BACKGROUND: Obesity is linked to a wide range of respiratory diseases. Several studies have shown that body weight at baseline and weight change were related to pulmonary function. The purpose of this study was to investigate the relationship between change in body mass index (BMI) and pulmonary function in adults. METHODS: Of those aged 40-64 years at baseline who had initially visited the health promotion center at one university-level hospital from January 2000 to December 2002, 499 (men: 309, women: 190) patients revisited the center over a 5-year period up to December 2009 and were enrolled in the study. Subjects were classified into 4 groups- group 1: normal-normal, group 2: normal-obese, group 3: obese-normal, and group 4: obese-obese, based on their BMI at baseline and follow-up. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC were measured by spirometry. RESULTS: Change in FEV1/FVC was significantly associated with change in BMI for men in all 4 groups. Change in FEV1/FVC was significantly different between group 1 and 3 and between group 1 and 4. Changes in FEV1, FVC and FEV1/FVC were significantly associated with change in BMI for women in all 4 groups. Change in FEV1 was significantly different between group 3 and 4, and change in FVC was significantly different between group 1 and 3. CONCLUSIONS: These results suggest that a change in BMI is negatively associated with change in pulmonary function. Obesity itself can be a risk factor for pulmonary dysfunction, and a decrease in BMI through weight reduction could reduce pulmonary dysfunction or improve pulmonary function in adults.
Adult ; Aged ; Body Mass Index ; Body Weight ; Female ; Follow-Up Studies ; Forced Expiratory Volume ; Health Promotion ; Humans ; Male ; Obesity ; Risk Factors ; Vital Capacity ; Weight Loss

PURPOSE: The purpose of this study was to analyze the histologic concordance of sonographically guided core needle biopsy for phyllodes tumors or fibroepithelial lesions with cellular stroma of the breast by comparing this with the outcomes of excision biopsy and to identify any sonographic features that are helpful to predict phyllodes tumors. MATERIALS AND METHODS: We retrospectively reviewed 60 breast masses that were diagnosed as phyllodes tumors (n = 43) or fibroepithelial lesions with cellular stroma (n = 17) on a sonographically guided core needle biopsy. The tumors were all subsequently excised by surgery. The sonographic features were compared between the phyllodes tumors and the non-phyllodes tumors according to the results of excision biopsy. RESULTS: By the results on excision biopsy, there were 48 (80%) phyllodes tumors and 12 (20%) non-phyllodes tumors. Phyllodes tumors were diagnosed at a rate of 90.7% (39/43) for the nodules with phyllodes tumors on the sonographically guided core needle biopsy, and at a rate of 52.9% (9/17) for the nodules with fibroepithelial lesions with cellular stroma on the sonographically guided core needle biopsy. On sonography, heterogeneous internal echotexture (58% vs. 17%, respectively, p = 0.0239), clefts (56% vs. 17%, respectively, p = 0.0331) and horizontal linear striations (71% vs. 33%, respectively, p = 0.0221) were significantly more frequent in the phyllodes tumors than that in the non-phyllodes tumors. CONCLUSION: Identification of a heterogeneous-internal echotexture, clefts and horizontal linear striations on sonography might help differentiate phyllodes tumors from non-phyllodes tumors.
Biopsy ; Biopsy, Large-Core Needle ; Breast ; Needles ; Phyllodes Tumor ; Retrospective Studies

PURPOSE: To assess the value of 3 dimensional fourier transformation interference in steady state magnetin resonance imaging(3 DFT CISS1 MRI) in depicting the inner ear and vascular structures. MATERIALS AND METHODS: Using 3DFT CISS axial and coronal MRI scans of both ears with 17.1 msec/8.0 msec/50 degree(TR/TE/FA) and 0.9mm in nominal thickness, we studied 68 normal ears of 34 volunteers aged between 15 and 54 years. We assessed the visualization of the membranous labyrinth, and of cranial nerves VII and VIII in the inner ear canal. We analyzed the location of the vascular loop of the anterior inferior cerebellar artery in relation to cranial nerves VII and internal auditory canal. To define the three-dimensional images of the membranous labyrinth, MIP reconstruction of axial images was carried out. RESULTS: The very high signal of the intralabyrinth fluid enabled one hundred percent of the membranous labrynth to be seen. There was a lack of contrast between soft tissue and bone such as the facial nerve canal, vestibular aqueduct and canal of the subarcuate artery. In 25% of cases, the vascular loop was recognized in the porus acusticus, and in 6% of cases, inside the internal auditory canal. CONCLUSION: 3DFT CISS MRI is useful for determining the detailed anatomy of the inner ear and the nearby vascular loop. This special MR technique can be added as a routine protocol in the study of diseases of the inner ear.
Arteries ; Cranial Nerves ; Ear ; Ear, Inner* ; Facial Nerve ; Fourier Analysis ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging* ; Vestibular Aqueduct ; Volunteers

