No abstract available.
Animals ; Brain* ; Mice* ; RNA, Messenger*

OBJECTIVE: We aimed to investigate the factors associated with suicidality among the elderly, focusing pain as the potential correlate. METHODS: This study was a community-based, cross-sectional study that included 413 elderly subjects aged 60 years and over with depression. Suicidality and pain were evaluated using Suicidal Ideation Scale and Geriatric Pain Measure, respectively. Participants were classified into two groups : 1) those with mild-to-moderate pain ; 2) those with severe pain. The risk of suicidality was determined using logistic regression, adjusting for age, sex, education, literacy status, marital status, living arrangement, the type of medical insurance, employment status, and the number of chronic medical illnesses. RESULTS: Among all subjects with depression, fifty-one (12.3%) presented clinically significant levels of suicidality. Those with severe pain were more likely to have suicidal idea (adjusted odds ratio : 20.49 ; 95% confidence interval : 8.15-51.51 ; p value : < 0.001) than those with mild-to-moderate pain, after adjusting for other variables. Other sociodemographic and clinical variables were not associated with the risk of suicide after adjustment. CONCLUSION: The severity of pain was strongly and independently associated with suicidality in the elderly individuals. This study suggests that the pain management should be emphasized to lower the rate of suicide in those experiencing depression in the late-adulthood.
Aged* ; Chronic Disease ; Cross-Sectional Studies ; Depression ; Education ; Employment ; Humans ; Insurance ; Logistic Models ; Marital Status ; Odds Ratio ; Pain Management ; Residence Characteristics ; Suicidal Ideation ; Suicide

Alcohol withdrawal syndrome (AWS) is a common condition occurring after intentional or unintentional abrupt cessation of alcohol in an alcohol-dependent individual. AWS represents a major problem in our society and alcohol withdrawal seizure is the major cause of seizures encountered by neurology residents in the emergency department. Patients with AWS present with mild symptoms of tremulousness and agitation or more severe symptoms including withdrawal seizures and delirium tremens. Particularly, severe AWS can produce significant rates of the morbidity (complications) and mortality. When diagnosed and managed insufficiently, the morbidity and mortality rates increase. Nevertheless, patients with AWS may be neglected and are often marginalized and the teaching about AWS to neurology residents is usually minimal. Also, attending neurologists are often poorly informed on the topic. Although there is insufficient consensus about the optimal investigation and management, the purpose of this review is to serve as a summary of the appropriate identification and management of this important condition in a neurological setting.
Alcohol Withdrawal Delirium ; Alcohol Withdrawal Seizures* ; Consensus ; Dihydroergotamine ; Disease Management ; Emergency Service, Hospital ; Humans ; Mortality ; Neurology ; Seizures

