No abstract available.
Suicide, Attempted*

OBJECTIVES: The purposes of this study were to determine the usefulness of transvaginal ultrasonographic assessment of the uterine cervix and to compare the diagnostic performance of ultrasonographic and digital examination of the cervix in predicting a successful induction of labor. STUDY DESIGN: One hundred-one singleton term pregnancies without ruptured membranes admitted for the labor induction were included in this study. Digital examination and transvaginal ultrasonography of the uterine cervix were performed at the time of admission. Cervical parameters evaluated included cervical length, presence of funneling, funnel length, and funnel width. Labor induction was underwent by prostaglandin E2 (PGE2) vaginal suppository and/or pitocin intravenous infusion. Outcome variable was a successful labor induction within 48 hours after beginning of the induction. RESULTS: The prevalence of induction failure was 10.9% (11/101). Receiver-operator characteristic (ROC) curve and multiple logistic regression analysis indicated a significant relationship between the successful induction of labor and cervical length <3.1 cm. The diagnositic indices of endocervical length was superior to those of Bishop's cervical score in predicting a successful induction of labor. In patients with cervical length <3.1 cm, the labor was induced successfully with fewer tablets of PGE2, less use of pitocin infusion, and shorter induction-delivery interval. CONCLUSION: Transvaginal ultrasonographical examination of the uterine cervix is more accurate than digital examination of the cervix in the prediction of a successful induction of labor in term gestation.
Cervix Uteri* ; Dinoprostone ; Female ; Humans ; Infusions, Intravenous ; Logistic Models ; Membranes ; Oxytocin ; Pregnancy* ; Prevalence ; Suppositories ; Tablets ; Ultrasonography

AIMS: To explore the relationship between shiftwork duration and metabolic risk factors on cardiovascular disease in shiftworkers. METHODS: The study subjects comprised of 226 nurses, from a hospital, and 130 male workers, from a diaper and feminine hygienic material manufacturing firm. The mean ages of the male workers and nurses were 29 and 28.5 years, respectively. The fasting blood sugar, serum cholesterol, blood pressure, height and weight, waist and hip circumferences (only in nurses), and number of step for a shift as indices of physical activity were measured. Using the Korean version of Karasek's job contents questionnaire, the job stress was assessed. Information about the number of years worked, duration of shiftwork, and past medical and behavioral histories, including smoking, were obtained by self-administrated questionnaires. Linear regression analyses were performed, to show the relationships between shiftwork duration and metabolic risk factors, using simple and multivariate models, adjusted for age, smoking, job strain and physical activity. The following criteria were defined: hypertension as a SBP>or160 or a DBP>or=90 mmHg at least once, hypercholesterolemia, as a serum total cholesterol >or=240 mg/dl, obesity as BMI (Body Mass Index) >or=25kg/m2 and central obesity as a WHR (Waist to Hip Ratio) >or=0.85; and the logistic regression analyses, according to years of shiftwork, were performed using simple and adjusted models. RESULTS: The cholesterol and fasting blood sugar showed increasing trends, but without statistical significances, according to the increase in shiftwork duration of the male workers, although, the increases in the blood pressure and BMI were statistically significant. In the nurses, only the WHR showed a significant increase in relation to the shiftwork duration. In the logistic regression analyses, hypercholesterolemia and obesity showed significant increasing risks according to the number of years of shiftwork (OR=3.32 95%CI 1.27-8.72 and OR=3.21 95%CI 1.24-8.32 respectively) in the male workers, but hypertension showed no significance. In the nurses, only an increased central obesity was significant as a risk factor (OR=1.30 95%CI 1.05-1.62). CONCLUSIONS: These results provide evidence of the associations between shiftwork and metabolic risk factors for cardiovascular disease, although healthy shiftworker effects might exist in our cross sectional study design.
Blood Glucose ; Blood Pressure ; Cardiovascular Diseases* ; Cholesterol ; Fasting ; Hip ; Humans ; Hypercholesterolemia ; Hypertension ; Linear Models ; Logistic Models ; Male ; Motor Activity ; Obesity ; Obesity, Abdominal ; Questionnaires ; Risk Factors* ; Smoke ; Smoking

