PURPOSE: It is well established that the presence of axillary nodal metastases is the most important prognostic factor in primary operable breast cancer. However, it has also been shown that 15-30% of patients without lymph node metastases as assessed by light microscopy have recurrence within 10 years. In this study, our aim was first to investigate the diagnostic value of immunohistochemical staining in detecting micrometastases and secondly to correlate their presence with prognosis (recurrence and survival) MATERIALS AND METHODS: We retrospectively analyzed 492 axillary nodes from 49 consecutive node-negative invasive breast cancers treated at Kyung-Hee University Hospital from 1991 to 1995 with average follow-up of 60.2 (21-100) months. An additional section of original paraffin blocks was cut and stained by immunohistochemical chemical technique using monoclonal antibodies (AE 1/3 and No.7) to cytokeratin. RESULTS: Micrometastases with individual cell and cell clusters were readily detected by this technique in 27% of the cases. These were no predictors of micrometastses among the clinicopathological data of patient. The presence of micometastases wes not associated with disease-free and overall survival but loco-regional recurrence rate. CONCLUSIONS: A combination of immunohistochemistry and serial sectioning of axillary lymph node would help evaluate the significance of occult axillary metastases. Patients with node-negative disease may relapse after many years and prolonged follow-up is required to establish the role of mirometastases. Such an approach, together with a search for bone marrow micrometastases and epidemiologic, clinical, pathologic and/or biochemical prognostic factors, may serve to identify high risk patients in the presumed node-negative group. It would provide a rational basis for the selective use of adjuvant therapy.
Antibodies, Monoclonal ; Bone Marrow ; Breast Neoplasms* ; Breast* ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Keratins ; Lymph Nodes ; Microscopy ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Paraffin ; Prognosis ; Recurrence ; Retrospective Studies*

The survey was undertaken among the 105 ostomates who attended the 2nd Workshop for Stoma Rehabilitation on Aug. 30th, 1997 by the Department of Surgery, Kyung-Hee University Hospital to assess the physical, psychosocial and sexual problems with a stoma. The 97% of ostomates had permanent colostomies following abdominoperineal resection. The 67% of ostomates had one or more physical problems caused by stoma. Frequent bowel movement (94.3%), impairment of irrigation (64.6%), unpleasant odor (27.3%), and urinary frequency (21.3%) were common problems encountered by ostomates. Concerning the psychosocial problems, 3.8% of them suffered from profound restriction of social activities and 1.9% of them had psychologic problems such as depression. 42 of 58 ostomates (72.4%) who were employed before operation returned to their work. Among 71 men, 44 (62%) were impaired by sexual function. Most ostomates suffered physical, social, psychologic and sexual problems in their daily life and needed helps of experts such colorectal surgeons, enterostomal therapists, and ostomy association. Attention is needed more to improve the quality of life for the ostomates.
Colostomy ; Depression ; Education ; Humans ; Male ; Odors ; Ostomy ; Quality of Life ; Rehabilitation

OBJECTIVES: Socioeconomic status plays an important role in health care and disease prevention. This study aimed to examine the association between socioeconomic status, measured by education levels and household income, and gastric cancer screening. METHODS: A total of 21,220 community-dwelling adults aged 40 to 69 years within a defined geographic area participated in a community health survey in 2009 and 2010. The survey was conducted using a structured questionnaire by trained investigators who visited the subjects' households directly. Logistic regression analysis was used to determine the relationship between self-reported participation in gastric cancer screening and socioeconomic variables (education and household income). RESULTS: The gastric cancer screening rate was 52.1% for subjects in their forties, 63.7% for those in their fifties, and 67.3% for those in their sixties. In multivariate analysis, higher education and income levels were associated with higher rates of gastric cancer screening (high school vs. elementary school: odds ratio [OR] 1.41, 95 % confidence interval [CI] 1.26-1.58; highest income quartile vs. lowest income quartile: OR 1.62, 95% CI 1.44-1.84). The gradient between income and screening rate was more pronounced in the population aged 40 to 49 years than in the other age groups. CONCLUSIONS: This study demonstrates that lower socioeconomic status is associated with decreased participation in gastric cancer screening. Our findings suggest that the screening program should be focused on low-income and less-educated populations, especially among younger adults, to reduce health disparities.
Adult ; Delivery of Health Care ; Education ; Family Characteristics ; Health Surveys ; Humans ; Logistic Models ; Mass Screening* ; Multivariate Analysis ; Odds Ratio ; Research Personnel ; Social Class* ; Stomach Neoplasms* ; Surveys and Questionnaires