PURPOSE: To evaluate the side effects, pattern of failure, and survival rate according to the sequence of postoperative adjuvant radiotherapy and chemotherapy, patients with stages II and lll rectal cancer who had undergone curative resection were randomized to early radiotherapy group (arm I) or 'late radiotherapy group (arm II)', then we intend to determine the most effective sequence of the radiotherapy and chemotherapy. MATERIALS AND METHODS: From January 1996 to March 1999, 3 13 patients with curatively resected stages II and III rectal cancer have been randomized to early' or late radiation therapy group and recei ved combined chemotherapy (5-FU 375 mg/m/day, leucovorin 20 mg/m, IV bolus daily D1-5, 8 cycles) and radiation therapy (whole pelvis with 45 Gy/25 fractions/5 weeks). Arm I received radiation therapy from day 1 with first cycle of chemotherapy and arm II received radiation therapy from day 57 with third cycle of chemotherapy after completion of first two cycles. Preliminary analysis was performed with 228 patients registered up to Jun 1998. Two out of the 228 patients were excluded because of double primary cancer. Median follow-up period was 23 months. RESULTS: Local recurrence occurred in 11 patients (9.7%) for arm I and 9 patients (8%) for arm II. There was no significant difference between both groups (p=0.64). However, distant metastasis was found in 22 patients (19.5%) for arm I and 35 patients (31.0%) for arm II and which showed statistically significant difference between the two groups (p=0.046). And neither 3-year disease-free survival (70.2% vs 59.2%, p=0.2) nor overall survival (89.4% vs 88.0%, p=0.47) showed significant differences. The incidence of leukopenia during radiation therapy and chemotherapy was 78.3% and 79.9% respectively but leukopenia more than RTOG grade 3 was only 2.1% and 6.0% respectively. The incidence of diarrhea more than 10 times per day was significantly higher in the patients for arm I than for arm II (71.2% vs 4 1.6%, p=0.02) but this complication was controlled with supportive cares. CONCLUSION: Regardless of the sequence of postoperative adjuvant radiation therapy and chemotherapy a fter curative resection for rectal cancer, local recurrence rate was low with combined chemoradiotherapy. But distant metastasis rate was lower in early radiation therapy group than in late radiation therapy group and the reason is unclear. Most patients completed these treatments without severe complication, so these were thought to be safe treatments but the treatment compliance should be improved.
Arm ; Chemoradiotherapy ; Chemotherapy, Adjuvant* ; Compliance ; Diarrhea ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Incidence ; Leucovorin ; Leukopenia ; Neoplasm Metastasis ; Pelvis ; Prospective Studies* ; Radiotherapy* ; Radiotherapy, Adjuvant ; Rectal Neoplasms* ; Recurrence ; Survival Rate

PURPOSE: To evaluate the clinical and radiologic findings of atypical ductal hyperplasia (ADH) using mammography and ultrasonography, and to correlate the radiologic and histopathologic findings. MATERIALS AND METHODS: Sixty-four pathologically proven lesions in 64 patients who were examined between March 2000 and March 2003 were the subject of this study. Mammography was performed in all 64 cases, and ultrasonography in 30. Two radiologists retrospectively evaluated the radiologic findings, classifying them as one of four types: mass, microcalcification, other finding, and no detected lesion. At mammography, masses were classified according to their shape, margin, and density and microcalcifications according to their shape and distribution. At ultrasonography, masses were evaluated in terms of their shape, margin, internal and posterior echotexture, ductal extension, and parallelism to skin. Geographic correlation between the radiologic and histopathologic findings was classified as direct, near direct, or remote correlation. RESULTS: Mammography demonstrated 37 cases of microcalcification (57.8%), 14 in which masses were present (21.9%), two in which there were other findings (3.1%), and 11 in which lesions were not detected (17.2%). The "other finding" was ductectasia. Microcalcifications were round in 19 cases, pleomorphic heterogeneous in 16, and branching linear in one. The most common distribution of microcalcification was clustered (29 cases; 78.4%). Masses were oval or round in nine cases and irregular in three, and in seven cases their margin was ill-defined. In 13 cases, the density of the masses was equal to that of breast tissue. Ultrasonography showed that the masses were round or oval in 15 cases and irregular in 14, and that the margin was ill-defined in 16 cases and circumscribed in ten. In 19 cases, the echotexture of the masses was low, and in 20 cases, heterogeneous. Parallel orientation was seen in 25 cases, and ductal extension in 22. Category 4 was the most common final assessed BI-RADS category, found in 75% of cases. Radiologic-histopathologic correlation was direct in 44 cases, near direct in 13, and remote in seven. Clinically, self or clinical examination of the breast revealed no abnormality in 47 cases, a palpable mass in seven, nipple discharge in seven, and breast pain in three. CONCLUSION: At mammography, the most common finding of ADH was clustered round or pleomorphic heterogeneous microcalcifications, and at ultrasonography, illdefined, round or oval, or irregular-shaped, hypoechoic masses with parallel orientation and ductal extension. Clinically, most ADH was incidentally discovered at radiologic examination. In this study, 17.2% of ADH cases were not demonstrated by mammography but were detected at ultrasonography, and for the detection of ADH, the use of this latter modality, alongside mammography, is thus feasible.
Breast Neoplasms ; Breast* ; Humans ; Hyperplasia* ; Mammography ; Mastodynia ; Nipples ; Retrospective Studies ; Skin ; Ultrasonography