BACKGROUND: Nucleoplasty is a minimally invasive spinal surgery using a Coblation(R) technique that creates small voids within the disc. The purpose of this study was to evaluate the efficacy of cervical nucleoplasty in patients with cervical disc disorder. METHODS: Between March 2008 and December 2009, 22 patients with cervical disc disorders were treated with cervical nucleoplasty after failed conservative treatment. All procedures were performed under local anesthesia, and fluoroscopic guidance and voids were created in the disc with the Perc(TM) DC Spine Wand(TM). Clinical outcomes were evaluated by the Modified Macnab criteria and VAS score at preprocedure, postprocedure 1 month, and 6 months. RESULTS: Six patients had one, eight patients had two and eight patients had three discs treated; a total of 46 procedures was performed. Mean VAS reduced from 9.3 at preprocedure to 3.7 at postprocedure 1 month and to 3.4 at postprocedure 6 months. There was no significant complication related to the procedure within the first month. Outcomes were good or excellent in 17/22 (77.3%) cases. Postprocedure magnetic resonance imaging was acquired in two patients after two months showing morphologic evidence of volume reduction of protruded disc material in one patient but not in the other. CONCLUSIONS: Percutaneous decompression with a nucleoplasty using a Coblation(R) technique in the treatment of cervical disc disorder is a safe, minimally-invasive and less uncomfortable procedure, with an excellent short-term clinical outcome.
Anesthesia, Local ; Decompression ; Diskectomy ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Spine

The purpose of this study is to review the operative management and outcome of operation for Crohn's disease. The medical records of 17 patients who underwent operations due to Crohn's disease at Seoul National University Children's Hospital from January of 1988 to June of 2005 were reviewed and retrospective study was carried out. The male-to-female ratio was 1.8: 1. The median age at the onset of symptom and the time of diagnosis was 9 years 6 months and 11 years 6 months respectively. The median interval time from diagnosis to operation was 2 years and 1 month (0 month~8 years). Ileocolic or ileocecal region was the most common site of involvement. The indications of operation were intractable symptoms (8 cases) and obstruction or stricture (7 cases). The median postoperative hospitalized days were 14.4 days (8~35 days). Five patients (29%) experienced postoperative complications. Symptom free state or symptom relief was observed in 11 cases after surgery and 6 cases had wax and wane course of aggravation and improvement. In pediatric Crohn's disease patients who present with intractable symptoms despite medical treatment or develop surgical complications, symptom free state or symptom relief can be achieved by minimal resection of involved lesion.
Child* ; Constriction, Pathologic ; Crohn Disease* ; Diagnosis ; Humans ; Medical Records ; Postoperative Complications ; Retrospective Studies ; Seoul

