-U.S. Gov't

We describe a 53-year-old woman with renal, gastric, and multiple intestinal metastases of invasive ductal carcinoma of breast. She was diagnosed as left breast cancer of stage II, received left modified radical mastectomy 10 years ago and has been followed up without any evidence of residual disease. During investigation for indigestion and lower abdominal pain, we found multiple masses in left kidney, multiple levels of colon, ovary, peritoneum and bone. The histology of the tissue taken from renal mass was adenocarcinoma, which had identical features with those of masses resected from her left breast 10 years ago. During 28 month palliative chemotherapy, we found gastric metastasis of breast cancer and finally, the colonic metastatic masses caused intestinal obstruction. The diagnosis of gastrointestinal metastases of breast cancer is very important in the view of improvement of survival and quality of life because they can lead to intestinal obstruction, bleeding, and perforation.
Abdominal Pain ; Adenocarcinoma ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Colon ; Diagnosis ; Drug Therapy ; Dyspepsia ; Female ; Hemorrhage ; Humans ; Intestinal Obstruction ; Intestines ; Kidney ; Mastectomy, Modified Radical ; Middle Aged ; Neoplasm Metastasis* ; Ovary ; Peritoneum ; Quality of Life ; Stomach