No abstract available.
Polyarteritis Nodosa*

PURPOSE: To evaluate the coronary angiographic findings of patients with Kawasaki disease and to investigatethe natural course of aneurysms of the coronary artery. MATERIALS AND METHODS: Between June 1989 and January1996, we evaluated the coronary angiographic findings of 12 consecutive children with Kawasaki disease whosecoronary artery was abnormal. On initial study, we retrospectively analysed the size, configuration, and locationof 35 coronary aneurysms, and in five children, follow-up coronary angiography was performed at intervals of 17 to28 (mean, 23) months. Seventeen aneurysms detected on initial study were evaluated for subsequent change. RESULTS: Initial coronary angiography showed the aneurysms to be diffuse in 7 cases(20%), saccular in 7(20%), fusiform in17(49%), and tubular in 4(11%). They were large in 10 cases (29%), medium in 22(63%), and small in 3(9%) ; theirlocation in the coronary artery was proximal(71%), middle in 6(17%), and distal in 4(11%). The right coronaryartery was involved in 18 case(51%), and the left coronary artery in 17(49%). Follow-up study showed that theaneurysm had regressed in 11 cases (65%), persisted in 2(12%), and progressed to stenosis in 1(6%) and occlusionin 3(18%). Two(50%) of the four large aneurysms showed complete occlusion. On the other hand, medium and smallaneurysms showed regression in 9(82%) and in all cases, respectively. Diffuse-type aneurysms were complicated byocclusion in 2 cases (50%) and stenosis in 1(25%). On the other hand, six fusiform aneurysms (75%) and allsaccular and tubular aneurysms had regressed. CONCLUSION: In patients with kawasaki disease, informationregarding the size and configuration of coronary aneurysms may be useful for predicting the natural course andprognosis of coronary artery disease.
Aneurysm ; Arteries ; Child ; Constriction, Pathologic ; Coronary Aneurysm ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Follow-Up Studies ; Hand ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Retrospective Studies

PURPOSE: The template-guided implant surgery offers several advantages over the traditional approach. The purpose of this study was to evaluate the accuracy of coordinate synchronization procedure with 5-axis milling machine for surgical template fabrication by means of reverse engineering through universal CAD software. MATERIALS AND METHODS: The study was performed on ten edentulous models with imbedded gutta percha stoppings which were hidden under silicon gingival form. The platform for synchordination was formed on the bottom side of models and these casts were imaged in Cone beam CT. Vectors of stoppings were extracted and transferred to those of planned implant on virtual planning software. Depth of milling process was set to the level of one half of stoppings and the coordinate of the data was synchronized to the model image. Synchronization of milling coordinate was done by the conversion process for the platform for the synchordination located on the bottom of the model. The models were fixed on the synchordination plate of 5-axis milling machine and drilling was done as the planned vector and depth based on the synchronized data with twist drill of the same diameter as GP stopping. For the 3D rendering and image merging, the impression tray was set on the conbeam CT and pre- and post-CT acquiring was done with the model fixed on the impression body. The accuracy analysis was done with Solidworks (Dassault systems, Concord, USA) by measuring vector of stopping's top and bottom centers of experimental model through merging and reverse engineering the planned and post-drilling CT image. Correlations among the parameters were tested by means of Pearson correlation coefficient and calculated with SPSS (release 14.0, SPSS Inc. Chicago, USA) (alpha = 0.05). RESULTS: Due to the declination, GP remnant on upper half of stoppings was observed for every drilled bores. The deviation between planned image and drilled bore that was reverse engineered was 0.31 (0.15 - 0.42) mm at the entrance, 0.36 (0.24 - 0.51) mm at the apex, and angular deviation was 1.62 (0.54 - 2.27)degrees. There was positive correlation between the deviation at the entrance and that at the apex (Pearson Correlation Coefficient = 0.904, P = .013). CONCLUSION: The coordinate synchronization 5-axis milling procedure has adequate accuracy for the production of the guided surgical template.
Chicago ; Collodion ; Cone-Beam Computed Tomography ; Gutta-Percha ; Mandrillus ; Models, Theoretical ; Silicones