BACKGROUND: Nucleoplasty is a minimally invasive spinal surgery using a Coblation(R) technique that creates small voids within the disc. The purpose of this study was to evaluate the efficacy of cervical nucleoplasty in patients with cervical disc disorder. METHODS: Between March 2008 and December 2009, 22 patients with cervical disc disorders were treated with cervical nucleoplasty after failed conservative treatment. All procedures were performed under local anesthesia, and fluoroscopic guidance and voids were created in the disc with the Perc(TM) DC Spine Wand(TM). Clinical outcomes were evaluated by the Modified Macnab criteria and VAS score at preprocedure, postprocedure 1 month, and 6 months. RESULTS: Six patients had one, eight patients had two and eight patients had three discs treated; a total of 46 procedures was performed. Mean VAS reduced from 9.3 at preprocedure to 3.7 at postprocedure 1 month and to 3.4 at postprocedure 6 months. There was no significant complication related to the procedure within the first month. Outcomes were good or excellent in 17/22 (77.3%) cases. Postprocedure magnetic resonance imaging was acquired in two patients after two months showing morphologic evidence of volume reduction of protruded disc material in one patient but not in the other. CONCLUSIONS: Percutaneous decompression with a nucleoplasty using a Coblation(R) technique in the treatment of cervical disc disorder is a safe, minimally-invasive and less uncomfortable procedure, with an excellent short-term clinical outcome.
Anesthesia, Local ; Decompression ; Diskectomy ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Spine

PURPOSE: To predict pulmonary arterial hypertension by comparing the extent of honeycombing lesion with the diameter of main pulmonary artery (MPA). MATERIALS AND METHODS: We retrospectively reviewed 21 patients (20 men, one woman) who showed honeycombing lesion on HRCT, and also analysized a control group of 30 (29men, one woman) who had no cardiopulmonary symptom and no abnormality on chest CT. On Chest HRCT, we scanned at four levels [1)aortic arch, 2) bifurcation of bronchus, 3) mid-portion of left ventricle, 4) dome of right diaphragm], and two radiologists then evaluated the proportion of honeycombing lesion within the entire lung field. According to the extent of this, we divided the patients into five groups [<20% (I), 20-39% (II), 40-59% (III), 60-79% (IV), > or = 80% (V)], and then divided Group I into two subgroups [<10 % (I|1), 10-19% (I-2)]. Using contrast-enhanced routine CT, the main pulmonary artery (MPA) was measured at its the widest diameter perpendicular to the long axisat the level of its bifurcation. RESULT: In group I (n=11) MPA was 28.4+/-2.6mm ; in group II (n=6), it was31.7+/-2.0mm ; in group III (n=2), 33.5mm ; in group IV (n=1), 33mm ; and in group V (n = 1), 39mm. In subgroup I-1MPA was 26.1+/-1.9mm, and in subgroup I-2, it was 29.8+/-1.6mm. In the control group, MPA was 25.1+/- 2.0mm. CONCLUSION: The extent of honeycombing lesion is closely related to the change in diameter of the MPA. Honeycombing lesion extending over more than 10% of the lung field may lead to pulmonary arterial hypertension.
Bronchi ; Heart Ventricles ; Humans ; Hypertension ; Hypertension, Pulmonary ; Lung ; Pulmonary Artery* ; Retrospective Studies ; Thorax ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Hirschsprung disease (HSCR) is a congenital disorder characterized by intestinal obstruction due to absence of intramural ganglion cell. RET and Endothelin-B receptor (EDNRB) gene have been shown as a susceptibility gene for HSCR. The aim of this study is to evaluate the association of the two genes with HSCR. METHODS: Mutation analysis of RET and EDNRB gene was performed in 33 sporadic HSCR patients by using single stranded confirmational polymorphism. We examined allelic frequencies at six polymorphic loci of RET by using restriction fragment length polymorphism. Allelic frequencies in HSCR were compared with those in the control populations. RESULTS: No mutation was detected in patients with HSCR. Two polymorphisms in RET, A45A (135G > A) and L769L (2307T > G) were over-represented in patients with HSCR compared to controls. In contrast, G691S (2071G > A) was under-represented in the HSCR patients. CONCLUSION: Polymorphism in the RET gene is associated with the development of sporadic HSCR.
Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Ganglion Cysts ; Hirschsprung Disease* ; Humans ; Intestinal Obstruction ; Polymorphism, Restriction Fragment Length