Background/Aims: There is increasing evidence that supplementation with pre- and probiotics appears to have positive effects on irritable bowel syndrome (IBS). The aim of this study was to determine the effects of a new synbiotic formulation on gastrointestinal symptoms in elderly patients with IBS. Methods: Sixty-seven IBS patients aged ≥60 years were randomly assigned to either a placebogroup (n=34) or a synbiotic group (n=33). During a 4-week intervention, subjects used a placebo or a synbiotic containing Lactobacillus paracasei DKGF1 and extracts of Opuntia humifusa once a day. Patients were evaluated with the subject global assessment, visual analog scale, and Bristol stool chart. The primary outcome was the overall responder rate and the secondary outcome was the responder rates for abdominal symptom reduction at week 4. Results: Overall, responder rates were significantly higher in the synbiotic group (51.5%) than in the placebo group (23.5%) (p=0.017). Abdominal pain (58.8% vs 81.8%) and psychological wellbeing (26.4% vs 60.6%) were noticeably improved in the synbiotic group (p=0.038 and p=0.004, respectively). However, there were no significant differences in gas and bloating symptoms (p=0.88 and p=0.88, respectively). In patients with constipation-dominant and diarrhea-dominant IBS (n=16), the synbiotic significantly improved abdominal pain and defecation symptoms (responder rates for the placebo vs the synbiotic: 22.2% vs 85.7%, p=0.04). There were no adverse events in either group. Conclusions The results indicate that this new synbiotic supplement can potentially relieve abdominal symptoms in elderly IBS patients.

A complete cDNA sequence encoding a pore-forming subunit (Kir6.2) of ATP-senstive potassium channel in the adult worm, Clonorchis sinensis, termed CsKir6.2, was isolated from an adult cDNA library. The cDNA contained a single open-reading frame of 333 amino acids, which has a structural motif (a GFG-motif) of the putative pore-forming loop of the Kir6.2. Peculiarly, the CsKir6.2 shows a lack-sequence structure, which deleted 57 amino acids were deleted from its N-terminus. The predicted amino acid sequence revealed a highly conserved sequence as other known other Kir6.2 subunits. The mRNA was weekly expressed in the adult worm.
Adenosine Triphosphate/metabolism ; Amino Acid Sequence ; Animals ; Base Sequence ; Cloning, Molecular ; Clonorchis sinensis/*genetics/metabolism ; Helminth Proteins/*genetics/metabolism ; Human ; Molecular Sequence Data ; Potassium Channels, Inwardly Rectifying/*genetics/metabolism ; RNA, Helminth/chemistry/genetics ; Sequence Alignment ; Support, Non-U.S. Gov't

The purpose of this study is to develop an internet based hospice information service system as a solution to the problems identified in our previous studies. Databases and homepage were designed and developed for the information needed for the hospice care and these services were available through the Internet. The hospice information service system has three subsystems. Frrst subsystem, which is training and education for the hospice care personnel includes general hospice information, pain and symptom management, the role of hospice care program information, and hospice care standard. Second subsystem which is patient management includes patient's general information, medical record, nursing record, major symptoms and nursing care plan, statistical data management, and hospice care facilities. Third subsystem includes Q and A for patient, family members, and hospice care team members. The system was tested through providing hospice care to the terminally ill patients and their family members by home visiting nurses. Through this study, it was found that hospice information system is very effective for those who need hospice care at home. But in order for the system to be more effective, system needs to be upgraded with more information on spiritual and social welfare and specialists who provided spiritual care and social welfare need to be included in the hospice care team.
Education ; Home Care Services ; Hospice Care ; Hospices* ; House Calls ; Humans ; Information Services* ; Information Systems ; Internet* ; Medical Records ; Nursing Records ; Patient Care Planning ; Social Welfare ; Specialization ; Terminally Ill

Cryptococcosis is an invasive fungal infection, which is more common in immunocompromised patients. However, pulmonary cryptococcosis can occur in immunocompetent patients and should be considered on a differential diagnosis for nodular or mass-like lesions in chest radiograph. Recently, we experienced a patient with pulmonary cryptococcosis, successfully treated with oral fluconazole therapy. A 74-year-old female patient was referred for an evaluation of abnormal images, a large consolidative mass with multiple nodular consolidations and small nodules that mimics primary lung cancer with multiple lung to lung metastases. Computed tomography-guided lung biopsy confirmed the diagnosis of pulmonary cryptococcosis. The follow-up image taken after 4 months with oral fluconazole treatment showed marked improvement.
Aged ; Biopsy ; Cryptococcosis ; Diagnosis, Differential ; Female ; Fluconazole ; Follow-Up Studies ; Humans ; Immunocompromised Host ; Lung ; Lung Neoplasms ; Multiple Pulmonary Nodules ; Neoplasm Metastasis ; Thorax