OBJECTIVES: The aim of this study is to find out the activity of autoproliferation of ratfibroblast exposed to crystalline silica and the role of mediators secreted from rat fibroblast. METHODS: The effect of alpha-quartz on production of growth factor (platelet-derived growth factor-AA and transforming growth factor beta)from rat fibroblasts were evaluated by ELISA and immunocytochemical analysis. Gene expression of these growth factors in rat fibrobast exposed to crystalline silica was evaluated by RT-PCR. Furthermore, fibroblast proliferation by culture supernatant of rat fibroblast was assayed by the neutral red test. RESULTS: The amounts of H2O2 and growth factors synthesized in rat fibroblasts were significantly increased by the stimulation of crystalline silica(alpha-quartz), which showed the dose-dependent manner to the concentration of alpha-quartz with the maximum response at the dosage of 100 microgram/cm2. The result of RT-PCR demonstrated that alpha-quartz induced gene expression of PDGF-AA and TGFbeta in rat fibroblast. We also found that supernatant of alpha-quartz-cocultured rat fibroblast induced a significant proliferation of fibroblast. CONCLUSION: Crystalline silica directly induce functional change in fibroblast such as increased release of reactive oxygen species and growth factors. The products of these functional change promote fibroblast proliferation via autocrine loop.
Animals ; Crystallins* ; Enzyme-Linked Immunosorbent Assay ; Fibroblasts* ; Gene Expression ; Intercellular Signaling Peptides and Proteins ; Neutral Red ; Rats ; Reactive Oxygen Species ; Silicon Dioxide* ; Transforming Growth Factor beta ; Transforming Growth Factors

BACKGROUND AND OBJECTIVES: Strain imaging has already been shown to quantify regional myocardial function in both acute ischemic myocardium and infarcted myocardium. We proposed that strain imaging could differentiate deformation of normal and ischemic myocardium that are without regional wall motion abnormality, as assessed by conventional echocardiography. The aim of this study is to determine the diagnostic value of strain imaging for the detection and localization of coronary lesions in patients with chest pain, but they are without apparent wall motion abnormalities. SUBJECTS AND METHODS: Strain imaging for advanced wall motion analysis was performed in 179 patients with suspicious stable angina (SA) and in 94 patients with suspicious acute coronary syndrome (ACS) prior to coronary angiography. All the patients had normal conventional wall motion scoring based on the standards of the American Society of Echocardiography. Longitudinal strain was measured in 3 apical views, and assessments of the strain value for individual segments with using an 18-segment division of the left ventricle were performed to determine the average strain value. Marked heterogeneity of strain was considered abnormal, and significant coronary artery disease was considered present if stenosis above 70% was noted on the quantitative angiography. RESULTS: Eighty (78%) of the 103 patients with SA and 18 (56%) of the 32 patients with ACS and who showed constant systolic strain throughout the left ventricular wall had normal or minimal coronary lesions. Fifty-one (67%) of the 76 patients with SA and 53 (85%) of the 62 patients with ACS and marked heterogeneity of strain had angiographically significant coronary stenosis. The receiver-operating characteristic (ROC) analysis of the peak systolic strain yielded that the ROC-area of peak systolic strain for the left anterior descending artery territory was 0.79 (95% CI 0.72-0.84), this was 0.87 (95% CI 0.79-0.91) for the left circumflex artery territory and 0.89 (95% CI 0.79-0.93) for the right coronary artery territory. CONCLUSION: Ultrasound-based strain imaging demonstrates a strong correlation with coronary angiography and it has potential as a noninvasive diagnostic tool for detecting coronary artery stenosis in patients with chest pain, but who are without apparent wall motion abnormalities on conventional echocardiography.
Acute Coronary Syndrome ; Angina, Stable ; Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Echocardiography ; Heart Ventricles ; Humans ; Myocardium ; Population Characteristics ; Sprains and Strains