PURPOSE: The aim of this study was to quantitatively assess the intensity of tumor budding in rectal carcinoma and to determine how it correlates with the malignant potential. MATERIALS AND METHODS: Intensities of the tumor budding at the invasive front of the surgical specimens from 90 patients (male, 51) with well- or moderately- differentiated rectal carcinoma were investigated. Differences in the budding intensity among pathologic variables were compared, and recurrences and survivals were analyzed in accordance with degree of the budding intensity. The patients ranged in age from 33 to 75 years (mean, 55.4) with the median follow-up being 43 months (range, 12~108). RESULTS: Tumor budding was identified in 89 patients (98.9%) with a mean intensity of 7.5+/-5.3. The budding intensity was significantly higher in tumors with lymphatic invasion (p=0.0081), blood vessel invasion (p<0.0001), and perineural invasion (p=0.0013) than in those tumor without these findings. It became significantly higher with the increase in nodal stage (p<0.0001). The intensity of tumor budding in patients with relapse (29 patients) was significantly higher than that in patients without relapse (6.2+/-5.0 vs. 10.2+/-4.9; p=0.0005), but this difference in the intensity was observed only for the node-positive patients (8.0+/-3.4 vs. 11.9+/-5.1; p=0.0064). When the patients were stratified into two groups on either side of the mean of the intensity, the higher intensity group showed a significantly less favorable disease- free (DFS) and overall survival (OS) (p=0.0026 and 0.0205, respectively). Based on the multivariate analysis, the nodal stage and the intensity of budding proved to be the independent variables associated with DFS (p=0.023 and 0.03, respectively). CONCLUSION: Tumor budding at the invasive margin is a reliable pathologic index that indicates a higher malignant potential and a less favorable prognosis for patients with advanced rectal carcinoma.
Blood Vessels ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Prognosis ; Recurrence

PURPOSE: To establish the CT findings and clinical characteristics of colorectal mucinous adenocarcinoma. MATERIALS AND METHODS: The CT features of 26 surgically proven cases of colorectal mucinous adenocarcinoma were reviewed. The subjects were selected from among 262 patients with colorectal cancer, of whom 40 with non-mucinous adenocarcinoma were included as a control group. Contrast-enhaneed CT images were analyzed for tumor location, the presence or absence of tumoral calcification, tumor shape (circumferential or eccentric, polypoid or infiltrative), tumor thickness-to-length ratio, and attenuation and homogeneity. In each group, the TNM stage of pathologic specimens was compared. During follow-up, the incidence of recurrence, and outcome, were also compared. RESULTS: CT images of mucinous adenocarcinoma revealed intratumoral calcification in three patients (12%, p < 0.01). Tumors were eccentric and polypoid-shaped, with a high tumoral thickness/length ratio (p < 0.01). On contrast-enhanced images, most were seen as a heterogenous hypoattenvuted mass. No differences in T-NM stage were found in surgical specimens. In patients with mucinous adenocarcinoma, recurrence during the early follow-up period is more common than in patients with non-mucinous cancer. CONCLUSION: Contrast-enhanced CT reveals mucinous adenocarcinoma as an eccentric polypoid mass with heterogeneous hypoattenuation. In patients with mucinous colorectal cancer, careful follow-up is required because tumors tend to recur early in the follow-up period.
Adenocarcinoma ; Adenocarcinoma, Mucinous* ; Colorectal Neoplasms ; Follow-Up Studies ; Humans ; Incidence ; Mucins* ; Recurrence ; Tomography, X-Ray Computed

