PURPOSE: The number of resected lymph nodes can influence the current N staging. This study examined the significance of the metastatic lymph node ratio on the survival of patients with pT2 gastric cancer. METHODS: The records of 176 patients who had undergone curative gastrectomy and diagnosed with pT2 gastric cancer by pathology, between February 1990 and October 2002 were retrospectively reviewed. Those patients with other organ metastases or those who had undergone a dissection of less than 15 lymph nodes were excluded. The clinicopathologic prognostic variables were evaluated using the SPSS statistical program. RESULTS: There were 115 men and 61 women with a mean age of 59 years. The median survival period was 93 months (2~184 months). Metastatic lymph nodes were found in 100 cases (56.8%), a mean of 34.6 lymph nodes were dissected, a mean of 3.2 lymph nodes metastasized, and a mean metastatic lymph node ratio of 0.09 was found. According to the UICC TNM classification, the number of stage IB (N0) cases was 76 (43.2%), stage II (N1) was 74 (42.0%), stage IIIA (N2) was 18 (10.2%), and stage IV (N3) was 8 (4.5%). The overall 5-year survival rate was 75.2%. According to the UICC TNM classification, the 5-year survival rate was stage IB, II, IIIA, and IV was 88.6%, 74.3%, 39.5%, and 33.3%, respectively. The metastatic lymph node ratio (nR) was divided into 4 categories; nR0 (76) = 0, 0 Classification ; Female ; Gastrectomy ; Humans ; Lymph Nodes* ; Male ; Neoplasm Metastasis ; Pathology ; Prognosis ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate*

A clinical observation was done on random 42 cases of acute and uncomplicated bacterial pyelonephritis. The following results were obtained: 1. All cases were female. 2. The most common age group was 2nd decade (47.6%). 3. All isolated organisms were Gram negative bacteria and E. coli was most common (90%). 4. On excretory urogram, 3 cases (7%)were abnormal and one of them showed acute segmental pyelonephritis. 5. The right side was affected 3 times more than left and 8 cases were bilateral.
Female ; Gram-Negative Bacteria ; Humans ; Pyelonephritis*

Insertion of intravascular catheters may be the most common procedure in neonatal intensive care units. One of these kinds of catheters, umbilical venous catheter is generally used for the small and sick neonates. But the indwelling umbilical venous catheter can cause many complications. The most common complication is thrombus formation in the lumen of the catheter. Neonatal thrombosis has symptomatic or asymptomatic clinical manifestations, which may have serious complications in case of intracardiac thrombosis. In our experience, the infant who has no symptom of thrombosis was treated with low dose aspirin and warfarin for right atrium thrombosis caused by umbilical venous catheterization. So, we report a case of right atrium thrombosis following umbilical catheterization in neonatal intensive care units.
Aspirin ; Catheterization* ; Catheters* ; Heart Atria* ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Neonatal ; Thrombosis* ; Warfarin

This is a very important differential diagnosis for postpartum hemorrhage following cesarean delivery because repeated life-threatening bleeding may induce multiple blood transfusion and require emergency surgery including hysterotomy. False or pseudoanuerysm can be acquired in association with trauma, previous surgery, trophoblastic disease, neoplasm, infection or diethylstilbestrol exposure. When a punctured or lacerated artery does not seal completely, blood may escape and dissects the adjacent tissues, and collects in perivascular areas. If this collection maintains in communication with the parent vessel, a pseudoaneurysm could result. Typically the lesion are discovered because the patients have symptoms related to delayed rupture of the pseudoaneurysms, causing hemorrhage. Radiographic techniques (angiography, ultrasound, and magnetic resonance imaging) have provided the opportunity to diagnose pseudoaneurysm, arteriovenous malformation. We report a case of postpartum hemorrhage following cesarean delivery attributed to a pseudoaneurysm of the uterine pedicle and treated with arterial embolization. Angiographic study confirmed the diagnosis and embolization of the false aneurysm was successful in controlling the hemorrhage.
Aneurysm, False* ; Arteries ; Arteriovenous Malformations ; Blood Transfusion ; Cesarean Section* ; Diagnosis ; Diagnosis, Differential ; Diethylstilbestrol ; Emergencies ; Female ; Hemorrhage ; Humans ; Hysterotomy ; Parents ; Postpartum Hemorrhage* ; Postpartum Period* ; Pregnancy ; Rupture ; Trophoblasts ; Ultrasonography ; United Nations

