Over the past 30 years, there has been an increase in the incidence of multifetal pregna-ncies, primarily because of the introduction of ovarian stimulants for ovulation induction and assisted reproductive technology ( ART ) in infertile patients. It is well established that multifetal pregnancies are associated with an increased frequency of the maternal complications and gre-ater perinatal morbidity and mortyality. The adverse outcome of multifetal pregnancies is dire-ctly proportional to the number of fetuses, primarily as an consequence of prterm delivery. Re-duction in the number of fetuses in multifetal pregnancies has been proposed as a way to impr-ove the perinatal outcome in this situation. Therefore, selective fetal reduction ( SFR ) is sugges-ted as a therapeutic option for continuation of pregnancy with fetuses mature enough to survi-ve. In this paper, we report our infertility clinic experiences with 6 patients who carried mult- ifetal pregnancies including 1 quintuplet, 1 quadruplet, and 4 triplets. from January, 1991 to May, 1996, transabdominal SFR was accomplished by fetal intrathoracic KCl injection at 9~10 weeks of gestation. After the prcedure, 4 patients remained as twin pregnancies, and 2 patients as single pregnancy. There have been 3 sets of twin deliveries and the 2 sets of single delivery. One case was aborted. Two patients were delivered after 37 weeks of gestation, 2 patients were at 35 weeks, and 1 patient at 24 weeks. All babies have been healthy after birth in patients after 35 weeks gestation. There was no fetal anomaly related to the procedure in the 6 cases. We concluded that transabdominal SFR is a rather safe and useful procedure that may improve the outcome of multifetal pregnancies.
Fetus ; Humans ; Incidence ; Infertility ; Ovulation Induction ; Parturition ; Pregnancy Reduction, Multifetal* ; Pregnancy* ; Pregnancy, Twin ; Quadruplets ; Quintuplets ; Reproductive Techniques, Assisted ; Triplets ; Twins

Midtrimester genetic amniocentesis has been a gold standard for prenatal diagnosis in antenatal care since last 25 years. After the triple serum marker test was introduced as a prenatal screening method for Down syndrome, the frequency of genetic amniocentesis was increased. OBJECTIVE: To determine the complication, risk of amniocentesis and detection rate of chromosomal abnormality. MATERIAL AND METHODS: A retrospective clinical analysis of 1,064 midtrimester genetic amnicentesis in IL Sin Christian Hospital antenatal clinic from Jan 1995 to Dec 1997. Chi square test was used for the statistical analysis and p value < 0.05 was considered significant. RESULTS: Amnicentesis were significantly increased in the age of 35-39 yrs and 40yrs over. And also the incidence of chromosomal abnormality was higher than younger age group. The indications of amnicentesis were screen positive of triple marker test(43%), advanced maternal age(20.8%), abnormal beta-hCG level, past history of chromosome abnormality or malformed baby and abnormal alpha-FP level in order. Total number of chromosomal abnormalities was 30 and the incidence of chromosomal abnormalities was 2.8%(30/1,064). The complications were developed in 13 cases and fetal loss rate was 0.78%(9/1,064). CONCLUSION: The detection rate of chromosomal abnormality in midtrimester amnicentesis for prenatal diagnosis was high and relatively safe procedure but, we should be attention to more careful manipulation.
Amniocentesis ; Biomarkers ; Chromosome Aberrations ; Down Syndrome ; Female ; Humans ; Incidence ; Pregnancy ; Pregnancy Trimester, Second* ; Prenatal Diagnosis ; Retrospective Studies

The bone is the most common location of breast cancer metastasis. Bone metastasis causes pain and skeletal-related events (SREs), and affects the quality of life and survival of breast cancer patients. Bone-modifying agents, including bisphosphonates and denosumab, reduce the risk of SREs in these patients. Among bisphosphonates, zoledronic acid is preferred due to its higher efficacy. Denosumab is marginally more effective than zoledronic acid in reducing the frequency of SREs. Patients with renal impairment should receive zoledronic acid with caution due to nephrotoxicity, and denosumab is an alternative option in these patients. Osteonecrosis of the jaw is a rare but severe complication of both zoledronic acid and denosumab, and all patients should undergo dental examinations before and during treatment. Although these drugs can reduce the risk of SREs in bone metastasis, no significant improvement in survival has been noted. This study reviews the effects and adverse events of bone-modifying agents for the treatment of bone metastasis from breast cancer.