The study aimed to verify the prognostic utility, therapeutic application and clinical benefits of tumor substaging and HER2 status in papillary non-muscle invasive bladder cancer (NMIBC). Select NMIBC transurethral resection specimens from 141 patients were used to construct tissue microarrays for assessing the substaging, HER2 protein expression by immunohistochemistry (HER2-IHC) and gene amplification by dual-color silver in situ hybridization (HER2-SISH). Substages were identified by the differing depth of tumor invasion (pTa / pT1a / pT1b / pT1c). HER2 protein expression was semiquantitatively analyzed and grouped into negative (score 0, 1+) and positive (score 2+, 3+). Other clinicopathological variables were also investigated. For NMIBC, HER2-IHC and HER2-SISH showed positive results in 6/141 (4.3%) and 4/141 (2.8%) respectively, which correlated well with tumor substaging. In multivariate analysis, substaging, HER2-IHC, and HER2-SISH were found to be independent predictors of progression-free survival (P < 0.001, P < 0.001, P = 0.031). HER2-IHC was the sole independent predictor of recurrent free survival in NMIBC (P = 0.017). It is suggested that tumor substaging and HER2 status are independent predictive markers for tumor progression or recurrence, and thus could be included in diagnostic and therapeutic management for NMIBC.
Adult ; Aged ; Aged, 80 and over ; Biomarkers, Tumor/*metabolism ; Carcinoma, Papillary/*metabolism/*pathology ; Carcinoma, Transitional Cell/metabolism/pathology ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Receptor, ErbB-2/*metabolism ; Reproducibility of Results ; Sensitivity and Specificity ; Urinary Bladder Neoplasms/*metabolism/*pathology ; Young Adult

BACKGROUND: Complete sequencing, except for intron 1, of the ABO allele in some populations has been reported. However, so far, one report on complete sequencing of the ABO gene in three Korean families with normal ABO phenotypes has been published. This study aimed to establish a reference database of common ABO alleles in Koreans. METHODS: Screening of common ABO alleles, including homozygote form, was performed by direct sequencing of exons 6 and 7 and by real-time PCR using displacing probes in 95 healthy donors. Genomic DNA from the common ABO group (n=8) and some ABO subgroups (n=7) was used in complete sequencing (except for intron 1) of the ABO allele. RESULTS: The sequences of B101/B101 (n=1), O01/O01 (n=1) were identical with the corresponding sequences registered in Genebank. A102 and A105 had a common point mutation, 1142 C>T in intron 4. A102 (n=3/11) and O02 (n=3/3), selected by sequencing of exons 6 and 7, were reclassified into A105 and O65 by whole genomic sequencing, respectively. Analytic results for ABO subgroups were as follows: B3, B101/O01 (n=3) and B101/O02 (n=1); A1B3, A102/B101 (n=1) and A105/B101 (n=1); Ax, A102/O01 (n=1). CONCLUSION: We established a reference database of common ABO alleles in Koreans and found that the molecular basis of introns of ABO alleles in the Korean population differs from that reported in previous studies of other populations.
Alleles ; DNA ; Exons ; Homozygote ; Humans ; Introns ; Mass Screening ; Phenotype ; Point Mutation ; Real-Time Polymerase Chain Reaction ; Tissue Donors

A 71-year-old man was admitted due to abdominal distension and periumbilical pain. He was diagnosed as having mucinous ductal ectasia (MDE) of the pancreas three months prior, but refused an operation. Three months later, an abdominal computed tomography revealed more dilated pancreatic duct, newly developed liver metastasis and ascites in comparison with previous findings. Fine-needle aspiration cytology of the cystic lesion in the pancreatic head was conducted and yielded adenocarcinoma. Also, an ascitic fluid cytology determined adenocarcinoma. This patient was diagnosed to be inoperable and received palliative chemotherapy and pain control. The patient expired 5 months after the initial diagnosis.
Adenocarcinoma ; Aged ; Ascites* ; Ascitic Fluid ; Biopsy, Fine-Needle ; Diagnosis ; Dilatation, Pathologic* ; Drug Therapy ; Head ; Humans ; Liver* ; Mucins* ; Neoplasm Metastasis* ; Pancreas* ; Pancreatic Ducts