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

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

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

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

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

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

No abstract available.
Polyarteritis Nodosa*

The aims of this study were to evaluate the clinicopathologic features of Helicobacter heilmannii-associated gastritis and to compare H. heilmannii-associated gastritis with H. pylori-associated gastritis. We reviewed 5,985 consecutive gastric biopsy specimens. All cases of chronic gastritis with Helicobacter infection were evaluated with the Updated Sydney System, and the grades of all gastritis variables were compared between H. heilmannii-associated gastritis and H. pylori-associated gastritis groups. There were 10 cases of H. heilmannii-associated gastritis (0.17%) and 3,285 cases of H. pylori-associated gastritis (54.9%). The organisms were superficially located within the mucous layer without adhesion to epithelial cells. Interestingly, in one case many intracytoplasmic H. heilmannii organisms were observed in parietal cells with cell damage. A case of low-grade mucosa-associated lymphoid tissue (MALT) lymphoma concomitant with H. heilmannii infection was detected. Compared to H. pylori-associated gastritis, H. heilmannii-associated gastritis showed less severe neutrophilic activity (p<0.0001), mononuclear cell infiltration (p=0.0029), and endoscopic findings of chronic gastritis devoid of erosion or ulcer (p=0.0309). In conclusion, we present the detailed clinicopathologic findings of H. heilmanniiassociated gastritis compared to H. pylori-associated gastritis. H. heilmannii-associated gastritis is uncommon and milder than H. pylori-associated gastritis, however it may be noteworthy with respect to the development of MALT lymphoma.
Stomach Neoplasms/etiology/pathology ; Middle Aged ; Male ; Lymphoma, Mucosa-Associated Lymphoid Tissue/etiology/pathology ; Humans ; *Helicobacter pylori ; *Helicobacter heilmannii ; Helicobacter Infections/*pathology ; Gastritis/*pathology ; Female ; Adult

PURPOSE: To evaluate the clinical and radiologic findings of coronary artery fistula (CAF) by reviwing adult patients in whom this condition had been diagnosed by coronary angiogram. MATERIALS AND METHODS: We retrospectively analysed the clinical findings, chest X-rays and angiographic findings of 37 adult CAF patients treated at three institutes over a period of is 15 years. RESULTS: On coronary angiogram, the origin of CAF was found to be the left coronary artery (LCA) in 20 cases (54%), the right coronary artery (RCA) in five (14%), and both in 12 (32%). By subdividing the coronary artery into four segments [RCA, left main coronary artery, left anterior descending artery(LAD), and left circumflex artery(LCX)], the origin of CAF (total 55 cases) was found to be the LAD in 23 cases (42%), the LCX in 12 (22%), the left main coronary artery in three (5%), and the RCA in 17 (31%). The draining site of CAF was the right heart [right atrium, right ventricle, and main pulmonary artery (MPA)] in 28 cases (75%) the left heart (left atrium and left ventricle) in 8 (22%), and both in one (3%). The fistula drained to the cardiac chamber in 12 cases (33%), the MPA in 23 (62%), and both in 2 (5%). Among 55 cases, the total number of fistulas to the MPA was 35, and their origin was the RCA in nine instances (26%), and the left coronary artery in26 (74%). CAF to the MPA was classified into four types : Type I (single, tortuous and not dilated) was seen in six patients (17%), type II (single, tortuous and dilated) in three (9%), type III (multiple and fine plexus) in 21 (60%), and type IV (multiple and dilated plexus) in five (14%). Eighteen cases (49%) were associated with the other cardiac disease. CONCLUSION: In these Korean adults, CAF originated most commonly from the LCA, especially from the LAD segment of this artery, and most frequently drained to the right cardic chamber, especially to the MPA. The morphology of the CAF to the MPA was mostly multiple and fine plexus. We suggest that to ensure the most suitable treatment, and for better prognosis, patients with other cardiac disease should be evaluated for the presence of CAF.
Academies and Institutes ; Adult* ; Arteries ; Coronary Angiography ; Coronary Vessels* ; Fistula* ; Heart ; Heart Atria ; Heart Diseases ; Humans ; Prognosis ; Pulmonary Artery ; Retrospective Studies ; Thorax

PURPOSE: The subareolar area is often difficult to evaluate ultrasonographically due to tissue shadowing, which obscures visualization of ducts and parenchymal tissue. The purpose of this study is to determine if real-time compound imaging improves evaluation of normal subareolar tissue and solid nodules in subareolar area compared to conventional ultrasonography. METHODS: 190 images of the subareolar area were obtained from 135 patients from March 2001 to July 2002. Thirty-three of 190 images showed solid nodules, extraductal nodules in 30 and intraductal nodules in three. We scanned both conventional and compound imaging with a stationary probe, to maintain an identical projection and tissue pressure. We used two compound techniques; survey mode (S) is made by 3 coplanar images and target mode (T) by 9 coplanar images. The evaluating points were 1) reduction in the density of shadowing, 2) resolution of duct wall, 3) resolution of duct lumen, 4) margin of nodule, and 5) internal echoes of nodule. In a blinded fashion, three radiologists graded the quality of images on a 5-point scale. RESULTS: For reviewer 1/2/3, S showed grade improvements in 1) reduction in the density of shadowing (0.4+/-0.6/1.1 0.6/0.5+/-0.5), 2) resolution of duct wall (0.9+/-0.2/1.5+/-0.6/1.0+/-0.5), 3) resolution of duct lumen (0.9+/-0.2/1.6 +/-0.6/0.7+/-0.6), 4) margin of nodule (1.0+/-0.3/1.5+/-0.5/1.2+/-0.5), and 5) internal echoes of nodule (1.1+/-0.3/1.5+/- 0.5/1.2+/-0.4) and T showed grade improvements in 1) reduction in the density of shadowing (0.4+/-0.6/1.2+/-0.6/0.7+/-0.7), 2) resolution of duct wall (1.0+/-0.3/1.5+/-0.6/1.1+/-0.5), 3) resolution of duct lumen (0.9+/-0.3/1.6+/-0.6/0.8+/-0.6), 4) margin of nodule (1.0+/-0.3/1.5+/-0.6/1.2+/-0.5), and 5) internal echoes of nodule (1.1+/-0.3/1.5+/-0.6/1.3+/-0.4). In all evaluating points, two modes of real-time compound imaging were superior to conventional imaging (P<0.05). There was no significant difference between two modes of compound imaging. CONCLUSION: Real-time compound imaging improves evaluation of normal subareolar tissue and subareolar solid nodules compared to conventional ultrasonography by reducing shadowing and increasing anatomic resolution of ducts.
Breast ; Humans ; Shadowing (Histology) ; Ultrasonography*