No abstract available.

PURPOSE: Focal segmental glomerulosclerosis(FSGS) is known to have a poor prognosis and a poor response to treatment. We performed a combination therapy of plasmapheresis, steroid pulse and immunoglobulin in 4 patients with relapsed steroid dependent(SD) or steroid resistant(SR) FSGS after steroid pulse therapy. MATERIALS AND METHODS: 8 cycles of plasmapheresis were performed in 4 patients with biopsy proven FSGS who had relapsed after steroid pulse therapy from March 1988 to July 2002. Clinical findings and treatment courses were reviewed retrospectively. RESULTS: Among the 4 patients, there were 3 males and 1 female. After 8 cycles of plasmapheresis, clinical remissions were obtained. Two of the four patients had two relapses and received 2 more cycles of plasmapheresis which resulted in remissions. One of these patients had two further relapses and was treated with oral steroid resulting in clinical remission. Three patients have maintained normal serum creatinine level and glomerular filtration rates during the follow-up period of 10 years, and the other 1 patient for 5 months. CONCLUSION: A combination therapy of plasmapheresis, steroid pulse and immunoglobulin led to a complete remission in patients with FSGS who were SD or SR and was effective in maintaining normal renal function.
Biopsy ; Creatinine ; Female ; Follow-Up Studies ; Glomerular Filtration Rate ; Glomerulosclerosis, Focal Segmental* ; Humans ; Immunoglobulins ; Male ; Plasmapheresis* ; Prognosis ; Recurrence ; Retrospective Studies

BACKGROUNDS: Today, tuberculosis cannot only be cured medically, but also controlled by public health. Despite the overall worldwide decline in tuberculosis, the disease continues to be a significant problem among developing countries and in the slums of large cities in some industrialized countries. Particularly, this communicable disease has come into the public health spotlight because of its resurgence in the 1990's Our country has been operating the Korean National Tuberculosis Control Program since 1962, focusing around public health centers. Therefore, this study aims to compare the effectiveness of tuberculosis control activities, one of the major public health activities in Korea, by producing indexes, such as the yearly registration rate per 100,000 population and treatment compliance of tuberculosis on in small areas (communities). METHODS: This work was accomplished by constructing a time-series analytic model using data from "1980~2000 : the Yearly Statistical Report" with patient registry data of 234 City. County. District public health centers and by identifying the factors influencing the tuberculosis indexes. RESULTS: The trends of pulmonary tuberculosis positive point prevalence and pulmonary tuberculosis negative point prevalence on X-ray screening have declined steadily, beginning in 1981 and continuing to 1998 by region (city. county. district). Although the tuberculosis mortality rate steadily shows a declining trend by year and region, but Korea still ranks first among 29 OECD countries in 1998, with a tuberculosis mortality rate of 7.1 per 100,000 persons, according to the time-series analysis for fatal diseases. CONCLUSION: The results of the study will form the fundamental basis of future health care planning and the Korean Tuberculosis Surveillance System on 2000. Since the implementation of local autonomy through the Local Health Act of 1995. it has now become vital for each city. county. district public health centers to determine its own priorities for relevant health care management, including budget allocation and program goals.
Budgets ; Communicable Diseases ; Compliance ; Delivery of Health Care ; Developed Countries ; Developing Countries ; Humans ; Korea* ; Mass Screening ; Mortality ; Poverty Areas ; Prevalence ; Public Health ; Tuberculosis* ; Tuberculosis, Pulmonary

Smoking leads to nicotine addiction and serious health problems and smoking cessation can reduce the risk of developing smoking-related diseases and premature death. Smoking is a chronic disease that requires repeated interventions, including counseling and pharmacotherapy. These are both effective for smoking cessation, but combined intervention is more effective than using either alone. Several first-line medications are effective and recommended for use, such as nicotine-replacement therapy (patch, gum, inhaler, lozenge, and nasal spray), bupropion SR, and varenicline. Special populations such as adolescent smokers, pregnant women, and smokers with mental illness can be treated with both counselling and medication. Physicians should recommend effective counselling and pharmacotherapy strategies to all smokers at every clinic visit. Insurance coverage for counselling and medications for quitting smoking are essential to reduce the smoking rate, especially in a primary care setting.
Adolescent ; Ambulatory Care ; Bupropion ; Chronic Disease ; Counseling ; Drug Therapy ; Female ; Gingiva ; Humans ; Insurance Coverage ; Mortality, Premature ; Nebulizers and Vaporizers ; Nicotine ; Pregnant Women ; Primary Health Care* ; Smoke ; Smoking ; Smoking Cessation ; Varenicline

