PURPOSE: The aims of this study were to evaluate the feasibility of local anesthesia in tension-free herniorrhaphy, using prosthetic mesh, and to directly compare PHS(R) and Perfix(R) herniorrhaphy under local anesthesia. METHODS: Patients with a groin hernia, who underwent tension-free herniorrhaphy (n = 107) under local anesthesia between March 2003 and February 2006, were included. PHS(R) (n = 63) and Perfix(R) (n = 44) meshes were randomly used, with no difference between the PHS(R) and Perfix(R) groups in relation to mean age, gender, number of combined diseases, body mass index (BMI), recurred hernia and types of hernia. RESULTS: Intraoperative analgesics and/or sedatives were used in 55 patients (51.4 %) where local anesthesia was insufficient. In a univariate analysis, the additional use of intraoperative analgesics and/or sedatives was related to the patient's age and BMI. The patients at an older age and with a lower BMI were more tolerant to local anesthesia. However, only the BMI was found to be a statistically significant factor from the multivariate analysis. There was no significant difference between the PHS(R) and Perfix(R) groups on the additional use of intraoperative analgesics and/or sedatives, the use of postoperative analgesics, length of hospital stay, complication and recurrence (P > 0.05). CONCLUSION: With tension-free herniorrhaphy using the PHS(R) or Perfix(R) mesh, local anesthesia was acceptable and securable, regardless of the mesh type used. Among these patients, those at an older age and with a lower BMI were more tolerant to local anesthesia.
Analgesics ; Anesthesia, Local* ; Body Mass Index ; Groin ; Hernia ; Herniorrhaphy* ; Humans ; Hypnotics and Sedatives ; Length of Stay ; Multivariate Analysis ; Recurrence

The position of interventricular septum, which was measured by transitional zone of EKG, was compared with that measured by 2-D echocardiography in 51 patient. 1) The position of interventricular septum measured by 2-D echocardiography was very similar to that measured by transitional zone of EKG. 2) Extensive AMI (Anterior Myocardial Infarction) and LBBB showed moderate differences between two method. 3) RBBB and replaced mitral valve state showed severe differences between two methods. Transitional zone of EKG was helpful to define the position of interventricular septum except extensive AMI, bundle branch block and replaced mitral valve state.
Bundle-Branch Block ; Echocardiography ; Electrocardiography* ; Humans ; Mitral Valve

Insular carcinoma of the thyroid(ICT) is an uncommon thyroglobulin-producing neoplasm, intermediate between well differentiated and anaplastic carcinoma. Only a few publications have addressed the fine needle aspiration cytologic(FNAC) findings from ICT. We experienced a case histologically diagnosed as ICT and with preoperative FNAC in a 52-year-old woman. The FNAC displayed scanty colloid and abundant monomorphic follicular cells presented singly, in small loose aggregates, and in cohesive trabecular or acinar clusters. Intact insulae of tumor cells were also identified. Necrosis and mitosis were rare. Tumor cells showed round and monomorphic nuclei, finely granular chromatin, and inconspicuous nucleoli. When insular structure is identified in thyroid FNAC specimen, ICT should be included in the differential diagnosis. Herein we discuss and review the cytologic criteria for separation of ICT from other thyroid neoplasms.
Biopsy, Fine-Needle* ; Carcinoma ; Chromatin ; Colloids ; Diagnosis, Differential ; Female ; Humans ; Middle Aged ; Mitosis ; Necrosis ; Thyroid Gland* ; Thyroid Neoplasms