PURPOSE: To establish the CT findings and clinical characteristics of colorectal mucinous adenocarcinoma. MATERIALS AND METHODS: The CT features of 26 surgically proven cases of colorectal mucinous adenocarcinoma were reviewed. The subjects were selected from among 262 patients with colorectal cancer, of whom 40 with non-mucinous adenocarcinoma were included as a control group. Contrast-enhaneed CT images were analyzed for tumor location, the presence or absence of tumoral calcification, tumor shape (circumferential or eccentric, polypoid or infiltrative), tumor thickness-to-length ratio, and attenuation and homogeneity. In each group, the TNM stage of pathologic specimens was compared. During follow-up, the incidence of recurrence, and outcome, were also compared. RESULTS: CT images of mucinous adenocarcinoma revealed intratumoral calcification in three patients (12%, p < 0.01). Tumors were eccentric and polypoid-shaped, with a high tumoral thickness/length ratio (p < 0.01). On contrast-enhanced images, most were seen as a heterogenous hypoattenvuted mass. No differences in T-NM stage were found in surgical specimens. In patients with mucinous adenocarcinoma, recurrence during the early follow-up period is more common than in patients with non-mucinous cancer. CONCLUSION: Contrast-enhanced CT reveals mucinous adenocarcinoma as an eccentric polypoid mass with heterogeneous hypoattenuation. In patients with mucinous colorectal cancer, careful follow-up is required because tumors tend to recur early in the follow-up period.
Adenocarcinoma ; Adenocarcinoma, Mucinous* ; Colorectal Neoplasms ; Follow-Up Studies ; Humans ; Incidence ; Mucins* ; Recurrence ; Tomography, X-Ray Computed

We aimed to examine whether there is a correlation between the health recovery of industrial accident victims and their perceived socioeconomic status. Data were obtained from the first Panel Study of Worker's Compensation Insurance, which included 2,000 participants. We performed multivariate regression analysis and determined the odds ratios for participants with a subjectively lower socioeconomic status and for those with a subjectively lower middle socioeconomic status using 95% confidence intervals. An additional multivariate regression analysis yielded the odds ratios for participants with a subjectively lower socioeconomic status and those with a subjectively upper middle socioeconomic class using 95% confidence intervals. Of all participants, 299 reported a full recovery, whereas 1,701 did not. We examined the odds ratio (95% confidence intervals) for participants' health recovery according to their subjective socioeconomic status while controlling for sex, age, education, tobacco use, alcohol use, subjective state of health prior to the accident, chronic disease, employment duration, recovery period, accident type, disability status, disability rating, and economic participation. The odds of recovery in participants with a subjectively lower middle socioeconomic status were 1.707 times greater (1.264-2.305) than that of those with a subjectively lower socioeconomic status. Similarly, the odds of recovery in participants with a subjectively upper middle socioeconomic status were 3.124 times greater (1.795-5.438) than that of those with a subjectively lower socioeconomic status. Our findings indicate that participants' perceived socioeconomic disparities extend to disparities in their health status. The reinforcement of welfare measures is greatly needed to temper these disparities.
Accidents, Occupational/psychology/*statistics & numerical data ; Adult ; Age Factors ; Cross-Sectional Studies ; Female ; Health Status Disparities ; Humans ; Insurance Benefits ; Male ; Middle Aged ; Odds Ratio ; Regression Analysis ; Republic of Korea ; Sex Factors ; *Social Class ; Workers' Compensation

We aimed to examine whether there is a correlation between the health recovery of industrial accident victims and their perceived socioeconomic status. Data were obtained from the first Panel Study of Worker's Compensation Insurance, which included 2,000 participants. We performed multivariate regression analysis and determined the odds ratios for participants with a subjectively lower socioeconomic status and for those with a subjectively lower middle socioeconomic status using 95% confidence intervals. An additional multivariate regression analysis yielded the odds ratios for participants with a subjectively lower socioeconomic status and those with a subjectively upper middle socioeconomic class using 95% confidence intervals. Of all participants, 299 reported a full recovery, whereas 1,701 did not. We examined the odds ratio (95% confidence intervals) for participants' health recovery according to their subjective socioeconomic status while controlling for sex, age, education, tobacco use, alcohol use, subjective state of health prior to the accident, chronic disease, employment duration, recovery period, accident type, disability status, disability rating, and economic participation. The odds of recovery in participants with a subjectively lower middle socioeconomic status were 1.707 times greater (1.264-2.305) than that of those with a subjectively lower socioeconomic status. Similarly, the odds of recovery in participants with a subjectively upper middle socioeconomic status were 3.124 times greater (1.795-5.438) than that of those with a subjectively lower socioeconomic status. Our findings indicate that participants' perceived socioeconomic disparities extend to disparities in their health status. The reinforcement of welfare measures is greatly needed to temper these disparities.
Accidents, Occupational/psychology/*statistics & numerical data ; Adult ; Age Factors ; Cross-Sectional Studies ; Female ; Health Status Disparities ; Humans ; Insurance Benefits ; Male ; Middle Aged ; Odds Ratio ; Regression Analysis ; Republic of Korea ; Sex Factors ; *Social Class ; Workers' Compensation