PURPOSE: GnRH stimulation test is golden standard for the diagnosis of central precocious puberty as well as evaluation of treatment, however, it is more expensive and inconvenient. This is the reason why many other tests have been suggested. We studied the efficacy of modified puberty suppression score by single blood sample for evaluation of GnRH agonist treatment in central precocious puberty. METHODS: Twenty-four girls (age, 9.56+/-1.56 years) diagnosed with early puberty or precocious puberty at Kangdong Sacred Heart Hospital from March 2002 to May 2005 were included in this study. All of patients were treated with leuprorelin acetate (83.66-115.12 microgram/kg). Total 24 patients including 11 suppression and 13 non-suppression cases were analyzed. The serum levels of LH, FSH, estradiol and progesterone were measured before and 8 weeks after treatment. The height, weight, bone age and Tanner stage of breast development in each patient were also measured before and 12 weeks after treatment. We modified puberty suppression score by Mul et al. in 1999. We defined scores based on statistical significance - estradiol, 2 points (>=1.36 ng/dL), progesterone, 2 points (>=0.31 ng/dL), LH, 1 point (>=2.0 IU/L), delta BA/delta CA, 1 point (>=0), delta HtSDS, 1 point (>=0.25/6 mo). Total score is 7 points and we defined suppression is less than 3 points. RESULTS: The serum levels of estradiol (<1.36 ng/dL, P=0.000) and progesterone (<0.31 ng/dL, P= 0.003) are significantly lower in suppression group than nonsuppression group. If the score according to modified puberty suppression score (MPSS) is less than 3 points, which is considered as a successful suppression by GnRH agonist. The sensitivity, specificity, positive predictive value and negative predictive value of MPSS are 100%, 92.8%, 90.9% and 100% respectively. CONCLUSION: Single blood sample is simpler and easier than GnRH stimulation test for the evaluation and monitoring of GnRH agonist treatment in central precocious puberty and MPSS by single blood sample may be useful in outpatient clinic.
Adolescent ; Ambulatory Care Facilities ; Breast ; Diagnosis ; Estradiol ; Female ; Gonadotropin-Releasing Hormone* ; Heart ; Humans ; Leuprolide ; Progesterone ; Puberty* ; Puberty, Precocious* ; Sensitivity and Specificity

PURPOSE: Microbial colonization of the intestine begins just after birth and development of the normal flora is a gradual process. The first bacteria colonizing the intestine in newborns are Staphylococcus, Enterobacteriaceae and Streptococcus. For several days after birth, the number of Bifidobacterium spp. increase. The aim of this study was to investigate the changes of microflora for seven days postnatally in neonatal stool. METHODS: Fifteen neonates (breast : formula : mixed feeding 1 : 8 : 6, vaginal delivery : cesarean section 3 : 12) who were born at the Kangdong Sacred Heart Hospital, Hallym University were enrolled. First meconium and stools of postnatal 1-, 3-, and 7-day were innoculated. Blood agar plates for total aerobes, trypton bile X-glucuronide agar for E. coli, phenylethyl alcohol agar for gram positive anaerobes, MRS agar for Lactobacillus spp., bifidobacterium selective agar for Bifidobacterium spp. and cefoxitin-cycloserine-fructose agar for Clostridium difficile were used in the general incubator (CO2 free incubator), CO2 incubator or the anaerobic chamber for 48 or 72 hours at 37oC and then colony forming units were counted. RESULTS: No microflora was identified in the first meconium. Total aerobes, E. coli, and gram positive anaerobes were significantly increased with advancing postnatal days. In only one baby, Lactobacillus acidophilus was detected 2x105 CFU/g in the seven-day stool. Bifidobacterium spp. was detected in two babies. Clostridium difficile was not detected during the seven days. There were no significant differences in the bowel flora depending on the delivery pattern and feeding method. CONCLUSION: This study shows many changes in the intestinal normal flora in neonatal stool during seven days postnatally. If these findings are confirmed with larger studies, the data may be preliminary findings to support use of probiotics in neonates.
Agar ; Bacteria ; Bifidobacterium ; Bile ; Cesarean Section ; Clostridium difficile ; Colon ; Enterobacteriaceae ; Feeding Methods ; Female ; Heart ; Humans ; Incubators ; Infant, Newborn* ; Intestines ; Lactobacillus ; Lactobacillus acidophilus ; Meconium ; Parturition ; Phenylethyl Alcohol ; Pregnancy ; Probiotics ; Staphylococcus ; Stem Cells ; Streptococcus

PURPOSE: Delivering bad news is a task that occurs in most medical practices, rendering communication skills essential to competent patient care. The purpose of this study was to identify factors that are associated with scores on an assessment of medical students' communication skills in delivering bad news to help develop more effective curricula to enhance these essential skills. METHODS: One hundred fifty-four fourth-year medical students at Pusan National University were included. Skills for delivering bad news were assessed using the SPIKES protocol in the CPX. The students were categorized into three main groups according to total scores: 'Exceeds expectations (E)', 'Meets expectations (M)', and 'Needs development (N)'. Personal experiences with misfortune and attitudes toward breaking bad news were surveyed, and school records were collected. The differences between the E and N groups were analyzed based on performance test and survey. RESULTS: Compared with students in the N group, E group students acquired significantlyhigher scores on the items of Perception, Invitation, a division of Knowledge, Empathy and Strategy, and Summary but not on Setting and a part of Knowledge. E group students had better records in classes and clerkships. There were no differences in personal experiences and attitudes toward breaking bad news between the groups. CONCLUSION: Personal experience with delivering bad news does not guarantee better communication, and attitudes toward this task do not influence student performance. We expect that deliberate educational programs will have a positive impact on improving communication skills for delivering bad news.
Curriculum ; Empathy ; Humans ; Patient Care ; Personality Inventory ; Professional-Family Relations ; Students, Medical