BACKGROUND: Identification of the genes expressed differentially in renal cell carcinoma (RCC)but not in the non-cancerous kidney is important for understanding the molecular basis ofrenal cell carcinoma and for defining possible prognostic value and therapeutic intervention.We investigated the changes in gene expression accompanying the development and progression of kidney cancer by cDNA microarrays. METHODS: To identify molecular alterations in renal cell carcinoma, we measured expression profiles for paired neoplastic and noncancerouskidney samples from an individual by means of a cDNA microarry representing 7, 500genes. Of the differentially expressed genes, we assessed the decorin gene at the proteinlevel using immunohistochemistry. RESULTS: The 60 genes were noted to have more than a fivefold change in expression (either increased or decreased) in RCC compared to the noncancerouskidney. The changed genes are those associated with signal transduction, metabolizingenzymes, the cytoskeleton, cell adhesion, cell cycle control, modulation of transcription, the tumor suppressor gene and tumor antigens. Under immunohistochemistry, the expressionof decorin was significantly decreased in the tumor than in the non-cancerous kidney.The expression rate of decorin was not associated with the patient's sex, age, histologic type, Fuhrmann nuclear grade and T stage. CONCLUSION: The author predicted that these geneexpression profiling experiments will lead to improvements in the basic understanding of renaltumor pathogenesis and will promote the discovery of novel molecular markers for renal tumordiagnosis and therapy.
Antigens, Neoplasm ; Carcinoma, Renal Cell* ; Cell Adhesion ; Cell Cycle Checkpoints ; Cytoskeleton ; Decorin* ; DNA, Complementary* ; Gene Expression* ; Genes, Tumor Suppressor ; Immunohistochemistry ; Kidney ; Kidney Neoplasms ; Oligonucleotide Array Sequence Analysis* ; Signal Transduction

OBJECTIVE: To estimate the status of HIV infection and AIDS incidence using a back-calculation model in Korea. METHODS: Back-calculation is a method for estimating the past infection rate using AIDS incidence data. The method has been useful for obtaining short-term projections of AIDS incidence and estimating previous HIV prevalence. If the density of the incubation periods is known, together with the AIDS incidence, we can estimate historical HIV infections and forecast AIDS incidence in any time period up to time t. In this paper, we estimated the number of HIV infections and AIDS incidence according to the distribution of various incubation periods RESULTS: The cumulative numbers of HIV infection from 1991 to 1996 were 708~1,426 in Weibull distribution and 918~1,980 in Gamma distribution. The projected AIDS incidence in 1997 was 16~25 in Weibull distribution and 13~26 in Gamma distribution. CONCLUSIONS: The estimated cumulative HIV infections from 1991 to 1996 were 1.4~4.0 times more than notified cumulative HIV infections. Additionally, the projected AIDS incidence in 1997 was less than the notified AIDS cases. The reason for this underestimation derives from the very low level of HIV prevalence in Korea. Further research is required for the distribution of the incubation period of HIV infection in Korea, particularly for the effects of combination treatments.
HIV Infections ; HIV* ; Incidence* ; Korea* ; Prevalence

BACKGROUND: Insulin-like growth factor binding protein 3 (IGFBP3), a member of six proteins with a high affinity for insulin-like growth factors (IGFs), seems to modulate the effects of IGFs on cells and to regulate cell proliferation through the IGF-independent pathway. We assessed the role of IGFBP3 in the colorectal carcinoma detected by cDNA microarray. METHODS: To identify molecular alterations in the colorectal carcinoma, we analyzed gene expression profiles of the colorectal adenocarcinoma by means of a cDNA microarray representing 7,500 genes. Of the differentially expressed genes, the author assessed the insulin-like growth factor binding protein 3 (IGFBP3) gene at the protein level using immunohistochemistry. RESULTS: The expressions of 21 and 16 genes were noted to have more than fivefold increases or decreases in the colonic adenocarcinoma tissue compared with the noncancerous colonic mucosal tissue. The differentially expressed genes include those associated with cell proliferation/apoptosis, signal transduction/transcription, metabolizing enzymes, cytoskeleton, angiogenesis, ion channel, extracellular matrix and others. Of the total 68 cases of colorectal adenocarcinomas observed, 34 cases (50%) showed positive immunohistochemical stainings for IGFBP3. CONCLUSIONS: In this study, it is suggested that IGFBP3 plays a role in colorectal carcinogenesis. And combining an immunohistochemistry with a cDNA microarray can facillitate the rapid characterization of a candidate novel molecular target.
Adenocarcinoma ; Carcinogenesis ; Cell Proliferation ; Colon ; Colorectal Neoplasms* ; Cytoskeleton ; DNA, Complementary* ; Extracellular Matrix ; Immunohistochemistry ; Insulin-Like Growth Factor Binding Protein 3* ; Ion Channels ; Mucous Membrane ; Oligonucleotide Array Sequence Analysis* ; Somatomedins ; Transcriptome