The purpose of this study is to assess dietary habits of the hazardous drinkers and the heavy episodic drinkers in Korean adults. The respondents consisted of 814 adults (415 male and 399 female) who are 20~69 years of age by random selection in partial area of Gyeonggi. A self-report questionnaire was used to cover questions regarding dietary habits, drinking behavior and physical activity. Total dietary habit scores in hazardous drinker group (63.25) was significantly lower than normal drinker group (68.61) in male respondents (P<0.001). Male hazardous drinker group less eat fruit (P<0.01), eat more processed food (P<0.01) than male normal drinker group. Female hazardous drinker group doesn't eat 3 meals a day than female normal drinker group. Total dietary habit scores in heavy episodic drinker group [occasional heavy episodic drinker (62.76), frequent heavy episodic drinker (63.77)] were significantly lower than abstainer group (69.16) in male respondents (P<0.001). Male heavy episodic drinker group less eat fruit (P<0.01), eats more processed food (P<0.01), salty food (P<0.001), sugary food (P<0.05), animal fat (P<0.01) and eats out often (P<0.01) than male abstainer group. Male heavy episodic drinker group significantly less apply nutrition knowledge to their life (P<0.05) and less exercise everyday-more than 1 hour (P<0.01) than male abstainer group. In drinking behavior index, AUDIT (alcohol use disorder identification test) score was negatively correlated with age (P<0.01). There was a positive correlation between dietary habits and physical activity (P<0.01) but there was negative correlation between dietary habits and AUDIT score (P<0.01). This study highlights that AUDIT score was negatively influenced dietary habits.
Adult ; Animals ; Surveys and Questionnaires ; Drinking Behavior ; Female ; Food Habits ; Fruit ; Humans ; Male ; Meals ; Motor Activity

Purpose: This study is to understand the experiences of people with serious mental illness following adjustment to independent living. Methods: Aphenomenological research approach was used. Research participants were recruited from community psychiatric rehabilitation centers where they received the support for successfully independent living in the community. In-depth interviews were conducted with a total of 20 research participants from September 2019 to August 2021. The collected data were analyzed using the phenomenological analysis method previously described by Giorgi. Results: Four major themes emerged from our analysis: (1) feeling free in everyday life changed when they started living independently; (2) being the owner of my life; (3) feeling surrounded by barriers at the start of independent living; and (4) required efforts and support for fully living independently. Conclusion Our study findings encourage fundamental understanding of benefits and difficulties in adjusting to independent living and the adjustment process among people with serious mental illness through in-depth analysis of their experiences. It is necessary to conduct further studies to develop interventions to support people with serious mental illness once they start living independently and instruments to measure their independence.

PURPOSE: Quality of life in patients with cancer may be influenced by various kinds of variables, such as personal, environmental, and medical factors. The purpose of this study was to identity the influencing factors on the quality of life in patients with cancer. MATERIALS AND METHODS: One hundred and forty seven patients, who were taking medical therapy or following up after surgery for cervix cancer, participated in the present study. Quality of life, medical variables (cancer stage, types of treatment, follow-up status, and symptom distress), and psychosocial variables (mood disturbance, orientation to life, and social support) were measured. The obtained data were computed using multiple regression analyses. RESULTS: The medical-and-psychosocial variables explained 63.3% of the total variance in the quality of life (R2=0.633, F=16.969, p=.000). Cancer stage, symptom distress, mood disturbance, social support (family), and optimistic orientation to life were significant factors influencing on the quality of life in patients with cervix cancer. CONCLUSION: An integrative care program which includes medical - and - psychosocial characteristics of patients is essential to improve quality of life in patients with cervix cancer.
Cervix Uteri* ; Female ; Follow-Up Studies ; Humans ; Quality of Life* ; Uterine Cervical Neoplasms*