OBJECTIVE: The purpose of this study was to examine the pharmacological treatment patterns and clinical responses in inpatients and/or outpatients with obsessive compulsive disorder (OCD) at a university hospital. METHODS: A total of 71 OCD patients were included and followed during the first 4 months, first year and second year from 1998. The patterns of medication use and clinical responses according to the Yale-Brown obsessive-compulsive scale (Y-BOCS) were analyzed descriptively in this period. RESULTS: During the first 4 months, 26.7% of the patients underwent monotherapy in which most of the drugs were serotonin reuptake inhibitors (SRIs). Therapy with two or more drugs was administered in 66.6% of the patients and combination drugs with SRIs were atypical antipsychotics and clonazepam. The clinical response rate using Y-BOCS was 24.0% compared with baseline score. During the first year, the frequency of the monotherapy decreased to 6.5%, while that of therapy with two or more drugs increased to 80.6% (two and three drug frequencies were 35.3%, and 32.3%, respectively). The clinical response rate was 26.4% during this period. During the second year, the frequency of the monotherapy was 25% and that of multidrug therapy was 70.8% (two and three drug frequencies were 20.8%, and 45.8%, respectively). The clinical response rate was 39.3% compared with baseline score. CONCLUSIONS: In this study, the frequency of the combination therapy was relatively high compared with SRI monotherapy during the first 4 months and it increased further during the first year. The combination therapy was maintained without change of SRI dosage during the second year. Most of the drugs used in the combination therapy were atypical antipsychotics and clonazepam.
Antipsychotic Agents ; Clonazepam ; Drug Therapy* ; Humans ; Inpatients ; Obsessive-Compulsive Disorder* ; Outpatients ; Serotonin Uptake Inhibitors

OBJECTIVE: Macrosomia is associated with increased birth injury and neonatal morbidity as well as a higher rate of cesarean delivery. Our purpose was to determine whether induction of labor after sonographic diagnosis of fetal macrosomia could improve maternal and neonatal outcome. STUDY DESIGN: The hospital records of 180 patients who delivered of an inFant with birth weight over 4000 gm were reviewed. The subjects were divided into three groups based on obstetric management as follows.. expectant management after sonographic diagnosis of fetal macrosomia(group I), induction of labor(group lI), unexpected patients who were underestimated of fetal weight(estimated fetal weight<90th percentile) (groupIII), Patients who underwent elective cesarean delivery and complicated with diabetes were excluded. Outcome variables for comparison in three groups were mode of delivery, 5 minute Apgar score below 7, presence of cephalohematoma, clavicular fracture, brachial plexus injury, and intraventricular hemorrhage. RESULTS: One hundred eighty patients who eligible for the study, of whom 32 patients were included to group I, 57 patients to group lI, and 91 patients to group Ill, respectively. The cesarean rate within elective induction group was 49%, which was significant higher than the 16% rate in expectant management group and 19% in unexpected group(p<0.05). The observed rates of cephalohematoma, clavicular fracture and 5 min Apgar score below 7 were not significantly different in three groups. CONCLUSIONS: There was an significant increased cesarean delivery rate without improvement in neonatal outcomes or reduction in birth injury among pregnancies in which labor was electively induced after sonographic diagnosis of fetal macrosomia. Elective induction of labor should be discharged in cases with fetal macrosomia.
Apgar Score ; Birth Injuries ; Birth Weight ; Brachial Plexus ; Diagnosis* ; Female ; Fetal Macrosomia* ; Hemorrhage ; Hospital Records ; Humans ; Infant ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Ultrasonography*