OBJECTIVES: The purpose of this study is to 1) conduct a discrimination analysis of schizophrenia and bipolar affective disorder using MMPI profile through artificial neural network analysis and logistic regression analysis, 2) to make a comparison between advantages and disadvantages of the two methods, and 3) to demonstrate the usefulness of artificial neural network analysis of psychiatric data. PROCEDURE: The MMPI profiles for 181 schizophrenia and bipolar affective disorder patients were selected. Of these profiles, 50 were randomly placed in the learning group and the remaining 131 were placed in the validation group. The artificial neural network was trained using the profiles of the learning group and the 131 profiles of the validation group were analyzed. A logistic regression analysis was then conducted in a similar manner. The results of the two analyses were compared and contrasted using sensitivity, specificity, ROC curves, and kappa index. RESULTS: Logistic regression analysis and artificial neural network analysis both exhibited satisfactory discriminating ability at Kappa index of greater than 0.4. The comparison of the two methods revealed artificial neural network analysis is superior to logistic regression analysis in its discriminating capacity, displaying higher values of Kappa index, specificity, and AUC(Area Under the Curve) of ROC curve than those of logistic regression analysis. CONCLUSION: Artificial neural network analysis is a new tool whose frequency of use has been increasing for its superiority in nonlinear applications. However, it does possess insufficiencies such as difficulties in understanding the relationship between dependent and independent variables. Nevertheless, when used in conjunction with other analysis tools which supplement it, such as the logistic regression analysis, it may serve as a powerful tool for psychiatric data analysis.
Discrimination (Psychology) ; Humans ; Learning ; Logistic Models* ; MMPI* ; Mood Disorders ; ROC Curve ; Schizophrenia ; Sensitivity and Specificity ; Statistics as Topic

PURPOSE: To report a case of recurrent endophthalmitis due to methicillin resistant Staphylococcus hemolyticus after phacoemulsification and posterior chamber intraocular lens (IOL) implantation. CASE SUMMARY: A 76-year-old female visited our outpatient clinic with decreased vision 40 days after uncomplicated cataract surgery in her right eye. At the visit, anterior chamber inflammation and cloudy fluid between the posterior capsule and IOL were observed. Uveitis due to residual cortex of lens or capsular block syndrome was suspected, so YAG laser capsulotomy and subconjunctival injection of dexamethasone were performed. Two days later, hypopyon and vitreous opacity were seen. The patient underwent an emergency vitrectomy and intravitreal antibiotic injection with suspicion of bacterial endophthalmitis. The culture was negative. Twenty days after the vitrectomy, anterior chamber inflammation and vitreous opacity developed. The recurrence of endophthalmitis was suspected due to infection by bacteria in the surrounding tissue of the IOL, so the patient underwent an IOL and lens capsule removal with intravitreal antibiotic injection. At this time, the culture revealed methicillin resistant staphylococcus hemolyticus. Systemic and topical vancomycin was then administered, resulting in decreased inflammation. Twenty days after the IOL removal, decreased vision, anterior chamber inflammation, and vitreous opacity developed. Endophthalmitis was decreased by intravitreal antibiotic injection and topical antibiotic treatment. CONCLUSIONS: Methicillin resistant staphylococcus hemolyticus should be considered in the differential diagnosis of chronic recurrent endophthalmitis after cataract surgery.
Aged ; Ambulatory Care Facilities ; Anterior Chamber ; Bacteria ; Cataract ; Dexamethasone ; Diagnosis, Differential ; Emergencies ; Endophthalmitis ; Female ; Humans ; Inflammation ; Lasers, Solid-State ; Lenses, Intraocular ; Methicillin Resistance ; Methicillin ; Phacoemulsification ; Recurrence ; Staphylococcus ; Uveitis ; Vancomycin ; Vitrectomy