PURPOSE: To evaluate whether soft tissue surrounding the celiac axis, as seen on abdominal CT imaging after gastrectomy for gastric carcinoma, should be considered as the recurrence of carcinoma or postoperative change. MATERIALS AND METHODS: One hundred and forty-one abdominal CT examinations of 71 patients who had undergone subtotal or total gastrectomy for gastric carcinoma were included in our study. Conventional CT scans were obtained with 1 cm thickness and interval from the diaphragm to the kidneys after contrast enhancement. It was considered that carcinoma had not recurred if findings were negative on UGI series, endoscopy with biopsy and a normal level of carcinoembryonic antigen except for soft tissue surrounding the celiac axis on abdominal CT. We then divided subjects into a recurrence group (N = 20) and normal group (N = 51) and on initial follow-up CT (FU-CT), analyzed the incidence, margin, shape, extent, degree and pattern of attenuation of the soft tissue surrounding the celiac axis in both groups. Since the second FU-CT examination, we observed changes in the soft tissue surrounding the celiac axis. RESULTS: On initial follow-up CT, at mean 308 days after surgery, fifty-five percent(39/71) of total patients (70% (14/20) of the recurrence group and 49% (25/51) of the normal group) showed soft tissue surrounding the celiac axis. The margin was distinct in 12 (86%) of the recurrence group and indistinct in 21 (84%) of the normal group (P < 0.001). Twelve (86%) of the recurrence group showed a nodular or confluent nodular shape and 21 (84%) of the normal group showed a permeative shape (P < 0.001). Extent was unilateral in eight (57%) of the recurrence group and bilateral in 16 (64%) of the normal group. Attenuation was similar to that of the spleen and muscle in seven (50%) of the recurrence group and was similar to that of muscle in 18 (72%) of the normal group. The pattern of attenuation was homogeneous in 13 (93%) of the recurrence group and 21 (84%) of the normal group. There was no significant difference in extent, degree and pattern of attenuation between the two groups. Since the second FU-CT examination, soft tissue surrounding the celiac axis was seen to have changed. In one patient in the recurrence group it had a distinct margin, was nodular in shape, unilateral in extent and showed attenuation similar to that of the spleen. In one patient in the normal group, it had changed and had an indistinct margin, three patients showed a decrease in the amount of soft tissue and eight showed decreased attenuation. CONCLUSION: Follow-up abdominal CT is useful in the differentiation of cancer recurrence and postoperative change, and for observing changes in soft tissue surrounding the celiac axis.
Axis, Cervical Vertebra* ; Biopsy ; Carcinoembryonic Antigen ; Diaphragm ; Endoscopy ; Follow-Up Studies ; Gastrectomy* ; Humans ; Incidence ; Kidney ; Recurrence ; Spleen ; Tomography, X-Ray Computed

PURPOSE: Delirium is a common and serious neuropsychiatric complication among terminally ill cancer patients. We investigated risk factors related to the development of delirium among hospice care patients. METHODS: Between May 2011 and September 2012, we included patients who were mentally alert and had no psychiatric disease or drug addiction at the hospice ward of two local hospitals. Among them, participants who had been diagnosed with delirium by two doctors according to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-4th edition) criteria were grouped as Delirium Group. We analyzed results of psychometric and other laboratory tests performed at the time of patient's admission - psychometric tests included cognitive function (mini-mental status examination, MMSE), depression (Beck Depression Inventory, BDI), anxiety, and insomnia (Insomnia Severity Index, ISI). Logistic regression analysis was used to compare delirium and the related factors. Cox's proportional hazard model was performed using significant factors of logistic regression analysis. RESULTS: Of the 96 patients who met the inclusion criteria, 41 (42.7%) developed delirium. According to the logistic regression analysis, primary cancer site, cognitive impairment (MMSE<24), depression (BDI> or =16), and insomnia (ISI> or =15) were significant factors related to delirium. Among the four factors, depression (OR 5.130; 95% CI, 2.009~13.097) and cognitive impairment (OR 5.130; 95% CI, 2.009~13.097) were found significant using Cox's proportional hazard model. CONCLUSION: The development of delirium was significantly related to depression and cognitive impairment among patients receiving hospice care. It is necessary to carefully monitor depression and cognitive function in hospice care.
Anxiety ; Delirium* ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Hospice Care ; Hospices* ; Humans ; Logistic Models ; Proportional Hazards Models ; Psychometrics ; Risk Factors* ; Sleep Initiation and Maintenance Disorders ; Substance-Related Disorders ; Terminally Ill