OBJECTIVE: Frozen section evaluation of gynecologic tumors can be used to establish a histopathologic diagnosis and guide the surgeon to perform the appropriate surgical procedure. A retrospective study was conducted to determine the accuracy of frozen section diagnosis of gynecologic tumors. METHODS: We compared the result of 459 consecutive gynecologic frozen section diagnosis with their final diagnosis by paraffin sections from January 1996 to August 2001. RESULTS: 459 gynecologic tumors that underwent frozen section evaluation were studied. Frozen section was accurate in 94.9% of 390 ovarian tumors and inaccurate in 5.1%. The sensitivity, specificity, positive predictive value, and negative predictive value for frozen section in ovarian tumors were 86.7%, 97.8%, 84.4%, 97.7%. There was three false-positive and twelve false-negative cases. And frozen section was accurate in 68 of 69 uterine tumors. CONCLUSION: Frozen section diagnosis has important implications regarding the type and extent of surgery performed at the initial operation and this method can obtain the highest accuracy when there is cooperation between experienced surgeons and reliable, careful pathologists. Most incompatible frozen section diagnosis occurred especially in mucinous ovarian tumor. Performing multiple section is recommended in the frozen section diagnosis of mucinous ovarian tumors.
Biopsy* ; Diagnosis* ; Frozen Sections* ; Mucins ; Paraffin ; Retrospective Studies ; Sensitivity and Specificity

OBJECTIVE: Diabetic nephropathy and ablation nephropathy are characterized by sclerotic processes in the glomeruli. To elucidate the site, degree and time-honored changes of glomerular sclerosis, morphometric analysis was performed using the experimental animals models. METHODS: The animals used were male Sprague Dowley rats and separated into 4 groups as young normal control, old control, streptozotocin-injected group, and right nephrectomized group. Chronologically kidney specimens were obtained after each treatment and processed to evaluated histologic changes. To evaluated the glomerular area, interstitial fibrosis and glomerular tuft fibrosis, the kidney specimens were fixed in Buin's solution, paraffin-embedded and 2 micrometer sections were Sirius red stained. To study the mesangial area, mesangial matrix area, glomerular basement membrane, and tubu lar basement membrane, the specimens were fixed in 2.5% glutaraldehyde, epon-embedded, double-stained and examined under the transmission electron microscope. All the specimens were analyzed morphometrically using the Image Pro Plus software. The obtained morphometric data were statistically analyzed to evaluate the differences of fibrotic processes and degree between experimental groups. RESULTS: Diabetic group revealed statistically significant increase of glomerular area from 8th week after streptozotocin injection to 24th week of experimental date. The parenchymal fibrosis and glomerular tuft fibrosis was prominent from the 2nd week of injection and steadily increased until the end of experimental date. The thickness of glomerular basement membrane was significantly increased even at the first week of injection and the tubular basement membrane also increased in thickness at the 3rd week of experiment. Ablation nephropathy model made by right nephrectomy showed increased glo merular area at the 7th week of ablation and the degree were intensified after 16th week of experimental date. The amount of stainable collagen in the renal parenchyme and glomerular tuft increased in the second week kidney sample and steadily increased thereafter until the end of experimental date. The increase of thickness of GBM and TBM also started to appear at the second week of operation. The old control also revealed fibrosis but the degree was less than the diabetic and ablation groups. Both diabetic and ablation nephropathy groups exhibited extensive increase of glomerular area, stainable colla gen, thickness of GBM and TBM at the end of experimental date and the ablation group revealed more extensive evidences of fibrosis without statistical significance. Comparison between the experimental groups were meaningless because the duration of the experimental manipulation was not the same. CONCLUSION: Glomerular and renal interstitial sclerosis and thickening of GBM and TBM are not the specific lesions of the diabetic glomerulopathy and are the common histologic changes occur in the kidney of partial parenchymal loss of any etiology. And it is suggested by this study that the common hemodynamic change involving the diabetic nephropathy, ablation nephropathy and physiologic aging is one of the important pathogenetic factors of glomerular sclerosis.
Aging ; Animals ; Basement Membrane ; Collagen ; Diabetic Nephropathies ; Fibrosis ; Glomerular Basement Membrane ; Glutaral ; Hemodynamics ; Humans ; Hyperglycemia* ; Kidney ; Male ; Models, Animal* ; Nephrectomy ; Rats* ; Sclerosis ; Streptozocin